o Detect faults

FINALS COVERAGE o Software glitches and intrusions

o take action so that services can
• Administrative Applications continue
• Information Technology Applications in o data are protected from corruption
Clinical Practice o destruction
o unauthorized distribution
• Consumer Use of Informatics
Five (5) Fundamental Guidelines
• Educational and Research Applications Architect for Dependability
• International Perspective
- an enterprise system architecture should be
• The Futures of Nursing Informatics developed from the bottom up so that no
critical component is dependent on a
component less trustworthy that itself.
Administrative Applications Anticipate Failures
- features that are transparent to software
Dependability and Healthcare Quality Safety
applications should be implemented to
- Healthcare industry is undergoing a dramatic detect faults, to fail over to redundant
transformation from today’s inefficient, costly, components when faults are detected, and
manually intensive, crises-driven model of care to recover from failures before they become
delivery to a more efficient, consumer- catastrophic. (threats or failures of the
centered, science-based model that proactively system)
focuses on health management. Anticipate Success
Dependability
- the systems planning process should
- is a measure of the extent to which a system anticipate business success and the
can justifiably be relied on to deliver the services consequential need for larger networks,
expected from it. more systems, new applications and
Six (6) Attributes additional integration. (kakayahan mag
• System Reliability – the system consistently accept and expand ng mga new applications)
behaves the same way. (there is continuity of Hire Meticulous Managers
correct service.) - good system administrators should
• Service Availability – required services are meticulously monitor and manage system
present and usable when they are needed. and network performance.
(correct readiness of availability) Don’t be Adventurous
• Confidentiality – sensitive information is - An organization must use only proven
disclosed only to those who authorized to see it. methods, tools, technologies and products
(ex. yung mga may mga stigma sa community; that have been in production, under
HIV, AIDS, Cancer, & etc. must be protected) conditions, at a scale similar to the intended
• Data Integrity – data are not corrupted or environment. (reduce the numbers of failure
destroyed. to the intended users)
• Responsiveness – the system responds to user Clinical Information System Revisited (CIS)
input within an expected and acceptable time - Healthcare providers must keep track of a
period. staggering amount of information -- and their
• Safety – the system does not cause harm. failure to do so can have a detrimental effect
Guidelines for Dependable System on patient care. (CIS is a solution to this
- All computer systems are vulnerable to both dilemma)
human-created threats (such as malicious - is designed to bring the management of
code attacks and software bugs) patient data into the information age. It is
- Natural threats (such as hardware aging and intended to replace the Medical Records
earthquakes) Department of a medical institution,
- Practical approach to attaining dependability supporting the acquisition, storage,
is to build tolerant systems that anticipate manipulation, and distribution of clinical
problems, such as: information throughout the organization.
1|Elisha Kate C. Abong
 - consist of information technology that is the end in mind. The results and
applied at the point of clinical care. improvements expected from implementing
Include: the system are described by the realistic
o Electronic medical records goals for the system. When updating or
o Clinical data repositories expanding the CIS, the project definition
o Decision support programs (such as clinical includes the identification of equipment
guidelines and drug interaction checking) currently available, its age, the degree of
o Handheld devices for collecting data and amortization, and the need for hardware or
viewing reference material operating system software upgrade prior to
o Imaging modalities and communication taking an upgrade project.
tools such as electronic messaging Feasibility Study
systems. - is a preliminary analysis to determine if the
- care is provided in multiple settings thus proposed problem can be solved by the
creating a need for clinicians to share data implementation of a CIS or component
with providers at other locations and to pool application. The feasibility study not only
them with other clinical data in order to clarifies the problem and/or stated goal but
provide a complete picture of an individual also helps to identify the information needs,
patient. objectives and scope of the project.
- Advances in computer networking and - It includes the following project areas:
wireless communication technology have • Statement of Objectives
now made it possible for clinicians to access • Environmental Assessment
these data from any location whether it is in
• Determination of Information Needs
the office, the hospital, at home, or even
when traveling out of town. • Determination of Scope
Challenges in Effectively Implementing Clinical Documentation and Negotiation of Project Scope
Information Agreement
• High cost - A project scope agreement is drafted by the
• The need to change clinical “workflow” project team and submitted to the project’s
• The need for providers to learn new skills steering committee for acceptance. The
• Challenges in capturing clinical data with a agreement includes the scope of the project,
minimum of time and effort on the part of the application level management
clinicians and representing it in computers requirements, and the proposed activation
for optimal use. strategy for implementing CIS or application,
Design, Implementation and Upgrading Clinical and the technical management and
Information Systems personnel who will maintain the equipment.
Allocation of Resources
Eight (8) Phases
- A firm commitment of resources for the
➢ The Planning Phase development of the entire CIS project scope
- The planning phase of the project begins agreement is needed before the system can
once an organization has determined that an fulfill its stated objectives.
existing need or problem may be filled or
- The following points should be considered:
solved by the development or
Present staffing workload
implementation of a CIS or application.
Establishing the committee framework to • Human resources
research and make recommendations for • Present cost of operation
the project is an important first step and is • Relationship of implementation events
variable based on the needs of the with non-project events
organization.
