Building Blocks of Nursing Informatics

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© Jones & Bartlett Learning, LLC ©SECTION Jones & BartlettI Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Building Blocks of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORNursing DISTRIBUTION InformaticsNOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 92367_CH01_001_016.qxd 3/31/11 11:53 AM Page 2

2 | SECTION I Building Blocks of Nursing Informatics

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTNursing FOR professionals SALE OR are DISTRIBUTION information-dependent knowledge workers.NOT As healthFOR SALE OR DISTRIBUTION care continues to evolve in an increasingly competitive information marketplace, professionals, the knowledge workers, must be well prepared to make significant contributions by harnessing appropriate and timely information. Nursing infor- © Jones & Bartlettmatics Learning, (NI), a product LLC of the scientific synthesis of© information Jones & inBartlett nursing, usesLearning, LLC NOT FOR SALEconcepts OR DISTRIBUTION from computer science, cognitive science,NOT information FOR SALE science, OR and DISTRIBUTION nursing science. NI continues to evolve as more and more professionals access, use, and develop the information, computer, and cognitive sciences necessary to advance nursing science for the betterment of patients and the profession. Regardless of future roles, it is clear that nurses need to understand the ethical © Jones & Bartlett Learning,application LLC of computer, information,© Jones and cognitive & Bartlett sciences Learning, to advance nursingLLC NOT FOR SALE OR DISTRIBUTIONscience. NOT FOR SALE OR DISTRIBUTION To implement NI one must view it from the perspective of the current healthcare delivery system and specific, individual organizational needs, while anticipat- ing and creating future applications in both the healthcare system and the nursing © Jonesprofession. & NursingBartlett professionals Learning, should LLC be expected to discover opportunities© Jones to & Bartlett Learning, LLC NOTuse FORNI; participate SALE ORin the DISTRIBUTION design of solutions; and be challenged to NOTidentify, FOR de- SALE OR DISTRIBUTION velop, evaluate, modify, and enhance applications to improve patient care. This book is designed to provide the reader with the information and knowledge needed to meet this expectation. Section I presents an overview of the building blocks of NI: nursing, informa- © Jones & Bartletttion, Learning, computer, and LLC cognitive sciences. Also included© Jones in this section & Bartlett is a chapter Learning, LLC NOT FOR SALEon OR ethical DISTRIBUTION applications of healthcare informatics. ThisNOT section FOR lays SALE the foundation OR DISTRIBUTION for the remainder of the book. Chapter 1 describes nursing science and introduces the Foundation of Knowl- edge model as the conceptual framework for the book. In this chapter, a clinical case © Jones & Bartlett Learning,scenario LLC is used to illustrate the concepts© Jones central & Bartlettto nursing science.Learning, A definition LLC of nursing science is also derived from the American Nurses Association definition of NOT FOR SALE OR DISTRIBUTIONnursing. Nursing science is the ethicalNOT application FOR SALE of knowledge OR DISTRIBUTION acquired through education, research, and practice to provide services and interventions to patients to maintain, enhance, or restore their health, and to acquire, process, generate, and disseminate nursing knowledge to advance the nursing profession. Information is a © Jonescentral concept & Bartlett and health Learning, care’s most LLC valuable resource. Information© science Jones and & Bartlett Learning, LLC NOTsystems, FOR together SALE with OR computers, DISTRIBUTION are constantly changing the way healthcareNOT FOR or- SALE OR DISTRIBUTION ganizations conduct their business. This will continue to evolve. To prepare for these innovations, the reader must understand fundamental information and computer concepts, covered in Chapters 2 and 3, respectively. © Jones & BartlettInformation Learning, science LLC deals with the interchange ©(or Jones flow) and & Bartlettscaffolding Learning, (or LLC structure) of information and involves the application of information tools for NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Building Blocks of Nursing Informatics | 3

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC solutionsNOT to FORpatient SALE care and OR business DISTRIBUTION problems in health care. To be able to NOTuse FOR SALE OR DISTRIBUTION and synthesize information effectively, one must be able to obtain, perceive, process, synthesize, comprehend, convey, and manage the information. Computer science deals with understanding the development, design, structure, and rela- © Jones &tionship Bartlett of computer Learning, hardware LLC and software. This science offers© Jones extremely & Bartlett valu- Learning, LLC NOT FORable SALE tools that,OR ifDISTRIBUTION used skillfully, can facilitate the acquisitionNOT and FOR manipulation SALE OR DISTRIBUTION of data and information by nurses, who can then synthesize these into an ever- evolving knowledge and wisdom base. This not only facilitates professional development and the ability to apply evidence-based practice decisions within nursing care, but if disseminated and shared, can advance the profession’s knowl- © Jones & Bartlett Learning,edge base. LLC The development of knowledge© tools, Jones such & as Bartlettthe automation Learning, of deci- LLC NOT FOR SALE OR DISTRIBUTIONsion making and strides in artificial intelligence,NOT FOR has altered SALE the understandingOR DISTRIBUTION of knowledge and its representation. The ability to structure knowledge electroni- cally facilitates the ability to share knowledge structures and enhance collective knowledge. As© discussed Jones in & Chapter Bartlett 4, cognitive Learning, science LLC deals with how the human mind© Jones & Bartlett Learning, LLC functions.NOT This FOR science SALE encompasses OR DISTRIBUTION how people think, understand, remember,NOT FOR SALE OR DISTRIBUTION synthesize, and access stored information and knowledge. The nature of knowledge, how it is developed, used, modified, and shared, provides the basis for con- tinued learning and intellectual growth. Chapter 5 focuses on ethical issues associated with managing private informa- © Jones &tion Bartlett with technology Learning, and provides LLC a framework for analyzing© Jones ethical issues & Bartlett and Learning, LLC NOT FORsupporting SALE OR ethical DISTRIBUTION decision making. NOT FOR SALE OR DISTRIBUTION The material within this book is placed within the context of the Foundation of Knowledge model (shown in Figure I-1 and periodically throughout the book, but more fully introduced and explained in Chapter 1). The Foundation of © Jones & Bartlett Learning,Knowledge LLC model is used throughout the© text Jones to illustrate & Bartlett how knowledge Learning, is used LLC to meet the needs of healthcare delivery systems, organizations, patients, and NOT FOR SALE OR DISTRIBUTIONnurses. It is through interaction with theseNOT building FOR blocks—the SALE OR theories, DISTRIBUTION archi- tecture, and tools—that one acquires the bits and pieces of data necessary, processes these into information, and generates and disseminates the resulting knowledge. Through this dynamic exchange that includes feedback, one continues the© interaction Jones & and Bartlett use of these Learning, sciences to inputLLC or acquire, process, and out-© Jones & Bartlett Learning, LLC put orNOT disseminate FOR generatedSALE OR knowledge. DISTRIBUTION Humans experience their environmentNOT FOR SALE OR DISTRIBUTION and learn by acquiring, processing, generating, and disseminating knowledge. When one then shares (disseminates) this new knowledge and receives feedback on the knowledge they have shared, the feedback initiates the cycle of knowledge © Jones &all Bartlettover again. Learning, As one acquires, LLC processes, generates, and disseminates© Jones the & knowl-Bartlett Learning, LLC edge, they are motivated to share, rethink, and explore their own knowledge base. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

