CHAPTER 24 INTERNET TOOLS FOR ADVANCED NURSING PRACTICE

CHAPTER 24 INTERNET TOOLS FOR ADVANCED NURSING PRACTICE

Spint– is the commercial pioneer of fixed wireless broadband technology. It provides geographic mobility up to 3. 5 miles. Both wireless and fixed wireless talk/internet time is usually limited to about 5 -6 hrs with standby time up to 1 week. • Wireless applications permit Internet connectivity and allows for web-based clinical decision support, patient and clinical e-mail communication, and point-of-care electronic health data entry, data sharing, and messaging, including prescription writing. •

• • Ø Ø Ø Bluetooth radio technology, on which wireless devices rely, was found to be safe and robust even within intensive care environments. Considerations for wireless technoloy use includes: Secure portals and encryption, which are mandatory to safeguard patient privacy/confidenciality. Incorporation of a wide range of practice guidelines to frame clinician and patient expectations and responsibilities. Cost per clinician time considerations.

Basic and Advanced Internet Search Methods Three strategies: Ø name precisely the information being sought Ø use search strings (one or more search terms) rather than single words Ø enhance search strings by using boolean or natural language methods • This search methods concludes with tips on evaluating the quality of government (gov), education (edu), organization (org), and commercial (com) domains. • Metasearch– represents a process similar to a parallel, federated, broadcast, or cross-database searches.

v • Ø Ø Ø • Internet-Available Clinical Practice Tools Assessment– the systematic collection of data needed to arrive at one or more diagnosis. Tools included: Forms Miscellaneous Screening tools Risk assessment instrument Information of the manifestations of s/s These tools represent a sampling of assessment content available on the internet.

v • • • Ø Ø Ø Diagnosis– based in its Greek roots ”dia“ means through, and ”gnosis“ means knowledge. Diagnosis is dependent on the knowledge base of the person diagnosing. Disease represents the knowledge base of physicians. Human responses to illness and helth represent the knowledge base of nursing. Knowledge bases classification systems: Medical classifications of diseases Nursing classifications of human responses to illness and health Functional health and disability

q New Threats to Health– include mass truma, biologic and biochemical warfare agents, and emerging infectious diseases. Primary care and emergency department practitioners need readily accessible information to facilitate diagnosis. The CDC’s Emergency Preparedness and Response Web page is an excellent source. -- Mass Trauma Preparedness and Response -- Bioterrorism Agents/Diseases -- Chemical Agents -- Recent Outbreaks and Incidents -- Bioterrorism Information Available through Academic Health Science Centers

Disease Diagnoses– the most familiar terminology is the ICD (World Health Organization, 1992). For use in the United states, WHO has authorized the Department of Health and Human Services National Center for Health Statistics to develop, WHO ICD conventionns, the ICD-10 -CM, where CM refers to clinical modification. � Use of ICD code allows the aggregation of disease data across patient care settings. q

Human Response to Illness/Health Diagnosis—the internet tools presented in this section are infrastructure tools, because much of the work that needs to be accomplished in the field of nursing diagnosis is at infrastructure level. � Terminologies designed for or listing nursing diagnoses include NANDA Diagnosis and Classification, Home Health Care System, The Omaha System, and the perioperative nursing data set. q

q The International Classification of Functioning, Disability, and Health (ICF) another terminology of interest in nursing practice that consists of four domains: body functions, body structures, activity and participation, and environmental factors. Of these, the body functions, activity and participation, and environmental factors contain subsets with terms applicable to or capable of being developed as nursing diagnosis.

