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Nursing Informatics: The Internet as a Nursing Resource

The world is at your fingertips with the internet. As nurses, what we find out there on the web can lead us to be being better health care professionals, better informed, and better connected and supported by our peers.

Kris Rykzx Basilla

on 5 August 2013

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Transcript of Nursing Informatics: The Internet as a Nursing Resource

The Internet as a Nursing Resource

To know more about the Internet and recognize its importance as a nursing resource.
To define Nursing informatics and identify its significance in the nursing profession.
To learn how to evaluate the quality of health information on the Internet.

has always been a key area of both interest and need for people, so it is not surprising that the internet is filled with an ever growing number of sources of health care information.
•Since the information is easily accessible, patients often come to health care professionals with a sizable amount of information about their conditions or concerns. How accurate and complete this information is becomes a matter that nurses and other health care professionals need to address.
•The Internet is a
global system of interconnected computer networks
that use the standard Internet protocol suite (TCP/IP) to serve several billion users worldwide.
•It is a
network of networks
that consists of millions of private, public, academic, business, and government networks, of local to global scope, that are linked by a broad array of electronic, wireless and optical networking technologies.
•The Internet carries an extensive range of information resources and services, such as the inter-linked hypertext documents of the World Wide Web (WWW) and the infrastructure to support email.
The internet’s tremendous impact on society
•Changing the way we communicate
•Conduct business
•Obtain information
•Manage life
Who Controls the Internet?
•The internet itself has
no owners, censors, bosses, board of directors, or stockholders
. In principle, any computer or network that obeys the protocols, which are technical, not social or political, can be an equal player.
•The over-all organizing force is the
, an international, non-profit, professional membership organization with no governmental allegiances. It is comprised of over 150 organizations and 16,000 individual members that represent over 180 nations worldwide. The society works to maintain standards, develop public policy, provide education and increase membership.
What are the Technologies behind the Internet?

- determined two devices how data will be transmitted between two devices.
-The main protocols on which the functioning of the internet is dependent are referred to as TCP and IP.

- the lower level protocol, responsible for making decisions about packets.

- data grams, detects and reorder the packets as necessary.

- Hypertext transmission protocol, supports the World Wide Web (www)

- files transmission protocol, permits users to send all types of electronic files over the internet.
World Wide Web
(Abbreviated as WWW or W3, commonly known as the web),
•is a system of
interlinked hypertext documents
accessed via the Internet. With a web browser, one can view web pages that may contain text, images, videos, and other multimedia, and navigate between them via hyperlinks.
The Domain Name System
•The internet DNS permits us to give
globally unique “names”
to network and computers.
Benefits of this system
•A name is easier to remember than the long strings of number that makes up an IP address, which is assigned to each computer in the network
•A name allows for a change in location that is transparent to the user.
Home page
•A home page is the
main page
of a Web Site. It serves as the index or table of contents to any other documents at the site or other sites.
Electronic mail


•1972- The first e-mail software appeared, that allowed users to list, selectively read file, forward and respond to messages.
•One of the most popular users for internet remains the ability to send and receive e-mail. An e-mail address has two parts separated by “@” sign.
Use of Emoticons and Abbreviations

•Emoticons or Smileys are small icons used to denote mood using characters on a standard keyboard to form a picture.
File attachments
•To send a file created by a word processor or other application programs.
Usenet News and Online Forums

: a sort of worldwide bulletin board system that is accessed using a software called newsreader.

