The Psychometric Properties of Version 2 of the Canadian Nurse Informatics Competency Assessment Scale.

In 2020, we conducted a mixed methods study comprised of a cross-sectional survey in which we applied a modified version of the 21-item Canadian Nurse Informatics Competency Assessment Scale and one-on-one interviews to explore self-perceived nursing informatics competency and readiness for future digital health practice. A total of 221 senior-level students in BScN programs in western Canada participated. This article reports on results related to the factor structure and internal consistency reliability of the 26-item (version 2) of the Canadian Nurse Informatics Competency Assessment Scale. Exploratory principal component analysis with the varimax rotation revealed a four-component structure, explaining 55.10% of the variance. All items on the Canadian Nurse Informatics Competency Assessment Scale 2 had good loadings, except item 7, which did not load to any domain but was retained based on an evaluation of the α value and item relevance to nursing practice. A few items shifted to different domains. The overall reliability of the Canadian Nurse Informatics Competency Assessment Scale 2 was ( α = .916) and its subscales: information and knowledge management ( α = .814), professional and regulatory accountability ( α = .741), and use of information and communication technology ( α = .895). This study provided preliminary evidence for the factor structure and reliability of the Canadian Nurse Informatics Competency Assessment Scale 2 among nursing students. Further testing is recommended.

Digital and informatics competencies: Requirements for nursing leaders in Canada.

The use of health information technologies continues to grow, especially with the increase in virtual care in response to COVID-19. As the largest health professional group in Canada, nurses are key stakeholders and their active engagement is essential for the meaningful adoption and use of digital health technologies to support patient care. Nurse leaders in particular are uniquely positioned to inform key technology decisions; therefore, enhancing their informatics capacity is paramount to the success of digital health initiatives and investments. The purpose of this commentary is to reflect on current projects relevant to the development of informatics competencies for nurse leaders in the Canadian context and offer our perspectives on ways to enhance current and future nurse leaders' readiness for participation in digital health initiatives. Addressing the digital health knowledge and abilities of nurse leaders will improve their capacity to champion and lead transformative health system changes through digital innovation.

The relation of critical care nurses' information-seeking behaviour with perception of personal control, training, and non-routineness of the task.

AIMS: The purpose of the study was to examine the relationship between (1) critical care nurses' information-seeking behaviour and the non-routineness of tasks; and (2) the extent to which nurses' perception of their problem-solving abilities when completing patient care tasks, moderate the relationship between information-seeking behaviour and non-routineness of tasks. METHODS: A cross-sectional survey design was used. A random sample (n = 177) of critical care nurses working in hospital settings was selected from the College of Nurses of Ontario (CNO) database. Descriptive statistics and multiple regression were used to analyze the data. RESULTS: Previous information-seeking training (p = 0.008), non-routineness of the task (p = 0.018), and the perception of the problem-solving ability domain of personal control (p = 0.040) had positive relationships with information-seeking behaviour. CONCLUSIONS: The development of problem-solving skills such as personal control, in addition to information-seeking training is essential so critical care nurses will have the skills to aid their information needs when faced with the completion of non-routine tasks.

Evaluating nurses' use of HOBIC in home care.

Health Outcomes for Better Information and Care (HOBIC), a program funded by the Ontario Ministry of Health and Long-Term Care, introduces a collection of evidence-based clinical outcome measures reflective of nursing care. The authors report on an evaluation of the experiences of nurse early adopters of HOBIC in home care. The findings reveal challenges and nuances associated with the introduction of HOBIC and the use of supporting technologies in the delivery of home nursing care. Future implementation efforts should focus on optimizing the usability of technology and the usefulness of HOBIC in nursing practice. In addition, efforts need to be directed at supporting the full integration and use of HOBIC outcome data by nurses and management personnel to inform practice directions.

Digital health education and training for undergraduate and graduate nursing students: a scoping review protocol.

