Nursing Informatics Theories and Models

Nursing Informatics Theories

• Nursing informatics theory (Information theory) exists
• Sociotechnical theory and social informatics exist
• Change theory is an idea
• General systems theory exists
• Chaos theory exists
• Cognitive science theory exists
• Usability theory exists
• Learning theories exist
• Theories contribute to informatics

Nursing Informatics Models

General Models

• Graves and Corcoran's Model (1989) views nursing informatics as linear
• Data progresses into information and knowledge
• Data, Information, and knowledge are in sequential boxes
• Boxes have one-way arrows pointing from data to information to knowledge
• Schiwirian's Model (1986) helps to stimulate and guide systematic research in nursing informatics
• Patricia Schwerin proposed the Schiwirian model
• The model gives a framework for finding key information needs
• Identifying needs can foster research
• Turley's Model (1996) includes 3 themes
• The themes are core components of informatics
• Cognitive science, information science, and computer science all factor

Turley's Model Themes

• Cognitive science involves using computer and computer science as key to definition
• Information science focuses on conceptual issues. These issues represent nursing knowledge and information
• Computer Science is how the computer helps nurses enter, organize, and retrieve information

5 Components of Information Literacy

• Acknowledge the need for information literacy

• Identify and retrieve information

• Evaluate information for relevance

• Integrate information into practice

• The effect of the information should be evaluated on the problem, or issues

• Competences in this area are critical to safe nursing practice.

• Nurses are faced with significant information amounts daily

• Nurses should understand how to make sense of information to gain knowledge

• Information should inform practice and decision-making

Specific Informatics Models

• Philippine Healthcare Ecosystem Model exists
• Nursing informatics encompasses all sectors of healthcare delivery system
• Government agencies, healthcare facilities, practitioners, insurance companies, pharmaceutical companies, academic institutions, and suppliers factored
• The government, nursing associations and developmental agencies maintain and balance the network
• Intel's shift left model suggests care shifts/progresses from high costs and high quality to a minimal health costs
• There is an inverse relationship between quality of life and cost of care/day
• Patient medical record information model(PMRI) is the basis of HER

Patient Medical Record Information Factors

• The type and pattern of documentation in the patient record depends on 3 healthcare dimensions
• Personal health dimension represents health record
• The individual or family maintains and controls personal health records
• Non-clinical information, self-care trackers, and health care directories factored dimensions
• Health care provider dimension boosts quality patient care
• Access is given to complete accurate patient data 24/7
• Provider notes/ prescription, clinical orders decision support systems, or practice guidelines factored dimensions
• Population health dimension informs health
• Stakeholders identify and track health threats, and assess population health
• Programs, services and research is conducted

Theories Supporting Informatics

• Informatics relies on principles from other disciplines

Nursing Informatics Theory (Information Theory)

• The discipline's core concepts are:

The Core Concepts of Informatics

• Data are discrete, objective facts or elements that are not interpreted
• Data is at the atomic level. Data describe things objectively without interpretation
• Data are the building blocks of meaning without context and are meaningless
• Information is data with some type of interpretation or structure and context
• Information combines different pieces of data
• Vital signs interpreted over time is information
• Knowledge is the synthesis of information with formalized relationships
• Knowledge is information collected to produce knowledge
• Interpreting vital signs and deciding on an action, with nursing knowledge is knowledge
• Wisdom is evaluating knowledge with reflection
• Wisdom factors when and how to use knowledge
• One combines knowledge, values and experience with data
• Interpreting signs in a postsurgical patient as indicative and acting appropriately is wisdom

Sociotechnical Theory and Social Informatics

• Sociotechnical theory developed in the middle of last century
• The theory suggests some technology implementations do not always increases productivity
• The main focus is the impact of technology implementation on an organization
• Focus is on interactions of an organization between information management tools and techniques. Knowledge, skills, attitudes, values and employee needs factored

Change Theory

• Computerization creates a change that affects workers
• Change can be unplanned
• Rogers's change theory of diffusion and innovation factors how change occurs in society
• Change can be represented by Lewin's change theory
• Lewin talks about stages of moving people from before the change, to comfort after it

Rogers' Diffusion of Innovation Theory

• The theory examines the patterns of acceptance in a population
• Adopters are divided into five categories:

Categories of Adopters

• Innovators (12.5%) adopt the innovation
• Early adopters (13.5%) are opinion leaders who promote innovation
• Early majority (34%) are averse to risks but will make safe investment
• Late majority (34%) are sure an innovation is beneficial
  • The adopt the innovation due to peer pressure
• Laggards (16%) are suspicious and resist
  • They see the innovation will not fail before adoption

Lewin's Change Theory

• Lewin's divided his theory into 3 stages (unfreezing, moving and refreezing)
• Moving from stages should be part of implementing a system
• The unfreezing stage factors human behavior with a balance of driving forces and restraining forces that create an equilibrium
• A driving force toward change causes a countering restraining forces to allowing the maintenance of equilibrium
• To unfreeze, reducing restraining forces and allow driving forces to become dominant is needed

General system theory Factors

• General theory helps think about complex structures and the information system
• The theory focuses on the interaction among the various parts of the system
• The general theory notes the whole is greater than the sum of its parts
• Change in the system will reflect across the system
• Computers factor with system changes
• An open system exchanges information continually with the environment
• A closed system is isolated
• The system does not factor input and sees disorganized breakdown

Chaos Theory

• Chaos theory addresses an entire structure without reducing it to parts
• The theory is helpful with complex systems such as information systems
• Order factors in chaotic situations
• Events and phenomena depend on initial conditions
• Chaos theory is nonlinear
• Assumptions questioned can be done using linear thought

Cognitive Science

• Studying the mind and intelligence factors in how to apply it
• Includes philosophy, psychology, artificial intelligence, neuroscience, linguistics and anthropology
• Cognitive science is part of social informatics
• Focus is on how the brain perceives and interprets a screen
• Cognitive science addresses the amount of information that an individual can absorb and use constructively
• Cognitive theory can help an informatics nurse specialist understand the information processing
• Aiding in tool design factors for support to make decisions

Usability Theory

• Usability factors information from cognitive science and sociotechnical theories
• Factors easy to use, user satisfaction, goals achieved, and technology aesthetics

The Five Goals of Usability

• Users accomplish tasks initially
• Users quickly and easily perform tasks after learned design
• Proficiency reestablished easily when system not used for a period of time
• Users make few and remedied errors
• Pleasant design

Learning Theories

• Theories important in informatics and nursing
• Users must be taught and theories can decrease training time

Contribution of theories to informatics

• Nursing informatics improves information processing
• Nurses bring wisdom
• Sociotechnical theory and social informatics factors system interaction and organization
• Change theory attends to system reactions of change
• General systems theory enhances the understanding of the complexity of the system
• Chaos theory improves the design of information systems
• Cognitive science theory facilitates gaining knowledge
• Usability theory enhances ease of use and satisfaction
• Learning theories helps with selecting instructions