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Preparing emerging health professionals for practicing in an ever-changing health care environment along with continually evolving technology is an international concern. This is particularly pertinent for nursing because nurses make up the largest part of the health workforce.
This study aimed to explore how health informatics can be included in undergraduate health professional education.
A case study approach was used to consider health informatics within undergraduate nursing education in New Zealand. This has led to the development of nursing informatics guidelines for nurses entering practice.
The process used to develop nursing informatics guidelines for entry to practice in New Zealand is described. The final guidelines are based on the literature and are refined using an advisory group and an iterative process.
Although this study describes the development of nursing informatics guidelines for nurses entering practice, the challenge is to move these guidelines from educational rhetoric to policy. It is only by ensuring that health informatics is embedded in the undergraduate education of all health professionals can we be assured that future health professionals are prepared to work effectively, efficiently, and safely with information and communication technologies as part of their practice.
Health professionals work with people of all ages and stages of life; across primary, secondary, and tertiary care; and in a variety of settings, from hospitals to the community [
The focus of this case study was nurses working in New Zealand. New Zealand is a small country situated deep in the South Pacific with a population of less than 5 million [
There are many terms concerning the use of ICT in health care, but in this instance, the term health informatics, or when specifically for nursing—nursing informatics, has been selected. Health informatics is defined as the discipline focused on the acquisition, storage, and use of information in a specific setting or domain, in this case health care [
Including health informatics within health professional educational preparation was noted in the literature from the early 1970s; however, there seems to have been a surge of articles from 1999 [
A survey of medical schools in the United Kingdom identified that 17% of the 76% of medical schools that responded had little or no health informatics included in their curricula, and this is despite the General Medical Council’s curriculum requirements [
For more than 30 years, nursing has had an interest in nursing informatics competencies [
Despite the use of ICT in health care practice becoming increasingly commonplace in developed countries, nursing education has lagged in providing the preparation needed for new nurses to be aware and have the opportunity to develop the knowledge, skills, and attitudes they will need in practice. As Murphy and Goosen state, “After almost 25 years it is still problematic how few schools of nursing offer education on how the values of patient focused care can be mixed with careful application of health informatics tools and good professional information management” [
New Zealand provides a context for this project, and this section includes some of the New Zealand health informatics history that helped to shape the current informatics landscape. Despite early recognition of the need for nursing informatics competencies and guidelines to inform practice and undergraduate nurse education in New Zealand, the embedding of nursing informatics within the nursing curricula did not occur [
In 1989, a nurse educator, Jan Hausman, was seconded by the Ministry of Education to develop New Zealand guidelines for teaching nursing informatics [
In 2000, NINZ joined the New Zealand Health Informatics Foundation to form Health Informatics New Zealand (HiNZ), a not-for-profit organization that supports the field of health informatics, with a focus on events and professional development in New Zealand. HiNZ members include health professionals (including nurses), health sector managers, ICT experts, industry managers, academics, students, and government personnel [
In 2006, a report identified that more people, particularly those already in the health workforce, needed to be trained in health informatics [
However, these efforts and the core competencies, although they included health professionals, were focused toward those already in practice and not those in training. A project to address this gap, specifically for nurses, commenced in 2016.
To identify the nursing competencies needed for New Zealand nurses, a project was initiated in 2016 by a team of 3 nurse educators from 3 different schools of nursing. The objective of this project was to use a case study approach to develop nursing informatics guidelines specific for the New Zealand context that were based on principles encompassing key knowledge, skills, and behaviors for student nurses to attain over the time of their undergraduate education to be ready to begin practice as a registered nurse (RN). A case study approach was selected as it allowed for descriptive and exploratory analysis [
The
The Guidelines identify the key knowledge, skills, and behaviors toward nursing informatics for nurses as they enter practice as an RN, and as such, they have been developed and articulated to inform undergraduate nursing education. The principles are explicitly aligned to the Nursing Council of New Zealand (NCNZ) Competencies for RNs [
Background literature that informed The Guidelines included reports from international nursing informatics initiatives including from Australia (the Australian National Informatics Standards for Nurses and Midwives) [
This project was informed by an advisory group of 12 nurse leaders from practice, education, policy, the nursing regulatory body, and industry. Drafts of The Guidelines were distributed, and feedback was sought using an iterative process. In addition, 4 nursing organizations were asked to be kept informed: The Office of the Chief Nurse in the Ministry of Health at the government level; the regulatory body, NCNZ; and The Council of Deans and Nurse Educators in the Tertiary Sector, from the education sector.
