j o u r n a l h o m e p a g e : w w w . i n t l . e l s e v i e r h e a l t h . c o m / j o u r n a l s / i j m i
Nursing informatics competencies required of nurses in
Taiwan
Jieh Chang
a, Mollie R. Poynton
b,∗, Carole A. Gassert
b, Nancy Staggers
baNational Taichung Nursing College, Taiwan bUniversity of Utah College of Nursing, United States
a r t i c l e
i n f o
Article history:
Received 10 October 2009 Received in revised form 17 December 2010 Accepted 16 January 2011 Keywords: Informatics Education Nursing Internationality Nursing
a b s t r a c t
Purpose:In today’s workplace, nurses are highly skilled professionals possessing expertise in both information technology and nursing. Nursing informatics competencies are recognized as an important capability of nurses. No established guidelines existed for nurses in Asia. This study focused on identifying the nursing informatics competencies required of nurses in Taiwan.
Methods:A modified Web-based Delphi method was used for two expert groups in nursing, educators and administrators. Experts responded to 323 items on the Nursing Informatics Competencies Questionnaire, modified from the initial work of Staggers, Gassert and Curran to include 45 additional items. Three Web-based Delphi rounds were conducted. Analysis included detailed item analysis. Competencies that met 60% or greater agreement of item importance and appropriate level of nursing practice were included.
Results: N= 32 experts agreed to participate in Round 1, 23 nursing educators and 9 admin-istrators. The participation rates for Rounds 2 and 3 = 68.8%. By Round 3, 318 of 323 nursing informatics competencies achieved required consensus levels. Of the new competencies, 42 of 45 were validated. A high degree of agreement existed for specific nursing informatics competencies required for nurses in Taiwan (97.8%).
Conclusions:This study provides a current master list of nursing informatics competency requirements for nurses at four levels in the U.S. and Taiwan. The results are very similar to the original work of Staggers et al. The results have international relevance because of the global importance of information technology for the nursing profession.
© 2011 Elsevier Ireland Ltd. All rights reserved.
1.
Introduction
Nurses must exploit information technology, especially clin-ical technology, to function in contemporary health care settings worldwide. Information technology has the potential to facilitate nursing care delivery by increasing time spent in direct patient care[1,2], improving decision making, reducing
duplicate work, decreasing error[3,4], and minimizing time
∗Corresponding author at: University of Utah College of Nursing, 10 S 2000 East Salt Lake City, UT 84112-5880, United States.
Tel.: +1 801 585 9740.
E-mail address:mollie.poynton@nurs.utah.edu(M.R. Poynton).
spent on documentation[1]. Recent publications identified
unintended consequences of applications such as provider order entry[5–8]and the lack of sufficient cognitive support in existing clinical systems[9]. Nevertheless, information tech-nology will increase its penetration into health care settings even with current drawbacks. The fact is that nurses in all spe-cialties and roles must have the knowledge and skills to use
information technology[10–12]. Informatics competencies are
a global imperative for nurses.
1386-5056/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2011.01.011
The identification of specific informatics competencies for nurses has been a topic of keen interest during recent years. Researchers and nurses in professional organizations completed substantial work toward defining nursing
infor-matics competencies[11,13–22]. Researchers in Australia are
currently identifying national information technology and
information management competencies for nurses[10]. The
Technology Informatics Guiding Educational Reform (TIGER) initiative released a list of informatics competencies for
prac-ticing nurses in the U.S. in late 2009 [23], adopting the
European Computer Driving License. This is a computer liter-acy certification program offered, for payment, by the Council
of the European Professional Informatics Societies[24]. The
International Medical Informatics Association (IMIA) devel-oped recommendations for educating health informaticists, including nurse specialists, first in 1999[25]and provided an updated version in early 2010[22]. Despite this flurry of work, research to validate the disparate lists of informatics compe-tencies is sparse. More informal consensus is the main method of competency development across groups. To date, the only existing informatics competencies formally validated is that identified by Staggers et al.[20]and the pending research in Australia.
