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How does data become knowledge and finally wisdom? Explain the relationship between knowledge acquisition, knowledge processing, knowledge generation, knowledge dissemination, and wisdom. Then provide examples from your clinical practice (or past work experiences) according to the following:

Examples of knowledge acquisition
Examples of knowledge generation
Examples of knowledge processing
Examples of knowledge dissemination
Examples of the use of feedback

(COs 2, 3, 4, 5, 6, 7, and 8)



The Pedagogy

Nursing Informatics and the Foundation of Knowledge, Third Edition drives comprehension through a variety of strategies geared
toward meeting the learning needs of students, while also generating enthusiasm about the topic. This interactive approach addresses
diverse learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters
include the following:



Dee McGonigle, PhD, RN, CNE, FAAN, ANEF
Chair, Virtual Learning Environments and Professor, Graduate Programs

Chamberlain College of Nursing
Member, Informatics and Technology Expert Panel (ITEP)

American Academy of Nursing
Member, Serious Gaming and Virtual Environments Special Interest Group for the Society for Simulation in Healthcare (SSH)

Kathleen Mastrian, PhD, RN
Associate Professor and Program Coordinator for Nursing

Pennsylvania State University, Shenango
Sr. Managing Editor, Online Journal of Nursing Informatics (OJNI)

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Library of Congress Cataloging-in-Publication Data
Nursing informatics and the foundation of knowledge / [edited by] Dee McGonigle, Kathleen Mastrian.—3e.

p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-284-04158-3 (paperback)
I. McGonigle, Dee, editor of compilation. II. Mastrian, Kathleen Garver, editor of compilation.
[DNLM: 1. Nursing Informatics. 2. Knowledge. WY 26.5]



Printed in the United States of America
18 17 16 15 14 10 9 8 7 6 5 4 3 2 1

Special Acknowledgments
We want to express our sincere appreciation to the staff at Jones & Bartlett Learning, especially Amanda, Becky, and Keith, for their
continued encouragement, assistance, and support during the writing process and publication of our book.


Authors’ Note


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

Quality and Safety Education for Nurses

2 Introduction to Information, Information Science, and Information Systems
Dee McGonigle and Kathleen Mastrian

Information Science
Information Processing
Information Science and the Foundation of Knowledge
Introduction to Information Systems
Information Systems

3 Computer Science and the Foundation of Knowledge Model
June Kaminski

The Computer as a Tool for Managing Information and Generating Knowledge
What Is the Relationship of Computer Science to Knowledge?
How Does the Computer Support Collaboration and Information Exchange?
What Is the Human–Technology Interface?
Looking to the Future
Working Wisdom
Application Scenario
Internet and Software Resources

4 Introduction to Cognitive Science and Cognitive Informatics
Dee McGonigle and Kathleen Mastrian

Cognitive Science
Sources of Knowledge
Nature of Knowledge
How Knowledge and Wisdom Are Used in Decision Making
Cognitive Informatics
CI and Nursing Practice
What Is AI?

5 Ethical Applications of Informatics
Kathleen Mastrian, Dee McGonigle, and Nedra Farcus

Ethical Issues and Social Media
Ethical Dilemmas and Morals
Ethical Decision Making
Theoretical Approaches to Healthcare Ethics
Applying Ethics to Informatics
Case Analysis Demonstration
New Frontiers in Ethical Issues


6 Overview of Nursing Informatics
Ramona Nelson and Nancy Staggers

Metastructures, Concepts, and Tools of NI
The Future of NI

7 Informatics Roles and the Knowledge Work of Nursing
Julie A. Kenney and Ida Androwich

The Nurse as a Knowledge Worker
The Knowledge Needs and Competencies of Nurses
What Is Nursing Informatics Specialty Practice?
The Future of Nursing Informatics

8 Information and Knowledge Needs of Nurses in the 21st Century
Lynn M. Nagle, Nicholas Hardiker, Kathleen Mastrian, and Dee McGonigle

Definition and Goal of Informatics
Health Information Technologies Impacting Nursing
Nurses Creating and Deriving New Knowledge
Generating Nursing Knowledge
Challenges in Getting There
The Future

9 Legislative Aspects of Nursing Informatics: HITECH and HIPAA
Kathleen M. Gialanella, Kathleen Mastrian, and Dee McGonigle

Overview of the HITECH Act
How a National HIT Infrastructure Is Being Developed
How the HITECH Act Changed HIPAA
Implications for Nursing Practice


