Table Of ContentComputers in Health Care
Kathryn J. Hannah Marion J. Ball
Series Editors
Marion J. Ball Kathryn J. Hannah
Ulla Gerdin Je lger Hans Peterson
Editors
Nursing Informatics
Where Caring
and Technology Meet
With 18 Illustrations
Springer Science+Business Media, LLC
Marion J. Ball Kathryn J. Hannah
Associate Vice Chancellor Professor, Faculty ofNursing
University of Maryland University of Calgary
Baltimore, MD 21201 Calgary, Alberta T2N IN4
USA Canada
Ulla Gerdin Jelger Hans Peterson
Health Care Information Systems Director, Health Care Information Systems
Stockholm County Council Stockholm County Council
Stockholm S-10272 Stockholm S-10272
Sweden Sweden
ISBN 978-1-4757-4162-9 ISBN 978-1-4757-4160-5 (eBook)
DOI 10.1007/978-1-4757-4160-5
Library of Congress Cataloging-in-Publication Data
Nursing informatics.
(Computers in health care)
Includes bibliographies and index.
1. Nursing-Data processing. 2. Information
storage and retrieval systems-Nursing. I. Ball,
Marion J. 11. Series: Computers in health care
(New York, N.Y.) [DNLM: 1. Computers. 2. Information
Systems. 3. Nursing. WY 26.5 N974]
RT50.5.N87 1988 610.73'028'5 87-32200
© 1988 by Springer Science+Business Media New York
Originally published by Springer-Verlag New York Inc in 1988.
Softcover reprint ofthe hardcover Ist edition 1988
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ware, or by similar or dissimilar methodology now known or hereafter developed is forbidden.
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Copyright is not claimed for works by U.S. Govemment Employees: Section 2, Unit 4,
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Typeset by Asco Trade Typesetting Ltd., Hong Kong.
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To the profession of nursing
Foreword
Nursing, like other health-related professions, is information-inten
sive. The quality of care a patient receives is based on the soundness of
judgment exercised by the health care team. Underlying sound judg
ment is up-to-date information. Unless nurses have access to accurate
and pertinent information, the care being rendered will not be of the
highest standard.
What is required is not necessarily more rapid and efficient informa
tion services. Modern technology can process immense amounts of
data in the blink of an eye. What we in the health professions need are
information systems that are more intelligent, systems that can inte
grate information from many sources, systems that analyze and syn
thesize information and display it so that it may be applied directly
in patient care-in other words, information that answers a question
or even gives practical advice.
In order to accomplish such objectives, work is needed to establish
the scientific and theoretical basis for the use of computing and infor
mation systems by health professionals. This is the research com
ponent. In addition, there is the need for continued development and
evaluation of practical information systems.
Implicit in this volume are the questions: Which of the present
systems will help most in nursing? Which areas in nursing could most
benefit from future informatics deve1opments? Computer-based aids
to learning and to continuing education have always been important
areas of emphasis for information system developments, likewise sys
tems that enhance access to the scientific literature. Yet in nursing,
especiaIly, one may safely place the highest value on papers and
systems that improve patient care. The nurse has always taken the role
of advocate for the patient; in the information age this may weIl be even
more critical.
There is no question in my mind that future progress in health care
will depend as much on how weil we communicate what we know as on
how much we know. This volume presents a comprehensive overview
viii Foreword
of the fast growing field of nursing contributions to automated infor
mation systems.
Donald A. B. Lindberg, M. D.
Director
National Library of Medicine
Bethesda, Maryland
Series Preface
This series is intended for the rapidly increasing number ofhealth care
professionals who have rudimentary knowledge and experience in
health care computing and are seeking opportunities to expand their
horizons. It does not attempt to compete with the primers al ready on
the market. Eminent international experts will edit, author, or contri
bute to each volume in order to privide comprehensive and current
accounts ofinnovations and future trends in this quickly evolving field.
Each book will be practical, easy to use, and well referenced.
Our aim is for the series to encompass all of the health professions by
focusing on specific professions, such as nursing, in individual vol
umes. However, integrated computing systems are only one tool for
improving communication among members of the health care team.