In Asia, Yee described Singapore nurses’ needs in basic
and work-related information technology[21], and necessary
computer competencies for nurses in Taiwan[16]. Nursing
professionals in Taiwan faced rapid changes in information technology and they are adapting to these changes[26]. Jiang
and colleagues[16]called for Taiwanese nurse educators and
administrators to educate nursing students on computer com-petencies. No standards or guidelines exist relative to what broader nursing informatics competencies should be, making it difficult to design appropriate nursing curricula or provide competency guidelines to employers in Taiwan. To that end, the purpose of this research was to identify nurse educators’ and nurse administrators’ perceptions of informatics compe-tencies required of nurses in Taiwan.
2.
Background
2.1. Nursing informatics competencies
Research related to informatics competencies began soon after computers became available to nurses in the 1980s. By 1988, nurses in the International Medical Informatics Associ-ation and the NAssoci-ational League for Nursing developed the first informatics competencies, and other studies soon followed [27,28]. Unfortunately, the early lists of competencies[29,30] were not adopted into nursing curricula[20]. Moreover, these identified competencies described entry-level competencies such as computer skills for nurses, and not the more sophis-ticated informatics skills needed by experienced nurses and especially, informatics nurse specialists (INS).
Renewed interest in informatics competencies for nurses
began in the early 2000s. Staggers et al.[18–20]defined and
validated informatics competencies for nurses at four lev-els of practice: beginning, experienced, INS and informatics innovator. Subsequently, authors identified informatics
com-petencies for nurse practitioners [14], expanded beginning
nurse competencies to include the knowledge and skills for
evidenced-based practice[15], identified a need for computer
literacy as well as information literacy for undergraduate nurs-ing students, and identified self-reported informatics content
taught in undergraduate programs in the U.S.[31]. Authors
outlined informatics competencies needed for nursing prac-tice to improve patient safety and expand nursing pracprac-tice [13,32,33]as well as knowledge and skills in organizational and
human behavior such as project management[34].
Consensus efforts to define new nursing and general infor-matics competencies are underway. Nurses in the Technology Informatics Guiding Educational Reform (TIGER) initiative in the U.S. reviewed past competency work and adopted the European Computer Driving License certification for nurses’ basic computer skills[23,24]. This certification is offered inter-nationally for pay by the Council for European Informatics Societies. This organization also offers certification for various
information technology professionals[24]. Australian nurses
reported on a national effort to create information technology
and information management competencies for nurses[10].
Development methods were described at a conference in June 2009[10]; however, the results are not yet available. Hart[17] completed a systematic review of existing informatics com-petencies in 2008, recommending that administrators shift from competencies creation to implementing existing com-petencies in work settings[20]. In 2009, nursing graduates at one U.S. institution reported moderate information technol-ogy skills with their priority educational need identified as exposure to the latest informatics systems[35]. Most recently, IMIA released a set of educational guidelines for informatics professionals in early 2010.
In summary, the work on competencies is flourishing. It expanded from a beginning focus on education to initial practice requirements including competencies for safe nurs-ing practice; however, the majority of work centers on the educational arena. Informatics competency determinations
in work settings lag behind curriculum development[17,20].
Although competencies lists are developed by IMIA, and orga-nizations in the U.S. and Australia, no current, consolidated, research-based list of competencies exists across informatics organizations or authors.
2.2. Nursing informatics in Taiwan
There is extensive use of clinical information systems in Taiwan. Most medical centers and large hospitals have installed improved information technology equipment and designed hospital information systems to provide high-quality health services. Available functions include nursing assessment, nursing diagnosis, nursing care plan, patient classification, and nursing care activities associated with finance, management, coordination, and multidisciplinary tasks[36]. A lack of research about nursing informatics com-petencies in clinical and education settings exists for nurses in Taiwan. Only one study identifying needed competencies exists for nurses in Taiwan and that work concentrated on domains of computer competencies across educational
pro-grams [16]. A master list of informatics competencies for
nurses in Taiwan is needed. To that end, the current study built on a previous study by Staggers et al.[20]and identified
Fig. 1 – Information Management Framework. From Staggers et al.[20]. Reprinted by permission.
nursing informatics competencies required by nurses in their practice.
