Cognitive Therapy for Mood Disorders: Analysis

Cognitive Therapy for Mood Disorders: Analysis Cognitive therapy is a highly effective treatment for mood disorders. Discuss. As Karasu noted in 1982, there has historically been a polarization of the field of treatment of all psychological conditions; on the one hand, there is a camp which touts psychotherapy as the most effective and superior form of treatment, and on the other, there are those who champion the cause of pharmacotherapy as the most effective treatment.[1] In Karasu’s words, this separation between the two disciplines is likely to be â€Å"symptomatic of the post-Cartesian mind-body dichotomy at the core of modern medicine.† Statements about the effectiveness of the one or the other, which is often held to be thus the superior of the two, should be viewed through this lens. Before we can address the question of whether or not cognitive therapy is a highly effective treatment for mood disorders, we need to be clear about what we mean by â€Å"cognitive therapy† and â€Å"mood disorders†. Mood disorders are typically taken to cover a range of depressive disorders which include both unipolar depression and bipolar disorder, and which might range from full-blown major depression through to the display of some depressive symptoms. According to Blackburn et al., citing Beck’s (1967, 1976) cognitive theory of depression, someone who is depressed will view themselves as a â€Å"loser† and will interpret all their experiences in terms of their own inadequacies. They will anticipate that their present difficulties will continue indefinitely and, blaming themselves, they will become increasingly self-critical. As well as this negative view of the self, the world and the future, they will also make â€Å"logical systematic errors†, which will lead them to draw erroneous conclusions about their experiences. Such errors might include personalization, over-generalization, magnification and minimization. They will also have â€Å"dysfunctional basic premises† or â€Å"idiosyncratic schemas†, which help them to sieve, categorize and act upon information that they receive from their experiences of the world around them..[2] The aim of cognitive therapy is to change these negative schemas through the use of a variety of cognitive and behavioural techniques. The approach is problem-oriented and time-limited, typically lasting about 12 weeks.[1] The most frequently reported forms of cognitive therapy in the literature are cognitive behavioural therapy (CBT) and interpersonal therapy (IPT). Other techniques include psychoeducation, psychodynamic focal therapies and mindfulness-based cognitive therapy (MBCT). Throughout this paper, the terms cognitive therapy and psychotherapy are used interchangeably. Among these different cognitive therapy techniques, CBT is the one most often considered in the literature, and it is widely reported to be effective, but how do we decide if something is highly effective or not? To decide how effective a treatment is, we need to consider the available evidence. What follows is not a full and systematic review of the literature, which is beyond the scope of this paper, but rather, a look at some of the available evidence to date on the subject and an outline of the key issues. In it, I propose that the evidence for the effectiveness of cognitive therapy as a treatment for depression is not unequivocal and that a more integrated approach would be more beneficial. Writing in 1981, Blackburn et al. cite a study by Rush et al. (1977), which was one of the earlier studies comparing cognitive therapy and pharmacotherapy, and which showed that cognitive therapy was superior to the drug imipramine in outpatients with unipolar depression in both level of response and rate of premature treatment termination.[2] They attempted to replicate that study, but comparing a range of drugs with cognitive therapy, rather than just imipramine, and they also tested a combination of both cognitive therapy and pharmacotherapy. They found cognitive therapy to be only minimally more effective than the drugs in a group of mildly to moderately depressed hospital outpatients, but significantly more so than drugs alone in general practice, both alone and in combination with drugs. In both groups, using a combination of cognitive therapy and pharmacotherapy produced the greatest effect of all.[1] However, as the researchers do note, they used no objective method to assess patients’ compliance with the pharmacotherapy regimen.[2] In their study of cognitive behaviour therapy (CBT) and assertion training (AT) groups for patients with depression and comorbid personality disorders, Ball et al. found CBT alone to produce a significant improvement in all the outcomes measured, including at follow-up.