Concepts of Nursing Informatics:
information technology.
Informatics:
• Is the science of and art of turning
data into information (Bemmel
and Mussen, 1997)
• Study of the structure, behavior
and interactions of natural and
engineered computational system
• Studies The representation,
processing and communication of
information in natural and
engineered system.
• Has Computational, cognitive and
social aspects
Health Informatics: (US National
Library of Medicine, 2014)
• interdisciplinary study of the
design, development, adoption and
application of IT-based innovations
in health care services delivery,
management and planning.
Nursing Informatics: (American Nurses
Association, 2001)
• A specialty that integrates nursing,
science, computer science and
information science to manage and
communicate data, information
and knowledge in nursing
practice.
• Facilitates the intergration of data,
information and knowledge to
support patients, nurses and other
providers in their decision making
in all roles and settings. This
support is accomplished through
the use of information structures,
information processes, and
• computer science, information
science, and nursing science
combined 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.
4 major roles of Nursing:
Health Promotion, Illness prevention,
Curative and Carative
Nursing Informatics (Canadian Nurses
Association, 2018)
• practice and science of integrating
nursing information and
knowledge with technology to
manage and integrate health
information.
• Goal: improve health of people and
communities while reducing costs.
Nursing Informatics (ANA, 2019; HIMSS,
2019)
• specialty that integrates nursing
science with multiple information
and analytical sciences to identify,
define, manage and
communicate data, information,
knowledge and wisdom in
nursing practice.
Historical Perspective in Nursing
Informatics:
• nursing informatics emerged as a
response to the innovations and
development in technologies kn
the healthcare industry and in
nursing practice.
SIX IMPORTANT TIME PERIODS IN THE
HISTORYOF NURSING INFORMATICS:
Before 1960s
• computers were initially used in
healthcare facilities for basic
business office functions.
• early computers used punch cards
to stores data and card readers to
read computer programs, sort and
prepare of data for presenting.
The 1960s
• Studies were conducted to
determine the effective utilization
of the computer technology in
health care industry and to identify
the areas of nursing that needs to
be automated.
• Hospital Information Systems
(HIS) were developed primarily to
process financial transaction
serves as billing and accounting
systems.
The 1970s
• Nurses recognized the computer’s
potential for improving
documentation of nursing practice,
the quality of patient care and the
repetitive aspects of managing
patient care.
• Nurses assisted in designing
several mainframes for the Health
Information System (HIS)
• Computers used financial and
management functions were
perceived as cost-saving
technologies.
• Many of early HIS were developed
and funded by contractors and
grants from federal agencies in the
United States.
The 1980s
• Nursing Informatics became an
accepted specialty and many
nursing experts entered the field.
• Discharge planning systems were
developed and used as referrals to
community health care facilities in
continuum of care.
• Microcomputers/PC emerged in
this period.
The 1990s
• In 1992, the nursing informatics
was approved bu the American
Nurses Association as new nursing
speciality.
After 2000s
• Clinical Information systems
(CIS) became individualized in
the Electronic Patient Record
(EPR) or also known as electric
health record.
• The internet has also provided a
means for development of clinical
applications.
• Home health care has also
increasingly partnered
information technology for the
provision of patient care.
• Telenursing, is increasing in
popularity and providing patient
care in an efficient.
NI PHILIPPINE EVOLUTION (Pe Benito,
n.d.)
1999: Development of Standards for
Health Information in the Philippines
(SHIP)
2005: Formation of Master of Science in
Health Informatics.
2009: CMO no. 14 Policies and Standards
for BSN - Informatics (2/1) is offered as
part of the Math, Nat Sci, & IT
2010: Formation of The Philippine
Nursing Informatics
• Sub specialty krganization of PNA
for Nursing Informatics
2017: CMO No. 15 - CHED policy,
standards and guidelines for BSN
program.
• NI as major subject (NCM 110) = 2
(1)
Why the Trend toward Informatics?
