Chapter 12 Managing Business Knowledge Managing and Using Information Systems: A Strategic Approach by Keri Pearlson & Carol Saunders 1 Learning Objectives Understand the difference between data, information, and knowledge. Define how tacit knowledge differs from explicit knowledge. Describe why knowledge management is so important. Understand how knowledge is generated and captured. Describe a knowledge map. Chapter 12 2 2 Real World Examples Harrah’s found a way to double revenues by collecting and then analyzing customer data. They mine their customer data completely. They use loyalty cards to track customer behavior and to determine high revenue customers. Determined that these customers were motivated by reduced hotel room rates, and wanted quick service. They found ways to reduce lines and wait time. High revenue customers rarely waited in any line. Found ways to keep customers coming back. Chapter 12 3 3 Knowledge Management Knowledge Management (KM) is defined as the processes needed to generate, capture, codify and transfer knowledge across the organization to achieve competitive advantage Technology plays a significant role in managing knowledge. Intellectual capital is defined as knowledge that has been identified, captured, and leveraged to produce higher-value goods. Intellectual property allows individuals to own their creativity. Chapter 12 4 4 Knowledge Management KM is related to IS in three ways: IT makes up the infrastructure for KM systems KM systems make up the data infrastructure for many IS applications KM is often referred to as an application of IS A position called “Coordinator for International Intellectual Property Enforcement” was created by the US Department of Commerce. Chapter 12 5 5 DATA, INFORMATION, AND KNOWLEDGE 6 Information Data, information, and knowledge have significant and discreet meanings within KM (Figure 12.1 shows their differences). Data are specific, objective facts or observations (inventory contains 45 units). Data is turned into information by organizing the data into some unit of analysis (dollars, dates, customers, etc.). Chapter 12 7 7 Figure 12.1 The relationships between data, information, and knowledge. Chapter 12 8 8 Knowledge Knowledge is a mix of contextual information, experiences, rules, and values. Richer, deeper, and more valuable. Consider knowing – What? - based upon assembling information and eventually applying it. How? – applying knowledge leads to learning how to do something. Why? – casual knowledge of why something occurs. (Figure 12.2 graphically illustrates these types of knowing). Chapter 12 9 9 Figure 12.2 Taxonomy of Knowledge Chapter 12 10 10 Tacit vs. Explicit Knowledge Tacit knowledge is personal, context-specific and hard to formalize and communicate A [knowledge] developed and internalized by the knower over a long period of time . . . incorporates so much accrued and embedded learning that its rules may be impo ...

1. Chapter 12
Managing Business Knowledge
Managing and Using Information Systems: A Strategic
Approach
by Keri Pearlson & Carol Saunders
1
Learning Objectives
Understand the difference between data, information, and
knowledge.
Define how tacit knowledge differs from explicit knowledge.
Describe why knowledge management is so important.
Understand how knowledge is generated and captured.
Describe a knowledge map.
Chapter 12
2
2
Real World Examples
Harrah’s found a way to double revenues by collecting and then
analyzing customer data.
They mine their customer data completely.
They use loyalty cards to track customer behavior and to
determine high revenue customers.
Determined that these customers were motivated by reduced
hotel room rates, and wanted quick service.

2. They found ways to reduce lines and wait time.
High revenue customers rarely waited in any line.
Found ways to keep customers coming back.
Chapter 12
3
3
Knowledge Management
Knowledge Management (KM) is defined as the processes
needed to generate, capture, codify and transfer knowledge
across the organization to achieve competitive advantage
Technology plays a significant role in managing knowledge.
Intellectual capital is defined as knowledge that has been
identified, captured, and leveraged to produce higher-value
goods.
Intellectual property allows individuals to own their creativity.
Chapter 12
4
4
Knowledge Management
KM is related to IS in three ways:
IT makes up the infrastructure for KM systems
KM systems make up the data infrastructure for many IS
applications
KM is often referred to as an application of IS
A position called “Coordinator for International Intellectual
Property Enforcement” was created by the US Department of
Commerce.
Chapter 12

3. 5
5
DATA, INFORMATION, AND KNOWLEDGE
6
Information
Data, information, and knowledge have significant and discreet
meanings within KM (Figure 12.1 shows their differences).
Data are specific, objective facts or observations (inventory
contains 45 units).
Data is turned into information by organizing the data into some
unit of analysis (dollars, dates, customers, etc.).
Chapter 12
7
7
Figure 12.1 The relationships between data, information, and
knowledge.
Chapter 12
8
8

4. Knowledge
Knowledge is a mix of contextual information, experiences,
rules, and values.
Richer, deeper, and more valuable.
Consider knowing –
What? - based upon assembling information and eventually
applying it.
How? – applying knowledge leads to learning how to do
something.
Why? – casual knowledge of why something occurs.
(Figure 12.2 graphically illustrates these types of knowing).
Chapter 12
9
9
Figure 12.2 Taxonomy of Knowledge
Chapter 12
10
10
Tacit vs. Explicit Knowledge
Tacit knowledge is personal, context-specific and hard to
formalize and communicate
A [knowledge] developed and internalized by the knower over a
long period of time . . . incorporates so much accrued and
embedded learning that its rules may be impossible to separate
from how an individual acts. ‘knowing how’
Explicit knowledge can be easily collected, organized and
transferred through digital means.

5. A theory of the world, conceived of as a set of all of the
conceptual entities describing classes of objects, relationships,
processes, and behavioral norms. Often referred to as ‘knowing
that’, or declarative knowledge.
See Figure 12.3 for more examples.
Chapter 12
11
11
Tacit Knowledge
Knowing how to identify the key issues necessary to solve a
problem
Applying similar experiences from past situations
Estimating work required based on intuition & experience
Deciding on an appropriate course of actionExplicit Knowledge
Procedures listed in a manual
Books and articles
News reports and financial statements
Information left over from past projects
Figure 12.3 Examples of explicit and tacit knowledge
Chapter 12
12
12
FROM MANAGING KNOWLEDGE TO BUSINESS
INTELLIGENCE
13

6. From Managing Knowledge to BI
Managing knowledge is not a new concept, but one
reinvigorated by IT.
KM is still an emerging discipline
Business Intelligence (BI) term used to describe the set of
technologies and processes used to describe business
performance.
BI is a component of KM.
Business Analytics – use of quantitative and predictive models,
and fact based mgmt to drive decisions.
An organization’s only sustainable competitive advantage lies
with how its employees apply knowledge to business problems
KM is not a magic bullet.
Chapter 12
14
14
WHY MANAGE
KNOWLEDGE?
15
Why Manage Knowledge?
Information and knowledge have become the fields in which
businesses compete.
Several important factors include:
Sharing Best Practice
Globalization
Rapid Change
Downsizing
Managing Information and Communication Overload

7. Knowledge Embedded in Products
Sustainable Competitive Advantage
Figure 12.4 summarizes these trends.
Chapter 12
16
16
Figure 12.4 Reasons for Managing Knowledge. ©IBM Global
Services
Chapter 12
17
17
Sharing Best Practices
Sharing best practices means leveraging the knowledge gained
by a subset of the organization.
Increasingly important in organizations who depend on applying
their expertise such as accounting, consulting and training
firms.
KM systems capture best practices to disseminate their
experience within the firm.
Problems often arise from employees who may be reluctant to
share their knowledge (managers must encourage and reward
open sharing).
Chapter 12

8. 18
18
Globalization
Historically three factors, land, labor and capital were the key
to economic success
Knowledge has become a fourth factor.
Knowledge-based businesses can grow without traditional land,
labor, and capital requirements.
Key competitive factor will be how well an organization
acquires and applies knowledge.
Chapter 12
19
19
Other factors
Rapid change: firms must be nimble and adaptive to compete
Downsizing: sometimes the wrong people get fired when
creating a leaner organization
Managing Info and Comm Overload: data must be categorized in
some manner if it is to be useful rather than overwhelming
Knowledge Embedded in Products: the intangibles that add the
most value to goods and services are becoming increasingly
knowledge-based
Sustainable Competitive Advantage: KM is the way to do this.
Shorter innovation life cycles keep companies ahead of the
competition.
Chapter 12
20

9. 20
KNOWLEDGE MANAGEMENT
PROCESSES
21
Knowledge Management
KM involves four main processes –
Generation – all activities that discover “new” knowledge.
Capture – all continuous processes of scanning, organizing, and
packaging knowledge after it has been generated.
Codification – the representation of knowledge in a manner that
can be easily accessed and transferred.
Transfer – transmitting knowledge from one person or group to
another, and the absorption of that knowledge.
Chapter 12
22
22
Knowledge Generation
Concerns the intentional activities of an organization to
acquire/create new knowledge.
Two primary ways are knowledge creation and knowledge
sharing.
Methods include:
Research and Development
Adaptation
Buy or Rent

10. Shared Problem Solving
Communities of Practice
Chapter 12
23
23
Figure 12.5 Knowledge Generation Strategies
Chapter 12
24
24
Research and Development
Knowledge generated by R&D efforts frequently arises from
synthesis
Synthesis brings disparate pieces of knowledge together, often
from extremely diverse sources, then seeks interesting and
useful relationships among them
Realizing value from R&D depends largely on how effectively
new knowledge is communicated and applied across the rest of
the firm
Chapter 12
25
25
Adaptation

11. Adaptation is the ability to apply existing resources in new
ways when external changes make old ways of doing business
prohibitive
A firm’s ability to adapt is based on two factors: having
sufficient internal resources to accomplish change and being
open and willing to change
Chapter 12
26
26
Buy or Rent
Knowledge may be acquired by purchasing it or by hiring
individuals, either as employees or consultants, who possess the
desired knowledge.
Another technique is to support outside research in exchange for
rights to the first commercial use of the results
Chapter 12
27
27
Shared Problem Solving
Also called “fusion,” shared problem solving brings together
people with different backgrounds and cognitive styles to work
on the same problem
The creative energy generated by problem-solving groups with
diverse backgrounds has been termed “creative abrasion”
Chapter 12
28

12. 28
Helping Fusion Work
Ideas that help fusion work effectively include:
(1) fostering awareness of the value of the knowledge sought
and a willingness to invest in it;
(2) emphasizing the creative potential inherent in different
styles of thinking and viewing the differences as positive;
(3) clearly specifying the parameters of the problem to focus the
group on a common goal
Chapter 12
29
29
Communities of Practice
Achieved by groups of workers with common interests and
objectives, but not necessarily employed in the same department
or location, and who occupy different roles on the organization
chart.
Workers communicate in person, by telephone or by e-mail to
solve problems together.
Communities of practice are held together by a common sense
of purpose and a need to know what other members of the
network know
Chapter 12
30
30
Knowledge Codification

13. Knowledge must be used or shared to be of value.
Codification puts the knowledge into a form that makes it easy
to find and use.
It is difficult to measure knowledge in discreet units (since it
changes over time).
Knowledge has a shelf life.
Chapter 12
31
31
Four Basic Principles of Knowledge Codification*
Decide what business goals the codified knowledge will serve
(define strategic intent).
Identify existing knowledge necessary to achieve strategic
intent.
Evaluate existing knowledge for usefulness and the ability to be
codified.
Determine the appropriate medium for codification and
distribution.
*Davenport and Prusak (1998)
Chapter 12
32
32
Knowledge Capture
Knowledge capture takes into account the media to be used in
the codification process.
The 3 main knowledge capture activities are:
Scanning (gather “raw” information) – can be electronic or
human.