4 | SECTION I Building Blocks of Nursing Informatics

Feedback Feedback © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION KA - Knowledge acquisition KD - Knowledge dissemination KG - Knowledge generation KP - Knowledge processing

© JonesInformation & Bartlett Learning, LLCBytes © Jones & Bartlett Learning, LLC NOTData FOR SALEBytes OR Bytes DISTRIBUTIONBits NOT FOR SALE OR DISTRIBUTION Bits Data Information Bits Data Bytes Information

Information Information Bits Data Bytes Bytes Bits © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION SOURCE: Designed by Alicia Mastrian.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC This complex process is captured in the Foundation of Knowledge model. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Reading the chapters in Section I, the reader is challenged to think about how the model can help them to understand the ways in which one acquires, processes, generates, disseminates, and then receives feedback on their new knowledge of the building blocks of NI. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC CHAPTER© Jones & Bartlett1 Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION INursing Science and the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORFoundation DISTRIBUTION of KnowledgeNOT FOR SALE OR DISTRIBUTION Kathleen Mastrian and Dee McGonigle

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1. Define nursing science and its relationship to various nursing roles and nursing informatics. Key Terms 2. Introduce the Foundation of Knowledge model as the organizing conceptual framework for the book. Borrowed theory Objectives © Jones & Bartlett Learning, LLC Building© Jones blocks & Bartlett Learning, LLC NOT 3.FORExplain SALE the ORrelationship DISTRIBUTION among knowledge acquisi- ClinicalNOT databases FOR SALE OR DISTRIBUTION tion, knowledge processing, knowledge generation, Clinical practice guidelines knowledge dissemination, and wisdom. Conceptual framework Data Nursing informatics is defined as the combination of nursing sci- Data mining Evidence © Jones &ence Bartlett, information Learning, science, andLLC computer science. This chapter© Jones fo- & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALEFeedback OR DISTRIBUTION cuses on nursing science as one of the building blocks of nursing Foundation of Knowledge informatics, although in this text the traditional definition of nurs- model ing informatics is extended to include cognitive science as one of the Information building blocks. The Foundation of Knowledge model is also intro- Knowledge duced as the organizing conceptual framework of this text, and the Knowledge acquisition © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,Knowledge LLC dissemination model is tied to nursing science and the practice of nursing infor- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONKnowledge generation matics. To lay the groundwork for this discussion, a patient scenario Knowledge processing is first presented. Knowledge worker Tom H. is a registered nurse who works in a very busy metropolitan Nursing informatics hospital emergency room. He has just admitted a 79-year-old man Nursing science Nursing theory whose© wife Jones brought & himBartlett to the hospitalLearning, because LLC he is having trouble © Jones & Bartlett Learning, LLC Relational database breathing.NOT Tom FOR immediately SALE ORclips aDISTRIBUTION pulse oximeter to the patient’s fin- TransparentNOT wisdom FOR SALE OR DISTRIBUTION ger and performs a very quick assessment of the patient’s other vital signs. He discovers a rapid pulse rate and a decreased oxygen saturation level in addition to the rapid and labored breathing. Tom determines that the pa- © Jones &tient Bartlett is not in Learning,immediate danger LLC and that he does not require© intubation.Jones & Tom Bartlett fo- Learning, LLC NOT FORcuses SALE his initial OR attentionDISTRIBUTION on easing the patient’s labored breathingNOT byFOR elevating SALE the OR DISTRIBUTION head of the bed and initiating oxygen treatment; he then hooks the patient up

