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Nursing Theory, Terminology, and Big Data: Data-Driven Discovery of Novel Patterns in Archival Randomized Clinical Trial Data

Monsen, Karen, A.; Kelechi, Teresa, J.; McRae, Marion, E.; Mathiason, Michelle, A.; Martin, Karen, S.

doi: 10.1097/NNR.0000000000000269

Background The growth and diversification of nursing theory, nursing terminology, and nursing data enable a convergence of theory- and data-driven discovery in the era of big data research. Existing datasets can be viewed through theoretical and terminology perspectives using visualization techniques in order to reveal new patterns and generate hypotheses. The Omaha System is a standardized terminology and metamodel that makes explicit the theoretical perspective of the nursing discipline and enables terminology–theory testing research.

Objective The purpose of this paper is to illustrate the approach by exploring a large research dataset consisting of 95 variables (demographics, temperature measures, anthropometrics, and standardized instruments measuring quality of life and self-efficacy) from a theory-based perspective using the Omaha System. Aims were to (a) examine the Omaha System dataset to understand the sample at baseline relative to Omaha System problem terms and outcome measures, (b) examine relationships within the normalized Omaha System dataset at baseline in predicting adherence, and (c) examine relationships within the normalized Omaha System dataset at baseline in predicting incident venous ulcer.

Methods Variables from a randomized clinical trial of a cryotherapy intervention for the prevention of venous ulcers were mapped onto Omaha System terms and measures to derive a theoretical framework for the terminology–theory testing study. The original dataset was recoded using the mapping to create an Omaha System dataset, which was then examined using visualization to generate hypotheses. The hypotheses were tested using standard inferential statistics. Logistic regression was used to predict adherence and incident venous ulcer.

Results Findings revealed novel patterns in the psychosocial characteristics of the sample that were discovered to be drivers of both adherence (Mental health Behavior: OR = 1.28, 95% CI [1.02, 1.60]; AUC = .56) and incident venous ulcer (Mental health Behavior: OR = 0.65, 95% CI [0.45, 0.93]; Neuro-musculo-skeletal function Status: OR = 0.69, 95% CI [0.47, 1.00]; male: OR = 3.08, 95% CI [1.15, 8.24]; not married: OR = 2.70, 95% CI [1.00, 7.26]; AUC = .76).

Discussion The Omaha System was employed as ontology, nursing theory, and terminology to bridge data and theory and may be considered a data-driven theorizing methodology. Novel findings suggest a relationship between psychosocial factors and incident venous ulcer outcomes. There is potential to employ this method in further research, which is needed to generate and test hypotheses from other datasets to extend scientific investigations from existing data.

Karen A. Monsen, PhD, RN, FAAN, is Associate Professor, School of Nursing, University of Minnesota, Minneapolis.

Teresa J. Kelechi, PhD, RN, FAAN, is Professor, College of Nursing, Medical University of South Carolina, Charleston.

Marion E. McRae, MScN, ACNP-BC, Robert Wood Johnson Foundation Future of Nursing Scholar, is Nurse Practitioner Nurse Practitioner-Coronary Care Unit, Ronald Reagan UCLA Medical Center, Los Angeles, California.

Michelle A. Mathiason, MS, is Statistician, School of Nursing, University of Minnesota, Minneapolis.

Karen S. Martin, MSN, RN, FAAN, is Consultant, Martin Associates, Omaha, Nebraska.

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Accepted for publication October 27, 2017.

The authors acknowledge that work was supported in part by the National Institutes of Health, National Institute of Nursing Research Award R01NR012237. The parent study is registered at (NCT01509599).

This paper was accepted under the Editorship of Susan J. Henly.

Conflicts of interest: Karen S. Martin is Chair of the Omaha System Board, is a consultant for the Omaha System, and receives royalties for sales of Omaha System books. Omaha System Board member Karen A. Monsen is a volunteer who does not receive any stipends or reimbursement for expenses. Teresa J. Keleche, Marion E. McRae, and Michelle A. Mathiason have no conflicts of interest to report. The Omaha System exists in the public domain.

Corresponding author: Karen A. Monsen, PhD, RN, FAAN, School of Nursing, University of Minnesota, 5-140 Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN 55455 (e-mail:

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