Chapter 13
Technology in Education
The Information Age
A period in history characterized by:
• Growth of technology
• Information explosion
The Information Age
Impact on teachers and learners:
• Learning has become a shared
responsibility.
• Teacher has taken on the role of
facilitator.
The Information Age
Impact of Information Age technology on
education:
• Greater access to educational programs
• Access to a world-wide audience
• Interactive learning opportunities
The Information Age (cont’d)
Trends:
• Establishment of standards
– e-Health Code of Ethics
– Criteria for evaluating Web sites
• Development of new field of study
– Consumer Informatics
E-Health Code of Ethics
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Candor
Honesty
Quality
Informed Consent
Privacy
Professionalism
Responsible partnering
Accountability
On-line Healthcare Education
• World Wide Web (WWW)
• Internet
Internet
• Global network of computers
• Designed to create and exchange
information
• Commissioned in 1969
Internet-based Communication
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•
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•
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E-mail
Chat
Listserv
Newsgroups
Discussion Boards
E-Mail
Advantages:
• Easy to use
• Can be used any time, day or night
• Low cost
• World-wide access
• Provides a written record
Chat (cont’d)
Disadvantages:
• Moves very quickly
• May be difficult to follow
• Requires everyone to be on at the same
time
E-Mail (cont’d)
Disadvantages:
• Messages lack context
• Takes time to complete an interaction
• Legal issues related to the written
record created
• Privacy cannot be assured
Chat
Advantages:
• Allows for real-time discussion
• Widely accessible
• Provides a mechanism for information
exchange
Electronic Discussion Groups
Broad category covering many formats of online discussion.
Advantages:
•
•
•
•
•
•
Means of networking
Vehicle for information exchange
Can be used to provide on-line support
Easy to use
Low cost
Anonymity
Electronic Discussion Groups
(cont’d)
Disadvantages:
• Few checks for accuracy
• Can be time-consuming
• May result in e-mail overload
World Wide Web
(WWW)
•
•
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•
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“Virtual Space” for information
Component of the Internet
More than 1 billion Web pages
Text, graphics, audio, and video
Released in 1989
Health Information on the WWW
• Designed for consumers and healthcare
professionals
• Averages over 22 million hits per month
• Used by over 52 million Americans per
month
• Wide range of sites providing a variety
of services and types of information
Pew Report on Web Use
Approximately 21 million Americans have used
Web information to:
• Make decisions about how to treat an illness
• Decide whether to seek a healthcare provider
• Identify questions to be answered
• Decide to seek a second opinion
Nurse Educators and the WWW
Recognizing the influence of the WWW
nurses should:
• Assess client’s use of the WWW
• Clarify information found by clients
• Share resources
• Create Web-based resources
• Teach information literacy skills
Professional Networking
• Communicate with colleagues worldwide
• Stay abreast of standards of care and
standards of practice
• Organizing and delivering healthcare provider
assistance, pharmaceuticals, and medical
supplies in times of disaster
• Providing care in times of disaster
Digital Library Basics
– Knowledge-based digital database
–Index to published literature
–Focus on a given area (e.g., health sciences,
business, history, government, law, ethics)
–Specialized by number & type of resources
indexed; span of years indexed; words
database uses to describe resources for
searching
– Factual digital database: replace reference
books with searchable and updatable online
information (e.g., drug and lab manuals)
Digital Library Basics (cont’d)
• Library vendors sell database bundles (e.g.,
EBSCO, Ovid).
• Index system used to file or catalog references
• Electronic databases searchable by different
attributes such as title, author name, year
• Keywords used for searches
• Federated search: searching more than one
database at a time
Personal Reference Manager
• Database software that allows user to create
a personal collection of citations
– Export feature on most library database
interfaces
– Examples: EndNote, ProCite, RefWorks
• Efficient means of managing citation
information
• Also available free online: Zotero, CiteULike
Library Guides and Tutorials
• Guides and tutorials important due to rapid and
continual changes in technology for library resources
• Librarians: most efficient way to develop/improve
library competencies
• Subject headings: standardized terms for indexing or
catalog referencing
• MeSH Terms: controlled vocabulary terms used to
index materials in PubMed and Medline databases,
CINAHL
Question
Is the following statement True or False?
• Knowledge-based digital databases are
designed to replace reference books with
searchable and updatable online information.
Answer
• False
– Knowledge-based digital databases focus
on a specific area; factual digital databases
focus on replacing reference books with
searchable and updatable online
information.
