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Nursing and Computers: An Anthology PDF

442 Pages·1989·8.39 MB·English
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Computers and Medicine Bruce I. Blum, Editor Computers and Medicine Information Systems for Patient Care Broce l. Blum (Editor) Computer-Assisted Medical Decision Making, Volume 1 James A. Reggia and Stanley Tuhrim (Editors) Computer-Assisted Medical Decision Making, Volume 2 James A. Reggia and Stanley Tuhrim (Editors) Expert Critiquing Systems Perry L. Miller Use and Impact of Computers in Clinical Medicine James G. Anderson and Stephen J. Jay (Editors) Selected Topics in Medical Artificial Intelligence Perry L. Miller (Editor) Implementing Health Care Information Systems Helmuth F. Orthner and Broce l. Blum (Editors) Nursing and Computers: An Anthology Virginia K Saba, Karen A. Rieder, and Dorothy B. Pocklington (Editors) A Clinical Information System for Oncology John P. Enterline, Raymond Lenhard, and Broce l. Blum (Editors) V.K. Saba K.A. Rieder D.B. Pocklington Editors Nursing and Computers An Anthology With 81 Illustrations Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Virginia K. Saba, RN, EdD Capt. Karen A. Rieder, NNC Georgetown University late of Health Resources School of Nursing Administration Washington, DC 20007, USA Department of Defense Washington, DC, USA Dorothy B. Pocklington, RN, MSN Health Systems Specialist Series Editor Composite Health Care Systems Bruce I. Blum Walter Reed Army Medical Center Applied Physics Laboratory Washington, DC 20307, USA The Johns Hopkins University Laurel, MD 20707, USA Library of Congress Cataloging-in-Publication Data Nursing and computers: an anthologyl Virginia K. Saba, Karen A. Rieder, Dorothy B. Pocklington, editors. p. em. - (Computers and medicine) Consists mostly of articles previously published in various sources. Includes index. ISBN-13: 978-1-4612-8182-S e-ISBN-13: 978-1-4612-3622-1 DOl: 10.1007/978-1-4612-3622-1 1. Nursing-Data processing. 2. Computers. 3. Information storage and retrieval systems-Nursing. I. Saba, Virginia K. II. Rieder, Karen A. III. Pocklington, Dorothy B. IV. Series: Computers and medicine (New York, N.Y.) [DNLM: I. Computers-collected works. 2. Nursing-collected works. WY 26.S N973S] RTSO.S.N86 1989 61O.73'028'5-dc 19 DNLMIDLC 89-4332 Printed on acid-free paper © 1989 by Springer-Verlag New York Inc. Softcover reprint of the hardcover 1s t editiion 1989 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag, 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analy sis. Use in connection with any form of information storage and retrieval, electronic adap tation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. Copyright is not claimed for works by U.S. Government Employees: Part VII, Chapter 22, and Part X, Chapter 30. Typeset by Publishers Service, Bozeman, Montana. 987654321 Dedicated in Memoriam to Karen A. Rieder Friend Colleague Co-Editor Series Preface This series in Computers and Medicine had its origins when I met Jerry Stone of Springer-Verlag at a SCAMC meeting in 1982. We determined that there was a need for good collections of papers that would help disseminate the results of research and application in this field. I had already decided to do what is now Information Systems for Patient Care, and Jerry contributed the idea of making it part of a series. In 1984 the first book was published, and - thanks to Jerry's efforts-Computers and Medicine was underway. Since that time, there have been many changes. Sadly, Jerry died at a very early age and cannot share in the success of the series that he helped found. On the bright side, however, many of the early goals of the series have been met. As the result of equipment improvements and the consequent lowering of costs, com puters are being used in a growing number of medical applications, and the health care community is very computer literate. Thus, the focus of concern has turned from learning about the technology to understanding how that technology can be exploited in a medical environment. This maturing of what is now called medical informatics caused me to reevalu ate my objectives. I had a choice of learning more about the medical domain or building on my development experience to concentrate on the computer science aspects of system implementation. I chose the latter. I made many friends in my work with computers and medicine-at Johns Hopkins, in the professional community, and at Springer-Verlag. It has taken me longer than I expected just to say goodbye. However, with this revised introduction I close out my last year as series editor. I must thank the authors and production people who made it all so easy for me. I am very pleased that Helmuth Orthner, of the George Washington University Medical Center, will succeed me as series editor. We have worked together for over a decade, and I am certain that he will bring the knowledge, insight, and background that will make this series respond to the dynamic needs of medical informatics. viii Series Preface By way of conclusion, let me observe that although many things have changed, the need for this series has not diminished. In the original Series Preface I wrote that there was a gap between current practice and the state-of-the-art. The three paragraphs that followed are equally true today, and I close out