Therefore, it is our hope that the series will stimulate professionals to
explore additional means of fostering interdisciplinary exchange.
This series springs from a professional collaboration that has grown
over the years into a highly valued personal friendship. Our joint va lues
put people first. If the Computers in Health Care se ries lets us share
those values by helping health care professionals to communicate their
ideas for the benefit of patients, then our efforts will have succeeded.
Kathryn J. Hannah
Marion J. Ball
Preface
This book represents for us the potential of the new information
technologies in health care and especially in nursing. In describing the
evolution now occurring in the field, the book presents its material in
two major divisions-Nursing Informatics and Where Caring and
Technology Meet.
The content and format of the book are represented by the illustra
tion on its cover. The wheel is made up of two concentric circles, joined
together by four spokes. The inner circle stands for the patient, always
the hub for nursing. The linking spokes are the four functional aspects
of nursing-Clinical, Administration, Research, and Education
whose first letters form the acronym CARE. The outer ring portrays
nursing informatics, the subject of this book and the field which
integrates caring and technology.
Information technology brings with it new capabilities and new
opportunities for the professions. Nursing and computing profes
sionals have begun to form a variety of alliances and to assume a
variety ofnew roles. In their 1984 book, Using Computers in Nursing,
Ball and Hannah included selected network contacts at the conclusion
of each chapter, illustrating the principle they stated in their Preface:
One important aim of the book is to encourage networking among all
nurses who are charting new ground in their individual efforts to apply
the computer to the field of nursing. Each chapter ... is dedicated to an
acknowledged expert who has indicated a willingness to share his or her
special expertise.
The authors urge the reader to join the network and "come on line"
with the leaders in health care computing! (p. xii)
Readers ofthe 1984 book took the invitation to heart and many new
bonds, both technical and personal, were formed. Such networking is
illustrated by the relationship of the four author/editors of this book
with each other and with their more than thirty contributors. In this
volume, Ball and Hannahjoin with their European colleagues, Gerdin
xii Preface
Jelger and Peterson, to serve at the center of a much wider network.
These four are joined by fellow professionals from nursing, business,
medicine, computer science, and health information-literally a host
of professional fie1ds and disciplines all concerned with the delivery of
the highest quality health care. Networked together, they can provide
more extensive and more current content, as they strive to integrate
information technology and nursing CARE.
This book itse1f was assembled through technical networking. The
four author/editors corresponded by international electronic mail,
exchanging text and discussing key decisions regarding the book with
what were often same-day responses. Manuscripts submitted by
authors around the world were either transmitted electronically or
translated by optical scanner into electronic form by the editors who
then loaded them into a standard file for formatting and editing.
The nursing informatics scene is moving rapidly, and many exciting
applications have developed since the publication of Using Computers
in Nursing. Technology links the microcomputer to the mainframe, the
operating room with the admissions office. It links the nurse in Austra
lia with the National Library of Medicine's Medline in the Uni ted
States and provides a means for a nurse to communicate electronically
with colleagues around the world. It links the c1inician with research
data, the practitioner with expert systems. The capabilities are enor
mous and, even more exciting, they are being realized in actual working
conditions!
Reflecting the new world that these linkages create, the book inter
twines the language of computing with the language ofhealth care. The
connectivity of computer hardware and software is linkened to the
human nervous system. Making this connectivity an integral com
ponent of applied information technology brings the power of comput
ing to the nursing profession. Health care computing capabilities and
applications not only integrate and extend nursing functions, but also
raise technical, legal, and ethical issues.
This new power and its implications are the concern of nursing
informatics, a field which will playa critical role in realizing the full
potential ofnursing to contribute to patient care. For nurses to realize
this potential, nursing informatics must be integrated into educational
curricula for nurses at the entry-to-practice level and the continuing
education level. This book is designed to be used as a tool for that
integration. Prepared with the assistance of the innovators in nursing
and information technology, it exemplifies the exponential growth of
information in all aspects of nursing.
No one, two, three, or four individuals can cover the excitement of
integrating computers into health care. Only a large network of experts
can provide a snapshot of nursing informatics as it is at the time of
publication. The picture will continue to change as the field evolves and