OBJECTIVE: The objective of this review is to collate and analyze literature reporting on digital health education and training courses, or other pedagogical interventions, for nursing students at the undergraduate and graduate level to identify gaps and inform the development of future educational interventions. INTRODUCTION: In this era of technology-driven health care, upskilling and/or reskilling the nursing workforce is urgently needed for nurses to lead the digital health future and improve patient care. While informatics competency frameworks serve to inform nursing education and practice, they do not address the entire digital health spectrum. INCLUSION CRITERIA: This review will include research studies, theoretical/discussion papers, and reports, as well as gray literature from relevant sources published in the last 10 years. Opinion pieces, editorials, conference proceedings, and papers published in languages other than English will be excluded. METHODS: The JBI methodology for scoping reviews will be followed. Searches will be conducted in Embase, CINAHL, ERIC, MEDLINE, Scopus, and Education Research Complete to retrieve potentially relevant studies. Hand searches of reference lists of included studies will be conducted. Two reviewers will independently screen records against predefined eligibility criteria and consult a third reviewer if conflicts arise. Decisions will be documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Quantitative data will be analyzed using descriptive statistics. Content analysis will be applied to qualitative data to identify categories and themes. Findings will be synthesized and reported in tables and narrative format. REVIEW REGISTRATION NUMBER: Open Science Framework osf.io/42eug.

Citizen perspectives on the future of healthcare.

The Citizen's Reference Panel was created to engage the people of Ontario in a dialogue about the directions for the future sustainability of healthcare. The primary concerns raised during the course of the panellists' deliberations included the need to (1) create a much closer integration of the health system's many providers and institutions, (2) accelerate the deployment of e-health solutions across the health system and (3) continue to focus on improving access to care, especially primary care and expanded community care services to reduce the pressure on institutional care.

Are Future Nurses Ready for Digital Health?: Informatics Competency Baseline Assessment.

BACKGROUND: Research continues to show significant gaps in nursing graduates' preparedness in digital health. PURPOSE: The aim of this study was to explore nursing students' self-perceived nursing informatics competency and preparedness in digital health, describe learning opportunities available, and identify perceived learning barriers and facilitators to developing informatics competency. METHODS: A sequential mixed-methods design, using a cross-sectional survey and interviews, was used. Senior undergraduate students (n = 221) in BScN programs in a Western Canadian Province participated. RESULTS: Participants self-reported being somewhat competent in nursing informatics. Three themes were identified: struggling to make sense of informatics nursing practice; learning experiences; and preparedness for future practice. CONCLUSION: Addressing inconsistencies in informatics education is an urgent priority so that nursing graduates are competent upon joining the workforce. Implications for nursing education, practice, and policy are discussed.

We Need Not Wait to See What Others Do.

In the last issue of the Canadian Journal of Nursing Leadership, authors provided numerous examples of nurse leaders making efforts to address the mental health of nurses in the midst of the pandemic. I personally thank guest editor Joan Almost for leading the collation of the issue and the authors who took the time to share their strategies and learnings. Unfortunately, we are not out of the woods yet, and I hope this collection of papers will continue to provide guidance to our readers for many months to come.

The Dawning of a New Era of Leadership.

This is the final issue of the Canadian Journal of Nursing Leadership (CJNL) for 2021, and the final issue for this editor-in-chief. It is with some reluctance that I step away from this role, but I am a firm believer in knowing when your expiry date is pending. When I took over CJNL from Dorothy Pringle in 2010, the task seemed daunting - what big shoes I had to fill - and almost immediately, imposter syndrome took hold of my psyche. But clearly, I forged ahead, and more than 10 years later, I have reflected on my editorial tenure, but more about that later.

Time to Adjust the Sails.

After a year of living a masked, isolated, virtual existence, there is much reflection among healthcare decision makers and providers around the world. What have we done well? What could we have done better? And more importantly, how will we ensure that our learnings inform decisions and actions the next time? In this latest installment of crisis leadership papers, authors address the toll exacted upon our profession thus far. Although profound, the psychological sequelae of the COVID-19 pandemic are directly related to a number of pre-existing conditions that have been festering below the surface for several years. In particular, blame for the state of health inequities, ageism, staff shortages and workplace violence cannot be ascribed to the pandemic. Rather, each has been exacerbated because of it.

A Cockeyed Optimist.