6 | CHAPTER 1 Nursing Science and the Foundation of Knowledge

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTto aFOR heart monitor.SALE OR Tom DISTRIBUTIONcontinues to assess the breathing status as heNOT performs FOR a SALE OR DISTRIBUTION head-to-toe assessment of the patient that leads to the nursing diagnoses and additional interventions necessary to provide comprehensive care to this patient. Consider Tom’s actions and how and why he intervened as he did. Tom relied © Jones & Bartletton the Learning, immediate data LLCand information that he acquired© Jones during & hisBartlett initial rapid Learning, LLC NOT FOR SALEassessment OR DISTRIBUTION to deliver appropriate care to his patient.NOT Tom FOR also SALEused technology OR DISTRIBUTION (pulse oximeter and heart monitor) to assist with and support the delivery of care. What is not immediately apparent, and some would argue is transparent (done without conscious thought), is the fact that during the rapid assessment, Tom reached into his knowledge base of previous learning and experiences to direct his © Jones & Bartlett Learning,care, LLC so that he could act with transparent© Jones wisdom & Bartlett. He used Learning, both nursing LLC theory NOT FOR SALE OR DISTRIBUTIONand borrowed theory to informNOT his practice. FOR TomSALE certainly OR usedDISTRIBUTION nursing process theory, and he may have also used one of several other nursing theories, such as Rogers’s science of unitary human beings, Orem’s theory of self-care deficit, or Roy’s adaptation theory. In addition, Tom may also have applied his knowledge © Jonesfrom some & Bartlettof the basic Learning, sciences, such LLC as anatomy, physiology, psychology,© Jones and & Bartlett Learning, LLC NOTchemistry, FOR SALE as he determined OR DISTRIBUTION the patient’s immediate needs. InformationNOT FORfrom SALE OR DISTRIBUTION Maslow’s hierarchy of needs, Lazarus’s transaction model of stress and coping, and the health belief model may also have helped Tom practice professional nursing. He gathered data, then analyzed and interpreted that data to form a conclusion— the essence of science. Tom has illustrated the practical aspects of nursing science. © Jones & BartlettThe Learning, American Nurses LLC Association (2003) defines© nursing Jones in &this Bartlett way: “Nursing Learning, LLC NOT FOR SALEis OR the protection,DISTRIBUTION promotion, and optimization ofNOT health andFOR abilities, SALE prevention OR DISTRIBUTION of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (p. 6). Thus, the focus of nursing is on human responses to © Jones & Bartlett Learning,actual LLC or potential health problems© Jones and advocacy & Bartlett for variousLearning, clients. LLC These human responses are varied and may change over time in a single case. Nurses NOT FOR SALE OR DISTRIBUTIONmust possess the technical skills NOTto manage FOR equipment SALE ORand performDISTRIBUTION procedures; the interpersonal skills to interact appropriately with people; and the cognitive skills to observe, recognize, and collect data, analyze and interpret data, and reach a reasonable conclusion that forms the basis of a decision. At the heart of all of © Jonesthese skills & liesBartlett the management Learning, of data LLC and information. This is a definition© Jones of & Bartlett Learning, LLC NOTnursing FOR science SALE as the OR ethical DISTRIBUTION application of knowledge acquired throughNOT educa- FOR SALE OR DISTRIBUTION tion, research, and practice to provide services and interventions to patients to maintain, enhance, or restore their health and to acquire, process, generate, and disseminate nursing knowledge to advance the nursing profession. © Jones & BartlettNursing Learning, is an information-intensive LLC profession.© TheJones steps &of Bartlett using informa- Learning, LLC tion, applying knowledge to a problem, and acting with wisdom form the basis of NOT FOR SALEnursing OR DISTRIBUTION practice science. Information is data that NOTare processed FOR usingSALE knowledge. OR DISTRIBUTION

Nursing Science and the Foundation of Knowledge | 7

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC For informationNOT FOR to SALEbe valuable, OR it DISTRIBUTION must be accessible, accurate, timely, complete,NOT FOR SALE OR DISTRIBUTION cost effective, flexible, reliable, relevant, simple, verifiable, and secure. Knowledge is the awareness and understanding of a set of information and ways that information can be made useful to support a specific task or arrive at a decision. In the © Jones &case Bartlett example, Learning, Tom used accessible, LLC accurate, timely, relevant,© andJones verifiable & Bartlett data Learning, LLC NOT FORand SALE information. OR DISTRIBUTION He compared that data and information toNOT his knowledge FOR SALE base OR DISTRIBUTION and previous experiences to determine which data and information were relevant to the current case. By applying previous knowledge to data, he converted data into information and information into new knowledge, an understanding of what nursing interventions were appropriate in this case. Thus, information is data © Jones & Bartlett Learning,made functional LLC through the application ©of Jones knowledge. & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONHumans acquire data and informationNOT in bits FOR and pieces SALE and OR then DISTRIBUTION transform the information into knowledge. The information-processing functions of the brain are frequently compared to those of a computer and vice versa (discussed further in Chapter 4). Humans can be thought of as organic information systems constantly© Jones acquiring, & Bartlett processing, Learning, and generating LLC information or knowledge© in Jones & Bartlett Learning, LLC their professionalNOT FOR and SALE personal OR lives. DISTRIBUTION Individuals have an amazing ability to man-NOT FOR SALE OR DISTRIBUTION age knowledge. This ability is learned and honed from birth as one makes their way through life interacting with the environment and being inundated with data and information. One experiences the environment and learns by acquiring, processing, generating, and disseminating knowledge. Tom acquired knowledge © Jones &in hisBartlett basic nursing Learning, education LLC program and continues to build© Jones his foundation & Bartlett of Learning, LLC NOT FORknowledge SALE OR by such DISTRIBUTION activities as reading nursing research andNOT theory FOR articles, SALE at- OR DISTRIBUTION tending continuing education programs, consulting with expert colleagues, and using clinical databases and clinical practice guidelines. As he interacts in the environment, he acquires knowledge that must be processed. This processing ef- © Jones & Bartlett Learning,fort causes LLC him to redefine and restructure© hisJones knowledge & Bartlett base and generateLearning, new LLC knowledge. He can then share (disseminate) this new knowledge with other col- NOT FOR SALE OR DISTRIBUTIONleagues, and he may receive feedback on NOTthe knowledge FOR SALE that he ORshares. DISTRIBUTION This dissemination and feedback builds the knowledge foundation anew as he acquires, processes, generates, and disseminates new knowledge as a result of his interac- tions. As others respond to his knowledge dissemination and he acquires yet more ©knowledge, Jones & he Bartlettis engaged toLearning, rethink, reflect LLC on, and re-explore his knowl-© Jones & Bartlett Learning, LLC edge acquisitionNOT FOR, thus SALE processing, OR DISTRIBUTION generating, and then disseminating anew. ThisNOT FOR SALE OR DISTRIBUTION process is captured in the Foundation of Knowledge model, used as an organizing framework for this text. At its base, the model has bits, bytes (computer terms for chunks of informa- © Jones &tion), Bartlett data, and Learning, information LLCin a random representation. Growing© Jones out of & the Bartlett base Learning, LLC are separate cones of light that expand as they reflect upward and represent NOT FORknowledge SALE OR acquisition, DISTRIBUTIONknowledge generation, and knowledgeNOT dissemination. FOR SALE At OR DISTRIBUTION

