Among the Resources in this module is the Rutherford (2008) article Standardized Nursing Language: What Does It Mean for Nursing Practice? In this article, the author recounts a visit to a local hospi
ojn i.o rghttp ://o jn i.o rg /is sues/? p=2852
T he H it c h hik er’s G uid e t o n urs in g i n fo rm atic s t h eo ry : u sin g
t h e D ata -K now le d ge-In fo rm atio n -W is d om f r a m ew ork t o g u id e
i n fo rm atic s r e se arc h
by
Maxim T o paz, P hD S tu dent, R N, M A
In vit e d G uest E dit o r
C it a tio n
T o paz, M . ( 2 013). In vit e d E dit o ria l: T he H it c h hik e r’s G uid e t o n urs in g in fo rm atic s t h eo ry : u sin g t h e D ata -
K no w le dge-In fo rm atio n-W is do m f ra m ew ork t o g uid e in fo rm atic s r e searc h .
Onlin e J o urn al o f N urs in g
I n fo rm atic s ( O JN I) ,
17
(3 ). A va ila ble a t h ttp :/ /o jn i.o rg /is sues/? p= 2852
E dit o ria l
T heo ry is o ne o f t h e f u ndam enta l b lo cks o f e ach s cie ntif ic d is cip lin e. It is im po ssib le t o im agin e b io lo gy
w it h o ut t h e t h eo ry o f E vo lu tio n o r p hys ic s w it h o ut t h e t h eo ry o f R ela tiv it y . N urs in g in fo rm atic s , a r e la tiv e ly
n ew d is cip lin e, is a ls o t h ir s ty f o r it s o w n t h eo ry . H ow eve r, it is c h alle ngin g t o f in d lit e ra tu re t h at p ro vid es
c le ar t h eo re tic a l g uid ance f o r n urs e in fo m atic ia ns. In t h is c o m menta ry , I w ill b rie fly o ve rv ie w a t h eo re tic a l
f ra m ew ork t h at h as h ig h p o te ntia l t o s erv e a s o ne o f t h e f o undatio ns f o r n urs in g in fo rm atic s . I w ill a ls o
a rg ue t h at t o a pply t h e d escrib ed f ra m ew ork , it n eeds t o b e m erg ed w it h a n urs in g s pecif ic t h eo ry . I w ill
p ro vid e a n e xa m ple o f m y d is serta tio n w ork t o illu stra te t h e n ece ssary m erg e. T his c o m menta ry m ig ht b e
u sed a s a t h eo re tic a l b lu eprin t - o r t h e H it c h hik e r’s G uid e- t o g uid e n urs in g in fo rm atic s r e searc h a nd
p ra ctic e .
T he D ata -In fo rm atio n-K no w le dge-W is d o m f ra m ew ork
N urs in g in fo rm atic s w as c re ate d b y t h e m erg e o f t h re e w ell e sta blis hed s cie ntif ic f ie ld s: In fo rm atio n
s cie nce , C om pute r s cie nce a nd N urs in g s cie nce . O ne o f t h e m ost c o m pellin g d efin it io ns o f t h e d is cip lin e
s ta te s: “ N urs in g in fo rm atic s s cie nce a nd p ra ctic e in te gra te s n urs in g, it s in fo rm atio n a nd k n o w le dge a nd
t h eir m anagem ent w it h in fo rm atio n a nd c o m munic a tio n t e ch no lo gie s t o p ro m ote t h e h ealt h o f p eo ple ,
f a m ilie s a nd c o m munit ie s w orld w id e” ( In te rn atio nal M edic a l In fo rm atic s A sso cia tio n – N urs in g W ork in g
G ro up, 2 010). U nfo rtu nate ly , v e ry f e w a tte m pts w ere m ade t o g enera te a b ro ad t h eo re tic a l f ra m ew ork f o r
n urs in g in fo rm atic s . T here a re s eve ra l c h alle nges t o g enera te s uch f ra m ew ork . F ir s t, t h e in te rd is cip lin ary
n atu re o f n urs in g in fo rm atic s d em ands t h e u se o f b ro ad e no ugh t h eo re tic a l f ra m ew ork t o e nco m pass a ll
t h e d is cip lin es. A ls o , t h e r e quir e d t h eo re tic a l f ra m ew ork s ho uld c o nsid er t h e p ra ctic e /a pplic a tio n d o m ain ;
t h e im ple m enta tio n o f n urs in g in fo rm atic s in r e al h ealt h ca re s ettin gs. R ece ntly , it w as s uggeste d t h at t h e
D ata -In fo rm atio n-K no w le dge-W is do m ( D IK W ) f ra m ew ork h as a h ig h p o te ntia l t o a ddre ss t h ese c h alle nges
a nd t h is f ra m ew ork w as a do pte d b y t h e A m eric a n N urs es A sso cia tio n ( A m eric a n N urs es A sso cia tio n, 2 008;
M atn ey, B re w ste r, S w ard , C lo ye s, & S ta ggers , 2 011 ).