[3] However, the group that received a combination of CBT and AT showed only minimal improvement on the social competence and anxiety measures[4], and only two of the four measures that were significant immediately after the treatment were still significant at follow-up.[5] In short, the presence of a comorbid personality disorder appeared to impede the response to CBT and AT and the outcomes at follow-up.[6] Since depressed patients have high rates of comorbid personality disorders[7], these results have significant implications for the use of cognitive therapy in combination with other forms of non-pharmacotherapy for the treatment of depression. The use of a much briefer CBT protocol in this study (15 hours over five weeks), which as Ball et al. note is about half that in most studies in the CBT outcomes literature, should be noted. If briefer protocols like this can produce appreciable long-term improvements in the prognosis of depression, then this is likely to be more cost-effective than the longer protocols typically employed.[8] However, since the study was uncontrolled, there may well be other explanations for the results. Clearly more studies, particularly randomised controlled trials (RCTs), of cognitive therapy in this under-researched group are needed. In their recent review of psychotherapy and pharmacotherapy treatments for mood and anxiety disorders, Otto et al. noted that in terms of acute outcomes, both CBT and pharmacological treatments have repeatedly been shown to be efficacious and in most cases to offer an approximately equal effect, though there are some suggestions that CBT is more tolerable and especially more cost-effective.[1] CBT has, however, consistently shown a strong relapse-prevention effect, in direct contrast to pharmacotherapy, which often requires ongoing treatment to prevent relapse.[2] It has been suggested that pharmacotherapy and cognitive therapy have differential effects, the former on symptom formation and affective distress, and the latter on interpersonal relations and social adjustment, each activated and sustained on a different time schedule, the pharmacological treatments sooner and over a shorter duration and the psychotherapeutic treatments later and over a longer duration.[3] There is some evidence that CBT and pharmacotherapy may produce similar limbic and cortical changes in the brain, but also that they target different primary sites.[4] There is, moreover, some evidence of complementary modes of action among patients who fail on one form of treatment but gain benefit from the other.[5] Such complementarity favours a more integrated approach to the treatment of depression that combines the beneficial effects of both pharmacotherapy and cognitive therapy, but is there any evidence that such an approach does indeed work? In their 1986 review of the evidence for the effectiveness of combined psychotherapy and pharmacotherapy for the treatment of depression, Conte et al. found a combination of the two approaches to be more effective than either of the treatments alone, though the apparently additive effect was not a strong one. Conte et al. highlight a number of possible explanations for the observed effect, including the high drop-out rates in the studies they considered, making generalization difficult, the differential response to pharmacotherapy or psychotherapy dependent on whether the diagnosis was endogenous or situational, questions about whether it is either ethical or even practically possible to have a placebo in psychotherapy trials, and the low power of their own overall approach to their review.[1] Conte et al. also suggest that whilst their results might support the additive model, they might also be explained if some patients benefit more from one treatment and some more from the other. [2] The non-standard nature of diagnoses, therapies, training and experience of therapists also makes comparisons and generalizations difficult, if not impossible.[3],[4] In 1997, Thase et al. suggested that their mega-analysis comparing psychotherapy with psychotherapy-pharmacotherapy combinations provided evidence of the superiority of a combination of psychotherapy and pharmacotherapy over psychotherapy alone for the more severely-depressed outpatients, both in terms of overall recovery rates and a shorter time to recovery.[5] However, none of the patients older than 60 received psychotherapy and none with non-recurrent depression were in the combination group.[6] The less seriously depressed patients treated with interpersonal therapy (IPT) or CBT alone achieved results comparable to those in the combination group.