8 | CHAPTER 1 Nursing Science and the Foundation of Knowledge

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTthe FORintersection SALE of theOR cones DISTRIBUTION and forming a new cone is knowledgeNOT processing FOR. SALE OR DISTRIBUTION Encircling and cutting through the knowledge cones is feedback that acts on and may transform any or all aspects of knowledge represented by the cones. One should imagine the model as a dynamic figure with the cones of light and the © Jones & Bartlettfeedback Learning, rotating and LLC interacting rather than remaining© Jones static. & Knowledge Bartlett acqui- Learning, LLC NOT FOR SALEsition, OR DISTRIBUTION knowledge generation, knowledge dissemination,NOT FOR knowledge SALE processing, OR DISTRIBUTION and feedback are constantly evolving for nurse scientists. The transparent effect of the cones is deliberate and is intended to suggest that as knowledge grows and ex- pands its use becomes more transparent—one uses it during practice without even being consciously aware of what aspect of knowledge is being used at any © Jones & Bartlett Learning,given LLC moment. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

FIGURE © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1-1 NOTFoundation FOR SALE of Knowledge OR DISTRIBUTION model. NOT FOR SALE OR DISTRIBUTION

KA KP KG

Feedback Feedback

© Jones & Bartlett Learning, LLC © Jones & BartlettKA - Knowledge Learning, acquisition LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALEKD - ORKnowledge DISTRIBUTION dissemination KG - Knowledge generation KP - Knowledge processing

Information Bytes Data Bytes Bytes Bits © JonesBits & Bartlett Data Information Learning, LLCBits © Jones & Bartlett Learning, LLC Data NOT FOR SALE ORBytes DISTRIBUTION Information NOT FOR SALE OR DISTRIBUTION Information Information Bits Data Bytes Bytes Bits

Nursing Science and the Foundation of Knowledge | 9

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC AnNOT experienced FOR nurse,SALE thinking OR DISTRIBUTION back to the novice years, may recall feeling NOTlike FOR SALE OR DISTRIBUTION their head was filled with bits of data and information that did not form any type of cohesive whole. As the model depicts, the processing of knowledge begins a bit later (imagine a time line applied vertically) with early experiences on the bottom © Jones &and Bartlett expertise growingLearning, as the LLCprocessing of knowledge ensues.© Early Jones on in & a nurse’sBartlett Learning, LLC NOT FOReducation SALE ORconscious DISTRIBUTION attention is focused mainly on knowledgeNOT acquisition, FOR SALE and OR DISTRIBUTION they depend on their instructors and others to process, generate, and disseminate knowledge. As the nurse becomes more comfortable with the science of nursing, they begin to take over some of the other Foundation of Knowledge functions. However, to keep up with the explosion of information in nursing and health care, © Jones & Bartlett Learning,one must continueLLC to rely on the knowledge© Jones generation & Bartlettof nursing theoristsLearning, and LLC NOT FOR SALE OR DISTRIBUTIONresearchers and the dissemination of theirNOT work. InFOR this sense,SALE nurses OR are DISTRIBUTION commit- ted to lifelong learning and the use of knowledge in the practice of nursing science. This book uses the Foundation of Knowledge model, reflecting that knowledge is a powerful tool and that nurses focus on information as a key building block of knowledge.© Jones The application & Bartlett of the Learning, model is described LLC in each section of the book© Jones & Bartlett Learning, LLC to helpNOT the readerFOR understandSALE OR and DISTRIBUTION appreciate the foundation of knowledgeNOT in FOR SALE OR DISTRIBUTION nursing science and how it applies to nursing informatics. All of the various nursing roles (practice, administration, education, research, and informatics) involve the science of nursing. Nurses are knowledge workers, working with information and generating information and knowledge as a product. They are knowledge ac- © Jones &quirers, Bartlett providing Learning, convenient LLC and efficient means of capturing© Jones and & storingBartlett Learning, LLC NOT FORknowledge. SALE OR They DISTRIBUTION are knowledge users, individuals or groupsNOT who FOR benefit SALE from OR DISTRIBUTION valuable, viable knowledge. Nurses are knowledge engineers, designing, develop- ing, implementing, and maintaining knowledge. They are knowledge managers, capturing and processing collective expertise and distributing it where it can cre- © Jones & Bartlett Learning,ate the largest LLC benefit. They are knowledge© developers Jones or& generators,Bartlett changingLearning, and LLC evolving knowledge based on the tasks at hand and information available. NOT FOR SALE OR DISTRIBUTIONIn the case scenario, at first glance one NOTmight labelFOR Tom SALE as a knowledge OR DISTRIBUTION worker, a knowledge acquirer, and a knowledge user. However, stopping here might sell Tom short in his practice of nursing science. Although he acquired and used knowledge to help him achieve his work, he also processed the data and information he© collected Jones to & develop Bartlett a nursing Learning, diagnosis LLC and a plan of care. The knowledge© Jones & Bartlett Learning, LLC storesNOT Tom used FOR to SALEdevelop andOR glean DISTRIBUTION knowledge from valuable information NOTare FOR SALE OR DISTRIBUTION generative (having the ability to originate and produce or generate) in nature. For example, Tom may have learned something new about his patient’s culture from the patient or his wife that he will file away in the knowledge repository of his © Jones &mind Bartlett to be used Learning, in another similarLLC situation. As he compares© this Jones new cultural & Bartlett in- Learning, LLC formation to what he already knows, he may gain insight into the effect of culture NOT FORon SALE a patient’s OR response DISTRIBUTION to illness. Thus, Tom is a knowledge NOTgenerator. FOR If he SALE shares OR DISTRIBUTION

