ࡱ>  bjbj WSjjlh h h h h h h | \2<| ez \\\\ddddddd$g i^dih @d5'h h \\)`e5'5'5'h \h \d5'd5'5'0)ZXh h 5^\n `K#| Z#[(5^ve0e[@j$\@j5^5'| | h h h h TO: Lisa Rabideau CVPH MEDICAL CENTER HOSPITAL LIBRARY LITERATURE SEARCH Please mark an X to the left of any item you feel is worth $35. [You will NOT be charged anything.] Please mark an 0 if you would like to see the item, but not as important as above. Disclaimer: The material provided is only for informative purposes and should not be construed as medical advice or instruction. Consult your Health Professional for advice relating to medical problems or conditions. Notice: This material may be protected by Copyright Law. Title 17. US Code. Articles accompanying this research in PDF: Enhance orientation through e-learning. Huryk, Laurie A. RN, OCN Nursing Management. 36(1):48-49, January 2005. E-learning in an educational program provides advantages to an instructor-based approach. Computer Use in an Urban University Hospital: Technology Ahead of Literacy Wayne A. Wilbright, MD, MS; Daniel E. Haun, MT; Teresa Romano, RN, MN, CCNS, APRN, BC; Teresa Krutzfeldt, RN, MN; Cathi E. Fontenot, MD; Thomas E. Nolan, MD, MBA Comput Inform Nurs. 2006;24(1):37-43.  HYPERLINK "http://www.medscape.com/viewarticle/523388" http://www.medscape.com/viewarticle/523388 The linkage of patient safety and care quality to the implementation of computerized information systems assumes that clinical staff are skilled with computers. Nurses and nursing support staff increasingly require computers to carry out their work. Minimum computer competencies for nurses have been identified. The determination of whether the current nursing workforce has acquired these competencies remains uncertain. We administered a self-assessment survey to nurses and nursing support staff to determine proficiency with computer skills they might perform at work. Respondents reported inadequacies in basic and work-related computer skills. More than 28% scored themselves as having fair or poor proficiency on all skills, and more than 50% as fair or poor on five of 11 skills. Respondents over age 50 and those graduating before 1984 tended to score proficiency lower. Our study suggests that many nurses and nursing support staff may not have the minimum computer competencies to effectively and efficiently perform their work. Carlock, Danielle MLS, AHIP; Anderson, Jonna MSN, RN Teaching and Assessing the Database Searching Skills of Student Nurses. Nurse Educator. 32(6):251-255, November/December 2007 Critical appraisal and application of the evidence to practice cannot proceed without first finding the evidence. To teach evidence-based practice database searching skills to students, a nurse educator partnered with a librarian to design, conduct, and assess instruction. The authors describe the creation, administration, and findings from the assessments and the implications for instruction. Brokel, Jane PhD, RN Creating Sustainability of Clinical Information Systems: The Chief Nurse Officer and Nurse Informatics Specialist Roles. Journal of Nursing Administration. 37(1):10-13, January 2007. Pravikoff, Diane S. PhD, RN, FAAN; Tanner, Annelle B. EdD, RN; Pierce, Susan T. EdD, RN Readiness of U.S. Nurses for Evidence-Based Practice: Many don't understand or value research and have had little or no training to help them find evidence on which to base their practice. AJN, American Journal of Nursing. 105(9):40-51, September 2005. ERDLEY, WILLIAM SCOTT DNS, RN Concept Development of Nursing Information: A Study of Nurses Working in Critical Care. CIN: Computers, Informatics, Nursing. 23(2):93-99, March/April 2005 This article proposes a definition of nursing information. Nurses use information to plan, implement, and evaluate patient care. They seek information from colleagues, books, electronic sources, and equipment, and give information to multiple audiences. Even with the pervasiveness of information in nursing practice, there has been little research aimed at developing a definition of nursing information. This study was undertaken to start filling that gap. The Hybrid Model of Concept Development served as the study design. This model consists of three phases: theoretical, fieldwork, and final analytical. In the theoretical phase, a working definition of nursing information was developed. The fieldwork phase involved observations and interviews of 13 expert nurses working in a critical care unit. The qualitative data obtained from the fieldwork phase were analyzed to refine and extend the working definition. Previously identified categories in the definition--context, form, communication, and value--were validated in the analysis. New categories--multidimensionality, intervening/doing, and power--emerged during the final analytical phase, and the definition was revised to include this new knowledge. The utility of the definition of nursing information and its impact on nursing practice, information technology, and theory development is discussed MOODY, LINDA E. PhD, MPH, FAAN; SLOCUMB, ELAINE PhD, RN; BERG, BRUCE MD; JACKSON, DONNA MSN, RN, BC Electronic Health Records Documentation in Nursing: Nurses' Perceptions, Attitudes, and Preferences. CIN: Computers, Informatics, Nursing. 22(6):337-344, November/December 2004. A descriptive study of 100 nursing personnel at a large Magnet hospital in Southwest Florida was conducted to assess their needs, preferences, and perceptions associated with Electronic Health Record (EHR) documentation methods. Nurses' attitudes about the use of EHRs and their perceived effects on patient care were assessed. The five-item, Likert-type attitude scale explained 54% of the variance in attitude scores and demonstrated sound construct validity and internal consistency (r = 0.77). More than one third, 36%, perceived that EHRs had resulted in a decreased workload. The majority of nurses, 64%, preferred bedside documentation but reported that environmental and system barriers often prevent EHR charting at the bedside. Overall, 75% of nurses thought EHRs had improved the quality of documentation and 76% believed electronic charting would lead to improved safety and patient care. Nurses with expertise in computer use, 80%, had a more favorable attitude toward EHRs than those with less expertise. Results have been used to implement clinical system changes. Dickerson, Suzanne Steffan DNS, RN; Feitshans, Lisa A. MS, RN Internet Users Becoming Immersed in the Virtual World: Implications for Nurses. CIN: Computers, Informatics, Nursing. 21(6):300-308, November/December 2003 Worldwide, people are using the Internet for computer-mediated communication (CMC) in increasing numbers. Nurse researchers have begun to examine the use of this medium for communication, education, and support of their clients. Therefore, it is important to know the experiences and meanings of CMC if the Internet is to be used for nursing interventions. The purpose of this study was to examine the experiences and meaning of online communications for frequent Internet users and discuss implications for nursing practice. Four virtual focus groups consisting of a total of 32 individuals were included in this study. Their stories of everyday Internet use were analyzed by hermeneutic interpretation. Six related themes and 1 constitutive pattern emerged from the data: (1) Internet as a resource for communication, information, and entertainment; (2) Internet as appealing, drawing one into frequent use; (3) developing dependencies; (4) Internet as frustrating; (5) learning the rules; and (6) developing physical and psychosocial effects. The constitutive pattern is immersion into the virtual world. This knowledge can be used to identify the potential effects of integrating the Internet into nursing interventions. Nurses who plan Internet-based interventions need to understand the appeal of this medium as well as the limitations and barriers to use Young, Kathleen M. MA, RN,BC Where's the Evidence?: 'Evidence-based practice' is not a reality for most nurses. AJN, American Journal of Nursing. 103(10):11, October 2003. Pravikoff, Diane S. PhD, RN, FAAN; Pierce, Susan EdD, MSN, RN; Tanner, Annelle EdD, MSN, RN Are Nurses Ready for Evidence-Based Practice?: A study suggests that greater support is needed. AJN, American Journal of Nursing. 103(5):95-96, May 2003. Evidence-based practice is characterized by using the best proven information when making clinical decisions, in lieu of intuition and unmethodical clinical experience. It is the new recommended standard in health care. Many agree that evidence-based practice has the potential to improve patient care and outcomes (even as the debate continues over what types of information constitute evidence), yet in order to be effective, information must be available and accessible, and practitioners must be skilled in using resources such as computers ROSENFELD, PERI PhD; SALAZAR-RIERA, NORALIZA MSN, RN, CCRN, CCNS; VIEIRA, DORICE MLS, MA Piloting an Information Literacy Program for Staff Nurses: Lessons Learned. CIN: Computers, Informatics, Nursing. 20(6):236-241, November/December 2002. Staggers, Nancy; Gassert, Carole A.; Curran, Christine A Delphi Study to Determine Informatics Competencies for Nurses at Four Levels of Practice. Nursing Research. 51(6):383-390, November/December 2002. BACKGROUND: Despite its obvious need, a current, research-based list of informatics competencies for nurses is not available. OBJECTIVE: To produce a research-based master list of informatics competencies for nurses and differentiate these competencies by level of nursing practice. METHODS: After a comprehensive literature review and item consolidation, an expert panel defined initial competencies. Subsequently, a three round Delphi study was conducted to validate the items. Participants were expert informatics nurse specialists in the United States of America. RESULTS: Of the initial 305 competencies proposed, 281 competencies achieved an 80% or greater agreement for both importance as a competency and appropriateness for the correct practice level. Five competencies were rejected. Six competencies were considered valid competencies but the appropriate level of practice could not be agreed upon. Thirteen competencies did not reach any consensus after the three Delphi rounds. DISCUSSION: The Delphi study had a high rate of participation, demonstrating the great level of interest and need for a list of informatics competencies for nurses. Out of the initial 305 competencies, only 24 items were not validated. Respondents commented during each round about whether computer skills should be considered informatics competencies. The authors propose that computer skills, while not high level, are one set of tools within the larger category of informatics competencies. This sample of experts did not deem programming skills as necessary for informatics nurses. This research study is an initial effort to fill the void of valid and reliable informatics competencies. It is the first study to span four levels of nurses, create competencies for both entry-level and experienced informatics nurse specialists, and examine the categories of computer skills, informatics knowledge and informatics skills. HOBBS, STEVEN D. MA, BSN, RN Measuring Nurses' Computer Competency: An Analysis of Published Instruments. CIN: Computers, Informatics, Nursing. 20(2):63-73, March/April 2002. The rapid expansion of computer-driven technologies into multiple aspects of modern healthcare suggests that many of the important competencies of the 21st century nurse will encompass mastery of computer technology. This is a comprehensive review of the published measures of computer competence during the past 12 years. Essential knowledge, attitudes, and skills were identified and classified. Multiple competency assessment instruments of varying quality were examined. Little agreement was found regarding specific computer-focused competencies necessary for nurses. Taken as a whole, however, there is consensus that the computer-competent nurse possesses a general knowledge and understanding of computer technology, coupled with a positive attitude toward computers and software. In addition, such a nurse is skillful in computer hardware and software use and able to grasp how such technology benefits nursing and the overall healthcare environment Ruland, Cornelia M. PhD, RN Developing a Decision Support System to Meet Nurse Managers' Information Needs for Effective Resource Management. Computers in Nursing. 19(5):187-193, September/October 2001. This article describes the development of a decision support system called CLASSICA, which assists nurse managers in financial management, resource allocation, activity planning, and quality control. CLASSICA integrates information about patient flow and activity, staffing, and the cost of nursing care at the nursing-unit level. The system provides assistance in planning activities, balancing the budget, and identifying barriers to unsatisfactory resource management. In addition, CLASSICA contains forecasting and simulation options to analyze the influence of factors that affect nursing costs. This article describes the system's development process steps to tailor it to the needs of nurse managers and their existing work practices. Nurse managers actively participated in defining their tasks and responsibilities; identified barriers and difficulties in managing these tasks; defined information needs, data input, and output and interface requirements; and identified expected benefits. Clear communication of project goals, strong user involvement, and purposeful benefit planning was used to achieve the goals for CLASSICA: (1) to provide essential information and decision support for effective financial management, resource allocation, activity planning, and staffing; (2) to improve nurse managers' competence in financial management and decision making; (3) to improve cost containment; and (4) to provide a helpful and easy to use tool for decision support SMEDLEY, ALISON BHSc (NURSING), RN, CM GRAD CERT CFH NURSING(TRES), GRAD DIP FET, MEd The Importance of Informatics Competencies in Nursing: An Australian Perspective. CIN: Computers, Informatics, Nursing. 23(2):106-110, March/April 2005 Over the past two decades, dramatic changes have occurred in the nature and extent of communication and information technology use in nursing worldwide. The need for student nurses to be well prepared for the use and application of information technology in nursing is arguably now paramount. This article details areas where information and communication technology is used in nursing in Australia and discusses why nurses must be diligent in maintaining skills in this area to facilitate the delivery of safe, quality care in any healthcare setting. It will then discuss the importance of information and communication technology (ICT) skills, knowledge and understanding as an integral aspect of nursing programs in tertiary institutions. The challenge for training providers to prepare nurses for ever-changing ICT technology and technological applications in their workplace is highlighted. Tanner, Annelle EdD, RN; Pierce, Susan EdD, RN; Pravikoff, Diane PhD, RN, FAAN Moving the Nursing Information Agenda Forward. CIN: Computers, Informatics, Nursing. 22(5):300-303, September/October 2004. STATE OF THE PROFESSION Ubiquitous reports from studies conducted by the Institute of Medicine that identified medical errors suggest resolution strategies that provide for implementation of evidence-based healthcare. National policies, especially those emerging from leaders addressing the National Health Information Infrastructure, Dr David Brailer, National Health Information Technology Coordinator, and Tommy Thompson, Secretary of Health and Human Services, acknowledge that the time is NOW for healthcare information to enter the electronic domain. Consumer health groups are insisting that their healthcare providers offer care based on evidence, with consideration for the individual's unique healthcare assessment. Additionally, consumers are demanding guidance in finding resources for personal information seeking for decision making regarding health matters for themselves and their families. With this increased demand for improved patient outcomes and accountability for healthcare provided, nurses must embrace a culture of evidence-based nursing. In this paradigm, best nursing practices are developed from the most current and best available information that fits the patient and environment. Such reports need to be made available expeditiously in an electronic format at a time and place most convenient for the nurse. The nurse must understand how to access and appraise the report for its applicability in the clinical environment. Recent studies indicate that nurses in the United States may not be prepared to engage in such a practice environment. NURSING INFORMATION LITERACY Smith, Kathleen MScEd, RN, BC; Bickford, Carol J. PhD, RN, BC Lifelong Learning, Professional Development, and Informatics Certification. CIN: Computers, Informatics, Nursing. 22(3):172-178, May/June 2004. Jane is a RN and has been working as a clinical systems analyst for 6 years. She serves as the liaison between her assigned clinical units and the Information Technology Department. She thoroughly enjoys her job and has learned a great deal from her experience, reading, and attendance at professional conferences. Now the time has come for Jane to consider becoming certified in nursing informatics. She has the application from the American Nurses Credentialing Center (ANCC) and knows she meets the minimum requirements to take the exam. But she wonders if she is ready to do so. There is also the matter of the application fee, which is several hundred dollars. Jane wonders about the investment of time and money to become certified and thinks, What's in it for me? When deciding what is important in professional practice, examination of the Code of Ethics 1 and published standards provides significant insight and understanding about What's in it for me? Such a review strategy can assist the nurse to gain a better understanding and appreciation of the role of lifelong learning, professional development, and certification in nursing informatics practice. Provision 5.2 of the Code of Ethics for Nurses With Interpretive Statements , 1 the profession's nonnegotiable ethical standard, identifies that Continual professional growth, particularly in knowledge and skill, requires a commitment to lifelong learning. 1 (p18) Similar references to attaining Davis Kirsch, Sallie E. PhD, RN, MN; Lewis, Frances M. PhD, RN, MN, FAAN Using the World Wide Web in Health-related Intervention Research: A Review of Controlled Trials. CIN: Computers, Informatics, Nursing. 22(1):8-18, January/February 2004. A review of published controlled trials was conducted to evaluate components, utility, and efficacy of Web-based healthcare interventions. Nine studies met the established review criteria. Knowledge gains were the most commonly reported significant changes; rarely were there measures or significant changes on behavioral outcomes. Studies varied in format of personal contact with participants, in the structure or sequence of intervention content, and in design features. Dosage was inconsistently measured and process evaluation was relatively absent. Despite limitations, several studies reported significant effects. Based on best evidence-to-date, elements of technologically mediated interventions important to future research are summarized. Taken together, research suggests that Web-based interventions may be an efficacious delivery system, especially for those with chronic conditions amenable to self-management and to those with various limitations to accessing healthcare. Husting, Pamela M. PhD, MPH, RN; Cintron, Lourdes BSN, RN HEALTHCARE INFORMATION SYSTEMS: EDUCATION LESSONS LEARNED. Journal for Nurses in Staff Development - JNSD. 19(5):249-253, September/October 2003. The educator is a key person during the implementation of a new healthcare computer system or a new software program. Computers require teamwork across departmental lines and flexibility in instructional approach. The authors share their experiences as educators at the San Francisco VA during the initiation of several new computer software packages. They examine the issues involved in this type of training and share the lessons learned.  HYPERLINK "http://find.galegroup.com/itx/retrieve.do?contentSet=IAC-Documents&resultListType=RESULT_LIST&qrySerId=Locale%28en%2C%2C%29%3AFQE%3D%28K0%2CNone%2C38%29nursing+staff+development+AND+computer%24&sgHitCountType=None&inPS=true&sort=DateDescend&sea How IT is shaping up: Susan Osborne looks at how advances in information technology will revolutionise the way nurses work.(CAREER DEVELOPMENT)(Information Technology). Susan Osborne.  HYPERLINK "http://find.galegroup.com/itx/publicationSearch.do?queryType=PH&inPS=true&type=getIssues&prodId=HRCA¤tPosition=0&userGroupName=nysl_nc_ncrefres&searchTerm=Nursing+Standard&index=JX&tabID=T002&contentSet=IAC-Documents" Nursing Standard21.12(Nov 29, 2006):p62(2). Winters CA, Lee HJ, Besel J, Strand A, Echeverri R, Jorgensen KP, Dea JE. Access to and use of research by rural nurses. Rural Remote Health. 2007 Jul-Sep;7(3):758. Epub 2007 Aug 24. PMID: 17892348 [PubMed - indexed for MEDLINE] INTRODUCTION: The use of relevant research findings to inform clinical practice is important for nurses, regardless of setting. Although there have been studies addressing the use of research among various practitioners, little is known about how nurses in rural areas access health information (specifically research findings), nor how such findings are incorporated into daily practice. The purpose of this study was to explore rural nurses' access, use and perceived usefulness of research for rural practice. METHODS: The study was conducted in a sparsely populated state located in the western part of the USA. An ethnographic method was chosen to answer the research questions for this descriptive study. Semi-structured interviews were conducted with 29 rural nurses from nine communities by graduate nursing students enrolled in a rural nursing course following in-class instruction and practice. Field notes taken by the students supplemented the interview data. The students' notes included a windshield survey or description of the context and location within which the participants lived and/or practiced as well as the interviewers' observations, thoughts and impressions about the research project. Interviews were audiotaped and transcribed verbatim. Once transcribed, the interview narratives, windshield data and field notes were analyzed by the students for common themes; the students then wrote and submitted papers to the faculty addressing the themes that emerged from their interviews. The analysis conducted by the faculty members included four sources of data: transcriptions of interviews; field notes; windshield data; and students' papers. The process of identifying themes was facilitated by using the software program NUD*IST (QSR International; Melbourne, VIC, Australia). Demographic information was entered into the Statistical Package for Social Scientists (SPSS Inc; Chicago, IL, USA) to compile descriptive information about the sample. FINDINGS: Twenty-seven female and two male nurses participated in the study. The nurses' ages ranged from 31-72 years and their experience in nursing spanned 3-50 years with a range of 1 to 35 years in rural nursing. The interviews revealed that most of the nurses used the term 'research' to mean 'gathering information'. When asked how often they used 'research' the responses ranged from 2-3 times per day to 2-3 times per month. The preferred means of obtaining information was asking a colleague. Additional resources included work-place journals, books, in-services, conferences and the internet. Twenty-three of the nurses reported having internet access at work; 25 had internet access at home. Supportive supervisors and articles in general nursing journals were identified as helpful. Barriers to using research included: lack of knowledge of research methods; lack of time at work or at home to look up information; and the lack of computers and internet access on the nursing units. When computers were available, the nurses reported that poor computer literacy decreased their ability to quickly find and evaluate information. Additional barriers included diminishing financial support from employers and the long travel distances required to attend conferences. The nurses reported finding little clinical research specifically related to rural practice. CONCLUSIONS: Education and mentorship is needed about how to evaluate the types and strength of evidence, access research using the internet, interpret findings, and incorporate evidence in clinical practice. Interventions that foster the appreciation and use of research by staff nurses and managers are needed in order to build an evidence based culture. Research is needed, specifically as related to rural clinical practice. An emerging giant: nursing informatics. HIMSS Nursing Informatics Awareness Task Force Nurs Manage - 01-MAR-2007; 38(3): 38-42 Websites of Interest to this Search: Resources for Nurses on Training and courses  HYPERLINK "http://www.nursing-informatics.com/sitemap.html" http://www.nursing-informatics.com/sitemap.html BIBLIOGRAPHY Comput Inform Nurs. 2006 Jan-Feb;24(1):37-43. Computer use in an urban university hospital: technology ahead of literacy. Wilbright WA, Haun DE, Romano T, Krutzfeldt T, Fontenot CE, Nolan TE. Louisiana State University Healthcare Service Division, Medical Center of Louisiana in New Orleans, New Orleans, LA 70112, USA. wwilbr@lsuhsc.edu The linkage of patient safety and care quality to the implementation of computerized information systems assumes that clinical staff are skilled with computers. Nurses and nursing support staff increasingly require computers to carry out their work. Minimum computer competencies for nurses have been identified. The determination of whether the current nursing workforce has acquired these competencies remains uncertain. We administered a self-assessment survey to nurses and nursing support staff to determine proficiency with computer skills they might perform at work. Respondents reported inadequacies in basic and work-related computer skills. More than 28% scored themselves as having fair or poor proficiency on all skills, and more than 50% as fair or poor on five of 11 skills. Respondents over age 50 and those graduating before 1984 tended to score proficiency lower. Our study suggests that many nurses and nursing support staff may not have the minimum computer competencies to effectively and efficiently perform their work. PMID: 16436911 [PubMed - indexed for MEDLINE] References 1. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000. 2. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. 3. Patient Safety: Achieving a New Standard for Care. Washington, DC: National Academies Press; 2004. 4. 15th Annual HIMSS Leadership Survey. Health Information and Management Systems Society; 2004. 5. Yee CC. Identifying information technology competencies needed in Singapore nursing education. Comput Inform Nurs. 2002;20(5):209-214. 6. McCannon M, O'Neal PV. Results of a national survey indicating information technology skills needed by nurses at time of entry into the work force. J Nurs Educ. 2003;42(8):337-340. 7. Staggers N, Gassert CA, Curran C. Informatics competencies for nurses at four levels of practice. J Nurs Educ. 2001;40(7):303-316. 8. Hobbs SD. Measuring nurses' computer competency: an analysis of published instruments. Comput Inform Nurs. 2002;20(2):63-73. 9. Spratley E, Johnson A, Sochalski J, Fritz M, Spencer W. The Registered Nurse Population: Findings From the National Sample Survey of Registered Nurses. Rockville, MD: US Department of Health and Human Services-Health Resources and Service Administration; 2003. 10. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press; 2004. 11. Bryson DM. The computer-literate nurse. Comput Nurs. 1991;9(3):100-107. J Prof Nurs. 2006 Jan-Feb;22(1):52-9. Computer literacy study: report of qualitative findings. McNeil BJ, Elfrink V, Beyea SC, Pierce ST, Bickford CJ. Division of Nursing and Health Sciences, Lewis-Clark State College, Lewiston, ID 83501, USA. bmcneil@lcsc.edu Computer literacy and information literacy are critical to the future of nursing. The very nature of health care is being transformed in response to environmental drivers such as the demands for cost-effective delivery of high quality services and enhanced patient safety. Facilitating the quality transformation depends on strategic changes such as implementing evidence-based practice (), promoting outcome research (), initiating interdisciplinary care coordination [Zwarenstein, M., Bryant, W. (2004). Interventions to promote collaboration between nurses and doctors. The Cochrane Library(I)], and implementing electronic health records (). Information management serves as a central premise of each of these strategies and is an essential tool to facilitate change. This report of the analysis of qualitative data from a national online survey of baccalaureate nursing education programs describes the current level of integration of the computer literacy and information literacy skills and competencies of nursing faculty, clinicians, and students in the United States. The outcomes of the study are important to guide curriculum development in meeting the changing health care environmental demands for quality, cost-effectiveness, and safety. PMID: 16459289 [PubMed - indexed for MEDLINE] J Contin Educ Nurs. 2007 May-Jun;38(3):132-8. Computer-assisted instruction for novice nurses in critical care. Travale IL. Hamilton Health Sciences, Cardiac and Vascular Program, Hamilton, Ontario, Canada. The current worldwide nursing shortage is having the greatest effect on the critical care areas as novice nurses enter these specialty areas in unprecedented numbers. Massive healthcare restructuring, a rapidly aging nursing work force, and high nursing turnover and absenteeism rates have all contributed to a healthcare environment that is struggling to care for critically ill patients. Computer-assisted instruction in the form of interactive computer programs may be used as an adjunct educational resource for these novice practitioners. These programs have the potential to bridge the gap between theory and practice, which may assist the novice nurse in achieving safe, competent clinical practice. PMID: 17542172 [PubMed - indexed for MEDLINE] Crit Care Nurs Q. 2006 Jul-Sep;29(3):218-30. Implementing Essentials of Critical Care Orientation: one hospital's experience with an online critical care course. Peterson KJ, Van Buren K. Methodist Hospital, Park Nicollet Health Services, St Louis Park, MN 55426, USA. kristine.peterson@parknicollet.com Critical care is a specialty area that requires a significant investment of time and money for clinical and classroom learning. One solution for learning that is flexible and cost-effective is the American Association of Critical Care Nurses' Essentials of Critical Care Orientation (ECCO). ECCO lays the theoretical groundwork for nurses to practice safely in critical care. Utilization of ECCO in one community hospital has been a 3-year process, which is continually refined by the critical care education team. Advantages to using ECCO include that it is self-paced, maintained by the American Association of Critical Care Nurses, and allows learners to flex their time and location for learning. Obstacles encountered include difficulties associated with computer learning, lack of hard copy notes, lack of face-to-face time interaction between orientees and education staff, increased work load for one education staff member, and keeping learners on track with their time and orientation. This article describes one hospital's experience with implementation of ECCO as the classroom portion of orientation to several critical care units. PMID: 16862023 [PubMed - indexed for MEDLINE] References: Pooler C, Slater-MacLean L, Simpson N, Giblin C. Knowledge and skill acquisition for critical care nursing practice. Dynamics. 