THEORIES SUPPORTING NURSING INFORMATICS

A profession needs theories to build

evidence for the existence of a
unique body of knowledge
(Bond et al., 2011).
THEORIES ARE CLASSIFIED INTO:

 Grand theories- broad in scope

 Situation-specific or practice theories- most specific; provide prescriptions or directions for practitioners
 Middle-range theories- more specific than grand theories but not as prescriptive as practice theories

Please provide a minimum of three (3) examples for each category.You

may refer to your Theoretical Foundations in Nursing course.
INTERRELATIONSHIPS AMONG RESEARCH, THEORY & PRACTICE

PRACTICE

 Kindly expound on this diagram.

THEORY RESEACH
THEORIES SUPPORTIVE OF NURSING INFORMATICS
 Nursing Theories
 Grand nursing theories discuss nursing practice in
broad terms, providing different worldviews of how,
when and why nurses related to clients
 Middle-range nursing theories might describe a
particular phenomenon of interest to nurses, explain
how one phenomenon relates to one or more other
phenomena
Any nursing theory might be useful for an informatics
nurse, since informatics nurse work with individuals, groups
and communities
THEORIES RELATED TO/SUPPORTIVE OF NI

 Patricia Benner’s Novice to Expert Theory

 explain how nursing students and professional nurses acquired nursing skills
 Adapted the model of Dreyfus & Dreyfus
 five stages:
 Novice- no experience with the situations in which they are expected to perform tasks; taught rules to guide actions
 Advanced beginner- demonstrate marginally acceptable performance; need help in setting priorities since they operate on
general guidelines & are only beginning to perceive recurrent meaningful patterns in their clinical practice
 Competent- nurse begins to see his or her actions in terms of long-range goals or plan; characterized by a feeling of mastery
and the ability to cope with and manage the many contingencies of clinical nursing
 Proficient- perceives situations as wholes; experience teaches the proficient nurse what typical events to expect in a given
situation and how to modify plan in response to these events
 Expert- the performer no longer relies on an analytical principle to connect hr/his understanding of the situation to an
appropriate action
 Systems Theory/General System Theory
 Properties of systems as a whole; based on the premises of maximization of interaction and democratic governance (Scott,
1974)
 Offers an alternative lens of understanding organizations as organisms
 Focuses on the organization and interdependence of relationships within a systems (a system is any set or group of
interdependent or temporarily interacting parts. Parts are systems themselves and are composed of other parts)
 Open/closed system
 Open systems refer to systems that interact with other systems or the environment outside of the systems, whereas closed systems do
not.

Figure 1. Basic system model

Source: Lunenburg and Ornstein
(1996, p. 18
 Information Science
 Gathering, manipulation, classification, storage, and retrieval of recorded knowledge
 Focused on humans and machines, and closely linked to communications and human behavior
 Encoding and decoding

 Computer Science
 Study of algorithms for solving computation problems
 If an algorithm can be identified for solving a particular problem, an automated solution to the problem can be developed
 Cognitive Science
 Is the interdisciplinary study of mind and intelligence,
embracing philosoph, psychology, artificial intelligence,
neuroscience, linguistics and anthropology (Stanford
Encyclopedia of Philosophy
 The study of the mind- of how we think
 Cognitive technologies, including computers, smart
phones, and Web browsers are media emerging rom
cognitive science that help in learning, memory, problem
solving, and living daily life in modern society
 ‘a collection of ideas about modifications to
an organization or social system that are
explicitly designed and put into place’

 Planned-Change Theory
 Informatics nurse specialist (INS) is the primary change
agent in facilitating the implementation of clinical  Lewin’s theory on planned change
information systems (CIS) in healthcare settings
 Diffusion-of-innovations model by Rogers
 In healthcare informatics and nursing informatics,
change has to be dealt with among groups of people
and heath care organizations
LEWIN’S PLANNED-CHANGE MODEL

 3 stages
 Unfreezing: overcoming inertia and dismantling the existing mind-set; change agent must uncover reasons or rewards that
will be influential in unfreezing or changing behavior
 For ex: consider an information system implementation. In this situation, the identified reasons or rewards can be used to help convert
behavioral intent (e.g., people considering adopting the system) to actual behavior (people become active system users)

 Changing: the behavioral change occurs (called moving); a period of confusion

 Refreezing: a new mind-set has formed, and the comfort level is returning to previous levels
DIFFUSIONS-OF-INNOVATIONS THEORY

