INFORMATICS THEORY

Presented by Group 5
WHAT IS THEORY?
 A theory is a scholarly, organized view of some aspect
of the world (reality). Theory can describe, explain,
predict or prescribe selected phenomena within this
reality. The concepts within a theory are interrelated.
Testing of this relationships through research is how
theories is gain or lose supporting evidence.
 Theories can be classified as:
 Grand theory – broad in scope and most complex.
 Middle range theory – more specific than grand theory
but not as prescriptive as practice theory.
 Situation-Specific or Practice theory – most specific of
the three classifications.
THEORIES SUPPORTING
NURSING INFORMATICS
NURSING THEORIES

 Nursing theories are about nursing practice-a nurse’s

interactions or relationships with individuals, groups,
or communities (also known as patients or clients)
focused on applying the nursing process
NOVICE TO EXPERT

 In 1989, Dreyfus & Dreyfus published a model on how

people in profession become experts. They proposed
five stages: novice, advanced beginner,
competent, proficient, and expert. Patricia Benner
and other nurse educators adapted this model to
explain how nursing students and professional nurses
acquired nursing skills.
COMPUTER SCIENCE

 Computer Science is the study of algorithms for

solving computation problems. If an algorithm can
be identified for solving a particular problem, an
automated solution to the problem can be developed.
Once an automated solution is developed, a machine
can be built to solve the solution without the
person or machine needing to understand the
solution.
INFORMATION SCIENCE
 Information science focuses on the Gathering,
Manipulation, Classification, Storage, and
Retrieval of Recorded Knowledge.
 Three important branches of Information science are
Information Retrieval, Human-Computer
interactions, and Information handling within the
system.
 For classic Information Theory, the decisive event that
established the discipline of Information Theory, and
brought it to immediate worldwide attention, was the
publication of Shannon’s classic paper, A
MATHEMATICAL THEORY OF COMMUNICATION.
This work introduced the concept of the
communication channel.
 This communication channel consist of:
 SENDER – Source of information.
 TRANSMISSION MEDIUM – Noise and distortion.
 RECEIVER – Whose goal is to reconstruct the sender’s
message.
 Another core concept is Encoding and Decoding. If
the amount of information to be transmitted exceeds
the channel capacity, there will be an occurrence of
errors in the transmission. If the amount of
information is below the channel capacity, there is a
way to encode the information so that it can be
receive without errors.
COMMUNICATION

 Communication theory uses these core concepts and

additional principles developed since then to analyze
information transfer and the effectiveness and
efficiency of communications.
 Within a communication model. Blum presented
Taxonomy, with definitions, of the central concepts of
data, information, and knowledge.
COGNITIVE SCIENCE

 Cognitive Science is the study of mind-of how we

think. Another way of saying this is that cognitive
science looks at mental activities and processes.
 Cognitive technologies including computers, smart
phones, and web browsers, are media emerging
from cognitive science that help in learning,
memory, problem solving, and daily life in
modern society.
 Cognitive enhancements of biological-based
intelligence and artificial intelligence are the two
significant branches of these technologies.
 SYSTEMS

 System theory relates to the properties of systems as

a whole. System theory focuses on the organization,
and interdependence of relationships within a system.
A system is any set (group) of interdependent or
temporarily interacting parts. Parts are the system
themselves and are composed of other parts.
The boundary of a system may be open or closed.
 A closed system has an impermeable boundary and
does not interact with the surrounding environment,
for example, The human circulatory system. The
circulatory system is considered closed because the
blood never leaves the system of blood vessel.
 An open system can be influenced by events
outside of the actual or conceptual boundaries.
 There are 6 key concepts related understanding
system change:
 Dynamic Homeostasis – preserves the character of
a system through its growth.
 Entropy – is a measure of the loss of information in a
transmitted message.
 Reverberation – is the idea that when one part of a
system changes, other parts of a system is affected.
 Equifinality – is the principle by which a system can
get to the same end (or goal) from various different
routes.
 Negentropy
BEHAVIORAL AND SOCIAL SCIENCES

