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ENHANCING CLINICALCARE THROUGH NURSING

INFORMATICS

DECEMBER 14, 2009

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QUOTE OF THE DAY

"Computers are incredibly fast,accurate and stupid. Human

beings are incredibly slow,inaccurate and brilliant.

Together they are powerfulbeyond imagination."

- Albert Einstein

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DO YOU KNOW WHAT A TOILET

BOWL CAN DO?

can redden faces

can measure sugar levels in urine

can measure blood pressure,heartbeat, body fat and weight

can do nearly everything

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An American diplomat was at adinner party in a Japanese home

when he excused himself to go tothe bathroom. He did his

business, stood up and realizedhe didn't have a clue about how toflush the toilet.

REDDEN FACE?

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The diplomat speaks Japanese, buthe was still baffled by the colorful

array of buttons on the complicatedkeypad on the toilet. So he just

started pushing. He hit the

noisemaker button that makes aflushing sound to mask any noise

you might be making.

REDDEN FACE?

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He hit the button that starts theblowdryer for your bottom. Then he

hit the bidet button and watchedhelplessly as a little plastic arm, sort

of a squirt gun shaped like a

toothbrush, appeared from the backof the bowl and began shooting astream of warm water across the

room and onto the mirror.

REDDEN FACE?

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And that's how one ofAmerica'spromising young Foreign Service

officers ended up frantically wipingdown a Japanese bathroom with a

wad of toilet paper.

"It was one of my most embarrassingexperiences in Japan," said theembassy employee who asked not to

be identified.

REDDEN FACE?

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NEOREST 600

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The Neorest 600 from Japanese plumbingmanufacturer Toto is a tankless toilet andpersonal cleansing unit. Its lid automatically

opens when a person approaches it. Whena person walks away from the Neorest 600,it automatically flushes and closes the seatand lid. There's a remote control for

operating features including water spraytemperature, pressure and direction; seatheater; air dryer; and deodorizer. List prices

for the Neorest 600 start at US$5,200.

NEOREST 600

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FRIENDLY RESTROOM

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Built-in assistance: The Friendly Rest Roomcombines a slew of high-tech features including acontactless smart card to store users' preferences,voice activation interface, and sensor systems for

detecting falls and emergency situations. Users cancontrol settings including seat height and tilt with aremote control or voice-activated commands.Researchers affiliated with Vienna University of

Technology in Austria conceived the Friendly RestRoom as a way to provide greater independence toelderly and disabled people who might otherwiserely on assistance from a caregiver to use a toilet.

FRIENDLY RESTROOM

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INTELLIGENT TOILET

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Japanese homebuilder DaiwaHouse Industry collaborated

with Toto to design theIntelligent Toilet, which doublesas an in-home health monitor.

The design includes devices formeasuring sugar levels in urine,blood pressure, body fat and

weight.

INTELLIGENT TOILET

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WHO AMONG US ARE LIKE

THIS FELLOW?

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HOW?

BY IMPROVING

YOUR

COMPUTERLITERACY

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COMPUTER LITERACY

On the least specialized level,computer literacy involves knowinghow to turn on a computer, start andstop simple application programs, andsave and print information. It alsorefers to the attitude about computersand the actual ability to do sometasks or programs on the computer.

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COMPUTER LITERACY

The relationship between computerliteracy, technological competenceand a nurse's ability to care iscongruent for quality care. Computerliteracy represents a proactiveresponse to technology whichenhances caring in nursing (Delaney,1990).

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COMPUTER LITERACY

AM ICOMPUTERLITERATE?

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ANIA

BCMA CI

CPOE CPU

CPRS

EHR

EMR HIS

PC PDA

RAM

HOW FAR DO YOU KNOW?

