NCM 110: INFORMATICS NURSING

MANAGEMENT

KARITSAKESIAH ARCEO, UKRN,HAAD RN/SN, RN

Course Instructor
 Nursing Informatics
Objectives
Agenda:
❖ Informatics Theory Standards
➢ Healthcare Project Management At the end of the discussion, the students

➢ Nursing Informatics Theory will be able to:

❖ Nursing Informatics as a Specialty ● Define project management and its
➢ Florence Nightingale’s Role in importance for healthcare informatics.
Nursing Informatics ● Analyze nursing informatics role for
➢ Informatics Nurse
nurses.
➢ Informatics Nurse Specialist
 Healthcare Project Management
Today there is good evidence that technology can
decrease medical errors and adverse events in Project Management
healthcare settings, but the complexity of these settings
can make technology implementation challenging. ➔ is facilitation of the planning,
scheduling, monitoring, and controlling

Project
of all work that must be done to meet the
project objectives.

➔ is the implementation of technology in

healthcare setting.

Components:
★ Temporary
★ Has defined beginning and end
★ Is managed for time, budget, and scope
 Healthcare Project Management
Project Managers
➔ These groups are integrated and not linear in nature,
➔ Decisions and actions taken in one group can affect
another.
➔ The level of activity and length of each process group
★ Meet the specific scope, time, cost, and quality vary for each project.
project goals
★ Facilitate the entire process to meet the needs and
expectations of the people involved in or affected by
the project activities.

Five Process Groups

★ Initiation activities
★ Planning activities
★ Executing activities
★ Monitoring and controlling activities
★ Closing activities
 Project Management
Four Core Areas ★ The business case includes the potential risks
and success criteria: benefits and costs.
1. Project Scope
2. Time
3. Cost ★ The IPG may lead to:
4. Quality Management
○ Formal project selection or
○ Decision to forgo or
Initiating Process Group (IPG) ○ To postpone a project.

➔ Processes performed to define the scope of a

new project or a new phase of an existing project
➔ The purpose of the IPG is to formally define a
project including the business need, key
stakeholders, and the project goals.
★ A clear definition of the business case is critical for
defining the scope of the project and for identifying
the opportunity associated with completing the
project.
 Planning Process Group (PPG) Steps in Project Planning
➔ Is often the most difficult and unappreciated process 1. Define project scope.
in project management.
2. Refine project objectives.
➔ It is one of the most important and should not be 3. Define all required deliverables.
rushed. 4. Create framework for project scheduled.
5. Select the project team.
➔ This is the phase where decisions are made on 6. Create the work breakdown structure.
how to complete the project and accomplish the 7. Identify the activities needed to complete the
goals and objectives defined in the IPG. deliverables.
8. Sequence the activities and define the critical
➔ Project plan is created (must be realistic &
path activities.
specific). 9. Estimate the resource requirements for the
activities.
10. Identify required skills and resources.
11. Estimate work effort; time and cost for
activities.
12. Develop the schedule.
13. Develop the budget.
14. Complete risk analysis and avoidance.
15. Create communication plan.
16. Gain formal approval to begin work.
 Executing Process Group (EPG) Executing Process Group Tools and
➔ Processes performed to complete the work defined in the
project management plan to satisfy the project Techniques
requirements.
During the EPG the project team follows the project plan ● Gathering project team for the purpose of advancing
and each team member contributes to the ongoing progress Project the work of the project.
Meetings ● All participants have a predefined role; action items
of the plan. and decisions are tracked and formally communicated.

★ Project deliverables are managed during the EPG by ● Tracks and communicates project tasks, resources,
careful tracking of scope, time, and resource use with Gantt
and milestones against time over the course of a
ongoing updates made to the project plan and timeline Chart
project.
to reflect progress made.
Request
for ● Used to solicit proposals from prospective vendors.
Proposal

● Provides a means to prioritize and track items that

Issue Log represents a degree of risk meeting project
deliverables.

