1. Week 10 - Public Policies Relating to Nursing Informatics

    Above is a video produced by Vancouver Coastal Health that analyzes the lives of two families and how they differ with and without the help of Public Policies. 

    This video demonstrates the importance and impact that public health policies has on individuals and families throughout Canada, even without the application of informatics in healthcare. Public policies work together with public health and health education to regulate the current healthcare system and strengthen the concept of health promotion (Epp, 1986). This enables individuals from all communities to have access to healthcare, particularly those who suffer from the challenges such as those mentioned in the video. As health is a global issue, developing universal health policies can be a challenging task due to variance in access to health information, literacy and health technologies. In fact, the implication of technologies in healthcare only makes this task more difficult. As previous policies no-longer applied with many new technologies, developers would need to apply public policies to every medium (of technology) used in healthcare (Etheredge, 2007).

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    Policies are necessary as they give direction to the development of technology in modern medicine. The four major policies that applied to informatics in nursing covered:

    1) The importance of understanding that EHR’s is only one of many tools that can be used to promote safe and effective care in a future with technology.
    2) The need for a safe way to manage data within and outside of the a medical center
    3) Looking at health as a daily act of living: allowing for inter-visit documentation while maintaining the standards of practice
    4) Understanding the importance of confidentiality and privacy before developing technologies that may potentially jeopardize these elements

    Each of these policies targeted the use of technology for healthcare outside of a clinical setting; this would enable individuals to collaborate their daily lives with their healthcare plan. This application of health policies was very interesting as it made me think, could these policies be useful universally?

    There is no doubt that technology – cell phones, computers, and radio – have touched all corners of the globe. However, it was only within the past 10 years that the healthcare system and government have considered using technology within healthcare. In-fact, by 2015, hospitals will be subject to financial penalties if they do not qualify the Health Information Technology for Economic and Clinical Health (HITECH) Act (DeRoches, Worzala, & Bates, 2013). Currently, grant programs are being offered to provide funding for adoption and implementation of the EHR system; this includes developing policies within hospitals to carefully monitor the progress (DeRoches, Worzala, & Bates, 2013). These policies must also ensure that the implementation of Electronic health records meet the meaningful-use standards of healthcare. In hopes that these policies carry universally, there are factors that must be considered prior to developing these health policies.

    Many factors relate to those of implementing one database available world-wide (Week 7); examples include difference in health literacy, access to technology & internet. However, more importantly, these policies will need to ensure the confidentiality and privacy of individuals. As seen in lecture, the internet is an open society where many can access others’ information without the individual even knowing – and of course, technology is lost or stolen daily. This would create a major problem if the information leaked was personal health information.

    There are current policies that strive to prevent this from occurring with paper-health records; however, not yet with EHRs. Personal health records hold great promise for empowering individuals as well as increasing accuracy and completeness; hence the reason why policies must be created to protect these PHR & EHRs (Wright, & Sittig, 2007). Ways to do this would be through encryption and security features; this supports the second and fourth policy discussed in class. However, the program would need to include an emergency plan (similar to 911 plans on cell-phones) that allow for a first response without using a password. This would not enable the user to full access of information (Wright, & Sittig, 2007).

    The Authors Thoughts

    Interestingly, this implication towards using technology in healthcare & the policies originating from it, may in-fact be safer than using paper documenting. The reason for this because of the ‘internet trail’; it allows systems to track who and when accessed the information and for how long. Even if the user is stolen, it would notify the system that it was used which can then be traced back to the user or potential invader. In contrast, any individual who wishes to steal paper-documented information could do so easily without the knowledge of overseers, as long as he/she returns it. This would also allow the user to make copies of the document without the system acknowledging. This is just one example of how important health & public policies are.

    By implementing a complete technological system, policies are required to regulate and guide future practices revolved around EHRs and PRHs.

    References

    DesRoches, C. M., Worzala. C.; & Bates, S. (2013). Some hospitals are falling behind in meeting ‘meaningful use’ criteria and could be vulnerable to penalties in 2015. Health Affairs, 32(8), 1355-1360. doi:10.1377/hthaff.2013.0469

    Epp, J. (1986). Achieving health for all a framework for health promotion. Health Promotion International, 1(4), 419-428.

    Etheredge, L. (2007). Technologies of health policy. Health Affairs, 26(6), 1537-1538.

    Wright, A., Sittig, D. F. (2007). Encryption characteristics of two USB-based personal health record devices. Journal of American Medical Information Association, 14(1), 397-399. doi:10.1197/jamia.M2352

    Video: http://www.youtube.com/watch?v=nH-iAXEnb5k

     
     

  2. Week 9 - eShift “Excellence Care for All”

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    Supported by Health Canada, the eShift serves to resolve the shortage of community nurses by placing more personal support workers (PSWs) into long-term care facilities instead of community nurses. Up to four PSWs would then be monitored by one registered nurse (RN). The eShift would then allow nurses to perform their role more efficiently and with less burden; PSWs would then care for each specific patient and cater to their needs instead of assigning one nurse to care for four patients (Service Ontario, 2012).

