Nursing Informatics

FAR EASTERN UNIVERSITY- MANILA
INSTITUTE OF HEALTH SCIENCES & NURSING BATCH 2025

NUR1211: NURSING INFORMATICS (LECTURE)
MR. GIAN DE JESUS
ADAPTED FROM: POWERPOINT/LECTURE
MODULE 1 American Nurses Association (ANA) began

Overview developing a statement to describe and define the
scope of nursing informatics (Baker, 2012). The
meaning of nursing informatics has evolved and been
We are in the digital age. What does this mean to us
refined, with the American Nurses Association (2008)
as nurses? The convergence of the
definition stated as ― a specialty that integrates nursing
telecommunications and computer industry has seen
a pervasive increase in how we communicate and science, computer science, and information science to
process information. Integrated systems support manage and communicate data, information,
knowledge, and wisdom in nursing practice‖. Another
evidence-based nursing practice, facilitate nurses‘
definition of nursing informatics comes from the
participation in the health care team, and document
American Medical Informatics Association (AMIA),
nurses‘ contribution to patient care outcomes. Nurses
are major stakeholders in health care and based on which states ―Nursing Informatics science and
their knowledge, they translate data to information, practice integrates nursing, its information and
knowledge and their management, with information and
information to knowledge and knowledge to wisdom.
communication technologies to promote the health of
For greater achievement in nursing practice, nurses
people, families and communities worldwide.
need to desire and adopt innovative means to make
their contribution to the patient care process and
patient outcome visible. Hence, Nursing informatics Nursing informatics (NI) has also been defined as a
specialty that integrates nursing science, computer
(NI) will brings nursing contributions to health
science, and information science to manage and
outcomes visible.
communicate data, information, knowledge, and
Objectives wisdom in nursing practice.
NI supports consumers, patients, nurses, and other
providers in their decision making in all roles and
At the end of this module, you should be able to:
settings. This support is accomplished using
information structures, information processes, and
● Define and describe nursing informatics,
information science, and information system information technology.
● Discuss the historical antecedents of nursing
OVERVIEW OF NURSING INFORMATICS
informatics.
REFERENCES ● 1957 - First coined by Karl Steinbuch as
American Nurses Association (ANA). (2008). Nursing “informatiks”
informatics: Scope and standards of practice. Silver Spring, ● 1962 -
MD: Nursebooks.org. ○ Phillipe used the term “informatique”
○ Walter Bauer translated in into
Baker, J. (2012). Nursing informatics. Perioperative Nursing “informatics”
Clinics, 7, 151-160. Kaminski, J. (Fall, 2010). Theory
● 1980 - Scholes and Barber coined the term
applied to informatics – Novice to Expert. CJNI:
“nursing informatics”
Canadian Journal of Nursing Informatics, 5 (4), Editorial. ● 1980’s - the term nursing informatics was
http://cjni.net/journal/?p=967 initially seen in literature, including a definition
of “combining nursing, information, and
McGonigle D., & Mastrian K (2009). Nursing Informatics computer sciences for managing and
and the foundation of knowledge USA: Delma Publishers. processing data into knowledge for use in
nursing practice” (Murphy, 2010).
● 1994 - The American Nurses Association
NURSING INFORMATICS (ANA) began developing a statement to
describe and define the scope of nursing
The term nursing informatics was initially seen in informatics (Baker, 2012).
literature in the 1980s, including a definition of ● 2008 - American Nursing Association (2008)
combining nursing, information, and computer sciences definition of nursing informatics “ a speciality
for managing and processing data into knowledge for that integrates nursing science, computer
use in nursing practice (Murphy, 2010). In 1994, The science, and information science to manage
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and communicate data, information, ○ These activities include the design and
knowledge, and wisdom in nursing practice. use of informatics solutions and/or
● American Medical Informatics Association technology to support all areas of
(AMIA), “Nursing informatics science and nursing, including, but not limited to,
practice integrates nursing, its information and the direct provision of care,
communication technologies to promote health establishing effective administrative
of people, families, and communities systems, designing useful decision
worldwide.” support systems, managing and
● Healthcare Information and Management delivering educational experiences,
Systems Society (HIMSS) defines nursing enhancing supporting lifelong
informatics as “a specialty that integrates learning, and supporting nursing
nursing science, computer science, and research.
information science to manage and ○ The term individual refer to patients,
communicate data, information, knowledge, healthcare consumers, and any other
and wisdom in nursing practice. recipient of nursing care or informatics
solutions.
● The definition and goal of NI is based upon
work by Staggers and Thompson (2002) and
evolved in this version to include the concept of
wisdom. Otherwise, the NI definition is
essentially ous with the 2001 Scope and
Standards document.
● NI is one example of a discipline-specific
informatics practice within the broader category
of health informatics. NI has become well
● Informatics is becoming increasingly present in established within nursing since its recognition
our profession due to rapidly changing as a specialty for registered nurses by the
technological advances. American Nurses Association (ANA) in 1992. It
● Healthcare systems are assimilating focuses on the representation of nursing data,
technology into daily practice at a quick pace. information, knowledge (Graves and Corcoran,
● Security and patient privacy must be upheld 1989) and wisdom (Nelson, 1989; Nelson,
while achieving the goal of transforming data 2002) as well as the management and
into useful knowledge. communication of nursing information within
● Integrating informatics with Evidence-Based the broader context of health informatics.
Practice (EBP) can only help improve the care
we provide to our patients. Notes:
● Staggers and Thompson (2002) believed that
there were too many definitions for NI, which Nurses translate data to information, information to
was causing the specialty to grow without a knowledge and knowledge to wisdom.
solid foundation. They believed that without this
foundation it was difficult to build a solid Integrated system support evidenced based practice,
facilitate nurses participation in the healthcare team, and
informatics practice or the needed educational
document nurses contribution to patient care outcome.
base for this specialty practice.
● Staggers and Thompson performed a critical Nurses need to adapt innovative means to make their
analysis of the definitions, which resulted in a contribution to the patient care process and patient
new definition. The new definition is as follows: outcome visible.
○ The goal of NI is to improve the health
of populations, communities, families, Data Privacy Act protects the patient’s security and privacy
and individuals, by optimizing of data.
information management and
Applying technology to knowledge may help identify a
communication.
problem (e.g. Electronic documentation can identify
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a. Provision and documentation of patient

changes in patient status quickly because of availability;
data is interpreted, systematized and arranged; nurses are care
able to formulate an appropriate plan of action; new nursing b. Education of healthcare providers
language facilitate acceptance of documentation in c. Scientific research for advancing
Electronic Health Record; template of nursing notes assists healthcare delivery
nurses in their daily workload such as in documentation, d. Administration of healthcare delivery
research studies and patient care data, and national and services
local standards are used to develop informatics program; e. Reimbursement for patient care
return on investment analysis, patient preferences and/ or
f. Legal and ethical implications
needs on infection control data are provided by nursing
g. Safety and quality issues
data)
4. A shift toward
Technology is addressed (e.g. medication errors analysis - a. Integrating multiple technologies and
data are collected in the other facilities if the problems exist. telecommunication devices
Findings are then presented to solve the collection. b. Invisible storage devices such as cloud
Implementation is then evaluated for the identification of storage
data helps performance of nurses) c. User-friendly, menu-driven,
touchscreen manipulation methods
Nursing informatics is one example of a discipline specific
5. Computers in nursing are used for
informatics practice within the border category of health
a. Managing patient care information
informatics. It has become well established in nursing as it
is a specialty of nurses according to ANA in 1992. It focuses b. Monitoring quality
on the presentation of data, information knowledge, and c. Evaluating outcomes
wisdom as well as the management and communication of d. Communicating data and message
nursing information within the border of health informatics. via the Internet
e. Accessing resources
f. Interacting with patients on the Web
HISTORICAL PERSPECTIVE OF NURSING
g. Documenting and processing real-
INFORMATICS
time plans of care
h. Supporting nursing research
OVERVIEW
i. Testing new systems
j. Designing new knowledge databases
Nursing Informatics
k. Developing data warehouses
● Evolved from the French word “informatics”
l. Advancing the role of nursing in the
● Referred to the field of applied computer
healthcare industry and nursing
science
science
● Concerned with the processing of information
such as nursing information
MAJOR HISTORICAL PERSPECTIVES OF
NURSING AND COMPUTERS
Computers
● First introduced into healthcare facilities in the
Seven Time Periods
1960s
● For the processing of basic administrative tasks
1. Prior to the 1960s
● The computer is an essential tool in HIT
a. Developed in the late 1930s and early
systems
1940s
b. Use in healthcare did not begin until
Health Information Technology (HIT)
the 1950s and 1960s
1. HIT is an all-encompassing term
c. A few experts formed a cadre to adapt
2. Refers to technology that
computers to healthcare and nursing
a. Captures health information
d. Computers in healthcare were used
b. Processes health information
for administrative and accounting
c. Generates health information
functions
3. Computerization affects all aspects of
2. 1960s
healthcare delivery including
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a. Use of computer technology began to f. Hospitals and public health agencies

be explored embarked on investigating computers
b. Studies were conducted to determine and nursing
how computer technology could be g. The opportunity to improve education
utilized using computer technology also began
c. The nurses’ station was viewed as h. Early nursing networks helped to
the most appropriate center for the expand nursing awareness of
development of computer applications computers and the impact HIT could
d. The mid-1960s presented nurses have on practice
with new opportunities for computer i. The Clinical Center at the National
use Institutes of Health implemented the
e. Increased time devoted to Technicon Medical Information
documentation and a rise in System (TDS) computer system
medication errors prompted the j. TDS one of the earliest clinical
investigation of emerging computer- information systems (called Eclipsys &
based information systems Allscripts)
3. 1970s k. TDS was the first system to include
a. During the late 1960s through the nursing practice protocols
1970s, hospitals began developing
computer-based information systems 4. 1980s
which initially focused on a. The field of nursing informatics
i. Physician order entry exploded and became visible in the
ii. Results reporting healthcare and nursing
iii. Pharmacy b. The nursing profession needed to
iv. Laboratory update its practice standards and
v. Radiology reports determine its data standards,
vi. Information for financial and vocabularies, and classification
managerial purposes schemes that could be used for the
vii. Physiologic monitoring computer- based patient record
systems in the intensive care systems
units c. Many mainframe healthcare
b. A few systems started to include information systems (HISs) emerged
i. Care planning with nursing subsystems
ii. Decision support d. These systems documented several
iii. Interdisciplinary problem lists aspects of the patient record
c. Nurses were often involved in e. The microcomputer or personal
implementing systems computer (PC) emerged during this
d. Interest in computers and nursing period
began to emerge in public and home f. The first Nursing Special Interest
health and education Group on Computers met for the first
e. In the 1970s, conferences helped time during SCAMC (Symposium on
public and home health nurses Computer Applications in Medical
i. Understand the importance Care) in 1981
of nursing data and their g. In 1985, the ANA approved the
relationship to new Medicare formation of the Council on Computer
ii. Provide information on the Applications in Nursing (CCAN)
usefulness of computers for h. CCAN became a very powerful force in
capturing and aggregating integrating computer applications into
home health and public health the nursing profession
information i. The first edition of this book published
in 1986
5. 1990s
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a. Advances in relational databases, for Healthcare Information

client-server architectures, and new Technology (HIT)
programming methods ii. Issued a recommendation
b. Better application development at calling for all healthcare
lower costs providers to adopt
c. Legislative activity in the mid-1990s interoperable electronic health
paved the way for electronic health records (EHRs) by 2014/2015
records through the Health Insurance c. Wireless, point of care, regional
Portability and Accountability Act database projects, and increased IT
(HIPAA) of 1996 (public-law 104-19) solutions proliferated
d. The complexity of technology, workflow d. The use of bar coding and radio-
analysis, and regulations shaped new frequency identification (RFID)
roles in nursing emerged as a useful technology
e. In 1992, the ANA recognized nursing e. Smaller mobile devices with wireless or
informatics as a new nursing Internet access increased access to
specialty separate Scope of Nursing information for nurses within hospitals
Informatics Practice Standards, and and in the community
also established a specific f. The development and refinement of
credentialing examination for it voice over Internet protocol (VoIP)
f. The demand for nursing informatics provided voice cost-effective
(NI) expertise increased communication
g. The ANA developed the Nursing g. The Internet provided a means for
Information and Data Set Evaluation development of clinical applications
Standards (NIDSEC) to evaluate and h. The nursing informatics research
recognize nursing technology rapidly agenda promoted the integration of
changed in the 1990s nursing care data in HIT systems that
i. PCs became smaller would also generate data for
ii. Computer notebooks became analysis, reuse, and aggregation
affordable 7. 2010s
iii. Computers were linked a. The impact of the Nursing Minimum
through networks Data Set (NMDS) demonstrated that
iv. The Internet became continued consensus and effort was
mainstream needed to bring to fruition the vision
v. The World Wide Web (WWW) and implementation of minimum
increased access to nursing data into clinical practice
information b. A new nursing informatics research
h. The purpose of Information systems agenda for 2008–2018 emerged as
was to guide the development and critical for this specialty
selection of nursing systems that c. The new agenda is built on one
included standardized nursing originally developed and published by
terminologies integrated throughout the National Institute for Nursing
the system Research (NINR) in 1993
d. During 2010, the ONC convened two
national committees:
i. National Committee on Health
6. 2000s Policy
a. More healthcare information became ii. National Committee on
digitalized and newer technologies Health Standards which
emerged outlined and designed the
b. In 2004 an Executive Order 13335 focus for the “Meaningful Use”
i. Established the Office of the (MU) legislation
National Coordinator (ONC)
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e. Meaningful Use was designed to be 4. There are currently several key events in which
implemented in at least three stages the NI community participates
f. Consists of the regulations which built a. Conferences
onto each other with the ultimate goal b. Symposia
of implementing a complete an c. Institutes
interoperable EHR and/or HIT system d. Workshops
in all US hospitals 5. Key events provide
g. In 2011/2012 MU Stage 1 was initiated a. An opportunity for nursing informatics
focusing primarily on the novices and experts to network and
Computerized Physician Order Entry share their experiences
(CPOE) initiative for physicians b. Key events provide the latest
h. In 2012/2013 MU Stage 2 was information, newest exhibits, and
introduced focusing primarily on the demonstrations.
implementation of Quality Indicators
i. The Quality Indicators are used to NURSING INFORMATICS IN THE PHILIPPINES
guide hospitals in patient safety and if
not implemented used as indicators ● The words “nursing informatics” were
subject to financial penalties unfamiliar among the nursing community until
j. It is anticipated that MU Stage 3 will the year 2008.
be implemented in 2014/2015 ● There were only a handful of people with
k. The Center for Medicare and knowledge and experience in nursing
Medicaid Services (CMS) plans to informatics but the discipline has not yet found
increase reimbursement for the its recognition as a sub-specialty of nursing
implementation of “MU” regulations in arts and science in the country.
their HIT and/or EHR systems through ● In 2008, the Nursing Informatics course in the
2015 undergraduate curriculum was defined by the
l. CMS may even penalize eligible Commission on Higher Education (CHED)
providers and facilities who do not Memorandum Order 5 Series of 2008.
meet the proposed MU criteria ● This was later revised and included as a Health
m. As the MU requirements increase they Informatics course in CHED Memorandum
will impact on the role of the NI experts 14 series of 2009.
in hospitals ● This was first implemented in the summer of
n. MU requirements ultimately on the 2010.
roles of all nurses in the inpatient
facilities, making NI an integral WHY NURSING INFORMATICS?: BENEFITS OF
component of all professional nursing NURSING INFORMATICS IN HEALTHCARE
services
1. NI informs and influences IT systems
LANDMARK EVENTS IN NURSING AND ● NI specialists spend much of their time helping to
COMPUTERS develop, implement, and optimize computerized
patient information systems.
● It’s their blend of clinical and technical knowledge
Major Milestones
and experience that makes them perfect liaisons
1. Computers were introduced into the nursing
between the clinical and technical communities.
profession over 40 years ago ● Nurse Informaticists can:
2. Major milestones of nursing are interwoven ○ Recommend the most practical layout
with the advancement of computer and forms and reports, and the best processes
information technologies for electronic medication administration.
3. The increased need for nursing data, ○ Prevent EHR mutiny because they can
development of nursing applications, and predict clinician reactions to technically
changes, making the nursing profession an efficient-but clinically clumsy - workflows,
and shape EHRs that avoid these poor
autonomous discipline
workflows.
● NI specialists are trilingual:
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○ They understand the clinical language of Explain built-in inter operatively and behind the scene
efficient patient care. interfaces to other clinical systems in language that are easily
○ They translate knowledge and clinician understood by nurses
feedback into the technical language of
business analysts and programmers. 4. NI leverages IT investments
○ They communicate clinical and technical ● Nursing informaticists help get maximum value from
matters with administrative leadership. these investments in at least 3 ways:
● “Informatics professionals with a nursing background 1. They ensure that systems are designed to
combine the best of both worlds: deep expertise in support effective patient care workflows
clinical care helps nurse informaticists understand (Benefit #1).
the needs and stresses of clinical workflow while 2. They help train other nurses to use IT
their education and background with information efficiently (Benefit #3)
technology systems and data analytics help them 3. They apply advanced analytics strategies to
sculp health IT infrastructure into a meaningful and develop predictive models.
helpful tool.” - Health IT Analytics Notes:
Every health facility invests a significant amount of budget on
Notes: essential health information technology products and
services.
One of the early contributions of the NI is to help move
healthcare away from paper forms into electronic Example: informatics nurses use analytic tools to identify the
documentation (standardized notes are readily available to risk of sepsis and readmission and potential benefit from
the physicians through EHR) palliative care
Work flows and decisions are more informed and efficient

5. NI contributes unique wisdom to clinical
care that is acquired only through a deep
Many EHR vendors recognize hiring nurse informaticists to
help design and build a system.
understanding of both clinical practice and
data analysis
Nurse informatics specialist to be indispensable in providing ● Informatics nurse specialists work with leadership
superior healthcare IT systems. regarding regulatory and quality initiatives and
governance for technology and implementation and
2. NI leverages evidence-based clinical best change
practices ○ (E.g. They work with the delivery of care
team, chief nursing officer, chief medical
● Researching clinical nursing practice outside of their
officer, and quality leadership who might
own experiences.
give a directive based on improving patient
● Finding evidence to prove which clinical practices
safety by decreasing readmission)
are best.
● Influencing the design of clinical systems to support
● Informatics nurse specialists identify the key areas
and promote the best evidence-based practices and
where studies identify where problems arise
workflows (Benefit #1).
○ (E.g. inadequate nursing discharge
● Training other nurses to use clinical IT systems
education, patient doesn't have support at
(Benefit #3).
home, poor hearing or sight, having multiple
medications will take those variables and
3. NI generates stronger nurse training in identify in the system where the nurse
clinical IT systems should be alert to decrease readmission)
● Clinical It system are complicated, and their
interfaces and workflows are not always intuitive. ● Because nurse informaticists understand data
● But NI specialists are well-suited to teach other analysis and nursing practice, they immediately
nurses how to get the full benefits of these systems. know which trends are worth analyzing, and which
anomalies are significant enough to escalate
Notes:
NI’s help decided to create those systems and they 6. NI enriches the evolving healthcare delivery
understand the reason from a nursing care perspective for the system
structure of each digital form and each sequence of clicks.
● Two examples are developments in communication
technology and remote healthcare, known as
Telehealth
○ Communication Technology
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○ Telehealth ● Dramatic savings

○ Healthcare expenditures are squared
Notes: on account of repeated expenditures
with more traditional methods of
NI specialist are helping providing beneficial options to both
sharing information. Electronic system
patient and clinicians
wastes can be curved to reach timely
Smartphones are used to transform the way communication care delivery reducing malpractice
in nursing happens. claims and errors as it increased
communication with efficiency
Patients are receiving education and health management ● Shared knowledge
training, forwarding medical data and seeing their clinician ○ NI provides knowledge in patient’s
from even far away from each other. disease, therapist, and disease to be
more easily shared.
NI specialist design telehealth system and train nurses on how
○ Knowledge is readily passed backed
to use it
and forth between providers and
7. NI improves patient care, patient safety, and patients, medicine practice gets better
outcomes ● Patient participation
○ Patient that have electronic access to
● More efficient electronic health records
● Better IT systems their history and recommendations it
● Research and application if clinical best practices empowers them to take their role in
● Training of other nurses healthcare more seriously
● Analytics-based predictive models ○ Patients with access to care portals are
● New avenues for patient education able to educate themselves more
● Support for telehealth technology effectively about diagnosis and
prognosis while keeping track of
Notes:
medications and symptoms
The more generalized field of healthcare informatics focuses
○ Able to interact with HCP easily to allow
mainly on administrative issues whereas NI focuses on patient
care. individuals to be felt valuable in the
Why nursing informatics? healthcare team
● Provides a nursing perspective ● The impersonalization of care
● Illuminates nursing values and beliefs ○ Care is becoming less personal
● Denotes a practice base for nurses in health because it is placed on data and
informatics algorithms used to determine care
● Produces unique knowledge offered.
● Distinguishes groups of practitioners, ○ Valid record of patient and HCP
● Focuses on the phenomena of interest for becomes are still vital
nursing, and ● Increased coordination
● Provides needed nursing language and word ○ Healthcare becomes more specialized
context (Brennan, 2003) to health informatics. coming from different specialized
HCPs in one hospital stay
PATIENTS’ BENEFIT FROM NURSING ○ It is the role of the Health Informatics
INFORMATICS that provide pharmaceutical concern,
blood levels, nutrition, physical
● Fewer medical errors therapy, X-ray, discharge instructions
● More informed clinical decision-making collated form different specialists
● Shorter hospital length of stay ○ Informatics makes unnecessary
● Lower admission and readmission rates coordination possible
● Better self-management ● Improved outcomes
○ Most important way in which
WAYS INFORMATICS IS TRANSFORMING informatics give benefit
HEALTHCARE ○ Electronic medical record provide high
quality of care and safer care as
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coordinated team provide better of objects that these systems processed. These
diagnosis and decrease the chance of were data, information and knowledge.
errors ● Thus, information science is the study of
○ Doctors and nurses are able to information systems, the application and usage
increase efficiency which decrease of knowledge focuses on why and how
time to spend with patients technology can be put to best use to serve the
○ Manual jobs and now are automated information flow within the organization.
saves time and money
CLINICAL INFORMATION SYSTEM
INFORMATION SCIENCE
● All members of the interprofessional healthcare
● Is the science and practice dealing with the team including nurses, physicians,
effective collection, storage, retrieval, and use pharmacists, social workers and therapists use
of information. programs available on a clinical information
● It is concerned with the recordable knowledge system (CIS)
and informations and the technologies services ● This program includes monitoring systems,
that facilitate their management use order entry systems, and laboratory, radiology
● Information Science is a multidisciplinary and the pharmacy systems
science that involves aspects from computer ● The monitoring system includes revisions that
science, cognitive science, social science, automatically monitor and record biometric
communication science, and library science to measurements - Vital Signs, Cardiac Index, and
deal with obtaining, gathering, organizing, Stroke Volumes.
manipulating, managing, storing, retrieving, ● The device sent the measurements
recapturing, disposing of, distributing, or electronically and directly to the nursing
broadcasting information. Information Science documentation system
studies everything that deals with information
and can be defined as the study of information NURSING CLINICAL INFORMATION SYSTEM
systems.
● It has matured into a major field of management ● Incorporates the principles of nursing
that is increasingly being emphasized as an informatics to support the work that nurses do
important area of research in management by facilitating documentation of nursing process
studies and has expanded to examine the activities and offering resources for managing
human-computer interaction, interfacing, and nursing care delivery
interaction of people, information systems, and ● Two designs of nursing clinical information
corporation. It is taught at all major universities system
and business schools around the world. ○ Nursing process design
Organizations have become intensely aware of ■ The most traditional. More
the fact that information and knowledge are advanced system incorporates
potent resources that must be cultivated and standardized nursing
honed to meet their needs. languages such as the
● This science originated as a sub-discipline of NANDA, Nursing Intervention
computer science, in an attempt to understand Classification (NIC), Nursing
and rationalize the management of technology Outcomes Classification
within organizations (NOC) into the software
○ Protocol or Critical Pathway Design
● In the mid-1980’s Blum (1986) introduced the (Hebda and Czar, 2013)
concepts of data, information and knowledge as ■ This design facilitates
a framework for understanding clinical interdisciplinary management
information systems and their impact on health of information because all
care healthcare providers use
● He did this by classifying the then-current evidenced-based protocols or
clinical information systems by the three types critical pathways to document
the care they provide
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Notes:
A nurse needs to access a computer program easily, review a

patient ,medical history, and the healthcare provider orders
then go to the bedside to conduct an assessment. Once
assessment is completed, enter data in the computer terminal,
adapt the patient's bedside, and develop a plan of care from
the information gathered. This allows you to quickly share the
plan of care with the patient. Periodically, return to the
computer to check on the laboratory test results and document
the care you deliver. The computer screens and optional pop-
up windows make it easy to locate information, enter the
computer data and make changes.
EXTRA READINGS AND VIDEOS

Nursing Informatics in Two Minutes
https://youtu.be/scY_9w-p0y4
Historical Perspective of Nursing Informatics

https://drive.google.com/file/d/1gneHcmo5n9K8GFQHaV3
rs-eWOFUgpDR4/view?usp=sharing
MODULE 2
1. From Novice to Expert

2. The Novice to Expert Theory
3. Levels of Nursing Practice
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MODULE 2-1 2. The development of technological system

competencies in practicing nurses working in
PATRICIA E. BENNER an institution;
● Born on August 1942 in Hampton Virginia 3. The education of nursing students, from first
● Worked as an admitting clerk at a local hospital year to graduation and;
during high school. 4. The transition from graduate nurse to expert
● 1964 - Registered Nurse (RN) / Bachelor in Science
nurse.
(BS) from Pasadena College.
● 1970 - Masters of Science from University of
California, San Francisco. LEVELS OF NURSING PRACTICE
● 1982 - PhD from University of California, Berkeley
● Nursing experience on medical surgical units, ● Benner described 5 levels of nursing
coronary care units, and medical intensive coronary experience as:
care units.
● Visiting Nursing Association 1. Novice
● 1970 - 1975 Research Associate: University of 2. Advanced beginner
California in San Francisco School of Nursing
3. Competent
● 1982 - 1989 Associate Professor: Department of
4. Proficient
Physiological Nursing
● Co-wrote numerous books and published articles. 5. Expert
NOVICE TO EXPERT THEORY
● By Dr. Patricia E. Benner NOVICE
● Dr. Patricia Benner introduced the concept that ● A novice does not know anything about the
expert nurses develop skills and understanding subject he/she is approaching and has to
of patient care over time through a sound memorize its context-free features.
educational base as well as a multitude of ● The novice is then given rules for determining
experiences. an action on the basis of these features.
● She proposed that one could gain knowledge ● To improve, the novice needs monitoring, either
and skills ("knowing how") without ever learning by self-observation or instructional feedback.
the theory ("knowing that"). ● For example, a nurse learning to use a new
● She further explains that the development of hospital information system needs explicit
knowledge in applied disciplines such as instruction and rules to learn to use the
medicine and nursing is composed of the computer interface and manipulate the
extension of practical knowledge (know how) software. Further, novice are described to be:
through research and the characterization and
understanding of the "know how" of clinical ○ Beginner with no experience
experience. ○ Inability to use discretionary judgment
● She conceptualizes in her writing about nursing ○ Follows rules
skills as experience is a prerequisite for ○ Nursing students on clinical
becoming an expert ○ Taught general rules to help perform
● The Novice to Expert Theory, a construct theory tasks
first proposed by Hubert and Stuart Dreyfus ○ Rules are: context-free, independent of
(1980) as the Dreyfus Model of Skill specific cases, and applied universally
Acquisition, and later applied and modified to ○ Rule-governed behavior is limited and
nursing by Patricia Benner (1984) provides a inflexible
very useful and important theory that clearly ○ “Tell me what I need to do and I’ll do it.”
applies to nursing informatics.
ADVANCED BEGINNER
● Within the field of nursing informatics, this
theory can be applied to: ● An advanced beginner is still dependent on
rules, but as he/she gains more experience with
1. The development of nursing informatics skills, real life situations, he/she begins to notice
competencies, knowledge and expertise in additional aspects that can be applied to related
nursing informatics specialists; conditions.
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a. Marginally acceptable performance the situation to the holistic perception of the

b. treats all attributes and aspects as entirety of the situation.
equally important because aspect ● The proficient hospital information system
recognition is dependent on prior learner would know how to interpret data from
experience. all departmental information and provide
c. Works with a mentor to provide guidance to other disciplinary members as
guidelines. needed.
d. Follow rules closely.
e. Needs support in the clinical setting. a. Perceives and understands situations
f. Help in setting priorities. as whole parts
g. Knowledge is developing. b. Knows what to expect, and how to
h. New Graduate Nurses modify their plan of care when
i. Demonstrates acceptable performance something goes wrong
j. Has gained prior experience in actual c. More holistic understanding improves
situations to recognize recurring decision-making due to experience
meaningful components gained
k. Principles, based on experiences, d. Learns from experiences what to
begin to be formulated to guide actions. expect in certain situations and how to
modify plans
COMPETENT
EXPERT
● At this stage, the competent person grasps all
the relevant rules and facts of the field and is, ● An expert‘s repertoire of experienced situations
for the first time, able to bring his/her own is so vast that normally each specific situation
judgment to each case. immediately dictates an intuitively appropriate
● This is the stage of learning that is often action.
characterized by the term - problem-solving. ● After a great deal of experience actually using
● A competent level nurse would be able to use a a system in everyday situations, the expert
hospital information system with ease and nurse discovers that without his consciously
know-how to solve technical difficulties or using any rules, situations simply elicit from him
interpret conflicting data. or her appropriate responses.
● The proficient performer, immersed in the world
a. Typically a nurse with 2-3 years of his skilful activity, sees what needs to be
experience on the job in the same area done, and decides how to do it.
or in similar day-to-day situations ● The expert not only knows what needs to be
b. More aware of long-term goals achieved, thanks to the well-refined ability to
c. Routine exercise situational discrimination, s/he knows
d. Feelings of Mastery how to achieve his or her goal.
e. Gains perspective from planning own
actions based on conscious, abstract, a. No longer relies on principles, rules, or
and analytical guidelines to connect situations and
f. Gains perspective from planning own determine actions
actions based on conscious, abstract, b. Nursing intuition
and analytical thinking and helps to c. Deep rooted understanding of clinical
achieve greater efficiency and problems
organization d. Much more background of experience
e. Has intuitive grasp of clinical situations
PROFICIENT f. Performance is now fluid, flexible, and
highly-proficient
● The fourth stage is called fluency and is
characterized by the progress of the learner KEY TERMS OF A THEORY
from the step-by-step analysis and solving of
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● Person : Relates to safe care of patients ○ discrete entities that are described
● Health : Skills acquired to notice deviation in objectively without interpretation.
health ○ smallest factors describing the patient,
● Nurse : Learning curve for new graduate disease, health environment etc.
nurses, and continuing skills gained with ○ Example: Principle Medical Diagnosis
experience. of Chronic Kidney Disease Stage 1,
● Environment : Relationships between all Marital Status
different levels of nurses ● Information:
● Patricia Benner and other nurse educators ○ Data that are interpreted, organized, or
adapted this model to explain how nursing structured
students and professional nurses acquired ○ data + meaning
nursing skills. ○ different data points are put together
● A novice follows rules provided for each ○ who, what, where, and when
situation and is not flexible in real-life situations. ● Knowledge: Information that is synthesized to
As a novice acquires real-life experiences and identify and formalize relationships
can appreciate environmental influences on ● Wisdom: Application of knowledge to the
rule sets, he or she moves to the advanced management and solution of human problems
beginner stage. At the competent stage, a Example:
learner is able to tell what is important and what
is not important in assessing a given situation— ● Data: A patient’s vital signs
a learner has gained perspective. A proficient ● Information: A serial set of vital signs, placed
practitioner is able to see a situation in terms of into a context and used for longitudinal
the larger setting or environmental situation and comparisons.
begins to use intuition in decision-making. ● Knowledge: Recognition of a pattern and
Finally, an expert intuitively understands a identification of interventions
situation and immediately connects action to ● Wisdom: Accuracy of the synthesis of
this understanding (Ajay, 2003). information and appropriate selection of
interventions
MODULE 2-2 DATA VS. INFORMATION
1. DIKW Paradigm ● Data – Raw facts
2. Metastructures of NI ● Information - Processed data that has
3. DIKW Theory meaning.
4. Analyzing Organizational Issues using the ○ For information to be valuable or
DIKW Hierarchy meaningful, it must be accessible,
5. The Usage and Limitations of DIKW Model accurate, timely, complete, cost
DIKW PARADIGM effective, flexible, reliable, relevant,
simple, verifiable, and secure.
FROM KNOWLEDGE TO WISDOM

