Chapter 1 by Kathleen Mastrian and Dee McGonigle Nursing Science and the Foundation of Knowledge

Objectives Define nursing science and its relationship to various nursing roles and nursing informatics. Introduce the Foundation of Knowledge Model © 2007 as the organizing conceptual framework for the book. Explain the relationship between knowledge acquisition, knowledge processing, knowledge generation, knowledge dissemination and wisdom.

Key Terms Defined Borrowed Theory Building Blocks Clinical Databases Clinical Practice Guidelines Conceptual Framework Borrowed theory - Theories borrowed or made use of from other disciplines; as nursing began to evolve, theories from other disciplines such as psychology, sociology, etc., were adopted to try to empirically describe , explain or predict nursing phenomena. As nursing theories continue to be developed, nurses are now questioning whether or not these borrowed theories were sufficient or satisfactory in their relation to the nursing phenomena they were used to describe, explain or predict. Building blocks - Basic element or part of nursing informatics such as information science, computer science, cognitive science and nursing science. Clinical Databases - A collection of related patient records stored in a computer system using software that permits a person or program to query the data in order to extract needed patient information. Clinical practice guidelines - Informal or formal rules or guiding principles that a healthcare provider uses when determining diagnostic tests and treatment strategies for individual patients, in the EHR they are included in a variety of ways such as prompts, pop ups and text messages. Conceptual framework - Used in research to chart feasible courses of action or to present a desired approach to a study or analysis; framework built from a set of concepts, these concepts are related to a proposed or existing system of methods, behaviors, functions, relationships and objects; a relational model; formal way of thinking or conceptualizing about a phenomenon, process, or system under study.

Key Terms Defined Data Data Mining Evidence Feedback Foundation of Knowledge Model© 2007 Data - Raw fact; lacks meaning. Data mining - Software that sorts thorough data in order to discover patterns and ascertain or establish relationships; software that discovers or uncovers previously unidentified relationships among the data in a database; program that conducts exploratory analysis looking for hidden patterns in data. Evidence - Artifacts, productions, attestations or other examples that demonstrate what an individual’s knowledge, skills or valued attributes. Feedback - Input in the form of opinions about or reactions to something such as shared knowledge; in an ISs, feedback refers to information from the system that is used to make modifications in the input, processing actions or outputs . Foundation of Knowledge Model© 2007 - This model believes that humans are organic information systems constantly acquiring, processing and generating information or knowledge both in our professional and personal lives. It is our high degree of knowledge that characterizes us as extremely intelligent organic machines. Individuals have the ability to manage knowledge. This ability is learned and honed from birth. We make our way through life interacting with our environment and being inundated with information and knowledge. We experience our environment and learn by acquiring, processing, generating and disseminating knowledge. As we interact in our environment, we acquire knowledge that we must process. This processing effort causes us to redefine and restructure our knowledge base and generate new knowledge. We then share (disseminate) this new knowledge, and receive feedback from others. The dissemination and feedback initiates this cycle of knowledge all over again since we acquire, process, generate and disseminate the knowledge gained from sharing and re-exploring our own knowledge base. As others respond to our knowledge dissemination and we acquire new knowledge, we are engaged to re-think about and reflect on our knowledge, processing, generating and then disseminating anew.

Key Terms Defined Information Knowledge Knowledge Acquisition Knowledge Dissemination Knowledge Generation Information - Data that are interpreted, organized, or structured; data that is processed using knowledge or data made functional through the application of knowledge. Knowledge - The awareness and understanding of a set of information and ways that information can be made useful to support a specific task or arrive at a decision; abounds with others’ thoughts and information; information that is synthesized so that relationships are identified and formalized; understanding that comes through a process of interaction or experience with world around us ; info that has judgment applied to it or meaning extracted from it; processed information that helps to clarify or explain some portion of our environment or world that we can use as a basis for action or upon which we can act; internal process of thinking or cognition; external process of testing, senses, observation, interacting. Knowledge acquisition - Act of acquiring or getting knowledge. Knowledge dissemination - Distribution and sharing of knowledge. Knowledge generation - Creating new knowledge by changing and evolving knowledge based on your experience, education, and input from others.

Key Terms Defined Knowledge Processing Knowledge Worker Nursing Informatics Nursing Science Nursing Theory Knowledge processing - The activity or process of gathering or collecting, perceiving, analyzing, synthesizing, saving or storing, manipulating, conveying, and transmitting knowledge. Knowledge worker - Work with information and generate information and knowledge as a product. Nursing informatics - A specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice; Nursing informatics facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology; “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge” (Staggers & Thompson, 2002, p. 260); synthesis of nursing science, information science, computer science and cognitive science to facilitate the management of healthcare data for the improvement of patient care and advancement of the nursing profession. Nursing science - The ethical application of knowledge acquired through education, research and practice to provide services and interventions to patients in order to maintain, enhance or restore their health; to advocate for health,  and to acquire, process, generate and disseminate nursing knowledge to advance the nursing profession. Nursing theory - Concepts, propositions and definitions that represent a methodical viewpoint and provide a framework for organizing and standardizing nursing actions.

Key Terms Defined Relational Database Transparent Wisdom Relational database - A collection of related records stored in a computer system using tables that can be related to one another and the data extracted in a variety of ways to gain needed information without having to reorganize the tables. Transparent - Done without conscious thought. Wisdom - Knowledge applied in a practical way or translated into actions; uses knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters; sometimes thought of as the highest form of common sense resulting from accumulated knowledge or erudition (deep thorough learning) or enlightenment (education that results in understanding and the dissemination of knowledge) it is the ability to apply valuable and viable knowledge, experience, understanding and insight while being prudent and sensible; is focused on our own minds; the synthesis of our experience, insight, understanding and knowledge; the appropriate use of knowledge to solve human problems.  It is knowing when and how to apply knowledge.