14. Organizing (move it into an acceptable form) – must be easy for
all types of users to access.
Designing knowledge maps (providing a guide for navigating
the knowledge base)
Chapter 12
33
33
Organizing Knowledge
Folksonomies – site for collaboratively creating and managing
tags for annotating and categorizing content.
One scheme for categorizing knowledge uses four broad
classifications (Ruggles 1997):
Process knowledge – best practices, useful for increasing
efficiency.
Factual knowledge – easy to document; basic information about
people/things.
Catalog knowledge – know where things are; like directories of
expertise.
Cultural knowledge – knowing how things get done politically
and culturally.
Chapter 12
34
34
Designing Knowledge Maps
A knowledge map (see figure 12.6) serves as both a guide to
where knowledge exists in an organization and an inventory of
the knowledge assets available.
A knowledge map can consist of nothing more than a list of

15. people, documents, and databases telling employees where to go
when they need help.
Provides access to resources that would otherwise be difficult or
impossible to find
Can capture tacit knowledge through narratives.
Good stories are effective for knowledge transfer.
Chapter 12
35
35
Figure 12.6 Contents of knowledge maps
Chapter 12
36
36
Knowledge Transfer
Nonaka and Takeuchi’s Knowledge Transfer describe four
different modes of knowledge conversion (transfer):
Socialization: from tacit knowledge to tacit knowledge
Externalization: from tacit knowledge to explicit knowledge
Combination: from explicit knowledge to explicit knowledge
Internalization: from explicit knowledge to tacit knowledge
Chapter 12
37
37

16. COMPETING WITH BUSINESS ANALYTICS
38
Business Analytics
Companies find success through better use of analytics.
Many companies offer similar products and user comparable
technologies.
Business processes are among the last remaining points of
differentiation.
They fuel fact-based decision making.
Chapter 12
39
39
Business Analytics
Davenport and Harris suggest that companies who are
successful competing with business analytics have these five
capabilities:
Hard to duplicate
Uniqueness
Adaptability
Better than competition
Renewability
Chapter 12
40
40

17. COMPONENTS OF
BUSINESS ANALYTICS
41
Figure 12.8 Components of Business
AnalyticsComponentDefinitionExampleData RepositoryServers
and software used to store dataData warehousesSoftware Tools
Applications and processes for statistical analysis, forecasting,
predictive modeling and optimization.Data mining process;
Forecasting software packageAnalytics
EnvironmentOrganizational environment that creates and
sustains the use of analytics toolsReward system that
encourages the use of the analytics tools; willingness to test or
experimentSkilled Work ForceWork force that has the training,
experience and capability to use the analytics toolsHarrahs and
Capital One have such work forces
Chapter 12
42
42
Components of Business Analytics
Data repositories - data warehouses sometimes serve as
repositories of organizational knowledge.
Software Tools – data mining is used to analyze data in the data
warehouse looking for “gems”.
Four categories of tools used:
Statistical analysis
Forecasting/extrapolation
Predictive modeling
Optimization

18. Chapter 12
43
43
Components of Business Analytics
Analytics Environment – alignment of corporate culture.
Incentive system
Metrics used to measure success of initiatives
Processes for using analytics
Skilled work force – experts are needed.
Managers must set the example (CEO-level sponsorship).
Require decisions be made using analytics.
Chapter 12
44
44
CAVEATS FOR MANAGING KNOWLEDGE
45
Caveats for Managing Knowledge
KM and BI are emerging disciplines
Competitive advantage increasingly depends on knowledge
assets that are hard to reproduce, so it is sometimes in the best
interests of the firm to keep knowledge tacit, hidden, and
nontransferable
Knowledge can create a shared context for thinking about the
future, not to know the future, but rather to know what

19. projections influence long-term strategy and short-term tactics
The success of KM ultimately depends on a personal and
organizational willingness to learn
Chapter 12
46
46
FOOD FOR THOUGHT: BUSINESS EXPERIMENTATION
47
Business Experimentation
Thomke discusses business experimentation as a means of
innovation.
Products and services are created and improved using analytics
through a process of experimentation.
Companies who excel are able to create new products and
services at a fraction of the cost of others.
Capital One is built around this methodology.
Ran 1,000s of experiments on their bank’s customer database to
test and develop new ideas.
Chapter 12
48
48
Business Experimentation
Capital One had the following results:
Increased business savings retention by 87%

20. Lowered the cost of acquiring new accounts by 83%
It is a concept of test and learn.
Projects are managed as experiments.
Projects are designed with a series of rapid iterations.
Both Harrah’s and Capital One have built a core competency in
business experimentation and analytics.
Chapter 12
49
49
Summary
KM is related to information systems in three ways: IT makes
up its infrastructure, KM makes up the data infrastructure for
many IS and apps, and KM is often referred to as an app of IS.
Data, information, and knowledge should not be seen as
interchangeable.
The 2 kinds of knowledge are tacit and explicit.
Manage knowledge carefully, there are many valid and of
course legal reasons.
KM projects can be measured using project-based measures.
Chapter 12
50
50
Valuable information
from the human mind:
includes reflection,
synthesis, context
•Hard to capture
electronically
•Hard to structure

21. •Often tacit
•Hard to transfer
•Highly personal to
the source
Data with relevance
and purpose:
•Requires unit of
analysis
•Needs consensus on
meaning
•Human mediation
necessary
•Often garbled in
transmission
Simple observations
of the world:
•Easily captured
•Easily structured
•Easily transferred
•Compact,
quantifiable
InformationKnowledgeData
Valuable information
from the human mind:
includes reflection,
synthesis, context
•Hard to capture
electronically
•Hard to structure
•Often tacit
•Hard to transfer
•Highly personal to
the source
Data with relevance
and purpose:
•Requires unit of

22. analysis
•Needs consensus on
meaning
•Human mediation
necessary
•Often garbled in
transmission
Simple observations
of the world:
•Easily captured
•Easily structured
•Easily transferred
•Compact,
quantifiable
InformationKnowledgeData
More human contribution
Greater value
More human contribution
Greater value
Know-Why
Know-WhatKnow-How
Application
Experience
Information
Procedure
Reasoning
Know-What
Know-Why
Know-How
Application

23. Experience
Information
Procedure
Reasoning
Sharing Best Practices
•
Avoid “ reinventing the wheel”
•
Build on previous work
Sustainable Competitive
Advantage
•
Shorter life
-
cycle of innovation
•
Knowledge as an infinite resource
•
Direct bottom
-
line returns
Managing Overload
•
Inability to assimilate knowledge
•
Data organization and storage
is needed
Downsizing
•
Loss of knowledge
•
Portability of workers

24. •
Lack of time and resources
for knowledge acquisition
Globalization
•
Decreased cycle times
•
Increased competitive pressures
•
Global access to knowledge
•
Adapting to local conditions
Embedded Knowledge
•
Smart products
•
Blurring of distinction between
service and manufacturing firms
•
Value
-
added through intangibles
Rapid Change
•
Avoid obsolescence
•
Build on previous work
•
Streamline processes
•
Sense and respond to change
Why Manage
Knowledge?

25. Sharing Best PracticesAvoid “ reinventing the wheel”Build on
previous work
Sustainable Competitive
AdvantageShorter life-cycle of innovationKnowledge as an
infinite resourceDirect bottom-line returns
Managing OverloadInability to assimilate knowledgeData
organization and storage
is needed
DownsizingLoss of knowledgePortability of workersLack of
time and resources
for knowledge acquisition
GlobalizationDecreased cycle timesIncreased competitive
pressuresGlobal access to knowledgeAdapting to local
conditions
Embedded KnowledgeSmart productsBlurring of distinction
between
service and manufacturing firmsValue-added through
intangibles
Rapid ChangeAvoid obsolescenceBuild on previous
workStreamline processesSense and respond to change
Why Manage
Knowledge?
KNOWLEDGE
GENERATION
Buy or Rent
Adaptation
Creating (R&D)
Shared Problem
Solving
Communities of
Practice

26. KNOWLEDGE
GENERATION
Buy or Rent
Adaptation
Creating (R&D)
Shared Problem Solving
Communities of Practice
Journal of Nursing Law, Volume 13, Number 3, 2009
68 • Copyright © 2009 Springer Publishing Company
DOI: 10.1891/1073-7472.13.3.68
Ethical Issues in Nursing Practice
Mihyun Park, MSN, RN
Nurses play a role as advocates to assist patients and families
struggling with complex information
and difficult decisions. In particular, the fact that nurses
encounter clinical situations that require
ethical judgment highlights the need for nursing staff to gain
knowledge and expertise in deliver-
ing care in an ethical manner. In this study, through reviewing
empirical studies of hospital-based
nurses’ experiences, the author identified the ethical issues that
nurses frequently face and the
approaches that they have taken to solving them. The findings
can serve to intensify the awareness

27. of the ethical issues in both clinical and educational areas.
Keywords: ethical issues; nursing practice; education;
hospitals
Advances in medical technology allow for bet-ter recovery for
critically ill patients and dramatically extend the human life
span.
However, while advances bring benefits to patients
and families, they simultaneously raise moral and
ethical issues regarding respect for patient integrity
and autonomy, soaring medical costs, quality care,
and end-of-life decision making (Scanlon & Fleming,
1990; Wright, Cohen, & Caroselli, 1997). As the largest
group of health care providers, nurses are frequently
placed in unique positions to assist patients and
families struggling with complex information and dif-
ficult decisions (Briggs & Colvin, 2002). The fact that
nurses encounter clinical situations that require ethi-
cal judgment highlights the need for nursing staff to
gain knowledge and expertise in delivering care in an
ethical manner.
Reporting the lack of ethical confidence among
newly graduated nurses, nursing ethics researchers
have emphasizes the importance of having well-
educated and well-qualified nurses who know how
to find feasible solutions to ethical problems (Bunch,
2001; Woods, 2005). Although nursing schools have
become more concerned with the ethical development
of their students, researchers point out that education
has not reflected reality and does not prepare newly
qualifying nurses to deal effectively with a variety of
ethical situations in the health care setting ( Woods,
2005). The traditional ethics education has tended
to emphasize the acquisition of philosophical and

28. theoretical knowledge and has created a gap between
theory and practice ( Woods, 2005). New approaches
are needed for teaching nursing ethics pragmatically.
The nursing ethic as a dynamic standard for nurses’
professional moral behavior should address ethical
issues confronted by nurses (Omery, Henneman, Bil-
let, Luna-Raines, & Brown-Saltzman, 1995). Therefore,
knowledge about specific nursing ethical issues found
in the health care setting and understanding the impact
of these issues on practice will be essential, pragmatic
parts of nursing ethics education. That is, the ethical
issues are subjects that should be dealt with in ethics
education for nursing students before entering in nurs-
ing practice. Thus, identifying what issues should be
dealt with in classes is needed.
Researchers have tried to identify ethical issues that
nurses confront in the clinical area since Vaughan’s
(1935) study. The earliest study of ethical issues in
nursing practice (Vaughan, 1935) identified 2,265
ethical issues based on the diaries of 95 nurses that
recorded ethical issues. Since this study, many other
studies have been focused on ethical issues that affect
the profession of nursing and the everyday practice
of individual nurses using qualitative methodolo-
gies. In a review study, Christensen (2002) identified
the ethical and legal issues that oncology nurses in
hospitals face: (a) advance directives, ( b) do-not-
resuscitate orders, (c) documentation and patient
privacy, (d) informed consent, (e) medication errors,
and (f ) pain management. A systematic analysis

