Nursing Opportunities and Challenges Essay

Nursing Opportunities and Challenges Essay

Nursing Opportunities and Challenges Essay

Jeanne Sewell, MSN, RN-BC Associate Professor, School of Nursing College of Health Sciences Georgia College & State University Milledgeville, Georgia

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5th edition

Copyright © 2016 Wolters Kluwer

Copyright © 2013 and 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2003, 1999 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quota- tions embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their offi- cial duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@, or via our website at (products and services).

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Library of Congress Cataloging-in-Publication Data Sewell, Jeanne P., author. Informatics and nursing : opportunities and challenges / Jeanne Sewell. — Fifth edition. p. ; cm. Includes bibliographical references. ISBN 978-1-4511-9320-6 I. Title. [DNLM: 1. Nursing Informatics. 2. Computers. 3. Internet. 4. Medical Records Systems, Computerized. WY 26.5] RT50.5 610.73—dc23


This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication his- tory, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and health- care professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particu- larly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or prop- erty, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. Nursing Opportunities and Challenges Essay

Jeanne Sewell, an associate professor of nursing at Georgia College & State University in Milledgeville, Georgia, is board certified as an informatics nurse specialist. Her credentials include a postgraduate certificate in nursing infor- matics from Duke University, a Master of Science in Nursing at the University of Maryland at Baltimore, a Bachelor of Science in Nursing at Georgia Regents University–Medical College of Georgia, and a nursing diploma from Georgia Baptist School of Nursing, now Georgia Baptist College of Nursing at Mercer University.

Jeanne’s expertise is nursing informatics, nursing education, and the scholarship of teaching and learning. She has received several teaching awards, including the Georgia College & State University 2015 Scholarship of Teaching and Learning Award. She teaches traditional face-to-face classes, as well as blended and online classes, across the nursing curriculum in the following programs: baccalaureate in nursing, RN-BSN, master of science in

nursing, and doctor of nursing practice. She has served as a consultant in nursing education and as a speaker at statewide, national, and international conferences.

Jeanne has clinical nursing experience in a variety of settings, including nursing administration, out- patient care, critical care, medical-surgical care, and pediatric nursing. Her interest in nursing informat- ics began in the early 1980s as she was completing graduate studies, when different clinical information systems began integration.

About the Author


Contributors to the Fifth Edition Omega Finney, MSN, RN-BC Informaticist Piedmont Healthcare Atlanta, Georgia

Karen Frith, PhD, RN, NEA-BC Professor and Associate Dean, Undergraduate Programs College of Nursing, The University of Alabama in Huntsville Huntsville, Alabama

Linda Q. Thede, PhD, RN-BC Professor Emerita of Nursing Kent State University Kent, Ohio

Contributors Contributors to the Fourth Edition Deborah Ariosto, PhD, MSN, RN Director, Patient Care Informatics Vanderbilt University Medical Center Nashville, Tennessee

Pamela J. Correll, RN, MS Nursing Informatics Consultant Maine Center for Disease Control and Prevention Public Health Nursing Program Bangor, Maine

Karen Frith, PhD, RN, NEA-BC Professor and Associate Dean, Undergraduate Programs College of Nursing, The University of Alabama in Huntsville Huntsville, Alabama

Judy Hornbeck, MHSA, BSN, RN Highland, Illinois

For a list of the contributors to the Student and Instructor Resources accompanying this book, please visit http://


Reviewers Kerry Allen, MSN Associate Professor Southern Adventist University Collegedale, Tennessee

Kim Amer, PhD, RN Associate Professor DePaul University Chicago, Illinois

Mary Boylston, MSN, EdD Professor Eastern University St. Davids, Pennsylvania

Elizabeth Carlson, PhD Associate Professor and Systems Leadership DNP Program Director Rush University, College of Nursing Chicago, Illinois

Laura Clayton, PhD, RN, CNE Assistant Professor of Nursing Education Shepherd University Shepherdstown, West Virginia Nursing Opportunities and Challenges Essay

Prudence Dalrymple, PhD, MS in Informatics Research and Teaching Professor Drexel University Philadelphia, Pennsylvania

Jeff Dowdy, MLIS Graduate Librarian Ina Dillard Russell Library, Georgia College & State University Milledgeville, Georgia

Tresa Dusaj, PhD(c) Assistant Professor Monmouth University West Long Branch, New Jersey

Robert Elshaw, MSN, RN-BC, ANCC Board Certified Informatics Nurse Adjunct Faculty Ursuline College Pepper Pike, Ohio

Willy Fahlman, BScN, MEd, EdD Sociology Faculty Athabasca University Athabasca, Alberta

Mary Fairbanks, MS, DNP, RN, PHN Associate Professor Bemidji State University Bemidji, Minnesota

Matthew Gaines, AAS Technical Support Tech Division on Information Technology, Georgia College & State University Milledgeville, Georgia

Debbie Greene, PhD, RN, CNE Associate Professor and Assistant Director for Undergraduate Nursing Programs School of Nursing, Georgia College & State University Milledgeville, Georgia

Janis Hayden, EdD, MSN, RN Professor St. Francis Medical Center, College of Nursing Peoria, Illinois

viii    Reviewers

Arlene Holowaychuk, RN, MSN, CNE Assistant Professor, Preceptor Coordinator Bon Secours Memorial College of Nursing Richmond, Virginia

