CHAPTER 32

The nursing Curriculum in the Information Age

This chapter presents nursing education within the context of rapidly evolving and deploying of
information including technology within education.

Information Management

The management of information is and will continue to become one of the most daunting
challenges for faculty, students, and nurses.

Educational Environment

A discussion of the education in the context of information technology and information

management.
Studies demonstrate that the majority of nursing schools have technology in place to deliver
learning materials.

Supportive infrastracture

such an environment embraces:

1. Adequate technical support, including personnel
2. An educational resource/ technology planning committee
3. Allocation of financial resources

Centralized Resources

Schools are in a position to develop and share resources with other departments and divisions in
an academic settings.
Centralize resources and are a natural extension of the information superhighway in the internet
II initiative of the government.

Collaboration

Create financial and infrastracture needs that university campuses will be forced to address : new
equipment, more user training, and new courses.

Faculty Development

For faculty development programs to be successful at integrating information technology into the
curriculum, they must be sensitive to both faculty interests and time limitations.
We are currently faced with a severe faculty shortage, an aging faculty, and rapid employment of
information technology within academic settings.

Barriers to Faculty Development

Faculty development programs that focus on enhancing faculty skills with the use of information
technologies will be most successful if known areas of resistance to change are specially addressed
during and implementation phases of program development.

Affective Responses

Faculty development programs should emphasize that new technologies are neither good or bad,
but merely a means for solving new problems.

Competing Demands
Cognitive and Information Technology

Computer literacy is the ability to perform computer operations at a skill level high enough to
meet the demands of society.

Nursing education and the World Wide Web (WWW)

Issues associated with online instructions have been described by several authors to include
preplanning strategies, preparation of materials, incorporation of interactivity, and other pedagogic
considerations.

Multimedia

Multimedia, with a ability to deliver text, full color graphics, sound, video, and animation,
provide an excellent example of how learning can be enhanced by computer base system.
CD-ROM/ DVD

CD-ROMs (compact disk-read only memory) as teaching learning tools for clinical nursing
education incorporate multimedia capability, portability, and large storage capacity.

Interactive CD-ROM Programs/simulation software

Self study modules/interactive CD-ROM programs and simulation software are computer-assisted
learning programs designed to achieve greater mastery of content and learning than the possible with
didactic instruction.

Testing System

Since April 1994, the National Council Licensure Examination for Registered Nurses (NCLEX-RN)
has been an online , computer-based test administered in selected locations in every state and United
States territory. Although computer literacy is not essential for tasking the test, student familiarity and
comfort with computer adaptive testing prior to taking the licensure examination are helpful to
decrease anxiety levels and improve computer literacy.

Electronic Communications

Today electronic communications are pervasive as we access communications from laptops, cell
phones, PDAs and internet cafes. Computer-mediated communication has become as commonplace
as the stationary telephone once was.

E-mail

E-mail remains the primary and most prominent use of the internet. E-mail can be used for
computer-mediated communication (CMC) between faculty and students, to facilitate group work,
and to distribute lecture notes and tutorial information. Many benefits of electronic communication
have been reported by both faculty and students.

Blogs/Listservs/Forums/Newsgroups

Weblogs sometimes called blog or a new page began as personal journals that were frequently
updated and published on the Web.

Synchronous Technologies

The ability of all members to express ideas at the same time, speaking in parallel, increases
participation and idea building.
 CHAPTER 33
Accesible, Effective Distance Education Anytime, Anyplace
Programs for distance learning are exploding, especially Internet courses. The advertisement
“new distance learning programs for working proffesionals” certainly has appeal' capturing the
attention of many people seeking to fit further education into their busy schedules.

What is Distance Education?

Distance education differs from the traditional classroom in two essential elements.The mojority
of course or program of study whether with teachers and students and students or with students and
students, is seperated by (1) physical distance and (2)often time, thus the term “education
anytime,anywhere.

Computer Technology and the Internet

Computer technology came slow to the forefront of distance education, and then its use
exploded. In the late1970s, computer based education (CBE), computer assisted instruction, were
implemented cautiosly, like so many other type of technologies used for distance education to
supplement traditional classroom course.

