Toward the Design of an Engagement Tool for Effective Electronic Health Record Adoption

As healthcare systems continue to expand their use of electronic health records (EHRs), barriers to robust and successful engagement with such systems by stakeholders remain tenacious. To this effect, this research presents the results of a survey tool utilizing both original and modified constructs from the Consolidated Framework for Implementation Research to assess key points of engagement barriers and potential points of intervention for stakeholders of EHRs in a large-scale healthcare organization (500-bed level II regional trauma center). Based on the extensive assessment, the paper presents recommendations for the utility of engagement process modeling and discusses how intervention opportunities can be used to mitigate engagement barriers.

[HYGIENIC EVALUATION OF STUDIES OF PRESCHOOLERS WITH THE USE OF PC TABLETS]

In the article there are presented the results ofphysiological and hygienic evaluation of studies in kindergarten with the use of educational games on an electronic PC tablet. The study involved 44 foster-children. In one of the groups children in the classroom used the interactive game software on electronic PC tablets "Samsung", the same time while working with the PC tablet did not exceed 10 minutes, in the other--the classes were held traditionally. There were investigated the state of health, psychosomatic and psycho-emotional state of children, determined their functional readiness for systematic training in school, mental performance, the functional state of the central nervous system (CNS) by simple visual-motor reaction (SVMR) and reactions to a moving object (RDO). Developing ofgame sessions with the use of electronic PC tablets for 10 minutes were established to contribute to the activation of the central nervous system and increase in children resistance to the development of fatigue.

An inquiry-based biochemistry laboratory structure emphasizing competency in the scientific process: a guided approach with an electronic notebook format

The laboratory setting is an exciting and gratifying place to teach because you can actively engage the students in the learning process through hands-on activities; it is a dynamic environment amenable to collaborative work, critical thinking, problem-solving and discovery. The guided inquiry-based approach described here guides the students through their laboratory work at a steady pace that encourages them to focus on quality observations, careful data collection and thought processes surrounding the chemistry involved. It motivates students to work in a collaborative manner with frequent opportunities for feedback, reflection, and modification of their ideas. Each laboratory activity has four stages to keep the students' efforts on track: pre-lab work, an in-lab discussion, in-lab work, and a post-lab assignment. Students are guided at each stage by an instructor created template that directs their learning while giving them the opportunity and flexibility to explore new information, ideas, and questions. These templates are easily transferred into an electronic journal (termed the E-notebook) and form the basic structural framework of the final lab reports the students submit electronically, via a learning management system. The guided-inquiry based approach presented here uses a single laboratory activity for undergraduate Introductory Biochemistry as an example. After implementation of this guided learning approach student surveys reported a higher level of course satisfaction and there was a statistically significant improvement in the quality of the student work. Therefore we firmly believe the described format to be highly effective in promoting student learning and engagement.

Comparative modeling of proteins: a method for engaging students' interest in bioinformatics tools

The huge increase in data being produced in the genomic era has produced a need to incorporate computers into the research process. Sequence generation, its subsequent storage, interpretation, and analysis are now entirely computer-dependent tasks. Universities from all over the world have been challenged to seek a way of encouraging students to incorporate computational and bioinformatics skills since undergraduation in order to understand biological processes. The aim of this article is to report the experience of awakening students' interest in bioinformatics tools during a course focused on comparative modeling of proteins. The authors start by giving a full description of the course environmental context and students' backgrounds. Then they detail each class and present a general overview of the protein modeling protocol. The positive and negative aspects of the course are also reported, and some of the results generated in class and in projects outside the classroom are discussed. In the last section of the article, general perspectives about the course from students' point of view are given. This work can serve as a guide for professors who teach subjects for which bioinformatics tools are useful and for universities that plan to incorporate bioinformatics into the curriculum.

Using an ePortfolio system as an electronic laboratory notebook in undergraduate biochemistry and molecular biology practical classes

Despite many apparent advantages, including security, back-up, remote access, workflow, and data management, the use of electronic laboratory notebooks (ELNs) in the modern research laboratory is still developing. This presents a challenge to instructors who want to give undergraduate students an introduction to the kinds of data curation and notebook keeping skills that will inevitably be required as ELNs penetrate normal laboratory practice. An additional problem for the teacher is that ELNs do not generally have student-administrative functions and are prohibitively expensive. In this report, we describe the use and impact of an ePortfolio system as a surrogate ELN. Introduction of the system led to several pedagogic outcomes, namely: increased preparedness of students for class, encouragement of creativity and reflection with respect to experimental methods, greatly enhanced engagement between students and tutors, and it gave instructors the ability to scrutinize original data files and monitor student-tutor feedback cycles. However, implementation led to a disruption of tutor workloads and incurred new levels of accountability that threatened to undermine the initiative. Through course evaluations and other reflective processes, we reached an appreciation of how an ELN should be introduced into practical class teaching so that it not only becomes an appropriate aid for teaching the laboratory experience, but also becomes a life-long resource for students.