H is to ric a lly , t h e d eve lo pm ent o f t h e D IK W f ra m ew ork w as u rg ed b y a s earc h f o r a n ew t h eo re tic a l m odel
e xp la in in g t h e e m erg in g f ie ld o f N urs in g In fo rm atic s in 1 980-9 0s. In t h eir s em in al w ork , G ra ve s a nd
C orc o ra n ( 1 989) d efin ed t h at
data , in fo rm atio n
, a nd
kn ow le dge
a re f u ndam enta l c o nce pts f o r t h e d is cip lin e.
T heir f ra m ew ork w as w id ely a cce pte d b y t h e in te rn atio nal n urs in g c o m munit y ( M atn ey e t a l., 2 011 ;
M cG onig le & M astria n, 2 011 ). In 2 008, t h e A m eric a n N urs es A sso cia tio n r e vis ed t h e S co pe a nd S ta ndard s
f o r n urs in g in fo rm atic s t o in clu de a n a ddit io nal c o nce pt, w is do m ( A m eric a n N urs es A sso cia tio n, 2 008).
R ece ntly , M atn ey a nd c o lle agues ( 2 011 ) h ave e xp anded o n t h e c o m po nents o f t h e D IK W f ra m ew ork : Data
: a re t h e s m alle st c o m po nents o f t h e D IK W f ra m ew ork . T hey a re c o m monly p re sente d a s
dis cre te f a cts ; p ro duct o f o bserv a tio n w it h lit tle in te rp re ta tio n ( M atn ey e t a l., 2 011 ). T hese a re t h e
dis cre te f a cto rs d escrib in g t h e p atie nt o r h is /h er e nvir o nm ent. E xa m ple s in clu de p atie nt’s m edic a l
dia gno sis ( e .g . In te rn atio nal S ta tis tic a l C la ssif ic a tio n o f D is eases ( IC D-9 ) d ia gno sis # 428.0 :
Congestiv e h eart f a ilu re , u nspecif ie d) o r liv in g s ta tu s ( e .g . liv in g a lo ne; liv in g w it h f a m ily ; liv in g in a
re tir e m ent c o m munit y ; e tc .) . A s in gle p ie ce o f d ata , d atu m , o fte n h as lit tle m eanin g in is o la tio n.
In fo rm atio n
: m ig ht b e t h o ught o f a s “ d ata + m eanin g” ( M atn ey e t a l., 2 011 ). In fo rm atio n is o fte n
co nstru cte d b y c o m bin in g d if fe re nt d ata p o in ts in to a m eanin gfu l p ic tu re , g iv e n c e rta in c o nte xt.
In fo rm atio n is a c o ntin uum o f p ro gre ssiv e ly d eve lo pin g a nd c lu ste re d d ata ; it a nsw ers q uestio ns
such a s “ w ho ”, “ w hat”, “ w here ”, a nd “ w hen”. F o r e xa m ple , a c o m bin atio n o f p atie nt’s IC D-9 d ia gno sis
#428.0 “ C ongestiv e h eart f a ilu re , u nspecif ie d” a nd liv in g s ta tu s “ liv in g a lo ne” h as a c e rta in m eanin g in
a c o nte xt o f a n o ld er a dult .
