The Australian Health Informatics Competency Framework: Conceptual Design, Framework Development, and Certification Delivery.

The Australian Health Informatics Competency Framework (AHICF) guides the healthcare workforce in identifying the required competencies to perform as a health informatician, and more definitively defines the foundational body of knowledge on which the discipline is based. The aim of this paper is to describe the conceptual foundations in developing the AHICF v1.0, detail the methods used to revise and publish AHICF v2.0, and explore the certification and workforce outcomes achieved. This paper contributes to the competency framework and certification discourse, and knowledge of the increasing importance and recognition of health informaticians through certification. Further, implications for workforce training and education, career advancement and recruitment strategies, are also discussed.

An Exploration of the Certified Health Informatician Australasia (CHIA) Participants.

The Certified Health Informatician Australasian (CHIA) is an assessment of a candidate's capabilities measured using a core set of health informatics competencies. The aim of this paper is to describe the outcomes of the first eight years since the program's launch. This paper contributes to the competency framework and certification discourse, and knowledge of the increasing importance and recognition of health informaticians through certification. An analysis of results and possible contributing factors is discussed.

Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics: Second Revision.

BACKGROUND: The purpose of educational recommendations is to assist in establishing courses and programs in a discipline, to further develop existing educational activities in the various nations, and to support international initiatives for collaboration and sharing of courseware. The International Medical Informatics Association (IMIA) has published two versions of its international recommendations in biomedical and health informatics (BMHI) education, initially in 2000 and revised in 2010. Given the recent changes to the science, technology, the needs of the healthcare systems, and the workforce of BMHI, a revision of the recommendations is necessary. OBJECTIVE: The aim of these updated recommendations is to support educators in developing BMHI curricula at different education levels, to identify essential skills and competencies for certification of healthcare professionals and those working in the field of BMHI, to provide a tool for evaluators of academic BMHI programs to compare and accredit the quality of delivered programs, and to motivate universities, organizations, and health authorities to recognize the need for establishing and further developing BMHI educational programs. METHOD: An IMIA taskforce, established in 2017, updated the recommendations. The taskforce included representatives from all IMIA regions, with several having been involved in the development of the previous version. Workshops were held at different IMIA conferences, and an international Delphi study was performed to collect expert input on new and revised competencies. RESULTS: Recommendations are provided for courses/course tracks in BMHI as part of educational programs in biomedical and health sciences, health information management, and informatics/computer science, as well as for dedicated programs in BMHI (leading to bachelor's, master's, or doctoral degree). The educational needs are described for the roles of BMHI user, BMHI generalist, and BMHI specialist across six domain areas - BMHI core principles; health sciences and services; computer, data and information sciences; social and behavioral sciences; management science; and BMHI specialization. Furthermore, recommendations are provided for dedicated educational programs in BMHI at the level of bachelor's, master's, and doctoral degrees. These are the mainstream academic programs in BMHI. In addition, recommendations for continuing education, certification, and accreditation procedures are provided. CONCLUSION: The IMIA recommendations reflect societal changes related to globalization, digitalization, and digital transformation in general and in healthcare specifically, and center on educational needs for the healthcare workforce, computer scientists, and decision makers to acquire BMHI knowledge and skills at various levels. To support education in BMHI, IMIA offers accreditation of quality BMHI education programs. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

Clinician Engagement in Quality: A Literature Review.

BACKGROUND AND OBJECTIVES: Defining quality in the health care context has proven difficult, with many organizations not able to clearly articulate their use of this term in a manner that is easily understood by their clinical staff. This review seeks to investigate the literature to explore clinician engagement in quality including where engagement has been problematic, and if the reasons for this have been identified. METHODS: An integrative review of the literature was undertaken to determine whether evidence within the literature supports a hypothesis that there is a lack of understanding of and engagement in quality at an organizational level by health professionals. A search of the literature was conducted using EBSCO Academic Complete, CINAHL, and MEDLINE databases. RESULTS: This article identified 18 studies where the understanding of quality by clinicians and their level of engagement with the process are investigated. We found that there has been no comprehensive study that explores the development of an agreed-upon definition and measurement of quality or clinician understanding and engagement in quality. The studies conducted have been small and discipline-specific. CONCLUSION: There is a growing body of evidence indicating that clinical and nonclinical staff interpret the meaning of quality and quality improvement differently. Quality and quality improvement are interpreted in relation to the clinician's individual work, professional, and learning and development experience. The literature suggests that clinician interpretation is influenced in part by their own personal beliefs and values, in addition to their interpretation of their individual work/professional responsibilities.

Does nurses' health affect their intention to remain in their current position?

