Philosophical Approaches to the Nursing Informatics Data- Information-Knowledge-Wisdom Framework
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ANS200077 January 25, 2011 20:18 Char Count= 0 Advances in Nursing Science Vol. 34, No. 1, pp. 6–18 Copyright c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Philosophical Approaches to the Nursing Informatics Data- Information-Knowledge-Wisdom Framework Susan Matney, MSN, RN, FAAN; Philip J. Brewster, PhD; Katherine A. Sward, PhD, RN; Kristin G. Cloyes, PhD, RN; Nancy Staggers, PhD, RN, FAAN Although informatics is an important area of nursing inquiry and practice, few scholars have articulated the philosophical foundations of the field or how these translate into practice in- cluding the often-cited data, information, knowledge, and wisdom (DIKW) framework. Data, information, and knowledge, often approached through postpositivism, can be exhibited in computer systems. Wisdom aligns with constructivist epistemological perspectives such as Gadamerian hermeneutics. Computer systems can support wisdom development. Wisdom is an important element of the DIKW framework and adds value to the role of nursing informati- cists and nursing science. Key words: constructivism, hermeneutics, information manage- ment, knowledge, nursing informatics, nursing, nursing research, objectivism, philosophy, postpositivism, qualitative research Where is the wisdom we have lost in knowledge? throughout the international NI community. Where is the knowledge we have lost in informa- In 2008, the American Nurses Association tion? (ANA) revised the Scope and Standards for Thomas Stearns Eliot1 Nursing Informatics to include an additional concept, wisdom, in the definition of nurs- ARLY definitions of nursing informatics 2 2 ing informatics. Data, information, knowl- E(NI) varied but soon coalesced around edge, and wisdom (DIKW) provide a founda- 3 Graves and Corcoran’s seminal article outlin- tional framework for NI and the framework is ing data, information, and knowledge as foun- useful for the broader nursing community as dational concepts for the specialty. Their con- well, providing a basis for linking theory and ceptual framework has been widely accepted practice. The philosophical foundations of this widely accepted framework have not been well described. The recognition of Graves and Author Affiliations: Office of the Associate Vice President for Health Sciences Information Corcoran’s work and its worldwide adoption Technology (Ms Matney), College of Nursing by the nursing informatics community, cou- (Ms Matney and Drs Sward, Cloyes, and Staggers), pled with the more recent addition of the con- Department of Biomedical Informatics (Dr Brewster, Sward, and Staggers), University of Utah, Salt Lake cept of wisdom, merit philosophical inquiry City; School of Nursing, University of Maryland, and clarification. Therefore, we describe the Baltimore (Dr Staggers). concepts of the data, information, knowl- We thank Dr Maeona K. Kramer for her review and edge, and wisdom (DIKW) framework and insightful critique of this article. how they are used in nursing and NI. We ex- Correspondence: Susan Matney, MSN, RN, FAAN, 1148 North Alice Lane, Farmington, UT 84025 (susan. plain two philosophical approaches, postpos- [email protected]). itivism and the hermeneutics of Hans-Georg 6 Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. ANS200077 January 25, 2011 20:18 Char Count= 0 Philosophical Approaches to Nursing Informatics 7 Figure 1. DIWK framework. Reprinted with permission from Nelson.17 Gadamer that collectively provide an episte- upon each other, growing in scope and mean- mological basis for understanding the DIKW ing as they become increasingly abstract and framework. We examine how each approach sophisticated.2 ‘Fuzzy’ or overlapping bound- contributes conceptual clarity and structure aries exist at the juncture between each of the for the DIKW framework as a foundation for concepts. As a prelude to the philosophical nursing informatics. We provide NI and nurs- discussion, the following section describes ing examples of these perspectives, and dis- each DIKW concept in more detail. cuss how DIKW can be useful in linking the- ory with practice. DATA DIKW FRAMEWORK IN NURSING Data are the smallest units in the DIKW Informatics has been identified as one of framework. They are typically understood the core competencies for nurses at all levels as symbols that represent objects, events, of practice, not just for informatics nurse and their properties. Data come in many specialists.2,4 Data, information, knowledge, forms such as numbers, words, sentences, or and wisdom are considered overarching pictures—they can be anything given, no mat- concepts (metastructures) supporting all of ter what the origin or form.6 Data have been nursing and informatics practice. The DIKW explained as the products of observation,7 dis- concepts, often described as a hierarchy, crete facts with a minimum of interpretation.3 originated in computer and information Thus, a single piece of data (a datum) has sciences, in particular, in the subspecialty little or no meaning in isolation. Data are of knowledge management.5 Figure 1 is the the form most often stored within patient most current model adopted by nursing in- records, and are used as a basis for further rea- formatics, illustrating how the concepts build soning, calculation, or discussion. Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. ANS200077 January 25, 2011 20:18 Char Count= 0 8ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2011 INFORMATION may call this “background” knowledge. Ex- plicit knowledge, in contrast, can be gener- Information may be thought of as “data ated and formalized, and is more amenable to plus meaning.” It can be derived by process- encoding and transmitting in a formal man- ing data.3 Information represents the facts and ner. Explicit knowledge is what knowledge ideas that are available to be known within management systems (such as computer deci- a certain context.8 When data are put into a sion support systems) seek to capture, codify, context and combined within a structure, in- store, transfer, and share. formation emerges.9 Like the transformation of data to infor- Data and information are not discrete bits; mation, the transformation of information to rather, there is a continuum of progressively knowledge in nursing and information sys- increased meaning and value.10 To describe tems can be conceptualized as a continuum an example of data becoming more meaning- of increasing understanding.10 Knowledge is ful information, consider the number “110.” derived by discovering patterns and relation- The number has little meaning without con- ships between types of information. text. When developed into a name-value pair, Consider the previous example of a patient such as “heart rate = 110” (where heart rate with a heart rate of 110 beats per minute. If is the name, and 110 beats per minute is we combine this with additional information the value), a meaning begins to emerge. The such as: this is a 70-year-old man with pneu- phrase “a heart rate of 110”increases in mean- monia, his blood pressure is 80/60 mm Hg ing when we know that the context is an older and decreasing steadily from previous values, adult. Data and information not only repre- his temperature is 101oF,his respiratory rate is sent physical observations, but may also rep- 30, his urine output has totaled 60 mL in the resent abstract concepts such as depression, past 4 hours, and his skin is dry to the touch— pain, spirituality, or psychosocial care.11 then based on known physiologic patterns Information answers questions that begin nurses will conclude that this person is ex- with basic words such as who, what, where, hibiting signs of dehydration caused by his when, and how many. Information may be or- fever and pneumonia, and he needs increased ganized in ways that serve the interests of a fluid intake. This exemplifies nursing knowl- discipline12 and in practice, health informa- edge. Similarly, knowledge may be exhibited tion is organized in a way unique to the prac- when a nurse formulates a nursing diagnosis, tice of nursing. such as spiritual distress, and identifies the po- tential interventions such as spiritual care or a clergy referral that could lead to a positive KNOWLEDGE outcome.11 Just as data can be transformed into mean- ingful information, so too can information be WISDOM transformed into knowledge. Knowledge is information that has been synthesized so that The ANA defines wisdom as the appropri- relationships are identified and formalized.3 ate use of knowledge to manage and solve hu- Knowledge answers questions that begin man problems.2 Beyond that, wisdom implies with “how”and “why.” a form of ethics, that is, knowing why things There are many types of knowledge.13 Two should or should not be done in practice.15 types are described within the field of knowl- It is not a fixed entity, but rather a recip- edge management: tacit and explicit. Tacit rocal, action-oriented process.16 Wisdom in- knowledge is difficult to summarize and com- volves recognizing what is most important, municate to others.14 It is personal, context- by making distinctions among alternatives. specific, and therefore hard to formalize.9 We It comprises the application of experience, Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. ANS200077 January 25, 2011 20:18 Char Count= 0 Philosophical Approaches to Nursing Informatics 9 intelligence, creativity, and knowledge, as me- to frame and illuminate how the DIKW diated by values, toward the achievement of functions as the basis of informatics inquiry a common good.17 Benner18 bases the un- and practice. derstanding of wisdom in nursing on clinical judgment and a thinking-in-action approach that encompasses intuition, emotions, and the DEFINITIONS senses. Yet, each of these extant definitions does not fully capture the complexity or so- The definitions and usages of philosophical phistication of the concept. terms have evolved over time, and nuances of There is an increased level of critical think- those definitions remain the subject of philo- ing at each level of the DIKW framework.