Chapter 15 Nursing Informatics Questions – Flashcards

ANS: A Informatics is a broad academic field encompassing artificial intelligence, cognitive science, computer science, information science, and social science. Medical informatics refers to informatics related to health care and describes a distinct specialty in the discipline of medicine. Nursing informatics is a specialty area of informatics that addresses the use of health information systems to support nursing practice. The American Nurses Association (ANA, 2008) states that the specialty of nursing informatics integrates nursing computer and information science for the management and communication of data, information, knowledge, and wisdom.

ANS: A, C, D Access to electronic records requires a user to have system access and verification codes as a measure of security and protection of the patient's privacy. The codes leave an electronic trail of authorized users that can be audited. HIPAA sets the standards on how security and confidentiality of health care information must be maintained. The act also sets the penalties for any breach in security of health care data.

ANS: A, B, E A standardized nursing terminology is a structured vocabulary that provides a common means of communication among nurses. A standardized language ensures that when a nurse talks about a specific patient problem, another nurse fully understands the problem. An example is the choice between pressure ulcer, decubitus ulcer, and bedsore. Do all nurses in all settings have a shared understanding of these labels for a patient problem? The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These core data, used on a regular basis by most nurses in the delivery of care across settings, provide accurate descriptions of the nursing diagnoses, nursing care, outcomes of care, and nursing resources used. Collected on an ongoing basis, the NMDS enables nurses to compare data across populations, settings, geographic areas, and time. The International Classification for Nursing Practice (ICNP), developed under the auspices of the International Council of Nurses (ICN), provides a standard that facilitates the description and comparison of nursing practice locally, regionally, nationally, and internationally.

ANS: A, C, D, E The Technology Informatics Guiding Education Reform (TIGER) initiative (2012) identified a set of skills needed by all nurses practicing in the 21st century. The TIGER Vision Pillars include management and leadership, education, communication and collaboration, informatics design, and IT policy and culture. This skill set includes informatics competencies that range from basic computer skills to advanced-level IT and literacy competencies and expertise. TIGER's vision for the future of nursing addresses informatics and emerging technologies to provide safer, patient-centered care by using evidence and technology in practice, education, and research. After meeting the educational and experience requirements, the nurse can receive certification in nursing informatics from the Health Care Information and Management Systems Society (HIMSS) and through the American Nurses Credentialing Center (ANCC). However, certification is not one of TIGER's Vision Pillars.

ANS: A, B, D, E The use of telemonitoring offers the opportunity to reduce the cost of health care while improving outcomes and patient satisfaction. Use of health care IT has improved organization, communication, and decision making; reduced duplicate orders, charting time, and paperwork; made medication administration safer; and enhanced information access and administrative functions.

ANS: A While adopting new technology that enhances patient care and safety, it is the nurse's responsibility to continue to provide compassionate care. The spread of IT supports consumer empowerment and self-management of wellness and disease. Consumers can electronically access their own health information, communicate with their health care providers, and seek needed education about health care.

ANS: D The focus of nursing informatics is not on direct patient care but on how the process of patient care can be improved and patient safety ensured. There are challenges to advancements in IT, such as increased amount of time spent documenting, cost of equipment, protection of patient privacy, use of different EHRs in different facilities, and resistance by health care providers to new technology.

ANS: A The Computer Ethics Institute (CEI) was founded in 1985 to serve as a forum and resource for identifying, assessing, and responding to ethical issues associated with the advancement of information technologies and to facilitate the recognition of ethics in the development and use of computer technologies. CEI developed the Ten Commandments of Computer Ethics. The eHealth Code of Ethics, developed by Health Informatics Europe (2005), is "to ensure that people worldwide can confidently and with full understanding of known risks realize the potential of the Internet in managing their own health and the health of those in their care." The Health Insurance Portability and Accountability Act (HIPAA) of 1996 sets the standards on how security and confidentiality of health care information must be maintained. The act also sets the penalties for any breach in security of health care data. The Internet Healthcare Coalition, founded in 1997, was created to promote quality health resources online and to ensure that consumers and professionals are able to find reliable, quality information online.