29. Park • Ethical Issues in Nursing Practice • 69
study of nurses’ ethical conflicts identified each main
ethical issue in a particular role or setting (Redman &
Fry, 2000). Examples were (a) harm/good of life-
prolonging aggressive therapies (intensive care unit);
( b) inadequacy of resources for care (administration);
(c) undertreatment, consent, and refusal of treatment
(oncology); (d) disagreement with quality of medical
care (diabetes educators); and (e) protection of child’s
rights (pediatric nurse practitioner). However, a sys-
tematic review of ethical issues encountered by nurses
in current practice is rarely found.
The purpose of this study is to review the empiri-
cal studies of hospital-based nurses’ experiences with
ethical issues to identify (a) the ethical issues nurses
face and ( b) the approaches they have taken to solving
them.
METHODS
This article reviewed quantitative studies of hospital-
based nurses’ experiences with ethical issues. To be
included in this review, a publication was to have
reported the findings from a research project studying
nurses’ experiences. The integrative review included
the reports of primary research studies that were pub-
lished in the English language from 1990 and 2007. This
study began with a search of multiple library databases,
including PubMed (MEDLINE), the Cumulative Index
to Nursing and Allied Health (CINAHL), and ISI Web of
Knowledge, to identify research related to ethical issues
that nurses face. Key words used in the search process
were “nursing ethics” and “issue” and/or “problem.”
Additional literature was identified by reviewing the

30. reference lists of journal articles identified during the
literature review.
Examination of the published abstracts and studies
resulted in a decrease of the number of studies included
in the first sampling because studies that did not match
the project criteria were excluded ( n = 25). This study
was limited to hospital-based research and settings in
the United States. Most studies in special clinic areas
dealt with a more specific ethical issue or conflict situa-
tion. Therefore, these articles were excluded. However,
this review included the studies done in operating room
areas and collected data from registered nurses in a
local area because the studies dealt with more general
ethical issues encountered by perioperative nurses or
registered nurses with a large sample size. One article
that collected data from directors of nursing in hos-
pitals was included because the directors explained
ethical issues not that they faced but that were faced by
staff nurses. Therefore, through the second review, the
researcher excluded the articles that did not match the
purpose of this project.
This review classified the ethical issues reported by
each study into three categories of the Ethical Issues
Scale (EIS): end-of-life treatment decisions, patient care
issues, and human rights issues. Fry and Damrosch
(1994) developed the EIS in a study of Maryland nurses.
The EIS was validated with a sample of New England
registered nurses currently in practice (Fry & Duffy,
2001). The scale described the full range of ethical
issues experienced by nurses in current practice. The
32-item scale represented three conceptual categories
of ethical issues: end-of-life treatments, patient care,
and human rights (Fry & Duffy, 2001) (see Table 1).

31. The end-of-life treatment category was defined as
issues about death or the dying process and included 13
issues. The patient care category addressed issues about
how patients receive or do not receive quality nursing
or health care (14 items). The human rights category
was defined as issues concerning the rights of nurse,
patients, and family members (five items). The EIS pro-
vides information about the full range of ethical issues
of registered nurses in active practice experience. The
reliability and validity of the EIS have been validated
through a study with a large RN sample ( n = 2,090) and
nurses with expertise in bioethics (Fry & Duffy, 2001).
RESULTS
Twenty-five studies were identified through the first
review process, and 11 studies met the inclusion crite-
ria. All studies used a descriptive research method with
survey instruments. Articles reviewed were classified
into two settings: hospital and operating room. One
article collected data from registered nurses in Mary-
land; this article was integrated to hospital setting data.
The ethical issues reported in reviewed studies were
divided into three categories (end-of-life treatment
decisions, patient care issues, and human rights issues)
in the EIS. This review described disturbing ethical
issues that were encountered by nurses separated from
the frequent ethical issues. This study identified the
top five frequent ethical issues and disturbing ethical
issues reported in each article and then integrated and
analyzed these issues. Furthermore, this study identi-
fied the approaches that nurses have taken to solve the
ethical issues and the resources that nurses frequently
used to get help and information.
Ethical Issues

32. As shown in Table 2, the most of frequent ethical issues
faced by nurses related to patient care issues and human
70 • Journal of Nursing Law • Vol. 13, No. 3
TABLE 1. The Ethical Issues Scale
Component 1: End-of-life treatment decisions
Prolong dying process with inappropriate measures
Treatment or nontreatment despite patient or family wishes
Use or removal of life support including nutrition and hydration
To resuscitate or not to resuscitate
Treatment or nontreatment of very disabled infant, child, adult
Not considering quality of patient’s life
Acting against your own personal or religious views
Acting against patient’s personal or religious values
Determining when death occurs
Organ transplantation, or organ or tissue procurement
Over- or underuse of pain management
Ordering too many or too few procedures, tests, etc.
Participation or refusal to participate in euthanasia or assisted
suicide
Component 2: Patient care issues
Staffing patterns that limit patient access to nursing care
Child or spousal or elderly or patient abuse or neglect
Allocation of resources (human, financial, equipment)
Implementing managed care policies threatening quality of care
Breaches of patient confidentiality or privacy (e.g., HIV status)
Irresponsible or unethical or incompetent or impaired colleague
Ignoring patient or family autonomy

33. Patients or families uninformed or misinformed about treatment,
prognosis, medical alternatives
Rights of minors versus parental rights
Discriminatory treatment of patients
Unsafe equipment or environmental hazards
Conflict in nurse or doctor relationship (or other professional
relationship)
Reporting unethical or illegal practice of health professional or
health agency
Implementing managed care policies threatening availability of
care
Component 3: Human rights issues
Use or nonuse of physical or chemical restraints
Issues involving advance directives
Protecting patient rights and human dignity
Informed consent to treatment
Providing care with possible risk to RNs’ health (e.g., TB, HIV,
violence)
Note. From “The development and the psychometric evaluation
of the Ethical Issues Scale,” by Fry and Duffy, 2001, Journal
of Nursing Scholarship, 33(3), p. 276.
rights issues rather than end-of life issues. The most
frequent issues were founded in patient care issue cat-
egory. Of patient care issues that nurses encountered,
staffing patterns that limit patient access to nursing care
( n = 6) was the most frequent ethical issue. In addition,
nurses frequently encountered patient care issues such
as conflict in nurse or doctor relationship ( n = 4), alloca-
tion of resources (human, financial, equipment) ( n = 4),
patient confidentiality or privacy ( n = 4), and incom-
petent or impaired colleague ( n = 4). In human rights
issue category, the following three items were identi-

34. fied as the most frequent ethical issues: (a) protecting
patient rights and human dignity ( n = 5), (b) providing
care with possible risk to RNs’ health ( n = 5), and (c)
informed consent to treatment ( n = 4).
When this review separated the setting into a gen-
eral hospital versus operating room area, studies done
in a general hospital setting identified other frequent
ethical issues: dealing with an irresponsible or unethi-
cal or incompetent or impaired colleague (Berger, Sev-
erson, & Chvatal, 1991; Cook, Hoas, & Joyner, 2000),
end-of-life care (Killen, 2002; Scanlon, 1990, 1994), and
pain management (Omery et al., 1995; Scanlon, 1994).
Nurses in hospitals reported that they experienced fre-
quent ethical problems related to patient confidential-
ity or privacy issues as well as staffing patterns issues.
T
A
B
L
E
2
.
F
re
q
u

35. en
t
E
th
ic
a
l
Is
su
es
A
rt
ic
le
s
Se
tt
in
g
E
n
d
-o
f-

36. L
if
e
T
re
at
m
en
t
D
ec
is
io
n
s
P
at
ie
n
t
C
ar
e
Is

37. su
es
H
u
m
an
R
ig
h
ts
I
ss
u
es
B
er
ge
r
et
a
l.
(1
99

38. 1)
A
h
o
sp
it
al
(
U
)
P
ro
lo
n
gi
n
g
li
fe
w
it
h
h

39. er
o
ic
m
ea
su
re
sa
St
af
fi
n
g
p
at
te
rn
s,
in
ap
p
ro
p

40. ri
at
e
al
lo
ca
ti
o
n
o
f
re
so
u
rc
es
,
d
ea
li
n
g
w
it

41. h
si
tu
at
io
n
s
w
h
er
e
p
at
ie
n
ts
a
re
d
is
cu
ss
ed

42. i
n
ap
p
ro
-
p
ri
at
el
y
,
d
ea
li
n
g
w
it
h
c
o
ll
ea
gu

43. es
’ i
rr
es
p
o
n
si
b
le
ac
ti
v
it
y
C
o
o
k
e
t
al
.
(2

44. 00
0)
H
o
sp
it
al
s
(R
)
St
af
fi
n
g
p
at
te
rn
s,
p
at
ie
n
t

45. fa
m
il
y
r
eq
u
es
ti
n
g
m
o
re
ag
gr
es
si
v
e
tr
ea
tm
en

46. t
o
p
ti
o
n
s,
a
p
at
ie
n
t
h
as
u
n
cl
ar
i-
fi
ed
c
o
n

47. fu
si
n
g
o
r
n
o
-c
o
d
e
o
rd
er
s,
c
o
ll
ea
gu
es
a
re

48. d
is
cu
ss
in
g
p
at
ie
n
ts
i
n
ap
p
ro
p
ri
at
el
y
,
d
ea

49. li
n
g
w
it
h
an
i
n
co
m
p
et
en
t
co
ll
ea
gu
e
F
ry
a

50. n
d
D
am
ro
sc
h
(
19
94
)
R
N
s
in
M
ar
y
-
la
n
d
Q

51. u
al
it
y
o
f
p
at
ie
n
t
li
fe
St
af
fi
n
g
p
at
te
rn
s,
n
u

52. rs
e–
p
h
y
si
ci
an
r
el
at
io
n
sh
ip
s
P
ro
v
id
in
g
ca
re

53. t
h
at
p
la
ce
s
th
e
n
u
rs
e
at
r
is
k
a
Je
n
k
in
s
et

54. a
l.
(2
00
6)
O
R
i
n
a
rm
y
St
af
fi
n
g
p
at
te
rn
s,
c

55. o
n
fl
ic
ts
i
n
t
h
e
n
u
rs
e–
p
h
y
si
ci
an
re
la
ti

56. o
n
sh
ip
a
P
ro
v
id
in
g
ca
re
w
it
h
r
is
k
to
s
el
f,

57. p
ro
te
ct
in
g
p
at
ie
n
t
ri
gh
ts
a
n
d
h
u
m
an
d
ig
n

58. it
y
K
il
le
n
e
t
al
.
(1
99
6)
O
R
St
af
fi
n
g
p
at
te
rn

59. s,
n
u
rs
e–
p
h
y
si
ci
an
r
el
at
io
n
sh
ip
P
ro
v
id
in
g
ca

60. re
w
it
h
r
is
k
t
o
se
lf
,a
i
n
fo
rm
ed
c
o
n
se
n
t,

61. p
at
ie
n
t
ad
v
o
ca
cy
K
il
le
n
(
20
02
)
O
R
E
n
d
-o

62. f-
li
fe
c
ar
e,
ab
o
rt
io
n
i
ss
u
es
Q
u
al
it
y
o
f
ca

63. re
,
tr
u
th
t
el
li
n
g,
a
b
u
se
o
f
ch
il
d
re
n
/o
ld
er

64. p
eo
p
le
,
co
n
fi
d
en
ti
al
it
y
,
p
ri
v
ac
y
In
fo
rm
ed

65. c
o
n
se
n
t,
a
H
IV
/
A
ID
S
ca
re
,
cl
in
ic
al
s
af
et
y

66. K
in
g
an
d
M
is
k
o
v
ic
(
19
96
)
O
R
St
af
fi
n
g
p

67. at
te
rn
s,
a
al
lo
ca
ti
o
n
o
f
re
so
u
rc
es
,
p
at
ie
n
ts
’ a

68. u
to
n
o
m
y
/a
d
v
o
ca
cy
In
fo
rm
ed
c
o
n
se
n
t,
o
cc
u

69. -
p
at
io
n
al
r
is
k
,
p
at
ie
n
t
se
lf
-
d
et
er
m
in
at

70. io
n
a
ct
O
m
er
y
e
t
al
.
(1
99
5)
A
h
o
sp
it
al
(
U
)

