Nurses and health information technology: working with and around computers

Information technology is nearly ubiquitous in health care settings. Nurses need basic computer skills and information literacy to effectively practice nursing. In addition, nurses must be prepared not only to work around complex health information technology, but also to communicate with individuals who can address the underlying problems.

Interventions for enhancing consumers' online health literacy

BACKGROUND

Access to health information is critical to enable consumers to participate in decisions on health. Increasingly, such information is accessed via the internet, but a number of barriers prevent consumers making effective use of it. These barriers include inadequate skills to search, evaluate and use the information. It has not yet been demonstrated whether training consumers to use the internet for health information can result in positive health outcomes.

OBJECTIVES

To assess the effects of interventions for enhancing consumers' online health literacy (skills to search, evaluate and use online health information).

SEARCH STRATEGY

We searched: the Cochrane Consumers and Communication Review Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2008); MEDLINE (Ovid); EMBASE (Ovid); CINAHL (Dialog); ERIC (CSA Illumina); LISA (CSA Illumina); PsycINFO (Ovid); Index to scientific and technical proceedings; SIGLE; ASLIB Index to Theses; ProQuest Dissertation Abstracts; National Research Register/UK CRN Portfolio database; Current Controlled Trials - MetaRegister of Controlled Trials. We searched all databases for the period January 1990 to March 2008.

SELECTION CRITERIA

Randomised controlled trials (RCTs), cluster RCTs and associated economic evaluations, quasi-RCTs, interrupted time series analyses, and controlled before and after (CBA) studies assessing interventions to enhance consumers' online health literacy, in any language.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, assessed their quality and extracted data. We contacted study authors for clarification and to seek missing data. We presented results as a narrative and tabular summary, and calculated mean differences where appropriate.

MAIN RESULTS

We included two studies: one randomised controlled trial (RCT) and one controlled before and after (CBA) study with a combined total of 470 participants. The RCT compared internet health information classes with patient education classes for participants with HIV infection. Only the RCT, which we rated as having a moderate risk of bias, reported statistically significant positive effects for primary outcomes related to online health literacy in the intervention group, for the following outcomes: 'Self-efficacy for health information seeking', 'health information evaluation skills' and the 'number of times the patient discussed online information with a health provider'. The CBA, which we rated as having a high risk of bias, compared internet health information classes with a control group receiving no intervention among healthy adults aged 50+. It showed significant positive changes only in a secondary (behavioural) outcome in the intervention group, regarding the readiness to adopt the internet as a tool for preventive health information. No adverse effects were reported.There is low quality evidence that such interventions may improve some outcomes relevant to online health literacy in certain populations.

AUTHORS' CONCLUSIONS

Due to the small number of studies and their variable methodological quality, the evidence is too weak to draw any conclusions about implications for the design and delivery of interventions for online health literacy. There is a need for well-designed RCTs to investigate the effects of such interventions. These should involve different participants (in terms of disease status, age, socio-economic group and gender) to analyse the extent to which online health literacy reduces a barrier to using the internet for health information. Trials should be conducted in different settings and should examine interventions to enhance consumers' online health literacy (search, appraisal and use of online health information) like internet training courses, measuring outcomes up to at least one year after the intervention to estimate the sustainability of the intervention effects.

Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability

Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

Comparative use of podcasts vs. lecture transcripts as learning aids for dental students

The purpose of this project was to describe dental students' use of lecture podcasts versus written lecture transcripts as learning aids under three different circumstances: studying for an exam, reviewing an attended lecture, and reviewing a missed lecture. Additional analyses were performed to see whether demographic differences (e.g., age, gender, language skills, and computer skills) or grade differences were associated with preferences for using podcast versus written lecture transcripts of class notes. Fifty-one percent (n=171) of the second-year dental students at the New York University College of Dentistry voluntarily participated in this survey. The major findings were that 1) a high percentage of students (70-92 percent) used one or both aids in all three utilization circumstances with a consistent preference for podcast use, especially when reviewing a missed lecture; 2) course grades were not associated with the preferred use of either lecture aid; and 3) over half the students listened to the podcasts at speeds that were one and one-half or two times faster than normal speech, especially younger students. Further studies are warranted to delve into the current student generation's preferred learning styles and the resultant learning outcomes associated with those preferences.