ANS: A One classification system for nursing informatics competencies uses technical, utility, and leadership categories. Leadership competencies address the ethical and management issues related to using IT in nursing practice, education, research, and administration. Specific leadership competencies include the application of accountability, maintenance of privacy and confidentiality, and quality assurance. Technical competencies pertain to the use of computers and other technological equipment and the use of a variety of software programs for word processing, spreadsheet and database development, presentation, referencing, and e-mail. Utility competencies address critical thinking and evidence-based practice applications. Nurses who have a utility competency recognize the relevance of nursing data for improving practice and can access multiple information sources for gathering evidence for clinical decision making.

ANS: C The Internet Healthcare Coalition, founded in 1997, was created to promote quality health resources online and to ensure that consumers and professionals are able to find reliable, quality information online. This organization consults with various government agencies, including the World Health Organization, the U.S. Food and Drug Administration, and the U.S. Federal Trade Commission, on efforts to promote credible online health care information and combat online health fraud.

ANS: D Authority involves knowing who the sponsor or publisher is. Is this a personal page? Where does it come from? Is the author or organization listed? What are the author's credentials? Purpose is determining to focus of the site. Does the site inform? Explain? Share? Disclose? Sell? What is the intended audience? Coverage tries to determine if citations are correct. Is there a balance of text and images? Currency refers to when the site was created. How often is it updated?

ANS: C After meeting the educational and experience requirements, the nurse can receive certification in nursing informatics from the Health Care Information and Management Systems Society (HIMSS) and through the American Nurses Credentialing Center (ANCC). Technical competencies pertain to the use of computers and other technological equipment and the use of a variety of software programs for word processing, spreadsheet and database development, presentation, referencing, and e-mail. Utility competencies address critical thinking and evidence-based practice applications. Nurses who have a utility competency recognize the relevance of nursing data for improving practice and can access multiple information sources for gathering evidence for clinical decision making. Leadership competencies address the ethical and management issues related to using IT in nursing practice, education, research, and administration. Specific leadership competencies include the application of accountability, maintenance of privacy and confidentiality, and quality assurance. Technical, utility, and leadership competencies can be achieved without certification.

ANS: B Descriptions of nursing informatics competencies often focus on levels that include beginner, experienced, specialist, and innovator. Beginner skills include computer, information, and web literacy; fundamental skills in information management and computer technology; and the ability to identify and collect relevant data. The nurse at the beginning level may have keyboarding skills, can document in the EHR, and look up medications and other health information on reputable Internet reference sites. The nurse at the experienced level of informatics competencies is able to see data relationships and make judgments based on trends and patterns in data, is skilled in information management and the use of computer technology, and is able to suggest areas for IT system improvement. The nurse at the specialist level of competency focuses on information needs for the practice of nursing; integrates and applies information science, computer science, and nursing science; and applies skills in critical thinking, data management, processing, and system development. At the specialist level of competency, the nurse may conduct research based on information trends or patient data, devise applications for computer technology in nursing, or develop new software to enhance nursing care. Nursing informatics innovators conduct research and generate theory. They develop solutions and understand the interdependence of systems, disciplines, and outcomes.

ANS: C Listservs can be used in health care to connect groups of patients with common problems or to send updated information to large groups. E-mail has become a common means of communication but would not be focused on the patient's issues. Social media include online technologies such as Facebook, Twitter, and LinkedIn that allow people to communicate easily by the Internet to share information and resources, but they are more general than listservs. These technologies enable a potentially massive community of participants to collaborate, providing a mechanism for tapping into collective power in ways previously unachievable. A blog is a social medium that is usually maintained by an individual and has regular entries of commentary, descriptions of events, or other material such as graphics or videos. Most blogs are interactive, allowing visitors to leave comments and message each other. Many blogs focus on health care issues.