(HIMSS, 2018)
• Increasingly present in our
profession due to changing and
advancing technology.
• Health care systems are
integrating technology daily
practice at very fast pace
• Security and patient privacy must
be upheld while achieving the goal
of transforming data into useful
knowledge.
Advantages of NI:
• Shared Data
• Centralized Control
• Disadvanatages of redundancy in
control
• Improved data intergrity
• Improved data security and
database systems
• Flexible conceptual designs
Role of Informatics in Nursing: (HIMSS,
2014)
• Help identify potential problems
earlier
• Identifying changes in patient
status can occur quickly
• Information is readily available
• Data are interpreted, systematized
and arranged
• Formalize an appropriate plan of
action
• Aligns nursing best practice with
clinical worklows and care -
Evidenced Based Practice (EBP)
• Improves clinical policies,
protocols, processes and
procedures.
• Strengthen nurses’ clinical
decision-making skills
• Enhance nursing practice
• Quicker access to patient
information
• Improve overall efficiency
• Reduction in potential errors
• Has potential to change in nursing
practice for the better - patient
care delivery.
D.I.K.W.:
DATA:
• Raw, uninterrupted fact, without
meaning
• Building blocks to create
information
INFORMATION:
• Group of data elements that have
been organized and processed so
that one can interpret the
significance of the data elements.
• Data and information are both
building blocks in producing
knowledge.
KNOWLEDGE:
• built on a formalization of the
relationships and
interrelationships between data
and information.
• This is the part where you
understand the information.
WISDOM:
 • Knowledge used to make
appropriate decisions and acting
on those decisions.
• It is appropriate to use of data,
information, and knowledge in
making decisions and
implementing nursing actions.
Nursing Informatics as Specialty:
ROLES:
• Theory Development
• Analysis of information needs
• Selection of computer systems
• Design of computer systems and
customizations
• Testing of computer systems
• Training users of computer
systems
• Education of users to computer
policies.
• Evaluation lf the effectiveness of
computer systems
• On-going maintenance and
enahncements
• Identification of computer
technologies that can benefit
nursing
• Compliance with regulatory
requirements for information
handling.
• Project management
• Research
Nelson - Data, Information, Knowledge and
Wisdom Model
Nelson D-W
The Data, Information, Knowledge and
Wisdom Model depicting the
megastructures and concept underlying
the practice of nursing informatics.
History
1989 - The three concepts of data,
information and knowledge were well
established in the field of information
science and had been introduced in the
emerging discipline of medical
informatics.
Graves and Corcoran's Model (1989)
Nursing Informatics as the linear
progression - from data into information
and knowledge
Management processing is integrated
within each elements
- NI =proper management of knowledge –
from data as it is converted into
information and knowledge
Example:
1. Procedural knowledge involves
knowing how to do something.
2. Knowing how to assess patient's breath
sounds requires procedural knowledge.
3. Management processing is the
procedural knowledge used to process
data, information and knowledge.
Blum (1986)
- Grave’s & Cororan’s Model was built on
Bruce Blum
- Defined the concepts of data,
information and knowledge in discussing
the discipline of medical informatics
-Goal - to explain that the discipline could
not be defined by information technology
that is used in the practice on medical
informatics, but rather the discipline of
informatics is defined by how the
provider uses technology to meet human
needs.
Blum (1989) – 3 objects that can be
processed by IT
Data – uninterpreted items, often
referred to as data elements.
Example: Person's weight
Without additional data elements such as
height, age, overall well-being it would be
impossible to interpret the significance of
an individual number.
Information – a group of data elements
that have been organized and processed
so that one can interpret the significance
of the data elements.
For example, height, weight, age, and
gender are data elements that can be used
to calculate the BMI.
The BMI can be used to determine if the
individual is underweight, overweight,
normal weight or obese
Knowledge is built on a formalization of
the relationships and interrelationships
between data and information.
