ILOCOS SUR POLYTECHNIC STATE COLLEGE -MAIN CAMPUS
COLLEGE OF ARTS AND SCIENCES
Bachelor of Science in Nursing
LESSON 2 1. The development of nursing informatics skills,
competencies, knowledge and expertise in
CONCEPTS PRINCIPLES AND THEORIES INNURSING
nursing informatics specialists;
INFORMATICS
2. The development of technological system
LESSON 2-1 competencies in practicing nurses working in
an institution;
PATRICIA E. BENNER
3. The education of nursing students, from first
year to graduation and;
● Born on August 1942 in Hampton Virginia
4. The transition from graduate nurse to expert
● Worked as an admitting clerk at a local hospital
during high school. nurse.
● 1964 - Registered Nurse (RN) / Bachelor in Science
(BS) from Pasadena College.
● 1970 - Masters of Science from University of LEVELS OF NURSING PRACTICE
California, San Francisco. ● Benner described 5 levels of nursing experience
● 1982 - PhD from University of California, Berkeley
as:
● Nursing experience on medical surgical units,
1. Novice
coronary care units, and medical intensive coronary
care units. 2. Advanced beginner
● Visiting Nursing Association 3. Competent
● 1970 - 1975 Research Associate: University of 4. Proficient
California in San Francisco School of Nursing 5. Expert
● 1982 - 1989 Associate Professor: Department of
Physiological Nursing
● Co-wrote numerous books and published articles.
NOVICE
NOVICE TO EXPERT THEORY ● A novice does not know anything about the
subject he/she is approaching and has to
By Dr. Patricia E. Benner
memorize its context-free features.
● Dr. Patricia Benner introduced the concept that
● The novice is then given rules for determining
expert nurses develop skills and understanding
an action on the basis of these features.
of patient care over time through a sound
● To improve, the novice needs monitoring,
educational base as well as a multitude of
either by self-observation or instructional
experiences.
feedback.
● She proposed that one could gain knowledge
● For example, a nurse learning to use a new
and skills ("knowing how") without ever
hospital information system needs explicit
learning the theory ("knowing that").
instruction and rules to learn to use the
● She further explains that the development of
computer interface and manipulate the
knowledge in applied disciplines such as
software. Further, novice are described to be:
medicine and nursing is composed of the
extension of practical knowledge (know how)
through research and the characterization and ○ Beginner with no experience
understanding of the "know how" of clinical ○ Inability to use discretionary judgment
experience. ○ Follows rules
● She conceptualizes in her writing about ○ Nursing students on clinical
nursing skills as experience is a prerequisite for ○ Taught general rules to help perform
becoming an expert tasks
● The Novice to Expert Theory, a construct ○ Rules are: context-free, independent of
theory first proposed by Hubert and Stuart specific cases, and applied universally
Dreyfus (1980) as the Dreyfus Model of Skill ○ Rule-governed behavior is limited and
Acquisition, and later applied and modified to inflexible
nursing by Patricia Benner (1984) provides a ○ “Tell me what I need to do and I’ll do it.”
very useful and important theory that clearly
applies to nursing informatics. ADVANCED BEGINNER
● An advanced beginner is still dependent on
● Within the field of nursing informatics, this rules, but as he/she gains more experience
theory can be applied to: with real life situations, he/she begins to
JENELI Q. WONG 1 I
ILOCOS SUR POLYTECHNIC STATE COLLEGE -MAIN CAMPUS
COLLEGE OF ARTS AND SCIENCES
Bachelor of Science in Nursing
notice additional aspects that can be applied
to related conditions. a. Perceives and understands
a. Marginally acceptable performance situations as whole parts
b. treats all attributes and aspects as equally b. Knows what to expect, and how to
important because aspect recognition is modify their plan of care when
dependent on prior experience. something goes wrong
c. Works with a mentor to provide guidelines. c. More holistic understanding
d. Follow rules closely. improves decision-making due to
e. Needs support in the clinical setting. experience gained
f. Help in setting priorities. d. Learns from experiences what to
g. Knowledge is developing. expect in certain situations and how
h. New Graduate Nurses to modify plans
i. Demonstrates acceptable performance
j. Has gained prior experience in actual EXPERT
situations to recognize recurring meaningful ● An expert‘s repertoire of experienced
components situations is so vast that normally each
k. Principles, based on experiences, begin to be specific situation immediately dictates an
formulated to guide actions. intuitively appropriate action.