In the 1958 musical South Pacific, the character Nelly Forbush trills a song of optimism and hope amid the darkness of World War II (South Pacific Enterprises and Logan 1958). The chipper message of this fictional navy nurse might well be welcome amid the negative timbre of the pervasive political, cultural and societal upheaval that we are experiencing today - not to mention the burden of a global pandemic. The tune delivers the message of a so-called "cockeyed optimist," staying positive while many are not and being buoyed by the anticipation of brighter, sunny days ahead (South Pacific Enterprises and Logan 1958). COVID-19 has unloaded countless blows to virtually every aspect of the life we once knew; surely, this is enough to leave any cockeyed optimist reeling. Where do we find the strength of character to prevail during times like this? Somehow, good leaders do; finding creativity, courage and conviction to make the most of a bad situation, they rise above it. They show optimism in the face of fear, the unknown and circumstances beyond their control. Instilling abiding trust in their followers, they lead out of the abyss, shining light on new possibilities and opportunities.

Creating a Silver Linings Playbook.

The intensity of the COVID-19 pandemic has tested the mettle of political, healthcare and public health leaders over the past year. Amid the unfolding events, healthcare leaders, including many nurses, have been pivoting, innovating, collaborating, safeguarding, inspiring and navigating - all the while informing the creation of an effective playbook to wage a counterassault for all of us. Despite all efforts, this previously unseen opponent has been unrelenting. Having been in the eye of the storm during the severe acute respiratory syndrome (SARS) outbreak, my memories of the events remain vivid. It was a time rife with uncertainty and fear, forcing the creation of a playbook on the basis of the best evidence and common sense but without the benefit of a precedent. Over the course of several months, our leadership was challenged by efforts to contain the virus and mitigate the very real possibility of a globally emerging pandemic. However, SARS was but a microcosm of the present situation. The COVID-19 pandemic is not like any other crisis we have experienced in our collective lifetime. We can only imagine the toll of this pandemic when it is finally over. It will be measured in terms of post-pandemic posttraumatic stress disorder, deaths from COVID-19 and delayed care, and deaths by suicide among healthcare workers and citizens; in the end, it will not be trivial. Those contributing to the COVID-19 playbook have given their all, and we should be eternally grateful to every single one of them.

What Do We Need to Do Now?

Over the past few months, in a world closed to face-to-face service delivery and social interaction, we have adapted and, for the most part, realized the importance of being apart to keep us all safe. In the face of the pandemic, we saw emergency department (ED) visits and hospitalizations for all but the most urgent injuries and illnesses drop dramatically. The number of people who failed to seek timely treatment because of fear of exposure to the contagion will never be known. But this also raises the question of how the thousands of non-emergent cases seeking care in Canada's EDs in pre-pandemic times have managed over these past months. Has anyone realized that once and for all, policy needs to mandate changes to ensure appropriate ED utilization?

Standardizing nursing information in Canada for inclusion in electronic health records: C-HOBIC.

The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project introduced systematic use of standardized clinical nursing terminology for patient assessments. Implemented so far in three Canadian provinces, C-HOBIC comprises an innovative model for large-scale capture of standardized nursing-sensitive clinical outcomes data within electronic health records (EHRs). To support this activity, nursing assessment and outcomes concepts were mapped to the International Classification for Nursing Practice (ICNP(R)). By comparing serial data on a patient across multiple time points, the C-HOBIC model can generate nursing-sensitive patient outcome reports. A principle benefit of the C-HOBIC model is that it provides nurses with information critical to planning for and evaluating patient care. Inclusion of nursing information in either provincial databases or EHRs in three Canadian provinces promotes continuity of patient care across sectors of the healthcare systems in those provinces and also facilitates aggregation and analysis by administrators and policy makers. The C-HOBIC model provides standardized, consistent, interoperable clinical information that reflects nursing practice throughout the Canadian healthcare System.

Moving to a culture of nurse as knowledge worker and a new way of knowing in nursing.