Michelle Hornack, MSN, BSN Assistant Professor of Nursing Graceland University Independence, Missouri

Janice Jones, PhD, RN, CNS Clinical Professor University at Buffalo Buffalo, New York

Rebecca Koeniger-Donahue, PhD, APRN Professor of Practice Simmons College Boston, Massachusetts

Elizabeth Kostas-Polston, PhD, APRN, WHNP-BC, FAANP Assistant Professor University of South Florida Tampa, Florida

Anne Krouse, PhD Professor Widener University Chester, Pennsylvania

Katherine Leigh, DNP, RN Assistant Professor Troy University Dothan, Alabama

Barry Lung, MSN, RN-BC Informaticist Byron, Georgia

Rosemary Macy, PhD, RN, CNE, CHSE Associate Professor Boise State University Boise, Idaho

Patricia Martin, MSN Associate Professor West Kentucky Community and Technical College Paducah, Kentucky

Priscilla Okunji, RN-BC, PhD Nursing Faculty Howard University Washington, District of Columbia

Jill Pence, MSN, BSN, RN, CNE Assistant Professor Samford University Birmingham, Alabama

Rorey Pritchard, EdS, MSN, RN-BC, CNOR, CNE Clinical Assistant Professor University of Wisconsin, Eau Claire Eau Claire, Wisconsin

Leandro Resurreccion, BSZ, BSN, MSN, EdD Professor of Nursing Oakton Community College Des Plaines, Illinois

Luis M. Cabret Rios, RN, MSN, APRN, FNP-BC, DNP(s) Nursing Instructor Turabo University Gurabo, Puerto Rico

Nicole Robert, MSN, RN Faculty Mentor Thomas Edison State College Zachary, Louisiana

Lisa Shaffer, MS, MBA Adjunct Instructor Galen College of Nursing Cincinnati, Ohio

Bonnie Stegman, PhD, MSN, RN Assistant Professor of Nursing and Coordinator of the BSN Online Completion Program Maryville University, St. Louis St. Louis, Missouri

Sharon Stoten, DNP Assistant Professor Indiana University East, School of Nursing Richmond, Indiana

Reviewers    ix

Debra Sullivan, PhD, MSN Assistant Professor Middle Tennessee State University Murfreesboro, Tennessee

Jeanne Tucker, PhD, MSN, RN, HSAD, CHES Assistant Professor of Nursing Patty Hanks Shelton School of Nursing Abilene, Texas

Laureen Turner, MSN, DNP Instructor University of San Francisco San Francisco, California

Denyce Watties-Daniels, MSN Assistant Professor Coppin State University Baltimore, Maryland

Bonnie K. Webster, MS, RN, BC Assistant Professor University of Texas, Medical Branch in Galveston, School of Nursing Galveston, Texas

Kathleen Williams, MSN, RN-BC (Informatics) Assistant Professor Charleston Southern University North Charleston, South Carolina

Ronda Yoder, PhD, ARNP Nursing Faculty Pensacola Christian College Pensacola, Florida

For a list of the reviewers of the Test Generator questions accompanying this book, please visit http://thepoint.lww. com/sewell5e.


Preface Advancements in computer technology and the Internet have made the use of informatics per- vasive in our society worldwide. Simply stated, informatics is the use of computers to dis- cover, manipulate, and understand information. Informatics is required to achieve the nursing transformation mentioned by the 2010 Institute of Medicine (IOM) report, The Future of Nursing, which includes enabling nurses to be full partners in redesigning healthcare in the United States and to engage in effective workforce planning and policymaking (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, Robert Wood Johnson Foundation, & IOM, 2011).

The first edition of this textbook, Computers in Nursing, which was published in 1999, was one of the first textbooks to address core informatics competencies for all nurses. Each edition, includ- ing this fifth edition, was designed to capture the innovative advancements in nursing informatics core competencies and applications and to teach students how informatics should be integrated into practice. This edition focuses on the best of the fourth edition, such as office computing software, interoperability, consumer informatics, telehealth, and clinical information systems, plus new topics that have entered the field since the last edition, such as social media use guidelines, software and hardware developments, and updates on mean- ingful use. Each chapter now includes a Quality and Safety Education for Nurses (QSEN) scenario designed to stimulate critical thinking. The book’s companion webpage at sewell5e includes many resources for students— for example, a sample database and spreadsheets, as well information on APA templates and e-mail signatures—along with a wealth of resources Nursing Opportunities and Challenges Essay

for instructors (see the “Additional Resources” section later in this preface for more informa- tion). The goal was to make it all interesting—and yes, thought-provoking—to you, the reader. For example, QSEN scenarios, as well as application and competencies critical thinking exercises, align with each chapter’s objectives. In the decade and a half since the first edition published, nursing and the entire healthcare arena have come to recognize the importance of informatics.

The major accrediting organizations for nurs- ing, American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN), have identified informatics as an essential competency for all nurses, ranging from the begin- ning practitioner to the doctor of nursing practice (DNP), doctor of philosophy (PhD), and doctor of nursing science (DNSc) (AACN, 1996, 2006, 2008, 2010, 2011; NLN, 2008, 2015). A call for nurs- ing education to adopt informatics competencies for all levels of education came from the TIGER Initiative, aimed at using informatics for improv- ing practice with evidence-based information (The TIGER Initiative Foundation, 2014).


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