• Anticipated training cost
Four (4) Steps
Definition of the Problem • Space availability
- the project definition includes a description • Current and anticipated equipment
of the how the system will be evaluated. requirements of a project team
Establishing the evaluation criteria early in - The 5M’s of management (manpower,
the process supports the successful materials, machine, minutes, money;
management philosophy of beginning with micro&macro costing, methods)

2|Elisha Kate C. Abong

 The System Analysis Phase o A concise statement of the problem and/or
- fact finding phase goals
- All data requirements related to the problem o Background information related to the problem
defined in the project scope agreement are
o Environmental factors related to the problem
collected and analyzed to gain a sound
understanding of the current system, how it 1. Competition
is used, and what is needed for the current 2. Economics
system. 3. Politics
Five (5) Steps 4. Ethics
Data Collection o Anticipated benefits
- the collection of data reflecting the existing o Proposed solutions
problem or goal is the first step in the system o Budgetary and resource requirements
analysis phase. As a result of thorough data o Project timetable
collection, refinements to the project scope Workflow document
agreement may occur. Added benefits to the - Assimilates the data collected into logical
organization may be realized through the sequencing of tasks and subtasks perform by
small refinements. Two important the end users for each goal or problem area.
documents are created as a result of data It includes a list of assumptions about the
collection: process of work efforts; major tasks
Data Analysis performed by the user and subtasks and
- the analysis provides the data for steps the user accomplishes and outlines
development of an overview of the nursing whether.
problem and/or stated goal defined in the Functional design
project scope agreement. - is the overview of the statement of how the
- Several tools can be used in the new system will work. It uses the workflow
development of the workflow and functional documents as its base, adding the critical
design documents: documentation of the integration of each of
o Data flowchart the workflow documents to create a new
o Grid chart system, implement a commercial software
application or upgrade a system.
o Decision table
The System Design Phase
o Organizational Chart - The design details of the system and the
o Model detailed plans for implementing the system are
Data Review developed for both the functional and the
- the review focuses on resolving the technical components of the system.
problems and/or attaining the goals defined - Acceptance of system proposal by the
in the feasibility study based on the committee heralds the beginning of the system
methods or pathways derived from the design phase.
workflow documents and the functional Three (3) Steps
design. Recommendations for streamlining Functional Specifications
workflow are suggested.
- use the functional design document developed
Benefits Identification
in the system analysis phase of a CIS and builds
- should reflect the resolution of the identified on the design by formulating a detailed
problem, formulated and stated in description of all system inputs, outputs and
quantifiable terms. The proposed benefits processing logic required to complete the scope
statements become the criteria for of the project.
measuring the success of the problem.
Technical Specifications
System Proposal Development
- dedicated technical manager is required. Each
- it includes submission to the project’s area requires that a detailed technical
steering committee for review and approval. The specification be developed.
format of the final system proposal includes the
- The four major areas includes:
following information:
o Hardware

3|Elisha Kate C. Abong

o Application Software entire system, identifying both the strengths and
o Interface Software weaknesses of the implementation process.
o Conversions - An evaluation study often leads to system
Implementation Planning revisions and, ultimately, a better system.
- includes establishment of a detailed work plan. - Approaches to evaluating the functional
The work plan identifies a responsible party and performance of the system exist. (re-assess the
a beginning date and end date of each phase, performance of the program, may glithces ba,
step, task and subtask. may kulang ba <sya kulang saakin the emzzzz>)
The Development Phase
- If the project steering committee decides to Information Technology
develop its own system programs, the project Applications in Clinical Practice
staff must proceed with the development phase
which includes hardware selection, software
Technologies in Critical Care
development, test system and document
- Critical care nursing is that specialty within
system.
nursing that deals specifically with human
The Testing Phase
responses to life-threatening problems.
- The system, whether newly developed or
- A critical care nurse is a licensed
commercially available, must be tested to
professional nurse who is responsible for ensuring
ensure all data are processed correctly and the
that acutely and critically ill patients and their
desired outputs are generated.
families receive optimal care.
- Testing verifies that the computer programs are
- Critical care nurses’ practice in settings
written correctly and ensures that when
where patients require complex assessment, high-
implemented in the production (live)
intensity therapies and interventions, and
environment, the system will function as
continuous nursing vigilance.
planned.
- rely upon a specialized body of knowledge,
The Training Phase
skills and experience to provide care to patients and
- It is essential to train the end users on how to
families and create environments that are healing,
use the system properly. A CIS will function only
humane and caring.
as well as its users understand its operation and
- the critical care nurse is a patient advocate.
the operation streamline the work.
Clinical Care Information Systems (CCIS)
- All users of the new system or application must
- Critical Care Setting is a system designed to:
receive training.
o Collect
- Training on a new system should occur no more
o Store
than six (6) weeks prior to the activation of the
o Organize
new system.