2005;16:20-23. 2. Jackson K, King KJ. Successfully integrating e-learning with critical care nursing education. Crit Care Nurse. 2005;25(suppl):36. 3. Maiocco G. Critical care: from classroom to CCU. Nurs Manag. 2003;34:54, 56-57. 4. Johanson LS. Tips for succeeding at Internet courses. Dimensions Crit Care Nurs. 2001;20:42-43. 5. Squires A, McGinnis S. Critical care nursing orientation in the rural community hospital. Dimensions Crit Care Nurs. 2001;20:40-45. 6. AACN mission statement. Available at: www.aacn.org. Accessed February 27, 2006. 7. Redding DA. The development of critical thinking among students in baccalaureate nursing education. Holistic Nurs Pract. 2001;15:57-64. 8. AACN. Available at:  HYPERLINK "http://www.aacn.org/aacn/conteduc.nsf/de2d9832c1042edd8825689a006a21b3/7a6e5410916ab75f88256edd00730f72?OpenDocument" \t "_blank" http://www.aacn.org/aacn/conteduc.nsf/de2d9832c1042edd8825689a006a21b3/7a6e5410916ab75f88256edd00730f72?OpenDocument. Accessed January 16, 2006. 9. Knowles MS, Holton EF III, Swanson RA. The Adult Learner. 6th ed. Burlington, Mass: Elsevier. 10. Feist L. Removing barriers to professional development. THE J. 2003;30:30, 32, 34-36. 11. Merriam SB. Something old, something new: adult learning theory for the twenty-first century. In: Merriam SB, ed. The New Update on Adult Learning Theory: New Directions for Adult and Continuing Education, No. 89. San Francisco: Jossey-Bass; 2001:93-96. 12. Tweedell CB. A theory of adult learning and implications for practice. Paper presented at: the Annual Meeting of the Midwest Educational Research Association; 2000; Chicago, Ill. 13. Marsick VJ, Watkins KE. Informal and incidental learning. In: Merriam SB, ed. The New Update on Adult Learning Theory: New Directions for Adult and Continuing Education, No. 89. San Francisco: Jossey-Bass; 2001:25-34. 14. Wiseman T. Essentials of critical care orientation. Crit Care Nurse. 2003;23:81. 15. ECCO Community listserv. Postings: ECCO assessment tools. Available at:  HYPERLINK "http://health.groups.yahoo.com/group/ecco_community/" \t "_blank" http://health.groups.yahoo.com/group/ecco_community/. Accessed May 29, 2006. 16. PCCN Certification FAQs. Available at: www.aacn.org. Accessed March 14, 2006. 17. Cobb SC. Internet continuing education for health care professionals: an integrative review. J Contin Educ Health Prof. 2004;24:171-180. 18. Berke WJ, Wiseman TL. The e-learning answer. Crit Care Nurse. 2004;24:80-84. Comput Inform Nurs. 2006 Mar-Apr;24(2):105-12. A survey study of pediatric nurses' use of information sources. Secco ML, Woodgate RL, Hodgson A, Kowalski S, Plouffe J, Rothney PR, Sawatzky-Dickson D, Suderman E. St. Francis Xavier/Cape Breton Universities Joint Nursing Program, Cape Breton University, Sydney, NS, Canada. Loretta.Secco@capebretonu.ca This survey study explored use of different information sources among a convenience sample of 113 bedside pediatric nurses. The study was guided by three interrelated concepts: types of information sources, levels of evidence, and computer skill. The Nursing Information Use Survey measured use of information sources, impact of information sources on nursing care, barriers to information, and expectations that a computerized clinical desktop or patient information management system would improve patient care. Significant correlations between use of interpersonal and non-computer-based information and non-computer- and computer-based information supported the conceptual model. Use of traditional, non-computer information sources such as textbooks and print-based journals was higher among baccalaureate, compared with diploma, prepared nurses. Nurses with greater computer and online searching skill used more computer-based information. Findings suggested that strategies to improve nurses' computer and information searching skills may promote use of higher-level evidence in planning nursing care. PMID: 16554694 [PubMed - indexed for MEDLINE] References: 1. CNA. What is nursing informatics and why is it so important? Nursing now: issues and trends in Canadian nursing. Can Nurses Assoc. 2001;11:1-4. 2. Clarke H, Nagle L. Assessing the informatics education needs of Canadian, Educational Institution Component, OHIH Final Report. Canadian Nursing Informatics Association; 2003. 3. Thompson C, McCaughan D, Cullum N, Sheldon TA, Mulhall A, Thompson DR. Research information in nurses' clinical decision- making: what is useful? J Adv Nurs. 2001;36(3):376-388. 4. Erdley WS. Concept development of nursing information: a study of nurses working in critical care. Comput Inform Nurs. 2005;23(2):93-99. 5. Bakken S, McArther J. Evidence-based nursing practice: a call to action for nursing informatics. J Am Med Inform Assoc. 2001;8(3):289-290. 6. Staggers N, Gassert CA, Curran C. A Delphi study to determine informatics competencies for nurses at four levels of practice. Nurs Res. 2002;51(6):383-390. 7. Hobbs S. Measuring nurses' computer competency: an analysis of published instruments. Comput Inform Nurs. 2002;20(2):63-73. 8. DiCenso A, Ciliska D, Marks S, McKibbon A, Cullum N. Resources for evidence-based nursing. McMaser University. Available at:  HYPERLINK "http://www.cebm.utoronto.ca/syllabi/nur/" \t "_blank" http://www.cebm.utoronto.ca/syllabi/nur/. Accessed May 14, 2004. 9. Saranto K, Leino-Kilpi H. Computer literacy in nursing: developing the information technology syllabus in nursing education. J Adv Nurs. 1997;(25):377-385. 10. Pravikoff D, Pierce S, Tanner A. Are nurses ready for evidence-based practice? A study suggests that greater support is needed. Am J Nurs. 2003;103(5):95-96. 11. Richards JA. Nursing in a digital age. Nurs Econ. 2001;19(1):6-11, 34. 12. Nagelkerk J, Ritola PM, Vandort PJ. Nursing informatics: the trend of the future. J Contin Educ Nurs. 1998;29(1):17-21. 13. DeBourgh GA. Champions for evidence-based practice: a critical role for evidence based nurses. AACN Clin Issues. 2001;12(4):491-508. 14. Hannah KJ. Transforming information: data management support of healthcare reorganization. J Am Med Inform Assoc. 1995;2(3):147-155. 15. Scott G. Information technology: nursing informatics 1. J Community Nurs. 2001;15(3):4-6, 8, 10. 16. Estabrooks CA, O'Leary KA, Ricker KL, Humphrey CK. The internet and access to evidence: how are nurses positioned?. J Adv Nurs. 2003;42(1):73-81. 17. Gerrish K, LClayton J. Promoting evidence-based practice: an organizational approach. J Nurs Manag. 2004;12:114-123. 18. McCaughan D, Thompson C, Cullum N, Sheldon TA, Thompson DR. Acute care nurses' perceptions of barriers to using information in clinical decision-making. J Adv Nurs. 2002;39(1):46-60. 19. Estabrooks CA. Will evidence-based nursing practice make practice perfect?. Can J Nurs Res. 1998;30:15-36. 20. Mulhall A. Nursing, research, and the evidence. Evid Based Nurs. 1998;1:4-6. 21. Rosenfeld P, Salazar-Riera N, Vieira D. Piloting an information literacy program for staff nurses. CIN Comput Inform Nurs. 2002;20(6):236-241. 22. Thompson C, McCaughan D, Sheldon T, Raynor P. Nurses, information use, and clinical decision-making-the real world potential for evidence-based decisions in nursing. Evid Based Nurs J. 2004;7:68-72. 23. Mckibbon KA, Marks S. Searching for the best evidence, Part 2: Searching CINAHL and Medline. Evid Based Nurs. 1998;1:105-107. 24. Ciliska DK, Pinelli J, DiCenso A, Cullum N. Resources to enhance evidence-based nursing practice. AACN Clin Issues. 2001;12(4):520-528. 25. Curran C. Informatics competencies for nurse practitioners. AACN Clin Issues. 2003;14(3):320-330. 26. Eisenberg J. What does evidence mean? Can the law and medicine be reconciled? Agency for Healthcare Research and Quality. Available at:  HYPERLINK "http://www.ahrq.gov/clinic/epcix.htm" \t "_blank" http://www.ahrq.gov/clinic/epcix.htm. Accessed May 6, 2004. 27. Guyatt GH, Haynes RB, Jaeschke RZ, et al. Users' guides to the medical literature XXV: evidence-based medicine: principles for applying the users' guide to patient care. JAMA. 2000;284(10):1290-1296. 28. Estabrooks CA, Floyd JA, Scott-Findlay S, O'Leary KA, Gushta M. Individual determinants of research utilization: a systematic review. J Adv Nurs. 2003;43(5):506-520. 29. McCleary L, Brown GT. Barriers to pediatric nurses' research utilization. J Adv Nurs. 2003;42(4):364-372. 30. Tooley MJ, Mayo A. Handheld technologies in the clinical setting: state of the technology and resources. AACN Clin Issues. 2003;14(3):342-349. 31. Hughes R. Clinical practice in a computer world: considering the issues. J Adv Nurs. 2003;42(4):340-346. 32. Sitzia J. Barriers to research utilization: the clinical setting and nurses themselves. Intensive Crit Care Nurs. 2002;18:230-243. 33. Davies B. Sources and models for moving research evidence into clinical practice. JOGN Nurs. 2002;31(5):558-562. 34. Stetler CB. Role of organization in translating research into evidence-based clinical practice. Outcomes Manag. 2003;7(3):97-103.Medinfo. 2007;12(Pt 1):228-32. Nurses and computers. An international perspective on nurses' requirements. Bond CS. Institute of Health and Community Studies, Bournemouth University, England. cbond@bournemouth This paper reports the findings from a Florence Nightingale Foundation Travel Scholarship undertaken by the author in the spring of 2006. The aim of the visit was to explore nurses' attitudes towards, and experiences of, using computers in their practice, and the requirements that they have to encourage, promote and support them in using ICT. Nurses were found to be using computers mainly for carrying out administrative tasks, such as updating records, rather than as information tools to support evidence based practice, or patient information needs. Nurses discussed the systems they used, the equipment provided, and their skills, or more often their lack of skills. The need for support was a frequent comment, most nurses feeling that it was essential that help was available at the point of need, and that it was provided by someone, preferably a nurse, who understood the work context. Three groups of nurses were identified. Engagers; Worried Willing and Resisters. The report concludes that pre-registration education has a responsibility to seek to ensure that newly qualified nurses enter practice as engagers. PMID: 17911712 [PubMed - in process] J Nurs Res. 2007 Mar;15(1):54-66. An exploration of nursing informatics competency and satisfaction related to network education. Lin JS, Lin KC, Jiang WW, Lee TT. Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital. The rapid development of computer technology has driven the growth of the Internet, which has made access to daily services more timely and convenient. Network education strategies for long-distance nursing education are increasingly being implemented to overcome distance barriers and allow nurses to obtain more knowledge. The purpose of this study was to investigate the relationship between the informatics competency of nurses and their satisfaction regarding network education as well as to explore related factors. A total of 218 nurses answered an online questionnaire after completing 4 hours of network education at their appropriate clinical level. Descriptive and inferential statistics were applied to analyze data. Study results found that nurses who took computer training less than 3 hours per week, were unable to connect to a network, or held an associate degree as their highest level of education achieved a lower nursing informatics competency than those who were older, were certified at an N4 clinical level, had previous online training experience or attended 4 or more course hours each week. Those who participated in the network education course more than 4 hours per week and owned their own computers were more satisfied with network education. Nurses who had higher nursing informatics competency were also more satisfied with network education. Network education not only enhances learners' computer competency but also improves learning satisfaction. By promoting network education and improving nurses' hardware/software skills and knowledge, nurses can use networks to access learning resources. Healthcare institutions should also enhance their computer infrastructures, and increase the interest of nurses to learn and apply network skills in clinical practice. PMID: 17370233 [PubMed - indexed for MEDLINE] Computer literacy study: report of qualitative findings. - McNeil BJ - J Prof Nurs - 01-JAN-2006; 22(1): 52-9 (From NIH/NLM MEDLINE) Abstract: Computer literacy and information literacy are critical to the future of nursing. The very nature of health care is being transformed in response to environmental drivers such as the demands for cost-effective delivery of high quality services and enhanced patient safety. Facilitating the quality transformation depends on strategic changes such as implementing evidence-based practice (), promoting outcome research (), initiating interdisciplinary care coordination [Zwarenstein, M., Bryant, W. (2004). Interventions to promote collaboration between nurses and doctors. The Cochrane Library(I)], and implementing electronic health records (). Information management serves as a central premise of each of these strategies and is an essential tool to facilitate change. This report of the analysis of qualitative data from a national online survey of baccalaureate nursing education programs describes the current level of integration of the computer literacy and information literacy skills and competencies of nursing faculty, clinicians, and students in the United States. The outcomes of the study are important to guide curriculum development in meeting the changing health care environmental demands for quality, cost-effectiveness, and safety. Citation: Computer literacy study: report of qualitative findings. McNeil BJ - J Prof Nurs - 01-JAN-2006; 22(1): 52-9 From NIH/NLM MEDLINE NLM Citation ID: 16459289 (PubMed ID) Full Source Title: Journal of professional nursing : official journal of the American Association of Colleges of Nursing Publication Type: Journal Article Language: English Author Affiliation: Division of Nursing and Health Sciences, Lewis-Clark State College, Lewiston, ID 83501, USA. bmcneil@lcsc.edu Authors: McNeil BJ; Elfrink V; Beyea SC; Pierce ST; Bickford CJ Major Subjects: Attitude of Health Personnel Attitude to Computers Computer Literacy Computer User Training / * standards Education, Nursing, Baccalaureate / * standards 1: Nurse Educ. 2000 Sep-Oct;25(5):210-2. Using computer technology to teach critical thinking. Kowalski SD, Louis MA. Department of Nursing, University of Nevada, Las Vegas, USA. kdocs@earthlink.net Publication Types: Controlled Clinical Trial PMID: 16646193 [PubMed - indexed for MEDLINE] 2: J Nurses Staff Dev. 2006 May-Jun;22(3):150-6. Preparing preceptors through online education. Phillips JM. Faculty and Nurse Planner, Center for Teaching and Lifelong Learning, Environments for Health, Indiana University School of Nursing, Indianapolis, Indiana, USA. janephil@iupui.edu Preceptor education is vital to the success of healthcare institutions. Preceptors' roles are complex and require up-to-the-minute programs reflecting crucial mentoring responsibilities for orientees in multifaceted working environments. Finding the time to properly educate preceptors while maintaining quality bedside care is a challenge for staff development educators during the nursing shortage. Offering a preceptor education program online can assist preceptors in the adoption of role changes in a timely manner. The outcome can provide excellent, competent, caring preceptors. In this article, the course content and intended outcomes of online preceptor preparation programs are discussed. The role of the staff development educator in assessing, planning, implementing, and evaluating online preceptor programs is also discussed. Publication Types: Review PMID: 16760776 [PubMed - indexed for MEDLINE] 3: Nurse Educ Today. 2007 May;27(4):341-7. Epub 2006 Jul 20. The presence of mathematics and computer anxiety in nursing students and their effects on medication dosage calculations. Glaister K. School of Nursing and Midwifery, Curtin University of Technology, Perth 6845, WA, Australia. k.glaister@curtin.edu.au AIM: To determine if the presence of mathematical and computer anxiety in nursing students affects learning of dosage calculations. METHOD: The quasi-experimental study compared learning outcomes at differing levels of mathematical and computer anxiety when integrative and computer based learning approaches were used. Participants involved a cohort of second year nursing students (n=97). RESULTS: Mathematical anxiety exists in 20% (n=19) of the student nurse population, and 14% (n=13) experienced mathematical testing anxiety. Those students more anxious about mathematics and the testing of mathematics benefited from integrative learning to develop conditional knowledge (F(4,66)=2.52 at p<.05). Computer anxiety was present in 12% (n=11) of participants, with those reporting medium and high levels of computer anxiety performing less well than those with low levels (F(1,81)=3.98 at p<.05). CONCLUSION: Instructional strategies need to account for the presence of mathematical and computer anxiety when planning an educational program to develop competency in dosage calculations. Publication Types: Comparative Study Randomized Controlled Trial PMID: 16857301 [PubMed - indexed for MEDLINE] 4: Nurse Res. 2006;13(4):50-65. Exploration of nurses' information environment. Ballard EC. School of Health, University of Wolverhampton, UK. Elaine Ballard's article focuses on health informatics, a field which has developed with limited input from nurses who provide direct care. PMID: 16897940 [PubMed - indexed for MEDLINE] 5: Nurs Outlook. 2006 Jul-Aug;54(4):254-5. Mission critical: a culture of evidence-based practice and information literacy. Pravikoff DS. Glendale, CA, USA. PMID: 16929570 [PubMed - indexed for MEDLINE] 6: Nurs Manage. 2006 Sep;37(9):12, 16. What's nursing's PLAN for IT ubiquity? Simpson RL. Nursing Informatics, Cerner Corporation, Kansas City, MO, USA. PMID: 16983231 [PubMed - indexed for MEDLINE] 7: J Contin Educ Nurs. 2006 Sep-Oct;37(5):225-32. An evaluative case study of online learning for healthcare professionals. Pullen DL. University of Tasmania, Faculty of Education, Launceston, Tasmania, Australia. Darren.Pullen@utas.edu.au BACKGROUND: This evaluation study assessed the pedagogical and instructional design (e-pedagogy) effectiveness of online continuing professional education (CPE) courses offered by a large Australian CPE provider. METHODS: A naturalistic theory approach and a multilevel evaluation were used to examine the impact of web-based learning on more than 300 healthcare professionals. Participant satisfaction, learning achievement, self-reported practice performance change, and e-pedagogical courseware characteristics were assessed by various qualitative and quantitative data collection methods. RESULTS: Findings revealed that learning online was an effective means for increasing CPE knowledge (p < .05) and improving self-reported practice performance change (p < .05). Courses containing a clinical tool resulted in an increased self-reported practice performance change over courses that did not (Zobs = 3.757). CONCLUSION: Online CPE offers a convenient format for healthcare professionals from educationally and geographically diverse populations to update their knowledge and view best practice. Publication Types: Evaluation Studies PMID: 17004396 [PubMed - indexed for MEDLINE] 8: Crit Care Nurs Q. 2006 Oct-Dec;29(4):362-75. A critical change in a day in the life of intensive care nurses: rising to the e-challenge of an integrated clinical information system. Popernack ML. Pediatric Intensive Care Unit, Penn State Children's Hospital, Penn State University/Milton S. Hershey Medical Center, Hershey, PA 17033, USA. mpopernack@psu.edu Critical care nurses in a large academic, tertiary care trauma center have adapted to a major system change since the implementation of a fully integrated Computerized Provider Order Entry (CPOE) system, an automated process of order entry. Working in a rapidly changing environment, clinicians are accustomed to viewing real-time discrete data and then using that data to provide safe, effective, and efficient intensive care to critically ill patients. This article describes how the implementation of the CPOE system from a major healthcare software vendor has changed the life of critical care nurses and the perceptions of the experience 1 year after the new technology was initiated. Through experience sharing, perhaps others may gain knowledge to ease their transition to CPOE. PMID: 17063103 [PubMed - indexed for MEDLINE] 9: Annu Rev Nurs Res. 2006;24:219-54. Informatics for patient safety: a nursing research perspective. Bakken S. Columbia University School of Nursing, New York, New York, USA. In Crossing the Quality Chasm, the Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing a health system that produces care that is "safe, effective, patient-centered, timely, efficient, and equitable" (Committee on Quality of Health Care in America, 2001, p. 164). A subsequent IOM report contends that improved information systems are essential to a new health care delivery system that "both prevents errors and learns from them when they occur" (Committee on Data Standards for Patient Safety, 2004, p. 1). This review specifically highlights the role of informatics processes and information technology in promoting patient safety and summarizes relevant nursing research. First, the components of an informatics infrastructure for patient safety are described within the context of the national framework for delivering consumer-centric and information-rich health care and using the National Health Information Infrastructure (NHII) (Thompson & Brailer, 2004). Second, relevant nursing research is summarized; this includes research studies that contributed to the development of selected infrastructure components as well as studies specifically focused on patient safety. Third, knowledge gaps and opportunities for nursing research are identified for each main topic. The health information technologies deployed as part of the national framework must support nursing practice in a manner that enables prevention of medical errors and promotion of patient safety and contributes to the development of practice-based nursing knowledge as well as best practices for patient safety. The seminal work that has been completed to date is necessary, but not sufficient, to achieve this objective. Publication Types: Review PMID: 17078416 [PubMed - indexed for MEDLINE] 10: Stud Health Technol Inform. 2006;122:190-3. Factors associated with computer literacy among nurses. Hsu HM, Hsiao HW, Huang IJ, Lin IC. Department of Information Management, National Chung Cheng University, Chayi, Taiwan, ROC. Nowadays, many hospitals have adopted information technology (IT) to help nurses in their practice; therefore, computers have become critical instruments for nurses. Many researchers have studied what information literacy or computer competencies a nurse should possess, but less research has focused on the types of factors associated with computer literacy. The purpose of this study was to discover which variables influence the computer literacy of nurses. The questionnaire was the instrument for data collection. The respondents were 180 nurses in Taiwan. The results of this study revealed that computer experience of nurses and personal innovation in IT were both factors associated with computer literacy and computer anxiety. The findings could assist nursing managers to screen computer-literate nurses and course designers in nursing school or hospitals to add more practical trainings in courses. PMID: 17102246 [PubMed - indexed for MEDLINE] 11: Stud Health Technol Inform. 2006;122:505-9. Computer literacy: Where are nurse educators on the continuum? Hanley E. School of Nursing, Christchurch Polytechnic Institute of Technology, Christchurch, New Zealand. hanleye@cpit.ac.nz Computers are becoming ubiquitous in health and education, and it is expected that nurses from undergraduate nursing programmes are computer literate when they enter the workforce. Similarly nurse educators are expected to be computer literate to model the use of information technology in their workplace. They are expected to use email for communication and a range of computer applications for presentation of course materials and reports. Additionally, as more courses are delivered in flexible mode, educators require more comprehensive computing skills, including confidence and competence in a range of applications. A cohort of nurse educators from one tertiary institution was surveyed to assess their perceived computer literacy and how they attained this. A questionnaire that covered seven domains of computer literacy was used to assess this. The results were illuminating and identified specific training needs for this group. Their perceived lack of skill with Groupwise email and the student database program are of concern as these are essential tools for nurse educators at this polytechnic. PMID: 17102309 [PubMed - indexed for MEDLINE] 12: Nurs Adm Q. 2007 Jan-Mar;31(1):84-8. Information technology: building nursing intellectual capital for the information age. Simpson RL. Cerner Corporation, Kansas City, MO 64117, USA. rsimpson@cerner.com Healthcare is evolving from a task-based industry to a knowledge-based one. To gain and retain value as intellectual capital, nursing likewise must evolve from a vocation of task performers to a profession of knowledge-workers. Information technology can transform nursing tasks into nursing knowledge. Publication Types: Review PMID: 17198124 [PubMed - indexed for MEDLINE] 13: Nurse Educ. 2007 Jan-Feb;32(1):21-3. Educating a new generation: teaching baby boomer faculty about millennial students. Mangold K. Department of Nursing, Mayo Clinic Hospital, Phoenix, AZ 85054, USA. mangold.kara@mayo.edu This review examines the impact of generational influences on the faculty-student relationship. Specifically, the baby boomer faculty-millennial learner dyad is explored, as these two generations are most representative of the faculty-student demographic. Teaching and learning preferences are emphasized, and implications and recommendations for nursing faculty are presented. Publication Types: Review PMID: 17220763 [PubMed - indexed for MEDLINE] 14: Nurse Educ. 2007 Jan-Feb;32(1):39-42. Tracking clinical use of personal digital assistant reference resources. Pattillo RE, Brewer M, Smith CM. School of Nursing, Auburn University, Auburn, AL 36849, USA. pattire@auburn.edu Mechanisms are needed to evaluate the effectiveness of ever-increasing technological resources for nursing student use. The authors tracked the use of personal digital assistants versus textbook resources by junior-level baccalaureate nursing students throughout 1 semester. The authors discuss the results of that activity and provide a starting point for the evaluation of the use of personal digital assistants by nursing students. PMID: 17220767 [PubMed - indexed for MEDLINE] 15: Nurs Outlook. 