CHAPTER 20:

PRACTICE
APPLICATIONS

HISTORICAL
PERSPECTIVES
More than 150 years ago, Florence Nightingale spoke about critical importance of nursing

informatics in patient care.

It was more than a century after Nightingales era that computers made their appearance on the
hospital landscape.
The first hospital information systems arrived in late 1950s to the mid-1960s.
In 1965, the American Hospital Association conferences for hospital administrators signaled the
emerging move toward more clinical adaption's of such systems in healthcare.
Throughout the 1990s, expanded uses of computers evolved as nurses in keeping with the
traditions begun 100 years before Nightingale.
They used computers to improve patient care and conduct research by analyzing patient trends,
variability in practice, and outcomes of care.
Nursing Informatics: An Evolving Definition
One view of the changing nature of technology use in nursing practice can be seen through the
evolving definition of nursing informatics.
Nursing informatics supports the practice of nursing specialties in all sites and settings whether
at the basic or advanced levels.
Standards for Practice
In 2001, an ANA workgroup reviewed and revised the existing scope and standards of nursing
information practice.
The new standards (ANA, 2001) built on the previous scope and standards of practice published
by the ANA Task Force to Develop Measurement Criteria for Standards for Nursing Informatics
(ANA, 1995).
Informatics Competencies: Beginning to Experienced
In the new 2001 standards for practice, the ANA makes a definitive statement about informatics
competencies needed in nursing practice today.

 At the beginning of the new century, much was written about the reality that
information technology had become important in the delivery of contemporary
healthcare.
Nursing Documentation
Nursing documentation in the patient record has become more complex as
nursing practice has expanded.
As technology advances have become standard of care in practice.
Care Planning
The computer-based patient record facilitates the automation of the nursing care
planning process.
The benefits and the challenges of integrating computerized systems with care
planning have been extensively reported in the literature during the last decade.
Decision Making with Administrative Data
Although nursing leaders typically administer million dollar budgets and are held
responsible for their units budget.
The desirability of cost containment in healthcare was the driving force behind
the development of CLASSICA, a Norwegian decision support system focused on
financial management, resource allocation, activity planning, and budgetary
monitoring and control.
Decision-Making with Expert Systems
The term clinical decision support system (CDSS) includes an array of computerbased applications that assist healthcare clinicians in the day-to-day work of
patient care.
The CDSS depends on computerized, standardized taxonomies.
Outcomes Management
A chapter on the use of computers in nursing practice today would be
incomplete without a description of how informatics is being used to organize

CHAPTER 21:
CRITICAL
CARE
APPLICATIONS

Critical care nursing is the nursing

specialty that deals with the human
responses to life-threatening
problems. A critically ill patient is
physically unstable with real or
potential life-threatening health
problems requiring continuous
intensive assessment and
interventions.

DEVELOPMENTS
Developers of automated

approaches to information
management in critical care
settings have incorporated
complex formulas into
physiologic monitors, rapidly
analyzed small samples of gas
or fluids, maintained near
normal physiologic ranges with

INFORMATION TECHNOLOGY
CAPABILITIES AND APPLICATIONS IN
CRITICAL CARE SETTINGS
Process, store, and integrate physiologic and

diagnostic information for various sources

Present deviations from present ranges by an alarm
or an alert
Accept and store patient care documentation in a
lifetime clinical repository
Trend data in a graphical presentation
Provide clinical decision support through alerts,
alarms, and protocols
Physiologic monitoring systems typically have a modular
platform, allowing the selection
of various monitoring
capabilities to match the needs of a variety of clinical settings.

INTERPRETIVE SYSTEMS
SEARCH THE ECG COMPLEX
FOR FIVE PARAMETERS:
Locations of QRS complex
Time from the beginning of the end

of the QRS
Comparison of amplitude, duration,
and rate of QRS complex with all
limb leads
P an T waves
Comparison of P and T waves with
all limb leads

COORDINATION AND SCHEDULING

OF PATIENT CARE ACTIVITIES

The critical care flowchart is a

predominant display format for
CCISs. The goal of CCISs is to
have as much information
integrated into the system as
possible to obtain a
comprehensive picture of the
patient.

