Doctoral Specialization in Nursing Informatics
Carole A. Gassert, PhD, RN Assistant Professor
Mary Etta Mills, ScD, RN Associate Professor
Barbara R. Heller, EdD, RN, FAAN Professor and Dean
University of Maryland School of Nursing Baltimore, Maryland Abstract
nurses for designing and developing innovative nursing systems, including the research of these systems.
A prototype program of doctoral study has been developed at the University of Maryland School of Nursing to prepare students with nursing expertise in the conceptualization and research of computer based information systems in hospitals, industry and other health care organizations. The graduate will be prepared to design effective nursing information systems; create innovative information technology; conduct research regarding integration of technology with nursing practice, administration, and education; and develop theoretical, practice, and evaluation models for nursing informatics.
The Role of the Doctoraily Prepared Nurse Scientist in Informatics Nurses are already employed in the health care environment at the Master's level as Nursing Information Systems Specialists. Inspection of a number of advertisements and position descriptions for these jobs confirms the role of the nurse as a planner, designer and implementor of clinical and management information systems in and for nursing. Further analysis reveals a desirability on the part of administrators to support further conceptualization of nursing information systems requirements and research which integrates technology with information needs. These doctorally prepared nurses will systematically study concepts underpinning effective and creative design and use of information systems. They will be instrumental in incorporating the results into new application models and further studying the effects. As noted by Hersher [3], nurses are presently functioning as project managers for the development and implementation of information technologies in the health care environment, as user training coordinators and as consultants and partners with commercial industries
Introduction As discussed by Ronald and Skiba [1], basic educational programs are beginning to include computer skills in their curricula allowing nurses to become users more easily. The University of Maryland Masters' level Track in Nursing Informatics described by Heller [2] currently prepares nurses to be Nursing Information Specialists and fulfill the role of system modifiers. To become nurse innovators additional study in nursing science, nursing research methodologies, computer science and information science is necessary. As a result, a decision was made to establish an emphasis area in Nursing Informatics at the doctoral level to adequately prepare 0195-4210/91/$5.00 C) 1992 AMIA, Inc.
263
developing marketable information systems for nursing and health care. Doctoral preparation in research and informatics will prepare nurse scientists to creatively interface humans and computers in a model that favors and supports patient care.
information be facilitated." The increasing reliance on information systems in practice and the focus on nursing research and development activities in informatics indicates a need for advanced educational preparation. Doctoral study most appropriately offers this foundation.
Indicators of Need To validate the need for a doctoral level emphasis in Nursing Informatics a feasibility study was carried out by the School of Nursing at University of Maryland at Baltimore in the Summer, 1990. The purpose was to identify employer responses and potential applicant pool. Questionnaires were distributed to a sample of employers and questionnaires were also administered to current Masters' Track Nursing Informatics students in the School of Nursing, University of Maryland.
In the past decade, the nursing world has virtually exploded with computer applications in practice, education and administration which, some nursing leaders believe, have revolutionized the management of patient care and health care systems. In 1988, the complementary need for knowledge in this area was recognized through funding by the USDHHS Division of Nursing to the University of Maryland School of Nursing for purposes of establishing a Masters Track in Nursing Informatics. At the present time however, no doctoral level program with an emphasis in
Nursing Directors
Nursing Informatics exists.
A mail survey was conducted in 1990 of 31 nursing directors of JCAHO accredited hospitals of 300 beds or more located in 19 states including Maryland and Washington, DC. A participation rate of 81% was achieved. Questionnaires from the 25 respondents indicated that all of these institutions currently use computer technology in nursing practice and/or administration. Almost threefourths of the hospitals (72%) already allocate one or more budgeted positions for nurse-managers of computer/information systems. (The median salary range reported for these positions was $39,000 and above.) An additional 50% of the respondents foresaw a need for such positions in their institutions within the next year or two.
In 1990 the National Center for Nursing Research made a decision to fund pre and post doctoral education through the development of nursing fellowships. Concomitantly, research on information technology has been identified by Moritz [4] as a priority for nursing and actions have been taken by the National Center for Nursing Research to develop a national agenda for information systems research. Furthermore, the 1991 standards of the Joint Commission on Accreditation of Healthcare Organizations [5] recommend that "nursing care data related to patient assessments, the nursing care plan, nursing interventions, and patient outcomes are permanently integrated into the clinical information system." The standards further recommend "the use of efficient interactive information management systems for nursing
The nursing directors were enthusiastic in their evaluation (Table 1) of the proposed doctoral Nursing Informatics program: virtually all 264
Masters' Informatics Nursing Students
respondents saw some need for the program, with 79% selecting a response in the upper end of the evaluation scale, and 59% endorsing the highest responses. Moreover, these respondents expressed a high degree of willingness to employ Nursing Informatics Scientists. The majority showed at least some willingness, with 50% selecting a response in the upper end of the evaluation scale.