Technology and everyday functioning in people with intellectual disabilities: a Rasch analysis of the Everyday Technology Use Questionnaire (ETUQ)

BACKGROUND

As people with intellectual disabilities (ID) today live integrated in society and use different technological artefacts and services in their everyday life, more in-depth evaluation methods are crucial to detect strengths and limitations of their everyday technology use. The Everyday Technology Use Questionnaire (ETUQ) was originally designed to investigate the extent to which older adults with cognitive limitations can use the everyday technology that is of relevance to them. The purpose of this study was to explore and evaluate evidence of the validity of ETUQ among adult persons with ID.

METHODS

The original 93-item ETUQ was used to interview 120 adult participants with ID, recruited from a region in northern Sweden. A Rasch model was used to analyse the psychometric properties of the rating scale, scale validity, person response validity and person separation.

RESULTS

The ETUQ rating scale displayed sound psychometric properties when used with this sample. The goodness-of-fit statistics showed that 15 (16%) of the 93 items demonstrated higher values than expected. A step-by-step removal process of items not demonstrating fit to the model resulted in an ETUQ version with 46 items (49%) that met all the criteria for scale validity. Fifteen participants (12%), primarily with mild ID, still demonstrated a higher number of unexpected responses included in ETUQ.

CONCLUSIONS

The results of this study indicate that the ETUQ generates a valid measure of perceived difficulty in using everyday technology including adult persons with ID.

Introduction of an electronic medical record system into physician practice offices: why is it so #%!&-ing hard for everybody?-Part II

Medical practice offices are experiencing a revolutionary change in the microprocesses that have been the norm for documenting and communicating patient care for decades. While this revolution is welcome for dozens of good reasons, migration of data storage from the paper-based record to electronic form often causes considerable stress for all involved. This three-part series looks at electronic medical record implementations from organizational and sociological perspectives, and draws attention to the often unappreciated aspects of medical work that give rise to the stress. In addition, IT professionals' perspectives are also addressed to highlight how medical /IT professional differences affect the experience of implementation.

mHealth

More than 17,000 mHealth apps now are available for smart phones and other devices, and they do everything from monitoring urine flow for patients with enlarged prostates to reminding people prone to kidney stones to drink more water. And that's just on the consumer side. Countless apps are avail-able for use by clinicians and hospitals. Mobile apps are changing health care in dramatic ways.

Implementation of evidence-based practice: outside the box, throughout the hospital

BACKGROUND

Evidence-based practice (EBP) is a generally accepted means to improve healthcare quality. However, not all healthcare professionals and managers apply EBP in daily practice. We investigated EBP attitudes, knowledge and the perceived barriers and facilitators to practising EBP , to define tailor-made interventions for improving evidence-based behaviour.

METHODS

In this cross-sectional survey, doctors and nurses from five major specialities of a university hospital were invited to complete the McColl and Barriers questionnaires.

RESULTS

Response rates were 70% (305÷435) for doctors and 74% (396÷537) for nurses. They were welcoming towards EBP, but considered time constraints, knowledge gaps and poor availability of evidence as major barriers to implement EBP . They also mentioned contradicting results (75%) and flawed methodology (69%), while nurses frequently mentioned unawareness of (75%), or difficulty in reading and interpreting research papers (70%). Regarding EBP knowledge, 6/8 common EBP terms could be explained by 54% of doctors but by only 15% of nurses. Facilitating factors among doctors concerned the availability and accessibility of high-level evidence and communication of evidence during various clinical meetings and handovers for clinical decision making. Among nurses, promoting factors involved more teaching and instances to incorporate EBP in clinical practice. Both groups desired more managerial support in terms of motivation and opportunities.

CONCLUSIONS

Doctors and nurses have embraced the EBP paradigm as an important means to improve quality of clinical patient care, but its application is still cumbersome. This paper offers a tailored programme for implementation and managerial role-models.sustainment of EBP, corroborated by professional and managerial role-models.