CHAPTER 23:
AMBULATORY
CARE SYSTEM:

On April 27, 2004,

President George Bush
announced a goal to
establish electronic
health records (EHRs).

THE REPORT IDENTIFIES FOUR

MAJOR GOALS, WITH
STRATEGIC SECTION AREAS
FOR EACH (DECADE 2004)
Goal
Goal
Goal
Goal

1:
2:
3:
4:
Health

Inform clinical practice

Interconnect clinicians
Personalize care
Improve population

WHERE AMBULATORY
CLIENTS ARE BEING
TREATED
As a response to increasing costs of providing
healthcare, the healthcare industry has moved away
from the expensive impatient, acute care environment
to caring for clients in various ambulatory care
setting. Other organizations that serve the
ambulatory population are faculty medical practice,
community health, prison health center, Indian health
center, Hospital-sponsored ambulatory health
services, urgent and immediate care centers, office
based surgery centers, and practices, pain
management clinics, podiatry offices, networks,
mobile clinics nurse managed centers and groups of
ambulatory care organizations.

APPLICATIONS NECESSARY IN
THE AMBULATORY
ENVIRONMENT
Ambulatory care information systems,
usually computer-assisted are designed
to store, manipulate and retrieve
information for planning, organizing,
directing, and controlling administrative
and clinical activities associated with
the provision and use of ambulatory
care services and facilities.

FINACIAL BENEFITS
Financial benefits of the
implementation of an automated
information system include a costeffective and timely bill submission
process resulting in decreased days
in accounts receivable and the
reduction of rejected claims.

CHAPTER 24: INTERNET

TOOLS FOR ADVANCED
NURSING PRACTICE

This chapter presents a variety of web-based

applications that help from the knowledge base of
advanced nursing practice. Furthermore, internet
access for wireless personal digital assistant.
(Das) and notebook, currently geographically
limited to requirements to stay with the
geographic limits of a wireless local area network
(WLAN) or physical proximity to high speed phone
lines is already being challenged by fixed wireless
broadband technology.
Wireless applications permit internet connectivity.
Wireless technology is electromagnetically safe.
Bluetooth radio technology, on which wireless
devices rely, was found to be safe and robust
even within intensive care environments other
issues surrounding wireless technology use are

BASIC AND ADVANCED

INTERNET SEARCH METHODS
Regardless of the search engine used, certain
search methodologies, if applied correctly, increase
the efficiency of retrieval of needed information.
Name precisely the information being sought. The

internet is not a book.

use a search string (one or more search terms)
rather than a single word to increase the
preciseness of a search.
Enhance search strings by Boolean or natural
language methods.

INTERNET-AVAILABLE CLINICAL
PRACTICE TOOLS

The section is divided into the

most basic components the
nursing process: assessment,
diagnosis, treatment,
outcome evaluation.

ASSESSMENT:

Assessment refers to the

systematic collection of data
needed to arrive at one
more diagnoses. Nursing
assessment is the first step
in the nursing process.

DIAGNOSIS:

Treatment is diagnosisspecific. Hence, diagnosis

and treatment
information categories
are frequently not
discreet

NURSING TREATMENT
Several internet sites are
available for those who
desire more information on
sabas
framework/structure.

PRACTIC AND TREATMENT

GUIDELINES: PROFFESIONAL
ORGANIZATION SITES

American diabetes association

American cancer society
guidelines for screening
American academy of family
physicians

PATIENT SAFETY
Patient safety is an outcome issue.

There are several safety sites. Which

are of prime importance to advanced
practice nurses.
Agency for healthcare research and
quality web morbidity and mortality
irounds, an online forum for
presentation and discussion of
medical errors.
The patient safety page of

NURSING OUTCOMES
The internet sites presented within this
section refer to standardized nursing
terminologies that either present outcomes in
a structured format or data sets that may be
used for evaluative purposes.
NOC is an acronym for the nursing outcomes

classification, a standardized nursing

terminology.
NMDS and i-NMDS are two related data sets

NURSING HOME AND

HOME HEALTHCARE
The minimum data set is a long

term care resident assessment

instrument used by the centers for
medicine and Medicaid.
OASIS (outcomes assessment
information set) measures are used
to evaluate quality within home.