A graphical model framework for decoding in the visual ERP-based BCI speller

We present a graphical model framework for decoding in the visual ERP-based speller system. The proposed framework allows researchers to build generative models from which the decoding rules are obtained in a straightforward manner. We suggest two models for generating brain signals conditioned on the stimulus events. Both models incorporate letter frequency information but assume different dependencies between brain signals and stimulus events. For both models, we derive decoding rules and perform a discriminative training. We show on real visual speller data how decoding performance improves by incorporating letter frequency information and using a more realistic graphical model for the dependencies between the brain signals and the stimulus events. Furthermore, we discuss how the standard approach to decoding can be seen as a special case of the graphical model framework. The letter also gives more insight into the discriminative approach for decoding in the visual speller system.

Information technology in ENT: are we ready to be ‘Connected For Health’?

The NHS Connecting for Health agency continues to implement the national programme for information technology within the National Health Service (NHS). In preparation, NHS employees are being encouraged to develop their information technology skills via the European computer driving licence training course.

A postal survey of British Association of Otorhinolaryngologists members was undertaken to evaluate their levels of information technology training, competency and knowledge. Three hundred and thirty-six surgeons responded.

Most respondents had received no formal information technology training. Only 3.9 per cent had taken the European computer driving licence course.

Most surgeons felt comfortable using word processing and presentation software but were less comfortable with other applications. Junior surgeons were more confident in all areas of information technology application than senior surgeons.

Seventy-two per cent of surgeons wanted more information technology training. Most felt that such training should be routine at undergraduate and postgraduate level.

With the national programme committed to improving information technology infrastructure within the NHS, more formal training should be provided to ensure a basic standard of information technology competency amongst ENT surgeons.

HIT plants SEEDS in healthcare education

By incorporating a clinical information system in the education curriculum as a teaching platform, the University of Kansas School of Nursing teaches nurses and other health professional students how to assess, plan, document and manage care in an electronic medium that develops healthcare informatics competencies. The outcomes of this integrated technology curriculum brings hope for transforming health professional education for 21st century practice and graduating a workforce with the leadership and competencies for improving quality and safety in patient care. It results in IT savvy healthcare providers who will cross the quality chasm.

Formal analysis and automatic generation of user interfaces: approach, methodology, and an algorithm

OBJECTIVE

We present a formal approach and methodology for the analysis and generation of user interfaces, with special emphasis on human-automation interaction.

BACKGROUND

A conceptual approach for modeling, analyzing, and verifying the information content of user interfaces is discussed.

METHODS

The proposed methodology is based on two criteria: First, the interface must be correct--that is, given the interface indications and all related information (user manuals, training material, etc.), the user must be able to successfully perform the specified tasks. Second, the interface and related information must be succinct--that is, the amount of information (mode indications, mode buttons, parameter settings, etc.) presented to the user must be reduced (abstracted) to the minimum necessary.

RESULTS

A step-by-step procedure for generating the information content of the interface that is both correct and succinct is presented and then explained and illustrated via two examples.

CONCLUSIONS

Every user interface is an abstract description of the underlying system. The correspondence between the abstracted information presented to the user and the underlying behavior of a given machine can be analyzed and addressed formally.

APPLICATIONS

The procedure for generating the information content of user interfaces can be automated, and a software tool for its implementation has been developed. Potential application areas include adaptive interface systems and customized/personalized interfaces.

Computer competencies in a BSN program

Beginning nurses need informatics skills to work efficiently in an environment that increasingly relies on information technology to promote patient safety. In addition, a federal order mandates that all Americans have an electronic medical record by 2014. Nursing programs must integrate informatics content into their curricula to prepare nurses to use information technology. This article describes a baccalaureate (BSN) curriculum evaluation of nursing informatics content. Results can inform faculty about strategies that can strengthen informatics competencies. A research-based tool, based on the informatics competence work of Staggers, Gassert, and Curran, was developed to evaluate course syllabi. Although evidence of learning experiences related to computer skills was present, students were not routinely exposed to computerized systems. No syllabi included evidence that addressed informatics knowledge competencies. We conclude that students received limited informatics exposure and may not be adequately prepared to use information technology. Recommendations for increasing nursing informatics experiences within a BSN curriculum are offered.

Nursing Students' Attitudes Toward Technology

Nursing students' predispositions toward technology may be a factor affecting their use of technology in educational and clinical settings. A national survey was conducted to collect attitudinal measures toward technology and data on technology instruction to assist educators with developing information technology curricula. Outcomes indicate an overall positive attitude toward technology; however, participants reports of formal education in the use of technology applications are low. This shortcoming should be addressed through enhancement of nursing core curriculum.

Computer literacy study: report of qualitative findings

Computer literacy and information literacy are critical to the future of nursing. The very nature of health care is being transformed in response to environmental drivers such as the demands for cost-effective delivery of high quality services and enhanced patient safety. Facilitating the quality transformation depends on strategic changes such as implementing evidence-based practice (), promoting outcome research (), initiating interdisciplinary care coordination [Zwarenstein, M., Bryant, W. (2004). Interventions to promote collaboration between nurses and doctors. The Cochrane Library(I)], and implementing electronic health records (). Information management serves as a central premise of each of these strategies and is an essential tool to facilitate change. This report of the analysis of qualitative data from a national online survey of baccalaureate nursing education programs describes the current level of integration of the computer literacy and information literacy skills and competencies of nursing faculty, clinicians, and students in the United States. The outcomes of the study are important to guide curriculum development in meeting the changing health care environmental demands for quality, cost-effectiveness, and safety.

