Nursing and Computers: An Anthology

442 Pages·1989·8.39 MB·English

by  Virginia K. Saba (auth.)

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