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.
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
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