Informatics (Chapter 26)

Nursing's data needs fall into four domains. Which of the following statements accurately describe the sources for data in each of the domains? (Select all that apply.) a. Client data is located in the client's health care record. b. Provider data refers to physicians and is located within the medical board. c. Administrative data is located in registry and regulatory performance data. d. Research data is only available with informed consent. e. Existing and newly gathered data can be a source of obtaining research information.

a. Client data is located in the client's health care record. c. Administrative data is located in registry and regulatory performance data. e. Existing and newly gathered data can be a source of obtaining research information. The sources of client data are the client's health care record, their personal health record, and patient-provider messages. Administrative data is located in administrative, fiscal, population, registry, and regulatory performance data. Existing and newly gathered data, relational databases, and common data elements are sources of research data.

According to the ANA, what elements are viewed as a relationship continuum as nurses apply them in decision making? (Select all that apply.) a. Data b. Technology c. Information d. Knowledge e. Wisdom

a. Data c. Information d. Knowledge e. Wisdom As defined by the ANA (2015a), the practice of nursing informatics views the relationship of data, information, knowledge, and wisdom as a continuum with increasing complexity and interrelations as nurses aggregate and apply them in decision making.

Which of the following statements are true regarding health information technology (HIT) applications in nursing services? (Select all that apply.) a. HIT involves nursing administration, clinical informatics, and effectiveness research. b. Health information data allow nursing leaders to make informed decisions regarding patient care. c. HIT is used primarily for financial decision making. d. Clinical decision support utilizes tools for downloading, collecting, organizing, and analyzing data. e. HIT is used by senior leaders only.

a. HIT involves nursing administration, clinical informatics, and effectiveness research. b. Health information data allow nursing leaders to make informed decisions regarding patient care. d. Clinical decision support utilizes tools for downloading, collecting, organizing, and analyzing data. HIT applications in nursing services arise from the intersection of three areas: nursing administration; clinical informatics; and effectiveness research, including research on client outcomes. The technologies are tools for downloading, collecting, organizing, and analyzing vast amounts of complex data, and clinical decision support. Having these data in an accessible format increases nursing leaders', managers', and administrators' ability to make informed decisions regarding the organization and delivery of patient care.

Nurse managers utilize outcomes data to make decisions about nursing care effectiveness. Which NMMDS data elements would be most effective in evaluating nursing care? (Select all that apply.) a. Nursing diagnosis b. Turnover c. Population served d. Client accessibility e. Intensity of nursing care

a. Nursing diagnosis b. Turnover e. Intensity of nursing care The NMMDS was developed to meet the need for "sharable and comparable" data, especially regarding the nursing workforce and the processes of patient care (Garcia et al., 2015). Such data are crucial for nurses to have in order to compare nursing practice and evaluate costs of care. Three categories of data elements are included in the NMDS: nursing care, demographic, and service. Data elements related to nursing care include nursing diagnosis, turnover, intervention, outcome, and intensity of nursing care.

What are some of the expected outcomes in the client domain of nursing data? (Select all that apply.) a. Patient satisfaction b. Achieved care outcomes c. Continuity of care d. Level of dependency e. Intensity of nursing care

a. Patient satisfaction b. Achieved care outcomes c. Continuity of care In the client domain, the cost and continuity of care for the client are important because data are now shared among providers within the HIE to manage care. Patient satisfaction and the achievement of care outcomes are also expected within the client domain. Some of the variables include diagnosis, age, gender, marital status, level of dependency, and intensity of nursing care.

Successful implementation of a health information system requires a great deal of time, education, and support. The process will require which of the following expertise within the organization? (Select all that apply.) a. Quality experts b. Marketing specialists c. Clinical nurse leaders d. Nurse informaticians e. Nurse managers

a. Quality experts c. Clinical nurse leaders d. Nurse informaticians e. Nurse managers Nurse managers are being asked to participate in the selection, design, and implementation of institutional information systems. Managers and clinical nursing leaders will serve as change agents to overcome resistance. Successful implementation and sustainability of these systems will require nurse managers, nurse informaticians, clinical nurse leaders, and quality experts to have leadership, vision, and commitment.