Treatment– is used in lieu of interventions and nursing actions, because it expresses more precisely the broad clinical management focus. • Calculators– internet tools are available to facilitate calculations used in planning treatment. Examples: - Martindale’s Calculators Online - Nursing calculators for drug administration purposes -Medical calculators developed by Cornell University Medical College, Pediatric Critical Care Medicine. v

• 1. 2. a) b) c) d) Drug Management– There is no shortage of information available on pharmacotherapeutics and the pharmacologic management of patients. Drug Enforcement Agency--excellent information on drugs and chemicals of concern Food and Drug Administration--with an outstanding search capability. Center for Drug Research and Evaluation Medwatch: The FDA Safety Information and Adverse Event Reporting Program Medwatch Adverse Event and Product Problem Forms Vaccine Adverse Event Reporting System

3 NLM Clinical Alerts Database. 4 The National Institutes of Health--provide. outstanding drug information a) National Institute on Alcohol Abuse and Alcoholism b) National Institute on Drug Abuse c) National Center for Complementary and Alternative Medicine 5 The CDC--provide a wealth of information of. vaccines as well as annually updated vaccine schedules for all age groups. a) CDC Vaccines and Immunization b) CDC National Immunization Program

6 University sites. a) Indiana University-Purdue University Indianapolis b) University of Missouri- Columbia, Pharmacy Services Department 7 Commercial sites. a) Medscape b) Rxlist

Evidence-Based Practice Guidelines • 1. a) b) c) d) Government Sites Practice/treatment guidelines are available at several gov. sites CDC Diseases and Conditions Sexually Transmitted Diseases Treatment Guidelines 2002 Tuberculosis Core Curriculum on Tuberculosis 2000 Tuberculosis Treatment per American Thoracic Society, CDC, and Infectious Disease Society of America

2 National. Guidelines Clearinghouse– this site includes the practice guidelines for the major nursing and medical specialty organizations as well as those developed by Schools of Nursing and Schools of Medicine. 3 National Institutes of Health. a) Guidelines for the Diagnosis and Management of Asthma, from the National Heart, Lung, and Blood Institute b) Detection, evaluation and treatment of high blood cholesterol in adults c) Hypertension d) Overweight and Obesity Clinical Guidelines

Practice and Treatment Guidelines: Professional Organization Sites American Diabetes Association, Clinical Recommendations 2. American Cancer Society Guidelines for Screening, Surveillance, and Early Detection of Adenomatous Polyps and Colorectal Cancer 3. American Academy of Family Physicians, Clinical Recommendations 1.

Outcomes– outcomes measurement is a tradition within nursing practice • Categories: Ø Patient Safety– is an outcomes issue. There are several patient safety sites, which are of prime importance to advanced practice nurses. -Agency for Healthcare Research and Quality Web Morbidity and Mortality Rounds -The patient safety page of Medscape. com -Institute for Healthcare Improvement v

Nursing Outcomes– refer to standardized nursing terminologies that either present outcomes in a structured format or data sets that may be used for evaluative purposes. • NOC– is an acronym for the Nursing Outcomes Classification, a standardized nursing terminology. • NMDS and i-NMDS– are two related data sets. NMDS refers to the nursing minimum data set. An international version, called i. NMDS, is being developed by the International Council of Nurses. Ø

Nursing Home and Home Healthcare Setting Outcomes– related to nursing outcomes are those measures that evaluate the quality of care within nursing homes and home healthcare settings. • The minimum data set– is a long-term care resident assessment instrument uesd by the Centers for Medicare and Medicaid. • The MDS information site provides historical questions, manual, forms, and technical specifications hyperlinks. • OASIS (outcomes assessment information set) measures are used to evaluate quality within home healthcare settings. Ø

Health Plan Outcomes � The acronym HEDIS stands for Health Plan Employer Data and Information Set– a trademark name of the National Committee for Quality Assurance (NCQA) Ø Office Tools: Online Healthcare Record Audit and Patient Satisfaction Forms � Health care record audit criteria � Patient Satisfaction Form (four-point-scale) � Patient Satisfaction Form (five-point-scale) Ø

Short Form (SF) Health Survey– this survey tool is especially useful for population-based intervention studies or in cohort studies. Ø Outcomes Measurement: Internet- Available Biostatistical and Analytical Tools -Qualitative data creation, management, and analysis software -Qualitative database software -Epidemiologic analysis software -Chi- square calculator -Student’s t-test calculator -Extensive listing of free biostatistical software and biostatistical tests online Ø