Health Informatics: An Issue of Social Justice

Looking back over the last few weeks, it's easy to understand why there has been such a large push in the adoption of technology and EHRs. Despite most people are familiar with social media and have some form of access to online resources, some people are vulnerable to being left out of the technology bandwagon.

Since technology has become such a prevalent information sources in society, people often forget about those who have limited to no access. While these people may get by in day to day life without the use of technology, what happens when their health is included into the equation?

Is health and health information access a human right?

Today I will explore those who are vulnerable to health inequalities and inequities regarding eHealth, and discuss whether health information technologies are bridging or widening the gap in health access.

To begin, let's define and distinguish the terms inequality and inequity, as these are often wrongly used interchangeably. I will be applying these two concepts to social issues that are present for vulnerable individuals.

Equality--> A concept that means that everyone receives the same portions of a resource. This works well and seems to make sense, but it only works if everyone has the same to begin with. If each person starts with the same amount, then equal division of assets is fair. Since people come from different backgrounds, this means they still end up with disproportion amounts of information.

Equity--> Equity is focused on fairness and giving people equal access and opportunities to resources. To ensure that everyone can enjoy the same thing, society must first acknowledge equitable rights. Equity may mean giving people different amounts, but it is so they finish with the same result. 

(Braveman & Gruskin, 2003)

When it comes to health, who are those who are consider vulnerable? Meaning, who is at a disadvantage for accessing and using health technologies and what are the barriers that causes these inequalities?

Accessibility 

• Do not own a computer
• No digital connection/ satellite signal
• Rural locations
• Limited physical ability to use technology

Education

• Not trained/ familiar with using computer/ social media
• Poor literacy decreases understanding of information available
• Increases feelings of isolation or inadequacy

Income/ Social Status

• Technologies are expensive
• May not have social support-- no online community

The groups who face these challenges are put at risk for isolation related to a society with increased technology use. Those who are at risk include homeless and those below the poverty line. These people often cannot afford computers and are unable to keep up with the constant updates. As well, those who are uneducated face information poverty. Elderly people are at increased risk for isolation as many of the programs are difficult to use, with small print and their social circles are less likely to be online (Taylor, 2011).

While there are many barriers that face these vulnerable populations, social media and technology can also address these issues. Social media provides an opportunity to raise awareness about global issues, and can help reduce feelings of loneliness. As well, online communities provide support to those looking to go back to school, and over 90% of job applications are posted to the internet. 

To help provide vulnerable populations with equal access to these online opportunities, nurses can help address the inequities they face. We need to public access to computers through libraries and open computer labs in schools. As well, funding to help education people on how to properly use these technologies and set up an online community group to begin a foundation of support for these peoples (Kaminski, 2011).

In the nursing community, I understand that technology can overall help address and overcome the social justice issues that face these populations. Since I come from a northern, rural town, I understand that living in a remote location can affect access to healthcare. There is a shortage of physicians and it is often difficult to receive specialized care.

Technology and online programs can actually help bridge this gap. Through webcams, doctors and nurses are able to connect with patients in the community to say up to date with their health history. Not only does this address access to care issues, but also is convenient for both the client and physician. Consider the video on the right, this video shows how tele-medicine bridges this gap (Cox, Mahone & Merwin, 2008). 

While health inequities exist during the implementation of eHealth and EHRs, online technologies can also help answer this social divides. Nurses can advocate for the patients who do not have access to computers. Through the health facility nurses can provide vulnerable groups with the necessary knowledge to maintain control of their health, and at the centre of their care (CNA, 2009).

---Student Nurse Katie

References

Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology and Community Health, 57(4), 254–258. doi: 10.1136/jech.57.4.254

CNA. (2009). Social justice in practice. Ethics in Practice for Registered Nurses. Retrieved from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/Ethics_in_Practice_April_2009_e.pdf

Cox, K., Mahone, I. & Merwin, E. (2008). Improving the quality of rural nursing care. PubMed. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18709750

Kaminski. (2011). Using communicative and creative technologies to weave social justice and change theory into the tapestry of nursing curriculum. Nursing-Informatics. Retrieved from http://www.nursing-informatics.com/socialjustice.html

Taylor, A. (2011). Social media as a tool for inclusion. Final Report for the Horizontal Policy Integration Division (HPID) of HRSDC. Retrieved from: http://www.homelesshub.ca/library/social-media-as-a-tool-for-inclusion-51607.aspx

Policy Issues and Health Informatics

This week focuses on the policies that come into play when technology is incorporated into healthcare settings.

Consider the barriers that have been discussed in previous posts that can occur from when computers, iPhones, iPads, and EHRs are implemented into hospitals and health facilities.

• Personal health information being shared--> confidentiality and privacy breached
• Organization and data accuracy
• Nurse accountability and advocacy issues

Theses concerns can be addressed by implementing policies in institutions to create secure, safe, and educative environments.  

Policies provide standards and guidelines that help to address issues the are present that take action for effective change. These policies include plans and decisions that provide guiding principles that nurses, physicians and members of institutions are responsible for upholding. Policies are established for a specific goal that enhances a facility and workplace. In the transition in a more technology focused workplace, policies are vital in meeting the needs of consumers and bridging these barriers. 