71. P
ai
n
r
el
ie
f/
m
an
ag
em
en
ta
D
ea
li
n
g
w
it
h
d
if
fi

72. cu
lt
p
at
ie
n
ts
,
p
at
ie
n
t–
p
h
y
si
ci
an
–
n
u
rs
e

73. re
la
ti
o
n
sh
ip
,
ca
re
o
f
n
o
n
co
m
p
li
an
t
p
at
ie

74. n
t,
co
st
o
f
ca
re
t
o
t
h
e
p
at
ie
n
t
Sc
an
lo
n
(

75. 19
90
)
H
o
sp
it
al
s
(U
)
D
o
n
o
t
re
su
sc
it
at
ea
d
ea

76. th
a
n
d
d
y
in
g.
P
ro
fe
ss
io
n
al
p
ra
ct
ic
e
is
su
es
,

77. A
ID
S,
a
ll
o
ca
ti
o
n
o
f
re
so
u
rc
es
P
at
ie
n
ts
’ r
ig

78. h
ts
,
A
ID
S
Sc
an
lo
n
(
19
94
)
H
o
sp
it
al
s
in
50
s
ta

79. te
s
E
n
d
-o
f-
li
fe
c
ar
e,
p
ai
n
m
an
ag
em
en
t
C
o

80. st
o
f
co
n
ta
in
m
en
t
is
su
e,
a
co
n
fi
d
en
ti
al
it
y
,

81. in
co
m
p
et
en
t,
u
n
et
h
ic
al
,
o
r
il
le
ga
l
p
ra
ct
ic

82. es
o
f
co
ll
ea
gu
es
Sc
h
ro
et
er
(
19
99
)
O
R
Im
p
ai
re

83. d
p
ro
v
id
er
/p
o
te
n
ti
al
f
o
r
u
n
sa
fe
p
ra
ct
ic
e,

84. m
is
re
p
re
se
n
ta
ti
o
n
b
y
c
ar
e
p
ro
v
id
er
,
p
ro

85. v
id
er
ju
d
gm
en
t/
co
m
p
et
en
cy
C
o
n
se
n
t/
ad
v
o
ca

86. cy
,a
d
is
re
sp
ec
t
fo
r
p
at
ie
n
t
N
ot
e.
U
=
u
rb
an

87. a
re
a;
R
=
r
u
ra
l
ar
ea
;
R
N
=
r
eg
is
te
re
d
n
u
rs

88. es
;
O
R
=
o
p
er
at
in
g
ro
o
m
.
a M
o
st
f
re
q
u
en
t

89. it
em
i
n
t
h
e
ar
ti
cl
e.
72 • Journal of Nursing Law • Vol. 13, No. 3
TABLE 3. Rankings of Frequent Ethical Issues and Disturbing
Ethical Issues
Frequent Ethical Issues
in All Reviews (N)
Frequent Ethical Issues
in Hospital Setting (N)
Frequent Ethical Issues in
Operating Room (N)
Disturbing Ethical
Issues (N)

90. Staffing patterns
that limit patient
access to nursing
care
(6) Patient confiden-
tiality or privacy
(4) Protecting patient
rights and human
dignity
(4) Prolong dying process
with inappropriate
measures
(4)
Protecting patient
rights and human
dignity
(5) Staffing patterns
that limit patient
access to nursing
care
(3) Informed consent
to treatment
(4) Child or spousal or
elderly or patient
abuse or neglect
(3)

91. Providing care
with possible risk
to RNs’ health
(5) Allocation
of resources
(human, finan-
cial, equipment)
(3) Providing care with
possible risk to
RNs’ health
(3) Staffing patterns that
limit patient access to
nursing carea
(2)
Conflict in nurse
or doctor rela-
tionship (or other
professional rela-
tionship)
(4) Irresponsible
or unethical or
incompetent or
impaired col-
league
(3) Staffing patterns
that limit patient
access to nursing
care

92. (3) Acting against your
own personal or reli-
gious views
(2)
Allocation
of resources
(human, finan-
cial, equipment)
(4) Conflict in nurse
or doctor rela-
tionship (or other
professional rela-
tionship)
(2) Conflict in nurse or
doctor relationship
(or other profes-
sional relationship)
(2) Irresponsible or uneth-
ical or incompetent or
impaired colleaguea
(2)
Informed consent
to treatment
(4) Providing care
with possible risk
to RNs’ health
(2) Providing care with

93. possible risk to RNs’
healtha
(2)
Irresponsible
or unethical or
incompetent or
impaired col-
league
(4) End-of-life deci-
sion
(2) Treatment or nontreat-
ment despite patient
or family wishes
(2)
Patient confiden-
tiality or privacy
(4) Pain manage-
ment
(2)
aFrequent ethical issues included in the disturbing ethical
issues.
In contrast, this review found that perioperative nurses
experienced more frequent ethical issues related to
protecting patient rights and human dignity issues and
informed consent than other issues (see Table 3).

94. Five of the reviewed articles reported disturbing eth-
ical issues separately from the frequent ethical issues
faced by nurses. Although these ethical issues would
not frequently happen in their practice areas, nurses
reported to be disturbed a great deal or quite a bit
when these occurred. As shown in Table 3, the disturb-
ing issues related to patient care issues and end-of-life
issues. The disturbing ethical issues were (a) prolonging
the dying process with inappropriate measures ( n = 4),
(b) child, spousal, elderly, or patient abuse or neglect
( n = 3); (c) staffing patterns that limit patient access
to nursing care (Berger et al., 1991; Jenkins, Elliott, &
Harris, 2006); (d) acting against your own personal or
religious views (Berger et al., 1991; Cook et al., 2000);
(e) irresponsible, unethical, incompetent, or impaired
colleague (Jenkins et al., 2006; Killen, Fry, & Damro-
sch, 1996); (f) providing care with possible risk to RNs’
health (e.g., TB, HIV, violence) (Fry & Damrosch, 1994;
Killen et al., 1996); and (g) treatment or nontreatment
despite patient or family wishes (Berger et al., 1991;
Cook et al., 2000) (see Table 4).
The most of disturbing issues were not frequent
ethical issues experienced by nurses. Disturbing issues
often related to end-of-life issues: prolonging the dying
process with inappropriate measures, acting against
your own personal or religious views, and treatment or
nontreatment despite patient or family wishes. Nurses
reported being disturbed when patient abuse or neglect
Park • Ethical Issues in Nursing Practice • 73
TABLE 4. The Most Disturbing Ethical Issues

95. Articles Setting
End-of-Life Treatment
Decisions Patient Care Issues
Human Rights
Issues
Berger et al. (1991) A hospital (U) Treatment despite
patients’ objectives,
prolonging life with
heroic measures,
acting against personal
principles
Inadequate staffing
patterns,a incidents
of patients’ abuse
Cook et al. (2000) Hospitals (R) Acting against
personal principles,a
prolonging life with
heroic measures
Patient family
requesting more
aggressive treat-
ment options, cost-
containment issues
that threaten quality
if care, treatment
or nontreatment
despite patient or
family wishes
Fry and Damrosch

96. (1994)
RNs in Maryland Prolonging life
with extraordinary
measures,a quality
of patient life
Cost-containment
issues that threaten
quality of care,
child/spousal /
elderly/patient
abuse or neglect
Providing care
with risk to selfa
Jenkins et al.
(2006)
OR in army Dealing with incom-
petent or impaired
colleagues,a
conflicts in the
nurse–physician
relationship,
staffing patterns,
unsafe equipment
and /or environment
hazards
Killen et al. (1996) OR Prolonging life with
extraordinary means,a
treatment over family
objectives

97. Irresponsible/incom-
petent colleagues,
patients and families
who are uninformed
or misinformed
about treatment
plans, prognosis,
child/other abuse
Providing care
with risk to self
Note. U = urban area; R = rural area; RN = registered nurses;
OR = operating room.
aMost frequent item in the article.
of patient care issues occurred. Furthermore, the
review found that the staffing pattern and incompetent,
impaired colleagues issues and providing care with pos-
sible risk to RNs’ health were disturbing issues as well
as frequent issues that were faced by nurses.
Approaches/Resources
This study also reviewed the approaches and resources
that nurses have taken to solving ethical issues. Four
articles reported that most nurses used their own per-
sonal values to solve ethical issues (Berger et al., 1991;
Cook et al., 2000; Killen et al., 1996; Schroeter, 1999)
(see Table 5). In addition, most nurses discussed ethical
problems with nursing peers (Berger et al., 1991; Cook
et al., 2000; Jenkins et al., 2006; Killen et al., 1996;
Scanlon & Fleming, 1990). One study reported that 68%
of respondents reported talking to a higher administra-
tive authority (e.g., managers, supervisors, or directors)

98. T
A
B
L
E
5
.
A
p
p
ro
a
ch
es
a
n
d
R
es
o
u
rc
es

99. f
o
r
E
th
ic
a
l
Is
su
es
A
rt
ic
le
s
Se
tt
in
g
Sa
m
p

100. le
Sa
m
p
le
S
iz
e
(N
)
M
ea
su
re
s
A
p
p
ro
ac
h
es
/R
es

101. o
u
rc
es
E
N
C
o
m
m
en
ts
B
er
ge
r
et
a
l.
(
19
91
)
A

102. h
o
sp
it
al
i
n
an
u
rb
an
a
re
a
N
u
rs
es
52
A
q
u
es
ti

103. o
n
n
ai
re
(E
th
ic
al
I
ss
u
es
i
n
N
u
rs
in
g
)

