CHAPTER 17
THEORIES,
MODELS, and
FRAMEWORKS
Objectives







Discuss the relationship between healthcare informatics
and nursing informatics.
Discuss different definitions and models of nursing and
healthcare informatics.
Discuss core concepts and the scope of practice of
nursing informatics.
Describe nursing informatics as a distinct specialty.
Discuss key aspects of the electronic health record(EHR).
Discuss terminologies for nursing.
Identify available organizational resources.
Foundational Documents Guide Nursing
Informatics


In 2001, the American Nurses Association(ANA)
published the Code of Ethics for Nurses with
Interpretative Statements, a complete revision of
previous ethics provisions and interpretive statements
that guide all nurses in practice, be it in the domains of
direct patient care, education, administration, or
research.
Terms – such as decision-making, comprehension,
information, knowledge, shared goals, disclosure,
policies, protocols, evaluation, judgment, standards, and
factual documentation abound throughout the
explanatory language of the interpretive statements.



In 2003, a second foundational professional
document, Nursing’s Social Policy Statement, Second
Edition, provided a new definition of nursing.
Nursing- is the protection, promotion, and
optimization of health and abilities, prevention of
illness and injury, alleviation of suffering through the
diagnosis and treatment of human response, and
advocacy in the care of individuals, families,
communities, and populations.
Early 2004- further reinforces the recognition of
nursing as a cognitive profession.






1st Assessment- data collection begins the nursing
process.
2nd step diagnosis/ Problem Definiton- reflects the
interpretation of the data and information gathered
during assessment.
3rd step- Outcomes identification
4th step- Planning
5th step- Implementation
Nursing Process – literature, includes numerous
feedback loops, and incorporates evaluation
activities throughout the sequencing.
Informatics and Healthcare Informatics


Informatics- is a science that combines a domain
science, computer science, information science, and
cognitive science.
Healthcare Informatics
-may be defined as the integration of
healthcare sciences, computer science, information
science, and cognitive science to assist in the
management of healthcare information.
-a subdiscipline of informatics.
Healthcare Informatics :
-is a relatively young addition to the informatics
umbrella, you may see other terms that seem to be
synonyms for this same area, such as health informatics
or medical informaticss.
Medical Informatics :
-historically has been used in Europe.
-is now more clearly a subdomain of healthcare
informatics and health informatics may mean informatics
used in educating healthcare clients and/or the general
public.

Nursing Informatics

Is a unique areas that address the special information
needs for the discipline of nursing.
In 1985, Kathryn Hannah proposed a definition that
nursing informatics is the use of information technologies
in relation to any nursing functions and actions of nurses.
Graves & Corcoran definition with the development of the
first scope of practice for nursing informatics, presented
a more complex definitions of nursing informatics.


ANA defined nursing informatics as the specialty
that integrates nursing science, computer science, and
information science in identifying, collecting,
processing, and managing data and information to
support nursing practice, administration, education,
research, and the expansion of nursing knowledge.
In 2000, the ANA convened an expert panel to
review and revise the scope and standards of
nursing informatics practice.
Models for Nursing Informatics

Models are representations of some aspect of the real
world.
- Models show particular perspectives of a selected
aspect and may illustrate relationships. Models evolve as
knowledge about the selected aspect changes and are
dependent on the “world view” of those developing the
model. It is important to remember that different models
reflect different viewpoints and are not necessarily
competitive; that is, there is no one “right” model.
- is a direct depiction of their definition of nursing
informatics.
- provides a framework for identifying significant
information needs, which in turn can foster research.
4 ELEMENTS :
1.Raw Material (nursing related information)
2.Technology (a computing system)
3. Users (nurses, students and context)
4. Goal or Object toward which the preceding elements are
directed.
 Bidirectional arrows connect the three base components of
raw material, user, and computer system to form the
pyramid’s triangular base.
 In 1996, proposed another model in which the core
components of informatics (cognitive science, information
science, and computer science) are depicted as intersecting
circles.
 Nursing science- a larger circle that completely encompasses
the intersecting circles.
Data, Information, and Knowledge




Identified as current met structures or overarching concepts
for nursing informatics with specific definitions in the Scope
and Standards of Nursing Informatics Practice.
Data are “discrete entities that are described objectively
without interpretation” and would include some value
assigned to a variable.
Information reflects interpretation, organization, or
structuring of data.
Knowledge emerges from the transformation of information.
“Knowledge is information that is synthesized so that
relationships are identified and formalized”.
>Registered Nurses as Knowledge



Knowledge work is the exercise of specialist
knowledge and competencies (Blackleaf, 1995).
Registered nurses are consummate twenty-first century
knowledge workers. Their skills in assessment, planning,
critical thinking, and evaluation are transferable to
many different settings but are most exquisitely
employed in nursing practice.
Competencies
Every Nurses must continually exhibit the
capability to acquire and then demonstrate specific
skills beginning with the very first student experience.