ANS: A Computerized provider order entry (CPOE) allows orders to be directly communicated to the appropriate department—diet orders to dietary, medication orders to the pharmacy, laboratory orders to the laboratory. Elimination of an intermediary for order transcription decreases the potential for errors related to the ambiguity of handwritten orders and allows quicker responses by appropriate departments. Legibility and availability of computerized documentation improve provider communication. The Agency for Healthcare Research and Quality (AHRQ) recommends CPOE as one of the safe practices for better health care. CPOE systems ensure legible orders and have the potential to reduce ordering and transcribing errors. Disadvantages of CPOE include workflow issues, provider resistance to new technology, and overdependence on technology (AHRQ, 2012).

ANS: A The electronic medical record (EMR), which is the documentation of a single episode of care (i.e., outpatient visit or inpatient stay), becomes a part of the electronic health record (EHR), which is a longitudinal record of care. EHRs are becoming widely used for individual health care encounters and for maintaining patients' health records over long periods. As EHRs become fully implemented, they include provider order entries, progress notes for all disciplines, computerized medication profiles, access to diagnostic test results on a timely basis, decision support systems, and online clinical reminders and alerts.

ANS: A Computerized provider order entry (CPOE) allows orders to be directly communicated to the appropriate department. CPOE systems ensure legible orders and have the potential to reduce ordering and transcribing errors. Disadvantages of CPOE include workflow issues, provider resistance to new technology, and overdependence on technology (AHRQ, 2012).

ANS: C When technology such as a BCMA system is used as part of the process of medication administration, fewer errors are made. After signing into the system or scanning his/her ID badge, the nurse electronically scans the bar codes of the patient ID, the MAR, and the drug to determine that the right patient is getting the right drug and dose at the right time. An alert signals a potential error, and it is the nurse's responsibility to verify all information before administration.

ANS: C IT can be used to increase patient safety. Errors are analyzed to develop strategies for prevention. Diagnostic test results are available faster to support treatment decisions and avoid redundancy in orders. When technology such as a bar-code medication administration (BCMA) system is used as part of the process of medication administration, fewer errors are made. After signing into the system or scanning his/her identification (ID) badge, the nurse electronically scans the bar codes of the patient ID, the medication administration record (MAR), and the drug to determine that the right patient is getting the right drug and dose at the right time. An alert signals a potential error, and it is the nurse's responsibility to verify all information before administration

ANS: A Telehealth nursing is the transmission by a nurse of electronic data, images, or audio from a patient's bedside or home to other health providers for the purpose of providing care and improving outcomes. Patients may have telehealth hardware in their homes to provide in-home monitoring and direct reporting to their health care providers. Computerized decision support systems (DSSs) include safe practice alerts and reminders that improve the quality of care. Some DSSs assist in determining a correct diagnosis and choosing an appropriate medication. Computerized provider order entry (CPOE) allows orders to be directly communicated to the appropriate department—diet orders to dietary, medication orders to the pharmacy, laboratory orders to the laboratory. Computers, tablets, or pocket devices used at the bedside for documentation are examples of point-of-care technology. Patient data collected by a nurse and recorded electronically are immediately available to all members of the health care team.

ANS: D Nurses working surrounded by computers and mobile IT must develop skills in the use of all available technology. At the same time, it is important to recognize that the rapid advancement of IT means that the technology in use today may be entirely different tomorrow. Some facilities have computer access at every bedside, and others have mobile computers, sometimes called workstations on wheels (WOWs), that can be taken to each bedside. Nurses using technology as part of patient care need to work within facility policy and HIPAA guidelines. The technology supports bedside and remote charting. Nurses may use a portable device such as a smartphone or tablet computer to access reference materials, including medical information and vast amounts of drug information. Some facilities issue these devices to staff.