    As a student ‘soon-to-be’ nurse, my assessment of the positives and negatives of eShift may be bias therefore, I will evaluate eShift from the perspectives of both patients and nurses

    As a Nurse

    As a student nurse, I recognize that I have yet to truly understand the realities of nursing and the struggles of working 12 hour shifts 7 days a week. However, over the course of my studies, nursing theories have drilled the importance of therapeutic nurse-client relationship into mine and many of my classmates’ minds. The Collage of Nurses of Ontario reinforces the therapeutic relationship as a standard of nursing that must be met in order to meet optimal care (CNO, 2006). By implementing the eShift, this is no longer possible as nurses will not be able to have true interactions with the patient. Instead, the nurse will be providing care technologically though a PSW and making judgement retaining to the client’s health without recognizing the client’s medical preferences. It also takes away from client-centered-care as it neglects the holistic aspect of nursing – to consider the individuals needs outside of medical necessities. It may also harm the patient if any critical information is missed by the PSW that include observations as the nurse would be unable to identify these mistakes without seeing the patient personally.

    Benefits of eShift would be that it allows nurses to work more efficiently at any location if the form of communication were provided to the nurse’s home. E-Shift can promote more jobs for PSWs and by allowing them to work in palliative care, nurses can then work in other areas of the hospital as well as palliative care, reducing the shortage of nurses.

    Most importantly eShift would also allow time for nurses to rest properly without the burden of juggling 4+ patients and working with sleep deprivation as this can lead to more accidents or missed information (Johnson, Brown, & Weaver, 2010). Nurses should not be working in 24-hour setting but because of the demand for nurses, they must. E-Shift may allow nurses to work most efficiently and effectively when they are present to work. As stated by the service Ontario (2012), “without the innovations such as eShift to care for clients at home – especially overnight- we would see an increased reliance on the ER or even a return to hospital. That isn’t the best solution for many clients and it is not sustainable as a health system” (Service Ontario, 2012, p.2). This quote supports the intention of eShift to improve the healthcare system, the lives of healthcare providers (nurses), and patient outcomes.

    As a Patient

    As a patient in palliative care, I believe having a PSW to care for me – and me only – would be pleasant as they would be there if I needed him/her instead of having to wait for a nurse to be free to care for me. A main priority for individuals in palliative care is to be comfortable before passing. Having 24 hour care would be convenient for the patient however, it would also be important that the patient has a voice in his/her end-of-life care.

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    Things to Consider (When Applying E-Shift)

    E-Shift is a “technology-based initative that connects an enhanced-skill Personal Support Worker (PSW) in the home with a registered nurse via a web-enabled iPhone (South West Local Health Integration Network, 2013). The South West CCAC uses eShift currently and according to their brochure, it is working well for both PSW/RN/RPNs and patients. The program states that it offers 24 hour care but, does not clarify whether or not the patient sees other healthcare providers aside from the PSW (Service Ontario, 2012). If the case is that the patient only sees the PSW, the eShift model must consider incorporating other health professionals to capture a more holistic aspect of the patient. Other improvements that could be made to the eShift program are creating rotational shift of PSWs at night and Nurses during the day. It would allow for the development of a healthy therapeutic nurse-client relationship as well as clarifies any additional questions the client may have that the PSW is unable to answer. The nurse can also clarify any observation that the PSW may have missed and document any additional information.

    Sadly, the major flaw in the eShift is the possibility of an emergency where, the technology fails and the PSW is left stranded without help or the credentials to provide additional care. The loss of service or battery power often hinders the technology aspect of healthcare. This can directly influence the patients’ outcome as it can be very detrimental to the system if the nurse is unable to communicate effective with the PSW.  

    The Authors Thoughts

    The overall idea of eShift is an effective program that allows PSWs and Registered nurses to work effectively and collaboratively together.
    I feel that eShift does better the care for patients due to the fact that they are able to have someone at all times. However, the system needs to improve their protection and prevention program to minimize the possibility of mistake from transferring information from PSW to Nurse. 
    Nevertheless, the prime role of nurses is to be there for the patient at all times and to see the client as a whole, instead of another ‘sick patient’. Ideally the solution of eShift is to simply have enough nurses to provide care individualized care to each patient in ever department. However, due to the unfortunate circumstances, I think that eShift is a necessity that would work better with some alterations like rotational shifts. E-Shifts would also need to stay within palliative care as the risk that eShift could take-over all departments in clinical settings is a scary thought. Nurses would no-longer be the ‘caring’ figure in the hospital but, simply a technological figure that watches over PSWs. 

    References

    Johnson, Arlene L, PhD,R.N., A.N.P., Brown, Kathleen,PhD., R.N., & Weaver, Michael T, RN,PhD., F.A.A.N. (2010). Sleep deprivation and psychomotor performance among night-shift nurses.AAOHN Journal, 58(4), 147-54; quiz 155-6. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/205435799?accountid=15115

    CNO Therapeutic Standard- http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf

    Government Support: http://www.health.gov.on.ca/en/pro/programs/ecfa/action/community/com_eshift_tool.aspx

    South West CCAC Brochure: http://www.southwestlhin.on.ca/newsletter.aspx?id=60

     

  3. Week 7 - Electronic Health Technologies within Clinical Practice Settings

    International travel and tourism creates a health risk for specific individuals as well as populations of both foreign and home countries (Li et al., 2012). An effective strategy that could be implemented in order to reduce health-related risks to travellers is, to provide individuals and relevant caregivers ongoing access to their personal health information (Li et al., 2012). The government has provided websites to advise travellers to take action in collecting his/her personal health records prior to travelling (Hochberg et al., 2013). However, the values show from 2012, majority (63%) of traveled do no seek pre-travel advice (Hochberg et al., 2013). Therefore, this shows that little has been done to assure travelers that their medical information is available at all times regardless of their location. These resources need to also consider the potential of varying health practices in other countries (Li et at., 2012).