 The study of behavior and processes driving action is

the focus of the Behavioral and social sciences. These
two terms, behavioral and social, are often combined
or used interchangeably when examining how people
act alone ( as individuals) and with others.
 Behavior can include emotions, cognition, and
motivation.
 Social processes and act can be status, level of
social context, and biosocial interactions.
CHANGE
 Change is disruptive, messy, and complicated. Even
with the best laid plans, events rarely occur exactly as
they were predicted.
 A study of change processes and change theories
will show many models and theories of planned
change.
 A planned change theory is a collection of ideas
about modifications to an organization or social
system that are explicitly designed and put into place.
 Two of the most familiar perspectives are Lewin’s
theory on planned change and the diffusion of
innovations model developed by Rogers.
 Lewin’s basic planned change model has three
stages:
 Unfreezing – involves overcoming inertia and
dismantling the existing mindset. Defense mechanism
or resistance patterns have to be bypassed.
 Changing – change is an important part of this
change. The second stage, called moving, the
behavioral change occurs. Typically, this stage is a
period of confusion. People are aware that the old ways
are being challenged but do not yet have a clear
picture of how to replace the old ways.
 Refreezing – the final stage. A new mindset has
formed, and the comfort level is returning to previous
levels.
 Everret rogers formalized the diffusion-of-
innovations theory in 1962 book called Diffusion
of Innovations.
 In his work, Rogers identified specific groups of
innovation adopters. These groups are known as
 Innovators
 Early adopters
 Early majority
 Late majority
 Laggards
 Along with the concept of different categories of
innovation adopters, Rogers proposed a Five-
Stage model for the diffusion of innovation:

 Stage 1 is Knowledge – learning about the

existence and function of innovation.
 Stage 2 is Persuasion – becoming convinced of
the value of the innovation.
 Stage 3, the adopter makes a decision –
committing to the adoption of the innovation.
 Stage 4, Implementation – putting it to use
 Stage 5, Confirmation – the ultimate acceptance
(or rejection) of the innovation.
 LEARNING
 Learning is a process of acquiring knowledge, skills,
attitudes, or values through the study,
experience, or teaching. Learning causes a change
in behavior that is persistent, measurable, and
specified. There are numerous theories addressing
how people learn.
 A look at categories of these theories will help guide
farther further study. One approach is to categorize
learning theories as
 Behavioral
 Cognitive
 Learning style
 Adult learning
 Behaviorists believe that learning process can be
studied most objectively when the focus is on stimuli
and responses (also known as operant
conditioning).
 At a very simplistic level, think of this learning
approach as having two basic elements;
 First, paring a combination of a stimulus and a
response
 Second, a positive reinforcement and negative
reinforcement.
 Positive reinforcement – every stimulus is followed
by something pleasant or in which the stimulus itself
is a good experience. This positive experience
encourages continued learning.
 Negative reinforcement - where learners may
 Cognitive Learning Theory focuses on internal
mental processes, including insight, information
processing, memory, and perception.
 Cognitive learning divides learning into four steps:
 Information input - information is received by the
learner.
 Input processing – the information is ether
remembered for a short time or moved to long termed
memory.
 Output behavior – demonstrates if learning has
taken place.
 Feedback – embeds the same information more
firmly or to correct errors .
 Learning style theory asserts that individuals have
tendency to both perceive and process information
differently. There are:
 Concrete Perceivers – absorb information through
direct experience by doing, acting, sensing, and
feeling.
 Abstract Perceivers – take information through
analysis, observation, and thinking.
 Active processors – make sense of an experience by
immediately using the new information.
 Reflective processors – make sense of experience
by reflecting on and thinking about it.
 Adult learning theory focuses on understanding
how adults learn as opposed to children. Adult
learners bring great deal of experience to the learning
environment.
 Adults expect to have a high degree of influence on
what they are to be educated for or how they are to
be educated.
 Adults learners expect to have a high degree of
influence on how learning will be evaluated.
 Adults expect their responses to be acted upon when
asked for feedback on the progress of the program.
ORGANIZATIONAL BEHAVIOR

