Nursing Informatics in South America

  Nursing Informatics in South America

nursing informatics in 13 south American countries has been based more on activities of individuals than on a policy established by governments or national efforts.Each country has varied levels of development and deployment of technological resources;however,the use of technology has been visible tendency in health and nursing education,practice,research, and administration.

The use technology by nurses follows the evolution of technology use in the region. most developed parts of the country have better access and ability to implement services and applications in nursing.

computers are considered an important tool to help nurses take care of their patients and to organize nursing service and nursing education.internet  and wireless communication are also a trend in this field.health institutes and universities are exploring ways to introduce new resource in order to facilitate the process of patients care and promote quality and safety.

Background:

Nursing has been identified around the world as an emerging profession for over 100 years.The professional evolution has been continuous process influenced by science and technology, which has been the driving force to further nursing development. for many years, nurses were considered as the primary users of technology in healthcare(Safran,Slack, and Beich, 1989)

Historically,  nurses are used to facing challenges, adapting new tools into practice to improve their performance, and creating a new models to enhance patient care. Technology can represent in a unique instrument to help nurses face further challenges and discover how to use its resources to innovate and maybe to redesign their way of taking care of people(Marin,1996)

Today’s technology causes significant modification of human activities and the way we le4n and work. Traditional methods of teaching, managing, and practicing a profession do not support the requirements of modern life anymore. Furthermore, information is the key element for decision-making process in the healthcare area. The more specific information in the place to support clinical decisions, the better care can be delivered to the patient. The quality of care is related to the scope of knowledge and information that health providers can access on which to base their clinical decisions. Thus, technology plays an important role in facilitating access to the information because for the information to be useful and meaningful, it has to be timely. Recognizing computers and all information technology resources available as powerful instruments, gradually, each country became more aware of the possibilities to apply information technology to enhance activities in taking care of clients/patients. There is a clear trend in the direction of the computerization of health records. In addition, more people are able to connect to the internet that is a telecommunication resource with no parallel to fast exchange data and information. As a result we can expect to see better-informed healthcare providers and consumers (Pan America Health Association/World Health Organization, 2001). Considering trends and tendency in healthcare informatics, and to facilitate the process in South America n countries, the Pan American Health Organization (PAHO) has published guidance and protocols to orient the development and deployment of information and communication technology in Latin America and the Caribbean (Pan America Health Association/World Health Organization, 1998, 2001, 2003). It is also important to emphasize that Latin America and the Caribbean region rank third in information technology expenditures. A study performed by the Pan America Health Organization/World Health Organization (1998) showed that the Information Society Index, Based on the use of information, computer, and social infrastructure, is evolving rapidly.

Nursing Informatics Initiatives:

In South American countries, as in any other country in the world, the initial motivation to develop computer systems in the healthcare area was driven by financial and administrative concerns. The hospital sector can be considered the area better served by information systems. Countries like Brazil, Mexico, Argentina, Colombia, Chile, and Paraguay have clinical information systems in hospitals or health institutes.

Although clinical information systems are being used in some ways to support clinical care and management, a few hospitals or healthcare institutes developed applications for nursing documentation where nursing data can be processed. In general, patient data that are also used for nursing administration are integrated in the system or nurses have to collect and analyze nursing data separately.

Hospitals have been working to design their own system in order to attend to specific needs and policies. More recently, national and international software industry became more represented in the South America healthcare market. Consequently, they provide a broader range of solutions with systems that address patient care documentation.

Many additional initiatives are spread throughout the Latin American countries. It can be observed that the use of computers as an instrument to support nurses’ activities in taking care of patients still needs a lot of investment of human and material resources. Clinical systems based on the nursing process are not common in these countries.  Most of the computers systems implemented are intended to control administrative data. The most frequently implemented and used applications still are the nursing orders.

In spite of this, nurses are becoming even more involved with the design, implementation, and evaluation of clinical information systems. Vendors and developers recognize that the success of computer system requires nursing input and collaboration.

In addition, as an open and evolving market, international developers are making investments to sell and implement computer systems in South America, because South America represents one of the most promising market in the world of technology.

Even so, it is necessary to emphasize that the inclusion of nursing elements of practice in the patient record is under the responsibility of nurses. They need to be involved with the programmers, vendors, and developers to drive the professional requirement. Taking care of patients is what nurses know how to do. Therefore, it is essential to assure that all information required to perform nursing care is present in the health information systems.

Congresses, conferences, workshops, education, ad training programs are being organized in the countries to share experiences and information in nursing informatics searching for solutions that could enhance the delivery of patient care.

Distance Learning and the Educational Perspectives in Nursing Informatics

Technology is transforming not only nursing practice but also nursing training and education models. With the introduction of computers in the healthcare area, nurses became primary users , responsible for data input . Consequently, they had to become computers literate in order to use computer technology in an efficient manner. To meet educational and training needs, nursing schools and hospitals initiated programs to prepare nurses to use computers. In addition to teaching how to use computer application, course instructors also considered the use of computers to reach nursing content.