The World Health Organization (WHO) defines an operational and successful policy has having the following characteristics:

                    1) Defines a vision for the future

                             -  Must have specific, clear goals that address explicit concerns or issues. 

                    2) Outlines priorities and expected roles of different groups/ parties

                              -  Labels what each person is responsbile for, relates to patients, HCPs, institutional                                         officials

                    3) Builds consensus and informs people

                               -  The public and workers have a common goal and must be informed

At every level there are different types of policies that govern nursing practice. 

                   Institutional --> Policies that apply specific institutions (hospital level)

                   Municipal-->Policies enforced by a municipality, city or community

                   Federal--> Applied at federal, provincial level (CNO, RNAO)

                   National--> Policies enforced by the nation governing body ( CNA)

                   International--> Global policies that set guidelines (WHO)

There are many policies that are currently present that apply to some of the concerns regarding eHealth, but nurses may have to take a significant role in implementing new change. Creating new policies is a dynamic and cyclical process that depends on on involvement from both the consumer (patient) and the institution (Rochon, 2010). 

Nurses must take an active role in recognizing where policies and guidelines are lacking. To formulate policy, specific common goals that unify the community are needed to be addressed. A clear and concise plan must be formed (Lomas, 2007). 

The nurses responsibilities to recognize where barriers exist. This involves having a thorough understanding of how technology is working to meet the needs of the health care provider and the patient. When inadequacies arise, nurses need to take initiative to reduce the barrier. For example, when patients find that their perception of illness is missing and being omitted from the EHR, nurses need to work with their eTools and the patient to fill the gaps. Patient-gathered data is an effective way to help address the patient perspective to understand inadequacies (Koliner & Flatley Brennan, 2013). 

The next step in policy construction is policy realization, and putting ideas into action. Many nurses are apprehensive in taking charge in their workplace and bringing concerns to the attention of their workplace (Perna, 2013). While this can be overwhelming, nurses should feel empowered to take a stance in their community to advocate for health rights. Nurses should partner with the inter-professional team and work with their patients to find the root of problems and make them known to the appropriate policy level. 

For instance, nurses and HCPs should advocate for policies that ensure adequate training regarding technology at the institutional level. By ensuring that technologies are properly used nurses are able to promote health privacy and security, and able to work efficiently. As well, this ensure that there is continuity of care, and that the health care team can work more cohesively via practice permissive policies (Koliner & Flatley Brennan, 2013). . Thus creating a properly trained network of health care providers who all understand the history of the patient. This policy will help meet and reduce barriers before they occur.

Policy learning requires the nurse to evaluate the effectiveness of policies and monitor changes. Once policies have been formulated and introduced to the workplace they need to be evaluated to see if they are meeting the desired goal. The nurse acts as educator by working closely with the patient to evaluate is they understand their rights and access to their personal health information (CNA, 2011). 

A policy that may apply is that nurses are responsible in keeping patients updated about their current health status and progress. This may involve showing patients trends and charts about their health that may help the patient recognize own trends in their lifestyle. A diabetic patient who is wanting a better understanding about how their blood glucose fluctuates throughout the day should be given access to this information to increase patient learning. Through policy learning and evaluation, nurses are able to enhance patient learning (Lomas, 2007). 

Since nurses work front-line, behind the scenes, and in every governing body level, they need to take action in recognizing inadequacies and potential barriers that exist. As technology becomes ingrained in hospitals, health units and community care, nurses are still the health care professional who works closest with patients. Nurses need to discuss with patients and evaluate their understanding about eHealth and advocate for their learning. 

---Student Nurse Katie

References

Canadian Nurses Association. (2011). Nursing informatics: Best nursing. Retrieved from http://www.cna-aiic.ca/en/on-the-issues/best-nursing/nursing-informatics

Lomas, C. (2007). Policy: Nurses' input vital to guideline development. Nursing Times.net. Retrieved from http://www.nursingtimes.net/policy-nurses-input-is-vital-to-guideline-development/304488.article

Perna, G. (2013). HIT voices: The policy challenges facing health IT leaders. Healthcare Informatics. Retrieved from http://www.healthcare-informatics.com/article/hit-voices-policy-challenges-facing-healthcare-it-leaders-part-1

Koliner, S., & Flatley Brennan, P. (2013). Advancing healthcare information technology through policy. CIN: Computers, Informatics, Nursing, 31(5), 205–207. doi: 10.1097/NXN.0b013e318299dc34 

Rochon, P. (2010). Institutional financial conflicts of interest policies at Canadian academic health sciences centres: A national survey. Open Medicine. 4(3). Retrieved from http://www.openmedicine.ca/article/view/340/341

Weill Cornell Medical College. (2013). Center for Healthcare Informatics and Policy. Retireved from http://weill.cornell.edu/chip/about-us/

Electronic Health Record and Clinical Settings

What exactly is an Electronic Health Record? How does it affect patients? And how does it affect health care professionals?

This week we will explore how electronic health records (EHRs) are being incorporated in health care settings, and how they influence the workload of nurses and health care professionals (HCPs). 

Before we dive into how EHR applies to nurses, let's quickly over view just what it is and some positives and negatives that may impact patients.

Electronic Health Records are an electronic profile documenting your entire health history. The record includes lab and tests results, past treatments and procedures, allergies, and past medications prescribed. This private information is all stored in one area where it can be easily accessed and analyzed by health care professionals.  By having all this information in one universally accessible spaces (EHR), HCP are quickly able to provide safe and effective interventions (Flipova, 2013). 