A questionnaire on the proposed doctoral level Nursing Informatics program was mailed to 39 current Masters' Informatics Track students at the University of Maryland. All standard procedures to ensure ethical conduct of research were used including anonymity and informed consent. It was made clear that anyone not wishing to participate should return a blank questionnaire. Twenty-seven (27) students (70%) completed the survey. The questionnaire included items on doctoral study plans, interest in the proposed program, as well as demographic and background variables.
Nursing Director's Assessssments of PhD Nursing Informatics Program Need
n
0 (no need) 1-2 3-4 5-6 7 (great need)
00 05 05 13
Q1
0 20.8 20.9 54.2 4.2
00 06 06 09 03
0 25.0 25.0 37.5 1.25
The students estimated the likelihood of their enrolling in a doctoral program after graduation. Frequencies and percentages as well as means, medians, and standard deviations are shown in Table 2. As can be seen, about 89% expressed at least some likelihood (i.e., chose 1 or higher on the 0 to 7 scale). Twenty-six (26) percent circled 5, 6, or 7, the highest values.
24
Mean = 4.21 Median = 5.00 (SD = 1.47)
Willingness to employ
0 (not willing) 1-2 3-4 5-6 7 (very willing)
Likelihood of Enrolling in an Informatics Doctoral Program Likelihood Scale
24
0 (not likely) 1-2 3-4 5-6 7 (very likely)
Table 1
Mean = 2.963 Median = 3.000 (SD = 2.01)
Mean = 4.08 Median = 4.50 (SP = 1.82)
In sum, these data indicate a high level of interest in and support for the development of the doctoral level Nursing Informatics emphasis area.
n
03 09 08 06 01 27
11.1 33.3 29.3 22.2 3.7
Table 2 Those with any likelihood of enrolling in doctoral study (i.e., 24 265
students then went on to indicate their degree of interest in the Informatics emphasis area. As can be seen in Table 3, of the 23 students indicating some degree of interest in the informatics area, 10 students (43%), selected 5 or higher on the scale; moreover, 17% circled 7, the maximum degree of interest. Those expressing any degree of interest in Informatics estimated how soon after graduation they would be likely to enroll. As Table 3 shows, 27% want to begin within 1 or 2 years after graduation; 27% within 3-4 years; 46% in 5 or more years. Degree of Interest in Informatics Program Interest
n
0 (not interested 1-2 3.4 5-6 7 (very interested)
,(%)
01 08 05 06 04 24
4.2 33.4 20.9 25.0 1.67
06 06 10 22
27.3 27.3 45.5
Prototype Program
The program is responsive to the needs of students who desire doctoral education in Nursing Informatics. Currently, no other school of nursing, either in the United States or abroad, offers such specialized education. Therefore, the curriculum offered by the University of Maryland will serve as a model for the development of other Nursing Informatics programs in the future. The program of study in Nursing Informatics is viewed as a prototype for other such programs, and judging from the amount of interest aroused in the academic community, it is expected that the program will be replicated in several educational institutions in both the United States and abroad. The program objectives of the PhD emphasis area in Nursing Informatics flow from both the Master's Nursing Informatics track and the nursing doctoral program. They will be attained through courses in nursing, nursing theory, nursing research, nursing informatics, and related disciplines, particularly information science and computer. science, in classes, seminars, conferences, and faculty-preceptorcolleague association. These objectives state that upon completion of the program, the graduate will be able to:
Mean = 3.83 Median = 4.00 (SD = 2.28)
Expected Time of Enrollment 1-2 years 3-4 years 5 years or more
Findings affirm the need for the program, a ready job market for the graduates and a sizeable applicant pool.
Median = 3-4 years
Conceptualize nursing information requirements.
Table 3
Design effective nursing information systems.
In sum, these data indicate a high level of interest in and support for the development of the doctoral level Nursing Informatics emphasis area.
.
266
Create innovative information technology.
administration of information technology. . Conduct research regarding integration of technology with nursing practice, administration, education and research.
