lack of education about information technology of the health care professional [2J. In June ... in the institution where he holds his job. On a modest scale the.
A Postgraduate Program in Nursing Informatics Jos Aarts Institute for Higher Health Care Education Hogeschool Midden Nederland Leusden, The Netherlands PROGRAM CONTENTS AND ORGANIZATION
ABSTRACT
2.
This paper describes the outline of a new one year postgraduate program in nursing informatics which started at the Hogeschool Midden Nederland in August 1989. The program is unique for Europe in its contents and duration. The rationale to start this program can be found in the issues of quality of care and cost containment and its effect on the professionalization of the nurse. Essential for this program is the desire for international cooperation with universities and colleges within the EEC and with American institutions.
The postgraduate program in nursing informatics has adopted a conceptual model of medical information processing developed by Van Bemmel [4J as a philosophy for the course contents. We feel that this model is not only valid for nursing information processing but also endorses the humanistic approach in the use of computers. The program consists of 420 hours of theoretical education and 420 hours of practical work in a health care institution. Essentially the program is part-time and can be completed in one year. However, it is expected that the completion of the theoretical part will require more time of the students and therefore the contents of the program has been organized into a modular structure with well defined courses.
1.
Upon completion of the program the student will essentially be able to analyze nursing information needs, use professional nursing knowledge to design nursing applications of information technology, compare and evaluate vendor products, identify user learning needs and implement training programs and assess and evaluate the effectiveness of clinical and/or management information systems to support the delivery of care. The student completes the theoretical part of the program by written exams of each course and the practical part by a thesis which he defends before an examination board. The theoretical part starts with an introductory set of courses which are shared by all above mentioned postgraduate programs, followed by the main track of the informatics program. Table 1 is an outline of the theoretical part of the program including the introductory courses. In the practical period the student applies his knowledge of nursing and informatics to the development and/or design of nursing applications, preferably in the institution where he holds his job. On a modest scale the Hogeschool can provide for projects. Our policy for this approach is to make the gained knowledge and skills as soon as possible available for the institution and to enhance its responsibility for the learning
INTRODUCTION AND RATIONALE
In 1988 the Hogeschool Midden Nederland decided to create a new postgraduate program in nursing informatics as a part of the postgraduate educational programs for health care professionals, which also include management, professional innovation, clinical specialization and research methods. The program builds on the established nursing informatics courses in the various nursing programs of the Institute for Higher Health Care Education of the
Hogeschool 11]. The reason for this initiative is twofold. A survey conducted under the auspices of the Dutch Ministry of Health showed that further development of information systems supporting care is hindered by a lack of education about information technology of the health care professional [2J. In June 1987 Working Group 8 (Nursing) of the International Medical Informatics Association established knowledge and competency levels for various groups of nurses and identified the need for a special program to educate nurses who can provide leadership in the development of (computerized) information systems to support health care delivery 13]. The rationale can be found in the fact that the health care professional is more and more made answerable for the quality of patient care and for the issue of balancing benefits and costs of health care delivery. This development is prompted by the need for professionalization which means that the delivery of care is based on scientific knowledge, but also external factors play an all important role. The general public is more demanding than ever and does not take no (or yes) for an answer. In Europe the governments are setting standards for the quality and costs of care and gradually the European Community becomes more influential in determining these standards. In the Netherlands a major revision of the health care delivery and fmancing system is taking place which allows the private carrier to be influential in terms of costs and quality of care. All these changes require data to be explicit and the amount of data is expected to increase enormously. It is only the use of automated information systems that can cope with these demands and developments. Dutch health care information systems will develop into health care support information systems but the involvement of the health care professional is crucial for a successfl change.
process of the student. The student will be able to choose a differentiation in the field of nursing care or nursing management. Therefore he can select courses from the post-graduate programs in clinical care nursing, professional innovation and/or management. The modular structure of our educational system facilitates possible choices. Also, this structure allows the faculty to grant exemptions from the program if the student shows adequate knowledge in a particular subject. The student can complete the program within a year when he can devote 50% of a nominal working week to attend the courses and do the practical work while at least another 10 hours per week is required for self study. We expect that most students will choose to complete the program in 1.5 to 2 years. 3.
It is our policy to select the students from applicants who work in a institution for health care (hospitals, community health care institutions, etc.) because we hold the opinion that primarily the institution should profit from the education offered. This is made visible by the requirement that the practical work should be carried out at the place where the student is employed. We will however consider applications from students who are not employed and seek a career in health care informatics.
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STUDENT POOL AND FACULTY
Table 1: The curriculum of the nursing informatics program (outline).
