Nursing 3160: Health Science 3
Nursing Decision Support and Expert Systems
& Artificial Intelligence
"Expert systems use artificial intelligence to model a decision that experts in the field would make. Unlike decision support systems that provide several options from which the user may choose, expert systems convey the concept that the computer has made the best decision based upon criteria that experts would use.”
(Hebda, Czar & Mascara, 1998, p. 254).
Expert systems generate decisions that an expert would make: they can recommend solutions to nursing problems which mimic the clinical judgement of a nurse expert. These systems are developed to facilitate and enhance the clinical judgement of nurses, not to replace them. Like decision support systems, expert systems provide information to help health professionals to make informed judgements when assessing the validity of data, information, diagnoses, and
choices for treatment and care.
Expert systems are comprised of four main components:
a) a natural language (such as English) to interface and interact with the user.
b) a knowledge base containing the rules from which the decisions can be made.
c) a database of facts specific to the domain of focus.
d) an inference engine to solve problems by linking the knowledge base rules with the database, using heuristics or “rules of thumb” logic.
The most popular reason for using an expert system is to make the knowledge of an expert available to a novice. Expert systems help nurses link client data to reveal information and patterns. The combination of factual and procedural knowledge allows an expert system to simulate, to a degree, the reasoning processes of human experts while keeping a record of each step of the decision making process. These systems also support the unification of nursing
language and diagnostic nomenclature.
Ends in View
This learning activity is intended to give the learner the opportunity to:
1. Gain awareness of the potential use of expert systems for assisting nurses in decision making and supporting clinical judgment.
2. Recognize the process of reasoning used in an expert system to make inferences from data, facts and rules (heuristics).
3. Reflect on the value of expert systems in augmenting nursing knowledge, particularly in novice nurses.
4. Explore the theory and principles of artificial intelligence and how it can be applied to health care and nursing.
5. Analyzes the benefits and pitfalls of applying expert systems, decision support systems, and artificial intelligence in health care.
1. READ: Darlington, Keith. (1997). Expert systems in Nursing. http://www.bcs.org/upload/pdf/nsg-itin-vol9-darlington1.pdf
2. READ: Blair, R. (2004). Tech and tenderness. Health Management Technology, May, 22-28.
3. READ: Feuerbach, R. & Panniers, T. (2003). Building an expert system: A systematic approach to developing an instrument for data extraction from the literature. Journal of Nursing Care Quality, 18 (2), 129 – 138.
4. EXPLORE: AI Research: Creating a new way of Life. Especially check out “Alan Speak-a-tron” which gives you an interactive experience of dialoguing with a simple AI powered expert system at http://www.a-i.com/
5. VIEW: the online slide show explaining the Dxplain clinical diagnostic decision-support system, created by the Harvard Medical School. Available online at: (Click on Dxplain Demonstration) http://www.lcs.mgh.harvard.edu/
6. VIEW VIDEOS: View these brief videos that present cutting edge research and breakthroughs in artificial intelligence, decision support and expert systems, many in health care.
DOWNLOAD: the Worksheet: Expert Systems and Artificial Intelligence to answer the following questions.
1. In your own words, write down what it means to be an “Expert Nurse”. How would you distinguish between a Novice Nurse and an Expert Nurse?
2. From your understanding of how data is processed into information, then integrated into knowledge, which hopefully, leads to wisdom, create a diagram, schema or flowchart that outlines the parallels and contrasts between:
a) The decision making processes of an Novice Nurse.
b) The decision making processes of an Expert Nurse.
c) The decision making processes facilitated by the use of a Nursing Expert System.
3. If possible, attend or engage in a demonstration of a Nursing Expert System. Sample the examples given in the “In Preparation” section as a minimum.
4. Blair (2004) described a simple artificial intelligence system (life coach) which incorporates caring nursing behavioural attitudes within its programming. What thoughts come up for you when you consider these initial attempts to mirror nursing care within an AI program? How does this reflect on nursing?
1. What advantages would using a Nursing Expert System offer a:
a) Nurse working in Acute Care?
b) Nurse working in Intensive Care?
c) Nurse working in the Community?
2. What disadvantages or limitations do you predict could occur when relying on a Nursing Expert System for decision making?
3. How useful would Prevention focused Nursing Expert Systems be for clients and families in Community settings? Why?
AI Research: Creating a new way of Life. http://www.a-i.com/
Blair, R. (2004). Tech and tenderness. Health Management Technology, May, 22-28.
Darlington, Keith. (1997). Expert systems in Nursing.
Harvard Medical School. Dxplain Expert System Slideshow.
Feuerbach, R. & Panniers, T. (2003). Building an expert system: A systematic approach to developing an instrument for data extraction from the literature. Journal of Nursing Care Quality, 18 (2), 129 – 138.
Olmstadt, W. (2000). Cataloguing Expert Systems: Optimism and Frustrated Reality Journal of Southern Academic and Special Librarianship, 1(3).
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