 Organizational behavior is a distinct field focused on

organizations. In this field. Organizations are examined,
using the methods drawn from economics, sociology,
political science, anthropology, and psychology.
 A healthy organization has a balance, among the
participants, of autonomy, control, and cooperation.
Understanding how organizations behave, and how a
particular organization behaves, can guide planning for
information system implementations.
MANAGEMENT

 Management science uses mathematics and other

analytical methods to help make better decisions,
generally in a business context.
 The management scientist uses rational,
systematic, science-based techniques to inform
and improve decisions of all kinds.
 The management science may be applied to military
situations, clinical decision support, public
administration, charitable groups, political
groups, or community groups.
 Some of methods within management science are
decision analysis, optimization, simulation,
forecasting, game theory, graph theory,
network problems, transportation-forecasting
models, mathematical modeling, and queuing
theory, as well as many others.
GROUP DYNAMICS
 Group dynamics is a social science field that focuses
on the nature of groups. Urges to belong to or identify
may make for distinctly different attitudes, and the
influence of a group may rapidly become strong,
influencing or overwhelming individual proclivities and
actions.
 Bruce Tuckman (1965) proposed a four-stage
model, called Tuckman’s stages,
 Tuckman’s model states that the ideal group
decision-making process should occur in four stages:
 Stage 1, Forming – pretending to get on or get
along with others
 Stage 2, Storming – letting down the politeness
barrier and trying to get down to the issues even if
tempers flare up
 Stage 3, Norming – getting used to each other and
developing trust and productivity
 Stage 4, Performing – working in on group to
common goal on a highly efficient and cooperative
basis
MODELS & FRAMEWORKS FOR
NURSING INFORMATICS
 Clinical-information-system
(CIS) model

A clinical-information-system (CIS) model shows

how modelling can be used to organize different
concepts into a logical whole.
Purpose of CIS model

Purpose of this model is to depict system

components, influencing factors, and relationships that
need to be considered when attempting to capture the
complexities of professional nursing practice.
GRAVES & CORCORAN’S MODEL

 Seminal work included a model of nursing informatics.

Their model placed data, information, and
knowledge in sequential boxes with one way arrows
pointing from data to information to knowledge.
SCHIWIRIAN’S MODEL

 In 1986, Patricia Schiwirian proposed a model of

nursing informatics intended to stimulate and guide
systematic research in this discipline. Her concern was
over the sparse volume of research literature in
nursing informatics. The model provides framework
for identifying significant information needs, which, in
turn, can foster research.
 In this model, there are four primary elements
arranged in a pyramid with a triangular base. The four
elements are:
 Raw material – nursing related information
 Technology – a computing system comprised of
hardware and software
 Users – nurses and students
 Goal – objective
 The bidirectional arrows connect the thee components
of raw material, user, and computer system to form
the pyramid’s triangular base. The goal was placed to
the apex to show its importance.
TURLEY’S MODEL

 Turley, writing in 1996, proposed another model in

which the core components of informatics (cognitive
science, information science, computer science)
are depicted as an intersecting circles. In Turley’s
model nursing science is a larger circle that
completely encompasses the intersecting circles.
Nursing informatics is the intersection between the
discipline specific science (nursing) and the area of
informatics
MCGONIGLE & MASTRIAN’S
KNOWLEDGE MODEL
 Mcgonigle & mastrian developed the foundation of
Knowledge model. The base of this model shows
data and information distributed randomly. From
this base, transparent cones grow upward and
intersect.
 The upward cone represents acquisition,
generation, and dissemination of knowledge.
 Knowledge processing is represented by the
intersections of the three cones
 Circling and connecting all of the cones is
feedback.
ADVANCED TERMINOLOGY
SYSTEMS
 NURSING REQUIREMENTS
 The HIT and HER systems that support functionality
such as decision support may require more granular
data that may be found in today’s interface
terminologies. More advanced terminology systems
are needed that allow for much greater granularity
though controlled composition, while avoiding a
combinatorial explosion of pre-coordinated terms.
 FORMAL TERMINOLOGIES
 Both terminologies facilitate two important facets of
knowledge representation for HIT and HER systems
that support clinical care. The describing concepts
and the manipulating and reasoning
 Advantages resulting from the first facet/describing
concepts includes
 (a). Non-ambiguous representation of concepts.