    By conducting a global electronic health record, this does not only act as prevention to potential disease, it also builds towards improving the current health care system by reduce costs from data collection, exchange, and storage (Shackak, & Jadad, 2009). This tool would promote health as it enables the people to advocate for themselves & empowers individuals to take responsibility of their own health. It would need to incorporate the concept of patient-centered-care by acknowledging the importance of social media and how it plays a large role in partnership, involvement, and communication between individuals and healthcare providers (Shackak, & Jadad, 2009). Before creating a global resource, developers must also consider the potential of offering non-developed countries the access to both personal health records as well as access to modern medical information. This account’s for the country’s literacy level which can greatly affect the healthcare provided. What if the agency had all your health records but, did not understand what a ‘CT Scan’ was? Or if they did not have the technology to perform the assessments offered by other countries (particularly developed ones)? However, this issue could be solved if the program was able to implicate medical procedures that are veered towards these countries. This can sponsor international healthcare system to a more in-depth international education, practice, and policies. Clinics and advocacy organizations could implement these changes into universal traveling by considering, partnership within primary healthcare professionals and travel agencies (Hochberg et al., 2013). This encourages obtaining pre-travel care and prepares healthcare centers for emergency situations when necessary.

    The development of a multi-national corporation to support global electronic medical record is possible with the help and development of electronic health records. The Global Deployment is working towards facilitating an international electronic health record in countries like Brazil, Mexico, Singapore, and Taiwan (Bey, Magalhaes, Boorquez, & Lin, 2013). The newly implemented system uses single application software to integrate first aid visits, which “secure[s] storage and retrieval for long-term record retention [and allows for] cost saving [methods] from purchasing [to] maintaining a single software application” (Bey et al., 2013, p.95). Unfortunately, this software still needs improvement as trials are still being conducted to test its effectiveness from the U.S to each of the countries. The study prioritizes several factors that need to be evaluated in order for the system to be implemented and deployed (Bey et al., 2013). Important factors included resolving language barriers from the patient to the healthcare team, maintaining patient confidentiality and privacy, and meeting specific cultural and/or ethnic needs of the individual (Bey et al., 2013). The ethics of an individual may challenge his/her safety when traveling as it may not agree with the culture and traditions of the former location (Richter, & Richter, 1999). This raises the question of whether or not a global system will work for individuals of faith.  

    The Authors thoughts

    Developing a single database within Canada or the United States is a difficult task however, not impossible. With the development of electronic health records and personal health records, confidentiality and privacy related issues are the only major dilemma with this system.

    Nevertheless, the true achievement would be to create on database that is accessible to all countries world-wide in order to have constant access to healthcare regardless of where you are situated. There are organizations currently that are testing out this program; however, I feel that many of these issues are solvable. For example, the concern related to cultural diversity. In Canada today, we have developed a healthcare system that accommodates to a multicultural spectrum of individuals. This demonstrates the ability to implicate change with some modifications in order to cater to a larger society of people.

    No system will ever be flawless, but if we never try, how will we ever make a change?

    References

    Bey, J. M., de Magalhães, J.,S., Bojórquez, L., & Lin, K. (2013). Electronic health records in an occupational health setting—part II. global deployment.Workplace Health & Safety, 61(3), 95-8. doi:http://dx.doi.org/10.3928/21650799-20130226-02

    Hochberg, Natasha S,M.D., M.P.H., Barnett, E. D., M.D., Chen, L. H., M.D., Wilson, M. E., M.D., Iyer, H., M.P.H., MacLeod, W. B., ScD., … Hamer, D. H., M.D. (2013). International travel by persons with medical comorbidities: Understanding risks and providing advice.Mayo Clinic Proceedings, 88(11), 1231-1240. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/1459205595?accountid=15115

    Li, Y., Detmer, D., Shabbir. S., Nguygen, P., Jian. W., Mihalas. G., & … Kimura, M. (2012). A global travelers’ electronic health record template standards for personal health records. Journal Of The American Medical Informatics Association, 19(1), 134-136.

    Richter, L., & Richter. W. L. (1999). Ethics Challenges: Health, Safety and Accessibility in International Travel and Tourism. Public Personnel Management, 28(4), 595.

    Shachak, A., PhD., & Jadad, Alejandro R,M.D., D.Phil. (2010). Electronic health records in the age of social networks and global telecommunications.JAMA, 303(5), 452. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/211385496?accountid=15115

     
  4. The Perspective of a Patient regarding Electronic Health Records (Intro to Week 7)

    This is a direct example of how having access to complete electronic health record from one database can truly impact patient’s health outcome. 

    It demonstrates the interrelated concept of not only having access to a personal health records, but also being able to have a complete collection of all your health information - from the time you got your first vaccination to your most recent visit to the clinic.

    This example reminds me of a similar example used in class facilitation where, the students were asked to gather a patient’s information from multiple sources that were located at different centers as well as organize each file into chronological order. This task was extremely time-consuming as the information was unorganized and often incomplete. This activity was very effective in demonstrating the frustration that patients may feel when seeking his/her past medical history from multiple sources. As shown in the video, it is also not uncommon for patients to pay a fee in order to access their health information from an agency; this can be very expensive and time consuming for individuals who are expected to get information from three or more organizations (Gladwin, 2013). These individuals are often the ones who spend the most on healthcare and need the most medical attention as they require more than one healthcare provider located at different organizations (Gladwin, 2013).

