INFORMATICS COMPILATIONS OF MODULES

MODULE 1

Nursing Informatics

 The term nursing informatics was initially seen in literature in the 1980s, including a definition of
combining nursing, information, and computer sciences for managing and processing data into knowledge
for using in nursing practice (Murphy, 2010). In 1994,
 The American Nurses Association (ANA) began developing a statement to describe and define the scope of
nursing informatics (Baker, 2012).
 The meaning of nursing informatics has evolved and been refined, with the American Nurses Association
(2008) definition stated as ― "a specialty that integrates nursing science, computer science, and
information science to manage and communicate data, information, knowledge, and wisdom in nursing
practice".
 Another definition of nursing informatics comes from the American Medical Informatics Association
(AMIA), which states ―Nursing Informatics science and practice integrates nursing, its information and
knowledge, and their management, with information and communication technologies to promote the
health of people, families, and communities worldwide.

Definition of Nursing Informatics

Nursing informatics (NI) has also been defined as a specialty that integrates nursing science, computer science, and
information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. NI
supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings. This
support is accomplished using information structures, information processes, and information technology.

Staggers and Thompson (2002) believed that there were too many definitions for NI, which was causing the
specialty to grow without a solid foundation. They believed that without this foundation it was difficult to build a
solid informatics practice or the needed educational base for this specialty practice. Staggers and Thompson
performed a critical analysis of the definitions, which resulted in a new definition. The new definition is as follows:
The goal of NI is to improve the health of populations, communities, families, and individuals by optimizing
information management and communication. These activities include the design and use of informatics solutions
and/or technology to support all areas of nursing, including, but not limited to, the direct provision of care,
establishing effective administrative systems, designing useful decision support systems, managing and delivering
educational experiences, enhancing supporting life- long learning, and supporting nursing research. The term
individuals refer to patients, healthcare consumers, and any other recipient of nursing care or informatics solutions.
The term patient refers to consumers in both a wellness and illness model.

The definition and goal of NI are based upon work by Staggers and Thompson (2002) and evolved in this version to
include the concept of wisdom. Otherwise, the NI definition is essentially synonymous with the 2001 Scope and
Standards document.

NI is one example of a discipline-specific informatics practice within the broader category of health informatics. NI
has become well established within nursing since its recognition as a specialty for registered nurses by the American
Nurses Association (ANA) in 1992. It focuses on the representation of nursing data, information, knowledge
(Graves and Corcoran, 1989), and wisdom (Nelson, 1989; Nelson, 2002) as well as the management and
communication of nursing information within the broader context of health informatics.

Why nursing informatics?

1. provides a nursing perspective

2. illuminates nursing values and beliefs
3. denotes a practice base for nurses in health informatics
4. produces unique knowledge
 5. distinguishes groups of practitioners,
6. focuses on the phenomena of interest for nursing, and
7. provides needed nursing language and word context (Brennan, 2003) to health informatics.

Information Science

Information science is the science and practice dealing with the effective collection, storage, retrieval, and use of
information. It is concerned with recordable information and knowledge, and the technologies and related services
that facilitate their management and use. Information Science is a multidisciplinary science that involves aspects
from computer science, cognitive science, social science, communication science, and library science to deal with
obtaining, gathering, organizing, manipulating, managing, storing, retrieving, recapturing, and disposing of,
distributing, or broadcasting information. Information Science studies everything that deals with information and
can be defined as the study of information systems. This science originated as a sub-discipline of computer science,
in an attempt to understand and rationalize the management of technology within organizations. It has matured into
a major field of management that is increasingly being emphasized as an important area of research in management
studies and has expanded to examine the human-computer interaction, interfacing, and interaction of people,
information systems, and corporations. It is taught at all major universities and business schools around the world.
Organizations have become intensely aware of the fact that information and knowledge are potent resources that
must be cultivated and honed to meet their needs.