 (b). Facilitation of data abstraction or de-abstraction

without loss of original meaning.

 (c). Non-ambiguous mapping among terminologies.

 Advantages gained from the second facet,
manipulating and reasoning are:
 (a). Auditing the terminology system
 (b). Automated classification of new concepts
 (c). An ability to support multiple inheritance of
defining characteristics.
 Both facets are vital to maintenance of terminology
itself as well as to the ability to subsequently support
the clinical utility of the terminology.
CHARACTERISTICS OF ADVANCED
TERMINOLOGIES
 The characteristics apply to any terminology being
used in healthcare industry as well as for nursing
terminology. It is clear that such terminology must be:
 Concept oriented – with explicit semantics rather
than based on surface linguistic
 Domain completeness and polyhierarchical
organization.
 Atomic level – single concept coded as single data
element.
 Non-redundancy – unique identifier.
 Nonambiguity – explicit definition.
 Concept permanence – cannot be duplicated
 Compositionality – ability to combine concepts to
form new unique concepts
 Synonymy – a single concept support multiple terms
or synonyms
CONCEPT ORIENTATION

 In order to appreciate the significance of concept-

oriented approaches, it is important to first
understand the definitions of and relationship among
things in the world, our thoughts about things in the
world, the labels we use to represent and
communicate our thoughts about things in the world,
and the coded data elements needed to represent and
be processed by computer.
 The terminology depicted by a descriptive model commonly called
semiotic triangle.
MODEL STRUCTURES
 A terminology model is a concept-based
representation of a collection of domain-specific
terms that is optimized for the management of
terminological definitions. It encompasses both
schemata and type definition.
 Schemata incorporate domain-specific knowledge
about the typical constellation of entities,
attributes, and events in the real world and, as
such, reflect plausible combinations of concepts for
naming a nursing diagnosis or problem, for example,
“pain” may be combined with “acute” or “chronic”
to make “acute pain” or “chronic pain’. Schemata
may be supported by either formal or informal
composition rules.
 Example of formal representation of nursing activity
concept
 Type definitions address obligatory conditions that
state only the essential properties of a concept, for
example, a nursing activity must have a recipient,
an action, and a target. Examples of terminology
models to guide our underpin nursing terminologies
are embedded within the International Technical
Standard ISO.
REFERENCE TERMINOLOGY
MODELS FOR NURSING
DEVELOPMENT OF ISO 18104: 2003

 ISO was motivated in part by a desire to harmonize

the plethora of nursing terminologies in use around
the world. The development of ISO was intended to
be “consistent with the goals and objectives and
objectives of other specific health terminology models
in order to provide more unified reference health
model”
 Potential uses identified for the terminology models
included to:
 (1). Facilitate the representation of nursing diagnosis and
nursing action concepts and their relationship in a manner
suitable for computer processing.
 (2). Provide a framework for the generation of
compositional expressions from atomic concepts within
reference terminology.
 (3). Facilitate the mapping among the nursing diagnosis
and nursing action concepts from various terminologies.
 (4). Enable the systematic evaluation of terminologies and
associated terminology models for purposes of
harmonization.
 (5). Provide language to describe structure of nursing
diagnosis and nursing action concepts in order to enable
appropriate integration with information models.
ONTOLOGIES