o Retrieve and manipulate all data related to
- Training takes place before and during the
care of the critically-ill client
activation of a new system. (mga users)
The Implementation Phase Component of CCIS
- The implementation phase organizes all steps • Patient management
into a detailed plan describing the series of • Vital signs monitoring
events required to begin using the system or
• Diagnostic testing results
application in the production or live
environment and details the necessary • Clinical documentation
computer and software maintenance • Clinical decision support
operations required to keep the system running. • Medication Management
- ensures that once the system is installed in the
• Healthcare provider order entry
live environment, the system and the delivery of
healthcare in the organization will run smoothly. - hindi ka na magpabalik balik sa mga
The Evaluation Phase information ng client sa hard copy ng info ng pt. kase
- describes and assesses, in detail, the new nandtio na lahar
system’s performance. Using the criteria Information Technology Capabilities in Critical
established in the planning and system design Care Settings
phases, the evaluation process summarizes the

4|Elisha Kate C. Abong

• Process, store and integrate physiologic and passes without a patient's breath being
diagnostic information from various sources detected. (this is to check the breathing
(the capabilities) pattern of the patient)
• Present deviations from present ranges by an Life Support and Emergency Resuscitative
alarm or an alert Equipment
➢ Ventilators - consist of a flexible breathing
• Accept and store patient care documentation in circuit, gas supply, heating/humidification
a lifetime clinical repository (E-Electronic mechanism, monitors, and alarms. They are
records, may disadvantages lang kapag na microprocessor-controlled and programmable,
corrupt or virus kaya need ng back up kapag and regulate the volume, pressure, and flow of
ganto) patient respiration. (if kapag mababa ang mga
• Trend data in a graphical presentation (weekly O2 level, this machine can help to give a life
or monthly report of your scopr sa work, support for the pt)
madami bang pt. ano bang nagyayari sa area ➢ Infusion Pumps - employ automatic,
nyo, madaming discharge, napupuno ba, programmable pumping mechanisms to supply
madaming tumatagal na pt.) the patient with fluids intravenously or
• Provide clinical decision support through alerts, epidurally through a catheter. The pump is hung
alarms, and protocols (this could help you to on an intravenous pole, which is located next to
identify a best diagnosis, library-like) the patient's bed.
➢ Crash Carts - also called resuscitation carts or
• Provide access to vital patient information from
code carts, are strategically located in the ICU
any location, both inside and outside of the
for immediate availability when a patient
critical care setting (demographic like)
experiences cardio-respiratory failure. The cart
• Comparatively evaluate patient for outcomes holds a defibrillator, which is used to apply an
analysis electric shock to a patient in ventricular
• Present clinical data based on concept- fibrillation.
oriented view ➢ Intra-Aortic Balloon Pump - use a balloon
Information Technology Application in Critical Care placed in the patient's aorta to help the heart
Patient Monitoring Equipment pump. The balloon is on the end of a catheter
that is connected to the pump's console, which
- (sounds and ECG, may initial reading na din
displays heart rate, pressure, and ECG
kasama pero partial pa lang kase do double
readings. The patient's ECG is used to time the
check pa ng physician kung tama ang analysis
inflation and deflation of the balloon.
ng machine)
Clinical Focus: Physiologic Monitoring Systems
➢ Acute Care Physiologic Monitoring System – - is pivotal for the appropriate assessment,
comprehensive patient monitoring systems diagnosis and treatment of patients. It ranges from
that can be configured to measure and display basic vital signs and visual assessment to the use of
various patient parameters (parang cardiac sophisticated physiologic monitoring equipment
monitor lang din to) that can measure a number of parameters such as
- CODE: G.I.K.W cardiac rhythm, oxygen saturation and central
➢ Pulse Oximeter – measure the arterial venous and pulmonary artery pressures.
hemoglobin oxygen saturation of the patient's - healthcare practitioners often rely on
blood with a sensor clipped over the finger or sophisticated monitoring technology
toe. - The use of physiologic monitoring enables
➢ Intracranial Pressure Monitors - are connected the clinician to detect changes in a patient's
to sensors inserted into the brain through a condition before they become clinically significant
cannula or bur hole. These devices warn of so that adverse outcomes to the patient can be
elevated pressure and record or display anticipated and prevented. The progress of
pressure trends. (Intra = loob, cranial = brain; technology to include flexible monitoring has now
monitoring the intracranial pressure) made it preferable in some care settings to bring the
technology to the patient instead of moving the
➢ Apnea Monitors - use electrodes or sensors
patient to a critical care unit.
placed on the patient to detect cessation of
- Modern monitoring systems are complex
breathing, display respiration parameters, and
and require adequately trained staff to ensure the
trigger an alarm if a certain amount of time
equipment is functioning properly and to be able to
5|Elisha Kate C. Abong
analyze monitoring data to prevent misdiagnoses. The Community Health Network System
Regardless of where the patient is located, the - is an innovative ambulatory care system
process for monitoring the patient should be specially developed to provide services by the
consistent. computer.
- The assurance of patient safety depends on - Computer terminals are placed in homes of
the appropriate, consistent and proper use of “heavy users of healthcare”, such as families with
physiological monitoring. young children, pregnant women, the disabled, and
- as our healthcare organization has the elderly.
expanded and changed, monitoring practices have - The system allows the subscribers to
not evolved to keep pace with the expansion in telephone for assistance and guidance on services
patient care areas or advances in technology offered via the terminal. The system performs triage
Components of Physiologic Monitoring Systems of actions but not necessarily diagnoses.
o Sensors Features
- Download the patient record from the
o Signal conditions to amplify or filter the
hospital to the home database
display device
- Enter a set of questions about symptoms
o File to rank and order information
using expert system logic until the pathways
o Computer processor to analyze data and are concluded
direct reports
- Track self-care and, depending on the
o Evaluation or controlling component to responses to questions, call or make an
regulate the equipment or alert the nurse appointment with a clinician
Technologies in Public Health Practice - Provide additional information on the
- Public health is defined as One of the efforts condition if self-care is chosen to assist the
of organized society to protect, promote, and client to resolve the problem
restore the people’s health. Public health combines Home High-Tech Monitoring Systems
science, specialized skills, and beliefs to help - Home high-tech monitoring systems are
maintain and improve the health of communities. using computers to link patients at home to
Public health activities change with changing healthcare facilities. Monitoring devices
technology and social values, but the goals remain that transmit vital signs and other critical
the same: to reduce the amount of disease, data are used in the home to conduct health
premature death, and disease-produced checkups for example
discomfort and disability. - They allow healthcare providers to monitor
- For all venues of Community Health Nursing the progress of their patients. Monitoring
(CHN), software developers responded by technology permits the transmission of
developing electronic IT systems instead of healthcare information. This is used not only
outdated data processing/ computer systems. for diagnosis and treatment but also for
- These IT systems allow for the following: prevention.