● Knowledge focuses on what is known.
● Wisdom focuses on the appropriate application
of that knowledge.
● Example:
● A knowledge base may include several options
for managing an anxious family, while wisdom
would guide the decisions about which of these
● DIKW stands for Data, Information, Knowledge, options are most appropriate with a specific
and Wisdom. family.
● NI centers on these concepts.
METASTRUCTURES OF NI USE OF KNOWLEDGE
● All nurses have the opportunity to be involved
● Data: in the formal dissemination of knowledge via
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their participation in professional conferences, ● The DIKW model of transforming data into
as either presenters or attendees. wisdom can be viewed from two different
concepts, which are contextual and
● All nurses, regardless of the practice arena, understanding.
must use informatics and technology to inform ● From the contextual concept, one moves from
and support that practice. a phase of gathering data parts (data), the
connection of raw data parts (information),
KNOWLEDGE VIABILITY formation of whole meaningful contents
● Refers to technology-based applications that (knowledge) and conceptualizing and joining
offer easily accessible, accurate, and timely those whole meaningful contents (wisdom).
information obtained from a variety of resources ● From the understanding concept, the DIKW
and methods and presented in a manner as to Pyramid can be viewed as a process starting
provide us with the necessary elements to with researching & absorbing, doing,
generate new knowledge. interacting, and reflecting.
● The DIKW hierarchy can also be represented
WISDOM IN INFORMATICS in terms of time. For instance, the data,
● The ability of the system to evaluate the information, and knowledge levels can be seen
documentation drawn from a health information as the past while the final step - wisdom -
system, and to adapt or change the system to represents the future.
improve the workflow of the clinical nurse
● Nurses’ decision making is described as an
array of decisions that include specific
behaviors, as well as cognitive processes
surrounding a cluster of issues.
● Can any aspect of nursing wisdom be
automated?
USE OF WISDOM
● Wisdom is the application of knowledge to an
appropriate situation.
● In the practice of nursing science, we expect
action and or actions directed by wisdom.
● Wisdom is developed through knowledge,
experience, insight, and reflection.
The "Data" of DIKW Hierarchy:
DIKW THEORY ● The first step in this DIKW model is Data.
● Collection of raw data is the main requirement
● DIKW is a useful framework for research and for coming up with a meaningful result in the
practice. end. Any measurements, logging, tracking,
● When raw data is collected, it gets mixed up records and many others are all considered as
and the view seems jumbled. The DIKW Model data. Since the raw data is collected in bulk, it
by Fricke (2018) on Russell Ackoff (1989) includes various things with both useful and not
describes how the data can be processed and so useful contents.
transformed into information, knowledge, and ● These are completely raw data and do not
wisdom. provide any meaningful result that can be used
● The DIKW Hierarchy comprises of the by the Information Technology (IT) Service
following: provider. Therefore the data doesn't answer
○ “D” = Data any question nor draw any conclusion.
○ “I” = Information ● To understand how the Data is transformed into
○ “K” = Knowledge utilizable results using the DIKW Pyramid
○ “W” = Wisdom model, we will discuss each of the subsequent
steps of the DIKW hierarchy (i.e. - information,
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knowledge, and wisdom) using sample

scenarios.
● For Example, Let’s assume the scenario is -
300 Users visit FEU on Canvas daily to take
online lessons. This is the raw data we have got
from statistics.
The "Information" of DIKW Pyramid:

● Information can be termed as the data that has
been given a meaning by defining relational
connections. Here, the word "meaning"
represents processed and understandable data
that may or may not be a useful piece of content
from the organization perspective.
● In an information processing system, a
relational database creates information from
the data stored within it. The "Knowledge" of DIKW Model:
● The information hierarchy stage of DIKW
Pyramid reveals the relationships in the data, ● Knowledge is the third level of DIKW Model.
and then the analysis is carried out to find the ● Knowledge means the appropriate collection of
answer to Who, What, When and Where information that can make it useful.
questions. ● Knowledge stage of DIKW hierarchy is a
● Now let come to the above example, the data deterministic process.
“300 users visit FEU on Canvas per day”, which ● When someone "memorizes" information due
is quite a generic number to get any insight. to its usefulness, then it can be said that they
● Now, to do the capacity planning and have accumulated knowledge.
availability planning, we must process it through ● Every piece of knowledge itself has useful
the information stage of DIKW Hierarchy. Now meanings, but it can't generate further
we can get answers like - 150 Users visit knowledge on its own.
Nursing Pharmacology, 145 Users visit Nursing ● In an information management system, most of
Research, 5 Users just visit the dashboards. the applications you use, such as modeling,
Out of them, 60% are in the age group of 18-22 simulation etc, exercise some sort of stored
years, 20% in the age group of 22-26 Years. knowledge.
Also, we get 70% of our visitors between 9 AM ● The knowledge step tries to find the answer to
to 11 PM. the "How" question. Specific measures are
● In the given scenario above, the generic data pointed out, and the information derived in the
now becomes information answering the previous step is used to answer this question.
questions of Who, What, When, and Where. ● With respect to our scenario, we must find the
This is the output we can get from the answer that “How do student nurses between
information stage. the age group of 18-22 years use our modular
approach?”
The “Wisdom” of DIKW Hierarchy:
● The Wisdom is the fourth and the last step of

the DIKW Hierarchy. It is a process to get the
final result by calculating through extrapolation
of knowledge. It considers the output from all
the previous levels of DIKW Model and
processes them through special types of
human programming (such as the moral, ethical
codes, etc.).
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● Therefore, Wisdom can be thought of as the THE USAGE AND LIMITATIONS OF DIKW MODEL:
process by which you can take a decision
between the right and wrong, good and bad, or ● Same as all other models, DIKW Model also
any improvement decisions. has its own limits. You may have noticed that
● Alternatively, we can say that in the wisdom the DIKW Hierarchy is quite linear and follows
stage, the knowledge found in the previous a logical sequence of steps to add more
stage is applied and implemented in practical meaning to data in every step forward. But the
life. reality is often quite different than that. The
● Wisdom is the topmost level in the DIKW Knowledge stage, for example, is practically
pyramid and answers the questions related to more than just a next stage of information.
"Why". ● One of the principal critiques of this DIKW
● In the case of our example scenario, one Pyramid is that it’s a hierarchical process and
example of wisdom gained might be that 70 % misses several important aspects of
of the student nurses visit our modules to get knowledge. In today's world, where we use
help with their lessons and technology needs. various ways to capture and process more and
more unstructured data, sometimes it forces us
ANALYZING ORGANIZATIONAL ISSUES USING to bypass a few steps of DIKW.
THE DIKW HIERARCHY: ● Though the previous statement is quite true,
● Data: however, the result still stays the same, such as
A way to identify the raw external inputs such what we do with the data warehouse and
as the facts and figures that are yet to be transforming data through big data analytics
interpreted. into decisions and actions (Wisdom).
● Information:
Analyze the raw data to determine the
organizational needs. An important aspect of
information management is that apart from
answering questions it can also help to find
other solutions in organizational contexts. MODULE 2-3
1. Computer Hardware
● Knowledge: 2. Computer Hardware Systems
Determines how something is remembered by 3. Open Source and Free Software
an individual or how information is applied by 4. Data Assessment
them. 5. Personal, Professional, & Educational
● Wisdom: Informatics
Uncover why the derived knowledge is applied REFERENCES
by individuals in a specific way. i.e. - finding the
reason behind any decision-making.
COMPUTER SYSTEM
1. COMPUTER HARDWARE
● Hardware refers to the physical parts of the

computer. It allows the user to enter data into
the computer, performs the actions of the
computer’s processing, and produces the
computer output. (Kozier, 2016) The size,
shape, and type varies depending on the
purpose of the computer. The essential
components of computer hardware are the
central processing units (CPUs) and the
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different types of input and output devices that the clock speed. Multi-core processors were
may also vary from one or more types. developed to help CPUs run faster as it became
more difficult to increase clock speed.
2. COMPUTER HARDWARE SYSTEMS ● Faster clock speeds mean that users can see
tasks ordered from the CPU to be completed
● The CPU is in the box that comprises the faster, making the user’s experience seamless
computer hardware necessary to process and and reducing the time waiting to interface with
store data. The power supply, disk drives, applications and programs.
chips, and connections for all other computer ● Based on Sirois (2018) on a review for HP
hardware (also known as peripherals) are also Computers, the reasonably fast CPU based on
located with the CPU. The performance of the average usage is between 3.5 to 4.0 GHz.
CPU or the determinant of how fast the CPU’s
performance is known by three components: 3. OPEN SOURCE AND FREE SOFTWARE
○ CPU processor cores and clock-speed,
which is typically measured in ● Software is the instructions being given to the
gigahertz hardware to perform certain tasks. They are
○ The amount of random-access classified based on availability and shareability
memory (RAM) as to free and open-source software and
○ The speed of data location or transfer proprietary or closed software.
rate of the disk drives. ● Free and open-source software (FOSS)
● Processor cores and clock speed are very allows users and programmers to edit, modify
different functions, but they’re working toward or reuse the software's source code. This gives
the same goal. Many computer experts talk developers the opportunity to improve program
about which you should give more emphasis to functionality by modifying it.
when purchasing or selecting a computer - but ● The term “free” indicates that the software does
they depend on each other equally to help your not have constraints on copyrights. The term
computer function at its best. “open source” indicates the software is in its
● Processor cores are individual processing units project form, enabling easy software
within the computer’s central processing unit development from expert developers
(CPU). collaborating worldwide without any need for
● The processor core receives instructions from a reverse engineering.
single computing task, working with the clock ● Free and open-source software may also be
speed to quickly process this information and referred to as free/libre open-source software
temporarily store it in the Random Access (FLOSS) or free/open-source software
Memory (RAM). (F/OSS).
● Permanent information is saved to your hard ● The basic and old classifications of software
drive when you request it. Most computers now include: System and Application Software.
have multiple processor cores that enable your
computer to finish multiple tasks at once. SYSTEM SOFTWARE
● Having the ability to run numerous programs ● System Software helps the user, hardware ,
and request multiple tasks like editing a and application software to interact and function
document and at the same time streaming a together. These types of computer software
video, as well as opening a new program, is allow an environment or platform for other
made possible with multiple processor core software and applications to work in. This is
units. why system software is essential in managing
● A computer’s processor clock speed the whole computer system.
determines how quickly the central processing ● When you first power up your computer, it is the
unit (CPU) can retrieve and interpret system software that is initially loaded into
instructions. This helps your computer memory. Unlike application software, the
complete more tasks by getting them done System software is not used by end-users like
faster. Clock speeds are measured in gigahertz you. It only runs in the background of your
(GHz), with a higher number then the higher is device, at the most basic level while you use
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other application software. This is why system ○ Accuracy and reliability

software is also called “low-level software”. ○ Serviceability
○ Methodological soundness
APPLICATION SOFTWARE ○ Assurances of integrity
● Application Software or most popularly known
as “apps” are what users regularly engage with 5. PERSONAL, PROFESSIONAL, & EDUCATIONAL
the most of the time. These types of computer INFORMATICS
software are productive end-user programs that
help you perform tasks. It can range from word PERSONAL INFORMATICS
processing to image editing, voice ● Information services, often accessible via a
communication or conferences, internet mobile device, that search, sort, mine, correlate
browsers, and many others. or otherwise filter information for a person
● With the advancement of technology, the based on their preferences, transaction logs,
software classification continues to change but location, social networks and other personal
the usability remains to be the main basis for its data.
classification.
PROFESSIONAL INFORMATICS
4. DATA ASSESSMENT ● Health informatics professionals use their
knowledge of healthcare, information systems,
● Data quality assessment (DQA) is the process databases and information technology security
of scientifically and statistically evaluating data to gather, store, interpret and manage the
in order to determine whether they meet the massive amount of data generated when care
quality required for projects or business is provided to patients. ...
processes and are of the right type and quantity ● Developing data-driven solutions to improve
to be able to actually support their intended use. patient health.
It can be considered a set of guidelines and
techniques that are used to describe data, EDUCATIONAL INFORMATICS
given an application context, and to apply ● Education informatics is an emerging sub-
processes to assess and improve the quality of discipline of education and informatics that
data. "incorporate[s] new technologies and learning
● Data quality assessment (DQA) exposes strategies to enhance the capture,
issues with technical and business data that organization, and utilization of information
allow the organization to properly plan for data within the field of education."
cleansing and enrichment strategies. This is ● While this sub-discipline typically covers K-12
usually done to maintain the integrity of and higher education, it is easily expanded to
systems, quality assurance standards and business- and enterprise-level education.
compliance concerns. Generally, technical
quality issues such as inconsistent structure
and standard issues, missing data or missing Theories that guide the discipline of NI
default data, and errors in the data fields are https://youtu.be/6kff8jXG18c
easy to spot and correct, but more complex
issues should be approached with more defined
processes.
● DQA is usually performed to fix subjective
issues related to business processes, such as
the generation of accurate reports, and to
ensure that data-driven and data-dependent
processes are working as expected.
● DQA processes are aligned with best practices
and a set of prerequisites as well as with the
five dimensions of data quality:
○ Accessibility
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MODULE 3 a. Sensors - most sensitive

1. Hospital and Critical Care Applications b. Signal conditioners - wired or
2. Community Health Applications wireless connectivity
3. Ambulatory Care Systems c. File to rank and order information
4. Emergency Preparedness & Response d. Computer processor to analyze data
5. Telehealth and direct reports
REFERENCES e. Evaluation or controlling
component to regulate the
Administrative Order 2014-0023. Designation of the
equipment or alert the nurse.
Research Institute for Tropical Medicine (RITM) as the
Philippine National Influenza Center (PNIC). DOH 2014
MICROPROCESSORS
UP National Telehealth Center ● Physiologic signals are typically of very small
amplitude and must be amplified, conditioned,
Mayoclinic and digitized by the device in preparation for
INFORMATION TECHNOLOGY SYSTEM processing by its embedded
APPLICABLE IN NURSING PRACTICE microprocessors.
● It analyzes information, stores pertinent
A. HOSPITAL AND CRITICAL CARE information in specific places and controls the
APPLICATIONS direction in reporting.
● It also alerts nursing personnel through a
● Information technology can be branched out report, an alarm or a visual notice.
based on the major functional departments ● Monitoring systems store various data
such as Administration, Clinical, and Nursing. elements with a time stamp derived from the
● Various Hospital and Critical care applications monitoring system’s internal clock
of information technology in this setting ● Physiologic monitoring systems typically have
particularly focusing on patient care: modern platforms allowing the selection of
○ Process store and integrate various monitoring capabilities to match the
physiological and diagnostic needs of a variety of clinical settings.
information from various sources ● More specialized monitoring capabilities like
○ Present deviations from pre-set ranges intracranial pressure or bispectral index
by an alarm or an alert. monitoring are also in modular format,
○ Accept and store patient care ● Physiologic monitors are usually built to
documentation in a lifetime’s clinical incorporate both arrhythmia and hemodynamic
repository monitoring capabilities.
○ Trend data in a graphical presentation
○ Provide clinical decision support HEMODYNAMIC MONITORS
through alerts, alarms, and protocols. ● Machines under the human machine interface
○ Provide access to vital patient used specifically for the following:
information from any location both 1. Measure hemodynamic parameters
inside and outside of the critical care closely examine cardiovascular
setting function
○ Comparatively evaluate patients for 2. Evaluate cardiac pump output and
outcomes analysis. volume status
○ Present clinical data based on concept- 3. Recognize patterns (arrhythmia
oriented views. analysis) and extract features
4. Assess vascular system integrity
PHYSIOLOGICAL MONITORS Evaluate the patient's physiologic
● Physiological monitors were developed to response to stimuli
oversee the vital signs of the astronauts 5. Continuously assess respiratory gases
● By the 1970's these monitors found their way (capnography)
into the hospital setting. 6. Continuously evaluate glucose levels
● Physiologic systems consist of 5 basic parts: 7. Store waveforms
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8. Automatically transmit selected data to saturation provides a measure of the amount of

a computerized patient database oxygen used by the patient
THERMODILUTION TECHNIQUE ● These problems usually cause nurses to spend

more time in troubleshooting and can lead to
● The bolus must be injected within 4 seconds less hours doing the necessary bedside care
● Amount of solution must be accurate ● To prevent these from happening,
● Temperature of the injective must be measured ○ It is important for nurses to become
and accurately maintained familiar with the user guide of the
● Catheter must be properly placed respective machines specifically on the
troubleshooting part.
THE PROCESS OF THERMODILUTION: ○ Some pulse oximeters are more
sensitive as compared to the others
a. The influence of these user-related issues is ○ Some need specific charging times,
negated by using heat of a thermal filament and some are more durable than the
embedded in the catheter to replace the others
injectate.
b. An alternative means of measuring cardiac
output noninvasively if provided by thoracic
electrical bioimpedance. Four sensors are TELEMETRY
positioned on the sides of the neck and thorax ● Hemodynamic monitoring can take place at the
c. Monitoring these changes permits bedside or can be conducted from a remote
measurement of stroke volume: indices of location via telemetry.
contractility such as velocity and acceleration of ● Telemetry allows for the continuous monitoring
blood flow, supraventricular rhythm and index. of patients usually outside of the ICU.
Using bioimpedance as a factor integrated with ● Telemetry monitoring is susceptible to signal
analysis of the finger blood pressure waveform loss.
has also been demonstrated as a method of ● Remember that computer-based hemodynamic
cardiac output measurement. monitoring offers the critical care nurse a wealth
of information that does not replace clinical
PULSE OXIMETRY judgment.
● A critical piece of hemodynamic information
involves the availability of oxygen to bodily ARRHYTHMIA MONITORS
tissues. ● Computerized monitoring and analysis of
● The standard for measurement of blood's cardiac rhythm have proved reliable and
oxygen saturation is co-oximetry effective in detecting potentially lethal heart
● Pulse oximetry is a noninvasive method of rhythms.
measuring oxygen saturation that also uses ● A key functional element is the system's ability
spectrophotometry. Light is emitted through a to detect ventricular fibrillation and respond with
pulsatile arteriolar bed and then detected by an alarm.
photosensor. ● SYSTEM TYPES: Detection Surveillance
Diagnostic or Interpretive.
ANTICIPATED PROBLEMS: ● What’s the difference?
○ In a detection system, the criteria for
Largest contributor to alarms in the ICU caused by: a normal ECG are programmed into the
1. blood pressure cuff computer.
2. tourniquet ○ Interpretive systems search the ECG
3. air splint that may cause venous pulsations complex for five parameters
4. limits the sensor’s ability to distinguish between ■ Location of QRS complex
arterial or venous blood pressure while pulse ■ Time from the beginning to the
oximetry provides a measure of oxygen end of the QRS
delivered to the tissue, mixed venous oxygen
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■ Comparison of amplitude, ● Supports the information needs of the critical

duration and rate of QRS care systems and helps monitor care capacity
complex with all limbs leads in the province
■ P and T waves ● Provides data to support decision-making
■ Comparison of P and T about:
■ waves with all limb leads ○ Performance improvement
○ Resource utilization
● Basic Components of arrhythmia Monitors - ○ Capacity planning
sensor signal conditioner cardiograph Pattern ○ Forecasting and strategic planning
recognition Rhythm analysis Diagnosis
CRITICAL CARE INFORMATION SYSTEMS (CCISs)

● a system designed to collect, store, organize,
retrieve, and manipulate all data related to care
of the critically ill patient.
● The primary purpose of a CCISs is the
organization of a patient’s current and
historical data for use by all care providers in
patient care.
● Provides a rich repository of patient information
that can be integrated for use in our outcomes
management. Each patient's data can be
accessed from any terminal or workstation.
● This capability can extend across units and VITAL SIGNS MONITORING
departments or be restricted to a single unit.
● includes Patient management service, length of ● Vital signs and other physiologic data can be
stay, mortality, readmit rates. Prognostic automatically acquired from bedside
scoring systems can be integrated to facilitate instruments and incorporated into the clinical
assessing the severity of an illness. database
● The CCIS can use the healthcare ● Data can be incorporated into flow sheets with
organization’s system to schedule patient care other data elements such as laboratory results,
activities, treatment, and diagnostic testing) body system assessment findings and problem
lists.
CIS ALSO INCLUDES
● Diagnostic Testing Result Results can be
displayed in flow sheets such as Laboratory,
Radiology, Cardiology results
● Clinicians can also access picture archival
information
CLINICAL DOCUMENTATION
● to support the process of Physical assessment

findings.
KEY FEATURES OF CCIS ● As the critical care environment requires
frequent assessments, these flowsheets may
● Integral to the Critical Care Strategy be configured to ease this extensive data
● Captures near real time data on every patient collection.
admitted to Level 3 and Level 2 critical care ● Flowsheets may also be organized by the body
units in the province. system. All disciples can document patient
assessment findings into the CCIS.
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● Automatic calculation of physiologic indices can ● Focuses on the health information system of
be performed. the community, it is centered on the majority
part of the public.
DECISION SUPPORT ● emphasizes the prevention of the disease,
medical intervention, and public awareness.
● The CCIS can provide alerts and reminders to ● fulfils a unique role in the community, promoting
guide care in accordance with evidence-based and protecting the health of the community at
guidelines. the same time maintaining sustainability and
● Point of care access to knowledge bases that integrity of health data and information.
contain information on evidence-based
guidelines of care, drug information procedures GOAL OF COMMUNITY HEALTH INFORMATICS
and policies.
● Data can be integrated with patient information ● Effective and timely assessment that involves
monitoring and tracking the health status of
MEDICATION MANAGEMENT populations including identifying and controlling
disease outbreaks and epidemics
● Can facilitate the medication administration
process Medication administration of COMMUNITY HEALTH APPLICATION SYSTEM
flowsheets incorporate the use of bar code
technology ● Encourages optimal application of computer
systems, computer programs and
INTERDISCIPLINARY PLANS OF CARE communication systems for the benefit of the
majority of individuals, families and community.
● Special flowsheets incorporating required
treatments and interventions may be provided PRIMARY FOCUS OF COMMUNITY INFORMATION
● Workflow management solutions that help SYSTEM
orchestrate all of the numerous, simultaneous ● Preventing, identifying, investigating and
processes eliminating communicable health problems.
● Accessibility of data and information, through
PROVIDER ORDER ENTRY communication
● Educating and empowering individuals to adopt
● Electronic entry and communication of patient health lifestyle
orders can help clinicians improve ● Facilitate the retrieval of data
communication, streamline processes, facilitate ● Effective transformation of data into information
care, and can help clinicians all providers in ● Effective integration of information to others
managing quality. disciplined to concretized knowledge and
creates better understanding.
COORDINATION & SCHEDULING OF PATIENT ● Creation of computerized patient records,
CARE ACTIVITIES medical information system
● Central repositions of all data such as data
● Critical care flowsheet is a predominant display warehouse
format for CCIS. ● Simple Graphical User Interface (GUI) for
● The goal of CCIS is to have as much nurses and other healthcare provider, patient
information integrated into the system as as consumer
possible to obtain a comprehensive picture of COMPUTER BASED SURVEY SYSTEM HEALTH
the patients. STATISTICAL SURVEYS
● used to collect quantitative information about
items in a population to establish certain
B. COMMUNITY HEALTH APPLICATIONS information from the obtained data.
● Focused on opinions or factual information
depending on its purpose and many surveys
involve administering question to individuals
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GOAL
ADVANTAGES ● strengthen the surveillance and response
● Consistent exchange of response capabilities at each level of the health system
● Disease tracking by building local capacities and leveraging
● Data and information sharing Building strengths and areas of expertise through
strategies partnership and coordination.
● Early detection and monitoring of disease and
sickness Control of spread of disease VISION
● National alertness and preparedness Building ● To improve the availability and use of
strong communication surveillance and laboratory data so that public
● Consistent exchange of response health managers and decision makers can plan
● Disease tracking for and carry out more timely detection and
● Data and information sharing Building response to the leading causes of illness, death
strategies and disability
● Early detection and monitoring of disease and
sickness Control of spread of disease FUNCTIONS
● National alertness and preparedness Building 1. Information from PIDSR is expected to be used
strong communication for the following purposes:
2. Facilitate collecting, managing, analyzing,
NURSING INFORMATICS: COMMUNITY HEALTH interpreting, and disseminating health-related
APPLICATION data for diseases designated as nationally
● Support and improve collaboration among the notifiable
doctors, community health providers and 3. Develop and maintain national standards, such
patients. as consistent case definitions for nationally
● Informatics is very useful in monitoring and notifiable diseases applicable across all the
tracking the health status of the community. provinces and cities
● The goal of community health informatics is to 4. Maintain the official national notifiable diseases
attain an effective and timely assessment that statistics
involves monitoring and tracking the health 5. Provide detailed data to control programs to
status of populations including identifying and facilitate the identification of specific disease
controlling disease outbreaks and epidemics. trends
● Advantages 6. Work with cities and provinces and partners to
○ The tracking and detection of the implement and assess prevention and control
disease in the community will be easy programs
because we can easily track the spread
of it, and the communication among the C. AMBULATORY CARE SYSTEMS
nurses and other health care providers ● The ambulatory care nurse focuses on patient
will be strong. safety and the quality of nursing care by
● A community health center should really use applying appropriate nursing interventions,
this kind of system because it has experienced such as identifying and clarifying patient needs,
how the health centers record and update performing procedures, conducting health
information of the people in the community and education, promoting patient advocacy,
believe it or not it takes us to weeks to do it from coordinating nursing and other health services,
letter A-Z. assisting the patient to navigate the healthcare
● A sample of informatics used in the Philippines system, and evaluating patient outcomes.
is the Philippine Integrated Disease ● The ambulatory care covers a wide range of
Surveillance and Response (PIDSR). It is a services that can be offered to patients that
multi-faceted public health disease surveillance need medical attention. By integrating the
system that provides public health officials the ambulatory care information system in the
capabilities to monitor the occurrence and nursing practice will really help in making the
spread of diseases. work easy like the processing of data and
information and the billing & charges etc.
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● advantages of the ambulatory care information ● Improved decision support and resource
system like: tracking/allocation tools bring added
○ access of medical records of patients to intelligence to the disaster situation.
health care providers ● Computer-assisted decision-making tools and
○ the nurses will be able to give quality intelligent adaptive planning provide
care and improve workflow, reduce alternatives to decisions that are typically made
medical errors ○ management and in a vacuum.
monitoring of the billing, doctors’ fees, BIOSURVEILLANCE
prescriptions and many more ● key capability of obtaining and maintaining
● One of the most important responsibilities of a situational awareness before and during a
nurse is to make sure that the patient receives health eEarly recognition and under-standing of
the care that he/she needs and with the use of departures from human, animal, plant and
this system, the quality of care can be given. environmental baselines, including detection of
novel occurrences, is necessary to give early
D. EMERGENCY PREPAREDNESS & RESPONSE warning and save lives
● Same with the objective in the application of ● Informatics and technology solutions such as
informatics in Community Health, the overall smartphones, tablets, and other wireless
objective is public health. devices may help to gather signals to detect
● only difference is the focus and level of potential incidents earlier, regardless of the
prevention cause, and communicate early warning and
● Community Health, the focus of the use of critical updates and foster electronic
informatics is on the promotive and preventive information exchange worldwide.
side ● Rapid detection is critical to save lives and
● while in emergency preparedness and improve incident outcomes, and the United
response focus on the mitigation and control of States serves in a key role as part of a global
emergencies. The use of informatics here is surveillance network.
much wider and critical. The need for
information in real-time is very crucial in saving E. TELEHEALTH
the lives of many.
● Based on Weiner and Slepski (2012) The ● Mayo Clinic (2020) Telehealth is the use of
modern movement toward HIE could go a long digital information and communication
way to expanding information outreach to technologies, such as computers and mobile
victims of disasters and humanitarian crises. devices, to access health care services
Although not the primary reason for the remotely and manage your health care.
legislation that has provided such sanctioned ● technologies you use from home or that your
growth in electronic health care records, for doctor uses to improve or support health care
once an unintended consequence has a services.
possible positive effect. Other efforts to expand For example, the ways telehealth could help
and upgrade communications to all populations you if you have diabetes. You could do some or
have benefits for the disaster community as all of the following:
well. As an example, radiofrequency ○ Use a mobile phone or other device to
identification (RFID) technology holds such upload food logs, medications, dosing
promise with early prototypes tagging victims and blood sugar levels for review by a
with treatment and other information. Longer nurse who responds electronically.
range RFID tags and readers will make it ○ Watch a video on carbohydrate
possible to continuously track victims as they counting and download an app for it to
move through the system from evacuation to your phone.
treatment facilities (National Research Council, ○ Use an app to estimate, based on your
Committee on Using Information Technology to diet and exercise level, how much
Enhance Disaster Management, 2007) insulin you need.
○ Use an online patient portal to see your
test results, schedule appointments,
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request prescription refills or email your 3. Order entry management

doctor. 4. Decision support
○ Order testing supplies and medications 5. Electronic communication and
online. connectivity
○ Get a mobile retinal photo screening at 6. Patient support
your doctor's office rather than 7. Administrative processes
scheduling an appointment with a 8. Reporting and population health
specialist. management
○ Get email, text or phone reminders
when you need a flu shot, foot exam or OWNERSHIPS OF EHRs
other preventive care.
● Adopting EHRs involves multiple steps and
GOALS OF TELEHEALTH requires integrating the EHR into both the
organization’s day-to-day operations and long
● The goals of telehealth, also called e-health or term vision, and the clinician’s day-to-day
mhealth (mobile health), include the following: practice.
○ Make health care accessible to people ● The first step of ownership is typically a vendor
who live in rural or isolated selection process.
communities. ● EHR certification ensures that a quality product
○ Make services more readily available will be selected.
or convenient for people with limited
mobility, time or transportation options. SYSTEMS SELECTION
○ Provide access to medical specialists.
○ Improve communication and ● Select a system based on the organization’s
coordination of care among members current and predicted needs
of a health care team and a patient ● criteria should include both subjective and
○ Provide support for self-management objective covering topics such as common
of health care. clinical workflows, decision support, reporting,
usability, technical build, and maintenance of
● In the Philippines, we have also adopted the system.
telehealth and have become an increasing
necessity with the emergence of the pandemic IMPLEMENTATION
and implementing the community quarantine
measures. ● Implementation planning occurs in the selection
● To promote safety among the public, telehealth process, during assessment of:
has been adopted by private and government ○ Scope of the work
hospitals. ○ Initial sequencing of the EHR
● The University of the Philippines – Manila components
(UPM) is one of the earliest in the Philippines to ○ Resources required
adopt telehealth in 1998. ● The implementation plan should also account
○ UP National Telehealth Center with the for the long-term optimization of the EHR.
commitment is to engage people to use
available technologies to improve INFORMATICS TOOLS TO PROMOTE PATIENT
health care albeit distance barriers SAFETY AND CLINICAL OUTCOMES
ELECTRONIC HEALTH RECORDS (EHR)
(Practice Applications: Caree Delivery) ● Computerized Physician Order Entry (CPOE)
(Clinical Informatics) Benefits
● Apps
● 8 Essential Components ● Bar-code medication labeling or RFID
technology
1. Health information and data ● Automated dispensing machines
2. Results management ● Smart Pump Technology
25 I YN & MD
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● Clinical Decision Support (CDS)

● Technologies for Home Medication
● Smart Room Technology
● Patient Monitoring Technologies
○ Robotics, chip
Supplemental Learning for Telehealth:

https://youtu.be/o8vaCW_A1us
Additional information on EHR:

https://youtu.be/QrvSBUmFcFg
https://youtu.be/luO7-KSA77k
26 I YN & MD
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MODULE 4
It helps in providing the highest possible quality of care in
Overview the most cost-effective and efficient manner.
Evidence-Based Nursing Practice refers to the The practice also enables the nurses to incorporate their
clinical expertise and current research to the data and turn
process of collecting, processing, and implementing
it into useful basis and the decision making process
research findings for the improvement of patient
outcomes, clinical nursing practice, and/or work
environment. It helps in providing the highest COMPUTERIZED NURSING CARE PLAN
possible quality of care in the most cost-efficient
manner. The practice also enables nurses to ● Ready-made NCPs using the Hospital’s
incorporate clinical expertise and current research to Information Management System
the data and turn it into a useful basis in the decision- ● Formulated with the purpose of addressing the
making process. The use of information technology time-consuming act in formulating NCPs
allows a more efficient facilitation in the applications
in Evidence-Based Nursing Practice such as the
computerized nursing care plan, use of clinical
pathway, clinical practice guidelines, and e-journals
that provide the latest and up-to-date accessible
literatures that can be used as support for new
evidence-based nursing practice projects. This
module will provide you an overview of the above-
mentioned applications and its intended purpose.
Objectives Notes:
At the end of this module, you should be able to: One of the most popular EVP available is the CNCP
● Provide evidence-based nursing care using In the clinical practice, there is a problem in the
nursing informatics and technology systems. reinforcement of NCP because there is a gap due to the
● Apply guidelines and principles of evidence- academe and the process of creating NCP. Thus it is hard
to find a completely written NCP due to emerged CNCP.
based nursing practice utilizing information
technology
Written NCP before is incomplete, outdated, and
REFERENCES sometimes rarely used and relied upon as a means of
communication which is the not intended purpose of the
NCP
The sample CNCP shows that the assessments are already

there and you just have to accomplish the checklist and you
WHAT IS EVIDENCE-BASED PRACTICE
just have to relate the individual presenting signs and
symptoms. NCP are generated based on the Information
1. Collection Management System.
2. Processing
3. Implementing Research Findings The individualization of care is also included in CNCP
4. Improvement of Outcome however you just applied information technology so that it
could be more time efficient for the nurses
Notes:
Evidence Based Practice refers to the process of collecting,

processing, and implementing research findings for the CRITICAL/ CLINICAL PATHWAY
improvement of patient outcomes in clinical nursing
practice and work environment.
27 I YN & MD
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● Multi-disciplinary Care Tool where all Clinical path way is multidisciplinary that’s why a patient care
procedures, care and treatment to be done to a may result into multiple clinical pathway of care therefore it
patient’s case is placed. depends on the patient’s case
● Purpose: Cost-efficiency
● Continuous Quality Improvement CLINICAL GUIDELINES
● Clinical practice guidelines are statements that

include recommendations intended to op2mize
patient care.
● This is a physician’s guideline in proving
treatment modalities to patients.
Notes:
To have a cost effective healthcare we must determine what Notes:

are the commonalities or what do we do in a particular case.
Clinical pathway is considered to be one of the best tools Clinical guidelines are not the same with the clinical pathway
utilized in the hospital to manage the quality in healthcare because the latter is multidisciplinary while clinical guidelines
concerning the standardization of care processes. are physician based or practice based.
It promotes an organized and efficient patient care based on They are formed by a systematic review of evidence and
evidence therefore proven that its implementation loses the assessment of benefits and harms of alternative care options.
variability in clinical practice but improves the outcome.
Clinical Practice Guidelines (CPG) should follow a sound and
The clinical pathway example above is multidisciplinary as it transparent methodology to translate the best evidence into
doesn't only focus on nursing but rather all allied health. All of clinical practice for improved patient outcomes
the activities are recorded there in the form of Gantt Chart for
standardization. Evidence based CPG is a key aspect in patient care
The development and implementation of the care pathway Above is the example of clinical guideline and are seen to be
involves a change in an organizational culture. The data tells as an algorithm on how patient is treated
the most cost efficient procedure as it allows communication
and collaboration. THE DIFFERENCES…
BARRIERS In a nutshell, the computerized nursing care plan and

the clinical guidelines of physicians can be found on the
1. The heterogeneity of patients and diagnosis clinical pathway as it promotes multi-disciplinary
2. The common reluctance among organizations collaboration and coordination of patient care.
and professionals to change. Please refer to your modules for a detailed discussion
on the differences
Notes:
Not all the same diagnosis must have the same process -
variance E-journals
● Electronic journals
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● Available at reliable websites or search engines

such as EBSCO Host
● This is the bases of the the review of related
literatures for your Evidence-Based Practice
Notes:
We can find rich evidences on E-journals
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MODULE 5 INTELLECTUAL PROPERTY LAW