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TOP BUSINESS ISSUES IMPACTINGHEALTHCARE

1. Increasing PatientSafety/Reducing Medical

Errors

2. Patient (Customer) Satisfaction

3. Nursing Shortage

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1. Reduce MedicalErrors/Promote Patient Safety

2. Implement an EMR

3. Connecting IT at Hospital and

Remote Locations

Source: Healthcare Information and Management Systems Society (HIMSS)

CURRENT IT PRIORITIES

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Fragmented, frequently interrupted, in chaoticwork environment

Interrupted mid-activity 8 times per every 8 hours*

Switch patients every 11 minutes* Average activity time 3.1 min/care activity*

Average of 8.1 operational failures per 8hours*

Missing med

Missing supplies

Missing order

Missing/ broken equipment

CHALLENGES FOR NURSING

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9% of time spent on resolving systemfailures or errors*

Most common was missing medications

Direct patient care tasks done in 2:43

minutes chunks Average 44 minutes overtime

Only 30% of shift time is in direct patient

care** Medication administration errors

in 1999, ADE cost the U.S. $2 billion annually

Sources:* Tucker and Spear.Operational Failures and Interruptions in Hospital Nursing. HSR 41:643-662, 2006

** Hendrich A., George V. Random work sampling ofMedical Surgical nurses using PDAs. Reported atHealth Management Academy, May 20, 2004. Unpublished Data

CHALLENGES FOR NURSING

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We practice with incomplete information

We have alarming error rates

We spend 30-50% of time on administrative

activities Errors are associated with surveillance,

change in venues, and patient handoffs

Fragmented, incomplete records can causeconfusion, communication breakdown, andthe opportunity for error.

We need to reduce burdens related to

documentation

CHALLENGES FOR CLINICIANS

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LEARNING OBJECTIVES

Define nursing informatics Demonstrate how NI supports nursing

process

Explain the value of NI to nursing practiceand healthcare

Identify roles for NI practice

Identify practice areas and settings Identify education paths and certifications

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The healthcare of your clients is largelydependant on information.

Every action taken depends on previous

information and knowledge. The delivery of health care requiresinformation about: Science of type of care (nursing)

Patient or client Provider

Outcomes

Process and systems for delivery of care

THE IMPORTANCE OF INFORMATIONTHE IMPORTANCE OF INFORMATION

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Information about each of these areashave an impact on the type and theamount of care given.

Information must be:accurate

timely

accessibleunderstandable

THE IMPORTANCE OF INFORMATIONTHE IMPORTANCE OF INFORMATION

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The structure of information Delivered in conversation, handwritten notes,

stored in a computer.

Regardless of the form, the same basicprinciples apply to the structure and the useofinformation.

Words are often used interchangeably todescribe information.

WHAT IS INFORMATION?WHAT IS INFORMATION?

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The structure of information

Data: discrete entities objectively described,without interpretation or context.

Example: 110

Information: data processed into a structured form.Data that are interpreted, organized, structuredand given meaning are referred to as information.

Example: When combining 110 with other data, itbecomes information. Systolic blood pressure of 110mmHg and diastolic blood pressure of70 mm Hg. Thisinformation can be captured in a form, on a graph in areport.


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Knowledge: synthesized informationderived from the interpretation of data. Itprovides a logical basis for making

decisions.Essential to decision-making andto new discoveries.

Example: When the blood pressurereading is combined with informationabout anatomy and physiology,pharmacology, pathophysiology,knowledge is used to decide about

further care and treatment.


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Information has five rights:

Right information

Right personRight time

Right place

Right amount

THE FIVE RIGHTS OF INFORMATIONTHE FIVE RIGHTS OF INFORMATION

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USING INFORMATION

Up-to-date,accurateinformation of

each step of theNursingProcess is thePowerbehind

safe, highquality patient-centered care!

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Evidence-based practice leads to: Determining standards and guidelines

Guide for decision-making process

Determines best practice

Nursing informatics can enable dissemination ofnew knowledge. Practitioners update themselves of new

developments through journals, conferences,

continuing education sessions. The information is varied and copious.

There is a need to find the relevant evidence in atimely way.

USING INFORMATIONUSING INFORMATION

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With the knowledge of the importance ofinformation in healthcare, healthcareinformatics has become a specialty.

Healthcare informatics is a combination ofcomputer science, healthcare science,information science and cognitive

science.

WHAT IS HEALTHCARE INFORMATICS?WHAT IS HEALTHCARE INFORMATICS?