o Relational database that facilitates the - Many HHAs are using telemonitoring for
retrieval of data for multiple purposes without monitoring biophysical parameters that they
rekeying are remotely transmitted each time the user
o Manipulation of data to create information and (patient) performs an assessment.
knowledge Examples
o Point-of-care devices, computerized patient • Care Watch – home tele-monitoring program
records (CPRs), and/or electronic health for patients with congestive heart failure
records (EHRs) (lumalala ba, nagkakaroon ba sya ng edema or
o Clinical repositories as a strategic resource for nag se severe or nagiging systemic ba yung
quality and practice congestion nya)
o Electronic interfacing systems to facilitate the • Remote Defibrillator – allows hospitals to
sharing of data diagnose and resuscitate a homebound
- critical step in the process of generating patient who has suffered a cardiac arrest.
more information for community health is the • Sophisticated Telemetry Devices – examples
definition of a data set using a consistent health are digitized x-rays and ECG, electronic
vocabulary or classification that will enable the stethoscopes, and interactive video
sharing of information
6|Elisha Kate C. Abong
 equipment that uses telecommunication o Social Services
technology (24/7 machine monitor) o Patient Education
• Alert Systems – communication devices that o Ethics
allow the homebound to signal for help in case - in addition to the traditional medical
of emergency knowledge base
US Government Medical and Health Informatics
• Two-Way Communication Devices – the
Resources
clinician can communicate with the patient
through an online meeting. NLM Gateway
Informatics in Ambulatory Care - This site is a handy entry point for searching
- is a unique realm of nursing practice. It is the many valuable resources at the National
characterized by rapid, focused assessments Library of Medicine.
of patients, long-term nurse/patient/family - It provides a global search function for
relationships, and teaching and translating Pubmed, Pubmed Central, and Medline Plus,
prescriptions for care into doable activities for all of which are discussed below.
patients and their caregivers. - Search results are divided into the following
- is a specialty practice area that is categories: bibliographic, consumer health,
characterized by nurses responding rapidly to and other information resources.
high volumes of patients in a short span of - excellent place to begin a search of health-
time while dealing with issues that are not related government information.
always predictable Access: http://gateway.nlm.nih.gov/gw/Cmd.
Executive Order 13335 on April 27, 2004 Resources for Medical Professionals and
Researchers
- it was signed by President Bush and
established the Office of the National Agency for Healthcare Research and Quality
Coordinator of Health Information (AHRQ)
Technology. - federal agency both conducts and sponsors
- Dr. David Brailer - the newly appointed research on healthcare quality, safety, and
National Coordinator for Health Information cost-effectiveness.
Technology, released his strategic framework - Its "Consumers and Patients" links provide
as a plan of action to ensure that all Americans information on specific conditions, health
have electronic health records within 10 years. insurance plans, prescriptions, health, and
(Not 3 months later). wellness. Some consumer information is
- The Centers for Medicare and Medicaid available in Spanish.
Services (CMS) has recently embarked on a - provides information for practitioners on such
three-year project with the state Quality areas as disaster preparedness, quality and
Improvement Organizations to promote the patient safety, datasets, and research
adoption of electronic health records in findings. It has a research section devoted to
ambulatory primary care settings. The nursing
business case for EHR in primary care (http://www.ahrq.gov/about/nursing/), which
ambulatory settings tends to be outlines the roles of AHRQ nurses, provides a
underdeveloped. listing of Web tools and resources for nurses,
and includes information on funding for
Consumer Use of Informatics research.
Access: http://www.ahrq.gov/
Internet Tools in Nursing Practice National Institute of Nursing Research (NINR)
Nurses and The Internet
- one of the National Institutes of Health, this
Professional Competencies organization’s mission is to support research
o Informatics in nursing in clinical and community settings
o Case Management through grants and other funding programs. It
o Health Care Policy provides information on its own funding
o Cultural Sensitivity initiatives, including diversity programs and
o Disaster Preparedness resources, links to nursing organizations for
Study of Nursing various specialties, and publications from
o Sciences national conferences and meetings.
o Psychology Access: http://ninr.nih.gov/ninr/index.html.
7|Elisha Kate C. Abong
 Pubmed Central BioMed Central
- a free “digital archive of life sciences journal - this resource publishes more than 140 open
literature,” the site offers access to the full text access journals covering all areas of biology
of more than 160 high-quality, open-access and medicine. Most of its publications are
life sciences journals from various publishers. freely available to the public, although some
(literature or research use) require a paid subscription. Included are
Access: http://www.pubmedcentral.nih.gov/. journals on nutrition, public and international
Centers for Disease Control (CDC) and Prevention health, and BMC nursing, specifically for
- the CDC’s mission is to monitor public health, nurses
put forth prevention initiatives, investigate (http://www.biomedcentral.com/bmcnurs/).
