Data-information-knowledge are words that can be used to assign meaning to our complex nursing work. In the field of information technology, these words are used to give meaning and direct the flow of organizational knowledge. What is missing is humanness, or in other words, understanding and wisdom. Human beings add the understanding and wisdom to organizational knowledge so that evidence-based clinical decision making can occur. Data-information-knowledge do not mean much to a healthcare organization if there is no clinically based individual on the front side to help design the technology systems so knowledge flows well within the healthcare organization. On the flip side, a human being must add deeper meaning to these words so that understanding and wisdom are applied to the knowledge.1,2

These words help information technologists develop the build specifications of technology systems that are repositories for the data that we collect everyday; used for clustering, processing, and transforming the data into useful clinical information; and then used to take information and apply it within the contextual situation to produce working knowledge of the clinical situation; and we (clinical experts) use them to evaluate the knowledge to understand or gain wisdom about our work.1,2 Defining data-information-knowledge-understanding-wisdom within the context of technology information systems that can be used to support clinical decision making helps us understand larger system implications whether we are using an electronic health record, a bar code medication administration system, or a research database to evaluate the implementation of new technology.

DEFINITIONS

Data are thought of as nothing more than a symbol or set of symbols that have very little independent meaning, relevance, or purpose. Most data are gathered and stored in some form of technology, for example, the vital signs and laboratory information on our most recent renal failure client in an electronic health record. To proceed through the hierarchy, the nurse must understand what data are important to gather so we can progress to information and gain knowledge, understanding, and wisdom.1,2

Information occurs when the data become relevant or develop a purpose. Data become information as they are processed and understood within the context of the healthcare situation, answering the "who," "what," "where," and "when" questions. The objective of processing data is to help us begin to cluster data to make a difference in what and how we do what we do. In order for data to make the transformation to information, some action must be taken on them-data must be contextualized, categorized, calculated (if they need some mathematical action), corrected (free from error), and/or condensed. These actions can occur together or independently. Information would be when the laboratory values are used to calculate the current renal function of our most recently admitted renal failure client.1,2

Knowledge occurs when we apply the data and information to obtain relevant and purposeful meaning. It answers our "how" questions and lends depth and breadth to our understanding of what is happening to our patient. Data and information are transformed through the comparison of this to previous situations, an understanding of the consequences of the data and information, connections that individuals can make between the data and information, and the personal conversations they have to understand this information. Knowledge is informed and understood within the personal intelligence and education of the individual. Knowledge is also informed by the interpretation of previous experiences, judgments, values, and beliefs of the interpreter. Knowledge is complex and can become difficult to discern by individuals. Data and information would become knowledge when we assign meaning to the vital signs, laboratories, and other assessment tools about our renal failure patient. 1,2

Understanding is the cognitive process that occurs when we analyze knowledge. It allows the interpreter to understand the "why" of the data, information, and knowledge. When we reach the level of understanding that it comes from a deeper relational value, it allows us or a technology system to make new knowledge from previously learned knowledge; for example, it allows us to understand the implications of the assessments done to our renal patient within an existing cognitive schema. We know what level of renal functioning exists and what needs to happen for our client.1

Wisdom is thought of as an inherently human trait in which you must possess the ability to judge or distinguish what is right or wrong. It is based in the very human understanding of morals, values, ethics, and cultural contexts. It is the conscience and compassion within the human race. It is our beliefs about how things ought to be. It allows us to make medical decisions within the context of the greater healthcare setting-for example, we know that our renal failure patient will need a lot of family support since he is a young father with several small children. We know that a renal transplant could be a good medical decision for this client.1

ROLE OF THE CLINICAL NURSE SPECIALIST IN KNOWLEDGE

Understanding these words and how to use them will make our healthcare systems work more efficiently and effectively. Understanding their hierarchical schema will enable us to work with system designers to make technology user-friendly, knowledge to flow within the organization, and good clinical decision support. Core competency directs the clinical nurse specialist to serve as a nurse "leader/consultant/mentor/change agent in advancing practice of nursing among the practice of nursing among other nurses and across organizations to achieve outcomes."3 These positive outcomes can be achieved when a clinical nurse specialist becomes involved in adoption, design, testing, implementation, and use of clinical technology that supports evidence-based decision making that results in decreases in medical error.

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