NURSING

INFORMA
ABSTRACT

The emergence of information and communication technologies (ICT) has significantly

influenced nursing practice. This paper begins with the evolution of nursing
informatics, the definition of nursing informatics and related historical, social, and
political influences in Canada. In particular, the impact of Canadian health care
policies and nursing organization emphasis on the need for nurses to be competent in
the area of nursing informatics are discussed. As a result, the recognition that nurses
must acquire computer and information literacy skills to work in this technological
rich environment in all four nursing domains is critical. Finally, a brief examination of
the impact of technology on nursing education is presented.

Definition of Informatics

Informatics, defined as the science of information, evolved from German, French and
Russian origins. In 1957, Karl Steinbach, a German pioneer in computer science, first
coined the term “informatics” originating from “informatik,” meaning computer
science (P, 2013) which concerns itself with the “application of computers to store
and process information” (Fourman, p.1, 2002). While another author (Saba, 2001)
states that it was first coined by the French computer scientist, Dreyfus in 1962 as “
informatique” .Walter Bauer translated the French term into English as “informatics”
(Pramilaa, 2013). In 1966, Mikhailov advocated for the Russian term” informatika”,
and the English term “informatics”, as the term for the study of the use of
information technology in various communities (Fourman, 2002).
BRIEF HISTORY OF NURSING INFORMATICS IN CANADA

Revolutions usually occur as a result of innovations and technological

advancements. There have been two major revolutions brought about by technology;
the Industrial Revolution and the Information Revolution. The Industrial Revolution
began in Britain in the late 18th century and continued into the 19th century
(History.com staff), then spread to other parts of the world. For the first time,
machines were used in the manufacturing sector to increase productivity, the steam
engine and automobile were developed to improve transportation and the telegraph
was used to quicken communication.

By the mid-19th century, a rudimentary computer developed by Charles

Babbage appeared (Thede, 2003). From here, further advancements in information,
technology and communication led us to the Information Revolution, which began in
the 1950’s. Computer systems such as Hospital Information Systems (HIS) were
developed and used in healthcare for administrative and accounting purposes (Saba,
2015). During the 1960’s, studies were conducted analyzing the applicability of
computers in nursing practice. Nurses began using electronic tools as monitoring
devices to assess patient status (Saba, 2015). By the 1970’s, HIS were being used for
processing physician order entries as well as for results reporting. In addition,
computer applications in nursing were beginning to appear in the literature (Ozbolt &
Saba, 2008). In the 1980’s, the first cellular phones and personal computers were
introduced. The mid-1990’s saw the development of the Internet which in turn made
communication and information available to anyone at any time. Computers are now
an essential part of healthcare, as they streamline nurses’ work, improve efficiencies,
and enhance the delivery and safety of the care delivered.

In the 2000’s, information was digitalized into music, books, and video.
Personal computers and mobile communications have become standard tools. Nurses
are expected to use electronic medication records (EMR) to assist in administering
medications, electronic health records (EHR) to document, implement and evaluate
care, and use mobile devices and the Internet to access point-of-care data and
relevant information. Some nurses are also using telehealth to provide nursing care to
patients in rural and remote areas (McIntyre & McDonald, 2014). This is in stark
contrast to 1874, when the first Canadian hospital-based nursing school, the St.
Catherine General and Marine Hospital in Ontario (Kirkwood, 2005), was established.
Here, nursing education was based on an apprenticeship model where nursing
students learned to nurse by providing care to the patients on the unit in exchange
for room and board, thus providing cheap labour to staff hospitals (Kirkwood, 2005).
Information was not readily available then, and the training a nurse received was
dependent on the knowledge of a few supervisors.

Nursing Informatics as a Specialty

The American Nurses Association recognized NI as a specialty in 1992 with its

own body of knowledge (Saba, 2001). In Canada, NI has not yet been recognized as a
specialty, however it is represented at the national and provincial levels through
numerous associations such as the Canadian Nursing Informatics Association (CNIA).

In 2001, founded by Dr. Lynn Nagle, a new nursing association emerged

dedicated to NI, called the Canadian Nursing Informatics Association (CNIA). The CNIA
is a special interest group representing the voice for Nursing Informatics in Canada.
The CNIA is designated as a full associate group of the CNA. CNIA is also a member
group of the International Medical Informatics Association- Special Interest Group in
Nursing Informatics, which has a role in furthering and expanding informatics in
healthcare through international collaboration. Canada is one of twenty-eight
countries participating in this association. In 1983, the association held its first
conference in nursing informatics in Amsterdam. This is where Dr. Marion Ball first
coined the term NI (Petrucka, 2014).