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Computer science: development, configuration,architecture of computer hardware and software.

Healthcare science: body of knowledge on

which healthcare profession bases theirpractice. The sciences of anatomy, physiologyand knowledge specific to each profession.

Information science: also includes information

technology which involves the process ofsending and receiving information.

Cognitive science: the process of humanthinking, understanding and remembering.

WHAT IS HEALTHCARE INFORMATICS?WHAT IS HEALTHCARE INFORMATICS?

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1992 First Scope ofPractice forInformatics Nurse

1992 Informatics Nursing recognized asa specialty by ANA

1994 First Informatics NursingCertification exam offered by ANCC

2007 3rd Version of Informatics Nursing

Scope ofPractice 2007: AONE identifies InformationManagement and Technology as a core

competency for Nurse Executives

HOW FAR HAVE WE COME?

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WHAT IS NURSING INFORMATICS (NI)?

Nursing Informatics is a specialty thatintegrates nursing science, computer science,and information science to manage andcommunicate data, information, and

knowledge in nursing practice. Nursinginformatics facilitates the integration of data,information, knowledge, and wisdom tosupport patients, nurses and otherprovidersin their decision-making in all roles and

settings. This support is accomplishedthrough the use of information structures,information processes, and informationtechnology.

(ANA Scope & StandardsofNursingInformatics Practice, 2008)

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WHAT IS NURSING INFORMATICS (NI)?

Like any knowledge-intensive field thesedays, nursing is greatly impacted by theexplosive growth of computer technology.

Nursing informatics is a new and excitingspecialty that combines nursing skills withcomputer expertise. Nurse informaticsspecialists manage and communicate

nursing data and information to improvedecision making by consumers, patients,nurses and other health care providers.

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System Lifecycle

Human Factors

Information Technology Information Management

Professional Practice

Models and Theories

SCOPE & STANDARDS OF PRACTICE

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IN vs. INS

IN Informatics Nurse: RN who works in the area of informatics

This RN is not formally prepared in

informatics but has an interest and/orexperience working in the area.

INS Informatics Nurse Specialist:

RN with advanced, graduate education innursing informatics or informationmanagement

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NI SPECIALIST SALARY

In 2007, the Healthcare Information andManagement Systems Society (HIMSS)conducted a major survey of nurse

informatics specialists. The average salaryearned by respondents to this survey was$83,675, compared to $69,500 in the 2004survey. This is strong evidence of theincreasing maturity and value of thespecialty.

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NURSE INFORMATICS CAREER OUTLOOK

The demand for all types of nurses isexpected to increase significantly over thenext ten years. In general, the more

training, certifications and experience anurse has, the more demand there will befor his or her skill set.

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HEALTHCARE INFORMATION AND MANAGEMENTSYSTEMS SOCIETY (HIMSS) LEVEL 7

STAGE CUMMULATIVE CAPABILITIES % OFHOSPITALS

7 Medical record fully electronic; care delivery organizationable to contribute to electronic health record as byproductof electronic medical record

0.0%

6 Physician documentation, full clinical decision supportsystem (variance and compliance), full PACS

0.1%

5 Closed-loop medication administration 0.5%

4 CPOE, clinical decision support system (clinical protocols) 1.9%

3 Nursing documentation, eMAR , clinical decision supportsystem (error checking), PACS

8.1%

2 Clinical data repository, controlled medical vocabulary,clinical decision support interface engine, document

imaging

49.7%

1 Ancillaries: laboratory, radiology, pharmacy 20.5%

0 All three ancillaries not installed 19.3%

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Nurses need to developcompetencies ininformatics.

Informatics enables

nurses to use informationand communicationstechnologies in the:

collection of data,

use of information

generation of knowledge tosupport nursing practice

Nursing

Technology

WHY IT IS IMPORTANT?

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the trend in hospitals are computerizingnursing documentations

for effective and efficient data

management such as workload statistics,performance monitoring, etc.

promotes and improves evidence-based

nursing practice and patient outcomes.