10 | CHAPTER 1 Nursing Science and the Foundation of Knowledge

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTthis FOR newly SALEacquired OR knowledge DISTRIBUTION with another practitioner, and as heNOT records FOR his SALE OR DISTRIBUTION observations and his conclusions, he is then disseminating knowledge. Tom is also using feedback from the various technologies he has used to monitor his patient’s status. He may also use feedback from laboratory reports or even other practition- © Jones & Bartletters to Learning, help him rethink, LLC revise, and apply the knowledge© Jones about this& Bartlett patient that Learning, he LLC NOT FOR SALEis ORgenerating. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Knowledge must also be viable. Knowledge viability refers to applications (most technology based) that offer easily accessible, accurate, and timely information ob- tained from a variety of resources and methods and presented in a manner so as to provide the necessary elements to generate new knowledge. In the case scenario, © Jones & Bartlett Learning,Tom LLC may have felt the need to consult© Jones an electronic & Bartlett database Learning, or a clinical LLC guide- NOT FOR SALE OR DISTRIBUTIONlines repository that he has downloadedNOT onFOR his PDASALE or that OR reside DISTRIBUTION in the emergency room’s networked computer system to assist him in the development of a comprehensive care plan for his patient. In this way, Tom is also using technology and evidence to support and inform his practice. It is also possible in this scenario that © Jonesan alert may& Bartlett appear in Learning, the electronic LLC health record or the clinical ©information Jones & Bartlett Learning, LLC NOTsystem FOR (CIS) SALE reminding OR DISTRIBUTIONTom to ask about influenza and pneumoniaNOT vaccines. FOR SALE OR DISTRIBUTION Clinical information technologies that support and inform nursing practice and nursing administration are an important part of nursing informatics and are covered in detail in Sections III and IV of this text. Technologies that support and inform nursing education and nursing research are covered in Section V. © Jones & BartlettThis Learning, book provides LLC a framework that embraces© knowledge Jones &so Bartlettthat the reader Learning, LLC NOT FOR SALEcan OR develop DISTRIBUTION the wisdom necessary to apply what theyNOT have FOR learned. SALE Wisdom OR is theDISTRIBUTION application of knowledge to an appropriate situation. In the practice of nursing science, one expects actions directed by wisdom. Wisdom uses knowledge and experience to heighten common sense and insight to exercise sound judgment in © Jones & Bartlett Learning,practical LLC matters. It is developed© through Jones knowledge, & Bartlett experience, Learning, insight, LLC and re- flection. Wisdom is sometimes thought of as the highest form of common sense NOT FOR SALE OR DISTRIBUTIONresulting from accumulated knowledgeNOT FORor erudition SALE (deep, OR thorough DISTRIBUTION learning) or enlightenment (education that results in understanding and the dissemination of knowledge). Wisdom is the ability to apply valuable and viable knowledge, experience, understanding, and insight while being prudent and sensible. Knowledge © Jonesand wisdom & Bartlett are not Learning,synonymous becauseLLC knowledge abounds ©with Jones others’ & Bartlett Learning, LLC NOTthoughts FOR and SALE information, OR DISTRIBUTION whereas wisdom is focused on one’s own mindNOT and FOR the SALE OR DISTRIBUTION synthesis of experience, insight, understanding, and knowledge. Wisdom has been called the foundation of the art of nursing. Some nursing roles might be viewed as more focused on some rather than © Jones & Bartlettother Learning, aspects of the LLC foundation of knowledge. One© might Jones argue & that Bartlett nurse educa- Learning, LLC tors are primarily knowledge disseminators and nurse researchers are knowledge NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Nursing Science and the Foundation of Knowledge | 11

