NURSING INFORMATICS – LECTURE
ELECTRICAL COUNTING MACHINES
Nursing Informatics (NI)
- Title that evolved from the French word
“informatics”
- Referred to the field of applied computer
science concerned with the processing of
information such as nursing information.
Computer
- An electronic machine that accepts
information (data), processes it according
to specific instructions, and provides the
results as new information.
I. ANCIENT COUNTING MACHINE
1. The Abacus (Base 5) – in ancient
Babylon, China and Europe
2. The Roman Numerals
3. The Arabic Numerals (Base 10)
II. MECHANICAL COUNTING MACHINES
4. Pascaline – a mechanical
calculating device invented by the
French philosopher and
mathematician Blaise Pascal in
1642.
5. Leibniz Wheel – invented by the
famous mathematician Leibniz in
1673
6. Punched Cards – used by the
French weaver Joseph Jacquard in
1810. The cards carried weaving
instructions for the looms, later
this idea offered a great use for
storing information
7. Babbage’s Difference Engine –
calculating machines made by
Charles Babbage to produce tables
of numbers that would be used by
ship’s navigators.
Invention of the Vacuum Tube
(1883)
8. Vacuum Tube – initially
discovered by Thomas Edison, the
vacuum tube formed the building
block for the entire electronics
industry. Were later used as
electron valves in the 20th century
to build the first electronic
computers.
9. Babbage’s Analytical Engine – a
partial model was completed in
1910 by his son. Used punched
cards to store numbers. The design
was no more successful than its
predecessors
III.
10.The US census of the 1880 took 9
years to compile and led to
inaccurate figures. To solve the
problem, Herman Hollerith
invented a calculating machine
that used electricity along with
punched cards instead of
mechanical gears.
 The company eventually
became known as:
International Business
Machines (IBM)
11.Mark I – built by a team from IBM
and Harvard University. Mark I
was mechanical telephone
switches to more information. It
accepted data punched cards,
processed it and then output the
new data.
IV. ELECTRONIC COUNTING MACHINE
12.ENIAC – was the first US-built-all-
electronic computer built to
perform ballistics calculations.
WHAT IS INTERNET?
- A worldwide system of interconnected
networks and computers.
WHAT IS NETWORK?
- A computer network is an
interconnection of a group of computers
EVOLUTION OF THE INTERNET
Arpanet
- World’s first operational network, and the
predecessor of the global internet
- Was developed by the US Department of
Defense. One theory was that it was
developed to survive a nuclear attack.
That theory is often disputed by
scientists.
- First WAN and had only 4 sites in 1969
The World Wide Web (WWW)
- Most popular and promising method of
organizing and accessing information on
the internet
NURSING AND THE COMPUTER – HISTORICAL
PERSPECTIVES
I. SIX TIME PERIODS
1. 1960’s
> Punch Cards – a piece of stiff paper that
can be used to contain digital information
 represented by the presence or absence
of holes in predefined positions.
> Card Readers – is a data input device that
reads data from a card-shaped storage
medium
> Sort and prepare data for processing –
a series of operations on data, especially
by a computer, to retrieve, transform, or
classify information
> Teletypewriters – an electromechanical
typewriter that can be used to send and
received typed messages from point to
point and point to multipoint over various
types of communications channel.
2. 1970’s
- Nurses began to see the value of
computers in the profession
> Documentation of nursing practice
> Quality of patient care
> Repetitive aspects of managing
patient care
- Computers are perceived as cost-saving
technologies
3. 1990’s
- LAN were developed in hospitals
- WAN were developed for linking care
across health care facilities
II. FOUR MAJOR NURSING AREAS
SIGNIFICANCE OF NURSING INFORMATICS
1. Nursing Clinical Practice
2. Nursing Administration
3. Nursing Education
4. Nursing Research
Nursing Clinical Practice
- Electronic Medical Record (EMR) and
Computer-Based Patient Record (CPR)
Nursing Administration
- Automated staff scheduling
- Email for improved communications
Nursing Education
- Computerized record keeping
- Computerized assisted instruction
- Interactive video technology
Nursing Research
- Computerized literature searching and
Web sources
III. STANDARDS INITIATIVE
1. Nursing Practice Standards
- Developed and recommended by the ANA
(American Nurses Association)
2. Nursing data Standards
3. Health Care Data Standards Organizations
- American National Standards Institute
(ANSI)
- American Society for Testing and
Materials (ASTM)
THEORY APPLIED TO INFORMATICS
Theory is an important component of robust
nursing informatics knowledge, a fast that is
sometimes overlooked in both education and
practice.
I. LEWIN’S CHANGE THEORY
- A theory focus continues in this issue with
a look at the oldest, simplest, yet robust
and applicable change management
theory, Kurt Lewin’s Change Theory.
Kurt Lewin
- A Gestalt social psychologist
- Father of Social Change Theories
- He is also lauded as the originator of
social psychology, action research, as well
as organizational development
- Lewin’s Change Theory is a “planned
change” guide that consists of three
distinct and vital stages:
 Unfreezing Stage
 Moving to a New Level or
Change Stage
 Refreezing Stage
1. Unfreezing
- First stage involves finding a method of
making it possible for people to let go of
an old pattern that was
counterproductive in some way.
- This is the stage where the desire to
change occurs, or at least the recognition
that change is needed.
2. Moving to a new level or Change
- The second stage involves a process of
change-in thoughts, feelings, behavior, or
all three, that is in some way more
liberating or more productive than doing
thing the old way.
- The people involved (change target
group) are convinced that the new way is
better than the old
3. Refreezing
- The third and final stage consists of