Progress ● Keeps project team informed of project status,

Reports milestones to date, and areas of concern.
 Monitoring & Controlling ★ It is performed throughout life of project across all
phases, and provides feedback between project

Process Group (MCPG)

phases

★ It allows issues and potential problems to be

identified in a timely manner and corrective action
➔ The purpose of the MCPG is to track, review and to be taken when necessary.
regulate the progress and performance of the
project; The Project Manager facilitates project control by:
➔ Identify any areas in which changes to the plan
Measuring actual performance against the planned or
are required; and estimated performance from the project plan in the areas:
➔ Initiate the corresponding changes. ● Scope
● Resources
● Budget
● Time

★ The Project Manager needs to

support the project team with
frequent checks and recognition of
the completion of incremental
work efforts.
 The Triple Constraint
Are often competing constraints that need to be
Constraints: SCOPE, COST,
balanced by the project manager throughout the project
TIME.
life cycle
Cost refers to the resources (materials and people) The concept of the triple constraint is
required to complete the project. that any modification to the project
Scope refers to the specific project requirements and will impact one or more of the three
work that needs to be done to accomplish the project constraints and will require trade-offs
goals. that can negatively impact the
Time is the duration of the project. success of the project.

For example:
❖ If there is an increase in scope, either cost or time or both will need to be increased as well.
❖ Or in another example, if time is decreased when a deadline is moved up, either scope will
need to decrease or cost (resources) will need to increase. It is a balancing act.
 Closing Process Group (CPG) Closing Group Tools and
➔ Those processes performed to formally
complete or close the project, phase, or contract.
Techniques
★ The goal of CPG is to finalize all project Provides an opportunity for project stakeholders
to evaluate the project from multiple perspectives
activities and to formally close the project. including:
Post-implementatio
➔ Product effectiveness
n Survey
★ Key stakeholders are engaged with evaluating ➔ Management of the triple constraint
➔ Communication Management
the degree to which project deliverables were ➔ Overall performance of the project team
met.
● Provides a means to document the formal
Post-mortem project evaluation.
Review Document ● Facilitates discussion related to lessons
learned that can be applied to future projects.

Used to ensure that agreed upon features of

project closure are completed related to the
following:
Project Closeout
➔ Post-implementation review
Checklist
➔ Administrative close-out procedures
➔ Formal acknowledgement of the project
team.
 Summary
❖ A project is temporary, has a defined ❖ The four core areas of project
beginning and end, and is managed for time, management are project scope, time,
budget, and scope. cost, and quality management.

❖ Project Management is facilitation of the

planning, scheduling, monitoring, and
controlling of all work that must be done to
meet the project objectives.

The project management process groups:

● Initiation activities
● Planning activities
● Executing activities
● Monitoring and Controlling activities
● Closing activities.
 Theories
★ Nursing Informatics Theory
★ General Systems Theory
★ Sociotechnical Theory and Social
Informatics ★ Chaos Theory

★ Change Theories
★ Cognitive Science Theory

★ Rogers' Diffusion of Innovations Theory

★ Usability Theory
★ Lewin's Field Theory
 Nursing Informatics Theory
Data
➔ Is concerned with the representation of nursing
data, information, and knowledge to facilitate ➔ are discrete, objective facts that have not been
the management and communication of nursing interpreted
information within the healthcare milieu. ➔ Data are described objectively without
interpretation.

information model for nursing informatics Information

➔ is data that have some type of interpretation or
By graves & Cocoran (1989) structure.
➔ it has a context.
This model identified the following as the key ➔ It is derived from combining different pieces of
components: data
● Data
Example:
● Information
A set of data, such as vital signs, when interpreted over
● Knowledge a period of time is information.
 Nursing Informatics Theory
Knowledge
➔ is a synthesis of information with relationships identified and formalized.
➔ It changes something or somebody by creating the setting for formulating
possible effective actions, evaluating their effects, and deciding on the
required action

Example:

Interpreting a set of vital signs over a period of time and deciding on an action
based on this information combined with nursing knowledge and experience is an
example of knowledge.

Wisdom
➔ is achieved through evaluating knowledge with reflection.
➔ involves seeing patterns and metapatterns and using them in different
ways and knowing when and how to apply knowledge to a situation.

Example:

Wisdom would be interpreting vital signs in a postsurgical patient as indicative

of an infection and taking the appropriate action.
 Nursing Informatics Theory
★ The general idea of informatics
theory is that the move from data to
knowledge is a progressive process
that follows a given path.