In 2006, a peer- reviewed journal, The Canadian Journal of Nursing Informatics,

was launched. It gives nurses a platform to disseminate Canadian research relating to
nursing informatics. It also includes presentations, reviews and other publishable
knowledge.

Influence of Health Care Policies

Numerous reports have emphasized the importance of incorporating

informatics into nursing practice. We are encouraged by policy makers at the
provincial and national levels to change the direction of health care. At the provincial
level, The Fyke Report (2001), Caring for Medicare: Sustaining a Quality System,
commissioned by the Saskatchewan government under Romonov, identified challenges
and outlined solutions for sustaining Medicare. One of those solutions was the
recommendation to develop EMRs, stating that they are the “cornerstone of an
efficient and responsive health care delivery system and quality improvement and
accountability” (p 74). That same year, the Mazankowski report (2001) was also
released; mandated to review the Alberta heath care system at the time by the
Premier. The recommendation focused on new technologies such as EMRs, and a
debit-style electronic health card to make the health system more efficient and cost-
effective.

At the federal level, The Kirby report (2002) entitled The Health of Canadians:
The Federal Role advocated again for the use of EMRs to help gather comprehensive
information but also to make informed decisions. The report was also instrumental in
developing Canada Health Infoway, a federal organization tasked with establishing
EMRs across Canada by the year 2015. It addition, it encouraged the use of digital
health such as e-prescribing, telehealth and remote patient monitoring to improve
the health of Canadians. Reporting the same year as the Kirby Report, Commissioner
Roy Romanow, presented the report Building on Values: The Future of Health Care in
Canada (2002) also referred to as the ‘Romanow Report.’ It also advocated for Canada
Health Infoway to take the initiative in establishing EMRs across Canada and
encouraged the use of information technology to provide safe, quality patient care
and patient access to health information to improve their health. As a result of these
two reports, the Prime Minster and Premiers agreed that all governments should take
measures to “improve the quality, accessibility and sustainability of our public
healthcare system” through the Frist Ministers Accord (2003, p.1). The Accord
addressed several significant issues in healthcare by improving information technology
through the use of EHRs and telehealth, and by providing support to Canada Health
Infoway in order to provide safe, quality and sustainable health care (First Ministers of
Canada, 2003).

Internationally, in 2004, The World Health Organization launched a patient

safety programme identifying that patient safety is a serious global public health
issue. It acknowledged implementing technology to ensure patient safety as one of its
thirteen action areas to improve patient safety.

All of these Reports have one theme in common: to provide safe quality health
care through the use of technology. As nurses, we have more contact with patients
than any other health care professional – therefore it is imperative for nurses to
incorporate technology into their daily practice to ensure safe patient care. In
addition, federal and provincial mandates have contributed to the impetus of
information, technology and communications (ICT) in nursing.
The National Nursing Informatics Project

In 1998, the Canadian Nurses Association spearheaded another initiative, the

National Nursing Informatics Project, to begin to develop a national consensus on
definition, competencies, and educational strategies and priorities in nursing
informatics development. "In 1998 a national steering committee was formed to
address Nursing Informatics issues and develop strategies to ensure that Registered
Nurses have the competencies required to successfully carry out the responsibilities of
their practice - whether that be clinical, administrative, educational or research. The
committee membership represented the Canadian Association of University Schools of
Nursing, Canadian Nurses Association, Registered Nurses Association of British
Columbia, Academy of Canadian Executive Nurses and the COACH Nursing Informatics
Special Interest Group. Each participating organization appointed a nurse expert in
Nursing Informatics to a five-member working group to develop and initiate a plan to:

 develop consensus on a definition of Nursing Informatics for Canada;

 recommend Nursing Informatics competencies for entry level nurses and

specialists, managers, educators, and researchers;

 identify curriculum implications and strategies for both basic and continuing
nursing education; and

 determine priorities for implementing national nursing informatics education

strategies.

Nursing Minimum Data Set

The Nursing Minimum Data Set was the first major Canadian Nurses Association
informatics initiative beginning in 1990. This was in response to the strong conviction
that nursing data must be included in the centralized national health data system
being planned by the Canadian Institute of Health Information (CIHI) described in
Chapter 2.”Registered nurses, as the single largest group providing health care
services, play a major role in health care in Canada. Incredibly, this contribution is
not abstracted from client records and saved in a permanent database of health
information. Most health care data collected in Canada include medical diagnoses and
interventions but do not reflect the contribution of other health care professionals.
Decisions are made in the absence of data reflecting the value of nursing” (Canadian
Nurses Association, 2000, p. 5). .The Canadian Nurses Association considered it
imperative that nursing data, that distinctly reflected nursing care became part of
the permanent health record being designed for the nation. “The impact of nursing
should be captured in national health care databases through the use of effective
nursing classification systems” (Canadian Nurses Association, 2003, p. 1).