Overview
● Intellectual Property (IP) refers to creations of
The health care environment in which advanced the mind, such as inventions; literary and
practice registered nurses are currently practicing is a artistic works; designs; and symbols, names
complex setting with rapid change underway driven by and images used in commerce.
a need to transform the health care delivery system by
focusing on improving patient safety, quality, and ● IP is protected in law by, for example, patents,
population health, while at the same time decreasing
copyright and trademarks, which enable people
the overall cost of health care. This module focuses on:
to earn recognition or financial benefit from
Intellectual Property Law; Copyright Law; Privacy of
Personal and Public Domains (Data Privacy Act); and what they invent or create. By striking the right
Netiquette Rules and Guidelines. balance between the interests of innovators
and the wider public interest, the IP system
Objectives: aims to foster an environment in which
creativity and innovation can flourish.
● Republic Act No. 8293 – “An act prescribing
● Describe the Intellectual Property Law and
the intellectual property code and establishing
Copyright law
the intellectual property office, providing for its
● Understand and explain the Privacy of
Personal and Public Domains (Data Privacy powers and functions, and for other purposes”.
Act)
● Determine and apply different Netiquette ● Definition:
Rules and Guidelines The term "intellectual property rights" consists
of:
1. Intellectual Property Law 1. Copyright and Related Rights;
2. Copyright Law 2. Trademarks and Service Marks;
3. Data Privacy Act
3. Geographic Indications;
4. Data Breach
4. Industrial Designs;
5. Netiquette Rules and Guidelines
5. Patents;
REFERENCES 6. Layout-Designs (Topographies) of
Integrated Circuits; and
Antolin, J. (2018). COPYRIGHT, TRADEMARK, CTTO etc. 7. Protection of Undisclosed Information
Explained! [Video (n, TRIPS).
blog post]. Retrieved from ● The term "technology transfer
https://www.youtube.com/watch?v=bkraYDJWw8k arrangements" refers to contracts or
agreements involving the transfer of systematic
Baldovino, R. (2020). Netiquette for Online Students [Video
blog post]. Retrieved August 11, 2020, from
knowledge for the manufacture of a product, the
https://www.youtube.com/watch?v=yy54u7ikoDE application of a process, or rendering of a
service including management contracts; and
Brooks, A. (2019). 10 Netiquette Guidelines Online the transfer, assignment or licensing of all forms
Students Need to Know. of intellectual property rights, including
Https://Www.Rasmussen.Edu/Student- licensing of computer software except
Experience/College-Life/Netiquette-Guidelines-Every- computer software developed for mass market.
Online-Student-Needs-to-Know
● The term "Office" refers to the Intellectual
Journal for Nurses in Professional Development
Property Office created by this Act.
National Privacy Commission
● The term "IPO Gazette" refers to the gazette
The International Comparative Legal Guides published by the Office under this Act.
World Intellectual Property Organization COPYRIGHT LAW
30 I YN & MD
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WHAT IS COPYRIGHT? the appropriate government agency;

● Copyright is a collection of all rights enjoyed by and
the owner of an artistic or literary work. 5. Statutes, rules and regulations, and
speeches, lectures, sermons,
WHAT ARE CONSIDERED COPYRIGHTABLE addresses, and dissertations,
WORKS IN THE PHILIPPINES? pronounced, read or rendered in courts
● Under Philippine Law, original intellectual of justice, before administrative
creations in the literary and artistic domain are agencies, in deliberative assemblies
copyrightable. These include books, and in meetings of public character.
pamphlets, articles and other writings;
periodicals and newspapers; lectures, IS A COPYRIGHT REGISTRATION NECESSARY TO
sermons, addresses, dissertations prepared for PROTECT ARTISTIC OR LITERARY WORKS?
oral delivery; letters; dramatic or dramatico-
musical compositions; choreographic works or ● No, copyrightable works are protected from the
entertainment in dumb shows; musical moment of their creation.
compositions; drawing, painting, architecture,
sculpture, engraving, lithography; models or WHO CAN APPLY FOR A COPYRIGHT
designs for works of art; original ornamental REGISTRATION?
designs or models for articles of manufacture;
illustrations, maps, plans, sketches, charts and ● The owner of the work or his/her assignees or
three-dimensional works relative to geography, successors-in-interest has the right to apply for
topography, architecture or science; drawings a copyright registration.
or plastic works of a scientific or technical
character; photographic works including works
produced by a process analogous to WHO ARE CONSIDERED OWNERS OF THE
photography; lantern slides; audio-visual works COPYRIGHTABLE WORKS?
and cinematographic works and works
produced by a process analogous to ● The owners of original literary and artistic
cinematography or any process for making works are:
audio-visual recordings; pictorial illustrations ○ The author of the work;
and advertisements and computer programs. ○ If the work is of joint ownership:
■ The co-authors are the original
WHAT ARE NOT PROTECTED BY COPYRIGHT owners and in the absence of
UNDER PHILIPPINE LAW? agreement, their rights shall be
governed by the rules on co-
● Copyright protection does not cover: ownership.
■ The author of each part is the
1. Idea, procedure, system method or owner of such a part he/she
operation, concept, principle, discovery created, if the work consists of
or mere data as such, even if they are parts that can be used
expressed, explained, illustrated or separately, and the author of
embodied in a work; each part can be identified.
2. News of the day and other ○ If the work is created in the course of
miscellaneous facts having the employment:
character of mere items of press ■ Employee is the owner, if the
information; work created is not part of
3. Official text of a legislative, employee’s regular duties
administrative or legal nature, as well even if he uses the time,
as any official translation thereof; facilities and materials of the
4. Work of the Philippine government, employer;
unless there was a prior approval by ■ Employer is the owner, if the
work created is the result of the
31 I YN & MD
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performance of employee’s DATA PROTECTION

regularly assigned duties,
unless otherwise agreed upon. ● The issue of privacy is difficult. The individual
○ If the work was commissioned, the one has the inherent right to control personal
who commissioned the work jointly information. However, to provide the best
owns it with the author/creator – but the possible care and service to the individual, the
copyright of the work remains with public, and private organizations must know
author/creator, unless otherwise some of that information. The issue is further
agreed upon; complicated because “privacy” has not been
● In the case of audio-visual work, the copyright defined in a way that is widely and generally
belongs to the producer, the author of the accepted. Actions such as collecting and
scenario, the music composer, the film director, storing unnecessary personal data, disclosing
and the author of the work adapted. However, data to individuals or organizations that do not
unless otherwise agreed upon among the have a genuine need for it, or using private
creators, the producer has the right to exercise information for something other than the
copyright to the extent required for the original purpose could be considered intrusive.
exhibition of the work in any manner, except for
the right to collect license fees for the ● Since the 1960s, the widespread use of
performance of musical compositions, with or computers has led to concern about the large
without words, which are incorporated into the mass of data collected through sophisticated
work. data linkage capabilities. The following socio-
● With respect to letters, the copyright belongs to legal concerns are widespread among the
the writer subject to the following: public.
○ Letters and other private ○ How and what information is collected
communications in writing are owned ○ How the collected information will be
by the person to whom they are used; who will have access to it
addressed and delivered, but the same ○ How the collected information can be
cannot be published or disseminated reviewed and, if necessary, corrected
without the consent of the writer or his
heirs. ● Within the nursing community, concern over
○ However, the court may authorize the data protection has always been present. The
publication or dissemination if the power provided by technologies such as
public goods or the interest of justice so computers and the Internet has heightened the
requires. concern of nurses for these reasons.
○ More data and information are
DATA PRIVACY ACT available.
○ More possibilities exist for errors in the
“DATA PRIVACY ACT OF 2012” data.
○ Organizations rely on information
● It is the policy of the State to protect the systems for essential functions.
fundamental human right of privacy, of ○ More data is shared between
communication while ensuring free flow of disciplines and
information to promote innovation and growth. organizations/institutions/facilities.
The State recognizes the vital role of ○ Public concern over possible abuse of
information and communications technology in information and privacy is strong.
nation-building and its inherent obligation to
ensure that personal information in information
and communications systems in the DATA PRIVACY ACT OF THE PHILIPPINES
government and in the private sector are
secured and protected. - National Privacy ● Implementing rules and regulations of Republic
Commission Act 10173, known as the “Data Privacy Act of
2012”
32 I YN & MD
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declared and specified

● Pursuant to the mandate of the national privacy purpose. Personal data shall
commission to administer and implement the be processed only if the
provisions of the data privacy act of 2012, and purpose of the processing
to monitor and ensure compliance of the could not reasonably be
country with international standards set for data fulfilled by other means.
protection, the following rules and regulations
are hereby promulgated to effectively ○ Section 19. General principles in
implement the provisions of the act: collection, processing and retention.
● Rule IV. Data Privacy Principles ○ The processing of personal data shall
○ Section 17. General data privacy adhere to the following general
principles. principles in the collection, processing,
○ The processing of personal data shall and retention of personal data:
be allowed, subject to compliance with 1. Collection must be for a
the requirements of the act and other declared, specified, and
laws allowing disclosure of information legitimate purpose.
to the public, and adherence to the 2. Personal data shall be
principles of transparency, legitimate processed fairly and lawfully.
purpose, and proportionality. 3. Processing should ensure data
○ Section 18. Principles of transparency, quality.
legitimate purpose and proportionality. 4. Personal data shall not be
○ The processing of personal data shall retained longer than
be allowed subject to adherence to the necessary.
principles of transparency, legitimate 5. Any authorized further
purpose, and proportionality. processing shall have
1. Transparency. The data adequate safeguards.
subject must be aware of the
nature, purpose, and extent of ● Rule VI. Security measures for the
the processing of his or her protection of personal data
personal data, including the ○ Section 25. Data privacy and security.
risks and safeguards involved, Personal information controllers and
the identity of the personal personal information processors shall
information controller, his or implement reasonable and appropriate
her rights as a data subject, organizational, physical, and technical
and how these can be security measures for the protection of
exercised. Any information and personal data. The personal
communication relating to the information controller and personal
processing of personal data information processor shall take steps
should be easy to access and to ensure that any natural person
understand, using clear and acting under their authority and who
plain language. has access to personal data, does not
2. Legitimate purpose. The process them except upon their
processing of information shall instructions, or as required by law. The
be compatible with a declared security measures shall aim to maintain
and specified purpose which the availability, integrity, and
must not be contrary to law, confidentiality of personal data and are
morals, or public policy. intended for the protection of personal
3. Proportionality. The data against any accidental or unlawful
processing of information shall destruction, alteration, and disclosure,
be adequate, relevant, as well as against any other unlawful
suitable, necessary, and not processing. These measures shall be
excessive in relation to a implemented to protect personal data
33 I YN & MD
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against natural dangers such as official duties shall be in the

accidental loss or destruction, and room or work station, at any
human dangers such as unlawful given time;
access, fraudulent misuse, unlawful 4. Any natural or juridical person
destruction, alteration and or other body involved in the
contamination. processing of personal data
shall implement policies and
○ Section 26. Organizational Security procedures regarding the
Measures transfer, removal, disposal,
○ Where appropriate, personal and re-use of electronic media,
information controllers and personal to ensure appropriate
information processors shall comply protection of personal data;
with the following guidelines for 5. Policies and procedures that
organizational security prevent the mechanical
1. Compliance officers destruction of files and
2. Data protection policies. equipment shall be
3. Records of processing established. The room and
activities. workstation used in the
4. Management of human processing of personal data
resources. shall, as far as practicable, be
5. Processing of personal data secured against natural
disasters, power disturbances,
○ Section 27. Physical security external access, and other
measures. similar threats.
○ Where appropriate, personal
information controllers and personal ● Rule VIII. Rights of Data Subjects
information processors shall comply
with the following guidelines for ○ Section 34. Rights of the data subject.
physical security: The data subject is entitled to the
1. Policies and procedures shall following rights:
be implemented to monitor and
limit access to and activities in 1. Right to be informed.
the room, workstation or
facility, including guidelines - The data subject has a right to be
that specify the proper use of informed whether personal data
and access to electronic pertaining to him or her shall be, are
media; being, or have been processed,
2. Design of office space and including the existence of automated
work stations, including the decision-making and profiling.
physical arrangement of
furniture and equipment, shall - The data subject shall be notified and
provide privacy to anyone furnished with information indicated
processing personal data, hereunder before the entry of his or her
taking into consideration the personal data into the processing
environment and accessibility system of the personal information
to the public; controller, or at the next practical
3. The duties, responsibilities and opportunity:
schedule of individuals
involved in the processing of a. description of the personal
personal data shall be clearly data to be entered into the
defined to ensure that only the system;
individuals actually performing
34 I YN & MD
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b. purposes for which they are in the preceding paragraph.

being or will be processed,
including processing for direct - When a data subject objects or
marketing, profiling or withholds consent, the personal
historical, statistical or information controller shall no longer
scientific purpose; process the personal data, unless:
c. basis of processing, when ➢ The personal data is needed
processing is not based on the pursuant to a subpoena;
consent of the data subject; ➢ The collection and processing
d. scope and method of the are for obvious purposes,
personal data processing; including, when it is necessary
e. the recipients or classes of for the performance of or in
recipients to whom the relation to a contract or service
personal data are or may be to which the data subject is a
disclosed; party, or when necessary or
f. methods utilized for automated desirable in the context of an
access, if the same is allowed employer-employee
by the data subject, and the relationship between the
extent to which such access is collector and the data subject;
authorized, including or
meaningful information about ➢ The information is being
the logic involved, as well as collected and processed as a
the significance and the result of a legal obligation.
envisaged consequences of
such processing for the data 3. Right to access.
subject; - The data subject has the right to
g. the identity and contact details reasonable access to, upon demand,
of the personal data controller the following:
or its representative;
➢ Contents of his or her personal
h. the period for which the
data that were processed;
information will be stored; and
➢ Sources from which personal
i. the existence of their rights as
data were obtained;
data subjects, including the
right to access, correction, and ➢ Names and addresses of
object to the processing, as recipients of the personal data;
well as the right to lodge a ➢ Manner by which such data
complaint before the were processed;
commission. ➢ Reasons for the disclosure of
the personal data to recipients,
2. Right to object. if any;
➢ Information on automated
- The data subject shall have the right to processes where the data will,
object to the processing of his or her or is likely to, be made as the
personal data, including processing for sole basis for any decision that
direct marketing, automated significantly affects or will
processing or profiling. The data affect the data subject;
subject shall also be notified and given ➢ Date when his or her personal
an opportunity to withhold consent to data concerning the data
the processing in case of changes or subject were last accessed
any amendment to the information and modified; and
supplied or declared to the data subject ➢ The designation, name or
identity, and address of the
35 I YN & MD
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personal information speech, of expression, or of

controller. the press or otherwise
authorized;
4. Right to rectification. f. the processing is unlawful;
- The data subject has the right to g. the personal information
dispute the inaccuracy or error in the controller or personal
personal data and have the personal information processor violated
information controller correct it the rights of the data subject.
immediately and accordingly, unless DATA PRIVACY ACT AS APPLIED IN NURSING
the request is vexatious or otherwise PRACTICE
unreasonable. If the personal data has
been corrected, the personal ● Nurse’s Guidelines to avoid Data Breach
information controller shall ensure the ○ Never breach a patient’s information
accessibility of both the new and the (SPI)
retracted information and the ○ If you are unsure about disclosing a
simultaneous receipt of the new and patient’s information, seek guidance
the retracted information by the from the Hospital’s Data Protection
intended recipients thereof: provided, Officer (DPO)
that recipients or third parties who have ○ Know by heart your hospital’s Privacy
previously received such processed Manual without fail.
personal data shall be informed of its ○ Never seek information about a patient
inaccuracy and its rectification, upon for whom you are not providing care.
reasonable request of the data subject. ○ Always maintain your patient’s
information confidential.
5. Right to erase or blocking.
- The data subject shall have the right to NETIQUETTE RULES & GUIDELINES
suspend, withdraw or order the
blocking, removal or destruction of his ● Netiquette is short for "Internet Etiquette." Just
or her personal data from the personal like etiquette is a code of polite behavior in
information controller’s filing system. society, netiquette is a code of good behavior
- This right may be exercised upon on the Internet. This includes several aspects
discovery and substantial proof of any of the Internet, such as email, social media,
of the following: online chat, web forums, website comments,
a. the personal data is multiplayer gaming, and other types of online
incomplete, outdated, false, or communication.
unlawfully obtained;
b. the personal data is being used ● While there is no official list of netiquette rules
for purpose not authorized by or guidelines, the general idea is to respect
the data subject; others online.
c. the personal data is no longer
necessary for the purposes for ● Examples of rules to follow for good netiquette:
which they were collected; 1. Avoid posting inflammatory or
d. the data subject withdraws offensive comments online (a.k.a
consent or objects to the flaming).
processing, and there is no 2. Respect others' privacy by not sharing
other legal ground or personal information, photos, or videos
overriding legitimate interest that another person may not want
for the processing; published online.
e. the personal data concerns 3. Never spam others by sending large
private information that is amounts of unsolicited email.
prejudicial to data subject, 4. No Yelling! There’s a time and a place
unless justified by freedom of for everything—BUT IN MOST
36 I YN & MD
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SITUATIONS TYPING IN ALL CAPS EXTRA READINGS AND VIDEOS

IS INAPPROPRIATE. Most readers RA #8293:
tend to perceive it as shouting and will https://www.officialgazette.gov.ph/1997/06/06/republic-act-
have a hard time taking what you say no-8293/
seriously, no matter how intelligent
your response may be. If you have COPYRIGHT, TRADEMARK, CTTO etc Explained! |
vision issues, there are ways to adjust Tagalog:
how text displays so you can still see https://www.youtube.com/watch?v=bkraYDJWw8k&t=2s
without coming across as angry.
Philippines: Copyright Laws and Regulations:
5. Show good sportsmanship when
https://iclg.com/practice-areas/copyright-laws-and-
playing online games, whether you win regulations/philippines
or lose.
6. Don't troll people in web forums or Copyright Law Basics for the Nursing Professional
website comments by repeatedly https://nursing.ceconnection.com/ovidfiles/01709760-
nagging or annoying them. 201509000-00002.pdf
7. Submit files the right way. Knowing
how to properly submit your work Further details of the Data Privacy Act of 2012:
https://www.privacy.gov.ph/data-privacy-act/
online is key to your success as an
online student. Online course
More information on Data Privacy Act:
instructors often establish ground rules https://www.privacy.gov.ph/data-privacy-act-primer/
for file assignment submissions, like
naming conventions that help them Data Privacy Act
keep things organized or acceptable https://drive.google.com/file/d/1pMZfyHEeuUu4IA4kwmW
file formats. Ignoring these instructions 5trzym2M0e9XX/view?usp=sharing
is a common example of bad
netiquette. TV Interview of Dr. Rolando Lansigan on the topic "Data
Breach":
8. Stick to the topic when posting in online
https://www.youtube.com/watch?v=c4Z33jTleAA
forums or when commenting on photos
or videos, such as YouTube or Netiquette for Online Students by: R. Baldovino:
Facebook comments. https://www.youtube.com/watch?v=yy54u7ikoDE
9. Don't swear or use offensive language.
10. Avoid replying to negative comments
with more negative comments. Instead,
break the cycle with a positive post.
11. If someone asks a question and you
know the answer, offer to help.
12. Attempt to find your own answer. If
you’re confused or stuck on an
assignment, your first instinct may be to
MODULE 6
immediately ask a question. But before
you ask, take the time to try to figure it Objectives
out on your own. For questions related
to class structure, such as due dates or At the end of this module, you should be able to:
policies, refer to your syllabus and
course FAQ. Attempt to find the ● Ensure a working relationship with
answers to any other questions on your individuals and family based on trust,
own using a search engine. If your respect, and shared decision-making using
questions remain unanswered after a appropriate electronic information systems
bit of effort, feel free to bring them up and technology.
with your instructor. ● Communicate effectively in speaking, writing,
13. Thank others who help you online. and presenting using culturally appropriate
language.
37 I YN & MD
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REFERENCES
PROFESSIONAL TIPS ON BOOKMARKING
1. Make each bookmark a small pictures

a. Add a bookmark by pressing the star in
Notes: the top right hand corner of your
omnibox (where you’d type a URL into
Chrome).
PERSONAL DIGITAL ASSISTANTS (PDA) b. Where it says “Name,” delete all of the
text.
● Personal Digital Assistants (PDAs) are pocket- c. Check to make sure “Folder” is listed as
sized computers that are capable of accessing “Bookmark Bar.”
the Internet, sending and receiving data, and d. Press “Done.”
storing textbooks worth of information.
Notes:
Notes:
In a hospital setting there are multiple users of common device
PDA and smartphones are not the same because PDAs therefore overtime, bookmarks might declutter and beat the
require a stylus to access the applications therefore it is not a purpose of bookmarking if not organized
touchscreen device.
2. Delete Old Bookmarks
PDA went for awhile around 1992 to 2007
a. It’s so important to go through your
PDA applications has been slowly incorporated in today’s bookmarks and delete the ones you no
smartphones or other mobile devices such as tablets (e.g. longer need. This will help make sure
tablet can be used as a device to access a patient's data). By that your bookmark bar is only filled
losing it’s stylus and making a touchscreen feature makes it with websites you actually need and
more practical want.
EMAILS AND BOOKMARKS 3. Organize the bookmarks you still need

a. Right click on your bookmark bar.
● Emails or electronic mails are ways to send (Watch this video to see how to right
messages between one user to another or to click on a Chromebook.)
multiple users. b. Click “Bookmark Manager.”
● Bookmarks, just as it is used in books for easy c. Right click to add folders.
retrieval of the page you are reading or for d. Click and drag websites to rearrange
common reference, it also has the same bookmarks.
function in the context of the Internet browsers Ko
and other reading applica.ons such as Kindle WIRELESS DEVICES/ MOBILE PHONES
and iBooks to name a few.
Notes: ● Means of communication
● Nurses communicate with multiple members of
In hospitals bookmarks can be used for easy retrieval of
the healthcare team, often while maintaining
formulas in drug computations, references, etc.
heavy patient loads. Optimal communication
procedures can help nurses use their time more
PROFESSIONAL TIPS ON EMAIL
efficiently to improve patient safety and
outcomes (VanDusen, 2017).
● Create an email that has a professional
Notes:
presentation. This is usually your first name and
last name or the first leSer of your name Replace the function of PDAs
followed by your last name for easy recall
○ i.e. ncu@feu,edu.ph The use of mobile devices are multipurpose (e.g.Access the
● Do not use these: fireman20, ako_ito, internet for information; used for communication) especially in
matermindme and those alike the collaboration of patient care.
38 I YN & MD
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Delay in communication can result in medical errors that’s why

making sure that drug orders are correct can be done through
communicating with the personnel who ordered the
medication.
The Joint Communication International made communication

between healthcare workers as part of the patient safety goal
to reduce medical errors according to studies
Updating ourselves (healthcare professionals) are part of our

professional responsibilities (e.g. attending meetings). It is
important for nurses unless it is taxing for them (tired from
work). Therefore teleconferencing/ video conferencing is
used. ● Uses of Social Media
○ Professional Networking
TELECONFERENCING ○ Professional Education
■ sharing a webinar, a short
● Video conferencing is a visual communication video, or an infographic
session between two or more users regardless especially during the pandemic
of their location, featuring audio and video such as in Facebook Live
content transmission in real time. ○ Organization Promotion
● This platform became very popular in the rise of ○ Patient Care
the Covid-19 Pandemic because social and ■ Reluctance of professional
physical distancing was instituted as part of the healthcare providers to use
health and safety protocols. social media because it might
cross the boundary between
SOCIAL MEDIA personal and professional
space. Virginia Science
● Websites and applications that enable users to University has WebView that
create and share content or to participate in allows patients reach doctors
social networking. to answer questions or ask for
Notes: medication refills (reluctance
are now breaking)
Facebook for Business is created by Facebook to target ○ Patient Education
specific people therefore privacy is not violated. Businesses
○ Public Health
can’t know that those data because of FB for Businesses (FB
■ Social media can quickly
is top one used for business)
spread information and
Healthcare organizations such as DOH use multiple social mobilize number of people to
media platform to reach as much as many people they can for facilitate greater progress
promotion purposes (Twitter for younger generations) toward public health goals
● Dangers of Social Media in the Healthcare
Youtube is more visual Practice according to Ventola (2014):
○ Poor Quality of Information
Instagram and Pinterest lacks engagements
■ fake news - since the social
media features content made
Services and professional self are best presented in Linked-
In. It is a professional network.
by users, verification might not
be available.
Google class is not much used because Facebook is more ○ Damage to Professional Image
accessible and user-friendly (least social media platform ■ this can happen when user
being utilized) take a screenshot and have an
erroneous post about a
professional that can damage
their image
○ Breaches of Patient Privacy
39 I YN & MD
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○ Violation of Professional-Patient ■ Use the most secure privacy

Boundary settings available.
■ e.g. you are a nurse and your ■ Keep personal and
patient is part of your social professional profiles separate.
network therefore the ○ Professional Ethics
professional boundary is ■ Disclose any in-kind or
crossed. financial compensation
○ Licensing Issues and other Legal received.
Issues ■ Do not make false or
■ avoid posting your license misleading claims.
especially with the license ○ Self-identification
number and other pertinent ■ Identify yourself on
details to avoid duplication of professional sites.
identity ■ Make sure that your
● Professional Practices in Social Media credentials are correctly
○ Content Credibility stated.
■ Share only information from ■ Specify whether or not you are
credible sources. representing an employer.
■ Refute any inaccurate Notes:
information you encounter.
○ Legal Concerns To minimize fake news, check official pages if they are verified
to be credible. Share only what is verified.
■ Remember that the content
you author may be
The content you author may be discoverable and might be
discoverable. used against you especially if it can affect your organization
■ Comply with federal and state and profession.
privacy laws.
■ Respect copyright laws. WEB 2.0. BLOGS AND WIKIS
○ Licensing Concerns The use of Web 2.0:
■ Know professional licensure ● patient care schedules,
requirements for your state ● e-consultation such as in private hospitals
○ Networking Practices where you can consult with a physician virtually,
■ Do not contact patients with ● patient information on diagnostic tests, its
requests to join your network. preparation, what to expect, and other pertinent
■ Direct patients who want to join details can be the variation of use.
your personal network to a
more secure means of
communication or to your Notes:
professional site.
○ Patient Care Web 2.0 are the social media platforms or websites already
■ Avoid wri.ng about specific wherein the users get to contribute to their respective
patients. contents. It is used by most health care organizations to
facilitate patient schedules instead of queueing physically,
■ Make sure you are in
patients can now schedule themselves online.
compliance with state and
federal privacy laws. E-consultation has been promoted by private hospitals during
■ Obtain patient consent when the pandemic where you can consult virtually. DOH is also
required. advocating E-consultation to minimize the spread of the virus
■ Protect patient information
through “de-identifica.on.” Web 1.0 are the usual web pages in which text and
■ Use a respectful tone when information are just displayed. You cannot contribute to the
discussing patients. content
○ Patient Privacy
40 I YN & MD
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SOCIAL MEDIA IN THE CONNECTED AGE: IMPACT engaging and educating

ON HEALTHCARE EDUCATION AND PRACTICE consumers and providers in
healthcare”
1. Overview iv. In the Connected Age,
a. The Internet has revolutionized the everything and everyone is
computer and communications world interconnected that ultimately
like nothing before will have an impact on how we
i. The Internet is at once a learn as well as how we
worldwide broadcasting receive healthcare
capability, a mechanism for v. The benefits and challenges
information dissemination, and related to the growing use of
a medium for collaboration and these tools are also discussed
interaction between individuals
and their computers without HISTORICAL PERSPECTIVE
regard for geographic location
b. There is no doubt the Internet provided 1. Internet
the necessary infrastructure to a. As early as the 1960s, computer
revolutionize the way scientists and scientists began to write about the
researchers from the worlds of creation of a network of interconnected
academia, business, and government computers where scientists could
could share data, interact, and share and analyze data by interacting
collaborate with each other across the network
i. But it was not until the i. According to Cerf, “the name
introduction of the World Wide ‘Internet’ refers to the global
Web that “everyday people” seamless interconnection of
without computer networks made possible by the
programming skills were protocols devised in the 1970s
enabled to reap the benefits of through DARPA-sponsored
this revolution research”
ii. The Web not only changed ii. The Internet is defined as “a
how governments and computer network consisting
businesses operate, it has of a worldwide network of
impacted every facet of computer networks that use
society—how we work, learn, the TCP/IP network protocols
play, and now, even how we to facilitate data transmission
manage our health and exchange”
c. In this chapter, there is a brief history of iii. Over the next decade, various
the evolution of the Internet to the Web government agencies and
and now to the Connected Age companies conducted
i. There is a specific focus on the considerable research to
use of social media digital support the advancement of
tools, and its impact on the Internet
healthcare and education iv. It was not until 1985 that a
ii. This is particularly true as we broader community, in
evolve from the Web 2.0 era to particular the academic
the Connected Age where it is community beyond the
not only access and computer scientists, was given
interactions but about access to the Internet
establishing relationships v. NSF funding for the Internet
iii. Sarasohn-Kahn noted, “the continued for almost a decade
use of social media on the before the Internet was
Internet are empowering, redistributed to regional
41 I YN & MD
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networks with the eventual access information and

move toward interconnecting knowledge housed on Web
networks across the globe pages complete with text,
b. As the Internet came to expand, Tim images, and even some
Berners-Lee wrote his seminal paper multimedia
Information Management: A Proposal ii. It was considered a
that circulated throughout the dissemination vehicle that
European Council for Nuclear democratized access to
Research (CERN) organization information and knowledge
i. The paper explicated his ideas iii. Many in the field designate the
that using a hypertext system time period between 1991 and
that would allow for storage 2004 as Web 1.0
and retrieval of information in a iv. This was an important era and,
“web of notes with links (like as noted by Friedman, the
references) between them is world suddenly became flat—
far more useful than a fixed his metaphor for the leveling of
hierarchical system” the global playing field
ii. In 1990, Berners-Lee’s paper v. The convergence of the
was recirculated and he began personal computer with the
development of a global world of the Internet and all its
hypertext system that would services facilitated the
eventually become the World flattening
Wide Web (WWW) vi. The flattening was particularly
iii. As the WWW concept evolved, powerful in the world of
Marc Andreessen and Eric commerce but also exploded in
Bina at the University of Illinois higher education, making it
developed a browser called easier for students to access
Mosaic that provided a knowledge beyond their own
graphical interface for users academic campus
iv. This browser is credited with vii. For healthcare, it was a time
popularizing the Web where consumers could now
2. World Wide Web have access to health
a. Overview information and knowledge
i. It is important to note that that was not locked in an
although many use the terms academic library or in a distant
Internet and Web ously, there place
are differences between them c. Web 2.0
ii. Whereas the Internet is the i. O’Reilly and Dougherty
network of interconnected introduced the term Web 2.0 at
computers across globe, the a 2004 conference
Web is an application that brainstorming session about
supports a system of the failures of the dot-com
interlinked, hypertext industry
documents. One uses the ii. It was apparent that despite
Internet to connect to the Web the demise of the dot-com
iii. A Web browser allows the user industry, “the Web was more
to view Web pages that contain important than ever, with
text, images, and other exciting new applications and
multimedia sites popping up with
b. Web 1.0 surprising regularity”
i. The Web in its first iteration
(Web 1.0) allowed users to
42 I YN & MD
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iii. There were several key tools, resources and practices

concepts that formed the that are seen by many as
definition of Web 2.0 returning the web to its early
iv. First, the Web is viewed as a potential to facilitate
platform rather than an collaboration and social
application interaction”
v. Second, the power of the Web xiii. Although some have predicted
is achieved by harnessing the that there will be Web 3.0,
collective intelligence of the known as the Semantic Web,
users this never materialized as
vi. A third important principle was projected
that the Web provided rich xiv. There have been more recent
user experiences references to such terms as
vii. The introduction of Web 2.0 the Internet of Things (IOT)
embodies the long history of and the Connected Age
community spirit of the Internet xv. Both are fairly similar but there
conceived by its originators are some distinctions
viii. As Leiner and colleagues xvi. Ashton first described the IOT
noted, “the Internet is as much as “a system where the
a collection of communities as Internet is connected to the
a collection of technologies, physical world via ubiquitous
and its success is largely sensors”
attributable to satisfying basic xvii. In the 2012 Horizon Report
community needs as well as (Johnson, Adams, &
utilizing the community Cummins), IOT “is the latest
effectively to push the evolution of network- aware
infrastructure forward” smart objects that connect the
ix. The transition from an physical world with
information dissemination information”
platform to an engaging, xviii. Skiba noted, “Several
customizable, social, and attributes are associated with
media-rich environment these smart objects; they are
epitomizes this next small, easy to attach and
generation of the Web unobtrusive, contain a unique
x. As Downes stated, “the Web identifier and data or
was shifting from being a information, and can connect
medium, in which information with an external device on
was transmitted and demand (e.g., your
consumed, into being a smartphone or tablet)”
platform, in which content was
created, shared, remixed, CONNECTED AGE
repurposed, and passed
along” 1. Overview
xi. Another important feature was a. More recently, Oblinger introduced the
the idea of users interacting concept of the Connected Age in higher
and sharing information, ideas, education
and content i. Abel, Brown, and Suess
xii. Owen, Grant, Sayers, and describe the Connected Age,
Facer aptly described the as an environment that “offers
transition of the Web, “we have new ways to connect things
witnessed a renaissance of that were previously
this idea in the emergence of considered disparate and ‘un-
43 I YN & MD
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connectable’: people, information regarding patient