OUTCOMES MEASUREMENT: INTERNETAVAILABLE BIOSTATISTICAL AND ANALYTICAL

TOOLS
Although the biostatistician measurement of
outcome variables is not a routine part of clinical
practice, it is likely to assume an important role
when new programs or initiative are begun.
1. Qualitative data creation, management, and
2.
3.
4.
5.

analysis software.
Qualitative database software
Epidemiologic analysis software
Chi-square calculator
Students test calculator

CHAPTER 25:
INFORMATICS SOLUTION
FOR EMERGENCY
PREPAREDNESS AND
RESPONSE
INTRODUCTION

States into the realization that the country was not

adequately protected from terrorism. Anthrax outbreaks
stressed the public health infrastructure to the point that
bioterrorism arose as an individual additional threat. Early
response by the informatics community focused in
contributions toward surveillance of threat detection. The
purpose of this chapter is to explore current and share roles
of informatics in emergency preparedness and response.
Changes in the federal system affecting emergency
preparedness and response: A new definition of community;
Community health has traditionally been defined in the
United States as the provision of healthcare outside the
hospital infrastructure. The public health departments have
been viewed as the major delivery system of
healthcare.unfortunately, over the public health infrastructure
has been deteriorating to the point that many of the rural
health department settings did not even have a fax machines
to receive notices about potential public health threats.
Federal funds were channeled through the centers for disease
control prevention (CDC) to the states in order to strengthen
the public health infrastructure. Federal funds were directed

Both funding agencies encouraged the development of systems

that Would intersect one another. Local agencies also began to
work together. Reporting systems that had traditionally only been
used within a hospitals in the area in a futile attempt to locate
their family members. Healthcare members in st. Louis wanted to
make certain this did not happen to their community. As a result,
they developed a bar code system to log and track their victims
(Hamilton, 2003). Unfortunately, not all communities have
advanced to an electronic system of data management for
healthcare professionals. Federal Responsibilities for Healthcare
providers . The us department of health and human services
(DHHS) is responsible for the education of healthcare
professionals in preparedness for emergencies, including
potential terrorism. The organization of the new department of
homeland security(DHS)caused some confusion about whether
education for emergency planning and response of health care
professionals would remain within DHHS or more to other first
responder training activities already instituted by the federal
emergency management agency(FEMA) New Visibility of CDC
Promotes informatics solutions CDC is recognized as the lead
federal agency for protecting the health and safety of people-at

Hospitals, emergency medical services system, and poison

control system, to response to incidents requiring mass
immunization, isolation, decontamination, diagnosis, and
treatment, in the aftermath of terrorism or other public health
emergencies. -Other Changes Affecting Emergency
Preparedness And Response Competency-Based Learning And
informatics Needs The American college of emergency
physicians (ACEP)formed a nuclear, biologic, and chemical task
force to evaluate the status of bioterrorism training in the
united states, identify barriers to this training, and offer
recommendations for effective education. The ACEP report was
welcomed by the healthcare community as a starting point for
mass casualty education. -Informatics and Volunteerism The
federal government does have a system by organizing by
organizing teams that are willing to travel to other regions of
the country in the event of an emergency these teams are
called disaster medical assistance.

CHAPTER 26:
VENDOR
APPLICATION

ADMISSION
ASSESSMENT

Physicians perform history and physicals on patient

admission.Physicians can enter medical orders directly
online via authorized designs RNs and clerks. In the manual
systems, physicians orders are separate from orders of
other care providers. A confluence of factors is driving
current heightened interest in standardized nursing and
multi interdisciplinary care and documents including:
A new organization model with a single clinical executive
overseeing all clinical service provident
Increased recognition of potential value of improved clinical
documentation and more collaborative team-oriented care
delivery
Patient demographics the increased role of allied health
professionals and growing focus on chronic disease
management
More IT savvy nurse and allied health clinical service
directors

CHAPTER 27:
ADMINISTRATIVE
APPLICATIONS OF
INFORMATION
TECHNOLOGY FOR
NURSING MANAGERS

NURSING MANAGEMENTS
ADMINISTRATIVE NEEDS
In 2002, the American Healthcare Association (AHA) commissioned

PricewaterhouseCoopers (PwC) to survey some of the American

hospitals about their patient care and paperwork experiences.
The rapid proliferation of nursing information systems compels
nursing to face the vast challenge of learning and working within
the age of technology.
The two levels of nursing administrators: nurse managers and nurse
executives.
Applications and Implications of Information Technology for Nursing
Management
In the 1980s, nursing IT education-what little there was of it-taught
the use of computers as tools for word processing, spreadsheet
analysis, graphics production, and statistical applications.