Library Guides and Tutorials (cont’d)
•
Search interface: search features vary for each library
vendor
– Familiarity of how vendor handles Boolean terminology
– Truncation (to search for spelling variations), wildcards,
asterisk, question mark (to replace single unknown
character or letter anywhere in the word) used with some
search engines
– Some allow restriction to peer-reviewed articles in
scholarly journals, articles with references, articles with
abstracts, research, or full text
Bibliographic Databases for Nursing
• Cumulative Index to Nursing and Allied
Health Literature (CINAHL)
• MEDLINE/PubMed
• Cochrane Library
• PsychINFO (see Tables 12-2 and 12-3)
CINAHL
• Citations and abstracts for over 500 nursing
journals and 400 allied health journals from 1982
to now
• CINAHL Plus: selected full-text documents in
addition to citations and abstracts
• Use Library of Medicine medical subject
headings (MeSH)
Question
Which of the following refers to the use of
spelling variations when completing a search
with a search engine?
a. Wildcard
b. Question mark
c. Truncation
d. Boolean term
Answer
c. Truncation
• Truncation is used to search for spelling
variations. Wildcards, such as asterisk or
question marks, can be used to replace an
unknown. Boolean terminology involves the
use of and, or, or not.
Healthcare Professional Information &
Health Literacy
• Necessary for lifelong learning
• Need:
– Domain knowledge
– Clinical experience
– Functional understanding of search skills
– Ability to analyze and integrate knowledge and
apply it to practice
Quest for Knowledge
• Questioning practice; recognizing need for
information
• Searching for appropriate evidence (systematic
and comprehensive process)
– Select appropriate library databases
– Identify search terms
– Search results (use most current citations [within past 3
to 5 years]); seminal work (frequently cited by others &
seems to influence others’ opinions); revise search if
necessary
– Save or download citation information for use in analysis
and summary of literature search
– Use of personal reference manager software
Quest for Knowledge (cont’d)
• Critically analyze literature findings
– Obtain full-text versions of relevant citations
– Review article; highlight key points; identify gaps in
knowledge; determine relevancy and currentness to
search topic
– Assess quality of evidence (systematic review, metaanalysis)
• Apply and implement search findings
• Evaluate results and effectiveness of practice
changes
Synchronous Internet Communication
• Text-based instant messaging
– Instant messaging (IM): short message service (SMS) or
multimedia message service (MMS)
– Chat
• Telephony (Voice over the Internet Protocol [VoIP])
• Teleconferencing via Internet
– Web conferencing
– Webcast
– Webinar
Information and Health Literacy
• Information literacy
– Awareness of need for information
– Ability to find it
– Ability to analyze its validity and relevance
– Ability to interpret it for use
• Health literacy
– Subset of information literacy
– Degree to which individuals have capacity to
obtain, process, and understand basic health
information and services needed to make
appropriate health decisions
• Both are learned competencies requiring
practice.
Advantages for Healthcare Professional
Information and Health Literacy
• Improved quality of care (first step in any research
study); justify, question, and improve patient care
• New knowledge, design of solutions,
implementation and evaluation methods
• Empowerment of healthcare consumer for
partnership in care
• Support of Joint Commission requirements for
access to knowledge-based information resources
• Essential for evidence-based practice
Information Literacy Skills for Web
Use
The ability to:
• Reduce a problem to a searchable
command
• Categorize a Web page according to its
purpose
• Identify sources of potential bias
• Make judgments about the accuracy
and reliability of information found
Critical Thinking
• Supported by information literacy; does not exist
unless used
• Two components
– Skill sets to process and generate information
– Intellectual commitment to use those skills to guide
behavior
• Vital part: asking questions, knowing when more
information is needed, developing and applying a
plan to acquire information, and using plan to
generate knowledge
• Result: directed toward improved outcomes based
on information and knowledge
Criteria for Evaluating Web Sites
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Accuracy & Authority
Authors/Sponsors
Currency
Design
Make decisions about the
comprehensiveness of information found
 Determine currency
Discovery and Evaluation of Health
Information on the Internet
• Need for a systematic, analytical review
process
• Essential information for validation
– Source
– Funding
– Validity and quality
– Privacy
Knowledge Generation
• Integration of published literature with
aggregated data from computerized clinical
information systems  knowledge
• Two parts
– Knowledge developed from turning nursing
data into information and interpreting it to
make new meaning
– Application of steps of information literacy
Knowledge Dissemination Activities
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Manuscript (via word processing)