2.3. Conceptual Framework for the Study
The concepts in this information management framework[20]
were synthesized from diverse sources of nursing and infor-mation systems literature with informatics competencies as the key concept of the framework. Informatics competencies along with human information processing skills comprise the overall construct of information management competencies. Three components of informatics competencies (computer skills, informatics knowledge, and informatics skills) are inter-dependent and of equal importance. The highlighted elements are the focus in this study (seeFig. 1).
3.
Methods
This study was approved by the Institutional Review Board of the University of Utah.
3.1. Sample
Purposeful sampling and snowball sampling were employed to identify expert nurse educators and administrators from 39 nursing schools and 15 medical centers/hospitals in Taiwan. Experts were chosen for their expertise in nursing, not the specialty area of nursing informatics, because Taiwan has few nursing informatics specialists. Potential experts meet-ing selection criteria were identified in databases of Taiwan’s Ministry of Education and Department of Health, and invited to participate. They were also asked to suggest other poten-tial experts for participation. Three criteria were employed in selection: (a) job position, (b) educational requirements, and (c) work experience in nursing. Informed consent was obtained from each participant electronically.
3.2. Instrumentation
The Delphi instrument used in this study, the Nursing Infor-matics Competencies Questionnaire (NICQ), was developed
from two sources: (a) the nursing informatics competencies for four levels of nursing identified by Staggers et al.[20]and (b) 45 added-item competencies derived from an updated liter-ature review that achieved a 75% or greater agreement of item importance in an expert panel. The original questionnaire developed by Staggers, Gassert and Curran included 281 com-petencies. After a review of the literature from 1998 to 2004, 56 potential additional competencies were identified. These competencies were assigned to one of three major classifica-tions: (a) computer skills – 14 items, (b) informatics knowledge – 26 items, (c) informatics skills – 16 items into four levels of nursing practice. In addition, two new subcategories of infor-matics knowledge (evidence-based and information literacy) were added. All candidate items were evaluated for relevance by a convenience sample of five nursing informatics experts. Of the 56 added items competencies, 45 achieved a 75% or greater agreement of item importance. One item was deleted due to duplication. In addition, six items were moved from
Level 2 to Level 1 with 75% agreement.Table 1presents the
changed and added items. The new questionnaire, the Nursing Informatics Competencies Questionnaire (NICQ), consisted of 323 competencies, including a rating scale and three domains groups: (a) computer skills, (b) informatics knowledge, and (c) informatics skills in four levels of nursing practice (begin-ning nurse, the experienced nurse, informatics specialist, and informatics innovator).
3.3. Delphi procedure
A three-round Delphi study was conducted to collect and refine group opinion on nursing informatics competencies in Taiwan using the NICQ. The three rounds were conducted in sequence, and Rounds 2 and 3 questionnaires were based on results of the previous round. A Web-based survey system was used to collect data.
