Nursing Informatics information, knowledge, and wisdom

NURS 2-4 in nursing practice.

• It supports consumers, patients,
INTRODUCTION nurses, and other healthcare
Nursing informatics (NI) professionals in their decision-making
⦿ We are in the digital age. What does in all roles and settings to achieve
this mean to us as nurses? The desired outcome. This support is
convergence of the accomplished through the use of
telecommunications and computer information structures, information
industry has seen a pervasive increase processes, and information technology
in how we communicate and process ⦿ The evolution of the terms
information. Integrated systems informatics and nursing informatìcs
support evidence-based nursing proceeded as follows:
practice, facilitate nurses' ⦿ In 1957 - first coined by Karl
participation in the health care team, Steinbuch as ''informatiks''; in 1962 -
and document nurses' contribution to Phillipe Dreyfus used the term
patient care outcomes. ''informatique''; Walter Bauer
⦿ Nurses are major stakeholders in translated it into ''informatics''; in
health care and based on their 1980 - Scholes and Barber coined the
knowledge, they translate data to term ''nursing informatics.‘’
information, information to knowledge ⦿ Thus, the term nursing informatics
and knowledge to wisdom. For greater was initially seen in literature in the
achievement in nursing practice, 1980s, including a definition of
nurses need to desire and adopt "combining nursing, information, and
innovative means to make their computer sciences for managing and
contribution to the patient care processing data into knowledgefor use
process and patient outcome visible. in nursingpractice'' (Murphy, 201O)
Hence, Nursing informatics (NI) will ⦿ American Nurses Association
bring nursing contributions to health (2008) definition stated as. - '' a
outcomes visible. specialty that integrates nursing
• is a specialty that integrates nursing science, computer science, and
science with multiple information information science to manage and
management and analytical sciences to communicate data, information,
identify, define, manage, and knowledge, and wisdom in nursing
communicate data, information, data, practice. ‘’
⦿ American Medical Informatics •
Association (AMIA), which states -
"Nursing Informatics science and ⌾ The terni individuals refer to
practice integrates nursing, its patients, healthcare consumers and
information and knowledge and their - any other recipient of nursing care or
management, with information and informatics solutions. The term
communication technologies to patient refers to consumers in both a
promote the health of people, families wellness and illness model.
and communities worldwide. ‘’
⦿ The Healthcare Information and What is Informatics?
Management Systems Society (HIMSS) ● Combination of terms information
defines nursing informatics as "a and automatic/automation which
specialty that integrates nursing means automatic information
science, computer science, and processing.
information science to manage and ● A science that combines the domain
communicate data, information, science, computer science,
knowledge, and wisdom in nursing information science and cognitive
practice. '' science.
⦿ Staggers and Thompson performed
a critical analysis of the definitions, Why nursing informatics?
which resulted in a new definition. The Benefits of Nursing Informatics in
new definition is as follows: Healthcare
⌾ The goal of NI is to improve the ⦿ Benefit #1: Nursing Informatics
health of populations, communities, informs and influences IT systems
families, and individuals by optimizing ⦿ Benefit #2: Nursing Informatics
information management and leverages evidence-based clinical best
communication. practices
⌾ These activities include the design ⦿ Benefit #3: Nursing Informatics
and use of informatics solutions generates stronger nurse training in
and/or technology to support all areas clinical IT systems
of nursing, including, but not limited ⦿ Benefit #4:. Nursing Informatics
to, the direct provision of care, leverages investments
establishing effective administrative. ⦿ Benefit #5: Nursing informatics
systems, designing useful decision contributes unique wisdom to clinical
support systems, managing and care that is acquired only through a
delivering educational experiences, deep understanding of both clinical
enhancing supporting life- long practice and data analysis
learning, and supporting nur.sing
research .
⦿ Benefit #6: Nursing Informatics
enriches the evolving healthcare
delivery system
⦿ Benefit #7: Nursing Informatics
Improves Patient Care, Patient Safety,
and Outcomes