What are the primary purposes and benefits of EHRs? (Select all that apply.) a. Single source of clinical, financial, and legal record b. Electronic format supports the storage and exchange of continuity of care c. Available within the health care facility to ensure confidentiality d. Originate from a single place e. Virtual record of retrospective, concurrent, and prospective information

a. Single source of clinical, financial, and legal record b. Electronic format supports the storage and exchange of continuity of care e. Virtual record of retrospective, concurrent, and prospective information The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the continuity of care document from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care (Hayrinena et al., 2008).

The implementation of an electronic health record (EHR) could enhance patient care by facilitating: a. communication across the health care continuum. b. diabetes mellitus education and ongoing care delivery. c. one-on-one counseling between the provider and the client. d. physical and occupational therapy dispensing errors.

a. communication across the health care continuum. The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the CCD from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care (Häyrinen et al., 2008).

Management information systems describe a broad scope of activities that includes but is not limited to the management of: a. decision support systems. b. merchandise. c. products. d. nursing services.

a. decision support systems. Management information systems (MIS) describe a broad scope of activities that includes but is not limited to managing: decision support systems, resource and people management applications, project management, and database retrieval applications.

The data analysts within a health care organization pull core measure data from patient records on a quarterly basis. This data is then analyzed and collated into a report that is uploaded to TJC for analysis of adherence to core measure requirements. This is an example of: a. health information exchange (HIE). b. effectiveness research. c. health information management. d. management information systems.

a. health information exchange (HIE). Health information exchange (HIE) is defined as the electronic movement of health-related information among organizations according to nationally recognized standards that allow health care providers to access and securely share vital medical information electronically (HealthIT.gov, 2014a). The HIE is a process within either a state health information network or a regional health information organization (RHIO), often for a geographic area.

The goals of meaningful use include: (Select all that apply.) a. improve quality of care and safety. b. engage patients and their families in care. c. improve population health. d. reduce costs associated with health care. e. improve care coordination.

a. improve quality of care and safety. b. engage patients and their families in care. c. improve population health. e. improve care coordination. Meaningful use of HIT brought with it four goals: improve quality of care and safety, engage patients and their families in care, improve care coordination, and improve population health (Calhoun et al., 2016).

Effectiveness research: a. is the study of relationships among health care problems. b. provides solutions to serious global health care issues. c. reflects sound, reliable, and valid data that can be examined closely. d. supplies data that are critical and worthy of gathering.

a. is the study of relationships among health care problems. Effectiveness research applies epidemiological methods to large databases to study relationships among health care problems, interventions, outcomes, and costs, and determine alternatives and their effects with different patient characteristics and intervening variables.

_____ was recognized by the American Nurses Association (ANA) as a nursing specialty in 1992 and is one of the fastest growing practice areas in health care. a. Nurse anesthesia b. Nursing informatics c. Nurse-midwifery d. Clinical nurse specialist

b. Nursing informatics Nursing informatics is one of the fastest growing practice areas in health care.

What are the roles of nursing informatics specialists? (Select all that apply.) a. Data analysis and reporting to governmental agencies b. Participation in education of nursing staff c. Providing direct patient care d. Providing information and evidence-based knowledge e. Supporting clinical decision making

b. Participation in education of nursing staff d. Providing information and evidence-based knowledge e. Supporting clinical decision making Nursing informatics specialists assist practitioners by providing information and evidence-based knowledge to support clinical decision making and delivery of safe patient care. Although these specialists may not be directly involved with care delivery, their effort is integrally related to reengineering work flow for clinical and administrative practice. Nursing informatics specialists participate in analysis, design, and implementation of information and communication systems; effectiveness and informatics research; and education of nurses in informatics and information technology.

The Office of National Coordinator for Health Information Technology (HIT) was created by: a. President Barack Obama. b. President George W. Bush. c. Hillary Clinton. d. President Bill Clinton.

b. President George W. Bush. In 2004, President George W. Bush created the position of Office of National Coordinator for HIT within the U.S. Department of Health and Human Services. The coordinator's role involved leadership to develop the standards and interoperability framework and establish the infrastructure necessary to harness the use of information technology and exchange of health information nationwide to improve patient care and reduce health care costs.

Nursing informatics includes the: a. coding and billing of hospital and physician services. b. management and communication of data, information, knowledge, and wisdom in nursing practice c. organization and selection of quality medical information. d. support and troubleshooting of computer software issues.

b. management and communication of data, information, knowledge, and wisdom in nursing practice Nursing informatics is a "specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice" (American Nurses Association [ANA], 2015a, p. 1).