In addition, the formatting was considered, and alongside each principle, examples were provided. The inclusion of examples from everyday practice in the New Zealand health system adds a local context (
Nurses are accountable and responsible for their use of information and communication technologies (ICT)
Use of information to inform and manage patient care
Nurses effectively use ICT to assist with the delivery of quality nursing care to improve patient outcomes
The nurse is adaptable in different health care environments through transferrable ICT skills
The Guidelines showing principle 2. NCNZ: Nursing Council of New Zealand.
This project aims to inform, influence, and potentially change professional nursing practice and policy through providing clear guidelines for nursing informatics competencies. The Guidelines align with the NCNZ competencies for RNs [
By considering the past and previous attempts to introduce nursing informatics competencies in New Zealand, there is an opportunity to learn and to improve on earlier endeavors. A common problem faced by earlier efforts includes moving from the creation of guidelines to a position where competencies are recognized and inform policy to where they are embedded in education. This project supports actively building connections between the tertiary education providers within the schools of nursing, thereby crossing perceived divisions between universities, polytechnics, and institutes of technology. By demonstrating engagement within the nursing communities, specifically nurse lecturers and the key nursing regulatory and policy stakeholders, The Guidelines may be acceptable to all and are more likely to be accepted and influence policy.
In terms of policy impact, this project has the potential to influence the NCNZ to explicitly address the inclusion of nursing informatics within undergraduate nursing curricula. The implementation of these guidelines nationally would impact all 17 schools of nursing in New Zealand by ensuring that present and future RNs are consistently prepared for working in a technological age. This will likely have flow-on effects for patient care, potentially improving safety and efficiency within the health care system and improving quality of care for recipients, while acknowledging the role of nurses in health maintenance and health promotion as well as providing health care for those who are sick or dying. Technology is used in all aspects of health care, and ensuring that our workforce is adequately prepared for its use in health care has the potential to assist all recipients of care, including Māori—the indigenous people of New Zealand—and those from neighboring Pacific Islands, who are overrepresented in New Zealand’s worst health statistics [
The impact of policy in terms of education will affect nursing students, who remain predominantly women (9% of the current nursing workforce is male) [
The challenge is to now disseminate this work to the New Zealand nursing education community so that The Guidelines can be incorporated into nursing curricula. The first step is to share The Guidelines across all schools of nursing in New Zealand so that nurse educators can consider how The Guidelines can be implemented into their undergraduate programs of nursing, which will facilitate effective knowledge transfer and uptake of The Guidelines into practice. Furthermore, there is a need to identify and then address the concerns, barriers, and facilitators to using The Guidelines in nursing education. In addition, from a New Zealand perspective, where the indigenous people are Māori, there is a need to understand any issues specifically from the perspectives of Māori as concerns related to data guardianship and nurses acting as kaitiaki/guardians of the data may apply [
Despite local and international efforts to include health informatics as part of the curricula for preparing health professionals for practice in the 21st century, there remains inconsistency in achieving this. This case study illustrates the development of heath informatics competencies and guidelines for one profession, in one country. The challenge is moving from educational rhetoric to practice and policy to ensure that health informatics is embedded into the educational preparation for all health professionals. The importance of learning from past initiatives is highlighted. The process used to develop the “Guidelines: Informatics for nurses entering practice” for use in New Zealand is expected to guide undergraduate nursing education and as such form a bridge between theory, education, and practice.
Health Informatics New Zealand
information and communication technologies
International Medical Informatics Association
Nursing Council of New Zealand
Nursing Informatics New Zealand
registered nurse
Technology Informatics Guiding Education Reform
None declared.