Theories of Nursing Informatics

A.Change Theories

  Change means making something different from the way it was originally. Change may be planned or unplanned. Unplanned changes bring about unpredictable outcomes, while planned change is a sequence of events implemented to achieve established goals. In nursing a change agent is a person who brings about changes that impact nursing services. The change agent may be a nurse leader, staff nurse or someone who works with nurses. Change theories are used to bring about planned change in nursing. Nurses and nurse leaders must have knowledge of change theories and select the right change theory as all the available change theories in nursing do not fit all nursing change situations.

1. Roger's Diffusion of Innovation Theory (unplanned change)

         Everette Rogers modified Lewin's change theory and created a five-stage theory of his own. The five stages are awareness, interest, evaluation, implementation and adoption. This theory is applied to long-term change projects. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially. Adopters are divided into 5 categories:

• Innovators (2.5%). They readily adopt the innovation; often seen as troublesome and are not able to sell others on the innovation.
• Early adopters (13.5%). They are respectable opinion leaders who acts as promoters for the innovation. 
• Early majority (34%). They are averse to risk of the innovation but are willing to make safe investments.
• Late majority (34%). Adopts innovation because of peer pressure, not because they see a use for innovation.
• Laggards (16%). They are suspicious about innovation and change and are very stubborn. They may grasp those weaknesses that others have failed to recognize.

2. Lewin's Change Theory (planned change)

     Kurt Lewin's change theory is widely used in nursing and involves three stages: the unfreezing stage, moving stage, and refreezing stage. Lewin's theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change. The resistant forces are employees or nurses who do not want the proposed change. For this theory to be successful, the driving force must dominate the resistant force. He describes the processes that occur in a planned change into three stages: Unfreezing, moving and refreezing.

• Unfreezing. Making use of processes that reinforces an individual's involvement in the change, having their own opinions respected and with continuous communication during the process while reducing forces that restrains the same individual from committing himself to the process such as psychological defenses or group norms.
• Moving. Planned change is implemented where anxieties are high that has to dealt with. The new system should be tested prior to implementation and users be provided with adequate training.
• Refreezing. The planned change becomes a norm. The users should be made to feel confident with the change and feel in control of the new process. A help system or support group should be made available to provide answers to their needs.

B. Information Theories

1. Blum's Theory

Blum stated in1986 that computer functions can be categorized into three groups: One where data is processed, another group where information is processed and another one where knowledge is processed.

2.Data-Information-Knowledge-Wisdom Continuum

Graves and Corcoran based the theory on nursing informatics on data, information and knowledge as initiated by Blum. They regarded that information has various levels of complexity depending on how much interaction is dome to attain it.

• Data are elements that are uninterpreted and plainly recorded and viewed as is.
• Information comprises interpreted data based on on's capacities, attitude and behavior.
• Knowledge is an organized collection of information.
• Wisdom (added by Joos and Nelson) considers the use of values in decision making.

C. Cognitive Theories

        Cognitive theory provides principles that may be used to develop systems that concentrate on the tasks at hand, rather than requiring cognitive tasks to deal with the computer interface. It helps a health informaticist in understanding the process during decision making for better designing of programs tools.