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Nursing informatics enables nurses toquickly move to the synthesis of nursingknowledge and the development of

nursing wisdom. Gone were the days ofmanual documentation that consumesmost of your time, now, more time areused in applying nursing knowledge andwisdom to everyday care because ofinformatics.


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NURSING INFORMATION SYSTEMS (NIS)includes:

1. Patient Charting

2. Staff Schedules3. Clinical Data Integration

4. Decision Support


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Patient Charting: A patients vital signs, admissionand nursing assessments, care plan and nursingnotes can be entered into the system either asstructured or free text. These are the stored in a

central repository and retrieved when needed. Staff Schedules: Nurse can self schedule their

shifts using scheduling rules provided in shiftmodules. The shifts can later be confirmed or

changed by a scheduling coordinator or manager.Shift modules are designed to handle absences,overtime, staffing levels and cost-effective staffing.


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Clinical Data Integration: Here clinical informationfrom all the disciplines can be retrieved, viewed andanalyzed by nursing staff and then integrated into apatients care plan.

Decision Support: Decision support module can beadded to NIS , and they provide prompts andreminders, along with guides to disease linkagesbetween signs/symptoms, etiologies/related factors

and patient populations. Online access to medicalresources can also be made available.


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Nurse programmers who write or modifycomputer programs for use by nurses

Nurse communicators who work with othernurses to identify computer system needs or toassist in the training and implementation ofthose systems

Informatics nurse managers who manage or

administer information systems Nurse vendor representatives who

demonstrates systems to potential customers

ROLE OF THE NURSE INFORMATICIST

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WHAT CAN AN INFORMATICS NURSE DO?

1. Support nursing work processes usingtechnology

Design systems to match clinical workflows

Telehealth

Homehealth

Ambulatory care

Long-term care

Acute care all specialties

Outpatient settings

Software development

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2. Increase the accuracy and completenessof nursing documentation

3. Improve the nurses workflow Eliminate redundant documentation

4. Automate the collection and reuse of

nursing data5. Facilitate analysis of clinical data

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Admitting a patientAdmission Assessment in computer

Placing orders

Requesting consults Sending data to NIS/HIS

Resolving clinical reminders

These things involve a computer as well Take V/S

Give medications

Consent for surgery

Make the bed

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Prepare/provide workload statistics How many new orders written on Ward X in

a day?

How many medications given on Ward X ina week?

Nurses bypassing BCMA by using Manual

Medication Entry Show me all restraint orders for the past

month


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6. Information system management

7. Documenting patient education

Incorporated into daily charting8. Training/educating

New employees

Student nurses


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COMPETENCIES REQUIRED

Most theorists also emphasize theneed for every nurse whether

employed in the practice or educationsetting, to develop a minimum of a"user" level in computer literacy and

informatics theory.

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LEVEL OF COMPETENCIES

beginner, entry or user level

intermediate or modifier level and;

advanced or innovator level ofcompetency.

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COMPUTER APPLICATIONS

All three levels of competencies -users, modifiers and innovatorsneed to develop a working

knowledge of the followingcomputer programs and processes:

Word processing

Keyboarding

Spreadsheets

Presentation Graphics

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COMPUTER APPLICATIONS

Databases (simple to complex) Desktop Publishing World Wide Web

E-mail programs Expert data systems Multimedia

Telecommunication devices Nursing information systems Hospital information systems

Peripherals (Printers, CD/DVD)

USER LEVEL TECHNICAL COMPETENCIES

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USER LEVEL TECHNICAL COMPETENCIESINCLUDE:

uses word processing applications demonstrates keyboarding skills

uses spreadsheet applications

uses telecommunication devices tocommunicate with other systems

uses e-mail systems to communicate withother health care professionals

uses presentation applications to createslides, displays, overheads(PowerPoint, Corel Presentation, etc.)

uses multimedia presentations


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uses internet resources to locate clientsupport groups, online resources

uses sources of data that relate to nursingpractice and care

accesses, enters and retrieves data relatedto client care via available hospital ornursing information systems

uses database management programs todevelop and access databases and tables

uses database applications to enter andretrieve data and information


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conducts online and database literaturesearches

uses decision support systems, expertsystems and other aids for clinical decision

making and care planning uses computer applications to document

client care

uses computer applications to plan clientcare, including discharge planning

uses computer applications to enter clientdata (demographic, V/S, physiological data)