ANS: B Patient data collected by a nurse and recorded electronically are immediately available to all members of the health care team. The computerization of nursing practice data enables capture, storage, retrieval, organization, processing, and analysis of information. The information can be used to make a diagnosis, plan for care, provide nursing decision support, enhance documentation, and identify nursing care trends and costs. Systems that support data collection at the point of care can directly enhance patient care by decreasing the time spent on documentation, reducing the potential for errors, and supporting improved assessment and data communication. Computers, tablets, or pocket devices used at the bedside for documentation are examples of point-of-care technology.

transmission by a nurse of electronic data, images, or audio from a patient's bedside or home to other health providers for the purpose of providing care and improving outcomes.

c. critical thinking and evidence based practice

d. prevention of medication errors

Answers: b, c Health care IT improves communication among providers by providing immediate access that is legible and standardized to patient data by all providers. IT improves administrative functions by addressing the issues of quality, cost-effectiveness, and outcomes of care. Although there are initial costs to purchase hardware and software, these systems are cost-effective in the long run. Systems that support data collection at the point of care can directly enhance patient care by decreasing the time spent on documentation, reducing the potential for errors, and supporting improved assessment and data communication

Answer: c The NMDS is a standardized collection of essential nursing data used by nurses to promote consistent, understandable documentation. Although standard terminology may be used during admission, and discharge, these tools are not a description of NMDS. Nursing diagnoses are organized using NANDA-I.

Answers: a, c, d The nurse at the intermediate level of informatics competency can see data relationships and is able to collect and group data. The nurse is skilled in the use of computer technology and can document in the EHR. Conducting informatics research and integration of the sciences is the advanced level of informatics competency.

Answer: c Use of CPOE enables orders to go directly to the appropriate department decreasing the potential for errors. There is no transcription of orders and no need for someone to transcribe the orders. Because the orders are typed into the computer, handwriting legibility is not an issue.

Answer: c The BCMA system scans the nurse's ID, the patient's ID, and the medication package to ensure that the proper drug is given to the correct patient. Asking the patient's address or two random identifiers that the patient may not be aware of would be inappropriate. Proper protocol for administration is to open the medication packages at the bedside. Use of a scanning device requires the medication to still be in the package while scanning to ensure that it is the proper medication.

Answer: a The nurse is demonstrating information literacy (the ability to recognize when information is needed and to locate and use that information) when researching a patient's diagnosis online. Entering patient data into the EHR or learning a new EHR system demonstrates beginner nursing informatics competency. Organizing patient data to study trends demonstrates an experienced level of nursing informatics competency.

Answer: a Patient information should be accessed only by staff caring for that patient. Security codes are required for EHR access, and access of records can be monitored. Professional ethics should dictate the nurse's behavior, and only the records of patients being cared for should be accessed. A patient's record can be discussed only with those who are caring for the patient, and, because the nurse is not on the same unit, the records should not be accessed or discussed by that nurse. Health Insurance Portability and Accountability Act (HIPAA) laws prevent the discussion of private patient information with anyone outside of the team providing care.

Answer: b The electronic MAR reduces medication errors by requiring the nurse to scan the patient's identification band and the medication. Although the electronic MAR alerts the nurse to potential errors such as the wrong dose, it is the nurse's responsibility to verify all information before administration of a medication. Narcotic counts are still kept in the electronic system. A hard copy of the MAR is not necessary.

Answers: a, b, c, e Point-of-care use of information technology provides more accurate documentation because the nurse documents patient information in real time. Diagnostic results are immediately available to the nurse. Confidentiality is protected when the nurse documents at the bedside using a secure log-in and password. Medication profiles are available to the nurse at bedside. Patients do not have direct access to their medical records because these records are secured by log-ins and passwords accessible to only health care providers caring for each patient.