104. O
w
n
p
er
so
n
al
v
al
u
es
(
88
%
)
N
u
rs
in
g
co
ll
ea

105. gu
es
(
97
%
)
(+
)
R
ec
o
m
m
en
d
at
io
n
:
n
u
rs
in
g

106. et
h
ic
s
ro
u
n
d
s,
e
d
u
ca
ti
o
n
al
o
p
p
o
rt
u
n

107. it
ie
s/
p
ro
gr
am
s,
a
sh
ar
ed
g
o
v
er
n
an
ce
m
o
d
el
C

108. o
o
k
e
t
al
.
(2
00
0)
21
h
o
sp
it
al
s
in
r
u
ra
l
ar
ea
N

109. u
rs
es
20
4
A
1
4-
p
ag
e
su
rv
ey
O
w
n
p
er
so
n
al
v
al

110. u
es
(
48
%
)
N
u
rs
in
g
co
ll
ea
gu
es
(
87
%
),
n
u
rs

111. in
g
le
ad
er
sh
ip
(
77
.4
%
),
p
h
y
si
ci
an
s
(7
0%
),
c

112. le
rg
y
(7
%
)
(+
)
E
d
u
ca
ti
o
n
t
o
p
ic
s:
p
ro
fe
s-

113. si
o
n
al
r
es
p
o
n
si
b
il
it
ie
s,
i
n
fo
r-
m
at
io
n
o

114. n
p
at
ie
n
t
ri
gh
ts
,
p
ri
v
ac
y
a
n
d
c
o
n
fi
d
en
ti

115. al
it
y
,
in
fo
rm
at
io
n
r
eg
ar
d
in
g
tr
u
th
te
ll
in
g
F

116. ry
a
n
d
D
am
ro
sc
h
(
19
94
)
R
N
s
in
M
ar
y
la
n

117. d
N
u
rs
es
46
2
T
h
e
su
rv
ey
in
st
ru
m
en
t
N
u
rs
in

118. g
p
ee
rs
(
71
%
),
n
u
rs
in
g
le
ad
er
sh
ip
(
51
%
),

119. p
h
y
si
ci
an
s
(5
6%
),
o
th
er
p
ro
fe
ss
io
n
al
s
(3
9%
),

120. et
h
ic
s
co
m
m
it
te
e
(1
1%
)
(+
)
E
d
u
ca
ti
o
n
t

121. o
p
ic
s:
e
m
p
o
w
er
-
m
en
t
o
f
n
u
rs
es
,
co
n
te
n

122. t/
in
te
rp
re
ta
ti
o
n
o
f
n
u
rs
es
’
et
h
ic
al
c
o
d
es

123. ,
ca
re
o
f
H
IV
/
A
ID
S
p
at
ie
n
ts
,
tr
ea
tm
en
t/
n
o
n

124. tr
ea
tm
en
t
o
f
th
e
d
y
in
g
an
d
/o
r
el
d
er
ly
,
q
u

125. al
it
y
o
f
li
fe
,
u
se
/r
em
o
v
al
o
f
li
fe
su
p
p
o
rt

126. s
y
st
em
s,
p
ro
fe
s-
si
o
n
al
r
es
p
o
n
si
b
il
it
ie
s,

127. ca
re
o
f
d
an
ge
ro
u
s
an
d
/o
r
o
ff
en
si
v
e
p
at
ie
n

128. ts
,
et
h
ic
al
d
ec
is
io
n
m
ak
in
g,
p
ai
n
m
an
-
ag
em
en

129. t,
m
o
ra
l
d
ev
el
o
p
-
m
en
t/
r
ea
so
n
in
g
Je
n
k
in

130. s
et
a
l.
(2
00
6)
A
rm
y
i
n
U
n
it
ed
S
ta
te
s
C
R

131. N
A
s
A
N
C
=
7
4;
D
A
C
=
2
2
M
o
d
if
ie
d
E
th
ic

132. al
Is
su
e
Sc
al
e
(E
IS
)
A
n
i
n
fo
rm
al
a
p
p
ro
ac
h

133. N
u
rs
in
g
p
ee
r
(8
4.
5%
),
n
u
rs
in
g
le
ad
er
sh
ip
(

134. 54
.6
%
),
et
h
ic
s
co
m
m
it
te
e
(5
.2
%
)
(+
)
E
d
u

135. ca
ti
o
n
t
o
p
ic
s:
e
th
ic
s
o
f
tr
ia
ge
,
co
n
d
u
ct
o

136. f
th
e
h
ea
lt
h
ca
re
p
ro
v
id
er
a
s
a
p
ri
so
n
er

137. o
f
w
ar
,
th
e
ro
le
o
f
n
u
rs
es
a
s
ad
v
o
ca
te
s,
e

138. th
ic
al
d
ec
is
io
n
m
ak
in
g,
q
u
al
it
y
o
f
li
fe
K
il

139. le
n
e
t
al
.
(1
99
6)
O
R
/r
ec
o
v
er
y
ro
o
m
P
O
R
N

140. s
37
3
P
re
-E
IS
N
u
rs
es
’ p
er
so
n
al
c
o
d
es
o
f
et
h

141. ic
s
N
u
rs
in
g
p
ee
rs
(
73
%
),
n
u
rs
in
g
le
ad
er
sh

142. ip
(
57
.7
%
),
p
h
y
si
ci
an
s
(5
0%
),
o
th
er
p
ro
fe
ss

143. io
n
al
(
30
.8
%
),
fa
m
il
y
o
r
fr
ie
n
d
s
(3
0.
8)
(+

144. )
E
d
u
ca
ti
o
n
t
o
p
ic
s:
p
at
ie
n
t’
s
ri
gh
t
to
i
n

145. fo
rm
at
io
n
,
tr
ea
t-
m
en
t
o
f
th
e
d
y
in
g
an
d
t
h

146. e
el
d
er
ly
,
tr
ea
tm
en
t
o
f
th
e
d
ef
o
rm
ed
a
n
d
h
an

147. d
ic
ap
p
ed
,
p
ai
n
m
an
ag
em
en
t,
p
at
ie
n
t’
s
ri
gh
t
to

148. d
em
an
d
o
r
re
fu
se
tr
ea
tm
en
t
K
il
le
n
(
20
02
)

149. T
h
e
m
em
b
er
s
o
f
th
e
A
O
R
N
P
O
R
N
s
21
4
A

150. c
ro
ss
-s
ec
ti
o
n
al
su
rv
ey
E
th
ic
al
p
ri
n
ci
p
le
s:

151. a
u
to
n
-
o
m
y
(
33
.8
%
),
n
o
n
m
a-
le
fi
ce
n
ce
(
42

152. .9
%
),
f
id
el
it
y
(9
.8
%
)
N
A
R
ec
o
m
m
en
d
at
io

153. n
:
ad
m
in
is
-
tr
at
iv
e
su
p
p
o
rt
K
in
g
an
d
M
is
k

154. o
v
ic
(1
99
6)
T
h
e
m
em
b
er
s
o
f
th
e
A
O
R
N
i
n

155. B
al
ti
m
o
re
P
O
R
N
s
21
7
E
th
ic
al
I
ss
u
es
:
A

156. Su
rv
ey
o
f
P
er
io
p
-
er
at
iv
e
N
u
rs
e
N
A
(+
)
R
ec

157. o
m
m
en
d
at
io
n
:
ed
u
ca
-
ti
o
n
a
b
o
u
t
th
e
A

158. m
er
ic
an
N
u
rs
es
A
ss
o
ci
at
io
n
c
o
d
e
o
f
et
h
ic

159. s
O
m
er
y
e
t
al
.
(1
99
5)
A
m
ed
ic
al
ce
n
te
r
in
a

160. n
u
rb
an
a
re
a
N
u
rs
es
79
4
T
h
e
E
th
ic
al
I
ss
u

161. e
an
d
R
es
o
u
rc
es
Su
rv
ey
N
A
N
A
N
A
Sc
an
lo
n
(
19

162. 90
)
In
st
it
u
ti
o
n
s
in
an
u
rb
an
a
re
a
D
ir
ec
-
to

163. rs
o
f
n
u
rs
in
g
71
A
q
u
es
ti
o
n
n
ai
re
F
o
rm
at
s

164. ad
d
re
ss
in
g
et
h
ic
al
is
su
es
i
n
n
u
rs
in
g:
n
u
rs

165. in
g
m
ee
ti
n
g
(6
6%
),
i
n
-s
er
v
ic
e
ed
u
ca
ti
o
n
(
18

166. %
),
h
o
sp
it
al
co
m
m
it
te
es
(
9%
),
i
n
d
iv
id
u
-

167. al
d
is
cu
ss
io
n
/c
o
n
su
lt
at
io
n
(9
%
),
h
o
sp
it
al

168. e
th
ic
s
co
m
m
it
te
e
(9
%
)
(+
)
U
se
d
e
th
ic
s
ed
u

169. ca
ti
o
n
m
et
h
o
d
s
in
h
o
sp
it
al
s:
o
ri
en
ta
ti
o

170. n
p
ro
gr
am
(
35
%
),
co
n
ti
n
u
in
g
ed
u
ca
ti
o
n

171. p
ro
gr
am
s
(4
2%
)
Sc
an
lo
n
(1
99
4)
R
N
s
in
50
s
ta
te

172. s
(h
o
sp
it
al
s)
N
u
rs
es
93
4
A
w
ri
tt
en
s
u
rv
ey

173. L
it
er
at
u
re
(
44
%
),
et
h
ic
s
co
m
m
it
te
es
(
42
%

174. ),
co
n
ti
n
u
in
g
ed
u
ca
ti
o
n
(3
9%
)
(+
)
N
A
Sc
h

175. ro
et
er
(
19
99
)
P
O
R
N
s
in
so
u
th
ea
st
er
n
W
is

176. co
n
si
n
P
O
R
N
s
40
A
d
es
cr
ip
ti
v
e
se
lf
-r
ep
o
rt

177. q
u
es
-
ti
o
n
n
ai
re
,
a
sc
en
ar
io
-b
as
ed
su
rv
ey
P

178. er
so
n
al
v
al
u
es
,
w
o
rk
ex
p
er
ie
n
ce
s,
n
u
rs
in

179. g
co
d
e
o
f
et
h
ic
s,
p
ro
fe
ss
io
n
al
ed
u
ca
ti
o
n

180. A
h
ig
h
er
a
d
m
in
is
tr
at
iv
e
au
th
o
ri
ty
(
68
%
),
d

181. ir
ec
t
co
n
fr
o
n
ta
ti
o
n
(
21
%
)
N
A
N
A
N
ot
e.
E

182. N
=
e
d
u
ca
ti
o
n
n
ee
d
;
(+
)
=
e
xp
re
ss
ed
e
d
u
ca

183. ti
o
n
n
ee
d
;
C
R
N
A
s
=
c
er
ti
fi
ed
R
N
a
n
es
th

184. et
is
ts
;
A
N
C
=
A
rm
y
N
u
rs
e
C
o
rp
s;
D
A
C
=
D

185. ep
ar
tm
en
t
o
f
th
e
A
rm
y
C
iv
il
ia
n
;
O
R
=
o
p
er

186. at
in
g
ro
o
m
;
P
O
R
N
s
=
p
er
io
p
er
at
iv
e
R
N
s;