Definition of a Nursing
Information System

In todays information age, nurses are expected to keep pace

with rapidly advancing technology.

Nurse Managers and nurse executives must collect and analyze
large amounts of data.
The Need for Nursing Data Standards
ANA established the Nursing Information and Data Set Evaluation
Center (NIDSEC) to create and disseminate standards for
information systems.
The NIDSEC standards apply to four aspects of nursing data sets
and the systems that contain them-nomenclature, clinical
content, clinical data repository, and general system
characteristics.
The Future of Computerized Nursing Administrative Systems
For nursing, technology is both a solution to short-term problems
and the foundation of a long-term vision. In other words,
technology is critical.
Nursing can either embrace technology and bend it to the

CHAPTER 28: TRANSLATION

OF EVIDENCE INTO NURSING
PRACTICE: EVIDENC, CLINICAL
PRACTICE GUIDELINES, AND
AUTOMATED
IMPLEMENTATION TOOLS
-FUNDAMENTALS OF CLINICAL
PRACTICE

As the starts of a new millennium

quality and cost issues drive the
direction of change in healthcare.
We are heading towards diffuse
information networks and
infrastructure. Information system
can provide ability to access the
needed information at the
appropriate time and place

guideline to promote effective and efficient care

in order to improve patient outcomes .
Effect of Guidelines the ability of guidelines to
improve the quality of care depends on what
evidence is incorporated with the guideline and
the implementation of that guideline into
practice. The nature of implementation studies is
shifting.
Putting Nursing Guidelines into Practice: Finding
what works Quality improvement finding
guidelines and other quality tools is most likely
believed and sustained over a long period when
there is ongoing commitment from leaders to
manage charge productively. Guideline
implementation has long been recognized as a
global process that is best promoted when users
have time to gain awareness to the guideline

Computers as a Tool to Facilitate Evidence

Based Practice and Guideline Implementation
Nursing Role in Automated Tools This role
increasingly appear in published literature, and
it is obvious that many new roles are involving.
Publication have covered a diverse range of
topics, the integration of IT with without
management, coding and taxonomy issues
relevant to outcomes including standardized
language and other issues tied to the nursing
minimum data set, and the development of
nursesensitive outcome measures. Guideline
developers do not readily know where to turn
when seeking nurses involvement.

CHAPTER 29: DATA

MINING AND
KNOWLEDGE
DISCOVERY

Decision-making in
healthcare is a
knowledge-intensive
activity that may surpass
the ability of the human
cognitive processing.

INNOVATIVE APPROACH TO
INFORMATION MANAGEMENT
IN HEALTHCARE
The move toward integrated health

systems and the tracking of data

from cradle to grave has highlighted
the need for a method by which the
vast amounts of data being collected
can be analyzed and visualized.

DIFFERENTIATION OF
VERIFICATION VERSUS
DISCOVERY APPROACHES
How traditional approaches are

different from current statistical

models based on regression possibility
of in-depth analysis but may require
used assumptions about and
interdependence of data or errors.

BACKGROUND OF KNOWLEDGE
DISCOVERY IN LARGE DATA SETS

Analyzing large data sets in the

quest to find nuggets of useful

and interesting patters of
information has been labeled
with many different titles.

THE USE OF BAYESIAN

NETWORKS IN HEALTHCARE
BNs have emerged in recent years as

a powerful data mining technique for

handling uncertainty in complex
domains and a fundamental
technique for pattern recognition and
classification (Heckerman1996: Pearl,
1998)

CHAPTER 30:CONSUMER
AND PATIENT USE OF
COMPUTERS FOR
HEALTH

Consumers of health services

(patients, families, and family
caregiver) are educating themselves
on all aspects of health, wellness,
and disease. Today, patients and
families expect to be partners in
care, evaluating with their caregivers
the implications of in care, evaluating
with their caregivers the implications
of the diagnostic tests and the
ramifications of treatment modalities,
including costs and effectiveness.