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC generators.NOT AlthoughFOR SALE the more OR frequent DISTRIBUTION output of their efforts can certainlyNOT be FOR SALE OR DISTRIBUTION viewed in this way, it is important to realize that nurses use all of the aspects of the Foundation of Knowledge model regardless of their area of practice. For nurse educators to be effective, they must be in the habit of constantly building and re- © Jones &building Bartlett their Learning,foundation of LLC knowledge about nursing science.© Jones In addition, & Bartlett as Learning, LLC NOT FORthey SALE develop OR and DISTRIBUTION implement curricular innovations, they mustNOT also FOR evaluate SALE the OR DISTRIBUTION effectiveness of those changes. In some cases, they use formal research techniques to achieve this and are therefore generating knowledge about the best and most effective teaching strategies. Similarly, nurse researchers must acquire and process new knowledge as they design and conduct their research studies. All nurses have © Jones & Bartlett Learning,the opportunity LLC to be involved in the formal© Jonesdissemination & Bartlett of knowledge Learning, via their LLC NOT FOR SALE OR DISTRIBUTIONparticipation in professional conferences,NOT either asFOR presenters SALE or ORattendees. DISTRIBUTION In addition, some nurses disseminate knowledge by formal publication of their ideas. In the cases of conference presentation and publication, nurses may receive feedback that stimulates rethinking about the knowledge they have generated and disseminated,© Jones thus prompting & Bartlett them Learning, to acquire and LLC process anew. © Jones & Bartlett Learning, LLC AllNOT nurses, FOR regardless SALE of theOR practice DISTRIBUTION arena, must use informatics and technol-NOT FOR SALE OR DISTRIBUTION ogy to inform and support that practice. The case scenario discussed Tom’s use of various monitoring devices that provide feedback on the physiologic status of the patient. It was also suggested that Tom might consult a clinical database or nursing practice guidelines residing on a PDA or a clinical agency network as he de- © Jones &velops Bartlett an appropriate Learning, plan ofLLC action for his nursing interventions.© Jones Perhaps & Bartlett the Learning, LLC NOT FORCIS SALE in the OR agency DISTRIBUTION supports the collection of data about patientsNOT inFOR a relational SALE OR DISTRIBUTION database, providing an opportunity for data mining by nursing administrators or nurse researchers. Thus, administrators and researchers can glean information about best practices and what improvements are necessary to deliver the best and © Jones & Bartlett Learning,most effective LLC nursing care (Swan, Lang, &© McGinley, Jones & 2004). Bartlett Learning, LLC The future of nursing science and nursing informatics is closely associated NOT FOR SALE OR DISTRIBUTIONwith nursing education and nursing research.NOT Skiba FOR (2007) SALE suggests OR that DISTRIBUTION techno- savvy and well-informed faculty are needed who can demonstrate the appropriate use of technologies to enhance the delivery of nursing care. Along those lines, Greenfield (2007) conducted research among nursing students to determine the effectiveness© Jones of PDA & technologyBartlett Learning,applied to medication LLC administration. Her study© Jones & Bartlett Learning, LLC makesNOT a good FOR case SALEfor incorporating OR DISTRIBUTION PDA technology into nursing curricula.NOT FOR SALE OR DISTRIBUTION Girard (2007) discussed cutting-edge operating room technologies, such as nanosurgery using nanorobots, smart fabrics that aid in patient assessment during surgery, biopharmacy techniques for the safe and effective delivery of anesthe- © Jones &sia, Bartlett and virtual Learning, reality training. LLC She makes an extremely provocative© Jones point & Bartlett about Learning, LLC nursing education: “Educators will need to expand their knowledge and teach for NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

12 | CHAPTER 1 Nursing Science and the Foundation of Knowledge

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTthe FORfuture andSALE not theOR past. DISTRIBUTION They must take heed that the old tried-andNOT true FORnurs- SALE OR DISTRIBUTION ing education methods and curriculum that has lasted 100 years will have to change, and that change will be mandated for all areas of nursing ...” (p. 353). Bassendowski (2007) specifically addresses the potential for the generation of © Jones & Bartlettknowledge Learning, in educational LLC endeavors as faculty apply© new Jones technologies & Bartlett to teaching Learning, LLC NOT FOR SALEand OR the DISTRIBUTION focus shifts away from individual to groupNOT instruction FOR SALE that promotes OR DISTRIBUTION sharing and processing of knowledge. Several key national groups are promoting the inclusion of informatics content in nursing education programs. These initiatives include the National League for Nursing (NLN, 2008), the Quality and Safety Education for Nurses (Cronen- © Jones & Bartlett Learning,wett LLC et al., 2007) report, the Technology© Jones Informatics & Bartlett Guiding Learning, Education LLCReform NOT FOR SALE OR DISTRIBUTION(TIGER) Initiative (2007), and theNOT American FOR AssociationSALE OR of DISTRIBUTION Colleges of Nursing (AACN, 2008). The NLN (2008) Position Statement, Preparing the Next Generation of Nurses to Practice in a Technology-Rich Environment: An Informatics Agenda, challenges © Jonesnurse educators & Bartlett to prepare Learning, informatics-competent LLC nurses who can practice© Jones safely & Bartlett Learning, LLC NOTin a FOR technology-rich SALE OR healthcare DISTRIBUTION environment. In the Quality and SafetyNOT Education FOR SALE OR DISTRIBUTION for Nurses (2007) report, Cronenwett and colleagues identified several core com- petencies for nursing education. One competency specifically addressed nursing informatics: “Use information and technology to communicate, manage knowl- © Jones & Bartlettedge, Learning, mitigate error, LLC and support decision-making”© (p.Jones 129). Another& Bartlett addressed Learning, LLC NOT FOR SALEthe OR appropriate DISTRIBUTION use of data and information in nursingNOT practice FOR toSALE promote OR qual- DISTRIBUTION ity improvement: “Use data to monitor the outcomes and processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems” (p. 127). © Jones & Bartlett Learning,The LLC TIGER (2007) initiative identifies© Jones a key purpose, & Bartlett “to create Learning, a vision for LLC the fu- NOT FOR SALE OR DISTRIBUTIONture of nursing that bridges the qualityNOT chasm FOR with SALE information OR DISTRIBUTIONtechnology, enabling nurses to use informatics in practice and education to provide safer, higher-quality patient care” (p. 4). The pillars of the TIGER vision include the following: • Management and Leadership: Revolutionary leadership that drives, empow- © Jonesers, and& Bartlett executes the Learning, transformation LLC of health care. © Jones & Bartlett Learning, LLC NOT• FOR Education: SALE Collaborative OR DISTRIBUTION learning communities that maximize theNOT possibili- FOR SALE OR DISTRIBUTION ties of technology toward knowledge development and dissemination, driv- ing rapid deployment and implementation of best practices. • Communication and Collaboration: Standardized, person-centered, technology- enabled processes to facilitate teamwork and relationships across the contin- © Jones & Bartlett uumLearning, of care. LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Nursing Science and the Foundation of Knowledge | 13

