Advancing Nursing Informatics

Our current featured article, available at no cost while it is featured, addresses a theoretical model that advances the independent development of nursing informatics.  The article is titled “The Evolution of Data-Information-Knowledge-Wisdom in Nursing Informatics.” by Charlene Ronquillo, MSN, RN; Leanne M. Currie, PhD, RN; and Paddy Rodney, PhD, RN. Here is their message about this important work  for ANS readers:

Setting out to question one of the foundational theories in nursing informatics was a task we approached with much caution, care and respect, in the paper we have contributed to this journal. The theoretical framework we are

Charlene Ronquillo

referring to is the data-information-knowledge-wisdom framework, often referred to as DIKW. Exploration of DIKW brought us on a very interesting journey: We delved into the literature from the early years when nursing informatics was first beginning to be established as a field of inquiry and we ended up exploring fields that included management information science, library sciences, and geographical sciences. DIKW is arguably one of the first concepts described as a unique feature of nursing informatics by Graves and Corcoran in their seminal paper, The Study of Nursing Informatics, published in 1989. DIKW might have faded into the past had it not been for the work that Nelson, and then Nelson and Staggers

Leanne M. Currie

added to the exploration and articulation of the framework. We feel privileged to be able to be able to build on the insights put forth by Graves and Corcoran almost thirty years ago, and advanced by Nelson and Staggers.

What began as a curiosity-driven exploration of the DIKW as part of a doctoral philosophy course in 2013 turned into a full investigation of this theoretical framework. Our investigation was spurred by the finding that beyond nursing informatics, many other fields of study mentioned, used, and critiqued DIKW. In the figure below, for instance, we provide a visual depiction of DIKW in the fields of nursing informatics (as a series of overlapping circles) and DIKW in computer science, management information systems, and library

Paddy Rodney

sciences (as a pyramid). We found the opportunity to contribute to the ongoing evolution of DIKW by incorporating these ‘non-nursing’ perspectives to be a possible way forward.

This drawing presents a side-by-side comparison of the DIKW models as depicted in nursing informatics (left) and computer science, management information systems, and library sciences (right) illustrate the common attributes of DIKW visualizations: consolidation of power, linear and positive growth, and an implicit assignment of value to concepts (i.e., “building” toward to the pinnacle of wisdom, which is the most important).

An important first step in our inquiry was gaining an understanding around what purpose DIKW served and the intention(s) around its introduction as a central aspect of nursing informatics. As is reflected in our paper, we continue to emphasize the crucial role and contributions of DIKW towards one of the key goals of nursing informatics–namely, to continue nursing’s historical efforts to make nursing work visible and “counted” in health systems by leveraging the opportunities presented by information technologies and the increasingly digitised world. The challenge, of course, as it has always been, is to develop methods that capture aspects of the complexity of nursing that cannot be easily measured or quantified.

We consider, in this paper, the various iterations and evolutionary developments of DIKW in nursing informatics as attempts at better understanding and operationalizing ways in which nursing work might be made more visible in health systems. In the process of developing this paper and attempting to gain clarity around how DIKW has been conceptualised, understood, and used, we stepped back and asked two key guiding questions: (1) Does DIKW serve clinical information systems, nurses, or both? And (2) What level of theory does DIKW occupy? It is by asking these questions that we offer a discussion about the assumptions implicit in the DIKW model and the subsequent implications of these assumptions. Finally, we explored the approaches taken by various authors in operationalizing DIKW in nursing, providing what we hope are fruitful insights into potential ways forward for this theoretical framework.

As Norma Lang claims, “If we cannot name it, we cannot control it, practice it, teach it, finance it, or put it into public policy” (Clark & Lang, 1992, p. 109). Indeed, Professor Lang has continued to be a pioneer in advocating for standard terminologies to advance nursing knowledge.  Here is a video in which Dr. Lang provides the context of this very famous quote.

It is with this guiding principle that we approached the critical examination of the evolution of DIKW. That is, we argue that each iteration, application, and attempt at further refining the DIKW model over the decades should be viewed as an important step forward towards the goal of making nursing work visible. It is our hope that our paper makes a contribution toward this end and supports other colleagues undertaking similar explorations.