Rural women with chronic illness: computer use and skill acquisition

Chronically ill rural women must manage complex illness without easy access to health care resources including support and health information. The Women to Women project is a technology-based program with an overarching aim to assist rural women in the day-to-day management of their illnesses. An important aspect of the Women to Women program is teaching the women how to use the Internet to meet their support and informational needs. The purposes of this article are to examine changes in 1) the level of computer skills, 2) degree of comfort in using the computer, and 3) knowledge of Internet functions for the participants in the Women to Women computer-based intervention. Results of the initial analysis of data from 63 women (intervention group n = 29, control group n = 34) indicate that women participating in the intervention reported greater computer skills and computer comfort and greater knowledge of specific aspects of Internet use than women in the control group. These findings were further strengthened considering that intervention and control group differentials were sustained 8 months after the end of the women's participation in the computer intervention. With the attainment of computer and Internet skills, it is expected that these rural women will have a sustained ability to access quality Internet information that will allow them to better manage and adapt to their chronic illnesses.

An exploratory study of Taiwanese consumers' experiences of using health-related websites

It is manifest that the rapid growth of Internet use and improvement of information technology have changed our lifestyles. In recent years, Internet use in Taiwan has increased dramatically, from 3 million users in 1998 to approximately 8.6 million by the end of 2002. The statistics imply that not only health care professionals but also laypersons rely on the Internet for health information. The purpose of this study was to explore Taiwan consumers' preferences and information needs, and the problems they encountered when getting information from medical websites. Using simple random sampling and systematic random sampling, a survey was conducted in Taipei from August 26, 2002 to October 30, 2002. Using simple random sampling and systematic random sampling, 28 boroughs (Li) were selected; the total sample number was 1043. Over one-quarter (26.8 %) of the respondents reported having never accessed the Internet, while 763 (73.2%) reported having accessed the Internet. Of the Internet users, only 396 (51.9%) had accessed health-related websites, and 367 (48.1%) reported having never accessed health-related websites. The most popular topics were disease information (46.5%), followed by diet consultation (34.8%), medical news (28.5%), and cosmetology (28.5%). The results of the survey show that a large percentage of people in Taiwan have never made good use of health information available on the websites. The reasons for not using the websites included a lack of time or Internet access skills, no motivation, dissatisfaction with the information, unreliable information be provided, and inability to locate the information needed. The author recommends to enhance health information access skills, understand the needs and preferences of consumers, promote the quality of medical websites, and improve the functions of medical websites.

Camp for all connection: a community health information outreach project

PURPOSE

The purpose of the Camp For All Connection project is to facilitate access to electronic health information resources at the Camp For All facility.

SETTING/PARTICIPANTS/RESOURCES

Camp For All is a barrier-free camp working in partnership with organizations to enrich the lives of children and adults with chronic illnesses and disabilities and their families by providing camping and retreat experiences. The camp facility is located on 206 acres in Burton, Texas. The project partners are Texas Woman's University, Houston Academy of Medicine-Texas Medical Center Library, and Camp For All.

BRIEF DESCRIPTION

The Camp For All Connection project placed Internet-connected workstations at the camp's health center in the main lodge and provided training in the use of electronic health information resources. A train-the-trainer approach was used to provide training to Camp For All staff.

RESULTS/OUTCOME

Project workstations are being used by health care providers and camp staff for communication purposes and to make better informed health care decisions for Camp For All campers.

EVALUATION METHOD

A post-training evaluation was administered at the end of the train-the-trainer session. In addition, a series of site visits and interviews was conducted with camp staff members involved in the project. The site visits and interviews allowed for ongoing dialog between project staff and project participants.

Evaluation of interactive online courses for advanced practice nurses

PURPOSE

The purpose of this study was twofold: (a) to examine the effectiveness of two interactive online learning modules for advanced practice nurses (APNs) and (b) to examine the participants' demographic characteristics and their perceptions of the strengths and weaknesses of online learning.

DATA SOURCES

A purposive sample of 73 registered nurses and APNs enrolled in graduate study or continuing education completed an online learning course. These participants were pretested and post-tested using a knowledge test developed by the authors. Participants were also surveyed for demographic characteristics and perceptions toward online learning.

CONCLUSIONS

The findings of this study support case-based online learning as a successful method in the education of APNs. The evaluation of the online modules and the enthusiasm from students indicated success of this teaching/learning method. The majority of learners responded positively toward the online method of learning and included comments that indicated they enjoyed learning using this method, would like to have the site available at their practice locations for reference, and would like to have other courses designed and delivered in this manner. IMPLICATIONS FOR PRACTICE AND EDUCATION: The effectiveness and quality of the online instruction ultimately matter most to student satisfaction in online courses. The future of online education is dependent on well-structured, interactive, and substantive programs. Educators are challenged to continually assess and evaluate the changing learning needs of APNs.