2007 Jan-Feb;55(1):15-9. Hospital nurses' use of knowledge-based information resources. Tannery NH, Wessel CB, Epstein BA, Gadd CS. Health Sciences Library System, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA. tannery@pitt.edu The purpose of this study was to evaluate the information-seeking practices of nurses before and after access to a library's electronic collection of information resources. This is a pre/post intervention study of nurses at a rural community hospital. The hospital contracted with an academic health sciences library for access to a collection of online knowledge-based resources. Self-report surveys were used to obtain information about nurses' computer use and how they locate and access information to answer questions related to their patient care activities. In 2001, self-report surveys were sent to the hospital's 573 nurses during implementation of access to online resources with a post-implementation survey sent 1 year later. At the initiation of access to the library's electronic resources, nurses turned to colleagues and print textbooks or journals to satisfy their information needs. After 1 year of access, 20% of the nurses had begun to use the library's electronic resources. The study outcome suggests ready access to knowledge-based electronic information resources can lead to changes in behavior among some nurses. PMID: 17289463 [PubMed - indexed for MEDLINE] 16: Nurs Health Sci. 2007 Mar;9(1):23-8. Decision aid software programs in telenursing: not used as intended? Experiences of Swedish telenurses. Holmstrm I. Department of Public Health and Caring Sciences, Health Services Research, Uppsala Science Park, Uppsala, Sweden. inger.holmstrom@pubcare.uu.se Telenurses at call centers use decision aid software programs to offer triage recommendations and self-care advice to the general public. Decision aid programs are intended to support medical safety but were suggested by telenurses to be a hindrance to the dialogue. The aim of this study was to explore the use of decision aid software programs for telenursing, from the perspective of the users. A qualitative, descriptive approach was used. Twelve telenurses in Sweden were interviewed twice. The interviews were transcribed and analyzed thematically. Four themes were found: support for assessment but not for the decision; inconsistency between actual practice and the decision aid software; limited support for learning and information; and communication challenges and software programs. The software programs were a support for assessment, rather than decision-making, assuring the nurses that the relevant questions were asked. They were not fully adapted to current clinical practice, focusing mainly on acute conditions. Nurses worked to a large extent with self-care advice, often over-riding the recommendations made. Publication Types: Research Support, Non-U.S. Gov't PMID: 17300541 [PubMed - indexed for MEDLINE] 17: J Nurs Educ. 2007 Mar;46(3):127-31. Medication error reduction and the use of PDA technology. Greenfield S. Adelphi University, School of Nursing, Garden City, New York 11530-0701, USA. Greenfi2@adelphi.edu The purpose of this study was to determine whether nursing medication errors could be reduced and nursing care provided more efficiently using personal digital assistant (PDA) technology. The sample for this study consisted of junior and senior undergraduate baccalaureate nursing students. By self-selection of owning a PDA or not, students were placed in the PDA (experimental) group or the textbook (control) group, provided with a case study to read, and asked to answer six questions (i.e., three medication administration calculations and three clinical decisions based on medication administration). The analysis of collected data, calculated using a t test, revealed that the PDA group answered the six questions with greater accuracy and speed than did the textbook group. Publication Types: Case Reports Controlled Clinical Trial Research Support, Non-U.S. Gov't PMID: 17396552 [PubMed - indexed for MEDLINE] 1: ABNF J. 2006 Summer;17(3):100-2. Nursing faculty members competence of Web-based course development systems directly influences students' satisfaction. Murray TL, Belgrave L, Robinson VI. Coppin State University Helene Fuld School of Nursing, Baltimore, Maryland, USA. Nursing faculty are compelled to use and implement computer assisted instruction to meet the technological needs of a diverse student population. Much of the current trend of nursing faculty and nursing curricula design encompasses a traditional face-to-face instruction mode and teaching methodology. Although faculty are using and implementing computer assisted instruction, the format is not personalized to the student. The goal of enhancing and maintaining continued student satisfaction will depend on the efficient nature of the faculty in the development of their individual technological competencies, nursing content area mastery and available university-wide technological support systems and resources. Publication Types: Review PMID: 16948361 [PubMed - indexed for MEDLINE] 2: Int J Nurs Stud. 2007 Sep;44(7):1075-8. Epub 2007 Apr 3. Comment in: Int J Nurs Stud. 2007 Sep;44(7):1279-82. Nurses' requirements for information technology: a challenge for educators. Bond CS. Publication Types: Editorial Review PMID: 17408671 [PubMed - indexed for MEDLINE] 3: Int J Nurs Stud. 2007 Sep;44(7):1270-8. Epub 2006 Jul 10. Reducing disparities in the access and use of Internet health information. a discussion paper. Gilmour JA. Massey University, Private Box 756, Wellington, New Zealand. J.A.Gilmour@massey.ac.nz Internet health information is rated highly by users and is used to compensate for gaps in health information provided by health professionals. Greater understanding of health issues and changes to personal health management has been reported as a consequence of Internet use. However, there are significant disparities in the access and use of Internet health information linked to income, education and ethnicity. In this paper a case is presented that on-line health information particularly benefits the already privileged in terms of health care; well-educated people with access to economic resources. Several intervention points are suggested to improve Internet health information accessibility and use for all population groups. Interventions at an institutional level include improving equity of Internet access through the provision of free services at strategic sites and improving the readability and cultural acceptability of health information. Individually focused interventions involve skill development to enable effective navigation of Internet sites, identification of patient and families' information needs and support to develop evaluation skills. The effectiveness of these interventions in reducing disparities is reliant on nurses and other health professionals' expertise in accessing, evaluating and using Internet health information in their clinical practise. On-line health information is a powerful medium for quick and dynamic knowledge distribution. The challenge for nurses and other health professionals is directing that knowledge to the groups most disadvantaged in the current health care systems, with an agenda of reducing inequalities in access to health information. Publication Types: Review PMID: 16828775 [PubMed - indexed for MEDLINE] 4: J Nurs Manag. 2007 Mar;15(2):207-13. How nursing leadership and management interventions could facilitate the effective use of ICT by student nurses. Willmer M. Nursing and Health Informatics, INAM - Institute of Nursing and Midwifery, University of Brighton, East Sussex, UK. m.willmer@brighton.ac.uk AIM: This article makes the case for how evidence-based nursing leadership and management activities could promote, implement and sustain quality patient care by student nurses using Information and Communications Technology. It is on aspects of the findings of a professional doctorate inquiry into Information and Communications Technology use and skills development by student nurses. BACKGROUND: The 21st century is both an information and knowledge age. Nursing and medical professions are facing the increasing usage of information technology in day-to-day operations with the overall aim of improving the quality of patient care. The quality of the future of the nursing profession is dependent on the calibre of those who are currently socialized to become professional nurses. The new United Kingdom Labour Government, in power since 1997, has placed increasing focus on the effectiveness of the National Health Service and using computers as one way to assist in achieving greater effectiveness. This has implications for nurse education and the future preparation of future nurses to acquire skills in Information and Communications Technology. METHOD: This is a case study approach using multiple triangulation methodology. This includes: semi-structured interview of six student nurses and four of their mentors; one unstructured meeting with the Research and Development Manager; observational visit to a medical admission ward and a renal unit; one semi-structured meeting with the Information Manager; Review of Documentation - the National Health Service Trust Nursing Strategy; and Review, Application and Development of relevant theory. FINDINGS: The overall findings are that student nurses are not using Information and Communications Technology in nursing practice in a structured and systematic way. The reasons for this are very many and very complex but are interrelated. They include strategic resource-based issues, what Jumaa referred to as Time, Human, Equipment, Information, Material and Money resources. These reasons include lack of time for Information and Communications Technology activities by both students and the qualified nurses and some staff with poor Information and Communications Technology skills. This situation is compounded by insufficient computer hardware; lack of information about the essence and value of Information and Communications Technology; perception of the direct relevance of Information and Communications Technology activities to patient care; software materials not adequate for purpose and lack of comprehensive budget and financial recognition for student's engagement with Information and Communications Technology. CONCLUSION: 'Smile and the whole world smile with you'. This old saying has a lot of truth in it. Applied to Information and Communications Technology skills development and use by student nurses we are confronted with an uncomfortable reality of many qualified nurses who themselves are not comfortable or proficient with the use of Information and Communications Technology. Some do not see the essential need for Information and Communications Technology and its direct relevance to improving patient care, nor is this always supported by the current software and systems. Willmer argued that the achievement of effective implementation of the National Health Service National Programme for Information and Technology requires efficient change management and leading people skills, and an understanding of National Health Service culture. In this article the case is made that evidence-based management and leadership interventions are a feasible approach for a sustained implementation of Information and Communications Technology use and skills development by student nurses. PMID: 17352704 [PubMed - indexed for MEDLINE] 8: J Nurses Staff Dev. 2006 May-Jun;22(3):150-6. Preparing preceptors through online education. Phillips JM. Faculty and Nurse Planner, Center for Teaching and Lifelong Learning, Environments for Health, Indiana University School of Nursing, Indianapolis, Indiana, USA. janephil@iupui.edu Preceptor education is vital to the success of healthcare institutions. Preceptors' roles are complex and require up-to-the-minute programs reflecting crucial mentoring responsibilities for orientees in multifaceted working environments. Finding the time to properly educate preceptors while maintaining quality bedside care is a challenge for staff development educators during the nursing shortage. Offering a preceptor education program online can assist preceptors in the adoption of role changes in a timely manner. The outcome can provide excellent, competent, caring preceptors. In this article, the course content and intended outcomes of online preceptor preparation programs are discussed. The role of the staff development educator in assessing, planning, implementing, and evaluating online preceptor programs is also discussed. Publication Types: Review PMID: 16760776 [PubMed - indexed for MEDLINE] 9: Nurs Adm Q. 2007 Jan-Mar;31(1):84-8. Information technology: building nursing intellectual capital for the information age. Simpson RL. Cerner Corporation, Kansas City, MO 64117, USA. rsimpson@cerner.com Healthcare is evolving from a task-based industry to a knowledge-based one. To gain and retain value as intellectual capital, nursing likewise must evolve from a vocation of task performers to a profession of knowledge-workers. Information technology can transform nursing tasks into nursing knowledge. Publication Types: Review PMID: 17198124 [PubMed - indexed for MEDLINE] 10: Nurs Manage. 2006 Sep;37(9):12, 16. What's nursing's PLAN for IT ubiquity? Simpson RL. Nursing Informatics, Cerner Corporation, Kansas City, MO, USA. PMID: 16983231 [PubMed - indexed for MEDLINE] 11: Nurs Outlook. 2007 Jan-Feb;55(1):15-9. Hospital nurses' use of knowledge-based information resources. Tannery NH, Wessel CB, Epstein BA, Gadd CS. Health Sciences Library System, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA. tannery@pitt.edu The purpose of this study was to evaluate the information-seeking practices of nurses before and after access to a library's electronic collection of information resources. This is a pre/post intervention study of nurses at a rural community hospital. The hospital contracted with an academic health sciences library for access to a collection of online knowledge-based resources. Self-report surveys were used to obtain information about nurses' computer use and how they locate and access information to answer questions related to their patient care activities. In 2001, self-report surveys were sent to the hospital's 573 nurses during implementation of access to online resources with a post-implementation survey sent 1 year later. At the initiation of access to the library's electronic resources, nurses turned to colleagues and print textbooks or journals to satisfy their information needs. After 1 year of access, 20% of the nurses had begun to use the library's electronic resources. The study outcome suggests ready access to knowledge-based electronic information resources can lead to changes in behavior among some nurses. PMID: 17289463 [PubMed - indexed for MEDLINE] 12: Nurs Outlook. 2006 Jul-Aug;54(4):254-5. Mission critical: a culture of evidence-based practice and information literacy. Pravikoff DS. Glendale, CA, USA. PMID: 16929570 [PubMed - indexed for MEDLINE] 13: Nurse Educ. 2007 Jan-Feb;32(1):39-42. Tracking clinical use of personal digital assistant reference resources. Pattillo RE, Brewer M, Smith CM. School of Nursing, Auburn University, Auburn, AL 36849, USA. pattire@auburn.edu Mechanisms are needed to evaluate the effectiveness of ever-increasing technological resources for nursing student use. The authors tracked the use of personal digital assistants versus textbook resources by junior-level baccalaureate nursing students throughout 1 semester. The authors discuss the results of that activity and provide a starting point for the evaluation of the use of personal digital assistants by nursing students. PMID: 17220767 [PubMed - indexed for MEDLINE] 14: Nurse Educ. 2007 Jan-Feb;32(1):21-3. Educating a new generation: teaching baby boomer faculty about millennial students. Mangold K. Department of Nursing, Mayo Clinic Hospital, Phoenix, AZ 85054, USA. mangold.kara@mayo.edu This review examines the impact of generational influences on the faculty-student relationship. Specifically, the baby boomer faculty-millennial learner dyad is explored, as these two generations are most representative of the faculty-student demographic. Teaching and learning preferences are emphasized, and implications and recommendations for nursing faculty are presented. Publication Types: Review PMID: 17220763 [PubMed - indexed for MEDLINE] 15: Nurse Educ Today. 2007 May;27(4):341-7. Epub 2006 Jul 20. The presence of mathematics and computer anxiety in nursing students and their effects on medication dosage calculations. Glaister K. School of Nursing and Midwifery, Curtin University of Technology, Perth 6845, WA, Australia. k.glaister@curtin.edu.au AIM: To determine if the presence of mathematical and computer anxiety in nursing students affects learning of dosage calculations. METHOD: The quasi-experimental study compared learning outcomes at differing levels of mathematical and computer anxiety when integrative and computer based learning approaches were used. Participants involved a cohort of second year nursing students (n=97). RESULTS: Mathematical anxiety exists in 20% (n=19) of the student nurse population, and 14% (n=13) experienced mathematical testing anxiety. Those students more anxious about mathematics and the testing of mathematics benefited from integrative learning to develop conditional knowledge (F(4,66)=2.52 at p<.05). Computer anxiety was present in 12% (n=11) of participants, with those reporting medium and high levels of computer anxiety performing less well than those with low levels (F(1,81)=3.98 at p<.05). CONCLUSION: Instructional strategies need to account for the presence of mathematical and computer anxiety when planning an educational program to develop competency in dosage calculations. Publication Types: Comparative Study Randomized Controlled Trial PMID: 16857301 [PubMed - indexed for MEDLINE] 16: Nurse Res. 2006;13(4):50-65. Exploration of nurses' information environment. Ballard EC. School of Health, University of Wolverhampton, UK. Elaine Ballard's article focuses on health informatics, a field which has developed with limited input from nurses who provide direct care. PMID: 16897940 [PubMed - indexed for MEDLINE] 17: Stud Health Technol Inform. 2006;122:190-3. Factors associated with computer literacy among nurses. Hsu HM, Hsiao HW, Huang IJ, Lin IC. Department of Information Management, National Chung Cheng University, Chayi, Taiwan, ROC. Nowadays, many hospitals have adopted information technology (IT) to help nurses in their practice; therefore, computers have become critical instruments for nurses. Many researchers have studied what information literacy or computer competencies a nurse should possess, but less research has focused on the types of factors associated with computer literacy. The purpose of this study was to discover which variables influence the computer literacy of nurses. The questionnaire was the instrument for data collection. The respondents were 180 nurses in Taiwan. The results of this study revealed that computer experience of nurses and personal innovation in IT were both factors associated with computer literacy and computer anxiety. The findings could assist nursing managers to screen computer-literate nurses and course designers in nursing school or hospitals to add more practical trainings in courses. PMID: 17102246 [PubMed - indexed for MEDLINE] 18: Stud Health Technol Inform. 2006;122:49-53. Literacy, consumer informatics, and health care outcomes: Interrelations and implications. Anton B, Nelson R. University of Pittsburgh Medical Center, Pittsburgh, USA. bba@nauticon.net Health care outcomes are clearly impacted by the ability of clients to participate in their health care. Nurses have always used education to empower their patients. With the advent of the Internet the concept of patient education has been transformed to the much broader concept of consumer informatics. For increasing numbers of clients the Internet has become a primary source of health information and a major factor influencing their knowledge and decisions related to their health. Successful use of the Internet depends on several different levels and types of literacies. This paper explores the interrelations between the concepts of basic literacy, computer literacy, information literacy, health information literacy and health literacy. It demonstrates the need for client assessment tools that are sensitive to each of these literacies and their interrelations. In concludes by challenging consumer informatics specialists to develop these assessment tools as well as teaching tools for empowering consumers using the Internet. PMID: 17102216 [PubMed - indexed for MEDLINE] 1: Nurs Educ Perspect. 2005 Sep-Oct;26(5):310-1. Preparing for evidence-based practice: revisiting information literacy. Skiba DJ. Diane.Skiba@uchsc.edu Publication Types: Review PMID: 16295311 [PubMed - indexed for MEDLINE] 2: J Nurs Educ. 2005 Nov;44(11):505-10. Information literacy: developing lifelong skills through nursing education. Barnard A, Nash R, O'Brien M. Queensland University of Technology, School of Nursing, Kelvin Grove, Queensland, Australia. a.barnard@qut.edu.au The amount and complexity of information nurses are expected to manage continues to increase exponentially. Support has grown for integrated curriculum approaches that include appropriate content on the use of a variety of information formats and instruction using resource-based and process methods. Such teaching-learning approaches demand a major shift in educational paradigms and encompass resource-based learning, undergraduate research, service learning, inquiry learning, and problem-based learning. The implementation of an integrated curriculum promises advanced information skills, access, and use of available evidence to support clinical decision making and a foundation for lifetime learning. In this article, we argue that for information literacy to be enhanced, collaboration between teaching faculty and librarians must be fostered in meaningful ways. We report on the rationale of an integrated curriculum, changes to nursing education, and obstacles to the development and application of advanced information skills that exist within higher education and clinical settings. Publication Types: Review PMID: 16342632 [PubMed - indexed for MEDLINE] 3: Nurse Res. 2005;13(2):55-70. Using the Internet to conduct research. Ahern NR. University of Central Florida, USA. The internet has become an everyday communication tool for countless people throughout the world. It has a variety of potential uses in education, practice and research, but only in the last decade have nurse researchers begun to take advantage of the multiple uses the internet has to offer. The author reviews the uses of the internet to conduct research and addresses challenges and issues that currently influence web-based research. Publication Types: Review PMID: 16416980 [PubMed - indexed for MEDLINE] 4: Comput Inform Nurs. 2006 Jan-Feb;24(1):37-43. Computer use in an urban university hospital: technology ahead of literacy. Wilbright WA, Haun DE, Romano T, Krutzfeldt T, Fontenot CE, Nolan TE. Louisiana State University Healthcare Service Division, Medical Center of Louisiana in New Orleans, New Orleans, LA 70112, USA. wwilbr@lsuhsc.edu The linkage of patient safety and care quality to the implementation of computerized information systems assumes that clinical staff are skilled with computers. Nurses and nursing support staff increasingly require computers to carry out their work. Minimum computer competencies for nurses have been identified. The determination of whether the current nursing workforce has acquired these competencies remains uncertain. We administered a self-assessment survey to nurses and nursing support staff to determine proficiency with computer skills they might perform at work. Respondents reported inadequacies in basic and work-related computer skills. More than 28% scored themselves as having fair or poor proficiency on all skills, and more than 50% as fair or poor on five of 11 skills. Respondents over age 50 and those graduating before 1984 tended to score proficiency lower. Our study suggests that many nurses and nursing support staff may not have the minimum computer competencies to effectively and efficiently perform their work. PMID: 16436911 [PubMed - indexed for MEDLINE] 5: J Prof Nurs. 2006 Jan-Feb;22(1):52-9. Computer literacy study: report of qualitative findings. McNeil BJ, Elfrink V, Beyea SC, Pierce ST, Bickford CJ. Division of Nursing and Health Sciences, Lewis-Clark State College, Lewiston, ID 83501, USA. bmcneil@lcsc.edu Computer literacy and information literacy are critical to the future of nursing. The very nature of health care is being transformed in response to environmental drivers such as the demands for cost-effective delivery of high quality services and enhanced patient safety. Facilitating the quality transformation depends on strategic changes such as implementing evidence-based practice (), promoting outcome research (), initiating interdisciplinary care coordination [Zwarenstein, M., Bryant, W. (2004). Interventions to promote collaboration between nurses and doctors. The Cochrane Library(I)], and implementing electronic health records (). Information management serves as a central premise of each of these strategies and is an essential tool to facilitate change. This report of the analysis of qualitative data from a national online survey of baccalaureate nursing education programs describes the current level of integration of the computer literacy and information literacy skills and competencies of nursing faculty, clinicians, and students in the United States. The outcomes of the study are important to guide curriculum development in meeting the changing health care environmental demands for quality, cost-effectiveness, and safety. PMID: 16459289 [PubMed - indexed for MEDLINE] 6: J Obstet Gynecol Neonatal Nurs. 2006 Jan-Feb;35(1):151-6. . Dickerson SS. School of Nursing, University at Buffalo, State University of New York, 14214-3079, USA. sdickers@buffalo.edu Women increasingly access the Internet for health information and social support in managing health-related changes. Some women's use of the Internet has empowered them and created changes in nurse-patient relationships. Nurses and patients must have a mutually respectful open dialogue to develop individualized appropriate plans of care, and nurses should recognize that women who do not have Internet access may have different learning needs. PMID: 16466365 [PubMed - indexed for MEDLINE] 7: Health Info Libr J. 2006 Mar;23(1):51-9. Knowledge in the Palm of your hands: PDAs in the clinical setting. Honeybourne C, Sutton S, Ward L. University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK. choneybourne@nhs.net OBJECTIVE: To explore the impact of hand-held computers on patient care by identifying: (i) how often clinical staff accessed resources on hand-held computers to inform their clinical decision making; (ii) Which hand-held resources were thought to be most useful in the clinical setting; (iii) the barriers to using hand-held resources to support patient care. DESIGN: A descriptive study comparing aspects of Personal Digital Assistant (PDA) resource use in two phases, between August 2002 and December 2003. There was variability in the way that resources were accessed between the two studies. SETTING: University Hospitals of Leicester NHS Trust, an acute teaching hospital, and one primary care practice. PARTICIPANTS: A purposive sample of 14 clinical and librarian staff participated in phase one and 14 in phase two of the study. Participants consisted of consultants, nurses, pharmacist, junior doctors, clinical librarians, and a general practitioner. MAIN OUTCOME MEASURES: Baseline Data Questionnaire to identify the participants' level of knowledge and use of hand-helds on entering the study. End-of-phase questionnaire with self-reported measures of use of the hand-held and PDA resources during the study. RESULTS: All of the participants used hand-helds in their clinical setting to support evidence-based practice and education, but with varying frequency. More staff reported using the hand-held to answer specific patient questions in phase two than phase one of the study. UK resources were preferred to American resources. The 'plug-in and go' method using Secure Digital (SD) cards was preferred to downloading resources from the Internet. CONCLUSIONS: Hand-held technology is emerging as an effective clinical tool to aid evidence-based practice and support the educational needs of clinical staff. The hand-held can provide a critical mass of information that is relevant, quickly accessible and in a coherent format: delivering clinical information at the point of need with a resulting benefit to patient safety. Publication Types: Comparative Study PMID: 16466499 [PubMed - indexed for MEDLINE] 8: Comput Inform Nurs. 2006 Mar-Apr;24(2):66-74. Lessons learned from the implementation of a Web-based nursing intervention. Bond GE. College of Nursing, University of Washington, Seattle, WA 98195-7263, USA. gbond@u.washington.edu The emergence of the World Wide Web in the last decade has introduced the belief that the Internet has the potential to revolutionize healthcare delivery and empower consumers. Given the power of technology to change the way we live, the healthcare community has begun to explore the feasibility of delivering interventions via the Web, including personalized care with chronic disease management. The purpose of this article is to describe this researcher's experience with the development and implementation of a Web-based intervention to enhance diabetes self-management for older adults. Challenges faced by the project involved inadequate funding to cover technology issues (programming, graphics design, etc),decisions regarding the appropriate environment/framework, and questions on how to merge the practice and theory of a given discipline with the limitations of Internet technology. This article will examine and discuss these issues and make recommendations on possible methods of improving the process. Publication Types: Research Support, N.I.H., Extramural Review PMID: 16554689 [PubMed - indexed for MEDLINE] 9: Comput Inform Nurs. 2006 Mar-Apr;24(2):105-12. A survey study of pediatric nurses' use of information sources. Secco ML, Woodgate RL, Hodgson A, Kowalski S, Plouffe J, Rothney PR, Sawatzky-Dickson D, Suderman E. St. Francis Xavier/Cape Breton Universities Joint Nursing Program, Cape Breton University, Sydney, NS, Canada. Loretta.Secco@capebretonu.ca This survey study explored use of different information sources among a convenience sample of 113 bedside pediatric nurses. The study was guided by three interrelated concepts: types of information sources, levels of evidence, and computer skill. The Nursing Information Use Survey measured use of information sources, impact of information sources on nursing care, barriers to information, and expectations that a computerized clinical desktop or patient information management system would improve patient care. Significant correlations between