The Practice Specialty of Nursing Informatics: Kathleen M. Hunter / Carol J. Bickford

Chapter 15
The Practice Specialty of Nursing Informatics

Kathleen M. Hunter / Carol J. Bickford
Chapter 15
A. The Practice Specialty of Nursing Informatics

a. Nurses regularly make frequent, critical, life-impacting
decisions
b. Good decisions require accurate and accessible data as
well as skill in processing information
c. At the heart of nursing informatics is the goal of providing
nurses with the data, information, and support for
information processing to make effective decisions
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B. Informatics Nurse/Informatics Nurse Specialist

a. An informatics nurse (IN) is a registered nurse who has experience
in nursing informatics.
b. Informatics nurse specialists (INS) are prepared at the graduate
level (master’s degree) with specialty courses in nursing
informatics.
C. Foundational Documents Guide Nursing Informatics Practice
1. Nursing informatics practice and the development of this specialty
has been guided by several foundational documents.
2. In 2001, the American Nurses Association (ANA) published the Code
of Ethics for Nurses with Interpretive Statements
a. A complete revision of previous ethics provisions and
interpretive statements that guide all nurses in practice
3. In 2003, a second foundational professional document, Nursing’s
Social Policy Statement, 2nd Edition, provided a new definition of
nursing
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4. The ANA’s Nursing: Scope and Standards of Practice, 2nd Edition,

further reinforces the recognition of nursing as a cognitive
profession
5. The nursing process provides a delineated pathway and process
for decision making
6. In healthcare, data, information, and knowledge are growing at
astronomical rates and demand increasing reliance on computer
and information systems
7. Nursing informatics is the nursing specialty that endeavors to make
the collection, management and dissemination of data,
information, and knowledge to support decision making
8. Healthcare informatics is a subset of informatics
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D. Nursing Informatics
1. Nursing informatics (NI) is a subset of healthcare informatics
2. It shares common areas of science with other health
professions
3. Nursing informatics also has unique areas that address the
special information needs for the nursing profession
4. A willingness to continue exploring possible definitions can
prevent premature conceptual closure, which may lead to
errors in synthesis and knowledge development
E. Nursing Informatics as a Specialty
1. In 1992, the ANA recognized nursing informatics as a specialty
in nursing with a distinct body of knowledge
2. Nursing informatics focuses on the information of nursing
3. Nursing informatics is represented in international, national,
regional, and local organizations
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4. In 1989, the University of Maryland established the first

graduate program in nursing informatics.
5. Doctoral programs in nursing informatics have been
established
6. The Healthcare Information and Management Systems
Society (HIMSS) established a certification program
7. Two other informatics-related certification programs are
offered by the American Health Information Management
Association (AHIMA)
a. The first certification is as a registered health information
administrator (RHIA)
b. The second AHIMA certification is as a registered health
information technician (RHIT)
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F. Models for Nursing Informatics

1. Models are representations of some aspect of the real world
2. Models evolve as knowledge about the selected aspect
changes and are dependent on the “worldview” of those
developing the model
3. It is important to remember that different models reflect
different viewpoints and are not necessarily competitive; that
is, there is no one “right” model
4. Different scholars in nursing informatics have proposed
different models
a. Turley, writing in 1996, proposed another model
b. McGonigle and Mastrian developed the foundation of
knowledge model
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G. Theories Supporting Nursing Informatics