    Nevertheless personal health record (PHRs) “hold great promise for empowering patient and increasing the accuracy and completeness of health information” (Wright, & Sittig, 2007, p. 397). A personal health record is the potential development of one database, where an individual can access a comprehensive record of his/her medical history that incorporates the data from all healthcare providers and agencies that were involved in the healthcare-plan. Unfortunately, the most crucial flaw about have this database is whether or not it will be accessible outside of Canada.

    References

    Gladwin, J. (2013, Sep). Increasing access to patient records.Nursing Times, 109, 22-4. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/1432623783?accountid=15115

    Wright, A., & Sittig, D. (2007). Encryption characteristics of two USB-based personal health record devices. Journal of the American Medical Informatics Association, 14(4), 397-399. 

    Link to Video: http://www.youtube.com/watch?v=msBYOYYeHPw#t=26

     
     

  5. What You Don’t Know Can’t Hurt You - Or Can It? (Week 6 - Second Marking Term)

    This is a continuation of the topic, consumer health informatics and eHealth where electronic health records (EHR) is the new interactive technology that is expected in future healthcare. However, this weeks topic explores, not only the medium of which patient data is recorded, but whether patients should have complete access to their health data.

    Aside from developing an electronic health record, the discussion of whether patients should or should not be given all their health information has always been a question at hand.

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    There are obvious pros and cons that exist from enabling access to healthcare information for patients and physicians. As stated by Jenkins, Dickinson, Heasman, & Ellis (1986), patients should have access to his/her complete health records as it promotes openness. It may also improve the quality of healthcare by preventing factual errors and reduces miscommunication between healthcare provider and patients (Jenkins et al., 1986). However, the article also mentions potential imperfections with having access to complete clinical & social records as it can cause distress and harm to the patient or someone else. Health care professionals may also argue that patients should not be given complete access to their health information due to the lack of understanding of medical terminology or diagnosis (Jenkins et al., 1986). As the education level of a medical degree may suggest that the ‘average person’ may not be able to truly understand medical terminology, this can lead to further confusion or frustration in the client (Jenkins et al., 1986). Unfortunately, the fear of misinterpretation can hinder physicians and health professionals from recording his/her true opinion in-case it is detrimental to the patient’s emotions (Jenkins et al., 1986). The interpretation of the information may also cause harm to the therapeutic relationship as the client may disagree with the health care provider’s opinion, diagnosis, or observation. 

    The interesting aspect of this article relates to when the article was published, 1986, which indicates that facilitating access to personal health records is a slow process, that has yet to be resolved even after twenty-plus years of development. From the pre-technological time period, individuals would need to confront the ‘courts’ if he/she wished to have full access their health information; this was extremely uncommon as it suggested that  a physician was performing malpractice or negligence and that there was conflict within the therapeutic relationship (Jenkin et al., 1986). Nevertheless, the article does confirm that withholding information is morally unjustifiable, which corresponds with current articles retaining to having access to personal health-records. As indicated by Gladwin (2013), the stretch to allow patients’ complete access to their health records is an ongoing battle; however, the implementation of electronic health records (EHR) has made it easier for individuals to access their records. The article even suggests that the assumption that patients react negatively towards physician feedback is false (Gladwin, 2013). On the contrary, patients often feel trusted with his/her own information and a sense of security that the information is accurate and up-to-date. Having access to the information at all times is also another benefiting factor (Gladwin, 2013). This may further strengthen the therapeutic relationship between health-provider and client as it empowers the patient to take control of his/her health and indicates that there is trust within the relationship (Weber, 2013).

    The Author’s Thoughts

    After analyzing each of the positive and negative components towards having access to personal health information, it is obvious that the movement concerning access is progressing. Due to the progress of technology and EHR, it has made it possible for individuals to have easier access to healthcare & records without jeopardizing the quality of healthcare provided. Unfortunately, there are still changes and alterations that must be made for full access to be accomplishable. These changes take into consideration of individuals who may be at risk if provided full access to his/her health information, for example: children or adolescents, and individuals who are emotionally or mentally unstable.

    Implications & Changes

    Currently there are acts and laws provided by the government that entitles individuals to having access to their health information. Some include the Access to Medical Records Act from 1988, the Data Protection Act (1998), and the Mental Capacity Act of 2005 (Gladwin, 2013). Sadly, even with these laws in place, there is a lack of reinforcement and advocacy behind these acts. The government is only beginning to emphasize the rights of individuals to their information by fining health organization for withholding health records without reason (Rode, 2011).

    Unfortunately, this is not always the case as there are exceptions when providing individuals with access to his/her health records. As mentioned in lecture, the struggle of restricting certain individuals is equally unfair but, may seem, necessary. The example that was used includes, charting the history of a drug-user who has abused the healthcare system in the past to feed his/her drug-addiction. An obvious conflicting factor is whether or not an individual should be allowed access to his/her health records as well as the necessary steps that need to be taken if the individual refuses to have this on their medical record or of if the client states that this is not the data is incorrect. Similar challenges arise when high-risk individuals such as, mentally or cognitively unstable, cannot accept that he/she has this diagnosis.

    Until there are proper policies in place that address these issues, the ability to fully access health information will always be a struggle. However, it is undeniable that healthcare providers must carry out their duty to support the client and his/her rights; this includes explaining diagnoses and treatments to the best of their ability as well as to offer complete access to medical notes on request (Rode, 2011).