[7] As it is, this evidence for the effectiveness of a combined approach is ambiguous. There are further problems with this study, though. Comorbid patients were excluded[8] – and as has been noted earlier, comorbidity is typically associated with poorer outcomes – and a disproportionately large number of the patients had recurrent depression, so if the combination of psychotherapy and pharmacotherapy is more effective in this sub-group, this will lend a skew to the picture suggesting effectiveness in all severely-depressed patients.[9] Finally, inasmuch as this is a mega-analysis, the non-standard nature of diagnoses, therapies, training and experience of therapists highlighted earlier makes generalizations very difficult, a problem noted by the authors of this study also.[1] In their 2004 review, Pampallona et al. concluded that a combination of pharmacotherapy and psychotherapy produced a greater improvement in depression scores than pharmacotherapy alone.[2] Pampallona et al. note that the addition of psychotherapy does appear to reduce the degree of non-response and increase adherence, but they question whether this is because psychotherapy has a genuine therapeutic effect or whether it is merely enhancing compliance with the pharmacological regimen, and suggest further studies with an improved range of outcome measures, including patient satisfaction, well-being and social functioning.[3] In their 2005 review, however, Otto et al. found that acute outcome studies with depressed outpatients provided only limited support for the theory that a combination of pharmacotherapy and psychotherapy is more efficacious than either approach alone. They did find higher rates of treatment response, but the differences were small and not statistically significant.[4] Adding psychotherapy to the acute phase of a pharmacological treatment regimen was found to offer a comparable efficacy to a long-term pharmacological regimen in helping to prevent more than one relapse.[5] Otto et al. did find that adding CBT to a pharmacological course of treatment improved medication adherence, reduced the impact of psychosocial stressors such as negative life events and anxiety comorbidity, prevented or limited the severity of prodromal episodes, and directly improved outcomes in bipolar disorder.[6] The evidence, then, for the effectiveness of cognitive therapy as a treatment for depression is not unequivocal. It does appear to improve outcomes, but it is unclear whether to a greater or approximately equivalent extent to pharmacological approaches to treatment. Whilst the evidence for adopting a combined approach is also not clear-cut, since the vast majority of people with depression experience multiple episodes over their lifetime, and are especially prone to relapses shortly after their first episode[1], and in light of both the possibly complementary mode of action of cognitive therapy and pharmacotherapy and the possibly harmful effects of long-term anti-depressant use, a more effective long-term strategy might involve the integration of both approaches. This might involve a drugs-based regimen in the earlier stages of depression, to treat symptoms and affective distress, and cognitive therapy throughout, to treat the interpersonal and social dimensions of depression, enhan ce compliance to the drugs-based regimen and treat and prevent relapses. Vos et al. modeled the impact of adopting a longer-term maintenance strategy on the burden of major depression, and suggested that this could avert half the depression occurring in the five years after an episode.[2] A combined strategy would appear therefore to show some promise in reducing the quite significant disease burden placed by depression on society and improving the lives of those who suffer from it. Further robust controlled trials are clearly needed to assess the effectiveness of cognitive therapy, both alone and in combination with pharmacotherapy, as a part of an integrated long-term strategy. References Ball, J., Kearney, B., Wilhelm, K., Dewhurst-Savellis, J. Barton, B. (2000) ‘Cognitive behaviour therapy and assertion training groups for patients with depression and comorbid personality disorders’, Behavioural and Cognitive Psychotherapy 28, 1, 71-85 Blackburn, I. M., Bishop, S., Glen, A. I. M., Whalley, L. J. Christie, J. E. (1981) ‘The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination’, Brit J Psychiatry 139, 181-189 Conte, H., Plutchik, R., Wild, K. V. Karasu, T. (1986) ‘Combined Psychotherapy and Pharmacotherapy for Depression: A Systematic Analysis of the Evidence’, Arch Gen Psychiatry 43, 471-479 Karasu, T. (1982) ‘Psychotherapy and Pharmacotherapy: Toward an Integrative Model’, Am J Psychiatry 139, 9, 1102-1113 Klein, D. F. (2000) ‘Flawed Meta-Analyses Comparing Psychotherapy with Pharmacotherapy’, Am J Psychiatr 157, 1204-1211 Otto, M. W., Smits, J. A. J. Reese, H. E. (2005) ‘Combined psychotherapy and pharmacotherapy for mood and anxiety disorders in adults: Review and