Ebook: Forecasting Informatics Competencies for Nurses in the Future of Connected Health

The book in front of you arose from a collaboration among nursing informatics experts from research, education and practice settings, from eighteen countries, and from varying levels of expertise – those beginning to forge new frontiers in connected health and those who helped form the discipline. Having participated in several NI post conferences before, each time it is a great pleasure to work in this condensed format of preparing viewpoints, discussing them in person, organizing them into chapters, and then producing the wealth of information into a fine book.

We would like to thank all the participants who attended the NI 2016 Post Conference, as well as all the authors and co-authors who participated but did not attend, for their significant contributions to this NI 2016 Post Conference Proceedings. We appreciate each and every one of you for your time and talent in adding to the wealth of information in this book.

In addition, Patrick Weber must be acknowledged and thanked as organizer of NI 2016, the NI 2016 Post conference, and for his assistance in editing all of the chapters to make them consistent and meet the publisher's requirements.

We are hopeful that this book will help forecast and define the informatics competencies for nurses in practice, and as such, help outline the requirements for informatics training in nursing programs around the world. We are further hopeful that this content will help shape the nursing practice that will exist in the future of connected health, when we believe that practice and technology will be inextricably intertwined. As you read about the concept of Connected Health in this book, consider the wise words from Virginia Henderson to “preserve the essence of nursing in a technological age.”

Please be inspired by this book and let it help you achieve the best care possible using health informatics solutions.

Judy Murphy, William Goossen, Patrick Weber

This introduction to the book discusses how the topic of competencies for nurses in a world of connected health needs to be addressed at the curriculum level to achieve the specific competencies for various roles, including practicing nurse, nurse teacher, nurse leader, and nursing informatics specialists. It looks back at milestone publications from the international Nursing Informatics post conferences that still serve a purpose for inspiring developments today and looks forward to the way nurses can use connected health to improve the health and health care for their patients. Specific emerging topics in health information technology are addressed as well, such as semantics, genetics, big data, eHealth and social media.

The use of health information technologies has evolved over the last 50 years. These technologies have moved from the automation of data and data processing to connected care tools that are part of a health care ecosystem that provides the best care at the point of care. To correspondence with the evolution of technologies and their disruptions within the health care delivery system, there is a need to re-examine the necessary competencies of health care professionals.

The updated version of the IMIA educational recommendations has given an adequate guidelines platform for developing educational programs in Biomedical and Health Informatics at all levels of education, vocational training, and distance learning. This chapter will provide a brief introduction of the recommendations pinpointing aspects for developing and assessing educational programs. We will provide a review of the existing feedback we have acquired during the IMIA site visits of accrediting educational programs at a worldwide level and discuss implementations issues. A brief overview of existing academic programs in Europe, North America and in other regions, especially for programs related to Nursing and to Nursing Informatics is provided. Finally, we will draw conclusions as how the IMIA recommendations may be required to be fitted into the specific needs of the Nursing Informatics and the needs of the Nursing professionals when they apply the recommendations to their academic and/or hospital/professional environments.

This chapter considers the development of nurse education over the past 50 years and ventures a view towards 2020. A link will be made to the introduction of informatics to nursing curricula. It is clear when looking over the recent history of nurse education that it has moved from a medical model and content driven apprentice mode to that of a reflective agile professional mode where autonomous practice allows for collaboration in care and connectivity between health professionals. Parallel to these pedagogical changes are the introduction of informatics across healthcare, starting with computer skills and moving through information management to decision support. The chapter will conclude with some thoughts around the next possible steps forward for nursing informatics education.

Nursing informatics competencies are fundamental to nursing practice in all areas of nursing work, including direct patient care, administration and education. The recent activity relating to the development of nursing informatics competencies for beginning level nurses has exposed a paucity of understanding of the requirements for nursing informatics competencies for nurse educators. So, whilst the challenge of educating faculty to teach informatics has been limited, research into such competencies is required to meet this challenge. This paper describes the challenges and issues associated with nursing informatics competency development for faculty, outlines the capabilities of faculty, and presents a vision for the future of informatics education for faculty. The final requirement of the introduction of new competencies is to determine appropriate evaluation measures that reflect the requirements of all stakeholders.