resources, experiences, status through smarter use of
diverse content, and data, devices, communication
communities, as well as platforms and people”
experts and novices, formal ii. Iglehart concurred that
and informal modes, mentors Connected health is “an
and advisors” umbrella term to lessen the
ii. Oblinger further noted confusion over definitions of
“Connecting is about reaching telemedicine, telehealth and
out and bringing in, about mHealth”
building synergies to create a iii. Iglehart considered connected
whole that is greater than the health as an emerging
sum of its parts disruptive technology that has
iii. Connecting is a powerful the potential to transform the
metaphor healthcare delivery system
iv. Everyone and everything— c. IOT and Connected Age, speak to
people, resources, data, connections to everything and
ideas—are interconnected: everyone
linked and tagged, tweeted i. IOT focuses on those
and texted, followed and connections with physical
friended. Anyone can objects
participate” ii. The Connected Age refers to
v. As noted by Skiba, “In higher more virtual connections
education, we can think of especially with people,
these as learning pathways, resources, and ideas
created by the individual or iii. It is within the context of the
guided by other students or Connected Age that we
faculty examine the digital tools being
vi. The bottom line is that learning used to transform education
pathways are about and healthcare practice
connecting the dots—in the d. In the Connected Age, digital tools are
classroom, online, or even with primarily associated within the broad
people and places outside the context of social media and mobile
traditional academic applications
environment” i. The Pew Research Internet
b. In healthcare, Caulfield and Donnelly Project has witnessed three
offered a model of Connected Health technology revolutions since it
that “encompasses terms such as wire- began studying the Internet
less, digital, electronic, mobile, and ii. The three revolutions include:
telehealth and refers to a conceptual broadband, mobile
model for health management where connectivity, and the rise in
devices, services or interventions are social media and social net-
designed around the patient’s needs, working in everyday life
and health related data is shared, in iii. The three revolutions are
such a way that the patient can receive primary driving forces behind
care in the most proactive and efficient the Connected Age
manner possible iv. According to Fox and Rainie,
i. In this model, patients, the WWW turned 25 on March
caretakers, and providers are 14, 2014 and has reached 87%
‘connected’ by means of timely penetration in terms of adult
sharing and presentation of usage in the United States
accurate and pertinent
44 I YN & MD
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v. There is also considerable integrated into the fabric of everyday

growth of cell phones from life
53% in 2000 to now 90% and i. The Digital Consumer Report
also smartphones has documented that 64% of social
increased to 58% media users log in at least
vi. When participants were asked once a day and almost 50% log
about the impact on their lives, into their social network on
90% claimed the Internet was their smartphone on a daily
a positive influence basis
vii. Users noted that being online ii. “Mobile devices are certainly
was essential for not only job- driving the growth in social
related responsibilities but for media, as social media app
many other facets of their lives usage increased 37% in 2013
such as learning, health, compared to last year”
politics, family, friends, and
community interactions
viii. It is interesting to note that DIGITAL TOOLS IN EDUCATION AND PRACTICE
67% of users indicated that
online communications were 1. Overview
positive and strengthened a. To better understand the tools being
relationships with family and used in the Connected Age, it is
friends important to define social media
2. Facebook i. In some cases, social media is
a. In a 2013 update specific to social used as the broad category
media, Duggan and Smith found that that encompasses all of the
although 73% use social networking Web 2.0 tools
sites, Facebook being the most ii. Anthony Bradley in his blog
prevalent, there are 42% who are also offered a new definition, “social
exploring other social networking media is a set of technologies
platforms and channels targeted at
i. On a daily basis, most users forming and enabling a
check both their Facebook and potentially massive com-
their Instagram accounts munity of participants to
ii. There is a growing use of productively collaborate ...
Pinterest, LinkedIn, and enable collaboration on a
Twitter much grander scale and
b. In terms of mobile devices, the Pew support tapping the power of
Internet Research Mobile Fact Sheet the collective in ways
indicated as of January 2014, 90% of previously unachievable”
American adults have cell phones of iii. According to Bradley, there are
which 78% have smartphones six defining characteristics that
i. There are also 52% of distinguish social media from
American adults with tablet other collaboration and
computer devices and 32% communication IT tools
with e-reader devices iv. These characteristics are
ii. It is also interesting to note that 1. Participation
70% of teens (13–17 years old) 2. Collective
and 79% of young adults (aged 3. Transparency
18–24) are owners of 4. Independence
smartphones 5. Persistence
c. According to Nielsen’s Digital 6. Emergence
Consumer Report, social media is well
45 I YN & MD
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v. Participation echoes the iii. A top listing of health-related

“wisdom of the crowds” blogs are available at the
concept, but note that there is following Web site:
no wisdom if the crowd does http://labs.ebuzzing.com/ top-
not participate blogs/health
vi. The term collective refers to iv. The Health Care Social Media
the idea that people collect or List, maintained by the Mayo
congregate around content to Clinic’s Social Media Health
contribute, rather than the way Network, documents the types
individuals create and of social media being used by
distribute content in the Web hospitals across the United
1.0 world States
vii. Transparency refers to the fact v. There statistics demonstrate
that everyone can see who is although blogs were once very
contributing and what popular, there are fewer blogs
contributions are made being maintained by hospitals
viii. Independence refers to the vi. Of the 1544 hospitals only 209
anytime, anyplace concept; have blogs
people can participate 3. Wikis
regardless of geography or a. Wikis are coined after the Hawaiian
time word for fast, and are a means to
ix. Persistence refers to the notion establish an easily and quickly
that information or content accessed consumer-driven knowledge
being exchanged is captured base; they are essentially collaborative
and not lost as in a tools that are “based on social
synchronous chat room regulation rather than technical
x. Lastly, “the emergence safeguards”
principle embodies the i. Wikis, as a form of social
recognition that you can’t writing, are also prevalent in
predict, model, design, and healthcare
control all human collaborative ii. CliniWiki is a popular wiki
interactions and optimize them targeted toward clinical
as you would a fixed business informatics topics
process” iii. This wiki contains information
xi. Taken together these on a variety of topics in such
characteristics define the new areas as clinical decision
world of social media support systems, unintended
2. Blogs consequences of technology,
a. In the Connected Age, social writing federal initiatives, and usability
and communication are important iv. Professional organizations,
concepts for sharing resources and such as HIMSS also maintain
ideas as well as for making a Decision Support Wiki
connections with people similar to you v. An interesting educational
i. Social writing can take many Web site in informatics is the
forms and include, but are not University of Edinburgh’s
limited to, wikis, blogs, and Informatics wiki that is focused
microblogging primarily on educational
ii. Blogs, short for Weblogs, are opportunities, student projects,
considered to be personal Web discussions, and resources
sites where content is vi. Another important wiki is of
displayed for visitors to review course the ever popular
and comment upon
46 I YN & MD
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Wikipedia that maintains over ii. The electronic medium can be

4 million articles supply driven, such as the
4. Microblogging information being published in
a. Microblogging, the combination of 1. Blogs
texting and blogging adds a new 2. Microblogs
dimension to communication and 3. Discussion groups
social writing and is growing in 4. Demand driven that
popularity includes Web
i. Historically, electronic mail (e- searching and
mail), instant messaging, and navigation
text messaging, have been
less public forms of SOCIAL NETWORKING
communication These forms
have been seen as one-to-one 1. Overview
communication a. Social networking embraces many of
b. Microblogging, using such tools like the defining characteristics of the
Twitter now allow consumers to post Connected Age and is a major
content to a Web site, which then component of connected learning and
automatically distributes the content to connected health
others who have “subscribed” to the i. First, participation and
individual’s site; this creates short collaboration were two of the
bursts of communication among any principle themes in Web 2.0
number of individuals and are the driving forces
i. These microblogging sites behind the social media
allow social communication to movement with continued
come directly to consumers, relevance in the Connected
rather than requiring that Age
consumers go and seek it out ii. Eysenbach further noted,
themselves “Social networking ... involves
ii. These short bursts of the explicit modeling of
communication, known as connections between people,
Tweets, are limited to a forming a complex network of
specific number of characters relations, which in turn enables
iii. In education, Twitter is being and facilitates collaboration
used in various ways and collaborative filtering
c. Educators are also using Twitter in the processes”
classroom to encourage student iii. Another aspect of social
engagement networking is the ability to
d. In healthcare, there is a rise in the use share user-generated content
of microblogging especially in the in the form of videos, stories, or
public health arena photographs
i. According to Eysenbach, iv. In addition to adding and
“Infodemiology can be defined viewing content, consumers
as the science of distribution can also post comments to
and determinants of media someone else has
information in an electronic contributed, thus adding
medium, specifically the another level of
Internet, or in a population, communication to these sites
with the ultimate aim to inform b. Of the available digital tools, social
public health and public policy” networking offers the most opportunity
for peer support and consumer
engagement
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i. Users can make connections 4. Fourth, younger rather

with people that they already than older users have
know in person or may connect “unfriended” a person
with others through 5. Fifth, although most
associations that they create users do not change
ii. Essentially, the social their status on
networking site serves as a Facebook, they do like
powerful tool to engage and to comment on friend’s
motivate consumers to share postings
personal information, establish 6. Lastly, those that do
relationships, and not use Facebook are
communicate with others still familiar with
c. This is definitively exemplified in the Facebook through
phenomenal growth of social networks their family members
such as Facebook d. Higher education, including healthcare
i. Facebook celebrated its tenth professional education, is taking full
anniversary in 2014 and is advantage of the collaborative features
considered the dominant of social networks and mobile access
social networking site where to create dynamic and collaborative
57% of adults and 73% of learning experiences
teens (12–17 years old) used i. The dynamic nature of
Facebook collaboration via the Internet
ii. According to a recent Pew offers learners the
Research Center study, opportunities to share working
despite the growing number of knowledge, provide
adults using Facebook on a professional support, and
daily basis, the younger create communities of learning
generation “are not ii. Social media compliments and
abandoning the site” supports e-learning
iii. Here are some additional facts opportunities where students
about Facebook are able to have more control
1. Although users dislike over the pace, sequence, and
some aspects of timing of their learning
Facebook (sharing too experience
much personal e. These new digital learning
information and environments aim at deepening the
posting photos without level of engagement for the student
permission), the users experience and also allows students to
do not want to miss out connect to a vast array of accessible
on social activities resources, knowledge, expertise, and
2. Second, 47% like the social connections
ability to share photos f. Healthcare institutions and consumers
and videos with friends have already begun to capitalize on the
as well as sharing with limitless utility of social networking
many people at the i. Numerous hospitals and
same time They also healthcare-related
like updates from their organizations have social
friends and humorous networking sites where
content patients and visitors can
3. Third, 50% of adult explore details about the
users have over 200 facility, learn more about
friends on Facebook available services, and find
48 I YN & MD
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information about diseases but also to other social

and/or treatments networks such as Facebook,
ii. Of the available social My Space, and Daily Strength
networking sites, Facebook ii. It provides videos, podcasts, e-
stands out as one of the more cards, widgets, RSS feeds,
popular, as it has proven useful and the ability to get text
for resource sharing, messages and join their Twitter
communication, and subscription
collaboration iii. Their Web site contains a
iii. According to the Mayo Clinic’s variety of resources that are
Center for Social Media List, of used such as current
the 1544 hospitals using social campaigns as well as a Social
media, there are 1292 Media Toolkit to help people
hospitals that have Facebook create their own social media
social networks and 651 that campaigns
have LinkedIn groups c. Perhaps one of the most interesting
iv. To learn more about the top and well-researched social networking
hospitals that are social media sites is PatientsLikeMe
friendly, you can visit the i. Through this social network,
rankings of hospitals patients from all over the world
conducted by MHdegree.org convene and share their
v. At the top of the list are experiences while dealing with
1. Mayo Clinic chronic conditions such as
2. Cleveland Clinic Multiple Sclerosis
3. University of Texas ii. The creators’ brother, who was
MD Anderson Cancer living with amyotrophic lateral
Center sclerosis (ALS), was the
4. Mt Sinai Medical inspiration for the network
Center iii. Two brothers and a friend, all
5. The University of Massachusetts Institute of
Michigan Hospitals Technology engineers,
and Health Centers created this network with the
2. Social network following goals in mind
a. One of the first social networks in 1. Share health data
healthcare was Matthew Zackery’s i2y 2. Find patients with
social network (I am too young for this similar conditions
Cancer Foundation) 3. Learn from each other
i. At one of the first Health 2.0 iv. Patients are asked to share
conferences, Zackery data in the hope of improving
presented his experiences in the lives of all diagnosed with
creating the social network that particular disease
targeted for young adults with v. The site currently supports
cancer over 250,000 members, over
ii. To learn more, you can visit the 2000 health conditions, over
following Web site: 40 published research studies,
http://stupidcancer.org/ and over 1 million treatment
b. The Center for Disease Control (CDC) and symptom reports
has embraced the use of social media vi. The site does not have any
and was used extensively in their H1N1 fees and is kept free from
campaign advertising through revenues
i. The CDC site not only stemming from research
connects people to the CDC, awareness programs, market
49 I YN & MD
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surveys, and the sale of members, and fellow patients)

processed anonymized data for emotional support and
vii. Members use aliases rather advice on everyday health
than real names and can issues”
openly share details about iii. Healthcare is in essence
their healthcare experiences, becoming more social
drug regimens, and treatment iv. Fox summarized it as “Peer-to-
side effects peer health care is a way for
viii. The primary motives behind people to do what they have
such sharing are to ask or offer always done—lend a hand,
advice and to build a lend an ear, lend advice—but
relationship with others in at internet speed and at
similar situations internet scale”
ix. “Rather than disseminating e. The eHealth Initiative Report
medical advice, developed a specific taxonomy to
PatientsLikeMe serves as a classify social media tools for chronic
platform for peers to interact diseases
with one another in a data- i. This taxonomy includes such
driven context” tools as
x. Patients have actually taken 1. Internet support
information they have learned groups
from PatientsLikeMe to their 2. Media sharing
own healthcare providers to 3. Messaging
request to be put on specific boards/discussions
treatments 4. Microblogs
xi. More recently, PatientsLikeMe 5. Social networking
has launched a Data for the general and specific to
Good Campaign to encourage a particular disease
patients to share their health 6. Weblogs
data to advance healthcare 7. Social games
research 8. Challenges
d. A recent report by the eHealth Initiative f. Grajales, Sheps, Ho, Novak-Lauscher,
with funding from the California and Eysenbach conducted a narrative
Healthcare Foundation, examined the review of social media and its use in
use of social media to prevent healthcare
behavioral risk factors associated with i. They reviewed 76 articles, 44
chronic disease Web sites, and 11 policy
i. According to this report, “By reports to derive 10 categories
seeking and sharing of social media
information online, health 1. Blogs
consumers (or ‘e-patients’) are 2. Microblogs
using social media to become 3. Social networking
more equipped, enabled, sites
empowered, and engaged in 4. Professional
managing their health, care, networking sites
and wellness” 5. Thematic networking
ii. Although healthcare providers sites
continue to play a primary role 6. Wikis
in the provision of health 7. Mashups
information, “more Americans 8. Collaborative filtering
than ever value social sites
networks (e.g., friends, family 9. Media sharing sites
50 I YN & MD
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10. Virtual worlds evidence for the use of these

ii. They found that social media tools in promoting and
was fairly extensive, there was managing various patient
a need to begin to address populations
challenges related to c. The eHealth Initiative Report
1. Governance concluded that social media provides a
2. Ethics multitude of benefits to patients by
3. Professionalism “enabling health education and
4. Privacy enhancing behavior by
5. Confidentiality i. Breaking down the walls of
6. Information quality patient–provider
communication
BENEFITS OF SOCIAL MEDIA ii. Improving access to health
information
1. Overview iii. Providing a new channel for
a. To understand the benefits of social peer-to-peer communications
media, it is important to examine the iv. Developing meaningful
growing number of studies over time relationships
i. In the past, most studies were v. Establishing communities of
descriptive. In a review by patients, caregivers, and
Skiba, Guillory, and Dickson, family members
there are three general areas vi. Engaging and empowering
of research in social media people”
ii. The first focused primarily on d. The development and continuing
the content being shared on research in the use of social media will
social media, in particular expand and more studies will continue
social networks and Twitter to provide additional evidence of their
iii. The second area was the effectiveness
specific use of social media by i. There is little doubt that the
patient populations such as social life of healthcare will
diabetics or cancer patients continue
iv. The final area was related to ii. Despite their prospects, digital
the use of social media for tools in the Connected Age do
recruitment of patients for not come without certain
research studies and the limitations and risks
collection of data from social iii. Like any element of our digital
media could be used as an environment, they pose
additional form of research concerns for privacy, security,
data and legal issues
v. Some interesting findings were
that Facebook, YouTube, and CHALLENGES OF SOCIAL MEDIA
Twitter were the most common
social media platform and 1. Overview
PatientsLikeMe was the most a. According to the eHealth Initiative,
studied network to date there are several key challenges
b. More recently, there have many more affecting the widespread adoption of
research studies, including clinical social media in healthcare
trials that have examined the impact of i. First, there are concerns about
social media tools on patient care privacy and HIPAA compliance
i. The growth of these studies ii. There are also concerns about
has generated several the balance of transparency
systematic reviews to provide and anonymity associated with
51 I YN & MD
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the sharing of personal students of their own

information online information in social networks
iii. The quality, validity, reliability, but also the potential of them
and authenticity of information sharing personal health
are an issue especially when information of their patients on
there is user- generated social networks
information v. Such was the case of nursing
iv. There is also the challenge of students posting a picture of a
the digital divide specifically patient’s placenta
with differing populations such d. There are also concerns about privacy
as the elderly, minorities, the and confidentiality
disabled, those living in rural i. Their concerns are not
areas, and those in poor or unfounded since the rates of
undeserved areas without identity theft are on the rise
access to broadband and Internet security cannot
b. The final challenge in this report also ever be fully ensured
mentions the lack of theoretical and ii. Social media applications
evaluation models for social media promote information sharing
given the paucity of effectiveness data and the open display of
i. Grajales et al. also echo many personal information, such as
of the same challenges, “The age, gender, and location
potential violation of ethical iii. Posting this and other content
standards, patient privacy, creates digital foot- prints, or
confidentiality, and lingering information that can
professional codes of practice, be connected back to the
along with the consumer who provided it;
misrepresentation of these bits of information can
information, are the most then be found and coalesced
common contributors to to form a more complete
individual and institutional fear picture of the individual, thus
against the use of social media negating the apparent
in medicine and health care” transparency supposed by
c. The Connected Age places unique Web 2.0 applications
circumstances around the sharing of iv. A recent study conducted by
protected health information, as it is Grajales et al. found there are
generally patient, student, or worries about sharing data,
consumer-driven many US adults (94%) are
i. That is, the consumer willing to share their health
voluntarily divulges his or her data to improve care and
information believe that data sharing can
ii. In such cases the HIPAA help other patients as well as
regulations do not apply, how- themselves
ever, healthcare institutions’ v. Users of social media are at
attempts to abide by the law risk for social threats as well
may hinder their adoption of vi. Characterized as stigmatizing
Web 2.0 applications and bullying, social threats can
iii. The sharing of personal pose significant dangers to
information is also an issue consumers and those with
with the use of social media by whom they are affiliated
students e. In addition, there may be legal issues
iv. It is not just the sharing by related to risk management and
healthcare professional liabilities
52 I YN & MD
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i. It has long been known that agencies are risk adverse

Internet content is not regarding patient care
regulated and may be ii. Professional organizations,
unreliable such as American Nurses
ii. Healthcare and educational Association, American Medical
organizations in the Association, and the National
Connected Age must also be Council of State Boards of
cognizant of the legal Nursing have provided
implications guidance and social media
iii. Not only will they have to policies
monitor the content being iii. Barton and Skiba also present
shared on their site for social media policy
appropriateness, reliability, recommendations for
and quality of their information, educational institutions
they will also need to be sure iv. The Mayo Clinic Center for
there are no copyright Social Media provides
infringements resources related to social
iv. Healthcare practice licenses media policies
are also an issue considering EXTRA READINGS AND VIDEOS
that in the Connected Age,
Social Media in the Connected Age
there are no real geographic
https://drive.google.com/file/d/1eF0lZTUhA2Pw6Jhh
boundaries KQ5HXvxDwmhHMh5J/view?usp=sharing
f. The digital divide, or gap in usability,
exists for some consumers who either MODULE 7
lack physical access to the Internet or 1. The Role of the Nurse
do not have knowledge or skills to 2. Nursing Informaticist Role
navigate the myriad information on the 3.
Internet safely and effectively REFERENCES
i. Physical access limitations can
Saba, V. K. and McCormick, K. A. (2015). Nursing
be described as lack of
Informatics Leadership. In Essentials of nursing informatics
resources to obtain the (6th ed.). New York: McGraw-Hill Education.
hardware or software to utilize
these tools American Nurses Association (ANA). (2015). Nursing
ii. Lack of experience describes informatics: Scope and standards of practice.
the knowledge and skill deficit Administration, Leadership, and Management. Silver
that hinders a consumer’s Spring, MD: Nursebooks.org.
ability to navigate tools
effectively and safely
iii. Some have also found that THE ROLE OF THE NURSE
ethnic disparities do exist in
regard to Internet access but, THE ROLE OF THE NURSE EXECUTIVE IN
surprisingly, not in regard to INFORMATION TECHNOLOGY DECISION-MAKING
social media use
g. As with most innovations, these ● To productively contribute and, ultimately, drive
challenges can be partially addressed technology decisions, nurse executives need to
through the development and be constantly updating and advancing their
implementation of social media policies hospital information technology (HIT)
by organizations, including user- knowledge.
generated networks ● This knowledge needs to go beyond baseline
i. This is particularly important functionality- level information of nursing and
given that most healthcare clinical information systems, which describes
what systems can accomplish, to a more
53 I YN & MD
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complex understanding of enterprise-wide ● Overlaying this lifecycle with an ever-present

integration, data and process mapping, and technology obsolescence complicates
business analytics. technology-related decision- making further.
● Commanding a deep well of HIT expertise Three key types of obsolescence exist:
helps nurse executives understand the delicate ○ Technology providers’ architecture,
interplay of nursing and outcome data inside product, and integration plans
the healthcare organization and beyond—to the ○ Third parties’ priority shifts
regulator and payer worlds. ○ Regulators’ unexpected recalls
● Few industries collect, analyze, and ● The impact of planned obsolescence cannot be
disseminate information with the velocity seen overlooked when nurse executives make HIT-
in healthcare and in no industry does the data- related decisions (The Economist, 2009).
driven decision have more importance. Technology providers worldwide require
● In healthcare, every patient care decision can engineers to design obsolescence into their
have a life-and-death implication. That is why systems to ensure ongoing market demand,
the timely communication of accurate data protect market share, and preserve revenue
plays such a critical role in healthcare delivery. streams (The Economist, 2009).
● Technology providers with nurse executives on
staff tend to exercise considerable influence
over architecture, product, and integration
efforts. However, those without such internal
nursing advocates may find nursing issues
significantly overshadowed by the financial and
business pressures public and privately held
TECHNOLOGY’S LIFE CYCLE technology companies face.
● In addition to providers’ planned obsolescence,
● To better understand the incessant nature and systems face being updated or even phased
far-reaching impact of technology-related out when the external market landscape
decisions, consider the six-stage Technology changes. Consider the massive overhaul
Life Cycle. needed to move financial information systems
from a cost-plus orientation to a system of
● capped reimbursement. Virtually overnight,
healthcare organizations had to replace large,
charge-capture legacy systems with technology
that could accurately predict total costs by
procedure.
● Shifts in regulatory- or payer-related priorities
can trigger a range of system changes from
code revisions all the way up to system
replacement. When healthcare organizations
face significant penalties, such as funding
● The lifecycle of every technology investment losses or reductions, fines and legal
spans six distinct phases, from planning to consequences, and fiscal threats to their very
procurement to deployment to management to existence, non-compliance is not an option.
support and disposition, only to cycle back to Complying with these environmental mandates
planning. can throw technology lifecycles into free fall as
● However, various “stops” and “starts,” some are legacy systems struggle to accommodate
internally caused and others are triggered regulator or payer mandates that were nowhere
externally. Issues that did not surface during on the horizon when these systems were built.
“Planning” or “Procurement” make themselves ● A third type of obsolescence, one of an
known during “Deployment,” “Management,” unexpected nature, can derail technology
“Support,” or even “Disposition,” wreaking decision-making and implementation in short
havoc on the most well-conceived order as well. This third type pertains to
implementation plan.
54 I YN & MD
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regulators changing the status of a medical the client factor encompasses the site-specific
device or technology, either narrowing the political, cultural, and social aspects of
approved scope of use or even recalling the embracing technology. The Informatics
product, after it has been introduced to the Research Organizing model (Effken, 2003)
market and is generally available. For example, captures the intrinsic complexity of the
one hospital selected an FDA-approved healthcare-centered technology decision-
monitoring device and conducted extensive making process.
staff training only to have the product recalled
three months before its formal deployment. In ● While the IRO model addresses HIT decision-
this case, the completed pre-rollout work was of making from an organizational perspective, a
no use as institutional leaders scrambled to vet nursing-centric analysis of the process reveals
a replacement device and reconvene round- further complexity coming from the dynamics of
the-clock training on the new monitoring the physician-dominated HIT discussions
technology. Obviously, the rollout was delayed (Simpson, 2012). The nursing-centered
but considerable time and money were discussion of HIT decision-making highlights
expended for a second time, which created a several reasons why medical staff demands
previously unpredictable drain on cost and staff. often relegate nursing’s HIT requirements to a
● While each of these types of obsolescence subservient position during technology
carries an import all its own, it is even more evaluation and selection (Simpson, 2012).
critical for nurse executives to recognize that FUNCTIONAL AREAS OF NI
the healthcare organization controls none of
them. In each case, these third-party decisions ● Informatics nurses, informatics nurse
have enormous impact on when and how specialists, and other stakeholders are helping
nursing uses technology-based products, transform health care through the use of
devices, and systems. Additionally, these third- informatics processes, tools, and structures.
party decisions occur on a timetable over which Across all healthcare environments, INs and
healthcare organizations have little to no INSs most commonly practice in
influence. interprofessional healthcare environments and
● Planned obsolescence, shifting environmental interact with information technology (IT)
mandates from regulators and payers, and professionals during all phases of the system
changes in regulatory status complicate the life cycle.
already complex landscape of technology- ● INs and INSs use scientific and informatics
related decision-making. What used to be principles and employ creative strategies in
episodic decision-making has morphed the six- informatics solutions. They bring the
stage life cycle into a technology model with perspectives of nursing, and very often the
ever-cycling potential. patients, to interprofessional work through a
solid understanding of operational processes
MULTI-LAYERED DECISION-MAKING and the value of consumer advocacy to
informatics functions. INs and INSs may need
● While the lifecycle seems straightforward, its additional education or other types of advanced
overlay with content, outcomes, Nursing preparation to manage the informatics projects
Informatics, and client intervention makes for a at hand.
complexity not seen in other types of healthcare ● Because of the tendency to confuse roles with
decision-making. Nursing-centric technology titles, this section describes the following
decisions emerge from a context that includes dynamic and evolving functional areas of
cultural, economic, social, and physical nursing informatics:
requirements. Adding an outcome orientation to ○ Administration, leadership, and
those decisions layer impacts the cost, quality, management
safety, and satisfaction. Nursing Informatics ○ Systems analysis and design
staff then views technologies under ○ Compliance and integrity management
consideration from the dual perspectives of ○ Consultation
content structure and information flow. Finally,
55 I YN & MD
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○ Coordination, facilitation, and into leadership and management. In other