Nursing Science and Informatics What is nursing informatics? A building block of nursing informatics One of the most frequently quoted and widely accepted definitions of nursing informatics is that it is a combination of nursing science, information science and computer science. In this chapter, we will focus on nursing science as one of the building blocks of nursing informatics, although in this text we extend the traditional definition of nursing informatics to include cognitive science as one of the building blocks.

Knowledge How we develop knowledge Use of knowledge Managing knowledge Experience environment Learn by acquiring, processing, generating and disseminating knowledge Use of knowledge Managing knowledge The Foundation of Knowledge Model © 2007 Individuals have an amazing ability to manage knowledge. This ability is learned and honed from birth. We experience our environment and learn by acquiring, processing, generating and disseminating knowledge. This book uses the Foundation of Knowledge Model © 2007 reflecting that knowledge is a powerful tool and for that reason, nurses focus on information as a key building block of knowledge.

Foundation of Knowledge Model The introduction of the Foundation of Knowledge Model Organizing conceptual framework for text Helps to explain the ties between nursing science and informatics and knowledge Informatics is viewed as a tool for founding knowledge We will also introduce the Foundation of Knowledge Model © 2007 as the organizing conceptual framework of this text, and tie the model to nursing science and the practice of nursing informatics. The American Nurses’ Association (2003) defines nursing in this way: “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.”

ANA Definition of Nursing American Nurses’ Association 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.” (ANA 2003).

Nursing The focus of nursing What must a nurse possess? Is nursing information intensive? What is the basis of nursing practice science? How is knowledge formed? Thus the focus of nursing is on the human responses to actual or potential health problems, and advocacy for various clients. Nurses must possess the technical skills to manage equipment and perform procedures, interpersonal skills to interact appropriately with people, and cognitive skills to observe, recognize and collect data, analyze and interpret data and reach a reasonable conclusion that forms the basis of a decision. Nursing is an information intensive profession. The steps of utilizing information, applying knowledge to a problem, and acting with wisdom form the basis of nursing practice science. We acquire data and information in bits and pieces and then transform the information into knowledge.

Nursing and Knowledge Nurses as knowledge workers Nurses as knowledge acquirers Nurses as knowledge users Nurses as knowledge engineers Nurses are knowledge workers, working with information and generating information and knowledge as a product. We are knowledge acquirers, providing convenient and efficient means of capturing and storing knowledge. We are knowledge users, individuals or groups who benefit from valuable, viable knowledge. Nurses are knowledge engineers, designing, developing, implementing and maintaining knowledge.

Nursing and Knowledge Nurses as knowledge managers Nurses as knowledge developers Is it important for knowledge to be viable? What is knowledge viability? We are knowledge managers, capturing and processing collective expertise and distributing it where it can create the largest benefit. We are knowledge developers or generators, changing and evolving knowledge based on the tasks at hand and information available. Knowledge must also be viable. Knowledge viability refers to applications (most technology based) that offer easily accessible, accurate and timely information obtained from a variety of resources and methods and presented in a manner as to provide us with the necessary elements to generate new knowledge.

Use of Knowledge Formal dissemination of knowledge The use of informatics and technology in nursing All nurses have the opportunity to be involved in the formal dissemination of knowledge via their participation in professional conferences either as presenters or attendees. All nurses regardless of the practice arena must use informatics and technology to inform and support that practice.

Use of Wisdom What is wisdom? How does wisdom direct our actions? How is wisdom used? 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. Wisdom uses knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters. It is developed through knowledge, experience, insight and reflection.

Beyond Clinical Nursing Practice How can nurse educators be effective? What must nurse researchers do? What affects the future of nursing? How important is it to be “techno-savvy”? In order for nurse educators to be effective, they must be in the habit of constantly building and rebuilding their foundation of knowledge about nursing science. Nurse researchers must acquire and process new knowledge as they design and conduct their research studies. The future of nursing science and nursing informatics is intimately associated with the nursing education and nursing research arenas. Skiba (2007) suggests that we need techno-saavy and well-informed faculty who can demonstrate the appropriate use of technologies to enhance the delivery of nursing care.

Beyond Clinical Nursing The importance of informatics and technology in nursing research Technology related priorities of National Nursing Research Agenda (NNRA) Nursing Informatics: Enhancing Patient Care Technology Dependency across the Life-Span What will technology do for nursing? Informatics and the use of technology in the practice of nursing are equally important in the nursing research arena. Participants in the development of The National Nursing Research Agenda (NNRA) identified these two technology related priorities (among other research priorities) for nursing research: Nursing Informatics: Enhancing Patient Care Technology Dependency across the Life-span Goosen (2002) believes that the focus on nursing informatics research should be on the structuring and processing of patient information and how these inform nursing decision making in clinical practice. It is clear that the increasing use of technology to enhance nursing practice, nursing education, and nursing research will open new avenues for acquiring, processing, generating, and disseminating knowledge.

Thought Provoking Question Imagine you are in a social situation and someone asks you, “ What does a nurse do?” Think about how you will capture and convey the richness that is nursing science in your answer.

Thought Provoking Question Choose a clinical scenario from your recent experience and analyze it using the Foundation of Knowledge Model. How did you acquire knowledge? How did you process knowledge? How you generate knowledge? How did you disseminate knowledge? How did you use feedback and what was the effect of feedback on the foundation of your knowledge?