The Nelson D-W Model was refined to

include wisdom, underscoring its crucial

role in nursing decision-making. This
addition has led to ongoing discussions
about how wisdom can be integrated into
technological systems, particularly in the
context of nursing informatics.

Informatics:
Evolution of the
Nelson Data,
Information,
Knowledge and
Wisdom Model

Ramona Nelson, PhD, BC-RN, ANEF, FAAN

 Table of Contents
Informatics: Evolution of the Nelson Data, Information, Knowledge and Wisdom
Model .......................................................................................................................................................... 1
The Future of Nursing Informatics........................................................................................... 4
Author .................................................................................................................................................... 9
References .......................................................................................................................................... 11
1 Friday, March 14, 2025

Informatics: Evolution of the Nelson Data, Information,

Knowledge and Wisdom Model

Ramona Nelson, PhD, BC-RN, ANEF, FAAN

Citation: Nelson, R., (September 19, 2018) "Informatics: Evolution of the Nelson Data,
Information, Knowledge and Wisdom Model: Part 1" OJIN: The Online Journal of Issues in
Nursing Vol. 23, No. 3.

DOI: 10.3912/OJIN.Vol23No03InfoCol01

The Data, Information, the emerging discipline of in nursing informatics.

Knowledge and Wisdom medical informatics. Under Dr. Graves’
Model (Nelson D-W) However, adding the direction, each of the four
depicting the concept of wisdom to these post-doc students that
megastructures and three concepts and summer were immersed
concepts underlying the defining how wisdom was in an educational process
practice of nursing related to the established based on defining the
informatics was included concepts was new. Part 1 practice of nursing
for the first time in the of this two-part informatics starting with
2008 American Nurses Informatics Column will the concepts of data,
Association (ANA) Scope focus on the addition of information, and
and Standards of Practice wisdom to the model. Part knowledge. Dr. Graves
for Nursing Informatics 2 will explore how the was also busy writing an
(ANA, 2018). The date of model has changed in the article that would become
this publication was almost 30 years since this one of the seminal articles
almost 20 years after the first brief article. in the nursing literature.
first version of the model
Two driving forces In 1989, Judith Graves
had been published. In
interacting together led to and Sheila Corcoran
1989, a colleague and I
my decision to include published their article
wrote a brief article
wisdom as part of the using the concepts of data
defining the concepts of
model. First, in the information and
data, information,
summer of 1988, I knowledge in defining
knowledge, and wisdom.
completed a post-doc in nursing informatics as a
(Nelson & Joos, 1989
nursing informatics with scientific discipline. “The
Fall). At that time, the
Judy Graves at the working definition of
three concepts of data,
University of Utah. Dr. nursing informatics [is]
information, and
Graves had just the study of the
knowledge were well
transitioned to the management and
established in the field of
university where she was processing of nursing
information science and
establishing one of the data, information and
had been introduced in
first graduate programs knowledge” (Graves &
© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
2 Friday, March 14, 2025