Despite now having to worry about losing documents, how else will this impact patients?

Positives

• Empowers consumers (patient) as they have greater access to their personal health information
• Enhances continuity of care from your health care team
• Effective in emergency situations when unable to supply own information (e.g allergies, medications, medical conditions)

Negatives

• Data accuracy and missing subjective information
• May not understand medical terminology and results
• Data privacy and confidentiality may be breached

Discussions about EHRs mostly focus on the client perspective, but what will these changes mean in clinical care settings? Adjusting to a technology-centred health care environment may be difficult for many health institutes. Thede (2008) states that nurses play an integral role in making this transition as smooth as possible. Nurses are responsible for reducing these barriers to aid the patient experience. 

For nurses EHRs present  a range of possibilities that can improve the care they provide, and their workload. When nurses have access to electronic health records it reduces the time spent on gathering generic health history each interview and interactions. Often, patients are repeatedly asked the same questions about their health and family history, which can be time consuming for the nurse. Much of the interview process can be spent going over history rather than focusing on the main reason for seeking care. EHRs contain all of this information in one area that will not be lost, and can be accessed at any time.

In turn, this also reduces the amount of paper work that nurses have to complete. EHR have specific sections for each type of data that can be directly imputed and have areas for fruther data and nurse's comments. This limits the paper being used, and ensures that the files are kept in  an organized manner. This also means that nurses are more accountable for their work.

Health records can only be accessed with a password and security codes that are different for each HCP. The computer keeps track of who is signed on, what they have accessed and what each member had added to the profile. This function addressed the confidentiality issues that are present. As well, tracking who is responsible for information allows for clarity, and ensures that nurses are thoroughly documenting. 

In my opinion, perhaps one of the greatest functions of the electronic health record is that it allows HCP is follow trends in data and track changes in results more efficiently. For example, consider a hypertensive patient who regularly has their blood pressure taken. Before the electronic health record, the documentation could be irregular, and difficult to compare if there are multiple paper records. These former reports mostly look at when the readings are normal and when they are irregular, but do not consider the contributing factors, time of day, and lifestyle of the patient. With EHR, nurses are able to graph and extrapolate data and relate it to the context of the individual. The EHR provides online functions to track specific details and take that into consideration when analyzing the data (Agency for Healthcare Research and Quality, 2012). 

This takes out the guess work that many nurses face. EHRs provide visual evidence of how a patient is progressing. For patients with eating problems and disorders who are overweight or underweight, these charts can be used to monitor changes. As well, a patient's personal chart can be compared directly with expected patterns. This will also be useful for infants and children, to track development and how they are researching certain developmental stages. The nurse should take an active role in fully using the functions available on EHRs to make the most of their assessments, and advocate for patients health and wellness. By noticing changes early, the nurse can work with the patient and health care team to adjust practices that best support the patient's needs. 

Unfortunately, there are still many  drawbacks of the EHR that can influence the nurse's workload, and provision of care. 

Continuity of care between institutions and facilities is a large concern. Implementing EHRs can be extremely expensive, and many rural health centres and hospitals are choosing to stay with traditional documentation. As well, there is yet to be one standard program that is used for all facilities. This causes gaps in the system, and means that information can be difficult to access and not as easily shared from one place to the next. 

As well, these programs are initially difficult to use and therefore nurses need adequate training. Unfortunately much of this training is expensive, and nurses are often not paid for their time (Thede, 2008). Budgets also mean that there is a restricted amount of time allotted to training, and many nurses only learn the basic function of the the electronic record. This can lead to data inaccuracy and technology problems that few understand how to resolve.

Most importantly, EHR do not capture the emotional aspect of nursing. As the focus of health care shifts to a more technological approach, less time is spent with face-to-face interactions. While, health information may be more accessible and time will be focused on noticing and tracking changes in health, there is the possibility that EHR will decrease the client's experience. This focus on monitoring health and trends unfortunately feels like a step  backward to when health-care had a bio-medical approach. Data may be solely concerned with physiology and pathology of a patient rather than holistic wellness. When nurses spend less time with patients, the trans-personal moments that foster the therapeutic relationship are lost (Thede, 2008). 

How can nurses maintain the therapeutic relationship despite the digital divide?

Last post, I discussed the role of educator and teacher or the nurse, but this week we expand the definition of nurse to include that of advocate. 

Nurses must advocate for their clients in health care settings to ensure that they are being met with holistic care. The nurse must use both the EHR and the client's unique experiences to create individualized care plans. EHRs provide the medical history and present condition of a patient. When the EHR is combined with the client's perspective, and mental and spiritual health is considered nurses can re-establish the therapeutic bond with patients that are based on mutual respect and trust (Coiera, 2004). 

As well, nurses should encourage patient involvement in imputing information that they believe is valid and significant. Patient gathered data allows the patient to feel like an integral member of their care, and be empowered by their health information. Moreover, nurses can educate their patients on their rights to access their health information, and help patients understand results. 

Since the implementation of electronic health records impact and influence nursing practice, nurses need to take an active role in utilizing these technology in the workplace. Nurses act as the regulator in allowing for a smooth transition and advocating for the holistic well-being in  technology-driven society (Vitera, 2013).

