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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 DefinitionOne 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 PracticeIn 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 ExperiencedIn the new 2001 standards for practice, the ANA makes a definitive statement about informatics competencies needed in nursing practice today.The ANA stated, Informatics competencies are needed by all nurses whether or not they specialize in nursing informatics.Problem Solving as an Organizing FrameworkThe informatics nurse specialist moves beyond the foundational competencies and into a practice specialty in which there are organized and recognized standards of practice and performance standards.In addition to standards of practice, the 2001 ANA guidelines include standards that guide the work performance of nurses who specialize in informatics.

2At 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 PlanningThe 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 DataAlthough 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 SystemsThe term clinical decision support system (CDSS) includes an array of computer-based applications that assist healthcare clinicians in the day-to-day work of patient care.The CDSS depends on computerized, standardized taxonomies.Outcomes ManagementA chapter on the use of computers in nursing practice today would be incomplete without a description of how informatics is being used to organize and implement systems for outcomes management.Discharge PlanningThe documentation of patient care usually begins with the admission assessment and ends with discharge care plan.Discharge care planning systems provide for continuity of care from the home to the hospital and back to the community, another care facility, an outpatient department, or the home. 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 life-supporting equipment.

INFORMATION TECHNOLOGY CAPABILITIES AND APPLICATIONS IN CRITICAL CARE SETTINGS

Process, store, and integrate physiologic and diagnostic information for various sourcesPresent deviations from present ranges by an alarm or an alertAccept and store patient care documentation in a lifetime clinical repositoryTrend 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 complexTime from the beginning of the end of the QRSComparison of amplitude, duration, and rate of QRS complex with all limb leadsP an T wavesComparison 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 1: Inform clinical practiceGoal 2: Interconnect cliniciansGoal 3: Personalize careGoal 4: Improve population Health

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 cost-effective 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 not minor.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 diagnosis-specific. Hence, diagnosis and treatment information categories are frequently not discreetNURSING 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 associationAmerican cancer society guidelines for screening American academy of family physiciansPATIENT 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 medscape.comInstitute for healthcare improvement

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: INTERNET-AVAILABLE 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.

Qualitative data creation, management, and analysis software.Qualitative database software Epidemiologic analysis software Chi-square calculator Students test calculator

CHAPTER 25: INFORMATICS SOLUTION FOR EMERGENCY PREPAREDNESS AND RESPONSE INTRODUCTIONThe events of September 11, 2011, catapulted the United 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 to hospitals through the health resources and services administration (HRSA). 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 home and abroad, providing credible information to enhance health decisions, and promoting health through strong partnership. As the lead federal agency for protecting the health and safety of people, also complies Statistical information to guide actions

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 providentIncreased recognition of potential value of improved clinical documentation and more collaborative team-oriented care deliveryPatient demographics the increased role of allied health professionals and growing focus on chronic disease managementMore IT savvy nurse and allied health clinical service directorsResource shortages, acute in nursing and allied health, and the need recoup RN indirect care timeSecond and third generation IT systems technologies and applications s

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 ManagementIn 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 StandardsANA 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 SystemsFor 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 professions purposes, or continue to wait in the wings, watching other industries and constituencies prosper and grow.

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 placeImplementation is the active employment 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 content, develop a favorable guide and make a choice to adopt.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 DISCOVERYDecision-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 record, and to correct information if that is warranted (USDHHS, 2003) APPLICATION AREAS: CONSUMER USE OF COMPUTERS FOR HEALTH

Information Seeking Information seeking about health is a 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 patient-provider 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 number of technologies.

ISSUES IN CONSUMER COMPUTING FOR HEALTH

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.)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 internet e-mail. This poses several problems, however. It is not uncommon for families to share a single e-mail address. Messages sent to a patient may be read by family members, resulting in possible violation of privacy.

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 will also have low health literacy, because of so much of medical terminology is dense and complex.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 Providers- the 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:Deep expertise in patient educationCultural diversity in the workplace and the strong ethic of cultural sensitivityStrong background in both patient- and community-focused researchStrong heritage of patient advocacy and patient empowermentSpecial 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 to gain the skills and knowledge needed to design, implement, and evaluate their systems.

THESE SPECIAL CONSIDERATION NEEDED:

Lay versus professional nomenclatureGeneral literacy and health literacyComputer literacy and the digital divideSpecial needs of the elderlyAccessibility 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 have much to contribute to the field.*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 application of decision theory to understand personal choice.

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 motivation about changing health and lifestyle habits. 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-makingAssessing utilities of health outcomesEnvisioning treatment optionsFacilitating data managementLinking 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, Web-enhanced, and interactive learning, cognition, electronic communications, and informatics are summarized. Models are presented and strategies suggested for meeting the educational challenges of the information age.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 and students as they acquire skills in computer literacy and knowledge of information management. 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 self-concept 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 addressed to prevent faculty disillusionment with the processCognition 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 computer-assisted learning programs designed to achieve greater mastery of content and learning than is possible with didactic instructionTesting 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 e-mail messages, transfer computer files, connect to use distant information services and databases, participate in and obtain information from special interest group mailing lists, and obtain electronic journals.Blogs/List serves/Forums/Newsgroups- weblogs sometimes called blogs or a news page began as personal journals that were frequently updated and published on the web.Synchronous Technologies- electronic meeting software is a collection of software tools to automate and improve the quality of group process and team building.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.Physical Distance Education-anytime, anywherePerspectives 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 the student enrolled in a traditional face-to-face course. Hybrid course formats have also emerged in era of learning.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 learning skillStrategies and Support for the Distance Education Faculty*Faculty presence in distance education programs*Communication with learners*Communication with an instructional team*Online course development*Assistance in course developmentDelivery of an Online Health Assessment Course- it 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 in this discussion are faculty effort and student-faculty ratios.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 IssuesFuture Trends- the consumer drive will push to meet this need for online education creating a venue of reality.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 technologies.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 advanced research.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 advanced research.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.