General procedures.Each expert was sent the following by e-mail: (a) a URL for instructions and (b) a URL for accessing the demographic questionnaire and the Nursing Informatics Competencies Questionnaire. For each questionnaire, experts were asked to indicate: (a) the important of the competency using a 4-point Likert-type scale and (b) whether the item
Table 1 – New and changed items, revised from Staggers, Gassert, Curran questionnaire (Nursing Informatics
Competencies Questionnaire).a
Level 1 (Beginning Nurse)
Uses decision support systems, expert systems and other aids for clinical decision making and care planning Uses an application to enter patient data (e.g., vital signs,demographic and physiological data)a
Uses spreadsheet application, such as Microsoft Excel
Uses basic computer terminology, especially for help-line support Uses existing external peripheral devices (e.g., CD-ROMs,DVD, zip drives)a
Uses a variety of search tools
Recognizes when information is needed and communicates that need Understands the procedure of scholarly information
Understands the importance of organized collection of information
Understands the essentials of information sources such as a variable form, different characteristics, and various physical formats Understands and applies essential information-seeking concepts and practices
Recognizes need for continual learning informatics skills, applications, and knowledge
Applies the principles of data integrity, professional ethics and legal requirements for patient confidentiality and data security Maintains privacy and confidentiality in clinical log management
Analyzes patient information needs, accesses technology resources to meet needs and evaluates effectiveness Evaluates health information on the Internet using a structure critique format
Level 2 (Experienced Nurse)
Uses administrative applications for budget (cost-effectiveness, cost-benefit, and cost utility)a
Uses administrative applications for quality assurance data
Uses telecommunications to support care delivery, empowers the consumer, transforms education, and enhances decision making Understands how to manage the development of a patient-friendly Web site
Uses applications to aggregate and analyzes data for forecasting, accreditation, clinician value, nurse-sensitive outcomes, EBP, and quality improvement
Uses applications to format and present data and information
Identifies pertinent literature resources and incorporates into practice and professional development Understands the principles of data display to facilitate analysis
Is knowledgeable regarding optimal search strategies to locate clinically sound and useful studies from information resources Critically analyzes data, information, and knowledge for use in site specific evidence-based practice
Identifies, evaluates and applies the most relevant information Synthesizes best evidence
Develops and presents evidenced-based case presentations Synthesizes data from more than one source and applies to practice
Acknowledges that the research process in nonlinear and iterative and requires flexibility Acts as an advocate of system users including patient and colleagues
Helps patients and clinicians utilize online systems
Integrates technology into clinical practice by teaching patients about online databases, e.g., PubMed Assesses the accuracy (quality, accountability, reliability and validity) of health information on the Interneta
Participates in quality management initiatives related to patient and nursing data in practice Converts information needs into answerable questions
Uses data and statistical analyses to describe and evaluate practice Uses the clinical log to evaluate one’s own practice against EBP standards Incorporates structured language into practice
Utilizes appropriate structured languages in the clinical log, e.g., ICD coding, nursing terminology, etc.
Generates/requests a custom report from existing database. Analyzes the data and applies the finding appropriately Demonstrates knowledge and clinical decision making processes within site specific practice
Evaluates the appropriateness of the monitoring systems for the type of data needed Converts data into information and the knowledge
Level 3 (Informatics Specialist) (No new or changed items) Level 4 (Informatics Innovator)
Analyzes information to generate new knowledge
a Italicized text indicates change to existing item.
was placed within the correct level of nursing practice. If they disagreed with the level, experts gave the correct place-ment. Finally, each questionnaire included an open-ended question asking the nurse educators and administrators to briefly describe any additional nursing informatics compe-tencies that should be considered for inclusion. Experts were asked to complete questionnaires within 2 weeks. Follow-up e-mail messages were sent to experts who did not finish the
questionnaires within 2 weeks.
Round 1.The criteria used to establish consensus on items in Rounds 1–3 was 60% or greater agreement.
Round 2.The Round 2 questionnaire included only compe-tencies that did not achieve consensus in Round 1. In addition, the following information from Round 1 was provided: (a) the frequencies and percentages for items below agreement and (b) the individual expert’s responses for each competency.
Table 2 – Item agreement for items not achieving consensus, Rounds 1–3.