Ways Informatics Is Transforming

Health Care
⦿ l. Dramatic Savings
⦿ 2. Shared Knowledge
⦿ 3. Patient Participation
⦿ 4. The Impersonalization of Care Why do we need to study Nursing
⦿ 5. Increased Coordination Informatics?
⦿ 6. Improved Outcomes ● Information is doubling every 5
years, if not tripling in quality and
Information Science quantity
⦿ Information science is the science ● INFORMATION is POWER
and practice dealing with the effective ● Technology facilitates the creative
collection storage, retrieval, and use of process in nurses, affording amazing
information. vehicles for, PATIENT EDUCATION,
⦿ It is concerned with recordable TEACHING and LEARNING
information and knowledge, and the ● Provides health promotion and
technologies and related services· that prevention in Global Scene.
facilitate their management and use.
⦿ multidisciplinary science that Clinical Information Systems
involves aspect from computer ⦿ All members of the
science, cognitive science, social interprofessional health care team,
science, communication science, and including nurse, physicians,
library science to deal with obtaining, pharmacists, social workers, and
gathering; organizing; manipulating, therapists, use programs available on a
managing, storing, retrieving, clinical information system (CIS).
recapturing, disposing of, distributing, These programs include monitoring
or broadcasting information. systems; order entry systems; and
laboratory, radiology, and pharmacy
systems.
⦿ A monitoring system includes interactions within healthcare
devices that automatically monitor contexts.
and record biometric measurements • Facilitates the creation of new
(e.g., vital signs, oxygen saturation, nursing knowledge.
cardiac index, and stroke volume) in
acute care, critical care, and specialty Nursing informatics specialists can
areas. The devices electronically send play a number of important roles,
measurements directly to the nursing including:
documentation system. • Managing the transition from paper
to digital records.
Nursing Clinical Information Systems • Developing information systems
⦿ A well-designed nursing clinical based on current evidence-based
information system (NCIS) standards of care and ensuring
incorporates the principles of nursing systems remain updated.
informatics to support the work that • Developing EHR interfaces that are
nurses do by facilitating conducive to good care while
documentation of nursing process remaining efficient to use.
activities and offering resources for • Analyzing EHR data to identify areas
managing nursing care delivery. where care can be improved and/or
costs better managed.
NCISs have two designs. • Working with policymakers and
⦿ nursing process design government agencies to ensure laws
⦿ protocol or critical pathway design and regulations support healthcare
technology and are compatible with
Specific Role of Nurse Information provider and patient technology
Specialist needs.
• Employs informatics theories, • Developing and/or implementing
concepts, methods, and tools to healthcare technologies outside of
analyze information and information EHRs, including patient health
system requirements. monitoring systems, quality tracking
• Design, select, implement, and initiative, and home care management
evaluate information systems, data systems.
structures, and decision support
mechanisms that support patients,
nurses, and their human-computer
2 ⦿ The relationships between the parts
Concepts, Principles and Theories in of the whole are examined to learn
Nursing Informatics how they work together.
⦿ A system is made up of separate
THEORIES and THEORETICAL components. The parts rely on one
MODELS The Major Theories and another, are interrelated, share a
Models Supporting Nursing common purpose, and together form a
Informatics are as follows: whole.
⦿ General Systems Theory ⦿ Input is the information that enters
⦿ Change Theory the system
⦿ Cybernetics Theory ⦿ Output is the end products of a.
⦿ Cognitive Learning Theory system.
⦿ Novice to Expert Theory ⦿ Feedback is the process through
⦿ DIKW Theory which the output is returned to the
system.
General Systems Theory ⦿ Von Bertalanffy (1969, 1976)
⦿ Ludwig von Bertalanffy in 1936 developed General Systems Theory,
⦿ Biologist which has the following assumptions:
⦿ He felt the need for a theory to ⦿ a. All systems must be goal directed.
guide research in several disciplines ⦿ b. A system is more than the sum of
because he saw striking parallels its parts.
among them. ⦿ c. A system is everchanging and any
⦿ His hunch was that if multiple change in one part affects the whole.
disciplines focused· their research and ⦿ d. Boundaries are implicit and
theory· development efforts, they human systems are open and dynamic.
would be able to identify laws and
principles which would apply to many Change Theory
systems. This would, allow scholars ⦿ The Change Theory was developed
and scientists to make sense of system by Kurt Lewin, who is considered the
characteristics such as wholeness, Father of Social Psychology.
differentiation, order, equifinality, ⦿ He theorized a three-stage model of
progression & others. change known as
⦿ Includes purpose, content and unfreezing-change-refreeze model that
process, breaking down the ''whole'' requires prior learning to be rejected
and analyzing the parts. and replaced.
⦿ Lewin's definition of Behavior in
this model
⌾ "a dynamic balance of forces overcome the ·strains of individual
working is opposing directions” resistance and group conformity.

Three major concepts: Three methods that can lead to the

⦿ Driving forces are those that push achievement of unfreezing
in a direction that causes change to ⦿The first is to increase the driving
occur. They cause a shift in the forces that direct behavior away from
equilibrium towards change. the existing situation or status quo.
⦿ Restraining forces are those forces ⦿Second, decrease the restraining
that counter the driving forces, They forces that negatively affect the
hinder change because they push the movement from the existing
patient in the opposite direction. They equilibrium.
cause a shift in the equilibrium that ⦿Thirdly, finding a combination of the
opposes change. first two methods.
⦿ Equilibrium is a state of being
where driving forces equal restraining Change stage
forces, and no change occurs. It can be ⦿ which is also called ''moving to a
raised or lowered by changes that new level'' or ''movement," involves a
occur between the driving and process of change in thoughts, feeling,
restraining forces. behavior,· or all three, that is in some
way more liberating or more
Three stages productive. Example, the shift to
⦿ unfreezing, electronic documentation.
⦿ change, and
⦿ refreezing. Refreezing stage
⦿ The refreezing stage is establishing
Unfreezing Stage the change as the new habit, so that it
⦿ Unfreezing is the process which now becomes the ''standard operating
involves finding a method of making it procedure." Without this final stage, it
possible for people to let go of an old can be easy for the patient to go back
pattern that was somehow to old habits.
counterproductive.
⦿ Example, embracing nursing Major Assumptions
informatics towards improved ⦿ People grow and change
healthcare, which will require throughout their lives. This growth
intensive trainings of all staff-- the and change are evident in the dynamic
young and the old. · It is necessary to
nature of basic human needs and how
they are met.
⦿ Change happens daily. It is subtle,
continuous and manifested in both
everyday occurrences and more
disruptive life events.
⦿ Reactions to change are grounded
in the basic human needs for
self-esteem, safety and security
⦿ Change involves modification or
alteration. It may be planned or
unplanned.