Computer applications in nursing education are also changing nursing education from a passive teaching to an active learning process. Computes allow students to work at the time the best meets their specific needs. Usually, the programs are very interactive and easy to use and offer immediate feedback about students’ performance.

Formal education programs in nursing informatics, such as a specific nursing informatics specialization and master or doctoral course is also being provided. The Nucleo de Informatica em Enfermagem at the Universidade Federal de Sao Paulo was the first center to offer specialization degree in South America. NIEn /UNFESP also provides, since 1989, the nursing informatics discipline in its graduate and undergraduate nursing programs. The research “line” in nursing informatics is attended by professionals from different regions of the country and has been responsible for the preparation of several master’s and doctoral students in nursing informatics. The students after graduation return to their own institutes to implement education and research programs and to participate in the development of patient care systems.

Latin American countries are investing a significant effort to prepare professionals in health informatics. An example of this was recently implemented in Brazil. A National Institutes of Health (U.S.), promoted the establishment of a bilateral consortium of health informatics faculty. A program was designed to enhance training in Brazil by augmenting the teaching resources of local faculty. This training program was based on the experience of the Brazilian faculty and some lessons learned from an existing training program in Boston (U.S.), which involved faculty from Harvard University and its affiliated hospitals: Massachusetts Institutes of Technology (MIT), Boston University, and Tufts University.

The program started in October 1999. Since then, it has sponsored 10 onsite courses in Brazil, which were subsequently made available on the Internet and CD – ROM, together with regular medical informatics courses taught yearly at Harvard and MIT. The program started, in years 1 and 2,  with activities  targeted at faculty from a leading universities in southern Brazil, which are better equipped with staff and material resources than universities in other parts of the country. There were short courses in Brazil, which were taught by a mix of Brazilian and U.S. faculty, as well as support for faculty enrichment via participation in international scientific events. In 3 years3 and 4, the training program was responsible for the organization of several scientific meetings in Brazil and continued to promote student and faculty participation in national and international conferences, short-term courses, and workshops.

During the development and implementation of this training program, different regions of Brazil were reached, delivering courses that were previously given in Sao Paulo or Rio de Janeiro. By the end of 2003 , it was found that around 1,724 professionals were involved as either a faculty member or a student in the program.

There has been a trend toward distance learning program development in South America. Computer technology is providing students living in distant regions and having difficulties in accessing the main educational centers the opportunity to improve their personal knowledge base. A contributing factor to the development and success of these programs is the distance between countries and cities due to the geographic characteristics of South America.

In Brazil, the Brazilian Council of Telemedicine was established in 2002. It is developing several educational programs. The council includes the telenursing group.

Nursing Terminology Documentation

Sharing and communicating is essential to make decisions and deliver care. Exchange of information requires the communicating channel, an exchange protocol, and alphabet, words, phrases, and symbols that express and assign meaning, understood by all users (Pan American Health Association/World Health Organization, 1997).

Clark (1995) pointed out that “communicating among ourselves has always been important but communicating with other people about nursing has acquired a new urgency since we are forced to recognize that the value of nursing is no longer apparent to those who have power to influence our practice”. Other issues to be considered are reimbursement policies, cost containment, and technological development in recent years.

However, it is the nurses responsibility to decide not only what kind of data are important  to describe the contribution of nurses in the healthcare process and to assure continuous care, but also to decide how these data could be could be described. What kind of language

 Will be useful to support the several different activities performed by nurses? In fact, the use of vocabulary in nursing must assure both communication among the nurses and communication between nurses and the other providers responsible for patient care.

In 1990, the international council of Nurses (ICN) initiated a long-term project to develop an International Classification for Nursing Practice (ICNP) with the objective to establish a common language about nursing practice to be used for describing nursing care for people in a variety of setting (Mortensen 1996).

In Brazil, the dissemination of ICNP started around 1996. When NIEn/UNIFESP became a sponsoring partner in the Telenurse Consortium, a projector led by Randi  Mortensen, director of the Danish Institute  for Health and Nursing Research. 

The paper and electronic forms of ICNP-Brazilian version (http://www.epm.br/enf/nien/cipe)

Have been available since September 1997. The ICNP beta 2 is also available in Brazilian Portuguese version ( Conselho International de enfermagem, 2003).

Other terminologies are also being used in the country. Including Home Health Care Classification (HHCC) system developed by Saba (1992), which is also available on the internet  (hhttp://www.sabacare.com) in Brazilian Portuguese version.

Nurses have several problems in obtaining nursing documentation. Currently, with the expansion of the health knowledge and information; the quantity if nursing documentation has certainly increased.

The Pan American Organization/World Health Organization decided to sponsor an expert meeting to produce guidebook that could provide information about how nursing informatics and standards can improve nursing practice and management. The main goal was to characterize how nursing informatics and the use of standards can improve nursing practice and management, taking advantage of resources