Answer: b Data are facts, observations, and measurements such as blood pressure and pulse rate. A printout of the patient's history and physical is organized information that is meaningful. Knowledge is organized and processed information such as a nurse's knowledge of a disease. When nurses interpret a change in the patient's condition, they are using wisdom or the use of knowledge and experience to manage and solve problems.

ANS: B, C, D Social media includes online technologies such as Facebook, Twitter, and LinkedIn, which allow people to communicate easily via the Internet to share information and resources. HIPAA stands for the Health Insurance Portability and Accountability Act, and is not an example of social media.

ANS: B Data are facts, observations, and measurements that can be used as a basis for reasoning, discussion, or calculation.

ANS: A, B, D It is not ethical to use proprietary software for which you have not paid. It is not ethical to assume a false identity. It is not ethical to take another person's intellectual output and claim it as your own. It is ethical to access your own patient's files for legitimate work purposes.

ANS: A, B, D Website evaluation criteria include authority, purpose, coverage, currency, objectivity, accuracy, and verification. Popularity is not one of the criteria to use when evaluating a website.

ANS: A, B Beginner skills include computer, information, and web literacy; fundamental skills in information management and computer technology; and the ability to identify and collect relevant data. The nurse at the beginning level may have keyboarding skills, can document in the EHR, and can look up medications and other health information on reputable Internet reference sites. Developing new software to enhance nursing care is at the specialist level of competency. Being able to suggest areas for IT system improvement is at the experienced level of competency.

ANS: B The Health Insurance Portability and Accountability Act (HIPAA) of 1996 sets the standards on how security and confidentiality of health care information must be maintained. Health care facilities may have additional guidelines to follow, but they do not set the standard. NANDA International has developed nursing terminology related to nursing diagnoses. The Computer Ethics Institute has developed its own Ten Commandments of Computer Ethics, but they do not set the standard.

ANS: D The International Classification for Nursing Practice (ICNP), developed under the auspices of the International Council of Nurses (ICN), provides a standard that facilitates the description and comparison of nursing practice locally, regionally, nationally, and internationally. NANDA, NIC, and NOC are examples of standardized nursing terminologies. SNOMED CT is an example of multidisciplinary terminology. ICD9 is used for billing purposes.

ANS: D Computer literacy is knowledge of computers and the ability to use them efficiently. Information literacy is the ability to recognize when information is needed and to locate, evaluate, and effectively use the needed information. Understanding data processing and knowing how to access an electronic library are not the best definitions of computer literacy.

ANS: B Information is organized and processed data that can be communicated and are meaningful and useful to the recipient. Knowledge is organized and processed information that can be applied to problem solving and decision making. The transformation of patient data to clinical information becomes nursing knowledge. Wisdom addresses the use of knowledge and experience to manage and solve problems. Wisdom is the appropriate application of knowledge.

ANS: C Information literacy is the ability to recognize when information is needed and to locate, evaluate, and effectively use the needed information. Computer literacy is knowledge of computers and the ability to use them efficiently. Understanding data processing and knowing how to access an electronic library are not the best definitions of information literacy.

ANS: B A standardized nursing terminology is a structured vocabulary that provides a common means of communication among nurses. A standardized language ensures that when a nurse talks about a specific patient problem, another nurse fully understands the problem. Standardized nursing terminologies recognized by the American Nurses Association include NMDS (nursing minimum data set), NMMDS (nursing minimum data set), CCC (clinical care classification), ICNP (international classification of nursing practice), NANDA-I (NANDA International), NIC (nursing interventions classification), NOC (nursing outcomes classification), Omaha System, and PNDS (perioperative nursing data set). ABC and SNOMED CT are examples of multidisciplinary terminologies. ICD-9 details terminology for billing and coding, not nursing.

ANS: D A listserv is a computer program that automatically sends messages to multiple e-mail addresses on a mailing list. Listservs can be used in health care to connect groups of patients with common problems or to send updated information to large groups.