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