187. A
O
R
N
=
A
ss
o
ci
at
io
n
o
f
P
er
io
p
er
at
iv
e
R
N

188. s;
N
A
=
n
o
t
ap
p
li
ca
b
le
.
76 • Journal of Nursing Law • Vol. 13, No. 3
(Schroeter, 1999). A small percentage of responding
nurses had experience consulting with ethics commit-
tee (Fry & Damrosch, 1994; Jenkins et al., 2006; Scan-
lon & Fleming, 1990) (see Table 4). However, one study
reported ethics committees as one of main resources
that nurses consider available when facing an ethical
problem (Scanlon, 1994).
Moreover, most of studies (n = 8) reported nurses’
educational need related to nursing ethics. In four stud-

189. ies, the nurses indicated the need for the following edu-
cation topics: (a) professional responsibility, (b) patient
rights, (c) ethical code/principles, (d) treatment/non-
treatment of the dying, (e) patient advocacy, (f) ethical
decision making, and so on (see Table 4).
DISCUSSION
Most of ethical issues mentioned in the reviewed
articles can be classified into three categories in the
EIS: end-of-life issues, patient care issues, and human
rights issues. Frequent ethical issues faced by nurses
related mainly to patient care issues and human rights
issues, whereas the disturbing issues frequently related
to end-of-life issues. The most frequent issues are staff-
ing patterns, protecting patient rights and human dig-
nity, providing care with possible risk to RNs’ health,
conflict in the nurse or doctor relationship, and alloca-
tion of resources. The disturbing ethical issues include
prolonging the dying process, child or elderly abuse
(neglect), staffing patterns, acting against your own
personal, and impaired colleagues.
Nurses in daily practice face various ethical issues.
In particular, as technology becomes more compli-
cated and medical care resources become more limited,
the concern over “staffing patterns” or “allocation of
resources” is centered frequently on nurses, reflecting
the industry-wide trend of balancing cost and quality
(Killen et al., 1996). The issues are also ranked among
the most disturbing issues; that is, it is not a rare event
that nurses are directly involved in these most disturb-
ing issues. Thus, nurses may need special support to
ethically respond to the issues that are particularly dis-
turbing to them.

190. Nurses in hospitals reported that they experienced
frequent ethical problems related to patient confiden-
tiality or privacy. In contrast, perioperative nurses
more frequently encountered ethical issues related to
protecting patient rights and the human dignity issue
and informed consent than other issues. The frequency
of ethical issues may differ depending on the nurses’
specialty areas. Redman and Fry (2000) reported that
the main ethical conflict was experienced differently
by nurses in a particular role or setting. The findings
indicate that ethical decision-making resources need to
be made available to nurses in a specialty area in view
of their higher-frequency issues.
In terms of how the nurses handle their ethical issues
and what resources help nurses handle these issues,
most of studies show that nurses deal with ethical
issues on the basis of their own values and receive guid-
ance from nursing peers rather than from ethics com-
mittees. The fact that nurses use their personal values
most frequently to clarify ethical issues draws atten-
tion to necessity of nurturing qualified nurses in ethi-
cal decision making through education. Furthermore,
most of the nurses in the reviewed studies recognized
the necessity of ethics education related to the ethical
issues that they face. Therefore, nursing education
should develop pragmatic ethics programs based on the
ethical issues and the needs of nurses. In particular, the
frequent ethical issue should be discussed in the ethics
curriculum of undergraduate programs for developing
skills in recognizing and analyzing the issues.
The code of ethics of the American Nurses Asso-
ciation (ANA, 2001) deals with moral accountability
as a nursing professional based on ethical principles.

191. According to study findings, nurses have not recog-
nized the code of ethics as their reference when ethical
issues are encountered. However, nurses simultane-
ously expressed education needs regarding professional
ethical responsibility and ethic codes. Ethics educators
in nursing programs need to explain the ANA’s code of
ethics as well as ethical principles. The code of ethics
will provide a guide for nurses when facing an ethical
dilemma.
During the process of review in this study, the
reviewer did not include several articles related to
specialty areas because they did not deal with ethical
issues in terms of frequency. This study may not have
identified all relevant studies. Furthermore, this review
has limitations related to information about nurses’ eth-
ical issues in other special areas, except the operating
room. Therefore, the author recommends further study
related to frequent ethical issues that nurses face in a
particular role or setting. Future study can help nurses
understand ethical issues in special areas and allows
developing ethics education focused on specific issues
in a particular nursing practice. Furthermore, new
ethical issues in nursing are emerging with changes in
our society. This study shows ethical issues frequently
repeating in nursing in the past two decades and may
not include some current issues. Therefore, nursing
educators and researchers continuously need to update
the ethical issues into nursing education.
Park • Ethical Issues in Nursing Practice • 77
The ethical issues measured by frequency provide
information about the specific ethical issues of nurses

192. in active practice experience. Therefore, the informa-
tion can serve to intensify awareness of the issues in
clinical areas as well as education areas. Gilbert (1982)
pointed out the identification of ethical issues as one of
critical content areas in ethics education. The findings
in this article can be used to design and improve eth-
ics education programs for nursing students as well as
practice nurses as pragmatic evidence.
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American Nurses Association. (2001). Code of ethics for
nurses
with interpretive statements. Silver Spring, MD: American
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Berger, M. C., Seversen, A., & Chvatal, R. (1991). Ethical
issues in nursing. Western Journal of Nursing Research,
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193. Fry, S. T., & Damrosch, S. (1994). Ethics and human rights
issues in nursing practice: A survey of Maryland nurses.
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Fry, S. T., & Duffy, M. E. (2001). The development and the
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Gilbert, C. (1982). The what and how of ethics education.
Top-
ics in Clinical Nursing, 4, 49–56.
Jenkins, C. L., Elliott, A. R., & Harris, J. R. (2006).
Identifying
ethical issues of the Department of the Army Civilian and
Army Nurse Corps certified registered nurse anesthetists.
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dilemmas for nurses. Nursing Ethics, 9 (4), 405–415.
Killen, A. R., Fry, S. T., & Damrosch, S. (1996). Ethics and
human rights issues in perioperative nurses: A subsample
of Maryland nurses. Seminars in Perioperative Nursing, 5 (2),
77–83.
King, C. A., & Miskovic, J. M. (1996). Ethical issues: A survey
of perioperative nurses. Seminars in Perioperative Nursing,
5 (2), 84–91.
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Brown-Saltzman, K. (1995). Ethical issues in hospital-based
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194. Redman, B. K., & Fry, S. T. (2000). Nurses’ ethical conflicts:
what is really known about them? Nursing Ethics, 7(4),
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at nurses experiences. The American Nurses , 22.
Scanlon, C., & Fleming, C. (1990). Confronting ethical issues:
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Biographical Data. Mihyun Park, MSN, RN, is a doctoral stu-
dent at the University of North Carolina, Chapel Hill, North
Carolina. She is also a Catholic Sister in Sisters of Our Lady of
Perpetual Help (SOLPH), South Korea.
Correspondence regarding this article should be directed to
Mihyun Park, MSN, RN, University of North Carolina at Chapel
Hill, School of Nursing, Carrington Hall, CB #7460, Chapel
Hill,
NC 27599-7460. E-mail: [email protected]

195. Copyright of Journal of Nursing Law is the property of Springer
Publishing Company, Inc. and its content may
not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written
permission. However, users may print, download, or email
articles for individual use.
Chapter 8
Governance of the Information Systems Organization
Managing and Using Information Systems: A Strategic
Approach
by Keri Pearlson & Carol Saunders
1
Learning Objectives
Define the role of the CIO.
Understand what a manager should expect from the MIS
organization.
Describe why a manager must know the organizations particular
needs.
Define what a lean, competitive enterprise looks like and how
IT plays a role.
Understand how decision rights are allocated.
List alternative structuring approaches.

196. Identify the risks of a global MIS organization.
2
Chapter 8
2
Real World Examples
When the new CEO of 3M came on board he broke up the
Information Systems Steering Committee (ISSC) that decided
on major IS directions and projects.
The CIO wanted corporate IT priorities decided at the highest
business level, not just by IT.
Now 3M’s IT governance structure starts at the business process
level.
Each division is responsible for documenting the productivity of
its IT projects.
Must be in line with the divisions cost reduction targets.
Business unit leadership is responsible to top executives.
Business units are more motivated to devote resources to make
sure that their IT projects are successful.
3
Chapter 8
3
UNDERSTANDING
THE
IS ORGANIZATION
4

197. CIO
The CIO (Chief Information Officer) is at the helm of the IS
organization.
CIO’s primary goal is to manage IT resources to implement
enterprise strategy.
Provide technology vision and leadership for developing and
implementing IT initiatives to help the enterprise maintain a
competitive advantage.
As the importance of technology has increased so has the
position of the CIO.
Must work effectively with ALL units of the company, not just
IS.
5
Chapter 8
5
Twelve Main CIO Responsibilities
The following responsibilities often define the role of the CIO:
Championing the organization.
Architecture management.
Business strategy consultant.
Business technology planning.
Application development.
IT infrastructure management.
Sourcing.
Partnership developer.
Technology transfer agent.
Customer satisfaction management.
Training.
Business discontinuity/disaster recovery planning.
6
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198. 6
CIO
Must have both technical and business skills.
Must see the business vision and how IT can help facilitate that
vision.
Is both a strategist and operations manager.
Some organizations do not have a CIO.
They hire someone to “run” their computer systems and do not
give them much decision making authority.
7
Chapter 8
7
CTO, CPO, and Other Roles
The CIO, particularly in larger organizations, cannot guide the
enterprise toward the future alone.
Other strategic areas require more focused guidance.
The CTO is a critical role.
Works alongside the CIO.
Needs business savvy and communication skills.
Must be able to create an organizational vision.
New positions created to deal with this growing need.
Figure 8.1 shows a list of other IT managers and their
responsibilities.
8
Chapter 8

199. 8
Title Responsibility Chief technology officer (CTO) Track
emerging technologies
Advise on technology adoption
Design and manage IT architecture to insure consistency and
compliance Chief knowledge officer (CKO) Create knowledge
management infrastructure
Build a knowledge culture
Make corporate knowledge pay off Chief telecommunications
officer (CTO) Manage phones, networks, and other
communications technology across entire enterprise Chief
network officer Build/maintain internal and external
networksChief resource officer Manage outsourcing
relationships Chief information security officerInsures
information management practices are consistent with security
requirements Chief privacy officer Responsible for processes
and practices that insure privacy concerns of customers,
employees and vendors are met
Figure 8.1 The CIO’s lieutenants
Chapter 8
9
9
What a Manager Can Expect from the IS Organization
10
Eight Core Activities
Anticipating new technologies.
IT must keep an eye on emerging technologies.

