NUR 7010 Module 6 Knowledge Management Paper: Capturing a Wound Expert's Tacit Knowledge and Protecting It Example

Thirty Years of Wound Knowledge Leaving in June: Capturing and Protecting Expertise at a Cherry Hill Home Health Agency

Student Name

M.S. in Nursing, Nursing Informatics, Thomas Edison State University

NUR-7010: Nursing Informatics: Databases and Knowledge Management

Mentor Name

Month Day, Year

Thirty Years of Wound Knowledge Leaving in June: Capturing and Protecting Expertise at a Cherry Hill Home Health Agency

Knowledge About to Leave

The agency and its staff are invented. A home health agency in Cherry Hill serves about 1,100 patients at a time across Camden and Burlington counties. Its senior wound nurse has thirty years of experience and is consulted on almost every difficult wound. Field nurses send her photos from their phones and call her from patients' homes. She can look at a wound and say whether it is pressure, venous or arterial, whether it is infected and which dressing will work given the patient's home, caregiver and insurance. Little of this is written down. She retires in June, and the agency's director asked the informatics nurse to plan how to keep as much of her knowledge as possible.

The photos raised a second problem. Field nurses had been sending wound images from personal phones by text message, and some photos stayed on those phones indefinitely.

What Knowledge Is

Davenport and Prusak (1998) described knowledge as a fluid mix of framed experience, values, contextual information and expert insight that provides a framework for evaluating and incorporating new experiences and information. In organizations, it is embedded in documents and in routines, processes, practices and norms, but much of it lives in people. They distinguished knowledge from data and information by its dependence on human judgment and argued that organizations manage knowledge best by creating the conditions for people to share it, not only by building repositories.

How Knowledge Is Created

Nonaka (1994) proposed that organizational knowledge is created through continuous conversion between tacit knowledge, which is personal, hard to express and rooted in action, and explicit knowledge, which can be written and shared. He described four modes. Socialization converts tacit to tacit through shared experience, as when an apprentice watches a master. In externalization, people put tacit knowing into words, often through conversation and metaphor. Combination converts explicit to explicit by sorting and combining documents. Internalization converts explicit to tacit as people learn by doing. Knowledge spirals through these modes, growing as it moves from individuals to groups to the organization.

The plan recognizes that much of her expertise cannot be written down. Shadowing lets two nurses absorb it through practice. The recorded conversations, in which she talks through twenty de-identified past cases, capture part of it in words. The decision guide combines those words with agency policy. And case reviews help nurses turn the guide back into their own judgment.

Protecting the Knowledge Base

The new knowledge base includes wound photos, case descriptions and the decision guide, stored in the agency's record system. Photos and case notes are protected health information, and the risk of exposure is not theoretical.

Liu et al. (2015) examined every breach of health information large enough (500 people or more) to require a federal report between 2010 and 2013. They counted 949 breaches affecting about 29 million records. Theft was the most common cause, and many breaches involved laptops and other portable electronic devices. Breaches occurred mostly at health care providers. The authors noted that encryption and better device management could prevent many of these breaches.

For a home health agency whose nurses carry phones and tablets into patients' homes, that finding points directly to devices.

Access and Security Controls

The informatics nurse set five controls. Wound photos are taken only through the agency's secure mobile application, which stores them in the record and not on the device, and texting of photos stops. Every agency phone and tablet is encrypted, and a lost one can be erased from the office within minutes of being reported missing. Access to the knowledge base is role-based: all clinical staff can read the decision guide, but only the wound team and the patient's assigned nurses can see identifiable photos. The record logs every access to a photo, and the privacy officer reviews a sample of logs each month. Photos used in teaching cases are cropped and stripped of identifying details.

The Retiring Nurse's Part

The plan depends on the wound nurse herself, and the informatics nurse asked her early how she wanted to be involved. She chose the twenty cases for the recorded conversations, insisting on including two in which she had been wrong, because she believed nurses learn most from mistakes. She asked that the decision guide not pretend to be a rule book, and it now begins with a note that it supports judgment rather than replacing it. She also agreed to remain reachable for three months after retirement for questions from the two resource nurses. Treating her as the author of the program, not as a source to be mined, made her more generous with what she knew.

Sustaining the Program

After June, two shadowed nurses become the agency's wound resource nurses, the decision guide is reviewed each year and new difficult cases are added to the library with consent. The informatics nurse tracks use of the guide, consultations with the resource nurses and wound healing times.

What the Plan Cannot Do

Some of the retiring nurse's knowledge will be lost no matter what. Shadowing takes two nurses away from their caseloads. Security controls add steps, and nurses may resist giving up quick texts, so training must explain the reasons.

Conclusion

Davenport and Prusak's view of knowledge explained why a document alone would not keep the wound nurse's expertise. Nonaka's model gave each kind of knowledge transfer a concrete activity, and the breach study showed that knowledge stored as photos and notes must be protected where breaches most often start. The plan keeps both the knowledge and the patients who appear in it safe.

References

Davenport, T. H., & Prusak, L. (1998). Working knowledge: How organizations manage what they know. Harvard Business School Press.

Liu, V., Musen, M. A., & Chou, T. (2015). Data breaches of protected health information in the United States. JAMA, 313(14), 1471-1473. https://doi.org/10.1001/jama.2015.2252

Nonaka, I. (1994). A dynamic theory of organizational knowledge creation. Organization Science, 5(1), 14-37. https://doi.org/10.1287/orsc.5.1.14