NURSING INFORMATICS

Computer technology transformed nursing profession Record keeping Information retrieval Clinical Information System (CIS) - A computer based system that is designed for collecting, storing, manipulating and making available clinical information important to the healthcare delivery system. Computer - general term referring to IT and computer systems. - In nursing, it is synonymous to nursing information system (NIS) - Use to manage information in patient care, monitor quality in nursing care and evaluate care outcomes - Networks with internet are used in communicating and accessing resources and interacting with the patient on the world wide web (WWW) Nursing Informatics - integration of nursing information management with information processing and information technology to support the people worldwide - A specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology. (ANA. 2009) Data unprocessed facts and figures without any added info or analysis. Information data that has been interpreted so that it has meaning for the use Knowledge combination of info, experience, and insight that may benefit the individual or the organization Clinical Information System (CIS) - used interchangeably with electronic information systems (EHR-S) computerized patient and electronic medical record - Refers to set components that form the mechanism by which patient records are created, used, stored, and retrieved usually located within a healthcare provider setting. - It includes peoples data rules and procedures, processing and storage Some barriers are: Initial cost of acquisition Privacy and security Clinician resistance Integration of legacy systems: this poses a stiff challenge to many organizations *legacy system is an old method, technology, computer, system or application program that continues to be used, typically because it still functions for the users' needs, even though newer technology or more efficient methods of performing a task are now available.

Benefits: Easy access Structured information Improved drug prescription and patient safety: clinical information systems improve drug dosing and this leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization MAJOR HISTORICAL PERSPECTIVES OF NURSING AND COMPUTER Prior to 1960s - simple beginnings - Use of punch cards and teletypewriters 1960s - use of computers in healthcare is questioned - Studies were conducted to determine how computer technology could be utilized effectively in the healthcare industry 1970s - nurses recognized the computers potential for improving the documentation of nursing practice, the quality of patient care, and the repetitive aspects of managing patient care 1980s - NI was formally accepted as new nursing specialty - Emergence of microcomputer or PC 1990 - computer technology become an integral part of healthcare setting - Policies and legislation on promoting computers in healthcare were adopted - Approval of NI by ANA as a new nursing specialty Post 2000 - clinical information system became individualized in the electronic patient record - Mobile computing device were introduced - New technology were utilized - Internet provided new means of development

COMPUTERS IN NURSING AREAS Nursing practice - Computer systems patient care data and NCPs are integrated to EHR - Need for EHR was perceived - New nursing terminologies were recognized by ANA Nursing Administration - Computers linked departments together - Hospital data are accessed through computers - Hospital process goes online - Internet was utilized

Nursing Education - Most nursing schools offered computer-enhanced courses - Campus-wide computer systems become available

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- Computer technology integrated into teaching methodologies B. Software - the programs that run the computer Software generally is designed to perform a particular type of taskfor example, to control the arm of a robot to weld a cars body, to write a letter, to display and modify a photograph, or to direct the general operation of the computer.

Computer is a special machine that performs tasks such as calculations, data processing and handling, electronic communication etc., under the control of a set of instructions called a program. Programs usually reside within the computer and are retrieved and processed by the computers electronics. The program results are stored or routed to output devices, such as video display monitors or printers. Computers perform a wide variety of activities reliably, accurately, and quickly. Uses of Computers: Business Track inventories with bar codes and scanners Check the credit status of customers Transfer funds electronically. Home Control the indoor temperature. Operate home security systems Tell the time Turn videocassette recorders (VCRs) on and off. Automobiles Regulate the flow of fuel, thereby increasing gas mileage. Used in anti-theft systems. Education use computers to track grades communicate with students visual aids Computers also entertain, creating digitized sound on stereo systems or computer-animated features from a digitally encoded laser disc. Four main functions of computers: Accepts data Processes data Produces output Stores results

RANGE OF ABILITY OF COMPUTERS Computers exist in a wide range of sizes and power. Computers can be generally classified by size and power as follows, though there is considerable overlap: A. Personal computer - A small, single-user computer based on a microprocessor. Actual personal computers can be generally classified by size and chassis/case. a) Tower model - power supply, motherboard, and mass storage devices are stacked on top of each other in a cabinet. b) Desktop model - designed to fit comfortably on top of a desk, typically with the monitor sitting on top of the computer. c) Notebook/ Laptop computer - extremely lightweight personal computer. Notebook computers typically weigh less than 6 pounds and are small enough to fit easily in a briefcase. d) Subnotebook computer - A portable computer that is slightly lighter and smaller than a full-sized notebook computer. Typically, subnotebook computers have a smaller keyboard and screen, but are otherwise equivalent to notebook computers. e) Personal digital assistant (PDA) - a handheld device that combines computing, telephone/fax, and networking features. B. Workstation - powerful, single-user computer. A workstation is like a personal computer, but it has a more powerful microprocessor and, in general, a higher-quality monitor. It is a type of computer used for engineering applications (CAD/CAM), desktop publishing, software development, and other types of applications that require a moderate amount of computing power and relatively high quality graphics capabilities. C. Mainframe - powerful multi-user computer capable of supporting many hundreds or thousands of users simultaneously. D. Supercomputer - extremely fast computer that can perform hundreds of millions of instructions per second.