10 Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
Dee McGonigle and Kathleen Mastrian
Waterfall Model
Rapid Prototyping or Rapid Application Development

Object-Oriented Systems Development
Dynamic System Development Method
Computer-Aided Software Engineering Tools
Open Source Software and Free/Open Source Software

11 Administrative Information Systems
Marianela Zytkowski, Susan Paschke, Dee McGonigle, and Kathleen Mastrian
Types of Healthcare Organization Information Systems
Communication Systems
Core Business Systems
Order Entry Systems
Patient Care Support Systems
Department Collaboration and Exchange of Knowledge and Information

12 The Human–Technology Interface
Judith A. Effken, Dee McGonigle, and Kathleen Mastrian
The Human–Technology Interface
The Human–Technology Interface Problem
Improving the Human–Technology Interface
A Framework for Evaluation
Future of the Human–Technology Interface

13 Electronic Security
Lisa Reeves Bertin, Dee McGonigle, and Kathleen Mastrian
Securing Network Information
Authentication of Users
Threats to Security
Security Tools
Off-Site Use of Portable Devices

14 Nursing Informatics: Improving Workflow and Meaningful Use
Denise Hammel-Jones, Dee McGonigle, and Kathleen Mastrian
Workflow Analysis Purpose
Workflow and Technology
Workflow Analysis and Informatics Practice
Informatics as a Change Agent
Measuring the Results
Future Directions


15 The Electronic Health Record and Clinical Informatics
Emily B. Barey, Kathleen Mastrian, and Dee McGonigle
Setting the Stage
Components of Electronic Health Records
Advantages of Electronic Health Records
Ownership of Electronic Health Records
Flexibility and Expandability
The Future

16 Informatics Tools to Promote Patient Safety and Clinical Outcomes
Kathleen Mastrian and Dee McGonigle
What Is a Culture of Safety?
Strategies for Developing a Safety Culture
Informatics Technologies for Patient Safety
Role of the Nurse Informaticist

17 Supporting Consumer Information and Education Needs
Kathleen Mastrian and Dee McGonigle
Consumer Demand for Information
Health Literacy and Health Initiatives
Healthcare Organization Approaches to Education
Promoting Health Literacy in School-Aged Children
Supporting Use of the Internet for Health Education
Future Directions

18 Using Informatics to Promote Community/Population Health
Margaret Ross Kraft, Ida Androwich, Kathleen Mastrian, and Dee McGonigle
Core Public Health Functions
Community Health Risk Assessment: Tools for Acquiring Knowledge
Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks
Applying Knowledge to Health Disaster Planning and Preparation
Informatics Tools to Support Communication and Dissemination
Using Feedback to Improve Responses and Promote Readiness

19 Telenursing and Remote Access Telehealth
Original contribution by Audrey Kinsella, Kathleen Albright, Sheldon Prial, and Schuyler F. Hoss; revised by Kathleen Mastrian
and Dee McGonigle
History of Telehealth
Nursing Aspects of Telehealth
Driving Forces for Telehealth
Telehealth Care
Telehealth Patient Populations
Tools of Home Telehealth
Home Telehealth Software
Home Telehealth Practice and Protocols
Legal, Ethical, and Regulatory Issues
A Day in the Life of a Home Telenurse
The Patient’s Role in Telehealth
Telehealth Research
The Foundation of Knowledge Model and Home Telehealth
Parting Thoughts for the Future and a View Toward What the Future Holds


20 Nursing Informatics and Nursing Education
Heather E. McKinney, Sylvia DeSantis, Dee McGonigle, and Kathleen Mastrian
Introduction: Nursing Education and the Foundation of Knowledge Model
Knowledge Acquisition and Sharing
Hardware and Software Considerations
Delivery Modalities
Technology Tools
Internet Tools: Webcasts, Searching, Instant Messaging, Chats and Online Discussions, Electronic Mailing Lists, and Portals
Promoting Active and Collaborative Learning

Knowledge Assessment Methods
Knowledge Dissemination and Sharing
The Future
Exploring Information Fair Use and Copyright Restrictions

21 Simulation in Nursing Informatics Education
Nickolaus Miehl
Nursing Informatics Competencies in Nursing Education
A Case for Simulation
Incorporating EHRs into the Learning Environment
Challenges and Opportunities
What Does the Future Hold?

