THEORIES, FRAMEWORKS, AND MODELS

NURSING INFORMATICS NURSING INFORMATICS MODELS MODELS

General Models• Graves and Corcoran’s model• Schiwirian’s model• Turley’s model• Data Information Knowledge (D-I-

K) model • Benner’s Novice to Expert model

GRAVES AND CORCORAN’S MODEL (1989)

Nursing informatics as the linear progression - from data into information and knowledge

• Management processing is integrated within each elements, depicting nursing informatics as the proper management of knowledge – from data as it is converted into information and knowledge

MANAGEMENT

DATA INFORMATION KNOWLEDGE

SCHIWIRIAN’S MODEL (1986)

Nursing informatics involves identification of information needs, resolution of the needs, and attainment of nursing goals/objectives

Patricia Schwirian – proposed a model intended to stimulate and guide systematic research in nursing informatics

Model/framework that enables identification of significant information needs, that can foster research (somewhat similar to Maslow’s hierarchy of needs)

GOAL

USERS

TECHNOLOGY

RAW MATERIALS(Nursing-related information)

TURLEY’S MODEL (1996)

• Nursing informatics is the intersection between the discipline-specific science (nursing) and the area of informatics

• Core components of informatics:–Cognitive science–Information science–Computer science

COMPUTER SCIENCE

INFORMATIONSCIENCE

COGNITIVE SCIENCE

NURSING

DATA-INFORMATION-KNOWLEDGE MODEL

NI is a specialty that integrates nursing science, computer science and information science to manage and communicate data, information, knowledge and wisdom into nursing practice (ANA)

Nursing informatics is an evolving, dynamic process involving the conversion of data into information, and subsequently knowledge

Important Note: Processing of information does not always result in the development of knowledge.

CO

MP

LE

XIT

Y

HUMAN INTELLECT

KNOWLEDGEKNOWLEDGE

INFORMATIONINFORMATION

DATADATA

BENNER’S LEVEL OF EXPERTISE MODEL

• Every nurse must be able to continuously exhibit the capability to acquire skills (in this case, computer literacy skills parallel with nursing knowledge), and then demonstrate specific skills beginning with the very first student experience

Levels of Expertise (Benner):

• Novice – individuals with no experience of situations and related content in those situations where they are expected to perform tasks

• Advanced Beginner – marginally demonstrate acceptable performance having built on lessons learned in their expanding experience base; needs supervision

• Competent – enhanced mastery and the ability to cope with and manage many contingencies

Levels of Expertise (Benner):

Proficient – evolution through continuous practice of skills, combined with professional experience and knowledge; individual who appreciates standards of practice as they apply in nursing informatics

Expert – individual with mastery of the concept and capacity to intuitively understand the situation and immediately target the problem with minimal effort or problem solving

NOVICE

ADVANCED BEGINNER

COMPETENT

PROFICIENT

EXPERT

INTEL’S SHIFT LEFT MODEL

• Patient care shifts/progresses from a high quality delivery of lif through technology with increased costs (right side) into quality of life with minimal health costs

• Inverse relationship between quality of life and cost of care/day

PATIENT MEDICAL RECORD INFORMATION MODEL (PMRI): BASIS OF EHR

The type and pattern of documentation in the patient record will be dependent on 3 interacting dimensions of health care:

Personal health dimension – personal health record maintained and controlled by the individual or family; nonclinical informatione.g. self-care trackers, directories of health care, and other supports

• Health care provider dimension – promotes quality patient care, access to complete accurate patient data 24/7e.g. provider’s notes/prescription, clinical orders decision support systems, practice guidelines

• Population health dimension – information on the health of the population and the influences to health; helps stakeholders identify and track health threats, assess population health, create and monitor programs and services, and conduct researche.g. Ushahidi program

*Important Terminologies (Data Sets):

• ABC codes• Perioperative Nursing Data Set (PNDS)• SNOMED CT• International Classification for Nursing

Practice (ICNP)• Patient Care Data Set (PCDS)• NANDA• LOINC

ABC CODES

• mechanism for coding integrative health interventions by clinician for administrative billing and insurance claims

• includes complementary and alternative medicine interventions and codes that map all NIC, CCC, and Omaha system interventions

Perioperative Nursing Data Set (PNDS)

• universal language for perioperative nursing practice and education; standardize documentation of perioperative data in all perioperative settings

• Diagnosis based on NANDA, interventions based on NIC, and outcomes based on NOC

SNOMED CT

• core clinical terminology containing over 357,000 healthcare concepts with unique meanings and formal logic-based definitions organized into multiple hierarchies

International Classification for Nursing Practice (ICNP)

• integrated terminology for nursing practice developed under sponsorship of ICN

ICNP elements:• Nursing phenomena (nursing diagnosis)• Nursing actions (nursing interventions)• Nursing outcomes

Patient Care Data Set (PCDS)

• terms and codes for patient problems, therapeutic goals, and patient care orders

• developed by Dr. Judith Ozbolt

ORGANIZATIONS as Resources

• AMIA• NLN• HIMSS

American Medical Informatics Association (AMIA)

• authoritative body in the field of medical informatics and frequently represents the United States in the informational area of medical informatics in international forums

• dedicated to the development and application of medical informatics in the support of patient care, teaching, research, and healthcare administration

National League for Nursing (NLN)

Mission: To advance quality nursing education that prepares the nursing workforce to meet the needs of diverse populations in an ever-changing healthcare environment

Addresses faculty development and educational research

*Educational Technology and Information Management Advisory Council (ETIMAC) – promote effective use of technology in nursing education, as a teaching tool and outcome for student-faculty learning

Healthcare information and management systems society (HIMSS)

• assumes leadership role in the health care information technology standards of nursing and advocacy of key innovations in health care delivery and administration