353chapter FOURTEEN
Refl ective Response 2
Cecilia Kennedy Page
In Chapter 14, by Cornelius, Childs, and Wilson, these authors describe the compe-
tencies required for a doctoral- prepared advanced practice nurse (APN) to lead in the
health care environment of the future. Grounded in the roots of patient safety move-
ment championed by the Institute of Medicine (IOM), a renewed national commitment
to the development of the information infrastructure was described as being critical to
support reengineering care processes and facilitate outcome measurements for account-
ability (IOM, 2001). The American Association of Colleges of Nursing (AACN, 2006) ac-
knowledges the leadership required by doctoral- prepared nurses to use information
systems to evaluate programs of care, outcomes of care, and care systems. This chapter
delineates the expert competencies of the Doctor of Nursing Practice (DNP) leader to
meet the leadership challenges of the health care industry in technology.
Described in this chapter are the base competencies required for Informatics. The
initial review of the master level practitioner and the doctoral APN are described in a
narrative format. A strong correlation or comparative analysis of these two levels would
have called out the cognitive maturation required for the expert level. These authors go
on to describe informatics competencies for specific doctoral advanced practice nurs-
ing roles. The functional differentiation is only separated by the focus domain of the
professional scope of clinical practice. All roles are required to support the AACN com-
petencies (AACN, 2006) demonstrating the ability to provide leadership within health
care systems and/ or academic settings related to the use of information systems. Much
of the chapter addresses the tools available to the advanced practicing nurse. In a more
concise fashion, the Technology Informatics Guiding Educational Reform (TIGER, 2009 )
collaborative states that APNs should be competent in: (a) basic computer competencies
or sources of knowledge; (b) information literacy integrating information to evidence-
based practice; and (c) information management leveraging the data from sources such
as the electronic health records.
What is missing in this chapter is the foundational work of informatics on the
metastructures: data, information, knowledge, and wisdom (DIKW); data as the dis-
crete entities; information as the data that has been interpreted, organized, or struc-
tured; knowledge as the information that is synthesized linking relationships; and
wisdom as the use of knowledge to manage and solve human problems (American
Nurses Association [ANA], 2015). In this chapter, the authors describe knowledge
management competencies but without the reference to the DIKW metastructure,