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • InformaticsNOT FOR Design: SALE Evidence-based, OR DISTRIBUTION interoperable intelligence systems thatNOT FOR SALE OR DISTRIBUTION support education and practice to foster quality care and safety. • Information Technology: Smart, people-centered, affordable technologies that are universal, useable, useful, and standards-based. © Jones & •Bartlett Policy: Consistent, Learning, incentives-based LLC initiatives (organizational© Jones and & govern- Bartlett Learning, LLC NOT FOR SALEmental) OR that DISTRIBUTION support advocacy and coalition-building,NOT achieving FOR andSALE re- OR DISTRIBUTION sourcing an ethical culture of safety. • Culture: A respectful, open system that leverages technology and informatics across multiple disciplines in an environment where all stakeholders trust each other to work together towards the goal of high quality and safety (p. 4). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONThe Essentials of Baccalaureate EducationNOT for FOR Professional SALE NursingOR DISTRIBUTION Practice (AACN, 2008, pp. 18-19) includes the following technology-related outcomes for baccalaureate nursing graduates:

1. Demonstrate skills in using patient care technologies, information systems, ©and Jones communication & Bartlett devices Learning, that support LLC safe nursing practice. © Jones & Bartlett Learning, LLC 2.NOT Use telecommunication FOR SALE OR technologies DISTRIBUTION to assist in effective communicationNOT FOR SALE OR DISTRIBUTION in a variety of healthcare settings. 3. Apply safeguards and decision-making support tools embedded in patient care technologies and information systems to support a safe practice envi- © Jones & Bartlettronment Learning, for both patients LLC and healthcare workers. © Jones & Bartlett Learning, LLC NOT FOR SALE4. Understand OR DISTRIBUTION the use of CIS systems to document interventionsNOT FOR related SALE to OR DISTRIBUTION achieving nurse-sensitive outcomes. 5. Use standardized terminology in a care environment that reflects nursing’s unique contribution to patient outcomes. 6. Evaluate data from all relevant sources, including technology, to inform the © Jones & Bartlett Learning,delivery LLC of care. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION7. Recognize the role of informationNOT technology FOR in SALE improving OR patientDISTRIBUTION care outcomes and creating a safe care environment. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality, and clients’ right to privacy. 9.© Apply Jones patient & care Bartlett technologies Learning, as appropriate LLC to address the needs of a© di- Jones & Bartlett Learning, LLC NOTverse patient FOR population.SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 10. Advocate for the use of new patient care technologies for safe, quality care. 11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice. 12. Participate in the evaluation of information systems in practice settings © Jones & Bartlettthrough Learning, policy and procedure LLC development. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

14 | CHAPTER 1 Nursing Science and the Foundation of Knowledge

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTThe FOR report SALE suggests ORthe following DISTRIBUTION sample content for achieving these NOTstudent FOR out- SALE OR DISTRIBUTION comes (AACN, 2008, pp. 19-20): • Use of patient care technologies (e.g., monitors, pumps, computer-assisted devices) © Jones & Bartlett• UseLearning, of technology LLC and information systems for© clinical Jones decision & Bartlett making Learning, LLC NOT FOR SALE OR• Computer DISTRIBUTION skills that may include basic software,NOT spreadsheet, FOR SALE and healthcare OR DISTRIBUTION databases • Information management for patient safety • Regulatory requirements through electronic data-monitoring systems © Jones & Bartlett Learning, LLC• Ethical and legal issues related© Jonesto the use & of Bartlett information Learning, technology, LLC includ- NOT FOR SALE OR DISTRIBUTIONing copyright, privacy, and confidentialityNOT FOR SALEissues OR DISTRIBUTION • Retrieval information systems, including access, evaluation of data, and application of relevant data to patient care • Online literature searches • Technologic resources for evidence based practice © Jones• Web-based & Bartlett learning Learning, and online literature LLC searches for self and patient© Jones use & Bartlett Learning, LLC NOT• FOR Technology SALE and OR information DISTRIBUTION systems safeguards (e.g., patient NOTmonitoring, FOR SALE OR DISTRIBUTION equipment, patient identification systems, drug alerts and IV systems, and barcoding) • Interstate practice regulations (e.g., licensure, telehealth) © Jones & Bartlett• TechnologyLearning, for LLC virtual care delivery and monitoring© Jones & Bartlett Learning, LLC NOT FOR SALE OR• Principles DISTRIBUTION related to nursing workload measurementNOT FOR and resources SALE ORand in-DISTRIBUTION formation systems • Information literacy • Electronic health record and physician order entry • Decision support tools © Jones & Bartlett Learning, LLC• Role of the nurse informaticist© Jonesin the context & Bartlett of health informaticsLearning, and LLC infor- NOT FOR SALE OR DISTRIBUTIONmation systems NOT FOR SALE OR DISTRIBUTION This text is designed to include the necessary content to prepare nurses for practice in the ever changing and technology-laden healthcare environments. Goossen (2000) believes that the focus of nursing informatics research should © Jonesbe on the & structuring Bartlett andLearning, processing LLC of patient information and how© Jonesthese in- & Bartlett Learning, LLC NOTform FOR nursing SALE decision OR making DISTRIBUTION in clinical practice. The increased useNOT of technol- FOR SALE OR DISTRIBUTION ogy to enhance nursing practice, nursing education, and nursing research will open new avenues for acquiring, processing, generating, and disseminating knowledge. © Jones & BartlettIn Learning, the future, nursing LLC research will contribute significantly© Jones to& the Bartlett development Learning, LLC of nursing science. Technologies and translational research will abound and clin- NOT FOR SALEical OR practices DISTRIBUTION will be evidence based, thus improvingNOT patient FOR outcomes SALE ORand de-DISTRIBUTION