Online forums
: often set up by organizations to allow members, or anyone, depending on how the forum is organized, to share ideas.
Hypertext Markup Language

•Is the main markup language for creating web pages and other information that can be displayed in a web browser.
Top-Level Domains
•A top-level domain is one of the domains at the
highest level
in the hierarchical Domain Name System of the Internet.
The top-level domains such as .com and .net and .org are the highest level of domain names of the Internet
How large is the Internet?
•The world’s largest index of the Internet, estimated the size at roughly
5 million terabytes
of data. That’s over
5 billion gigabytes of data, or 5 trillion megabytes
. Schmidt further noted that in its seven years of operations, Google has indexed roughly 200 terabytes of that, or .004% of the total size.
•There are thought to be some
155 million websites
on the Internet, but this number fluctuates wildly from month to month, and one runs into a problem of what exactly constitutes a website. Is a person’s individual Facebook page its own website? How about their LiveJournal or blog? What if the blog is hosted by a blog service?
How old is the web?
•The oldest currently registered URL(Uniform Resource Locator, also known as web address) is Symbolics.com, which was registered March 15, 1985. Other notable domains in the first 10 registered URLs include Northrop.com, Xerox.com, and HP.com, all registered in 1985.

is a device that modulates an analog carrier signal to encode digital information, and also demodulates such a carrier signal to decode the transmitted information.

(Wireless Fidelity)
– uses radio waves, allows access without wire connection.

– refers to the wide bandwidth characteristics of a transmission medium and its ability to transport multiple signals and traffic types simultaneously. The medium can be coax, optical fiber, twisted pair or wireless. In contrast, baseband describes a communication system in which information is transported across a single channel.

Digital Subscriber Lines
– use sophisticated technology to pack data onto copper wires.


(Worldwide Interoperability for Microwave Access) –is a WAN (wide area network)
standard that is designed to operate in a cell-phone type of network but provide relatively high-speed data access. Like WiFi, it is a networking standard (actually several) that’s designed to allow various devices to interoperate, however unlike
WiFi it’s designed to operate over large distances outdoors
to support a service provider using a WiMAX network to serve many individual customers. Usually WiMAX is used to provide internet access to end-users as opposed to LAN-style connectivity.
Typical Speeds: 7Mbps download; 2Mbps upload; Latency: 40ms


(long-term evolution)
, marketed as
, is a standard for wireless communication of high-speed data for mobile phones and data terminals. It is based on the
network technologies, increasing the capacity and speed using a different radio interface together with core network improvements.
Typical Speeds: 10Mbps(100Mbps max) download; 3Mbps(50Mbps max) upload; Latency: 30ms

Nursing Informatics
is the
"science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide."
(IMIA Special Interest Group on Nursing Informatics 2009).

•The application of nursing informatics knowledge is empowering for all healthcare practitioners in achieving patient centered care.
•Worldwide use of computer technology in medicine began in the early 1950s with the rise of the computers.
•In 1949,
Gustav Wagner
established the first professional organization for informatics in Germany.
•In 1960s, Specialized university departments and Informatics training programs began in France, Germany, Belgium and The Netherlands.
•1960's, use of computers in healthcare is questioned, but studies on computers in nursing is started. The introduction of cathode ray tubes and development of hospital information system for financial transactions started.
•In 1970s, Medical informatics research units began to appear in Poland and the US
•In 1970's, nurses assisted in the design of HIS. Computers are used in financial and management functions, and several communities developed management information system.
•In 1980's, nursing Informatics is formally accepted as new nursing specialty.
•In 1990's, computer technology became an integral part of the healthcare setting.
•And in the year 2000,
Clinical Information System
became individualized in the electronic patient record, mobile computing device were introduced, new technologies were utilized, internet provided new means of development and
•Computers can perform a wide range of activities that save time and help nurses provide quality nursing care. Computer systems, patient care data and NCP’s are integrated to
Electronic Health Record
. Need for EHR was perceived and new nursing terminologies were recognized by ANA. Computers linked department together, hospital data are accessed through computer and process goes on line, and internet was utilized.
Nursing Education
, most nursing schools offered computer enhanced courses. Then, the computer technology was integrated into teaching methodologies and WWW facilitates student-centered instructional settings.
Nursing Research
, it provides an avenue for analyzing data and research databases engaged.
Nurse informaticians
work as developers of communication and information technologies, educators, researchers, chief nursing officers, chief information officers, software engineers, implementation consultants, policy developers, and business owners, to advance healthcare.

