How do nurses keep up with the knowledge explosion, managing the plethora of information now available in so many formats and venues? For anyone wanting to be fairly informed (fully seems impossible), we need to find ways to digest the constant flow of new information about the world, our nation, and in healthcare that affects our lives and professional practice. Further new developments in technology (and new gadgets) that might assist us in organizing, evaluating, and prioritizing the flow of information must be quickly and continuously evaluated.
 | Figure. No caption available. |
Recently, I was signing off on a doctoral student's completed clinical dissertation when she commented, “I cannot imagine trying to have written this clinical dissertation without the computer or the Internet!” That comment led me to remember that I did not begin to use a computer until late 1991 (not really so long ago) during the last course in my master's program. And, I first used work e-mail and AOL in 1992. This was also the era when cable TV was still relatively new with the largest cable presence probably CNN. Back in the nineties, it was easier to keep up, to maintain currency in one's field, and without the continuous 24/7 news cycle and complete domination of the Internet and e-mail and cell phones and texting that makes the current pace of life increasingly more frenetic. Sociologist and futurologist Alvin Toffler first described the phenomena of “information overload” in his 1970 classic book Future Shock.1 Twelve years later in 1982, another author and futurist John Naisbitt published his influential and groundbreaking book Megatrends,2 in which it now appears he correctly predicted:
* a shift from an industrial age to the information age;
* the advent of national economies into a global economy, now called “globalization,” a new term that was just beginning to be used; and
* networks as a way of radically transforming and increasing public access to goods, services, and data on a global scale
In 1998, Davis and Meyer3 described this frenetic pace of contemporary life as a world where the rate of change is so fast, it is only a “blur.”3 Many scholars have concurred with this now decades old view that knowledge continues to expand (or explode?) exponentially. And, thus the pace of change can leave some of us literally breathless. This surge in the amount of new information an educated individual needs to absorb (ie, the registered nurse or any healthcare professional) led to a new field called “knowledge management” (KM) in the 1990s. The term was likely first coined by Nonaka, who in 1991 described the “knowledge-creating company” in a Harvard Business Review article.4 Another commentator has defined this movement as such: “Like water, this rising tide of data can be viewed as an abundant, vital and necessary resource. With enough preparation, we should be able to tap into that reservoir—and ride the wave-–by utilizing new ways to channel raw data into meaningful information. That information, in turn, can then become the knowledge that leads to wisdom.5 Bellinger has made some interesting observations on KM and observes that (1) a collection of data is not information, (2) a collection of information is not knowledge, (3) a collection of knowledge is not wisdom, and (4) a collection of wisdom is not truth. He thus concludes that “information, knowledge, and wisdom are more than simply collections. Rather the whole represents more than the sum of its parts and has a synergy of its own.”6(p1) His diagram above outlines these concepts (Fig 1).
 | Figure 1. Conceptual diagram: Knowledge development as systems thinking (2004). Reprinted with permission from Bellinger G. |
The indomitable Wikipedia (now emerging as a recognized contemporary repository of the bottomless pit of global information) defines Knowledge Management as “a range of practices used in an organization to identify, create, represent, distribute and enable adoption of insights and experiences. Such insights and experiences comprise knowledge, either embodied in individuals or embedded in organizational processes or practice.” Wikipedia describes this new discipline, which includes courses taught in business administration, information systems, management, and library and information sciences.7,8 Contemporary fields that are also contributing to KM research now include information and media, computer science, public health, and public policy.9
Knowledge management today is still evolving and flourishing and it appears to have the largest impact on business and industry. Recently, Pugh and Dixon have written in the Harvard Business Review about employing individuals, known as “knowledge seekers,” who are particularly adept and valuable because they “are self-interested, they ask tough, exploratory questions of knowledge originators, extracting important nuances—not only about how a project was executed but also about how costs built up, how knowledge might be applied elsewhere, what worked and what didn't, and so on.”10(pp21–22) They also describe a “knowledge harvest” where workers/individuals engage in a time-dimensional, systematic, facilitated gathering and circulation of knowledge with a specific aim. So how do these concepts apply to nursing or nurses who seek to stay informed, both as global citizens and as credible health educators, an important role for both the professional and the advanced practice nurse?