Kurt Lewin (1962) developed the

change theory, which identifies the Cybernetics Theory
following six components: ⦿ Cybernetics is a transdisciplinary
⦿ Recognition of the area where approach for exploring regulatory
change is needed. systems their structures, constraints,
⦿ Analysis of a situation to determine and possibilities. Norbert Wiener
what forces exist to maintain the defined cybernetics in 1948 as "the
situation and what forces are working scientific study of control and
to change it. communication in the animal,
⦿ Identification of methods by which machine, and society".
change can occur. ⦿ Cybernetics is applicable when a
⦿ Recognition of the influence of system being analyzed incorporates a
group mores or customs on change. closed signaling loop-originally
⦿ Identification of the methods that referred to as a "circular causal"
the reference group uses to bring relationship that is, where action by
about change. ⦿ The actual process of the system generates some change in
change. its environment and that change is
reflected in the system in some
manner (feedback) that triggers a
system change.
⦿ Cybernetics is relevant to, for
example, mechanical, physical,
biological, cognitive, and social Major Concepts
systems. ⦿ Cybernetics introduces the concept
⦿ Cybernetics includes the study of of circularity and circular causal
feedback, black boxes and derived systems.
concepts such as communication and ⦿ Systems are defined by boundaries.
control in living organisms, machines ⦿ Every system has a goal.
and organizations including self- ⦿ System acts, aims toward the goal.
organization ⦿ Environment affects aim.
⦿ Concepts studied by cyberneticists ⦿ Information returns to system
include, but are not limited to: 'feedback'.
⌾ learning, ⦿ System measures difference
⌾ cognition, between state and goal
⌾ adaptation, ⦿ Detects 'error'.
⌾ social control, ⦿ System corrects action to aim
⌾ emergence, toward goal.
⌾ convergence, ⦿ Cycle repeat.
The word cybernetics comes from
Greek word 'kubernetes' means Scope & Application of Cybernetics
'steering' and 'governor' in Latin. ⦿ Basis of modem communication
⌾ communication, systems,
⌾ efficiency, ⦿ Application incognitive science for
⌾ efficacy, and modeling of learning.
⌾ connectivity. ⦿ Application in management science.
⦿ In cybernetics these concepts ⦿ Cybernetics is applicable in any
(otherwise already objects of study in discipline relying on feedback
other disciplines such as biology and processes including health sciences,
engineering) are abstracted from the sociology and psychology; which are
context of the specific organism or based on communication process.
device.
Cognitive Learning Theory
⦿ Cognitive Learning Theory explains
why the brain is the most incredible
network of information processing
and interpretation in the body as we
learn things.
⦿ This theory can be divided into two
specific theories:
⌾ Social Cognitive Theory (SCT)
⌾ Cognitive Behavioral Theory (CBT) Cognitive Behavioral Theory
⦿ developed by Aaron Beck.
Social Cognitive Theory 3 variables: ⦿ Cognitive Behavioral Theory
⦿ Behavioral factors describes the role of cognition
⦿ Environmental factors (extrinsic) (knowing) to determining and
⦿ Personal factors (intrinsic) predicting the behavioral pattern of an
individual.
⦿ individuals tend to form
self-concepts that affect the behavior
they display These concepts can be
positive or negative and can be
affected by a person's environment.

The Novice to Expert Theory

⦿ First proposed by Hubert and
Stuart Dreyfus
⦿ Dreyfus Model of Skill Acquisition,
⦿ later applied and modified to
nursing by Patricia Benner

The Novice to Expert Theory Within

the field of nursing informatics, this
theory can be applied to:
Basic Concepts Social Cognitive Theory
⦿ the development of nursing
includes several basic concepts that
informatics skills, competencies,
can manifest not only in adults but
knowledge and expertise in nursing
also in infants, children and
informatics specialists;
adolescents.
⦿ the development of technological
⦿ Observational Learning
system competencies in practicing
⦿ Reproduction
nurses working in an institution;
⦿ Self-efficacy
⦿ the education of nursing students,
⦿ Emotional coping
from first year to graduation and;
⦿ Self-regulatory capability
⦿ the transition from graduate nurse
to expert nurse.
 transformed into information,
knowledge, and wisdom.