In the mid-1980 Blum (1986) introduced the concepts of data, information, and knowledge as a framework for
understanding clinical information systems and their impact on health care. He did this by classifying the then-
current clinical information systems by the three types of objects that these systems processed. These were data,
information, and knowledge.

Thus, information science is the study of information systems, the application, and usage of knowledge focus on
why and how technology can be put to best use to serve the information flow within the organization.

THEORIES

FROM NOVICE TO EXPERT THEORY

Introduction

Dr Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient
care over time through a sound educational base as well as a multitude of experiences.

She proposed that one could gain knowledge and skills ("knowing how") without ever learning the theory
("knowing that").

She further explains that the development of knowledge in applied disciplines such as medicine and
nursing is composed of the extension of practical knowledge (know how) through research and the
characterization and understanding of the "know how" of clinical experience.

She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming an
expert

The Novice to Expert Theory

The Novice to Expert Theory, a construct theory first proposed by Hubert and Stuart Dreyfus (1980) as
the Dreyfus Model of Skill Acquisition, and later applied and modified to nursing by Patricia Benner (1984)
provides a very useful and important theory that clearly applies to nursing informatics.

Within the field of nursing informatics, this theory can be applied to:

1. the development of nursing informatics skills, competencies, knowledge and expertise in

nursing informatics specialists;
2. the development of technological system competencies in practicing nurses working in an
institution;
3. the education of nursing students, from first year to graduation and;
4. the transition from graduate nurse to expert nurse.

Levels Of Nursing Experience

Benner described 5 levels of nursing experience as;

1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert

1. Novice

A novice does not know anything about the subject he/she is approaching and has to memorize its
context-free features. The novice is then given rules for determining an action on the basis of these
features. To improve, the novice needs monitoring, either by self-observation or instructional feedback.
For example, a nurse learning to use a new hospital information system needs explicit instruction and rules
to learn to use the computer interface and manipulate the software. Further, novice are described to be:

 Beginner with no experience

 Taught general rules to help perform tasks
 Rules are: context-free, independent of specific cases, and applied universally
 Rule-governed behavior is limited and inflexible
 “Tell me what I need to do and I’ll do it.”

2. Advanced Beginner

An advanced beginner is still dependent on rules, but as he/she gains more experience with real-life
situations, he/she begins to notice additional aspects that can be applied to related conditions. 

 Demonstrates acceptable performance

 Has gained prior experience in actual situations to recognize recurring meaningful
components
 Principles, based on experiences, begin to be formulated to guide actions

3. Competent

At this stage, the competent person grasps all the relevant rules and facts of the field and is, for the first
time, able to bring his/her own judgment to each case. This is the stage of learning that is often
characterized by the term - problem-solving. A competent level nurse would be able to use a hospital
information system with ease and know-how to solve technical difficulties or interpret conflicting data.

 Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-
day situations
 More aware of long-term goals
 Gains perspective from planning own actions based on conscious, abstract, and analytical
thinking and helps to achieve greater efficiency and organization

4. Proficient

The fourth stage is called fluency and is characterized by the progress of the learner from the step-by-step
analysis and solving of the situation to the holistic perception of the entirety of the situation. The
proficient hospital information system learner would know how to interpret data from all departmental
information and provide guidance to other disciplinary members as needed.

 Perceives and understands situations as whole parts

 More holistic understanding improves decision-making
 Learns from experiences what to expect in certain situations and how to modify plans

5. Expert

An expert‘s repertoire of experienced situations is so vast that normally each specific situation
immediately dictates an intuitively appropriate action. After a great deal of experience actually using a
system in everyday situations, the expert nurse discovers that without his consciously using any rules,
situations simply elicit from him or her appropriate responses. The proficient performer, immersed in the
world of his skilful activity, sees what needs to be done, and decides how to do it. The expert not only
knows what needs to be achieved, thanks to the well-refined ability to exercise situational discrimination,
s/he knows how to achieve his or her goal.