Category Agreement of item importance Agreement of appropriate level
Round 1 Round 2 Round 3 Round 1 Round 2 Round 3
Level 1: Beginning Nurses
10. Uses decision support systems, expert systems and other aids for clinical decision making and care planning
50% 54% 50% 54% 41% 50%
20. Uses basic computer terminology, especially for help-line support
57% 94% 94% 90%
24. Uses existing external peripheral devices (e.g., CD-ROMs, DVD, zip drives)
52% 81% 81% 82%
29. Uses a variety of search tools 57% 73% 73% 86% 32. Understands the procedure of
scholarly information
51% 45% 45% 64%
34. Understands the essentials of information sources such as a variable form, different characteristics, and various physical formats
47% 38% 59% 38% 73% 68%
48. Explains the use of networks for electronic communication (e.g., Internet)
47% 62% 41% 62% 86% 73%
49. Identifies the basic components of the current computer system (e.g., features of a PC, workstation)
47% 59% 64% 59% 77% 81%
Added item: Searches medical dictionary, pharmacy information and health information via Interneta
– 91% – – 91% –
Added item: Presents data analysis and statistical capabilitya
– 62% – – 62% –
Level 2: Experienced Nurses
99. Markets self, system, or application to others
41% 70% – 70% 55% –
101. Performs basic trouble-shooting in applications
55% 55% – 55% 71% –
Level 3: Informatics Specialists 180. Serves as a liaison among agency
departments and vendors
52% 79% 57% 79% 82% 81%
a Added-item competency.
Added-item competencies submitted in Round 1 were also included. Each expert was asked to reassess his or her ratings based on the whole group’s response.
Round 3.The final questionnaire included only competen-cies that did not achieve consensus in Round 2. Frequencompeten-cies and percentages below the agreement level and experts’ responses for each competency were again provided and experts were asked to reassess their ratings based on the whole group’s response.
4.
Results
4.1. Demographics
Of the 91 potential experts willing to participate, 32 (35.2%) qualified experts agreed to participate and completed Round 1. The sample consisted of 23 nursing educators and 9 nursing administrators, from a variety of institutions within Taiwan.
Nursing educators.The nursing educators were all female with the majority (65.2%) between 41 and 50 years of age. The modal educational level was a master’s degree.
The nursing educators’ areas of expertise included 11 medical–surgical (47.8%), 2 maternal–child (8.7%), 2 admin-istration/management area (8.7%), 2 mental health, and 5 community health (8.7%). “Other” expertise consisted of gerontology, nursing professional issues, hospice care, inten-sive care, nursing education, and long-term care (39.1%). The nursing educators reported a mean 18.7 years of experience in nursing, ranging from 10 to 30 years. The mean length of time nursing educators had been in their current nursing educa-tional experience was 14.3 years with a range of 1–24 years. As for type of nursing school, a majority (73.9%) were vocational schools, with most of the schools (69.6%) being private schools. Ten nursing educators were teaching in junior colleges (43.5%), 6 in colleges (26.1%), and 7 were in universities (30.4%). Nurs-ing educators reported 30.3 h of computer use every week. All used information systems in their institutions.
Nursing administrators.Most of the nursing administrators were female (88.9%). Four were 41–50, 3 were 31–40, and 2 were 51–60 years old. Eight of the 9 held a master’s degree. Areas of expertise among nursing administrators included 5 surgi-cal (55.6%), 4 medisurgi-cal (44.4%), 4 administration/management (44.4%), 1 maternal–child (11.1%), 1 oncology (11.1%), and
Table 3 – Group differences in agreement: educators vs. administrators.
Competency Item importance Appropriate level
Round 1N= 32 Round 2N=22 Round 3N=22 Round 1N= 32 Round 2N= 22 Round 3N= 22
Uses an application to document patient care
.06* – – 1.00 – –
Demonstrates basic technology skills (e.g., turn computer off and on, load paper, change toner, remove paper jams, print documents)
.07* – – 1.00 – –
Describes patients’ rights as they pertain to computerized information management
.06* – – .38 – –
Uses decision support systems, expert systems and other aids for clinical decision making and care planning
.44 .06* 1.00 .26 .26 1.00
Is able to navigate Windows (e.g., manipulate files using file manager, determine active printer, access installed applications, create and delete directories)
.56 – – .06* – –
Recognizes that one does not have to be a computer programmer to make effective use of the computer in nursing
.60 – – .07* – –
Assesses the accuracy (quality, accountability, reliability and validity) of health information on the Internet
.42 – – .03** – –
Determines the limitations, reliability of computerized patient monitoring systems
1.00 – – .05* – –
Determines priorities for new requirements within budget constraints
1.00 – – .06* – –
Uses a variety of search tools 1.00 .29 – .65 .07* –
∗ p< .1. ∗∗ p< .05.