health problems, and promote healthy HealthWeb
behaviors. - this well-organized collection of evaluated,
- Its Web site provides information on specific noncommercial resources is a collaborative
health and safety topics, a public health image project of health sciences libraries at more
library, state and national data sets on health than 20 leading academic medical centers in
and disease. the Midwest. Easy to use, it offers basic and
- Its A-to-Z index, it is a convenient way to find guided searching or browsing by categories
statistical and other information on specific from AIDS and HIV to Women’s Health. Each
conditions. category is further divided into subcategories
Access: http://www.cdc.gov/. of annotated links. For example, under
Healthfinder “Nursing” are Academic Institutions,
- this consumer health information site is Associations, Career Resources, Databases,
maintained by the National Health Information Discussion Groups, Electronic Journals, and
Center of the U.S. Department of Health and Grants and Funding. Additional special topics
Human Services. links are offered for each category; in
- hand-selected directory of the health-related “Nursing,” these are Clinical Resources and
Web sites of more than 1,500 organizations— Reference Resources. Especially helpful is the
government, nonprofit, and educational. ability to search by keyword either within a
- Also available in Spanish. category (i.e., “Nursing”) or throughout
Access: http://healthfinder.gov. HealthWeb.
Access: http://healthweb.org/index.cfm.
MedlinePlus
Mayo Clinic: Tools for Healthier Lives
- a consumer health resource that brings
together information from various government - Users can choose “Diseases and Conditions,”
agencies, including the National Library of “Drugs and Supplements,” “Treatment
Medicine, the National Institutes for Health, Decisions,” “Healthy Living,” “Ask a
and others. Specialist,” and “Health Tools.”
- provides simple but accurate health-related - The medical information is high quality and
information for the general public. comprehensive, but the “Tools” section sets
- Its medical encyclopedia, drug and herbal this resource apart.
supplement information, current health news, - Online calculators (including BMI, calorie,
and superior interactive tutorials. heart disease risk), self-assessments
(www.nlm.nih.gov/medlineplus/tutorial.html) are (including depression, prostate, stress,
excellent resources for nursing students. obesity), a symptom checker, and quizzes.
Access: http://www.mayoclinic.com.
National Institutes of Health—Health Information
(NIH) Online Journal of Issues in Nursing (OJIN)
- another directory of consumer health - free, peer-reviewed, international journal
information, this site has a simple design, and addressing topics affecting nursing practice,
is organized by conditions, body systems, type research, education, and the wider health care
of patient, etc. sector. Both Medline and CINAHL index the
- provides links to MedlinePlus and to specific journal.
institutes within NIH. - Presents timely information required by
Access: http://health.nih.gov/. nurses and other healthcare professionals to
Non-Governmental Portals provide current and informed patient care, to
be socially responsive healthcare
8|Elisha Kate C. Abong
 professionals, and to meet professional Francisco General Hospital’s
development needs. complete online textbook
- Was first published in June 1996, making it the o Medical treatment information,
first totally electronic journal in nursing, and commentary, and resources
one of the few sustained totally electronic o Prevention
nursing journals. o Policy analysis
Access: http://www.nursingworld.org/ojin/. o Countries and regions.
Public Library of Science (PLoS) Access: http://hivinsite.ucsf.edu/.
- PLoS is an initiative by scientists and doctors Oncolink
to publish quality, peer-reviewed literature - University of Pennsylvania cancer specialists
and make it freely available to the public and launched this site in 1994 to "help cancer
other researchers. patients, families, health care professionals
- Publishes journals in biology, medicine, and the general public get accurate cancer-
clinical trials, and genetics. PLoS Medicine related information at no charge."
publishes articles on public health and - Updated daily and offers information from
international health issues as well as clinical basic to in-depth in English and Spanish on
research. specific types of cancer, updates on cancer
Access: http://www.plos.org/. treatment, and news about research
World Health Organization (WHO) advances.
- an excellent source of global health - Searchable by keyword or advanced searches,
information, including statistics and country- or by user-friendly menus, including "Types of
by-country health overviews. Cancer," "Treatment Options," "Coping with
- This site is well indexed and easy to navigate. Cancer," "Clinical Trials," "Cancer Resources,"
Search WHOLIS to find full text WHO health "Ask the Expert," and "Oncolink Library."
information. - The library includes access to many full-text
Access: http://www.who.int/en/. articles from peer-reviewed journals.
Nursing Specialties and Diseases-Specific Sites Access: http://www.oncolink.com.
Alzheimer's Association Public Health Nursing Section of the American
Public Health Association
- provides information and support to family
members, caregivers, and health - provides current health-related news, links to
professionals on Alzheimer's disease. information about public health advocacy,
- updated daily and includes news, resources articles of concern to public health nurses,
and information (such as causes, warning general links on health and nursing, links to
signs, diagnosis, treatments, stages, brain images, ask-an-expert sites, and a discussion
tour, myths, statistics, and related disorders). forum on public health nursing.
- There are fact sheets and a diversity toolbox - A good all-purpose resource for nurses, with
(information aimed at specific ethnic groups). an emphasis on public health.
- Also included are a useful glossary, chat and Access:
other online forums, a clinical trials index, http://www.csuchico.edu/~horst/index.html.
funded studies (by state), papers and Nursing Associations, Forums and Discussion
presentations, research theories, and much Links
more. American Nurses Association (ANA)
- Keyword searchable (and there is a useful site - Represents American registered nurses (RNs).
map) and information for caregivers is also - Provides information on current issues in
available in Spanish. nursing (workplace rights, patient safety, and
Access: http://www.alz.org/. ethics) and a sophisticated career center with
HIV InSite: Gateway to AIDS Knowledge a searchable jobs database, space for posting
- San Francisco School of Medicine gives résumés, and advice for jobseekers.
comprehensive, up-to-date information on - Some content is limited to members only, but
HIV/AIDS treatment, prevention, and policy at there is plenty of quality free information.
this site. Access: http://www.ana.org or
- site is divided into five sections: http://nursingworld.org.
o Knowledge Base University of International Council of Nurses
California-San Francisco and San
9|Elisha Kate C. Abong
 - "A federation of National Nurses ‘Associations - Information on scholarships, links to state
(NNAs), representing nurses in more than 128 affiliates and an online discussion forum are
countries," that focuses on quality in nursing all available here.
internationally and global health policy. Access: http://www.nflpn.org/.