 No longer relies on principles, rules, or guidelines to connect situations and determine actions
 Much more background of experience
 Has intuitive grasp of clinical situations
 Performance is now fluid, flexible, and highly-proficient

Patricia Benner and other nurse educators adapted this model to explain how nursing students and
professional nurses acquired nursing skills.

A novice follows rules provided for each situation and is not flexible in real-life situations. As a novice
acquires real-life experiences and can appreciate environmental influences on rule sets, he or she moves to
the advanced beginner stage. At the competent stage, a learner is able to tell what is important and what
is not important in assessing a given situation—a learner has gained perspective. A proficient practitioner is
able to see a situation in terms of the larger setting or environmental situation and begins to use intuition
in decision-making. Finally, an expert intuitively understands a situation and immediately connects action
to this understanding (Ajay, 2003).

The DIKW Theory

When raw data is collected, it gets mixed up and the view seems jumbled. The DIKW Model by Fricke
(2018) on Russell Ackoff (1989) describes how the data can be processed and transformed into
information, knowledge, and wisdom.

The DIKW Hierarchy comprises of the following:

“D” = Data

“I” = Information

“K” = Knowledge

“W” = Wisdom

The DIKW model of transforming data into wisdom can be viewed from two different concepts, which are
contextual and understanding.

From the contextual concept, one moves from a phase of gathering data parts (data), the connection of
raw data parts (information), formation of whole meaningful contents (knowledge) and conceptualizing and
joining those whole meaningful contents (wisdom).

From the understanding concept, the DIKW Pyramid can be viewed as a process starting with researching
& absorbing, doing, interacting, and reflecting.

The DIKW hierarchy can also be represented in terms of time. For instance, the data, information, and
knowledge levels can be seen as the past while the final step - wisdom - represents the future.

Please refer to the following diagram to understand the representation:

The "Data" of DIKW Hierarchy:

The first step in this DIKW model is Data. Collection of raw data is the main requirement for coming up
with a meaningful result in the end. Any measurements, logging, tracking, records and many others are all
considered as data. Since the raw data is collected in bulk, it includes various things both useful and not so
useful contents.

These are completely raw data and do not provide any meaningful result that can be used by the
Information Technology (IT) Service provider. Therefore the data doesn't answer any question nor draw
any conclusion.
To understand how the Data is transformed into utilizable results using the DIKW Pyramid model, we will
discuss each of the subsequent steps of the of DIKW hierarchy (i.e. - information, knowledge, and wisdom)
using sample scenarios.

For Example, Let’s assume the scenario is - 300 Users visits FEU on Canvas daily to take online lessons.
This is the raw data we have got from statistics.

The "Information" of DIKW Pyramid:

Information can be termed as the data that has been given a meaning by defining relational connections.
Here, the word "meaning" represents processed and understandable data that may or may not be a useful
piece of content from the organization perspective.

In information processing system, a relational database creates information from the data stored within it.

The information hierarchy stage of DIKW Pyramid reveals the relationships in the data, and then the
analysis is carried out to find the answer to Who, What, When and Where questions.

Now let come to the above example, the data “300 users visit FEU on Canvas per day”, which is quite a
generic number to get any insight. Now, to do the capacity planning and availability planning, we must
process it through information stage of DIKW Hierarchy.

Now we can get answers like - 150 Users visit Nursing Pharmacology, 145 User visits Nursing Research, 5
Users just visits the dashboards. Out of them, 60% is in the age group of 18-22 years, 20% in age group of
22-26 Years. Also, we get 70% of our visitors between 9 AM to 11 PM.

In the given scenario above, the generic data now become an information answering the questions of
Who, What, When, and Where. This is the output we can get from information stage.

The "Knowledge" of DIKW Model:

Knowledge is the third level of DIKW Model. Knowledge means the appropriate collection of information
that can make it be useful.
Knowledge stage of DIKW hierarchy is a deterministic process. When someone "memorizes" information
due to its usefulness, then it can be said that they have accumulated knowledge.