    Consider this…

    Do you think it is appropriate to simply leave out information because one does not think another will understand? Or is it more logical to simply teach the individual about what they may or may not understand?                                                                         

    References

    Gladwin, J. (2013, Sep). Increasing access to patient records.Nursing Times, 109, 22-4. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/1432623783?accountid=15115

    Jenkins, S., Dickinson, C. J., Heasman, M. A., & Ellis, B. W. (1986, January). Patients’ Access To Personal Health Information. British Medical Journal (Clinical Research Edition)292(6515), 254-256. Retrieved November 16, 2013, from http://www.jstor.org/stable/29521988

    Rode, D. (2011). Enabling patient access.Journal of AHIMA, 82(4), 16-16,18. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/861041035?accountid=15115

    Webster, P. C. (2013). Patients want access to digital health information. Canadian Medical Association.Journal, 185(10), E441-2. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/1424334331?accountid=15115

    Photos: Taken from Google

     

  6. Consumer Health Informatics & eHealth

    With an unlimited access of information and the internet at our disposal, it is simply a force of habit to research medical advice or treatment in our own home.

    Can you think of a time when you started developing symptoms that were abnormal to the common cold and simply ‘google’ it instead of consulting your family doctor? 
    I sure can — and I also remember thinking that I had some rare immune disorder because the internet ‘told me so’. 

    Unfortunately this is not an uncommon scenario, especially in the healthcare world. The internet has made it possible for patients of all ages to access vast quantities of information that previously would have been difficult for anyone but a physician to access (Hanif, Read, Goodacre, & Chaudhry, Gibbs., 2009) As the internet expands, it is becoming more and more difficult to differentiate what is legitimate and what is simply opinion based. This is the case due to the large variety of health information websites and their range of differences in quality and reliable content (Hanif et al., 2009). 

    Self-diagnosis can be a physicians worst nightmare. This is especially true when the individual is convinced and truly believes that the internet is more accurate than healthcare professionals. 

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    So where does the line get drawn? Does the government simply ban self-diagnosing? 
    …Or it could do something that is much more practical

    The healthcare system could develop a plan to teach the public where to find credible resources as well as ways to evaluate online websites to determine whether or not the information is reliable.

    Even as a nursing student, I constantly find myself evaluating websites and resources whenever resourcing for assignments are necessary (which is a lot). So, when this topic was brought to my attention, I thought to myself “what could be so hard? I do this all the time.” - But then I realized, not everyone does
    -These are the 7 guidelines that are provided to help asses the credibility of a website. Using these guidelines, it can prevent individuals from mistaking a non-reputable website for a reputable one when dealing with health related issues & information. 

    Assessing the Quality of Internet Health Information 

    - Credibility: Sources, currency, relevance, editorial review
    - Content; is it accurate & complete?
    - Disclosure: collection of information associated with the website
    - Design: Navigation, professionalism
    Links: types of links, reliable or not?
    - Interactivity: exchange amount users, communication, blog, chatting
    - Caveats: reason for the website – ie. selling or information based

    Even with these guidelines, many will still continue to believe in websites before doctors or nurses. So what are the pros and cons of researching health information in your own home?

    The Pros of Self-research:

    Location - An obvious pro as the internet is often much more accessible than clinics or hospitals. In a study done in USA (2007), it was approximated that “52 million adult Americans (55%) of the Internet-users … use internet sources to seek health information” (Halif et al., 2009, p. 232). 

    Time - Travelling to and from the doctor can often be very time consuming. By using the internet, one can determine ways to relieve a sore throat in a matter of minutes. Not to mention the wait times and the number of hours individuals must wait in the Emergency simply to be looked at for five minutes.

    Cost - This mainly applies for individuals outside of Canada or are required to travel quiet far in order to access healthcare and can still applies as internet is so easily available in public spaces everywhere.

    Emotions (such as Fear) - This point relates to those who have had a bad experience at the clinic ranging anywhere from, being treated with disrespect to an improper diagnosis. Individuals who internet search their health concerns simply because they don’t want to see their doctor - or any doctor. 

    Resources - The amount of resources that are available online are unlimited, if the client is able to narrow which ones are credible, they could have complete control of his/her own health. Not to mention the ability to connect with specialists and clinics online as well as other patients that may be experiencing similar health concerns. This provides opportunity for long-term ongoing support among patients and providers (Hanif et al., 2009).

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    The Cons of eHealth:

    Incomplete - Health information on the internet can vary significantly on many factors. Web users must understand and consider that information may be incomplete, misleading or inaccurate when taken from the internet.

    Exaggeration/Under-exaggeration - This can be from one or both the patient and the internet. This relates to the fact that even with punctuation, the ‘tone’ of seriousness can range quiet largely depending on the author and the reader. 

    Lack of Understanding - Although this can also occur in a real-life situation, the difference is that the patient can ask for clarification on the spot or just not understanding at all. The terminology used online can be just as confusing as reading a medical textbook.

    Confusion/Emotions - This relates to the points above, however as the client becomes more confused, they are also often agitated and/or frustrated which can lead to other health concerns (ie. stress or anxiety). It can then be increasingly hard for a healthcare professional to convince the individual otherwise.

    Trust - As the client is always the expert of his/her own care, it can be difficult to help a patient if he/she is convinced that the internet is more credible than their own family doctor. 

    Safety/Confidentiality - This topic relates to the idea of confidentiality and what should be considered confidential. Is it ethically/morally correct as healthcare providers to simply hand over medical files to the patient, especially when you are aware that the client will most likely blog their health concerns and ask for medical advice online? Or is that where the line is drawn?

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    Example
    A study by Gordon, Barot, and Fahey (2001) evaluated the internet for information on the topic of breast augmentation. The study showed that “83% of the sites were biased towards a particular surgical technique and … 15% of the sites were acceptable to be recommended to patients” (p. 233 of Hanif et al., 2009).

