Oklahoma Nursing Research Consortium

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Oklahoma Nursing Research Consortium

• Nursing Research Preparing for the Next
  Millennium

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Virginia K. Saba, EdD, RN, FAAN, FACMI

• Distinguished Scholar - Georgetown University,
  SON
• Professor Advisor Educational Technologies -
  USUHS,GSN

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Nursing Impact - 21st Century

• Information Technology
• Computer Infrastructure
• Internet Technology
• Communication Network

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Web Site

• Home Page Addresses
• lthttp//www.sabacare.orggt

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Computer Literacy

• By the year 2000, those nurses who are illiterate
  in computer technology will be likened to the
  reading illiterate at turn of 20th Century.
• Dr. Lindberg, NLM / 1990

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Nurses are Computer Literate

• Personal Computers (PCs)
• Communicate by E-Mail
• Surf the Net

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IT Systems

• Fragmented
• Census Information
• Medical Model
• Use Diagnostic Terms
• Billing Strategies

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IT Systems - Cont

• Lack National Data Standards
• Partial Electronic Patient Record (EPR)
• Partial Paperless Chart

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IT Systems

• Do Not Capture the Care Process
• Do Not Document Nursing Care
• Nurses Do Not Get Reimbursed
• Nurses Remains Invisible

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Goals - 21st Century

• Implement Integrated IT Systems
• Utilize Internet
• Integrate Nursing Terms
• Impact Health Care Policy

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Focus

• What Do We Have - IT Internet
• How Do We Use What We Have Today
• What Do We Need to Resolve for 21st Century

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What DO We Have?
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We Have

• Information Technology
• Nursing Informatics - Tools
• Internet Technology
• Network Protocols

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Informatics -Informatique French Computer
Milieu

• Computer Science
• Information Science
• Nursing Science

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Computer Science

• Hardware - PCs/ Storage / Speed
• Software - User -Friendly Generic Packages
• Communication Networks

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Internet Network of Networks

• Electronic Mail (E-Mail)
• Listservs
• Bulletin Boards
• Chat Rooms
• File Transfer Protocols - Data
• Telnet - Link to a Host
• Gopher - Text Links

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World Wide Web - Multi-Media Browsers

• Internet Explorer
• Netscape
• CompuServe
• AOL

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WWW Search Engines

• Yahoo Search
• Magellan
• Alta Vista
• WebCrawler

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Web Site

• Sigma Theta Tau
• lthttp//www.stti.iupui.edugt

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Information Science

• Data ---gt Information ---gt Knowledge

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What is Data?

• Raw Facts / Data Elements (Atomic Level)
• Single Words, Objects, or Numeric Values
• Data Base - Fields, Records, Files

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Data Classifications

• Terms Hierarchical Categorized to a Set of
  Rules.
• Terms Coded to Index Classify Logical Concepts

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Clinical Data Standards

• Clinical Vocabularies
• Transmission of Clinical Messages
• Provide a Guide for Policy, Law, IT Systems

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Web Site

• American Nurses Association
• lthttp//www. ana. orggt

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ANA Information Technology

• Supported Practice Standards
• Over 25 Years -1970 - 1981 - 1998
• Nursing Process Assessment, Diagnosis, Outcome
  Identification, Planning, Implementation,
  Evaluation

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ANA Database Committee

• 1990 - Nursing Minimum Data Set (NMDS)
• 1992 - Recognized 4 Vocabularies
• 1989 - ICNP (ICN)
• 1994 - UMLS (NLM)
• 1997 - NIDSEC

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NMDS 16 Data Elements

• Nursing Care (4)
• Nursing Diagnosis
• Nursing Interventions
• Nursing Outcomes
• Intensity of Nursing Care
• Patient Demographics (5)
• Services (7)

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ANA 6 Recognized Vocabularies

• NANDA Taxonomy I Revised
• Omaha System
• NIC - Iowa
• NOC - Iowa
• HHCC - Georgetown

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Unified Medical Language System

• 1986 NLM - Metathesaurus
• 1992 ANA - 4 -Vocabularies
• 1998 Linked to MeSH

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International Classification of Nursing Practice
- ICNP- ICN Initiative

• 1989 - ICN Initiated ICNP
• 1995 - ICNP - Alpha Version
• 1999 - ICNP - Beta Version

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National Information Data Set Evaluation
CenterNIDSEC - ANA Initiative

• 1997- ANA Establish NIDEC Standards
• 1999- ANA Score ITs NIDSEC Nursing Vocabularies