A knowledge base makes it possible to
understand that an individual may have a
calculated BMI that is over 30 and not be
obese.
Several automated decision support
systems (DSS) included a knowledge base
and a set of rules for applying the
knowledge base in a specific situation.
Example, the knowledge base may include
the following information.
A fever or elevated temperature often
begins with a chill. At the beginning of the
chill the patient’s temperature may be
normal or even sub-normal but in 30
minutes it is likely the patient will have
spiked a temp. A rule might read: if a
patient complains of chills, then take the
patient’s temperature and repeat in 30
minutes (DSS)
Nelson and Joos (1989)
- Add the concept of wisdom to the triad
of DIK
- Wisdom – “as the appropriate use of
data, information and knowledge in
making decisions and implementing
nursing actions”
- “includes the ability to integrate data,
information and knowledge with
professional values when managing
specific human problems” (Nelson, 2018)
What are the terms for?
An INFORMATION SYSTEM processes
data to produce information
A DECISION SUPPORT SYSTEM is defined
as an automated system that can support
a decision maker in the process of
decision making by providing data and
information.
An EXPERT SYSTEM goes one step farther
and actually uses data and information to
make a decision. A common example of an
expert system in operation can be seen if
one has ever opened a new credit card
account while checking out of a store. In a
few minutes an automated system makes
a decision rather or not to offer credit.
DIKW and Nursing Process
The nursing process might be thought of
as a representation of the hermeneutic
circle— from the flow of data collection
and problem identification, through
outcome measurements, which are a form
of data collection. Documentation that
links nursing diagnoses, interventions,
and outcomes, tracks those links over
time, and is evaluated and revised, also
reflects a form of the hermeneutic circle.
(Matney, Brewster, Sward, Cloyes &
Staggers (2011)
-hermeneutic circle is a back and forth
interplay that makes us aware of the
“preunderstandings” that are essential to
our understanding of the world.
Data (Matney, 2011)
- Data are the smallest units in the DIKW
framework
- Data are the form most often stored
within patient records, and are used as a
basis for further reasoning, calculation, or
discussion.
Information (Matney, 2011)
-thought of as “data plus meaning.”
- It can be derived by processing data.
- Example of data becoming more
meaningful information, consider the
number “110.” The number has little
meaning without context. When
developed into a name-value pair, such as
“heart rate = 110” (where heart rate is the
name, and 110 beats per minute is the
value), a meaning begins to emerge.
- Data and information not only represent
physical observations, but may also
represent abstract concepts such as
depression, pain, spirituality, or
psychosocial care
- Information answers questions that
begin with basic words such as who,
what, where, when, and how many.
Knowledge (Matney, 2011)
- is information that has been synthesized
so that relationships are identified and
formalized
- answers questions that begin with “how”
and “why.”
- Two types – Tacit and explicit
Tacit Knowledge (Matney, 2011)
- is difficult to summarize and
communicate to others
- It is personal, context specific, and
therefore hard to formalize
- Also called as “background” knowledge
Explicit Knowledge (Matney, 2011)
- can be generated and formalized, and is
more amenable to encoding and
transmitting in a formal manner
- is what knowledge management systems
(such as computer decision support
systems) seek to capture, codify, store,
transfer, and share.
Knowledge (Matney, 2011)
- is derived by discovering patterns and
relationships between types of
information
- Such as spiritual distress, and identifies
the potential interventions such as
spiritual care or a clergy referral that
could lead to a positive outcome.
Wisdom (Matney, 2011)
- as the appropriate use of knowledge to
manage and solve human problems (ANA)
- implies a form of ethics, that is, knowing
why things should or should not be done
in practice
- It is not a fixed entity, but rather a
reciprocal, action-oriented process
- involves recognizing what is most
important, by making distinctions among
alternatives
- comprises the application of experience,
intelligence, creativity, and knowledge, as
mediated by values, toward the
achievement of a common good
- Involves the process of internalization
- Previous examples, wisdom is displayed
when the nurse chooses a specific,
tailored means of providing fluid to the
elderly patient with pneumonia.