---Student Nurse Katie 

References 

Agency for Healthcare Research and Quality. (2012). Electronic health records improve nursing care, coordination and patient safety. Research Activities. 5(381). Retrieved from http://www.ahrq.gov/news/newsletters/research-activities/may12/0512RA11.html

Coiera, E. (2004). Four rules for the reinvention of health care. BMJ, 328(7449), 1197–9. 

doi:10.1136/bmj.328.7449.1197 

Flipova, A. (2013). Electronic health records use and barriers and benefits to use in skilled nursing facilities. CIN: Computers, Informatics, Nursing. 37, 305-319. doi:10.1097/NXN.0b013e318295e40e

Thede, L. (2008). Informatics: The electronic health record: Will nursing be on board when the ship leaves? The Online Journal of Issues in Nursing. 13(3), doi:10.3912/OJIN.Vol13No03InfoCol01

Vitera. (2013). Nurses' integral role in EHR adoption. SuccessEHS. Retrieved from http://www.successehs.com/item/nurses-integral-role-in-ehr-adoption.htm

Consumer Health and eHealth

Quick Review:
... If you recall, last post we discussed how patients are more likely to turn to their computers to access health information, rather than primarily speaking to a health care professional (HCP). Information that was once only privileged to HCPs is now openly broadcast. Because of this, patients are becoming constant consumers of information related to their health, and it is the responsibility of nurses to ensure that this information is reliable and is being appropriately used.


Now that we have an understanding about how patients and clients are consumers of health information, how is social media and technology being applied to support  these consumers?

This week I will examine online communities of sharing, and the role the nurse has to contribute to these communities.

In the past, people accessed information through word of mouth, textbooks, radio, and television. However, as technology has become more prevalent in our everyday lives, people are more likely to access a newspaper article on their phone or computer rather than in print. Instead social media has became our greatest supplier or knowledge and information that allows for open discussion, posts and forums that can facilitate discussion (Gruzd & Haythornthwaite, 2013).

Online communities of sharing are internet groups that provide support to specific groups, raise public awareness, increase policy discussion and promote involvement, and provide medical education. These groups have a common goal and passion of how to improve and increase awareness about an issue or concern (Gruzd & Haythornthwaite). These sources can range from an online support forum, to Pinterest groups, Facebook communities to newspaper apps for phones. This week, I will explore how communities have utilized the different streams of social media to share information and create discussion, critique the benefits and barriers to these portals, and analyze how the nurse can contribute to these online communities.

To begin, let's address some of the organizations and communities that have utilized social media to broadcast their message.

Information transmission primarily takes place through social networking sites and phone applications. When news is released about world issues, political disputes, and natural disaster, information is typically spread through these outlets. Information is quickly distributed by simply pressing the 'share' button. As well, these sites allow for increased information transmission as they are constantly updated and globally accessed, thus information is extremely recent and relevant (Eysenbach, 2008).

                                                                                    For example, the Canadian Medical Association

Journal (CMAJ) has an active twitter profile that supplies knowledge if you're looking to stay updated in medical research and new discoveries. Not only does the CMAJ account post their recent editorials and direct links to their articles, they also provide their followers with medical research projects, social support groups, and fun facts in science. As well, they weigh-in on current events and encourage followers to provide their opinions and tweet questions. This is effective as it allows for
information exchange, and creates a supportive                                                                                             community where curiousity is welcome.

Communities are using social media as a way to raise awareness for causes and issues, and to provide an online community of support. Many people make not have adequate social support networks or coping mechanisms, or may live in an isolated area. These portals allow patients and consumers to share their experiences living with a disease or illness, provide support to those who are struggling, and to communicate and share resources. Social media presents a great opportunity for these communities as it is estimated that over 60% of all people use some form of social media (Statistic Brain, 2013). Connecting with others through these outlets is convenient and allows for quick alliances to be made regardless of location.


Facebook is the most commonly used social
networking site, with over 1.4 billion users worldwide (Statistic Brain, 2013) . Due to this, many of these communities use Facebook to reach a large audience. For instance the Mental Health Foundation uses a Facebook page to reach out to those suffering with illness related to mental health, and to reduce the negative stereotypes associated with mental health. They provide their members with sources on managing stress and anxiety, awareness events, and secure discussion forums. These forums create a safe online environment as they can be submitted anonymously, only members can access the information and it cannot be shared to other Facebook groups or pages. This site creates an effective online community as they provide their members with external resources that may apply to their specific illness.

Additionally, communities use social media as an educative tool. As stated last post, most people use the internet as their primary and first means of gathering information. Often people are looking for a fast and simple way to understand concepts that are sometimes difficult to understand. Patients and health consumers feel empowered by self-educating, and these communities provide them with adequate support for health teaching (Donelle & Booth, 2012).

An effective social media outlet for education is YouTube. These short videos are accessible without an account, and provide consumers with a multi-dimensional environment for learning. Educational YouTube videos are great as they meet the learning needs of many through visual, written and audio teaching. Since these videos are easily shared, and comments are responded to quickly, viewers are able to be engaged and active in this community. AsapSCIENCE is an online science community that answer viewers health and medical questions in videos that are easy to understand and humorous. The videos are available in categories to help navigate the site and find exactly what is needed. As well, the site encourages viewers to post more                                                                                               questions that are on their mind, and advocate for                                                                                          increasing knowledge (Gruzd & Haythornthwaite,                                                                                        2013).