Two personal characteristics that

distinguish the successful evolution to
the expert level seem to be:
⦿ Deliberate practice and
⦿ the willingness to take risks, to go
beyond the norm.

The level of skill acquired have some

distinguishing behavior and features
peculiar to each of the levels in Novice
to Expert theory (Frisoli, 2007). These
are enumerated below:
⦿ Novice Computer Hardware
⦿ Advanced Beginner • Hardware is the physical part of the
⦿ Competent computer and its associated
⦿ Proficient equipment. Computer hardware can
⦿ Expert comprise many different parts, these
include:
The DIKW Theory ● Input Devices
⦿ When raw data is collected, it gets ● Output Devices
mixed up and the view seems jumbled. ● Central Processing Unit (CPU)
⦿ The DIKW Model by Fricke (2018)
on Russell Ackoff(1989) describes
how the data can be processed and
 memory, and functioning as secondary
storage in the hierarchy of computer
storage.

SECONDARY STORAGE
⦿ Provides space to retain data in an
area separate in an area computer’s
memory after the computer is turned
off, these include; hard disk drives,
floppy disks, tape, zip drives, optical
drives and CD – ROM drives. And also
there are many storage drives that are
available like flash drive, external hard
drive etc,.

• Read-only memory (ROM) is

permanent; it remains when the
power is off. A start-up instruction for
the computer is an example of ROM.
• Random access memory (RAM) is a
temporary storage area for program
instructions and data that is being
processed; it is only active while the
computer is turned on. (Located on
the motherboard not part of CPU).
• Control Unit: manages instructions to
other parts of the computer, including
input and output devices “traffic cop”
• Solid-state drive (SSD) is a
solid-state storage device that uses
integrated circuit assemblies to store
data persistently, typically using flash
 support their intended use. It can be
considered a set of guidelines and
techniques that are used to describe
data, given an application context, and
to apply processes to assess and
improve the quality of data.

Five dimensions of data quality·

⦿ Accessibility
⦿ Accuracy and reliability
⦿ Serviceability
⦿ Methodological soundness
⦿ Assurances of integrity
⦿ Personal Informatics
⦿ Professional Informatics
⦿ Educational Informatics

Data Assessment
⦿ Data quality assessment (DQA) is
the process of scientifically and
statistically evaluating data in order to
determine whether they meet the
quality required for projects or
business processes and are of the right
type and quantity to be able to actually
 “Nursing Informatics “

Applications in Evidenced-Based Nursing been also reinforced by the Join Commission on

Accreditation for hospitals (JCAH). But in actual clinical
-Factual Information -Collecting data
settings, it is difficult to find completely written NCPs. If
-Clinical Practices -Processing data
any case that a written care plan is found, they can be
-Research -Implementing data collected
incomplete, outdated, rarely used for determining care
-Systematic approach
and infrequently relied upon as a means of
communicating problem management from one shift to
➢ Evidence-based practice
another.
• Collecting
• Processing The nurses view the care plan burdensome, as it is
• Implementing research findings time-consuming paperwork, preparation or revision of
the plan is low in practice settings (Dharmarajan and
For the improvement of patient outcomes, clinical Gangadharan, 2013). It is with this practice that the
nursing practice, and/or work environment. initiation of a computer-generated NCP was done.

The computer-generated NCPs promotes the value

➢ What are the benefits of EBNP?
of planning care but at the same time addresses the
• it helps in providing the highest possible quality
burden of the workload NCPs can consume from he
of care at the most cost-efficient manner
nurses. It works by providing a template that nurses can
• The practice also enables nurses to incorporate work on and modify based on the individual cases of
clinical expertise and current research to the their clients.
data and turn it into a usable basis in the
decision-making process Nursing documentation, which is often identified as
the sixth step in the nursing process, nursing process is
➢ How can we utilize EBNP? vital in information management. Therefore, it is
necessary for nurses to document accurately and
The use of information technology allows a more precisely to determine the desired outcome. Remember
efficient facilitation in the applications in EBNP such as the Rule “Garbage In-Garbage Out” also applies to
the computerized nursing care plan, use of clinical nursing documentation.
pathway, clinical practice guidelines, and e-journals
that provide the latest and up-to-date accessible ➢ Garbage In-Garbage Out (GIGO)
literatures that can be used as support for new EBNP The quality of information coming out cannot be
projects. This unit will provide you an overview of the better than the quality of the information that went in.
above-mentioned applications and its intended GIGO is used in IT and mathematics.
purpose.
• Demonstrates commitment to continuity of
➢ Nursing Clinical Practice (Point-of-care systems and
care
Clinical information systems)
• Guides safe and effective nursing action
a. Computer generated nursing care plans
• Legal record of care provided
b. Critical pathways
• Improves policy and procedure compliance
c. Clinical guidelines
• Reduces risk by early identification and tracking
d. E-journals
of problems or needs
• Generates cist reimbursement
A. Computer Generated NCP
Nursing care plans- are essential to delivering the
NCPs as we use them in our conversations with our
appropriate care to patients.
colleagues, have been introduced o us during our stay in
the nursing school. It has been used extensively inside - Will differ in every place you work – they can also
the academic institution as an essential teaching tool to be called Care Tracks or Care Maps.
present the value of planning patient care, which has - Are used to outline patients care on a daily basis.
➢ Critical pathways Scope of Clinical Pathways