1. A theory is a scholarly, organized view of some aspect of the
world (reality)
2. Theories can be classified as grand, middle-range, and
situation-specific or practice theories
3. Theories are part of an interrelated, circular triad: research,
theory, and practice
H. Nursing Theories
1. In 1989, Dreyfus and Dreyfus published a model on how
people in a profession become experts
a. They proposed five stages: novice, advanced beginner,
competent, proficient, and expert
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2. Computer Science
a. Computer science is the study of algorithms for solving
computation problems
b. If an algorithm can be identified for solving a particular problem,
an automated solution to the problem can be developed
c. A computer is a tool of this science, not its focus
3. Information Science
a. Information science focuses on the gathering, manipulation,
classification, storage, and retrieval of recorded knowledge
b. For classic information theory, a central problem has been the
engineering problem of the transmission of information over a
noisy channel
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4. Communication
1. Within a communication model, Bruce I. Blum presented a
taxonomy, with definitions, of the central concepts of data,
information, and knowledge
a. Data is the facts without context
b. Information is data that has been interpreted, organized, or structured
c. Knowledge is information that has been synthesized
d. Think of wisdom as the appropriate use of knowledge in managing and
solving problems
5. Cognitive Science
1. At its most basic, cognitive science is the study of the mind – of
how we think
2. Cognitive science looks at mental activities and processes
Chapter 15
6. Systems
a. Systems theory relates to the properties of systems as a whole
b. The basic model of a system is one of input crossing the boundary,
processing of the input through the system (throughput), and the
emergence through the system boundary of some kind of output.
7. Behavioral and Social Sciences
a. The study of behavior – the processes driving actions -- is the focus
of the behavioral and social sciences
8. Change
a. Change is disruptive, messy, and complicated
b. The informatics nurse specialist (INS) is often the primary change
agent in facilitating the implementation of clinical information
systems
Chapter 15
c. A study of change processes and change theories will show many

models and theories of planned change
d. Diffusion of innovation looks at how, why, and at what rate new
ideas and technologies spread through cultures
e. Everett Rogers formalized the diffusion-of-innovations theory in a
1962 book called Diffusion of Innovations
9. Learning
a. Learning is a process of acquiring knowledge, skills, attitudes, or
values through study, experience, or teaching
b. Behaviorists believe that learning processes can be studied more
objectively when the focus is on stimuli and responses (also
known as operant conditioning)
Chapter 15
c. Proponents of learning styles theory assert that individuals have a

tendency to both perceive and process information differently
d. Adult learning theory focuses on understanding how adults learn as
opposed to children
12. Organizational Behavior
a. Organizational behavior is a distinct field focused on organizations
13. Management
a. Management science uses mathematics and other analytical
methods to help make better decisions, generally in a business
context
14. Group Dynamics
a. Group dynamics is a social science field that focuses on the nature
of groups.
Chapter 15
I. Competencies
1. Benner’s work, built on the Dreyfus model of skill acquisition,
describes the evolution of novice to expert and merits discussion for
nursing informatics
2. The Technology Informatics Guiding Educational Reform (TIGER)
focused on the minimum set of competencies needed by every nurse
J. Organizations as Resources
1. American Nurses Association (ANA) and Specialty Nursing
Organizations
2. AMIA Nursing Informatics Working Group (NIWG)
3. American Nursing Informatics Association (ANIA)
4. British Computer Society (BCS) Nursing Specialist Group (NSG)
5. HIMSS Nursing Informatics Community
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6. Nursing Informatics Australia (NIA)

7. Nursing Informatics Special Interest Group of the
International Medical Informatics Association (IMIA/NI-SIG)
8. Alliance for Nursing Informatics (ANI)
9. TIGER (Initiative Foundation)
10. Canadian Nursing Informatics Association (CNIA)
11. American Academy of Nursing (AAN)
12. Sigma Theta Tau International (STTI)
Chapter 15
K. Scope of Practice & Standards of Practice

1. The American Nurses Association (ANA) provides the
definition of nursing : the non-negotiable Code of Ethics
for Nurses With Interpretive Statements and Nursing: Scope
and Standards of Practice, Second Edition
2. Nursing Informatics Scope of Practice Statement
a. The current, detailed nursing informatics scope-of-
practice statement, available in provides the definition
of nursing informatics as a specialty that integrates
nursing with information sciences.
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3. Standards of Nursing Informatics Practice

a. Such a nursing scope of practice statement is expected to adequately
answer six questions: who, what, when, where, how, and why; so the
readers can close their eyes and easily envision an informatics nurse
and nursing informatics practice

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Chapter 15

The Practice Specialty of Nursing Informatics

A. The Practice Specialty of Nursing Informatics

B. Informatics Nurse/Informatics Nurse Specialist

4. The ANA’s Nursing: Scope and Standards of Practice, 2nd Edition,

4. In 1989, the University of Maryland established the first

F. Models for Nursing Informatics

G. Theories Supporting Nursing Informatics

c. A study of change processes and change theories will show many

c. Proponents of learning styles theory assert that individuals have a

6. Nursing Informatics Australia (NIA)

K. Scope of Practice & Standards of Practice

3. Standards of Nursing Informatics Practice

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