Raising Canadian Nursing Awareness

The Canadian Nurses Association released a number of other supportive

documents in 2001. A key one was published in the September Nursing Now Bulletin,
entitled: What is Nursing Informatics and why is it so important? This publication was
a critical overview of the essential characteristics of the emerging field of nursing
informatics in Canada. It also introduced a definition of nursing informatics,
formulated by the National Nursing Informatics Project working group. “Nursing
Informatics (NI) is the application of computer science and information science to
nursing. NI promotes the generation, management and processing of relevant data in
order to use information and develop knowledge that supports nursing in all practice
domains” (Canadian Nurses Association, 2001, p.1)

Another influential group, the Canadian Institute for Health Information (CIHI)
also plays a unique and crucial role in the development of this new Canadian health
information system. CIHI has described its' role as:

1. Setting National standards for financial, statistical, and clinical data

2. Setting National standards for health information technology,

3. Collecting, processing, and maintaining health related databases and registries

The CIHI links federal, provincial, and territorial governments with non-
government, health-related groups. Rhial LeBlanc, President and Chief Executive
Officer of CIHI described the organization as having one main focus, "The work of
health care facilities and professionals is what CIHI supports, and truly improving that
service is our constant objective," (1996, p.1). LeBlanc was clear that CIHI exists to
"...serve all elements of Canada's health care system in an equal and responsive way."
Even though CIHI was initially formed by federal, provincial, and territorial Ministers
of Health, the Institute has been given latitude to grow and chart it's own course. CIHI
members have chosen to keep at "arms-length" from the various levels of government
and do not report directly to government officials. The Canadian Nurse's Association
(CNA) and the provincial nursing associations (for example, the R.N.A.B.C.) plan to
link more and more with CIHI in the future.

The CIHI helped introduce the Strategic Plan for Health Information
Management in British Columbia in 1996 that provides guidelines for holistic
assessment and processing of information. The Plan is based on the four domains of
people, environment, health system and processes. In 1995, the CIHI initiated a
project to provide a cohesive set of guidelines for Canadian health information
privacy. In 1999, a second edition of these guidelines was produced, which
incorporated issues related to the advancement of health information and techology.
In 2002, an updated version Privacy and Confidentiality of Health Information at CIHI:
Principles and policies for the protection of health information , the 3rd edition is
available in PDF (437 k) format

In March 2000, the CIHI published an updated version of the Roadmap

Initiative, a national vision and four-year action plan to modernize Canada's health
information system. Led by CIHI, this Initiative is a collaborative effort with Statistics
Canada, Health Canada and many other groups at the national, regional and local
levels.

The CIHI also provide a comprehensive Goodsourcing Statistics website related

to Canadian health and health care, society, the environment and National
populations. Dozens of other reports are available on the CIHI website, related to
population health, health indicators, health workforce, issues in health and health
care institutions.

Another national organization, the Canadian Organization for the Advancement

of Computers in Health or COACH, founded in 1975, has actively initiated professional
protocols for using computer systems in Canadian health care. One important
document, Guidelines to Promote Confidentiality and Security of Automated Health-
related Information (1979), has been incorporated into the national accreditation
guidelines approved by the Canadian Council of Health Facilities Association in 1991.
These guidelines were also supported by the CNA in 1993.
 In 2001, COACH, as Canada's Health Informatics Association, launched the
Patron Program. As an individual member based organization, COACH promotes
understanding and effective utilization of information and information technologies
within the Canadian Healthcare industry through education, information, networking
and communication. With the development of the Patron program, members are
hoping to build stronger links between COACH and private and public enterprise in
pursuit of this mission. It is an opportunity for corporations to join in partnership with
COACH. COACH's vision is to be THE catalyst in advancing the practice of health
information management in Canada.

Today, COACH is a leading organization with an evolving membership. It is in

the forefront of the Canadian Healthcare information resource and technology field
by working cooperatively with health institutions, professions, associations,
consultants, vendors of information technology and applications, government and
regulatory organizations in the pursuit of its mandate.

The backgrounds of COACH members range from health executives, physicians,

nurses and allied health professionals, researchers and educators to information
systems managers, technical experts, consultants, and information technology vendor
representatives. Organizations represented include the broad range of healthcare
institutions, community and public health, private practice, government, consulting
firms, commercial providers of information and telecommunications technologies,
educational institutions and industry.

In February 1999 the Canadian Federal government published the timely

document, Strengthening Health Care for Canadians, outlining new initiatives and
funding to promote health care technology and informatics initiatives.

