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

 

 

Welcome to the Progress Notes!

Hi there fellow bloggers, nurses and everyone in between, and welcome to my blog!

My name is Katrina Piekarski (or call me Katie), and I am a second year nursing student at the wonderful Western University, who is excited to chronicle my nursing progress and share the serious, wonderful and touching moments that unite all nurses.

This blog is a combination of my passion for nursing narratives and part of an E-portfolio assignment for my Health Informatics class. You might be asking yourself, "what is Health Informatics?"

Well--in as short as possible-- this cutting edge class focuses on how technology is changing the face of health care. As technology and the internet grow, and become practically a physiological necessity, health care professionals need to understand how to incorporate these resources to create real change for everyone's well-being.

While society has quickly adopted to the quick-changing advancements of everyday technology, the health care systems have taken their time to adapt. Paper records are slowly becoming things of the past, diagnostic tests can be shared through e-mail, billing is online, and people can self-diagnose simply with a Google search. Although these changes are exciting and can mean reduced wait times, faster diagnoses, and less costs, there are still some issues to be addressed.

Safety and privacy have always been matters of concern when it comes to the internet, but have greater repercussions when our health information and history is concerned.

This Health Informatics class addresses these issues, and how they have an impact for both patients and nurses.

Each week, I'll discuss a topic from class. Like any good progress note: I will share the subject and objective data, holistically assess the topic, and plan how to incorporate this in my nursing future.

Stay tuned, and enjoy.