integration positions, administration may be part of a
○ Development of systems, products, position merged with other functional areas.
and resources Typical examples include:
○ Educational and professional ○ INS at a large hospital system,
development supervising an implementation and
○ Genetics and genomics education team, representing nursing
○ Information management/operational interests on various IT committees,
architecture performing project management for
○ Policy development and advocacy multiple documentation projects, and
○ Quality and performance improvement having oversight of nursing standards
○ Research and evaluation and vocabularies used in applications.
○ Safety, security, and environmental
health
○ Project director for a clinical software
ADMINISTRATION, LEADERSHIP, & company, managing implementation
MANAGEMENT teams for various client projects
(hospitals to ambulatory facilities) and
● As is true of administration in general, consulting with clients on all aspects of
leadership and management functions in systems selection, customization,
nursing informatics incorporate both higher- adoption, and use of software.
level and mid-level administrative functions.
Increasingly, INSs are attaining senior ○ Grants administrator for an information
leadership positions. Positions may be titled science research agency, seeking and
Chief Nursing Informatics Officer (CNIO), Chief writing grants that would fund NI-
Information Officer (CIO), director, or similar related projects, designing budgets,
leadership titles (American Organization of and ensuring optimal allocation of
Nurse Executives [AONE], 2012; Hodges & resources.
Wierz, 2012).
● In this functional capacity, nursing informatics NURSING INFORMATICIST ROLE
leaders are expected to be visionary and
establish the direction of large-scale informatics ● Technologies optimized for the nursing process
solutions. The nursing informatics leader often organize and prioritize patient care data against
serves as a catalyst for developing strategic a complex backdrop of quality and patient
plans and creating national or system policies safety. Nurse executives’ responsibility to
and procedures, while serving as the champion evaluate, select, and deploy these advanced
for integrated projects and systems. technologies requires one of two things:
● In mid-level management, INSs may supervise
resources and activities for all phases of the 1. either a deep personal and nursing-
system life cycle. These activities may include centric knowledge of technology or
needs analysis, requirements gathering, 2. access to that knowledge, which is
design, development, selection and purchase, resident in a technology expert.
testing, implementation, and evaluation of
systems to support all facets of nursing and ● Considering the organizational and
healthcare delivery. interdisciplinary demands on nurse executives,
● At all levels, leadership is characterized by the a direct reporting structure to the technology
combination of superb communication skills, expert offers the most efficient and effective
collaboration, change management, risk pathway to this highly specialized knowledge.
assessment, and coalition building with political
finesse, business acumen, and strategic ● Often, this direct reporting relationship with the
application knowledge. INSs serving in this technology-infused individual leads to a Nurse
functional area may put most of their energy Informaticist (NI). While some confusion over
56 I YN & MD
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the preferred background of the graduate- experience to the workflow creation process.
prepared NI exists, nursing experts agree that While evidence in the standardization of
effective NIs command highly specialized processes and practices is a universal
knowledge from three distinct disciplines: application goal, site- specific modifications are
1. clinical nursing, needed to have the software accepted and
2. information technology, and used by nurses delivering patient care.
3. research.
● From a nursing perspective, leaving this critical
● NIs use this rich, interdisciplinary perspective to foundational work to engineers and
analyze patient care and outcome data, technologists who lack the hands-on
creating new knowledge that advances the experience of delivering patient care at the bed-
clinical practice of nursing. As a trusted advisor side is pure folly. Delegating these two key
to the nurse executive, the NI serves a foundational activities to non-nurses resembles
“translator” of technology capabilities, options, the potential disaster created by allowing
and alternatives to the nurse executive, who individual motorists to build their own roads—
looks to the NI to align technologies and with no regard for the needs of their fellow
systems under consideration with motorists and no knowledge of construction,
organizational objectives. traffic flow, volume, or local weather conditions.
● Even with such an expert on staff, the nurse
executive must be able to converse, debate, INFORMATICS COMPETENCIES AND ROLES
and champion specific technologies and clinical ● Very few of today’s nurses have worked in only
information systems personally. Simply put, one role or even one specialty of nursing
there is no one else at the executive decision- throughout their careers, and this will likely hold
making table with the expertise, knowledge, or true for coming generations of nurses. The
perspective to advance the requirements and need for informatics competencies exists in all
needs of patient care during technology-related nursing roles and specialties. This section
discussions and debates. examines the informatics competencies
required for all practicing nurses, regardless of
2 KEY AREAS OF EXPERTISE specialty.
● Nurse executives and NIs involved in ● The National Council of State Boards of
technology decision-making need to leverage Nursing (NCSBN) has developed and is
two specific types of IT expertise when they studying a Transition to Practice (TTP)
evaluate, select, and implement clinical (Spector, 2013) nursing preceptor model that
information systems: process mapping and includes “five transition modules” consisting of
workflow design. “communication and teamwork, patient-
centered care, evidence-based practice, quality
● Process mapping delineates the actual steps of improvement and informatics” (2013). This
clinical practice as they occur during patient model incorporates many key aspects from the
care, while workflow design spans the Institute of Medicine’s report on The Future of
mechanical arrangement of information, forms, Nursing: Leading Change, Advancing Health
and triggers to document nursing practice. (2010) related to competencies for all nurses,
and “is an inclusive model, which would take
● The success of every HIT implementation place in all health care settings that hire newly
hinges on having a clear understanding of graduated nurses and for all educational levels
process mapping and workflow design, as well of nurses, including practical nurse, associate
as the ability to chart these activities in a format degree, diploma, baccalaureate and other
understandable by computers. entry-level graduates” (2013, para. 2). Because
informatics and technology are now integral
● Vendor-resident engineers lack the site-specific tools used in all aspects of nursing practice,
and nursing practice-specific knowledge from entry-level to advanced practice, it is
required to add the context of the lived strongly recommended that the state boards of
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nursing require that basic informatics EHRs, report writing programs, and database
competencies be incorporated into all nursing management systems.
program curricula, ranging from licensed
practical nurse (LPN) to doctoral levels. ● Informatics Competencies for Informatics
Nurses and Informatics Nurse Specialists
● As noted previously, the American Association
of Colleges of Nursing (2008) provided ● In addition to the competencies that every
guidance on the educational requirements for registered nurse needs, additional
the baccalaureate education for professional competencies for the IN and INS are found in
nursing practice. “Essential IV: Information the “Standards of Nursing Informatics Practice”
Management and Application of Patient Care section of this professional resource. As part of
Technology” identified informatics its preparation for the new nursing informatics
competencies that all BSN graduates should certification exam test form, the American
possess. For nurses prepared at the graduate Nurses Credentialing Center (ANCC)
level, the AACN provided foundational completed its Role Delineation Study: Nursing
informatics competencies in The Essentials of Informatics—National Survey Results (ANCC,
Master’s Education in Nursing, “Essential V: 2013), which reported the collected information
Informatics and Healthcare Technologies”. on the work activities that informatics nurses
perform in practice. The final report listed 8
● Nurses who hold a master’s degree in domains and 71 separate tasks, as well as
something other than nursing can gain a calling out the 20 task statements with the
postmaster’s certificate in nursing informatics. highest and lowest values of initial risk.
Many of the numerous programs available have
similar competencies, but in general the ● The McGonigle, Hunter, Hebda, and Hill (2013)
curricula focus on gaining specific knowledge online assessment of nursing informatics
and skills in nursing and healthcare informatics, competencies can assist faculty and
thereby supporting evidence-based practice management to develop curricula or continuing
and the improvement of healthcare outcomes. education that best meets the needs of their
students or employees. While there are obvious
● AACN’s Essentials of Doctoral Education for concrete informatics competencies that every
Advanced Nursing Practice (2008) lists nurse must have, there are many other, more
informatics-based competencies in “Essentials progressive, processes that will likely never be
III: Clinical Scholarship and Analytical Methods part of an educational curriculum or added to a
for Evidence-Based Practice.” Although only formal list of competencies. An example is the
the Doctor of Nursing Practice (DNP) is ever-changing landscape of meaningful use
specifically addressed by the AACN, this does criteria. Another example is the numerous ways
not imply that informatics education is not in which technologies are enhancing
important in PhD programs. In many PhD practitioners’ ability to monitor patients and
programs, computer science and biomedical coordinate care remotely via telehealth
informatics are required courses. However, methodologies. All of these areas require
because the DNP is considered a “practice informatics nurses and informatics nurse
doctorate” and the PhD a “nursing research specialists to be involved in defining benefit
doctorate,” the emphasis on informatics and versus impact, although it may be difficult to
clinical practice impact is reduced, though predict how the evolving technologies will be
these areas are not considered unimportant used in the future.
(AACN, 2011; see also Duke University, 2012).
Thus, it is strongly recommended that PhD ● In addition to numerous researchers,
curriculum writers incorporate courses that academics, and employers, many professional
examine the tenets of nursing informatics and organizations are actively working toward
focus on the methods of data entry, data validating, creating resources, and providing
storage, data retrieval, and data analysis from education in nursing informatics. These include
the:
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○ American Nurses Association (ANA) authoritative statements of the duties that all
○ American Medical Informatics registered nurses, regardless of role,
Association (AMIA) population, or specialty, are expected to
○ American Nursing Informatics perform competently. The standards published
Association (ANIA) herein may be utilized as evidence of the
○ Health Information and Management standard of care, with the understanding that
Systems Society (HIMSS) Nursing application of the standards is context
Informatics Working Group dependent. The standards are subject to
change with the dynamics of the nursing
profession, as new patterns of professional
practice are developed and accepted by the
INFORMATICS COMPETENCIES FOR NURSE nursing profession and the public. In addition,
EDUCATORS specific conditions and clinical circumstances
● oday’s nursing educators are challenged to may affect the application of the standards at a
include information on informatics in a basic given time (e.g., during a natural disaster). The
nursing education curriculum that is already full. standards are subject to formal, periodic review
A second challenge is that many nurse and revision.
educators themselves lack informatics
competencies (AACN, 2013; Flood, Gasiewicz, ● The competencies that accompany each
& Delpier, 2010). standard may be evidence of compliance with
the corresponding standard. The list of
● The Gordon and Betty Moore Foundation competencies is not exhaustive. Whether a
funded a pilot conference to teach faculty how particular standard or competency applies
to teach informatics. The “QSEN Nursing depends on the circumstances.
Informatics Deep Dive Workshop” was co-
sponsored by the American Association of STANDARDS OF PRACTICE IN NI
Colleges of Nursing and the Schools of Nursing
at the Universities of Minnesota and Maryland. STANDARD 1: ASSESSMENT
The presentations and resources are available ● The informatics nurse collects comprehensive
to anyone, without charge, on the AACN data, information, and emerging evidence
website (http://www.aacn.nche.edu/ qsen- pertinent to the situation.
informatics/2012-workshop). ● Competencies
● Additional challenges include: ● The informatics nurse:
○ continuing to enhance and disseminate ○ Uses evidence-based assessment
resources and teaching strategies for techniques, instruments, tools, and
all faculties across the country; effective communication strategies in
○ the lack of requirements for PhD collecting pertinent data to define the
programs in nursing to include issue or problem.
informatics (researchers are going to ○ Uses workflow analyses to examine
need advanced informatics skills); and current practice, workflow, and the
○ the need for methods required for “big potential impact of an informatics
data” research to be integrated into solution on that workflow.
curricula for future faculty and nurse ○ Conducts a needs analysis to refine the
researchers. issue or problem when necessary.
○ Involves the healthcare consumer,
STANDARDS OF NI PRACTICE family, interprofessional team, and key
stakeholders, as appropriate, in
SIGNIFICANCE OF STANDARDS relevant data collection.
○ Prioritizes data collection activities.
● The Standards of Professional Nursing ○ Uses analytical models, algorithms,
Practice, on which the Standards of Nursing and tools that facilitate assessment.
Informatics Practice are based, are
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One example of an assessment ○ Uses standardized clinical

algorithm is PIECES: terminologies, taxonomies, and
■ Performance—throughput or decision support tools, when available,
response time; to identify problems, needs, issues,
■ Information—outputs, inputs, and opportunities for improvement.
and/or stored data; ○ Documents problems, needs, issues,
■ Economics—costs versus and opportunities for improvement in a
profits; manner that facilitates the discovery of
■ Control—too little security or expected outcomes and development
control or too much control or of a plan.
security; STANDARD 3: OUTCOMES IDENTIFICATION
■ Efficiency—people, ● The informatics nurse identifies expected
machines, or computers waste outcomes for a plan individualized to the
time, and; healthcare consumer or the situation.
■ Service—inaccurate, ● Competencies
inconsistent, unreliable, hard ● The informatics nurse:
to learn, difficult to use, ○ Involves the healthcare consumer,
inflexible, incompatible, not family, healthcare providers, and key
coordinated with other stakeholders in formulating expected
systems (Wetherbe, 1994). outcomes when possible and
● Synthesizes available data, information, appropriate.
evidence, and knowledge relevant to the ○ Defines expected outcomes in terms of
situation to identify patterns and variances. the healthcare consumer, healthcare
● Applies ethical, legal, and privacy regulations worker, and other stakeholders; their
and policies for the collection, maintenance, values; ethical considerations; and
use, and dissemination of data and information. environmental, organizational, or
● Documents relevant data in a retrievable situational considerations.
format. ○ Formulates expected outcomes after
considering associated risks, benefits,
STANDARD 2: DIAGNOSIS, PROBLEMS, AND costs, available expertise, evidence-
ISSUES IDENTIFICATION based knowledge, and environmental
● The informatics nurse analyzes assessment factors.
data to identify diagnoses, problems, issues, ○ Develops expected outcomes that
and opportunities for improvement. provide direction for project team
● Competencies members, the healthcare team, and
● The informatics nurse: key stakeholders.
○ Derives diagnoses, problems, needs, ○ Includes a time estimate for the
issues, and opportunities for attainment of expected outcomes.
improvement based on assessment ○ Modifies expected outcomes based on
data. changes in the status or evaluation of
○ Validates the diagnoses, problems, the situation.
needs, issues, and opportunities for ○ Documents expected outcomes as
improvement with the healthcare measurable goals.
consumer, family, interprofessional
team, and key stakeholders when STANDARD 4: PLANNING
possible and appropriate. ● The informatics nurse develops a plan that
○ Identifies actual or potential risks to the prescribes strategies, alternatives, and
healthcare consumer’s health and recommendations to attain expected outcomes.
safety, or barriers to health, which may ● Competencies
include, but are not limited to, ● The informatics nurse:
interpersonal, systematic, or ○ Develops a customized plan
environmental circumstances. considering clinical and business
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characteristics of the environment and ○ Utilizes health information technology

situation. to measure, record, and retrieve
○ Develops the plan in collaboration with healthcare consumer data, implement
the healthcare consumer, family, and support the nursing process, and
healthcare team, key stakeholders, improve overall healthcare outcomes.
and others, as appropriate. ○ Uses specific evidence-based actions
○ Establishes the plan priorities with key and processes to resolve diagnoses,
stakeholders and others as problems, or issues to achieve the
appropriate. defined outcomes.
○ Incorporates strategies in the plan to ○ Advocates for health care that is
address each of the identified sensitive to the needs of healthcare
diagnoses, problems, needs, and consumers, with emphasis on the
issues. needs of diverse populations and use
○ Incorporates planned strategies of self-care theory.
addressing health and wholeness ○ Applies available healthcare
across the life span. technologies to maximize access and
○ Incorporates an implementation optimize outcomes for healthcare
pathway or timeline within the plan. consumers.Uses community and
○ Considers the clinical, financial, social, organizational resources
and economic impact of the plan on the systematically to implement the plan.
stakeholders ○ Collaborates with the healthcare team
○ Integrates current scientific evidence, and other stakeholders from diverse
trends, and research into the planning backgrounds to implement and
process. integrate the plan.
○ Utilizes the plan to provide direction for ○ Accommodates different styles of
the healthcare team and other communication used by healthcare
stakeholders. consumers, families, healthcare
○ Integrates current statutes, rules and providers, and others.
regulations, and standards within the ○ Implements the plan using principles
planning process and plan. and concepts of enterprise
○ Modifies the plan according to the management, project management,
ongoing assessment of the healthcare and systems change theory.
consumer’s response and other ○ Promotes the healthcare consumer’s
outcome indicators. capacity for the optimal level of
○ Integrates informatics principles in the participation and problem-solving.
design of interprofessional processes ○ Fosters an organizational culture that
to address identified situations or supports implementation of the plan.
issues. ○ Incorporates new information and
○ Documents the plan in a manner that strategies to initiate change if desired
uses standardized terminologies and outcomes are not achieved.
taxonomies. ○ Documents implementation and any
modifications, including changes or
STANDARD 5: IMPLEMENTATION omissions, of the identified plan.
● The informatics nurse implements the identified
plan. STANDARD 5a: COORDINATION OF ACTIVITIES
● Competencies ● The informatics nurse coordinates planned
● The informatics nurse: activities.
○ Partners with the healthcare consumer,
healthcare team, and others, as
appropriate, to implement the plan on STANDARD 5b: HEALTH TEACHING & HEALTH
time, within budget, and within plan PROMOTION
requirements.
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● The informatics nurse employs informatics ● The informatics nurse coordinates planned
solutions and strategies for education and Identifies the informatics nurse practices
teaching to promote health and a safe ethically, with further detailing of associated
environment. competencies, such as the use of the Code of
Ethics for Nurses with Interpretive Statements
STANDARD 5c: CONSULTATION to guide practice.
● The informatics nurse provides consultation to
influence the identified plan, enhance the STANDARD 8: EDUCATION
abilities of others, and effect change. ● Addresses the need for the informatics nurse to
attain knowledge and competence, including
STANDARD 6: EVALUATION the competency associated with demonstration
● The informatics nurse evaluates progress of a commitment to lifelong learning.
toward attainment of outcomes.
● Competencies STANDARD 9: EVIDENCE-BASED PRACTICE AND
● The informatics nurse: RESEARCH
○ Conducts a systematic, ongoing, and ● Confirms that the informatics nurse integrates
criterion-based evaluation of the evidence and research findings into practice.
outcomes in relation to the structures
and processes prescribed by the STANDARD 10: QUALITY OF PRACTICE
project plan and indicated timeline. ● Describes the expectation for the informatics
○ Collaborates with the healthcare nurse’s contribution related to the quality and
consumer, healthcare team members, effectiveness of both nursing and informatics
and other key stakeholders involved in practice.
the plan or situation in the evaluation
process.
○ Evaluates, in partnership with the key
stakeholders, the effectiveness of the
planned strategies in relation to STANDARD 11: COMMUNICATION
attainment of the expected outcomes. ● Explains that the informatics nurse
○ Evaluates the link between outcomes communicates effectively through a variety of
and evidence-based methods, tools, formats, with several accompanying
and guidelines. competencies delineating specific requisite
○ Evaluates the effectiveness of planned knowledge, skills, and abilities for
strategies in relation to attainment of demonstrated success in this area.
the expected outcomes.
○ Documents the results of the STANDARD 12: LEADERSHIP
evaluation. ● Promotes that the informatics nurse leads in the
○ Disseminates the results to key professional practice setting, as well as the
stakeholders and others involved, in profession. Accompanying competencies
accordance with organizational address such skills as mentoring, problem
requirements and federal and state solving, and promoting the organization’s
regulations. vision, goals, and strategic plan.
STANDARDS OF PROFESSIONAL PERFORMANCE STANDARD 13: COLLABORATION

FOR NURSING INFORMATICS
● Encompasses the informatics nurse’s
● The Standards of Professional Performance
collaborative efforts with the healthcare
express the role performance requirements for
consumer, family, and others in the conduct of
the informatics nurse and informatics nurse
nursing and informatics practice.
specialist.
STANDARD 14: PROFESSIONAL PRACTICE
STANDARD 7: ETHICS
EVALUATION
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● Identifies that the informatics nurse conducts

evaluation of their own nursing practice
considering professional practice standards
and guidelines, relevant statutes, rules, and
regulations.
STANDARD 15: RESOURCE UTILIZATION

● Addresses that the informatics nurse uses
appropriate resources to plan and implement
safe, effective, and fiscally responsible MODULE 8
informatics and associated services. Overview
STANDARD 15: ENVIRONMENTAL HEALTH New applications for facility-based clinical practice
● Closes out the list of professional performance continue to be the fastest growing area of interest in
standards by describing that the informatics nursing informatics. Although there are many
nurse supports practice in a safe and healthy technological advances discussed here, the areas of
environment. greatest interest are conceptual. Source data
capture, the development and use of decision
support and expert systems, and the development of
a nursing minimum data set as they relate to facility-
based care are the most important issues. Although
none of these concepts is easily categorized, the
nursing process provides the structure for this
chapter. Clinical applications of nursing informatics
are related to assessment, planning, implementation,
and evaluation.
Objectives
● Describe the application of nursing

informatics in a clinical setting.
● Understand and apply how nursing
informatics improves patient care.
REFERENCES
Hannah, K. J. (2006). Clinical Practice Applications: Facility
Based. In Introduction to Nursing Informatics (3rd ed.).
Springer.
Saba, V. K., & McCormick, K. A. (2015). Translation of

Evidence into Nursing Practice. In Essentials of nursing
informatics (6th ed.). New York: McGraw-Hill Education.
TigerConnect. (n.d.). How Nursing Informatics Improves

Patient Care. Retrieved July 31, 2020, from
https://tigerconnect.com/blog/how-nursing-informatics-
improves-patient-care/
APPLICATION OF NURSING INFORMATICS IN A

CLINICAL SETTING
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A. Assessment - Computerization helps when computerized cardiac monitoring of

gathering and storing data about each patient. patients dramatically increases the
For example, assessment data can be early detection of arrhythmias and
physiological measures automatically charted contributes todecreased mortality of
through a patient monitoring system. Other CCU patients. Additionally, many of
assessment data are added to the electronic these monitoring systems are
patient record by departments such as the integrated into decision support
laboratory and radiology. The largest source of systems (Staggers, 2003).
assessment data is the ongoing nursing ● Assessment Data from Other Departments -
assessment. The following sections briefly Detailed discussion of computer systems
describe these sources of assessment data. designed for use in special diagnoses (e.g.,
a. Patient Monitoring - The major area of laboratory, radiography), support (e.g.,
development for automated patient pharmacy, dietary), or special treatment (e.g.,
monitoring originally was coronary radiation therapy, dialysis) is beyond the scope
care. In coronary care units and of this book. However, patient data from many
pacemaker clinics, computers were departments forms the basis for computerized
initially used to monitor patient care plans and many decision support
electrocardiograms, analyze the systems. Nurses must be able to retrieve and
information, and reduce former use these data to provide quality patient care.
volumes of data to manageable ● Nursing-Generated Assessment Data -
proportions, generally some type of Source data capture is the key to useful nursing
graph. The computers were also generation of patient data. Source data capture
programmed to recognize deviations means gathering data and information about
from accepted norms and to alert patients where it originates, that is, with the
attending personnel to the deviation by patient. By entering data wherever the patient
some indication (e.g., an alarm or light). is, the reliability of the data is increased. There
In addition to arrhythmia monitoring, is less chance of transcription errors than if the
computers in acute care areas, such as nurses copy data they have written on their
emergency departments and intensive hands (or on pieces of paper towel) into the
care (ICU), coronary care (CCU), and patient chart.
neonatal intensive care units, are now ● For source data capture to be feasible, nurses
widely used for hemodynamic and vital must be able to enter patient data from many
sign monitoring, calculation of places other than the nursing station. This need
physiological indices such as has required a revolution in computer
peripheral vascular resistance and hardware. The local nursing station terminal of
cardiac output, and environmental the hospital mainframe computer is no longer
regulation of iso- lets. Sophisticated adequate. Computer data entry must occur
computerized ICU monitoring systems wherever patients are found. This is called a
for management of patient data, “point of care” information system. Goals for
including patients’ heart rates, arterial moving to point of care systems are identified
blood pressure, temperature, as follows (Hughes, 1995).
respiratory rate, central venous ○ To minimize the time spent
pressure, intracranial pressure, and documenting patient information
pulmonary artery pressures, are used ○ To eliminate redundancies and
around the world (Varon and Marik, inaccuracies of charted information
2002; Wong et al., 2003). Automated ○ To improve the timeliness of data
approaches to patient monitoring free communication
the nurses from the technician role of ○ To optimize access to information
watching machinery and allow them to ○ To provide information required by the
focus their attention on the patient, the clinician to make the best possible
family, and the nursing process. It is patient care decisions
now widely accepted that
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● Source data capture is the first step reducing

the time nurses spend charting and eliminating
redundancies and inaccuracies. When
information can be entered directly into the
patient’s electronic health record at the point of
care by the healthcare professional or a
medical device such as hemodynamic
monitors, infusion pumps, or ventilators and it is
made immediately available to others involved
in the patient’s care, time is saved and data
have been accurately transformed into usable
information (Hughes, 1995). Point of care
systems use a variety of computer hardware.
Ideally, a portable, real- time communication
device with many input options (e.g., touch,
pen, voice) able to display patient information
as needed, including graphics, an easy
documentation method, and long battery life, is
preferred. Technology is fast moving toward
this ideal. However, most point of care systems
in existence rely on full-sized personal
computers, workstations, bedside terminals,
and some portable terminals.
● When considering the adoption of point of care

systems, the following points should be
evaluated.
○ 1. Point of care systems must allow the
nurse to interact with the main in-
formation system. Systems that do not
allow information to be extracted, as
well as entered, are not useful to
nurses.
○ 2. Point of care systems must interface
with the existing hospital information
system. The nurse at the patient’s
bedside must be able to access data
that has been generated by the
laboratory, or radiology, or pharmacy.
○ 3. The open systems concept is
valuable to nurses considering point of
care systems. This concept allows
machines from all vendors to
communicate. Open systems allow the
most appropriate type of machine to be
selected for each nursing environment.
○ 4. Point of care systems must have a
small footprint (take up a small amount
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of floor space). Not all hospitals have ○ 9. Information to be retrieved using the
the opportunity to configure a new point of care system must be
building from the ground up. Most represented in ways that can be quickly
hospitals are trying to fit new used and easily understood by nurses.
technology into “old skin.” Early Traditional nursing notes are
examples of bedside terminals took up voluminous. Trying to find key data in a
a large amount of space in patient narrative is too time-consuming when
rooms. With limited electrical outlets the information is urgently needed.
and no piped-in oxygen or suction, a Figure below illustrates a cardiac risk
patient room that had all the equipment assessment tool. At a glance, the nurse
necessary to care for seriously ill can tell which factors must be
patients left no room for the nurse. addressed.
○ 5. Point of care systems must be easy
to use and must adapt to a variety of
nursing environments. Patient contact
occurs 24 hours a day. For example,
bedside terminals must allow the nurse
to access and input data without
turning on the lights or disturbing the
patient. The annoying little “beeps” a
computer makes when you have made
a mistake in data entry have no place
in bedside terminals.
○ 6. Point of care systems must be easily
disinfected and cleaned between
patients. Bedside keyboards should
have a membrane keyboard or a
protective “skin” over the keyboard to
protect it from liquids.
○ 7. For source data capture to be easily
accomplished, nurses require a variety
of ways for entering data. Keyboards
require some typing skills. Other
devices include bar code readers for
scanning identification bands and
medications, physiological probes,
microphones for voice input, light pens
and touch screens, digital cameras,
and natural speech input devices. The
touch screen uses icons (pictures)
rather than words. Icon menus are
easier to use, especially if the exact key
word is not known.
○ 8. For effective source data capture, b. Documentation - Good nurses’ notes
the nurse must go wherever the patient are generally lengthy, narrative,
is. If that is the visiting lounge or the handwritten, and unbiased
coffee shop or the outside deck, a fixed observations. At their worst, they are
bedside terminal is not appropriate. inaccurate, inconsistent, incomplete, or
Notebook technology and pen-based consist of such trivia as, “Had a good
portable systems offer the best choice day.” Automated methods for recording
for mobility. nursing observations are some of the
most readily available nursing
informatics applications. Two
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approaches predominate. With the first and increased standardization,

approach, a computerized library of accuracy, and reliability of
frequently used phrases is arranged in observations.
subject categories. The nurse chooses ○ Improved standards compliance
the phrase or combination of phrases ○ Increased efficiency: legible notes,
that best describes the patient’s which decrease reading time and
condition. For example, by selecting a increase accuracy of interpretation and
primary subject such as “sleeping elimination of repetitive data recording
habits,” a screen menu of standard and resulting transcription errors
descriptions appear, allowing for ○ Enhanced timeliness: less time spent
additionally selected comments such writing notes, specifically end-of-shift of
as “slept through breakfast— charting
voluntarily” or “awoke early at a.m.” ○ Expanded accessibility: data available
When completed, the nursing station on-line immediately and access not
printer immediately prints a standard, limited to one person at a time as with
easy-to-read, complete narrative that paper record
could then be attached to the patient’s ○ Augmented data archive: ready
chart. An example of an assessment statistical analysis and easier nursing
screen is shown below. audit because of the use of standard
terminology
c. Clinical Documentation
Management - EHRs are fundamental
to the success of the retail clinics model
of care. Like all practice EHRs, those
developed for retail clinics support the
assessment, diagnosis, and treatment
workflows of the provider. The goal of
the retail EMR is to help providers
practice autonomously, streamlining
administrative functions, while
suggesting clinically appropriate
actions generated from evidence-
● The second approach has been to develop a based practice guidelines and clinical
“branching questionnaire.” The terminal documentation (Ryan, 2009).
displays a list of choices, and the nurse selects
her choice and indicates it by pressing the d. Data Issues - Nurses spend a great
corresponding number on the keyboard or deal of time and energy gathering data.
touching the terminal with a light-sensitive input Unfortunately, many of these data are
device (called a light pen). The terminal then probably for someone else’s use (e.g.,
displays a further list of choices appropriate to administrative or government
the original selection. Thus, the nurse is led statistics). Often these same data are
through a series of questions that can be duplicated by the data- gathering
“customized” for each patient. activities of other healthcare
● Many advantages that have been claimed for professionals (e.g., how many times
automated documentation of nursing are patients who are being admitted to
observations include the following (Husting and your institution asked by different
Cintron, 2003; Moody et al., 2004). categories of staff why these patients
○ Content standardization: increased have presented themselves). Similarly,
charting completeness including in- data are gathered ostensibly for
creased numbers of observations nursing use but are never looked at
because of prompting or forced recall again (e.g., the voluminous nursing
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histories gathered in many institutions). assesses, plans, and evaluates the plan for
Nurses should only be gathering data care, although auxiliary personnel might be
that are essential for nursing decisions involved in implementing the plan. The evolving
about patient care. The principle approach to care planning is the development
involved is to gather essential of decision support systems for nursing
information while avoiding replication practice.
and duplication of data that waste ● The following list summarizes the advantages
resources such as manpower, storage of automated care plans or pathways over
space, and memory. Although much traditional nursing care plans.
research remains to be done in this ○ Time is saved by eliminating the need
aspect of nursing practice, the for daily handwriting of patient
foundation work has been done that assignments and by decreasing the
defines that essential information. amount of verbal explanation required.
○ Accountability is increased because
B. Planning personnel have printouts of care plans
a. Automated Care Planning - In most for each of their patients.
healthcare settings, the kardex or some ○ Errors and omissions are decreased.
similar tool has been the repository of ○ Consistency of care from shift to shift
nursing care plans. This tool has had and day to day is increased; quality of
drawbacks similar to those patient care improves.
encountered with nursing notes as well ○ Judgments for nursing care are no
as other drawbacks that are unique to longer delegated to whoever walks into
the kardex. Nursing care plans, if they a room to care for the patient; they are
are ever entered in the kardex at all, the responsibility of the professional
are usually outdated, illegible, nurse who now has tools available to
inconsistent, and incomplete. help make nursing judgments.
Notations are made by all levels of ● There are many implications of these
nursing personnel from nursing aides advantages for nursing practice (DeLuc, 2000).
to head nurses. Written patient care Time saved during the preparation and
assignments are usually accompanied communication of care plans means more time
by verbal explanations that are often available for the nursing process. Increased
forgotten. accountability for care improves nursing
practice because documentation is available to
evaluate the quality of care and thus the quality
of practice.
● Benefits to patient care of decreased errors and
omissions and increased consistency of care
include more rapid diagnosis, more valid
assessment, and more rapid recovery. These
factors all reduce the cost of healthcare for the
patient and open the system to more patients.
Placing the responsibility for nursing judgments
clearly on the shoulders of the professional
nurse helps define nursing practice and helps
● Alternate approaches to the automation of the profession in its search for a clearly
nursing care plans is to design care maps or delineated identity.
pathways for meeting patient needs, store them
in the computer memory banks, and then adapt C. Implementation - Computers rarely help the
them to individual patients (Catt et al., 1997; nurse in the giving of care or nursing service.
Renholm et al., 2002). The resulting printout is Generally, computers are used more in other
unique for each patient’s assessed needs for phases of the nursing process. One example of
daily care. In all cases, it is the nurse who how computers are used in intervention is the
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programmed administration of preloaded drugs and procedures used in a healthcare

in the ICU. organization. A nurse informaticist will measure
and analyze how specific parts of the
D. Evaluation - Computers can be used to organization are performing, with a focus on the
evaluate nursing care through real-time resulting patient outcomes.
auditing and quality management activities ● They can then make changes to specific parts
of the process to streamline activities, avoid
HOW NURSING IMPROVES PATIENT CARE bottlenecks, and improve care. Informaticists
will see what the results are and continue
● The healthcare information revolution is upon making changes to enhance every part of the
us. Clinicians have more access than ever to clinical care process.
electronic health records, diagnostics, and ● Providing Training and Learning Based on
treatment plans. Clinical communication and Objective Data - One of the most valuable
collaboration platforms are making it easier to ways a nursing informaticist can enhance
manage healthcare workflows, improve patient outcomes is through providing training
coordination, and enhance patient outcomes. to clinical staff. They can use data to identify
Systems integration and data access mean that endemic issues in a healthcare organization
information and analysis are more vital than and consult on the best way to resolve these
ever. problems. These learnings can be integrated
● The secret to using this data to provide better with onboarding new staff, ongoing in-house
care comes down to nursing informatics — training, or external education and certification.
integrating nursing science with other areas to Nursing informaticists can help to create highly-
identify, define, manage, and communicate targeted educational programs to deal with
data, information, knowledge, and wisdom to specific gaps between ability and provider
provide better care. expectations.
● The informatics nurse is part of the delivery of ● Selecting and Testing New Medical Devices
care, the building of knowledge, skills, and - Connected medical devices can provide vast
experience in the use of information amounts of health data on patients. Nursing
technology. They often lead clinical informatics informaticists are ideally positioned to
committee meetings that have a major understand the true value of that data and
influence for nurses in assisting them to provide recommendations on how it can be
coordinate all the multifaceted technology recorded, accessed, and used. Involving
activities in regards to patient care, informaticists in the selection of medical
documentation, and safety. devices will ensure you have additional criteria
● Aligning Nursing Best Practice with Clinical for understanding how device data can inform
Workflows and Care - Nursing informatics is diagnostics, treatment plans, and ultimately
focused on the best ways to achieve good patient outcomes.
patient outcomes — it is about applying the ● Reducing Medical Errors and Costs -
overall process and best practice to maximize Nursing informaticists can reduce the chance of
patient care wherever possible. As a result, medical errors in a healthcare organization,
nurse informaticists are often involved in together with associated costs. A combination
process design, clinical workflow reviews, and of staff training, process improvement, and best
new diagnostics and treatment plans. They take practice will enhance the quality of care and
into account the various options for providing limit patient risks. There are four main areas
care and use objective facts and analysis to that drive medical errors:
determine the actions that will lead to the most ○ Communication doesn’t take place
patient-centered, value-based care. when it should
● Improving Clinical Policies, Protocols, ○ Incorrect or incomplete information is
Processes, and Procedures - Data is the communicated
lifeblood of nursing informatics. That data and ○ Information is shared with the wrong
information can be used to measure the recipient or third party
success of the various protocols, processes,
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○ The message lacks critical facts or is

unclear, meaning it isn’t understood
correctly.
● Informaticists can look at how your organization
communicates and collaborates around patient
information. They can audit individual cases,
identify gaps, and provide recommendations for
avoiding errors in the future.
● Enhancing End-to-End Treatment and
Continuity of Care - A patient’s care may
involve several areas, many teams, and dozens
of individuals. Nursing informaticists can create
protocols and processes to ensure proper
communications and interactions between
departments, teams, individuals, and patients.
They can help healthcare employees to seek
out “one view of the truth” through electronic
health records, so everyone has the context
and insight they need to ensure excellent
continuity of care.
CLINICAL DECISION SUPPORT
This topic overviews the key technology feature that

supports clinicians’ decisions and ensures that care is
provided to the right patient at the right time. We will
focus on the steps needed to develop a clinical-
guideline-based decision support system. By the end of
the topic, the students will be able to analyze the
structure of a clinical decision support tool and evaluate
its potential impact on the clinical care.
Please refer to the readings and video pasted in the last

page of this module…

Introduction to Clinical Decision Support
https://youtu.be/e8a6hE1PrcQ
Clinical Decision Support

https://youtu.be/BBRDPXEBIxs
Clinical Decision Support Demonstration

https://youtu.be/1eynspbmGp0
Clinical Decision Support (Reading)

https://drive.google.com/file/d/1PlJUTAotm3uDcVPX
RwTl66IjYPMu0vhi/view?usp=sharing
70 I YN & MD
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MODULE 9
Overview
New applications for facility-based clinical practice

continue to be the fastest growing area of interest in
nursing informatics. Although there are many
technological advances discussed here, the areas of
greatest interest are conceptual. Source data
capture, the development and use of decision
support and expert systems, and the development of
a nursing minimum data set as they relate to facility-
based care are the most important issues. Although
none of these concepts is easily categorized, the
nursing process provides the structure for this
chapter. Clinical applications of nursing informatics
are related to assessment, planning, implementation,
and evaluation.
Objectives
● Describe the application of nursing

informatics in a clinical setting.
● Understand and apply how nursing
informatics improves patient care.
REFERENCES
LITERATURE REVIEW
● CINAHL Plus with Full Text

● Cochrane Library
● EMBASE : Excerpta Medica Database
● EBSCOhost
● HAPI: Health and Psychosocial Instruments
● Medline/ PubMed
● Scopus
● Google Scholar
● Virginia Henderson International Nursing
Library
Notes:
These lists have been validated and research articles cannot

publish these search engines without undergoing rigorous
selection.
In FEU we have access to the EBSCOhost, Google Scholar,

and Virginia Henderson International Nursing Library.
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DATA COLLECTION AND STATISTICAL TOOLS ability to name a specific

variable
● Review on Statistics ● Identity - Name
○ Data - raw material or raw numbers ● No Comparison
○ statisticians work on ● Name
■ Qualitative ● E.g. Pneumonia,
■ Quantitative Diabetes,
● Discrete Hypertension
● Continuous ■ Ordinal - It has something to
Notes: compare with.
● Magnitude
Data can be found on surveys, experimental studies, and ● Identity + Magnitude
other modes of research.
● E.g. Good, Better,
Best
Data should be gathered in order for the researchers to study
their characteristics which is now called a variable. These ■ Interval - Check if it has an
variables can be classified into qualitative or quantitative. equal unit of measurement.
This data has an actual
Qualitative represents differences of quality, character, or amount, nothing more, nothing
kind. They do not yield any numerical variable (E.g. birthplace, less. This is an equal unit of
geogra[hic location, religion, civil status, sex, skin color, eye measurement that separates
color) the value in an equal interval.
● Numerical
Quantitative can be divided to discrete and continuous.
● Equal
Quantitative variables are numerical in nature. It can be
ordered, ranked. (E.g. age, height, weight, test scores, vital ● Unit of Measurement
signs). ● Doesn’t include
greater than or less
Discrete variables using integral or non decimal values (E.g. than relationship but
number of students, number of admissions, number of testing has a limit of
centers) measurement that
permits us to describe
Continuous variables are counted as decimals or fractions that
how much more or
represent a numerical difference over an interval (E.g. height,
less, one object than
weight, temperature, blood pressure)
another (E.g.
Temperature, score
● Variables
on formative
○ Independent
assessments).
○ Dependent
Notes: ● E.g. The difference
between 60 and 70 is
Independent variable is stand-alone.It cannot be affected by equal to the difference
any types of variable. of 80 and 90. They
both have the same
Dependent variable will change depending on the influences difference of 10.
of independent variables ■ Ratio -
● Numerical
But it is not enough to only know these variables. You also
● 0 is significant and
need to identify its scale of messenger to determine the
statistical tool that you will be needing has multiple meanings
● Scales of Measurement - this is important in ● E.g. You have zero
conducting survey because you will need balance on your
statistical tool and data.n mobile account or E-
○ Property wallet. This means
■ Nominal - Property of the scale that the zero here
of measurement if it has the means you don’t have
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any money or load.