● After a great deal of experience actually using
COMPETENT a system in everyday situations, the expert
● At this stage, the competent person grasps all nurse discovers that without his consciously
the relevant rules and facts of the field and is, using any rules, situations simply elicit from
for the first time, able to bring his/her own him or her appropriate responses.
judgment to each case. ● The proficient performer, immersed in the
● This is the stage of learning that is often world of his skilful activity, sees what needs to
characterized by the term - problem-solving. be done, and decides how to do it.
● A competent level nurse would be able to use ● The expert not only knows what needs to be
a hospital information system with ease and achieved, thanks to the well-refined ability to
know-how to solve technical difficulties or exercise situational discrimination, s/he
interpret conflicting data. knows how to achieve his or her goal.
a. Typically a nurse with 2-3 years experience a. No longer relies on principles, rules, or
on the job in the same area or in similar day- guidelines to connect situations and
to-day situations determine actions
b. More aware of long-term goals b. Nursing intuition
c. Routine c. Deep rooted understanding of clinical
d. Feelings of Mastery problems
e. Gains perspective from planning own actions d. Much more background of experience
based on conscious, abstract, and analytical e. Has intuitive grasp of clinical situations
f. Gains perspective from planning own actions f. Performance is now fluid, flexible, and
based on conscious, abstract, and analytical highly-proficient
thinking and helps to achieve greater
efficiency and
organization KEY TERMS OF A THEORY
● Person : Relates to safe care of patients
PROFICIENT
● Health : Skills acquired to notice deviation in
● The fourth stage is called fluency and is health
characterized by the progress of the learner ● Nurse : Learning curve for new graduate
from the step-by-step analysis and solving of nurses, and continuing skills gained with
the situation to the holistic perception of the experience.
entirety of the situation. ● Environment : Relationships between all
● The proficient hospital information system different levels of nurses
learner would know how to interpret data from ● Patricia Benner and other nurse educators
all departmental information and provide adapted this model to explain how nursing
guidance to other disciplinary members as students and professional nurses acquired
needed. nursing skills.
JENELI Q. WONG 2 I
ILOCOS SUR POLYTECHNIC STATE COLLEGE -MAIN CAMPUS
COLLEGE OF ARTS AND SCIENCES
Bachelor of Science in Nursing
● A novice follows rules provided for each ● Knowledge: Information that is synthesized to
situation and is not flexible in real-life identify and formalize relationships
situations. As a novice acquires real-life ● Wisdom: Application of knowledge to the
experiences and can appreciate environmental management and solution of human problems
influences on rule sets, he or she moves to the Example:
advanced beginner stage. At the competent
stage, a learner is able to tell what is important ● Data: A patient’s vital signs
and what is not important in assessing a given
● Information: A serial set of vital signs, placed
situation— a learner has gained perspective. A
into a context and used for longitudinal
proficient practitioner is able to see a situation
comparisons.
in terms of the larger setting or environmental
● Knowledge: Recognition of a pattern and
situation and begins to use intuition in decision-
identification of interventions
making. Finally, an expert intuitively
● Wisdom: Accuracy of the synthesis of
understands a situation and immediately
information and appropriate selection of
connects action to this understanding (Ajay,
interventions
2003).
DATA VS. INFORMATION
LESSON 2-2 ● Data – Raw facts
1. DIKW Paradigm ● Information - Processed data that has
2. Metastructures of Nursing Informatics meaning.
3. DIKW Theory ○ For information to be valuable or
4. Analyzing Organizational Issues using the meaningful, it must be accessible,
DIKW Hierarchy accurate, timely, complete, cost
5. The Usage and Limitations of DIKW Model effective, flexible, reliable, relevant,
DIKW PARADIGM simple, verifiable, and secure.
FROM KNOWLEDGE TO WISDOM
● Knowledge focuses on what is known.
● Wisdom focuses on the appropriate
application of that knowledge.
