NURSING

INFORMATICS
THEORIES AND
APPLICATION
BENNETTE PAUL D. CAMPANO, PTRP
THEORIES
• Major theories (mnemonic: GC di co na caya)
• General Systems Theory
• Change Theory
• DIKW Theory
• Cognitive Learning Theory
• Novice to Expert Theory
• Cybernetics Theory
• Purpose: enhances practice in in research, education,
clinical settings, and administration
• Nursing informatics is viewed as both a science and a
system.
• As a system, it brings order and coordinates processes
• As a science, it involves quantitative knowledge acquisition
DEFINITION OF TERMS
• Input: energy or raw material to be transformed
• Throughput: process to convert input to product
or service
• Output: product or service result of throughput
• Feedback: information about data/energy
processing that can be used for improvement
• Boundary: line where a system/subsystem can be
divided (can be rigid or permeable)
• Goal: overall purpose for existence
DEFINITION OF TERMS
• Subsystem: system that is part of a larger system
• Static system: neither system elements or the
system changes in relation to the environment
• Dynamic system: system constantly changes
because of interaction with the environment
• Closed systems: fixed, automatic relationships in a
system with no give or take (nothing is allowed to
enter/escape, like a sealed box)
• Open systems: interacts with the input from the
environment to produce output; able to grow,
develop, and adapt.
DEFINITION OF TERMS
• Entropy: tendency to develop energy and order
over time
• Negentropy: tendency to lose energy and dissolve
into chaos
• Control or cybernation: activities and processes
to evaluate input, throughput, and output to make
corrections
• Equifinality: objectives can be done in many
different ways
GENERAL SYSTEMS THEORY
• Developed by biologist Ludwig von Bertalanffy in 1936
• Identifies universal laws and principles applicable to
different systems
• Focus: breaking down the "whole" into purpose, content,
and process, analyzing the relationships between parts, and
recognizing that a system is more than the sum of its parts.
• Principles: input, output, and feedback
• Assumptions (mnemonic: GEMIGS)
• All systems must be goal directed.
• A system is ever changing and any change in one part
affects the whole.
• A system is more than the sum of its parts.
• Boundaries are implicit and human systems are open and
dynamic.
BASIC PRINCIPLES OF A
SYSTEMS APPROACH
• Wholeness Matters: look at the whole
• Predictability is Key: We should be able to
anticipate how a part of the world (system) behaves
• Interconnected Subsystems: Everything is
interconnected and part of a higher order.
• Central Objectives Rule: Other goals might need to
be sacrificed to achieve this main objective
• Information is Everywhere: Every system, whether
living or mechanical, is an information system.
• Systems and Environment are Linked: Changes in
one affect the other
BASIC PRINCIPLES OF A
SYSTEMS APPROACH
• Breaking Down Complexity: Highly complex systems may
need to be broken into smaller parts (subsystems)
• Objectives and Relationships: These objectives guide how
different parts interact.
• Dynamic Network: Changing one part affects all others in the
system.
• Subsystems in Series: When subsystems are arranged in a
series, changes in one affect the others. They're interdependent.
• Seeking Equilibrium: Systems naturally tend toward
equilibrium
• Flexible Boundaries: The boundary of a system can be adjusted
by a systems analyst as needed
• Viable Systems Adapt: A system must be goal-directed,
responsive to feedback, and adaptable to changing
circumstances
CHANGE THEORY

• Developed by Kurt Lewin

• unfreezing (letting go of counterproductive patterns), change
(transition to a new level), and refreezing (establishing the
change as a new habit).
• Assumptions
• People continuously grow, driven by dynamic human needs.
• Change occurs in both subtle, continuous ways and through more
disruptive events.
• Reactions to change are rooted in fundamental human needs for
self-esteem, safety, and security.
• Change involves planned or unplanned modification
CHANGE THEORY
• Kurt Lewin's Six Components of Change Theory:
• Recognition of the need for change.
• Analysis of the situation
• To understand forces maintaining the status quo and
those driving change.
• Identification of methods for change.
• Consideration of the influence of group norms
• Recognition of methods used by reference groups
• The actual process of change.