Corcoran, 1989, p. 228). and information leading As Graves and Corcoran

The article also provided a to knowledge. Procedural point out in their article,
conceptual model that knowledge involves the model was built on the
was “intended to serve as knowing how to do work of Bruce Blum. “This
a model for something. For example, framework for nursing
understanding the knowing how to assess a informatics relies on a
relationships between the patient’s breath sounds taxonomy and definitions
concepts and procedural requires procedural of the central concepts of
knowledge” (Graves & knowledge. In the Graves data, information and
Corcoran, 1989, p. 228). model, management knowledge put forward by
The model presented the processing is the Blum (1986)” (Graves &
three concepts of nursing procedural knowledge Corcoran, 1989, p. 227).
data, information and used to process data, Blum had
knowledge in a linearly information, and
relationship with data knowledge.
leading to information
previously defined the could be processed by the data elements.
concepts of data, information technology. For example,
information and height, weight,
• Data –
knowledge in discussing age, and gender
uninterpreted
the discipline of medical are data elements
items, often
informatics (Blum, 1986). that can be used to
referred to as data
One of his goals was to calculate the BMI.
elements. An
explain that the discipline The BMI can be
example might be
could not be defined by used to determine
a person’s weight.
information technology if the individual is
Without additional
that is used in the underweight,
data elements
practice on medical overweight,
such as height,
informatics, but rather normal weight or
age, overall well-
the discipline of obese.
being it would be
informatics is defined by • Knowledge is built
impossible to
how the provider uses on a formalization
interpret the
technology to meet of the
significance of an
human needs. “The relationships and
individual
emphasis is on the interrelationships
number.
medical use of the between data and
• Information – a
information technology information. A
group of data
and not on the application knowledge base
elements that
of technology to medicine” makes it possible
have been
(Blum, 1989, p. 24). In to understand that
organized and
making his point, Blum an individual may
processed so that
defined three objects that have a calculated
one can interpret
BMI that is over 30
the significance of
© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
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and not be obese. will have spiked a nursing to senior nursing

At this time, temp. A rule might students in the classroom
several automated read: if a patient and the clinical setting.
decision support complains of chills, The clinical setting was in
systems included a then take the a major medical center.
knowledge base patient’s The nursing staff in this
and a set of rules temperature and unit were excellent and
for applying the repeat in 30 provided outstanding role
knowledge base in minutes. models for students. The
a specific patients were acutely ill
The second driving force
situation. For with major medical
came from my experience
example, the problems. In other words,
as a university faculty
knowledge base it was an ideal setting for
member in a clinical
may include the teaching senior nursing
setting. When I returned
following students.
in the fall 1988 to my
information. A
faculty position, this During this fall term one
fever or elevated
literature and these of the patients on this
temperature often
concepts building the clinical unit had a major
begins with a chill.
foundation of nursing impact on my thinking
At the beginning of
informatics were well about the concepts of data
the chill the
engraved in my thinking. information and
patient’s
knowledge. The patient
temperature may One of my primary
was a young woman who
be normal or even responsibilities as a
had delivered her
sub-normal but in faculty member was
30 minutes it is teaching medical surgical
likely the patient
first child and had been illness. Caring for such a forward and finish a
immediately transferred patient is always a heart difficult procedure such as
to the medical center with wrenching challenge. deep suctioning and when
a variety of serious to stop and let the patient
The students and I
medical problems and rest. They were
worked closely with the
related symptoms comfortable and confident
staff in providing quality
including high volume in this role as caregiver.
care for this patient, but
congestive heart failure, 4 Students on the other
one thing was obvious to
plus edema and hand were very
me from the first day.
pulmonary effusion. One uncomfortable. While
Experienced staff seems
year earlier she had been they were dedicated in
to be intuitive in how to
fully heathy and planning learning their role they
provide both physical and
her first pregnancy. were also very afraid of
emotional care. They
Shortly after admission to saying or doing the wrong
knew what to say and
our unit she was thing. Before walking in
what to leave unsaid.
diagnosed with a terminal the room, I would often
They knew when to move
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see a student take a deep and in turn the practice of the practice of nursing is
breath. nursing informatics defined by how nurses use
occurs when data, data, information and
I suspect if we had given a
information and knowledge in providing
theory-based test on the
knowledge are used to care. The wisdom of
stages of death and dying
meet the health needs of nursing is demonstrated
to both students and staff
individuals, families, when the nursing data,
the scores would be very
groups and communities. information and
similar. It is even possible
knowledge are managed
that the students’ scores The more I considered
and used in making
would be higher since what I was seeing on the
appropriate decisions that
they had studied this clinical unit and what I
meet the health needs of
material more recently. understood about the
individuals, families,
But as my observations conceptual framework of
groups and communities.
about the care of this nursing informatics, the
While these concepts do
patient demonstrated more I felt that the model
not require technology,
there is a difference was not complete. A part
the practice of nursing
between knowing of the picture was
informatics does require
something and being able missing. The data,
technology. The practice
to apply that knowledge information and
of nursing informatics
to a specific situation. knowledge that nurses
uses “information
Data can be processed to use is the foundation on
structures, information
produce information. which nursing
processes and information
Data and information are educational programs are
technology” to support
the building blocks for built and in turn is the
this practice. (American
creating knowledge. But foundation for the
Nurses
the practice of nursing practice of nursing. But
Association, 2015, p. 2) As When the concept of informatics. For example,
Blum pointed out decades wisdom was first the 2001 edition of the
ago, the technology does proposed several experts ANA Nursing
not define the practice but in the field questioned Informatics: Standards
rather the practitioners’ whether the concept and Scope of Practice
use of technology defines belonged in the model included the following
the practice. depicting the conceptual statement:
framework for nursing
The Future of Nursing
Informatics
After the Graves and knowledge (Nelson and decisions and
Corcoran (1989) article, Joos, 1989). Wisdom may implementing nursing
others proposed adding be defined as the actions. It includes the
the concept of wisdom to appropriate use of data, ability to integrate data,
the triad of data, information, and information, and
information, and knowledge in making knowledge with
© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
5 Friday, March 14, 2025

