A Treatise on Rural Public Health Nursing

The objective of this chapter is to promote public health nursing and community health nursing’s role in the new care delivery patterns, with predictive and preventative care models for populations. This entry will broaden the range of information available for informaticists, as their role expands in the new healthcare arena. Articulation with nursing informatics and the ‘quality chasm’ crossings in US healthcare will assist the informaticists with search and retrieval activities. All players in the healthcare arena will continue to be involved, but probably with a more rational policy-making role.

Assessment in a Computer-Based Nursing Documentation

Experience in nursing practice shows that there are still problems with assessment in computer-based nursing documentation. In addition to nursing documentation an assessment instrument, which captures the needs for care, must also be integrated. The chapter describes different Nursing Assessment Instruments and the advantages of Computer-Based Nursing Process Documentation by using quality criteria for assessment instruments such as validity, sensitivity, specificity, reliability, practicability and the appropriateness of the instrument. Quality criteria for computer-based systems are basically software ergonomic aspects and therefore not part of this study. Each country should choose for itself those specific assessment instruments that capture the needs for care of their clients. The data presented make it possible that facilities are compared (also in regard of reliable cost estimates).

Clinical Decision Support Systems in Nursing

Increasingly, new and extended roles and responsibilities for nurses are being supported through the introduction of clinical decision support systems (CDSS). This chapter provides an overview of research on nurses’ use of CDSS, considers the impact of CDSS on nurse decision making and patient outcomes, and explores the socio-technical factors that impact the use of CDSS. The chapter presents the results of a multi-site case study that explored how CDSS are used by nurses in practice in a range of contexts. The study reveals that how a system is used may vary considerably from the original intentions of the system designer.

Culturally Sensitive Healthcare for Newcomer Immigrants

This chapter will give an overview of the health care related challenges that most newcomer immigrants and refugees encounter as they acculturate into their new environments in Western countries. It will highlight practical tips that can: enhance the caregiver and patient relationships across cultures and across continents; enhance culturally sensitive health care services; and help to create culturally inviting health care environments. It is also evident that, although these newcomers enrich their new nations with their diverse backgrounds, language and cultural differences continues to pose formidable obstacles to their health, health care providers and health system in general. While the patients and providers realize the effects of immigration on the quality and access to health care, they seem to be overwhelmed by the barriers.

Mobile technology experiences and future in development

This chapter presents the imperatives of mobile technologies in the health care. It presents the contextual overview in development of the diffusion, penetration, and uptake of health related mobile technologies. A consideration of the roles and responsibilities of the diaspora in the embracing of information and communication technologies is emphasized. Key examples of mobile technologies in development to increase understanding and demonstrate promising practices in this emergent field are given.

Nursing Documentation in a Mature EHR System: a VA Case Study

Computerized patient care documentation (CPD) is a vital part of a Patient Care Information System (PCIS). Studying CPD in a well-established PCIS is useful because problems of system adoption and startup do not interfere with observations. Factors interfering with optimal nursing use of CPD are particularly challenging and of great concern, given today’s shortage of nursing manpower. The chapter describes problems and advantages of CPD usage identified by nurses in a series of research interviews. It is shown that explicit consideration of nursing workflow constraints and communication processes is necessary for development of effective nursing documentation systems. Some findings point to a PCIS reconfiguration strategy that is feasible in the short term. Other findings suggest the value of considering mobile and team-oriented technologies in future versions of the PCIS.

Nurses and Telehealth current practice and future trends

Home telehealth, the use of information and communication technologies to deliver and support health care directly to the home, is emerging as an important application for nurses. This chapter provides an overview of home telehealth and how it may be applied to the practical challenges nurses face everyday. We provide a summary of the evidence available to support its use in specific areas and a guide for those thinking of implementing telehealth in their own practice. The future of home telehealth lies in carefully considered and designed research, ongoing education and training and a multidisciplinary approach.

Online Teaching and Learning Strategies

This chapter presents a theoretical framework and research base for the successful transition of an established Master of Science in Nursing program from that of traditional classroom delivery to one that is web-based with no geographic limitations to students. The application of socio-technical systems theory to facilitate creation of a positive learning environment for future nurse leaders is described. Use of social processes and application of technology to optimize learning is explained and the latest research on content presentation and student engagement in an e-learning environment are presented. The chapter gives an understanding of the competencies necessary for students and faculty to be successful in online education.

Shaping Funding Policy for Nursing Services

Concerning nursing resource allocation health service executives have different views about whether systems based on ratios or those based on patient dependency are more accurate. This chapter reports on a statistical analysis of almost 2 million hours of nursing data provided by 22 acute care public and private hospitals in Australia, New Zealand and Thailand. To evaluate both ways an informatics system was used which has the capacity to simultaneously measure nurse patient ratios and nursing workloads by a dependency method of nursing hours per patient day. The results showed that it predicts actual direct nursing care requirements with greater accuracy than ratios for all hospital and patient types, facilitating better allocation of nursing resources and demonstrating that the cost of nursing care would be less for hospitals using that system than for ratios.