establishing the change as a new habit or
process, so that it now becomes the
“standard operating procedure” or status
quo.
- Rewards, support and champion
leadership continue to be important
 through this stage, which is essentially
ongoing until the next major change is
needed.
FORCE FIELD ANALYSIS
- Offers direction for diagnosing situations
and managing change within
organizations and communities.
- Lewin assumed that in any situation there
are both driving and restraining forces
that influence any change that may occur
- According to Lewin’s Theory, human
behavior is caused by forces – beliefs,
expectations, cultural norms, and the like
– within the “life space” of an individual
or society.
Driving Forces
- Forces that influence a situation, pushing
in a particular direction; they tend to
initiate a change and keep it going.
Restraining Forces
- Forces that act to restrain or decrease the
driving forces; they make it difficult to
move a change forward.
Equilibrium
- Is the status quo or the present level of
productivity, and can be disrupted or
fortified by changes in the relationship
between the driving and the restraining
forces.
II. DIFFUSION OF INNOVATION THEORY
- Developed by Everett Rogers in 1962, one
of the oldest social science theories.
- It originated in communication to explain
how, over time, an idea or product gains
momentum and diffuses (or spreads)
through a specific population or social
system.
- The end result of this diffusion is that
people, as part of social system, adopt a
new idea, behavior, or product
Five Established Adopter Categories
(IEELL)
1. Innovators
- First to try the innovation; Risk takers
- They are venturesome and interested in
new
- ideas
- Often the first to develop new ideas
2. Early Adopters
- People who represent opinion leaders
- They enjoy leadership roles and embrace
change opportunities.
- They are already aware of the need to
change and so very comfortable adopting
new ideas
- They do not need information to convince
them to change
3. Early Majority
- People who are rarely leaders, but they do
adopt new ideas before the average
person.
- They typically need to see evidence that
the innovation works before they are
willing to adopt it.
4. Late Majority
- People are skeptical of change, and will
only adopt an innovation after it has been
tried by the majority.
5. Laggards
- People are bound by tradition and very
conservative.
- They are very skeptical of change and are
the hardest group to bring on board.
The stages by which a person adopts an
innovation, and where by diffusion is
accomplished, include;
- Awareness of the need for an innovation,
- Decision to adopt (or reject) the
innovation,
- Initial use of the innovation to test it, and
- Continued use of the innovation
There are five main factors that influence
adoption of an innovation, and each of these
factors is at plat to a different extend in the five
adopter categories; (RCCTO)
1. Relative Advantage – innovation is seen
as better than the idea, program or
product it replaces
2. Compatibility - how consistent the
innovation is with the values, experience,
and needs of the potential adopters
3. Complexity – how difficult the innovation
is to understand and/or use
4. Triability – which innovation can be
tested or experimented with before a
commitment to adopt is made.
5. Observability – innovation provides
tangible results.
THE DATA-INFORMATION-KNOWLEDGE-
WISDOM FRAMEWORK (DIKW)
- Nursing informatics was created by the
merge of three well established scientific
 fields; Information Science, Computer
Science and Nursing Science.
DATA
- are the smallest components of DIKW
framework.
- Commonly presented as discrete facts;
products of observation with little
interpretation
INFORMATION
- Might be thought of as “data + meaning”
- Often constructed by combining different
data points into a meaningful picture,
given certain context; it answers
questions such as who, what, where and
when
c. Outcome – the change in health care
status attributed to the object being
evaluated
HISTORICAL BACKGROUND OF ELECTRONIC
HEALTH RECORDS
- An electronic record composed of health
information regarding an individual
patient that exists as part of a complete
system designed to provide access to, and
management of, such information
- The EHR is developed and managed by
the health facility or provider
- The term Electronic Health Record has
largely replaced the older “Electronic
Medical Record”
Computer-Based Patient Record Institute
(CPRI)

KNOWLEDGE - Founded in 1992

- Information that has been synthesized so
that relations and interactions are defined
and formalized; it is built of meaningful
information constructed of discrete data
points
- Knowledge answers questions of “why”
and “how”
WISDOM
- An appropriate use of knowledge to
manage and solve human problems
- Implies a form of ethics, or knowing why
certain things or procedures should or
should not be implemented in healthcare
practice
- It was an organization representing all
the stakeholders in healthcare, focusing
on the clinical applications of information
technology
The Healthcare Information Management
System Society
Vision – advancing the best use of information
and management systems for the betterment of
healthcare
Mission – to lead change in the healthcare
information and management systems field
through knowledge sharing, advocacy,
collaboration, innovation, and community
affiliations

III. INFORMATION THEORY

- Dr. Claude E. Shannon, innovated
information theory by extending the
mathematical observations of Boltzmann,
Szilard, von Nuemann, and Wiener in the
area of physics, quantum mechanics and
particle physics
- Information theory is concerned with the
adaptability of a message through a
particular channel for optimum
transmission. In health informatics,
information theory can be a benefit by
improving
a. Structure – the capacity of the
facilities and the capacity and
qualification of the personnel and
organization
b. Process – the changes in the volume,
cost and appropriateness of activities