In this paper, the authors speculate on the future of nursing practice as it will be informed by emerging technologies for the management of clinical information and knowledge and the generation of new understandings. It is postulated that without a concomitant effort to transform nursing practice, the fulsome benefits of electronic health records and associated tools will not be realized for nurses, other clinicians and patients. The path to creating a nursing practice culture of integrated knowledge management necessitates new thinking about clinical care delivery and an expansion of the ways of knowing in nursing. For the purpose of this paper, clinical practice transformation is defined as: moving beyond the form and function of nursing practice as we know it today by boldly advancing the redesign of clinical processes and being open to emerging transformative possibilities within society and healthcare through the use of technology.

Live Until You Die.

Amid the profile of Medical Assistance in Dying (MAID) and a prevailing interest to support living until death, discussions of appropriate care and care settings for dying abound. The when and how of easing the passage from this corporeal being to a state of other being, whatever you believe that to be, has been focal in healthcare discussions in recent years. I remember a time when the notion of "palliative care" was somewhat novel, in later years when a family member was the recipient of excellent end-of-life care, but still many recent instances in which we, "the system" fail to ensure that that final life journey is aligned (as much as possible) with a person's final wishes. Alas, a 2013 survey by the Canadian Institute for Health Information (CIHI) showed that a majority of Canadians preferred to die at home, but few (15%) died outside of a hospital (CIHI 2018).

Let's Get Digital.

The editor-in-chief provides an overview of this issue's focus on nursing leadership and digital health. She encourages nurse leaders to be knowledgeable and engaged in digital health initiatives.

Being a Nurse - More Than Just Tasks.

Within Canada, nurses' scope of practice is varied between jurisdictions, often poorly understood and way too often defined on the basis of tasks. Nurse leaders generally recognize that defining the practice of nurses solely on the basis of tasks only serves to devalue the critical thinking and evidence-base of the profession. But nurses themselves have also frequently fallen into the trap of delineating their practice in terms of tasks and time. An unfortunate outcome of this task orientation is a lack of appreciation for the full breadth of nurses' knowledge and scope of practice capabilities. In the extreme, (as I recently read in a letter to the editor) this leads to the conclusion that one doesn't need a university education to be a nurse - hospital-based training schools did the job just fine.

Approaches for defining and assessing nursing informatics competencies: a scoping review protocol.

REVIEW QUESTION: How are nursing informatics competencies defined or assessed in the literature?

Adapting and validating informatics competencies for senior nurse leaders in the Canadian context: Results of a Delphi study.

BACKGROUND: Nurse leaders in senior leadership positions in various parts of the world can play an important role in the acquisition, implementation and use of health information technologies. To date, international research related to nurse leader informatics competencies has been carried out in specific healthcare delivery contexts with very specific health information technology environments. In this body of literature, the definition of a 'nurse leader' has not been clearly defined. As a result, it is challenging for senior nurse leaders in leadership and management positions in other countries to apply this research to their unique contexts. PURPOSE: The objective of this study was to obtain consensus on the informatics competencies of priority to senior Canadian nurse leaders. The goal of completing this work was to adapt and validate a set of nurse leader informatics competencies to be endorsed and supported nationally. METHODS: This study used a modified Delphi technique with a panel of nurse leaders with significant informatics knowledge from across Canada. Three rounds of information gathering were completed electronically. In Round 1, participants were provided a series of 26 potential competency statements obtained from a review of the literature; they were asked to comment on the clarity and wording of each statement. Two statements were eliminated after Round 1 due to redundancy. In Rounds 2 and 3, participants rated the remaining competency statements on a 7-point Likert scale for relative priority to nurse leaders. RESULTS: A total of 25, 24 and 23 participants completed the survey in Rounds 1, 2 and 3 respectively. Consensus was achieved at the end of Round 3 with the inclusion of 24 competency statements. All of the statements had a mean of 5 or greater on a 7-point Likert scale (1=low priority and 7=high priority). CONCLUSIONS: The study participants agreed upon 24 informatics competency statements of priority to Canadian nurse leaders. These competencies will be presented to senior national nursing leaders and nursing informatics organizations for endorsement. Inspired by work completed in the United States, the authors plan to develop a self-assessment instrument for use by Canadian nurse leaders using the identified competency statements. Future anticipated work includes identifying and creating resources for nurse leaders to develop these important informatics competencies.