200. Work closely with management on decisions.
Weigh risks and benefits of new technologies.
Participating in setting strategic direction.
IS can act as consultants to management.
Educate managers about current technologies/trends.
Innovating current processes.
Review business processes to innovate.
Survey best practices.
Developing and maintaining systems.
Build or buy software.
11
Chapter 8
11
Eight Core Activities
(continued)
Supplier management.
Carefully manage outsourced IT.
Architecture and standards.
Be aware of incompatibilities.
Inconsistent data undermines integrity.
Enterprise Security
Important to all general managers.
Much more than a technical problem.
Business continuity planning
Disaster recovery.
“What if” scenarios.
12
Chapter 8
12

201. Business Continuity Plan
Approved set of preparations and sufficient procedures for
responding to a variety of disaster events.
What do we do in case of an emergency such as 9/11?
Three major stages of BCP:
Pre-planning - management’s responsibility is defined, possible
risks are evaluated, and a business impact analysis is performed.
Planning - alternative business recovery operating strategies are
determined.
Post-planning - familiarizes employees with the plan through
awareness and training programs.
13
Chapter 8
13
Managing Data, Information and Knowledge
Managing information and knowledge in the enterprise is of
particular concern to IS.
Database administration.
Includes the collecting and storing the actual data created,
developed, or discovered.
Deciding on format, location, and indexing of stored data.
Knowledge management is covered in detail in chapter 12.
14
Chapter 8
14
Managing Internet and Network Services
Intranets, extranets, Web pages, and e-mail are becoming

202. essential in most business environments.
General managers must interact with the Web master, Web
designers, and Web developers.
Networking groups design, build, maintain, and manage the
network architecture.
Managers must be concerned with telecommunications and their
costs.
15
Chapter 8
15
Managing Human Resources
IS must manage its own resources.
Provide business and technical training.
Hiring and firing of staff.
Tracking time, managing budgets, etc.
Maintain skills inventory.
Individual managers are responsible.
16
Chapter 8
16
Operating Data Center
Houses large mainframe computers or rows of servers on which
the company’s data and business applications reside.
Managers rarely have direct contact with data center staff.
Many organizations outsource data center operations.
17
Chapter 8

203. 17
Providing General Support
Providing support for users of IS.
Support requests are normally centralized.
Centralized help desk – first contact point.
Forward requests to knowledgeable staff.
Many companies outsource this function.
Not uncommon to call support and speak to someone in another
country.
Figure 8.2 provides a framework for traditional and newer IS
activities that are considered the responsibility of the IS
organization.
18
Chapter 8
18
Figure 8.2 User management activities
Chapter 8
19
19
WHAT THE IS ORGANIZATION DOES NOT DO
20

204. What IS Does Not Do
Does not perform core business functions such as:
Selling
Manufacturing
Accounting.
Does not set business strategy.
General managers must not delegate critical technology
decisions.
21
Chapter 8
21
IT GOVERNANCE
22
22
Centralized vs. Decentralized Organizational Structures
Centralized – bring together all staff, hardware, software, data,
and processing into a single location.
Decentralized – the components in the centralized structure are
scattered in different locations to address local business needs.
Federalism – a combination of centralized and decentralized
structures.
Figure 8.3 shows the continuum of where these structures fall.
23
Chapter 8

205. 23
Figure 8.3 Organizational continuum
24
The 5 Eras of Information Usage
1960s - mainframes dictated a centralized approach.
1970s - remained centralized due in part to the constraints of
mainframe computing
1980s - advent of the PC and decentralization
1990s - the Web, with its ubiquitous presence and fast network
speeds, shifted some businesses back to a more centralized
approach
2000+ - the increasingly global nature of many businesses
makes complete centralization impossible
25
Chapter 8
25
Federalism
Most companies would like to achieve the advantages derived
from both centralized and decentralized organizational
paradigms.
This leads to federalism – a structuring approach which
distributes, power, hardware, software, data and personnel
between a central IS group and IS in business units.
26
Chapter 8

206. 26
Figure 8.5 Federal IT
Chapter 8
27
27
Another Perspective on IT Governance
Weill and his colleagues define IT governance as “specifying
the decision rights and accountability framework to encourage
desirable behavior in using IT.”
The focus is not what, but who.
Good IT governance provides a structure to make good
decisions.
The assignment of decision-making authority and responsibility
The decision-making mechanisms
28
Chapter 8
28
CategoryDescriptionExamples of Affected IS Activities IT
PrinciplesHigh-level statements about how IT is used in the
businessParticipating in Setting Strategic Direction IT
ArchitectureAn integrated set of technical choices to guide the
organization in satisfying business needs. The architecture is a
set of policies and rules for the use of IT and plots a migration
path to the way business will be done Establishing architecture

207. and standards IT Infrastructure StrategiesStrategies for the base
foundation of budgeted-for IT capability (both technical and
human) shared throughout the firm as reliable services, and
centrally coordinated Managing internet and network services;
providing general support; Managing data; Managing human
resources Business Application NeedsSpecification of the
business need for purchased or internally developed IT
applicationsDeveloping and maintaining information systems IT
Investment & PrioritizationDecision about how much and where
to invest in IT including project approvals and justification
techniquesAnticipating new technologies
Figure 8.6 - Five major categories of IT decisions
29
Chapter 8
29
Decision-Making Mechanisms
Policies may be used.
The steering committee is common and works well in the
federal archetype.
IT Governance Council – steering committee at the highest
level.
Reports to board or CEO.
Comprised of top-level executives.
Provides strategic direction and funding authority.
Lower level steering committees are responsible for effectively
allocating scarce resources.
Companies usually have one or the other.
30
Chapter 8

208. 30
Managing the Global Considerations
Large global MIS organizations face many of the same
organizational issues as any other global department.
For IS, a number of issues arise that put the business at risk
beyond the typical global considerations.
Table 8.9 summarizes how a global IT perspective affects six
information management issues.
31
Chapter 8
31
Issue Global IT Perspective Example Political Stability
How risky is investment in a country with an unstable
government ? India, a country that faces conflict with Pakistan
Transparency Domestically, an IT network can be end-to-end
with little effort compared to global networks SAP-R3 can be
used to support production processes but only if
installedBusiness Continuity Planning When crossing borders, it
is important to make sure that contingency plans are in place
Concern when crossing boarders is will data center be available
when/if needed Cultural Differences IT systems must not offend
or insult those of a different culture Using images or artifacts
may be insulting to another culture Sourcing Some technologies
cannot be exported or imported into specific countries
Exporting it to some countries, especially those who are not
political allies is not possible Data Flow across Borders Data,
especially private or personal data, is not allowed to cross some
borders. For example: Brazil
Figure 8.9 - Global Considerations for the MIS Organization
Chapter 8
32

209. 32
FOOD FOR THOUGHT:CIO Leadership Profiles
33
CIO Leadership Profiles
The work of the CIO has grown in scope and complexity.
1/3 of CIOs manage an additional corporate function
¾ of the CIOs report to the CEO, president or COO
over ½ listed corporate strategy as a top responsibility
Recent study shows four profiles that characterize the CIOs
leadership role:
IT Orchestrator (32%) – an effective IS leader involved in
strategic decision making.
IT Advisor (18%) – possesses the strategic and IT skills to be
effective, but not adequately funded.
IT Laggard (18%) – high-level of decision making authority but
doesn’t have business or strategic skills.
IT Mechanic (32%) - low levels of strategic effectiveness,
business skills and decision making authority.
34
Chapter 8
34
SUMMARY

210. 35
Summary
The CIO is a high-level IS officer.
There are a variety of key job titles in the IS organization.
IS organizations can be expected to anticipate new technologies,
set strategic direction, etc.
Managers must work with IT leaders to develop a lean,
competitive enterprise, where IT acts as a strategic enabler.
36
Chapter 8
36
Chapter 11
Project Management
Managing and Using Information Systems: A Strategic
Approach
by Keri Pearlson & Carol Saunders
1
Learning Objectives
List the elements of a good project.
Understand why so many IT projects fail to meet their targeted
goals.
Explain the relationship between time, scope, and cost of a

211. project.
Explain why Gantt charts are so popular for planning schedules.
Define RAD and explain how it compares to the SDLC.
Be able to identify when it is time to pull the plug on a project.
Chapter 11.
2
2
Real World Example
Rural Payments Agency (RPA), UK, blamed poor planning and
lack of system testing for delays in paying out 1.5billion pounds
of EU subsidies.
Only 15% were paid out by the end of 2006.
The RPA had to make substantial changes to the system post
implementation.
The system had not been properly managed.
Costs were at 122 million pounds, and were originally estimated
at 46.5 million.
Chapter 11.
3
3
Failed IS Projects
Standish Group found that 67 percent of all software projects
are challenged
Late, over budget or fail to meet performance criteria.
Managing a business project means managing an information
systems project.
Many systems use or integrate the Internet.
Typical adaptation projects include the following elements:

212. Rightsizing the organization
Reengineering business processes
Adopting more comprehensive, integrative processes
Chapter 11.
4
4
WHAT DEFINES
A
PROJECT
5
5
Project Definition
“[A] project is a temporary endeavor undertaken to create a
unique product or service. Temporary means that every project
has a definite beginning and a definite end. Unique means that
the product or service is different in some distinguishing way
from all similar products or services.”
-Project Management Institute (1996)
6
6
Chapter 11.
Projects

213. Companies use projects and operations to generate revenue.
Projects are temporary endeavors that have a fixed start and
stop date and time.
Operations are ongoing, repetitive tasks that are performed until
they are changed or replaced.
Project managers may break projects into sub-projects
depending upon the work.
Figure 11.1 show the differences between operational and
project based work.
7
7
Chapter 11.CharacteristicsOperationsProjectsLabor skills
Training time
Worker autonomy
Compensation system
Material input requirements
Suppler ties
Raw Materials inventory
Scheduling complexity
Quality control
Information flows
Worker-mgmt communication
Duration
Product or serviceLow
Low
Low
Hourly or weekly wage
High certainty
Longer duration
More formal
Large

214. Lower
Formal
Less important
Less important
On-going
RepetitiveHigh
High
High
Lump sum for project
Uncertain
Shorter duration
Less formal
Small
Higher
Informal
Very important
Very important
Temporary
Unique
Fig. 11.1 Characteristics of operational and project work
8
8
WHAT IS
PROJECT MANAGEMENT
9
9
Chapter 11.
Project Management

215. Project management is the application of knowledge, skills,
tools, and techniques to project activities in order to meet or
exceed stakeholder needs and expectation from a project.
Involves continual trade-offs
Manager’s job - manage these trade-offs.
10
10
Chapter 11.
Typical Project Management trade-offs
Scope
Product and project
Time – the time required to complete the project
Cost – all the resources required to carry out the project.
Cost vs. Quality
The quality of a system will normally impact its cost.
Figure 11.2 shows the three sides of the project triangle.
11
11
Chapter 11.
Figure 11.2 Project Triangle
12
12

216. Chapter 11.
Project Manager’s Role
The project manager will typically be involved in:
Ensuring progress of the project according to defined metrics..
Identifying risks.
Ensuring progress toward deliverables within time and resource
constraints.
Running coordination meetings.
Negotiating for resources on behalf of the project.
Business projects are often initiated because of a successful
business case.
A successful project begins with a well-written business case
(spells out components of the project).
13
13
PROJECT
ELEMENTS
14
14
Chapter 11.
Essential Components
There are four components essential for any project. Necessary
to assure a high probability of project success.
Common Project Vocabulary: so all team members can
communicate effectively (very important as many are new).
Teamwork: to ensure all parts of the project come together
effectively and correctly (make sure to clearly define the teams
objectives).