22 Games, Simulations, and Virtual Worlds for Educators
Brett Bixler
Case Scenario
Educational Games
Educational Simulations
Virtual Worlds
Choosing Among Educational Games, Simulations, and Virtual Worlds
The Future of Games, Virtual Worlds, and Simulations


23 Research: Data Collection, Processing, and Analysis
Heather E. McKinney, Sylvia DeSantis, Kathleen Mastrian, and Dee McGonigle
Introduction: Nursing Research and the Foundation of Knowledge Model
Knowledge Generation Through Nursing Research
Acquiring Previously Gained Knowledge Through Internet and Library Holdings
Fair Use of Information and Sharing
Informatics Tools for Collecting Data and Storage of Information
Tools for Processing Data and Data Analysis
The Future

24 Data Mining as a Research Tool
Dee McGonigle and Kathleen Mastrian
Introduction: Big Data, Data Mining, and Knowledge Discovery
KDD and Research
Data Mining Concepts
Data Mining Techniques
Data Mining Models
Benefits of KDD
Ethics of Data Mining

25 Translational Research: Generating Evidence for Practice
Jennifer Bredemeyer and Ida Androwich
Clarification of Terms
History of Evidence-Based Practice
Bridging the Gap Between Research and Practice
Barriers to and Facilitators of Evidence-Based Practice
The Role of Informatics
Developing EBP Guidelines
Meta-Analysis and Generation of Knowledge

The Future

26 Bioinformatics, Biomedical Informatics, and Computational Biology
Dee McGonigle and Kathleen Mastrian
Bioinformatics, Biomedical Informatics, and Computational Biology Defined
Why Are Bioinformatics and Biomedical Informatics So Important?
What Does the Future Hold?


27 The Art of Caring in Technology-Laden Environments
Kathleen Mastrian and Dee McGonigle
Caring Theories
Strategies for Enhancing Caring Presence
Reflective Practice

28 Emerging Technologies and the Generation of Knowledge
Peter J. Murray, W. Scott Erdley, Dee McGonigle, and Kathleen Mastrian
Looking Back from the Future
Historical Overview
Some Technologies of Today
Some Views of What Will Affect the Future
Some Emerging Technologies and Other Issues That Will Impact Nursing and Health Care 491 Summary

29 Nursing Informatics and the Foundation of Knowledge
Dee McGonigle and Kathleen Mastrian
Foundation of Knowledge Revisited
Knowledge Use in Practice



The idea for this text originated with the development of nursing informatics (NI) classes, the publication of articles related to
technology-based education, and the creation of the Online Journal of Nursing Informatics (OJNI), which Dee McGonigle cofounded.
Like most nurse informaticists, we fell into the specialty; our love affair with technology and gadgets and our willingness to be the first
to try new things helped to hook us into the specialty of informatics. The rapid evolution of technology and its transformation of the
ways of nursing prompted us to try to capture the essence of NI in a text.

As we were developing the first edition, we realized that we could not possibly know all there is to know about informatics and the
way in which it supports nursing practice, education, administration, and research. We also knew that our faculty roles constrained our
opportunities for exposure to changes in this rapidly evolving field. Therefore, we developed a tentative outline and a working model
of the theoretical framework for the text and invited participation from informatics experts and specialists around the world. We were
pleased with the enthusiastic responses we received from some of those invited contributors and a few volunteers who heard about the
text and asked to participate in their particular area of expertise.

In the second edition, we invited the original contributors to revise and update their chapters. Not everyone chose to participate in
the second edition, so we revised several of the chapters using the original work as a springboard. The revisions to the text were guided
by the contributors’ growing informatics expertise and the reviews provided by textbook adopters. In the revisions, we sought to do the

• Expand the audience focus to include nursing students from BS through DNP programs as well as nurses thrust into
informatics roles in clinical agencies.

• Include, whenever possible, an attention-grabbing case scenario as an introduction or an illustrative case scenario
demonstrating why the topic is important.

• Include important research findings related to the topic. Many chapters have research briefs presented in text boxes to
encourage the reader to access current research.

• Focus on cutting-edge innovations, meaningful use, and patient safety as appropriate to each topic.
• Include a paragraph describing what the future holds for each topic.

New chapters that were added to the second edition included those focusing on technology and patient safety, system development life
cycle, workflow analysis, gaming, simulation, and bioinformatics.