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uses information management systems forclient education

uses technology based client monitoringsystems

operates peripheral devices (bedside andhand held)

uses operating systems

uses computer peripheral devices (CDROMs, DVD, zip drives)

uses computer technology safely


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navigates in Windows environmenteffectively

demonstrates basic technology skills (loadpaper, change toner, unjam printers, print)

MODIFIER LEVEL TECHNICAL

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MODIFIER LEVEL TECHNICALCOMPETENCIES INCLUDE:

applies technology support to provideevidenced based practice

synthesizes data from more than onesource and applies to practice

demonstrates awareness of and ability toaccess data and information from multiplesources

uses decision support systems in practice

MODIFIER LEVEL TECHNICAL

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MODIFIER LEVEL TECHNICALCOMPETENCIES INCLUDE:

accesses pertinent literature resources andincorporates into practice and professionaldevelopment

creates and accesses research and otherdocuments electronically

INNOVATOR LEVEL TECHNICAL

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INNOVATOR LEVEL TECHNICALCOMPETENCIES INCLUDE:

participates in the design and developmentof information systems for nursing practice

develops inventive ways to access dataand interact with information systems

participates in the design and developdesign and development of newapplications for nursing practice

participates in developing new methods fordata and information organization


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collaborates with information technologyconsultants and other members ofinformation system development team

collaborates, negotiates with and directs

information technology vendors proficiency in diverse computer application

programs

manipulates and enhances nursing datasets

organizes and directs applications ofshared data sets


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develops data gathering tools andprocesses for literature search access fornurses

develop charting and documentation

templates for use in nursing practice design and development of evidenced

based practice documentation and

processing within practice area

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CERTFICATION AND EDUCATION

HEALTHCARE INFORMATION &MANAGEMENT SYSTEMS SOCIETY(HIMSS)

Certified Professional in Healthcare Informationand Management Systems (CPHIMS 3%)

OTHER 9%

NONE 55%

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SUMMARY

Informatics can make nursing practice visiblein local, national, and international healthcare data sets, thus empowering nurses withinformation to influence policy.

Information is a critical component ofeffective decision-making and high qualitynursing practice. The information and

knowledge gained through nursinginformatics can bring increased awarenessand understanding of nursing and health

care issues.

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SUMMARY

Nursing Informatics is committed tomaintaining a clinical perspective andpromoting research that would bear directlyon improving patient care.

Recognition of Nursing Informatics teamvalue in support of clinical excellence iscrucial to any healthcare organizations

success.

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FRIENDLY ADVICE

Work towards achieving theINNOVATOR LEVEL of technicalcompetency

Keep abreast of latest greatesttechnology trends

Assess newest technology for fitand potential applicability in yournursing profession

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NURSING INFORMATICS ORGANIZATIONS

Ashort list of examples includes:

American Nursing Informatics Association (ANIA)

Australian Nursing Informatics Council (ANIC)

Brazilian Nursing Association Nursing Informatics Group

British Computer Society Nursing Specialist Group

European Nursing Informatics (ENI)

International Medical Informatics Association NursingInformatics Special Interest Group (IMIA-NI)

NURSINFO: Hong Kong

Spanish Society of Nursing Informatics and Internet (SEEI)

Swiss Special Interest Group Nursing Informatics (SIG-NI)

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CONCLUSION

Computers cannot replace anurse, they cannot replace your

intuition, and they cannot replaceyour intelligence and certainly notyour TLC. Nurses cannot become

robots, doing only what thecomputer tells them to do.

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QUOTE OF THE DAY

"Computers are incredibly fast,accurate and stupid. Human

beings are incredibly slow,inaccurate and brilliant.Together they are powerfulbeyond imagination."

- Albert Einstein

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http://nursing-informatics.com

http://ojni.org

http://www.ania.org/http://www.ania.org/ http://www.himss.orghttp://www.himss.org

http://www.cnahttp://www.cna--nurses.canurses.ca

REFERENCES

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