Access: http://www.icn.ch/index.html. Philippine-Based Nursing Resources
Links to nursing organizations at the National • Philippine Nurses Association
Institute of Nursing Research - Access: http://www.pna-ph.org/
- the National Institute for Nursing Research, • Nurse Directory - contains information
described earlier, offers an excellent list of regarding nursing industry including
links to scores of organizations representing Nurse Companies, Nursing Review
nursing specialties and issues in nursing. Centers, Nursing Schools, Care Givers,
Access: and Nursing articles.
http://ninr.nih.gov/ninr/links/organizations.ht
National Council of State Boards of Nursing
Educational and Research
- this nonprofit membership organization is Applications
comprised of State Boards of Nursing from the
United States and its territories. The Nursing Curriculum in the Information
- It is also the body that develops and Age
administers the National Council Licensure - Acceleration of technological development
Examination. and availability of information will have
Access: http://www.ncsbn.org. profound effects on how students learn, how
National League for Nursing (NLN) nursing is taught, and how care is delivered.
- The management of information is and will
- A membership organization whose mission is
continue to become one of the most daunting
to advance "excellence in nursing education"
challenges for faculty, student, and nurses.
and prepare the workforce to "meet the needs
- Health Informatics will enable the medical and
of a diverse population in an ever-changing
paramedical student, practitioner, and faculty
healthcare environment."
member to access and critically evaluate
- Provides continuing education for its
biomedical information, and efficiently utilize
members, information on careers in nursing,
increasingly complex biomedical information
and an "eCareer Center," where jobseekers
for problem solving and decision making
and post a résumé or search listings.
- Empowering the individual to act his role as
- Provides recent political and health news that
life-long learner, clinician,
affects nurses. It also provides grants and
educator/communicator, researcher, and
funding for research in nursing education.
manager.
Access: http://www.nln.org.
- Information management and educational
National Coalition of Ethnic and Minority Nurse environment as key steps in transforming the
Associations (NCEMNA)
education to meet the needs of the 21st
- Offers information and links to American century. Faculty development must also be
nurses’ associations representing major U.S. established as well as a thorough analysis in
ethnic groups, including Asian integrating Nursing Informatics in the new
American/Pacific Islander (AAPINA), Alaska curriculum.
Native American (NANAINA), Hispanic Nursing Education Informatics Model
(NAHN), Black (NBNA), and Philippines - Travis and Brennan (1998) propose a model
(PNAA). that emphasizes the inclusion of information
Access: http://www.ncemna.org/. science as essential in the undergraduate
National Federation of Licensed Practical Nurses curriculum.
(NFLPN) - Riley and Saba (1996) proposed the Nursing
- The organization for LPNs, vocational nurses Informatics Education Model (NIEM). In NIEM,
and nursing students, fosters competence the domains of computer science, information
through continuing education and science and nursing science are integrated
professionalism. throughout the curriculum in a progressive
leveling to ensure the development of nursing
informatics competencies.

10 | E l i s h a K a t e C . A b o n g
 - Carty (2000) proposed an informatics model in virtual stethoscope (Real Player needed) to
graduate informatics that has an assess both respiratory and cardiovascular
interpretation of data, information, data and conditions. Also included is a review of
knowledge that is complex and non-linear. selected cardiac and pulmonary physiology
- Turley (1996) suggested that nursing and pathophysiology topics. This tutorial is
informatics has a specific nursing focus, but one of more than 50 created by McGill medical
there are acknowledged areas of students under faculty supervision; all are
interdisciplinary and collaborative foci that accessible by clicking on “MMI Student Project
need to be explored and studied. Main Page.” Each tutorial has a cover page
Study – Aids for Nursing Students listing names of the students and their
AMA Medical Ethics Web Pages supervisors, intended audience, any plugins
- the American Medical Association (AMA) required, a synopsis of the tutorial’s focus,
offers resources and information about and date completed. Some examples are
medical ethics. One especially helpful Biomedical Ethics and Law in Clinical
resource for nursing students is their "Virtual Practice, Clinical Nutrition, Histology, EKG
Mentor, an interactive, Web-based forum for Tutorial, Gastroenterology, Endoscopic
analysis and discussion of ethical and Pathology, Immunology, and Virtual CPR.
professional issues." Access: Access:
http://www.ama- http://sprojects.mmi.mcgill.ca/mvs/mvsteth.htm.
assn.org/ama/pub/category/2416.html. Merck Manual of Diagnosis and Therapy
Geriatric Assessment-Case Studies - The Merck Manual’s 17th, Centennial Edition
- the Virtual Health Care Team Web site is is available free, searchable by keyword or the
sponsored by the School of Health Professions table of contents. Merck also offers two other
and the School of Medicine at University of complete manuals through this site: The
Missouri. Among other resources, it offers four Merck Manual of Geriatrics and The Merck
"interdisciplinary geriatric assessment" case Manual of Health and Aging. Access:
studies. The approach, as explained authors, http://www.merck.com/mrkshared/mmanual
is an integrated team approach in which "team /sections.jsp.
members actively coordinate care and Physical Exam Study Guides
services across disciplines in a process - created by the University of Florida Medical
resembling problem-based learning." (for the program, these guides are thorough and clear.
elderly) Access: The exams offered are: Vital Signs, Back and
http://www.vhct.org/index.shtml. Extremity, Chest and Lung, Cardiology, Head
Gray’s Anatomy of the Human Body and Neck, Eye, Abdominal, Breast, Pelvic,
- the Bartleby.com edition of Gray’s Anatomy Neurologic, and Mental Status.
features 1,247 pictures from the classic 1918 Access:
publication, as well as a subject index with http://medinfo.ufl.edu/year1/bcs/clist/index.html.