● Example:
● A knowledge base may include several options
for managing an anxious family, while wisdom
● DIKW stands for Data, Information,
would guide the decisions about which of these
Knowledge, and Wisdom.
options are most appropriate with a specific
● NI centers on these concepts.
family.
METASTRUCTURES OF Nursing
USE OF KNOWLEDGE
Informatics ● All nurses have the opportunity to be involved
● Data: in the formal dissemination of knowledge via
○ discrete entities that are described their participation in professional conferences,
objectively without interpretation. as either presenters or attendees.
○ smallest factors describing the patient, ● All nurses, regardless of the practice arena,
disease, health environment etc. must use informatics and technology to inform
○ Example: Principle Medical Diagnosis and support that practice.
of Chronic Kidney Disease Stage 1,
Marital Status KNOWLEDGE VIABILITY
• Information: ● Refers to technology-based applications that
○ Data that are interpreted, organized, offer easily accessible, accurate, and timely
or structured information obtained from a variety of
○ data + meaning resources and methods and presented in a
○ different data points are put together manner as to provide us with the necessary
○ who, what, where, and when elements to generate new knowledge.
JENELI Q. WONG 3 I
ILOCOS SUR POLYTECHNIC STATE COLLEGE -MAIN CAMPUS
COLLEGE OF ARTS AND SCIENCES
Bachelor of Science in Nursing
WISDOM IN INFORMATICS as the past while the final step - wisdom -
● The ability of the system to evaluate the represents the future.
documentation drawn from a health
information system, and to adapt or change the
system to improve the workflow of the clinical
nurse ● Nurses’ decision making is described
as an array of decisions that include specific
behaviors, as well as cognitive processes
surrounding a cluster of issues.
● Can any aspect of nursing wisdom be
automated?
USE OF WISDOM
● Wisdom is the application of knowledge to an
appropriate situation.
● In the practice of nursing science, we expect
action and or actions directed by wisdom. The "Data" of DIKW Hierarchy:
● Wisdom is developed through knowledge, ● The first step in this DIKW model is Data.
experience, insight, and reflection. ● Collection of raw data is the main requirement
for coming up with a meaningful result in the
end. Any measurements, logging, tracking,
DIKW THEORY records and many others are all considered as
data. Since the raw data is collected in bulk, it
● DIKW is a useful framework for research and
includes various things with both useful and not
practice.
so useful contents.
● When raw data is collected, it gets mixed up
● These are completely raw data and do not
and the view seems jumbled. The DIKW Model
provide any meaningful result that can be used
by Fricke (2018) on Russell Ackoff (1989)
by the Information Technology (IT) Service
describes how the data can be processed and
provider. Therefore the data doesn't answer
transformed into information, knowledge, and
any question nor draw any conclusion.
wisdom.
● To understand how the Data is transformed
● The DIKW Hierarchy comprises of the
into utilizable results using the DIKW Pyramid
following:
model, we will discuss each of the subsequent
○ “D” = Data
steps of the DIKW hierarchy (i.e. - information,
○ “I” = Information knowledge, and wisdom) using
○ “K” = Knowledge sample scenarios.
○ “W” = Wisdom ● For Example, Let’s assume the scenario is -
● The DIKW model of transforming data into 300 Users visit FEU on Canvas daily to take
wisdom can be viewed from two different online lessons. This is the raw data we have
concepts, which are contextual and got from statistics.
understanding.
● From the contextual concept, one moves The "Information" of DIKW Pyramid:
from a phase of gathering data parts (data), the ● Information can be termed as the data that has
connection of raw data parts (information), been given a meaning by defining relational
formation of whole meaningful contents connections. Here, the word "meaning"
(knowledge) and conceptualizing and joining represents processed and understandable
those whole meaningful contents (wisdom). data that may or may not be a useful piece of
● From the understanding concept, the DIKW content from the organization perspective.
Pyramid can be viewed as a process starting ● In an information processing system, a
with researching & absorbing, doing, relational database creates information from
interacting, and reflecting. the data stored within it.