Nursing Informatics can be applied to all areas of nursing practice, which include;
clinical practice, administration, education, and research

Nursing, like so many other fields, has changed dramatically with the advent of the internet. Information is at your fingertips. From the desktop at the nurses' station, to the personal laptop, to smart phones everywhere, nurses need never be more than a few keystrokes from their patients, colleagues and worldwide resources. And, it's not just being on the job that has been changed by the latest turn of the information age. Education, licensing and certification, even career advancement can all be achieved by signing on to the closest computer.
•For nurses it makes professional information easily accessible.
The Internet is a fast and efficient way of accessing evidence to support nursing practice.

Diagnosis and Direct Care
If a patient has a problem or disease process with which the nurse is unfamiliar it is just a quick trip to the computer. Between in-house resources and the internet any RN can have a quick overview of what the problem is, where it comes from, what symptoms it exhibits and what are the standard forms of care.

Patient safety can also be attributed to information accessible on the internet. If the nurse is doesn't recognize an ordered drug prescription or feels there is a problem with the dosage she can look it up immediately. Well established websites like WebMD.com provide current information about clinical management and treatment of disease.

Nurses have always had a strong sense of community. Nurses belong to societies, associations and support groups.
Nursing blogs are web logs that range from the academic to the personal. They can provide news and information about the nursing world, practice issues and resources available to nurses which they might not yet know about. Some are diaries or journals sharing intimate thoughts, patient stories, job frustrations or even adventure and leisure activities. The ability to comment allows readers to enter and interact in the lives of their colleagues. They can be a valuable source for information, support and understanding.
Nursing Research

•Computerized literature searching-CINAHL, Medline and Web sources
•The adoption of standardized language related to nursing terms- NANDA, etc.
•The ability to find trends in aggregate data, that is data derived from large population groups-Statistical Software, SPSS
Two categories:

Electronic Medical Record (EMR)

Decision-support software Nursing Education Computerized record-keeping

New roles of nurses:
•Correcting misinformation
•Reassuring patients who have misinterpreted what they have found
•Answering questions about new trends and treatments
Benefits of Internet to Nurses
•Serves as a constant source of up-to-date professional information
•Used to network with colleagues all over the world, sharing their knowledge and learning from each other, thus broadening the body of nursing knowledge.
•Cause nursing standards to expand from community and regional, to national and international.

“Criteria for Assessing the
Quality of Health Information
on the Internet”
: must be accurate and complete, and an appropriate disclaimer provided.
(To help judge accuracy, examine the hierarchy of evidence, presence of original sources. Are disclaimers provided? )

: includes informing the user of the purpose of the site, as well as any profiling or collection of information associated with using the site.
(What is the purpose of the site? Who is sponsoring it? What will the site owners do with any information that they collect?)
: evaluated according to selection, architecture, content, and back linkages.
(What is the quality of the links provided?)

includes feedback mechanisms and means for exchange of information among users.
(Does the site allow for feedback and exchange of information?)

: clarification of whether site function is to market products and services or is a primary information content provider.
(Does the site clearly state its function/ Is its purpose primarily information or it is trying to see products or services?)

is a dynamic profession and computer technology can transform the nursing profession.
Clinical Information System
is common to modern health care and is a computer based system that is designed for collecting, storing, manipulating and making available clinical information important to the healthcare delivery process.
Computer is a general term referring to information technology (IT) and computer systems.
The computer
is the most powerful technological tool to transform nursing profession prior to the new century and computer has transformed the nursing paper based record to computer based record.
Nurses are becoming more computer literate and the nursing profession is implementing practice standards for its clinical care and data standards for its nursing information technology system.
Nursing informatics
is specialist emerged as a new specialty in the field of professional nursing practice. In nursing it synonymous into nursing information system (NIS). Clinical Information system can be used interchangeably with electronic information systems (EHR-S) computerized patient and electronic medical record. It refers to a set components that form the mechanism by which patient records are created, used, stored and retrieved usually located within a healthcare provider setting. It includes people, data rules and procedures, processing and storage devices, communication and support facilities (institute of Medicine, 1991).
The world is at your fingertips with the internet. As nurses, what we find out there on the web can lead us to be being better health care professionals, better informed, and better connected and supported by our peers.
Krisry L. Basilla, RN

Thank you for listening!