Despite, the overwhelming positives that erupt from these resources, there are still barriers and areas that need thorough consideration from a nursing standpoint. With any form of online interaction there is always the implication of privacy and confidentiality. This becomes more critical when you consider the sensitivity of the issues discussed, and the personal health information that can be posted and accessed by millions.

Consider how consumers use social media as an educative tool. Over-use can lead to self-diagnosing that relates back to cyberchondria discussed previously (White & Horvitz, 2009). Additionally, people must be aware of the credibility of the sources they use, and how they use the information provided. As well, consumers need to understand the policies present on these sites and how they use the information that is posted to forums and discussion panels.

This is where nurses can become involved. Nurses are educators and take a directive role in health teaching. Nurses should discuss with their patients where they primarily obtain their health information and knowledge about disease. When patients bring online data forward, nurses should not criticize patients but encourage and support that they are taking an active role in their health. As well, the nurse should offer to work with their patients to appropriately use this information and discuss the effectiveness of online communities in their patients health experience.

Consider your role in online health communities. How do you most benefit from these resources, and what sites do you find particularly effective?

Until next post,
---Student Nurse Katie


References
AsapSCIENCE. (2012). Your daily dose of science. Retrieved from http://www.youtube.com/watch?      v=N3DWtVhEnbE

Donelle, L., & Booth, R. G. (2012). Health Tweets : An exploration of health promotion on Twitter. Online Journal of Issues in Nursing, 17(3). doi:10.3912/OJIN.Vol17No03Man04

Eysenbach, G. (2008). Medicine 2.0: Social networking, collaboration, participation, apomediation, and openness. Journal of Medical Internet Research, 10(3), e22. doi:10.2196/jmir.1030

Gruzd & Haythornthwaite. (2013). Knowledge translation of evidence-based medical information in the age of social media. Social Media Lab. Retrieved from http://socialmedialab.ca/?p=8921

Statistic Brain. (2013). Social networking statisitcs. Statistic Brain. Retrieved from http://www.statisticbrain.com/social-networking-statistics/

White, R. & Horvitz, E. (2009). Cyberchondria: Studies of the escalation of medical concerns in web search. ACM Transactions on Information Systems. 27(4). doi:10.1145/1629096.1629101

Consumer Health Informatics

What is consumer health?

In Canada, over 80% of people aged 16 and over used the internet for personal and educational use, with the average person using 10+ hours per week (Statistics Canada, 2013). With this much time spent online, people are becoming consumers of online media and use the information provided as they seem fit. Websites act as stores of information but what exactly are we buying into?

As information becomes easier to access with the use of technology, people are obtaining their health education and recommendation online as opposed to their regular health care professional.
Information that once only belonged in the hands of healthcare professionals is now readily available at the tips of our fingers with a simple search (CPHA, 2013). This crossover of how information is being accessed, shared and used has great significance to health of all. Ensuring that patients and public are receiving valid information and using it properly is difficult to monitor as a nurse.

Traditionally, when a person was feeling ill, they would call their doctor or drop by a health clinic to find out what was wrong, and seek a simple solution. Unfortunately, with the shortages of doctors and the increasing wait times at offices and emergency rooms, people are seeking more convenient sources to diagnose. There is a growing number of websites that offer to help understand what their symptoms mean and what the underlying cause could be. Like many aspect of technology, this can cause a negative impact on health consumers.

For example, WebMD is a website that offers a "symptom checker" option that allows browsers to click what symptoms apply to them. The checker then provides the user with a list of possible most likely and common conditions and ailments the person might have.

 While it seems more convenient to simply check rather than taking the time to see a professional for something that might be minor, these results can cause more problems than benefits. These searches are meant to be a first step in the process of seeking help and expanding health knowledge. When these sites are over-used and abused, it can create a sense of panic when they receive the results list.

Cyberchondria is the growing phenomena of people self-diagnosing based on internet results. Many people are already in a vulnerable mindset when they are feeling ill, and these "diagnoses" can intensify their vulnerability and fear. Someone might be expecting to see the result of influenza, but instead receive a more serious diagnosis. Not only can this lead to misdiagnosing, but also create a hover sense of anxiety (White & Horvitz, 2009).

If a person continues to believe that they are seriously ill without contacting professional help, this anxiety builds within. Initially these sites are helpful but cyberchondria can create an almost negative placebo effect. The longer a person revolves around the cyberchondria cycle, the worse their mental health can become causing stress- induced anxiety. A person who is relatively well can self-induce anxiety over the possibility of disease, which can result in physical signs of stress such as headaches, loss of appetite and socially withdraw.

This is where of the nurse intervenes to discuss how to properly use these resources. These sites should not be used alone when patients are gathering information about illness and disease. As well, nurses can educate and promote other forms of health teaching available online. The public needs to be aware that there are other reliable resources that are non-for-profit (CPHA, 2013).

For instance, the Health Canada (2013) website is a great beginning resource to expand health knowledge in a controlled and easy to navigate environment. The site is frequently updated and contains no alluring ads that may distract or give false information. Health Canada online continues a wide variety of information that is relevant to Canadians including printable health facts sheets, nutrition and physical activity information, and updates on consumer health safety.