Know le dge
: is in fo rm atio n t h at h as b een s yn th esiz ed s o t h at r e la tio ns a nd in te ra ctio ns a re d efin ed
and f o rm aliz ed; it is b uild o f m eanin gfu l in fo rm atio n c o nstru cte d o f d is cre te d ata p o in ts ( M atn ey e t
al., 2 011 ). K no w le dge is o fte n a ffe cte d b y a ssum ptio ns a nd c e ntra l t h eo rie s o f a s cie ntif ic d is cip lin e
and is d eriv e d b y d is co ve rin g p atte rn s o f r e la tio nship s b etw een d if fe re nt c lu ste rs o f in fo rm atio n.
Kno w le dge a nsw ers q uestio ns o f “ w hy” o r “ h o w ”.
Fo r h ealt h ca re p ro fe ssio nals , t h e c o m bin atio n o f d if fe re nt in fo rm atio n c lu ste rs , s uch a s t h e IC D-9
dia gno sis # 428.0 “ C ongestiv e h eart f a ilu re , u nspecif ie d” + liv in g s ta tu s “ liv in g a lo ne” w it h a n
addit io nal in fo rm atio n t h at a n o ld er m an ( 7 8 y e ars o ld ) w as ju st d is ch arg ed f ro m h o spit a l t o h o m e
wit h a c o m plic a te d n ew m edic a tio n r e gim en ( e .g . b lo od t h in ners ) m ig ht in dic a te t h at t h is p ers o n is a t a
hig h r is k f o r d ru g-re la te d a dve rs e e ffe cts ( e .g . b le edin g).
Wis d om
: is a n a ppro pria te u se o f k n o w le dge t o m anage a nd s o lv e h um an p ro ble m s ( A m eric a n
Nurs es A sso cia tio n, 2 008; M atn ey e t a l., 2 011 ). W is do m im plie s a f o rm o f e th ic s , o r k n o w in g w hy
ce rta in t h in gs o r p ro ce dure s s ho uld o r s ho uld n o t b e im ple m ente d in h ealt h ca re p ra ctic e . In n urs in g,
wis do m g uid es t h e n urs e in r e co gniz in g t h e s it u atio n a t h and b ased o n p atie nts ’ v a lu es, n urs e’s
exp erie nce , a nd h ealt h ca re k n o w le dge. C om bin in g a ll t h ese c o m po nents , t h e n urs e d ecid es o n a
nurs in g in te rv e ntio n o r a ctio n. B enner ( 2 000) p re sents w is do m a s a c lin ic a l ju dgm ent in te gra tin g
in tu it io n, e m otio ns a nd t h e s enses. U sin g t h e p re vio us e xa m ple s, w is do m w ill b e d is pla ye d w hen t h e
ho m eca re n urs e w ill c o nsid er p rio rit iz in g t h e e ld erly h eart f a ilu re p atie nt u sin g b lo od t h in ners f o r a n
im media te in te rv e ntio n, s uch a s a f ir s t n urs in g v is it w it h in t h e f ir s t h o urs o f d is ch arg e f ro m h o spit a l
to a ssure a ppro pria te u se o f m edic a tio ns.
T he b o undarie s o f t h e D IK W f ra m ew ork c o m po nents a re n o t s tric t; r a th er, t h ey a re in te rre la te d a nd t h ere is
a “ c o nsta nt f lu x” b etw een t h e f ra m ew ork p arts . S im ply p ut, d ata is u sed t o g enera te in fo rm atio n a nd
k n o w le dge w hile t h e d eriv e d n ew k n o w le dge c o uple d w it h w is do m , m ig ht t rig ger a ssessm ent o f n ew d ata
e le m ents ( M atn ey e t a l., 2 011 ).