 Terminology models may be formulated and

elucidated in an ontology language that represents
classes and their properties such as Web Ontology
Language (OWL). In this way, ontology languages or
terminologies and able to support, through explicit
semantics, the formal definition of concepts in terms
of their relationships with other concept. Ontology
languages are often used to support advanced
terminologies. One example is the use of OWL to
present ICNP.
OWL REPRESENTATION OF ICNP
 Owl is intended for use when applications, rather than
humans, process information. As such, It should be
able to meet the requirements of advanced terminology
systems that support contemporary healthcare. Owl
builds on existing recommendations such as
Extensible Markup (XML), Resource Description
Framework (RDF), and RDF Schema by providing
additional vocabulary and formal semantics. Software,
both proprietary and open source is available for:
 (a). Managing terminology models or ontology
developed in OWL
 (b). Reasoning on the model
ICNP AS TERMINOLOGY
 ICNP is a major product of International Council of
Nurses (ICN). It is a formal terminology for nursing
practice and is used to represent nursing diagnosis,
outcomes, and interventions. The primary
motivation for an international nursing terminology
involves sharing and comparing nursing data across
settings, countries, and languages. These data can
be use to support clinical decision making,
evaluate nursing care and patient outcomes,
develop health policy, and generate knowledge
through research. Using formal ontological approach,
ICNP can complement existing terminologies, such as
the CCC system and SNOMED-CT.
 The CCC has been demonstrated to support the
electronic capture of discrete patient care data for
documenting and coding the “essence of care”
and measuring the relationship of nursing care to
patient outcomes. The CCC, an “interface
terminology” is being mapped to ICNP which will
benefit terminologies and their users, for example, by
enabling ICNP users to code their terminology using
the CCC or to allow the comparison of CCC data with
data recorded using other terminologies.
SNOMED-CT
 SNOMED-CT is another advanced terminology
system being used within a wider healthcare context,
SNOMED-CT, which was developed collaboratively by
the College of American Pathologists and the UK
National Health service, now falls under the
responsibility of International Health Terminology
Standards Development Organization (IHTSDO).
 SNOMED-CT is considered to be the most
comprehensive, multilingual clinical healthcare
terminology in the world and integrates, through
external mappings, concepts from many nursing
terminology
NURSING MINIMUM DATA SET (NMDS)
 Terminologies obviously rely on structures and
processes that guide the collection of data. A Nursing
Minimum Data Set (NMDS) identifies essential,
common, and core data elements to be collected
for all patients/clients receiving nursing care. An
NMDS generally includes three broad categories of
elements:
 (a). Nursing care
 (b). Patient or client demographics
 (c). Service elements
 Many of the NMDS elements are consistently
collected in the majority of patient/client records
across healthcare settings in especially the patient
and service elements.
 The aim of NMDS is not to be redundant with respect
to other data sets, but rather to identify what minimal
data are needed to be collected from records of
patients receiving nursing care.
NURSING MINIMUM MANAGEMENT
DATA SET (NMMDS)
 The 18 NMMDS are organized into three categories:
environment, nursing care resources, and
financial resources.
 The NMMDS is the minimum set of items of
information with uniform definitions and categories
concerning the specific dimension of the context of
patient/client care delivery.
 The NMMDS most appropriately focuses on the
nursing delivery unit/service/center of excellence
level across this settings.
 The NMMDS support numerous constructed variables
as well as aggregation of data, for example, unit
level, institution, network, system.
 This NMMDS provides the structure for the collection
of uniform information that influences quality of
patient care, directly and indirectly.
 The Environment and Nursing Care categories for
the NMMDS have been reviewed, normalized to the
national data definition standards, and incorporated
into LOINC.
INTERNATIONAL NURSING MINIMUM
DATA SET (i-NMDS)
 The International Nursing Minimum data Set
project is intended to build on and support data set of
work already underway in individual countries.
 Data collected in the i-NMDS pilot project will be
cross-mapped and normalized to ICNP. This i-NMDS
work will assist in testing the utility of i-NMDS and
also advancing the ICNP as a unifying framework.
 Overall, the i-NMDS project focuses on coordinating
on going national-level efforts.
 The i-NMDS includes the core, international
relevant, essential, minimum data elements to be
collected in the course providing nursing care
 This data can provide information to describe,
compare, and examine nursing practice around the
globe. Work toward the i-NMDS is intended to build
on the efforts already underway in individual
countries.
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