● The DIKW hierarchy can also be represented ● The information hierarchy stage of DIKW
in terms of time. For instance, the data, Pyramid reveals the relationships in the data,
information, and knowledge levels can be seen and then the analysis is carried out to find the
JENELI Q. WONG 4 I
ILOCOS SUR POLYTECHNIC STATE COLLEGE -MAIN CAMPUS
COLLEGE OF ARTS AND SCIENCES
Bachelor of Science in Nursing
answer to Who, What, When and Where ● The knowledge step tries to find the answer to
questions. the "How" question. Specific measures are
● Now let come to the above example, the data pointed out, and the information derived in the
“300 users visit FEU on Canvas per day”, previous step is used to answer this question.
which is quite a generic number to get any ● With respect to our scenario, we must find the
insight. answer that “How do student nurses between
● Now, to do the capacity planning and the age group of 18-22 years use our modular
availability planning, we must process it approach?”
through the information stage of DIKW
Hierarchy. Now we can get answers like - 150 The “Wisdom” of DIKW Hierarchy:
Users visit Nursing Pharmacology, 145 Users
visit Nursing Research, 5 Users just visit the ● The Wisdom is the fourth and the last step of
dashboards. Out of them, 60% are in the age the DIKW Hierarchy. It is a process to get the
group of 18-22 years, 20% in the age group of final result by calculating through extrapolation
22-26 Years. Also, we get 70% of our visitors of knowledge. It considers the output from all
between 9 AM to 11 PM. the previous levels of DIKW Model and
● In the given scenario above, the generic data processes them through special types of
now becomes information answering the human programming (such as the moral,
questions of Who, What, When, and Where. ethical codes, etc.).
This is the output we can get from the ● Therefore, Wisdom can be thought of as the
information stage. process by which you can take a decision
between the right and wrong, good and bad, or
any improvement decisions.
● Alternatively, we can say that in the wisdom
stage, the knowledge found in the previous
stage is applied and implemented in practical
life.
● Wisdom is the topmost level in the DIKW
pyramid and answers the questions related to
"Why".
● In the case of our example scenario, one
example of wisdom gained might be that 70 %
of the student nurses visit our modules to get
help with their lessons and technology needs.
ANALYZING ORGANIZATIONAL ISSUES USING
THE DIKW HIERARCHY:
● Data:
The "Knowledge" of DIKW Model: A way to identify the raw external inputs such
as the facts and figures that are yet to be
● Knowledge is the third level of DIKW Model. interpreted.
● Knowledge means the appropriate collection of ● Information:
information that can make it useful. Analyze the raw data to determine the
● Knowledge stage of DIKW hierarchy is a organizational needs. An important aspect of
deterministic process. information management is that apart from
● When someone "memorizes" information due answering questions it can also help to find
to its usefulness, then it can be said that they other solutions in organizational contexts.
have accumulated knowledge. ● Knowledge:
● Every piece of knowledge itself has useful Determines how something is remembered by
meanings, but it can't generate further an individual or how information is applied by
knowledge on its own. them.
● In an information management system, most of ● Wisdom:
the applications you use, such as modeling, Uncover why the derived knowledge is applied
simulation etc, exercise some sort of stored by individuals in a specific way. i.e. - finding the
knowledge. reason behind any decision-making.
JENELI Q. WONG 5 I
ILOCOS SUR POLYTECHNIC STATE COLLEGE -MAIN CAMPUS
COLLEGE OF ARTS AND SCIENCES
Bachelor of Science in Nursing
THE USAGE AND LIMITATIONS OF DIKW MODEL:
● Same as all other models, DIKW Model also
has its own limits. You may have noticed that
the DIKW Hierarchy is quite linear and follows
a logical sequence of steps to add more
meaning to data in every step forward. But the
reality is often quite different than that. The
Knowledge stage, for example, is practically
more than just a next stage of information.
● One of the principal critiques of this DIKW
Pyramid is that it’s a hierarchical process and
misses several important aspects of
knowledge. In today's world, where we use
various ways to capture and process more
and more unstructured data, sometimes it
forces us to bypass a few steps of DIKW.
● Though the previous statement is quite true,
however, the result still stays the same, such
as what we do with the data warehouse and
transforming data through big data analytics
into decisions and actions (Wisdom).
JENELI Q. WONG 6 I