Nursing Outlook
Volume 56, Issue 6 , Pages 332-333, November 2008

Cognitive informatics: An essential component of nursing technology design

  • Kathleen Mastrian, PhD, RN

      Affiliations

    • Corresponding Author InformationCorresponding author: Kathleen Mastrian, Penn State Shenango, 147 Shenango Avenue, Sharon, PA 16146
    • ,
  • Dee McGonigle, PhD, RN, FACCE, FAAN

Article Outline

The implementation of various information technology (IT) systems designed to support, enhance and even transform healthcare delivery is inevitable. What is less certain, however, is whether or not these systems will be utilized to their greatest capacity and whether nurses will appreciate how IT systems can contribute to the knowledge base of nursing and to clinical practice. One might wonder why this seemingly counterintuitive discrepancy over information system usage and appreciation exists. The answer may very well lay behind the scenes in the infrastructure of the IT system and its user interfaces, especially in how closely the functions of the system resemble human cognition and practice patterns of the nurses utilizing them. A relatively new addition to the informatics foundations family, cognitive informatics (CI), will provide useful insights into how and why IT is embraced or resisted. In this column, we will provide an overview of cognitive informatics and the potential contributions of this emerging field to the design of effective clinical IT systems.

 

Nurse informaticists and nurse scientists recognize the need to capture and describe the cognitive aspects of the knowledge work of nurses in critical thinking, decision-making, and problem-solving processes that are central to nursing practice. The use of cognitive science principles and, particularly, the examination of how information is represented, processed, stored and retrieved in the mind have helped to shape the development and advancement of computing procedures as computer scientists attempted to mimic these natural processes in the artificial world. Cognitive informatics seeks to investigate these human cognitive processes and apply them to computer science and information management to improve the human-computer interface and usability of programs. “CI is a cutting edge and interdisciplinary research area that encompasses informatics, computer science, software engineering, mathematics, knowledge theory, cognition science, neurobiology, psychology, and physiology.”1 Cognitive informatics is the missing link between science and informatics as our brains and minds are explored. The brain processes information from the real world into the mind or the abstract realm of one's being that exemplifies the subjectivity or individuality of our processing—our thoughts, memory, intelligence, emotional expression, reasoning abilities and our personality—who we are. This connection between our physical and abstract or perceived worlds has been the basis of scientific dialogues and studies related to CI.2, 3, 4 According to Pacific Northwest National Laboratory4: “A main goal is to research and develop technologies capable to facilitate and extend the information management capacity of individuals through the development and application of novel concepts in human-system integration to address cognitive bottlenecks (e.g., limitations in attention, memory, learning, comprehension, visualization abilities, and decision making). Such mitigations may include applications and technologies informed by research in psychology/behavioral science, neuroscience, artificial intelligence, or linguistics.”

Understanding CI principles and applying them appropriately will help design engineers develop usable, efficient, and appropriate technology interfaces to transform nursing practice. Smith5 suggests that a well-designed clinical IT system may increase nurse retention rates by reducing the opportunities for clinical error, saving valuable time in the processing of information for efficient care delivery and improving work flow.

An additional clinical IT design challenge is the fact that several disciplines (physicians, nurses, pharmacists, etc.) use a clinical information system. Johnson and Turley6 found that the cognitive processing of physicians and nurses differ significantly and reflect their respective practice models. Clearly, one size does not fit all. Therefore, clinical interfaces must be separate and uniquely designed to be consistent with the practice domain. “Successful software reflects the users' goals, task and processes.”6 When a system is appropriately designed, it can reduce the cognitive load of the clinician using the interface and allow the user to focus energies on higher-order thinking skills, rather than on using the interface.7 So, how can system designers use CI principles to help ensure that technology will complement nursing knowledge and practice and be accepted and utilized by nurses?