References | 15

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC creasingNOT safety FOR concerns. SALE Schools OR ofDISTRIBUTION nursing will embrace nursing science as theyNOT FOR SALE OR DISTRIBUTION strive to meet the needs of changing student populations and the increasing com- plexity of healthcare environments.

© Jones &SUMMARY Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORThis SALE chapter OR provides DISTRIBUTION an overview of nursing science and howNOT nursing FOR science SALE re- OR DISTRIBUTION lates to typical nursing practice roles, nursing education, and nursing research. The Foundation of Knowledge model was introduced as the organizing conceptual framework for this book. Finally, the relationship of nursing science to nursing informatics was discussed. In subsequent chapters the reader will learn more about © Jones & Bartlett Learning,how nursing LLC informatics supports nurses© in Jones their many & Bartlett and varied Learning, roles. In an LLC NOT FOR SALE OR DISTRIBUTIONideal world nurses would embrace nursingNOT science FOR as knowledge SALE users,OR DISTRIBUTION knowledge managers, knowledge developers, knowledge engineers, and knowledge workers.

THOUGHT-PROVOKING© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORQuestions DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1. Imagine you are in a social situation and someone asks you, “What does a nurse do?” Think about how you will capture and convey the richness that is nursing sci- © Jones & Bartlettence Learning, in your answer. LLC © Jones & Bartlett Learning, LLC NOT FOR SALE2. ORChoose DISTRIBUTION a clinical scenario from your recent experienceNOT FOR and analyze SALE it usingOR DISTRIBUTIONthe Foundation of Knowledge model. How did you acquire knowledge? How did you process knowledge? How did you generate knowledge? How did you disseminate knowledge? How did you use feedback, and what was the effect of the feedback © Jones & Bartlett Learning, onLLC the foundation of your knowledge?© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

For a full suite of assignments and additional learning activities, use the access code located in the front of your book to visit this exclusive website: http://go.jblearning.com/mcgonigle. If you do not have an access code, you can obtain one at the site. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION References American Association of Colleges of Nursing. (2008, October 20). The Essentials of Baccalaureate Education for Professional Nursing Practice. Retrieved from American Association of Colleges of © Jones & BartlettNursing Web Learning,site: http://www.aacn.nche.edu/Education/pdf/ LLC BaccEssentials08.pdf© Jones & Bartlett Learning, LLC American Nurses Association. (2003). Nursing’s social policy statement (2nd ed.). Silver Spring, MD: NOT FOR SALEAuthor. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

16 | CHAPTER 1 Nursing Science and the Foundation of Knowledge

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTBassendowski, FOR SALE S. (2007). OR NursingQuest: DISTRIBUTION Supporting an analysis of nursing issues. JournalNOT of NursingFOR SALE OR DISTRIBUTION Education, 46(2), 92–95. Retrieved from Education Module database [document ID: 1210832211]. Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., …Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122–131. Girard, N. (2007). Science fiction comes to the OR. Association of Operating Room Nurses. AORN © Jones & BartlettJournal, Learning, 86(3), 351–353. LLC Retrieved from Health Module database© Jones [document & ID:Bartlett 1333149261]. Learning, LLC NOT FOR SALEGoossen, OR DISTRIBUTION W. (2000). Nursing informatics research. Nurse Researcher,NOT 8(2), FOR 42. Retrieved SALE from ORProQuest DISTRIBUTION Nursing & Allied Health Source database [document ID: 67258628]. Greenfield, S. (2007). Medication error reduction and the use of PDA technology. Journal of Nursing Education, 46(3), 127–131. Retrieved from Education Module database [document ID: 1227347171]. National League for Nursing. (2008). Preparing the next generation of nurses to practice in a technol- © Jones & Bartlett Learning, LLCogy rich environment: An informatics© agenda.Jones (Position & Bartlett Statement). RetrievedLearning, from: http://www LLC NOT FOR SALE OR DISTRIBUTION.nln.org/aboutnln/PositionStatements/informatics_052808.pdfNOT FOR SALE OR DISTRIBUTION Skiba, D. (2007). Faculty 2.0: Flipping the novice to expert continuum. Nursing Education Perspec- tives, 28(6), 342–344. Retrieved from ProQuest Nursing & Allied Health Source database [document ID: 1401240241]. Swan, B., Lang, N., & McGinley, A. (2004). Access to quality health care: Links between evidence, nurs- © Jonesing language, & Bartlett and informatics. Learning,Nursing Economics, LLC 22(6), 325–332. Retrieved from© Health Jones Module & Bartlett Learning, LLC NOT databaseFOR [documentSALE OR ID: 768191851]. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Technology Informatics Guiding Education Reform. (2007). Evidence and Informatics Transforming Nursing: 3-Year Action Steps Toward a 10-year Vision. Retrieved from The Tiger Initiative website: http://www.aacn.nche.edu/Education/pdf/TIGER.pdf