Critical pathways- are made to follow certain policies • Medical protocols

and procedures and there is generally one for a certain • Nursing protocols
area, illness, and procedure. • Standardized care maps
• Clinical practice guidelines
Care pathways are one of the best tools hospitals can
use to manage the quality in healthcare concerning the
➢ Critical Pathways
standardization of care processes, since they promote
organized and efficient patient care based on evidence. Care pathways are powerful tool for care process
management since they permit to check the compliance
It has been proven that their implementation reduces
of all the interventions included in the healthcare plan,
the variability in clinical practice and improves
fic care standards and- traduce clinical audits as a part
outcomes.
of the process. Likewise, pathways are very useful to
Care pathways are also known as Clinical or Critical identify improvement areas in theses standardize are
pathways. A care pathway is a multidisciplinary processes, under the umbrella of the culture of
healthcare management tool based on healthcare Continuous Quality Improvement (CQI).
plans for a specific group of patients with a predictable
CQI – the development and implementation of a care
clinical course, in which the different tasks or
pathway involves change in the organizational culture at
interventions by the professionals involved in the
any setting.
patient care (physicians, nurses, pharmacists, physical
therapists, social workers, etc.) are defined, optimized - This process may involve overcoming of come
and sequenced ither by hour (ED) or day (acute care). hurdles in its way of implementation.
Outcomes are tied to specific interventions.
Following are some of the activities to be done to
➢ NCP and Critical Pathways develop and implement a care pathway:

- Are not generally patient specific but changes of • Preparing multidisciplinary documents
additions can be made depending on the patients • Reviewing the process by all the concerned staff
plan of care. • Holding care pathway meetings to facilitate the
e.g., patient is having daily dressing, can Swrite the exchange of opinions about patient care by
type of dressing used different professionals
• Conducting periodic reviews to monitor some
- All care plans must have a patient label, have a defined indicators
commencement date and time and should be • Analyzing variances or deviations
signed on a per shift basis • Preparing common record documents for all the
staff
Clinical Risk Assessment Tools should be filled out on
admission so that clinical pathways and nursing care
➢ How to document variances?
plans can meet the needs of the patient.

➢ Gantt Chart 1. Similar to DAR (data, action, and response)

format, we utilize VAO (variance, action, and
outcome) to document variances
2. Variance – includes all subjective and objective
data observed by the nurse to the outside of
the pathway management of the patient’s case
3. Action – includes all interventions used to
address the variance
4. Outcome – includes all patient care outcomes
after the interventions were performed to
address the variance.
 Nursing Information System
(Relevance of Informatics system to communication in
nursing)

In the healthcare setting, patient safety is the upmost

priority of the health care team.

- To reach this goal, it is imperative to practice

effective communication.

These communication techniques can be found on

teamSTEPPS by the Agency for Healthcare Research
➢ Clinical Guidelines Quality (AHRG). According to AHRG (2013), individuals
can learn four/five primary trainable teamwork skills.
Clinical practice Guidelines (CPGs) These are:
-systematically developed statements to assist • Team structure (addition) – identification of the
practitioner and patient decisions about appropriate components of a multi-team system that must
health care for specific clinical circumstances. (IOM work together effectively to ensure patient
1990) safety.
Increasing international interest in the development • Communication – structured process by which
and implementation of CPGs. information is clearly and accurately exchanged
among team members.
• Clinical guidelines should be feasible, measurable, • Leadership – ability to maximize the activities of
and achievable. team members by ensuring that team actions
• Clinical performances measures may be developed are understood, changes in information are
from clinical practice guidelines and used in quality shared, and team members have the necessary
improvement initiatives. When these performances resources.
measure are incorporated into public reporting, • Situation monitoring – process of actively
accountability, or pay for performance programs, scanning and assessing situational elements to
the strength of evidence and magnitude of benefit gain information or understanding, or to
should be sufficient to justify the burden of maintain awareness to support team
implementation. functioning.
• In the clinical setting, implementation of clinical • Mutual support – ability to anticipate and
practice guidelines should be prioritized to those support team members’ needs through
that have the strongest supporting evidence, and accurate knowledge about their responsibilities
the most impact on patient population morbidity and workload.
and mortality.
• Research should be conducted on how to effectively If a team as tool and strategies, it can leverage to build
implement clinical practice guidelines, and the a fundamental level of competency in each of those
impact of their use of quality measures. skills, research has shown that the team can enhance
three types pf team work outcome.