As well, the site helps you find resources available in your area. The site is also available in various social media outlets such as Facebook, Twitter, Reddit, Myspace, Google bookmarks and email. This allows users to maintain the accessibility that they enjoy about consumer health.

 It is important to adapt the way information is accessed as technology changes so people receive proper health education. While there ca. be a possibility of negative impacts as patients have increased access to information, it is mostly a positive process. This wide spread of knowledge allows patients to have a better understanding of their care and options, which truly supports the movement and need for client-centred care. As patients learn more about health, they take control of their care to be the leader of their health (Dekker 2012).


References

Canadian Pubic Health Association. (2013). Evaluating health information online. Retrieved from http://www.cpha.ca/en/portals/h-l/web.aspx

Dekker, R. (2012). Survey: Consumers show high degree of trust in online health information, report success in self-diagnosis. Wolters Kluwer. Retrieved from          http://www.wolterskluwerhealth.com/News/Pages/Survey-Consumers-Show-High-Degree-of-  Trust-in-Online-Health-Information,-Report-Success-in-Self-Diagnosis--.aspx

DNews. (2013). Why you shouldn’t self-diagnose on the internet. Retrieved from            http://www.youtube.com/watch?v=W-P30s7c1d0

Health Canada. (2013). Retrieved from www.hc-sc.gc.ca

Statistics Canada. (2013). Canadian internet use survey. Retrieved from http://www.statcan.gc.ca/daily-quotidien/130419/dq130419d-eng.htm

WebMD. (2013). Symptom Checker. Retrieved from http://www.webmd.com/

White, R. &Horvitz, E. (2009). Cyberchondria: Studies of the escalation of medical concerns in Web search. ACM Transactions on Information Systems. 27(4). Doi:10.1145/1629096.1629101

Evidence -Informed or -Based?

How nurses make decisions for car plans comes down to how and where they acquire their knowledge. With overwhelming supply of information provided online with new research, cutting edge treatments, and resources readily available, nurses must be careful on how they base these clinical decisions.

With the plethora of knowledge that nurses receive from textbooks, clinical trials, and doctor's orders, it is easy to overlook how the individual patient fits in to the care.

Older systems of health care  focused on biomedical models that looked solely at the disease and pathology of the patient. But now is the time for transition. Nurses need to shift their focus from how to cure and care, to the perspective of the client and how the patient feels about their care and treatment (Lamoure, J. 2011).

Often used interchangeably are the terms, evidence-based and evidence-informed practice. However, these concepts are synonymous.

 Evidence-based practice and medicine refers to making choices based on what research and practice says to be the best choice. This involves applying an intervention based on experience that it works. While effective, this practice often leads to a "one size fits all" plan of care for those with the same diagnosis. The intervention seems rigid and involves little consideration of external factors such as the patient's beliefs, values and preferences. This gives the patient the appearance that nurses were just going through the motions to treat the illness rather than care for the patient.

Furthermore, evidence-based practice was deemed less effective due to several barriers it posed to nurses including, time constraints to research, limited access to scholarly literature and medical advancements, and workplaces that did not have up-to-date technologies.

To avoid overlooking these important aspects of care and to ultimately enhance the client's well-being, the phenomena of evidence-informed practice was adopted. This approach is dynamic and considers both the quantitative (research information) and qualitative (client's well-being) data. When a nurse considers and understands a broader spectrum of information, she/he is able to tailor balanced care for the client (Lamoure, J. 2011).

By focusing on evidence-informed decisions, client-centred care is ensured and other consideration can be included into care such as spirituality, home care and alternate medication.

This information is also relevant when considering the information available online. Nurses need to sift through the many different opinions and perspectives offered. To analyze information and come to balanced conclusions, nurses must consider:

Applying evidence-informed practice to technologies and resources requires nurses to look at various sources instead of using the same database over and over. As well, it calls nurses to analyze the sources and research available online to distinguish whether the information is current, relevant, and easily understood.

Consider how many people obtain their information first hand in today's society. The first step often involves using an online search engine. But when nurses uses these databases to acquire their knowledge and reference, they need to be aware of how these search engines display their information.

Most search tools tailor the given results based on previous searches. Based on what websites you have visited before, and resources commonly use, web searches narrow down the margin and prioritize their results. If you and a friend searched the same topic into the same search engine your results would be different and in a different order. These companies do this in best interest of the user to make it easy to navigate and have a smaller range to choose from, but it significantly influences the knowledge we use (ComputerWeekly.com, 2009).

This video explains how these searches adapts the results we see:

Many people are likely to choose the first link or website offered, but how reliable is this? If our search engines are shaping the results to best suit us, how are we as nurses supposed to use this for our unique patients? This is hardly evidence-informed practice.

To incorporate evidence-informed decisions into the expanding world of technology, nurses need to exercise their media literacy skills, and go beyond the first page. This again draws to mind the balance:

• Clinical expertise
• Resources
• Research evidence
• Patient preferences.

Technology is becoming increasingly intelligent but nurses often forget about the power of their own experience and expertise. As nurses we do a majority of the assessment and spend a great amount of time with the patient. This gives nurses a special insight into the individual experience of the client, what works well, and how to improve in a similar situations. We are constantly reflecting back on our clinical knowledge without realizing the power it holds. Our internal databases influence and shape our care for each patient based on their needs. By using Tanner's nursing process, we can effectively reflect on these experiences to best chose a plan of care (Brown, et al. 2006).