Website review: diabetes insight--www.diabetes-insight.info

In previous Diabetes Information Technology & WebWatch columns some different diabetes Websites have been highlighted. In this issue we focus on one particular site and use this to illustrate how such Internet-based repositories of information can provide important and useful resources for people with diabetes and their carers. Diabetes is perhaps unique in the fact that much of the day-to-day responsibility for care rests with individuals themselves. Successful therapy demands considerable understanding of the condition by the person with diabetes, or his or her carer, and this can only be made possible with access to appropriate information. Provision of information via a Website is now recognised to be cost-effective and convenient, available 24 hours a day, 365 days a year-and access to the Internet by the general public has grown rapidly in recent years. The increasing way in which the Internet is being used to supply individuals with tools and information for their self-care is exemplified by the Diabetes Insight Website (at: www.diabetes-insight.info).

The Importance of Informatics Competencies in Nursing

Over the past two decades, dramatic changes have occurred in the nature and extent of communication and information technology use in nursing worldwide. The need for student nurses to be well prepared for the use and application of information technology in nursing is arguably now paramount. This article details areas where information and communication technology is used in nursing in Australia and discusses why nurses must be diligent in maintaining skills in this area to facilitate the delivery of safe, quality care in any healthcare setting. It will then discuss the importance of information and communication technology (ICT) skills, knowledge and understanding as an integral aspect of nursing programs in tertiary institutions. The challenge for training providers to prepare nurses for ever-changing ICT technology and technological applications in their workplace is highlighted.

Knowledge and use of electronic information resources by medical sciences faculty at The University of the West Indies

OBJECTIVE

The objective was to determine faculty's knowledge of electronic resources, access to a computer, use of electronic resources (both number and frequency) available at the Medical Sciences Library (MSL), and the areas of training needed and to identify areas for further research.

METHODS

A survey was administered to faculty in medicine, pharmacy, dentistry, and veterinary sciences at The University of the West Indies. The questions covered computer literacy, computer access and location, knowledge and use of electronic resources, and training needs.

RESULTS

The response rate was 70%, of whom 97% were computer users. Seventy-three percent used computers daily, and 82% felt that their computer literacy level was average or beyond. Overall, it was found that faculty had high awareness of the electronic resources made available by the MSL but low use of MSL-specific resources supporting the suggested problem of underutilization. Many respondents felt that e-resources were important, and, though many felt that they were competent users, 83% were self-taught and many still expressed a need for training. Over 60% felt that a workshop with a hands-on component was the preferred format for training. It was recommended that there be greater promotion of the library's e-resources.

A survey of the information management and technology training needs of doctors in an acute NHS trust in the United Kingdom

BACKGROUND

Doctors need information skills to deliver health care in the 21st century. There is concern that those who trained before the 'information age' will be inadequately equipped for their work.

OBJECTIVES

To assess doctors' use of computers for clinical tasks, and their knowledge and skills in health information management and technology.

DESIGN

Questionnaire survey.

SETTING

An acute NHS trust in the UK.

PARTICIPANTS

96 (83%) of all doctors in the trust responded.

MAIN OUTCOME MEASURES

Proportion of respondents reporting the following: use of computer-based systems for clinical tasks, knowledge in eight health informatics topics, skills in using specific hardware and software applications. Also comparison of reported skills between senior and junior staff; proportion of doctors identifying specific training needs.

RESULTS

All but one (1%) of the responding doctors used a computer regularly. Over three quarters of respondents reported they were semi-skilled or fully skilled in basic office applications, though the juniors scored significantly more highly than the seniors for some applications. However, 44% of doctors reported no skills in database software, identifying this as a training need. Around half of the doctors were unaware of health informatics topics, including electronic patient records, the Caldicott report and data protection law. In each case the senior doctors were significantly more aware than the juniors of the topic in question.

CONCLUSION

Both junior and senior doctors have basic computer literacy, but nearly half of this population identify the use of database software as a training need. In addition, there are several health informatics topics of which a large proportion of doctors, particularly the juniors, have little knowledge, but which have not been identified as training needs. Some recommendations are made for provision of in-house health informatics education for doctors.

Orienting the clinician to point of service systems

Today's home care clinicians are expected to begin employment with basic computer skills and to learn informatics skills applicable to the position. This article discusses the technology competencies clinical home care staff must master in agencies that use Point of Service (POS) documentation systems. It also shares tips that facilitate new clinicians' orientations to a POS system.

Development and evaluation of a charge capture program for long-term care providers

OBJECTIVE

Clinicians often have difficulty determining the appropriate Current Procedural Terminology Evaluation and Management code to assign to the type and intensity of patient care they provide. The purpose of this study was to develop, implement, and evaluate a handheld charge capture program for use by providers in the long-term care setting.

DESIGN

Using a pre-post study design, we compared the coding accuracy and user satisfaction of an established paper process with a handheld charge capture program created for this study by means of: (1) preimplementation and postimplementation assessment of coding accuracy, and (2) preimplementation and postimplementation clinician survey.

SETTING

We studied an academic division of geriatric medicine.

