The paper is entitled Nursing Informatics Theory Paper: An Analysis and it generally discusses Patricia M. Schwirian’s Nursing Informatics Theory called NI Pyramid and Schwirian Cube. The goal of the paper is to establish its usefulness in the clinical nursing practice and find ways in which the system can further be developed to address the recent trends in information technology to fit the demands of the nursing health care delivery system. After extensive review it was established that the model has perfect use for the clinical nursing practice. However, issues on security, cost and maintenance should be addressed. The proposed model may run some risk with issues concerning privacy and confidentiality.
Keywords: Nursing Informatics Theory, NI Pyramid, Schwirian Cube, privacy and confidentiality, clinical nursing practice
According to the AMIA, “[nursing informatics]is defined as science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide” . The growing population of technology and information technology has paved the way for organizations to reinvent their system to a process that would not only expedite work, but at the same time ensure quality, efficiency and accuracy. In lieu with this, different organizations, including the nursing profession has ventured into the information technology platform in the hope of serving their clientele better. While, nursing informatics is a new practice, the immense popularity of the said practice has led many researchers and health professionals to extensively evaluate the system and create a more substantial evidence that would justify that it will improve the practice of nursing. This paper would hope to evaluate the nursing informatics theory as developed by Patricia M. Schwirian, in the hope of establishing the efficiency and effectiveness of the system. It would integrate a review of the nursing informatics theory model taking into consideration the individual variables that the proponent utilized to develop her system of nursing information through information technology.
Background of the Theory
Numerous researchers and nurse informaticists have conceptualized different theoretical frameworks and models that has served as the basis and foundation of innumerable careers in the healthcare and nursing profession. A renowned pioneer of one of nursing’s newly founded theory is Patricia M. Schwirian. Ms. Schwirian was one of the principal advocate to stress the necessity of developing a framework that would serve as the model to a specialization in informatics.
An esteemed professor at The Ohio State University College of Nursing & Department of Family Medicine, Patricia M. Schwirian has been known for developing two theoretical frameworks that is presently being used as a valuable tool in the nursing profession ("American Medical Informatics Association," 2015). Schwirian’s first model was named after her being the developer and conceptualizer of the model. It is known as the “Schwirian’s Cube”, a title that was dubbed by Gary Hales. Although the Schwirian’s Cube was not really a cube but a parallelepiped, it was called as such because of the impression that it is multidimensional. The second model developed by the Schwirian was known as “The NI Pyramid”, short for nursing informatics.
In an interview with Professor Patricia M. Schwirian she revealed that she was not really into computers and information technology at the beginning of her career. In fact, according to the professor her career initially began in education and her fascination and interest in computers on came when she was conceptualizing on a research that connects education and social behavioral pattern . The professor said that during this process, she saw how computers are useful tools for data analysis. Nevertheless, the idea on the potentials of computers in nursing through computer informatics came in further in 1982 as mentioned earlier.
Statement of the Problem
This paper entitled, Nursing Informatics Theory Paper: An Analysis is designed to assess and evaluate the merits of the NI Pyramid and Schwirian Cube in the practice of clinical nursing. The following questions were formulated to serve as a guide to facilitate the course of the study:
What are the factors or components that makes up the Schwirian’s Cube and the NI Pyramid model?
What relevance does the different factors or components hold in reference to the nursing informatics theory or model?
What is the contribution of the nursing informatics theory developed by Professor Patricia M. Schwirian to the nursing practice?
What implications does it have for the future of nursing?
Objective of the Study
The purpose of studying the two nursing informatics theory—Schwirian’s Cube and the NI Pyramid model is to establish its usefulness in the clinical nursing practice and find ways in which the system can further be developed to address the recent trends in information technology to fit the demands of the nursing health care delivery system.
Significance of the Study
This study is specifically designed to address the nursing profession, particularly the clinical nursing practice. In lieu with this the following sectors had been identified to find this study useful and relevant.
The Nursing Academe.
The nursing academy is believed to benefit from this study as it would serve as a guide that would establish the future trend in nursing. This could help the nursing schools in preparing a curriculum that would help future nurses in utilizing computers and other similar platform to improve the nursing practice. At the same time, this paper also contains two useful models that could be used as a foundation for the curriculum that will be developed.