The framework for nursing informatics relies on the central concepts of data, information and knowledge.
Data Information Knowledge

is defined as discrete entities that are described objectively without interpretation
as data that is interpreted, organized or structured
as information that has been synthesized so that interrelationships are identified and formalized.
Decision-support software benefits include:

•Decision-support tools as well as alerts and reminders notify the clinician of possible concerns or omissions
•Effective data management and trend-finding. Includes the ability to provide historical or current data reports.
•Extensive financial information can be collected and analyzed for trends. An extremely important benefit in this era of managed care and cost cutting.
•Data related to treatment such as inpatient length of stay and the lowest level of care provider required can be used to decrease costs.
EMR benefits include:
•Improved access to the medical record.
•Decreased redundancy of data entry.
•Decreased time spent in documentation.
•Increased time for client care.
•Facilitation of data collection for research.
•Improved communication and decreased potential for error.
•Creation of a lifetime clinical record facilitated by information systems
Nursing Clinical Practice:
Point-of-Care Systems and Clinical Information Systems.

Work lists to remind staff of planned nursing interventions

Computer generated client documentation

Electronic Medical Record (EMR) and Computer-Based Patient Record (CPR)

Monitoring devices that record vital signs and other measurements directly into the client record (electronic medical record)

Computer - generated nursing care plans and critical pathways

Automatic billing for supplies or procedures with nursing documentation

Reminders and prompts that appear during documentation to ensure comprehensive charting.

Becoming a nurse or advancing a nursing degree has never been more accessible, with the advent of the internet. Students everywhere have access to virtual classrooms and degree programs. Online education means limitations of location and time become much less difficult.

Patient Education and Support
In terms of educating patients about their health issues the internet is also invaluable to nurses. A nurse can answer questions all day long but backing up those answers with printed materials reinforces the teaching, whether it is about a specific disease, activities that can help with healing or rehabilitation or what to expect from the medications prescribed for treatment.

This also allows nurses to guide patients and their families to websites that are reliable and trustworthy.
Support groups are great ways for patients to find an understanding community while dealing with their illness. Nurses can suggest online communities for people experiencing chronic illness or going through debilitating treatments.
Getting on the Information superhighway
Nursing Administration:

Health Care Information Systems

•Automated staff scheduling
•E-mail for improved communication
•Cost analysis and finding trends for budget purposes
•Quality assurance and outcomes analysis
Nursing Education
•Computerized record-keeping
•Computerized-assisted instruction
•Interactive video technology
•Distance Learning-Web based courses and degree programmes
•Internet resources and formal nursing courses and degree programs
•Presentation software for preparing slides and handouts-PowerPoint and MS Word
Application of Nursing Informatics
Benefits of Computer Automation in Health Care
What makes the Internet valuable for Nurses?

Nurses seeking to stretch their wings have the job world at their fingertips. Clearing houses like NursingJobs.com and monster.com list available nursing positions all over the country.
Hospitals may exclusively accept applications and resumes over the internet. Nurses can take virtual tours of hospitals and cities they are interested in working in, find statistics for pay rates, and book their travel to a job interview.
health information
proliferates on the Internet, there is a growing need for objective, reproducible, widely accepted criteria that can be used to evaluate the quality of the information. Yet the quality of health information on the Internet is extremely variable and difficult to assess.

To address these needs,
Mitreteck System
put forth
seven areas
which should be considered when evaluating health information obtained on the web.

: includes the source, currency, relevance/utility, and editorial review process for the information.
(What is the source of information? How current is it? Is it useful and relevant? What was the process for editorial review?)

: encompasses accessibility, logical organization (navigability), and internal search capability.
(Is the site accessible, easy to navigate and searchable?)
Full transcript