NURSING INFORMATICS: Theories, Models and Frameworks

 

A. CODE OF ETHICS IN NURSING

According to the American Nurses Association (ANA), the nursing code of ethics is a guide for “carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.”

There are 4 main principles that are part of the nursing code of ethics. They are,

1. Autonomy - Autonomy is recognizing each individual patient’s right to self-determination and decision-making.
2. Beneficence - Beneficence is acting for the good and welfare of others and including such attributes as kindness and charity. The American Nurses Association defines this as “actions guided by compassion.”
3. Justice - Justice is that there should be an element of fairness in all medical and nursing decisions and care.
4. Non-maleficence - Nonmaleficence is to do no harm.

Principles of the Nursing Code of Ethics

Revised in 2015 to include 9 provisions, the ANA’s nursing code of ethics now includes interpretative statements that can provide more specific guidance for nursing practice. 

Currently, the nurse’s code of ethics contains 9 main provisions:

1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
9. The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

B. NURSING'S SOCIAL POLICY STATEMENT

    The social policy statement describes the pivotal nature and role of professional nursing in society and health care. Registered nurses focus their specialized knowledge, skills, and caring on improving the health status of the public and on ensuring safe, effective, quality care. The statement serves as a resource to assist nurses in conceptualizing the professional practice of nursing, and it provides direction to educators, administrators, and researchers within nursing. It also informs other health professionals, legislators, other regulators, funding bodies, and the public about nursing’s responsibility, accountability, and contribution to health care. It assists in better understanding the foundation on which the nursing profession and registered nurses base their practice.

C. NURSING: SCOPE AND STANDARDS OF PRACTICE

The Nursing Scope and Standards of Practice describe the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice:

• Who: Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) comprise the “who” constituency and have been educated, titled, and maintain active licensure to practice nursing.
• What: Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations.
• Where: Wherever there is a patient in need of care.
• When: Whenever there is a need for nursing knowledge, compassion, and expertise.
• Why: The profession exists to achieve the most positive patient outcomes in keeping with nursing’s social contract and obligation to society.

When each of these questions is answered, the complex considerations in scope of practice become clear. In a profession as dynamic as nursing, and with evolving health care demands, changes in scope of practice and overlapping responsibilities are inevitable in our current and future health care system.

D. STANDARDS OF NURSING INFORMATICS PRACTICE

Nursing informatics (NI) is the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. NI supports nurses, consumers, patients, the interprofessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, information processes, and information technology

STANDARDS OF PRACTICE:

1 Assessment  

2 Diagnosis, Problems, and Issues Identification 

3 Outcomes Identification

4 Planning

5 Implementation 

5A Coordination of Activities 

5BHealth Teaching and Promotion 

5C Consultation 

6 Evaluation

7 Ethics

8 Education 

9 Evidence-based Practice and Research 

10 Quality of Practice 

11 Communication 

12 Leadership

13 Collaboration 

14 Professional Practice Evaluation 

15 Resource Utilization 

16 Environmental Health

E. HEALTHCARE INFORMATICS MODEL

The health informatics model consists of three essential parts: data, information and knowledge. These elements are arranged in a hierarchy, with data at the base of the model providing the basis for establishing information and leading in turn to the potential generation of knowledge.

I. GRAVES AND CORCORAN, 1989

    Nursing informatics as a linear progression - from data into information into knowledge.

    Management processing is integrated within each element, depicting nursing informatics as the proper management of knowledge –from data as it is converted into information and knowledge.

II. SCHWIRIAN, 1989

    Nursing informatics involves the identification of information needs, resolution of the needs, and attainment of nursing goals/objectives.

    Patricia Schwirian proposed a model intended to stimulate and guide systematic research in nursing informatics, a model/framework that enables the identification of significant information needs, that can foster research (somewhat similar to Maslow’s hierarchy of needs)

III. TURLEY, 1996

    Nursing informatics is the intersection between the discipline-specific science (nursing) and the area of informatics.

    In this model, there are 3 core components of informatics, namely Cognitive science, Information science, and Computer science.

Nursing science:

• The vehicle, the knowledge base for understanding the other 3 sciences.
• The overarching goal for the use of the other 3 sciences within the sphere of nursing science.