1 community health (11.1%). “Other” expertise consisted of anesthesia and intensive care (33.3%). The nursing admin-istrators reported an average of 17.9 years of experience in nursing, ranging form a low of 9.6 years, claimed by 1 expert, to a high of 35 years. The average length of time nursing admin-istrators had been in their current nursing administrational experience was 13 years with a minimum of 1 year and a maxi-mum of 20 years; a majority (55.7%) worked in private medical centers. The nursing administrators reported an average of 35.1 h of computer use every week. All reported that they used an information system in their institution. Twenty-two (68.8%) of the initial participants completed Rounds 2 and 3.
4.2. Round 1 results
In this round, 312 competencies (96.6%) achieved a 60% or
greater agreement of item importance. Many items (n= 164)
resulted in 90–100% agreement in the first round. Eleven competencies achieved less than 60% agreement of item importance. Of these 11 competencies, 6 competencies achieved 60% or greater agreement on appropriate level of nursing practice (uses basic computer terminology, especially for help-line support; uses existing external peripheral devices [e.g., CD-ROMs, DVD, zip drives]; uses a variety of search tools; explains the use of networks for electronic
communi-cation [e.g., Internet]; markets self, system or applicommuni-cation to others; and serves as a liaison among agency departments and vendors). Another five competencies did not achieve 60% or greater agreement of appropriate level of nursing prac-tice (“uses decision support systems,” “expert systems and other aids for clinical decision making and care planning;” “understands the procedure of scholarly information;” “under-stands the essentials of information sources such as a variable form, different characteristics, and various physical formats;” “identifies the basic components of the current computer sys-tem [e.g., features of a PC, workstation];” and “performs basic trouble-shooting in applications”). Round by round agree-ment on items not achieving the 60% criteria for consensus
is detailed in Table 2. Two additional competencies were
suggested by one participant (“searches medical dictionary, pharmacy information and health information via Internet” and “presents data analysis and statistical capability”). These two competencies were added to the Round 2 questionnaire.
4.3. Round 2 results
Twenty-two nursing experts completed this round, a response rate of 68.8% (22 of 32). The Round 2 questionnaire was 13 items: 11 items that nursing experts previously rated but did not achieve consensus, along with two additional items
suggested in Round 1. For item importance, 6 original com-petencies moved from less than 60% agreement to greater than 60% agreement for both importance and level of prac-tice, increasing the consensus percentage (318) from 96.6% to 98.5%. One of the six competencies that achieved consen-sus, “Markets self, system, or application to others”, achieved
consensus of itemnon-importance (68%), and was removed
from the Round 3 questionnaire. The two newly introduced competencies in Round 2 also achieved consensus for item importance and level of practice.
4.4. Round 3 results
All Round 2 participants completed Round 3. In Round 3, only one competency moved to greater than 60% agreement of item importance and appropriate level of nursing prac-tice, increasing the consensus percentage (318) from 97.5% to 97.8%. The competency, “identifies the basic components of the current computer system (e.g., features of a PC, work-station)”, achieved agreement for both item importance and appropriate level of practice.
After three rounds of Delphi questionnaires, four com-petencies were at less than 60% agreement about item importance (Table 2). In these four competencies, three com-petencies achieved 60% or greater agreement on appropriate level of nursing practice (“understands the essentials of information sources such as a variable form, different char-acteristics, and various physical formats”; “explains the use of networks for electronic communication [e.g., Internet]”; and “serves as a liaison among agency departments and vendors”). Another competency did not achieve 60% or greater agree-ment on appropriate level of nursing practice, “uses decision support systems, expert systems and other aids for clinical decision making and care planning.”
4.5. Group differences: educators versus administrators
A series of Fischer’s exact tests described group differences in agreement on item performance and level between educators and administrators. Statistically significant group differences in agreement were found in Rounds 1 and 2 for several items, though overall agreement usually met or exceed the 60%
cri-terion. These are summarized inTable 3.