A pply in g t h e
Data -In fo rm atio n-K no w le dge-W is d o m f ra m ew ork t o g uid e
i n fo rm atic s r e se arc h
T he D IK W f ra m ew ork d o es n o t p ro po se a ny r e la tio ns b etw een t h e d is tin ct
data
e le m ents t h at le ad t o t h e
g enera tio n o f m eanin gfu l
in fo rm atio n
a nd
kn ow le dge
. T o a cco m plis h t h at, a d is cip lin e s pecif ic t h eo ry is
r e quir e d in c o m bin atio n w it h t h e D IK W f ra m ew ork . T o illu stra te t h at, I w ill u se a p ra ctic a l e xa m ple f ro m m y
d is serta tio n f o cu sin g o n id entif y in g p atie nts ’ r is k f o r p o or o utc o m es d urin g t ra nsit io n f ro m h o spit a l t o
h o m eca re .
I n m y d is serta tio n, I h ave c h o sen t o u se t h e n urs in g s pecif ic T ra nsit io ns t h eo ry ( M ele is , 2 010) t o d escrib e
t h e t ra nsit io n o f in te re st ( p atie nt’s t ra nsit io n f ro m h o spit a l t o h o m e). A s n urs es f re quently s tu dy a nd
m anage v a rio us t y p es o f t ra nsit io ns ( e .g . im mig ra tio n t ra nsit io n, h ealt h -illn ess t ra nsit io n, a dm in is tra tiv e
t ra nsit io n, e tc ), T ra nsit io ns t h eo ry h as b een e asily a do pte d a nd w elc o m ed in n urs in g r e searc h , e duca tio n,
a nd p ra ctic e ( Im , 2 011 ; M ele is , S aw ye r, Im , M essia s, & S ch um ach er, 2 000). In m y d is serta tio n, t h e
T ra nsit io ns t h eo ry h elp s m e t o a naly z e t h e d if fe re nt e le m ents a ffe ctin g t ra nsit io n f ro m h o spit a l t o h o m e.
F o r e xa m ple , t h e T ra nsit io ns t h eo ry s uggests t h at s eve ra l p ers o nal c o ndit io ns ( s uch a s t h e h ig h le ve l o f
f a m ily s uppo rt) m ig ht f a cilit a te h o spit a l t o h o m e t ra nsit io ns f o r o ld er a dult s a nd s ho uld b e m easure d. T hus,
t h e d is cip lin e s pecif ic t h eo ry s erv e s a s t h e g lu e t h at b in ds a ll t h e d is tin ct
data
p o in ts ( e .g . c a re giv e r’s
a va ila bilit y t o a ssis t w it h p atie nt’s b asic n eeds) t o geth er t o p ro duce m eanin gfu l
in fo rm atio n
(e .g . t h e le ve l o f
f a m ily s uppo rt). T his
in fo rm atio n
is t h en s yn th esiz ed a nd u sed – w it h t h e h elp o f T ra nsit io ns t h eo ry - t o
b uild
kn ow le dge
a bo ut t h e s pecif ic p heno m eno n. T his e xa m ple illu stra te s t h e D IK a spects o f t h e D IK W
f ra m ew ork in t h e c o nte xt o f T ra nsit io ns t h eo ry .
T he
wis d om
c o m po nent o f t h e D IK W f ra m ew ork is o fte n a ddre ssed b y t h e c lin ic ia ns in t h e f ie ld . F o r
e xa m ple , t h e f in al p ro duct o f m y d is serta tio n w ill b e a d ecis io n s uppo rt t o ol h elp in g h o m eca re c lin ic ia ns w it h
i d entif ic a tio n o f p atie nts ’ r is k f o r p o or o utc o m es. W hen u sin g t h e t o ol in p ra ctic e , t h e c lin ic ia ns w ill h ave t o
a ct a cco rd in g t o a s pecif ic k n o w le dge p re sent in e ach c lin ic a l s it u atio n ( e .g . e th ic s , c lin ic a l p ra ctic e
r e gula tio ns in e ach p artic u la r s ta te in t h e U S e tc .) . In o th er w ord s, t h e c lin ic ia ns w ill u se t h eir
wis d om
t o
i n te rp re t s uggestio ns a nd m ake c lin ic a l ju dgm ents u sin g in fo rm atio n r e ce iv e d f ro m t h e d ecis io n s uppo rt
t o ol. F ig ure I p re sents t h e p o ssib le in te rp la y b etw een t h e d is cip lin e s pecif ic t h eo ry ( T ra nsit io ns t h eo ry ) a nd
d if fe re nt c o m po nents o f t h e D IK W f ra m ew ork .