Various nursing programs are beginning to offer courses and content in Nursing
Informatics. Some programs integrate informatics into individual courses, which is the
model we have adopted in the BSN Nursing Program at Kwantlen. Others offer
individual stand alone courses which provide computer skills and some theory. A
generous list of educational opportunities in informatics is available on the CNIA site
 Slowly but steadily, other colleges and universities are expanding their
curricula to include Nursing Informatics at both the undergraduate and graduate
levels. As more nurses become computer literate, and become aware of the potential
of technology to support nursing documentation, decisions, and professionalism,
Nursing Informatics can become a strong and integral part of Canadian nursing
science. With this goal in mind, the The BSN Nursing Program has adopted Nursing
Informatics as an integral component of the curriculum.

The Canadian Nurses Portal Project, NurseONE, E-Nursing Strategy

Over the last two decades Canadian leaders in nursing informatics have
discussed and conceptualized a nation wide nursing informatics strategy that would
benefit all nurses and nursing students. In 2006, the Canadian Nurses Association
launched the Canadian Nurses Portal Project, shortened to NurseONE to address this
vision, in the form of a e-nursing strategy. “The purpose of the e-nursing strategy is
to guide the development of ICT initiatives in nursing to improve nursing practice and
client outcomes” (Canadian Nurses Association, 2006, p. 7).

Initial goals of this e-nursing strategy include:

 advocating for nurses' access to ICT and the resources required to integrate ICT
into nursing practice;
 supporting the development and implementation of nursing informatics
competencies among the competencies required for entry-to-practice and
continuing competence; and
 advocating for the involvement of nurses in decision-making about information
technology and information systems. (Canadian Nursing Association, 2006, p.
10).

The e-nursing strategy will address these goals by adopting a three pronged
approach:

 Access – better connectivity in work environment, more access to a variety of

computer technologies, e.g. PDAs, hardware, software, station computers.
 Competency- ongoing ICT skill development, integration into nursing curriculum
 Participation - “as knowledge workers in this technological age, it is essential
that nurses play an increased role in the development of ICT solutions”
(Canadian Nursing Association, 2006, p. 15).
 Information and communication technologies have revolutionized health care and
nursing education, and will continue to have profound effects as new technologies
and innovations emerge in healthcare. Evolving applications in ICT have given rise to a
new era of nursing and nursing informatics. Nursing informatics is the blending of ICT
and nursing science to be used for nursing practice. This paper highlighted historical,
social and political influences in the development of nursing informatics in Canada. It
explored how ICT has influenced nursing curricula as educators have been challenged
to incorporate CASN competency guidelines. New generations of students are
technologically confident, but must also become information literate. Emerging
technologies have and will continue to change pedagogy and the delivery of nursing
education. Ongoing advances will continue to shape the nursing landscape in the
twenty-first century.

The CNIA works to ensure that nursing informatics informs clinical practice,
education, research, administration and policy and is a strong advocate of
technological innovations that improve access to care during this global challenge and
in our healthcare future. This resource page will be updated to provide reliable
resources to support best practices in digital health and communication as the world
responds to this pandemic.

International Academy of Health Sciences Informatics IAHSI Statement to WHO on

the Use of Informatics in Pandemic Situations

FEPA - Focused Education Preparation Advancing Frontline RNs

This self-directed, online course is designed to ‘level up’ your knowledge to

assist, in a team based approach, with the anticipated hospital acute overflow from
COVID 19.
REFERENCES

Canadian Nurses Association. (2006). E-nursing strategy for Canada. Ottawa: Author.

Canadian Nurses Association. (2004). Position statement: Promoting Nursing history.

Ottawa: Author.

Canadian Nurses Association. (2003, January). International classification for nursing

practice: Documenting nursing care and client outcomes. Nursing Now: Issues and
trends in Canadian nursing, Number 14. Ottawa: Author.

Canadian Nurses Association. (2001). What is nursing informatics and why is it

important? Nursing Now: Issues and trends in Canadian nursing, Number 11. Ottawa:
Author.

Canadian Nurses Association. (2000). Collecting data to reflect nursing impact: A

discussion paper. Ottawa: Author.

Canadian Nurses Association. (1993). CNA policy statement on HI:NC. Ottawa: Author

Hebert, M. (1999). National Nursing Informatics Project: Discussion paper. Ottawa:

Canadian Nurses Association.

https://cjni.net/journal/?p=5032

http://pearliansubcninfo.weebly.com/canada.html#:~:text=The%20Canadian
%20Nursing%20Informatics%20Association,informatics%20on%20a%20national%20level