analysis’, Clinical Psychology: Science and Practice 12, 1, 72-86 Pampallona, S., Bollini, P., Tibaldi, G., Kupelnick, B. Munizza, C. (2004) ‘Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review’, Arch Gen Psychiatry 61, 7, 714-719 Thase, M. E., Greenhouse, J. B., Frank, E., Reynolds, C. F., Pilkonis, P., Hurley, K., Grochocinski, V. Kupfer, D. J. (1997) ‘Treatment of Major Depression With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations’, Arch Gen Psychiatry 54, 1009-1015 Vos, T., Haby, M., Barendregt, J. J., Kruijshaar, M., Corry, J. Andrews, G. (2004) ‘The Burden of Major Depression Avoidable by Longer-term Treatment Strategies’, Arch Gen Psychiatry 61, 11, 1097-1103 1 Footnotes [1] Karasu, T. (1982) ‘Psychotherapy and Pharmacotherapy: Toward an Integrative Model’, Am J Psychiatry 139, 9, 1102 [2] Blackburn, I. M., Bishop, S., Glen, A. I. M., Whalley, L. J. Christie, J. E. (1981) ‘The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination’, Brit J Psychiatry 139, 181 [1] Blackburn, I. M., Bishop, S., Glen, A. I. M., Whalley, L. J. Christie, J. E. (1981) ‘The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination’, Brit J Psychiatry 139, 181 [2] Blackburn et al., 182 [1] Blackburn, I. M., Bishop, S., Glen, A. I. M., Whalley, L. J. Christie, J. E. (1981) ‘The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination’, Brit J Psychiatry 139, 188 [2] Blackburn et al., 188 [3] Ball, J., Kearney, B., Wilhelm, K., Dewhurst-Savellis, J. Barton, B. (2000) ‘Cognitive behaviour therapy and assertion training groups for patients with depression and comorbid personality disorders’, Behavioural and Cognitive Psychotherapy 28, 1, 77 [4] Ball et al., 80 [5] Ball et al., 81 [6] Ball et al., 82 [7] Ball et al., 73 [8] Ball et al., 81,82 [1] Otto, M. W., Smits, J. A. J. Reese, H. E. (2005) ‘Combined psychotherapy and pharmacotherapy for mood and anxiety disorders in adults: Review and analysis’, Clinical Psychology: Science and Practice 12, 1, 73 [2] Otto et al., 73 [3] Karasu, T. (1982) ‘Psychotherapy and Pharmacotherapy: Toward an Integrative Model’, Am J Psychiatry 139, 9, 1111 [4] Otto et al., 74 [5] Otto et al., 74-75 [1] Conte, H., Plutchik, R., Wild, K. V. Karasu, T. (1986) ‘Combined Psychotherapy and Pharmacotherapy for Depression: A Systematic Analysis of the Evidence’, Arch Gen Psychiatry 43, 477-478 [2] Conte et al., 478 [3] Conte et al., 478 [4] Klein, D. F. (2000) ‘Flawed Meta-Analyses Comparing Psychotherapy with Pharmacotherapy’, Am J Psychiatr 157, 1204 [5] Thase, M. E., Greenhouse, J. B., Frank, E., Reynolds, C. F., Pilkonis, P., Hurley, K., Grochocinski, V. Kupfer, D. J. (1997) ‘Treatment of Major Depression With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations’, Arch Gen Psychiatry 54, 1012-1013 [6] Thase et al., 1012-1013 [7] Thase et al., 1013 [8] Thase et al., 1014 [9] Thase et al., 1014 [1] Thase, M. E., Greenhouse, J. B., Frank, E., Reynolds, C. F., Pilkonis, P., Hurley, K., Grochocinski, V. Kupfer, D. J. (1997) ‘Treatment of Major Depression With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations’, Arch Gen Psychiatry 54, 1014 [2] Pampallona, S., Bollini, P., Tibaldi, G., Kupelnick, B. Munizza, C. (2004) ‘Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review’, Arch Gen Psychiatry 61, 7, 718 [3] Pampallona et al., 718 [4] Otto, M. W., Smits, J. A. J. Reese, H. E. (2005) ‘Combined psychotherapy and pharmacotherapy for mood and anxiety disorders in adults: Review and analysis’, Clinical Psychology: Science and Practice 12, 1, 73 [5] Otto et al., 75 [6] Otto et al., 76 [1] Vos, T., Haby, M., Barendregt, J. J., Kruijshaar, M., Corry, J. Andrews, G. (2004) ‘The Burden of Major Depression Avoidable by Longer-term Treatment Strategies’, Arch Gen Psychiatry 61, 11, 1102 [2] Vos et al., 1101-1102

Man and a Woman: A Yin and Yang

It’s still fresh in my memory the answer of 2008 Miss Universe Dayana Mendoza in her question â€Å"Does a man or a woman live and easier life? †- â€Å"actually there’s not much difference about how a woman or man lives but rather they differ on the way they think. Man thinks the easiest way to get to the point is to go straight. Woman, not exactly, they go through many curves and fixed it†. This answer is just one among the many answers on how to differentiate a man between women. In the field of hard sciences, the difference between a man and a woman is far way varied.It is usually differentiated through sex or the possession of certain organs and hormones that make them unique. Man or male is characterized by possessing the male genitalia which composed of the testicles, the penile gland and of course Adams apple. Women or female is otherwise characterized by the possession of uterus, ovary, and vagina. In terms of the Hippocratic eye, there are differ ent hormones