Nursing Informatics Theories and Models

Theories of Nursing Informatics

• Nursing informatics theory, sociotechnical theory, change theory, and general systems theory contribute to nursing informatics
• Chaos theory, cognitive science theory, usability theory, and learning theories also factor

Nursing Informatics Models

General Models

• Models provide frameworks for identifying significant information needs to foster research
• Graves and Corcoran's Model (1989) describes nursing informatics as a linear progression from data into information and knowledge, represented in sequential boxes
• Schiwirian's Model (1986), proposed by Particia Schwerin, stimulates and guides research in nursing informatics
• Turley's Model (1996) identifies 3 core components of informatics: 1) cognitive science, 2) information science, and 3) computer science

Information Literacy

• Information literacy necessitates awareness, identification, evaluation, integration, and assessment
• Competencies in information literacy are crucial for safe nursing practice
• Information management involves nurses processing significant amounts of daily information to inform practice and decision-making

Specific Informatics Models

• Nursing informatics includes government agencies, healthcare facilities, practitioners, insurance companies, pharmaceutical companies, academic institutions and suppliers
• The Philippine Healthcare Ecosystem Model indicates that a network is maintained by the government, nursing associations, and developmental agencies
• Intel's shift left model illustrates that patient care progresses from technology-heavy, high-cost delivery to quality of life with minimal health costs
• The inverse relationship exists between quality of life and cost of care/day under Intel's shift left model
• Patient medical record information model (PMRI) is the foundation of HER
• Three dimensions of healthcare impact the type and pattern of documentation:
  • Personal health dimension: personal health record maintained and controlled by an individual or family
  • Health care provider dimension: promotes quality patient care with access to accurate patient data
  • Population health dimension: uses information on population health to identify threats and monitor programs

Theories with Informatics Support

• Informatics relies on principles from other disciplines.

Nursing Informatics Theory (Information Theory)

• The core concepts of informatics include data, information, knowledge and wisdom
• Data are discrete, objective, facts or elements in isolation
• Information is data with interpretation or structure, derived from combining data pieces
• Knowledge synthesizes information with relationships, collected to produce knowledge
• Wisdom evaluates knowledge through reflection, combining knowledge, values and experience

Sociotechnical theory and social informatics

• Sociotechnical theory was developed to address the impact of technology implementation on organizational productivity, focusing on the interactions between information management tools, employee skills and organizational structures

Change Theory

• Rogers's diffusion of innovation theory addresses the integration of computerized information and its effect on workers
• Lewin's change theory outlines stages for moving people to a state of comfort with change
  • Rogers's diffusion of innovation theory categorizes adopters into:
    • Innovators (12.5%) adopt the innovation
    • Early adopters (13.5%) promote the innovation
    • Early majority (34%) make safe investments
    • Late majority (34%) adopt due to peer pressure
    • Laggards (16%) resist change until assured of success
  • Lewin's change theory stages:
    • Unfreezing: reducing restraining forces to allow driving forces to become dominant
• Moving
• Refreezing

General systems theory

• General systems theory examines complex structures like information systems, focusing on the interaction among system parts
• Change in one area of the system will affect other sections
• An open system continuously exchanges information with its environment
• A closed system is isolated with no external input

Chaos theory

• Chaos theory addresses entire structures without reducing it to elemental parts
• The seemingly chaotic can actually have order based on initial conditions
• Questioning linear assumptions can stimulate new thinking

Cognitive Science

• Cognitive Science studies the mind and intelligence, applicable across disciplines
• Cognitive Science focuses on how the brain perceives and interprets screens and how much information one can absorb and use constructively
• Cognitive theory can assist informatics nurses to understand decision-making processes

Usability Theory

• Usability theory uses cognitive science and sociotechnical theories to focus on ease of use and aesthetics of technology
• Usability's five goals:
  • Easy accomplishment of basic tasks on first use
  • Quick and easy task performance after learning
  • Easy reestablishment of proficiency after periods of non-use
  • Minimal errors with easy remedies
  • Pleasant design and use

Learning Theories

• Learning theories are useful in teaching users to use the system as well as decreasing the time it takes to train and learn

Contribution of Theories to Informatics

• Nursing informatics helps to convert data into information and knowledge
• Sociotechnical theory improves the interaction between an information system and the organizational culture
• Change theory increases the success when implementing a new system
• General systems theory improves understanding the complexity of an information system
• Chaos theory refines information system design
• Cognitive science theory improves a user's ability to absorb knowledge from an information system
• Usability theory enhances ease of use and user satisfaction
• Learning theories inform the design and selection of computer-aided instruction