use of interpersonal and non-computer-based information and non-computer- and computer-based information supported the conceptual model. Use of traditional, non-computer information sources such as textbooks and print-based journals was higher among baccalaureate, compared with diploma, prepared nurses. Nurses with greater computer and online searching skill used more computer-based information. Findings suggested that strategies to improve nurses' computer and information searching skills may promote use of higher-level evidence in planning nursing care. Publication Types: Research Support, Non-U.S. Gov't PMID: 16554694 [PubMed - indexed for MEDLINE] 10: Nurse Educ. 2000 Sep-Oct;25(5):210-2. Using computer technology to teach critical thinking. Kowalski SD, Louis MA. Department of Nursing, University of Nevada, Las Vegas, USA. kdocs@earthlink.net Publication Types: Controlled Clinical Trial PMID: 16646193 [PubMed - indexed for MEDLINE] ONLINE COMPUTER BASICS TRAINING:  HYPERLINK "http://dotatmac.mcmaster.ca/db_basics/db_01_home.htm" Database Basics   HYPERLINK "http://dotatmac.mcmaster.ca/db_basics/db_01_home.htm" http://dotatmac.mcmaster.ca/db_basics/db_01_home.htm Web Basics ---AARP  HYPERLINK "http://www.aarp.org/learntech/computers/basic_web/a2004-10-15-lti-basicbrowsing.html" http://www.aarp.org/learntech/computers/basic_web/a2004-10-15-lti-basicbrowsing.html  INCLUDEPICTURE "http://www.biopoint.com/inquiry/headerepaper2.gif" \* MERGEFORMATINET  INCLUDEPICTURE "http://www.biopoint.com/inquiry/authors.gif" \* MERGEFORMATINET  HYPERLINK "http://www.biopoint.com/inquiry/ibr.html" http://www.biopoint.com/inquiry/ibr.html How to Research on the Internet Tutorials  HYPERLINK "http://www.lib.monash.edu.au/vl/www/wwwcon.htm" http://www.lib.monash.edu.au/vl/www/wwwcon.htm Evaluating Internet Research Sources Robert Harris  HYPERLINK "http://www.virtualsalt.com/evalu8it.htm" http://www.virtualsalt.com/evalu8it.htm [****The Best training online---Bill] Finding Information on the Internet  HYPERLINK "http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/FindInfo.html" http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/FindInfo.html  HYPERLINK "http://www.winiconference.net/id11.html" http://www.winiconference.net/id11.html WINI Brochure INCLUDEPICTURE "http://www.winiconference.net/imagelib/sitebuilder/layout/spacer.gif" \* MERGEFORMATINET  INCLUDEPICTURE "http://www.winiconference.net/imagelib/sitebuilder/layout/spacer.gif" \* MERGEFORMATINET   INCLUDEPICTURE "http://www.icce.us/sitebuildercontent/sitebuilderpictures/6banner06.jpg" \* MERGEFORMATINET   INCLUDEPICTURE "http://www.icce.us/sitebuildercontent/sitebuilderpictures/p1010042.jpg" \* MERGEFORMATINET  INCLUDEPICTURE "http://www.winiconference.net/imagelib/sitebuilder/layout/spacer.gif" \* MERGEFORMATINET Description of WINI This conference focuses on trends and issues in practice facing the nursing professional and provides a comprehensive examination of nursing informatics theories, impact of human factors, systems analysis, and design approaches. Methods for managing information databases and systems, as well as the evaluation of computer technology systems are included. The content provides an opportunity to prepare for the ANCC Nursing Informatics Certification Exam and is conducted by certified informatics nurses. Conference Objectives: At the completion of the conference, participants will be able to: Examine theories, models, and frameworks that could be used in healthcare and nursing informatics practice, education, administration, and research domains. Distinguish among the terms human factors, ergonomics, human-computer interaction and usability. Discuss system planning concepts. Describe available hardware, software, and communications components for a healthcare information management solution. Identify strategies to establish a solution. Develop an implementation plan and project management plan for an information systems plan. Evaluate the implementation of a healthcare IS solution. Identify opportunities to contribute to local, state, national, and international informatics initiatives. Assess readiness to complete the ANCC certification examination for nursing informatics. Conference Topics: Welcome, Introductions and Overview of course Theories Used in Nursing Informatics Human Factors in Nursing Informatics Case Studies and Group Work Standard I Identify the Issue or Problem Standard II Identify Alternatives Standard III Choose or Develop a Solution Standard IV Implement the Solution Standard V Evaluate and Adjust Solutions Professional Performance, Trends and Issues Certification Exam Preparation Course Evaluation, Certificate of Completion Award Target Audience and Teaching Methods: This conference is designed for nurses who want to expand or clarify their working knowledge of nursing informatics. Experienced informatics nurses will find this program helpful as they prepare for the ANCC Nursing Informatics Examination. New informatics nurses will understand the breadth of knowledge and skills expected of the role. Nursing Educators and Staff Nurses on implementation teams will particularly benefit from this course. According to the ANA Scope and Standards of Practice, all nurses need to utilize nursing informatics concepts in their practice. Goals: At the completion of this workshop, the participant should be able to identify the key concepts of nursing informatics. Purpose: This conference focuses on trends and issues in practice facing the profession and provides a comprehensive examination of nursing informatics theories, impact of human factors, systems life cycle approach, methods for managing information databases and information technology overview. The content provides an opportunity to prepare for the ANCC Nursing Informatics Certification exam and gain nursing informatics specific contact hour continuing credit. ANCC Questions: From the ANCC: "Requirements for eligibility to take the Informatics Nurse certification exam have been expanded to include a bachelor's or higher degree in nursing or a bachelor's degree in a relevant field (sciences, professional disciplines, or academic liberal arts)." For information about the Informatics Nurse Certification Exam please visit American Nurses Credentialing Center:  HYPERLINK "http://nursingworld.org/ancc/cert/eligibility/informatics.html" http://nursingworld.org/ancc/cert/eligibility/informatics.html Informatics Nurse Exam References  HYPERLINK "http://nursingworld.org/ancc/cert/testrefs/BSN27_48_Info_refs.html" http://nursingworld.org/ancc/cert/testrefs/BSN27_48_Info_refs.html   INCLUDEPICTURE "http://www.winiconference.net/imagelib/sitebuilder/layout/spacer.gif" \* MERGEFORMATINET   INCLUDEPICTURE "http://www.icce.us/sitebuildercontent/sitebuilderpictures/banner06.jpg" \* MERGEFORMATINET  For more information or to host a conference, Contact: Kathleen Smith (301) 869.7428  HYPERLINK "mailto:webmaster@icce.us" webmaster@icce.us   HYPERLINK "http://www.winiconference.net/" http://www.winiconference.net/ WINI INCLUDEPICTURE "http://www.winiconference.net/imagelib/sitebuilder/layout/spacer.gif" \* MERGEFORMATINET  INCLUDEPICTURE "http://www.winiconference.net/imagelib/sitebuilder/layout/spacer.gif" \* MERGEFORMATINET Weekend Immersion in Nursing Informatics New:2008 Planned WINIs now posted WINI, (Weekend Immersion in Nursing Informatics) is a nursing informatics continuing education course that travels around the country to provide affordable, in-depth nursing informatics education. Approved by the Maryland Nurses Association, an approved provider of nursing continuing education, WINI focuses on basic competencies in nursing informatics. WINI and Informatics Insights are developed and presented by managing members, Carol J. Bickford,PhD, RNBC, and Kathleen Smith, MScEd, RNBC. Both members are board certified in Nursing Informatics by the American Nurses Credentialing Center (ANCC). WINI provides an opportunity to have guided discussion and education in a variety of informatics topics including the systems life cycle, theories used in nursing informatics and professional practice trends and issues. The WINI Faculty received the Information Technology Award for Knowledge Advancement from Sigma Theta Tau, the International honor society in nursing in 2001. In November 2003, the WINI Facultyreceived the Outstanding Nurse Educator award from the Maryland Nurses Association for their work presenting WINI throughout theUS and in Canada. Join us at an upcoming WINI Date Host, Location Contact 2007 Oct 12 - 14 (Fri-Sun) Hosted by: Greater Chicago Chapter HIMSS Continuing Education Credit: This course has been approved for 20.4 contact hours by the Maryland Nurses Association, an accredited approver of nursing continuing education by the American Nurses Credentialing Centers Commission on Accreditation. The Winngate Inn Schaumburg 50 East Remington Rd Schaumburg, Illinois 60173 847-882-5000  HYPERLINK "http://icce.us/chicago.doc" \t "tlx_new" WINI Brochure For additional information related to program content, contact Ruth MacCallum, 312-543-7346,  HYPERLINK "mailto:ruth.maccallum@healthiaconsulting.com" ruth.maccallum@healthiaconsulting.com To register securely on-line, go to The Greater Chicago Chapter of HIMSS at http://www.gcchimss.net  HYPERLINK "http://www.gcchimss.net/" \t "tlx_new" Greater Chicago Chapter HIMSS Website Oct 26-27 (Fri-Sat) Hosted by: The Cleveland Clinic The Cleveland Clinic Lyndhurst Campus, 1950 Richmond Road, Lyndhurst, Ohio 44124 Continuing Education Credit: This course has been approved for 20.4 contact hours by the Maryland Nurses Association, an accredited approver of nursing continuing education by the American Nurses Credentialing Centers Commission on Accreditation.  HYPERLINK "http://www.icce.us/CCF.doc" \t "tlx_new" WINI Brochure For additional information related to program content, contact Terri Wimms at  HYPERLINK "mailto:wimmst@ccf.org" wimmst@ccf.org or 216.444.4988. For registration information, contact Stephanie Vargo at  HYPERLINK "mailto:vargos2@ccf.org" vargos2@ccf.org or 216.445.4010 Hotel reservations: Hampton Inn & Suites at 3840 Orange Place, Beachwood, Ohio 44122. Rooms are available for Thursday through Saturday nights at $99.99 plus tax. Please mention the Cleveland Clinic Group when making reservations. These rooms will be held until October 5, 2007. Call: (216) 831-3735. Nov 30 - Dec 2 (Fri - Sun) Hosted by Stanford Hospitals and Clinics Location: Center for Education and Professional Development Stanford Hospital and Clinics 1451 S. California Ave, Palo Alto, CA 94304 Mailing Address 300 Pasteur Drive, MC 5534 Stanford, CA 94305-5534 CA BRN and ANCC Contact Hours will be provided  HYPERLINK "http://icce.us/WINICA.doc" \t "tlx_new" WINI Brochure Contact: The Center for Education at 650-723-6366, press option 2. Or email:  HYPERLINK "mailto:CECENTER@STANFORDMED.ORG" CECENTER@STANFORDMED.ORG Hotel Reservations: Crowne Plaza Cabana Palo Alto at 4290 El Camino Real, Palo Alto, CA 94306 2008 Planned WINIs Feb 8 - 10, 2008 (Fri-Sun) Medical University of South Carolina Charleston, SC Hotel Reservations: CourtyardMarriottRiverview 35LockwoodAve. Charleston,SC29401 Call: 1 800 549 8154 and please mention  WINS as your group code.  HYPERLINK "http://icce.us/WINI_MUSC_0208.pdf" \t "tlx_new" WINI Brochure Contacts: Registration KathieFaulknerintheCenterforProfessionalDe velopmentandClinicalEducationResources, (843)792 2409 Program Weatherly Brice, MSN, RN-BC Clinical Educator Medical University of South Carolina Authority Charleston, SC (843) 792-6572  HYPERLINK "mailto:rogersw@musc.edu" rogersw@musc.edu March 28-30, 2008 (Fri - Sun) ANIA Event Clark Memorial Hospital Jeffersonville IN Contact: Vicki Vallejos  HYPERLINK "mailto:vicki.vallejos@clarkmemorial.org" vicki.vallejos@clarkmemorial.org April 11-12, 2008 (Fri - Sat) Albert Einstein Medical Center Philadelphia, PA Contact Sharon Majarowitz  HYPERLINK "mailto:majarowitzs@einstein.edu" majarowitzs@einstein.edu 215.456.7581  HYPERLINK "mailto:majarowitzs@einstein.edu"   April 25-27, 2008 (Fri-Sun) Children's Medical Center Cincinnati, OH Contact: Jack Warfield  HYPERLINK "mailto:Jack.Warfield@cchmc.org" Jack.Warfield@cchmc.org July 14-16, 2008 (Mon - Wed) University of Maryland School of Nursing, Baltimore Pre Conference Tutorial in conjunction with the Summer Institute in Nursing Informatics (July 16-19,2008) Christine Ward, M.S. Program Manager Organizational Partnerships, Outreach and Clinical Enterprise University of Maryland School of Nursing 655 West Lombard St. Room 425 A Baltimore, MD 21201-1579 Phone: 410-706-1838 Fax: 410-706-0018  HYPERLINK "mailto:cward006@son.umaryland.edu" cward006@son.umaryland.edu  HYPERLINK "http://www.nursing.umaryland.edu/events" www.nursing.umaryland.edu/events Sept 20 - 21, 2008 (Sat, Sun) Royal Victoria Hospital, Barrie, Ontario, Canada Fern Watson  HYPERLINK "mailto:watsonf@hhsc.ca" watsonf@hhsc.ca Dec 5-7, 2008 (Fri-Sun) UTMB Galveston, TX Poldi Tschirch PhD,RN,BC Email:  HYPERLINK "mailto:ptschirc@utmb.edu" ptschirc@utmb.edu For information about Nursing Informatics Certification, application process, and requirements for certification please visit the American Nurses Credentialing Center (ANCC.) Web site:  HYPERLINK "http://www.nursecredentialing.org/cert/eligibility/informatics.html" \t "_self" ANCC  Subscribe to Computers, Informatics, Nursing (CIN). CIN's ongoing mission to keep you in touch with the latest technological advances so critical to your success as a nursing professional. CIN offers a complete package that delivers realistic solutions. Readers discover how to use technology to save time and money, increase productivity, and improve communication. Continuing education contact hours are available in every issue. Web site:  HYPERLINK "http://www.cinjournal.com/" \t "_self" CIN   HYPERLINK "http://www.nursing-informatics.com/sitemap.html"  INCLUDEPICTURE "http://gateway.tx.ovid.com/gw1/banners/00124645.gif" \* MERGEFORMATINET  2000 Lippincott Williams & Wilkins, Inc. Volume 16(2),March/April 2000,pp 73-79 MICROCOMPUTER EDUCATION FOR NURSING: AN APPROACH TO MICROCOMPUTER EDUCATION IN A LARGE TERTIARY CARE CENTER [Articles] Inman, Diane BSN, RN; Johansen, Martha MSN, RN; Powlas, Karen; Timm, Jane MSN, RN; Turner, Diana Diane Inman, BSN, RN, is a Nurse Manager, Rochester Methodist Hospital, Rochester, Minnesota. Martha Johansen, MSN, RN, is a Nursing Education Specialist, Mayo Medical Center, Nursing and Professional Development, Rochester, Minnesota. Karen Powlas is a Microcomputer Education Coordinator, Mayo Foundation-Microcomputer Education Services, Rochester, Minnesota. Jane Timm, MSN, RN, is a Nursing Office Supervisor, Mayo Foundation, Rochester, Minnesota. Diana Turner is a Nursing Office Supervisor, Mayo Foundation, Rochester, Minnesota. Address for correspondence: Diane Inman, BSN, RN, Rochester Methodist Hospital, 201 West Center, Rochester, MN 55902. Abstract HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Communication skills needed for the healthcare environment are changing. In the past, poor reading and writing skills made it difficult to use a paper chart. Current computer technology provides many new opportunities for communicating in the clinical setting. Computer literacy has become a necessary skill for efficient use of clinical computer systems. At this large tertiary care setting, a survey was developed and distributed to staff to assess learner needs. Nursing staff identified educational needs for basic computer knowledge, the ability to move between computer functions, and the skills to navigate through specific applications. Based on survey analysis, three educational classes were constructed that addressed the department's specific needs.  Information technology provides great advances to support and enhance nursing practice; however, a gap can exist between the "creation of the new health care enterprise and the end user's ability to fully leverage its potential" ( HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "76" Simpson, 1997, p. 85). The first hospital computer systems developed in the 1960s were useful for administration functions  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "74" (Bowles, 1997). Today, healthcare budgets for system purchases and implementation average 2% of annual expenditures  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "77" (Simpson, 1998). Computer literacy has become a necessary communication skill for efficient use of clinical computer systems just as reading and writing skills were necessary to use a paper chart. Computer literacy is defined as "the ability to exchange information with computers at the level appropriate to the problem the user wishes to solve" ( HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "75" Coffman, 1996, p. 260). The skill needed may be specific to a computer application or may be having the basic comfort with and knowledge about computers to integrate various applications. A common response on a staff survey was "Someone else has accessed a screen I am not familiar with and now I don't know how to get what I need." This was an important clue identifying a gap in the computer literacy of staff. Setting HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  In this large mid-western tertiary medical center, department-wide computer education applications needed included systems for classification of nursing workload, laboratory/test results inquiry, electronic mail, communication of physician and supply orders to other areas, and reference applications using World Wide Web technology. Clinical information systems (CIS) were used for patient documentation in three intensive care units and two general care units with plans for expansion. Specific education programs were part of the implementation of the CIS. Most of the computer applications exist with a dual paper system; however, it is anticipated that paper systems will gradually be reduced to minimize duplication and streamline documentation and communication processes. Learning Needs Identification HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Institutional programs already existed for computer classes. Diverse resources were available to assist in developing computer education programs. Nursing staff members were interested in expanding their computer skills, yet challenges existed with the "fit" between departmental needs and current institutional computer education programs. The process for nursing staff to register for institutional educational sessions was tedious: 1) information on sessions scheduled were not readily available for staff; 2) separate forms were needed for class registration and reimbursement for educational time, 3) the process was delayed because of the need for the signature of the nurse manager for reimbursement of educational time, and 4) sessions were often filled before nursing staff could coordinate their work schedules to assure attendance. Challenges also existed for nursing areas seeking a departmental approach to computer education. Redundant efforts were visible as resources and content were designed by individual units. It was difficult to find available computer workstations for teaching sessions and practice times. As multiple institutional departments used workstations for various programs, the nursing staff's computer use increased. Nursing orientation provided computer education for new employees. Central computer education programs received increased requests for education. Resources no longer met needs-needs had extended beyond what the institutional programs offered. An Alternative Process HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  In response to these challenges, the Nursing Informatics Committee formed the Electronic Education (EE) Work Group, comprised of an informatics nurse specialist, nursing education specialist, nurse manager, nursing office supervisor, and educational coordinator from Microcomputer Education Services (MES). This group assessed the educational needs for the Department of Nursing using a combined institutional and departmental approach. Key steps were defined and a timeline developed for the training project. The main categories in the timeline included start-up, class material, physical and human resources, class schedule, and evaluation. The program was communicated to numerous areas through announcements in the Department of Nursing communication bulletin and in management, education, and nursing informatics meetings. Survey Design HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  A survey was designed to determine learning needs and plan education. Strategies for planning concentrated on the highest educational needs within the department. Demographic information was collected on the role categories of staff RN, staff LPN, unit secretary, nursing service secretary, nursing assistant, and members of the expanded nursing leadership such as nurse managers, clinical nurse specialists, and nursing education specialists. Questions were structured and open ended. Structured questions included a list of applications in the following categories: computer basics, nursing/clinical tools, nonclinical tools, and resource/troubleshooting (see  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "TT1" Table 1). Responses were designed to determine where the educational focus would be placed. Response options included "I don't anticipate using it"; "I need to learn this"; "I use this and need more education"; and "I use this and am comfortable with it." Highest priority was given to questions with the response of "I use this and need more information" (see  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "TT2" Table 2).   HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?View+Image=00124645-200003000-00007|TT1&S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&WebLinkReturn=Full+Text%3dL%7cS.sh.15.16%7c0%7c00124645-200003000-00007"  INCLUDEPICTURE "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&Graphic=00124645-200003000-00007%7cTT1%7cT%7cjpg" \* MERGEFORMATINET   HYPERLINK "javascript:openWeblink('http://gateway.tx.ovid.com/gw1/ovidweb.cgi?S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&HC=imview&HR=1&RI=543d4a53265345415243483d313039382d373838362e69732e2b616e642b31362e766f2e2b616e642b322e69702e2b616e642b37332e70672e26443d6f76 [Help with image viewing]  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&Save+As+Jumpstart=Image%7c%26PAGE%3dimage%26IMAGE%3d00124645-200003000-00007%7cTT1%26D%3dovft&WebLinkReturn=Full+Text%3dL%7cS.sh.15.16%7c0%7c00124645-200003000-00007" [Email Jumpstart To Image] TABLE 1 Sample Questions    HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?View+Image=00124645-200003000-00007|TT2&S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&WebLinkReturn=Full+Text%3dL%7cS.sh.15.16%7c0%7c00124645-200003000-00007"  INCLUDEPICTURE "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&Graphic=00124645-200003000-00007%7cTT2%7cT%7cjpg" \* MERGEFORMATINET   HYPERLINK "javascript:openWeblink('http://gateway.tx.ovid.com/gw1/ovidweb.cgi?S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&HC=imview&HR=1&RI=543d4a53265345415243483d313039382d373838362e69732e2b616e642b31362e766f2e2b616e642b322e69702e2b616e642b37332e70672e26443d6f76 [Help with image viewing]  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?S=NPGCFPODIADDLKECNCILHDMLPAPPAA00&Save+As+Jumpstart=Image%7c%26PAGE%3dimage%26IMAGE%3d00124645-200003000-00007%7cTT2%26D%3dovft&WebLinkReturn=Full+Text%3dL%7cS.sh.15.16%7c0%7c00124645-200003000-00007" [Email Jumpstart To Image] TABLE 2 Survey Responses  Types of learning methods were assessed by prompting responses of "yes" or "no" to whether the following choices would be helpful: 1) classroom with "hands-on" computer training, 2) paper learning modules/tutorials using the computer on your own, 3) on-line computer learning modules/tutorials using the computer on your own, 4) videotapes, 5) reference cards, 6) reference manual, 7) instruction sheets, and 8) newsletters. The open-ended questions included common problems encountered using computers in work areas, resolving computer problems, and anticipated/additional needs. The final question on the survey was whether the individual would be interested in being a nursing resource person to assist with education and/or be a local computer expert. Additional education was planned for interested individuals. Survey Distribution HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  The survey was distributed to all individuals in the nursing department. The cover letter accompanying the survey was a scenario of the typical computer tasks integrated in the daily activities of a nurse. It was emphasized that the survey results would be used to plan education classes for the department. Survey Analysis HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  There were 1,144 surveys returned, a return rate of 28.8%. The highest areas of educational need in descending order of frequency were basic computer skills on Windows"! and Macintosh"! platforms, e-mail, basic printing, and accessing the Department of Nursing home page on the institutional Intranet. The learning method described by most nurses who returned the survey listed classroom education with computer hands-on training as being the most helpful (95.7%). Second most helpful was the use of instruction sheets (74.9%) and reference cards (72.5%). Newsletters were listed as the least helpful (43.7%) learning style. In the open-ended query, 47% of the comments related to basic computer skills. Computer lock-up or down time accounted for 13% and software issues accounted for 12% of the most common problems. Computer problem resolution, as noted by survey participants, was achieved through asking a coworker (40%), calling the computer Help Desk (33%), and troubleshooting independently (14%). Survey Application HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  The results of the survey were used to plan the educational program. They were also used in planning resources for the Help Desk (an institution-wide resource for telephone on-line and in person support that provides triage service for computer questions and problems). Budget planning for the Microcomputer Education Service incorporated aspects of the survey results to project needs for instructors, equipment, and training facilities. The Planning Process HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Passwords assist to ensure confidentiality of information; however, it is difficult to manage IDs and passwords from various systems with different people responsible for each system, with variable duration for validity of passwords, and with a variety of log-in procedures. Passwords needed to be in place to prepare for the class. A memo was mailed to all nursing staff outlining the program IDs most likely to be used in the course of a typical workday. This memo included attachments for individuals to complete and return to the persons responsible for providing access to computer systems. These password assignments gave the user enough system access to participate in the hands-on versions of the computer classes. Curriculum Development HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  The nursing education specialist and educational coordinator from Microcomputer Education Services identified curriculum content. Survey data analysis determined areas of technical and psychosocial/emotional needs of nursing staff. Knowledge skills and support needs were categorized into related groups. Verbal comments collated from survey results indicated that although staff were aware of the specific applications used in conjunction with patient care, they were unable to use the applications on the computer. The limiting factor was not the application, but the use of a multipurpose workstation. Staff lacked an understanding of the concepts of what a computer does and how it works, as well as the skills necessary to effectively use the computer. Additionally, personnel from the computer Help Desk contributed a list of topics that were frequently mentioned as problems. These topics were incorporated into the class curriculum. The curriculum development process began with identification of objectives and desired outcomes. This process led to the conclusion that three separate classes would be the most logical way to organize the curriculum. During curriculum development, the minimum amount of time necessary to cover the topics, and the ideal length of hands-on classes for maximum information retention were considered. There were potentially 3,300 staff in the nursing department requiring all or part of the content. Although nurse managers were willing to send staff to classes during work shifts, time was an important scheduling and budget issue. Topics were divided into the three classes with each focusing on a major construct. The sequence of classes was developed from broad concept to specific nursing application. Content and Methods HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  The first class, "Computer Concepts for Nursing," focused on basic concepts and principles related to computer functions and operations. The outline reflected novice level concepts. The major goal for this class was to build a strong foundation prior to the hands-on portion of the curriculum. Concepts presented in this class were generic for all computer operating systems. Similarities and differences among systems were highlighted. The lecture included the computer cycle, operating systems, ways of communicating with other computers, basic security issues, and types of computers found in the work environment. By presenting these topics as a lecture, the planning group believed staff would be less intimidated because they could concentrate on the concepts and did not have to use the computer. "Computer Basics for Nursing" was designed to provide application of the concepts participants learned in class one. The major goals for this class included having the users experience hands-on practice and problem solving at a basic level within a supportive environment. Survey results had identified that over 95% of staff preferred hands-on education. The hands-on basics class