informatics is extended to include cognitive science.
The Foundation of Knowledge model is also introduced as the organizing conceptual framework of this text, and the model is tied to nursing science and the practice of nursing informatics. To lay the groundwork for this discussion, consider the following patient scenario:
Tom H. is a registered nurse who works in a very busy metropolitan hos- pital emergency room. He has just admitted a 79-year-old man whose wife brought him to the hospital because he is having trouble breathing. Tom immediately clips a pulse oximeter to the patient’s finger and performs a very quick assessment of the patient’s other vital signs. He discovers a rapid pulse rate and a decreased oxygen saturation level in addition to the rapid and labored breathing. Tom determines that the patient is not in immedi- ate danger and that he does not require intubation. Tom focuses his initial attention on easing the patient’s labored breathing by elevating the head of the bed and initiating oxygen treatment; he then hooks the patient up to a heart monitor. Tom continues to assess the patient’s breathing status as he performs a head-to-toe assessment of the patient that leads to the nursing diagnoses and additional interventions necessary to provide comprehensive care to this patient.
Consider Tom’s actions and how and why he intervened as he did. Tom relied on the immediate data and information that he acquired during his initial rapid assessment to deliver appropriate care to his patient. Tom also used tech- nology (a pulse oximeter and a heart monitor) to assist with and support the delivery of care. What is not immediately apparent, and some would argue is transparent (done without conscious thought), is the fact that during the rapid assessment, Tom reached into his knowledge base of previous learning and experiences to direct his care, so that he could act with transparent wisdom. He used both nursing theory and borrowed theory to inform his practice. Tom certainly used nursing process theory, and he may have also used one of several other nurs- ing theories, such as Rogers’s science of unitary human beings, Orem’s theory of self-care deficit, or Roy’s adaptation theory. In addition, Tom may have applied his knowledge from some of the basic sciences, such as anatomy, physiology, psy- chology, and chemistry, as he determined the patient’s immediate needs. Informa- tion from Maslow’s hierarchy of needs, Lazarus’s transaction model of stress and coping, and the health belief model may have also helped Tom practice profes- sional nursing. He gathered data, and then analyzed and interpreted those data to form a conclusion—the essence of science. Tom has illustrated the practical aspects of nursing science.