- Also shown when the nurse who chooses
a form of spiritual care, based perhaps on
the preferences and inclinations of the
patient
- Computer systems can support wisdom
development.
- Transforming clinical data into wisdom-
Artificial intelligence implications for
nurse leaders by Cato, Mcgrow & Rosetti
(2020) will provide us with some
discussions about it -
Discipline with Influence
The Nursing Informatics Model (circle
diagram)
Information Science
• Includes information technology
which involves the process of
sending and receiving information
and understanding of how the
organizational environment are
structured and how information
flows in that environment.
• Information science enables the
processing of information. This
processing links people and
technology.
• Information Science impacts
information interfaces, influencing
how people interact with
information and subsequently
develop and use knowledge.
• Deals with the interchange (or
flow) and scaffolding (or
structure) of information and
involves the application of
information tools for solutions to
patient care and business
problems in health care.
To use and synthesize information-
effectively, one must be able to:
• obtain
• Perceive
• Process
• Synthesize
• Comprehend
• Convey and
• Manage the information.
Computer science:
• development, configuration,
architecture of computer
hardware and software.
• Everything that occurs in
informatics derives from insights
and changes in computer
technology, which is the core of
both teaching and understanding
informatics.
Nurses and Computer Technology:
Computer systems assists nurses to
provide quality care:
• Computers enable nurses to
quickly access important
information about the patient’s
health or illness and treatment
plan from from the electronic
health record which helps them
monitor recovery process over
time.
• Enable nurses to access
information such as laboratory
tests and x-ray results and health
reports from other health care
team members to formulate the
optimal plan of care.
The nurse informacists will be some of
the major movers of change
1. Information management - An
elemental process by which one
files, stores, manipulates, and
reports data for various uses.
2. Information Communication -
Enables systems to send data and
to present information in formats
that improve understanding.
3. Information Structures - organize
data, information and knowledge
for processing by computers.
4. Information Technology - includes
computer hardware, software,
 communication and network
technologies, derived primarily
from computer science. Its use
distinguishes informatics from
more traditional methods of
information management.
Cognitive Science
• is an interdisciplinary field that
results from the convergence of
psychology, linguistics, computer
science, philosophy, and
neuroscience.
• The focus of cognitive science is
understanding of the mind and the
phenomena the mind addresses.
• From perception to thinking,
understanding, and remembering.
• The traditional and widely
accepted definition of NI advanced
by Graves and Corcoran (1989) is
that NI os a combination of nursing
science, computer science, and
information science used to
describe the processes nurses use
to manage data, information, and
knowledge in nursing practice.
• Turley (1996) proposed the
addition of cognitive science to this
mix, as nurse scientists are seen to
strive to capture and explain the
influence of the human brain on
data, information, and knowledge
processing and to elucidate how
these factors in turn affect nursing
decision making.
• Connectionism is a component of
cognitive science that uses
computer modleing through
artificial neural networks to
explain human intellectual
abilities.
• Deals with how the human mind
functions.
• Encompasses how people think,
understand, remember, synthesize,
and access stored information and
knowledge
• The nature of knowledge,
including how was it developed,
used, modified, and shared
provides the basis for continued
learning and intellectual growth.
General Systems Theory
• One of the oldest theories
• Explains that systems are complex
and intricate yet hold
commonalities.
• Emphasizes the interactions of the
various part of systems, insteadof
individual parts.
• Can be physical structures
(education, financing, etc.), manual
(patient’s hygiene, baking a cake,
etc.) or those that are electronic or
computerized (electronic medical
record, automatic medication
dispensing, etc.)
• Its premise - teh whole is greater
than the sum of its parts
Three Main Components:
Input - where raw data enters the
system.