For some nursing classes, the traditional face-to-face course has become Web-enhanced
extending the classroom by incorporating some of electronic tools.

Web-enhanced the instructor may use online modules electronically provide, required handouts
or printed materials.

Hybrid course formats have also emerged in the era of online learning.
• Educational Electronic Platforms
An educational platform is an electronic product that assist the delivery of Internet course.
Characteristic of Five Educational Platforms Commonly Used For Nursing Distance Eduaction
Angel
Blackboard
ecollege AU+
First Class
Web CT Campus Edition

Angel ePorfolio is used to create by students to create an electronic porfolio of their digital work.

Blackboard is an internet -based application which allows instructors to put class materials on
the internet.

First Class is a client server groupware, email, online conferencing, voice/fax services and bulletin
board system for Windows ,Macintosh and Linux.

Web CT (Course Tools) or Blackboard Learning System is an online proprietery virtual learning
environment system that is licensed to colleges and other instituition and used in many campuses for
elearning
 CHAPTER 34
INNOVATIONS IN TELEHEALTH
Diane J. Skiba
Amy J. Barton
Marilyn M. Nielsen

"The future of humanity is inextricably linked to technology"

- John Petersen Technological Innovations Challenges and Issues CHAPTER 34
Progression of Telehealth Applications Telehealth Technological advances are
providing healthcare with many opportunities to transform the business.
This will advance the ability of nurses to participate in telehealth applications.

Legal Issues The Concept of Telehealth /Telecommunications - it is the use

of wire, radio, optical or any other electromagnetic channels that transmit and
receives signal for voice, data, and video communication.

ANA - delivery of health care services or activities with time and distance barriers
removed and using technologies such as telephones, computers, or interactive
video transmission.
Telemedicine IOM - electronic information and communication technologies to
provide and support health care when distance separates the participants.
MOSBY - use of telecommunication technologies to provide health care services
and access to medical and surgical information for training and educating health
care professionals and consumers, to increase awareness and educate the public
about the health r/t issues and to facilitate medical research across distances.

M - Health Has the following advantages: Low cost for installation, low cost per
use, minimal training for use, and ubiquity. It is enhanced to improve the
following:
Conferencing, voice mails, facsimiles, computer communications, and
videophones.

The practice of medicine and public health, supported by mobile devices

E - Health healthcare- practice supported by electronic processes and
communication Video Store and forward radiology, dermatology, and pathology
images. Real time visits for medical consults and telepsychiatry.
Transforming the Practice of Health Care Patients as "Health Consumers" are
becoming more health conscious, and more active in managing their own health.
Advances are occurring in digital imaging, remote wireless monitoring,
videoconferencing, robotics and remote control, simulation and training,
and diagnostics. As telehealth solutions are applied to healthcare situations,
nurses must think about how these technologies will impact patient care, and
understand the functional capability of the application within the healthcare
delivery system.

Future Telehealth applications will build communication links between the

patient, clinics, hospitals, and primary care providers enhancing the continuum of
care by linking the patient and family to the provider of care.

Healthwear - are wearable systems with sensors that can continuously monitor
vital signs, physical activities, social interactions, and sleep patterns.

Robotics and three dimensional imaging will increasingly be used in surgical

settings. Robots are being studied as a potential solution to such things as the
nursing shortage. Transforming the Way We Learn Web based educational
programs are changing the way consumers and healthcare providers learn. The
internet allows nurses and students alike to access to the most up-to-date
research and knowledge facilitating evidence-based practice. Web-based
educational programs can reach remote students who otherwise would be unable
to attend class. Computer based education program are becoming more effective
method to present information and improve outcomes. Online educational
materials can be tailored to an individual's literacy level and presented in a
bilingual format. Remote interactive telehealth networks have been shown to be
effective in providing preoperative patient education to rural locations and are
increasingly being used for disease management.

Transforming How We Conduct Research Information Technology played

an important role in the advancement of human knowledge, activities and
research.

