Data are considered the “essential element of information” containing the “measurements and facts” (Institute of Medicine {IOM}, 2003a, p. 126) that public health nurses need to make decisions in practice. According to Thede (2003), data are defined as “discrete elements that have not been interpreted” (p. 11). The ANA (2008) uses similar language explaining that “data are discrete entities that are described objectively without interpretation” (p. 3). For example, a newly diagnosed case of tuberculosis in a small town is considered data and is reported to the local county department of health, which then reports this case to the state department of health. This case of tuberculosis singularly is considered data and is entered into a database. Certain other diseases may also be reported to the Centers for Disease Control and Prevention (CDC) and to the World Health Organization. Once reported, these data are also entered into a database.

There are many sources of data, some of which include mortality reports, vital statistics, morbidity data, and hospital data such as falls, length of stay, wounds, injuries, and occupational illnesses. Once data are reported and located in a database, analysis may be carried out. Often, the amount of data may be so overwhelming that the message the data would ordinarily convey is overlooked. It is only when the data are reported and placed into a database that patterns emerge to inform the practitioner as to what the best practice interventions may be.

Databases are systems or structures that allow for data to be stored in an organized way and that support access and retrieval (Hebda, Czar, & Mascara, 2005). Databases are collections of related records stored in a computer that permit a person or program to query in order to extract needed information (McGonigle and Mastrian, 2012). For example, in a database that maintains surveillance data for use by public health nurses, available data may represent patient chief complaints from an emergency visit, ambulance logs, prescriptions filled, or reportable laboratory results. The ANA (2008) explains that data become information after they are “interpreted, organized, or structured” (p. 3). The various
database systems help to organize and depict the data so they can become information and eventually knowledge. The data may be accessed and shared, but the end result may be different for each user depending on who retrieves the information and how he or she interprets it. Public health nurses who note an increase in mumps, a nationally reportable disease, may see the need to develop a health education program for young families if an outbreak were to occur in their community. Immunization programs may be another intervention to consider, and yet who interprets the data, such as a private practitioner or an outpatient clinic, may direct the kind of immunization program developed. It is therefore important that public health nurses know the different types of databases available to them, how to find databases, and how to use the statistics and other vital information for their practice at the local, state, and national level. Box 6-1
provides some examples of the types of databases that are available for the public health nurse.

Another important application of technology and nursing informatics for practice is data mining. In 1849, the gold rush in California brought people from all over the world to small towns in northern California, like Grass Valley. The gold mine established in Grass Valley is open to visitors today. Tourists can see how the various veins of gold were identified and then extracted from the earth to create wealth and improve lives. Likewise, the rich veins of data stored in databases can be extracted to show relationships and patterns to help us develop new information and knowledge. The data collected through surveillance processes can be “mined,” just as the veins of gold were mined, for any number of purposes to enhance and enrich lives in the public sphere. Data mining looks for patterns and relationships from large aggregate data sources. Data, however, have to be considered “clean” enough to be mined. Gold, when it was extracted, went through a chemical process to obtain the pure gold. The process used to clean data in preparation for effective data mining consists of “scrubbing” the data for errors that have the potential to skew any relationships or patterns. Cleansing the data, as it is called, means looking at the data for inconsistencies such as typographical errors, misspelled words, and multiple names for similar terms (e.g., “SOB” could mean “short of breath” or some other term). Abbreviations vary from institution to institution, and this can skew the data, making them difficult to use. Software packages exist to help scrub the data and remove the inconsistencies (Hebda et al., 2005).

McGonigle and Mastrian (2009) state that data mining “helps to identify patterns in aggregate data, gain insights, and ultimately discover and generate knowledge applicable to nursing science” (p. 148). Thede (2003) explains data mining as “the automated processes that permit the conversion of data to information and knowledge by finding hidden relationships within data” (p. 277). The use of data mining is a key concept in nursing informatics that has relevance to public health nursing. The challenge for nursing is to continue to refine and develop
a standardized language that will enable data to be coded in like formats. The data then may be later mined for patterns and relationships.

The practice of public health nursing can be viewed from the nursing informatics perspective of data, information, knowledge, and wisdom (ANA, 2008). Three areas of information science that the IOM (2003a) identifies include “data, information, and knowledge” (p. 126). Data become information as they are organized and “placed in context” in information systems (IOM, 2003a, p. 126). The IOM (2003a) explains that information and information systems are essential tools that public health agencies need to monitor a population’s health status and identify health hazards and risks. The information gained from these systems helps the public health nurse provide evidenced-based care to the individual, family, population, or community they serve.