NURSING INFORMATICS: UNIT 2

Concepts, Principles and Theories in Nursing Informatics

Informatics Theory
A. Theories
 In nursing informatics, there are different theories, which help to frame and
inform this discipline. This include the:
1. General systems theory,
2. Change theory,
3. Cybernetics theory and the
4. Cognitive learning theory
 In addition,
1. Novice to Expert Theory and the
2. DIKW Theory also support the framework of Nursing Informatics.
 All the theories support nursing informatics in different ways
 Nursing practitioners can combine the knowledge they acquire from the theories,
with that they obtain from their nursing practice to enhance their performance.
1. General Systems Theory
 Developed by biologist Ludwig von Bertalanffy in 1936
 Includes purpose, content and process, breaking down the “whole” and analyzing
the parts
 The relationships between the parts of the whole are examined to learn how they
work together
 A system is made up of separate components. The parts rely on one another, are
interrelated, share a common purpose and together form a whole
 Assumptions of General System Theory
A. All systems must be goal directed
B. A system is more than the sum of its parts
C. A system is everchanging and any change in one part affects the whole.
D. Boundaries are implicit and systems are open and dynamic
 Concepts and Definition
1. Input – Energy & raw Material (Ex. Information, Money, Energy, time)
2. Throughput – processed used by the system to convert raw materials to
products (Ex. Thinking , planning, Decision making, constructing, meeting
3. Output – The product or service from throughput
4. Feedback – Information about some aspect of data or energy processing that
can be used to evaluate and monitor the system
5. Subsystem – A system which is a part of a larger system. They can work
parallel to each other or in a series with each other
 6. Static System – Neither system elements nor the system itself changes
much over time in relation to the environment
7. Dynamic system – The system constantly changes the environment & is
changed by the environment
8. Closed systems – Fixed , automatic relationships among system
components no give or take with the environment
9. Open Systems – Interacts with the environment trading energy & raw
material for goods & services produced by the system
10. Boundary – The line or point where a system or subsystem can be
differentiated from its environment or from other subsystems
11. Goal – The overall purpose for existence or the desired outcomes. (mission
statement)
12. Entropy – The tendency for a system to develop order & energy over time
13. Negantropy – the tendency of system to lose energy & dissolve chaos
14. Control or cybernation – The activities and processes used to evaluate
input, throughput & output in order to make corrections
15. Equifinality – Objectives can be achieved with varying inputs & in different
ways
 Basic Principles of a System Approach
1. A system is greater than the sum of its parts.
 Requires investigation of the whole situation rather than one or two aspects of
a problem.
 Mistakes can’t be blamed on one person, rather a system analyst would
investigate how the mistakes occurred within a subsystem and look for
opportunities to make corrections in the processes used.
2. The portion of the world studies (system) must exhibit predictability.
3. Though each sub-system is a self-contained unit, it is part of wider and higher
order
4. The central objective of a system can be identified by the fact that other
objectives will be sacrificed in order to attain the central objective.
5. Every system, living or mechanical, is an information system. Must analyze how
suitable the symbols used are for information transmission.
6. An open system and its environment are highly interrelated
7. A highly complex system may have to be broken into subsystems so each can be
analyzed and understood before being reassembled into a whole.
8. A system consists of a set of objectives and their relationships
9. 9A system is a dynamic network of interconnecting elements A change in only
one of the elements must produce change in all the others.
10. When subsystems are arranged in a series, the output of one is the input for
another; therefore, process alterations in one requires alterations in other
subsystems
11. All systems tend toward equilibrium, which is a balance of various forces within
and outside of a system.
 12. The boundary of a system can be redrawn at will by a system analyst
13. To be viable, a system must be strongly goal-directed, governed by feedback,
and have the ability to adapt to changing circumstances.

2. Change Theory
 Developed by Kurt Lewin who is considered the father of Social Psychology
 Lewin’s definition of behavior in this model is “a dynamic balance of forces
working in opposite directions”
 3 Major Concepts
1. Driving Forces – are those that push in a direction that causes change to occur.
They cause a shift in the equilibrium towards change
2. Restraining Forces – are those forces that counter the driving forces
3. Equilibrium – is a state of being where driving forces equal restraining forces and
no change occurs.
 3 Stages
1. Unfreezing – process which involves finding a method of making it possible for
people to let go of an old pattern that was somehow counterproductive
2. Change Stage – “moving to a new level” or “movement”. Involves a process of
change in thoughts, feeling, behavior, or all three, that is In some way more
liberating or more productive.
3. Refreezing Stage – establishing the change as the new habit.
 Major Assumptions
A. People grow and change throughout their lives
B. Change happens daily
C. Reactions to change are grounded in the basic human needs for self-esteem,
safety and security
D. Change involves modification or alteration.
 6 Components
1. Recognition of the area where change is needed
2. Analysis of a situation
3. Identification of methods by which change can occur
4. Recognition of the influence of group mores or customs on change.
5. Identification of the methods that the reference group uses to bring about change
6. The actual process of change
Kurt Lewin’s Model of Change