AIM: To investigate and describe nurses' and midwives' physical health, rates of symptoms and disease, and to determine if these factors contribute to intention to leave. BACKGROUND: The nursing and midwifery workforce is ageing yet little is known about their physical health or its relationship to intention to leave. METHODS: An online survey of health and work-related assessments was distributed through the New South Wales Nurses and Midwives Association and professional contacts. RESULTS: Nurses and midwives (n = 5041) reported good-very good health overall. With 22.2% intending to leave in the next 12 months, older age, better perceived health and job satisfaction, regional residence and not working shifts predicted no intention to leave while breathing problems predicted intention to leave. CONCLUSIONS: Study findings flag the importance of health as an influence on intention to leave. Alongside job satisfaction and shift-working, health presents opportunities for workplace initiatives to maintain nurses in the workforce. IMPLICATIONS FOR NURSING MANAGEMENT: Educators, managers and policy makers should heed the significant influence of health for retention of staff and consider what strategies may mitigate health risks for this workforce.

Cancer patient experience measures: An evidence review.

OBJECTIVES: This research investigates the instruments currently available to measure the cancer patient experience of health care. An investigation of the number of instruments, the domains covered by the instruments, and the structure and psychometric performance of instruments is undertaken. METHODS: A narrative synthesis approach is used to gather evidence from multiple studies and explain the findings. Purposely broad search terms and strategies are used to capture studies with cancer patients at all stages of disease and across a range of cancer types and health care settings. RESULTS: The majority of identified instruments were originally designed for the oncology field. Twelve of the studies developed new cancer patient measures; eight studies adapted existing or utilized items from existing instruments, and seven studies assessed the psychometric properties of existing instruments or assessed validated tools under different conditions (e.g., cross-cultural adaptation). The number of instruments assessing cancer patient experience that have sound psychometric properties across items was found to be low. The properties least tested are test-retest reliability, construct, convergent and discriminant validity, scale variability (floor/ceiling effects), and interpretability. CONCLUSION: This review examined 10 years of research on the development of instruments to measure the cancer patient experience of health care. It found that research in this area is still in early stages of development. Further inquiry based on development and validation of cancer patient experience measures is required to support improvements in cancer care based on the perspective of cancer patients.

Why older nurses leave the workforce and the implications of them staying.

AIMS AND OBJECTIVES: To identify factors that motivate older nurses to leave the workforce. BACKGROUND: As many older nurses are now reaching retirement age and will be eligible for government-funded pensions, governments are concerned about the impending financial burden. To prepare for this scenario, many are looking at increasing the age of retirement to 67 or 70 years. Little is known about how this will affect the continuing employment of older nurses and the consequences for employers and the nurses themselves if they remain longer in the workforce. DESIGN: Prospective randomised quantitative survey study. METHODS: The Mature Age Workers Questionnaire, Job Descriptive Index and Job in General Scale were used to measure job satisfaction, intention to retire and factors encouraging retirement in registered nurses aged 45 years and over (n = 352) in Australia (July-August 2007). RESULTS: There were 319 respondents. The mean age proposed for leaving the workforce was 61·7 years. Key motivators were: financial considerations (40·1%), primarily financial security; nurse health (17·4%) and retirement age of partner (13·3%). CONCLUSIONS: Older nurses are leaving the workforce prior to retirement or pension age, primarily for financial, social and health reasons, taking with them significant experience and knowledge. As financial considerations are important in older nurses decisions to continue to work, increasing the age of retirement may retain them. However, consideration will need to be given to ensure that they continue to experience job satisfaction and are physically and mentally able to undertake demanding work. RELEVANCE TO CLINICAL PRACTICE: Increasing retirement age may retain older nurses in the workforce, however, the impact on the health of older nurses is not known, nor is the impact for employers of older nurses continuing to work known. Employers must facilitate workplace changes to accommodate older nurses.

Why do older RNs keep working?

OBJECTIVE: To identify the reasons older RNs (≥45 years) remain in the healthcare workforce. BACKGROUND: Despite predictions of early retirements of older nurses, many continue to work past the age when they can gain access to their retirement funds. METHODS: The authors surveyed nurses older than 45 years in New South Wales, Australia. RESULTS: The need for income was the most common reason for staying in nursing (61.9%; n = 210), with nearly 43% (n = 130) identifying this as the main reason for staying. CONCLUSIONS: Retaining older nurses in the workforce is an important strategy for managing workforce shortages. Nurse executives will need to consider strategies that will enhance retention of older nurses and focus on the reasons older nurses want to keep working.

Health information systems and improved patient outcomes: do nurses see the connection?

A major focus of nurses is to improve patient outcomes, and any introduction of technology into their work environment should add value through enhancing patient care and contributing to the development of nursing intelligence. This study addressed whether nurses working in an emergency department (ED) perceived a relationship between using an emergency department information system (EDIS) and patient outcomes. A cross-sectional survey design was used, with data collected from the population (n=168) of nurses from five Australian metropolitan public hospital emergency departments (EDs). The questionnaire collected information on how EDIS impacted on patient outcomes in terms of waiting times, triage process, departmental accountability, documentation focus, computer interaction, and system purpose. Nurses acknowledged the value of an information system in improving the triage process and increasing the accountability of the ED, however failed to identify any impact on reducing overall ED waiting times or its relationship to improved care delivery. Over half the respondents could not identify negative effects such as compelling nurses to focus on documentation details or 'treat the computer' rather than the patient. The use of technology in this study evoked optimistic responses, however results indicated a lack of clarity about the impact of EDIS on patient outcomes.