Summaries Summaries are included at
the end of each chapter to provide a
concise review of the material covered,
highlighting the most important points
and describing what the future holds.
uncertainty to the situational factors and personal beliefs that must be considered cre-
ates a need for an ethical decision-making model to help one choose the best action.
Ethical Decision Making
Ethical decision making refers to the process of making informed choices about ethical
dilemmas based on a set of standards differentiating right from wrong. This type of
decision making reects an understanding of the principles and standards of ethical
decision making, as well as the philosophic approaches to ethical decision making,
and it requires a systematic framework for addressing the complex and often contro-
versial moral questions.
As the high-speed era of digital communications evolves, the rights and the needs
of individuals and groups will be of the utmost concern to all healthcare profession-
als. The changing meaning of communication, for example, will bring with it new
concerns among healthcare professionals about protecting patients’ rights of con-
dentiality, privacy, and autonomy. Systematic and exible ethical decision-making
abilities will be essential for all healthcare professionals.
Notably, the concept of nonmalecence (“do no harm”) will be broadened to
include those individuals and groups whom one may never see in person, but with
whom one will enter into a professional relationship of trust and care. Mack (2000)
82 CHAPTER 5 Ethical Applications of Informatics
RESEARCH BRIEF
Using an online survey of 1,227 randomly selected respondents, Bodkin and
Miaoulis (2007) sought to describe the characteristics of information seekers on
e-health websites, the types of information they seek, and their perceptions of the
quality and ethics of the websites. Of the respondents, 74% had sought health in-
formation on the Web, with women accounting for 55.8% of the health informa-
tion seekers. A total of 50% of the seekers were between 35 and 54 years of age.
Nearly two thirds of the users began their searches using a general search engine
rather than a health-specic site, unless they were seeking information related to
symptoms or diseases. Top reasons for seeking information were related to dis-
eases or symptoms of medical conditions, medication information, health news,
health insurance, locating a doctor, and Medicare or Medicaid information. The
level of education of information seekers was related to the ratings of website
quality, in that more educated seekers found health information websites more
understandable, but were more likely to perceive bias in the website information.
The researchers also found that the ethical codes for e-health websites seem to be
increasing consumers’ trust in the safety and quality of information found on the
Web, but that most consumers are not comfortable purchasing health products
or services online.
The full article appears in Bodkin, C., & Miaoulis, G. (2007). eHealth information quality and
ethics issues: An exploratory study of consumer perceptions. International Journal of Pharmaceuti-
cal and Healthcare Marketing, 1(1), 27–42. Retrieved from ABI/INFORM Global (Document ID:
1515583081).
9781284122688_CH05.indd 82 16/12/16 5:52 PM
practices are sometimes more harmful than benecial). A case in point is the
long-standing practice of instilling endotracheal tubes with normal saline before
suctioning (O’Neal, Grap, Thompson, & Dudley, 2001). Based on the evidence
gathered through several studies, the potentially deleterious effects of this practice
have become widely recognized. Conceivably, a meta-analysis approach to clinical
studies will be expedited by convergence of large clinical data repositories across
care settings, thereby making available to practitioners the collective contribu-
tions of health professionals and longitudinal outcomes for individuals, families,
and populations.
Nurses need to be engaged in the design of CIS tools that support access to and
the generation of nursing knowledge. As we have emphasized, the adoption of clini-
cal data standards is of particular importance to the future design of CIS tools. We
are also beginning to see the development and use of expert systems that implement
knowledge automatically without human intervention. For example, an insulin pump
that senses the patient’s blood glucose level and administers insulin based on those
data is a form of expert system. The expert system differs from decision support tools
in that the decision support tools require the human to act on the information pro-
vided, whereas the expert system intervenes automatically based on an algorithm that
directs the intervention. Consider that as CISs are widely implemented, as standards
for nursing documentation and reporting are adopted, and as healthcare IT solutions
continue to evolve, the synthesis of ndings from a variety of methods and world-
views becomes much more feasible.
BOX 63 CASE STUDY: CASTING TO THE FUTURE
In the year 2025, nursing practice enabled by technology has created a profes-
sional culture of reection, critical inquiry, and interprofessional collaboration.
Nurses use technology at the point of care in all clinical settings (e.g., primary
care, acute care, community, and long-term care) to inform their clinical deci-
sions and effect the best possible outcomes for their clients. Information is gath-
ered and retrieved via human–technology biometric interfaces including voice,
visual, sensory, gustatory, and auditory interfaces, which continuously monitor
physiologic parameters for potentially harmful imbalances. Longitudinal records
are maintained for all citizens from their initial prenatal assessment to death;
all lifelong records are aggregated into the knowledge bases of expert systems.
These systems provide the basis of the articial intelligence being embedded in
emerging technologies. Smart technologies and invisible computing are ubiqui-
tous in all sectors where care is delivered. Clients and families are empowered
to review and contribute actively to their record of health and wellness. Invasive
diagnostic techniques are obsolete, nanotechnology therapeutics are the norm,
and robotics supplement or replace much of the traditional work of all health
professions. Nurses provide expertise to citizens to help them effectively manage
their health and wellness life plans, and navigate access to appropriate informa-
tion and services.