Since this study is designed to establish the relevance of nursing informatics in clinical nursing, clinical nurses are targeted to benefit from this study. This study is supposedly to make the practice of clinical nursing more efficient, accurate and convenient. At the same time, this paper hopes to serve as an avenue that would inspire clinical nurses to contribute to the future of nursing informatics through data and insights about the practice to which nursing informatics could be most beneficial.
Considering that nursing informatics is new in the field of nursing and is still at a very critical stage, this study is particularly designed to serve as an avenue that hopes to motivate and encourage future researchers to conduct study on how to further improve nursing informatics and find new channels where the specialized sector of the nursing practice can be used. Furthermore, this paper hopes to offer additional materials that can be utilized as useful reference to future study.
While this study is not designed to assume to generalize its findings, it is not ambitious to declare that it will provide solutions or answers to the issues that confronts the nursing profession.
This section of the paper aims to discuss two of Professor Patricia M. Schwirian’s theoretical models on nursing informatics—the Schwirian’s Cube and the NI Pyramid. Each model shall be discussed based on the variables used in the system, its respective role and relevance in the system. Finally, it will highlight the significant contribution of each model to the nursing profession in general and the specialization of nursing informatics as a specialized branch of nursing.
The Schwirian’s Cube
In a published researcher co-authored by Professor Patricia M. Schwirian, the authors dealt with the use of computers in the nursing profession, particularly in the process of research and data analysis. The paper was in fact a primer to a course in nursing research explaining how students and nurses could utilized computers as a tool that would allow them to complete their research more efficiently and effectively. According to the authors, a Masteral degree in Nursing would require the completion of a thesis. However, initially this was not preferred by candidates because of the complexities of documentation, data processing, and data analysis. The introduction of computers has allowed students to reconsider their decision. In fact, approximately 90% of students from the University of Ohio were taking the program with thesis writing as an extension for completing their Masteral degree . However, as the number of enrollees for thesis writing increases the faculty that is equipped with the proper knowledge of understanding and using computer software and application has drastically decreased.
The proposed course in nursing, particularly relating to research implores the use of a matrix which Professor Schwirian developed called the Schwirian’s Cube. The said model contains three components: (a) the type of practice, (b) the type of computer and (c) practice setting. This matrix is collaborated with the Schwirian’s Parallelopiped, which is a three dimensional model. According to Schwirian, two dimensions of the Schwirian Parallelopiped are similar to the one contained in the Cube—the type of compute and the practice setting. The third dimension, however, varies in terms of activities. These activities often include the following: (a) the literature review; (b) data input, storage and retrieval; (c) statistical analysis of data, (d) model building and testing; and (e) word processing (Schwirian & Yates, 1984, p.966).
The NI Pyramid
The NI Pyramid is composed of four tiers of topics arranged in a pyramidal shape. Each tier contains an element of information that will aid the researcher in developing and answering questions on interest to the topic of nursing informatics. The elements are as follows, “(1) the “raw material”, (2) the technology, (3) the users, and (4) the goal”, (Schwirian, 1989, p. 292). The first element, or “raw material” is simply any information that the researcher can find related to the nursing profession. From this element, the researcher proceeds to the second element, the technology. The technology refers to the computer and its respective computer system. Next is the third element, the users. The users refer to the individuals who are utilizing the technology. For this specific framework, the third element is referred to nurses or students. Lastly, the researcher will focus on the fourth element, and the most relevant element, the goal. At this point of the framework, the goal is the purpose of all the research in its entirety. The goal is the basis for the remaining three elements.
Figure 1: Schwirian’s NI Pyramid
Above is a figure of the pyramid. The formation of a pyramid may lead the reader to believe that a certain element is more important than another. In actuality, the figure has the four elements arranged in the order in which the theory is most easily defined and described. The arrows on either side of the pyramid show that the researcher can begin their focus with any of the elements and still be able to complete their objective. The figure presents the goal at the top of the pyramid as a reminder for the researcher that this is the main focus of their research to begin with.