Information-seeking behaviors of first-semester veterinary students: a preliminary report

Although emphasis in veterinary education is increasingly being placed on the ability to find, use, and communicate information, studies on the information behaviors of veterinary students or professionals are few. Improved knowledge in this area will provide valuable information for course and curriculum planning and the design of information resources. This article describes a survey of the information-seeking behaviors of first-semester veterinary students at Purdue University. A survey was administered as the first phase of a progressive semester-long assignment for a first semester DVM course in systemic mammalian physiology. The survey probed for understanding of the scientific literature and its use for course assignments and continuing learning. The survey results showed that students beginning the program tended to use Google for coursework, although some also used the resources found through the Purdue libraries' Web sites. On entering veterinary school, they became aware of specific information resources in veterinary medicine. They used a small number of accepted criteria to evaluate the Web site quality. This study confirms the findings of studies of information-seeking behaviors of undergraduate students. Further studies are needed to examine whether those behaviors change as students learn about specialized veterinary resources that are designed to address clinical needs as they progress through their training.

Contextual inquiry method for user-centred clinical IT system design

Little can be found in the literature about the applicability of field study methods, particularly contextual inquiry, in the health informatics field. This paper aims to inform and promote the use of contextual inquiry for user-oriented design of clinical information technology (IT) systems. The paper describes how the method was applied in two empirical studies to gather data about end-users' needs, as well as the use and usability of dictation solutions and electronic nursing documentation systems from the viewpoint of their end-users' in real working surroundings. Experience indicates that, compared to typical usability evaluation methods, contextual inquiry may provide valuable support for user-centred design activities: the method is suitable for increasing researchers' understanding of clinical practices, contexts of work, and end-users' interaction with numerous IT systems. However, in clinical settings there are special challenges related to recording and privacy issues, a wide variety of clinical practices and contexts of technology usage, as well as the hectic nature of clinical work.

Use of technology for educating melanoma patients

We evaluated the feasibility of using technology for melanoma patient education in a clinic setting. We assessed technology skill level and preferences for education. Data were collected using an adapted version of the Use of Technology Survey. Most participants owned a computer and DVD player and were skilled in the use of these devices, along with Internet and e-mail. Participants preferred the option of using in-clinic and at-home technology versus in-clinic only use. Computer and DVD applications were preferred because they were familiar and convenient. Using technology for patient education intervention is a viable option; however, patients' skill level and preferences for technology should be considered.

Using an Extended Automatic Target Acquisition Program with dual cursor technology to assist people with developmental disabilities improve their pointing efficiency

The latest research adopting software technology to improve pointing performance is through an Extended Automatic Pointing Assistive Program (EAPAP). However, EAPAP has some limitations. This study evaluated whether two children with developmental disabilities would be able to improve their pointing performance through an Extended Dual Cursor Automatic Pointing Assistive Program (EDCAPAP), which solves the limitations of EAPAP. Initially, both participants had their baseline sessions. Then intervention started with the first participant. New baseline and intervention occurred with the second participant when his performance was consolidated. Finally, both participants were exposed to the maintenance phase, in which their pointing performance improved significantly. Results of this study showed that, with the assistance of EDCAPAP, participants can position targets quickly, easily, and accurately, thus helping the disabled to solve their pointing problems.

Surfing or still drowning? Student nurses' Internet skills

A study into student nurses' ability to use the Internet was published in Nurse Education Today in 2004. This paper repeats the research with a cohort of students starting their pre-registration programme in a UK university in 2007. In 2004 students were reported as having poor Internet skills, and as not being frequent users of the Internet. In this study students were found to have significantly better ability to carry out basic tasks and significantly higher levels of Internet use. Their ability to apply these skills to more complex information literacy tasks however had not increased, with more than half of all students saying they found far too much irrelevant information when searching for specific information on the Internet. The earlier study found that skills and age were not related, which appears to still be the case. The need for these skills is increasing as education, lifelong learning, and patient information are all increasingly drawing on the developing Internet. Nurse education however is not integrating the skill and knowledge base essential to support this into pre-registration programmes, and the evidence suggests that this will not happen without active management.