 Innovation could either be a new idea, a behavior, practice or product

 Diffusion is possible when adoption occurs.
 Adoption means that a person does something differently than what they had previously
 The key to adoption is that the person must perceive the idea, behavior, or product as new or innovative.
 Diffusions-of-innovations theory refers to the process that occurs as people adopt new idea, product, practice,
philosophy, and etc.
 Roger’s identified 5 specific groups of innovation adopters. The categories are:
 Innovators: technology enthusiasts; risk takers; motivated by idea of being a change agent; appreciate technology for its own
sake; gatekeepers for the next group of adopters
 Early adopters; visionaries; serve as opinion leaders; serve as role models within their social system, respected by peers;
provide excellent tester subjects to trial the innovation; attracted by high-risk/high-reward projects
 Early majority: pragmatists; interact frequently with peers; want proven applications, reliable service; want to pick the same
proven technology solution as others; prudent; make slow, steady progress, need simple user friendly training
 Late majority: conservatives; respond to peer pressure; skeptical; often technologically shy; motivated only by need to keep
up with competitors or proven trends in their industry
 Laggards: skeptics; isolated from opinion leaders; suspicious of innovations; want to maintain status quo; think technology is
a hindrance to operations; usually invest in technology only if all other alternatives worse
The distribution (or percentage of each category in a population) approximates a bell curve. Each adopter’s
willingness and ability to adopt an innovation would depend on their awareness, interest, evaluation, trial,
and adoption.
 As these early innovators ‘spread the word’ more
and more people become open to it which leads to
the development of a critical mass. Over time, the
innovative idea or product becomes diffused
amongst the population until a saturation point is
achieved
 5 stage model for the diffusion of innovation
 Knowledge: learning about the existence and function
of the innovation.
 Persuasion: becoming convinced of the value of the
innovation.
 Decision: adoption/rejection
 Implementation: putting it to use
 Confirmation: the ultimate acceptance (or rejection) of
the innovation (Rogers, 2003).
CHARACTERISTICS OF AN INNOVATION ( AFFECT THE RATE OF
ADOPTION)

 Relative advantage: degree to which innovation is perceived as better than the idea it replaces
 Compatibility: degree to which an innovation is perceived as being consistent with existing values, past
experiences, and needs of potential adopters
 Complexity: degree to which an innovation is perceived as difficult to understand and use
 Trialability: degree to which an innovation may be tried out or experimented with
 Observability: degree to which the results of an innovation are visible to others
 WHAT IS THE NATURE OF A GROUP?

GROUP DYNAMICS
 A social science field that focuses on the nature of
groups
 Formal and informal groups
  How do we differentiate a formal group from an
informal group?
 Forming: pretending to get on or get along with
others
 Storming: letting down the politeness barrier &
trying to get down to the issues even if tempers flare
up
 Norming: getting used to each other and developing
trust and productivity
 Performing: working in a group to a common goal on
a highly efficient and cooperative basis
 Adjourning: the team breaks up as the project ends
  Learning theories
 Process of acquiring knowledge, skills, attitudes, or
 Behavioral
values through study, experience, or teaching.
 Cognitive
 Cause a change in behavior that is persistent ,
measurable, and specified.  Adult learning
 Learning stykes
 Behavioral Learning Theory
 behaviorism is a theory of learning focusing on
observable behaviors and discounting any mental
activity. Learning is defined simply as the acquisition
of new behavior ( Pritchard, 2005)
 Stimuli & responses (operant conditioning)
 2 basic elements:
 Pairing: combination of a stimulus and a response
 Reinforcement: stimulus-response element that has 2
pathways
 Positive reinforcement: every stimulus is followed by
something pleasant or in which the stimulus itself is a good
experience
 Negative reinforcement: learners may associate a stimulus
with unpleasant or painful experiences
COGNITIVE LEARNING THEORY

 Focuses on internal mental processes, including insight, information processing, memory, and perception
 4 steps of information processing:
 Information input: information is received by the learner
 Input processing: the information is either remembered only for a short time or is moved to long-term memory where it
can be drawn upon as needed
 Output behaviors: that demonstrate if learning has taken place
 Use of feedback: embed the same information more firmly or to correct errors
 Learning Styles Theory Kolb’s Learning Styles

 Assert that individuals have a tendency to both

perceive and processes information differently
 Concrete perceivers: absorb information through
direct experience by doing, acting, sensing & feeling
 Abstract perceivers: take in information through
analysis, observation and thinking
 Active processors: make sense of an experience by
immediately using the new information
 Reflective processors: make sense of an experience by
reflecting on and thinking about it
ADULT LEARNING THEORY
 Focuses on understanding how adults learn as opposed to children
 Adult learners expect to have a high degree of influence on how learning will be evaluated
 Adults expect their responses to be acted upon when asked for feedback on the progress of the program
COMMUNICATION

How does it work?

 BLUM’S TAXONOMY OF DATA-INFORMATION-KNOWLEDGE
(CONCEPTS ADOPTED BY NI)

Informatics
theorists added  Data: discrete entities that are described objectively
the concept of without interpretation; facts without context; “raw”
Wisdom to
 Information: data that are interpreted, organized, or
Blums’s theory
structured; idea of processing data
 Knowledge: information that has ben synthesized so
that interrelationships of data and information are
identified and formalized
 Wisdom: appropriate use of knowledge in managing
and solving problems
AN EXAMPLE OF DIKW

 Data: A patient’s vital signs

 Information: A serial set of vital signs, placed into a context and used for longitudinal comparisons
 Knowledge: Recognition of a pattern and identification of interventions
 Wisdom: Accuracy of the synthesis of information and appropriate selection of interventions
JUST A SEGUE: REFLECTIVE JOURNALING

 What was the most interesting thing I read for this lesson (list it down)- why was that?

 What did we not cover that I expected we should?