    In this example, it clearly demonstrates that as much as researching may be useful often, articles are misleading or incorrect can potentially cause harm the patients health behavior. The patient could read this information, that is originally intended for health professionals, and misunderstand the information or may develop wrong expectations regarding treatment options. 

    Thoughts of the Author

    At this point in time, I believe that there is not right or wrong but that there has yet to be enough advocacy and guidelines available on the internet to help individuals determine what is credible and what is not. And even if these resources were available, will the public actually take the time to read through the list or simply continue to ‘Google’ their health concerns?

    It is important that the healthcare system takes in consideration of taking advantage of this amazing value resource but also, consider the cons at hand and ways that could prevent them.

    I believe that eHealth is definitely a possibility in the near future especially with newer generations relying on technology as a major resource. However, until we develop proper guidelines regarding confidentiality along with which websites are credible, the system will never be truly reliable in the healthcare world. 

    As we dig deeper into this topic, the question of ‘Should individuals be allowed to access their health information online?' is raised and will be discussed in the following post.

    References

    Hanif, F., Read, J. C., Goodacre, J. A., Chaudhry, A., & Gibbs, P. (2009, December). The role of quality tools in assessing reliability of the Internet for health information. Informatics for Health and Social Care34(4), 231-243. doi:10.3109/17538150903359030

    Gordon JB, Barot LR, Fahey AL. (2001). The Internet as a source of information on breast augmentation. Plastics and
    Reconstructive Surgery, 107,171–176.

    ** This Article Comes AFTER POST 4: The Truth about Filter Bubbles. and BEFORE POST 6: What You Don’t Know Can’t Hurt you **

     

  7. The Truth about Filter Bubbles

    What would you do if you could only be friends with the people who you regularly speak to? - decided by your cellphone

    If suddenly a machine was making all your social decisions for you even without your consent?

    Filter Bubbles are exactly that. Presented by Eli Pariser (2011), filter bubbles are personalized filters that exist online in order to amplify the user’s interests and opinions. He warns users of the risks that are at hand as these filters limit what individuals see online even without them knowing it.

    Personalization is problematic as it “moves us very quickly towards a world in which the internet is showing us what it thinks we want to see, but not necessarily what we want to see” (Pariser, 2011). 
    It removes the ethical and moral components in information related to important public problems by creating the “friendly world syndrome” (Beinsteiner, n.d.). This means that we are no longer tuned into diverse amounts of information but only what is ‘pleasing’ in our eyes; this also eliminates the exposure to public news events that are significant issues. (Beinsteriner, n.d.). The horrors of this idea is that many are still oblivious towards the fact that your Google searches and Facebook feeds are in fact bias. The thought that you no longer have the freedom to see the ‘whole story’ at your own will is a scary thought. So is this a breach of personal freedom?

    Unfortunately, it is now impossible to live in this generation without the use of internet and social media. 
    So what do we do? 

    As nurses and healthcare providers, it is part of our duty to teach the general public about these truths and to be aware of them. It is also important to keep in mind that this applies to healthcare research as your research can be bias based on your search history and location. This applies directly to nursing practice as discussed in how to critique a website for its credibility.

    Resources:
    Beinsteiner, A. (n.d.). Filter Bubble and Enframing: On the Self-Affirming Dynamics of Technologies (Master’s thesis). Retrieved October 10, 2013, from http://ceur-ws.org/Vol-859/paper3.pdf
     

     

  8. Evidence Informed Practice in a Technological Workplace

    Better quality research results in better quality projects.
    Research in the healthcare profession is extremely important; the more accurate the research applies to the client, the better the possibility of a positive patient outcome. As discussed in my lecture, the elements of researched based practices are:

    Evidence Based Practice (EBP) - This was the more common of the two as it has been known to be the best model for a number of years; it is described as”the conscientious use of current best evidence in making decisions about patient care” by Melnyk & Fineout-Overholt, (2005).

                 Evidence-based practice is data-based decision making that mostly relies on research findings, evidence-based theories, the opinions of recognized experts, clinical experiences and from post-patient outcomes (Norwood, 2010). 

     Evidence Informed Practice (EIP)- This is a more innovative & enhanced version of evidence-based practice as it takes into account of the patient’s values and beliefs; this allows healthcare providers to see the client as a unique individual and not simply a diagnosis. 

                 Evidence-informed practice should be understood as more than a fixed protocol but rather a wide range of information sources, case studies, empirical findings, and experiences from both the healthcare team and the client (Nevo, Slonim-Nevo, 2011). This means that research findings should be overridden by clinical experiences and the clients’ wishes, values, and knowledge. 

    image

    Active Stages/Models and comparisons between Evidence based practice and Evidence Informed based practice.

    Evidence-Based Practice Model (Image 2):
    This model demonstrates the stages of a client’s care plan; unfortunately, this model has limitations as it fails to consider other options should the patient decide that the initial plan is not what he or she wishes to carry out.  

    image

    Evidence Informed Practice Model:
    The pathway to evidence informed policy and practices involves 3 active stages:
    1) Sourcing the evidence
    2) Using the evidence
    3) Implementing the evidence

    This model also involves decision-making factors and the “adopt, adapt, and act” term. This means that once the evidence is adopted, the evidence should either be adapted or charged before used in the plan (Bowen, Zwi., 2005).

    Figure 1             The Evidence-Informed Policy and Practice Pathway

    Thoughts of the Author

    As I was researching about each of these topics, I had a hard time distinguishing between these two practices. As I read into these models, I realized that they definitely demonstrate differences, yet also share similarities. They are both useful tools that healthcare providers use daily in order to provide the best care possible.