Mnemonic: RAI-CoRT
CYBERNETICS THEORY

• Studies regulatory systems, including their structures,

constraints, and possibilities.
• Coined by Norbert Wiener in 1948
• Focuses on control and communication
• Historical Evolution:
• Originating in the 1940s and often linked to the Macy Conferences
• Cybernetics evolved into first-order (about observed systems) and
second-order (about observing systems) cybernetics. There's also
discussion about third-order cybernetics.
CYBERNETICS THEORY
• Key Concepts:
• Cybernetics explores closed signaling loops, known
as "circular causal" relationships
• The primary goal is to understand the functions and
processes of goal-oriented systems
• It includes the study of feedback, black boxes,
communication, and control
• The term "cybernetics" is derived from the Greek
word 'kubernetes,' meaning "steering" and
"governor" in Latin.
CYBERNETICS THEORY
• Major Concepts in Cybernetics:
• Circular causality and circular systems.
• Systems defined by boundaries with goals.
• System action aims toward the goal.
• Environment affects the system's aim.
• Information returns as feedback.
• System measures the difference between its state
and goal.
• Detects 'error,' correcting actions to align with the
goal.
• The cycle repeats.
COGNITIVE LEARNING THEORY
• Explains how the brain processes and interprets
information during learning.
• Learning is influenced by intrinsic and extrinsic
factors.
• Effective cognitive processes = learning easier
• Ineffective cognitive processes = difficulties
• Social Cognitive Theory (SCT):
• Positive learning requires interaction of:
• positive personal characteristics
• appropriate behavior
• supportive environment.
COGNITIVE LEARNING THEORY
• Basic Concepts of SCT
• Observational Learning:
Learning by watching others.
• Reproduction: Practicing to
reinforce learned behaviors.
• Self-efficacy: Applying new
knowledge or behavior for
better learning.
• Emotional Coping: Effective
coping enhances adult
learning.
• Self-regulation: Controlling
behavior even in challenging
environments.
COGNITIVE LEARNING THEORY
• Cognitive Behavioral Theory
(CBT):
• Developed by Aaron Beck.
• Emphasizes cognition's role in
determining and predicting
behavior.
• Individuals form self-concepts
that influence behavior.
• Self-concepts can be positive
or negative and are affected
by the person's environment.
NOVICE TO EXPERT THEORY
• Proposed by Hubert and Stuart Dreyfus
(1980) and adapted to nursing by
Patricia Benner (1984).
• Applicable in nursing informatics for skill
development, education, and transition
from novice to expert.
• Novice to Expert model has five levels:
Novice, Advanced Beginner, Competent,
Proficient, and Expert.
• 5 years minimum to move, not all
novices become experts, one must seek
excellence, take risks, and embrace
diverse perspectives
NOVICE TO EXPERT THEORY
• Novice (New)
• Knows nothing, relies on memorization and rules.
• Needs monitoring and explicit instruction.
• Advanced Beginner (Adds concepts from exp)
• Still rule-dependent but recognizes additional aspects
through experience.
• Competent (judgement and problem solving)
• Grasps all relevant rules and facts, applies judgment.
• Enters problem-solving stage.
• Proficient (fluent and holistic)
• Develops fluency and holistic perception of situations.
• Interprets data from various sources and guides
others.
• Expert (situational intuition)
• Vast repertoire of experiences leads to intuitively
appropriate actions.
• Acts without consciously using rules, excels in
situational discrimination.
DIKW THEORY
• DIKW Model transforms raw data into
meaningful results.
• By Fricke (2018) on Russell Ackoff (1989)
• Comprises Data, Information, Knowledge,
and Wisdom
• DIKW Hierarchy Concepts:
• Two Views:
• Contextual Concept: Phases from
gathering data to forming wisdom.
• Understanding Concept: Process involves
researching, doing, interacting, and
reflecting.
• Time Perspective:
• Data, information, and knowledge
represent the past.
• Wisdom represents the future.
• Main limitation: DIKW Pyramid follows
logical steps. Limits include bypassing steps
in today's data-driven world.
DIKW HIERARCHY
• Data: raw information, does not answer anything
• Ex: # of website visits (300)
• Information: determines relationships in the data to answer Who,
What, When and Where questions.
• Ex: 150 Users visit Nursing Pharmacology section, 145 User visits
Nursing Research section, 5 Users just visits the website.
• Out of them, 60% is in the age group of 18-22 years, 20% in age
group of 22-26 Years. Also, we get 70% of our visitors between 9 AM
to 11 PM.
• Knowledge: Appropriate collection of useful information.
Answers the "How" question
• Ex: Understanding how student nurses (18-22 years) use the
modular approach.
• Considers moral, ethical codes, makes decisions. Answers the
"Why" question.
• Ex: 70% of student nurses visit for lessons and technology needs.
ALL THE THEORIES
• General Systems Theory: Ludwig von Bertalanffy
(1936)
• Change Theory: Kurt Lewis
• DIKW Theory: Russell Ackoff (1989)
• Cognitive Learning Theory: N/A
• Novice to Expert Theory: Hubert and Stuart
Dreyfus (1980) and adapted to nursing by Patricia
Benner (1984)
• Cybernetics Theory: Norbert Wiener (1948)
INFO TECH IN HOSPITALS
• Physiological monitoring systems
• They consist of sensors that help in
tracking vital signs and other
physiological data
• Hemodynamic Monitors
• Measure cardiovascular parameters,
assess cardiac output and volume status,
and recognize patterns
• Assesses the following
• Vascular system integrity
• Evaluate the patient's physiologic
response to stimuli
• Continuously assess respiratory gases
(capnography)
• Continuously evaluate glucose levels
• Store waveforms
INFO TECH IN HOSPITALS
• Arrhythmia Monitors
• help detect potentially dangerous