Drawings, presentation or poster presentation
Spreadsheets to create graphs
Databases to query, aggregate data, and create
reports
Web documents
Statistical software to analyze quantitative data
Email for collaborating and sharing nursing
knowledge
Wikis, blogs for interactive Web-based
collaboration
Healthcare Consumer Information and
Health Literacy
• Important for discharge planning and patient
education
• Educational materials written at no higher than a
fifth-grade level
• Include nonwritten materials into patient education
• Readability (testing via Flesch Reading Ease and
Flesch-Kincaid Grade Level tests)
• Results of readability statistics as alert to nurses
that further explanation may be necessary
Digital Divide
• The gap between those individuals who
have access to information technology
resources and those who do not
Digital Divide (cont’d)
Risk Factors:
• Age (>65 years)
• Income (<$35,000/year household
income)
• Race/Ethnic Origin (African-American,
Hispanic)
• Level of Education (<High School)
Interventions with
Older Adults
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Teach principles of ergonomics
Provide access to resources
Use motivational strategies
Create nonthreatening teaching
environments
Promoting Digital Inclusion for
People with Disabilities
• Web page design
• Software selection
• Adaptive devices
Working with Groups
at Risk
• Recognize/assess risk factors.
• Be knowledgeable about resources.
• Create supportive environments.
Professional Education
• Degree programs for distance learners
are increasingly available.
• Continued education programs are
widely available in a variety of formats.
• Staff development and training via
technology is increasing.
Nursing Knowledge on the Internet
• Web sites related to:
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Laws, rules, and regulations related to nursing practice
Nursing care
Healthcare agencies and nursing education programs
Government-sponsored and not-for-profit health and
disease specialty organizations
– Nursing professional organizations
– Continuing education resource
– Evidence-based nursing resources
Clinical Practice and Informatics
• Evidence-based nursing
• Star Model of Knowledge Transformation©
– Cyclical process of moving knowledge from original
research into patient care
– Evidence summary  translation into practice
guidelines + clinical expertise  set of
recommendations for best practice 
implementation into practice evaluation via patient
outcomes, health status, efficiency, satisfaction,
economic factors
Distance Education
• Degree programs are offered at all
levels.
• Accredited by NLNAC and/or CCNE
• Increased use of on-line format.
• Standards for quality in distance
education have been developed.
• Still a relatively new way of educating
nurses.
E-Learning
• “Just-in-time training”
• “Anytime. . .anywhere”
• Designed for convenience and
functionality
M-Learning
• New strategy which makes use of
wireless portable devices.
• Currently only limited use.
Use of PDAs in Nursing
• Benefits
– Time saving
– Time management
– Patient safety
– Error reduction
• Shortcomings
– Patient perception
– Changing technology
– Device selection &
preparation
– Expense
– Faulty devices; short
battery life
Handheld Computers in Clinical Practice
• Affordable and indispensible in a variety of nursing clinical
settings
• Clinical information systems incorporating use of handheld
computers for point-of-need documentation
• Wireless synchronization allowing for real-time
documentation
• Personal handheld computers: electronic references to
provide point-of-need information for decision making
• Clinical information systems: bar-code medication
administration
Use of Handheld Computers & Nursing
Research
• Useful for research process
– Web-based research surveys
– Storage of data from surveys
– Audio recording of focus group interviews for later
download
– Camera for pictures of changes resulting from a
treatment
• Mobility of device makes it excellent for accessing and
collecting research data.
Question
Is the following statement True or False?
• Any handheld device that is used for
clinical data must be secured or
encrypted.
Answer
• True
– Security issues are associated with the use of
handheld devices and clinical information.
Thus, when a device contains clinical
information, the device should be secured or
encrypted using a password or biometrics
such as fingerprint recognition.
The Promise of the Internet in
Healthcare
• Requires that all healthcare records be integrated
• Issues: privacy, development of a national network
of healthcare records
• National Health Information Network (NHIN): an
electronic birth-to-death healthcare record that also
provides consumer access
• Requires each healthcare provider to:
– Use electronic patient care records
– Have records accessible to those designated by patient
– Allow patients to access their healthcare records
Electronic Records
• Electronic patient record (EPR)
– Created by healthcare provider or agency
– Owned and managed by institution or agency that
created them
– Also called electronic medical record (EMR)
• Electronic health record (HER)
– One’s health information is available from any
location
– Many advantages
Question
Is the following statement True or False?