    I found it interesting that even though Evidence-informed practice is a more advanced and practical model, the resources about it were very limited and almost non-existent.
    As discussed in Rycroft-Malone’s (2008) article about Evidence-informed practice, he mentions that many nurses embrace the evidence-based movement without fully understanding that it is impersonal and unreliable for anyone who has preference towards their care-plan.

    Evidence-informed practice takes into consideration of the facts and protocols that are developed from EBP but, still allows the patient to be in control of his/her care. Evidence-Informed practice also considers the lifestyle of the client along with the social-determinants that may affect their choice of care. This includes proposing that factors, such as individual skills and experiences, influence the adoption and adaptation of evidence in the care plan (Bowen, Zwi., 2005)

    References

    Image 2 & 3 : 
    Bowen, S., & Zwi, A. B. (2005). Pathways to “Evidence-Informed” Policy and Practice: A Framework for Action. Plos Medicine2(7), 600-605. doi:10.1371/journal.pmed.0020166

    Melnyk, B., & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. In B. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing and healthcare: A guide to best practice (pp. 3-24). Philadelphia: Lippincott Williams and Wilkins.

    Nevo, I., & Slonim-Nevo, V. (2011). The Myth of Evidence-Based Practice: Towards Evidence-Informed Practice. British Journal Of Social Work41(6), 1176-1197. doi:10.1093/bjsw/bcq149

    Norwood, S. L. (2010). Research and Contemporary Nursing. In Research Essentials Foundations for Evidence-based Practice(pp. 12-14). Upper Saddle River, NJ: Pearson Education., Inc.

    Rycroft-Malone, J. (2008). Professionalism in nursing behaviors of nurse practitioners. In Journal of Nursing Management(16th ed., Vol. 4, pp. 404-408). Bangor, UK: Centre for Health-Related Research School of Healthcare Sciences, College of Health & Behavioural Sciences. Retrieved October 11, 2013, from http://journals1.scholarsportal.info/details-sfx.xqy?uri=/87557223/v17i0004/203_pinbonp.xml

     

  9. Professionalism; Confidentiality and Privacy

    image

    When dealing with social media, it is not often that a situation is simply ‘right’ from ‘wrong’. Because there has never been any ‘rules’ per-say when posting online, even adults can get carried away with their posts. Of course it is common sense to anyone who has ever had a job to understand not to post inappropriate photos of you at the cottage intoxicated to the point of no return.
    However, consider this, is it appropriate to post sexual jokes on your friend’s Facebook page - knowing that your friend understands that it is a joke? 
                                                     image

    Professionalism is a very broad subject that can be quite subjective to the user when online. It often escapes ones mind as professionalism varies heavily on the area of work.

    An interesting example came to mind as I was discussing with some friends of mine about the topic of how fragile the system really is. That, without guidelines, many are threatened by social media in ways that you could never imagine. A friend of mine brought up an example of a teacher who was fired from her job because a photo was leaked to the school board; the teacher was in a bikini holding a beer while was on vacation. As I was unable to retrieve this particular article, I was able to find another that shared a similar conclusion. A teacher, Ashley Payne, was suspended from working from a photo of her holding two alcoholic beverages that was posted on her Facebook page. They described her activity as unacceptable and that ”her page ‘promoted alcohol use’ and ‘contained profanity” (Sullivan, 2011, Para. 6). We continued arguing for the next hour as to whether or not these examples were fair punishment for their actions.

    These are prime examples of just how different public workers are treated for their display of professionalism in comparison to other areas of work such as, construction workers or mechanics. 

    At the end of the day, it matters not whether it was just or unjust but that, these teachers’ reputations will forever be tarnished simply from one misjudgment.  

    Now, how does this all relate? 
    Even as students, we are presented daily of examples like Mrs.Paynes. 

    So, What can we do as Health-care Providers?

    Nurses in the present are expected to practice autonomously when delivering client care and therefore, must monitor their own levels of professionalism (Adams, & Miller,. 2001). 

    Mentioned in my last post (using the example of Mayo Clinic), it is extremely important that guidelines are set in place regarding this new movement of incorporating social technology into the professional world. Using these guidelines, we can then provide public-workers a bases of what is and isn’t acceptable behavior online. These guidelines must also provide examples and reasoning; this helps to distinguish right from wrong and why the guidelines are in place. 

    This is a model of “The Wheel of Professionalism in Nursing” that outlines professional behaviors; identified by “sociologists, nursing leaders, the American Nurses Association, standards of practice and the ANA Code [of Ethics] for Nurses (Adams, & Miller., 2001, p. 204). It demonstrates the importance of education in nursing and how it can directly impact the professionalism in practice.

    image

    In my next post I will be reviewing the difference of evidence informed versus evidence based nursing practice & how they relate to filter bubbles in social media.

    As an example 

    Sullivan, L. (2011, February 7). Teacher Ashley Payne fired for posting picture of herself holding beer on Facebook. Georgia Daily News, p. 1. Retrieved October 8, 2013, from http://www.gadailynews.com/news/61845-teacher-ashley-payne-fired-for-posting-picture-of-herself-holding-beer-on-facebook.html

    References

    Adams, D., & Miller, B. K. (2001, July). Journal of Professional Nursing. Professionalism in nursing behaviors of nurse practitioners17(4), 203-210. doi:10.1053/jpnu.2001.25913

     
  10. Initial thoughts on Social media & Professionalism

    Is this really the core of social media?