• Performance – adaptability, accuracy,

productivity, efficiency, and safety
• Knowledge – shared mental model
• Attitudes – mutual trust and team orientation

Shared Mental Model in healthcare

-are the overlap of individuals’ set of knowledge and/or

assumptions that act as the basis for understanding and
decision making between individuals. Within The steps include the following:
healthcare, shared mental models facilitate effective
1. Sender initiates the message
teamwork and theorized to influence clinical decision
2. Receiver accepts the message and provides
making and performance.
feedback
SBAR- a technique for communicating critical 3. Sender double-checks to ensure that the
information that requires immediate attention and message was received
action concerning a patient’s condition.
Example:
Situation- What is going on with the patient?
Doctor: Give 25mg Benadryl IV push.
“I am calling about Mrs. Joseph in room 251. Chief Nurse: 25mg Benadryl IV push
complaint is shortness of breath of new onset.” Doctor: That is correct

Background- What is the clinical background or

context? Handoff- the transfer of information (along with
authority and responsibility) during transitions in care
“Patient is a 62-year-old female post-op day one from
across the continuum. It includes an opportunity to ask
abdominal surgery. No prior history of cardiac or lung
questions, clarify, and confirm.
disease.”
Examples of transitions in care include shift changes;
Assessment- What do I think the problem is?
transfer of responsibility between and among nursing
“Breath sounds are decreased on the right side with assistants, nurses, nurse practitioners, physician
acknowledgement of pain. Would like to rule-out assistants, and physicians; and patient transfers.
pneumothorax.”
Handoff- strategy designed to enhance information
Recommendation and Request- What would I do to exchange during transitions in care.
correct it?
I PASS THE BATON
“I feel strongly the patient should be assessed now. Can I Introduction Introduce yourself and your
you come to room 251 now?” role/job (include patient)
P Patient Identifiers: Name, age, sex,
Call-Out- strategy used to communicate important or location
critical information. A Assessment (E/C) Present chief complaint,
vital signs, symptoms, and
• Informs all team members simultaneously diagnosis
during emergent situations S Situation (One line summary) Current
• Helps team members anticipate next steps status/circumstances, including
• Important to direct responsibility to a specific code status, level of
individual responsible for carrying out the task (un)certainty, recent changes,
and response to treatment
Example during an incoming trauma: S Safety (Unexpected labs, incidental
Leader: Airway status? radiology, social issues, changes
Resident: Airway clear. in vitals) Critical lab
Leader: Breath sounds? values/reports, socioeconomic
Resident: Breath sounds decreased on right. factors, allergies, and alerts
Leader: Blood pressure? (falls, isolation, etc.)
Nurse: BP is 96/62 THE
B Background Comorbidities, previous
Check-back- using closed-loop communication to ensure episodes, current medications,
that information conveyed by the sender is understood and family history.
by the receiver as intended. A Actions Explain what actions were taken
or are required. Provide
 rationale. (Timing, Ownership, State policy declaration:
Next)
T Timing Level of urgency and explicit The State recognizes that an effective intellectual and
timing and prioritization of industrial property system is vital to the development of
actions. domestic and creative activity, facilitates transfer of
O Ownership Identify who is responsible technology, attracts foreign investments, and ensures
(person/team), including market access for our products.
patient/family members.
It shall protect and secure the exclusive rights of
N Next What will happen next?
Anticipated changes? scientists, investors, artists and other gifted citizens to
What is the plan? their intellectual property and creations, particularly
Are there contingency plans? when beneficial to the people, for such periods as
provided in this Act.

I PASS the BATON: The use of intellectual property bears a social function.
To this end, the State shall promote the diffusion of
- was developed because handover is unsafe knowledge and information for the promotion of
- may make handover safer, but it does not make it national development and progress and the common
completely safe good.
- does not eliminate the need to find ways to
minimize the number of handovers we do in our It is also the policy of the State to streamline
emergency department administrative procedures of registering patents,
trademarks and copyright, to liberalize the registration
The Joint Commissions has identified safe patient on the transfer of technology, and to enhance the
transfer and handoff as a National Patient Safety Goal. enforcement of intellectual property rights in the
Philippines.