In this, the third edition, we reviewed and updated all of the chapters, reordered some chapters for better content flow, eliminated
duplicated content, split the education and research content into two sections, integrated social media content, and added two new
chapters: Data Mining as a Research Tool and The Art of Caring in Technology-Laden Environments.

We believe that this text provides a comprehensive elucidation of this exciting field. Its theoretical underpinning is the Foundation
of Knowledge model. This model is introduced in its entirety in the first chapter (Nursing Science and the Foundation of Knowledge),
which discusses nursing science and its relationship to NI. We believe that humans are organic information systems that are constantly
acquiring, processing, and generating information or knowledge in both their professional and personal lives. It is their high degree of
knowledge that characterizes humans as extremely intelligent, organic machines. Individuals have the ability to manage knowledge—
an ability that 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 initiate this cycle of knowledge over again, as we acquire, process,
generate, and disseminate the knowledge gained from sharing and reexploring our own knowledge base. As others respond to our
knowledge dissemination and we acquire new knowledge, we engage in rethinking and reflecting on our knowledge, processing,
generating, and then disseminating anew.

The purpose of this text is to provide a set of practical and powerful tools to ensure that the reader gains an understanding of NI
and moves from information through knowledge to wisdom. Defining the demands of nurses and providing tools to help them survive
and succeed in the Knowledge Era remains a major challenge. Exposing nursing students and nurses to the principles and tools used in
NI helps to prepare them to meet the challenge of practicing nursing in the Knowledge Era while striving to improve patient care at all

The text provides a comprehensive framework that embraces knowledge so that readers can develop their knowledge repositories
and the wisdom necessary to act on and apply that knowledge. The text is divided into seven sections.

• The Building Blocks of Nursing Informatics section covers the building blocks of NI: nursing science, information science,
computer science, cognitive science, and the ethical management of information.

• The Perspectives on Nursing Informatics section provides readers with a look at various viewpoints on NI and NI practice as
described by experts in the field.

• The Nursing Informatics Administrative Applications: Precare and Care Support section covers important functions of
administrative applications of NI.

• The Nursing Informatics Practice Applications: Care Delivery section covers healthcare delivery applications including
electronic health records (EHRs), clinical information systems, telehealth, patient safety, patient and community education,

and care management.
• The Education Applications of Nursing Informatics section presents subject matter on how informatics supports nursing

• The Nursing Informatics: Research Applications section covers informatics tools to support nursing research, including data

mining and bioinformatics.
• The Imagining the Future of Nursing Informatics section focuses on the future of NI, emphasizes the need to preserve caring

functions in technology-laden environments, and summarizes the relationship of informatics to the Foundation of Knowledge
model and organizational knowledge management.

The introduction to each section explains the relationship between the content of that section and the Foundation of Knowledge
model. This text places the material within the context of knowledge acquisition, processing, generation, and dissemination. It serves
both nursing students (BS to DNP/PhD) and professionals who need to understand, use, and evaluate NI knowledge. As nursing
professors, our major responsibility is to prepare the practitioners and leaders in the field. Because NI permeates the entire scope of
nursing (practice, administration, education, and research), nursing education curricula must include NI. Our primary objective is to
develop the most comprehensive and user-friendly NI text on the market to prepare nurses for current and future practice challenges.
In particular, this text provides a solid groundwork from which to integrate NI into practice, education, administration, and research.

Goals of this text are as follows:
• Impart core NI principles that should be familiar to every nurse and nursing student
• Help the reader understand knowledge and how it is acquired, processed, generated, and disseminated
• Explore the changing role of NI professionals
• Demonstrate the value of the NI discipline as an attractive field of specialization

Meeting these goals will help nurses and nursing students understand and use fundamental NI principles so that they efficiently and
effectively function as current and future nursing professionals. The overall vision, framework, and pedagogy of this text offer benefits
to readers by highlighting established principles while drawing out new ones that continue to emerge as nursing and technology


We are deeply grateful to the contributors who provided this text with a richness and diversity of content that we could not have
captured alone. Joan Humphrey provided social media content integrated throughout the text. We especially wish to acknowledge the
superior work of Alicia Mastrian, graphic designer of the Foundation of Knowledge model, which serves as the theoretical framework
on which this text is anchored. We could never have completed this project without the dedicated and patient efforts of the Jones &
Bartlett Learning staff, especially Amanda Martin and Becky Myrick. Both fielded our questions and concerns in a very professional
and respectful manner.