covered hardware and environment issues. Hardware issues included using and maintaining the mouse or pointing device, checking computer connections, keyboard key definitions, reset and power buttons for the system unit, and monitor settings. Graphical User Interface (GUI) skills were practiced: opening, closing, sizing, and moving windows. Another important skill included determining which programs were running versus those that were available. Maneuvering from one program to another was emphasized and practiced. Different types of computer connectivity were discussed and used. This information included connecting to the mainframe computer for patient registration information, using the computer for reviewing laboratory results, creating a database for history sheets, accessing the Internet for drug and referral information, conducting literature searches, and using a local area network for shared data. All of the skills presented would be used daily in the clinical area. Survey results indicated that printing was a problem for many users. Common problems-including clearing paper jams, loading paper, resetting printers, and determining which printer was being used-were covered. The third class, "Computer Applications for Nursing" focused on the applications supporting nursing practice and patient care. The goal for the class was to have users access applications, enter information, modify information, exit a program, and switch between programs successfully. Content related to confidentiality and security in the work environment was also emphasized. The content in this class was organized to allow various departmental staff to leave before the end of the session when the information did not relate to their duties. By finishing the series with the applications class, staff were able to identify the need for computer use and the overall scope of the computer capability as reported in course evaluations. Class Format HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Participants enrolled in the hands-on computer classes the same week as the lecture. The first two hands-on classes, "Computer Basics for Nursing," and "Computer Applications for Nursing," were scheduled so one followed the other, primarily to accommodate unit scheduling needs. The back-to-back classes were then offered on Macintosh"! and Windows NT"! formats, depending on which operating system the unit or area used. The scheduling of the classes for specific classrooms was based on the number of unit staff using each platform. Enough hands-on classes were scheduled during a particular week to accommodate lecture participants during the same week. Each class was designed to be 2 hours. The "Concepts" class could be offered in lecture format to large audiences; however, the "Basics" and "Applications" classes needed to be offered to small groups of fewer than 24 people in a computer classroom with a computer available for each participant. Because of limited time, and keeping adult learning principles in mind, class handouts were provided. Reference materials included program objectives, speaker qualifications, class manuals or outlines, and other supportive materials such as cue cards and a dictionary of terms. The development of the handouts was motivated by several factors: a) adult learners are self-directed and would use the reference materials beyond the classroom setting; b) classes offered for contact hours needed to include certain components as directed by the Board of Nursing, and c) consistent materials were necessary for presentation of the classes by multiple instructors. Reviewing the goals and desired outcomes for the program, it was determined that provision for contact hours would be added motivation for attendance. Minnesota Board of Nursing requirements were considered and incorporated into the program materials. Participants were asked to complete a half sheet of information in each class. Each participant indicated whether he or she desired contact hours for the class. Implementation HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Once the content drafts were completed and materials designed, a pilot class was offered to the program planning group. Members of other departments were also invited to participate to critique the content, methods, presentations, and applicability of the programs to their departments. The pilot test was helpful in determining the time to present the content adequately. It was determined that the "Applications" class was too lengthy; therefore, topics relating to confidentiality and security were moved to the "Basics" class and used as a transition into the "Applications" content. Instructors HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  The classes were originally taught by the members of the work group responsible for development of the curriculum. Microcomputer Education Services (MES) staff presented the "Concepts" and "Basics" classes while nurse educators presented the "Applications" classes. As there were many iterations of the classes scheduled, additional staff from these departments were used. The additional staff first attended the classes as observers to familiarize themselves with the materials and learning needs and style of the audience. Multiple instructors could teach without concern for major content variation because the curriculum had been tested. Seven instructors from MES and five from Nursing Education and Professional Development were comfortable with their computer skill or attended class before participating in the presentations. As the program would be ongoing, scheduling of the classes was incorporated into the calendar for staff development offerings. This facilitated registration for computer classes in a format consistent with other nursing staff development offerings. Resource/Training HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Literature had shown the concept of "superusers"-people who receive additional education or are comfortable with computers to provide additional support, field questions, and problem-solve-to be a beneficial strategy  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "78" (Stebbins et al., 1997). An initial group of 25 resource people was identified from 165 volunteers who expressed interest in being available for support as staff returned to their units applying their new computer knowledge from the computer sessions. These initial resource people were selected based on two factors: 1) having current basic computer knowledge and 2) the expanded work group's desire to have resources available from as many patient care units as possible. The resource staff were encouraged to attend the initial computer sessions to familiarize themselves with the content. They also received 4 hours of additional computer troubleshooting information, incorporating the common mistakes made by new users. Topics included log-in problems; determining active, loaded, and available programs; switching between programs; and fixing basic screen, mouse, keyboard, and printer problems. Mainframe connectivity and problems were emphasized. The class concluded with simulated problems on various computers. The participants were required to determine a solution for each problem. It was determined that nurses needed resources that are accessible and available in a timely manner. The use and expansion of the resource role is currently undergoing evaluation. Challenges with this role include availability of the individuals on the shifts and units when needed, maintaining competency in troubleshooting strategies, and identifying methods for communicating who these resources are. Participant Evaluation HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Participants completed an evaluation at the end of each class. In addition, it was arbitrarily determined to have a follow-up evaluation completed approximately 6 months after attendance. This time frame was realistic for the department and fell within the time frame recommended for outcome evaluation. Questions exist regarding the structure of future computer education sessions. Will the "next generation" of employees arrive with greater computer literacy? Will any remaining gaps for new employees be eliminated through day-to-day sharing of knowledge and experiences? Will a need exist for a condensed amount of core information in orientation sessions? Whether it is in a large tertiary care center or elsewhere, fluctuations in computer learning needs exist. The National Advisory Council of Nurse Education and Practice recommends education of nursing students and practicing nurses in the core informatics content  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "77" (Simpson, 1998). The initial goals of the sessions were to provide a strong foundation prior to hands-on computer sessions, practice computer problem solving in a supportive environment, and develop skills with specific applications. Post-class evaluations verify that these goals were met. Thus far, 12 series were completed with a total attendance of 450 staff. Nurse managers continue to support the program. Personnel from the Computer Help Desk report a decrease in the number of calls. The teaching curriculum has undergone modifications based on the evaluations and feedback from attendees. Changes were made to the number of classes offered on various platforms as well as the content and timing of education for specific applications. Summary HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Institutions experience unique challenges in establishing microcomputer education for their specific needs. Successful components in this program included completion of a needs survey, tailoring a program to meet the needs of this setting, institutional support for the initiative, and a positive response from staff and management. Participation in educational sessions provided staff with a foundation in basic computer skills and the ability to integrate this knowledge synchronously with computer platform and application standardization. Acknowledgment HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  The authors thank Katie Paulsen, Communication Technology Services; Jeff Stevens, Communication Technology Services; and Bryan Klimek, Information Systems for their valuable assistance in the survey process and computerizing on-line registration. REFERENCES HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "toc"  INCLUDEPICTURE "http://gateway.tx.ovid.com/rel_live/server1/gifs/ftup.gif" \* MERGEFORMATINET  Bowles, K. (1997) The barriers and benefits of nursing information systems. Computers in Nursing, 15(4), 191-198.  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00002771_1997_15_191_bowles_information_%7c00124645-200003000-00007%23xpointer%28id%28R1-7%29%29%7c10%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.5c103e04ef61e5550ce59 Ovid Full Text  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00002771_1997_15_191_bowles_information_%7c00124645-200003000-00007%23xpointer%28id%28R1-7%29%29%7c60%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.14038a58de48ffa86f4ee Bibliographic Links  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "17" [Context Link] Coffman, S. (1996). Applying adult education principles to computer education. Journal of Nursing Staff Development, 12(5), 260-263.  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00005108_1996_12_260_coffman_principles_%7c00124645-200003000-00007%23xpointer%28id%28R2-7%29%29%7c10%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.5c103e04ef61e5550ce59 Ovid Full Text  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00005108_1996_12_260_coffman_principles_%7c00124645-200003000-00007%23xpointer%28id%28R2-7%29%29%7c60%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.14038a58de48ffa86f4ee Bibliographic Links  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "18" [Context Link] Simpson, R. (1997). Are staff prepared for the new information-based hospital enterprise? Nursing Administrative Quarterly, 21(2), 85-87.  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00006216_1997_21_85_simpson_information_%7c00124645-200003000-00007%23xpointer%28id%28R3-7%29%29%7c25%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.03201b32af5d6ac4aad4a Buy Now  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00006216_1997_21_85_simpson_information_%7c00124645-200003000-00007%23xpointer%28id%28R3-7%29%29%7c60%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.14038a58de48ffa86f4ee Bibliographic Links  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "17" [Context Link] Simpson, R. (1998). The technologic imperative: A new agenda for nursing education and practice, part 1. Nursing Management, 29(9), 22-24.  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00043623_1998_29_22_simpson_technologic_%7c00124645-200003000-00007%23xpointer%28id%28R4-7%29%29%7c25%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.03201b32af5d6ac4aad4a Buy Now  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00043623_1998_29_22_simpson_technologic_%7c00124645-200003000-00007%23xpointer%28id%28R4-7%29%29%7c60%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.14038a58de48ffa86f4ee Bibliographic Links  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "17" [Context Link] Stebbins, J., Gentes, J., Kagen-Fishkind, J., LaMountain, S., Sheehan, S., & Colburn, C. (1997). A clinical information system transition: A nursing perspective. Journal of Nursing Staff Development, 13(6), 309-313.  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00005108_1997_13_309_stebbins_information_%7c00124645-200003000-00007%23xpointer%28id%28R5-7%29%29%7c10%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.5c103e04ef61e5550ce Ovid Full Text  HYPERLINK "http://gateway.tx.ovid.com/gw1/ovidweb.cgi?Link+Set+Ref=00124645-200003000-00007|00005108_1997_13_309_stebbins_information_%7c00124645-200003000-00007%23xpointer%28id%28R5-7%29%29%7c60%7chttp%3a%2f%2facs.tx.ovid.com%2facs%2f.14038a58de48ffa86f4 Bibliographic Links  HYPERLINK "http://gateway.tx.ovid.com/gw1/" \l "63" [Context Link] KEY WORDS: COMPUTER; EDUCATION; LEARNING NEEDS; STAFF DEVELOPMENT; TECHNOLOGY  HYPERLINK "http://www.ihealthbeat.org/articles/2007/11/8/IT-Could-Help-Nurses-Boost-Efficiency-Safety-Study-Finds.aspx?topicID=53" http://www.ihealthbeat.org/articles/2007/11/8/IT-Could-Help-Nurses-Boost-Efficiency-Safety-Study-Finds.aspx?topicID=53 November 08, 2007 IT Could Help Nurses Boost Efficiency, Safety, Study Finds  INCLUDEPICTURE "http://www.ihealthbeat.org/~/media/iHealthBeat/graphics/ProviderAndPatient jpg.ashx" \* MERGEFORMATINET  The American Academy of Nursing's Workforce Commission on Wednesday released a study identifying more than 1,200 technology products that would let nurses spend more time with patients,  HYPERLINK "http://www.ahanews.com/ahanews_app/jsp/display.jsp?dcrpath=AHANEWS/AHANewsNowArticle/data/ann_071107_AAN&domain=AHANEWS" \t "_new" AHA News reports. The Technology Targets project, funded by the Robert Wood Johnson Foundation, was based on case studies in 25 hospitals and health systems (AHA News, 11/7). Linda Burnes Bolton, president of the American Academy of Nurses, said nurses spend only 30% of their time on direct patient care because of inefficient work processes and environments. The study identified more than 300 workflow issues that could be improved through the use of technology, including: Care delivery and coordination; Communication; Documentation; Medication administration; and Supplies and equipment. Pam Cipriano, chief clinical officer of the University of Virginia Health System, said a single industry standard for interoperability will help address these issues. Cipriano added that feedback from nurses should be included in the design of technology to reduce the potential for error and that vendors should ensure that their products are user-friendly (Lubell,  HYPERLINK "http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071107/REG/311070023" \t "_new" Modern Healthcare, 11/7).  HYPERLINK "http://www.healthcareitnews.com/story.cms?id=8265" http://www.healthcareitnews.com/story.cms?id=8265 Hospitals help nurses get more from IT Healthcare IT News By  HYPERLINK "mailto:diana.manos@medtechpublishing.com" Diana Manos, Senior Editor 12/04/07Loading story... DAVENPORT, IA - According to results of a recent  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=American+Academy+of+Nursing" \o "American Academy of Nursing" American Academy of Nursing survey, healthcare IT has a long way to go before it fully serves nurses in their environment. Yet some hospitals have already begun trying new ways to make healthcare IT more user-friendly to nurses, increasing the time they can spend with patients.  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Genesis+Health+System" \o "Genesis Health System" Genesis Health System in  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Davenport+(Iowa)" \o "Davenport (Iowa)" Davenport, Iowa began by establishing a nursing collaborative group to serve as a liaison between the hospital's IT department and nursing staff, according to  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Shirley+Gusta" \o "Shirley Gusta" Shirley Gusta, IT manager of application services at Genesis.The health system pilots new technology initiatives in one nursing unit prior to launching it facility-wide, whenever possible,  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Shirley+Gusta" \o "Shirley Gusta" Gusta said.  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Jamie+Allen" \o "Jamie Allen" Jamie Allen, telecom supervisor at Genesis said the hospital emphasizes duality of ownership when it comes to IT. "We heavily engage the clinical staff in system selection and when we're building systems in order to meet their needs and we study their business practices,"  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Jamie+Allen" \o "Jamie Allen" Allen said. "We're trying to learn from them." According to  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Shirley+Gusta" \o "Shirley Gusta" Gusta, in 2003, Genesis began using both wall-mounted devices between patient rooms in the main corridors and computers on carts. Despite the mobility that the computers on carts offered, nurses continued to migrate to the nurses' station to complete the majority of their electronic clinical documentation. In 2005, GenesIs expanded the mobile computing options to include wireless laptops,  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Shirley+Gusta" \o "Shirley Gusta" Gusta said. "While these devices did provide the nurses with more flexibility to support their workflow processes and complete documentation at the patients bedside, durability and connectivity issues did present new challenges," she added. "The IT team has continued to focus on resolution for these issues by introducing more rugged laptops and expanding the wireless infrastructure to support the increased demand for wireless connectivity." In  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Wilmington" \o "Wilmington" Wilmington,  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Delaware" \o "Delaware" Delaware,  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Alfred+I.+duPont+Hospital+for+Children" \o "Alfred I. duPont Hospital for Children" Alfred I. duPont Hospital uses wireless devices for communication in cardiac care, according to  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Lori+Betts" \o "Lori Betts" Lori Betts, nurse manager. Patients wear cardiac monitors that communicate through an IT platform to badges nurses wear.  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Lori+Betts" \o "Lori Betts" Betts attributes the success in the rollout of the devices to the vigilant help of the hospital's IT department that was able to tweak the system and give constant training for a full week until nurses adapted. "When we went live, the first week was hectic and it was hard to learn to work differently, but it wasn't too technical,"  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Lori+Betts" \o "Lori Betts" Betts said. "It was frustrating because we were learning to function in a new way" According to  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=John+Antes" \o "John Antes" John Antes, president of  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=Progress+West+Healthcare+Center" \o "Progress West Healthcare Center" Progress West Healthcare Center in  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=St.+Louis" \o "St.Louis" St.Louis, nurses play a key part in advising the hospital on IT issues and the organization has increasingly looked for ways to provide more mobile technology to its clinicians. The hospital uses Vocera, a communications product, to eliminate central nurse stations. The product helps nurses communicate hands-free with other nurses, doctors and other departments of the hospital. The units are voice activated so nurses don't have to remember phone numbers,  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=John+Antes" \o "John Antes" Antes said. Progress West also uses the devices to notify daily assigned code blue teams. "It really has created some nice efficiencies and ease of communication for moving nurses," Antes said. The hospital also uses bedside clinical electronic documentation, bedside bar-coding of patients and fingerprint notification to allow nurses to log onto several programs quickly. Medication is kept at the bedside in carts along with laptops,  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=John+Antes" \o "John Antes" Antes said. The use of effective healthcare IT has contributed to allowing nurses more time at the bedside,  HYPERLINK "http://www.healthcareitnews.com/informResults.cms?origin=8265&keywords=John+Antes" \o "John Antes" Antes said. "If you walk our floors, most of the nurses are in patients' rooms."  HYPERLINK "http://www.amazon.com/gp/product/images/0131512625/sr=8-1/qid=1197085783/ref=dp_image_0/102-5728641-8808145?ie=UTF8&n=283155&s=books&qid=1197085783&sr=8-1" \t "AmazonHelp"  INCLUDEPICTURE "http://ecx.images-amazon.com/images/I/518TM1GTN9L._AA240_.jpg" \* MERGEFORMATINET Handbook of Informatics for Nurses & Health Care Professionals (3rd Edition) (Paperback) by  HYPERLINK "http://www.amazon.com/exec/obidos/search-handle-url/102-5728641-8808145?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Toni%20Lee%20Hebda" Toni Lee Hebda (Author),  HYPERLINK "http://www.amazon.com/exec/obidos/search-handle-url/102-5728641-8808145?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Patricia%20Czar" Patricia Czar (Author),  HYPERLINK "http://www.amazon.com/exec/obidos/search-handle-url/102-5728641-8808145?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Cynthia%20M.%20Mascara" Cynthia M. Mascara (Author) Price:$38.30 Paperback: 496 pages Publisher: Prentice Hall; 3 edition (July 19, 2004) Language: English ISBN-10: 0131512625 ISBN-13: 978-0131512627  HYPERLINK "http://www.amazon.com/gp/product/images/0131512552/ref=dp_image_0/102-5728641-8808145?ie=UTF8&n=283155&s=books" \t "AmazonHelp"  INCLUDEPICTURE "http://ecx.images-amazon.com/images/I/51SGFCP35WL._AA240_.jpg" \* MERGEFORMATINET Internet Resource Guide for Nurses and Health Care Professionals (3rd Edition) (Paperback) by  HYPERLINK "http://www.amazon.com/exec/obidos/search-handle-url/102-5728641-8808145?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Toni%20Lee%20Hebda" Toni Lee Hebda (Author),  HYPERLINK "http://www.amazon.com/exec/obidos/search-handle-url/102-5728641-8808145?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Patricia%20Czar" Patricia Czar (Author),  HYPERLINK "http://www.amazon.com/exec/obidos/search-handle-url/102-5728641-8808145?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Cynthia%20M.%20Mascara" Cynthia M. Mascara (Author $23.95 Paperback: 144 pages Publisher: Prentice Hall; 3 edition (November 22, 2004) Language: English ISBN-10: 0131512552 ISBN-13: 978-0131512559  HYPERLINK "http://cms.clevelandclinic.org/nursing/body.cfm?id=8" http://cms.clevelandclinic.org/nursing/body.cfm?id=8 Nursing Informatics A Legacy of Leadership and Achievement Nursing leadership at the Cleveland Clinic has long recognized that superior quality of care depends on the alignment of people, processes and technology. The Department of Nursing Informatics -within the Division of Nursing- plays an essential role in defining and implementing the strategy for innovative technological systems and processes to support the delivery of quality patient care and to improve nursing practice. Although informally referred to as Nursing Information Systems since its inception in 1988, the area was officially established as a department in 1993 one year before the American Nurses Association recognized Nursing Informatics as a specialty with ANCC Certification. The name change to Nursing Informatics was implemented in 2006 to coincide with current standards of practice and scope. Nursing Informatics participates in multidisciplinary strategic planning to determine system solutions that support patient care, set standards for clinical applications and conform to accreditation standards and regulatory requirements. The department also facilitates the development of automation policies, procedures and guidelines for nursing and is the primary liaison between the Cleveland Clinic Information Technology Division and the Division of Nursing. At the onset of the department, information technology needs within the Division of Nursing were focused on supporting mainframe applications, developing databases, maintaining desktop applications and deploying office computers. It was during this time when various clinical systems were beginning to evolve, and a clinical nurse manager interested in how technology could affect nursing practice and patient care, became the first manager of the department. With the advent of an automated order entry/results reporting system, the role of the department quickly expanded along with the staff. The Nursing Informatics department is now comprised of registered nurses, educators, systems analysts and system administrators whose focus is to improve nursing practice through the creative use of technology, maximizing nursing productivity, improving the work environment infrastructure and increasing the Clinics world class excellence in patient care. Champions for Change Informatics nurses see technology as a tool to support, rather than hinder, their love of nursing as well as impact future nursing practices. For this team, technology is leveraged for the benefit of nursing practice and improved excellence in patient care systems and processes. Informatics nurses routinely support staff in using the automated applications in their daily assignments on the units and play an important interdisciplinary role that combines their passion for nursing with their love of technology, bringing a nursing perspective into the evaluation of innovative systems so that positive patient outcomes are achieved on all levels. Clinical Analysts in the Department of Nursing Informatics are Registered Nurses who assess opportunities for innovative technology to improve clinical practices analyzing clinical workflow to determine current practices. Based upon these observations, they facilitate the design and development, testing, implementation and evaluation of automated clinical systems. Informatics Clinical Analysts convene work groups from the nursing staff to study and quantify technology impact on improvement of specific nursing practice and processes. Collaborative Approach to Nursing Education, Quality and Research Clinical Instructors in the Department of Nursing Informatics are also nurses - providing centralized application training to nursing staff in support of new or revised clinical applications implemented on the nursing units. Working collaboratively with the nurse managers, nursing staff, and the Department of Nursing Education & Professional Development - NIS Clinical Instructors provide instruction and user support to ease the introduction of new technology into nursing care workflows. Classes favor independent learning with directed computer lab environments as well as self-directed manuals, but also incorporate computer-based traininga component still evolving from yearly competencies and training in federal regulations to clinical applications training with competency assessment. Unit nursing staff respond positively to the computer-based training, which can be taken at times most convenient to them even from home. The progressive evolution to electronic documentation of the medical record not only improves access to patient information at the point of care, it also greatly enhances nursing abilities to benchmark, monitor, audit and report quality measures in support of JCAHO and MAGNET initiatives. Additionally, collaborative nursing-led research is enhanced by the ability to support these projects with patient data that is more easily extracted electronically. Supporting these efforts and initiatives is a dedicated team of system analysts who provide support for the development and management of information databases, systems and processes to bring efficiency to nursing-driven quality and research endeavors through informatics. Maintenance and support of all databases and desktops is provided with a team of system administrators within the department of Nursing Informatics whose efforts are driven by a strong sense of ensuring employee satisfaction through greater efficiency. Innovative Use of Technology Improves Employee and Patient Satisfaction The Department of Nursing Informatics encourages nursing staff, patients and their families to suggest ideas for greater patient satisfaction. As a result, the department has made computers available for patients who have extended hospital stays. Dedicated solely to patients and their families, the computers provide access to the Internet for e-mailing friends and loved ones, interaction with support groups, researching information or playing computer games. All Cleveland Clinic nursing staff have an email account in addition to access to the Nursing Division Intranet site complete with Cleveland Clinic policies and procedures, clinical references, announcements of educational classes and opportunities for professional growth, hospital and nursing award opportunitieseverything the nursing staff needs to know in a comprehensive, easy-to-access site. In 2006, wireless Voice-over-IP (voice carried over internet protocol networks) phones were implemented in all nursing units to facilitate ease of communication and coordination of patient care between staff, physicians, ancillary departments and patients. Voice-over-IP technology is the most state of the art telecommunications methodology available commercially today and is fast becoming the standard for voice communications globally. The results improved communication and enhanced efficiency to improve patient care. Taking Patient Care to New Levels Nursing Informatics, in collaboration with the Information Technology Division, is implementing an electronic medical records system from Epic Systems of Madison, WI. Electronic documentation of the patients medical record is changing the face of nursing and medical practice at Cleveland Clinic. EpicCare includes order entry, nursing care documentation, medication dispensing and administration, and results reporting. After using EpicCare successfully in ambulatory outpatient services for two years, the Cleveland Clinic is currently undergoing a phased implementation of the Epic system in the inpatient setting enabling health care providers to examine a patient record across the entire continuum of care. Cleveland Clinic patients may even access their own records via the internet with the Epic MyChart application. Nursing Unit of the Future One of the most visionary nursing projects currently at the Cleveland Clinic is the Nursing Divisions Nursing Unit of the Future, a collaborative project between the Divisions of Nursing and Information Technology. Established on a foundation of defining the ways in which people, processes and technology can improve patient outcomes and nursing practice, the Nursing Unit of the Future evaluates the feasibility of innovative mobile devices, applications and communication technologies that have the potential to support enhanced workflow and documentation of patient care. The Nursing Unit of the Future provides nurses with an opportunity to experience, assess benefits and provide feedback regarding new information technologies prior to implementation. As the nurses evaluate the devices and applications, the Nursing Informatics team evaluates various outcomes criteria including: How devices withstand normal wear and tear How easily information is gathered and recorded User friendliness Clinician satisfaction Time efficiency versus existing methods Impact on patient safety Impact on patient satisfaction Impact on caregiver satisfaction More Promise for the Future The future holds rapid and ongoing paradigm shifts for clinical caregivers, especially in the areas of electronic documentation and physician order entry. Technology promises to eliminate redundancy and improve caregiver efficiency, as well as change nursing practice while it improves patient quality outcomes. For Cleveland Clinic nurses, the future promises an explosion of new information technology that includes, among others- implementation of RFID technology and personalized electronic scheduling - filling open time slots and requesting vacation from the comfort of home. All of these technology advances are designed to keep Cleveland Clinic nurses at the forefront of quality care delivery and the Destination for Nursing Practice. Contact Us: HYPERLINK "mailto:wimmst@ccf.org" Teresa Wimms, RN, Director of Nursing Informatics  HYPERLINK "mailto:oblakm@ccf.org" Marlene Oblak , RN, Nurse Manager, Nursing Informatics Access to Quality Health Care: Links Between Evidence, Nursing Language, and Informatics Beth Ann Swan; Norma M. Lang; Anne M. McGinley Nurs Econ. 2004; 22 (6): 325-332. 