This includes the
usual measurement
such as the length,
height, weight,
money, velocity,
duration, horsepower
of AC, compensation
of the faculty member,
age of the student.
This is the highest
level of measurement ● Data Collection Using Informatics
● Which statistical tools do we use? ○ Online Questionnaires (Google Forms/
● MS Forms)
Notes: ■ MS Forms:
htps://www.youtube.com/watc
If you are looking for data, ask yourself if you are looking for h?v=BOoTBzHM4fQ&pbjreloa
the difference of the data or an association of the data; d=101
independent or dependent sample selection; two or greater
● This feature has qr
than two measures.
code
■ Google Forms:
https://www.youtube.com/watc
h?v=KTsT4QilR9k
Notes:
Survey is one way of gathering data from a specific

population. It is one of the most commonly used tools by
researchers to facilitate the study. It is usually done in a face
to face basis but it usually takes up a large amount of time -
15 - 20 minutes. Because of the pandemic, the use of f to f
surveys becomes online.
● Quick Polls
○ Messenger
○ Mentimeter
○ Survey Monkey - one of the most
popular but has a premium account to
access the advance features
Notes:
Used to immediately know the response of the majority.
● Statistical Tools
○ Spreadsheets (Excel, Sheets)
○ SPSS by IBM and PSPP - one of the
most popular statistical tool but are
costly and it doesn’t come in free
package PSPP is there to have a free
access as an alternative of SPSS
○ SAS - also an alternative to SPSS but
not a freeware
○ NVivo - for qualitative data
Notes:
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■ What did you find?

Used to process gathered data. ■ Narration of your findings.
■ Remember not to have any
You still need to know the proper scale of measurement explanation or commentary on
and proper statistical tool and formula needed for your the findings.
study. ○ Discussion
■ What does it mean?
● Data Presentation ■ Summary of your main
○ Presentation of data needs planning findings
and appropriate means of ■ Comment and connect them
presentation. to your research
○ Readers need to be interested and ■ Limitation of your study
understand the presented data. ■ Suggestions for future
Notes:
research
Notes:
Common ways of presenting data are:
1. Text form - paragraph explanation of your data. It
Hypothesis is usually presented at the end of the introduction
gets boring and confusing if everything is textual
2. Tabular form - presents data in rows and columns for
Methodology typically use subheading and in a past tense
a quick summary and comparison purposes. So
form and uses a lot of passive voice
readers can have a quick bird’s eye view of what you
are trying to present and trying to point out.
3. Graphical form - Used if there is too much data that SUMMARY: INFORMATION LITERACY AND
is confusing (E.g. Pie Chart, Bar Graph). Each one COMPUTERIZED INFORMATION RESOURCES
has a specific purpose. This is a more visual
presentation that is easier to understand. There are OVERVIEW
purposes and rules in choosing the appropriate
graph or diagram.
a. This chapter presents information about electronic
resources that are easily available and accessible and can
● IMRAD assist nurses in maintaining and enhancing their professional
○ Introduction -> Methods -> Results -> practices
Discussion (1) These resources aid in keeping current with the
○ Introduction published literature, in developing a list of sources
■ Make a case for your research for practice, research, and/or education, and in
■ Explain the importance. collaborating with colleagues
■ Establish the problem b. As is evidenced in earlier chapters, nurses use
situation that motivates the computers for many purposes
research. (1) In the past, most of the focus has been on
■ Discussing the current state of computerized patient records, acuity systems, and
research in the field; then physician ordering systems
reveal a “gap” or problem in (2) One of the major purposes for which computers can
the field. be used, however, is searching for information
■ Finally, explain how the (3) Many resources are available by computer, and the
research will provide a information retrieved can be used to accomplish
SOLUTION. different ends
○ Methods - What did you do? (4) Computers also are available in various sizes,
■ How you conducted your improving portability and availability wherever a
nurse is practicing
study?
(5) Many of the resources described in the following
■ Population, Sample, Methods,
sections will be available via mobile devices
and Equipment
c. To maintain professional credibility, nursing
■ It should enable readers to
professionals must (1) keep current with the published
duplicate your study - The
literature, (2) develop and maintain a list of bibliographic
Gold Standard of Methodology and other sources on specific topics of interest for practice,
○ Results
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research, and/or education, and (3) collaborate and network (1) To identify the best evidence and apply it in the care
with colleagues regarding specifics of professional practice of the patient, the nurse must apply the
(1) Electronic resources are available to meet each of information literacy process
these needs (i) Recognize the need for evidence
(2) This chapter addresses each of these requirements (ii) Know how to search and find relevant
for professional credibility and discusses both information
essential and supportive computerized resources (iii) Access, utilize, and evaluate such
available to meet them information within the practice
(3) Essential computerized resources are defined as environment
those resources that are vital and necessary to the
practitioner to accomplish the specific goal b. Information literacy is identified as a competency for
(4) In the case of maintaining currency, for example, the basic nurse
these resources include bibliographic retrieval
systems such as MEDLINE or the CINAHL database, (1) The American Library Association describes the
current awareness services, review services, or “information literate” person as one who can
point-of-care tools and may be accessible on the “recognize when information is needed and have
World Wide Web the ability to locate, evaluate, and use effectively
(5) Supportive computerized resources are those that the needed information” and identifies it as a basic
are helpful and interesting and supply good competency for higher education
information but are not necessarily essential for
professional practice c. This landmark study demonstrated that many
(6) In meeting the requirement of maintaining nurses were not aware that they needed information; once
currency, supportive computerized resources they recognized a need, online resources available for them
include document delivery services, electronic to use were inadequate and respondents had not been
publishers, and metasites on the World Wide Web taught how to use online databases to search for the
(7) There are many resources available to meet each of information they needed (1) Additionally, they did not value
the above requirements for professional credibility research as a basis on which to formulate and implement
(8) For the purposes of this chapter, selective patient care
resources are identified and discussed as examples
of the types of information available d. Since these findings were published, many
(9) Web site URLs of the various resources are included subsequent studies have been conducted in various
as well specialty areas and countries with similar results
(10) It is important that the nursing professional
determine her or his exact requirements before (1) Melnyk and Fineout-Overholt surveyed randomly
beginning the search selected members of the American Nurses
(11) Planning the search will be stressed throughout this Association and found that over 70% of
chapter respondents either needed or strongly needed (1)
tools to implement evidence- based practice, (2)
INFORMATION SEEKING BEHAVIORS OF REGISTERED online education and skills-building modules in
NURSES evidencebased practice, and (3) an “online resource
center where best EBPs for patients are housed and
OVERVIEW experts are available for consultation”
(2) Melnyk and Fineout-Overholt determined that

a. Multiple practice standards organizations (Institute of
nurses valued and were ready to practice nursing
Medicine [IOM], Agency for Healthcare Research and
based on evidence, but need several things to be
Quality [AHRQ], American Nurses Credentialing
able to do so: more time, knowledge, skills, access,
Center’s [ANCC] Magnet Recognition Program,
and a supportive organizational culture
American Association of Colleges of Nursing [AACN],
National League for Nursing [NLN], The Joint
e. The rate of expansion in health information
Commission [TJC]) insist that nursing care be based on
technology (e.g., electronic health records) is phenomenal;
information derived from best practice evidence
additionally, clinical knowledge is multiplying exponentially
and dissemination methods are changing to include
scholarly databases and social networking
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(1) Despite the demands for EBP, nurses continue to The resource is updated regularly and
have difficulty finding information they need for is current
practice and prefer colleagues as their primary iv. The resource covers the appropriate
source g. Nurses—students, clinicians, educators, period
and managers— must develop efficient and v. The resource covers material published in
effective search strategies that embrace different countries and languages vi. There
information literacy as a framework to search the is some form of peer review, reference
myriad of information resources available for checking, or other means of evaluation
evidence (1) According to recent efforts, education 2. ESSENTIAL COMPUTERIZED RESOURCES
is embracing the change by embedding well- a. Essential computerized resources for maintaining
designed courses that offer opportunities to currency include bibliographic retrieval systems for the
develop these skills throughout program curricula journal literature, current awareness services, review
(2) Results indicate that such courses are indeed services of the journal literature, point-of-care tools, and
effective in improving the nurse’s skills and currently published books
confidence in searching for evidence (1) All of these assist the nurse in gathering the
(3) Change in practice culture is needed to infuse most current and reliable information
information literacy throughout the workplace
f. The resources and search strategy introduced in 3. BIBLIOGRAPHICAL RETRIEVAL SYSTEMS
this chapter provide the reader with tools that will become
the basis of lifelong learning for the nurse—tools for a. One of the most useful resources for accessing
evidence- based practice information about current practice is the journal literature
(1) Although there may be a delay between the writing
and publishing of an article, this time period is seldom
more than a few months
MAINTAINING CURRENCY WITH THE PUBLISHED (2) The best way to peruse this literature is through a
LITERATURE bibliographic retrieval system, since there is far too
much literature published to read it all
1. OVERVIEW (3) Bibliographic retrieval systems also allow filtering
and sorting of this vast amount of published
a. It is obvious that one of the most important material
obligations a nurse must meet is to maintain currency in her b. A bibliographic retrieval system database allows the nurse
or his field of practice to retrieve a list of citations containing bibliographic
(1) With the extreme demands in the clinical details of the material indexed, subject headings, and
environment—both in time and amount of author abstracts (1) The nurse can search these systems
work— nurses need easily accessible resources using specific subject headings or keywords
to answer practice-related questions and ensure (2) Most bibliographic retrieval systems have a
that they are practicing with the latest and most controlled vocabulary, also known as a thesaurus or
evidence-based information subject heading list, to make electronic subject
(2) Information is needed about current searching much easier
treatments, trends, medications, safety issues, (3) For this reason, the vocabulary is geared toward the
business practices, and new health issues, specific content of the database
among other topics (4) These controlled vocabularies are made available
b. The purpose of the information retrieved from the online as part of the database
sources listed below is to enable nurses to keep abreast of (5) Keyword searching is necessary when there are no
the latest and most evidence-based information in their subject headings to cover the concepts being
selected field searched
(1) Both quantity and quality must be considered (6) The nurse can also search by specific fields,
(2) When using a resource, check that including author, author affiliation, journal title,
i. The resource covers the journal serial number (ISSN), grant name or
required number, or publication type
specialty/field (7) In bibliographic retrieval systems, most fields in the
ii. The primary journals and peripheral records are word-indexed and can be searched
material in the field are included iii. individually to retrieve specific information
76 I YN & MD
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c. Previously available as print indexes, these systems are NLM Gateway