Effect on international conventions and on principle of

reciprocity: Any person who is national or who is
POLICIES, GUIDELINES AND LAWS IN NURSING domiciled or has a real and effective industrial
INFORMATICS establishment in a country which is a party to any
convention, treaty or agreement relating to intellectual
Intellectual Property Law- it refers to creations of the
property rights or the repression of unfair competition,
mind, such as inventions; literary and artistic works;
to which the Philippines is also a part, or extends
designs; and symbols, names and images used in
reciprocal rights to nationals of the Philippines by law,
commerce.
shall be entitled to benefits to the extent necessary to
IP is protected in law by, for example, patents, give effect to any provision of such convention, treaty
copyright and trademarks, which enable people to earn or reciprocal law, in addition to the rights to which any
recognition or financial benefit from what they invent owner of an intellectual property right is otherwise by
or create. By striking the right balance between the this Act.
interests of innovators and the wider public interest,
➢ Parts of the Law:
the IP system aims to foster an environment in which
creativity and innovation can flourish. The Intellectual Property Code of the Philippines is
divided into five (5) parts, to wit:
Republic Act No. 8293 (An Act Prescribing the
• Part I- The Intellectual Property Office
Intellectual Property Code and Establishing the
• Part II- The Law on Patents
Intellectual Property Office, Providing for Its Power, and
• Part III- The Law on Trademarks, Service
Functions, and for Other Purposes) otherwise known as
Marks, and Trade Names
the Intellectual Property Code of the Philippines. (June
• Part IV- The Law on Copyright
6, 1997)
• Part V- Final Provisions
 indication includes the name of the place of origin of
the goods.
Intellectual property rights under the I.P. Code:
The intellectual property rights under the Intellectual Trade secrets- are IP rights on confidential information
Property Code are as follows: which may be sold or licensed. The unauthorized
acquisition, use or disclosure of such secret information
1. Copyright and related rights; in a manner contrary to honest commercial practices by
2. Trademarks and service marks; others is regarded as an unfair practice and a violation
3. Geographic indications; of the trade secret protection.
4. Industrial designs;
5. Patents;
6. Layout designs (topographies) of integrated Copyright Law (Under the Intellectual Property Code of
circuits; and the Philippines)
7. Protection of undisclosed information
What is copyright?
➢ Types of intellectual property
-Copyright is a collection of all rights enjoyed by the
Copyright- is a legal term used to describe the rights owner of an artistic or literary work.
that creators have over their literary and artistic works.
Works covered by copyright range from books, music, What are considered copyrightable works in the
paintings, sculptures and films, to computer programs, Philippines?
databases, advertisements, maps, and technical
drawings. Under Philippine law, original intellectual creations in
the literary and artistic domain are copyrightable. These
Patents- is an exclusive right granted for an invention. include books, pamphlets, articles and other writings;
Generally speaking, a patent provides the patent owner periodicals and newspapers; lectures, sermons,
with the right to decide how-or whether- the invention addresses, dissertations prepared for oral delivery;
can be used by others. In exchange for this right, the letters; dramatic or dramatico-musical compositions;
patent owner makes technical information about the choreographic works or entertainment in dumb shows;
invention publicly available in the published document. musical compositions; drawing, painting, architecture,
sculpture, engraving, lithography; models or designs for
Trademarks- is a sign capable of distinguishing the works of art; original ornamental designs or models for
goods or services of one enterprise from those of other articles of manufacture; illustrations, maps, plans,
enterprises. Trademarks date back to ancient times sketches, charts and three-dimensional works relative
when artisans used to put their signature of “mark” on to geography, topography, architecture or science;
their products. drawings or plastic works of a scientific or technical
character; photographic works including works
Industrial designs- constitutes the ornamental or produced by a process analogous to photography;
aesthetic of an article. A design may consist of three- lantern slides; audiovisual works and cinematographic
dimensional features, such as the shape or surface of an works and works produced by a process analogous to
article, or of two-dimensional features, such as cinematography or any process for making audio-visual
patterns, lines or color. recordings; pictorial illustrations and advertisements
and computer programs.
Geographical indications- and appellations of origin are
signs used on goods that have a specific geographical Derivative works are also protected as new works,
origin and possess qualities, a reputation or provided that it does not affect the existing copyright
characteristics that are essentially attributable to that on original works. Derivative works may include:
place of origin. Most commonly, a geographical dramatizations, translations, adaptations,
abridgements, arrangements, and other alterations of
literary music work; collections of literary, scholarly or creators, the producer has the right to exercise
artistic works, and compilations of data and other copyright to the extent required for the
materials which are original by reason of the selection exhibition of the work in any manner, except for
or coordination or arrangement of their contents. the right to collect license fees for the
performance of musical compositions, with or
Is a copyright registration necessary to protect artistic or without words, which are incorporated into the
work.
literary works?
6. With respect to letters, the copyright belongs to
the writer subject to the following:
-No, copyrightable works are protected from the 1. Letters and other private
moment of their creation. communications in writing are owned
by the person to whom they are