F ig ure I: C om bin in g t h e d is cip lin e s p ecif ic a nd D IK W t h e ore tic al f ra m ew ork s
I n s um mary , t h is e dit o ria l p re sents a p o ssib le t h eo re tic a l b lu eprin t f o r n urs in g a nd h ealt h ca re in fo rm atic s
r e searc h ers t h at in te nd t o u se t h e D IK W f ra m ew ork . T he c o m bin atio n o f d is cip lin e s pecif ic t h eo rie s a nd t h e
D IK W f ra m ew ork o ffe rs a u sefu l t o ol t o e xa m in e t h e t h eo re tic a l a spects a nd g uid e t h e p ra ctic a l a pplic a tio n
o f in fo rm atic s r e searc h .
A ckn ow le dgm ent
: I w ante d t o t h ank m y a ca dem ic a dvis er, D r. K . B ow le s P hD , R N, F A AN , F A C M I, f o r h er
g uid ance o n t h e p re sente d w ork . A ls o , I w ante d t o t h ank C harle ne R onquillo , R N, M SN , P hD s tu dent
( U niv e rs it y o f B rit is h C olu m bia , C anada) f o r h er r e vie w a nd c o m ments o n t h is m anuscrip t.
Refe re nce s
A m eric a n N urs es A sso cia tio n. ( 2 008).
Nurs in g in fo rm atic s: S co pe a nd s ta ndard s o f p ra ctic e
. S ilv e r S prin g, M D:
n urs esbo oks .o rg .
B enner, P . ( 2 000). T he w is do m o f o ur p ra ctic e .
T he A m eric a n J o urn al o f N urs in g, 1 00
(1 0), 9 9-1 01, 1 03, 1 05.
G ra ve s, J . R ., & C orc o ra n, S . ( 1 989). T he s tu dy o f n urs in g in fo rm atic s .
Im age–th e J o urn al o f N urs in g
S ch ola rs h ip , 2 1
(4 ), 2 27-2 31.
I m , E . O . ( 2 011 ). T ra nsit io ns t h eo ry : A t ra je cto ry o f t h eo re tic a l d eve lo pm ent in n urs in g.
N urs in g O utlo ok,
5 9
(5 ), 2 78-2 85.e 2. d o i: 1 0.1 016/j.o utlo ok.2 011 .0 3.0 08
I n te rn atio nal M edic a l In fo rm atic s A sso cia tio n – N urs in g W ork in g G ro up. ( 2 010). IM IA d efin it io n o f n urs in g
i n fo rm atic s u pdate d. R etrie ve d 0 1/0 2, 2 013, f ro m
http :/ /im ia new s.w ord pre ss.c o m /2 009/0 8/2 4/im ia -n i-
d efin it io n-o f-n urs in g-in fo rm atic s -u pdate d/
M atn ey, S ., B re w ste r, P . J ., S w ard , K . A ., C lo ye s, K . G ., & S ta ggers , N . ( 2 011 ). P hilo so phic a l a ppro ach es t o
t h e n urs in g in fo rm atic s d ata -in fo rm atio n- k n o w le dge-w is do m f ra m ew ork .
A dva nce s in N urs in g S cie nce ,
3 4
(1 ), 6 -1 8.
M cG onig le , D ., & M astria n, K . ( 2 011 ).
Nurs in g in fo rm atic s a nd th e fo undatio n o f k n ow le dge
J o nes & B artle tt
L e arn in g.
M ele is , A . ( 2 010).