2004Jannetti Publications, Inc. Introduction Five years have passed since the Institute of Medicine's (IOM) Committee on Quality Health Care in America launched its initiative on health care quality. One of the products of the committee was a series of quality reports identifying gaps in overall quality in health care in such areas as patient safety, racial and ethnic disparities, and nurses' work environments (IOM, 2000, 2001, 2002, 2003). Each of these reports included problems with health care, an extensive assessment and evaluation of the evidence of the problems including statistical data, and recommendations for closing the gap and improving quality care for all Americans. With both quality and cost in mind, public and private sector organizations have used these reports to examine the evidence base for quality and to drive quality improvements in various areas of the health care delivery system (Swan & Boruch, 2004). For example, the Leapfrog Group (2004), a coalition of purchasers, has advanced three specific quality improvement strategies for metropolitan hospitals, as well as developed a quality index of 27 safe practices. The National Quality Forum (NQF, 2004) has developed over a dozen sets of performance measures, including a "never practices" (adverse conditions that should never happen) program. The goal of NQF is to enable national quality measurement and reporting. The Joint Commission on Accreditation of Health Care Organizations (2004) instituted its "sentinel event" program and more recently its tracer methodology. The National Committee on Quality Assurance (2004) measures the quality of the nation's managed care plans and recently introduced its "Quality Plus" program for Web-enabled health plans. The Agency for Healthcare Research and Quality (2004) supports the National Guidelines Clearinghouse (NGC), the National Quality Measures Clearinghouse, and a quality tools inventory. In January 2004, the Institute of Medicine held its first summit in followup to the Crossing the Quality Chasm (2001) report. The IOM convened a public/private multidisciplinary group to offer strategies to overcome the barriers, both nationally and locally, that confront the health care sector when attempting to improve the delivery of high-quality care to people with chronic diseases. The five diseases targeted were asthma, depression, diabetes, heart failure, and pain control. The recommended strategies were categorized as: (a) measurement, (b) information and communications technology, (c) care coordination, (d) patient self-management support, (e) financing, and (f) community coalition building (IOM, 2004). Specific strategies relevant to accessing quality care in this article are improving information technology infrastructure (measurement), focusing on patient-centered outcomes (measurement), improving public reporting (measurement), using standardized systems (information and communication technology), identifying and disseminating evidence-based self-management practices (patient self-management support), performance-based payment models (financing), and implementing evidence-based benefit design (financing) (IOM, 2004). National nursing organizations have also used these reports to guide their contributions to quality initiatives (Lang & Mitchell, 2004; Mitchell & Lang, 2004; Vahey, Swan, & Lang, & Mitchell, 2004). For example, the American Academy of Nursing's Expert Panel on Quality convened three state-of-the-science conferences since 1996. Recommendations from the conferences reflected five major areas for strategy development including: (a) information technology, (b) nursing language, (c) research, (d) evidence-based practice, and (e) public visibility of nursing (Lamb, Jennings, Mitchell, & Lang, 2004). Related to information technology, for example, current clinical information systems rarely include data elements considered sensitive to nursing care problems and interventions and rarely measure the impact of nursing on patient outcomes. The purposes of this article are to describe, from a nursing perspective, the relationships between public reporting, performance indicators, guidelines, evidence, information technology, language, and accessing quality care; and to propose ways for leveraging the relationships between these multiple quality components. Quality Perspectives In 1974, Lang proposed a model for quality assurance in nursing (Lang, 1975, 2003). The model took the form of a continuous feedback loop beginning with the formation of values, informed by societal and professional values and scientific knowledge. Next, criteria for nursing care and structure, process, and outcome standards were established. The degree of discrepancy between the standards and criteria and the current level of nursing practice was assessed; followed by selecting and implementing an alternative for changing nursing practice, ultimately, leading to improving nursing practice. Terminology for nursing and for quality assurance has changed over the past 30 years, but the process remains the same. The IOM defines quality as, "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (1990, p. 21). This definition identifies the concepts of individual, populations, health services and outcomes, and current professional knowledge. The IOM's quality definition does not include cost; however, its 1974 statement on quality assurance does include the concept of "...resources...chosen to spend for that care" (IOM, 1990, pp. 20-21). Cost concerns often compete with the desire and ability to delivery quality care. Similar concepts are used to define evidence-based nursing practice. In addition, current descriptions of evidence-based nursing practice take into account cost and resources, as well as clinical decision making (Swan & Boruch, 2004). Scientific nursing knowledge is the link connecting the origins of nursing quality assurance to today's evidence-based nursing practice movement made increasingly possible by information technology. Evidence Evidence-based nursing, "is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, and patient preferences, in the context of available resources" (DiCenso, Cullum, & Ciliska, 1998, p. 38). Evidence can be located in a variety of ways, and each source is important. As there has been a dramatic increase in nursing research, there have been increases in ways to use this research. Finding usable evidence requires considerable effort. Methods include searching library and Internet databases and the Internet, as well as hand searching: tracking down gray or "fugitive" literature, such as quality organizations' consensus documents on standards, guidelines, indictors, and measures. The reader is referred to Swan, McGinley, and Lang (2002) for a further discussion of evidence. The NGC and the Cochrane Collaboration are examples of growing resources to find interdisciplinary evidence. Journals such as Evidence-Based Nursing and WORLDviews on Evidence-Based Nursing , begun in the past several years, offer many kinds of evidence for nursing practice. Examples of available evidence resources can be found on Table 1. What is still needed is that each researcher think of disseminating research via these Web sites and journals. Nurses in all clinical settings make hundreds of clinical decisions every day. Patients are sometimes assessed from minute to minute and sometimes over a period of months depending on the nature of the practice. In so doing, nurses identify patient problems/diagnoses based on assessment and collection of patient data. Next, nurses decide on and provide complex interventions. Many of these decisions are strongly influenced by organizational clinical practice guidelines together with professional and personal values. Accurate diagnosis and selection of interventions based on searching and evaluating evidence and research literature at the point of care occurs minimally (Thompson, McCaughan, Cullum, Sheldon, & Raynor, 2002; Thompson, McCaughan, Cullum, Sheldon, & Mulhall, 2001). Therefore, the provision of some nursing care interventions is based on opinion-based decision making with limited attention to evidence-based decision making. For nurses to incorporate higher percentages of evidence-based nursing into their practice, several important components must be in place. The process and issues to consider when implementing evidence-based practice include: (a) identifying the clinical problem based on analysis of current nursing knowledge and practice, (b) searching the published and unpublished literature for applicable and significant research and evidence and asking if sufficient research has been published on the specific clinical problem or issues, (c) evaluating the evidence using established rating schema and asking do nurses have the knowledge and skills to analyze and evaluate the strength of different levels of evidence, (d) choosing nursing interventions based on the quality and strength of the evidence, and (e) developing an evidence-based care plan (Olade, 2004; Swan & Boruch, 2004). Examples of available evidence-based resources related to nursing quality initiatives are listed in Table 2. It is necessary to point out that nurses in clinical practice will never have time to find the appropriate evidence at the time of need unless there is a clinical information and decision support system available at the point of use. There is little time in an active practice to run down the hall to search the Internet or locate hard copies of evidence-based articles. Every health organization must have quick access to available evidence-based information, along with the computerized clinical information system. Dropdown options, alerts, and reminders offering the best nursing evidence are the goals for every clinical information system. If the clinician wishes linkages to more evidence about a topic, this information should be programmed into the system. In addition, in the past 2 decades, nursing research and measurement of nursing quality in acute and nonacute settings has increased markedly (Rantz, 1995; Rantz, Bostick, & Riggs, 2002). This research not only answers questions about clinical components of the practice, but also about the structure components of the practice. Acute care examples include research on nurse staffing and quality indicators (Aiken, Clarke, & Sloane, 2002a, 2002b; Aiken, Sochalski, & Lake, 1997; Dunton, Grajewski, Taunton, & Moore, 2004; Needleman & Buerhaus, 2003; Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002), educational level of hospital nurses and relationship to patient outcomes (Aiken, Clarke, Cheung, Sloane, & Silber, 2003), nurse work environment and nurse burnout on patients' satisfaction with their nursing care (Vahey, Aiken, Clarke, Sloane, & Vargas, 2004), nurse staffing and the quality of nursing care in hospitals (Sochalski, 2004), and the working hours of nurses and patient safety (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). Nonacute care examples include measuring nursing care quality and using large datasets (Rantz & Connelly, 2004; Ryan, Stone, & Raynor, 2004), advanced practice nurse workforce and patient outcomes and health care costs (Brooten et al., 2001; Brooten, Youngblut, Deatrick, Naylor, & York, 2003; Brooten, Brooks, Madigan, & Youngblut, 1998; Brooten, Youngblut, Kutcher, & Bobo, 2004; Naylor et al., 1999). Nursing Language Despite this evidence on nursing's contribution to the quality of care, much of what nurses "do" remains essentially invisible. Lang repeatedly challenges that "If we cannot name it (nursing) we cannot control it, teach it, finance it, research it, or put it into public policy" (Clark & Lang, 1992). How can nurses continue to improve their diagnosing and interventions in practice so that health care consumers are accessing and receiving quality care and nurses' interventions are identifiable and measurable? One way is to use a unified or standardized language to describe the care that is provided and also to be able to take advantage of exploding clinical information system technology. Nurses around the world have been working on developing nursing language (Baernholdt & Lang, 2003; Lang & Clark, 1997). Standardized nursing language "names" the elements of nursing care and facilitates communication among nurses and between nurses and other health care providers. Implementing a standardized nursing language is critical to making the work of nurses visible to health care professionals, health care consumers, payers and regulators of health care, as well as health and public policymakers. Nurses' work must be included in clinical information systems. Nursing language describes the care delivered by nurses in a variety of settings. It enables comparison of nursing data across clinical populations, settings, geographical areas, and time. It demonstrates or projects trends in providing nursing interventions and allocating resources to patients according to their needs, based on nursing diagnoses. It stimulates nursing research through links to data available in nursing information and it provides data about nursing practice in order to influence policy (Baernholdt & Lang, 2003; Coenen, Marin, Park, & Bakken, 2001; Coenen, McNeil, Bakken, Bickford, & Warren, 2001; Elfrink, Bakken, Coenen, McNeil, & Bickford, 2001; Wake & Coenen, 1998). Ultimately, nursing language also makes it possible to easily access evidence-based knowledge stored in national and international databases. Commonly used and recognized standardized nursing language terminologies are listed in Table 3. The reader is referred to original sources listed in the reference section and the American Nurses Association Web site for a detailed description and explanation of each. Using standardized language for nursing diagnosis and nursing interventions allows nurses' activities to be described along side medical diagnoses and medical interventions, and their impact measured in relation to patient outcomes. For example, chronic renal failure is a medical diagnosis identified by ICD-9 code #585. Chronic renal failure is linked with the following nursing diagnoses: activity intolerance, chronic sorrow, death anxiety, decreased cardiac output, excess fluid volume, fatigue, imbalanced nutrition, impaired comfort, impaired urinary elimination, ineffective coping, risk for infection, risk for injury, risk for noncompliance, and risk for powerlessness. Each North American Nursing Diagnosis Association (2004) nursing diagnosis can be connected to a series of Nursing Interventions Classification (NIC) nursing interventions. Nursing interventions for activity intolerance related to chronic renal failure may include activity therapy and/or energy management. Each nursing intervention can be evaluated on the basis of the available evidence and its applicability to the individual patient, group, or population. For example, NIC activities related to energy management are ensuring that the patient changes position slowly and monitoring for symptoms of inactivity tolerance. Patient outcomes may include activity tolerance, endurance, and energy conservation (Ackley & Ladwig, 2003). What is the evidence supporting these nursing interventions in patients with chronic renal failure? What is the evidence supporting the accurate diagnosis, the selection of the right intervention, and the predicted outcome? The ideal clinical information system is connected to a best evidence resource so that nurses need only to click to find it. In all care settings, it is essential to have structure/administrative data, as well as the clinical data for nursing care. In other words, cost-effectiveness determination requires that data are available about the nurses, the hours of care, severity of illness of the patient, as well as the nursing care components (Werley & Lang, 1988). In addition to the importance of standardized clinical language to describe and measure the structure of care, there is a need for accurate description and measurement of the process and outcomes of care (Gallagher & Rowell, 2003). Bolton and Goodenough (2003) describe the debilitating effects of stroke and that the nurse is the "center and the coordinator of the interdisciplinary team" (p. 350). They point out that there are some studies that address resource use in stroke care but are limited because of lack of clinical and financial data. Nursing Informatics Nursing informatics is the vehicle that enables evidence of the effects of nursing interventions to be linked with the outcomes of care in relation to the problems identified for a specific patient or groups of patients (Swan et al., 2002). Nursing informatics addresses the management and processing of data, information, and knowledge to support nursing practice and the delivery of care (Bakken, Cimino, & Hripcsak, 2004; Delaney, 2001). Graves and Corcoran (1989) define nursing informatics as "a combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care" (p. 227). The Division of Nursing uses this same definition for nursing informatics and adds "...to deliver quality care to the public, particularly to disadvantaged and underserved populations" (National Advisory Council on Nurse Education and Practice, 1997, p. 7). The integration of computer science, information science, and nursing science requires a sustainable technology infrastructure to achieve nursing goals related to quality patient care. Computer science or literacy refers to hardware, software, computing power and speed, interconnected networks, understanding of basic concepts, formal representation of evidence in computer-based systems, and the machinery used to access data and information systems. Information science refers to information retrieval, database searching, accessing unpublished studies, coordinating, utilizing, evaluating data and information systems, information management, hand searching, and direct communication with sources. Nursing science includes evidence, guidelines, research, knowledge generation, knowledge integration, decision making, and integration. Management of the outcomes of nursing care that contribute to nursing science is accomplished through the use of information systems, technology, and databases (Plocher & Wilson, 2002). Literacy in these areas of computer science and information science is a basic and fundamental requirement for nursing informatics competency. Core informatics knowledge and computer skills are essential for all nurses to function effectively in the current health care environment (Carty & Phillip, 2001; Travis & Brennan, 1998). Basic computer skills are not the same as being computer literate in managing clinical and administrative information, which is essential for nurses to deliver quality care (Vanderbeek et al., 1994). What is also needed is the involvement of administrative and practicing nurses in the design and implementation of information systems. Often these systems are left to the informatics experts with little or no input from nurses. Even more distressing is that as health systems purchase information systems from vendors, no nursing executive is present at the table (Simpson, 2003). As information systems are developed, the first inclusion has been administrative and financial data. The second wave of content has been physician orders and execution, and use of pharmaceuticals. Simultaneously, much development is underway for virtual use and documentation of radiology tests. Last and rarely included in the information technology priority list is nursing care, especially the nursing problems, interventions, and outcomes in a standardized format to be stored in administrative and clinical data repositories. This lack severely limits science/evidence-based practice, quality improvement activities, cost-effectiveness studies, and the use of the data for nursing research (Maas & Delaney. 2004); for example, nursing information and data set evaluation, integration of nomenclature, clinical content, and clinical data repositories. Technologic and informatics literacy are critical in the 21st century workplace. Information technology has dramatically changed the way nurses work. It is clear that advances in technology and the Internet have transformed consumer and professional access to information and have influenced changes in public policy and the public's role in its health care. The public's expectations are presenting both challenges and opportunities for professionals and communities addressing health issues. Patients will identify more health information online and will take more responsibility for their care. Nurses and other health professionals will assist patients to assess the quality of information (Delaney, 2001; Kassirer, 2000; Stead, 1998; Stead & Lorenzi, 1999). Using evidence and standardized nursing language embedded in information technology systems allows nurses and health care providers to act individually or collectively in performing a wide array of information creation and processing activities (Bakken & McArthur, 2001). Health organization information systems must provide the technology environment that enables nurses to use clinical information systems to access and synthesize information and evidence from a wide variety of sources, to evaluate the quality and importance of accessed information and evidence, to perform relevant manipulations of the information to describe best evidence, and to disseminate the results of their activities. In addition, the clinical data must be aggregated and stored in a data repository where it can be used for clinical research. When clinical data are added to administrative and financial data, cost effectiveness can be determined. As Simpson stated so well, "now more than ever, health care organizations need to understand the costs and how properly to assign resources to patients and they need to track outcomes and few decision support systems can help them do that" (Simpson, personal communication, June 28, 2004). This process can be illustrated by the same continuous feedback loop Lang used to describe quality assurance. It is vital to recognize the need for a paradigm shift in nursing that utilizes new informatics tools required for optimum use of evidence related to the delivery of quality nursing care. An example of these tools, predictive modeling, uses information about health status to predict future health care needs. Evidence is then used to translate that patient information to a predictor of health risks and outcomes (Celebi, 2003). Through the use of artificial intelligence, predictive modeling and evidence-based practice algorithms are being used for disease management (Solz, Liachenko, & Gilbert, 2002). Similar strategies must be developed and implemented for nursing management of patient problems. The speed with which scientific nursing knowledge can not only be generated, but used to improve the quality of health care can be greatly accelerated by linking easily accessible computerized evidence to clinical information systems, and in turn capturing and storing the documented nursing data for new quality improvement and research studies. Informatics is the vehicle to facilitate this linkage. Embedding nursing language within informatics structures is essential to make the work of nurses visible, and articulate evidence about the quality and value of nursing in the care of patients, groups, and populations. NOTE: A preliminary version of this article was presented at the American Nurses' Association 2004 Biennial Convention, Minneapolis, Minnesota in June, 2004. This column is written by members of the American Academy of Ambulatory Care Nursing and edited by Elizabeth Dickey , MPH , RN , FNP . For more information about the organization, contact: AAACN, East Holly Avenue, Box 56, Pitman, NJ 08071-0056; (856)256-2300; (800)AMB-NURS; FAX (856)589-7463; E-mail:  INCLUDEPICTURE "http://images.medscape.com/pi/editorial/patiented/ornaments/check-box.gif" \* MERGEFORMATINET aaacn@ajj.com aaacn@ajj.com ; Web Site:  INCLUDEPICTURE "http://images.medscape.com/pi/editorial/patiented/ornaments/check-box.gif" \* MERGEFORMATINET http://AAACN.inurse.com http://AAACN.inurse.com  INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  Table 1.Selected Internet-Based Evidence Resources Evidence ResourceURL AddressNational Guideline Clearinghousehttp://www.guideline.govEvidence-Based Nursinghttp://evidencebasednursing.comSigma Theta Tau Internationalhttp://stti.iupui.edu/libraryWORLDviews on Evidence-Based Nursinghttp://www.blackwellpublishing.com/journalsGlobal Evidencehttp://www.globalevidence.comCochrane Collaborationhttp://www.cochrane.orgCampbell Collaborationhttp://www.gse.upenn.edu/campbellJoanna Briggs Institute for Evidence Based Nursing and Midwiferyhttp://www.joannabriggs.edu.auSarah Cole Hirsh Institute for Best Nursing Practices Based on Evidencehttp://fpb.cwru.edu/hirshinstitute/aboutWelch Library Online: Evidence-Based Resourceshttp://www.welch.jhu.edu/aboutCentre for Evidence-Based Nursinghttp://www.york.ac.uk/healthsciencesRoyal College of Nursinghttp://www.rcn.org.ukRegistered Nurses Association of Ontariohttp://rnao.org/bestpracticesGerontological Nursing Interventions Research Center Centre for Transcultural Studies in Healthhttp://www.nursing.iowa.edu/centers/gnircCentre for Transcultural Studieshttp://www.mdx.ac.uk/www/rctsh/ebp/main.htm Table 2.Selected Evidence-Based Resources Related to Nursing Quality Initiatives American Academy of Nursing http://www.aannet.orgExpert Panel on Quality Quality Health Outcomes Model State of the Science Conferences 1999, 2002, 2004American Nurses Association http://www.nursingworld.org/quality http://www.nursingworld.org/quality/database http://www.nursingquality.orgPatient Safety and Nursing Quality Initiative (1994) National Database of Nursing Quality Indicators (NDNQI) (1997) Acute Care Indicators: 10 indicators Non-Acute Care Community-Based Indicators National Center for Nursing QualityNational Quality Forum http://www.qualityforum.orgQuality Nursing Performance Measures: 15 indicators Table 3.Recognized Nursing Terminology DatasetsNursing Minimum Data Set (NMDS) (Werley & Lang, 1988) Nursing Management Data Set (NMMDS) (Huber & Delaney, 1998)Classification SystemsAlternative Billing Codes (ABCcodes) (ABC Coding, 2004) Home Health Care Classification (HHCC) (Saba, 1992) North American Nursing Diagnosis Association (NANDA) (NANDA International, 2004) Nursing Interventions Classification (NIC) (McCloskey & Bulecheck, 2000) Nursing Outcomes Classification (NOC) (Johnson, Maas, & Moorhead, 2000) Omaha System for Community Health (Martin & Scheet, 1992) Perioperative Nursing Data Set (PNDS) (Beyea, 2002) International Classification for Nursing Practice (ICNP) (International Council of Nurses, 2001)NomenclaturesLogical Observation Identifiers Names and Codes (LOINC) (Matney, Bakken, & Huff, 2003) Patient Care Data Set (PCDS) (Ozbolt, 1997; Ozbolt, 1999) Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) (Bakken, Warren et al., 2002; College of American Pathologists, 2002)  INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  References ABC Coding. 