To obtain concrete research evidence and reliable resources, nurses must seek other portals besides Google and Yahoo, and examine nursing-based databases found in library websites. Additionally, nurses can visit the College of Nurses websites, and nationally recognized associations. It is important to consider what these standards recognize as best practice, and apply the appropriate intervention. Although the patient may not chose what the research deems to be the best intervention, it is essential that nurses still understand and know what process works best. As well, this allows for better health teaching, to help the patient understand why the research and medicine favour a certain treatment (CNA, 2010).

Finally is understand how technology can be incorporated to understand patient preferences. Not only does patient preference refer to client comfort and physical care, but also spiritual and mental support. As outlined by the nursing theorist Watson, patient care is holistic and therefore I must adopt a holistic lens as I search for knowledge (Brown, et al. 2006). Nurses must consider the lens of the client and their family. Putting yourself in their place involves empathic communication and ultimately respecting their choices.

As nurses, we often want to fix and heal, doing whatever we can to keep the patient alive, but this is not always in the best interest of the client. As well, this involves respecting information that the patient provides and their perspective of illness. Providing patients with choice allows them to feel in control and at the centre of the care team, which is the core principle of why evidence-informed practice is greater than evidence-based.


References
Brown, D. McWilliam, C., Ward-Griffin, C. (2006) Client-centred empowering partnering in nursing. Journal of Advanced Nursing, 53(2), 160-168. Doi: 10.1111/j1365-2648.2006.03711.x

Canadian Nurses Association. (2010). Evidence-informed decision making and nursing practice. Retrieved from http://www.cnaaiic.ca/~/media/cna/page%20content/pdf%20en/2013/07/26/10/52/ps113_evidence_informed_2010_e.pdf

ComputerWeekly.com (2009). Google tailors search results based on user behaviour. Retrieved from http://www.computerweekly.com/news/1280091581/Google-tailors-search-results-based-on-user-behaviour

The Cochrane Collaboration. (2013). Evidence-based health care and systemic reviews. Retrieved from http://www.cochrane.org/about-us/evidence-based-health-care

Deutschewelleenglish. (2012). Simple search engines like Google and Bing, shift. Retrieved from http://www.youtube.com/watch?v=WwIoTW3DRfM

Lamoure, J. (2011). The collaborative patient/person-centric care model (CPCCM): Introducing a new paradigm in patient care involving an evidence-informed approach. Academic.edu Research. Retrieved from http://www.academia.edu/455869/The_Collaborative_Patient_Person-

 

Social Media--Ethical Practice and Privacy

According to Gallup (2013), nursing has been viewed as the most trustworthy profession by the public for the past eleven years consecutively. While this feat demonstrates how trust is a key component of the nursing therapeutic relationship, can the influence of social media and nurse's online presence affect this image of trust?

Social media and online networking profiles have blurred the line between what is considered professional and personal. Though many individuals worry about employers are searching profiles and basing decisions on what you allow the world to see, nurses also need to consider what they can see of their patients and what their patients can see of them. This requires a careful balance of privacy, posting professionally, and acting ethically.

This week's class posed many challenging ethical question that have become a nurse's reality because of the use of social media.

Can I document my nursing assessments on a smart phone or tablet?

Is it legal to Google a client's name?

Can I vent about my job if I don't reveal names?

After class, I analyzed various forms of social media and searched links involving nursing, nursing students, and health-care. Among the different streams I began to notice similar themes of the content related to nursing. These major themes focused on nursing "problems and humour", praise of nurses, and education-based.

To begin, let's analyze the first topic of "nursing problems". Across every form of online media many nurses have found a place to vent about their jobs and complain about the daily toils they face. Twitter, Facebook, Pinterest, Tumblr and blogs each have pages dedicated to this topic, where nurses can post, tag, or hashtag photos and cartoons that belittle the profession. Unfortunately, a majority of these posts provide negative lenses of the nursing profession and role.

Take for example this tweet by a group called 'Male Nurse Problems':

The tweet was public and retweeted (shared) by 146 others, and most likely viewed by many more on the popular site of #NursingProbs. This post almost comes across as a threat to prospective patients: either you behave or be prepared to receive the worst treatment imaginable.

As well, it is highly insensitive to those who require a brief or incontinence product to be seen as just another problem. Yes, these jobs are very hard and have an impact on nurses physically and emotionally but it is inappropriate to make light of these situations. While hygienic care may be unpleasant, it is still a very important aspect that when not completed properly significantly affects a person's health.

Another form of patient belittling can be found in the common nursing cartoon and photos:


While this picture (right) may seem harmless and humorous, to others it may seem insensitive and uncaring. This picture enforces the idea that the patient is ignorant, and the nurse doesn't want to hear their perspective. If the patient thinks nurses feel this  way, they may withhold information for fear of being judged by the nurse.

 Additionally, it sends the message that nurses assume a false pretense of that they care and that all patients can be handled the same way. Instead of spending individual time with each client, this message portrays that this is a waste of time and patience.
Other websites have forums where health care professionals can share stories of the most strange and outrageous cases they have seen. Despite not revealing names, these stories do include many identifiers such as age, gender, location and some health history that can be considered violated confidentiality (CNO, 2009).