Tra nsit io ns th eory : M id dle r a nge a nd s it u atio n s p ecif ic th eorie s in n urs in g r e se arc h a nd
p ra ctic e
S prin ger P ublis hin g C om pany.
M ele is , A ., S aw ye r, L . M ., Im , E . - ., M essia s, D . K . H ., & S ch um ach er, K . ( 2 000). E xp erie ncin g t ra nsit io ns: A n
e m erg in g m id dle -ra nge t h eo ry .
A dva nce s in N urs in g S cie nce , 2 3
(1 ), 1 2-2 8.
A uth o r’s B io
M axim T o paz, R N, M A, D octo ra l s tu dent
M axim T o paz, M A, R N, is a S pence r S ch o la r, a F ulb rig ht F ello w a nd a P hD S tu dent in N urs in g a t t h e
U niv e rs it y o f P ennsylv a nia . H e e arn ed h is B ach elo rs in N urs in g a nd M aste rs in G ero nto lo gy ( c u m la ude)
f ro m t h e U niv e rs it y o f H aif a , Is ra el. Back to Is sue In d ex
I n t h e p ast, M axim w as in vo lv e d in n urs in g p ra ctic e a nd e duca tio n in Is ra el. In h is c u rre nt w ork , M axim
f o cu ses o n E le ctro nic M edic a l R eco rd s, C lin ic a l D ecis io n S uppo rt a nd S ta ndard iz ed T erm in o lo gie s. M axim
h as m ore t h an a d o zen o f p ublic a tio ns in h ealt h ca re in fo rm atic s
http :/ /s ch o la r.g o ogle .c o m /c it a tio ns?
h l= en& user= 7M xxJ2 U AAAAJ& vie w _o p= lis t_ w ork s & pagesiz e= 100
. C urre ntly , h e s erv e s a s a C hair o f t h e
S tu dents ’ g ro up w it h In te rn atio nal M edic a l In fo rm atic s A sso cia tio n N urs in g In fo rm atic s S pecia l In te re st
G ro up ( IM IA -N IS IG ). A ls o , M axim s erv e s a s a m em ber o f t h e S tu dent E dit o ria l B oard w it h t h e J o urn al o f
A m eric a n M edic a l In fo rm atic s A sso cia tio n. A ddit io nally , M axim is in vo lv e d in s eve ra l in fo rm atic s o rie nte d
p o lic y m akin g e ffo rts w it h t h e O ffic e o f N atio nal C oord in ato r f o r H ealt h In fo rm atio n T ech no lo gy ( O NC) in
t h e U .S . a nd t h e Is ra eli M in is try o f H ealt h , D epartm ent o f In fo rm atio n T ech no lo gy. M axim is r e cip ie nt o f
s eve ra l in fo rm atic s a w ard s, f o r e xa m ple t h e P hD S tu dent In fo rm atic s M eth o do lo gis t a w ard f ro m r e ce iv e d a t
t h e F ir s t In te rn atio nal C onfe re nce o n R esearc h M eth o ds f o r S ta ndard iz ed T erm in o lo gie s
h ttp :/ /o m ahasys te m partn ers hip .o rg /in te rn atio nal- c o nfe re nce -o n-re searc h -m eth o ds-fo r- s ta ndard iz ed-
t e rm in o lo gie s/c o nfe re nce -m eth o do lo gis t- a w ard s/
.
“ I a m t h rille d t o b e in vo lv e d in t h e e xp andin g a nd f a st- p ace d f ie ld o f h ealt h ca re in fo rm atic s . N urs es- t h e
l a rg est s ecto r o f h ealt h ca re p ro vid ers w orld w id e- a re in t h e m id st o f h ealt h in fo rm atio n t e ch no lo gy
r e vo lu tio n. N urs in g in fo rm atic s h as a h ig h p o te ntia l t o im pro ve p atie nt o utc o m es, in cre ase t h e q ualit y o f
h ealt h ca re a nd b rid ge t h e g ap b etw een h ealt h ca re s cie nce a nd p ra ctic e .”
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