★ As one moves up the continuum,

each level becomes more complex
and requires intellect that is more
human.
★ The processes of converting data
into knowledge include capturing,
sorting, organizing, storing,
retrieving, and presenting the data to
give it meaning and produce
information.
 Sociotechnical Theory & Social informatics
★ The overall focus of this theory is the ★ Research based on sociotechnical theory is aimed at
impact of technology’s implementation on maximizing performance by designing or redesigning
an organization. systems that fit the organizational system into which
they are implanted.
★ It originated in the middle of the last
century when it became evident that not all
implementations of technology were The importance of social informatics is evidenced by the
increasing productivity. failure of many information systems including the much
publicized shutdown by Cedars Lebanon Hospital in Los
Focuses on the interactions within an organization Angeles in early 2003 of their multimillion dollar
among:
computerized physician order entry (CPOE).
● Information management tools and
techniques. CPOE created a change seen as too radical by the
● The knowledge, skills, attitudes, values, and physicians,who believed that their interests were not
needs of its employees. sufficiently represented, the system was jammed down their
● Rewards and authority structures of the throats, and that it was poorly designed.
employer.
 Change Theories
Roger’s Diffusion of
Change theories recognize that instituting a
change in documentation, whether it is a
relatively simple change such as a minor
system upgrade or a major one such as
moving from a paper record to a Innovations Theory
completely paperless electronic system, can
This theory examines the pattern of acceptance that innovations
provoke discomfort.
follow as they spread across the population and the process of
decision making that occurs in individuals when deciding whether
“What will this mean to me?” is always
uppermost in the mind of a person faced to adopt an innovation.
with change.
As an example for when this theory is helpful, when making
Ignoring the psychosocial nature of decisions on how to implement changes, such as computerized
changing information management is too provider order entry (CPOE), it is best to assess the nursing units
often a one-way ticket to failure of the that might best adopt the changes.
system.
 Rogers classifies people into five categories
SOCIETAL CHANGES to view how innovations are accepted by the
general population
1. INNOVATORS: Readily adopt the innovation.
These persons are often seen as disruptive by those
who are averse to risk taking.

2. EARLY ADOPTERS: They are respectable

opinion leaders who function as promoters of an
innovation.

3. EARLY MAJORITY: Is averse to risks but will

make safe investments.

4. LATE MAJORITY: They need to be sure that the

innovation is beneficial. They may adopt the
innovation not because they see a use for it, but
because of peer pressure.

5. LAGGARDS: They are suspicious of innovations

and change and are quite resistant. Laggards must
be certain that the innovation will not fail before
they adopt it.
 In Rogers' theory, individuals go through FIVE STAGES in deciding to
INDIVIDUAL CHANGES adopt an innovation.
FIRST STAGE: FOURTH STAGE:
➔ Knowledge of an innovation, the potential adopter ➔ If the decision is positive, the fourth stage, or
gains an understanding of how the innovation implementation, follows.
operates. ➔ At this stage, the adopter wants knowledge, such
as how to use the innovation and how to
SECOND STAGE: overcome problems with its use.
➔ Persuasion, is based on the perception of the relative
advantage of the innovation, compatibility with FIFTH STAGE:
existing norms, and its observability. ➔ Confirmation, the fifth stage, may occur when
➔ At this stage, an individual forms an opinion about reinforcement of the decision is sought.
the innovation - negative, neutral, or positive. ➔ Conflicting information about the innovation
may cause the adopter to reverse a decision.
THIRD STAGE:
➔ The individual uses personal opinions to make a
decision.
➔ A potential adopter may try the innovation or base
an opinion on the experience and opinion of a
respected peer who has tried the innovation.
➔ The individual then decides to either adopt or reject
the innovation.
 Lewin divides these changes into three stages or force fields:
Lewin’s Field Theory 1. Unfreezing
2. Moving
3. Refreezing
★ Lewin's field theory provides a guide to
helping individuals achieve a positive
decision in relation to an innovation.

★ This theory holds that human behavior is

related to both personal characteristics and
the social milieu in which the individual
exists.

★ It focuses on the variables that need to be

recognized and observed in a situation of
change.
 Lewin’s Field Theory
UNFREEZING STAGE is based on the idea that a
balance of driving and restraining forces that creates
equilibrium supports human behavior.

● To institute change, the driving and restraining

forces that are part of the maintenance of
equilibrium in the organizational culture and
individual have to be changed.

● To unfreeze, one must identify and change the

balance so that the driving forces are stronger than
the restraining forces.

● Driving forces can be involvement in the process,

respect of one's opinion, and continuous
communication during the process.
 Lewin’s Field Theory
MOVING STAGE - the planned change is implemented.

● Its success depends on how situations were handled

in the first stage.
● This is not a comfortable period. Anxieties are high,
and if they are not successfully dealt with, the
change may be unsuccessful.

