School of Nursing - University of Minnesota



Nursing Knowledge: Big Data Research for Transforming

University of Minnesota, School of Nursing, Center for Nursing Informatics

August 12 – 13, 2013

Developed by: Susan A. Matney, MSN, RN-C, PhD(c), FAAN

Nursing Knowledge Model

1 Data, information, Knowledge, Wisdom (DIKW) Framework

▪ The Data, Information, Knowledge, Wisdom (DIKW) framework is one of the core conceptual frameworks for the practice of nursing informatics. However, in order for the framework to be effective, nurses must define knowledge, within electronic health records, to accurately capture the context of nursing practice.

o Nursing overview of the DIKW framework can be found in:

▪ American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: .

▪ McGonigle, D., Mastrain, KG, Overview of Nursing Informatics. , retrieved July 30 2013.

o Articles describing the DIKW framework:

▪ Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework. ANS Adv Nurs Sci, 34(1), 6-18.

▪ Bernstam, E., Smith, J., & Johnson, T. (2010). What Is Biomedical Informatics? Journal of biomedical informatics, 43(1), 104-110.

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2 Knowledge

▪ Nursing actions are based on the interrelations between the concepts used in nursing. Decisions are based critical thinking which is guided by knowledge. It’s pertinent that we provide information and knowledge for nurses to use during the process of care. Nursing knowledge has been referenced since the onset of nursing, therefore, how knowledge is defined and how it is represented in EHRs is cited here:

o Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in Knowledge Translation: Time for a Map? J Contin Educ Health Prof, 26(1), 13-24. doi: 10.1002/chp.47

o Roberts, D. (2012). Representing Nursing Knowledge in Electronic Health Records. Nursing management, 43(8), 12-14.

3 Information Models useful to Nursing

▪ Current Care Plan Model Initiatives (note that they are trying to communicate and play in the same sandbox, but it’s hard):

o S&I Framework - in the process of developing a longitudinal care plan. Documents and information can be found at:

o HL7 Patient Care Committee is creating a domain analysis model .

▪ Nursing Information Models in practice:

o Goossen, W. T., Jonker, M. J., Heitmann, K. U., Jongeneel-de Haas, I. C., de Jong, T., van der Slikke, J. W., & Kabbes, B. L. (2003). Electronic Patient Records: Domain Message Information Model Perinatology. Int J Med Inform, 70(2-3), 265-276.

o Goossen, W. T., Ozbolt, J. G., Coenen, A., Park, H. A., Mead, C., Ehnfors, M., & Marin, H. F. (2004). Development of a Provisional Domain Model for the Nursing Process for Use within the Health Level 7 Reference Information Model. Journal of American Medical Informatics Association, 11(3), 186-194.

o Goossen, W. T. F., Park, H.A., Mead, C., Ozbolt, J., Ehnfors, M., Marin, H. (2003, July, 2003). Development of a Tentative Domain Model for the Nursing Process for Use within Health Level 7 Rim.

o Park, H. A., Min, Y. H., Jeon, E., Kim, Y., & Km, H. Y. (2012). Development of an Electronic Nursing Records System Based on Information Models and Clinical Practice Guidelines. [Research Support, Non-U.S. Gov't]. Stud Health Technol Inform, 180, 1206-1208. Domain Analysis Models (DAM) and Clinical Detailed Models (CDM) are deliverables that specify content, information and relationships. Pressure Ulcer Prevention was one of the first DAMs to be developed, .

▪ Clinical models that may influence the nursing knowledge model

o The Federal Health Information Model, .

▪ The standardized pressure ulcer model with associated coded data can be found at this site.

o The United States Health Information Knowledgebase (USHIK) is a portal that houses models used in healthcare including the meaningful use quality measure and HL7 balloted models.

o The Clinical Information Modeling initiative is an international collaboration that is dedicated to developing and providing a common format for detailed specifications for representing healthcare data under the direction of Stan Huff. This initiative started in 2010.

o The National Cancer Institute’s Data Standards Repository. This is a collection of information models that started with cancer research. It has been extended to include model that support other types of clinical research.

4 Nursing Data – (see terminology section in Dr. Westra’s handout)

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