122 CHAPER 6 History and Evolution ofNursingInformatics
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The Future
The future landscape is yet to be fully understood, as technology continues to evolve
with a rapidity and unfolding that is rich with promise and potential peril. Box 6-3
helps us to imagine what future practice might entail. It is anticipated that computing
power will be capable of aggregating and transforming additional multidimensional
data and information sources (e.g., historical, multisensory, experiential, and genetic
sources) into CIS. With the availability of such rich repositories, further opportunities
will open up to enhance the training of health professionals, advance the design and
application of CDSs, deliver care that is informed by the most current evidence, and
engage with individuals and families in ways yet unimagined.
The basic education of all health professions will evolve over the next decade to
incorporate core informatics competencies. In general, the clinical care environments
will be connected, and information will be integrated across disciplines to the benet
of care providers and citizens alike. The future of health care will be highly dependent
on the use of CISs and CDSs to achieve the global aspiration of safer, quality care for
all citizens.
The ideal is a nursing practice that has wholly integrated informatics and nursing
education and that is driven by the use of information and knowledge from a myriad
of sources, creating practitioners whose way of being is grounded in informatics.
Nursing research is dynamic and an enterprise in which all nurses are engaged by
virtue of their use of technologies to gather and analyze ndings that inform specic
clinical situations. In every practice setting, the contributions of nurses to health and
well-being of citizens will be highly respected and parallel, if not exceed, the preemi-
nence granted physicians.
Summary
In this chapter, we have traced the development of informatics as a specialty, dened
nursing informatics, and explored the DIKW paradigm central to informatics. We
also explored the need for and the development of standardized terminologies to
capture and codify the work of nursing and how informatics supports the knowledge
work of nursing. This chapter advanced the view that every nurse’s practice will make
contributions to new nursing knowledge in dynamically interactive CIS environ-
ments. The core concepts associated with informatics will become embedded in the
practice of every nurse, whether administrator, researcher, educator, or practitioner.
Informatics will be prominent in the knowledge work of nurses, yet it will be a sub-
tlety because of its eventual fulsome integration with clinical care processes. Clinical
care will be substantially supported by the capacity and promise of technology today
and tomorrow.
Most importantly, readers need to contemplate a future without being limited by
the world of practice as it is known today. Information technology is not a panacea
for all of the challenges found in health care, but it will provide the nursing profes-
sion with an unprecedented capacity to generate and disseminate new knowledge at
rapid speed. Realizing these possibilities necessitates that all nurses understand and
leverage the informatician within and contribute to the future.
Summary 123
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This text is designed to include the necessary content to prepare nurses for prac-
tice in the ever-changing and technology-laden healthcare environments. Informatics
competence has been recognized as necessary in order to enhance clinical decision
making and improve patient care for many years. This is evidenced by Goossen
(2000), who reected on the need for research in this area and believed that the
focus of nursing informatics research should be on the structuring and processing of
patient information and the ways that these endeavors inform nursing decision mak-
ing in clinical practice. The increased use of technology to enhance nursing practice,
nursing education, and nursing research will open new avenues for acquiring, pro-
cessing, generating, and disseminating knowledge.
In the future, nursing research will make signicant contributions to the devel-
opment of nursing science. Technologies and translational research will abound,
and clinical practices will continue to be evidence based, thereby improving patient
outcomes and decreasing safety concerns. Schools of nursing will embrace nursing
science as they strive to meet the needs of changing student populations and the
increasing complexity of healthcare environments.
Summary
Nursing science inuences all areas of nursing practice. This chapter provided an
overview of nursing science and considered how nursing science relates to typical
nursing practice roles, nursing education, informatics, and nursing research. The
Foundation of Knowledge model was introduced as the organizing conceptual
framework for this text. Finally, the relationship of nursing science to nursing
informatics was discussed. In subsequent chapters the reader will learn more
about how nursing informatics supports nurses in their many and varied roles.
Inan ideal world, nurses would embrace nursing science as knowledge users,
knowledge managers, knowledge developers, knowledge engineers, and knowl-
edge workers.
THOUGHTPROVOKING QUESTIONS
1. Imagine you are in a social situation and someone asks you, “What does a nurse
do?” Think about how you will capture and convey the richness that is nursing
science in your answer.
2. Choose a clinical scenario from your recent experience and analyze it using the
Foundation of Knowledge model. How did you acquire knowledge? How did
you process knowledge? How did you generate knowledge? How did you dis-
seminate knowledge? How did you use feedback, and what was the effect of the
feedback on the foundation of your knowledge?
18 CHAPTER 1 Nursing Science and the Foundation of Knowledge
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Research Briefs These summaries
encourage students to access current
research in the field.
Thought-Provoking Questions Students
can work on these critical thinking assign-
ments individually or in a group. In addition,
students can delve deeper into concepts by
completing these exercises online.
Case Studies Case studies encourage
active learning and promote critical think-
ing skills. Students can ask questions,
analyze situations, and solve problems in
a real-world context.