professional values when with that technology.

managing specific human Information technology is
problems. necessary for the practice
of nursing informatics but
Some nursing informatics
it is not sufficient to
(NI) experts believe
define the practice. In a
strongly that wisdom is
2002 publication, I
the purview of humans
created a figure
and cannot or should not
demonstrating how the
be considered as a
different levels of
function within
information technology
technology. Others
related to the concepts of
believe that informatics
data, information,
solutions consistent with
knowledge and wisdom.
professional values and
(Englebardt & Nelson,
useful to expert nurses
2002).
will require the
incorporation of wisdom.
This controversy makes
the inclusion of wisdom
into the triad of data,
information, and
knowledge currently an
unresolved issue within
NI. (American Nurses
Association, 2001, p. 130)

For this author the

question goes back to the
original question that
Blum raised. Is the scope
of the practice defined by
the functionality of the
technology or by the
practitioner’s use of the
technology? This is not a
simple question. The
practice of informatics
would not exist without
the technology. In
addition, the functionality
offered by the technology
has a strong influence on
what practitioners can do

© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
6 Friday, March 14, 2025

Figure 1. The Relationship of Data, Information, Knowledge, and Wisdom and Automated Systems: version 1

Credit: Copyright Ramona Nelson. Used with the permission of Ramona Nelson, President Ramona Nelson Consulting at
[email protected] and Sheila P. Englebardt. All rights reserved.

© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
7 Friday, March 14, 2025

In the figure, an The first model, Figure 1,

information system failed to clearly
processes data to produce demonstrate the
information. A decision overlapping
support system is defined interrelationship between
as an automated system the concepts used in the
that can support a model and the levels of
decision maker in the technology as classified
process of decision within the Figure. In
making by providing data response to this reality,
and information. An Figure 2 was developed
expert system goes one showing the overlapping
step farther and actually interrelationships
uses data and information
to make a decision. A
common example of an
expert system in
operation can be seen if
one has ever opened a new
credit card account while
checking out of a store. In
a few minutes an
automated system makes
a decision rather or not to
offer credit. Historically
these types of decisions
were made by human
beings based on
information included in
an application for a credit
card as well as other
sources of data. The
judgement of credit
worthiness of the
customer depended on
how a person interpreted
that information and
data. Today in many cases
the decision concerning
the creditworthiness of a
customer has been
automated.

© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
8 Friday, March 14, 2025

Figure 2. The Relationship of Data, Information, Knowledge, and Wisdom and Automated Systems: version 2.