. Develop theoretical, practice, and evaluation models for nursing informatics.
The curriculum plan for the PhD emphasis area in Nursing Informatics has been developed to approximate the 60 semester credit curriculum pattern for other emphasis areas within the PhD program. This pattern has been developed for students who have completed the Master's in Nursing Informatics Track of study. A second pattern has been developed for students who have a Master's in nursing in a field other than Nursing Informatics. A third curriculum pattern has been developed for students who have a baccalaureate degree in nursing to obtain a PhD with an emphasis in Nursing Informatics.
Program completion will provide for career opportunities in every commercial, governmental, and service organization of the nation which employs computer-based information services related to health care. The program would provide instruction in those competencies needed for increased responsibility in a wide range of occupations in the private and the public sectors. The doctoral emphasis in Nursing Informatics at the University of Maryland will serve as a model for the development of other such programs in the future. References
1. Ronald, J.S., Skiba, D.J. (1987). Guidelines for basic computer education in nursing. New York: National League for Nursing.
2. Heller, B.R., Romano, C.A., Moray, L.R., Gassert, C.A. (1989). The implementation of the first graduate program in nursing informatics. Computers in Nursing, 7(5), 209-213.
Educational preparation focuses on nursing theory (14 credits), research (17 credits), nursing informatics and related disciplines (17 credits) - particularly information science and computer science - and dissertation research (12 credits). Subject matter treated in the course material includes: nursing, information, ergonomic, cognitive and organizational theories as they apply to computer technology; research design and statistics; issues in clinical and management information systems, administration, ethics and evaluation as areas of scholarly inquiry; design of the innovation process; decision analysis; and information needs analysis related to advanced practice in health care. The ultimate goal of such a futuristic curriculum is to prepare nurses to conceptualize, research and design the new tools of this era and to take advantage of the growing opportunities provided by the appropriate
3. Hersher, B.S. (1985). The Job Search and Information Systems Opportunities for Nurses. Nursing Clinics of North America, 20(3), 585594. 4. Moritz, P. (1990). Information Technology. Computers in Nursing. 8(3), 111-115. 5. Joint Commission for Accreditation of Healthcare Organizations, 1991 Standards Manual. Chicago, III: JCAHO.
267
Carole A. Gassert, PhD, RN Assistant Professor
Mary Etta Mills, ScD, RN Associate Professor
Barbara R. Heller, EdD, RN, FAAN Professor and Dean
University of Maryland School of Nursing Baltimore, Maryland Abstract
nurses for designing and developing innovative nursing systems, including the research of these systems.
A prototype program of doctoral study has been developed at the University of Maryland School of Nursing to prepare students with nursing expertise in the conceptualization and research of computer based information systems in hospitals, industry and other health care organizations. The graduate will be prepared to design effective nursing information systems; create innovative information technology; conduct research regarding integration of technology with nursing practice, administration, and education; and develop theoretical, practice, and evaluation models for nursing informatics.
The Role of the Doctoraily Prepared Nurse Scientist in Informatics Nurses are already employed in the health care environment at the Master's level as Nursing Information Systems Specialists. Inspection of a number of advertisements and position descriptions for these jobs confirms the role of the nurse as a planner, designer and implementor of clinical and management information systems in and for nursing. Further analysis reveals a desirability on the part of administrators to support further conceptualization of nursing information systems requirements and research which integrates technology with information needs. These doctorally prepared nurses will systematically study concepts underpinning effective and creative design and use of information systems. They will be instrumental in incorporating the results into new application models and further studying the effects. As noted by Hersher [3], nurses are presently functioning as project managers for the development and implementation of information technologies in the health care environment, as user training coordinators and as consultants and partners with commercial industries
Introduction As discussed by Ronald and Skiba [1], basic educational programs are beginning to include computer skills in their curricula allowing nurses to become users more easily. The University of Maryland Masters' level Track in Nursing Informatics described by Heller [2] currently prepares nurses to be Nursing Information Specialists and fulfill the role of system modifiers. To become nurse innovators additional study in nursing science, nursing research methodologies, computer science and information science is necessary. As a result, a decision was made to establish an emphasis area in Nursing Informatics at the doctoral level to adequately prepare 0195-4210/91/$5.00 C) 1992 AMIA, Inc.