and chromosomes that discriminates both sexes- chromosome XY for male and XX for female (York 2008).In the society, one can easily differentiate a man from a woman by the way they act, they dress and they appear in public. A man usually is short haired contented with t-shirts and pants or tuxedo for the elite while women are often long haired, fond of having fancy dresses with playful colors and distinguished by their high pitched voices as contrast to male with a distinguishable baritone voice. During the olden times, in terms of gender and socialization, a masculine is usually viewed to be brave, aggressive, and bread winner while a feminine is usually calm, conservative, and responsible in child rearing.Tracing the history, women in the olden days are considered as one among the lower society wherein they are not allowed to vote and their only profession is to become a plain housewife. In the ancient times in Asia and Europe, women are often the subjects of slavery. In Japan, once a woman has been married to a man, she no longer free. Her work is just centered on family rearing and farewell assistance to the husband. The only way to escape from the marriage is to commit hara-kiri or the virtue of killing themselves.In the Philippines during the sultanate period, only the son of the king or sultan can inherit the land and women are just for marriage rites and are just means to procreate through pregnancy. The worst thing is that they are not allowed to rule the land. In contrast, Egypt is known to have women rulers before man became the ruler. One good example is Cleopatra who ruled the ancient Egypt and who have man as subordinates (timemagazine. com 1972). But with the rise of industrial revolution, feminists became more gender sensitive and gender equality had been on the rise.Now, there had been widespread gender stereotyping such as female police enforcers, pilots, soldiers, and the existence of working moms and even female engineers. In ad dition, there is an increase of women politicians and rulers and believe it or not that the Philippines being a democratic republic had some sort of girl power because they had already to female presidents whom actually won through people power revolution. Tracing the history is likewise one way of differentiating man between women based on their family roles and social responsibility. The existence of pluralism in nature allowed varied responsibilities of a man and a woman.Delving deeper in differentiating man and women is through their matter of feelings. Men are thought to be pride and full of ego. Women are the exact opposite as they are more patient and unruffled. Usually in a family a woman/wife is usually the mother of all chores in the house doing all the laundry, cleaning, and preparing food except if a there is a hired nanny, but still a nanny is a woman. On the other hand, those of the man usually sips coffee while reading the daily news and eats the breakfast and then go to work. Going back to the answer of Miss Universe 2008, it would be nice if we cite some examples.Man thinks that the easiest way to get through a point is to go straight. I might as well agree on that. When a man goes to off a particular thing in the department store, he goes exactly to the rack or place where it is located, grabs it and pays it over the counter immediately. Women don’t, they actually took many more time visiting every lane of the shop and fit all things that she thinks it’s nice for her and grabs unnecessary things forgetting what to buy. This only means that man is more straightforward on everything. When he wants an answer, he wants it immediately. When he takes orders in a restaurant, he wants it in a brisk.Women are more patient and complicated, they are the ones who usually start the husband-wife fight because of their hasty tongue who usually nags and nags until both of them gets pissed off. Among all of these opposite characters, I still vie w man as being a yin and a yang, a perfect opposite but a perfect combination. Every imperfection of a man can be complemented by a woman and every woman’s flaw is complemented by a man. That is why there is the existence of marriage, to unite both the ideals of a man and a woman and to live together as one body and being separate entities.A man and a woman are created complementary to work and help each other. Each sex/gender represents a function in a society. There has been a saying that â€Å"No man is an island†. Truly no man is alone because there is the existence of a woman. Every human beings life is like a puzzle, it will only be completed when the remaining pieces are there. A woman therefore is never complete without a man, which maybe her father or her lover. Likewise a man is never complete without there woman, which is his mother and his lover.