Communicating health information to disadvantaged populations

Interest in the communication of health information among disadvantaged populations has increased in recent years with the shift from a model of patient-provider communication to one of a more empowered healthcare consumer; with the use of new communication technologies that increase the number of channels through which health information may be accessed; and with the steadily increasing number of people without health insurance. Three separate research literatures contribute to our current understanding of this issue. In the medicine and public health literature, disparities in health access and outcomes among socioeconomic, ethnic, and racial groups are now well documented. In the information sciences literature, scholars note that on a continuum of health information behaviors, ranging from information avoidance and nonseeking to active seeking, nonseeking behaviors are associated with disadvantaged populations. In the communication literature, enthusiasm over the technology-driven growth of online health information seeking is tempered by evidence supporting the knowledge gap hypothesis, which indicates that as potential access to health information increases, systematic gaps in health knowledge also increase as groups with higher socioeconomic status acquire this information at a faster rate than those with lower socioeconomic status. A number of diverse strategies show promise in reducing information and health disparities, including those that focus on technology, such as programs to increase computer and Internet access, skills, and comprehension; those that focus on interpersonal communication, such as the community health worker model; and those that focus on mass media channels, such as entertainment education.

Dentistry students' perceptions of learning management systems

This paper reports an exploratory survey study about students' perceptions of learning management systems (LMS) at the Faculty of Dentistry, University of Sydney. Two hundred and fifty-four students enrolled in the Bachelor of Dentistry and the Bachelor of Oral Health programmes participated in an online survey aimed at exploring their beliefs and attitudes as well as their preferences for eLearning tools. Results indicated a strong preference of students for using LMSs as resource repositories rather than for higher-order learning activities such as online discussion forums. This finding holds importance for consideration of the development of the educational resources modalities that support development of essential graduate attributes such as information literacy and collaborative learning.

The health informatics workforce: unanswered questions, needed answers

This chapter gives an educational overview of: * The value of health information technology in the health industry and the need for well-trained HIT professionals * The current HI workforce characteristics, occupational status and educational opportunities * Health informaticians roles and functions.

Healthcare students' e-literacy skills

To be critical healthcare consumers, patients must learn self-management skills and become active participants in knowledge management and exchange. eHealth literacy is considered critical to the development of these self-management skills. The World Health Organization identifies five core competencies required of all healthcare providers working with persons with chronic conditions, and this paper focuses on the fourth--the ability to employ information and communication technology. To supplement our literature-based argument, we also present findings from a class of first-year masters-level occupational therapy students asked to complete an existing standardized e-health literacy survey, eHEALS, as a learning activity. The eHEALS revealed that students reported confidence in their ability to critically appraise internet information but were not confident enough in those skills to use the information to make decisions without consulting a healthcare provider. It appeared that the students were not yet fully immersed in their role of healthcare professional and seemed to move between the roles of healthcare provider and healthcare recipient as they reflected on the class' answers to the eHEALS assessment. Evaluation of eHealth literacy is complex and needs to consider the multiple roles assumed by those whose knowledge is being assessed.

Medical education and information literacy in the era of open access

The Open Access movement in scholarly communications poses new issues and concerns for medical education in general and information literacy education specifically. For medical educators, Open Access can affect the availability of new information, instructional materials, and scholarship in medical education. For students, Open Access materials continue to be available to them post-graduation, regardless of affiliation. Libraries and information literacy librarians are challenged in their responses to the Open Access publishing movement in how best to support Open Access endeavors within their own institutions, and how best to educate their user base about Open Access in general.

Computer literacy for life sciences: helping the digital-era biology undergraduates face today's research

Computer literacy plays a critical role in today's life sciences research. Without the ability to use computers to efficiently manipulate and analyze large amounts of data resulting from biological experiments and simulations, many of the pressing questions in the life sciences could not be answered. Today's undergraduates, despite the ubiquity of computers in their lives, seem to be largely unfamiliar with how computers are being used to pursue and answer such questions. This article describes an innovative undergraduate-level course, titled Computer Literacy for Life Sciences, that aims to teach students the basics of a computerized scientific research pursuit. The purpose of the course is for students to develop a hands-on working experience in using standard computer software tools as well as computer techniques and methodologies used in life sciences research. This paper provides a detailed description of the didactical tools and assessment methods used in and outside of the classroom as well as a discussion of the lessons learned during the first installment of the course taught at Emory University in fall semester 2009.

