Week 11: Social Justice

What is social justice? Equity? Equality? How is social justice related to nursing? 

According to Braveman & Gruskin (2003), social justice is often used interchangeably with equity. Equity is defined as "the absence of socially unjust or unfair health disparities", social justice, and fairness. (p. 254). The definition of fairness varies with every individual; thus, what I believe to be fair may or may not be fair to another person. 

Health is promoted and seen as an inequity, not an inequality. Similar to fairness, the meaning of health is different for everyone. Some people may associate being healthy as the absence of disease or illness, while others may think being healthy means exercising and avoiding chips and soda. Health inequity is present due to the social determinants of health that affects each individual. Geographically speaking, some individuals are more prone to certain diseases than others because they live in certain areas where the atmosphere and water are more polluted. Biologically speaking, some individuals may grow up free of diseases or illnesses while others develop diseases because of their genetic makeup. In addition, education and health practices can also affect peoples' health. These are some of the social determinants that cause health inequity. 

Furthermore, employment, social status, and income are factors that cause health inequity. These factors were played out during class facilitation where we were divided into three groups ranging from higher social class status, middle social class status, and lower social class status/poverty. The activity demonstrated that if the middle and lower social classes wanted to achieve their goal and obtain what they wanted, then they would need to make wise decisions such as purchasing a hard copy of the scholarly articles. On the other hand, it was noted that the higher social class was able to obtain their goal while spending the most money and having the most money left over. In addition, the higher class outbid the middle class for the fight to answer one question. The activity demonstrated inequity in the social environment because even though everyone was offered the same resources, not everyone was able to take them to their advantage because they did not have the income to do so.   

Equity is, however, not used interchangeably with equality. Equality is something that is fair and evenly distributed. 

For example, if Jacky buys Lizzy one scoop of strawberry flavoured ice cream and Belle one scoop of chocolate flavoured ice cream, then that is fair. However, if Jacky buys Lizzy one scoop of strawberry flavoured ice cream and Belle two scoops of chocolate flavoured ice cream, then that is unfair because Jacky did not buy equal numbers of ice cream scoops for the girls.  

The above case scenario demonstrated inequality because the girls did not receive the same amount of ice cream scoops. However, if we were told that Lizzy is 4 years old and Belle is 16 years old, then it is understandable that Belle has received one more scoop of ice cream than Lizzy. In this case, Lizzy may understand that Belle is older and eats more than her, therefore she gets two scoops of ice cream. Thus, this second case scenario demonstrates equity because Belle is older and can eat more.  

Below is another example of equality vs equity. Equality is based upon fair distribution between all members of a party, though it does signify that everyone gains equal benefits to it. The photo on the left shows how the three boys are treated equally because they are each given one box to stand on. Though, because the three boys are not the same height, one boy benefits from the box more than the other because the shortest one cannot see the game. In contrary, the photo on the right shows how the three boys are treated with equity because they are all able to benefit from the box since they can all view the game. 

Figure 1. Equality vs Equity. Adopted from "The problem with 'Equality'" by the City of Portland, Oregon, 2013. Retrieved from http://www.portlandoregon.gov/oehr/article/449547?

Another topic that was discussed in class is information poverty. Information poverty is a growing issue that is said by Britz (2004) to have a "negative effect on the economic, cultural, and socio-political development of the Third World nations" (p. 192). The author also mentions that people do not have the knowledge to obtain complete information needs because they lack the resources and materials to do so. There are three factors to information poverty: connectivity approach, content approach, and human approach (Britz, 2004). 
  
The connectivity approach in information poverty focuses on those who lack the access to information and communication technologies (ICT) due to digital barriers. Individuals who do not have access to the Internet or have a computer to connect to the Internet are affected by this approach. 

There are solutions to the connectivity approach. The community or public libraries can offer free internet access to those who want to use ICT. In addition, public libraries can set up workshops or groups for individuals to come in and learn how to operate a computer and to improve their literacy level.  