PARTICIPANTS

Participants consisted of six clinicians who currently spend at least 50% of their clinical time practicing in the long-term care setting.

INTERVENTION

A handheld charge capture program to replace the current paper-based charge capture process was reviewed.

RESULTS

Overall coding accuracy improved by approximately 20% when the handheld program was used instead of a paper coding process. The majority of clinicians found that the handheld program was more widely available, efficient, easier to use, and encouraged the participants to document more completely and accurately in the patient's medical record.

CONCLUSION

A handheld billing and coding program used by clinicians who provide care for long-term care residents is not only feasible, but leads to an improvement in coding accuracy when compared with a paper process. In addition, clinician satisfaction toward the billing and coding processes improved with the use of the handheld program.

Important Computer Competencies for the Nursing Profession

Nursing requires computer competencies. This study aimed at identifying those competencies required for the nursing profession in Taiwan. The Delphi technique was deployed in this study. In the Delphi questionnaires, computer competencies were sorted into seven domains: concepts of hardware, software, and networks; principles of computer applications; skills of computer usage; program design; limitations of the computer; personal and social issues; attitudes toward the computer. In three Delphi questionnaires, nursing informatics experts gave us their opinions on the importance of each computer competency for the nursing profession. The experts also designated when the competency should be cultivated. This study provides a comprehensive list for nursing professionals to check on their computer competence. The results of this study should also serve as good references for teachers and schools in designing related curriculums.

Assessing computer skills in Tanzanian medical students: an elective experience

BACKGROUND

One estimate suggests that by 2010 more than 30% of a physician's time will be spent using information technology tools. The aim of this study is to assess the information and communication technologies (ICT) skills of medical students in Tanzania. We also report a pilot intervention of peer mentoring training in ICT by medical students from the UK tutoring students in Tanzania.

METHODS

DESIGN

Cross sectional study and pilot intervention study.

PARTICIPANTS

Fourth year medical students (n = 92) attending Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.

MAIN OUTCOME MEASURES

Self-reported assessment of competence on ICT-related topics and ability to perform specific ICT tasks. Further information related to frequency of computer use (hours per week), years of computer use, reasons for use and access to computers. Skills at specific tasks were reassessed for 12 students following 4 to 6 hours of peer mentoring training.

RESULTS

The highest levels of competence in generic ICT areas were for email, Internet and file management. For other skills such as word processing most respondents reported low levels of competence. The abilities to perform specific ICT skills were low - less than 60% of the participants were able to perform the core specific skills assessed. A period of approximately 5 hours of peer mentoring training produced an approximate doubling of competence scores for these skills.

CONCLUSION

Our study has found a low level of ability to use ICT facilities among medical students in a leading university in sub-Saharan Africa. A pilot scheme utilising UK elective students to tutor basic skills showed potential. Attention is required to develop interventions that can improve ICT skills, as well as computer access, in order to bridge the digital divide.

Leadership in Nursing Informatics

Nursing informatics is a 21st century science with great potential for improving the quality, safety, and efficiency of health care. Perinatal, neonatal, and women's health nurses have an opportunity to contribute and lead in informatics. Leaders must learn about current informatics issues from essential resources, including the literature, professional organizations, and education programs, to develop successful strategies for innovation, collaboration, and implementation. Most important, nurses must be accountable for humanizing the use of technology using a nursing model.

'Rage against the machine?': nurses' and midwives' experiences of using Computerized Patient Information Systems for clinical information

BACKGROUND

Computerized Patient Information Systems (CPIS) are used increasingly in health care, yet few studies have asked clinicians to describe their experiences of using these systems and what they mean to their practice and patient care.

AIMS AND OBJECTIVES

The aim of this study was to explore clinical nurses' and midwives' perceptions and understandings of computerized information systems in everyday practice. The objective was to provide a detailed and faithful account of clinicians' experiences of using such systems.

DESIGN

A qualitative design was used, based upon interpretive phenomenology.

METHODS

A total of 13 focus groups involving 53 practitioners was conducted in hospitals across five Australian states with nurses and midwives from a wide range of practice settings. The participants ranged from Level 1 RNs to Clinical Nurse Consultants and nurses with an IT project management role.

RESULTS

This study focuses specifically on clinicians' experiences of using CPIS to manage clinical information. Clinicians' experiences were characterized by digital disappointment rather than electronic efficiencies. Clinicians reported generally that computerization had neither enhanced their clinical practice nor patient care, nor had it improved patient outcomes.

CONCLUSIONS

Participants' experiences were predominantly negative and mostly critical of CPIS and their: perceived inability to capture 'real nursing', difficulty in use, incompatibilities, non-responsiveness and irrelevance to patient care and meaningful clinical outcomes.

RELEVANCE TO CLINICAL PRACTICE

Technological 'solutions' to health care problems are endlessly seductive and easily entrance policy and decision makers. Computerization will continue to impact upon clinical practice and cannot be wished away. Today's computerized systems may have been developed with scant regard for clinician end-users. A crucial issue facing everyone in health informatics is how point-of-care systems can be developed in ways that involve clinicians meaningfully and which recognize and respond to the complexity and subtlety of the world of nursing and midwifery practice.