Internationally, countries are challenged to prepare nurses for a future that has ever increasing use of technology and where information management is a central part of professional nursing practice. There has been a growing trend to move nursing to competency-based education, especially for those students undertaking their first nursing qualification. This first nursing qualification may be linked to pre-registration, pre-licensure or undergraduate education; the term used depending on the country. The authors are drawn from the International Medical Informatics Association special interest group, Nursing Informatics (IMIA-NI) Education Working Group and represent New Zealand, the United States of America, England, Australia, Finland and Canada.

The American Nurses Association (ANA) recognized nursing informatics as a nursing specialty in 1992, developed the first scope and standards of nursing informatics practice in the mid-1990s, and remains the custodian and steward of each document revision. Over the past two decades, the definition of nursing informatics, scope of practice statement, and framework of the standards of practice have evolved to now include a collection of competencies for the informatics nurse and informatics nurse specialist. The American Nurses Credentialing Center (ANCC), an ANA subsidiary, created and maintains a nursing informatics certification program that offers a board certification credential to qualified applicants, including international nurse colleagues. Such a certification program is intended to assess and publicly recognize competence of the informatics nurse.

The TIGER Initiative aims to explain how to equip practicing nurses with informatics competencies. This chapter describes a collaborative effort to identify global informatics requirements in relation to core competencies and to match them with national and regional needs. Recommendations from the TIGER Informatics Competency Synthesis Project, described here, have implications for an international framework of informatics competencies for all types of health care professionals including nurses.

Informatics and information management competency has an important role for nursing. However, these competencies in Brazil and South America lack definition, and are just beginning to develop in these regions with different realities. This chapter presents information related to the development of informatics competencies for nursing in these areas.

The advancement of information and communication technology have enabled nurses to practice more effectively, efficiently, and safely. This chapter introduces nursing informatics competency and information management competency for nurses in China (including Mainland China, Hong Kong and Taiwan), India, Japan, Korea, and Singapore. Most countries in Asia are still in the process of developing and standardizing competences that are relevant to nurses and those specialized in nursing informatics. The level and content of nursing informatics offered in entry-to-practice nursing education programs varies greatly. There is a growing need to adopt more comprehensive curriculum for entry-to-practice nursing education programs, as well as offer continuing education to help nurses to develop knowledge, skill, and attitude related to nursing informatics and information management in the world of connected health.

During the modernization process in hospitals, information technology is an important indicator. “Informatics nurses” play a critical role in hospitals and clinics. In Taiwan, the certification system of informatics nurses just recently began in 2016. The development of certificated personnel results from students who have graduated with a university degree in nursing and have taken classes in informatics, as well as nurses who have been trained in informatics at clinics and hospitals, and the establishment of a national nursing informatics association. Clinically, the main responsibilities of Informatics Nurse Specialists are system analysis, training, problem solving, data analysis, and communication. In Taiwan, as of September 2016, only 48 informatics nurses have been certified. They are working either in hospitals or at universities.

At the present time, nearly all Dutch nursing schools are searching for suitable ways to implement technology-based healthcare in their curriculum. Some Universities chose elective education, others a mandatory solution. Several studies were executed to determine competencies needed by nurses in order to work with technology-based healthcare. In 2016 a nationwide new curriculum for nurses has been published. Providing technology-based healthcare is included under the core competencies of this new curriculum. All baccalaureate nursing educational institutes must implement this new curriculum at the start of 2016 which will have a huge impact on the implementation of technology-based healthcare in the education programs. In the future, technology centers from Universities will collaborate and specialize, partner with technology companies and crossovers between information and communication technology and healthcare education will be expanded.

Most of the health issues encountered in persons of older age are the result of one or more chronic diseases. The evidence base reports that chronic diseases can be prevented or delayed by engaging in healthy behaviors. Education provides a cost effective intervention on both economic grounds in addition to delivery of optimal patient outcomes. Information and Communication Technology (ICT) increasingly is viewed as a critical utility in eHealth delivery, providing scope for expanding online education facilities for older persons. Developing nursing competencies in the delivery of eHealth solutions to deliver user education programs therefore makes sense. This chapter discusses nursing competencies on the development of targeted eHealth programs for healthy ageing. The role of Advanced Nurse Practitioner in Ireland and its associated competency set identifies how a strong action learning model can be designed to deliver eHealth educational programs for effective delivery of healthy ageing in place.