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Disease Conditions Classifications

• ICD-10
• ICD-9-CMVol 12
• DSM-III-R

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Procedure Classifications

• CPT-4
• ICD-9-CM Vol 3
• HCPCS / HCFA

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Other Classifications

• SNOMED-III - 11 Modules
• Read Clinical Classification -UK
• Oasis - HCFA-HH Data Set
• 79 Survey Questions

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Data Standards National Initiatives

• CPRI
• ASTM
• HL7
• ANSI-HISB

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Web Site

• Health Level Seven
• lthttp//www.hl7.orggt

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How Do We Use What We Have Today?
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We Use - ITs WWW

• Nursing Practice,
• Nursing Administration,
• Nursing Research,
• Nursing Education

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Nursing Informatics / IT

• Use of technology and/or computer systems to
  collect, store, process, display, retrieve, and
  communicate timely data and information in and
  across health care facilities to

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Nursing Informatics Cont

• Deliver clinical care / practice
• Administer resources services
• Apply technologies to education
• Link research findings to practice

Saba McCormick (1996)
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Deliver Nursing Practice

• Acuity Levels
• Care Plans
• Critical Pathways
• Discharge Planning

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IT Internet Practice Uses

• Home Monitoring Technologies
• Tele-Home Office Visits
• Brennan - WebTV
• Institute Online Support Groups

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Management of Resources

• ADT - Census Data
• Order Entry - Results Reporting
• I/O Charting
• Staffing Scheduling
• Quality Assurance

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Administration Applications

• Budgeting - Care Costs
• Forecasting
• Billing Systems
• Reimbursement

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Link Research to Practice

• Evidenced-Based Practice
• Decision Support Systems
• Quality Care Outcomes
• Clinical Practice Guidelines

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Research - Impact on Care

• Critical Path Evaluation
• Best Practices
• Data Warehousing Mining
• Knowledge Data Base Syntheses

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Web Site Guidelines

• Agency for Health Care Policy and Research
• lthttp// www.ahcpr.govgt

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Bibliographic Systems

• CINAHL Online
• Virtual EMUNRS Database
• MEDLINE
• Online Journals
• CINAHL OnLine Journal

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Web Site

• Lippincotts Nursing Center
• lthttp//www.nursingcenter.comgt

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Patient Education

• Glaxo Wellcome Health Education
• lthttp//www.helix.com/gt
• Patient Support Groups
• e.g. Diabetes Web Site
• lthttp// diabetes.orggt
• Listservs - Web Site
• lthttp//tile.net/lists/medicine.htmlgt

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Student Education

• Support Educational Process
• CAI, IVD, VCR Tapes
• Digital Video Streaming
• Teaching Tools -Web Site
• Interactive Patient
• lthttp//medicus.marshall.edu/medicus/htm

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Distance Education

• Tele-Conferencing Courses
• PictureTel Transmission
• Land Lines vs Sattelite
• DoD/VA Distance Learning Project

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Distance Education Cont

• Conduct Internet Courses
• Lotus Notes - Program
• Web CT - Program
• Online Syllabus - Articles
• Online E-Mail - Faculty Students

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What Do We Need to Resolve for 21st Century?
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We Need to Address Legislation

• Health Insurance Portability Accountability Act
  of 1996 (HIPAA)
• Supports Information Exchange (EPR)
• Monitors Outcome Data
• Create a National Knowledge Database

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Electronic Patient Record

• Framework for Clinical Practice
• Incorporate Nursing Vocabularies
• Diagnoses / Problems
• Interventions / Treatments
• Outcomes

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Nursing EPR

• Code, Index, Classify Care
• Determine Care Costs
• Develop Discharge Data Summaries
• Communicate Care Data
• In Facilities Across Facilities
• Use HL7 Standards

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Practice Policies

• Lobby to Get Paid for Our Care
• Lobby to Get a PIN

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21st Century - Paperless Chart

• Electronic Patient Record
• Illness Care Across Settings
• Virtual Record
• Electronic Health Record
• Wellness Care Life Long
• Personal Record

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Summary

• What We Have - IT WWW
• How We Use What We Have Today
• What We Need to Resolve for 21st Century

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Score Your Research

• What - IT Tools?
• What- INTERNET Protocols?
• What - Approved ANA Vocabulary?
• What - Professional Involvement?

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Why a Classification?

• If we cannot name it
• We cannot control it
• Finance it
• Teach it
• Research it, or
• Put it into public policy

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lthttp//www.nursecare.orggt