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Nursing diagnosis in the international classification for nursing practice (ICNP). Nursing Diagnosis: The Journal of Nursing Language and Classification, 9 (3), 111-118. Werley, H.H., & Lang, N.M. (1988). Identification of the nursing minimum data set . New York: Springer Publishing.  INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  Sidebar: Executive Summary Despite evidence on nursing's contribution to the quality of care, much of what nurses "do" remains essentially invisible. It is vital to recognize the need for a paradigm shift in nursing that utilizes new informatics tools required for optimum use of evidence related to the delivery of quality nursing care. Embedding nursing language within informatics structures is essential to make the work of nurses visible, and articulate evidence about the quality and value of nursing in the care of patients, groups, and populations.  INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET   INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  Beth Ann Swan , PhD , CRNP , is an Adjunct Assistant Professor, Family & Community Health Division, and Associate Director, Office of International Programs PAHO/WHO Collaborating Center for Nursing and Midwifery Leadership, University of Pennsylvania School of Nursing, Philadelphia, PA. Norma M. Lang , PhD , RN , FAAN , FRCN , is the Lillian S. Brunner Professor of Nursing, and Director, PAHO/WHO Collaborating Center for Nursing and Midwifery Leadership, University of Pennsylvania School of Nursing, Philadelphia, PA. Anne M. McGinley , PhD , CRNP , is an Associate Professor, and Director, Undergraduate Nursing Program, Jefferson College of Health Professions, Department of Nursing, Thomas Jefferson University, Philadelphia, PA.  HYPERLINK "http://www.medscape.com/viewarticle/497037_print" http://www.medscape.com/viewarticle/497037_print  HYPERLINK "http://www.medscape.com/viewarticle/514532_print" http://www.medscape.com/viewarticle/514532_print Implementing Evidence-Based Nursing Practice Teri Britt Pipe; Kay E. Wellik; Vicki L. Buchda; Carol M. Hansen; Dana R. Martyn Urol Nurs. 2005;25(5):365-370. 2005Society of Urologic Nurses and Associates Posted 10/31/2005  INCLUDEPICTURE "http://images.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  A methodology for establishing and supporting evidence-based nursing practice is examined. Description of a clinical and administrative scenario serves as an example of a systematic appraisal of the relevant literature that had implications for clinical practice. Abstract and Introduction Abstract Within the nursing profession, it is expected that new information in the form of research findings will be incorporated constantly and knowledgeably into nursing practice. The staff nurse is a critical link in bringing research-based changes into clinical practice. Depending on the environment, a health care organization may or may not have the resources to ensure critical, succinct, reasonable evaluation and application of research findings as they relate to the point-of-care delivery. Health care organizations are beginning to create mechanisms to facilitate the process of information translation from the literature to practice. Introduction The Purpose of this article is to describe a methodology for establishing and supporting evidence-based nursing practice (EBNP). After establishing the background for this project, authors describe a clinical and administrative scenario in which an issue was identified that warranted a systematic appraisal of the relevant literature to inform clinicians. An operational definition for EBNP is presented, and a conceptual framework for translating evidence into practice is outlined. Next, a case study is presented to describe the process of critically appraising the evidence and translating the findings into nursing practice, education, and administration. The clinical and administrative outcomes are highlighted and the roles of EBNP team members explained. The hospital described in this article has 205 licensed beds, 15 operating rooms, and a level II emergency department. Inpatient specialty units include critical and intermediate care as well as several medical/surgical units serving various specialties (orthopedics, neurology and neurosurgery, hematology and oncology, bone marrow transplant, solid organ transplant, cardiology, and cardiac surgery). The environment is technology based, with an electronic medical record for all nursing documentation, telemetry available to each inpatient bed, an epilepsy monitoring unit, electronic supply charging, filmless radiology, wireless phones for each nurse, and a robotic surgical system. The hospital staff members are registered nurses assisted by patient care assistants. Staff participation in nursing committees is encouraged. Support staff include unit-based educators and specialty-based clinical nurse specialists (CNSs). Participation in nursing and other clinical research studies is encouraged. In examining the issue of translating research-based evidence into practice, authors focused on collaboration, service, and integration. Each of these components figures prominently in the work performed at the medical center. The approach selected to use research in practice reflects the structure and mission of the organization, which is to provide the best care for the patient using the three "shields" of practice, education, and research. The themes of collaboration, service, and integration were used to weave together the expertise of library sciences and nursing services as well as collaboration among the nursing practice subcommittee (NPS), the nursing education subcommittee (NES), and the nursing research subcommittee (NRS). This project is an example of the integration of the work of these three subcommittees that was presented to the nursing staff in an attempt to identify the best possible service for patients. Evidence-Based Nursing Practice Nursing has a strong tradition of focusing on various ways of knowing to provide excellent care. Carper (1978) identified four fundamental patterns of knowing in nursing: empiric, ethics, personal, and aesthetic patterns. More recently, Fawcett, Watson, Neuman, Walker, and Fitzpatrick (2001) updated and applied Carper's theory. Empirical knowing relates to factual descriptions, explanations, and predictions. Ethics refers to moral obligations, values, and desired ends. Personal knowing pertains to the genuine transpersonal relation between each nurse and each patient. Aesthetic knowing shows the nurse's perception of what is significant in the patient's behavior and also addresses the artful performance of nursing skills and ways of being. All these ways of acquiring, processing, reflecting, and evaluating nursing knowledge are important in developing a comprehensive clinical perspective. Evidence-based practice explores the empiric way of knowing, focusing on Methods of critically appraising and applying available data and research to understand and inform clinical decision-making better. Although it clearly is not the only way of knowing, evidence-based practice provides a way to frame and address questions about how to provide the best patient care. For the Purpose of this article, the following definition of evidence-based practice has been selected: "the integration of best research evidence with clinical expertise, and patient values" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). This definition highlights the importance of combining the best available evidence with clinical judgment, and emphasizes a pivotal role for patient-centered care. Nurses face a real challenge when translating best evidence into clinical practice. For example, the relevant research-based databases are not comprehensive in many areas. Also, there is an ongoing explosion in the amount and type of information available. Time constraints are inherent in clinical practice, and they are exacerbated by increasing demands for nursing care. A need also exists for accurate and systematic ways to make inferences from the research as applied to particular patient populations (Craig & Smyth, 2002). Bridging the gap from research to clinical practice can be accomplished by multiple means. One of the most common is incorporating evidence-based research into an organization's policies and procedures (Craig & Smyth, 2002). However, several operational issues arise. First, numerous small studies have been published in the nursing literature, and evaluating studies for scientific merit can be a large task. In some cases, published guidelines can help reflect national standards and minimize this task. Second, although policies can be changed to reflect current guidelines (developed from the evidence), the critical issue becomes the actual change in nursing practice to reflect evidence-based research. For example, the traditional method for verifying the placement of a nasogastric tube was air insufflation. However, according to current nursing research, the accurate method for verifying placement is radiologic examination (Metheny & Titler, 2001). Presentation of the Clinical Question A question was posed to the NPS about the feasibility of using a method of scoring patient physiologic data to detect early development of the deterioration of a patient's status in the general medical-surgical areas. The belief was that early detection could allow earlier intervention to avert deterioration and perhaps prevent the need for a higher level of care for the patient. After a recognized change in a patient's status, communication among disciplines needs to be timely, accurate, and conveyed so that the patient's actual need and the information provided by the reporter are congruent. The concept was that a screening instrument might facilitate communication between disciplines. The clinical question to be explored was, "Is there evidence to support the use of an early warning scoring system and communication triggers to guide nurses in clinical decision making in the medical-surgical environment?" The NPS elected to approach the question in a scholarly, systematic fashion and contacted the NRS to use an evidence-based nursing practice framework. The subcommittees worked together with representatives from nursing education to ensure a balanced and comprehensive approach. Historical Context: Use of Clinical Scoring Instruments Medical physiologic scoring models have been developed for use in intensive care units (ICUs). The goal of these models has been to use physiologic data to stratify the patient's risk of hospital mortality while in the ICU and provide quality data about resource utilization and efficacy of ICUs (Knaus, Draper, Wagner, & Zimmerman, 1985; Le Gall, Lemeshow, & Saulnier, 1993; Lemeshow et al., 1993). In the critical care environment, use of data is time-driven. Each system requires a substantial commitment of resources (human and technologic). No documented trials of these systems have been attempted in medical-surgical care areas for identifying early deterioration of a patient's status. When outcomes from medical ICUs were investigated, differences in the quality of care (mortality) could be linked specifically to communications and coordination of care by the unit staff(Knaus, Draper, Wagner, & Zimmerman, 1986). McArthur-Rouse (2001) evaluated the feasibility of using a scoring system on general wards in England for early identification of patient deterioration. Providing resources by way of an ICU outreach team was investigated, acknowledging that current staffing levels also affected timely care. The author concluded that the use of early warning scoring systems and specific criteria for notifying physicians required further Discussion. The importance of the ward staff making sense of patient data and communicating the findings to the appropriate person was also emphasized. In another study in the critical care environment, the meaning of time also was important in evaluating the changes in a patient's condition (Peden-McAlpine & Clark, 2002). Coupling the knowledge of the patient's specific situation with the patient's status over time facilitated early recognition of changes. The subsequent "time to act" became clear when the patient-specific data did not fit the pattern expected for the patient. Being familiar with the pattern of change of the patient's condition over time was important for providing good nursing care. Conceptual Model for Translating Evidence Into Clinical Practice Rosswurm and Larrabee (1999) proposed a model for guiding nurses through a systematic process for the change to evidence-based practice (see Figure 1). This model recognized that translation of research into practice requires a solid grounding in change theory, principles of research utilization, and use of standardized nomenclature. The model has the following six phases:  INCLUDEPICTURE "http://images.medscape.com/images/514/532/art-un514532.fig1.gif" \* MERGEFORMATINET  Figure 1. A Model for Evidence-Based Practice Assess the need for change in practice. Link the problem with interventions and outcomes. Synthesize the best evidence. Design a change in practice. Implement and evaluate the practice. Integrate and maintain the practice change.The model provides a pragmatic, theory-driven framework for empowering clinicians in the process of evidence-based practice. The Rosswurm and Larrabee conceptual framework (1999) was used to adapt the existing medical evidence-based practice conferences to an approach that incorporated a focus on nursing phenomena with the goal of teaching nurses the EBNP model, while also evaluating the possibility of changing clinical practice. The application of the model is as follows: Assess the Need for Change in Practice. Is there evidence to support the use of an early warning scoring system and communication triggers to guide nurses in clinical decision making in the medical setting? The issue came to the NPS as part of an examination of current practice. Stakeholders were involved intentionally by asking a staff nurse (who serves as team leader) and a CNS to lead the literature search. Link the problem, Interventions, and Outcomes. Standardized nursing classification systems and nomenclature were used to identify the problem, and the desired outcomes of recognition of early warning signs and prevention of clinical deterioration in medical-surgical patients. Synthesize the Best Evidence. The director of library services used a systematic, organized strategy to guide the nursing literature search using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database. The team read and critically reviewed the literature, and weighed the evidence in conjunction with the clinical nurse researcher. Design Practice Change. A roundtable Discussion was conducted at the EBNP conference, followed by several other focused discussions about practice changes. Several strategies were identified to explore the original issue further and to implement it into practice. For instance, programs have been implemented educating and mentoring nurses in strategies of detecting early warning signs and communicating these effectively to other members of the health care team. Implement and Evaluate the Change in Practice. Currently, the evidence does not support changing practice, but rather building and fortifying systems of knowing the patient, identifying problems early, and communicating and managing changes in patient status in a timely manner. Integrate and Maintain the Change in Practice. This step of the model is pending further evaluation and consideration. As a start, the article by Minick and Harvey (2003) and information from the conference have been included in the Advanced Preceptor Workshop.The nursing evidence-based practice conference had the following objectives, which were adapted from the original medically focused program: Develop knowledge and skills in assembling critically appraised topics based on relevant clinical nursing questions. Recognize knowledge gaps and articulate well-formulated, answerable clinical questions. Search and evaluate the nursing and health sciences literature with guidance and in collaboration with library sciences. An initial review of the citations retrieved indicated a variety of indexing terms of potential interest. The original combination of "medical-surgical nursing" and "decision making, clinical" yielded more than 400 articles. These were narrowed using other key indexing terms. Finally, approximately 20 articles were reviewed and one exemplar article was chosen to represent the state of current literature on the topic. Present evidence-based conclusions with applications to nursing practice. Use group Discussion as a vehicle for education on the EBNP process and for organizational learning. Develop a culture to allow self-perpetuation of the EBNP seminar. Progress learners (staff nurses and CNSs) into facilitators (teachers). Promote continuous self-directed learning as a professional value. Establish a library of electronic and paper EBNP resources. Promote the concept of using best evidence in daily clinical practice. Study and overcome gaps between research and practice. Improve use of informatics and library resources by staff nurses. Encourage clinician use of published critically appraised topics (products of the curriculum). Encourage study of changes in clinician practice patterns. The strategy to accomplish these objectives was planned by representatives from nursing administration, research, and practice, with input from nursing education. The conference was implemented by designing educational sessions in which a staff nurse teamed with a CNS based on self-expressed interest in the topic, and the director of library services helped to search and review the relevant literature. One article was chosen as an exemplar and reviewed in further detail. The article and critique guidelines were distributed electronically to nurses (Minick & Harvey, 2003). Next, the staff nurse and CNS consulted with the clinical nurse researcher to weigh the evidence and to discuss the research methodology used. Team members described their search and the findings in a 1-hour conference, with continuing education credit awarded. The nurse researcher presented a short Discussion on the research methodology used in the article. A small group Discussion (30 to 40 attendees) format was used to critique the article and to provide feedback on the clinical usefulness of the findings. The chair of the NPS described how the specific evidence presented in the conference pertained to institutional practice. The Specific Search Strategy A crucial step in the Rosswurm and Larrabee (1999) model is the synthesis of research findings from the relevant literature. After the clinical problem has been identified, it has to be stated as a clinical question that was focused and answerable by searching the appropriate literature. A focused question is instrumental in selecting components to convert into subject headings, keywords, and limits (publication types, research methodologies, age groups, etc.) to build a precise search strategy. The CINAHL and MEDLINE databases in Ovid were searched. The initial search was conducted in the CINAHL database because the indexing practices and features are designed to meet the unique needs of nursing and allied health professionals (Allen & Levy, 2002). The indexing and other features of searching differ between CINAHL and MEDLINE. Relevant terms and limits must be selected for each database. For example, "research" is an option for limiting retrieval in CINAHL and indicates a research study containing data collection, methodology, and Discussion of Results. This limit is not available in MEDLINE and must be addressed through the use of Medical Subject Headings (MeSH) and limiting by publication type. Unlike studies in therapeutic interventions that are answered by randomized controlled trials or systematic reviews, this question would most likely be found in qualitative research publications using the research limit feature in CINAHL. An initial review of the retrieved citations indicated various terms used to index articles of potential interest. The additional terms were added to the original search strategy to answer more effectively the clinical question. A comparable search was conducted in MEDLINE. No additional studies were identified. The search retrieval was reviewed and the article by Minick and Harvey (2003) was selected for the group Discussion because it mirrored the medical-surgical practice setting of the medical center. Review of the Exemplar Article The article used as an exemplar of the evidence-based nursing literature search strategy was "The Early Recognition of Patient Problems Among Medical-Surgical Nurses" (Minick & Harvey, 2003). It was selected because of its scientific rigor and its focus on the medical-surgical environment rather than on critical care. The study used interpretive phenomenology to describe the process of early recognition of problems by medical-surgical nurses. The sample comprised medical-surgical nurses employed in an urban hospital who were identified by their nurse managers to be skillful in the early detection of patient problems. In-depth, audiotaped interviews were conducted with groups of 2 to 4 nurses, who were asked to describe a clinical scenario in which they thought that they had made a difference by early recognition of a clinical problem. When the data were coded and analyzed, three themes emerged: knowing the patient directly, knowing the patient through the family, and knowing that a change in status is not as expected. Minick and Harvey (2003) concluded that "nurses learn subtle patterns from individual patients...as well as groups of patients...learning the subtle patterns of differences from patients is crucial to the early recognition of patient problems" (p. 296). Furthermore, they stated: "When the nurses in this study recognized patient changes indicating a problem, the nurses felt compelled to consult with the physician even without corroborating objective data. The nurses were willing to risk a negative response from physician colleagues, but when they were direct about the treatment response they expected, then physicians tended to respond positively even without objective data" (p. 297). Lessons Learned An unexpected outcome of the EBNP nursing program was the effect it had on staff nurses. The following quotation aptly summarizes the perspective of staff nurses: "It was immediately clear to me as a registered nurse team leader that because the goal of the evidence-based practice seminar is to teach nurses how to apply the principles of evidence-based practice, the program had far-reaching professional implications." Application of Findings to Practice The Evidence-Based Nursing Practice Seminar participants determined several implications for nursing practice based on the review of the literature. Participants included staff nurses, nurse educators, team leaders, and nursing leadership. Clinical conclusions from this project include the following: Education for the new graduate nurse must include the value of knowing the patient and how to develop the "knowing of the patient." Preceptors can assist the new graduate in the application of general nursing knowledge in specific patient situations and the integration of new patient information as it unfolds in the clinical environment. Explore how nurses' work shifts should be scheduled to allow for continuity of patient assignments (and to enhance knowing the patient). Early communication of the patient's unexpected change in pattern to other members of the health team is essential to facilitate early intervention (sometimes before objective signs, such as vital signs, change). Professional collaboration has the potential to facilitate the best patient care.One of the goals of the process outlined above was a summary statement that would reflect the literature search and critical appraisal of the research. The process was summarized and appears as follows on the authors' internal Web site so that clinicians can quickly access the Results: A systematic search of the nursing literature revealed little support for use of an early warning clinical screening instrument in the adult medical-surgical milieu. Rather, the literature suggests that detecting early warning signs in the medical-surgical setting requires an in-depth knowledge of the patient that cannot be adequately captured in a short scoring instrument. The emphasis is also on accurate, timely, and effective patient management, including communication between nurses and physicians. Conclusion A model for systemically asking a clinical question, searching the relevant literature, critically evaluating the evidence, and applying the Results to the practice setting was described. The Purpose was to educate and mentor nurses in this process, with the overarching goal of enhancing professional nursing care. References Allen, M., & Levy, J. (2002). Evidence-based searching for nursing and allied health. Bibliotheca Medica Canadiana, 23, 90-95. Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-23. Craig, J.V., & Smyth, R.L. (Eds.) (2002). The evidence-based practice manual for nurses. Edinburgh: Churchill Livingstone. Fawcett, J., Watson, J., Neuman, B., Walker, P.H., & Fitzpatrick, J.J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship, 33(2), 115-119. Knaus, W.A., Draper, E.A., Wagner, D.P., & Zimmerman, J.E. (1985). APACHE II: A severity of disease classification system. Critical Care Medicine, 13(10), 818-829. Knaus, W.A., Draper, E.A., Wagner, D.P., & Zimmerman, J.E. (1986). An evaluation of outcome from intensive care in major medical centers. Annals of Internal Medicine, 104(3), 410-418. Le Gall, J.R., Lemeshow, S., & Saulnier, F. (1993). A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. Journal of the American Medical Association,270(24), 2957-2963. Erratum in: JAMA. (1994). 271(17), 1321. Lemeshow, S., Teres, D., Klar, J., Avrunin, J.S., Gehlbach, S.H., & Rapoport J. (1993). Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. Journal of the American Medical Association, 270(20), 2478-2486. McArthur-Rouse, F. (2001). Critical care outreach services and early warning scoring systems: A review of the literature. Journal of Advanced Nursing, 36(5), 696-704. Metheny, N.A., & Titler, M.G. (2001). Assessing placement of feeding tubes. American Journal of Nursing,101(5), 36-45. Minick, P., & Harvey, S. (2003). The early recognition of patient problems among medical-surgical nurses. MEDSURG Nursing, 12(5), 291-297. Peden-McAlpine, C., & Clark, N. (2002). Early recognition of client status changes: The importance of time. Dimensions of Critical Care Nursing, 21(4), 144-150. Rosswurm, M.A., & Larrabee, J.H. (1999). A model for change to evidence-based practice. Image, The Journal of Nursing Scholarship, 31(4), 317-322. Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., & Haynes, R.B. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh: Churchill Livingstone. INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  Teri Britt Pipe, PhD, RN, is a Director of Nursing Research and Chair, Nursing Research Subcommittee, Mayo Clinic, Scottsdale, AZ Kay E. Wellik, MLS, AHIP, is a Director, Library Services, Mayo Clinic, Scottsdale, AZ Vicki L. Buchda, MS, RN, is a Director of Nursing and Chair, Nursing Practice Subcommittee, Mayo Clinic, Scottsdale, AZ Carol M. Hansen, MS, RN, is a Clinical Nurse Specialist, Banner Desert Medical Center, Phoenix, AZ Dana R. Martyn, MSN, RN, is an Assistant Director, RAU/CCO/Trans- port, Banner Estrella Mountain Hospital, Phoenix, AZ. The Role of E-Health in the Changing Health Care Environment Jeffrey P. Harrison, Phd, Mba, Mha, Fache; Angela Lee, Msh, Ches Nurs Econ. 2006;24(6):283-288. 2006Jannetti Publications, Inc. Posted 02/21/2007  INCLUDEPICTURE "http://images.