this final preface with them. The lag in the diffusion of technology results from a combination of two fac tors. First, there are few sources designed to assist practitioners in learning what the new technology can do. Secondly, because the potential is not widely under stood, there is a limited marketplace for some of the more advanced applications; this in turn limits commercial interest in the development of new products. In the next decade, one can expect the field of medical information science to establish a better understanding of the role of computers in medicine. Further more, those entering the health care professions already will have had some for mal training in computer science. For the near term, however, there is a clear need for books designed to illustrate how computers can assist in the practice of medicine. For without these collections, it will be very difficult for the practi tioner to learn about a technology that certainly will alter his or her approach to medicine. And that is the purpose of this series: the presentation of readings about the interaction of computers and medicine. The primary objectives are to describe the current state-of-the-art and to orient medical and health professionals and students with little or no experience with computer applications. We hope that this series will help in the rational transfer of computer technology to medical care. Laurel, Maryland Bruce Blum 1988 Preface In an era when information is a key commodity, the field of nursing informatics has gained momentum. Nurses realize that the knowledge base of nursing is uncontrollable using traditional paperbase methods and are beginning to feel an urgent need to understand the computer systems upon which they have become increasingly dependent. As a result, nursing informatics, which integrates com puter sciences and information management technology to facilitate patient care, is emerging. Recently, the American Nurses Association officially endorsed nursing informatics as a critical component of the practice of nursing and the education of its practitioners. We are experiencing a time of dynamic change within the health care industry. Nursing is being influenced dramatically by transitions in its financial, organiza tional, and methodologic structure. The shift to prepaid managed care, to large mUltipurpose corporations competing for increased shares of the health care dollar, and to a health care system in which outpatient community-based care dominates is challenging our abilities and creativity as nursing leaders, teachers, and managers. To survive and flourish in this cost- and quality-conscious envi ronment, nursing departments must embrace automation and recognize the need for practicing nurses with specialized knowledge and skills in the use of com puters and the management of information. Although the need is paramount, it is extremely difficult for the individual nurse practitioner to keep current on tech nological advances and to discern their implications for health care delivery. This book, which is an anthology, consists of selected classical articles on nursing informatics and is a vehicle for maintaining and expanding the knowl edge base of computer technology in nursing. The articles demonstrate represen tative experiences and philosophies in the development and use of computer technology in the areas of nursing administration, practice, research, and educa tion. They reflect a transition of nursing knowledge of computer technology as it developed within the profession as well as the uses of computers within nursing'S many environments. x Preface Many of the authors of the articles in this compendium have been pioneers in computer technology within the nursing profession. Other authors recognized as newcomers to this aspect of nursing represent the future for nursing's progress in computer technology. It is observed that many of the authors have shifted focus from theoretical "how to approach the design" articles, to practical "what has worked" essays, to innovative "what could be done" applications. This growth, along with the rapid proliferation of the literature in this field, speaks eloquently for the evolution of nursing informatics in the profession. There is a risk in presenting a review of any specialty topic since the informa tion may be dated at the time of publication. Yet there is a greater risk that the experiences and learning acquired by nurses during the development, implemen tation, and use of automated systems will be lost to the profession. The articles in this book were chosen to provide the reader with descriptions of experiences, with prescriptions in the form of evolving philosophies, and with conceptual frameworks for the future expansion of nursing's body of knowledge in computer technology. It is critical to highlight the status of nursing informatics within the profession as a stepping-stone to future practice. To reach this goal, the articles in the book have been divided into 14 sections and organized according to the four content areas in which information systems are found, namely nursing administration, nursing practice, nursing research, and nursing education. A short review of each section will provide the reader with a guide for locating articles of interest. Section I provides an overview of nursing information systems and sets the