Dee acknowledges the undying love, support, patience, and continued encouragement of her best friend and husband, Craig, and
her son, Craig, who has also made her so very proud. She sincerely thanks her cousins Camille, Glenn, Mary Jane, and Sonny, and her
dear friends for their support and encouragement, especially Renee.

Kathy acknowledges the loving support of her family: husband Chip; children Ben and Alicia; sisters Carol and Sue; and parents
Bob and Rosalie Garver. Kathy also acknowledges those friends who understand the importance of validation, especially Katie,
Bobbie, Kathy, Anne, and Barbara.

Authors’ Note

This text provides an overview of nursing informatics from the perspective of diverse experts in the field, with a focus on nursing
informatics and the Foundation of Knowledge model. We want our readers and students to focus on the relationship of knowledge to
informatics and to embrace and maintain the caring functions of nursing—messages all too often lost in the romance with technology.
We hope you enjoy the text!


Ida Androwich, PhD, RN, BC, FAAN
Loyola University Chicago
School of Nursing
Maywood, IL

Emily Barey, MSN, RN
Director of Nursing Informatics
Epic Systems Corporation
Madison, WI

Lisa Reeves Bertin, BS, EMBA
Pennsylvania State University
Sharon, PA

Brett Bixler, PhD
Pennsylvania State University
University Park, PA

Jennifer Bredemeyer, RN
Loyola University Chicago
School of Nursing
Skokie, IL

Steven Brewer, PhD
Assistant Professor, Administration of Justice
Pennsylvania State University
Sharon, PA

Sylvia M. DeSantis, MA
Pennsylvania State University
University Park, PA

Eric R. Doerfler, PhD, NP
Pennsylvania State University
School of Nursing
Middletown, PA

Judith Effken, PhD, RN, FACMI
University of Arizona
College of Nursing
Tucson, AZ

William Scott Erdley, DNS, RN
Niagara University
Niagara University, NY

Nedra Farcus, MSN, RN
Pennsylvania State University, Altoona
Altoona, PA

Kathleen M. Gialanella, JD, RN, LLM
Law Offices
Westfield, NJ
Associate Adjunct Professor
Teachers College, Columbia University
New York, NY
Adjunct Professor

Seton Hall University, College of Nursing & School of Law
South Orange & Newark, NJ

Denise Hammel-Jones, MSN, RN-BC, CLSSBB
Greencastle Associates Consulting
Malvern, PA

Nicholas Hardiker, PhD, RN
Senior Research Fellow
University of Salford
School of Nursing & Midwifery
Salford, UK

Glenn Johnson, MLS
Pennsylvania State University
University Park, PA

June Kaminski, MSN, RN
Kwantlen University College
Surrey, British Columbia, Canada

Julie Kenney, MSN, RNC-OB
Clinical Analyst Advocate Health Care
Oak Brook, IL

Margaret Ross Kraft, PhD, RN
Loyola University Chicago
School of Nursing
Maywood, IL

Wendy L. Mahan, PhD, CRC, LPC
Pennsylvania State University
University Park, PA

Heather McKinney, PhD
Pennsylvania State University
University Park, PA

Nickolaus Miehl, MSN, RN
Pennsylvania State University
Erie, PA

Peter J. Murray, PhD, RN, FBCS
Coachman’s Cottage
Nocton, Lincoln, UK

Lynn M. Nagle, PhD, RN
Assistant Professor
University of Toronto
Toronto, Ontario, Canada

Ramona Nelson, PhD, RN-BC, FAAN, ANEF
Professor Emerita, Slippery Rock University
President, Ramona Nelson Consulting
Pittsburgh, PA

Nancy Staggers, PhD, RN, FAAN
Professor, Informatics
University of Maryland
Baltimore, MD

Jeff Swain
Instructional Designer
Pennsylvania State University
University Park, PA

Denise D. Tyler, MSN/MBA, RN-BC
Implementation Specialist

Healthcare Provider, Consulting
ACS, a Xerox Company
Dearborn, MI

The Editors also acknowledge the work of the following first edition contributors (original contributions edited by McGonigle and
Mastrian for second edition):

Kathleen Albright, BA, RN
Strategic Account Manager at GE Healthcare
Philadelphia, PA

Schuyler F. Hoss, BA
Northwest Healthcare Management
Vancouver, WA

Audrey Kinsella, MA, MS
Information for Tomorrow
Telehealth Planning Services
Asheville, NC

Susan M. …

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