Throughput - involves the processes
used in managing information.
Output - resulting end-product of the
processes information.
Example - Hospital Sytem
• The admission and registration
process and how they relate to
wait time, patient satisfaction and
the quality of care.
• The interrelationships are more
relevant than each of the processes
as separate.
• Each part is relavant but only to
the extent that it influences the
efficient and effective flow of
patients into the system.
 • In terms of the three main
components according to the
general systems theory, an
aberration in one can
detrimentally affect the others.
Other assumptions in the general
systems theory that need mentioning:
• There is a purpose for the system
that needs to be achieved
• There are structures, functions and
tasks within the system that are
meant to be carried out efficiently
and effectively in order to achieve
the purpose of the system
• The structure also follows the
function, with specifications and
attributes designed to meet the
expectations
• There is dynamic homeostasis or
the capability to maintain stability
or equilibrium
• There is entropy or the tendency
to break into its smallest parts
• There is also negentropy or the
likelihood to grow big and
complex
• The system has the capability for
specialization or the ability to be
unique and differentiate from the
whole
• There is also reverberation which
makes changes cut across the
entire system
• And finally, there is equifinality, or
the ability to reach the same end
despite varying beginning points
Communications Theory
• Shannon and Weaver's
Information-Communication
Model (1949)
• As we communicate, there are
various channels that our
information goes through. The
model has been criticized as overly
simplistic (Al-Fedaghi, 2012),
• It provides an easy conceptual and
visual model that is easily
understood in order to
demonstrate its relationship to
nursing informatics and the work
of nurses
• Nurses spend 90% of their work
schedule communicating -verbally,
written or through behavioral
cues.
• Manual of electronic, the model
remains a good framework use in
explaining hoe tings can go well or
wrong.
Changes Theories
• Lewin's Theory of Planned Change
• Roger's Diffusion of Innovation
Theory
Lewin's Theory of Planned Change
• For planned change
• Has three distinct steps:
unfreezing, moving and refreezing
• Unfreezing is creating an
imbalance or some form of
distraction to shake up the status
quo between the driving forces
(motivators for change) versus the
 restraining forces (factors that
resist change)
• The unfreezing stage is such a
crucial step in the chnage process
because it creates some form of
conflict that makes the scenario
conducive to questioning the
status quo.
• Once the imbalance is created, it is
somewhat easier to influence
change or to encourage resistors to
consider and embrace the change.
Once this is achieved, the second
step set: in-moving, or altering
forces.
• Moving is when the actual change
occurs, If prior to moving the
restraining forces are stronger, at
this stage, they have now become
susceptible to change.
• Change is then adopted and the
drivibg forces become more
dominant. However, for chabge to
stick, the third step has to set in -
refreezing, or assuring that change
has indeed occured and has been
adopted.
Roger's Diffusion of Innovation Theory
• For unplanned change
• When planned accordingly and
done correctly, Lewin's model
works best in effectuating change.
When introducing computer
applications to healthcare staff and
professionals, this is often helpful
since it is a long process and there
is more time to pump up the
driving forces and weaken the
restraining forces by holding many
meetings, open town hall
discussions of the pros and cons of
the change. There is more
opportunity to hear both sides and
weigh the advantages and
disadvantages.
• Each group has its own
characteristics, and the strategies
to influence the adoption of change
naturally differ from group to
group
• Innovators - 25%; hear what the
change is and its benefits - no need
to convince them, quick to
embrace change
• Early adopters- 13.5% - ask some
questions but generally adopts
change,
• Early majority-34% - require a bit
more convincing- have some
questions
• Late majority - 34% - they dilly-
dally - have a lot more questions,
refuse to comprehend the need for
change
• Laggards-16% - hard core
resistors, avoid accepting change
• Change is inevitable
• The nurse informacists will be
some of the major movers of
change
• These are tools when faced with
challenging innovative scenarios.