    This video focuses mainly on the initial goal of social media -  To be connected at all times. Unfortunately due to the verity of mediums that are available on the web, we are starting to confusing physical interaction with web interaction. As they are two completely different things, many individuals of the newer generations have begun using them interchangeably & forgetting the importance of personal interaction; hence starting ‘The innovation of Loneliness’. 

    However, this topic goes beyond simple interaction. The internet has found a way to enter, not only our personal lives but also our professional lives. So, Is it possible that we can use social media in an effective and professional way where we can learn from one another beyond a mere connection with society? 

    As we all know, the ability to connect with anyone, at anytime, in any location, can be overwhelming but yet also exciting. It is not uncommon for individuals to use the web in an unprofessional manner and cross boundaries that they may not have in the real-world. As the internet evolves, many still do not understand the consequences of being connected at all times — especially those in the newer generation. 

    This is mainly the case as the educational system that is set in place at the moment does not incorporate the use of technology beyond word documents and excel spread sheets. The system fails to teach students of the consequences of social media. By using examples that apply to students directly, it can really enhance the students’ knowledge and understanding of the web. 

    Nursing informatics is exactly this. This subjects apply to nurses and nursing students by discussing the relationship of social media and how it can be beneficial yet also harmful to the health-care profession. 

    The Pros:
    The positive usage of social media and modern technology in the healthcare system can be analyzed in many aspects. I have decided to categorize it into sections of use: Documentation, Connectivity, and Resources. 

    Documentation is a key component of health care as it allows us to stay relevant with the information that the patient provides. As nurses, we must be precise when documenting, insuring that we do not miss any crucial details or events. Organization can play a huge role when documenting. If we were to lose a file or accidentally document into the wrong chart, it directly affects the patient and the care that we give them.

    Have you ever tried to read a doctor’s writing and thought to yourself - I have no idea how anyone reads this?
    Majority of the time, nurses and pharmacists are the ones who have to read and interpret those notes. Think of the consequences if a 150mL dosage suddenly looks like 750mL…

    By using modern technology such as computers, it can be a great tool for health care providers to stay organized and clear when documenting. 

    Connectivity is the new Abercombie&Finch. As mentioned in the video above, staying connected allows individuals to feel ‘heard’ and less alone. However, it can also be used as a beneficial way in the healthcare setting. Twitter or Emailing provides as a fast way to connect someone when necessary, this includes providing info about a situation to them that is faster than calling or finding them in person.
    Social technologies can also allow other health providers from other institutes to network and work collaboratively by inputting their ideas and thoughts when exploring options for healthcare-plans or research topics (Terry, 2009). 

    This links to the use of technology when searching for resources that are credible yet still easy to find. The internet provides many databases and scholarly articles that can be used when referencing information, this ranges anything from locating Help-service centers to ways to preform a specific brain surgery. By providing healthcare professionals these resources, time can then be used more effectively and patients can often explore more than one option when provided a care-plan. 

    As discussed in my lecture, Mayo clinic is a not-for-profit medical practice and medical research group based in Rochester, Minnesota. Mayo clinic is currently putting these social technologies to the test by implementing them into their work, research and even, leisure time. The organization uses the web as resource in clinical settings such as twitter and facebook in order to allow the healthcare professionals to stay connected with each-other as well as with the general public. They have also provided guidelines about the regulations that apply in their clinic when working with technology.This transitions into looking potential negatives when applying technology and social media into healthcare. 

    The Cons:
    Once again, the cons can also be broken into categories of resources, confidentiality, and professionalism.

    Unfortunately, as useful as resources can be, it can be considered a negative aspect of healthcare when used improperly. As healthcare providers, we (should) understand how to evaluate the credibility of a site/resource. Sadly, not all individuals do. Because of the accessibility of the internet, many turn to the internet for health-aid before consulting a physician. There are many reasons as to why this happens. However, what many do not know or understand that, there are websites that are designed to manipulate the healthcare system; this includes promoting or selling a product to treat a certain illness without proper medical research. As long as anyone can simply press the ‘edit’ button on an article about a certain illness, this con will continue to exsist. It is our job as healthcare providers to educate the public of how to properly evaluate the credibility of a website

    Confidentiality and privacy is a key aspect of healthcare as any patient has the right to his/her own privacy however, this can be an extremely difficult process when social technologies are implemented into the work force. The reason for this has to do with the lack of guidelines when working with the internet; a resource that is accessible by anyone at anytime. The internet holds information about everyone and everything that has ever been posted or researched. This applies to patients, nurses, doctors.. etc. who use Google or has a Facebook account. So how do we know what is considered a breach of confidentiality? Where is the line? And what makes it okay for employers and clients to Google nurses, yet, it is wrong for nurses to Google patients?

    This ties into professionalism as it applies mainly to the field of work. In this case, nurses are expected to maintain professionalism not only, in the clinical setting but also, in their daily lives. By having Facebook profiles and twitter accounts, nurses and public health workers must be consciously aware of what they are posting to ensure that they are not breaching confidentiality and also maintaining professionalism. As this subject covers many dimensions, I will further elaborate on each topic in detail in future posts while also providing examples to support my thoughts.

    References

    Cohen, S. (2013, July 2013) Retrieved from http://vimeo.com/70534716#at=0

    30/09/2013 http://www.mayoclinic.com/

     Terry, M. (2009). Twittering Healthcare: Social Media and Medicine. Telemedicine and e-Health,15(6), 507-510. Retrieved October 11, 2013, from http://online.liebertpub.com/doi/abs/10