The NITRD ( Networking and Information Technology Research and

Development) -focuses on the foundations for national security, scientific
leadership, research, and learning. It enables major research agencies to
coordinate plans and activities and to leverage strengths and avoid duplication
maximizing investments. Collaborative efforts have resulted in digital libraries
that are today invaluable tools in research, and vital components for medical
practice, healthcare, education, and training.

The predominant legal issues concerning telehealth are LICENSURE and

LIABILITY and MALPRACTICE Licensure The lack of infrastructure for interstate
licensure has been a key impediment to the growth of telehealth.

Alternative approaches to licensure outlined included consulting exceptions,

endorsement, mutual recognition, reciprocity, registration, limited licensure,
national licensure, and federal licensure. Consulting Exceptions are common to
most states, they allow an out-of-state physician to provide services at the
request of and in consultation with a referring physician. Licensure by
endorsement is currently used to permit providers licensed in one state to apply
for licensure in another state in which they would like to work. Mutual Recognition
is a licensure system where in the licensing bodies agree to accept the policies of
the licensee's home state.

• Consulting Exceptions –are common to most states, they allow an out-of-state physician to
provide services at the request of and in consultation with a referring physician.
• Licensure by endorsement -is currently used to permit providers licensed in one state to
apply for licensure in in another state in which they would like to practice.
• Mutual recognition- is a licensure system used in Europe and Australia in which licensing
bodies agree to accept the policies of the license’s home state.
• Reciprocity –is an approach that would allow states to grant practice privileges to a provider
of another state without further credential review.
• Registration system –a provider is required to notify another state of intent to practice.
• Limited licensure –is an option in which an providers are required to obtain a license in every
state in which they practice.
• National licensure –involves standardized requirements for licensure throughout united
states
• Federal licensure –in which providers are issued one license by the federal government that
would be valid throughout the U.S. the system would be administered through federal
agencies at the national state, or local level.

The state licensure committee of an American Telemedicine Association

(ATA, 1998)

• Preserves the right of each state to regulate medicine in traditional face to face physical
setting
• Preserves licensure authority at the state level
 • Avoids unnecessary restraints on interstate commerce
• Ensures that all patients have access to the healthcare expertise necessary to protect and
promote their health, regardless of the location of the provider
• Advances telemedicine as a valuable service delivery strategy that can play a critical role in
overcoming time and distance barriers that often limit access to quality healthcare.
The ATA report continuous with proposed “rules of engagement” for telemedicine
• A telemedicine request originates from a physician who is fully licensed in the patients state.
• The patient and requesting patient must have a real physician-patient relationship the patient
and requesting must have a real face to face encounter.
• The out of state physician using telemedicine must be fully licensed in the state in which the
physician is located.
• The responsibility of medical care for the patient must remain with the requesting physician.
Liability and Malpractice
-The second level issue, currently malpractice cases hinge on two legal questions:
1.Whether a physician-patient relationship existed and
2. Whether a physician breaches his or her duty of care.
The PIAA (1998), developed risk management recommendations for providers engage in
telehealth applications;
• Become proficient with the technology.
• Ensure that the use of telemedicine is appropriate for the situation.
• Educate the patient regarding options and limitations in the use of telemedicine.
• Become familiar with referring physician and their credentials.
• Inform your insurance carrier of the nature and scope of your telemedicine practice.
• If technology does not provide a clear assessment or if results are equivocal, see the patient
in person or refer him/her face to face or follow up consultation.
• Make sure there are realistic expectations of all parties.
• Clarify role and responsibilities of all practitioners.
• Make sure contractual issues are reviewed and clarified.
• Maintain an archive of each in system in use.
• Make every attempt personalize the telemedicine encounter
• Document, document, document.

Ethical Issues
Privacy- the right of an ind. To be left alone to be protected against physical or psychological
invasions.
Confidentiality- status accorded to data or information indicating that it is sensitive for some
reason
Data security- the result of effective data protection measures, the sum of measures that
safeguard data and comp. programs.
System security- security protects both the system and the info. Contained within from
unauthorized access from without and from misuse rom within.

Public policy
The western governor( WGA, 1998) identify three key policy barriers to the growth of telehealth
initiatives. Those three issues include infrastructure planning and development, telecommunications
regulation, and lack of reimbursement for telehealth services.