• Electronic health records and electronic
patient records refer to the same thing.
Answer
• False
– Although some may consider these terms
to be the same, electronic patient records
are created by the healthcare agency or
provider and owned by that entity. An
electronic health record is one that
contains information and is available from
any location.
Electronic Records (cont’d)
• Personal health record (PHR)
– Client access to healthcare information
– Possible client data entry
– Impact of HIPAA
– Currently PHRs are in a state of evolution:
–No consensus on definition
–Various models
Electronic Records (cont’d)
• Personal health record (cont’d)
– Benefits: enhanced collaborative care; better
management of one’s disease treatment; more
personalized, higher quality of care with improved
communication
– Barriers: provider reluctance and responsibility;
need for unique patient identifier; data security; lack
of data standardization and presentation; required
change in patient thinking to that of healthcare
consumer with responsibility for active participation;
financing
The Road to PHRs
• Self-created
– On paper or via computer
– Many fee-based Web services available; some allow
healthcare providers via a consumer-created PIN to
interact with records
– Time consuming for entering data and decisions
about what to enter
– One that plugs into a USB port (see Fig. 14-1)
• Smart cards: created by providers for patients’ use (like a
credit card with an embedded computer chip); require
password and PIN
Question
Is the following statement True or False?
• Personal health records are currently
standardized and being used throughout the
United States.
Answer
• False
– Currently, personal health records are in a
state of evolution, with no one agreeing on
exactly what they are. There are at least
five models of a computerized PHR.
Electronic Records (cont’d)
• Smart cards (cont’d)
– Security as the biggest concern
– Can be designed to ensure adherence to HIPAA
– Can be programmed to be locked in case of loss
• Practitioner instituted
– Vendor-created and clinic-hosted
– Self-built provider-hosted
– Self-built research system that is agency-neutral
E-Encounters
• Two-way exchange of healthcare information between
provider and client, initiated by either
– Email communication with providers
– Benefits (retention, compliance, visitation rates,
telephone follow-up)
– Barriers (privacy, liability, workload)
• Issues and implementation of E-encounters
– What to post and when (see Table 14-1)
– Contractual relationship
– Response and triage of messages
– Payment
Introduction
• Telemedicine: electronic exchange of patient
information between two sites for the purpose
of improving the patient’s health status
• Telehealth: broader term; extends beyond
delivery of clinical services
• Telenursing: telecommunications technology
in nursing to enhance patient care
Telehealth
• Store-and-forward (S&F) technology
– Still image captured electronically that generates
electronic images sent to a specialist for
interpretation at a later time
– Asynchronous transmission of clinical data
• Real-time telehealth
– Patient and provider interacting at the same time
using interactive video/television
– Video conferencing
– Telepresence
Question
Is the following statement True or False?
• Telemedicine is a broad term that addresses
more than just the delivery of clinical services.
Answer
• False
– Telemedicine is the electronic exchange of
patient information between two sites for
the purpose of improving the patient’s
health status. Telehealth is the broader
term that extends beyond delivery of
clinical services.
Examples of Telehealth
• Telehomecare: monitoring and delivery of
healthcare in patient’s home rather than provider’s
work setting
– Portable monitoring devices (see Display 22-1)
– Pill dispensers/reminders
– Wearable monitoring garments (biometric
garment)
– Telehomecare for chronic disease management
Examples of Telehealth (cont’d)
• Telemental health
• Clinic visits
• e-intensive care units
– eICU: telepresence
– Robotics
• Teletrauma care (second opinions and advice from
trauma care experts for rural hospitals)
• Disaster healthcare
Telenursing
• Non-disaster settings as a specialty
• Variety of settings
Question
Is the following statement True or False?
• Telehomecare is limited to the use of portable
monitoring devices.
Answer
• False
– Telehomecare includes a variety of devices
and measures, such as portable monitoring
devices, pill dispensers/reminders,
wearable monitoring garments, and
telehomecare for chronic illness
management.
