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(4)- General system theory
Nursing Informatics Models
A. General Models
(7)- Usability theory
*General theory is a method of thinking about complex structures such as an information system. In system theory the focus is on the interaction among the various parts of the system instead of individual parts, it is based on the premise that the whole is greater than the sum of its parts.
*General theory described that any change in one part of the system will be reflected in other parts of the system. Computer is a living example of the system any change in one area will affect other sections.
1)GRAVES AND CORCORAN's MODEL (1989)
2)SCHIWIRIAN’S MODEL (1986)
Patricia Schwerin - proposed model of nursing informatics intended to stimulate and guide systematic research in this discipline.
The model provides a framework
for identifying significant information
needs, which in turn can
foster research.
*The system is described as being either open or closed.
* Open system; is continually exchanges information with the environment outside the system itself or higher levels of complexity in the system.
*Closed system; is isolated from the environment and receive no input from outside or disorganized breakdown of the system.
*It uses information from both cognitive science and sociotechnical theories.it involves the ease f use, users’ satisfaction that they have achieved their goals, and the aesthetics of the technology.
*The five goals of usability
1- It is easy for users to accomplish basic tasks the first time they use the product.
Nursing informatics as the linear progression - from data into information and knowledge. (Data, information and knowledge in sequential boxes with one-way arrows pointing from data to information to knowledge.
2- Once learned, the design permits users to quickly and easily perform the needed tasks.
3- It is not used for a period of time, it is easy to reestablish one’s proficiency in using the product.
4-users make very few errors, but any that they do make are easily remedied.
5-the design is pleasant to use.
*Contribution of theories to informatics
(9)- learning theories
1. Nursing informatics
Convert data into information and information to knowledge. Nurse add wisdom.
2. Sociotechnical theory and social informatics. Improve interaction between an information system and the organizational culture.
3. Change theory.
Increase the chance of success in implementing a system by attending to the reactions to the change.
4. General system theory Contribute to the understanding of the complexity of an information system.
Learning theories are important in informatics as well as in all nursing endeavors. Users must be taught to use a system, and use of these theories can decrease the time for training as well as the time for learning.
Prepared by
Amany Abd El-Ghany
Supervised by
Dr\Magda Abd El-Hamid
2015- 2016
Nursing informatics is an established and growing
area of specialization in nursing. Nursing
informatics is a specialty that integrates
nursing science, computer science, and
information science to manage and
communicate data, information
and knowledge in nursing
practice.
Introduction
Nursing Informatics Models
A. General Models
Graves and Corcoran’s model
Schwerin’s model
Turley’s model
Data Information Knowledge (D-I-K)model
Benner’s Novice to Expert model
B. Specific Informatics Models
Philippine Healthcare Ecosystem model
Shift Left Model
Patient medical record information model (PMRI).
models Models are representations of
some aspect of the real world.
It is important to remember that different models reflect different viewpoints and are not necessarily competitive; that is, there is no one “right” model.
Informatics theory builds not just on
information theory, but uses concepts
from change theories, systems theory,
chaos theory, cognitive theory, and
sociotechnical theory.
Nursing Informatics theories
Contribution of theories to informatics
Computer science
Gives us the hardware, the ability to program the hardware to process nursing information.
It is the skills in using software and understanding how they can work for processing nursing knowledge.
Nurses need to understand some basics
-Hardware
-Software
,
Information science
5 component of information literacy
1- Acknowledge awareness of a need for information literacy.
2- Identify and retrieve information.
3- Evaluate information for relevance.
4- Integrate information into practice.
5- Evaluate the effect of the information
on problem or issues.
Information literacy
Competences in this area are critical to safe nursing practice.
Information management
At the end of this lecture the student will be able to:
Chaos theory.
Improve the design of an information system
Cognitive science theory. Improve the ability of user to gain knowledge from an information system.
Usability theory.
Improve ease of use and satisfaction with an information system.
Learning theories.
Teach use of a system and design or select computer-aided instruction.
B-Theories that lend support to Informatics
(6)- Cognitive science
*Cognitive theory can aid an informatics nurse specialist in understanding the information processing done by a nurse in decision making, thus facilitating the design of tools to support these processes (staggers& Thompson, 2002).