stage for the book. Saba highlights the four areas where nursing information systems are found and provides several examples of applications, some of which are described in detail by subsequent authors. Section II contains four articles that identify the need for nursing information systems. Using a conceptual model as a base, Rieder and Norton describe an integrated nursing information system for patient care, unit management, and nursing administration. The functional description discussed provides a blue print for translating nursing's information requirements into computer applica tions. Edmunds takes another approach and describes what large hospital information systems can do for nurses in terms of increased productivity. Jacob sen and Fennell depict the impact of an information system's life cycle on nursing and stress that the profession must be committed to ensuring that its information needs are met. The final article is a landmark piece; it details the deliberations of the Study Group on Nursing Information Systems, which was convened to consider issues and challenges surrounding the development of systems for nurs ing data. It is in this article that the term nursing information system (NIS) is defined and the functions of NIS are described. Section III focuses on nursing administration and offers the reader four articles on the various types of systems. To assist nurse managers in determining their information needs, Thomas describes how an effective model can enhance com munication between administrators and computer systems specialists and link information requirements to organizational objectives. Zielstorff presents Preface xi several computer applications for nurse administrators and discusses the problems of using sophisticated systems with technically unsophisticated nurse administrators and computer professionals who are unfamiliar with the nursing role. Simpson, Roby, and Rodney present a different perspective in that they identify major issues in the design of a multihospital nursing administration system and provide specific criteria for evaluation. This section ends with an article by McHugh and Schultz, who speculate on the impact of computer tech nology on nursing administration and predict changes for line, middle, and top management. Section IV presents four articles that address nursing administration resource management systems for determining nursing costs, staffing, and scheduling. Each article describes a state-of-the-art application. Hylton, Johnson, and Moran describe the computerization of a manual system for classifying patients. Giovannetti, Mayer, and Silverman describe a computerized nursing manage ment system that relates staffing to patient care requirements in order to control staffing costs. In addition, they provide an example of a distributed system that can be user-maintained and is extremely flexible. Holloran, Patterson, and Kiley discuss the nursing information system they are designing based on patient assessment descriptors, 50 of which are nursing diagnoses. Adams and Duchene describe a computerized patient classification system which integrates patient acuity with patient care plans and nursing diagnoses. They demonstrate how the system can be used to determine direct costs of nursing care according to patient needs and outcomes. In Section V articles on community health nursing systems are presented. In the first article, Saba overviews the status of computerized community health information systems, discusses their value in today's world, and speculates on the requirements for tomorrow's systems. Miller and Sienkiewicz expand this theme by describing the benefits and implications of an automated information system on nursing practice in a community health agency. In the final article, O'Grady describes the individual computerized record developed by the Ramsey County Public Health Nursing Service. This system is used by community health nurses to make decisions about nursing practice priorities. Sections VI through IX focus on different aspects of nursing practice. Section VI provides an overview of nursing practice information systems and begins with Hannah's article written in the mid-1970's, which is considered to be one of the oldest articles in the nursing literature. This landmark publication details how the computer could influence and improve the quality of nursing practice. Fol lowing this is an article by Andreoli and Musser on how computer applications in nursing service can affect patient care. A second landmark paper is the one written by Werley, Devine, and Zorn, which describes how a Nursing Minimum Data Set can be used as an abstraction tool for computerizing standardized nurs ing service data. Section VII presents three articles which highlight nursing practice systems. Cook describes the computer's potential for enhancing nursing practice by detailing how the Technicon Medical Information System (TMIS) at El Camino

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Intended for nurses who would like to know more about the development of the computerized information systems on which they have become so dependent, Nursing and Computers: An Anthology is a wide-range introduction to the literature of this field. The editors have selected historical and contemporar
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