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  Summary and Introduction Summary The role of the Internet in health care information access and delivery is increasing rapidly as evidenced by the fact that 86% of adults with Internet access have used it for health-related information and health queries represent 37% of their total Internet usage. Consumers (50%) demonstrate significant interest in accessing their own medical information via the Internet as well as describe themselves as likely to switch providers in order to communicate electronically with their physician (33%). While privacy and information quality present notable risks, the opportunity for e-health technology to improve access to information, reach rural or underserved populations, reduce care delivery costs, and integrate health care services and information is significant. The role of nursing in this growing e-health market will be best supported if nurses play a role ranging from system architect to expert end-user, all requiring additional basic training and continuing education.Introduction There Are Over 100,000 Web sites worldwide with varying quality of health information that are used by consumers and professionals (Kwankam, 2004). Additionally, several hundred million people world wide use the Internet (Maloney, Ilic, & Green, 2005). In 2001, 86% of all adults in the United States with Internet access consulted it for health-related information and 90% of primary care physicians used the Internet (Kwankam, 2004). Of those adults using the Internet, health information results in approximately 37% of their Internet usage (Appleby, 2000; Maloney et al., 2005). The study results presented here are significant because they provide the latest data on leveraging information technology to improve quality and efficiency in the health care industry. Key to this improvement is use of the Internet as a global communications network. The volume of health and medical research information continues to grow. Consider, on an average day, there are 55 new clinical trials taking place, 1,260 articles indexed in MEDLINE, and 5,000 papers published in the biomedical sciences (Kind & Silber, 2004). As a result, there is an urgent need for tools, referred to as e-Health, that can aggregate information from multiple sources to give an overall understanding of clinical modalities and the health care system. According to Kind and Silber (2004), there were only 52 articles listed in Medline with e-Health in the title until the year 2000. However, there is growing interest in e-Health within academic medicine and the Internet is being integrated into health care professionals training programs (Kwankam, 2004; Maloney et al., 2005). The speed with which new technologies and treatments are being developed means that many clinical providers are dependent on the Internet to gain current information on clinical practice guidelines. As a result, the use of the Internet has significant potential to improve health care decision making, enhance health management, and produce better patient outcomes (Maloney et al., 2005). Defining E-Health E-Health emerged early in the 21st century and is an all-encompassing term for the combined use of electronic information and communication technology in the health sector. This term refers to that technology used for clinical, educational, research, and administrative purposes, both at the local site and across wide geographic regions. The use of e-Health has enhanced networking, facilitated global thinking, and improved health care on local, regional, and national levels (Cashen, Dykes, & Gerber, 2004). While some definitions associate e-Health strictly with the Internet, the term broadly refers to any electronic exchange of health-related data collected or analyzed through an electronic connectivity for improving efficiency and effectiveness of health care delivery. Therefore it is often used to describe virtually everything related to computers and medicine (Cashen et al., 2004; Deluca & Enmark, 2000; Kind & Silber, 2004; Kwankam, 2004). The goals of e-Health can be summarized to include increased efficiency in health care, im proved quality of care, increased commitment to evidence-based medicine, empowerment of patients and consumers, and the development of new relationships between patients and health professionals (Austin & Boxerman, 2003). From a global perspective, e-Health can be used to disseminate health information as well as ensure that the most current information is used to improve people's health (Kwankam, 2004). Rural areas may be the greatest benefactors of e-Health by having easier access to information and access to telemedicine services (Kwankam, 2004). According to Richards and colleagues (2005), the use of e-Health in rural areas is important because 95% of respondents have used the Internet and many have access to scanners, digital cameras, and videoconferencing. E-Health networks can remove time and distance barriers to the flow of health information and can help to ensure that collective knowledge is brought to bear effectively on health problems throughout the world (Kwankam, 2004). Austin and Boxerman (2003) describe four areas of e-Health: e-Business, consumer marketing, organizational management, and clinical customer service. Some of these are accessed via the public Internet, while others are restricted by passwords on Intranets or local area networks. According to Deluca and Enmark (2000), e-Business in cludes online procurement processing between health care providers and suppliers, online electronic claims processing, eligibility authorization from insurance companies, and consumer purchase of prescription drugs and health insurance. As of 2000, electronic claims submission and materials management were the most widely implemented e-Health technologies in health care. As an example, one large practice association automated nearly half of their claims volume with an Internet-based claims submission system and reduced their per-claim processing cost by almost 40% (Deluca & Enmark, 2000). Consumer marketing includes the use of Web sites to showcase organizational information to attract new patients and provide wellness information and disease-specific information to existing patients. Organizational management includes posting employee information on a company Intranet Web site, delivering educational programs, listing job announcements, and announcing employee health benefit programs. It also includes administrative processes such as billing management and strategic planning. Clinical customer service includes patient access to medical information via electronic health records allowing them to conduct risk assessments of their own health and include patient-physician interaction using e-mail. According to Kind and Silber (2004), e-mail communication can provide an opportunity for patients with Internet access to e-mail questions and receive responses from their physicians. This form of electronic contact shows promise as a means of enhancing communication and facilitating interactions between patients and the health care delivery system (Kind & Silber, 2004). One survey found that 50% of patients expressed an interest in accessing their personal physician's Web site or e-mailing their physician, and one-third considered themselves likely to switch providers in order to e-mail their physician (Deluca & Enmark, 2000). Additional clinical applications include real-time alerts, clinical screening, and access to reference materials for physicians. Many clinicians now keep patient information in an electronic format and access this information by downloading into handheld computers or personal digital assistants (PDAs) whenever patient-specific decisions need to be made (Pancoast, Patrick, & Mitchell, 2003). In 2004, 40% of practicing physicians owned a PDA, up from 19% in 2001 (Chin, 2005). This represents more than four times greater PDA usage among physicians than the usage rate of consumers (Chin, 2005). However, PDA's have yet to be used to their fullest potential in medicine and new developments may encourage greater usage. Smart phones will continue to evolve into mobile computing devices that will have computer capabilities and still fit in your hand (Chin, 2005). Current Status of E-Health According to Appleby (2000), health care has historically underinvested in information technology (IT); however, e-Health is receiving a significant portion of new IT spending. Data for this research was drawn from the 2005 HIMSS Analytics database which surveyed almost 4,000 hospitals in the United States and provided extensive data on the hardware, software, and information technology infrastructure within health care organizations. Access to the HIMSS analytics 2005 database was obtained from HIMSS Analytics by the University of North Florida Health Admin istration Program for research purposes. Data were collected and updated by the HIMSS Analytics staff. The HIMSS Analytics 2005 data represents a comprehensive collection of public and private U.S. hospitals. As noted in  HYPERLINK "http://www.medscape.com/viewarticle/551712_Tables" \l "T1" \t "Tables" Table 1 , the HIMSS Analytics database found that of those hospitals responding, the annual expenditure on information technology was 2.3% of total operating expenses resulting in an average annual investment of $2.3 million. The data also indicate that 13.8% of hospitals currently use biometric technology and an additional 8.4% plan to purchase biometric technology. The data show that 25% of responding hospitals purchased a computerized practitioner order entry system while only 4.3% mandated its use. It is also interesting to note that 2.1% of reporting hospitals provide contract information technology services to other health care organizations through outsourcing agreements. According to Deluca and Enmark (2000), the Internet drove the initial development of e-Health applications. Now, it is suggested that employers and engaged consumers are fostering the continued development of new e-Health applications (Austin & Boxerman, 2003). Access to health care on the Internet by women is growing with eight out of ten women choosing their children's doctors and two-thirds of women choosing their family's health plan via online e-Health applications (Boeke, 2000). This supports the premise that e-Health via the Internet creates more flexibility and options among health care consumers. According to Austin and Boxerman (2003), by 2004 the e-Health industry will have generated $370 billion in revenues. According to Deluca and Enmark (2000), the early adopters of e-Health are willing to accept the risks inherent in technology development as well as low return on investment in order to take advantage of consumer-oriented programs. Pros and Cons of E-Health As discussed by Austin and Boxerman (2003), the key stakeholders in the e-Health industry include employers, patients, providers, and health plans. Employers want to analyze health care costs and utilization by their employees. Patients want information about their own health. Providers want to save time and money by streamlining communications. Health plans want to strengthen relationships with members and providers while reducing the cost of doing business (Austin & Boxerman, 2003). For patients, who can also be viewed as consumers, e-Health represents an opportunity to change their relationship with providers and insurance companies. Opportunities for improved communication include provider messaging, access to electronic medical records, and the ability to access information about alternative approaches to medical treatment. Patients generally get only 10 minutes of face-to-face time with their physician and through e-Health have access to thousands of health care Internet sites where they can gain unlimited health information. Also, it can take a week to get a return phone call from a physician and almost a month to get a regular office appointment (Deluca & Enmark, 2000). According to Cashen et al. (2004), the potential for e-Health technologies to educate patients and promote improved self-management skills is well documented. Employers face growing health care costs, which jeopardize their competitive position in the international market. Since health care costs are a large share of product cost, employers are seeking new and innovative approaches to improve efficiency and quality in health care. As a result, employers are becoming engaged in activities such as the Leapfrog Group, which review the cost and quality in health care because they see this involvement as essential to economic viability. Some organizations consider the Internet as a way to streamline health care administrative costs and improve communication among the various health care organizations (Meyers, Van Brunt, Patrick, & Greene, 2002). Since employers negotiate benefits packages, review geographic coverage, and maintain a benefits administration staff, it is estimated that administration costs add up to $10 billion a year to U.S. health care costs (Meyers et al., 2002). In addition, many of the company health promotion activities are offered through the organization's Intranet site because they reduce health care costs and improve productivity (DeGroot & Kiker, 2003; Sofie, 2000). Providers view e-Health as an opportunity to improve efficiency, reduce administrative costs, facilitate communication, and en hance patient care (Kirshenbaum, 2002). While providers are also interested in the use of PDAs at the point of care, the cost and lack of connectivity with electronic medical records and clinical practice management software are continuing problems (Kirshenbaum, 2002). According to Chin (2005), U.S. medical schools are increasingly requiring the use of PDAs and related information as a mechanism to promote efficiency and safety in health care. As the public use of the Internet grows, health care organizations are using this opportunity to reach a large part of the population cost effectively (Deluca & Enmark, 2000). This includes using the Internet for marketing, patient education, administrative transactions, establishing new relationships with consumers, and increasing operational efficiency (Appleby, 2000). The greatest barrier to e-Health is the difficulty for consumers to find accurate and reliable information (Maloney et al., 2005). According to Dutta-Bergman (2004), the two critical indicators of e-Health information quality are source credibility and information completeness. Medical experts suggest that health information provided by a source that is not credible is detrimental to consumer outcomes. Also, unless health information is complete, it is likely to mislead the consumer into making incorrect decisions. The completeness of health information is considered the single most important criterion in health care decision making (Dutta-Bergman, 2004). Since the Internet as a communications system is relatively uncontrolled, initiatives have been introduced in an attempt to improve the quality of Internet-based health information. One such control is the Health on the Net (HON) code, which offers a stamp of approval for Web sites adhering to agreed quality principles. Similarly, Health Internet Ethics (Hi-Ethics) has developed the "e-Health Code of Ethics" in an effort to respond to concerns regarding reliability of information, privacy, and confidentiality (Kind & Silber, 2004; Maloney et al., 2005). The Health Insurance Por tability and Accountability Act (HIPAA) Privacy Rule expanded federal regulations about the confidentiality of patient information and some organizations are reluctant to implement e-Health technology. However, a major provision of HIPAA was to expand electronic data exchange between payer and provider entities (Kind & Silber, 2004). Therefore, the adoption of electronic data exchange has the potential to improve efficiency, facilitate electronic claims processing, and enhance patient outcomes. How ever, it also imposes a requirement to safeguard patient data in the face of increased risks (Pancoast et al., 2003). From a societal perspective, there are technological, organizational, managerial, and ethical implications associated with e-Health proliferation (Deluca & Enmark, 2000). According to Cashen et al. (2004), the most vulnerable people in our society may be the least able to benefit from e-Health due to cognitive, social, and cultural barriers. These barriers include literacy, cultural differences, language differences, access to technology and educational deficiencies (Cashen et al., 2004). Only through conscious efforts to address these barriers can e-Health initiatives be expanded to meet a broad range of society's needs. Future Developments in E-Health As technology continues to improve, the e-Health industry will revolutionize health care in America. Providers will increasingly utilize automated systems to verify eligibility from payers as well as process claims; patients will have access to electronic medical records as well as condition-specific clinical data from providers; and employers will sponsor disease management and wellness programs for their employees (Deluca & Enmark, 2000). As discussed by Austin and Boxerman (2003), e-Health will become a major factor in the infrastructure of health care. However, due to the open architecture of the Internet, organizational policies and procedures are needed to guarantee the privacy and integrity of e-Health systems. These policies need to focus on data security as well as the other ethical issues pertaining to e-Health (Kind & Silber, 2004). The emerging field of biometric technology provides the capability to enhance data security through the identification of an individual's biological trait. According to Altee and colleagues (2004), biometric security technology will be in common use by 2010 to protect patient information. Additionally, Nara yan swamy, Johnson, Silveira, and Wach (2005) document the biometric use of the human iris in the area of security recognition applications. However, the full potential of e-Health will only be realized through greater investments in telecommunications equipment and supporting information technology (Richards et al., 2005). According to Chun, Kang, Kim, Park, and Kim (2005), the use of clinical biometric technology through a personal wearable device allows patients to be monitored at home via a telehealthcare system. Managerial Implications These results have important managerial implications as the U.S. healthcare industry faces a more competitive environment. Low profits, combined with increasing health care inflation, place health care organizations at a distinct disadvantage. As discussed by Harrison and Sexton (2004), many hospitals are experiencing low return on assets which, when combined with high levels of debt, make further investment in expensive information technology difficult. Health care executives who wish to improve efficiency and profitability are challenged to implement meaningful programs that can positively affect the organization's financial status. This study demonstrates that the implementation of e-Health programs may be an opportunity to improve efficiency and reduce costs in their institutions. Additionally, the coordination of care across multiple facilities within an integrated health system may enhance efficiency. This was supported by Harrison, Nolin, and Suero (2004) who found that greater coordination of clinical services enhances operational efficiency and im proves organizational profitability. Implications for Nursing Leadership As key stakeholders in the health care industry, nursing support is critical to the development and implementation of e-Health initiatives. Additionally, as coordinators of health care services, nurses function as patient advocates as well as resource sponsors. These factors make nurses critical to the delivery of high-quality and cost-efficient health services (Harrison et al., 2004; Ramsey, Ormsby, & Marsh, 2001). Therefore nurse leadership must understand the technical characteristics of health information technology as well as the clinical capabilities of e-Health within the health care system. Since the health care information technology landscape is changing so rapidly and health information courses are not routinely included in nursing curriculum, it is incumbent on nursing leaders to foster an environment among the clinical staff to support new and innovative uses of information technology. More importantly, nursing leadership is in a unique position within the health care industry to take the lead in leveraging health information technology to en hance the quality of patient care. Policy Implications This research shows that health care organizations are investing in information technology and are implementing e-Health programs. Additionally, the data indicate that e-Health initiatives such as telecommunications systems have the potential for significant improvement in health status in rural communities. How ever, further study is necessary to determine whether barriers to e-Health in rural communities such as the lack of resources, lower education levels, or large Medi care populations negatively im pact the implementation of e-Health programs. From a policy perspective, directing additional resources into e-Health initiatives has the potential to reduce health care cost while improving the health status of patients at the regional and national levels. Faced with the rapid growth of the elderly population, e-Health initiatives may help meet the challenges of providing efficient, cost-effective care for this population. Success ful e-Health programs should be studied not only for financial impact but also to identify opportunities to integrate care within local and regional health care organizations. Policymakers at the local and national levels need to further evaluate e-Health as a mechanism to coordinate preventive services, outpatient care, and inpatient health services. According to Kwankam (2004), e-Health systems are essential to keeping pace with the exponential growth of health information and to applying this knowledge to resolving world health problems. E-Health technology has already demonstrated the ability to provide access to information that will result in improved quality of care for patients. It will also allow for more efficient use of medical resources, a reduction in administrative costs, and facilitate collaboration across the continuum of care (Kirshenbaum, 2002). While not addressed by this study, e-Health has the ability to reduce health care errors by providing the most appropriate disease-specific clinical care protocols. Addition ally, it supports evidence-based medicine as a mechanism to increase the quality and efficiency of the health care system by providing the information technology necessary for communication within provider networks. By linking researchers, clinicians, health care providers and patients, e-Health can reduce malpractice liability while enhancing quality of care. Future initiatives in e-Health will empower consumers to use health information technology to enhance their knowledge of disease processes and improve their health status. However, we must recognize that e-Health is de signed to support the relationship between patients and their health care providers and can never substitute for the personal interaction between patient and provider (Kind & Silber, 2004). CE Disclaimer Print Version of this article was originally certified for CE Credit. For accreditation details, please contact the publisher, Anthony J. Jannetti, Inc., East Holly Avenue Box 56, Pitman, New Jersey 08071-0056.  INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  Table 1.Status of Information Technology (IT) in U.S. Hospitals  INCLUDEPICTURE "http://images.medscape.com/images/551/712/art-ne551712.tab1.gif" \* MERGEFORMATINET   INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  References Altee, K., McLaughlin, N., Corkhill, E., Beavans, I., Broderick, M., & Green, M. (2004). Readers' perspective. By 2010 biometric security technology will be commonly used to protect patient information. Health Data Management, 12(1), 64. Appleby, C. (2000). Healthcare.com. Trustee, 53(1), 18-22. Austin, C., & Boxerman, S. (2003). Information systems for healthcare management (6th ed.). Chicago: Health Administration Press. Boeke, A. (2000). Women and e-health. Health Management Technology, 21(12), 48. Cashen, M., Dykes, P., & Gerber, B. (2004). eHealth technology and internet resources: Barriers for vulnerable populations. The Journal of Cardio vascular Nursing, 19(3), 209-217. Chin, T. (2005). Untapped power: A physician's handheld. American Medical News, 48(2), 25-26. Chun, H., Kang, J., Kim, K.J., Park, K.S., & Kim, H.C. (2005). IT-based diagnostic instrumentation systems for personalized healthcare services. Studies in Health Technology Information, 117, 180-190. DeGroot, T., & Kiker, S. (2003). A meta-analysis of the non-monetary effects of employee health management programs. Human Resource Manage ment, 42(1), 53-69. Deluca, J., & Enmark, R. (2000). E-health: The changing model of healthcare. Frontiers of Health Services Management, 17(1), 3-15. Dutta-Bergman, M. (2004). The impact of completeness and Web use motivation on the credibility of e-health information. Journal of Communication, 54(2), 253-269. Harrison, J.P., Nolin, J., & Suero, E. (2004). The effect of case management on U.S. hospitals. Nursing Economic$, 22(2), 64-71. Harrison, J., & Sexton, C. (2004). The paradox of the not-for-profit hospital. The Health Care Manager, 23(3), 192-204. HIMSS Analytical Database. (2005). Chicago:Author. Kind, T., & Silber, T. (2004). Ethical issues in pediatric e-health. Clinical Pediatrics, 43(7), 593-599. Kirshenbaum, D. (2002). Ehealth: Past, present, & future. Powerpoint presentation - West End Associates. Retrieved April 1, 2005, from http://www.nehimss.org/pubs/Kirshenbaum.ppt Kwankam, S. (2004). What e-Health can offer. World Health Organization: Bulletin of the World Health Organization, 82(10), 800-802. Maloney, S., Ilic, D., & Green, S. (2005). Accessibility, nature and quality of health information on the Internet: A survey on osteoarthritis. Rheuma tology, 44(3), 382-385. Meyers, J., Van Brunt, D., Patrick, K., & Greene, A. (2002). Personalizing medicine on the Web. Health Forum Journal, 45(1), 22-26. Narayanswamy, R., Johnson, G.E., Silveira, P.E., & Wach, H.B. (2005). Extending the imaging volume for biometric iris recognition. Applied Optics, 44(5), 701-712. Pancoast, P., Patrick, T., Mitchell, J. (2003). Physician PDA use and the HIPPAA privacy rule. Journal of the American Medical Informatics Association, 10(6), 611-612. Ramsey, C., Ormsby, S., & Marsh, T. (2001). Performance-improvements strategies can reduce costs. Healthcare Financial Management (Suppl.), 2-6. Richards, H., King, G., Reid, M., Selvaraj, S., McNicol, I., Brebner, E., et al. (2005). Remote working: Survey of attitudes to eHealth of doctors and nurses in rural general practices in the United Kingdom. Family Practice, 22(1), 2-7. Sofie, J. (2000). Creating a successful occupational health and safety program: Using workers' perceptions. AAOHN Journal, 48(3), 125-131.Acknowledgements The authors would like to thank HIMSS (Healthcare Information and Management Systems Society) Analytics for access to the 2005 HIMSS AnalyticsSM Database for research purposes.  INCLUDEPICTURE "http://www.medscape.com/pi/global/ornaments/spacer.gif" \* MERGEFORMATINET  Jeffrey P. Harrison, Phd, Mba, Mha, Fache, is an Assistant Professor, Department of Public Health, University of North Florida, Jacksonville, FL. Angela Lee, Msh, Ches, is the Wellness Director, Avanti Wellness Center, Saint Augustine, FL. Disclosure: The authors reported no actual or potential conflict of interest in relation to this continuing nursing education article.  HYPERLINK "http://www.medscape.com/viewarticle/551712_print" http://www.medscape.com/viewarticle/551712_print  HYPERLINK "http://find.galegroup.com/itx/retrieve.do?contentSet=IAC-Documents&resultListType=RESULT_LIST&qrySerId=Locale%28en%2C%2C%29%3AFQE%3D%28KE%2CNone%2C27%29nurse+AND+computer+literacy%24&sgHitCountType=None&inPS=true&sort=DateDescend&searchType=Bas Time shortages and a poor knowledge of computers are preventing nurses getting hold of new research and using it in their practice, the conference heard.(Brief Article).  HYPERLINK "http://find.galegroup.com/itx/publicationSearch.do?queryType=PH&inPS=true&type=getIssues&prodId=HRCA¤tPosition=0&userGroupName=nysl_nc_ncrefres&searchTerm=Nursing+Standard&index=JX&tabID=T002&contentSet=IAC-Documents" Nursing Standard17.31(April 16, 2003):p7(1). Time shortages and a poor knowledge of computers are preventing nurses getting hold of new research and using it in their practice, the conference heard. That was a conclusion from a study by nurse researcher Dorothy McCaughan, from the University of York, who investigated how nurses are impeded from accessing research papers. 'It wasn't just about proximity to computers--they said they did not know how to use them.' Timmons, S. (2003). Nurses resisting information technology. Nursing Inquiry, 10(4), 257-269. Resistance in the workplace, by nurses, has not been extensively studied from a sociological perspective. In this paper, nurses' resistance to the implementation and use of computer systems is described and analysed, on the basis of semistructured interviews with 31 nurses in three UK NHS hospitals. While the resistance was not "successful", in that it did not prevent the implementation of the systems, it nonetheless persisted. Resistance took a wide variety of forms, including attempts to minimise or "put off" use of the systems, and extensive criticism of the systems, though outright refusal to use them was very rare. Resistance was as much about the ideas and ways of working that the systems embodied as it was about the actual technology being used. The patterns of resistance can best be summed up by the phrase "resistive compliance". Wears, R., & Berg, M. (2005). Computer technology and clinical work. JAMA, 293(10), 1261-1263. Wolf, D., Greenhouse, P., Diamond, J., Fera, W., & McCormick, D. (2006). Community hospital successfully implements eRecord and CPOE. CIN: Computers, Informatics, Nursing, 24(6), 307-316. The objectives of this study were to undertake a systematic review to determine the effectiveness of information skills training, to identify effective methods of training and to determine whether information skills training affects patient care. A systematic review, using an iterative approach to searching, was employed. Studies selected for inclusion in the review were critically appraised using a tool used in previous reviews. A tabular approach was used to provide a summary of each paper allowing synthesis of results. One thousand, three hundred and fifty-seven potentially relevant papers were located. On the basis of titles and abstracts, 41 potentially relevant studies were identified for potential inclusion. Further reading and application of the inclusion criteria left 24 studies for critical appraisal and inclusion in the review. Study designs included randomised controlled trials, cohort designs and qualitative studies. The majority of studies took place in US medical schools. Wide variations were found in course content and training methods. Eight studies used objective methods to test skills, two compared training methods and two examined the effects on patient care. There was limited evidence to show that training improves skills, insufficient evidence to determine the most effective methods of training and limited evidence to show that training improves patient care. 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