Foundations of Practice · 5 min read
Methodologies and Theories
The Data–Information–Knowledge–Wisdom Continuum
Graves and Corcoran's foundational model describes nursing informatics as the management and processing of nursing data, information, and knowledge. The ANA later added wisdom: the appropriate use of knowledge to manage and solve human problems. The DIKW continuum is the most tested NI framework.
| Model or theory | Key idea | Exam application |
|---|---|---|
| Graves and Corcoran | NI combines nursing, computer, and information science to manage data, information, and knowledge | Foundational definition of the specialty |
| Turley | Adds cognitive science to computer and information science within nursing science | Design must fit how users think |
| Staggers, Gassert, and Curran | Competencies grow across four levels: beginning nurse, experienced nurse, informatics specialist, informatics innovator | Match training and roles to competency level |
| Benner (novice to expert) | Skill develops from rule-based novice to intuitive expert | Super users and analysts need different support |
| Shannon and Weaver | Information is sent, encoded, transmitted, decoded, and received; noise distorts the signal | Alert noise hides clinically important signals |
| Sociotechnical theory (Sittig and Singh) | Eight dimensions: hardware and software infrastructure; clinical content; human-computer interface; people; workflow and communication; internal organizational features; external rules and regulations; system measurement and monitoring | Safety problems arise from interaction of technology and people, not technology alone |
| Technology Acceptance Model (TAM) | Perceived usefulness and perceived ease of use predict intention to use | Show nurses how the tool helps them |
| UTAUT | Performance expectancy, effort expectancy, social influence, and facilitating conditions predict use | Peer champions and support resources raise adoption |
Systems Theory and Complexity
A system is a set of interrelated parts working toward a purpose. Healthcare organizations are open systems that exchange inputs and outputs with their environment, use feedback to adjust, and show emergence: properties such as safety and quality arise from interactions, not from any single part. Negative feedback restores stability (an alert that prompts a correction), and positive feedback amplifies change. Complexity science adds that small changes in a complex adaptive system can have large, unpredictable effects, which is why pilots and monitoring matter.
Change Management Theories
| Model | Stages or elements | Use it when |
|---|---|---|
| Lewin | Unfreeze, change, refreeze; driving and restraining forces (force-field analysis) | Planning a single change and its barriers |
| Kotter (8 steps) | Create urgency; build a guiding coalition; create a vision; communicate the vision; empower action by removing obstacles; generate short-term wins; consolidate gains and produce more change; anchor new approaches in the culture | Leading large organizational change |
| Rogers' Diffusion of Innovations | Knowledge, persuasion, decision, implementation, confirmation; innovation attributes: relative advantage, compatibility, complexity, trialability, observability | Targeting adopter groups |
| Prosci ADKAR | Awareness, Desire, Knowledge, Ability, Reinforcement | Coaching individuals through change |
| Lippitt | Seven phases emphasizing the change agent's role, from diagnosing the problem to terminating the helping relationship | Consultant-led change |
- Sources of resistance: fear of the unknown, loss of control or competence, added workload, poor communication, and past failed projects.
- Effective responses: involve users early, explain the why, provide training and at-the-elbow support, listen to and act on concerns, and celebrate short-term wins.
Process Improvement Methods
| Method | Core steps | Best for |
|---|---|---|
| PDSA (Model for Improvement) | Plan, Do, Study, Act: small rapid tests of change | Testing a change on one unit before spreading it |
| Lean | Identify value, map the value stream, create flow, establish pull, pursue perfection; remove waste (defects, overproduction, waiting, unused talent, transportation, inventory, motion, extra processing) | Removing waste and delays |
| Six Sigma (DMAIC) | Define, Measure, Analyze, Improve, Control | Reducing variation and defects with statistics |
| Root cause analysis (RCA) | Retrospective review of an event; 5 Whys and fishbone (Ishikawa) diagrams | After a sentinel or serious safety event |
| Failure mode and effects analysis (FMEA) | Prospective: list failure modes; score severity × occurrence × detection = risk priority number (RPN) | Before implementing a new or changed process |
Project Management Methodologies
The PMI framework organizes project work into five process groups: initiating, planning, executing, monitoring and controlling, and closing. Waterfall projects move through sequential phases; agile projects deliver working functionality in short iterations (sprints) with frequent user feedback; hybrid approaches combine the governance of waterfall with the iteration of agile and are common in healthcare.
- Product owner: prioritizes the backlog for business value.
- Scrum master: removes impediments and coaches the process.
- Sprint: a time-boxed iteration, usually 1–4 weeks.
- Daily stand-up, sprint review, and retrospective keep work visible and improving.
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