Study of Basic Computer Competence Among Public Health Nurses in Taiwan

Rapid advances in information technology and media have made distance learning on the Internet possible. This new model of learning allows greater efficiency and flexibility in knowledge acquisition. Since basic computer competence is a prerequisite for this new learning model, this study was conducted to examine the basic computer competence of public health nurses in Taiwan and explore factors influencing computer competence. A national cross-sectional randomized study was conducted with 329 public health nurses. A questionnaire was used to collect data and was delivered by mail. Results indicate that basic computer competence of public health nurses in Taiwan is still needs to be improved (mean = 57.57 +- 2.83, total score range from 26-130). Among the five most frequently used software programs, nurses were most knowledgeable about Word and least knowledgeable about PowerPoint. Stepwise multiple regression analysis revealed eight variables (weekly number of hours spent online at home, weekly amount of time spent online at work, weekly frequency of computer use at work, previous computer training, computer at workplace and Internet access, job position, education level, and age) that significantly influenced computer competence, which accounted for 39.0 % of the variance. In conclusion, greater computer competence, broader educational programs regarding computer technology, and a greater emphasis on computers at work are necessary to increase the usefulness of distance learning via the Internet in Taiwan. Building a user-friendly environment is important in developing this new media model of learning for the future.

Becoming a web-based learner: registered nurses' experiences

AIMS

The purpose of the study was to describe Registered Nurses' experiences when taking a web-based course from either the workplace or home, and the impact of their learning on clinical practice.

RATIONALE

Little is known about the web-based learners' experience, particularly when courses are accessed from the nursing practice setting. Even less is known about whether nurses transfer their web-based learning to clinical practice.

METHODS

A qualitative design employing focus group interviews was used. Participants included hospital and community nurses from three Canadian provinces and one territory. Data were collected at three points over a 6-month period and analysed using a thematic analysis process. These findings emanate from a larger study using survey method and focus group interviews.

RESULTS

The focus group interviews captured the hurdles nurses faced during the first weeks when they struggled with technology, re-framed their views of teaching and adjusted to web-based learning from home and work. These first stressful weeks were followed by a period during which nurses developed relationships with the teacher and peers that enabled them to focus on learning and prevented attrition. Most nurses reported the web course was convenient and that they would be interested and comfortable using technology for learning and work purposes in the future. Six weeks after the course was completed, nurses articulated a number of ways the course had improved their practice.

CONCLUSION

Initial weeks in a web-based course can be very challenging for novice Internet users, however, most nurses who completed the course reported a positive learning experience. Nurses, employers and educators should evaluate computer skills, computer access and the learning environment when preparing for web-based learning.

A Toolbox of Technical Supports for Nurses New to Web Learning

This article describes a number of strategies that have been used by an online Nurse Practitioner program to help learners and faculty become comfortable and proficient in the technical skills necessary for an Internet-based program. Various components of the "toolbox" of help strategies and how they have evolved over time are described. Results of a project to systematically develop and evaluate the toolbox are discussed.

Factors for Consideration in the Development and Implementation of an Online RN-BSN Course

An online "issues in nursing" course was developed over the summer 2000 and subsequently implemented over a 4-semester time period in an RN-BSN program. Student and faculty anecdotal evaluation records were compiled and reviewed to determine universal needs and concerns associated with online learning for this particular population. Seven themes emerged from student course evaluation data and 5 "factors for faculty consideration" were identified by the course facilitator.

Improving governance and reducing risk in electronic patient record systems: ensuring appropriate competencies for support and end-user staff

As clinical health information systems, particularly Electronic Patient Records, become widely used, so it is important to address the Governance and Risk Reduction policies needed to ensure their safe and effective use. Greater emphasis needs to be placed on ensuring that all staff involved have relevant, recognized competencies. This paper describes two initiatives--one for health informatics staff, and one for end-user health professionals--ensure and assess such competencies

Information skills training: a systematic review of the literature

The objectives of this study were to undertake a systematic review to determine the effectiveness of information skills training, to identify effective methods of training and to determine whether information skills training affects patient care. A systematic review, using an iterative approach to searching, was employed. Studies selected for inclusion in the review were critically appraised using a tool used in previous reviews. A tabular approach was used to provide a summary of each paper allowing synthesis of results. One thousand, three hundred and fifty-seven potentially relevant papers were located. On the basis of titles and abstracts, 41 potentially relevant studies were identified for potential inclusion. Further reading and application of the inclusion criteria left 24 studies for critical appraisal and inclusion in the review. Study designs included randomised controlled trials, cohort designs and qualitative studies. The majority of studies took place in US medical schools. Wide variations were found in course content and training methods. Eight studies used objective methods to test skills, two compared training methods and two examined the effects on patient care. There was limited evidence to show that training improves skills, insufficient evidence to determine the most effective methods of training and limited evidence to show that training improves patient care. Further research is needed in a number of areas.

Ethical and legal issues in the use of clinical decision support systems

The clinician must be able to make informed decisions on when to seek out, follow, or ignore the clinical decision support system's advice. In addition, knowledge bases must be properly maintained, and vendors should inform the client about how the systems were developed and tested, the source of the rules in the system, expectations of the user, and type of user training required.