Simulations to Assess Medication Administration Systems

A range of new technologies/information systems are being implemented in clinical settings in order to reduce errors associated with the medication administration process. Simulation methods can be used to assess the impact of integrating new technology/information systems into the nurses’ work environment prior to full scale implementation of a health technology/information system. Simulations as an evaluative tool emerged from a direct need to assess unintended and intended consequences of health information systems upon nurses’ work before systems are fully implemented. Nurse informatician use of simulations to assess and test health technologies/information systems will allow nurses to determine the impact of a new software and/or hardware upon aspects of nurses’ work before its implementation to allow for appropriate system modifications.

Socio-Technical Structures, 4Ps and Hodges' model

This chapter explores the potential of a conceptual framework – Hodges’ model – both as a socio-technical structure and means to explore such structures of relevance to nursing informatics theory and practice. The model can be applied universally by virtue of its structure and the content which it can encompass. In apprehending this chapter readers will be able to draw, describe and explain the scope of Hodges’ model within contemporary health care contexts and the wider global issues presented by the 21st century that influence and shape nursing informatics. Critically, the reader will also gain insight into how socio-technical structures can facilitate cross fertilization of clinical and informatics theory and practice; drawing attention to information as a concept that provides a bridge between socio-technical, clinical and informatics disciplines. The paper will review the socio-technical literature and venture definitions of socio-technical structures related to Hodges’ model and advocate the need for sociopolitical-technical structures. The paper also proposes the 4Ps as a tool to facilitate reflection upon and the construction of socio-technical structures. The adoption and significance of the hyphenated form as per ‘socio-technical’ will also be explained.

Strategies for Creating Virtual Learning Communities

Teaching nursing online requires teachers to purposefully use strategies that facilitate the development of virtual learning communities. The chapter proposes answers to the question, “How can educators effectively teach the very social discipline of nursing in virtual classrooms?” Specific online teaching strategies including Photovoice, Virtual Reflective Centers, and Conceptual Quilting are explored. The social and socio-technical implications of teaching nursing online are considered. A final section in the chapter describes how these developments in online nursing education are changing the social and pedagogical perspectives of distance learning. Research questions that arise from this exploration are presented.

The Impact of technology in organizational communication

In this chapter a case study is presented, in which the ethnomethodological approach is used to analyze the impact of the implementation of an information system, called Sispes, on organizational communication processes in the residence for elderly Giovanelli (Italy). Sispes is a web based platform which sustains communication processes and knowledge management according to a customized workflow management system.
Adopting structuration theories in the analysis of the case study, and taking inspiration from the philosophical tradition, especially in epistemology and in the analytic philosophy of law, an innovative perspective is adopted, which specifically acknowledges the role played by the communication processes in shaping both the attitudes of the involved actors and the social reality in which they are immersed. According to this perspective, three types of communication processes are presented, namely the normative, descriptive and constructive approach. These latter are then applied to a concrete case study.

The roles of a nurse in telemedical consultations

Telemedicine, or distant medical consultations using communication via electronic networks, is gradually becoming a standard of medical care delivery in distant areas worldwide, including both the most developed and the developing countries. For instance, in 2007 telemedical centres existed in 55% of the Russian regions (on average, about 4 centres in each region). In most of the cases, nurses are actively involved into organization of various types of distant consultation. Main types of telemedical services include: (1) emergency consultations of patients by telephone (2) telemedical consultations using videoconferences or store-and-forward systems and (3) home telecare systems. Possible roles of nurses in different types of telemedical consultations are discussed.

The Role of EBM and Nursing Informatics in Rural Australia

The purpose of this chapter is to discuss broadly the need for enhanced evidence-based medicine (EBM) by nurses in the context of rural Australia and the role that nursing informatics and an informed strategy could facilitate in making such need a feasible reality. First, the introduction highlights current time gaps between health discoveries and eventual practice and the potential for information technology to positively affect this gap. Then, the need for nurses to take an active role in evidence based medicine in rural settings is argued. The link between information literacy and evidence medicine is consequently presented and gaps in knowledge regarding nursing informatics training are highlighted. Concluding with the argument that to achieve evidence based research and eventual use, there needs to be a purposeful health informatics learning strategy that recognises the role of computer and information literacy.

Use of handheld computers in nursing education

The use of mobile technologies in nursing education is rapidly increasing. Handheld computers are the most frequently used of these technologies as they can provide students with information for point of care clinical reference, such as diagnostics, medical terminology, and drug references. Integrating the management and processing of information into clinical practice is an effective learning approach for students and reflects a changing paradigm in nursing education. Traditionally, nursing programs have the tendency to separate the acquisition of academic knowledge from clinical practice, and the process of integrating academic information into the decision-making processes in the clinical area has been difficult for student nurses. This chapter will provide an overview of the use of handheld computers in nursing and medical education, including a brief synopsis of current use in clinical practice. It will discuss the advantages and disadvantages of their use, barriers to implementation and future directions.

Using Information Technology in Nursing Education

This chapter addresses issues relating to nursing informatics as used and applied in nursing education. This includes the use of information technology (IT) in delivering nursing education, as well as the teaching of IT and informatics skills to prepare nurses for practice. Drivers associated with the development and use of IT in nursing education are discussed, as well as current use of IT in nursing education and practice, including both mainstream and emerging technologies. Lastly some key issues for the future are identified. Internationalism is regarded as a consistent theme in IT development and occurs as a recurring thread throughout this chapter.