The answer is in the cognitive processing analysis techniques that attempt to uncover the cognitive structures and processes of the users interacting with the IT system. Although much of the research related to cognitive processing analysis has focused on physician use of—or resistance to—clinical technologies, these same techniques could be easily used for analysis of nursing practice. Research approaches to complex cognitive analysis described in the literature include design heuristics, cognitive task analysis using task based models or think out loud techniques (to discover the essence of the tasks and decision-making processes), propositional and semantic analyses (to uncover the mental models used by practitioners), and distributed cognition that focuses on the organizational culture rather than the individual as the unit of analysis.6, 8, 9, 10

As Paley, Cheyne, Dalgeish, Duncan, and Niven11 state, “The central claim, in both cognitive science and nursing, is that there are two distinct forms of cognition, holistic-intuitive and analytical-scientific, and that this distinction is theoretically significant.” According to Mastrian,12 the very core of nursing practice requires problem-solving and decision-making as nurses help people manage their responses to illnesses and work to maintain or restore their health. As the nurse's holistic-intuitive and analytical-scientific forms of cognition weave into this dynamic interplay between the patient, circumstance, healthcare team and healthcare system, the IT systems that nurses rely on must be able to support their practice. The software that is designed and used by nurses must model the human/natural decision-making processes that result from the holistic-intuitive and analytical-scientific cognition while taking into account educational level, experiential background and grasp of the current situation being faced. These cognitively robust systems will support and extend our thinking, helping us choose the best course of action and, ultimately, make better decisions for our patients.

Future implications for nursing while somewhat difficult to imagine, will surely include determining how we will interact with cognitive information systems and each other; determining how and what information to document, what information to share and how to share it; and identifying the key players in the shared information loop. We are just beginning to witness the impact from the seminal work being done in cognitive science, and nursing policymakers, educators, researchers, clinicians, and administrators must all work together to see this new area of cognitive science actively embraced and integrated within our evolving nursing practice. We call upon the academy to take the lead in ensuring that cognitive informatics principles are integrated into nursing support tools; well-designed systems that reflect the cognition of nurses will lead to well-supported, safe, secure, and transformed practice.

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References 

  1. Wang Y. Cognitive informatics: A new transdisciplinary research field. Brain and Mind. 2003;4:115–127
  2. Wang Y. On cognitive mechanisms of the eyes: The sensor vs. the browser of the brain. http://csdl2.computer.org/comp/proceedings/icci/2003/1986/00/19860225.pdfAccessed on September 3, 2008
  3. Dartnell C, Martin E, Hagege H, Sallantin J. Human discovery and machine learning. http://hal-lirmm.ccsd.cnrs.fr/docs/00/27/43/08/PDF/IJCINI_simple.pdfAccessed on September 4, 2008
  4. Pacific Northwest National Laboratory (PNNL). (2008). Cognitive Informatics. http://www.pnl.gov/cogInformatics/Accessed on September 1, 2008
  5. Smith C. New technology continues to invade healthcare: What are the strategic implications/outcomes?. Nurs Adm Q. 2004;28:92–98
  6. Johnson C, Turley J. The significance of cognitive modeling in building healthcare interfaces. Int J Med Inform. 2006;75:163–172
  7. Patel V, Currie L. Clinical cognition and biomedical informatics: Issues of patient safety. Int J Med Inform. 2005;74:869–885
  8. Adams R, Langdon P. Principles and concepts for information and communication technology design. J Vis Impair Blind. 2003;97:602–611
  9. Patel V, Arocha J, Diermeier M, Greenes R, Shortliffe E. Methods of cognitive analysis to support the design and evaluation of biomedical systems: The case of clinical practice guidelines. Int J Med Inform. 2001;34:52–66
  10. Hazelhurst B, Gorman P, McMullen C. Distributed cognition: An alternative model of cognition for medical informatics. International Journal of Medical Informatics. 2008;77:226–234
  11. Paley J, Cheyne H, Dalgeish L, Duncan E, Niven C. Nursing's ways of knowing and dual process theories of cognition. J Adv Nurs. 2007;60:692–701
  12. Mastrian K. Cognitive Informatics (CI) and Nursing Practice. http://ojni.org/12_1/kathy.htmlAccessed on September 16, 2008

 Kathleen Mastrian, PhD, RN, is an Associate Professor and Program Coordinator for Nursing, Penn State Shenango, Sharon, PA 16146.

 Dee McGonigle, PhD, RN, FACCE, FAAN, is an Associate Professor of Nursing & Information Sciences and Technology, Penn State New Kensington, New Kensington, PA 15068.

PII: S0029-6554(08)00270-4

doi:10.1016/j.outlook.2008.09.010

Nursing Outlook
Volume 56, Issue 6 , Pages 332-333, November 2008

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