217. Project cycle plan: method and schedule to execute the project
(Gantt charts, CPM, and PERT diagrams).
Project management is needed so that it is coordinated and
executed appropriately
15
15
Chapter 11.
Project Cycle Plan
The project cycle plan organizes discrete project activities,
sequencing them into steps along a time line.
Identifies critical beginning and ending dates and breaks the
work spanning these dates into phases
The three most common approaches are:
Project Evaluation and Review Technique (PERT) (Figure 11.3)
Critical Path Method
Gantt chart (Figure 11.4)
Figure 11.5 provides detail on the project cycle template.
16
16
Chapter 11.
Figure 11.3 PERT Chart
17
17

218. Chapter 11.
Figure 11.4 GANTT Chart
18
18
Chapter 11.Requirements
Definition periodProduction PeriodDeployment/
Dissemination PeriodInvestigation Task ForceUser requirement
definitionResearch concept definitionInformation use
specificationCollection planning phaseCollection and analysis
phaseDraft report phasePublication phaseDistribution
phaseTypical High Tech Commercial BusinessProduct
requirement
phaseProduct
definition phaseProduct proposal phaseProduct develop-ment
phaseEngineer model phaseInternal test phaseProduction
phaseManufactur-ing, sales & support phaseGeneric Project
Cycle TemplateUser require-ment definition phase.Concept
definition phaseSystem specification phaseAcquisition planning
phaseSource selection phaseDevelopment phaseVerification
phaseDeployment or production phase
Deactivate phase
Figure 11.5 Project cycle template
19
Click to edit Master text styles

219. Second level
Third level
Fourth level
Fifth level
19
Chapter 11.
Elements of Project Management
The following elements can be considered as managerial skills
that influence a project’s chance for success.
Identification of requirements
Organizational integration
Team management
Risk and Opportunity management
Project control
Project visibility
Project status
Corrective action
Project leadership
See figure 11.6 in the text for a description of each element
Figure 11.7 reflects the inverse relationship between the players
of a project.
20
20
Chapter 11.
Project
Leadership
Project

220. Management Process
More leadership
Needed
Less leadership
Needed
No PM process
Team is new to PM process
Team does not value process
PM process exists
Team is fully trained in process
Team values process
Figure 11.7 Project leadership vs. project management process
21
21
IT Projects
Chapter 11.
22
22
IT Projects
IT projects are a specific type of business project.
IT projects are difficult to estimate.
Many projects are measured in “man-months”.
How many people will be required to complete the project in a
specified time period.
Additional people may speed up the process (but may not).
Chapter 11.

221. 23
23
IT PROJECT DEVELOPMENT
METHODOLOGIES
24
24
Chapter 11.
Project Development Methodologies
The choice of development methodologies and managerial
influences distinguish IT projects from other projects.
There are four main methodologies IT professionals use to
manage the technology projects:
Systems Development Life Cycle (SDLC)
Prototyping
Rapid applications development (RAD)
Joint applications development (JAD)
25
25
Chapter 11.
Systems Development Life Cycle
SDLC typically consists of seven phases
Initiation of the project
The requirements definition phase
The functional design phase

222. The system is actually built
Verification phase
The “cut over” where the new system is put in operation and all
links are established
The maintenance and review phase
See Figure 11.8 for more information on each step.
26
26
Chapter 11.
Limitations of SDLC
Traditional SDLC methodology for current IT projects are not
always appropriate:
Many systems projects fail to meet objectives because of the
difficulty in estimating costs and each project is often so unique
that previous experience may not provide the necessary skills
Objectives may reflect a scope that is too broad or two narrow
so that the problem the system was designed to solve may still
exist, or the opportunity that it was to capitalize upon may not
be appropriately leveraged.
If the business environment is very dynamic, there may not be
enough time to adequately do each step of the SDLC for each IT
project
27
27
Chapter 11.
Prototyping
SDLC may not work for all situations, requires a lot of planning

223. and is difficult to implement quickly.
Prototyping is a type of evolutionary development.
Builds a fast, high-level version of the system at the beginning
of the project.
Advantages include:
User involvement and comment early on and throughout the
development process.
Disadvantages include:
Documentation may be difficult to write.
Users may not understand the realistic scope of the system.
28
28
Chapter 11.
System Concept
Version “1”
Version “2”
Version “N”
Software Development Process
Figure 11.9 Iterative approach to systems development

224. 29
29
Chapter 11.
RAD and JAD
RAD (Rapid Application Development) is similar to the SDLC
but it substantially reduces the time through reduction in steps
(4 instead of 7).
RAD, like prototyping, uses iterative development tools to
speed up development:
GUI, reusable code, code generation, and programming,
language testing and debugging
Goal is to build the system in a much short time frame than
normal.
JAD (Joint Application Development) is a technique developed
by IBM where users are more integrally involved throughout the
development process.
30
30
Chapter 11.
Other Development Methodologies
Agile development methodologies are being developed for those
situations where a predictable development process cannot be
followed.
Examples include:
XP (Extreme Programming), Crystal, Scrum, Feature-Driven
Development and Dynamic System Development (DSDM).
Tend to be people rather than process oriented.

225. DSDM is an extension of RAD used in the UK.
Object Oriented (OO) development is becoming increasingly
popular.
31
31
MANAGERIAL INFLUENCES
32
32
Chapter 11.
Technical Influences
General managers face a broad range of influences during the
development of projects.
Four software tools are available to aid in managing the
technical issues:
Computer-Aided Software Engineering (CASE) suite of tools
Software development library
Automated audit trail
Software metrics
33
33
Chapter 11.
Key Terms
Below is a list of key terms that a general manager is likely to
encounter:

226. Source lines of code (SLOC) is the number of lines of code in
the source file of the software product.
Source statement is the number of statements in the source file
Function points describe the functional requirements of the
software product and can be estimated earlier than total lines of
code
Inheritance depth is the number of levels through which values
must be remembered in a software object
Schedule slip is the current scheduled time divided by the
original scheduled time
Percentage complete measures the progress of a software
product in terms of days or effort
34
34
Chapter 11.
Managing Organizational and
Socioeconomic Influences
Balance goals of stakeholders
project manager
customer
end-user (there’s a difference)
sponsor
Sustain commitment
project
psychological (personal responsibility, biases)
social (rivalry, norms for consistency)
organizational (political support, culture)
35
35

227. MANAGING PROJECT RISK
36
36
Chapter 11.
Complexity
Factors influencing a project’s complexity include:
How many products will this website sell?
Will this site support global, national, regional, or local sales?
How will this sales process interface with the existing customer
fulfillment process?
Does the company possess the technical expertise in-house to
build the site?
What other corporate systems and processes does this project
impact?
How and when will these other systems be coordinated?
37
37
Chapter 11.
Clarity
Clarity is concerned with the ability to define the requirements
of the system.
A project has low clarity if the users cannot easily state their
needs or define what they want from the system.
A project with high clarity is one in which the systems
requirements can be easily documented and which do not change
38

228. 38
Chapter 11.
Size
Plays a big role in project risk
A project can be considered big if it has:
Large budget relative to other budgets in the organization
Large number of team members (= number of man months)
Large number of organizational units involved in the project
Large number of programs/components
Large number of function points or lines of code
39
39
Chapter 11.
Managing Project Risk Level
Large, highly complex projects that are usually low in clarity
are very risky
Small projects that are low in complexity and high in clarity are
usually low risk
Everything else is somewhere in between
The level of risk determines how formal the project
management system and detailed the planning should be
When it is hard to estimate how long or how much a project will
cost because it is so complex/clarity is so low, formal
management practices or planning may be inappropriate
40
40

229. Chapter 11.
Managing the Complexity Aspects of Project Risk
Strategies that may be adopted in dealing with complexity are:
Leveraging the Technical Skills of the Team such as having a
leader or team members who have had significant work
experience
Relying on Consultants and Vendors – as their work is primarily
project based, they usually possess the crucial IT knowledge
and skills
Integrating Within the Organization such as having frequent
team meetings, documenting, critical project decisions and
holding regular technical status reviews
41
41
Chapter 11.
Managing Clarity Aspects of Project Risk
When a project has low clarity, project managers need to rely
more heavily upon the users to define system requirements
Managing stakeholders – managers must balance the goals of
the various stakeholders, such as customers, performing
organizations and sponsors, to achieve desired project outcomes
Sustaining Project Commitment – there are four primary types
of determinants of commitment to projects
42
42
Chapter 11.
Pulling the Plug

230. Often projects in trouble persist long after they should have
been abandoned
The amount of money already spent on a project biases
managers towards continuing to fund the project even if its
prospects for success are questionable
When the penalties for failure within an organization are also
high, project teams are often willing to go to great lengths to
insure that their project persists
Or if there is an emotional attachment to the project by
powerful individuals within the organization
43
43
Chapter 11.
Gauging Success
At the start of the project, the general manager should consider
several aspects based on achieving the business goals.
Care is needed to prevent a too narrow or too broad set of
goals.
It is important that the goals be measurable so that they can be
used throughout the project to provide the project manager with
feedback.
44
44
Chapter 11.
Four dimensions of success
Four dimensions of project success:
Resource constraints: does the project meet the time and budget
criteria?

231. Impact on customers: how much benefit does the customer
receive from the project?
Business success: how high and long are the profits produced by
the project?
Prepare the future: has the project altered the infrastructure of
the org. so future business success and customer impact are
more likely?
See Figure 11.12 in the text for more information.
45
45
The PMO
Chapter 11.
46
46
The PMO
Project Management Office (PMO) – some companies create to
boost efficiency, gather expertise, etc.
Sarbanes-Oxley is a driver to create a PMO
May lead to cost savings in the long run.
PMOs can be expected to function in seven areas:
Project support; Project management process and methodology;
Training; Project Manager home base; Internal consulting and
mentoring; Project management software tools and support;
Portfolio management.
Chapter 11.
47

232. 47
PMO
Responsibilities range widely.
Clearinghouse to full managing projects.
Usually it mirrors the organization, culture and bureaucracy of
the CIO’s organization.
Chapter 11.
48
48
FOOD FOR THOUGHT: OPEN SOURCING
49
49
Chapter 11.
Open Sourcing
Linux, a version of Unix created by Linus Torvalds, is a world-
class OS.
Linux was built using the open-source model.
Open-source software is really free software that can be
modified by anyone since the source code is free.
It is premised upon open and unfettered access to the code to
modify, update, etc.
50

233. 50
Chapter 11.
Open sourcing = Free Software
Offers four kinds of freedom for the software users:
The freedom to run the program, for any purpose
The freedom to study how the program works, and adapt it to
your needs. Access to the source code is a precondition for this
The freedom to distribute copies so that you can help your
neighbor
The freedom to improve and release your improvements to the
public, so that the whole community benefits. Access to source
code is a precondition for this
51
51
Chapter 11.
Managerial Issues associated with Open Sourcing
Preservation of intellectual property – As its use cannot be
restricted how are the contributions of individuals recognized?
Updating and maintaining open source code – Because it is
“open”, difficult to achieve these
Competitive advantage – Since the code is available to all, hard
to achieve competitive this
Tech support – The code may be free, but technical support
usually isn’t
Standards – As standards are open, open sourcing may be
unable to charter a viable strategy for selecting and using
standards
52

234. 52
Chapter 11.
Summary
General manager fulfills an important role in project
management.
Project management involves continual trade-offs.
Four important project elements: Common vocabulary,
teamwork, project cycle plan, and project management.
Important to understand the complexity of a project.
SDLC, prototyping, JAD and RAD are used for development of
IS systems.
Manage project risk carefully.
The PMO can be very useful.
53
53
Time Cost
QUALITY
Scope
Time
Cost
QUALITY
Scope