Comparator

COMPARATOR a device which compares two  voltages  or  currents  and switches its output to indicate which is larger. COMPARATOR WITH HYSTERESIS Hysteresis is achieved by positive feedback and makes the comparator less sensitive to noise on the input. [pic] VHYS = V2 – V’2 V2 = R2 R2 + R1 V2 = R2 R2 + R1 Jonathan Archer captain of the first starship Enterprise The most difficult task facing any captain, any crew, is the loss of a shipmate.We've come here to honor one of our own. In the time we knew him, he showed us just how much one life can truly matter. We will never forget what he did for us, and for the ship he loved so much. We will go forward with renewed determination to complete this mission, so that his sacrifice won't just have been for the people on this ship, but for all the citizens of Earth. Samuel J. Palmisano Chairman of the Board and Chief Executive Officer IBM CorporationThere are, however, certain kinds of aspirations that can't be achieved th rough organizational capabilities, global reach or technology—or by applying the lessons of the past. To capture the biggest economic opportunities or to tackle society's most daunting problems—to imagine what the world might be, and actually to build it—people have sought something more fundamental: a unique ability to conceptualize opportunities, to analyze developments, to tackle and overcome grand challenges. SHINICHI SASAKI EXECUTIVE VICE PRESIDENT, TOYOTA MOTOR CORPORATIOFully aware that support from customers is essential to its continued success, Toyota is striving to provide its customers with the highest-quality products and services under its â€Å"Customer First† policy. Based on the â€Å"kaizen (continuous improvement)† philosophy at the heart of its manufacturing activities, Toyota is working hard to continuously improve customer satisfaction through initiatives in all areas of its business activities, including development, purchasi ng, production, sales and after-sales services, throughout the entire Toyota Group.

Nursing Informatics - Free Essay Example

Sample details Pages: 4 Words: 1169 Downloads: 10 Date added: 2019/10/10 Did you like this example? Introduction The concept of information technology is changing the field of healthcare with the use of new tools such as devices and software. The transformation has particularly transformed the nurse who is the reason why the healthcare information technology is always known as nursing informatics. The following paper is a discussion of a relation on how a nurse can work on four steps which are knowledge, information, data and wisdom continuum. Don’t waste time! Our writers will create an original "Nursing Informatics" essay for you Create order The paper describes how the gained information can turn it into usable knowledge. The progress of using the useful knowledge to the wisdom in the making decision is also discussed in the paper. Nursing informatics is applied in practice to assist in the organization and application of data, knowledge, information, and wisdom. The continuum of information, data, wisdom, and knowledge depicts how nurses use facts in decision making and providing health care (Topaz 2013). The continuum offers an insight in how the nursing informatics contribute in different levels of comprehending, evidence-based practice and decision making. The content is made up of four ideas which are overlapping. The plans include the data, knowledge, information and wisdom. The component of information is given the structure of data while that of knowledge is attributed from the identification of the relationships and patterns which exist between the different types of information. The aspect of data is a representation of the symbols which speak to the characteristics of events, objects and the environment where they exist particularly when the environment alone cannot possesses little significant (Knudsen 13). The component of wisdom is mainly the use of knowledge to clarify issues which are aligned to human. The concept shows the form of intelligence as the ability to define the skills and information within the components of utilizing, caring and judgment to settle on the decision and attention. There are different types of transition which a nurse faces time after time, and therefore, it is important for a nurse to have special skills in the management of these forms of development. An example is a transition which is attributed to the immigration, changes in their health and managerial development. The theory of transition has been greatly used in the nursing research, practice and education due to its wide importance and applications. This transition from the hospital to home is a matter of concern in this context. For example, in the theory of transition, it