 

While these funny cartoons and stories seem like a fun way to vent about the job to release stress, this affects the public's view of nursing. This may not break confidentiality but it seems morally wrong as it mocks the role of the nurse and reduces the importance of messy tasks.  Seeing nurses discuss and make fun of their patients (even when confidentiality is maintained) makes nurses seem uncaring and untrustworthy which hinders the therapeutic relationship (CNO, 2009). Patients will wait in fear that either they are being a nuisance to their nurse or that their experience will be unknowingly shared. Not only will patients view nurse as untrustworthy but also they will lose their respect for the importance of the nursing role. When this bond is broken it is very difficult to re-establish, and unfortunately this means that the patient loses a vital resource in the health sphere.

As these stories and complaints continue, patients may group all nurses to be uncaring and ungenuine. Just as there are sites of nurses complaining, there are sites for patients to analyze their nursing care and share their "horror stories" of nursing care. Take for example the following forum posted by a mother after giving birth:

 This experience should have been one of great joy, it was clouded by the impression left by poor nursing. When these sites become common place the public generalize and make unfair biases towards other health care professionals.

Despite the large presence of negative sites, within the online community exists a nursing faculty dedicated to advocating for the role of the nurse and providing online resources (Betton, V. & Tomlinson, V. 2013).

These sources use social networking sites in their favour to not only educate the public on the importance of nursing care, but also to continue learning for nurses. This benefits young graduates who are still in need of support to continue good practice and to help seasoned nurses become familiar with social media.
On YouTube, there are many nursing vloggers who offer tips and their own experience. These modern day narratives are a great way to reach a large audience to share stories and discuss current events pertaining to nursing.

While insightful, it is important to maintain confidentiality as these videos can be globally shared with others. One vlogger who maintains these boundaries while still keeping the audience engaged is NurseMendoza (video right). His positive perspective is refreshing as he offers tips to nursing students and advocates for male nurses. In his videos, he explains his experience in different nursing fields, how to prepare for clinical practice and caring for a spectrum of diseases.

Other educational forms of social media include a series of nursing pin boards on Pinterest: http://www.pinterest.com/clarityh/nursing/

 

These quick posters offer nurses easy references for an array of conditions and important care and considerations to remember. This health information is useful and enhances communication between nurses and patients at home. These and other guides improve health literacy and allow nurses to share their knowledge in safe and fun way.

 

As well, positive social media plays a large role in how nurse stay connected and up-to-date with standards of care. Many nursing organizations and associations now have online presences that are more easily accessed.

The Canadian Nurses Association (CNA) have profiles on Facebook (see right), Twitter, and YouTube that updates followers about Canadian news such as Aboriginal health, and articles on mental health awareness. The CNA profiles encourage nurses to contact them and ask questions, but ask to do so respectively. The  profile states that profanity, nudity, discrimination and defamation, and name calling will not be tolerated on their site. Any comment or member who does so will be removed.

By encouraging discussion of current events and promoting a safe online environment, these site set the example of how nurses need to consider behaving before posting, tweeting or venting. These positive sources help the public to regain their trust in the health care system to create open communication and awareness.
By targeting the online audience these networks are able to establish fast and convenient bridges of information between nurses and patients. This appeals to modern society as it is readily available as opposed to visiting a health clinic or hospital, and receive a number of different opinions (Betton, V. & Tomlinson, V. 2013).

To maintain confidentiality and professional standard, nurses need to follow their practice standards, the Personal Health Information Privacy Act, and abide by employers regulations. This means understanding that personal health information is more than a patient's name, but includes pictures of them, body parts or their surroundings, documentation of previous care, and ANYTHING that can identify or recognize a person (CNO, 2009).

Personally, I do an internal test to see if I think a post, comment or picture is morally accepted. I think to myself : would I want a potential patient to see this? Does this make me look like a "bad" nurse? If you're posting or uploading information that you would be embarrassed to show a client, chances are it probably is embarrassing. Although these posts likely don't reflect who you are as a nurse, be aware that they can inadvertently define your practice.

References

Betton, V. & Tomlinson, V. (2013, June 19) Benefits of social media for nurses and service users. Nursing Times.net. edited by Jenni Middleton. Retrieved from   http://www.nursingtimes.net/nursing-practice/clinical-zones/educators/benefits-of-social-      media-for-nurses-and-service-users/5060041.article

 

College of Nurses of Ontario. ( revised 2009). Therapeutic nurse-client relationship. Retrieved from http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
 

College of Nurses of Ontario. (2009) Confidentiality and privacy—Personal health information.  Retrieved from http://www.cno.org/Global/docs/prac/41069_privacy.pdf

Jones, J. M. (210, December 3). Nurses top honesty and ethics for 11^th year. Gullup Economy. Retrieved from http://www.gallup.com/poll/145043/nurses-top-honesty-ethics-list-11-year.aspx

 

Lehavot, K., Ben-Zeev, D., & Neville, R. E. (2012). Ethical considerations and social media: A case of suicidal postings on Facebook. Journal of Dual Diagnosis, 84 (4), 341 – 346. doi: 10.1080/15504263.2012.718928

NurseMendoza. (2012, March 4). Diabetes mellitus type 1 & 2. Retrieved from   http://www.youtube.com/watch?v=98uMco2YiCM