Every piece of knowledge itself has useful meanings, but it can't generate further knowledge on its own.

In information management system, most of the applications you use, such as modelling, simulation etc,
exercise some sort of stored knowledge.

The knowledge step tries to find the answer to the "How" question. Specific measures are pointed out, and
the information derived in the previous step is used to answer this question.

With respect to our scenario, we must find the answer that “How do student nurses between the age
group of 18-22 years use our modular approach?”

The “Wisdom” of DIKW Hierarchy:

The Wisdom is the fourth and the last step of the DIKW Hierarchy. It is a process to get the final result by
calculating through extrapolation of knowledge. It considers the output from all the previous levels of
DIKW Model and processes them through special types of human programming (such as the moral, ethical
codes, etc.).

Therefore, Wisdom can be thought as the process by which you can take a decision between the right and
wrong, good and bad, or any improvement decisions.

Alternatively, we can say that in wisdom stage, the knowledge found in the previous stage is applied and
implemented in practical life.

Wisdom is the topmost level in the DIKW pyramid and answers the questions related to "Why".

In case of our example scenario, one example of wisdom gained might be that due to 70 % of the student
nurses visit our modules to get help with their lessons and technology needs.

Analyzing Organizational Issues Using the DIKW Hierarchy:

Data: A way to identify the raw external inputs such as the facts and figures that are yet to be interpreted.

Information: Analyze the raw data to determine the organizational needs. An important aspect of
information management is that apart from answering questions it can also help to find other solutions in
organizational contexts.

Knowledge: Determines how something is remembered by an individual or how information is applied by

them.

Wisdom: Uncover why the derived knowledge is applied by individuals in a specific way. i.e. - finding the
reason behind any decision-making.
The Usage and Limitations of DIKW Model:

Same as all other models, DIKW Model also has its own limits. You may have noticed that the DIKW
Hierarchy is quite linear and follows a logical sequence of steps to add more meaning to data in every step
forward. But the reality is often quite different than that. The Knowledge stage, for example, is practically
more than just a next stage of information.

One of the principal critiques of this DIKW Pyramid is that it’s a hierarchical process and misses several
important aspects of knowledge. In today's world, where we use various ways to capture and process
more and more unstructured data, sometimes forces us to bypasses few steps of DIKW.

Though the previous statement is quite true, however, the result still stays the same, such as what we do
with the data warehouse and transforming data through big data analytics into decisions and actions
(Wisdom).

Computer System

1. Computer Hardware

Hardware refers to the physical parts of the computer. It allows the user to enter data into the computer,
performs the actions of the computer’s processing, and produces the computer output. (Kozier, 2016) The
size, shape, and type varies depending on the purpose of the computer. The essential components of
computer hardware are the central processing units (CPUs) and the different types of input and output
devices that may also vary from one or more types.

2. Computer Hardware Systems

The CPU is in the box that comprises the computer hardware necessary to process and store data. The
power supply, disk drives, chips, and connections for all other computer hardware (also known as
peripherals) are also located with the CPU. The performance of the CPU or the determinant of how fast
the CPU’s performance is known by three components:

 CPU processor cores and clock-speed, which is typically measures in gigahertz

 The amount of random-access memory (RAM)
  The speed of data location or transfer rate of the disk drives.

Processor cores and clock speed are very different functions, but they’re working toward the same goal.
Many computer experts talk about which you should give more emphasis to when purchasing or selecting
a computer - but they depend on each other equally to help your computer function at its best. Processor
cores are individual processing units within the computer’s central processing unit (CPU). The processor
core receives instructions from a single computing task, working with the clock speed to quickly process
this information and temporarily store it in the Random Access Memory (RAM). Permanent information is
saved to your hard drive when you request it. Most computers now have multiple processor cores that
enable your computer to finish multiple tasks at once. Having the ability to run numerous programs and
request multiple tasks like editing a document and at the same time streaming a video, as well as opening a
new program, is made possible with multiple processor core units.