Credit: Copyright Ramona Nelson. Used with the permission of Ramona Nelson, President Ramona Nelson Consulting at
[email protected]. All rights reserved

© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
9 Friday, March 14, 2025

There is no question that While the new model does Nelson D-W model in
computers can process a better job of showing their doctoral dissertation
data yielding information. overlapping relationships research and have been
IBM’s Watson as well as there have been problems confused by this error.
other artificial how this model is Figure 2 as depicted here
intelligence (AI) based understood. There has is used to illustrate how
systems are been as least one textbook the concepts in the Nelson
demonstrating how published that modified D-W model might interact
automated systems can this figure and described with the various levels of
process information to their modification as the information technology. It
create new knowledge. Nelson D-W model. I have does not illustrate the
Today the amazing been assured this error relationships and
developments within will be corrected with the interrelationships with
applications based on AI second printing of that the actual model. The
the question becomes book. However, as a result evolution of the model as
where does wisdom fit in of this error, I have been well as the relationships
automated systems? contacted by two doctoral and interrelationships
students to date who are will be further explored in
planning to use the part 2 of this series.

Author
Ramona Nelson, PhD, early 1980’s, one of Dr. Dr. Nelson’s more recent
BC-RN, ANEF, FAAN Nelson’s employee research and publications
Email: benefits while teaching at focus on the specialty area
[email protected] the University of of health informatics. Her
et Pittsburgh was the latest book, Health
opportunity to take Informatics: An
Dr. Nelson holds a
university courses for Interprofessional
baccalaureate degree in
only $5.00 a credit. After Approach (2018), co-
nursing from Duquesne
taking courses in authored with Nancy
University, and master’s
computer assisted Staggers, received the
degrees in both nursing
instruction and second place American
and information science,
information science Journal of Nursing Book
as well as a PhD in
theory, she recognized of the Year award for
education, from the
these tools (computers) Information
University of Pittsburgh.
just might be somewhat Technology/Informatics.
Prior to her current
useful at the bedside and The second edition
position as President of
in the classroom. She has continues today as a
her own consulting
been exploring and primary textbook in the
company, she was
discovering just how field of health
Professor and Chair of the
useful they can be ever informatics. Based on her
Department of Nursing at
since. contributions to nursing
Slippery Rock University
and health informatics
in Pennsylvania. In the
she has been inducted
© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
10 Friday, March 14, 2025

into both the American discipline by the inter-professional world

Academy of Nursing and American Medical of healthcare can
the first group of fellows Informatics Association. maximize the advantages
in the National League for Her goal in serving as and manage the
Nursing Academy of Editor of OJIN’s challenges that
Nursing Education. She Informatics Column is to computerization brings to
has also been recognized open a discussion about our practice.
as a pioneer within the how we as nurses in the

© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018
11 Friday, March 14, 2025

References
American Nurses Association. (2001). Scope and Standards for Nursing Informatics Practice.
Silver Spring, MD: Nursesbooks.org.

American Nurses Association. (2008). Nursing Informatics: Scope and Standards of Practice.
Slivers Springs, MD: Nursesbooks.org.

American Nurses Association. (2015). Nursing Informatics: Scope and Standards of Practice.
(2nd, Ed.). Silver Spring, MD: Nursingbooks.org.

Blum, B. (1989). Medical informatics - Phase II. In H. Orthner, & B. Blum (eds.),
Implementing Health Care Information Systems (p. 24). New York, NY: Springer-Verlag,

Blum, B. L. (1986). Clinical Information Systems. New York, NY: Springer-Verlag.

Englebardt, S., & Nelson, R. (2002). Health care informatics: An interdisciplinary approach.
St Louis, MO: Mosby, Inc.

Graves, J., & Corcoran, S. (1989 Winter). The study of nursing informatics. IMAGE: Journal
of Nursing & Scholarship, 21(4), 227-231.
Nelson, R., & Joos, I. (1989 Fall). On language in nursing: From data to wisdom. PLN Vision,
p. 6.

© 2018 OJIN: The Online Journal of Issues in Nursing Article published September 19, 2018