Fig. 20.1
Humanistic information model
Each cogwheel has a core function and yet, each cogwheel cannot act independently of the ones to which it is attached. To start with the ‘Acquisition’ cog, all our senses acquire information all of the time whether we want it or not, some of this information is bland but most information we acquire is value-laden, either with the senders’ values, or our own. For example, national news will have different slants depending upon the target audience, the editor will determine the story to feature and we can see the result through comparing different news providers. We are dependent upon the considered values of the editor.
The cogs next to acquisition are to the right of the processing or filtering cog and to the left of the dissemination cog. The processing cog is where filtering of information takes place; here the conscious and subconscious decisions about information and how to manage information are considered. The processing cog is linked to the storage cog for it is here that intrinsic and extrinsic self exists [6] and the extrinsic self is a result of life experiences. Each person will filter (or value) information differently based upon his or her life and experiences. Decisions are made upon a matrix of previous such situations and outcomes. An example of filtering could occur when we pass into and out of rooms, offices, cars, or trains; how often do we consciously think about how to enter a room with a closed door, very rarely, for we have learned how to ‘do doors’. However, if we have been standing at the door for some time and nothing happens then we might raise ‘doors’ into conscious thought and while we have been pushing at the door, we read ‘pull’ and act accordingly. The same could be said of a registered nurse approaching a patient; is it conscious or unconscious thought as we near the patient resulting in an action of some kind. We can see that the processing cog links back with the acquisition cog; this allows for ‘enquiry’ to help complete a process requiring new or additional knowledge, connecting self with out-sourced information.
The storage cog is a mass of information. If the model is being used to consider an individual and their information ‘self’, then the storage cog represents all the activities, experiences, thoughts, ideas and dreams of that individual. If the model is being used to consider an organisation then the storage cog represents all the previous work documented and/or experienced of that organisation. If the model is being used to consider a profession, for example nursing, then the storage cog represents the history of the profession along with all the standards and processes to the present. Some of the stored information may be immediately retrievable for most of us, but a lot of it is lost until an appropriate gateway is opened, for example for an individual a photograph bringing back memories or someone saying something which triggers a remembrance, or a file or document for an organisation or profession. The ‘tip of the tongue’ experience classically identifies something we know we know but the gateway is not completely open to the item. If the new information reaching the storage cog is incomplete we may feel the need to actively acquire further information. This can be at either a conscious or subconscious level in order to give both complete meaning and a gateway through which to connect to the new information so it can be found again when needed.
The dissemination cog is where we demonstrate our values to others and to ourselves be this associated with an individual, organisation or profession. Every action we make as an individual has a value, for example the way we use words and the very words themselves have a value. We decide what is of value and what is not. We can only operate on the information we have at the time, disseminated decisions are based upon known information. If after a decision has been made a new piece of information is obtained the decision may be different. Our filtering system can only operate in real-time however long that real-time might be. There is an automatic knock-on effect to dissemination; this too is in real-time whenever we communicate with others, either in person or through technology, for example the telephone, video calls or email.
What is required in nursing and health care generally, is a re-definition of healthcare roles and a definition of our ‘value-sets’. We need to decide what is important for health care in this information intensive era. In addition, we also must determine how to prepare those starting, returning or continuing education who will practice further into this new millennium with the plethora of digital devices expected, the emergence of pharmacogenomics, nano technologies and medical innovation. We need to know how we filter information to meet the needs of our value-sets. What we do not need are replacements for clinicians and teachers by mechanistic computer systems/packages, which have neither the humanistic understanding nor the flexibility to respond to patients’ needs in a supportive human way.
Nurse Education Driving Information Change
Within healthcare there are expected to be major information implications as we move further into becoming an information society [7]. Nursing education must be fully able to prepare practitioners to be ready to act as information management advocates for patients and clients, in order to help patients and clients navigate the masses of accessible information in a safe and effective way. Moreover, nurses also need to be prepared to act as custodians of health and social care information within a governance framework.
Nursing faces new opportunities and challenges, from both the society around us and the increasing demands to work effectively in an information intensive environment. Nursing must look both to the past and to the future in order to prepare nurses to cope at the highest level with the demands placed upon them.
Taking the information model described, do we rely upon stored tradition or do we travel a less trodden path? Tradition in nursing is a strong influencer, which may be more in the minds of those who uphold it rather than in fact. We have seen poor tradition in action in both nursing education and in practice settings. In the world of health information technology, the plethora of computer systems introduced over the past 20 years has done little more than mechanize traditional processes; forms have been replicated on a computer screen under the guise of computerization. Similarly in nursing education, lecture notes have been loaded onto the Web under the guise of using the Web for teaching. Neither of these is helpful or effective for the purpose for which it was intended.
If we move away from tradition, life becomes considerably more uncomfortable. No longer can we rely upon previously safe methods in nursing education. It is easily understood why tradition plays such an important part in the nursing education of today. However, let us examine another possible area of consideration, that of developing curriculum that accepts the argument of conscious and subconscious thought. With the potential of reducing the currently crammed curriculum with one that has a clear mission of separating conscious and subconscious nursing.
We, in nursing education must get our act together and undertake the role of education within today’s and tomorrow’s information society or we are disadvantaging our students. We, in nursing education must take the lead as opposed to catching up around nursing/health informatics. As discussed in an earlier chapter the unique role nursing has is that of being the only health professional with 24/7 patient contact.
There is an information and communications technology continuum upon which we should all position ourselves. At the one end is information, where those positioned understand personal and professional value sets of information, its acquisition, its filtering (conscious and unconscious), its storage, its dissemination, and its use. At the other end is technology, where those positioned are fully versed with all manner of technology and are able to affect its use with competence. In the middle, are those positioned with the ability to have insight into information management and an insight into the possibilities of technology probably without the skills to affect such possibilities. At all times, while positioning ourselves on the continuum, we must be aware of the professional needs of nursing education and prepare ourselves to meet and surpass those needs.
Does Mrs Smith, admitted yesterday for a hip replacement operation expect a nurse to be skilled in word-processing, or does she expect a nurse to be skilled in information management? I would suggest the latter, although the words used by Mrs Smith may not be as above, more likely she will ask questions such as, ‘This will help my walking won’t it nurse?’, ‘I won’t have too much pain after the operation, will I?’, ‘It is only two years since I was last in this hospital but everything seems to have changed.’ And ‘I have no family who can come and collect me when I’m ready for discharge, how will I get home?’ The nurse must know how to obtain answers to these and similar questions and how to record any information outcomes from her answers.
In the next chapter we examine some ways in which nursing education has exploited technology to provide solutions now embedded into nursing courses by moving away from using the technology in a mechanistic fashion.
It is clear that there is growing reliance upon health based information from computer systems to inform local, State (or regional) and National decision making, “Throughout many western national healthcare services, extensive e-Health infrastructures and systems are now viewed as central to the future provision of safe, efficient, high quality, citizen-centred health care” [8]. The information generated will guide choices for provision of healthcare. As key informaticians, nurses need to understand why the information used must be accurate, timely and appropriate for us to be able to move forward with confidence in the healthcare provision choices made. Such confidence will be achieved through nursing education.
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