Guest Editorial: Using informatics to go beyond technologic thinking

This issue of Nursing Outlook focuses on how nursing is making, or should make, use of information and communication technology (ICT) to improve the situation of patients and their caregivers, in part because using informatics is 1 of 5 core competencies all health professionals are expected to possess in the 21st century.1 The need to elaborate on this topic was brought home in the 2007 special issue focusing on quality and safety education which noted that informatics is essential for developing the other core competencies, but nursing faculty still do not know how or what to teach in this area.2

The articles that follow fill a needed knowledge gap. Ozbolt and Saba provide a brief history of nursing informatics, reminding us that Nightingale long ago recognized the importance of consistent clinical records to the assessment and improvement of care processes and patient outcomes. Westra and Delaney describe the value of standardized data, while Lang illustrates how such data might be warehoused and transformed into information for reports, eventually leading to executable knowledge. Clancy, Effken, and Pesut argue that health care systems are best understood in terms of complex systems theory requiring rich communication networks; some of the teaching advice that Skiba and Connors provide (e.g., mirror practices of uncertainty; instill sense of interdependence) addresses the unpredictable nature of complex systems. McDaniel, Schutte, and Keller provide an insightful model of consumer health informatics that considers the range of consumers from individuals to policymakers and the levels of health data needed from the sub-cellular to population-wide. Abbott and Coenen challenge our thinking further by their emphasis on how ICT is speeding globalization. Bakken, Stone, and Larson complete the series by reminding us of the research agenda we must embrace if we are going to manage the “data tsunami” ahead, even as they remind us of the progress made since the first research agenda in that area was compiled in 1993 by the then National Center for Nursing Research.

The articles are important in their own right, but even more important is the thinking they collectively trigger. Reading them, one is forced to ponder some of the larger issues of these times: Why do most nurses remain disinterested in representing the work of nursing using standardized terminology when Harriet Werley first proposed the idea of a nursing minimum data set almost 5 decades ago and the North American Nursing Diagnosis Association (NANDA) held its first meeting 25 years ago? It has been 2 decades since the University of Maryland opened the first graduate program in nursing informatics, so why is that subject matter still invisible in our curricula? Why does wide-scale adoption of innovation take so long?

Without devaluing the importance of personal care, why is the nursing process of assessing, treating, and evaluating the situation of the individual still assumed to be of defining importance when the Institute of Medicine (IOM) has called for nurses to take on leadership in transforming the environment in which care occurs.3 Such environmental management still is not seen as a core responsibility all nurses must assume, not just those with administrative titles, so it is not surprising that informatics is viewed as largely of concern to a select few rather than to the profession as a whole. Related to this issue is the question of why we are so slow to build in feedback loops to promote safety when systems theory has long stressed their value in complex organizations. Are we afraid that we will be regarded as less professional if we pay more attention to the context of care than to individual care plans? In this respect, we may have succumbed more than we wish to admit to valuing rugged individualism over team work.

We have heard so much of late about the shortage of nursing faculty, but we have had relatively little discussion about the new kind of faculty needed in a world capable of cataloguing learning resources in a digital repository that can be accessed by partners across various boundaries. In such a world, teachers do not have to create programs from scratch and learners can be self-paced in their mastery of material. Such changes should force us to consider whether our historic emphasis on body count—number of nurses per patients, number of faculty per students—should not be supplanted by more nuanced conceptualizations as to what kind of nursing expertise is really needed.4 Shifting research paradigms—more respect for proven effectiveness (what works in real life) as a complement to efficacy testing (what works in controlled conditions); increased availability of large clinical data sets—will further change our view of the nurse scientist part of the faculty role.

It is good to review a few implications of the IOM's educational vision.1 It believes that all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. Informatics goes beyond ICT; indeed, it involves interdisciplinary investment in change and flexibility, engaging all relevant stakeholders, including all relevant non-professionals in communications and data exchange. Bakken and Ozbolt make this point in their contributions and we wish to underscore it. To have a care system that delivers equitable, patient-centered, safe, timely, efficient, and effective care requires process improvement engaging all players over time without end. The Association of Academic Health Centers and its Affiliate Roundtable is embarking on a new initiative that seeks to create a common curriculum for the education of all health professionals in the basics of informatics and related skills. Nursing has a great deal to offer this important effort and others akin to it.

We are living in a time when old-fashioned views of nursing as characterized by strong hands and smiling face are finally giving way to a view of nursing as care-giving and care-shaping leadership. The traditional competencies taught by schools of nursing are still prized (e.g., critical thinking, effective communication, problem solving, assessment and evaluation) but they are now aided by ICT and a host of informatics solutions. What we have not yet mastered to our professional satisfaction is how to promote practice to a national standard without succumbing to cookbook standardized care. Informatics solutions leave us uneasy because we jump to the erroneous conclusion that more technology means we will all be transformed with our patients into automatons. What we have to remember as we read this special issue is the extent to which we need to embrace ICT and informatics to move beyond technologic thinking and truly achieve our professional aspirations. Informatics and ICT are the tools of the knowledge worker, not the factory worker.