*It is the study of the mind and intelligence (Thagard, 2010) and how this information can be applied. It is interdisciplinary, includes philosophy, psychology, artificial intelligence, neuroscience, linguistics and anthropology and is a part of social informatics.
*It focus on how the brain perceives and interprets a screen (Turley, 1996). Additionally, cognitive science addresses the amount of information that an individual can absorb and use constructively.
(5)-Chaos theory
A. Rogers’s diffusion of innovation theory (unplanned change)
Cognitive science
Informatics relies on principles from other disciplines such as:
(1)- Nursing informatics theory (Information theory).
* The core concepts of informatics:
Data are discrete, objective facts or elements that have not been interpreted (Clark, 2009) or are out of context they are at the atomic level. Data are describe objectively without interpretation. They are the building blocks of meaning but lack context, and hence are meaningless.
*Chaos theory, such as general systems theory, addresses an entire structure without reducing it to the elemental parts. This makes it useful with complex systems such as information systems.
*The idea behind this theory is that what may appear to be chaotic actually has an order. It is based on the recognized fact that events and phenomena depend on initial conditions.
*Chaos theory is nonlinear. It allows us to question assumptions that we normally might reach using linear thought (Vincenzi, 1997). Seeing things reframed as a whole can stimulate new thinking and new approaches.
“Cognitive science is the missing link between
science and our brains and minds are
explored” Mast rain and McGonagall, 2008.
His theory examines the patterns of acceptance that innovations follow as they spread across the population of people who adopt it. Adopters are divided into five categories:
*Social changes:
1-Innovators (12.5%): people
who adopt the innovation.
2-Early adopters (13.5%): they are respectable opinion leaders who function as promoters of the innovation.
Information is data that has some type of interpretation or structure; that is, it has a context is derived from combining different pieces of data (Clark, 2009). A set of data,
Such as vital signs when interpreted over a period of time is information.
Knowledge is the synthesis of information with relationship identified and formalized or it is information is collected to produce knowledge.
For example, interpreting a set of vital signs over period of time and deciding on an action based on this information combined with nursing knowledge and experience is an example of knowledge.
Wisdom is achieved through evaluating knowledge with reflection. Knowing when and how to use knowledge to situation (ANA, 2008). It requires people to combine their knowledge, values and experience with the three types of data.
For example, wisdom would interpreting vital signs in a postsurgical patient as indicative of an infection and taking the appropriate action.
.
The continuum the above concepts are constructs, not absolutes and are a continuum or analog process.
Nurses as knowledge workers
Core concepts
4)Data, information, and knowledge model
Data – discrete entities that are described objectively w/out interpretation
*include some value assigned to a variable
Information – reflects interpretation, organization
or structuring of data result of processing of data
(which occurs when raw facts are transformed
through the application of context to give meaning)
Knowledge – emerges from the transformation
of information or Information synthesized so that relationshipsare identified and formalized.
The processing of information doesn’t always result in the development of knowledge.
Further, knowledge is necessary to the processing of data and information.
Knowledge itself may be processed to generate decisions and new knowledge.
B. Specific Informatics Models
of information.
generate decisions – that can be known as wisdom.
*Individual changes:
3-Early majority (34%): people who are averse to risks but will make safe investment.
4-Late majority (34%): make up another group of adopters, they need to be sure that the innovation is beneficial, they adopt the innovation not because they see a use of it, but because of peer pressure.
5-Laggards (16%): they are suspicious about the innovation and change, they see their resistance as rational and must be certain that the innovation will not fail before they are willing to adopt it.
1. First stage: knowledge of an innovation in which the potential adopter gains an understanding of how the innovation operates.
2. Second stage: persuasion, is based on the perception of the relative advantages of the innovation, computability with existing norms and its observability.at this stage, individual forms an opinion about the innovation (negative, neutral, or positive).
3. Third stage: the individual uses his opinions to make a decision (adapt or reject the innovation).
4. Fourth stage: implementation (if decision is positive).
5. Fifth stage: confirmation (when reinforcement of the decision is sought).
1)Philippine Healthcare Ecosystem model
5)- Benner’s level of expertise model
*Nursing informatics is a huge network that encompasses all the sectors of the health care delivery system – government agencies, healthcare facilities, practitioners, insurance companies, pharmaceutical companies, academic institutions, and suppliers.
*the government, different nursing associations and developmental agencies maintain and balance the network.