Health Insurance Portability

and Accountability Act (HIPPA)
Privacy Rule grants specific
rights to family members and
patients regarding their health
information.
*Patients must be made when
their record is shared outside of
pre specified boundaries, and
patients must be granted the
ability to view their medical

APPLICATION AREAS:
CONSUMER USE OF
COMPUTERS FOR HEALTH
1. Information Seeking Information seeking about health is a
2.

3.

4.

5.

common use of computers by patients and consumers.

Communication and Support e-mail continues to be the
killer app of the Internet and it is very useful for health-related
matter. People may communicate and inform their families about
their health status.
Personal Health Records- even though patients medical
records are more available to them now, thanks to HIPPA Privacy
Rule, many consumers are daunted by the size, complexity,
eligibility, and sheer number of institutionally-based medical
records that accumulate over a persons lifetime.
Decision Support- a broad range of decision- support is available
to the interested consumer. Some applications offers advice for
follow-up depending on the information entered.
Disease Management- technological support for joint patientprovider collaboration in disease management is a promising
application area, though not yet widespread. Patients or family
caregivers are enrolled in a program and participate using one of a

ISSUES IN CONSUMER
COMPUTING FOR HEALTH
1. Variability in Quality of Information Available to

Consumers- because there are no quality control of the

content of health information available on the internet, health
professionals have been concerned about the influence of
unreliable information on consumer and patient behavior.
Research shows that the fears may be unfounded . Ferguson
observed that although both health professionals and patients
are concerned with the quality information available on the
World Wide Web, patients are less so. They claim that the web
is no more dangerous medium than is print information, or
even verbal information dispensed by well-meaning but
occasionally incorrect healthcare professionals. (Ferguson,
2002 c , d.)
2. Lack of Security in Internet-based Transactions- there is
a great demand from consumers to communicate with their
healthcare providers online. Clinicians sometimes offer their
patients the ability to communicate with them via open

3.

Uneven Accessibility across Age, Ethnic, and

Socioeconomic Groups : The Digital Divide-from the
time that statistics were first gathered by internet usage,
it was apparent that internet users were not
representatives of the population at large. Surveys shows
that internet users are better educated, wealthier,
younger, urban, and largely White (Harris Interactive
2003,2004). Although the demographics of internet users
are slowly changing, there persist was has become known
as the Digital Divide. This is a matter of concern to health
providers and public health officials, because poorer,
minority, and older populations have more health
problems, and are the very once who could benefit from
internet-based healthcare applications.
4.
Educational and Cultural Barriers- even among
those have access to the internet, factors such as literacy,
language preference, and cultural background can be
barriers to use of the internet for health. The 1992 Adult
Literacy Survey found out that up to 47% of adults were
functionally or marginally illiterate, and up to 66% of
adults age of 60 and up are inadequate or marginally
skills. It is generally accepted that person with low literacy

Physical and Cognitive Disabilities- 38% of persons

with disabilities went online, 20% said their disability
makes using the internet difficult. Yet the internet has
enormous potential to assist the homebound and
disabled.
Impact on Relationship with Healthcare Providersthe knowledgeable patient is no longer dependent on
the clinicians advice, and, in fact, may challenge it. The
empowered patient wishes to collaborate in the
clinicians care, and wants to be treated respectfully as
a fully-pledge partner in achieving mutually agreed on
goals. Some clinicians welcome the new partnership,
believing that better quality, lower-cost care will result.
Others have a most difficult time adjusting to the power
of shift and would rather not deal with patients who will
not accept their recommendations at face value.

THE NURSE INFORMATICIANS ROLE IN

CONSUMER AND PATIENT COMPUTING
Scopes and Standards of Nursing Informatics Practice- a

technology that so impact s patients and consumers health

decisions should be a central focus of nurse informaticians .
Areas of Nursing Expertise that can be Applied to
Consumer/Patient Computing- nurses bring unique skills to the
arena of consumer informatics by virtue of their professional
education in nursing. Among these skills:
1. Deep expertise in patient education
2. Cultural diversity in the workplace and the strong ethic of cultural
sensitivity
3. Strong background in both patient- and community-focused
research
4. Strong heritage of patient advocacy and patient empowerment
.Special Considerations in Designing Applications for Patients
and Consumers- nurse informaticians who have designed and
implemented applications for health professionals to use should be
aware of the special considerations required in applications for
consumers and patients. They may need to seek further education

THESE SPECIAL CONSIDERATION

NEEDED:
1.
2.
3.
4.
5.

