Chapter 2:

Nursing
Informatics
Theories and
Models
Thursday, April 15, 2010
 What is Nursing
Informatics?
Informatics (informatics comes from the French word
informatique which means computer science).
Informatics is defined as computer science +
information science. Used in conjunction with the
name of a discipline, it denotes an application of
computer science and information science to the
management and processing of data, information,
and knowledge in the named discipline. Thus we
have, medical informatics, nursing informatics,
pharmacy informatics and so on.

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 Hebda (1998 p. 3), defines nursing informatics
as "the use of computers technology to support
nursing, including clinical practice,
administration, education, and research."  

American Nurses Association (ANA) (1994)

has defined nursing informatics as "the
development and evaluation of applications,
tools, processes, and structures which assist
nurses with the management of data in taking
care of patients or supporting the practice of
nursing."

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 Graves, J. R., & Corcoran, S. (1989). The Study of Nursing Informatics.
Image: Journal of Nursing Scholarship, 27, 227-231. Define nursing
informatics as "a combination of computer science, information science
and nursing science designed to assist in the management and processing
of nursing data, information and knowledge to support the practice of
nursing and the delivery of nursing care."

The framework for nursing informatics relies on the central concepts of

data, information and knowledge:

Data is defined as discrete entities that are described objectively

without interpretation

Information as data that is interpreted, organized or structured

Knowledge as information that has been synthesized so that

interrelationships are identified and formalized.

Resulting in decisions that guide practice

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 1950s - Conceptualization of automated
nursing information process in the US

1960s - Computers found its way in

automating accounting and business functions.
There were attempts to address clinical
applications but was unsuccessful at that time.

1963 - Mary Ann Bitzer wrote a simulation

program on obstetric nursing

1970s - In the West, many projects were done

regarding use of computers in nursing
especially in the area of nursing care

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 1985 - Marion Ball and Kathryn Hannah presented in their
paper in a nursing journal the use of nursing informatics
in many nursing processes. They defined nursing
informatics as the use of IT in relation to those functions
within the purview of nursing that are carried out by
nurses when performing their duties

1986 - Blum grouped & classified computers into functions

Early 1989 - Judith Graves and Sheila Corcoran proposed

that nursing informatics is a combination of computer
science, information science & nursing science designed to
assist in the management & processing of nursing data,
information and knowledge to support the practice of
nursing & the delivery of nursing care.

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 Data to Wisdom Continuum
Information Model
Increasing Complexity

Wisdom
Knowledge
Information
Data

Increasing Interactions and Inter-Relationships

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 Late 1989 - Irene Joos and Ramona Nelson added
wisdom to the continuum

1992 - ANA recognized NI as a specialty

1996 - Goosen included Graves and Corcoran’s

definition thinking that is done by nurses to make
knowledge-based decision & inferences for patient
care

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Thursday, April 15, 2010
 Theories in
Nursing
Informatics

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 A. Change Theories
1. Roger’s Diffusion of
Innovation Theory
(unplanned change)

Examines the pattern

of acceptance that
innovations follow as
they spread across
the population of
people who adopt it.

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 5 Categories of Adopters:

Innovators (2.5%) - Readily adopt

Early Adopters (13.5%) - Respectable opinion

leaders

Early Majority (34%) - Averse to risk of the

innovation but are willing to make safe investments

Late Majority (34%) - Adopts because of peer

pressure

Laggards (16%) - Suspicious and very stubborn

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 2. Lewin’s Change Theory (planned change)

• Unfreezing - Making use of processes that

reinforces an individual’s involvement in
change

• Moving - Planned change is implemented

• Refreezing - Planned change becomes the

norm

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 B. Information Theories
1. Blum’s Theory

Computer functions can be categorized in 3

groups:

Where data is processed

Where information is processed

Where knowledge is processed

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 2. Data-Information-Knowledge-Wisdom Continuum

• Graves and Corcoran regarded that information has various

levels of complexity depending on how much interaction is
done to attain it.

• Data are elements that are uninterpreted & plainly recorded

and viewed as is.

• Information comprises interpreted data based on one’s

capacities, attitude and behavior.

• Knowledge is an organized collection of information.

• Wisdom considers the use of ethical, moral, personal, social,

cultural, religious, political & other values in decision making.

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 B. Cognitive Theories
• Provides principles that may be used to develop
systems that concentrate on the tasks at hand ,
rather than requiring cognitive tasks to deal with
the computer interface

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 Some Applications of
NI Theories
a. Automating data entry

b. Sharing of information through network systems

c. Knowledge bases and decision support system

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 Knowledge base - formed from
interrelationship between pieces of
information

Decision Support Systems - process

information by comparing a selected or an
entered data against a standard set of
information also known as a knowledge base

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 d. Wisdom and expert systems

An expert system is a knowledge-based

system with built-in procedures for
determining when and how to use that
knowledge. It is composed of database or
knowledge base, inference engine and a user
interface

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 Nursing Informatics can be applied to all areas
of nursing practice, which include; clinical
practice, administration, education, and
research. Below are some examples of how
nursing informatics, information technology
and computers, are used to support various
areas of nursing practice.

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 Nursing Clinical Practice (Point-of-Care Systems and Clinical
Information Systems)
Work lists to remind staff of planned nursing interventions
Computer generated client documentation
Electronic Medical Record (EMR) and Computer-Based
Patient Record (CPR)
Monitoring devices that record vital signs and other
measurements directly into the client record (electronic
medical record)
Computer - generated nursing care plans and critical
pathways
Automatic billing for supplies or procedures with nursing
documentation
Reminders and prompts that appear during documentation
to ensure comprehensive charting

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 Nursing Administration (Health Care
Information Systems)

Automated staff scheduling

E-mail for improved communication

Cost analysis and finding trends for budget

purposes

Quality assurance and outcomes analysis

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 Nursing Education

Computerized record-keeping

Computerized-assisted instruction

Interactive video technology

Distance Learning-Web based courses and degree

programs

Internet resources-CEU's and formal nursing courses

and degree programs

Presentation software for preparing slides and

handouts-PowerPoint and MS Word
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 Nursing Research

Computerized literature searching-CINAHL,

Medline and Web sources

The adoption of standardized language

related to nursing terms-NANDA, etc.

The ability to find trends in aggregate data,

that is data derived from large population
groups-Statistical Software, SPSS

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Thursday, April 15, 2010
 Review Questions

1. Explain how computers evolved in

healthcare community.
2. Discuss how IT revolution influenced
nursing informatics.
3. Describe a nurse-computer interface.

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 - End. -

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