HOW DO COMPUTERS WORK? A computer is divided into two main components: A. Hardware - physical computer and its components memory - stores data and program instructions central processing unit (CPU) - carries out program instructions input devices - allow the user to communicate with the computer; keyboard or mouse output devices - enable the computer to present information to the user; printers and video display monitors buses (hardware lines or wires) - connect these and other computer components

MAIN COMPONENTS OF A TYPICAL COMPUTER A. Central Processing Unit (CPU) - microprocessor (brain) of the computer system. Everything that a computer does is overseen by the CPU. It is the main information processor of the computer.

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B. Memory - very fast storage used to hold data. It has to be fast because it connects directly to the microprocessor. There are several specific types of memory in a computer: Random access memory (RAM) temporarily store information that the computer is currently working with. Read only memory (ROM) a permanent type of memory storage used by the computer for important data that does not change. Basic input/output system (BIOS) a type of ROM that is used by the computer to establish basic communication when the computer is turned on. Caching the storing of frequently used data in extremely fast RAM that connects directly to the CPU. Virtual Memory space on a hard disk used to temporarily store data and swap it in and out of RAM as needed. C. Motherboard - main circuit board that all of the other internal components connect to. The CPU is usually on the motherboard. Other systems may be found directly on the motherboard or connected through a secondary connection. D. Power supply - An electrical transformer regulates the electricity used by the computer E. Hard disk - a large capacity permanent storage used to hold information such as programs and documents F. Operating system - software that allows the user to interface with the computer. G. Integrated Drive Electronics (IDE) Controller - primary interface for the hard drive, CD-ROM and floppy disk drive. H. Peripheral Component Interconnect (PCI) Bus - most common way to connect additional components to the computer PCI uses a series of slots on the motherboard that PCI cards plug into. I. Accelerated Graphics Port (AGP) is a very high-speed connection used by the graphics card to interface with the computer. J. Sound Card - used record and play audio by converting analog sound into digital information and back again. K. Graphics Card - translates image data from the computer into a format that can be displayed by the monitor.

An executable file is designed to launch or start on computers. When launched a copy of the executable file together with other files, is loaded into the RAM and provides an interface on the screen so the user can interact with program to elicit function and produce output. Classification of Software: There are typically three types of software that are distinguished according to its function and according to the manner it processes the system: A. System Software - basic computer software that commands the computer hardware and computer system to perform specific task. It includes the following components: Basic output and input system (BIOS) - built into the PC, and is the first code run by a PC when powered on (boot firmware). Primary function: to load and start an operating system. When the PC starts up, the first job for the BIOS is to initialize and identify system devices such as the video display card, keyboard and mouse, hard disk, CD/DVD drive and other hardware. Operating system - consisting of programs and data, that runs on computers, manages computer hardware resources, and provides common services for execution of various application software. Utility programs - designed to help analyze, configure, optimize and maintain the computer. B. Programming software - provides tools to assist a programmer in writing commands or codes using different programming languages in a more convenient way. Ex. Visual basic, Turbo Pascal, Turbo C C. Application software - written for the computer to do specific functions such as creating documents, crunching numbers, doing presentations or movies, drawing pictures, and editing photographs. Document production Spreadsheet Presentation, animation Database Management Graphics Computer Aided Design (CAD) Mathematical and Statistical Entertainment, Music Video Educational

SOFTWARE Software - series of instructions written for the computer to do functions It is a set of instructions with step by step algorithm that directs the computer hardware to perform specific task. Computer software is a collective term in information technology used to describe the function or the contribution of the sets of commands, procedures in computer systems. Software comes as a package and is usually distributed on removable media like floppies, CDs and DVDs. They are typically composed of many files. At least one of the files included in software contains an executable file.

COMPUTER NETWORK Computer Network - group of interconnected computer systems located at different places In computer network two or more computers are linked together with a medium and data communication devices for the purpose of communicating data and sharing resources.

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Types of computer networks: A. Personal Area Network (PAN) - used for communication among computer devices close to one person such as the computer systems in hospital departments (pharmacy, laboratory, nursing, etc.) examples of such devices includes printers, fax machines, telephones, PDA and scanners. B. Local Area Network (LAN) - covering a small physical area such as hospitals and inter department computer systems. Current wired LANs are most likely to be based on Ethernet technology. Ethernet - a trademark for a system for exchanging messages between computers on a local area network using coaxial, fiber optic, or twisted-pair cables. C. Metropolitan Area Network (MAN) - connects two or more local area networks but does not extend beyond the boundaries of the immediate town/city. D. Wide Area Network (WAN) - covers a broad area. WAN is a network that uses routers and public communication links. The largest and most well-known example of a WAN is the internet. A WAN is a data communications network that covers a relatively broad geographic area and that often uses transmission facilities provided by common carriers, such as telephone companies.

disadvantage of ring network is that the breakdown of any one station on the ring can disable the entire system.