heart rhythms
• identification and analysis of
abnormal ECG patterns
• Critical Care Information Systems
(CCIS):
• system designed to collect, store, and
organize data related to critically ill
patients
• CCIS provides a centralized
repository of patient information
accessible across units and
departments, aiding in outcomes
management.
INFO TECH IN HOSPITALS
• Vital Sign Monitoring
• vital signs and
physiologic data from
bedside instruments
• includes flow sheets
for laboratory results,
assessments, and
problem lists,
simplifying data
collection.
INFO TECH IN HOSPITALS
• Clinical Documentation
• Automatic calculation of physiologic
indices (e.g., HR, BP, RR, Temp, O2
sat., and GCS)
• Decision Support
• CCIS provides alerts and reminders
based on evidence-based guidelines
• Medication Management
• CCIS facilitates medication
administration through flowsheets
that incorporate barcode
technology
INFO TECH IN HOSPITALS
• Interdisciplinary Plans of Care
• Special flowsheets in CCIS provide
required treatments and interventions,
and workflow management solutions
help coordinate various processes
simultaneously
• Provider Order Entry
• Electronic entry and communication of
patient orders
• Typically includes
• Medication
• Laboratory Tests
• Diagnostic Studies
• Ancillary Support
• Nursing Orders
• Involves electronic communication of
orders
• Consultation
INFO TECH IN HOSPITALS
INFO TECH IN COMMUNITY
• Focus: Centers on community health information systems,
emphasizing disease prevention, medical intervention, and public
awareness.
• Role: Promotes and protects community health while maintaining
data integrity.
• Goal of Community Health Informatics: effective assessment to
contribute to epidemiology
• Optimal tech use: promotes use of technology to provide better
care
• Priorities
• Prevention: Identify and eliminate health issues.
• Accessibility: Easy access to data through communication.
• Education: Empower individuals for healthy lifestyles.
• Data Retrieval: Efficient data retrieval.
• Transformation: Effectively turn data into information.
• Integration: Combine information for better understanding.
• Record Management: Create computerized patient records.
• User Interface: Simple graphical interface for healthcare providers.
INFO TECH IN COMMUNITY
• Computer survey systems (Health Statistical Surveys): Collect
quantitative information for population-based insights [focuses
on epidem.]
• Community health application
• Collaboration: Enhances teamwork among doctors, community
health providers, and patients.
• Monitoring: Useful for tracking and monitoring community health
status.
• Advantages: Simplifies disease tracking, strengthens
communication among healthcare providers.
• Philippine Integrated Disease Surveillance and Response
(PIDSR):
• Goal: Strengthening surveillance and response capabilities at all
health system levels.
• Vision: Improving data availability for timely detection and
response to health issues.
• Functions: Facilitating data collection, maintaining national
standards, and providing detailed data for control programs.
INFO TECH IN COMMUNITY
• Ambulatory Care Systems
• Focus: patient safety and quality of nursing care in various
services
• Integration: Integrating ambulatory care information
systems
• Advantages: Provides access to patient records, enhances
care quality, reduces errors, and facilitates billing and
management.
• Emergency Preparedness and Response
• Objective: mitigation and control of emergencies
• Informatics Role: Enables real-time information for timely
decision-making during emergencies.
• Benefits: Improves decision support, resource tracking, and
collaboration for effective disaster management.
INFO TECH IN COMMUNITY
• Telehealth
• Definition: Using digital tech for remote healthcare
access and management.
• Examples: Mobile health data uploads, online
patient portals, remote screenings, and preventive
care reminders.
• Goals: Boost accessibility, offer convenience, aid
self-management, and enhance healthcare
communication.
• Philippine Adoption: Telehealth widely adopted,
especially during the pandemic, with the University
of the Philippines pioneering since 1998.
IT DURING THE PANDEMIC
• Supporting functions
• Emergency Actions: supply chain issues, labor shortages,
telecommuting, and security.
• Mass Notifications: mass communication systems to
update staff promptly.
• Client Information: Chatbot AI aids in directing patients
to relevant COVID-19 information
• Client Teaching: developing health promotion materials
• Privacy of Health Data: safety of personal health
information and educate staff on potential scams
• Equipment Disinfection: Emphasis on sanitizing
equipment
• System Interoperability: Supports EHR-based processes,
laboratory testing, decision support, and patient-facing
technology related to COVID-19.
IT DURING THE PANDEMIC
• Supporting Virtual and Telehealth Care
• Virtual Care Codes: information specialists assists
physicians with codes for virtual and telehealth
care
• Well-defined guidelines for telehealth
• Limitations for general practice without virtual
diagnostic tools.
• Zoom, Skype, and others for virtual care
IT DURING THE PANDEMIC
• Simplified Tracking and Forecasting
• Informatics Impact: tracking and forecasting COVID-
19, creating easy-to-understand dashboards for the
public.
• Privacy Considerations: IT and IS must follow privacy
guidelines during tracking
• AI Screening Support: AI bots help quickly identify
COVID-19 symptoms, making a swift distinction
between cases.
• AI in Forecasting: AI aids in early warnings, tracking,
predictions, data dashboards, diagnosis, treatments,
and social control.
• Human Collaboration: The effectiveness of AI tools
depends on collaboration between data scientists,
domain experts, and creative thinkers.