Dikw in nursing informatics

How does the concept of wisdom in nursing informatics compare to the concept of professional nursing judgment? What is DIKW and how do you "use" it in your practice(Rehab unit/imfection control)? The conceptual framework underpinning the science and practice of NI centers on the core concepts of data, information, knowledge, and wisdom, also known as the DIKW paradigm. As an aside, it is important to note that this paradigm is not exclusive to nursing, and is in fact used by others who work with data and information. When we assess a patient to determine his or her nursing needs, we gather and then analyze and interpret data to form a conclusion. This is the essence of nursing science. Information is composed of data that were processed using knowledge. Knowledge is 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. When we apply previous knowledge to data, we convert those data into information, and information into new knowledge—that is, an understanding of which interventions are appropriate in practice. Thus information is data made functional through the application of knowledge. Wisdom is the appropriate application of knowledge to a specific situation. In the practice of nursing science, one expects actions to be ultimately directed by wisdom. Wisdom uses knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters. Data: The smallest components of the DIKW framework. They are commonly presented as discrete facts; product of observation with little interpretation (Matney et al., 2011). These are the discrete factors describing the patient or his/her environment. Examples include patient’s medical diagnosis (e.g. International Statistical Classification of Diseases [ICD-9] diagnosis #428.0: Congestive heart failure, unspecified) or living status (e.g., living alone, living with family, living in a retirement community, etc.). A single piece of data, known as datum, often has little meaning in isolation. Information: Might be thought of as “data + meaning” (Matney et al., 2011). • Information is often constructed by combining different data points into a meaningful picture, given certain context. Information is a continuum of progressively developing and clustered data; it answers questions such as “who,” “what,” “where,” and “when.” For example, a combination of patient’s ICD-9 diagnosis #428.0 “Congestive heart failure, unspecified” and living status “living alone” has a certain meaning in a context of an older adult. Knowledge: Information that has been synthesized so that relations and interactions are defined and formalized; it is a build of meaningful information constructed of discrete data points (Matney et al., 2011). Knowledge is often affected by assumptions and central theories of a scientific discipline and is derived by discovering patterns of relationships between different clusters of information. Knowledge answers questions of “why” or “how.” For healthcare professionals, the combination of different information clusters, such as the ICD-9 diagnosis #428.0 “Congestive heart failure, unspecified” + living status “living alone” with an additional information that an older man (78 years old) was just discharged from hospital to home with a complicated new medication regimen (e.g., blood thinners) might indicate that this person is at a high risk for drug-related adverse effects (e.g., bleeding). • Wisdom: An appropriate use of knowledge to manage and solve human problems (ANA, 2008; Matney et al., 2011). Wisdom implies a form of ethics, or knowing why certain things or procedures should or should not be implemented in healthcare practice. In nursing, wisdom guides the nurse in recognizing the situation at hand based on patients’ values, nurse’s experience, and healthcare knowledge. Combining all these components, the nurse decides on a nursing intervention or action. Benner (2000) presents wisdom as a clinical judgment integrating intuition, emotions, and the senses; using the previous examples, wisdom will be displayed when the homecare nurse will consider prioritizing the elderly heart failure patient using blood thinners for an immediate intervention, such as a first nursing visit within the first hours of discharge from hospital to assure appropriate use of medications (para. 2). Reflect on the examples given by Topaz and create your own application example the DIKW scenario. In the 2015 Nursing Informatics: Scope and Standards of Practice, Ramona Nelson offers a graphic depiction of the DIKW paradigm in NI and how it relates to the evolution of information systems, decision support systems, and expert systems to support clinical practice. Her model indicates that as one moves from data to information to knowledge to wisdom, there is increasing complexity (shown as the X-axis) and increasing interactions and relationships (shown as the Y-axis). Information systems are shown at the intersection of data and information, decision support systems are depicted at the intersection of information and knowledge and expert systems, the most complex of the systems, reside at the intersection of knowledge and wisdom (Figure 6-1). The development of informatics tools to support nursing practice will continue to evolve as we develop more and better understanding of these complex relationships. “The addition of wisdom raises new and important research questions, challenging the profession to develop tools and processes for classifying, measuring, and encoding wisdom as it relates to nursing and informatics education. Research in these directions will help clarify the relationship between wisdom and the intuitive thinking of expert nurses. Such research will be invaluable in building information systems to better support healthcare practitioners in decisionmaking” (ANA, 2015, p.6). Figure 6-1 The Relationship of Data, Information, Knowledge, and Wisdom Copyright Ramona Nelson.