13,000 entries. RN Central
Access: http://www.bartleby.com/107/. - created by nurses for nurses and students,
Human Anatomy Online this site offers good resource links, but the
- easy to navigate, the user begins by choosing highlight is its “Careplan Corner,” with
among ten systems: skeletal, digestive, predefined nursing care plans under three
muscular, lymphatic, endocrine, nervous, categories: “Altered/Alterations,”
cardiovascular, male or female reproductive, “Impaired/Impairment,” and “General.” Some
and urinary. Graphics are interactive and users examples of care plans that nursing students
can view animations of the system, tutorials, can use as examples for their own plans are
and descriptions. Two caveats: users must “Comfort: Chest Pain,” “Sexuality Patterns,”
have a java-enabled browser, and there is no “Physical Mobility,” “Skin Integrity,” and
search capability within the site. “Anxiety and Ineffective Airway Clearance.”
Access: Users can copy, save, or print and modify any
http://www.innerbody.com/htm/body.html. of the plans, and there is also a blank plan
McGill University Virtual Stethoscope template to print out and fill in.
- this is surely a unique Internet resource for Access: http://w ww.rncentral.com/.
medical and nursing students. As its name
suggests, it is a multimedia tutorial featuring a
11 | E l i s h a K a t e C . A b o n g
 RxList move towards using EMR software, primarily
- information provided for each drug includes for the purpose of secure medical billing.
the description, clinical pharmacology, - 2004 the US Department of Health and Human
indications and dosage, side effects and drug Services (HHS) formed the Office of the
interactions, warnings and precautions, drug National Coordinator for Health Information
over dosage, contraindications, and patient Technology (ONCHIT), headed by David J.
information. Words in the articles and Brailer, M.D., Ph.D. The mission of this office is
descriptions that may need to be defined for widespread adoption of interoperable
the layperson or student are hyperlinked to electronic health records (EHRs) in the US
Taber’s online medical dictionary. within 10 years. See quality improvement
Access: http://www.rxlist.com. organizations for more information on federal
Computers in Nursing Research initiatives in this area. Brailer resigned from
- Computers facilitate the research process in a the post in April 2006.
number of ways. Computerized literature - The Certification Commission for Healthcare
searches are a particular advantage to the Information Technology (CCHIT), a private
researchers because they save time and can nonprofit group, was funded in 2005 by the
increase the scope of the search and the U.S. Department of Health and Human
number of data base that can be searched. Services to develop a set of standards for
The computer can also help researchers electronic health records (EHR) and
collect and analyze data, prepare research supporting networks and certify vendors who
reports, and disseminate research findings meet them. In July 2006 CCHIT released its
- Use of computer in research in science is so first list of 22 certified ambulatory EHR
extensive that it is difficult to conceive today a products, in two different announcements.
scientific research project without computer. Europe
Many research studies cannot be carried out - European Union's Member States are
without use of computer particularly those committed to sharing their best practices and
involving complex computations, data experiences to create a European eHealth
analysis and modeling. Area, thereby improving access to and quality
- Computer in scientific research is used at all healthcare at the same time as stimulating
stages of study-from proposal/budget stage to growth in a promising new industrial sector.
submission/presentation of findings. The European eHealth Action Plan plays a
fundamental role in the European Union's
International Perspective strategy. Work on this initiative involves a
collaborative approach among several parts of
the Commission services. The European
Health Informatics Around the World
Institute for Health Records is involved in the
United States of America
promotion of high-quality Electronic Health
- The earliest use of computation for health was
Record systems in the European Union.
for dental projects in the 1950s at the United
- United Kingdom moves towards registration
States National Bureau of Standards by Robert
and regulation of those involved in Health
Ledley.
Informatics have begun with the formation of
- 1970s a growing number of commercial
the UK Council for Health Informatics
vendors began to market practice
Professions (UKCHIP).
management and electronic medical records
England
systems.
- has also contracted out to several vendors for
- Homer R. Warner, one of the Fathers of
a National Medical Informatics system 'NPFIT'
Medical Informatics, founded the Department
that divides the country into five regions and is
of Medical Informatics at the University of Utah
to be united by a central electronic medical
in 1968, and the American Medical Informatics
record system nicknamed "the spine". The
Association (AMIA) has an award named after
project, in 2006, is well behind schedule and
him on application of informatics to medicine.
its scope and design are being revised in real
- The US HIPAA of 1996, regulating privacy and
time.
medical record transmission, created the
- 2006, 60% of residents in England and Wales
impetus for large numbers of physicians to
have more or less extensive clinical records
and their prescriptions generated on 4000
12 | E l i s h a K a t e C . A b o n g
 installations of one system (EMIS) written in 'M' diverse software systems have created
(MUMPS as was). The other 40% "information islands" that impede data
predominantly have records stored on sharing.
assorted SQL or file-based systems. Australia
Scotland - 2002 the Australian College of Health
- Scotland has the GPASS system whose source Informatics (ACHI) was formed as a
code is owned by the State and controlled and professional association and peak health
developed by NHS Scotland. It has been informatics professional body.
provided free to all GPs in Scotland but has - It represents the interests of a broad range of
developed poorly. Discussion of open clinical and non-clinical professionals working
sourcing it as a remedy is occurring. within the Health Informatics sphere through a
- GPASS – General Practice Administration commitment to quality, standards, and ethical
System for Scotland practice.