3. Cybernetics Theory
Cybernetics
 is a transdisciplinary approach for exploring regulatory systems, their structures,
constraints and possibilities
 “the scientific study of control and communication in the animal, machine and
society” as defined by Norbert Wiener.
 is applicable when a system being analyzed incorporates a closed signaling loop-
originally referred to as “circular causal” relationship, that is where action by the
system in some manner (feedback) that triggers a system change.
 The essential goal of the broad field of cybernetics is to understand and define
the functions and processes of systems that have goals and that participate in
circular, causal chains that move from action to sensing comparison with the
desired goal, and again to action.
 Its focus is how anything (digital, mechanical or biological) processes
information, reacts to information and changes or can be changed to better
accomplish the first two tasks.
 Comes from the Greek word “Kubernetes” means “steering” and “governor” in
Latin.
 Major Concepts
A. Cybernetics introduces the concept of circularity and circular causal systems
B. Systems are defined by boundaries
 C. Every system has a goal
D. Environment affects aim
E. Information returns to system- “feedback”
F. System measures difference between state and goal
G. Detects “error”
H. System corrects action to aim toward goal
I. Cycle Repeat
 Scope and Application of Cybernetics
1. Basis of modern communication systems
2. Application in cognitive science for modeling and learning
3. Application in management science
 Conclusion
 Cybernetics is applicable in any discipline relying on feedback processes
including health sciences, sociology and psychology, which are based on
communication process

4. Cognitive Learning Theory

 Explains why the brain is the most incredible network of information processing
and interpretation in the body as we learn things
 2 specific Theories
A. Social Cognitive Theory
B. Cognitive Behavioral Theory
 A. Social Cognitive Theory
 We consider 3 variables
1. Behavioral factors
2. Environmental factors (extrinsic)
3. Personal Factors (intrinsic)
 Basic Concepts
1. Observational Learning
2. Reproduction
3. Self Efficacy
4. Emotional Coping
5. Self regulatory Capability
 B. Cognitive Behavioral Theory
 Describes the role of cognition (knowing) to determining and predicting the
behavioral pattern of an individual.
 Developed by Aaron Beck
5. 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).
 This Theory Can Be Applied to
A. The development of nursing informatics skills, competencies, knowledge and
expertise in NI
B. The development of technological system competencies in practicing nurses
working in an institution
C. The education of nursing students, from first year to graduation and
D. Transition of graduate nurse to expert nurse
 The currently accepted five levels of development as presented by Benner
 Novice-Competent-Proficient-Expertise-Mastery was initially proposed by
Hubert and Dreyfus
 Distinguishing Features
A. Deliberate Practice – is a trait shown by people who use a personal, goal-
oriented approach to skill and knowledge development. This requires years of
sustained effort to continually improve quality of practice and performance
within the skill
B. Taking Risks – Continuous climb to expert level – requires people to move
beyond the status quo of mere competence through the levels of Proficiency
then Expertise
5.1 Novice
 A novice doesn’t know anything about the subject he/she approaching and has to
memorize its context-free features.
  The novice is then given rules for determining an action on the basis of this
features.
 To improve the novice needs monitoring either by self observation or instructional
feedback.
5.2 Advance Beginner
 Still dependent on rules, but as he/she gains more experience with the real-life
situations, he/she begins to notice additional aspects that can be applied to
related conditions
5.3 Competent
 The competent person grasps all relevant rules and facts of the field and is, for
the first time, able to bring his/her own judgement to each case.
 This is the stage of learning that is often characterized by 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.

5.4 Proficient
 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.

5.5 Expert
 An expert’s repertoire of experienced 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/her appropriate responses.
6. The DIKW Theory

 When raw data is collected, it gets mixed up and the view seems jumbled
 Model by Fricke (2018) and Russell Ackoff (1989)
o “D” = Data
o “I” = Information
o “ K” = Knowledge
o “W” = Wisdom
 The DIKW model of transforming data into wisdom can be viewed from two
different concepts
1. 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)
2. Understanding Concept – the DIKW Pyramid can be viewed as a processing
starting with researching & absorbing, doing, interacting, and reflecting
A. The “Data” of DIKW
 The first step
 Collection of Raw data is the main requirement
  Any measurements, logging, tracking, records and many others are all
considered as data.
 Since the raw data is collected in bulk, it includes both useful and not useful
contents.
 Example: 300 Users visits a website daily to take online lessons
B. The “Information” of DIKW

 Data that has been given meaning by defining relational connections

 “meaning” represents processed and understandable data.
 Example: 150 Users Visit Nursing Pharmacology section, 145 for Nursing
Research , Out of them, 60% is in the age group of 18-22 years old , 70% of our
visitors between 9am – 11pm
C. The “Knowledge” of DIKW
 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.
 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 old use our modular approach.
D. The “Wisdom” of DIKW
 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.
 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 working professionals visit our tutorials to get help with their
certifications 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).