Computer science:

• Gives us the hardware and the ability to program the hardware to process nursing information.
• It is the skills in using software and understanding how they can work for processing nursing knowledge.

Information science:

• The ability to access information, research, and knowledge.
• It includes the ability to evaluate the quality of the information as well as the applicability.

Cognitive science:

• Critical thinking
• Decision making
• Problem-solving

IV. DREYFUS MODEL

    Every nurse must be able to continuously exhibit the capability to acquire skills (in this case, computer literacy skills parallel with nursing knowledge), and then demonstrate specific skills beginning with the very first student experience.

    Dr. Patricia Benner’s novice to expert model was derived from the Dreyfus Model of Skill Acquisition and adapted to provide a more objective way for evaluating the progress of nursing skills and subjects.

    According to BENNER, there are 5 levels of expertise:

1. Novice – individuals with no experience of situations and related content in those situations where they are expected to perform tasks.

2. Advanced Beginner – marginally demonstrate acceptable performance having built on lessons learned in their expanding experience base; needs supervision.

3. Competent – enhanced mastery and the ability to cope with and manage many contingencies.

4. Proficient – evolution through continuous practice of skills, combined with professional experience and knowledge; an individual who appreciates standards of practice as they apply in nursing informatics.

5. 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.

V. STAGGERS, GASSERT, AND CURRAN, 2001

Definitions of Four Levels of Practicing Nurses 

Beginning Nurse 

• Has fundamental information management and computer technology skills. 
• Uses existing information systems and available information to manage the practice.  

Experienced Nurse 

• Has proficiency in a domain of interest (e.g., public health, education, administration).
• Highly skilled in using information management and computer technology skills to support their major area of practice. 
• Sees relationships among data elements and makes judgments based on trends and patterns within these data. 
• Uses current information systems but collaborates with the informatics nurse specialist to suggest improvement to systems. 

Informatics Nurse Specialist 

• An RN with advanced preparation possessing additional knowledge and skills specific to information management and computer technology. 
• Focuses on information needs for the practice of nursing, which includes education, administration, research, and clinical practice. 
• The practice is built on the integration and application of information science, computer science, and nursing science. 
• Uses the tools of critical thinking, process skills, data management skills (including identifying, acquiring, preserving, retrieving, aggregating, analyzing, and transmitting data), systems development life cycle, and computer skills. 

Informatics Innovator 

• Educationally prepared to conduct informatics research and generate informatics theory. 
• Has a vision of what is possible and a keen sense of timing to make things happen.
• Leads the advancement of informatics practice and research. 
• Functions with an ongoing, healthy skepticism of existing data management practices and is creative in developing solutions. 
• Possesses a sophisticated level of understanding and skills in information management and computer technology. 
• Understands the interdependence of systems, disciplines, and outcomes, and can finesse situations to maximize outcomes.

REFERENCES:

Neuman, C. E. N. (n.d.). Nursing’s Social Policy Statement. Essentialguidetonursingpractice.Files.Wordpress.Com. https://essentialguidetonursingpractice.files.wordpress.com/2012/07/pages-from-essential-guide-to-nursing-practice-chapter-1.pdf

Gaines, K. (2020, September 4). What is the Nursing Code of Ethics? Nurse.Org. https://nurse.org/education/nursing-code-of-ethics/

Nursing Scope of Practice | American Nurses Association. (n.d.). ANA. https://www.nursingworld.org/practice-policy/scope-of-practice/

ANA. (2014). Nursing Informatics: Scope and Standards of Practice, Second Edition. www.nursebooks.org. https://www.himss.org/

McLaughlin, C. (2016). THEORIES, MODELS, AND FRAMEWORKS. SlidePlayer. https://slideplayer.com/slide/5972232/

Davis, A., & Maisano, P. (2016). NursingALD.com - Patricia Benner: Novice to Expert – A Concept Whose Time Has Come (Again). NursingALD. https://www.nursingald.com/articles/16408-patricia-benner-novice-to-expert-a-concept-whose-time-has-come-again

U. (2018, July 3). Staggers, Gasserts, And Curran, 2001. Redrann.Blogspot.Com. http://redrann.blogspot.com/2018/07/staggers-gasserts-and-curran-2001.html