Education
• Most telehealth projects have a built-in
patient education component
– Some during the “visit”
– Others via Web pages
• Continuing education and practitioner
preparation
Telehealth Issues
• Reimbursement
– Barrier to widespread adoption of telehealth
– No uniformity for reimbursement
• Medical-legal issues
• Technical issues
– Patient safety
– Standards
–Telehealth Nursing Practice Administration
and Practice Standards
–Core Standards for Telemedicine Operations
Telehealth Issues (cont’d)
• Research
– Early studies not demonstrating strong
evidence of telemedicine vs. face-to-face
patient care recommendations
– Maturation of technology and telehealth
research since that time
– Evidence for telehealth stronger
Question
Is the following statement True or False?
• Currently reimbursement for telehealth is
standardized.
Answer
• False
– There is no uniformity for reimbursement in
telehealth, and this issue is a common
barrier to the widespread adoption of
telehealth.
Question
Is the following statement True or False?
• The major concern associated with smart
card use is security.
Answer
• True
– The biggest concern with smart cards is
security. However, the intelligence
embedded in the card, as well as its
processing capability and the use of
standards-based cryptography, can be
designed to comply with the privacy
requirements of HIPAA.
Consumer Informatics
• Analyzes consumer needs for
information
• Studies/implements methods for making
information accessible
• Models/integrates consumer
preferences into medical information
systems
Use of Internet for Health Information
• Client teaching to find and evaluate Web-based
information
– Trusted sites
– Computer as the host of site
• Clients coming with health information from the
Web
– Validation of suspect or new information
– Discussion with the client
• Cyberchondriac (person who searches for health
information on the Web; not obsessive about an
illness)
Use of Internet for Health Information
(cont’d)
• Internet pharmacies
– Some lawful online pharmacies; numerous ones
that allow purchase without prescription or
consultation with healthcare provider
– Client education about using online pharmacies
(see Display 15-1)
• Health literacy (see Display 15-2)
• Health numeracy
• Help to use computers
Online Medical Opinions
• First opinions for minor, non-emergency
conditions
• Second opinions
– Usually patient’s physician sends specified
documents to physicians at the site
– Specialist identified; fee-based consultation
over a secure server
– Follow-up consult one week later
Provision of Web-Based Patient
Information
• Most agencies have Web sites; content varies
• Some have sites specific to a given condition; functions
like an extranet (access restricted to only their clients)
• Single Web page creation
• Design principles (see Display 15-5, Table 15-1):
– Artistic approach
– Use for problem solving
Provision of Web-Based Patient
Information (cont’d)
• Accessibility factors
– Screen readers
– Color blindness
– Usability
– Dropdown menus
– Information on screen
– Text and background
– Content clarity and language
Question
Is the following statement True or False?
• Second opinions obtained via the Internet are
usually free of charge.
Answer
• False
– A second opinion involves a fee-based
consultation over a secure server.
Laws, Rules, and Regulations (cont’d)
• HIPAA protection limitations
– Criticism for not protecting all private health
information
– Health record private and confidential by law
only if it meets HIPAA regulations
– Questions about interoperability of electronic
health records using NHIN made up of Regional
Health Information Organizations (RHIOs)
Legal and Ethical Issues & Telehealth
• 10th Amendment: individual states with power to regulate
healthcare practitioners; no state has authority over practice
in another state
• Transport nursing and telehealth problematic with these
assumptions; which state has authority over practice when
two states are involved?
• American Telemedicine Association (ATA) and American
Medical Association support licensure regulation at state
level.
• Federation of State Medical Boards (FSMB): framework for
regulating interstate practice  restricted license for
practicing telemedicine across state lines
Legal and Ethical Issues & Telehealth
(cont’d)
• ATA Position statement: support of collaborative
agreements between states for licensure of
professionals practicing telemedicine
• Nurse Licensure Compact (NLC): framework for
regulating interstate practice of RN and LPN/VN
nursing
– Nurse licensed in one state can practice in other
states according to rules and regulations of
states.
– Stipulation for licensure data storage in a
Coordinated Licensure Information System (see
Display 26-1)
Question
Is the following statement True or False?
• Any patient’s health record is considered
private and confidential by law.
Answer
• False
– A patient’s health record is considered
private and confidential by law only if it
meets HIPAA regulations.
Future Trends
• Easier to use, with more intuitive software
• Improved voice commands; voice becoming a
primary method of data input
• Smartphones using mobile broadband are
becoming the norm.
• Smaller market for standalone PDA
• Lower cost
• Removable flash memory as a standard feature
• Major communication device for healthcare
agencies
Summary
• Technology is a powerful tool to
enhance learning. However, technology
is a means to an end, not an end in and
of itself. It must be used with thought,
careful planning, and thorough
evaluation.