First, it is evident that new social media tools such as blogs, wikis, and tagging (and now Twitter) can change KM. The whole Enterprise 2.011 movement is largely built around the model that the infiltration and integration of social media and related technologies will change the way workers (including nurses) not just work, but think. And I would add, and to acquire knowledge. For example, I am a regular user of Twitter (and those experts or scholars etc I follow) as a filter for information management.12 I often rely on the filter of another scholar or expert who is microblogging (in this case twittering regularly) about a subject that interests me, but that I may or may not investigate more thoroughly based on the information I am succinctly (140 characters/spaces or less) given. Other types of social media networks that can be used to transmit information in near real time across the Internet include the following top 25 social networks13 that you will commonly see in a dropdown menu on any Web site when you go to “share” or “forward” the link to someone else.
One social network not in the top 25 that has currently piqued my interest is Mister Wong. Mister Wong (http://www.mister-wong.com/ ) is a master bookmark site that can save all your favorite Web sites to a personal account, so you have access to them online no matter where you are. The unique feature about this social media network is that it can organize Internet sites of interest to make accessing information from them more efficient (Table 1).
 | Table 1. Top 25 social networks rerank |
In our own doctoral nursing program we are teaching our students how to explore and to utilize various social media networks to make their information retrieval (both personal and professional) more expeditious. This is partly why the concept of a “library” has changed or evolved so rapidly in the digital area. Libraries, including our own university library, are actually purchasing fewer books and instead subscribing to increasing bundles of journals that can be accessed electronically. Today's “library” functions very differently from how it did in the past. Interestingly, in a recent Library Review14 publication the authors report that in both the United States and the United Kingdom, overall circulation was not down when digital acquisition delivery was factored in. This is not surprising, as I am certain the majority of nursing students too conduct their MEDLINE and CINAHL searches for journal articles from their desktop computers at home. They also likely use the relatively inexpensive document delivery service or interlibrary loan to have their retrieved articles sent to them if they are not available electronically. Indeed, sometimes I wonder how often students ever physically walk into the university library at all!
It is unclear just how Internet savvy the average registered nurse is and whether this is the primary way RNs today get their information. A 2004 study from the United Kingdom15 surprisingly found very poor computer literacy skills among entering nursing students. Even a recent 2007 study of rural US nurses16 found that while the majority of the sample had computer access at home, their self-identified barriers to accessing and using clinical research findings in their practice were attributed to a lack of knowledge of research methods; lack of time at work or at home to look up information; and the lack of computers and Internet access on the nursing units. Furthermore, when computers were available, the nurses reported that poor computer literacy skills decreased their ability to quickly find and evaluate information. Additional barriers, which may have increased since 2007 (from the global economic decline), included diminishing financial support from employers for conference travel and, in their particular case, the long distances required to travel to attend such conferences.
Second, newspapers are dying everywhere. Even the Philadelphia Inquirer was near bankruptcy recently and there was a recent reorganization of their debt to keep it afloat.17 If print newspapers are dying from low circulation, does that necessarily mean RNs are getting their basic information electronically? Or, are many RNs as overwhelmed as I am sometimes? Do many others just give up because of the stress of their jobs and frustration over having so little time to easily access relevant information for their personal and professional lives? The KM movement has certainly not infiltrated or impacted nursing in any measurable way that I can discern. The only remote impact I see is the slow rise of the use of evidenced-based databases such as the Cochrane Reviews18 or the Joanna Briggs Institute Best Practice Nursing Reviews19 out of Australia to drive primary care differential diagnoses and decision making. It is also unclear what impact the Enterprise 2.0 movement is going to have in educational institutions beyond the corporate walls. Here I am slightly more optimistic. With the information explosion in healthcare and the discovery of new findings within our discipline (and in fields that are closely related that impact our practice), there must be some innovation that would better allow RNs to more systematically and efficiently maintain their personal and professional competence. Who wants to be cared for by an uninformed or underinformed nurse? Not I!
REFERENCES
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4. Nonaka Ikujiro. The knowledge creating company. Harvard Business Review. 1991;69(6):96–104. http://hbr.harvardbusiness.org/2007/07/the-knowledge-creating-company/es. [Context Link]
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16. Winters CA, Lee HJ, Besel J, et al. Access to and use of research by rural nurses (Online). Rural Remote Health. 2007;7:758. http://www.rrh.org.av/publishedarticles/article_print_758.pdf. Accessed July 21, 2009. [Context Link]
17. Brubaker H. Philadelphia Newspapers' Owner Files for Bankruptcy. Philly.com. February 22, 2009. Philadelphia newspapers' owner files for bankruptcy. Accessed June 10, 2009. [Context Link]
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