263
developing marketable information systems for nursing and health care. Doctoral preparation in research and informatics will prepare nurse scientists to creatively interface humans and computers in a model that favors and supports patient care.
information be facilitated." The increasing reliance on information systems in practice and the focus on nursing research and development activities in informatics indicates a need for advanced educational preparation. Doctoral study most appropriately offers this foundation.
Indicators of Need To validate the need for a doctoral level emphasis in Nursing Informatics a feasibility study was carried out by the School of Nursing at University of Maryland at Baltimore in the Summer, 1990. The purpose was to identify employer responses and potential applicant pool. Questionnaires were distributed to a sample of employers and questionnaires were also administered to current Masters' Track Nursing Informatics students in the School of Nursing, University of Maryland.
In the past decade, the nursing world has virtually exploded with computer applications in practice, education and administration which, some nursing leaders believe, have revolutionized the management of patient care and health care systems. In 1988, the complementary need for knowledge in this area was recognized through funding by the USDHHS Division of Nursing to the University of Maryland School of Nursing for purposes of establishing a Masters Track in Nursing Informatics. At the present time however, no doctoral level program with an emphasis in
Nursing Directors
Nursing Informatics exists.
A mail survey was conducted in 1990 of 31 nursing directors of JCAHO accredited hospitals of 300 beds or more located in 19 states including Maryland and Washington, DC. A participation rate of 81% was achieved. Questionnaires from the 25 respondents indicated that all of these institutions currently use computer technology in nursing practice and/or administration. Almost threefourths of the hospitals (72%) already allocate one or more budgeted positions for nurse-managers of computer/information systems. (The median salary range reported for these positions was $39,000 and above.) An additional 50% of the respondents foresaw a need for such positions in their institutions within the next year or two.
In 1990 the National Center for Nursing Research made a decision to fund pre and post doctoral education through the development of nursing fellowships. Concomitantly, research on information technology has been identified by Moritz [4] as a priority for nursing and actions have been taken by the National Center for Nursing Research to develop a national agenda for information systems research. Furthermore, the 1991 standards of the Joint Commission on Accreditation of Healthcare Organizations [5] recommend that "nursing care data related to patient assessments, the nursing care plan, nursing interventions, and patient outcomes are permanently integrated into the clinical information system." The standards further recommend "the use of efficient interactive information management systems for nursing
The nursing directors were enthusiastic in their evaluation (Table 1) of the proposed doctoral Nursing Informatics program: virtually all 264
Masters' Informatics Nursing Students
respondents saw some need for the program, with 79% selecting a response in the upper end of the evaluation scale, and 59% endorsing the highest responses. Moreover, these respondents expressed a high degree of willingness to employ Nursing Informatics Scientists. The majority showed at least some willingness, with 50% selecting a response in the upper end of the evaluation scale.
A questionnaire on the proposed doctoral level Nursing Informatics program was mailed to 39 current Masters' Informatics Track students at the University of Maryland. All standard procedures to ensure ethical conduct of research were used including anonymity and informed consent. It was made clear that anyone not wishing to participate should return a blank questionnaire. Twenty-seven (27) students (70%) completed the survey. The questionnaire included items on doctoral study plans, interest in the proposed program, as well as demographic and background variables.
Nursing Director's Assessssments of PhD Nursing Informatics Program Need
n
0 (no need) 1-2 3-4 5-6 7 (great need)
00 05 05 13
Q1
0 20.8 20.9 54.2 4.2
00 06 06 09 03
0 25.0 25.0 37.5 1.25
The students estimated the likelihood of their enrolling in a doctoral program after graduation. Frequencies and percentages as well as means, medians, and standard deviations are shown in Table 2. As can be seen, about 89% expressed at least some likelihood (i.e., chose 1 or higher on the 0 to 7 scale). Twenty-six (26) percent circled 5, 6, or 7, the highest values.
24
Mean = 4.21 Median = 5.00 (SD = 1.47)
Willingness to employ
0 (not willing) 1-2 3-4 5-6 7 (very willing)
Likelihood of Enrolling in an Informatics Doctoral Program Likelihood Scale
24
0 (not likely) 1-2 3-4 5-6 7 (very likely)
Table 1
Mean = 2.963 Median = 3.000 (SD = 2.01)
Mean = 4.08 Median = 4.50 (SP = 1.82)
In sum, these data indicate a high level of interest in and support for the development of the doctoral level Nursing Informatics emphasis area.