Lay versus professional nomenclature

General literacy and health literacy
Computer literacy and the digital divide
Special needs of the elderly
Accessibility to persons with disabilities

*The field of consumer health informatics, though

young, is broad and multifaceted. It does not
belong to anyone discipline, but draws on the
expertise of a variety of health, science, social,
and technical fields. Armed with the additional
knowledge of special considerations in designing,
implementing, and evaluating applications aimed
at patients and consumers, nurse informaticians

CHAPTER 31:
DECISION SUPPORT
FOR CONSUMERS

Quality of healthcare demands that

patients assume increasingly central
and active roles in personal health
promotion and disease
management. Patients who are more
informed and knowledgeable about
clinical and quality of life (QOL)
aspects of their disease and
treatment are more likely to have
increase satisfaction with their care
process and treatment outcomes.

Health Related Decision-Making- is challenging for

patients for several reasons.
Decision-making is a complex, perceptual, cognitive, and
social process.
Health-related decision-making is complicated because the
substance of the problems and choices is itself complex and
exceeds the knowledge and education of most laypersons.
Health-related decision-making is complex because it is
generally involves more than a single person.
Shared Decision-Making and Informed Choice- shared
decision-making advocates that patients are best able to
determine which values should govern their care. It is also
the concept of evidence-informed choice. Informed consent
has been an establish practice that involves the patient
acknowledging that they have received an adequate
information to assent to the care that is recommended by
the clinician.
Patient Preferences- attention to patient preferences as
an input into healthcare decision-making is rooted into the

Efficacy of Decision Aids-decision aids for providing

information regarding treatment options and health states

leading to the elicitation of patient preferences have been
developed to provide assistance to patients who are facing
complex healthcare decisions.
Points in Decision Support System Intervention- DSS
have introduced at several types of intervention points. The
most commonly deployed systems are those that are used
when the patient has entered an acute phase of a
disease.Acute disease decision support system- DSSs
that are employed in the support of acute disease states
typically are narrowly focused on supporting the patient by
providing for their informational and preference
determination needs regarding a single episode of treatment
choices. Chronic disease management decision
Support System- chronic disease such as multiple sclerosis
(MS), HIV/AIDS, amyotrophic lateral sclerosis (ALS), asthma,
cancer, and hypertension are present at significant and
growing rates in many of the countries around the world.
Decision-making to Promote Health Behavior
Change- several behavior of health behavior change
provide insight into individuals decision-making and

 Decision Support in Screening for Latent Health

Conditions- the advent of a wide variety of new medical
technologies has enabled the screening for the presence of
latent diseases or health problems ranging from genetic
testing for mutations of different kinds of diseases.
Computer Technology and Patient Decision-making
1. Assessing utilities of health outcomes
2. Envisioning treatment options
3. Facilitating data management
4. Linking preferences with Treatment decision
*Decision-making and choice in healthcare is shaped by
three important trends: recognition of both the value and
limits of science as guide for care, a philosophy of care
management that emphasizes the standards and
coordination, and growing importance of the patient as the
key participant in selecting and implementing clinical
treatment*

CHAPTER 32: THE

NURSING CURRICULUM
IN THE INFORMATION
AGE

This chapter presents nursing

education within the context of
rapidly evolving and deploying
information technology within
education. Curriculum implications
including faculty development, Webenhanced, and interactive learning,
cognition, electronic
communications, and informatics are
summarized. Models are presented
and strategies suggested for meeting
the educational challenges of the

Information Management- the management of

information is and will continue to become one of the most
daunting challenges for faculty, students, and nurses.
Maintaining currency with the technology as well as with
dramatic changes within the education system as a result of
digital technology will occupy the energies of faculty and
administration. Educational Environment- a discussion of
the process of education in the context of IT and information
management necessitates inclusion of educational
environment to promote the delivery of curriculum content.
Supportive Infrastructure- the educational and curriculum
goals of nursing education are forced by the nature of
information technology to operate within an infrastructure
that shares and supports access to available technology and
technological innovations.
Centralized Resources- with the availability of
interconnectivity of both internet and intranet capability,
schools are in a position to develop the share resources with
other departments and divisions in an academic setting.
Collaboration- the development of interdisciplinary courses
and cross-fertilization of experiences can benefit both faculty

