Question

Summarize the history of nursing informatics (20% of grade)

What is the DIKW frame work and how does it relate to the development of nursing informatics? (20% of grade)

Explain the TIGER initiative (20% of grade)

Answer 1

Summarization of history of nusring informatics

Exploring interplays of data, information, knowledge, and wisdom, nursing informatics takes a practice turn, accommodating to processes of application design and deployment for purposeful use by nurses in different settings. Collaborative efforts will be key to further achievements that support task shifting, mobility, and ubiquitous health care.

The seminal paper by Graves and Corcoran in 1989 set the stage for conceptualizing the specialty of nursing informatics. They defined nursing informatics as "

• a combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data,
• information and knowledge to support the practice of nursing and the delivery of care". Here they draw attention to the information of nursing, elaborating data, information, and knowledge as the foundational components for collection,
• processing, or manipulation by technological tools. Although there are different perspectives on the relations between data, information, and knowledge (i.e., portraying linear, progressing complexity or as mutually constituted, accumulated elements), the components can be understood as follows. Data is "raw facts," that is, the basic elements (atomic structure) or uninterpreted building blocks for composition to information or knowledge. Information is combined or structured data interpreted in different contexts or situations.
• Knowledge is data or information synthesized by formulas, heuristic strategies, or formally delineated relationships These interrelated elements of data, information, and knowledge point out important attributes of evidence in nursing, but they also differentiate foci within nursing informatics. The establishment of comprehensive nursing vocabularies with interface and reference properties, e.g., enumerative classification systems, combinatorial terminologies, or reference terminologies is an example of the important efforts to articulate, represent, and sort nursing data Combining data into a structure gives the meaning and value of these raw facts and basic expressions. Therefore, the structuring of nursing documentation and the developing of care protocols, care maps, or clinical pathways are examples of organizing, filtering, interpreting, and clarifying nursing information. Examples of efforts to outline nursing knowledge include modeling the expert nurse's decision-making to provide computerized decision support to enhance clinical judgment or elaborating on the knowledge resources at play to construct standards, common guidelines, and procedures . Development of and access to information and knowledge are core requisites for supporting experiential and evidence-based decision-making, continuity of care, and patient safety. In sum, considerable achievements have been gained in terms of expressions for nursing assessment, nursing judgments, nursing interventions, and patient outcomes that are sensitive to nursing care. Substantial resources in informatics are currently committed to establishing comprehensive and formalized terminologies to represent clinical practice and standards for information exchange. This allows relationships among various types of data to be examined or transformed through more automated processes. This examination and transformation is surrounded with unresolved challenges due to the situated nature of patient care, the variation in personal health needs, and evolving opportunities resulting from new achievements and new tools.

Over time, scholars have suggested, discussed, and added functional elements that contribute to the collective effort to elaborate and expand the understanding, concepts, tools, and structures available to nursing informatics and nursing. These ideas include enhancing the patient's role, emphasizing the nurse's role as information integrator, developing sound collaborative relationships between providers or between providers, technologies, and specific contexts of decision-making, and including true interdisciplinary issues for patient safety and evidence-based practice [9]. A significant addition to the conceptual understanding of nursing informatics came more recently when Matney et al. suggested the inclusion of wisdom, complementing the foundational concepts of data, information, and knowledge. Wisdom is understood as the "appropriate use of knowledge to manage and solve human problems" [. This is of great significance, important in understanding the variations in clinical processes in sufficient detail and in acknowledging previous experiences. In reality, Matney et al. challenge us to acknowledge the situatedness embedded in nurses work, and to embrace accumulated clinical expertise. These are resources for skillful, competent clinical judgment, and they involve the contextual and intertwined nature of data, information, and knowledge.

2. Application and Use of Informatics in Health Care

Achievements in nursing informatics have inspired the systematization and formalization of information where data, structured information, and articulated knowledge are important building blocks for the development of IT-based applications. Most attention and in-depth study has been directed to describing information used in clinicians' judgments and modeling prototype applications for management that are decision-supportive. The studies also strive to provide the best evidence at the point of care to improve decision-making. So far, feasible practice models giving new tools for information handling have received little attention, and reported studies are often examples of workflow failure or unintended consequences .

When we zoom in on applications using achievements in health informatics, there is also a plethora of tools, devices, and applications aiming to support the management of data, information, and knowledge related to health and wellbeing. The following types of applications add new opportunities and challenges to the field:

1. EHR is a repository maintained by health facilities, with a set of functionalities and services, that accumulates the health providers' assessments, actions, and evaluations of a person's clinical problems as separate episodes or over the life trajectory.
2. PHR is a repository maintained by the consumer, with a set of personal observations, information from health providers, and relevant information resources. The scope and comprehensiveness of the accumulating content in a PHR depends on the individual's effort.
3. Smart assistive tools include stand-alone applications and tools for personal self-care activities for everyday, everywhere use. Passive, environmental monitoring by sensors also supports the individual's personal health information management and safety.

DKIW frame Work in Nursing Profession:

The DIKW framework does not propose any relations between the distinct dataelements that lead to the generation of meaningful information and knowledge. To accomplish that, a discipline specific theory is required in combination with the DIKW framework. To illustrate that, I will use a practical example from my dissertation focusing on identifying patients’ risk for poor outcomes during transition from hospital to homecare

As nurses frequently study and manage various types of transitions (e.g. immigration transition, health-illness transition, administrative transition, etc), Transitions theory has been easily adopted and welcomed in nursing research, education, and practice (Im, 2011; Meleis, Sawyer, Im, Messias, & Schumacher, 2000). In my dissertation, the Transitions theory helps me to analyze the different elements affecting transition from hospital to home. For example, the Transitions theory suggests that several personal conditions (such as the high level of family support) might facilitate hospital to home transitions for older adults and should be measured. Thus, the discipline specific theory serves as the glue that binds all the distinct data points (e.g. caregiver’s availability to assist with patient’s basic needs) together to produce meaningful information (e.g. the level of family support). This information is then synthesized and used – with the help of Transitions theory- to build knowledge about the specific phenomenon. This example illustrates the DIK aspects of the DIKW framework in the context of Transitions theory

The TIGER Initiative

the Technology Informatics Guiding Education Reform (TIGER) Summit participants defined action steps that the nursing profession can take to better prepare our nursing workforce to use technology and informatics with the goal of improving the delivery of patient care. Today a practicing nurse’s portfolio of necessary skills includes computer literacy, information literacy, and informatics skills. The TIGER Initiative is focused on helping the nursing profession to adopt informatics tools, principles, theories, and practices that make healthcare safer and more effective, efficient, patient-centered, and equitable for all stakeholders.

While the TIGER Initiative started out as a grass-roots effort to engage all stakeholders who are committed to a common “vision” of an ideal electronic health record (EHR) for nursing practice, today more than 120 diverse organizations are joining this effort. While the original 70 organizations that attended the Summit work towards completing their strategic action plans, additional nursing professionals have joined the TIGER Initiative to collaborate on nine important topics. These nine topics include:

Standards and Interoperability

Healthcare Information Technology National Agenda/Policy

Informatics Competencies

Education and Faculty Development

Staff Development/Continuing Education

Usability/Clinical Application Design

Virtual Demonstration Center

Leadership Development

Consumer Empowerment/Personal Health Record