REFREEZING STAGE - equilibrium returns as the

planned change becomes the norm and it is surrounded by
the usual driving and restraining forces.

● For this state to occur, individuals need to feel

confident with the change and feel in control of the
procedures involved in the new methods.
 General Systems Theory
➔ A simplified description of systems theory holds that The feedback loop operates using input,
any change in one part of a system will be reflected in
other parts of the system.
process (throughput), and output.

★ The objective of any system is to be in

equilibrium,which is maintained by the correction
forces from a feedback loop.
● Negative feedback results when there is a lack of
something.
● The action it produces is to add the missing item to
restore a variable to its state of equilibrium.
● Positive feedback results when there is too much of
something.
● The action in positive feedback is to take away the
excess.
 General Systems Theory
● Input involves adding information or matter to a
system.
● Process is the throughput, or evaluation of the
input, that the system performs using the input
information.
● Output is the information or action that results
from what the processing finds.
This output may produce no action, or the action
needed from either negative or positive feedback.
A simple example is inputting a patient's temperature into a computer system.
➔ The computer processing that data by combining it with the order that if this patient's temperature is more than
101°F, a specific medication should be given, and presenting the information to the nurse along with the action
that needs to be taken.
➔ This is positive feedback--there was too much of something, body heat.
➔ The action it produced was to tell the nurse to give a medication.
 Chaos Theory
★ Chaos theory deals with the This theory is often associated with the so-called butterfly
differences in outcomes
effect, or the result on worldwide atmospheric conditions
depending on conditions at
the starting point. caused by the flapping of one butterfly's wings.

★ For example, the conditions where an

information system is first envisioned will
affect the overall design.

★ The idea behind this theory is that what may

appear to be chaotic actually has an order.
★ It is based on the recognized fact that events
and phenomena depend on initial
conditions.
 Cognitive Science Theory
Principles from these theories
★ It is the study of the mind and intelligence and how this
provide a guide to developing
information can be applied.
systems that allow users to
concentrate on the task, rather
★ It is interdisciplinary; includes philosophy, psychology,
than requiring cognitive tasks to
artificial intelligence, neuroscience, linguistics, and
deal with the computer
anthropology; and is a part of social informatics. interface.
★ It adds to informatics concepts that focus on how the brain
perceives and interprets a screen.
★ These factors are important in all aspects of information
systems.
★ When designing input screens, the screen locations where
information is entered must be organized to facilitate data
entry.
 Usability Theory
★ Usability theory represents a
multidimensional concept and 5 Goals of Usability Theory
involves users' evaluation of several
measures, each one representative of 1. It is easy for users to accomplish basic tasks
their effectiveness in performing a the first time they use the product.
task. 2. Once learned, the design permits users to
★ It involves the ease of use, users' quickly and easily perform the needed tasks.
satisfaction that they have achieved 3. If it is not used for a period of time, it is easy
their goals, and the aesthetics of the to reestablish one's proficiency in using the
technology. product.
4. Users make very few errors, but any that they
★ It uses information from both the do make are easily remedied.
cognitive science and sociotechnical 5. The design is pleasant to use.
theories.
 Summary
Different theories used:

1. Nursing Informatics Theory

2. Sociotechnical Theory and Social
Informatics
3. Change Theory
4. Rogers' Diffusion of Innovations
Theory
5. Lewin's Field Theory
6. General Systems Theory
7. Chaos Theory
8. Cognitive Science Theory
9. Usability Theory
Contributions of Theories In Nursing Informatics
★ Nursing Informatics ➔ Convert data into information & information to knowledge; nurse adds
Theory wisdom.
★ Sociotechnical Theory ➔ Improve interaction between an information system and organizational
and Social Informatics culture.
➔ Increase the chance of success in implementing a system by attending to
★ Change Theories
the reactions to the change.
➔ Contributes to the understanding of the complexity of an information
★ General Systems Theory
system.

★ Chaos Theory ➔ Improve the design of an information system.

★ Cognitive Science
➔ Improve the ability of user to gain knowledge from an information system.
Theory

★ Usability Theory ➔ Improve ease of use and satisfaction with an information system.
References:
Saba, V. K., & McCormick, K. A. (2021). Essentials of Nursing Informatics (7th ed.). McGraw Hill.

Sewell, J. (2016). Informatics and Nursing: Opportunities and Challenges (5th ed.). Wolters Kluwer.