now available electronically through online services, or via (1) The full text of articles for some journals is
the World Wide Web available via a link to the publisher’s Web site
(1) To access them, a computer with a modem, from the PubMed abstract or record display (2)
and/or Some of the full text is available free of charge
Internet access is required (3) The links indicating free full-text display on the
d. Since each of these bibliographic retrieval systems has its Loansome Doc order page prior to order placement
own specific content, a nurse may have to search several and on the Loansome Doc Order Sent page
systems to retrieve a comprehensive list of citations on a immediately after the order is finalized
particular topic (4) NLM has a fact sheet for Loansome Doc users
(1) Directories of descriptions of bibliographic covering the registration process, how to place an
retrieval systems can be found at many sites on order, order confirmation, check order status, and
the World Wide Web, for example, universities updating account information
(University of California, San Francisco), medical h. CINAHL
centers (University of Kansas Medical Center A. (1)The CINAHL database, produced by Cinahl
R. Dykes Library), and government agencies Information Systems, a division of EBSCO
(National Library of Medicine) Information Services (EBSCO), provides
(2) The main bibliographic retrieval systems that comprehensive coverage of the literature in nursing
should first be considered are and allied health from 1982 to the present
MEDLINE/PubMed, the CINAHL database, (2) CINAHL has expanded to offer five databases
Mosby’s Index, ERIC, PsycINFO, the including three full-text versions
Social Sciences Citation Index, and SocIndex (3) The database covers chiropractic, podiatry, health
e. MEDLINE/PubMed. The NLM provides free access to many promotion and education, health services
online resources administration, biomedicine, optometry, women’s
(1) One of these, MEDLINE, covers 5600 journals in health, consumer health, and alternative therapy
39 languages with over 20 million references (4) More than 4900 journals, as well as books,
from 1946 to the present in the fields of pamphlets, dissertations, and proceedings are
medicine, nursing, preclinical sciences, indexed
healthcare systems, veterinary medicine, and (5) Some journals covered are published in other
dentistry countries
(2) The nursing subset in MEDLINE covers 189 (6) It is updated weekly
nursing journals i. The CINAHL database also uses a controlled vocabulary for
(3) The database is updated weekly on the World effective subject searching
Wide Web (1) The CINAHL Subject Heading List uses the NLM’s
(4) The NLM’s databases use a controlled MeSH terms as the standard vocabulary for
vocabulary disease, drug, anatomic, and physiologic
(thesaurus) called MeSH (Medical Subject concepts
Headings) (5) These index terms facilitate subject (2) There are approximately 12,714 unique CINAHL
searching within the databases terms for nursing and the allied health
f. MEDLINE and the nursing subset are available free over disciplines (3) Specific field searching and quality
the World Wide Web through the NLM’s home page (1) filters are available in the CINAHL database and
There are two ways to search this database: PubMed and are similar to those found in MEDLINE
the NLM Gateway j. An essential part of research papers is the list of
(2) The NLM Gateway is a Web-based system that references pointing to prior publications
allows users to search multiple NLM retrieval (1) Cited references for more than 1300 nursing and
systems simultaneously allied health journals are searchable in the
(3) The database is also available through the CINAHL database
commercial vendors mentioned below k. Mosby’s Index
(4) All of these options allow the nurse to search by (1) Content from over 3150 peer-reviewed journals,
subject, keyword, author, title, or a combination of trade publications, and electronic titles, and
these provides access to over 3 million records, as far
g. Loansome Doc allows the nurse to place an order for a back as 1974, is indexed in this database
copy of an article from a medical library through PubMed
or the
77 I YN & MD
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(2) It uses the EMTREE Thesaurus, a hierarchically from more than 12,000 high impact research
structured, biomedical thesaurus, which has journals worldwide”
been enhanced for nursing (3) This particular index was developed by the
(3) Both the thesaurus and the index are published Institute for Scientific Information and is a
by Elsevier B.V. multidisciplinary citation index which covers
more than 3000 journals in the social,
behavioral, and related sciences
m. ERIC (4) The nurse can search the cited references as in
(1) The ERIC (Educational Resources Information the citation index in the CINAHL database
Center) database is sponsored by the Institute of p. Google Scholar
Education Sciences (IES) of the US Department (1) Google Scholar (GS) offers a version of the
of Education and contains more than 1,400,000 Google search engine with which most nurses
citations covering education-related literature are familiar
(2) It covers virtually all types of print materials, (2) In fact, approximately 67% of the more than 170
published and unpublished, from 1966 to the billion Internet searches each month are
present day conducted using Google
(3) Currently, more than 650 journal titles are (3) Like PubMed, GS is free to access and use and
indexed in ERIC links to some full text articles
(4) It is updated monthly (4) It offers broad search capability across many
(5) This database gives the nurse a more disciplines and types of literature, including
comprehensive coverage of education than any articles from scholarly journals, theses, books,
other bibliographic retrieval system Web sites, and court opinions
(6) The Thesaurus of Eric Descriptors, a controlled (5) This capability may be useful in an initial search
vocabulary, assists with computer searches of on a topic to get an overview, but may not be
this database on the Internet through the World precise enough for a specific search
Wide Web (ERIC) (6) Limited advance search capability is available,
(7) As with the other two bibliographic databases but a searcher cannot limit to a specific resource
mentioned, nurses are able to access all of the type
data in each record on ERIC by searching, using (e.g., research, clinical trial) or discipline
subject headings or keywords, or by searching (7) Good analytical and evaluative skills are
for a word(s) in a specific field essential (8) GS is not a replacement for the
n. PsycINFO above-described academic databases, but one
(1) The PsycINFO database, produced by the to be used in conjunction with them
American Psychological Association, provides (9) It may also be particularly useful for nurses who
access to psychologically relevant literature do not have easy access to a hospital or academic
from more than 2543 journals, dissertations, library where such databases are typically housed
reports, scholarly documents, books, and book (10) Of particular note when searching GS are the
chapters with more than 3 million references “Cited by” and “Related articles” options with each
from the 1880s to the present (2) Updated citation
weekly, most of the records have abstracts or (11) It is possible to examine the development and
content summaries from material published in direction of a concept, idea, or innovation by seeing
over 49 countries citations of other authors referring to a given article
(3) Using the Thesaurus of Psychological Index Terms (12) Authors can also easily find where their work
of more than 8400 controlled terms and cross has been cited
references, the nurse can search for specific q. A few other bibliographic retrieval systems to keep in
concepts effectively mind are databases such as
(4) Keyword and specific field searching are also (1) The database AgeLine owned by EBSCO
available (2) The Excerpta Medica database EMBASE (3) The
o. Social Sciences Citation Index National Technical Information Service NTIS
(1) This database can be accessed via Web of database
Science for a fee (4) The UMI Proquest Digital Dissertations
(2) Web of Science includes a broad range of
databases offering “multidisciplinary coverage 4. CURRENT AWARENESS SERVICES
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a. Most bibliographic retrieval systems are updated (1) Possibilities include such areas as advanced
weekly or monthly nursing practice, case management, home
(1) In addition to the delay between the writing and healthcare, or military/uniformed services (2) By
publishing of the material that is indexed in the selecting one of these categories, documents are
database, there is also a delay between the retrieved that are either in specific journals in the
receipt of material, the indexing, and finally the field or have been selected by indexers as being of
inclusion of the citations for the indexed interest to those in that field
material in the database (2) To obtain access to (3) The results can be limited by any of the available
more current material than that available in a limits on the database, for example, publication
bibliographic database, the nurse should use a type such as research, journal subset such as
current awareness service blind peer reviewed, and the presence of full
b. Current awareness services are helpful when used text
in addition to bibliographic retrieval systems (4) A nurse with limited time can peruse the latest
(1) These services provide access to tables of literature in one of these fields in this way
contents of journals and allow individuals to
request articles of interest 5. REVIEW SERVICES
(2) They may include not only journal articles, but a. Although the bibliographic retrieval systems and
also proceedings from conferences, workshops, the current awareness services and databases act as filters
symposia, and other meetings to the everexploding volume of literature, sometimes the
(3) Often, hospital or university librarians may information retrieved needs to be evaluated to determine
provide these services as well whether or not it is appropriate
(4) Unlike the bibliographic databases, where (1) Supportive computerized resources that synthesize
subject searching using controlled vocabulary is the literature include the Joanna Briggs
available, only keyword searching for the Institute for Best Practice
subject, author, title, or journal is available in (2) Clinical Evidence (BMJ Publishing) or the Cochrane
current awareness services or databases Library Database of Systematic Reviews
c. Some current awareness services or databases are (3) Review services such as Doody’s Review Service or
Current Contents Connect, the in-process database for reviews noted in bibliographic databases or review
MEDLINE (formerly PREMEDLINE), and the PreCINAHL journals, such as, Evidence-Based Nursing,
records on EBSCOHost Evidence- Based Practice, Best Practice, and ACP
(1) Current Contents Connect from Thomson Journal Club can also be used to evaluate sources
Reuters, provides a Web-friendly current (4) Review services provide information to searchers
awareness service to tables of content, about recently published books, journal articles,
abstracts, and bibliographic information from audiovisuals, and software
the most recently published scholarly journals as (5) These reviews may also include ratings, opinions, or
well as from more than 7000 relevant, evaluated commentaries about the material
Web sites b. Doody’s Review Service is a service in which
(2) PubMed’s in-process records (formerly members develop a profile and a weekly bulletin is e-mailed
PREMED- LINE) provide basic information and describing books and software that meet the parameters of
abstracts before the citations are indexed and the profile (1) According to the Web site, the service
are found as part of a topic search currently contains over “130,000 book, eBook, and software
d. The PreCINAHL records offered by Cinahl titles in 140 specialties”
Information Systems, a division of EBSCO, publishers of the (2) The searcher can use author names, title, specialty,
CINAHL database, are available on EBSCOHost and provide a publisher, and keywords to find books of interest
method to access basic information, abstracts, and some- (3) The results show price, ISBN, and publisher as well
times full text before the citations are formally indexed as a rating, when available
(1) The records are retrieved as part of a topic (4) Materials are rated using a star system and a
search. questionnaire that assesses the extent to which
They can also be excluded from a topic search objectives are met and the appropriateness of the
e. The second type of current awareness provided by work’s readability, among other criteria
Cinahl Information Systems is within the bibliographic (5) The information presented allows serious
database itself, where the searcher is able to choose from a consideration of the book along with information to
group of 36 specific or special interest categories, which assist in making choices
actually function as “virtual” databases
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c. It is well-known that books are generally long in the (4) Quick Lessons are clinically organized nursing
development stage and are not as current as journal articles overviews of diseases and conditions
or documents on the World Wide Web; however, the depth (5) They represent the best available evidence and
of material presented in books must be considered are designed to match the nursing work flow
(1) An in-depth discussion of all aspects of cardiac (6) They provide nurses with information the nurses
rehabilitation, for example, may be valuable in need about diseases, including
planning care and would probably not be included i. A description of the disease ii. Its signs
in a journal article where space is a consideration and symptoms iii. Typical tests the
(2) Yet it would still be necessary for maintaining clinician will order to diagnose it, or
currency in the field measure progress in treating it
iv. The interventions nurses will likely be
6. POINT OF CARE RESOURCES involved in while the patient is in their care
v. Information necessary to share with the
6. Point-of-care resources patient/ patient’s family
a. Point-of-care resources are resources that support patient d. Evidence-Based Care Sheets provide evidence about
care at the bedside aspects of a disease or a condition in terms of what we
(1) Lists of these resources are available know about it and what we can do about it
b. Mosby’s Nursing Suite (1) The evidence is coded as to its strength so the
(1) Mosby’s Nursing Suite from Elsevier includes user can evaluate it and determine its
Mosby’s Nursing Consult, Mosby’s Nursing Skills, applicability to their practice
and Mosby’s Index (discussed earlier) e. In the database, there are nearly 1200 nursing skills and
(2) Mosby’s Nursing Consult provides information procedures, providing access to clinical papers detailing
to help nurses with patient care the necessary steps to achieve proficiency in a specific
(3) The database includes evidence-based nursing nursing task
monographs, nursing journals and clinics, (1) Skill Competency Checklists are provided with
nursing and medical reference texts, practice these documents
guidelines, images, drug information, and (2) Many papers are also available that define key
several thousand customizable patient considerations to providing culturally competent
handouts care to specific population groups
(4) Mosby’s Nursing Skills is an online skills f. Point-of-care reference books include
reference and competency management i. Davis’s Comprehensive Handbook of Laboratory
resource from Elsevier (5) There are over 1300 & Diagnostic Tests with Nursing Implications ii.
nursing skills that use a learning management Taber’s Cyclopedic Medical Dictionary
system (LMS) which allows nurse managers and iii. Davis’s Drug Guide for Nurses; AHFS Drug
educators to assign, track and manage skills, and Essentials
test hospital staff iv. Diseases and Disorders: A Nursing Therapeutics
c. Nursing Reference Center Manual
(1) Nursing Reference Center (NRC), published by v. And more
EBSCO, is a point-of-care tool designed to g. There are more than 3600 evidence-based customizable
provide relevant clinical resources to nurses and patient handouts (English and Spanish) together with
other healthcare professionals thousands of detailed medical illustrations
(2) The database offers staff nurses, nurse (1) Nearly 1400 CE modules are also available (2)
administrators, nursing students, nurse faculty, These modules are accredited through the ANCC
and hospital librarians the best available and and the International Association for Continuing
most recent clinical evidence from thousands of Education and Training (IACET)
full-text documents (3) Over 30 CE modules have been accredited by the
(3) NRC contains over 3600 Quick Lessons and Commission for Case Manager Certification
Evidence-Based Care Sheets covering conditions h. Users can search NRC by entering keywords in the Find
and diseases, cultural competencies, patient field and then clicking on the Search button
education resources, drug information, (1) NRC will display a Result List that is sorted by
continuing education (CE), lab and diagnosis source type
detail, legal cases, research instruments, and (2) Users can search the database using the
best practice guidelines standard nursing process ADPIE (assessment,
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diagnosis, planning, implementation, and referral system provided through the National
evaluation) Library of Medicine
(3) Nursing process limiters are used to clarify a d. Electronic publishers
search in NRC (1) Many publications are now being published
(4) Users can select one or multiple nursing process electronically, either as an “e-journal” only or
limiters to rapidly target applicable content as a print journal with electronic supplements
i. Users can launch a CINAHL-type search, and limit searches (2) There are several advantages to this form of
by document types, full-text, publication date, or source publication such as speed, ease of availability,
(1) They can also browse CINAHL headings or and space required for publication
indexes and other EBSCOhost databases that may (3) Searching for information in these journals is
be relatively easy
subscribed to by the institution (4) The Morbidity and Mortality Weekly Report
(2) Users can store search results, persistent links to (MMWR), published by the Centers for Disease
articles, images, saved searches, alerts, and Web Control and Prevention, is one such electronic
pages to pull in the latest information needed on publication that can be subscribed to and
the floor and to create department-specific patient provided by e-mail
education packets (5) The credibility and accuracy of the source of
j. A Nursing Reference Center “app” is available for the electronically published material must always
iPhone, iPad, and iPod Touch for nurses who wish to be considered just as it is in print publications
access it via those devices (6) The criteria mentioned along with additional
criteria discussed later can be useful in
7. SUPPORTIVE COMPUTERIZED RESOURCES evaluating this material
(7) Two examples of electronic-only nursing
7. Supportive computerized resources journals are the Online Journal of Issues in
a. Supportive computerized resources that assist the nurse Nursing, published by the American Nurses
in maintaining currency provide additional information Association, and the Online Journal of
and enhance the value of the essential computerized Informatics, published in Pennsylvania (8)
resources described previously Other journals such as Nursing Standard Online
b. Obtaining a bibliographic list of citations is only the first have print counterparts, but may have portions
step in obtaining information on a particular topic that are only electronic
(1) After carefully evaluating the citations, either e. Nursing publishers and organizations have their own Web
from the title and/or the abstracts, or after sites, which have details about new publications, some-
using one of the review processes described times the full text of some of the latest journal articles,
previously, the nurse will need to get the full official position statements of organizations, and/or
text of the sources retrieved (2) Many articles practice guidelines
are available in full text directly through the (1) To identify the Web sites of nursing publishers
bibliographic databases searched (3) If not, a and organizations, search Web site indexes
local library or academic institution would be a such as Yahoo or Google, or browse Web site
place to go to locate the items retrieved in a lists on Web sites such as that of the University
search of Buffalo Library or the Allnurses.com have
c. Document delivery services been provided
(1) Publishers of journals or books, database (2) On a Web site index such as Yahoo or Google,
vendors and providers (NLM, American do a general search for “nursing and
Psychological Association, Ovid Technologies, publishers,” “nursing and organizations,” or
EBSCO, Proquest Information and Learning), “nursing and associations” or under the
and document delivery services are secondary specific names of the publishers and
sources through which full text of items can be organizations (e.g., Sage, Sigma Theta
obtained for a fee Tau)
(2) Fees differ depending on the service, the (3) Advanced search options are also available
urgency of the request, and the publisher’s f. Lippincott Williams & Wilkins has placed over 60 journals
charges (3) Copy is usually sent via fax, mail, or including the
electronic delivery (1) AJN, American Journal of Nursing; Nursing
(4) Many libraries provide document delivery for Research
each other through services such as DocLine, an (2) CIN: Computers, Informatics, Nursing
automated interlibrary loan (ILL) request routing
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(3) JONA: Journal of Nursing Administration, vi. Additionally, who sponsors or benefits
among others, on their journals’ page with from the site? vii. Is there a fee involved?
issues from January 1996 to the present viii. Is its foundation evidence based?
(4) The site has a search capability that allows i. There are also Web sites that can be used to evaluate other
keyword searching of the contents of the Web sites
journals on the site (1) HON (Health on the Net Foundation) is an
(5) There are both free and fee-based articles international initiative funded by the various
available on the site European entities
g. Many nursing organizations provide a significant amount to promote effective Internet development and use
of support to practicing nurses in the areas of medicine and health
(1) They publish journals and provide these as a (2) Other Web sites that critically evaluate sites are
member benefit National Council Against Health Fraud, a voluntary
(2) They also provide access to the full text of their health agency that focuses on health fraud; and
position statements and/or practicing Quack Watch, founded out of concern about
guidelines healthrelated frauds, myths, and misconduct
(3) Some of these resources are the (3) Additionally, Web sites providing information or
i. American Nurses Association’s Web site discussions concerning specific diseases should be
Nursing-World evaluated in this way (e.g., the Web sites of the
ii. The Web sites of the American Academy American Diabetes Association, American Heart
of Nurse Practitioners iii. American College Association, and the Multiple Sclerosis Foundation)
of Nurse Practitioners
iv. The Association of Pediatric DEVELOPING AND MAINTAINING A LIST OF SOURCES FOR
Hematology/Oncology Nursing v. And RESEARCH/PRACTICE/EDUCATION
many others
(4) Details regarding new publications and 1. ESSENTIAL COMPUTERIZED RESOURCES
ordering items can be found on the Web sites
a. The purpose of the information retrieved from these
of most publishers
information resources is to enable nurses to answer specific
h. Metasites on the World Wide Web questions that relate to research, practice, and/or education
(1) Since there is so much information on the b. Bibliographic retrieval systems
World Wide Web, identification and evaluation (1) Resources essential in answering these types of
of Web sites is very important to determine questions again include bibliographic databases as
which provide valid information well as various Web sites
(2) One of the ways to identify Web sites is to (2) Once again, the resources need to be carefully
consult a metasite evaluated for coverage and currency
(3) There are several Web sites that can be (3) Once a resource has been selected, the nurse
classified as metasites concerning the same breaks down her or his needs into a search
specific topic (4) The Hardin Meta Directory of statement such as, “I need information on oral care
Internet Health Sources, sponsored by the and prevention of pneumonia”
Hardin Library for the Health Sciences at the (4) The information on this topic would best be found
University of Iowa is one of these as is the
in a bibliographic database
National Information Center on Health Services
(5) On such a database, the best method of searching
Research & Healthcare Technology (NICHSR), a
is to do a subject search using a controlled
government site
vocabulary
(5) These sites basically function as lists of lists that
(MeSH headings in MEDLINE, CINAHL subject
provide links to other subject-specific Web sites
headings in the CINAHL database, and so forth)
(6) Once the Web sites have been identified, it is
c. Search strategies
very important to evaluate them
(1) One of the most important aspects of searching
(7) At minimum, the nurse should consider the
the literature is formulating the exact strategy to
following
obtain the information from a resource,
i. Who created the site?
whether from a bibliographic retrieval system or
ii. Is its purpose and intention clear? iii. Is a Web site
the information accurate and current? iv. (2) There are six steps in planning the search
Is the site well designed and stable? v. strategy
How frequently is it updated?
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i. Plan the search strategy ahead of time ii. qualifications, and education among other
Break down the search topic into important details
components. To find information on oral (3) Additionally, Cinahl Information Systems
care and the prevention of pneumonia, currently includes nurse practice acts as one of
remember to include synonyms or related its publication types in the CINAHL database
terms. The components of the above (4) These appear in full text and can be read online
search would be oral hygiene or mouth or printed
care and prevention of pneumonia. e. Continuing education and computer-assisted learning (1)
Sometimes the terms for the search will be Many nurses do not have the time or money to attend
subject headings in the database’s subject conferences and workshops to keep abreast of the latest
heading list (often called a thesaurus); in information in their specialties or to complete the
other cases, they will not be necessary units or credits for CE for relicensure or
iii. Check for terms in a subject heading list, if recertification
available. If the concept is new and there (2) The World Wide Web is a wonderful source for
are no subject headings, a text word or nurses that can be used to satisfy their
keyword search is necessary. For example, requirements for CE
before the term critical path or critical (3) To identify CE Web sites visit the Nurse friendly
pathways was added to the CINAHL or National Consumer Health Directories, or use one
MeSH Subject Heading List, respectively, it of several search engines to obtain CE nursing sites
was necessary to do a text word search for (4) There are many nursing sites or point-of-care
this concept. A search using the broad resources that offer online CE and CEU certificates,
term case management would have such as Nursing Reference Center through EBSCO,
retrieved many articles that would not RnCeus. com, and the CE Connection at Lippincott
necessarily discuss or include critical Williams & Wilkins site
paths. Combining the two concepts results (5) A directory of free online CE opportunities for
in a more specific result: articles on case nurses can be found at nurseCEU.com
management that include critical paths f. As mentioned at the beginning of this chapter, nurses use
iv. Select operators, which are words used to computers for many purposes
connect different or synonymous (1)Computer-assisted instruction (CAI), computer-
components of the search. The AND assisted learning (CAL), and interactive videodisc
operator, for example, makes the search (IVD) provide easy learning experiences using a
narrower or more specific as the results of computer
the search for two different terms will only
result in records that include both terms as 2. SUPPORTIVE COMPUTERIZED RESOURCES
subject headings a. Supportive computerized resources that assist in
v. Run the search. For the search on oral care practice, research, and education contain all types of health
and pneumonia, select the option explode information, including drug and treatment information,
for the subject headings oral hygiene and anatomy, and physiology
mouth care. This would ensure the (1) Specific products such as the Merck Manual of
retrieval of articles on the broad heading Diagnosis and Therapy or the Physician’s Desk
and the more specific headings. For Reference available as PDRhealth are also
example, the specific headings under oral available on the World Wide Web
hygiene are “dental devices, home care” (2) The Visible Human Project includes complete,
and anatomically detailed, three-
“toothbrushing” dimensional representations of the male and
vi. View the female human bodies
results (3) The National Library of Medicine itself claims to
d. Practice guidelines and position statements be the “largest health science library in the
(1) Organization-specific practice guidelines, world”
position statements, and standards of practice b. Other Web sites of particular interest in this
can often be accessed and obtained from the category include the Nursing Theory Page and the Virginia
Web site of an individual’s professional Henderson Global Nursing e-Repository as well as the
organization Interagency Council on Information Resources in Nursing
(2) These are extremely useful documents that (ICIRN)
present information on scope of practice, (1) ICIRN prepares a list of “Essential Nursing
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Resources” which are available online (4) In a moderated group, an individual or group of
individuals reads the messages prior to distribution
COLLABORATION AND NETWORKING REGARDING ISSUES to the group
OF PROFESSIONAL PRACTICE (5) Subject-specific listservs include NURSENET
(general nursing), Nursing-L (nursing informatics),
1. OVERVIEW NRSED (education issues/faculty), and NurseRes
(research)
(6) Specialty listservs are very helpful in increasing
a. Nurses frequently gather information from their
dialogue between individuals within the same
personal networks—either at the worksite or at professional
specialty
meetings (1) The increased availability of computers makes
contact with other professionals much easier, resulting in
networking and collaboration possibilities heretofore 3. SUPPORTIVE COMPUTERIZED RESOURCES
impossible
(2) Information retrieved by this method enables a. Electronic bulletin boards, forums, newsgroups,
nurses to learn from their colleagues’ experiences blogs, chat rooms, and social networking sites
(3) When considering with whom to network, the (1) Bulletin boards, forums, newsgroups, and chat
specialty of the person should be evaluated along rooms are examples of supportive computerized
with experience, the material they have published resources
in their field, and the research undertaken by the (2) Similar to a traditional bulletin board, the
institution with which they are affiliated electronic version has an administrator who
(4) Most of this information is not published and sends the discussion to various Web sites, where
would be unavailable through traditional nurses visit to read and participate in the
information resources discussion
b. Computerized resources for collaboration and (3) This format for electronic networking has
networking vary in several technical details (e.g., their focus, almost entirely been replaced by forums and
the presence or absence of a moderator to monitor newsgroups, which have become more and
messages, the number of participants, and their level of more sophisticated in their interactivity and
interactivity) design
(4) The premise behind each of them is similar
2. ESSENTIAL COMPUTERIZED RESOURCES (5) An individual posts a message concerning a topic
(known as a thread) for others to read and respond
a. Electronic mail and listservs to (6) Allnurses.com has a “Break Room,” a
general topic area in which nurses are invited to
(1) An important fundamental computerized resource
discuss anything of particular interest to them
for collaboration and networking is e-mail, which is
at the core of almost any electronic communication (7) Newsgroups operate in much the same way (8)
(2) Necessary components for e-mail are access to Nursezone.com is an online news magazine that
Internet services (often provided by cable television offers blogs, a job center, and various nurse-
and local telephone companies) and e-mail viewing related information
software, such as Internet Explorer or Firefox (3) E- (9) All of these resources are interactive but on a
mail allows one-to-one communication between delayed basis
individuals and can provide immediate response to (10) An individual may respond to a message
practice-related questions immediately or wait several days
b. A second essential computerized resource for (11) Chat rooms, on the other hand, are interactive in
collaboration is an electronic discussion group or “listserv” real time
(1) Listservs allow individuals to subscribe free of (12) Conversations in chat rooms can be compared to
charge and to read and respond to messages via telephone conversations
email (13) “Nursing Chat Room” in LinkedIn is an example
(2) Since the messages are posted to all of the focused especially on psychiatric nursing
members, the listserv allows sharing and b. Each of these methods of collaboration and
dissemination of information with colleagues (3) networking provides an option for nurses to contact and
Some listservs have a closed membership for a build relationships with other professionals concerning
specific group (e.g., librarians or specific nursing issues important to them
groups), and some are moderated (1) Newer social networking sites such as LinkedIn,
Facebook, and Twitter offer great potential for
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sharing experiences and ideas about practice nursing informatics, which is revolutionizing how health
issues (2) Using features of smartphones such as information is documented in the Electronic Health Record
texting also enhance communication (EHR) and producing pools of searchable secondary data
opportunities waiting to be tapped
c. All of the above sites offer end users the ability to (1) The context for nursing informatics research has
disseminate information about practice and/or products proliferated since the National Institute of Nursing
that they have found useful Research (NINR) published an agenda outlining the
(1) By “liking” a particular site, an end user can be need for nursing informatics research in the Nursing
included in any notifications about new Informatics Research Agenda
information on that site (2) Other reports called for organizing priorities and
con- structing models to develop a context
connecting nursing and informatics that would
SUMMARY: COMPUTER USE IN NURSING RESEARCH provide the basis for studying the practice of
nursing informatics
OVERVIEW (3) Today, hospital wide information technology (IT) is
the spine of all healthcare delivery, which is tied to
a. Nursing research involves a plethora of tools and reimbursement, and which inevitably forms the
resources that researchers employ throughout the research data engine that health systems put to work to
process research improvement and outcomes-driven
(1) From the individual or collaborative project initiation, questions (4) It is therefore imperative to
through refinement of the idea, selection of approaches, understand the underlying terminologies and
development of methods, capturing the data, analyzing the sources of data, communication of those connected
results, and disseminating the findings, computer pieces of information, and the elements in the
applications are an indispensable resource for the nursing environments through informatics research
researcher if one is to understand how computers and nursing
(2) The investigators must be well prepared in a variety research coexist
of computerized techniques for research activities d. Outside the EHR and computerized health systems,
as they are employed in the domain of knowledge in the rapidly changing world of Internet technologies,
that will be investigated information management, and computer-enhanced
(3) Without the power of technology, contemporary intervention research on the use of computers has produced
research would not reach the levels of a new body of science that will continue to grow
sophistication required to discover and understand (1) Blending the focus of computer use in research
health and illness today (tools and process) and research on computer use
b. In addition to the traditional approaches of the (informatics research) calls for an understanding of
scientific method, researchers today have new avenues to process and products
explore in the development of knowledge (2) This chapter will provide an overview of the
(1) New opportunities to mine existing data for research process for two separate and
evaluation and discovery are forming a bridge fundamentally different research approaches—
between the process of conducting research and quantitative and qualitative— and discuss select
the products of discovery computer
(2) New tools for automatic capture and analysis are applications and uses relative to these approaches
changing the methods textbooks (3) The discussion will be supplemented by
(3) New online strategies and apps are being examples of current science and the trajectory of
implemented as the process of researching health research on the impact of informatics, electronic
and the product of researched interventions in records, treatments, and integrated technologies
health (4) From mobile applications that are using the computer as a tool
downloadable to smartphones for researchers or e. The computer has been a tool for researchers in
patients or both, to tools for exploring large data many aspects of the research process and has gone beyond
sets that have been already captured, computer its historic application once limited to number crunching and
use in nursing has exploded concomitantly with business transactions
computers in (1) Field-notes binders, ring tablets, index cards, and
healthcare paper logs have all but disappeared in the
c. What is also of importance for computer use in researcher’s world
nursing is the research on computerized applications and (2) Personal computers (PCs), laptops, PC-tablets and
iPads, and handheld devices have become part of
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the researcher’s necessary resources in mounting a examining preoperative procedures that minimize
research project or study postoperative complications
(3) Wireless technologies are ubiquitous and connect h. With a wider view of computer use in nursing
people to people as well as researchers to devices research, the objective of this chapter is fourfold
(4) Cloud computing today connects diverse (1) To provide an overview of general computer and
enterprises with stable sources of software and software applications related to the stages of the
data that can be shared or used by anyone, at any research process
time, or any place (2) To describe how computers facilitate the work of
(5) Numerous enhancements have been added to the researcher in both quantitative and qualitative
the well-known text processing software products aspects
that reduce time and effort in every research office (3) To highlight research on computer use in
(6) In addition, a wide range of new technologies for healthcare
database management of subjects, contacts, or (4) To give attention to the explosion of research in
logistics have emerged in the research product categories delineating clinical and nursing
marketplace informatics research
(7) Nurse researchers use a range of hardware and i. These will serve as a snapshot of the research on
software applications that are generic to research computer use for the future with contextual influences
development operations in addition to the tools j. To begin, the chapter will focus on some of the
and devices that are specific to research data considerations related to the logistics and preparation of the
collection, analysis, results reporting, and research proposal, project planning, and budgeting,
dissemination (8) New apps appear continuously, followed by the implementation of the proposal with data
customized to the data collection, management, or capture, data management, data analysis, and information
analysis process presentation
f. In today’s electronic healthcare environment, (1) The general steps of proposal development,
numerous advances have been made with the sources of preparation, and implementation are applicable to
data collection relative to general clinical applications in both quantitative and qualitative approaches (2)
nursing, health, and health services However, no discussion about computer use in
(1) System implementations for large clinical research could be complete without acknowledging
enterprises have also provided opportunities for the range of
nurses and health service researchers to identify research now appearing in the literature that
and extract information from existing computer- examines the trajectory of new technologies and
based resources computer use in patient care
(2) In an era when the federal government is calling for (3) With increasing emphasis on cost and quality of
comparative effectiveness research (CER) to healthcare, the computer-sources-of-data and
address the rising costs of healthcare, the richness computer-as- intervention must be part of
of capturing nursing data that can be managed and understanding computer use in nursing research
mined for advanced analyses should be recognized today
in the development of EHRs and other sources
g. In addition, the era of Web-based applications has PROPOSAL DEVELOPMENT, PREPARATION, AND
produced a wide range of innovative means of entering data IMPLEMENTATION
and, subsequently, automating data collection in ways that
were not possible before 1. OVERVIEW
(1) With the advancements in clinical systems, accept-
able terminology and vocabularies to support
a. All research begins with a good idea
nursing assessment, interventions, and evaluation,
(1) The idea is typically based on the nurse researcher’s
computers are increasingly being used for clinical
identification of a problem that is amenable to
and patient care research
study using a philosophical and
(2) Although research is a complex cognitive process,
theoretical orientation
certain aspects of carrying out research can be
(2) The philosophical aspect sets the stage for selecting
aided by software applications
one’s approach to investigating the problem or
(3) It is noteworthy when hospital systems today can
developing the idea
use analytics across institutions with large samples
(3) Good clinical ideas often come from personal
of existing data to compare and predict best
experiences, based on the researcher’s foundation
outcomes with select interventions, for example,
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of knowledge that aids in drawing inferences from meanings ascribed to the data such as a person’s lived
real clinical situations experiences
(4) These unfold by way of iterative consideration of (1) With this view, a theory is not tested, but rather,
problem and process—leading the investigator to perspectives and meaning from the subject’s point
evolve an approach to the problem, and of view are described and analyzed
subsequently a theoretical paradigm to address the (2) For nursing studies, knowledge development is
problem generated from the participant’s experiences and
(5) Because the theoretical paradigm emerges from responses to health, illness, and treatments (3) The
these iterative considerations, and because the requirements of the qualitative approach are a
theoretical perspective will subsequently drive the function of the philosophical frames through which
organization of the research study, it is important the data unfold and evolve into meaningful
to distinguish between these two distinct interpretations by the researcher
approaches (4) A variety of software applications assist the
(6) Each theoretical paradigm directs how the problem qualitative methodologist to enter, organize,
for study will unfold frame, code, reorder and synthesize text, audio,
(7) The researcher uses a selected theoretical video, and sometimes numeric data
approach and operationalizes each step of the
research process that will become the research 3. GENERAL CONSIDERATIONS IM PROPOSAL
design and methodology, either qualitative, PREPARATION
quantitative, or some combination of both in mixed a. Several computer applications have become
methods indispensable in the development of the research proposal
(8) Each approach can be facilitated at different points and generally in planning for the activities that will take
along the proposal process with select computer place when implementing the study
applications (1) These include broad categories of office programs
(9) These will be described as they relate to the including word processing, spreadsheet, and
methodology database management applications
(2) According to Forrester Research, an independent
2. QUANTITATIVE OR QUALITATIVE METHODOLOGY research firm, Microsoft Office products currently
a. The important distinction to be made between the capture 80% of users with 64% of enterprises using
quantitative and qualitative approaches is that for a Office 2007
quantitative study to be successful, the researcher is obliged (3) Office 365 is the new release from Microsoft,
to fully develop each aspect of the research proposal before programs with cloud capability that continue to
collecting any data, that is, a priori; whereas, for a qualitative offer improved clerical tools to manage the text
study to be successful, the researcher is obligated to allow from numerous sources and assemble them in a
the data collected to determine the subsequent steps as it cogent and organized package
unfolds in the process and/or the analysis (4) The cloud connectivity gives researchers access to
(1) Quantitative research is derived from the all programs and data virtually from anywhere. PC,
philosophical orientations of empiricism and logical Mac, and Droid tablets and smartphones extend
positivism with multiple steps bound together by the reach of all connectivity with a range of text
precision in quantification processing and data management standard tools
(2) The requirements of a hypothesis-driven or b. Microsoft Office products provide capabilities and a
numerically descriptive approach are logical platform into which other off-the-shelf applications can be
consequences of, or correspond to, a specific integrated
theory and its related tenets (1) Tables, charts, and images can be inserted, edited,
(3) The hypothesis can be tested statistically to support and moved as the proposal takes shape, with final
or refute the prediction made in advance (4) products in publishable forms
Statistics packages are the mainstay of the (2) PC applications that allow inserting simple graphic
quantitative methodologist, but are not the only designs give the researcher a powerful means of
connection to computers for the researcher expressing concepts through art
b. The qualitative approaches offer different research (3) Line art and scanned images using Adobe industry
traditions (e.g., phenomenology, hermeneutics, standards such as Illustrator CC or Photoshop CC,
ethnography, and grounded theory to name a few) that now with cloud capability, can be integrated into
share a common view of reality, which consists of the the document for clear visual effects
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(4) These offer the researcher and grants managers the researcher to maintain the fidelity of the procedures,
tools to generate proposals, reports, and manage the subject information and paper flow, and keep
manuscripts that can be submitted electronically the data confidential and secure (2) These processes
directly or following conversion to portable require researchers to use a database management
document formats (pdf) using Adobe Acrobat or system (DBMS) that is reliable (3) Several DBMS software
other available conversion products applications exist and have evolved to assist the
c. There are a variety of reference management researcher in the overall process of study implementation
software products available as add-ons to word processing, (4) These applications are operations oriented,
with ranging prices and functionalities used in non-research programs and projects as well,
(1) Bibliographic management applications emerge but can assist the researcher in management of
frequently and librarians often help sort out best time, personnel, money, products, and ultimately
ways to keep reference materials in order dissemination, with reporting capability for reviews
(2) Common programs such as Reference Manager, and audits
Procite, and Endnote are products of the Thomson b. The ubiquitous Microsoft Office suite includes programs
Corporation, the industry standard software tools that manage data in a relational database (Microsoft
for publishing and managing bibliographies on the Access) and number crunch in a flat database (Microsoft
Windows and Macintosh desktops Excel) available to every researcher
(3) RefWorks adds another option for reference (1) Proprietary database applications and new
management from a centrally hosted Web site (4) customized, more sophisticated, integrated, and
Searching online is one function of these proprietary database management applications
applications, and then working between the from companies such as Oracle and Lotus provide
reference database and the text of the proposal the researcher with ways to operationalize the
document is efficient and easy, calling out citations personnel, subjects, forms, interviews, dates,
when needed with “cite as you write” capability times, and/or tracking systems over the course of
into the finished document the project (2) Most of these applications require
(5) Output style sheets can be selected to match specially designed screens that are unique to the
publication or proposal guidelines project if the research warrants complicated
d. Research applications and calls for proposals are connections such as reminders, but simple mailing
often downloadable from the Internet into an interactive lists and zip codes of subjects’ addresses and
form where individual fields are editable and the documents contact information in a generic form can also be
can be saved in a portable format such as Adobe Acrobat, extremely useful for the researcher
printed, or submitted from the Web (3) Some of these applications are beginning to
(1) The Web also allows the researcher to explore include add-ons to increase application portability
numerous opportunities for designing a proposal with devices such as the smartphones and tablets,
tailored to potential foundations for consideration and mini-tablets
of funding c. Several other generic computer programs can aid the
(2) Calls for proposals, contests, and competitive researcher in daily operations and project management
grants may provide links from Web sites that give (1) Spreadsheet applications are invaluable for budgeting
the researcher a depth of understanding of what is and budget planning, from proposal development
expected in the proposal through project completion (2) One multipurpose
(3) There are more and more homegrown submission Microsoft Office application is Microsoft Excel
procedures today for grants and journal (3) Universally understood and easy to use, Excel
manuscripts with Web-based instructions allows the researcher to manage costs and
(4) These often convert the documents automatically calculate expenses over the course of the project
to portable formats (pdf) for submission with key period, producing a self- documenting plan by
data fields organized and sorted for easier review categories to track actual spending and money left
procedures. Instructions are customized for the d. Templates can be developed for repetitive tasks
user (1) Scheduling and project planning software is also
available from Microsoft including Microsoft
Project that allows the project director to organize
4. RESEARCH STUDY IMPLEMENTATION the work efficiently and track schedules and
a. A funded research study becomes a logistical challenge for deadlines using Gantt charts over the lifetime of the
most researchers in managing the steps of the process (1) project (2) In more sophisticated research offices,
Numerous demands for information management require customized tracking and data capture devices,
programs and systems have been launched,
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including the exemplar of data management tools data capturing applications that have been
from the recent US Census that have captured and developed recently that facilitate large group data
made data available to researchers with data tools capture in single contacts or allow paper versions of
e. One other important consideration related to research questionnaires to be scanned directly into a
proposal implementation for the seasoned researcher or database ready for analysis or provided online with
the novice, doctoral dissertation investigator is the Web-based survey tools
essential step of submitting the proposal to the b. Paper and pencil questionnaires
Institutional Review Board (IRB) (1) Paper and booklet surveys do still exist today in
(1) Home institutions that have IRBs will have specific data collection, but new enhancements aid the
procedures and forms for the researcher who can researcher in time-saving activities
benefit from the proposal development (2) Surveys and questionnaires can be scanned or
electronically programmed into a computer application either in
(2) In some institutions, the IRB document a microcomputer or on a Web site accessed
management has been done through contracts through the Internet
with outside Internet organizations providing (3) Computers are being used for direct data entry in
mechanisms for posting IRB materials, managing studies where subjects enter their own responses
the online certifications required, and via a computer, and simultaneous coding of
communicating with the principle investigators response to questions and time “online” can be
f. In summary, the general considerations of developing and captured or Web surveys can be distributed widely
conducting a research study are based on philosophical (4) These online survey tools can provide a wide range
approaches and will dictate which methodology the of applications, including paper or portable
researcher will use to develop the study versions, and range in price and functionality
(1) Although this will subsequently influence the (5) The use of notebook microcomputers, tablets, and
research and computer applications to be used in mini-tablets have gained popularity in recent years
carrying out the project, the steps of proposal for allowing the user to enter the data directly into
preparation are less specific, and the computer the computer program at the time of the interview
applications are useful in both quantitative and with a subject, with innovations emerging in touch
qualitative studies screens, screen pens, and even wireless data entry
(2) After identifying the research problem, however, with smartphones
the researcher must proceed through the steps of (6) Responses to questions can be entered by the
the process, where computers play an important respondent or a surrogate directly into the
role that computer or Web site through Internet access
is unique to each of the methodologies (7) There are several research study examples where
patients with chronic conditions used a computer
THE QUANTITATIVE APPROACH application or the Internet as the intervention as
well as the data capture device; patients or
caregivers responded to questions directly and the
1. DATA CAPTURE AND DATA COLLECTION
data were processed with the same system
(8) Other examples of unique data capture in research
a. Data capture and data collection are processes that are
include individual devices such as the “Smart Cap”
viewed differently from the quantitative and qualitative
used to measure patient compliance with
perspectives
medications
(1) Nurses may already be familiar with data collection
(9) The Medication Event Monitoring System
that is focused on the management of patient care
(MEMS®6) automates digitized data that can be
(2) Patient monitoring, patient care documentation,
downloaded for analysis in research such as patient
and interview data are collected by nurses,
adherence studies
although not always for research purposes
(10) A variety of online survey tools also provide
(3) Data collection can take a number of forms
researchers the power to collect data from a
depending on the type of research and variables of
distance, without postage, using the Internet
interest
(11) These applications can present questionnaire data
(4) Computers are used in data collection for
in graphically desirable formats, depending on the
paperand- pencil surveys and questionnaires as
price and functionality of the software, to subjects
well as to capture physiologic and clinical nursing
delivered via e-mail, Web sites, blogs, and even
information in quantitative or descriptive patient
social networking sites such as Facebook or Twitter
care research (5) There are also unique automated
if desirable
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(12) Social media mechanisms such as blogs and tweets (25) Programs such as SNAP Survey software and
are often providing sources of data analyses, albeit Remark Office OMR 8 can facilitate scanning large numbers
questionably scientific, that have sometimes been of questionnaires with speed and accuracy (26) These
harnessed to extract meaning for researchers (13) products, enhanced even more with Web- based products
Web surveys, although often criticized for yielding such as Remark Web Survey, increase the accuracy of data
poorer response rates than traditional mail are entry with very low risk of errors, thereby improving the
becoming increasingly popular for their cost and efficiency of the data capture, collection, and entry
logistical benefits processes
(14) The data from the Internet can be downloaded for c. Physiologic data
analysis and several applications provide instant summary (1) The collection of patient physiologic
statistics that can be monitored over the data collection parameters has
period long been used in physiologic research
(15) Several of these programs are available for free (2) Some of these parameters can be measured
with limited use; others yield advanced products that can be directly from patient devices such as cardiac
incorporated into the research, giving mobility (e.g., monitoring of heart rhythm, rate, and fluid or
smartphones) and flexibility (e.g., scanning or online entry) electrolytes and be captured in the patient
to the data capture procedures (16) Several of these care records of the hospital systems
applications include: (3) Now that many measurements taken from
(1) Survey Monkey various types of imaging (e.g., neurologic,
(2) E-Surveys Pro cardiovascular, and cellular) have become
(3) Survey System digitized, they can also be entered directly
(4) Qualtrics from the patient into computer programs for
(5) SNAP Survey software analysis
(17) Many of these products continue to enhance (4) Each of these applications is unique to the
functionality and delivery modes as well as integration with measures, such as systems to capture cardiac
statistical analyses programs and qualitative narrative functioning and/ or pulmonary capacity,
exportability devices that can relay con- tractions, or
(18) Several special applications have been used in monitors that pick up electronic signals
nursing research that can facilitate large group data capture remotely
(19) Group use applications in specially designed (5) Numerous measurements of intensity,
facilities have been developed to engage an audience in amplitude, patterns, and shapes can be
simultaneous activity, recording their impressions through characterized by computer programs and used
electronic keypads located proximal to the users, and in research
capturing that information for display or later analysis (6) Each of these measurement systems have
(20) One type of application, Expert Choice 11.5 uses the evolved with the unfolding of research specific
analytic hierarchy process (AHP), a mathematical technique, to their questions, and within each community
with handheld keypad technology to elicit group responses of scholars, issues about the functionality,
and automatically score, analyze, prioritize, and present accuracy, and reliability of electronic data
information back to the group graphically extracted from these physiologic devices are
(21) AHP has been used as the multiple criteria decision debated
making analysis technique in nursing research studies, and (7) Along with the proliferation of clinical
the Expert Choice software allows for group data entry diagnostic measurement systems, there has
(22) This kind of groupware for collaborative decision been a rapid expansion of unique computer
making can supplement data collection from a focus group applications that have emerged for the data
to add a quantitative component to the subjective question analysis aspects of these clinical systems,
as it elicits and captures opinion via pairwise comparisons physiologic and record sources
(23) Software packages also exist that can be integrated (8) Millions of gigabytes of data are stored in
with the researcher’s scanner to optically scan a specially machines that can be tapped for multiple
designed questionnaire and produce the subjects’ studies on the existing data
responses in a database ready for analysis (9) Data mining is a powerful tool in the
(24) OmniPage 18 is a top rated optical character knowledge discovery process that can now be
recognition (OCR) program that converts a scanned page done with a number of commercial and open-
into plain text source software packages
(10) Data mining and the evolving “big data”
initiatives to make patient care data available
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introduces new ways to manipulate existing care terms for computer-based patient care
information systems systems
(11) With increased attention to CER, several (3) The clinical and economic importance of
government and private organizations are structured recording to represent nursing care
encouraging researchers to hone the was recognized by the acceptance of the
techniques to extract valid and reliable nursing minimum data set (NMDS)
information from these large data sets (4) The ANA has accepted seven systems of
(12) Data mining is a mechanism of exploration and terminology for the description of nursing practice
analysis of large quantities of data in order to
discover meaningful patterns and rules, (1) The North American Nursing Diagnosis
applied to large physiologic data sets as well as Association (NANDA) taxonomy of nursing
clinical sources of data diagnosis
(13) The nature of the data and the research (2) Georgetown Home Healthcare Classification
question determine the tool selection (i.e., (renamed Clinical Care Classification [CCC]
data-mining algorithm or technique) System)
(14) Tools and consultants exist to help researchers (3) Nursing Interventions Classification
unfamiliar with data mining algorithms to use (4) Nursing
data mining for analysis, prediction, and Outcomes Classification
reporting purposes (5) Patient care data set
(15) Many of the first commercial applications of (6) Omaha Home Healthcare
data mining were in customer profiling and (7) The International Classification of Nursing
marketing analyses Practice
(16) Today, many special technologies can be (5) The Clinical Care Classification System nursing
applied, for example, to predict physiologic terminology has been accepted by the US
phenomena such as genetic patterns in tumors Department of Health and Human Services (HHS) as
that might respond to therapy based on a named standard within the Healthcare
classification of primary tumor gene Information Technology Standards Panel (HITSP)
expression or tissue rejection post-heart Interoperability Specification for Electronic Health
transplantation from blood samples and Records, Biosurveillance and Consumer
biopsies (17) The National Institutes of Health Empowerment as presented to a meeting of the
(NIH) is undertaking several initiatives to American Health Information Community (AHIC), a
address the challenges and opportunities federal advisory group on health IT
associated with big data (18) As one (6) Although none of the above has emerged as a single
component of the NIH-wide strategy, the standard, national efforts and collaborative efforts
Common Fund in cooperation with all NIH with the International Classification of Nursing
Institutes and Centers is supporting the Big Practice (ICNP) from the International Council of
Data to Knowledge (BD2K) initiative, which Nursing (ICN) are underway to “harmonize” the
aims to facilitate broad use of biomedical big data elements in the NMDS and SNOMED CT
data, develop and disseminate analysis (Systematized Nomenclature of Medicine Clinical
methods and software, enhance training for Terms)
disciplines relevant for large-scale data (7) With a structured coding system to record patient
analysis, and establish centers of excellence for care problems that are amenable to nursing
biomedical big data actions, the actual nursing actions implemented in
d. Unique nursing care data in research the care of patients, and the evaluation of the
(1) Scientists and technologists from a variety of effectiveness of these actions, researchers can
disciplines are working hard to identify the analyze large nursing data
domain of data and information that is (8) Outcomes research and quality indicators extracted
transferable across situations, sites, or from health information systems (HIS) have
circumstances that can be captured become the data end-points that can justify
electronically for a wide array of analyses to healthcare services
learn how the health system impacts the (9) The American Recovery and Reinvestment Act
patients it serves (ARRA) of 2009 called for increased development,
(2) The American Nurses Association (ANA) has certification, and wide-range “meaningful use” of
supported the need to standardize nursing EHRs across healthcare
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(10) The federal government has incentivized consideration in the coding and analyses (14) New
development of cross-platform compatibility and versions of advanced statistical software help in these
collaboration activities
(11) Research on outcomes of care is one of the center- (15) Reviewing data for values outside of those
pieces of this massive policy that has begun to show allowable is another way of examining the data for
an impact on integrated information technologies errors
in healthcare that can transform practice (16) It can best be done by examining the multiple print-
(12) Nursing research on nursing practice captured from outs produced by the statistical software packages
standardized terminology will be essential to or procedures invoked in the statistical application
document outcomes of nursing care and by carefully perusing for outliers or artifacts
(17) Another type of data coding can be described in the
2. DATA CODING example of the process of translating data from
a. In most quantitative studies, the data for the variables of documentation of patient care using coding
interest are collected in a numerical form strategies
(1) These numerical values are entered into designated (18) Current research on coding nursing data using
fields in the process of coding (2) Coding may be inherent in standardized nursing terminology from
software programs for the physiologic data and many of the standardized codes is evident in several research
electronic surveys studies in the literature
(3) The coding may be generated by a computer program (19) In several studies by Saba and Taylor, Moss and
from measurements directly obtained through Saba, and Saba and Arnold, researchers have
imaging or physiologic monitoring, or entered into a discussed mechanisms of aggregating nursing
computer by a patient or researcher from a printout or action types, for example, assess, perform, teach,
a questionnaire or survey into a database program or manage, into aggregated information on the
(4) Most statistical programs contain data editors that amount of time or effort a nurse spends in a day and
permit the entry of data by a researcher as part of the concomitant costs associated
statistical application (20) Another application of coding data occurs with
(5) In such a situation, fields are designated and numeri- map- ping concept codes from one terminology to
cal values can also be entered into the appropriate another
fields without the use of an extra program (21) These translations of codes support the
(6) For mechanisms that translate and transfer source everevolving interoperable computer systems that
data to prepare it for analysis, generic programs such produce nursing data reports which can cross
as Microsoft Excel serve multiple needs platforms or institutions
(7) In addition to allowing simple transfers of data from
source to a statistical analysis package, Excel has its
own powerful, but simple, analysis capabilities and 3. DATA ANALYSIS
exceptionally easy to use graphic translators that can
turn statistics into visual graphs and charts a. Data analysis in a quantitative study combines a variety of
(8) Coding data is a precise operation that needs careful techniques that apply statistical procedures with the
consideration and presents the researcher with researcher’s cognitive organization of research questions,
challenges that warrant technical or cognitive results, and visual or textual information, translated into
applications tables, charts, and graphs to make the data meaningful (1)
(9) Coding data is a combination of cognitive decisions and It translates the numeric and conceptual elements of the
mechanical clerical recording of responses in a inquiry into meaningful representations of information
numerical form with numerous places for error to (2) In general, the statistical analyses are ordered
occur by the conceptual arrangement of hypotheses,
(10) There are several ways of reviewing and variables, measurements, and relationships, and
“cleaning” the data prior to analysis ultimately answer the research questions (3) There
(11) Some computer programs allow for the same data to are many ways to consider data analysis (4) The
be entered twice called double-data entry or two-pass presentation below is organized around the broad
verification types of research of interest in nursing and general
(12) This is done preferably by different people to check for research goals or questions
errors, with the premise that if the double entry does (5) The researcher may use different types of analyses
not match, one entry is wrong (13) One also must depending on the goal of research
check for missing data and take them into
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(6) These goals may require different statistical with respect to variables as well as groups of study
examinations: descriptive and/or exploratory subjects of interest
analyses, hypothesis testing, estimation of (7) Both commercial statistical packages provide the
confidence intervals, model building through ability to calculate these tests and graphically
multivariate analysis, and structural equation display the results in a variety of ways
model building (8) IBM SPSS Statistics 22 (IBM SPSS, 2010) provides
(7) Various types of nursing research may contain a the user with a broad range of capabilities for the
number of these goals entire analytical process
(8) Quality improvement, patient outcome, and (9) SPSS is a modular, tightly integrated, and
survival analysis studies may likewise contain a fullfeatured software comprised of the SPSS base
number of different types of analyses depending on and a range of add-on modules
the specific research questions (10) With SPSS, the researcher can generate decision-
(9) In general, the statistical analysis steps of the making information quickly using a variety of
research process rely heavily on the functions powerful statistics, understand and effectively
specific to a variety of statistical software present the results with high-quality tabular and
applications (10) Two of the most popular programs graphical output, and share the results with others
in use today are the IBM SPSS Statistics 22 (formerly using various reporting methods, including secure
Statistical Package for Social Sciences) and Web publishing
Statistical Analysis Services (11) SAS 9.2 provides the researcher with tools that can
(SAS Version 9.2), however a variety of other pack- help code data in a reliable framework, extract data
ages and programs exist, such as STATA or Minitab for quality assurance, exploration, or analysis, per-
17 unique to particular scientific disciplines form descriptive and inferential data analyses,
(11) Which package one selects depends on the user’s maintain databases to track, and report on
personal preference, particular strengths, and administrative activities like data collection, subject
limits of the applications including number of enrollment or
variables, options for analyses, and ease of use grant payments, and deliver content for reports in
(12) These packages have given the user the power to the appropriate format
manipulate large data sets with relative ease and (12) SAS allows for creating unique programming within
test out statistical combinations that have the variable manipulations and is often the format
exponentially improved the analyses possible in a for large publicly available data sets for secondary
fraction of time that it once took analysis
(13) The different types of analyses required by the (13) Stata 13 and SYSTAT 13 are also fully integrated
goals of the research will be addressed further (14) statistical packages with full database management
This description will be followed by examples of capabilities and a range of sophisticated statistical
types of nursing research that incorporate some of tests particularly useful for epidemiologists and
these types of analyses physical scientists
b. Descriptive and exploratory analysis (14) All of these statistical packages have evolved to pro-
(1) The researcher may first explore the data means, vide an integrated collection of tools that assist in
modes, distribution pattern, and standard aspects of research study management—from
deviations, and examine graphic representations planning to dissemination—in addition to the
such as scatter plots or bar graphs reputable statistical analyses and data
(2) Tests of association or significant differences may manipulation capabilities that they have provided
be explored through chi-squares, correlations, and for many years (15) As part of exploratory analysis,
various univariate, bivariate, and trivariate simple, binary, and multiple regression analyses can
analyses, and an examination of quartiles be used to examine the relationships between
(3) During this analysis process, the researcher may selected variables and a dependent measure of
recode or transform data by mathematically interest
multiplying or dividing scores by certain log or (16) Certain models can be developed to determine
factor values which collection of variables provides the best
(4) Combining several existing variables can also create prediction of the dependent measure
new variables (17) Printouts of correlation matrices, extensive internal
(5)These transformations or “re-expressions” or tests of data assumptions on the sample, and
“dummy-coding” allow the researcher to analyze regression analysis tables provide the researcher
the data in appropriate and interpretable scales (6) with condensed, readable statistical information
The researcher can then easily identify patterns about the relationships in question
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c. Hypothesis testing or confirmatory analyses create more realistic models than if using standard
(1) Hypothesis testing or confirmatory analyses are multivariate methods or regression alone (9) Amos
based on an interest in relationships and describing is a program for visual SEM and path analysis (10)
what would occur if a hypothesis was true (2) The User-friendly features, such as drawing tools,
analysis of data allows us to compare the actual configurable toolbars, and drag-and-drop
outcomes with the hypothesized outcomes (3) capabilities, help the researcher build structural
Inherent in hypothesis testing is the probability (P equation models (11) After fitting the model, the
value) of an event occurring given a certain Amos path diagram shows the strength of the
relationship relationship between variables
(4) These are conditional relationships based on the (12) Amos builds models that realistically reflect
variables selected for study, and the typical complex relationships because any variable,
mathematical tables and software for determining whether observed (such as survey data) or latent
P values are accurate only insofar as the (such as satisfaction or loyalty) can be used to
assumptions of the test are met predict any other variable
(5) Certain statistical concepts such as statistical e. Meta-analysis
power, type II error, selecting alpha values to (1) Meta-analysis is a technique that allows
balance type II errors, and sampling distribution are researchers to combine data across studies to
decisions that the researcher must make regardless achieve more focused estimates of population
of the type of computer software parameters and examine the effects of a
(6) These concepts are covered in greater detail in phenomenon or
research methodology courses and are outside the intervention across multiple studies
scope of the present discussion (2) It uses the effect size as a common metric of study
d. Model building effectiveness and deals with the statistical
(1) An application used for a confirmatory hypothesis problems inherent in using individual significance
testing approach to multivariate analysis is tests in a number of different studies
structural equation modeling (SEM) (3) It weights study outcomes in proportion to their
(2) Byrne describes this procedure as consisting of two sample size and focuses on the size of the outcomes
aspects rather than on whether they are significant (4)
i. The causal processes under study are Although the computations can be done with the
represented by a series of structural (i.e., aid of a reliable commercial statistical package such
regression) equations ii. These structural as Meta- Analysis, the researcher needs to consider
relations can be modeled pictorially the following specific issues in performing the
to enable a metaanalysis
clearer i. Justify which studies are comparable and
conceptualization of the theory under which are not
study (3) The model can be tested statistically in a ii. Rely on knowledge of the substantive area
simultaneous analysis of the entire system of to identify relevant study characteristics
variables to determine the extent to which it is iii. Evaluate and account for differences in
consistent with the data study quality
(4) If goodness of fit is adequate, the model argues for iv. Assess the generalizability of the results
the plausibility of postulated relationships among from fields with little empirical data (5) Each of
variables these issues must be addressed with a critical
(5) Most researchers may wish to consult a statistician review prior to performing the meta-analysis (6)
to discuss the underlying assumptions of the data Meta-analysis offers a way to examine results of a
and plans for testing the model number of quantitative research that meet
(6) Traditionally, different types of modeling programs, metaanalysis researchers’ criteria
such as LISREL or EQS are commercially available (7) Meta-analysis overcomes problems encountered in
(7) The researcher will identify latent (unobservable) studies using different sample sizes and
variables of interest (e.g., emotions) and link them instruments
to those that are observable (direct measurement) (8) The software application Meta-Analysis provides
and plan with the statistician to specify and the user with a variety of tools to examine these
examine the impact of one latent construct on studies
another in the modeling of causal direction (9) It can create a database of studies, import the
(8) IBM SPSS 22 (IBM SPSS Software Inc.) offers Amos abstracts or the full text of the original papers, or
22, a powerful SEM and path analysis add-on to enter the researcher’s own notes
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(10) The meta-analysis is displayed using a schematic applications that aid the researcher in quantitative
that may be modified extensively, as the user can data analysis
specify which variables to display and in what (12) As computers have continued to integrate data
sequence management functions with traditional statistical
(11) The studies can be sorted by any variable, including computational power, the researchers have been
effect size, the year of publication, the weight able to develop more extensive and sophisticated
assigned to the study, the sample size, or any user- projects with data collected
defined variables to facilitate the critical review (13) Gone are the days of the calculator or punch cards,
done by the researcher as the computing power now sits on the
f. Graphical data display and analysis researchers’ desktops or laptops, with the speed
(1) There are occasions when data need to be and functionality at their fingertips
displayed graphically as part of the analysis and
interpretation of the information or for more
fundamental communication of the results of
computations and analyses
(2) Visualization software is becoming even more
THE QUALITATIVE APPROACH
useful as the science of visualization in combination
with new considerations of large data from the
“Fourth Paradigm” unfolds 1. DATA CAPTURE AND DATA COLLECTION
(3) These ideas begin with the premise that meaningful a. The qualitative approach focuses on activities in the
interpretation of data intensive steps of the research process that differ greatly from the
discoveries need visualizations that quantitative methods in fundamental sources of data,
facilitate understanding and unfolding of new collection techniques, coding, analysis, and
patterns interpretation (1) Thus, the computer becomes a
(4) Nurses are currently discovering new ways to different kind of tool for the researcher in most aspects
present information in meaningful ways through of the research beginning with the capture and recording
these visualization techniques of narrative or textual data
(2) In terms of qualitative research requiring narrative
(5) Most statistical packages including SPSS, SAS, and
content analysis, the computer can be used to
STATA, and even spreadsheets such as Excel,
record the observations, narrative statements of
provide the user with tools for simple to complex
subjects, and memos of the researcher in initial
graphical translations of numeric information, thus
word processing applications for future coding
allowing the researcher to display, store, and
communicate aggregated data in meaningful ways (3) Software applications that aid researchers in
transcription tasks include text scanners, such as
(6) Special tools for spatial representations exist, such
OmniPage 18
as mapping and geographic displays, so that the
researcher can visualize and interpret patterns (4) Other devices include vocal recorders or speech
inherent in the data recognition software such as consumer priced
Dragon Naturally Speaking 12, where the
(7) Geographic information system (GIS) technology is
researcher can input the information into text
evolving beyond the traditional GIS community and
documents by speaking into a microphone without
becoming an integral part of the information infra-
typing (5) New digital recorders are also on the
structure of visualization tools for researchers
market that use sophisticated and higher cost voice
(8) GIS technology illustrates relationships,
recognition software
connections, and patterns that are not necessarily
(6) From these technologies, researchers or
obvious in any one data set, enabling the researcher
transcriptionists can easily manipulate the
to see overall relevant factors
recording and type the data verbatim
(9) ArcGIS 10 system is a GIS for management, analysis,
(7) Even iPhones and smartphones have high-quality
and display of geographic knowledge, which is
recording applications that aid the qualitative
represented using a series of information sets (10)
research capture narrative statements
The information sets include maps and globes with
3-dimensional capabilities to describe networks, (8) These narrative statements, like the quantitative
topologies, terrains, surveys, and attributes (11) In surveys, can be either programmed for use in other
summary, the major emphasis of this section has applications or subjects’ responses can be entered
provided a brief discussion about the range of directly into the computer
traditions, statistical considerations, and computer b. Qualitative data collection
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(1) Audiotaping is often used for interviews in developed specifically for the purpose of managing
qualitative studies, whereby the content is some of the mechanical tasks of QDA
transcribed into a word processing program for (7) Ethnography 6.0 gave users, a project management
analysis interface with functions to code, edit, and search
(2) The narrative statements are stored for subsequent data
coding and sorting according to one’s theoretical (8) The older nonnumerical unstructured data
framework indexing, searching, and theorizing (NUD-IST)
(3) Through analysis, categories from the data emerge software was another qualitative package
as interpreted by the researcher commonly used, now absorbed in other QDA
(4) It is important to point out that for both products (9) This program assisted the researcher
quantitative and qualitative data, the computer to establish an index of data codes and seek
application program is only a mechanical, clerical relationships among the coding categories
tool to aid the researcher in manipulating the data (10) The ease with which researchers can code and
(5) Using the Internet for indirect and direct data recode large amounts of data with the aid of
collection in qualitative studies can also provide a computerized programs encourages the researcher
vehicle for data analysis that yields a quantitative to experiment with different ways of thinking about
component as well as the qualitative analysis data and recategorizing them
(6) Computers are not only able to record the subject’s (11) Retrieval of categories or elements of data is
responses to the questions, but can record the facilitated by computer storage
number of minutes the subject was online and the (12) Newer technologies have evolved from Ethnograph
number of times they logged in and NUD-IST with improved user interfaces,
(7) Many new online technologies are providing including the latest versions of NVivo 10 (QSR,
functionality for qualitative studies: for example, 2012), MAXQDA 11, and ATLAS.ti 7
Audacity, an open source free audio recording (13) Qualitative research, like quantitative research, is
package can edit captured voice and export audio not a single entity, but a set of related yet individual
data to be analyzed; conversely, online survey traditions, aims, and methods
packages such as SurveyMonkey, can now export (14) Some individual traditions within qualitative
participants’ free text data into qualitative software research are ethnography, grounded theory,
packages phenomenology, and hermeneutics
(15) The distinguishing feature of qualitative research is
2. DATA CODING AND DATA ANALYSIS that the goal is to understand the qualities or
a. Historically, qualitative researchers have relied on essence of phenomena and/or focus on the
narrative notes, often first recorded as audio and later meaning of these events to the participants or
transcribed by a typist respondents in the study
(1) Coding qualitative text data was a time-consuming (16) The forms of data are usually the words of the
task, often involving thousands of pages of respondents or informants rather than numbers
typewritten notes and the use of scissors and tape (17) Computerization is especially helpful to the
for the development of coding and categories (2) researcher in handling large amounts of data (18)
With the advent of computer packages, the However, it must be stressed that the computer
mechanical aspects of the coding and sorting have applications aid the analysis as a management tool
been reduced rather than an analytical one
(3) The researcher must decide on which text may be (19) Synthesis of the data is still the interpretive
of interest and can use a word processing program work of the researcher
to search for words, phrases, or other markers b. Computer application programs
within a text file (1) A number of general-purpose or specific software
(4) However, this process is cumbersome and packages can be used in qualitative analysis
timeconsuming, with limited ways to aggregate text i. One package is a free text retrieval
into meaningful combinations for identifying program such as that available in a word
themes from the narrative processing program ii. Another is any
(5) Some specific software packages developed for number of standard database
qualitative data analysis (QDA) interface directly management or indexing programs iii.
with the most popular word processing software Third is a program specifically developed
packages (6) The early application program for the purpose of qualitative analysis
Ethnograph was one of the first packages c. General purpose software
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(1) Word processing programs offer a number of WhileNVivo10supportsfluid,richdata,detailedtext