The formal process of using patient data for providing evidence for the design of care protocols is termed: a. evidence-based practice. b. practice-based evidence. c. data analysis. d. effectiveness research.

b. practice-based evidence. Collecting and extracting data that describe the processes and outcomes of nursing care electronically has provided evidence for the design of care protocols and delivery models (Horn & Gassaway, 2010). The formal process of using these patient data for providing this evidence is termed practice-based evidence.

Nursing data need to include which of the following domains? a. Fiduciary data b. Outcome data c. Client data d. Tertiary data

c. Client data Nursing's data needs fall in four domains: client care, provider competencies and staffing, administration of care and sustainability of the organization, and knowledge-based research for evidence-based practice.

The first person to analyze patient outcomes associated with nursing care delivery was: a. Clara Barton. b. Dorothea Dix. c. Florence Nightingale. d. Luther Christman.

c. Florence Nightingale. Florence Nightingale was the first person to analyze patient outcomes associated with nursing care delivery. This occurred in the nineteenth century.

Which of the following statements best describes a desirable characteristic of a good management information system? a. Data should be sorted and labeled within 2 weeks. b. For accurate interpretation, data should reflect a health bias. c. Information gathering should be comprehensive and cost-effective. d. The management information system operating system should be Windows-based.

c. Information gathering should be comprehensive and cost-effective. Ten criteria or desirable characteristics for a good management information system are the following: (1) informative, (2) relevant, (3) sensitive, (4) unbiased, (5) comprehensive, (6) timely, (7) action-oriented, (8) uniform, (9) performance-targeted, and (10) cost-effective (Austin, 1979).

The collection of data to measure performance is required by: a. the Health Insurance Portability and Accountability Act (HIPAA). b. the Centers for Medicare & Medicaid Services. c. The Joint Commission (TJC). d. Health Information Technology.

c. The Joint Commission (TJC). The collection of data to measure performance is a requirement of TJC.

Nursing outcome databases are critical because nurses must be able to: a. assess the differences between an associate degree in nursing and a bachelor's of science degree in nursing. b. compare interventional care strategies between physicians. c. evaluate nurse's aide- and licensed practical/vocational nurse-sensitive outcomes. d. measure how nurses influence patient outcomes.

d. measure how nurses influence patient outcomes. Nursing outcome databases are critical for two reasons: (1) nurses are able to measure and document how nurses influence patient outcomes across care providers for populations of patients, and (2) the study of nursing-sensitive outcomes allows comparisons among interventional strategies and advances the science of nursing care delivery (Furukawa et al., 2011; Minthorn & Lunney, 2010; Muller-Staub, 2009; Scherb et al., 2011).

The Nursing Minimum Data Set (NMDS) was designed to: a. determine differences in care delivery between the holder of an associate degree in nursing and a bachelor's of science in nursing. b. evaluate the nursing language of NANDA, Nursing Interventions Classification, and Nursing Outcomes Classification. c. provide data for leaders to make decisions about staffing patterns. d. standardize the collection of nursing data across populations.

d. standardize the collection of nursing data across populations. The formulation of the NMDS was an effort to standardize the collection of essential nursing information for comparison of nursing data across patient populations.

In the provider domain, what are some of the variables that are used to measure variability in nursing? (Select all that apply.) a. Certification b. Hours of work c. Education level d. Years of experience e. Attitudes and beliefs

c. Education level d. Years of experience e. Attitudes and beliefs In the provider domain, professional skills/knowledge and intensity of nursing care are variables that may be measured to monitor variability and to control workforce capacity. The quality and types of services are dependent on the competencies of the professional workforce.

It is estimated that nurses spend approximately _____ of their time documenting information in the EHR. a. 7% b. 17% c. 20% d. 35%

d. 35% Nurses spend approximately 19% of their time in patient care, 7% with assessments, 17% managing medications, 20% coordinating care, and 35% documenting patient information in EHRs (Burnes-Bolton, 2009).

Nurses utilize _____ through critical thinking and clinical reasoning skills to determine when and how to apply evidence-based knowledge. a. orders b. data c. information d. wisdom

d. wisdom Wisdom is the appropriate use of knowledge in managing and solving patient problems, risks, and needs for health enhancement. Wisdom is knowing when and how to apply the evidence-based knowledge with client information, which nurses exercise through critical thinking and clinical reasoning skills.