A computer’s processor clock speed determines how quickly the central processing unit (CPU) can retrieve
and interpret instructions. This helps your computer complete more tasks by getting them done faster.
Clock speeds are measured in gigahertz (GHz), with a higher number then the higher is the clock speed.
Multi-core processors were developed to help CPUs run faster as it became more difficult to increase
clock speed.

Faster clock speeds mean that users can see tasks ordered from the CPU to be completed faster, making
the user’s experience seamless and reducing the time waiting to interface with applications and programs.

Based on Sirois (2018) on a review for HP Computers, the reasonable fast CPU based on average usage is
between 3.5 to 4.0 GHz.

3. Open Source and Free Software

Software are the instructions being given to the hardware to perform certain tasks. They are classified
based on availability and shareability as to free and open-source software and propriety or closed
software.

Free and open-source software (FOSS) allows users and programmers to edit, modify or reuse the
software's source code. This gives developers the opportunity to improve program functionality by
modifying it.

The term “free” indicates that the software does not have constraints on copyrights. The term “open
source” indicates the software is in its project form, enabling easy software development from expert
developers collaborating worldwide without any need for reverse engineering.

Free and open-source software may also be referred to as free/libre open-source software (FLOSS) or
free/open-source software (F/OSS).

The basic and old classifications of software include: System and Application Software.

System Software helps the user, hardware , and application software to interact and function together.
These types of computer software allow an environment or platform for other software and applications
to work in. This is why system software is essential in managing the whole computer system.

When you first power up your computer, it is the system software that is initially loaded into memory.
Unlike application software, the System software is not used by end-users like you. It only runs in the
background of your device, at the most basic level while you use other application software. This is why
system software is also called “low-level software”.

Application Software or most popularly known as “apps” are what users regularly engage with the most of
the time. These types of computer software are productive end-user programs that help you perform
tasks. It can range from word processing to image editing, voice communication or conferences, internet
browsers, and many others.

With the advancement of technology, the software classification continues to change but the usability
remains to be the main basis for its classification.

4. Data Assessment

Data quality assessment (DQA) is the process of scientifically and statistically evaluating data in order to
determine whether they meet the quality required for projects or business processes and are of the right
type and quantity to be able to actually support their intended use. It can be considered a set of guidelines
and techniques that are used to describe data, given an application context, and to apply processes to
assess and improve the quality of data.

Data quality assessment (DQA) exposes issues with technical and business data that allow the organization
to properly plan for data cleansing and enrichment strategies. This is usually done to maintain the integrity
of systems, quality assurance standards and compliance concerns. Generally, technical quality issues such
as inconsistent structure and standard issues, missing data or missing default data, and errors in the data
fields are easy to spot and correct, but more complex issues should be approached with more defined
processes.

DQA is usually performed to fix subjective issues related to business processes, such as the generation of
accurate reports, and to ensure that data-driven and data-dependent processes are working as expected.

DQA processes are aligned with best practices and a set of prerequisites as well as with the five
dimensions of data quality:

 Accessibility
 Accuracy and reliability
 Serviceability
 Methodological soundness
 Assurances of integrity

5. Personal, Professional, and Educational Informatics

Personal Informatics

Information services, often accessible via a mobile device, that search, sort, mine, correlate or otherwise
filter information for a person based on their preferences, transaction logs, location, social networks and
other personal data.

Professional Informatics

Health informatics professionals use their knowledge of healthcare, information systems, databases and
information technology security to gather, store, interpret and manage the massive amount of data
generated when care is provided to patients. ... Developing data-driven solutions to improve patient
health.

Educational Informatics

Education informatics is an emerging sub-discipline of education and informatics that "incorporate[s] new
technologies and learning strategies to enhance the capture, organization, and utilization of information
within the field of education."

While this sub-discipline typically covers K-12 and higher education, it is easily expanded to business- and
enterprise-level education.