The IMIA-NIstudents' and emerging professionals' working group conducted a large international survey in 2015 regarding research trends in nursing informatics. The survey was translated into half-a-dozen languages and distributed through 18 international research collaborators' professional connections. The survey focused on the perspectives of nurse informaticians. A total of 272 participants responded to an open ended question concerning recommendations to advance nursing informatics. Five key areas for action were identified through our thematic content analysis: education, research, practice, visibility and collaboration. This chapter discusses these results with implications for nursing competency development. We propose how components of various competency lists might support the key areas for action. We also identify room to further develop existing competency guidelines to support in-service education for practicing nurses, promote nursing informatics visibility, or improve and facilitate collaboration and integration with other professions.

The purpose of the implementation of nursing terminologies is to capture and process meaningful health data wherein facts about patients and nursing care can be recorded and inferences for nursing care, patient outcomes and associations with all care delivered by the interprofessional team can be made. This paper describes the clinical information landscape, implementation of semantic content, and competencies required for nurses. Health data can be outlined in a high level clinical information ecosystem where nursing terminologies can be represented for implementation. This ecosystem consists of both the structural and dynamic aspects of the support of care.

The majority of health professionals now have genetic and genomic competencies and some are measured by certification standards. Nursing has a proud history of defining roles for nursing in informatics and genetics. In addition, the nursing professional organization, the American Nurses Association, has a Certification Center that has successfully achieved ISO 9001:2008 certification in the design, development, and delivery of global credentialing services which encompasses certification of advanced practice nurses in genetics. ISO 9001:2008 certification is the firmly established global standard for assuring stakeholders of an organization's ability to satisfy quality-related requirements. However, despite the addition of genomics into the Informatics Scope and Standards of Practice, there is a need to define the integration of the genetic, genomics and other omics competencies into the informatics domain, especially the Electronic Health Record. Currently, there are also international and interprofessional activities and organizations that have established or are identifying competencies in genetics and genomics. There remains a need for more international collaborations to build upon the current resources and strategies implemented by several countries, to learn from each other, support each other, and to collaborate to answer questions and reduce duplication of efforts.

Big data is becoming increasingly more prevalent and it affects the way nurses learn, practice, conduct research and develop policy. The discipline of nursing needs to maximize the benefits of big data to advance the vision of promoting human health and wellbeing. However, current practicing nurses, educators and nurse scientists often lack the required skills and competencies necessary for meaningful use of big data. Some of the key skills for further development include the ability to mine narrative and structured data for new care or outcome patterns, effective data visualization techniques, and further integration of nursing sensitive data into artificial intelligence systems for better clinical decision support. We provide growth-path vision recommendations for big data competencies for practicing nurses, nurse educators, researchers, and policy makers to help prepare the next generation of nurses and improve patient outcomes trough better quality connected health.

An overview of the rapid and diverse number developments in health information technologies (HIT) in recent years are described in this chapter and the move towards more integrated and connected health is described. The evolution of HIT is described as it has increased in complexity, diversity, connectivity, and more recently, the move towards multiple modalities. Examples of developments in various settings are represented from clinical settings, at home, and in low-resource settings. The implications of the move towards multiple modalities for nursing competencies and the move towards personalized and connected health are discussed, highlighting important areas for consideration and development in the future.

In today's life, social media offer new working ways. People are increasingly expanding interactions from face-to-face meetings to online ways of communication, networking, searching, creating and sharing information, and furthermore taking care of patients/citizens via tweeting care, Facebook care, blogging care, vlogging care, infotainment care, gamification-care, infographic care, for instance. This chapter discusses the utilisation of social media in the healthcare domain including nursing education, practice and research. When in the current healthcare era, social media is used effectively and purposefully, it can give all of us a greater choice in how we live, how we take care of our health and how we learn and build both our professional competences and produce evidence-based, qualified data. Nurses need continuous education and proper tools to take the most of the benefits of social media, not forgetting privacy and ethical issues. This use of social media in professional nursing generates the need for new competences.

Nurse leaders must demonstrate capacities and develop specific informatics competencies in order to provide meaningful leadership and support ongoing transformation of the healthcare system. Concurrently, staff informatics competencies must be planned and fostered to support critical principles of transformation and patient safety in practice, advance evidence-informed practice, and enable nursing to flourish in complex digital environments across the healthcare continuum. In addition to nurse leader competencies, two key aspects of leadership and informatics competencies will be addressed in this chapter – namely, the transformation of health care and preparation of the nursing workforce.