2) - Intel’s shift left model
Levels of Expertise (Benner):
1. Novice
**Individuals with no experience of situations
and related content in those situations where
they are expected to perform tasks
2. Advanced Beginner **marginally demonstrate acceptable
performance having built on lessons learned
in their expanding experience base; needs supervision.
*Patient care shifts/progresses from a high quality delivery of life 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
3) - Patient medical record information model (PMRI): Basis of HER
The type and pattern of documentation in the patient record will be dependent on 3 interacting dimensions of healthcare:
1-Personal health dimension – personal health record maintained and controlled by the individual or family; non clinical information e.g. self-care trackers, directories of health care, and other supports
2- 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.
3- 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 research.
3. Competent **enhanced mastery and the ability to cope with
and manage many contingencies.
4. 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.
5. 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.
Lewins change theory: (planned change)
Lewins divided his theory into three stages (unfreezing, moving and refreezing). The ways to move from the first stage to the last stage must be a part of the plan for implementation of a system.
*Driving Forces:
Driving forces are forces that influence a situation, pushing in a particular direction: they tend to initiate a change and keep it going. In terms of improving productivity.
*Restraining Forces:
Restraining forces are forces that act to restrain or decrease the driving forces – they make it difficult to move a change forward. Such as, Apathy, prohibitive cost, hostility, technology illiteracy.
(2). Information theory
The theory of nursing informatics is based on Blooms taxonomy and definition of data, information and knowledge. These three entities are regarded as the core concepts of informatics:
Data are discrete elements that have not been interpreted.
Information comprises data that has some type of interpretation or structure, and
Knowledge is the synthesis of information. Using taxonomy data are combined to produce information and information is collected to produce knowledge.
(2)-Sociotechnical theory and social informatics
1. Unfreezing stage:
*This stage is based on the idea that human behavior
is supported by a balance of driving forces and restraining
forces that create an equilibrium. When a driving force
toward change occurs, a countering restraining force
develops to allow the maintenance of equilibrium.
Thus to unfreeze, it is necessary to reduce the
restraining forces and allow the driving forces to
become dominant.
*Equilibrium:
Equilibrium is the present level of productivity, and it is the relationship between the driving and the restraining forces. Equilibrium is reached when the sum of the driving forces equals the sum of the restraining.
2. Moving stage:
*In this stage the panned change is implemented. This is not a comfortable period, anxieties are high and if they are not successfully dealt with, the change may be unsuccessful.
*this stage occur in the wrong direction if the system has many problems that don’t supported by administration, so it is important to gain the support of administration in the planning process, involve users that the system serves them, test the system before implementation, provide adequate training and deal with any implementation problems immediately.
3. Refreezing stage
In this stage the planned change becomes the norm, people involved need to feel confident with the change and feel in control of the procedures involved in the new methods.
Wisdom or knowing when and how to use knowledge was added to this taxonomy by Nelson and Joss (1992). It requires people to combine their knowledge, values and experience with the three types of data.
*The general idea of information theory is that the move from data to knowledge is a progressive process that follows given steps.
(3)- General system theory
*General theory is a method of thinking about complex structures such as an information system. In system theory the focus is on the interaction among the various parts of the system instead of individual parts, it is based on the premise that the whole is greater than the sum of its parts.
*General theory described that any change in one part of the system will be reflected in other parts of the system. Computer is a living example of the system any change in one area will affect other sections.
The system is described as being either open or closed.
* Open system; is continually exchanges information with the environment outside the system itself or higher levels of complexity in the system.
*Closed system; is isolated from the environment and receive no input from outside or disorganized breakdown of the system.
*Sociotechnical theory developed in the middle of the last century when it became evident that not all implementations of technology were increasing productivity. The overall focus is the impact of technology implementation on an organization.
*To this end, it focuses on interactions of an organization between information management tools and techniques and the knowledge, skills, attitudes, values and needs of its employees as well as the rewards and authority structures of the employer (Wade& Schneberger, 2005).
(3)Change theory
*Computerization of information is a new experience that create a change that affect workers, this change may be unplanned represented by Rogers change theory of diffusion and innovation address how change occurs in society and individual.
*And may be planned represented by lewin’s change theory who talks about stages in moving people from comfortable state before the change, and finally back to a comfort with the change.