Faculty Development- for faculty development to be

successful at integrating information technology into the
curriculum, they must be sensitive to both faculty interests
and time limitations.
Barriers to Faculty Development- integration of IT into
curriculum forces major changes within an organization
and its individuals. As with any change, driving and
restraining forces exist that impact on the integration of
innovation.
Effective Responses integrating information
technology can create a potential threat to faculty selfconcept in a variety of ways. Proposing that an educator
needs to learn new media for teaching implies that the old
way is not optimal.
Competing Demands- integration of IT into the
curriculum is a time-intensive process. A realistic
assessment of this time variable and the impact of
information technology on faculty workload need to be

Cognition and Information

Technology- it is essential to emphasize
both the content taught and the delivery
method. With the complex clinical practice
environment of the next millennium, it is
anticipated that nurses will face the
escalating information management
challenges as well as require psychomotor
skills to use over-changing technology in
their nursing practice.

Nursing Education and The world Wide Web

(WWW)-nursing education is being conceptualized
by the increasing use of online instruction. The
number of traditional college-age student has
decreased while the nontraditional part-time student
who works and has family obligations has become
the norm for the most programs. Multimedia, with
its ability to deliver text, full color, graphics, sounds,
videos, and animation provides an excellent example
of how learning can be enhanced by computer-based
system. CD-ROM/DVD ,as teaching-learning tools
for clinical nursing education incorporate multimedia
capability, portability and large storage capacity.
Interactive CD-ROM Programs/Simulation
Software, self-study modules/interactive CD-ROM
programs and simulation software are computerassisted learning programs designed to achieve

Testing System- although computer

literacy is not essential for taking the test ,
student familiarity and comfort with
computer adaptive testing prior to taking the
licensure exam are helpful to decrease
anxiety levels and improve computer literacy.
Electronic Communications- the internet
with the www as a platform offers access to a
host of information and communication
resources for student educators. Multiple
benefits include the ability to exchange email messages, transfer computer files,
connect to use distant information services
and databases, participate in and obtain

Blogs/List
serves/Forums/Newsgroupsweblogs sometimes called blogs or
a news page began as personal
journals that were frequently
updated and published on the
web.
Synchronous Technologieselectronic meeting software is a
collection of software tools to
automate and improve the quality

CHAPTER 33:
ACCESSIBLE,
EFFECTIVE DISTANCE
EDUCATION ANYTIME,
ANYPLACE

PROGRAMS FOR DISTANCE

LEARNING ARE EXPLODING,
ESPECIALLY INTERNET COURSES.
Distance Education-differs from the traditional classroom in two

essential elements.
1. Physical Distance
2. Education-anytime, anywhere
.Perspectives of Distance: The Past and Present- in the past,
schools and educators needed an excuse to develop and conduct
education at the past. Today, the term distance education is
associated with the learner accessibility, whether learning is
experienced locally or globally, at home, a dormitory, or in a
workplace, regardless of a rural or urban setting, across the state
lines, and even internationally.
.The Evolution of Distance Education- distance education has
experienced bumps and surges of acceptance with the evolving
presence of print, audio, TV, and the various computer-interactive
technologies.

Correspondence and Radio Courses- although it can be

said that distance education is new, the earliest form began
in the 19th century as correspondence courses in Sweden.
Telephone, Television, and Satellite Courses- in
distance education have been termed as moving from plain
old telephone service (POTS) to pretty new amazing stuff
(PANS). Audio conferencing used telephone handsets,
speaker, phones, and an audio bridge to collect multiple
phone lines.
Computer Technology and the Internet- computer
technology came slowly to the forefront of distant
education, and then its use exploded. CBE- computer-based
education, CAI- computer assisted instruction, and
computer-managed instruction, were implemented
cautiously, like so many other types of technologies used
for distance education to supplement traditional classroom
courses. In Web-enhanced course, the instructors may use
online modules, electronically provide required handouts or
printed materials, and may use a synchronous and
asynchronous chats to extend the learning experience for