5.
Discussion
At the end of three Web-based Delphi rounds, 318 of the original 323 nursing informatics competencies achieved con-sensus for both item importance and appropriate level of nursing practice. The level of consensus for these items (97.8%) is very high indicating that respondents agreed about the importance and level of informatics competencies required of Taiwanese nurses. The validated competencies comprise a master list of nursing informatics competencies that can be used to design and develop nursing informatics courses and training programs. Based on the similarity of our results to those of Staggers et al. [20] in their original U.S. study, nursing informatics competencies required of nursing
profes-sionals in Taiwan are similar to those required of U.S. nursing professionals. Therefore, this revised and updated list of com-petencies can be internationally accepted for use.
In this study, 42 new competencies were validated, adding to the master list of competencies identified by Staggers et al.[20]. These additional competencies reflect technologi-cal changes and newer technologies need in nursing. Both this study and the Staggers et al. study indicate a majority of com-petencies are for the nursing informatics specialist indicating that it continues to be important to develop educational pro-grams that prepare nursing informatics specialists. Currently, there are no master’s or PhD programs in nursing informatics in Taiwan. The results also indicate few significant differ-ences between nursing educators and administrators in their perception of nursing informatics competencies required of nurses in Taiwan.
The myriad efforts on developing nursing informatics competencies are beginning slowly to converge. The TIGER initiative in the U.S. adopted the European Computer Driver’s License as basic competencies for all nurses, creating consen-sus for nurses in these nations for basic nurse preparation in informatics. The current research updates and confirms the majority of earlier informatics competencies across four levels of nurses in both Taiwan and the U.S. Other authors expanded the original Staggers et al. informatics compe-tencies to specific groups, e.g., for nurse practitioners[17]
and student nurses [41]. Hart in 2008 called for an end
to developing unique lists of competencies and suggested redirecting energy into implementing existing informatics
competencies into settings [17]. While we agree that the
time for action is now; informatics competencies will con-tinue to evolve and require rethinking to be current and pertinent.
Nursing informatics competencies are critically necessary in health care delivery systems[37–39]. Several studies have connoted the impact information technology has had on
the nursing profession and nursing education[31,40–42]. In
the U.S., informatics is becoming an integral part of nurs-ing curricula at both the baccalaureate and graduate level [43,44]as nursing educators work to meet the requirements of the health care delivery systems in which nurses pro-vide care. In Taiwan, nursing informatics is a new nursing domain with only beginning integration into nursing
pro-gram models[45,46]. This study and previous work clearly
indicate that there are specific nursing informatics compe-tencies required of nurses that apply internationally, and should be used to guide nursing educational programming. The challenge of integrating informatics education to achieve competencies into existing nursing education programs is upon us.
Author contributions
Dr. Jieh Chang served as principal investigator of the study. She was supervised by Drs. Carole Gassert and Mollie Poyn-ton. Dr. Poynton also wrote portions of the current article, and prepared it for submission. Dr. Staggers led and conducted the original competencies research upon which this study was based, and wrote portions of the current article.
Summary points
Previously known about this topic
• Research-validated nursing informatics competencies were originally established by Staggers et al.[20]. • Consensus work on the topic is in progress in the U.S.
and Australia.
• No informatics competencies were available in Asia,
specifically in Taiwan to guide nursing education. This study
• Created the Nursing Informatics Competencies
Ques-tionnaire by updating the 2002 Staggers, Gassert, and Curran questionnaire with 45 new competencies.
• Found that 318 of 323 questionnaire items achieved
consensus for item relevance and appropriate level of nursing practice.
• Found that 42 of the 45newitems achieved consensus.
• Provides an international, master list of current infor-matics competencies for nursing.
Conflict of interest statement
The authors have not conflicts of interest to disclose.
Appendix A. Supplementary data
Supplementary data associated with this article can be found, in the online version, atdoi:10.1016/j.ijmedinf.2011.01.011.
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