Considering the valuable insights that have been derived from understanding the two nursing informatics theory—the Schwirian’s Cube and the NI Pyramid, developed by Professor Patricia Schwirian it has been established that both models offer a significant contribution to the nursing profession, particularly in the clinical nursing practice as it has already established great use in research and development. Aside from serving as a tool of data analysis, the system can also allow for efficient access and delivery of information using a more efficient and convenient channel. Clinical Nursing Practice allows nurses to document important information regarding the patient’s identification, medical history, medical records and other relevant documentations. With the system of nursing informatics fitted specifically and designed in accordance to the forms and requirements of the hospital and selected medical institution, there would be a uniformity that would standardize the information secured by hospitals. This uniformity would be very useful, especially in a more effective diagnosis and transfer of care. The receiving hospital and medical team would find it more convenient to properly diagnose the patient if all information is transferred immediately from the original facility of care. In addition, applying nursing informatics in the clinical practice as initially proposed by Professor Patricia Schwirian would allow for more convenient and accessible channeling of information. Delays caused by the transfer would significantly be decreased therefore expediting the necessary care and medical attention needed by the patient. Documentation is also very effective using an electronic based system of information. This would mean that doctors and other members of the medical team responsible in the care of the patient can easily just access the information, make necessary additional and correction without having to redo all the process. Similarly, the format does not have to be frequently changed because it is already fed into the system. Storage is also done more efficiently because it is no longer paper based. The absence of papers in the traditional paper stock filing would save an enormous amount of money and space.
Nevertheless, there are also some challenges identified in adapting a nursing informatics system which is not addressed by the model proposed by Professor Patricia Schwirian. Among these challenges included security. The professor failed to discuss what could potentially safeguard the information from being leaked to the internet for malicious purposes. If information about the patient is available in the hospital system for quick and easy access, then that would mean that is also susceptible to being access for malicious intention. In addition, the development of this system has no safety protocol that would determine who can have access to the information. Usually sensitive information is found in patient’s medical records which could potentially damage the reputation of the patient. Another, is the potential of losing the information in the event of a system crash. Recover of information during a crash are usually impossible. If this is to happen, then it would generally compromise the details. Development of a personalized nursing information system can also be very expensive. In lieu with this, a long-term investment would be needed to fund the new system. However, not all medical and healthcare facilities may be able to have sufficient funding for this.
Conclusion and Recommendation
After extensive review and analysis of the models in Nursing Informatics developed by Professor Patricia Schwirian, it has come to the conclusion that as the professor mentioned in her initial interviews on the relevance of nursing informatics that this system of using computers as a tool in the clinical practice is very helpful in making the roles and responsibilities of clinical nurses more efficient and convenient. The professor’s proposal through the system and model she has developed has been able to enumerate all the bases that was covered to make the process easier to understand for nontechnical users. In addition, the professor has also developed a detailed curriculum as mentioned in her position paper entitled Computer Utilization for Nurse Researchers: A Course for Thesis Survival, which she co-authored with Nurse Karan Johnson-Yates in 1984.
Nevertheless, there are some grey areas that the professor failed to cover in her study. This largely involves costs, security and maintenance. While the basic foundations had been laid and identified, what generally happens after the system has been applied and implemented are generally missing. Security is largely what is very important. Considering that privacy and confidentiality are serious cases that is considered in the nursing practice, using an electronic platform is feared to violate this clauses. More so, many critics find this concern alarming if not dealt with accordingly. The proposed models both failed to capitalize on these two important implications. While advocates suggest that this is a common problem for many industries and is considered highly inevitable to control and manage 100%, this may not be a valid excuse in the nursing practice.
Hence, it is recommended that these three grey areas—cost, security and maintenance should be re-evaluated. These areas are major concerns that needs to be addressed immediately so that the clinical nursing practice can better enjoy the proposed system without having to run some issues with breach, negligence’s, privacy and confidentiality issues. There are many benefits and advantages of the nursing informatics for the clinical nursing practice. However, unless these general issues and challenges are resolved, there would be no chance of ever taking advantage of these because the risks are still very serious that it could compromise the welfare of the patients.
Overall, it can only be concluded that the effectiveness of a system or a model does not only rely on the basic framework, but on the overall output and results that usually comes after implementation. Hence, for a model to be fully successful and useful, developers should be able to look into the whole process and address all issues before actually pushing for the recommendation and adoption of their proposed model.
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Schwirian, P., & Yates, K. (1984). Computer Utilization for Nurse Researchers: A Course for Thesis Survival. Sixth Annual Symposium on Computer Applications in Medical Care (pp. 965-968). New York: LWW Publishing.
Schwirian, P. M. (1989). The NI Pyramid- A model for research in nursing informatics. In Nursing and computers: An anthology (pp. 291-294). New York: Springer.
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