Educational Consortiums- numerous

consortia are present across the US with state
or multistate membership to promote distance
education.
Educational Electronic Platforms- it is an
electronic product that assists the delivery of
internet courses.
Strategies and Support for the Distance
Education Learner
*Principles and Evaluation Criteria
*The role of faculty will change
*Importance of orientation
*Importance of communication
*Importance of communication and
Flexibility
*Student development of self-directed

*Faculty presence in distance education

programs
*Communication with learners
*Communication with an instructional team
*Online course development
*Assistance in course development
Delivery of an Online Health Assessment Courseit is commonly included in a baccalaureate nursing
program. The student is expected to take a health
history and perform a physical examination on a client,
whether peer or paid actor.
*Faculty Workload- the increase of faculty workload,
the instructional costs, especially during the initial
phases, will increase.
*Assignment type for Course Preparation- at least
1 semester of preliminary course planning is important
to alter teaching methods and modify instructional
materials for distance education.
*Online course management two factors important

Legal, Ethical, and Copyright Issues- the faculty

are accountable for any kind of educational endeavor,
including for the distance learning. Legal concern
relate to established laws associated with
telecommunication technologies, whereas ethical
concerns relate to the rights and wrongs stemming
forms the values and beliefs of the various users of
the distance education systems.
Further research for distance Education- has
focused on comparing traditional and distance
educations instructions.
*Professional socialization- after the completion of
the online academic of students, they think and
perceive the profession differently.
*Faculty and Student Interaction as well as
critical thinking*Gender and environment Issues
Future Trends- the consumer drive will push to
meet this need for online education creating a venue

CHAPTER 34:
INNOVATIONS IN
TELEHEALTH

The future of humanity is inextricably

linked to technology. says John L.
Petersen (2004), president of the
Arlington Institute.
The Concept of Telehealthproviding
healthcare and education at a distance is not a
newphenomenon.
Telecommunications it is the use of wire,
radio, optical, or other electromagnetic
channels to transmit and receive signals for
voice, data and video communications.
Progression of Telehealth Applications
for the last century, telehealth applications
have evolved from simple communications to
sophisticated pervasive and ubiquitous systems
in the home that make use of wireless,
wearable, robotic, and multisensorial

Applications for Advanced

Practice:Transforming the Practice of
Healthcare healthcare is undergoing evolution
due to major societal changes and the need to
provide access to quality and cost-effective care.
Applications for Advanced
Practice:Transforming the Way We Learn
web-based educational programs the way
consumers and healthcare providers learn.
Computer-based education programs are becoming
an effective method to present information and
improve outcomes.
Applications for Advanced
Practiced:Transforming How We Conduct
Research the decoding of the human genome in
February 2001 showcased the central role IT play in

Applications for Advanced

Practice:Transforming the Practice of
Healthcare healthcare is undergoing
evolution due to major societal changes and
the need to provide access to quality and costeffective care.
Applications for Advanced
Practice:Transforming the Way We Learn
web-based educational programs the way
consumers and healthcare providers learn.
Computer-based education programs are
becoming an effective method to present
information and improve outcomes.
Applications for Advanced

Challenges and Issues

*legal issues concerning telehealth are licensure
and liability and malpractice.
*licensure is a key impediment to the growth of
telehealth.
*ethical issues concerning telehealth are
privacy, confidentiality and security.
*privacy data security exists when data are
protected from accidental or intentional disclosure
to unauthorized persons and from unauthorized or
accidental alterations.
*confidentiality status accorded to data or
information indicating that it is sensitive for some
reason and therefore it needs to be protected
against theft, disclosure, or improper use, or both,
and must be disseminated only to authorized
individuals or organizations with a need to know.

*data security the sum of measures that

safeguard data and computer programs from
undesired occurrences and exposure to accidental or
intentional access or disclosure to an authorize
persons.
*system security security enable the entity or
system to protect the confidential information it
stores from unauthorized access, disclosure or
misuse, thereby protecting the privacy of the
individuals who are the subjects of the stored
information.
*public policy the WGA discovered that state
policy makers failed to consider telecommunication
needs across various state activities, resulting in
missed opportunities for cost-sharing and reducing
redundancy in states networks.