Creating and testing a deaf-friendly, stop-smoking web site intervention

Deaf adults' access to smoking cessation programs is limited due to cultural, linguistic, and geographic barriers. Web-based stop-smoking interventions have demonstrated cessation rates comparable to other interventions. The Internet is widely used by Deaf adults, but difficulties with online English text remain. We found no published accounts of Internet interventions promoting smoking cessation among Deaf individuals. The purpose of our project was to create and pilot test a prototype interactive Web site that provides users with information in American Sign Language related to smoking cessation. We utilized web cams to create real-time "video chat rooms" for virtual support groups and had an "ask the experts" feature. Deaf community members participated in all phases of development and testing, and a Deaf former smoker served as the moderator for the site. Evaluations were positive, with emphasis on interactive and visual aspects of the site.

Clinical health informatics education for a 21st Century World

This chapter gives an educational overview of: * health informatics competencies in medical, nursing and allied clinical health professions * health informatics learning cultures and just-in-time health informatics training in clinical work settings * major considerations in selecting or developing health informatics education and training programs for local implementation * using elearning effectively to meet the objectives of health informatics education.

Dutch home-based pre-reading intervention with children at familial risk of dyslexia

Children (5 and 6 years old, n = 30) at familial risk of dyslexia received a home-based intervention that focused on phoneme awareness and letter knowledge in the year prior to formal reading instruction. The children were compared to a no-training at-risk control group (n = 27), which was selected a year earlier. After training, we found a small effect on a composite score of phoneme awareness (d = 0.29) and a large effect on receptive letter knowledge (d = 0.88). In first grade, however, this did not result in beneficial effects for the experimental group in word reading and spelling. Results are compared to three former intervention studies in The Netherlands and comparable studies from Denmark and Australia.

A taxonomy characterizing complexity of consumer eHealth Literacy

There are a range of barriers precluding patients from fully engaging in and benefiting from the spectrum of eHealth interventions developed to support patient access to health information, disease self-management efforts, and patient-provider communication. Consumers with low eHealth literacy skills often stand to gain the greatest benefit from the use of eHealth tools. eHealth skills are comprised of reading/writing/numeracy skills, health literacy, computer literacy, information literacy, media literacy, and scientific literacy [1]. We aim to develop an approach to characterize dimensions of complexity and to reveal knowledge and skill-related barriers to eHealth engagement. We use Bloom's Taxonomy to guide development of an eHealth literacy taxonomy that categorizes and describes each type of literacy by complexity level. Illustrative examples demonstrate the utility of the taxonomy in characterizing dimensions of complexity of eHealth skills used and associated with each step in completing an eHealth task.

A framework for predicting EHR adoption attitudes: a physician survey

With a focus on improving the quality of patient care, the President George W. Bush called for electronic health records (EHRs) for all Americans by the year 2014; however, recent estimates for EHR adoption in the ambulatory care environment are just over 10 percent. The objective of this study was to determine the individual characteristics and the social and technical factors that may contribute to physician acceptance of EHRs. This first paper of a two-part study presents a framework grounded in Diffusion of Innovations theory and the Technology Acceptance Model, which was developed using case study and survey methods, and tested using structural equation modeling (SEM). Model variables explained over 73 percent of the variance in attitude toward EHRs, and acceptable model fit was achieved. Lack of user acceptance continues to impede diffusion of EHRs, and this analysis supports the impact that leadership and other organizational changes have on user adoption.

Computer skills among trainee doctors

Computer skills are an essential part of every field, including medicine. However, training in computers is limited mainly to clerical and paramedical staff. We conducted this questionnaire survey to assess the extent of training and the opinion of trainee doctors in obstetrics and gynaecology in Wales. The results showed that the computer skills among these doctors was low and the majority of them agreed that there was a need for training in computer skills to assist them in their career progress. In view of the findings of this survey, we feel that incorporation of computer skills courses in the training curriculum must be of benefit.