Who can apply for a copyright registration? addressed and delivered, but the same
cannot be published or disseminated
-The owner of the work or his/her assignees or without the consent of the writer or his
successors-in-interest has the right to apply for a heirs.
copyright registration. 2. However, the court may authorize the
publication or dissemination if the
Who are considered owners of the copyrightable works? public goods or the interest of justice so
requires.
The owners of original literary and artistic works are:
BASIS FOR PRIVACY CONFIDENTIALITY
COMPARISON
1. The author of the work;
2. If the work is of joint ownership: Meaning The state of Confidentiality
1. The co-authors are the original owners being secluded refers to the
and in the absence of agreement, their is known as situation when it
rights shall be governed by the rules on Privacy. is expected from
co-ownership. someone that he
2. The author of each part is the owner of will not divulge
such part he/she created, if the work the information
consists of parts that can be used to any other
separately and the author of each part person.
can be identified. What is it? It is the right to It is an agreement
3. If the work is created in the course of be let alone. between the
employment: persons standing
1. Employee is the owner, if the work in fiduciary to
created is not part of employee’s maintain the
regular duties even if he uses the time, secrecy of
facilities and materials of the employer; sensitive
2. Employer is the owner, if the work information and
created is the result of the performance documents.
of employee’s regularly-assigned duties, Concept Limits the Prevents
unless otherwise agreed upon. access of the information and
4. If the work was commissioned, the one who public. documents from
commissioned the work jointly owns it with the unauthorized
author/creator – but the copyright of the work access.
remains with author/creator, unless otherwise Applies to Individual Information
agreed upon; Obligatory No, it is the Yes, when the
5. In the case of audio-visual work, the copyright personal choice information is
belongs to the producer, the author of the of an individual professional and
scenario, the music composer, the film director, legal.
and the author of the work adapted. However, Disallowed Everyone is Only
unless otherwise agreed upon among the disallowed from unauthorized
 involving the persons are • Transparency- data subject is aware of the nature,
personal affairs disallowed from purpose and extent of the processing of his or her
of an individual. using the personal data.
information. • Legitimate purpose and- processing of information
purposes must not be contrary to law, morals, or
The importance of preserving anonymity, public policy.
confidentiality, and privacy of health information: • Proportionality- processing information shall be
adequate, relevant, suitable, necessary, and not
• To ensure safe and compassionate nursing excessive in relation to declared and specified
practice that includes an understanding of the purposes.
ethic-moral and legal boundaries
• To ensure protection of patients from identity ➢ Rights of the Data Subject
theft, and other improper use of patient
information, specifically for financial gain Right to:
• To maintain patient’s trust. Thus, they will Be informed whether personal information pertaining
prevent hiding certain facts about themselves to him or her shall be, are being or have been
• The integrity and availability of the EHI will be processed.
essential for the physician and the entire clinical
team to be able to trust the data for patient Right to:
care and decision making Object the processing of his/her personal data,
• To prevent unintended consequences including processing for direct marketing, automated
detrimental to health research and public
processing or profiling.
health practice
• To ensure availability of accurate health
Right to Access:
information when needed by the patient
• To help maintain a professional attitude in ➢ Reasonable access to, upon demand, the
health care settings following:
• To prevent legal suits-thus avoid negative
repercussions on the health care institutions (1) Contents of his or her personal information that
were processed;
(2) Sources from which personal information were
obtained;
➢ Republic Act 10173 – Data Privacy Act of the (3) Names and addresses of recipients of the personal
Philippines information;
(4) Manner by which such data were processed;
This Act shall be known as the “Data Privacy Act of (5) Reasons for the disclosure of the personal
2012” information to recipients;
(6) Information on automated processes where the data
AN ACT PROTECTING INDIVIDUAL PERSONAL will or likely to be made as the sole basis for any
INFORMATION IN INFORMATION AND
decision significantly affecting or will affect the data
COMMUNICATIONS SYSTEMS IN THE GOVERNMENT
subject.
AND THE PRIVATE SECTOR, CREATING FOR THIS
PURPOSE A NATIONAL PRIVACY COMMISSION, AND FOR
OTHER PURPOSES Right to Rectification:
Dispute the inaccuracy or error in the personal
General Data Privacy Principles- The processing of information and have the personal information
personal information shall be allowed, subject to controller correct it immediately and accordingly, unless
compliance with the requirements of this Act and other the request is vexatious or otherwise unreasonable.
laws allowing disclosure of information to the public
and adherence to the principles of: Right to Erasure/Blocking:
Suspend, withdraw or order the blocking, removal or
destruction of his or her personal information from the
personal information controller’s filing system upon
discovery and substantial proof that the personal
information is incomplete, outdated, false, unlawfully
obtained, used for unauthorized purposes or are no
longer necessary for the purposes for which they were
collected.

➢ Data Privacy Act as Applies in Nursing Practice

• Maintaining the integrity of patient

confidentiality- DO NOT SHARE INFORMATION
ABOUT THE PATIENT TO THOSE OUTSIDE OF
CARE
• Always seek the guidance of Hospital’s Data
Protection Officer (DPO)
• Know by heart your hospital’s Privacy Manual
without fail
• Never seek information about a patient for
whom you are not providing care
• Always maintain your patient’s information
confidential
• Always get consent in obtaining information as
well as in taking photographs