A comparison of technologies for database-driven websites for medical education

Static web pages may be easy to setup using text processors or user-friendly web editing software. However, some basic knowledge of the implementation (HTML) is usually needed for final editing and maintenance. As a result many static web pages are left without appropriate updating. With a database driven, dynamic approach web contents may change through user interaction, the pages are usually easier to maintain, and design elements are separated from contents. Database driven solutions (or content management systems) for larger organizations may be purchased at many different levels of complexity. For smaller systems, such as separate courses or projects, they may, however, be developed locally. The present study compares four alternative technologies for database driven web pages. Each technology offers advantages and disadvantages and many issues need to be considered when selecting platform. The present study demonstrates that database driven web pages may be effectively deployed using free Open Source software. Details may be found at www.intermed.dk/datadriven.

Computing and information technology skills of final year medical and dental students at the College of Medicine University of Lagos

This study was conducted to determine awareness, level of use of computers and the use of the Internet for medical research amongst final year medical and dental students at the University of Lagos. A self-administered structured questionnaire was used to collect data. A response rate of 88% was achieved (136/155). Eighty per cent had used the computer before. Use of software applications was poor with computer games being the most frequently used (19%) followed by word processing softwares (18%). The Internet and electronic mail had been used by 58% but only 23% had used the Internet for medical research. Twenty-one percent classified themselves as proficient on the computer, 59% had little skills and 20% had no skills. Younger students (age less than 26 years) were found to have significantly better skills than older colleagues (p = 004). Majority of final year students at College of Medicine, University of Lagos have little computing skills.

A descriptive study of registered nurses' experiences with web-based learning

AIMS

To describe the experiences of registered nurses (RNs) who enrolled in a web-based course from either their home or the workplace.

RATIONALE

In order to maintain competency in rapidly changing health care systems, and meet the challenge of overcoming traditional barriers to continuing education, RNs need access to innovative educational delivery methods. As yet, little is known about the web-based learners' experience, particularly when courses are accessed from the nursing practice setting.

METHODS

The article focuses on the results from questionnaires conducted with 57 RNs enrolled in a web-based, postdiploma course. These findings emanate from a larger study using survey method and focus group interviews. Nurses' experiences were measured using the Online Learner Support Instrument which was developed and tested for use in the study.

RESULTS

Most nurses found the course highly satisfactory. Not all experiences were positive however, and a number of challenges were faced. Access to the course from home was reported as very satisfactory for the majority, while work users encountered a number of serious barriers such as insufficient time and limited computer access. The RNs made significant gains in their learning with e-mail, Internet, keyboarding and word processing skills during the 16-week course. Lack of computer skills, erroneous perceptions of course workload and inadequate preparation for web learning were largely responsible for the majority of withdrawals.

CONCLUSION

Web-based learning can be an effective mode of delivery for nursing education. Advance preparation by educational institutions, employers and prospective students is essential. Teachers, peers, technology, course design and the learning environment are key variables that influence the learners' experience and success.

A Delphi study to determine informatics competencies for nurses at four levels of practice

BACKGROUND

Despite its obvious need, a current, research-based list of informatics competencies for nurses is not available.

OBJECTIVE

To produce a research-based master list of informatics competencies for nurses and differentiate these competencies by level of nursing practice.

METHODS

After a comprehensive literature review and item consolidation, an expert panel defined initial competencies. Subsequently, a three round Delphi study was conducted to validate the items. Participants were expert informatics nurse specialists in the United States of America.

RESULTS

Of the initial 305 competencies proposed, 281 competencies achieved an 80% or greater agreement for both importance as a competency and appropriateness for the correct practice level. Five competencies were rejected. Six competencies were considered valid competencies but the appropriate level of practice could not be agreed upon. Thirteen competencies did not reach any consensus after the three Delphi rounds.

DISCUSSION

The Delphi study had a high rate of participation, demonstrating the great level of interest and need for a list of informatics competencies for nurses. Out of the initial 305 competencies, only 24 items were not validated. Respondents commented during each round about whether computer skills should be considered informatics competencies. The authors propose that computer skills, while not high level, are one set of tools within the larger category of informatics competencies. This sample of experts did not deem programming skills as necessary for informatics nurses. This research study is an initial effort to fill the void of valid and reliable informatics competencies. It is the first study to span four levels of nurses, create competencies for both entry-level and experienced informatics nurse specialists, and examine the categories of computer skills, informatics knowledge and informatics skills.

Identifying information technology competencies needed in Singapore nursing education

The purpose of the study was to identify Singapore's healthcare industry's minimum information technology (IT) performance standard expectations for nurses' competencies. A needs assessment was conducted with a panel representing nursing education, nursing management and nursing practice. The findings in this study would provide suggestions to improve the current diploma and advanced diploma nursing programs curricula to meet the present workforce demands. The experts agreed that information technology is necessary and there were two main categories of IT skills identified, basic IT skills and work-related IT skills.