ANCC content expert panel has oversight responsibility
for the content of this examination and considers the
current informatics environment and research when
defining the test content outline.
The topics addressed include human factors, system life
cycle (system planning, analysis, design,
implementationand testing, evaluation, maintenance, and
support), information technology (hardware, software,
communications, data representation, and security),
information management and knowledge generation
(data, information, knowledge), professional practice,
trends, and issues (roles, trends and issues, ethics), and
models and theories (foundations of nursing informatics,
nursing and healthcare data sets , classification systems
and nomenclatures, related theories and sciences).
Electronic Health Record (EHR)






Healthcare environment is characterized by significant emphasis on
establishing the EHR in all settings.
Data sets are comprised of data elements brought together for a
specific reason.
Modern databases are used for storing data in a way that
maintains the logical relationships among data elements, and are
stored in a computer.
The focus in this chapter is on the client health record as a database.
Simple perspective is that the EHR is a client health record database
supported by computer, electronic, and communications technologies.
American Society for Testing and Materials(ASTM) Standard E
1384-02a defines the EHR as “any information realated to the past,
present or future physical/mental health, or condition of an
individual.
Terminologies


to convey important data and information to others,
the communication must be understood by the
listener and be interpreted as having meaning.
The nursing minimum data set (NMDS) developed
through Dr. Harriet Werley’s research is considered
the foundational work for nursing languages and
represents the first attempt to standardize the
collection of essential nursing data.

1.
2.
3.
4.

-
Four Nursing Care Elements include;
Nursing Diagnosis
Nursing Intervention
Nursing Outcome
Intensity of Nursing care
Patient/Client Demographic
Elements address personal identification
Date of birth
Gender
Race
Residence

1.
2.
3.
4.
5.
6.
7.

Seven Service Elements include;
Unique facility or service agency number
Unique health record number of patient or client
Unique number of principal registered nurse provider
Episode admission or encounter data
Discharge or termination date
Disposition of patient or client
Expected payer
NANDA
- Nanda-I 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.


Nursing Interventions Classificiation (NIC)
- the fourth edition of NIC contains 514 nursing
interventions that describe the treatments nurses
perform, updated linkages with NANDA diagnoses, and
core interventions identified for 44 specialty practice
areas (including three new specialties).
Nursing Outcomes Classification (NOC)
- the latest edition of NOC has 330 researchbased outcomes to provide standardization of expected
patient, caregiver, family, and community outcomes for
measuring the effect of nursing interventions.
Clinical Care Classification (CCC) [Formerly Home
Health Care Classification (HHCC)
- the CCC system is research-based nomenclature
designed to standardize the terminologies for
documenting nursing care in all clinical care settings.
2 Interrelated terminologies;
- CCC of Nursing Diagnoses and Outcomes
- CCC of Nursing Interventions and Actions
 Omaha System
- the ohama system is used in all clinical settings.
It includes an assessment component (Problem
Classification Scheme), an intervention component
(Intervention Scheme), and an outcomes component
(Problem Rating Scale for Outcomes).




Perioperative Nursing Data Set (PNDS)
- the PNDS provides a universal language for
perioperative nursing practice and education and a
framework to standardize documentation.
SNOMED CT
- the SNOMED CT is a core clinical terminology
containing oer 357,000 healthcare concepts organized
into multiple hierarches.
ABC Codes
- the ABC codes provide a mechanism for coding
integrative health interventions by clinician by state
location for administrative billing and insurance claims.
Patient Care Data Set (PCDS)
- the PCDS includes terms and codes for patient problems,
therapeutic goals, and patient care orders. This data set was
developed by Dr. Judith Ozbolt from research data from
nine acute care hospitals throughout the United States.
 Logical Observation Identifiers Names and Codes (LOINC)
- the LOINC originated as a database of standardized
laboratory terms for results reporting for chemistry,
hematology, serology, microbiology, and toxicology.
> International Classification for Nursing Practice developed by
the international nursing community under sponsorship of the
International Council of Nurse (ICN).




Nursing Management Minimum Data Set (NMMDS)
- the NMMDS includes terms to describe the context and
environment of nursing practice, and includes terms for
nursing delivery unit/service, patient/client population, care
delivery method, personnel characteristics, and financial
resources.
Organizations as Resources
- Many organizations have emerged to provide information
resources and value-added membership benefits that
support those individuals interested in healthcare and nursing
informatics.
American Medical Informatics Association
- the AMIA is an individual membership organization
dedicated to the development and application of Medical
informatics in the support of patient care, teaching, research,
and healthcare administration.



Healthcare Information and Management Systems Society
- the HIMSS represents a membership of over 14,000
individuals and 200 corporations interested in healthcare
informatics, clinical systems, information systems,
management engineering, and telecommunications.
National League for Nursing
- the mission of NLN is to advance quality nursing education
that prepares the nursing education that prepares the
nursing workforce to meet the needs of divers populations in
an ever-changing healthcare environment.
Society for Health Systems
- the Society for Health Systems (SHS) is a society of the
Institute of Industrial Engineers.



Association for Computing Machinery
- the ACM was founded in 1947 and has become a major
force in advancing the skills of information technology
professionals and students worldwide.
ARMA International
- ARMA International (ARMA) is a non-for-profit
association serving more than 10,000 information
management professionals in the United States, Canada, and
over 30 other nations.
American Society for Information Science and Technology
- the ASSIS&T established in 1937, describes itself as the
society for information professionals leading the search for
new and better theories, techniques, and technologies to
improve access to information.
THE END  
THANK YOU for Listening!  