OPEN SOURCE AND FREEWARE Open ware - the application software is free to users as a well as programmers. Has communities that support the user and work on mutual partnerships on the development and finalization of the software Program source code is available to all potential users, and they are free to use, modify, and re-distribute the source code. One of the best-known examples of open source software is Linux, which is widely used as an alternative to commercial operating system (OS) software. Free ware Free to use software The source code is not readily accessible There is no community and no development infrastructure available Very little potential way to improve it. Shareware You can download and try shareware for free, but if you use it, you are supposed to pay for it. It is developed and released by someone who keeps full control of the intellectual property. The user does not have access to the source code and cannot modify it.

NETWORK TOPOLOGY The term topology in the context of communication network refers to the way the computers in the network are linked together. There are three major types of network topology: A. Star Topology - workstations are directly linked to a central station called node. Any communication on a star LAN must pass through the central node. The central workstations are responsible for the controls all the activities of the substation. The breakdown of one station does not affect any other device on the network. The major disadvantage of star topology is that failure of the central node disables communication throughout the whole network. B. Bus Topology - workstations are connected to a single communication line called bus. In this type of network topology there is no central work station. Transmission from any station travels he length of the bus in both directions and can be received by all workstations. If one station of the topology fails it does not affect the entire system. C. Ring Topology - each station is attached to nearby station on a point to point basis so that the entire system is in the form of a ring. The advantage of this topology is hat any signal transmitted on the network passes through all the LAN stations. The

COMPUTER DATA PROCESSING Data is defined as the characters that represent measurement or that can be quantifiable from observable conditions such as, dimension, amount, capacity, height, weight, length, or any number etc. The measured data is then feed to system, such as statistical information system, to statistically transform it to necessary information. Information is defined as either a meaningful answer to a query or a meaningful stimulus that can cascade into further queries. Data processing is the process of transforming data into information.

Data Analysis After the data transformation into useful information, the healthcare officer or nurse should carefully examine the information and should be able to interpret the harvested information for proper application. Data analysis cannot be understood in one day, the healthcare giver or nurse should have a strong background in biostatistics coupled with nursing informatics and experience in the field.

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A responsible healthcare provider or nurse should train himself the basic pre-requisite of data analysis.

The vastness, versatility and usefulness of the Internet most probably inspired the many innovation and technologies in information and communication that included nursing informatics.

PROCEDURE FOR STATISTICS STUDY INTERNET AND WORLD WIDE WEB (WWW) Doctors and clinicians need to understand the basic process of statistics mainly so that they can interpret results. The purpose of statistical studies is: To describe the samples from the population. Draw conclusion about the population from which the sample is drawn Decisions made concerning the population based on sample information are based on probability. ORIGIN OF INTERNET EXPERIMENTAL DATA AND SURVEY AND SURVEY DATA Experiment - collection of measurements or observations about populations that are treated or controlled by the experimenter. Survey - examination of a system in operation in which the investigator does not have an opportunity to assign different conditions to the objects of the study. used to collect quantitative information about items in a population to establish certain information from the obtained data May focus on opinions or factual information depending on its purpose. Involve administering questions to individuals. Advantage of Survey It is an efficient way of collecting information from a large number of respondents. Surveys are flexible in the sense that a wide range of information can be collected Free form errors. They are relatively easy to administer There is an economy in data collection Maximization of time Disadvantage of Survey Depends on subject motivation, honesty, memory, and ability to respond. Low validity of result Errors due to non-responsive Vague data sets Non-conclusive results due to choice of data. In 1968 the US Department of Defense started a network called Advanced Research Projects Administration Network (ARPANET) with one computer at California and three at Utah. Later on other universities and R and D institutions were allowed to connect to the network. ARPANET quickly grew to encompass the entire American continent and become a huge success. The network was broken down to two smaller parts: MILNET- managing military Sites ARPANET- managing non-military sites 1980 - National Science Foundation Network (NSFNET) was created. With the advancement in modern communication facilities, others were also allowed to be linked up with any computer of NSFNET. 1990 - Many computers were hooking up to NFSNET giving birth to Internet. The internet is a global data communication system; it is a hardware and software infrastructure that provides connectivity between computer systems. The World Wide Web is one of the services communicated by the internet. it is a collection of interconnected documents , files, data and other resources, coupled by a hyperlink.

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Internet a vast connection of hundreds of millions of computers working together to share information. A global system that is interconnected by a computer system, thru a network, that uses the standard internet protocol. Carries an enormous collection of information resources and services that change the lifestyle.