n
03 09 08 06 01 27
11.1 33.3 29.3 22.2 3.7
Table 2 Those with any likelihood of enrolling in doctoral study (i.e., 24 265
students then went on to indicate their degree of interest in the Informatics emphasis area. As can be seen in Table 3, of the 23 students indicating some degree of interest in the informatics area, 10 students (43%), selected 5 or higher on the scale; moreover, 17% circled 7, the maximum degree of interest. Those expressing any degree of interest in Informatics estimated how soon after graduation they would be likely to enroll. As Table 3 shows, 27% want to begin within 1 or 2 years after graduation; 27% within 3-4 years; 46% in 5 or more years. Degree of Interest in Informatics Program Interest
n
0 (not interested 1-2 3.4 5-6 7 (very interested)
,(%)
01 08 05 06 04 24
4.2 33.4 20.9 25.0 1.67
06 06 10 22
27.3 27.3 45.5
Prototype Program
The program is responsive to the needs of students who desire doctoral education in Nursing Informatics. Currently, no other school of nursing, either in the United States or abroad, offers such specialized education. Therefore, the curriculum offered by the University of Maryland will serve as a model for the development of other Nursing Informatics programs in the future. The program of study in Nursing Informatics is viewed as a prototype for other such programs, and judging from the amount of interest aroused in the academic community, it is expected that the program will be replicated in several educational institutions in both the United States and abroad. The program objectives of the PhD emphasis area in Nursing Informatics flow from both the Master's Nursing Informatics track and the nursing doctoral program. They will be attained through courses in nursing, nursing theory, nursing research, nursing informatics, and related disciplines, particularly information science and computer. science, in classes, seminars, conferences, and faculty-preceptorcolleague association. These objectives state that upon completion of the program, the graduate will be able to:
Mean = 3.83 Median = 4.00 (SD = 2.28)
Expected Time of Enrollment 1-2 years 3-4 years 5 years or more
Findings affirm the need for the program, a ready job market for the graduates and a sizeable applicant pool.
Median = 3-4 years
Conceptualize nursing information requirements.
Table 3
Design effective nursing information systems.
In sum, these data indicate a high level of interest in and support for the development of the doctoral level Nursing Informatics emphasis area.
.
266
Create innovative information technology.
administration of information technology. . Conduct research regarding integration of technology with nursing practice, administration, education and research.
. Develop theoretical, practice, and evaluation models for nursing informatics.
The curriculum plan for the PhD emphasis area in Nursing Informatics has been developed to approximate the 60 semester credit curriculum pattern for other emphasis areas within the PhD program. This pattern has been developed for students who have completed the Master's in Nursing Informatics Track of study. A second pattern has been developed for students who have a Master's in nursing in a field other than Nursing Informatics. A third curriculum pattern has been developed for students who have a baccalaureate degree in nursing to obtain a PhD with an emphasis in Nursing Informatics.
Program completion will provide for career opportunities in every commercial, governmental, and service organization of the nation which employs computer-based information services related to health care. The program would provide instruction in those competencies needed for increased responsibility in a wide range of occupations in the private and the public sectors. The doctoral emphasis in Nursing Informatics at the University of Maryland will serve as a model for the development of other such programs in the future. References
1. Ronald, J.S., Skiba, D.J. (1987). Guidelines for basic computer education in nursing. New York: National League for Nursing.
2. Heller, B.R., Romano, C.A., Moray, L.R., Gassert, C.A. (1989). The implementation of the first graduate program in nursing informatics. Computers in Nursing, 7(5), 209-213.
Educational preparation focuses on nursing theory (14 credits), research (17 credits), nursing informatics and related disciplines (17 credits) - particularly information science and computer science - and dissertation research (12 credits). Subject matter treated in the course material includes: nursing, information, ergonomic, cognitive and organizational theories as they apply to computer technology; research design and statistics; issues in clinical and management information systems, administration, ethics and evaluation as areas of scholarly inquiry; design of the innovation process; decision analysis; and information needs analysis related to advanced practice in health care. The ultimate goal of such a futuristic curriculum is to prepare nurses to conceptualize, research and design the new tools of this era and to take advantage of the growing opportunities provided by the appropriate
3. Hersher, B.S. (1985). The Job Search and Information Systems Opportunities for Nurses. Nursing Clinics of North America, 20(3), 585594. 4. Moritz, P. (1990). Information Technology. Computers in Nursing. 8(3), 111-115. 5. Joint Commission for Accreditation of Healthcare Organizations, 1991 Standards Manual. Chicago, III: JCAHO.
267
