New terms to describe the impact of the global economic downturn include the creation of health ecosystems which can be linked in structure and form to communities of practice – a common denominator being sharing of expertise and action to address current health issues, such as chronic illness. There is an increasing realisation that action must be taken to ensure provision of robust structures to protect the healthcare system, which as a consequence of increasing fiscal costs and an increasing and aging population is under threat. Chapter 15 noted that nurses hold a unique function as they are the only healthcare professionals to interact with individuals, carers and families on a 24 h, 7 days a week basis. When one considers the scale of skill hours and the overall projected costs of nursing skill mix within healthcare, it is reasonable to suggest that within this emerging health ecosystem nursing as a profession is potentially vulnerable and so too are recipients of health care. The profession as it is today faces a global challenge, similar in nature to bees. The deliberate analogy to bees is drawn as there are distinct similarities to nursing ‘communities’ as both possess certain attributes as social groups. Nurses are excellent communicators, structurally they are highly organised and can offer front line resilience to defend their specific community and respective populations. How can nursing adopt and adapt to use informatics to ensure sustainability for the future of the profession is now a question that requires careful consideration.

The remainder of this chapter offers some examples of differing communities of practice which strive to address this question (Fig. 21.2). Figure 21.3 offers an illustrative overview of some of the communities of practice which are discussed in the following sections.

PARTNERSCT is a community of practice devised as part of a nursing informatics study completed in Ireland in 2010. The purpose of this study was to develop, with nurses, a shared assessment tool for older persons for use across and between six differing health service providers. The project was entitled PARTNERSCT. The term was adopted as an acronym for Participatory Action Research To develop Nursing Electronic Resources and the initials CT related to Concepts and Terms. The community of practice has evolved since this date and is now entitled PARTNERS. The PARTNERSCT study sought to examine the complex process of patient referral across acute, primary and continuing care sectors as well as ongoing assessment data collection processes on individual patients over an extended time interval. The process involved six health service providers and 18 patients over a 6 month time frame, and the tool was devised from a patient centred perspective. A key output from the study was to understand the complexity of connected health from a nursing practice perspective i.e. sharing nursing records across more than one health service provider. To achieve interoperability health informatics standards were used to guide the development process. Interoperability in this context is described as achieving communication between different technologies and software applications for efficient, accurate, and sound sharing and of data. This communication process included two components (1) the data is understood at a computing level and can be transmitted across different service providers – computer science (2) Once data is received it is legible and fit for purpose – information science. To deliver on both of these components health informatics standards are required.

Health informatics standards which are discussed in detail in Chap.​ 7 offer a set of rules, regulations, guidelines, and definitions with technical specifications to make the integrated management of health systems viable at the computer and information science levels [10].

Health informatics standards were therefore viewed within the PARTNERS study as a set of guidelines to direct the development work. The PARTNERS team considered the standards as Models of Thought created by health informatics experts to assist practitioners engaged in such studies to steer through the development process in an incremental and co-ordinated fashion. These Models of Thought offered the practitioners a set of labels to reference their ideas, increase understanding whilst informing the discussion. As this project was part of a PhD study, an action research design was adopted. Dymek’s Action and Sense Making Model (2008) was used to assist the group to develop a shared Model of Meaning. This resulted in a set of agreed concepts and terms to be used by the nurses in the prototype patient assessment and referral tool which was agreed to be piloted over a 6-month duration [11], argues that adapting existing frames with new emerging work practices is the first step of an action cycle. In many instances this approach requires a fundamental change in organisation’s thinking and the implementation process requires change at a schemata level. By linking this course of action with informatics, Dymek (2008), provides a key component for the development and implementation of information systems [11; p. 576].

In this study, the participating nurses from different services agreed upon a set of specific concepts and terms to enable shared care of elderly patients using a shared assessment which was evaluated as fit for purpose. Using a mixed methods approach the study integrated a Community of Practice to address local challenges which were experienced by the participating nurses. The resources were published on a dedicated website and subsequently used within nursing informatics education in Ireland. Examples of this project are available to view from PARTNERSCOP website [3].

The process of developing the PARTNERs tool included capturing practice workflow activities with group participants, and mapping the process for similarities and differences in the existing respective health service providers to each other. A detailed analysis of the existing assessment documentation in each service was carried out. Early recognition that there was a great deal of overlap in the concepts and terms collected across the service was evident, however the order in which data was collected and the qualifiers used in the measurement of concepts were dissimilar, and a revised structure was agreed and piloted by all participants.

Specific educational sessions were offered on language construction using Ogden and Richards Semiotic Triangle [12], and consideration was given to using language that was referenced and standardised. The semiotic triangle which was originally conceived by Ogden and Richards in 1923 is considered a seminal thesis which has influenced the development of language upon thought particularly in regard to the science of symbolism [12]. The semiotic triangle and Freirks semantic stack [13] offered the team clarity on decision making and were used to make sense, locate, and build the assessment tool within the context of the participant’s clinical practice. Figure 21.4 offers a summary of the PARTNER’s activity as a process.