Module 3.4.: Systems analysis duration 39 hours
INTRODUCTORY COURSES
duration: 100 hours
contents - objectives and methods - project organization
themes - principles of care, quality and organization of health care delivery in the Netherland - health care policies and management - methods of research, including statistics - introductory health care informatics
- methods and techniques
(SDM, ISAC, SISP etc.) - design realization and introduction - role of 4 GL tools
Informatics and health care Module 3.5.: duration 36 hours
MAIN TRACK
MODULE 1:
Management. administration and research
contents - health care information systems - departmental applications - principles of decision support systems - applications in nursing management
Module 1.1.: Organization and informatlon policy duration 30 hours contents
- national health care information systems
- management, decision making and information - administrative organization
MODULE 4: Societal and ethical issue of information technology duration 24 hours
- information policy and planning
MODULE 2: Professional innovation duration 72 hours
contents - information technology and professional responsibility - job innovation - data protection - responsibilities with respect to the management of health care
contents - data collection in nursing - reporting and records in nursing - 'unified nursing language system': standardization of nursing concepts - dinical decision making - protocols and quality assurance in nursing - protocols and specialization in nursing - nursing audit - the DRG concept and the minimal nursing data set MODULE 3:
data - rights of patients - legal issues
MODULE 5: Social skills duration 24 hours contents - negotiating. - methods of
Informatics
Module 3.1.: Computer science duration 36 hours
The prerequisite for this program is a baccalaureate or master's degree in nursing or equivalent to the judgment of the admission board. Also the student needs to have a working experience of at least two years. A survey held among hospitals in the Utrecht area showed interest in our initiative but some hesitation about the prospect of having well defined jobs in the area information technology and nursing. Most hospitals reacted very positively to the intention to relate the contents of the program to the health care profession, instead of offering another computer science course. A few hospitals were very positive to send students to our program and will charge them with duties in the field of nursing information processing. It is our expectation however that the number of jobs will increase, because there are quite a few senior nurses who have duties in the area of information systems as a part their current job description. These duties are expected to grow into new functions as the impact of information technology grows. We now estimate a steady yearly enrollment of about 20 students who will come from all over the Netherlands. For the 1989/1990 academic year 11 students have enrolled into the program; table 2 sketches a profile of this student pool. Faculty for the program is mainly derived from the existing staff of the Hogeschool while for specific subjects specialists are hired from hospitals and other health care institutions, software houses and colleague universities. We believe that introducing specialists from practice as teachers in our program strengthens the involvement of health care in education.
contents - representation of data -
presenting and conflict handling techniques supervision
architecture and principles of computers peripheral devices operating systems data communication data collections and storage structures programming languages
Module 3.2.: Elementary information science duration 39 hours contents - information handling in an organization - data analysis and data structuring - developments in informatics
Module 3.3.: Databases duration 30 hours contents - database principles - hierarchical, network and relational DBMS - development of nursing 'data dictionary'
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Table 2: Profile of student pool, academic year 1989/1990.
REFERENCES
Number of students: 11 3 female, 8 male, all professional nurses (RN's)
[1] Aarts, J.E.C.M., A curriculum in nursing informatics, in: Salamon, R. et al. (eda.), Medical informatics and education, Victoria: School of Health Infomation Science, University of Victoria, 1989 381-383. [21 Ouwerkerk, W., Iersel, F.M.M. van, Op Hey, IG.LM.M., Towards future hospital information systems: a government strategy, in: Bakker, A.R. et.al.
Provenance: General Hospital: 3 Psychiatric Hospital: 2 Mental Health Institution: 3 Community (extramural) Health Care: 2 Other: 1
(eds.), Towards new hospital information systems, Amsterdam: North Holland, 198& 303-307. [3] Peterson, H.E. and Gerdin-Jelger, U. (eds.), Preparing nurses for using information systems: recommended informatics competencies, New York: National ILgue for Nursing, 198& [4J Bemmel, J.H. van, A comprehensive model for medical information processing, Meth. Inform. Med. 1983; 22: 124-130. [SJ Heller, B.R. etal., Education for specialization in nursing informatics, in: Daly, N. and Hannah, KLI. (eds.), Proceedings of third international symposium on nursing use of computers and information science, St. Louis: CV. Mosby, 1988. [6J Heller BR, etal., A needs assessment for graduate specialization in nursing informatics, in Greenes, RA. (ed.), Proceedings of twelfth annual symposium on computer applications in medical care, New York, IEEE Computer Society
Places of provenance: Amsterdam: 2 Utrecht: 2 Utrecht area (50 km radius circle): 4 Arnhem (East of Netherlands): 1 Vught (South of Netherlands): 1 Leeuwarden (North of Netherlands): 1
4.
Press, 198& 337-342.
[71 Romano, CA. and B.R. Heller, A curriculum model for graduate specialization
in nursing informatics, in: Greenes, RA., Proceedings of twelfth annual symposium on computer applications in medical care, New York, IEEE Computer Society Press, 1988: 343-349.
INTERNATIONAL COOPERATION
Our program is unique in its contents and duration in Europe. From the start we have strived towards international cooperation because we are convinced that an advanced program should be supported in an international network. It is not coincidental that we have established contacts with the University of Maryland, Campus for the Professions, at Baltimore where the School of Nursing in 1988 has started a master's degree program in nursing informatics [5,6]. This program has set an example for us [7J. The Hogeschool strives towards cooperation with universities and colleges in the European Community, advanced programs like our post-graduate program in nursing informatics are instrumental to achieve this in the field of education and research. This cooperation reflects the opportunity graduates have to work all over the EC and the fact that boundaries for them are vanishing. The magic year 1992 casts its shadow over our activities. The Hogeschool has established formal links among others with the University of Wales at Cardiff, Brighton Polytechnic and the City University of London in Great Britain in the field of nursing and
paramedic education. 5.
CONCLUSION
The program finds its roots in the development of the nursing profession and the issues of quality of care and bears relationship to the development of new health care information systems. We were able to start this program because its builds on the informatics courses which have been established in all our educational nursing programs. This approach reflects our philosophy that informatics should be considered as a tool for the health care professional. The program is expected to attract 20 students per year; the number might increase as the impact of information technology on health care delivery becomes more visible. The fact that this program is unique for Europe opens the way for international cooperation in and outside Europe; also it can stimulate research in the field of health care delivery and informatics. We acknowledge the generous financial support of the Dutch Ministry of Health by grant DGVgz/GBO/OZ 515406.
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