- The European Commission's preference, as - Works to enhance the national capacity in
exemplified in the 5th Framework, is for health informatics in research, education and
Free/Libre and Open-Source Software (FLOSS) training, policy and system implementation.
for healthcare. - The Health Informatics Society of Australia Ltd
- More advance than English (HISA) is regarded as the major umbrella group
and is a member of the International Medical
Asia Informatics Association (IMIA).
- Asia and Australia-New Zealand, the regional - Nursing informaticians were the driving force
group called the Asia Pacific Association for behind the formation of HISA, which is now a
Medical Informatics (APAMI) was established company limited by the guarantee of the
in 1994 and now consists of more than 15 members.
member regions in the Asia Pacific Region - The membership comes from across the
Hong Kong informatics spectrum that is from students to
- a computerized patient record system called corporate affiliates.
the Clinical Management System (CMS) has - HISA has a number of branches;
been developed by the Hospital Authority • Queensland
since 1994. This system has been deployed at • New South Wales
all the sites of the Authority (40 hospitals and • Victoria
120 clinics) and is used by all 30,000 clinical • Western Australia
staff on a daily basis, with a daily transaction - as well as special interest groups such as
of up to 2 million. The comprehensive records nursing (NIA), pathology, aged and community
of 7 million patients are available on-line in the care, industry and medical imaging
Electronic Patient Record (ePR), with data New Zealand
integrated from all sites. Since 2004 radiology - Health Informatics New Zealand (HINZ) is a
image viewing has been added to the ePR, with national, not-for-profit organization – whose
radiography images from any HA site being focus is to facilitate improvements in business
available as part of the ePR processes and patient care in the health
China sector through the application of appropriate
- Health information technology is now entering information technologies.
its second software generation and IT usage in - September 2000. It emerged in from two
hospitals resembles that of the late 1970s in health informatics organizations: Nursing
the United States. Most hospitals in China Informatics New Zealand (NINZ) and New
incorporate IT software into their payment and Zealand Health Informatics Foundation
billing systems, and many have also begun (NZHiF).
integrating IT into clinical systems in the past - 1990 – Nursing Informatics was originally
five years. formed
- The use of IT in clinical systems has emerged - 1994 – NZHiF was originally formed.
on a departmental basis. As a result of - The New Zealand Health IT Cluster is an
inexperience with IT infrastructure, however, alliance of organizations interested in health
hospitals have encountered several IT, comprising software and solution
obstacles. Fragmentation, duplicative developers, consultants, health policymakers,
systems, and poor integration between health funders, infrastructure companies,
13 | E l i s h a K a t e C . A b o n g
 healthcare providers, and academic continuity of care through convenient follow-
institutions - who have agreed to work up.
collaboratively. - Telehealth applications vary greatly and
include client monitoring, diagnostic
evaluations, decision support systems,
The Futures of Nursing Informatics storage and dissemination of records for
diagnostic purposes, image compression for
Aspects of Nursing Care efficient storage and retrieval, research, voice
- Assess recognition for dictation and education of
- Diagnose healthcare professionals and consumers.
- Determine the appropriate action - Many providers expect that telehealth will
- Intervention revolutionize healthcare.
- Communication - It promises to improve speed and accuracy of
- Use computer technology as a way to communicating with medical providers to
decrease costs, increase patient nurse gather information and address concerns.
interactions and decrease redundancy of Nursing informatics and Telehealth will
documentation. continue to grow and become commonplace.
- is an established and growing area of - Provide savings in the following areas:
specialization in nursing. All nurses employ Improved access to care, allow clients to be
information technologies in their practice. treated earlier and with fewer interventions
Informatics nurses are - Clients will receive treatment in their own
- key people in the design, development, community where services cost less,
implementation, and evaluation of those improving quality of care and improved
technologies and in the development of the continuity of care through convenient follow-
knowledge underlying them. up
- Information is power and critical to making - Applications vary greatly (client monitoring,
decisions. diagnostic evaluations, decision support
- Nursing is a cognitive profession – analysis system, storage and retrieval, research, voice
and interpretation (DKW) recognition for dictation and education of
- is the thinking that occurs before physical healthcare professionals and consumers.
action. (ADPIE)
o Assessment - data collection
o Diagnosis - interpretation of assessment
data
o Planning - cognitive components of nursing
o Implementation - is the visible
operationalization of this thinking
- The collection of data about a situation is
guided by a nurse’s knowledge:
- Knowledge built from formal education and
from experience. The decisions a nurse makes
are guided by his or her knowledge, as well as
extended informational updates.
- Nursing informatics can aid nurses by helping
them to obtain important data for their
patients and help them make guided decisions
in regard to patient care
- Telehealth may provide savings in the
following areas:
o Improved access to care
o allowing clients to be treated earlier
o with fewer interventions
- Clients may receive treatment in their own
community where services cost less,
improving quality of care and improved
14 | E l i s h a K a t e C . A b o n g