is proposed that the condition of a few people such as high support from the family will encourage a high level of transition from hospital to homes in adults who are fairly older. Therefore, the field has a specific theory which serves as the factor that holds the different points of data together to produce information that is important. For instance, the level of family support (Topaz 2013). This information is later utilized and integrated with the help of the hypothesis of transition in the building of knowledge concerning a particular phenomenon. The component of wisdom in the structure is taken care of by the clinicians in the field. An example is the final results, which will be a decision by the support to help the nurses of a home care with evidence which is recognizable to the risk of the patient for the results that are poor (American Nurses Association 2014). At the particular moment of utilization of tool in practice, the nurse will be required to make a rush decision to show a certain knowledge which is presented in each clinical occasion. An example is a clinical practice which is prescribed in every particular state and the universal morals in nursing. In the end, the nurse will make the use of their knowledge to give recommendations and make an outstanding judgment by using the information that is obtained as the tools of decision making and the support that is offered. An example in the nursing field on the utilization of the data, knowledge, information, and wisdom is a male middle age patient who is fairly obese. The blood test of the patient shows that he is suffering from high cholesterol intolerance and impaired glucose. All these information represents the data of this patients. There is a discussion of the results of the blood test of the patient between the doctor and the patient, who is invited to return for a visit of follow-up. The second blood test of the patient represents the information which is then taken by the nurse who then refer to the electronic health record of the patient. The addition of this data to the system will represent knowledge (Knudsen 13). The illustration is a flow of information from data to knowledge and knowledge to wisdom. It is also a demonstration of how a nurse can use the continuum in their daily activities and how the informatics a significant role. The technology is utilized in the support of nursing profession and in the care of patients and changes of immediate development and collection of new services. The dynamics and advancement of the nursing considerations, specialization of therapeutic services and treatment should be incorporated to improve the examination of how to outfit opportunities and handle challenges. This helps in the reduction of damages that emanates from the use of robots during the period of transition. The intention of using the instruments that are advanced is among the main techniques aimed at meeting the expected social insurance crisis (American Nurses Association 2014). The informatics of wellbeing includes the commitment which arises from a few sources such as medical informatics, nursing informatics, dental informatics and clinical informatics. The accomplishment in the health informatics and biomedical are seen in the provision of care to the progressive treatments that are customized, symptomatic procedures and in the advancement of health management techniques to control conditions which are interminable. They also add to the counteractive action, moving assignment or early intersection to meet the necessities for maturing and freedom. After a while, a few effort have been developed to show the diversity in the interdisciplinary of health informatics. The people who are interested in the health informatics are normally educated and skilled. To join the field one is required to have an extensive knowledge in the field of computer and date science (Topaz 2013). In this context, the health informatics will be analyzed from a state of takeoff to have an extended knowledge in the commitment of a nurse especially in the field of nursing informatics. The application of an analysis of field like Personal Health Records and assis tive device such as Electronic health Records, home dwelling, savvy and community care cases are used as tools of data. Conclusion The above paper describes the data, knowledge, wisdom and information and how the information obtained from the framework can be used and transformed into usable knowledge. The structure of data, information, wisdom, and knowledge represent interrelated parts of the model. The entered data is utilized in the generation of knowledge and information while the obtained knowledge is integrated to the wisdom to develop an assessment of data that has new elements.