Information technology training in primary care: the nurses' voice

Information technology (IT) is now essential to the development and delivery of health services. Healthcare professionals, including nurses, need appropriate educational training to enable them to use IT adequately because care is shared within multiprofessional teams in both hospitals and the community. In particular, primary care nurses have had less access than other health professionals to IT training and fewer opportunities to benefit from IT. Furthermore, there is little evidence in the literature on the current situation of IT training needs and requirements for primary care nurses. The PRACTIS (PRimary care nurses Access to Communications Technology and Informatics Skills) UK-based project has addressed these issues through an empirical investigation to establish a picture of the current primary care situation. This was done using a questionnaire, followed by practicing nurse focus groups. Directions for further work in the IT training of primary care nurses are discussed, together with recommendations to investigate the effect that the organization of the work within primary care groups may have on nurses' use and access to communications technology and informatics skills.

Student perspectives on transitioning to new technologies for distance learning

This article reports on students' perceptions of their learning experiences when an existing distance-learning master's program transitions to new technologies and new instructional strategies. Unique elements addressed in this article include (1) findings when a program with extensive experience delivering distance education changes to new technologies and (2) findings when a multidimensional format is used to evaluate program delivery. The technology changes involved migrating from a satellite-based technician-supported videoconferencing system to a land-based faculty-operated videoconferencing system and the addition of class Web materials and asynchronous computer conferencing to course delivery. The multidimensional evaluation format examined student experiences within the context of specific interactions among instructional activities, technology applications, and desired learning outcomes. The evaluation process involved (1) open-ended and structured items in course surveys and (2) an end-of-year student focus group discussion. A formative evaluation approach was used; this article reports on efforts to address the problems identified. Findings include (1) program planners should not assume that prior institutional experiences with distance education facilitate a smooth transition to use of different technologies and (2) a formative multidimensional approach to program evaluation is critical for understanding student experiences with technology-mediated distance education.

Informatics competencies for nurse managers and their staffs

Nurses have always dealt with data, information, and knowledge. Therefore, as automated information systems become increasingly important in health care, all nurses should have core competencies in computer skills and data and information management. These competencies differ according to the skill level of the nurse, from a beginning nurse to nursing manager, and on to those who specialize in nursing informatics.

Out with computer literacy, in with information literacy: the nurse manager's challenge for the 21st century

As computer literacy has given way to information literacy, knowing how to manage and utilize the information that technology brings is essential for the nurse manager of the future. This article examines some of the challenges facing nursing as it attempts to turn data into information and usable knowledge.

Overview on security standards for Healthcare information systems

The intense need for Healthcare information exchange has revealed a lack of interoperability of systems and applications. Security controls, usually based on proprietary methods and techniques, aggravate the current situation. However, timely development of HIS security standards may improve the interoperability and enable the integration of systems. This chapter provides an overview of the standardisation work that is being done by official standardisation organisations in Europe and world-wide.

Demonstration results for the standard ENV 12924

Within the working programme of CEN/TC251 (Health Informatics), a standard for Security Categorisation and Protection for Healthcare Information Systems has been developed. This document was formally adopted in 1997 by CEN as pre-standard CEN ENV 12924. A demonstration and implementation effort, which was to be effected in principle at one location, was planned and executed as part of the MEDSEC project. The standard CEN ENV 12924 contains a security categorisation model for information systems in Healthcare, distinguishing six categories, plus some refinements. For each category it specifies the required protection measures. The project task consisted of demonstrating and implementing the standard (as far as possible within a limited period) in a real life situation, and providing feedback on these results to the CEN organisation. To this end, the categorisation scheme, as specified in the standard, was applied to a large part of the information (sub)-systems in the Leiden University Medical Centre. A set of ten sub-systems was then selected for a more detailed investigation. The actual protection status for each sub-system was evaluated on the basis of the recommended protection profiles specified in the standard. For each of the relevant recommendations in the standard, its status was recorded, and remarks were added on its relevance, feasibility, etc. These detailed data have been gathered in separate reports for each sub-system. These reports evidently are confidential, in view of protection of the hospital's information security. A similar, though more limited exercise has been done at Magdeburg University Hospital (UHM), in order to be able to allow for possible differences in local situations. A thorough comparison of results for different hospitals was beyond the scope of the project, however. From the overall picture we have tried to draw conclusions on the quality, completeness and applicability of the standard, as well as on the actual level of protection of the systems. As a by-product of the investigation, for all systems out of the small group, implementation plans have been specified to bring the protection in the various (sub)-systems on a higher level, where necessary. Subsequently, these plans have been realised to a large extent. To facilitate the bookkeeping of the results, we have used the SIDERO model, resulting from the SEISMED project. This model has been enhanced, for this purpose, with the recommendations from this standard. A brief description of this database model has been included in Appendix B. As an overall conclusion, we may state that the standard has proven to be a very useful instrument, providing a good basis for a security review of the types of Healthcare information systems which are encountered in a hospital environment. Some suggestions have been presented, for amending recommendations that were found too unpractical or too heavy in the circumstances considered. Also, we suggest to add one category to the set of six which is being used now. Furthermore, the use of a 'bookkeeping tool' (like e.g. SIDERO) is strongly recommended.