features useful to the qualitative researcher in the analysis, and theory building, it also can manage
early stages of analysis documents, audio and video files as categories,
(2) The ability to search for certain key words allows attributes or nodes in visual displays that show the
the researcher to tag the categories of interest (3) structure and properties of the document (12) The
In addition, such features as cut and paste; linking latest version of NVivo 10 also allows researchers to
texts; insertion of pictures, tables, and charts; and import exported data from other applications such
the inclusion of video and audio data enhance the as the online survey tool, Survey Monkey, as well as
application bibliographic management programs, Facebook
(4) Add-on applications specific to integrating multiple and Twitter
elements help the researcher organize a range of (13) New analysis tools provide the research ways
data and materials for analysis to cluster, map and visualize text and images in
(5) These files can then be incorporated into more meaningful ways to aid the interpretive process in
sophisticated programs the qualitative analysis
(6) A comprehensive program is ATLAS.ti (Version 7.0) f. Conceptual network systems
a powerful workbench for the qualitative analysis of (1) A system known as concept diagrams, semantic
large bodies of textual, graphical, audio, and video nets, or conceptual networks is one in which
data information is represented in a graphic manner (2)
(7) It offers a variety of tools for accomplishing the The objects in one’s conceptual system (e.g., age
tasks associated with any systematic approach to and experiences) are coded and represented by a
“soft” data, such as material that cannot be box diagram (node)
analyzed by formal and statistical approaches in (3) The objects are linked (by arcs) to other objects to
meaningful ways show relationships
d. Special purpose software (4) Like rule-based systems, semantic nets have been
(1) Several software products have evolved and widely used in artificial intelligence work
improved (5) In order to view the relationships of an object in the
for the specific purpose of analyzing qualitative system, the researcher examines the node in the
data (2) Ethnograph from Qualis Research is one graph and follows the arcs to and from it
such older program, which is used after the data (6) Semantic network applications may be useful in
have been entered with a word processing program model building and providing a pictorial overview
and con- verted to an ASCII file (7) Decision Explorer offers the user a powerful set
(3) Each file can be designated by its context and of mapping tools to aid in the decision-making
identifying features using markers provided by the process for audience response activities
computer program (8) Ideas can be mapped and the resulting cognitive
(4) The researcher can have the program produce a file map can be further analyzed
that numbers each line of the narrative data (9) The software has many practical uses, such as
(5) From this line file, the researcher can begin to gathering and structuring interview data and as an
assign each line or paragraph a category aid in the strategy formulation process
(6) The researcher keeps track of the category (10) The software is primarily described as being a
definitions and is alert to dimensions that emerge recording and facilitation tool for the elicitation of
(7) Recoding can be done to provide for inductive ideas, as well as a tool to structure and
thinking and iterative comparisons communicate qualitative data
(8) Through the use of a search command, the (11) It allows the user to gather and analyze qualitative
computer program can be made to search for data data and thus make sense of many pieces of
segments by categories throughout the typed qualitative data in order to achieve a coherent
document picture of a given issue or problem
(9) NVivo 10 and XSight from QSR provide a new g. Data analysis for qualitative data
generation of software tools with multiple (1) Qualitative data analyses often occur on an ongoing
advantages for researchers basis
(10) Because qualitative research takes many forms, with data collection in a reflexive and iterative
these two applications can be selected based on the fashion (2) There is no clear demarcation of when
user’s specific methodologic goals, the nature and data collection should end and analysis should
scale of the study, and the computer equipment begin (3) The process of obtaining observations,
(11) interviews, and other data over a period of time
results in a vast body of narrative that may include
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hundreds or thousands of pages of field notes and investigator’s confidence in believing such findings
researcher memos and relationships, when in fact these may be an
(4) Although computer applications can aid artifact of the way in which the data are
considerably in organizing and sorting this mass of manipulated
data, the theoretical and analytical aspects of (6) While computer programs facilitate coding,
decision making about concepts and themes must organization of data, and preparation of the
be made by the researcher data for interpretation, they cannot replace the
(5) Researchers can only use the tools to help in thinking and decision making that is at the heart
creating composites described by methodologists of qualitative analysis
in coding levels and categorical clusters (7) As in all research, the burden of analysis and
(6) Once a researcher has determined which parts of interpretation rests with the researchers
the interviews and observations can be tagged as
categories, certain properties or dimensions can be 3. DISSEMINATION OF RESULTS
determined and coded up through levels a. While dissemination of results continues to occur by
(7) The researcher may engage in “constant traditional means such as presentations at professional
comparison,” comparing the meanings of all meetings and publication in journals and monographs,
incidents that have been similarly categorized online reporting is becoming increasingly common
(8) This process should continue until the researcher (1) Some Web sites frequented by nurses are peer-
determines that the categories are internally reviewed journals such as Online Journal of Nursing
consistent, fit with the data, and are saturated. Informatics and selected nursing articles on various
Saturation is achieved when the researcher can find Web sites such as that of the ANA
no more properties for a category and new data are (2) Nursing forums sponsored by various professional
redundant with the old nursing organizations (e.g., American Journal of
(9) Classic qualitative methods experts Strauss and Nursing, Sigma Theta Tau, and National League for
Corbin suggested that in the later stages of Nursing) often allow participants to chat online with
research, the researcher may engage in axial coding presenters or authors of certain articles on
(10) In this stage, the researcher elaborates and designated dates during scheduled times (3) Nearly
explains key categories, considering the conditions all organizations have their own Web sites (4) The
under which the event occurs, the processes that Cochran Collection has numerous centers all over
take place, and possible consequences the world through the Cochrane Collaborative (5)
(11) Another well-known methodologist, Glaser As with all publications, online as well as hardcopy,
indicated that the researcher may engage in the information accessed must be evaluated by the
theoretical sampling, which is a deliberate search users regarding appropriateness for the purpose for
for episodes in incidents that enlarge the variances which it was retrieved
of properties and place boundaries around (6) Reports to most government and some
categories (12) Using software, these cognitive nongovernment agencies require the
processes are applied by the researcher in data researcher to submit a con- verted document
analysis of narrative interviews, field notes, and online
supplementary data (7) Grant proposals submitted to the federal
h. Uses and caution government currently require online
(1) Software programs exist for qualitative research submission with conversion to PDF
that save researcher time doing file management, (8) NIH applicants are directed to a page with
reducing the manual labor of cutting, pasting, downloadable programs to convert the
sorting, and manual filing documents before submitting them
(2) They may also encourage the researcher to (9) In fact, there is a trend for all manuscripts to be
examine the data from different perspectives, submitted online for print, online, or both
recoding and reorganizing the data in different (10) Online journals continue to grow
frameworks (11) In addition, there has been a rise in the number
(3) However, one must be mindful that qualitative of open access journals that give researchers
analysis is a cognitive process, not a mechanical one more options for dissemination
(4) The essence of qualitative research is the (12) Online journals have been discussed in the
meaning and interpretation of the data within nursing and academic community with mixed
context (5) The ability of software enhancements to reception; while it allows the researcher-
generate quasi-frequency distributions and cross- consumer of articles the ability to search wider
tabulations tend to further increase the
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publicly available science, other stakeholders (1) For example, a team of researchers developed the
in the publishing and academic worlds have Personal Patient Profile-Prostate (P3P), a Web-
been concerned on the decision support system for men newly diagnosed
ramifications of this disruptive innovation with prostate cancer that assesses patients’
(13) Regardless of the method of submission and preferences prior to clinic visit and gives providers
medium for publication, the published article and patients information to aid decision making
may be incorporated into one or several online among choices of treatment
bibliographic retrieval systems (2) The studies showed that decision support was
(14) The researcher is not finished until the work is feasible with the technology support
disseminated (3) Decision regret was significantly influenced by
(15) This chapter has summarized the processes of personal characteristics and posttreatment
quantitative and qualitative research and symptoms, although the P3P was not itself
described select computerized tools that can significant on the outcomes measured in the study
assist the researcher in proposal preparation, (4) In another Web-based intervention, caregivers
data collection, data coding, data analysis, and were randomly assigned to one of two types of
dissemination for both types of research online support groups and compared to non-active
(16) The following section highlights examples for participants on their depressive symptoms,
three categories of research on computer use caregiver burden, and quality of life
and nursing informatics in (5) In this study, both types of online support groups
i. Electronic data, such as data mining reduced depressive symptoms and improved
large electronic data sets and electronic quality of life over non-active participants
nursing documentation ii. Web-based
interventions iii. Specialized computer 3. TECHNOLOGY, ELECTRONIC DATA, AND ELECTRONIC
applications in DOCUMENTATION RESEARCH
clinical a. There are several different studies that highlight using
practice electronic data and EHRs in data mining or care
(17) The examples include both quantitative and documentation b. Secondary analysis of large data sets
qualitative studies in which the nurse (1) Large public data sets are becoming more
researchers inevitably used a variety of available to
software tools in the proposal development, nurse researchers to explore health-related
data collection, measurement questions (2) The sites provide tutorials and
of variables, analysis, and dissemination activities assistance, making them more accessible for
secondary analyses (3) One data source is the
EXAMPLES OF RESEARCH STUDIES Medical Expenditures Panel (MEPS) database, a
multiyear set of large-scale surveys of families and
1. OVERVIEW individuals, their medical providers, and employers
across the United States (4) MEPS is the most
a. Computers are inextricably tied to the process of complete source of data on the cost and use of
conducting research, but there are also good examples of healthcare and health insurance coverage
research on computer use in the nursing literature (5) Another collection used by a variety of nurse
(1) Several of the following examples also describe researchers is the HCUP data from AHRQ
computerized processes for conducting (6) HCUP databases bring together the data collection
quantitative and qualitative research approaches efforts of state data organizations, hospital
(2) These examples provide focus on nursing research associations, private data organizations, and the
related to computer use and informatics as well as federal government to create a national
using computers in the process of doing the information resource of encounter-level healthcare
research data (7) It includes the largest collection of
longitudinal hospital care data that enables
2. CLINICAL INTERVENTIONS WITH COMPUTERS research on a broad range of health policy issues,
including cost and quality of health services,
medical practice patterns, access to healthcare
a. Over the past 10 years, Internet applications have been
programs, and outcomes of treatments at the
introduced into practice and tested in a variety of clinical
national, state, and local market levels
trials aimed to improve conditions for patients
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(8) The EHRs today are frequently providing source (9) Students were instructed to document the care
data for studies immediately following the interview on a laptop
(9) These hospital systems have been used in the stationed at the patient’s bedside
literature (10) Measures were developed to assess the quality of
(10) Westra and colleagues studied urinary and the care plans and the participants’ evaluation of
bowel incontinence for home health patients using the system
using EHR data to predict improvements (11) Data were analyzed, revealing a statistically
(11) In these cases, the EHR served as the data significant difference (p =.05) for the Microsoft
source (12) Figar and colleagues used a private Access care plans completed by students and a
HIS clinical documentation system to study statistically significant difference in the students’
whether captured data could predict influenza reports on using the system (p = .025)
outbreaks (12) In a follow-up field study, the system was
(13) They used a local interface terminology server, implemented on 49 students over three semesters
which provides support through data auto-coding who documented care for each patient they were
of clinical records and analyzed specific data sets to assigned to in their clinical rotations
compare the burden of influenza in epidemiological (13) Students were assessed on their care plan
weeks identified among 150,000 Health documentation and they reported usability and
Maintenance Organization members in Argentina satisfaction with the computer-based
(14) The HIS detected the outbreak two weeks before documentation system
the health department gave a national alert and (14) Results continued to show that the coded language
was useful in assessing morbidity and mortality and PC care planning method was efficient and
during the effective
2009 influenza epidemic H1N1 outbreak d. Web-based tools and interventions
c. Computerized documentation of nursing care plans (1) (1) A significant body of research has been conducted
Moss and Saba studied the utility of costing out nursing on using the Internet as a tool for conducting
care with the CCC terminology on five most commonly research, as well as studies on Web-designed
executed interventions interventions for clinical problems
(2) Using an observation study of nurses performing (2) For example, Yen and Bakken tested the usability of
routine care on an acute-care unit, investigators a Web-based tool for managing open shifts on
collected data with a specialized data collection nursing units
program entered directly into the PC database (3) A (3) Using observational and interview approaches,
total of 251 interventions were observed, coded, they evaluated a Web communication tool
and analyzed (BidShift) designed to allow managers to announce
(4) From the analysis of time spent on each entered open work shifts to solicit staff to request their own
intervention, researchers could describe the four work shifts (4) They used specialized software to
action types by average cost and percent of activity capture screens and vocal utterances as
(5) The study demonstrated the feasibility of participants were asked to think aloud as they
valuating the nursing care given to patients based completed three subtasks associated with the
on the standardized CCC terminology open-shift management process (5) After task
(6) In a randomized trial on electronic documentation completion, they were asked about the process and
of nursing care plans, Feeg, Saba, and Feeg tested their responses were recorded (6) Their data were
the quality of nursing student care planning on a managed and coded using Morae, specialized
bedside PC using a standardized nursing software developed for usability testing (7) This
terminology in a specially designed Microsoft example of qualitative research reported
Access database program (Clinical Care participants’ patterns of use and themes related to
Classification System) compared with an open-text their perceptions of usability of the communication
format type-in application with the same tool
terminology (8) In another qualitative study on electronic
(7) Students were randomly assigned to one of the two encounters using Web-based
versions of electronic nursing documentation videoconferencing, Nystrom and Ohrling
formats and interviewed two simulated patients created a series of e-meetings for new fathers
who served for all of the participants of children under one year old to “meet” in
(8) The simulated patients were interviewed about parental support groups
their symptoms: one presented with congestive (9) The technology allowed both one-on-one and
heart failure, the other with pneumonia group encounters. The fathers were
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interviewed using a narrative approach and data as demonstrated by the report by Wilkie and
content analysis was applied to the interview colleagues who evaluated the feasibility and
data acceptability of a pentablet-based software
(10) The researchers identified three categories program that assesses patients’ cancer-related
from the transcripts symptoms, the PAIN Report It®
i. Being unfamiliar and insecure talking about (2) In the study, 131 patients were able to use the
fatherhood computerized tool and reported high acceptability
ii. Sharing experiences and being confirmed iii. scores
Being supported and limited by the electronic (3) Vawdrey and colleagues pilot tested a tablet
encounters computer application for patients to participate in
(11) Andersen and Ruland studied an Internet- their hospital care
based online patient–nurse communication (4) A prototype application was developed for a tablet
(OPNC) service to support patients with computer using EHR queries and updates in real
prostate and breast cancer time
(12) Using qualitative content analysis, they (5) Patients were invited to participate in the study
examined 276 messages in a tailored Internet after consultation between the patient’s providers
support intervention over 15 months and the investigator, an attending cardiologist
(13) Two main themes emerged (6) They were given an iPad device and encouraged to
i. Concerns about physical symptoms and use the application
treatment side effects ii. Worries and (7) Structured interviews were used to test the patient
questions about treatment and follow-up engagement and the tablet usefulness of having access to
(14) They concluded that the OPNC service can patient’s own medication and hospital history
meet patients’ needs for advice and (8) Mobile technologies have also proliferated in
information, thus improving the quality of care health-related applications today
(15) In a qualitative study by Lichenstein, (9) For example, systems that support medication
McDonough, and Matura, 98 participants who management of patients with SMS texting and Webbased
selfidentified as caregivers for a person with interface programs have emerged using simple cell phones
pulmonary hypertension (PH) engaged in an and sophisticated smartphones
online discussion board posted by the (10) The MyMediHealth (MMH) is a medication
Pulmonary Hypertension Association over an management system that includes a medication scheduler,
18-month period a medication administration reminder engine, and sends
(16) Clinical variables collected were medications text messages to patient phones (11) In a review done by
and oxygen use, and years since diagnosis Schroeder, a variety of studies used computerized
(17) Thematic analysis yielded four themes: fear telephone technologies as an assessment tool specifically for
and frustration, questions and concerns, the collection of daily, self-reports of HIV-risk behaviors
someone to listen to, and moving on with life (12) The review presented advantages of applications of
(18) Results showed that caregivers of people with interactive voice response technology (IVR) to HIV- risk
PH may be ill equipped to care for their loved behavior research, including feasibility studies, assessment
one because of lack of knowledge or mode comparisons between IVR and alternative self-
psychological reporting methods, and unique findings derived from event-
distress level data analyses illuminating risk factors for unprotected
(19) In a review of Web-based cognitive behavioral intercourse on within-person level
interventions for chronic pain, researchers (13) The author concluded that these specialized
conducted a systematic review and meta- interactive, computerized voice systems are highly
analysis to quantify the intervention efficacy promising tools for various research and healthcare
for treatment of patients with chronic pain applications that should be considered more frequently for
(20) Using 11 studies from MEDLINE and other data use in HIV-risk populations
sources, the investigators found that Web- (14) Some studies that incorporate remote technologies
based interventions for chronic pain resulted in in special applications have been described in the literature
small pain reductions in the intervention (15) Mahoney reported on several mixed methods
groups compared with waiting-list control studies that describe innovative monitoring intervention
groups research with older adults and their informal and/or formal
e. Specialized computer applications in clinical care caregivers
(1) Computer-based administration of assessment is a (16) The studies were conducted in “real-world” homes
reliable means of collecting patient assessment and focused on improved ways to monitor elders, taking into
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account the goal of independence and privacy, to alert with research to support their functionality, ease of
caregivers on elders’ activities, and safety issues adoption, and efficacy
(17) In another collection of case studies, Rantz and (19) The range of innovation has been astounding as the
colleagues describe instances of technologyenhanced technologies have increasingly become less expensive,
monitoring capabilities, using sensors, alarms, and smaller, wireless, and now interconnected with cloud
environmentally embedded devices, that wirelessly computing
communicate with programmed systems for the purpose of (20) Nursing research and computers today are
detecting potential problems inseparable in bothh areas of using computers for the
(18) These and other innovations that connect research and studying the impact of computers on patient
computer technology with nursing practice have emerged care.

Computer Use in Nursing Research
https://drive.google.com/file/d/1-
38xrQdlubtPSdikNlzcfAtgb5j8MFa0/view?usp=sharing
Helpful video tutorial on using PSPP:

Learning PSPP Guide 1
https://www.youtube.com/watch?v=NqS6DTXeXC4
Helpful video tutorial on NVivo (for Qualitative Research):

NVivo 12: Introduction and what is NVivo?
https://www.youtube.com/watch?v=rnBBJDW4RhI
Helpful video tutorial on Microsoft Forms:

How to Create a Form with Microsoft Forms
https://www.youtube.com/watch?v=BOoTBzHM4fQ&t=32
6s
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Nursing Informatics

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What is nursing informatics?

What is nursing informatics?

What are some examples of technologies used in nursing informatics?

What are some examples of technologies used in nursing informatics?

FAR EASTERN UNIVERSITY- MANILA

INSTITUTE OF HEALTH SCIENCES & NURSING BATCH 2025

MODULE 1 American Nurses Association (ANA) began

a. Provision and documentation of patient

a. Use of computer technology began to f. Hospitals and public health agencies

a. Advances in relational databases, for Healthcare Information

Work flows and decisions are more informed and efficient

○ Telehealth ● Dramatic savings

A nurse needs to access a computer program easily, review a

EXTRA READINGS AND VIDEOS

Historical Perspective of Nursing Informatics

1. From Novice to Expert

MODULE 2-1 2. The development of technological system

a. Marginally acceptable performance the situation to the holistic perception of the

FROM KNOWLEDGE TO WISDOM

knowledge, and wisdom) using sample

The "Information" of DIKW Pyramid:

The “Wisdom” of DIKW Hierarchy:

● The Wisdom is the fourth and the last step of

● Hardware refers to the physical parts of the

other application software. This is why system ○ Accuracy and reliability

MODULE 3 a. Sensors - most sensitive

8. Automatically transmit selected data to saturation provides a measure of the amount of

THERMODILUTION TECHNIQUE ● These problems usually cause nurses to spend

■ Comparison of amplitude, ● Supports the information needs of the critical

CRITICAL CARE INFORMATION SYSTEMS (CCISs)

● to support the process of Physical assessment

request prescription refills or email your 3. Order entry management

● Clinical Decision Support (CDS)

Supplemental Learning for Telehealth:

Additional information on EHR:

The sample CNCP shows that the assessments are already

Evidence Based Practice refers to the process of collecting,

● Clinical practice guidelines are statements that

To have a cost effective healthcare we must determine what Notes:

BARRIERS In a nutshell, the computerized nursing care plan and

● Available at reliable websites or search engines

We can find rich evidences on E-journals

EXTRA READINGS AND VIDEOS

MODULE 5 INTELLECTUAL PROPERTY LAW

World Intellectual Property Organization COPYRIGHT LAW

WHAT IS COPYRIGHT? the appropriate government agency;

performance of employee’s DATA PROTECTION

declared and specified

against natural dangers such as official duties shall be in the

b. purposes for which they are in the preceding paragraph.

personal information speech, of expression, or of

SITUATIONS TYPING IN ALL CAPS EXTRA READINGS AND VIDEOS

1. Make each bookmark a small pictures

EMAILS AND BOOKMARKS 3. Organize the bookmarks you still need

Delay in communication can result in medical errors that’s why

The Joint Communication International made communication

Updating ourselves (healthcare professionals) are part of our

○ Violation of Professional-Patient ■ Use the most secure privacy

SOCIAL MEDIA IN THE CONNECTED AGE: IMPACT engaging and educating

networks with the eventual access information and

Saba, V. K., & McCormick, K. A. (2015). Translation of