Theories, Models and Frameworks

1. Theories, Models and Frameworks

2. Nursing Informatics • Is an established and growing area of specialization in nursing. • Informatics nurses are key persons in designs, development, implementation, and evaluation of these technologies and in the development of the specialty’s body of knowledge.

3. Informatics and Healthcare Informatics • Informatics is a science that combines a domain science, computer science, information science, and cognitive. • Healthcare informatics may be defined as the integration of healthcare sciences, computer, information, and cognitive science to assist in the management of healthcare information.

4. Nursing Informatics 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

5. Graves and Corcoran’s Model (1989) • Nursing Informatics as a 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.

7. Schiwirian’s Model (1989) • Nursing informatics involves identification of information needs, resolution of the needs, and attainment of nursing goals/objectives. • Patricia Schiwirian- proposed a model intended to stimulate and guide systematic in nursing informatics. • Model/framework that enables identification of significant information needs that can foster research (somewhat similar to Maslow’s hierarchy of needs)

9. TURLEY’S MODEL (1996) • Nursing informatics is the interaction between the discipline-specific science (nursing) and the areas of informatics • Core components of informatics: • Cognitive science • Information science • Computer science

10. COMPUTER SCIENCE NURSING INFORMATION SCIENCE COGNITIVE SCIENCE

11. 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). • NI is an evolving, dynamic process involving the conversion of data into information, subsequently knowledge. • Important Note: Processing of information does not always result in the development of knowledge.

12. KNOWLEDGE COMPLEXITY INFORMATION DATA HUMAN INTELLECT

13. BENNER’S LEVEL OF EXPERTISE MODEL • Every nurses must be able to continuously exhibit the capability to acquire skill ( in this case, computer literacy skills parallel with nursing knowledge) and then demonstrate specific skills beginning with the very first student experience.

14. Levels of Expertise (Benner): • Novice- individuals with no experience of situations and related content in those situations where they are expected to perform tasks. • Advance Beginner- marginally demonstrate acceptable performance having built on lessons learned in their expanding experience base; needs supervision. • Competence- enhanced mastery and the ability to cope with and manage contingencies.

15. 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.

17. PATIENT MEDICAL RECORD INFORMATION (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 dimensions- PHR maintained and controlled by the individual or family; nonclinical information. E.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 24/7. E.g.. provider’s notes/prescription, clinical orders decision support system, practice guidelines

18. 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 e.g. Ushahidi program

19. 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

20. ABC CODES • Mechanism for coding integrative health interventions by clinician for administrative billing and insurance claims • Includes complementary alternative medicine intervention and codes that map all NIC, CCC, and Omaha system interventions

21. 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 intervention based on NIC, and outcomes based on NOC

22. SNOMED CT • Core clinical terminology containing over 357,000 healthcare concepts with unique meaning and formal logic-based definitions organized into multiple hierarchies.

23. 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

24. Patient Care Data Set (PCDS) • Terms and codes for patient problems, therapeutic goals, and care orders. • Developed by Dr. Judith Osbolt

25. NANDA • Has evolved from an alphabetical listing in the mid- 1980’s to a conceptual system that guides the classification of nursing diagnoses in a taxonomy and includes definitions and defining characteristics. • Currently includes 167 recognized diagnoses focus of the terms used for medicine and third party payment claims.

26. Logical Observation Identifiers Names and Codes (LOINC) • Originated as database of standardized laboratory terms for results reporting for chemistry, hematology, microbiology, serology and toxicology. • Including a clinical portion with codes for observations at key stages of the nursing process, including assessments, goals, and outcomes. Such entries V/S, I&O.ECG and etc.

27. ORGANIZATION as resources AMIA NLN HIMSS

28. American Medical Informatics Association (AMIA) • Authoritative body in the field of medical informatics and frequently represents the US in the informational area of medical forums. • Dedicated to the development and application of medical informatics in the support of patient care, teaching, research and healthcare administration

29. National League for Nursing (NLN) • Mission: to advance quality nursing education that prepares the nursing workforce to meet the needs of diverse population in an ever-changing healthcare environment. • Addresses faculty development and educational research

30. 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.