The content approach in information poverty is affected by a person's budget to afford the access to ICT. This approach plays an economic factor to individuals who do not have the income to purchase digitized formats of information. In addition, this approach also affects those with lower educational levels since they are unable to operate digital technologies with limited literacy. 

There are solutions to the content approach in information poverty. Similarly to the solutions to the connectivity approach, individuals can access ICT at public libraries or other institutions. 

Lastly, the human approach is determined by the individual's level of literacy to understand, read, write, and communicate the information that they are presented with. If an individual has access to ICT but does not have the literacy to understand how to operate it, then the individual is dealing with information poverty. 

Communities can promote and teach individuals how to operate computers and improve their literacy levels through training and education. For example, public libraries can form information groups or set up workshops for those who are willing to learn more about ICT. 

Information poverty is caused by three underlying factors which include the fundamental causes, socio-economic causes, and contextual causes. 

The fundamental cause of information poverty is due to the fact that the individual does not have the skill to access ICT or operate one that is up-to-date. For example, even if an individual has the capability to work an older version of ICT, it does not mean that the same individual will be capable of operating the newer version of ICT. 

In order for individuals to overcome the fundamental cause of information poverty, they will need to keep up-to-date with the ever-growing ICT. One such method can include attending workshops to improve one's ICT skill or obtaining a more recent version of ICT. 

Socio-economic cause of information poverty is affected by "globalization and integration of the world's socio-economic life" (Britz, 2004, p. 195). Since socio-economic is a huge factor that affects many people, the solution may involve authorized individuals to advocate for the vulnerable individuals for better resources. 

Lastly, the contextual causes of information poverty is often seen in comparison with two groups of individuals who share the same physical context, but differs in their level of literacy to understanding how to properly access ICT (Britz, 2004). For example, Audrey and Lydia are both international students from England and Korea who have come to Canada to study. Even though Audrey and Lydia are now within the same environmental and physical contexts, their levels of literacy differ because of where they came from. Audrey may have an easier time adjusting to ICT in Canada because she is fluent with English while Lydia may have a harder time adjusting since English may not be her native language. In this case, Audrey may be classified as information rich since she is able to access ICT with minimal issues and Lydia is information poor because she is having difficulties understanding English to an extent.  

To minimize or eliminate the contextual causes of information poverty, one must understand and learn another person's culture and beliefs in order to recognize the differences in both cultures. When the person is culturally aware, he/she can educate others easier as the person will be free of assumptions which can cause an unhealthy relationship. 

Overall, the three approaches in information poverty can be easily dealt with if individuals have equal access to public libraries. Public libraries provide basic literacy training and an open area for group discussions. They also contain "welcome desk, information provider, information producer, referral agent, and authority controller" to guide individuals and promote education (Ogunsola, 2009, p. 67). Public libraries also offer programs to alleviate those who are affected by poverty by encouraging them to learn basic adult literacy, health literacy, and information literacy (Ogunsola, 2009).  

In class, we also discussed how social media is used as a tool to include the vulnerable population to overcome exclusion and isolation. The vulnerable population include the aboriginal, refugee, older adults, homeless, and disabled. Though I will not touch upon all groups of the vulnerable population, I will be specifically looking at the disabled population since that is what my group focused on. 

For starters, taken from a census in 2006, the disability rate of Ottawa's population is 18% (Taylor, 2011). The majority of the disabled population is of people between the ages of 20-64. 
Social media attempts to include people affected by disability by creating and updating software that can assist their needs (mobility, vision, hearing, etc..) The population spend an average of six hours a week working on school assignments on social media and twelve hours a week on social media for leisure time (Taylor, 2011). Individuals use the Internet to go on social networking sites such as FaceBook, YouTube, or Skype. 

The advantages of including the disabled population via social media include eliminating the physical and geographical barriers that prevent them from interacting with friends or relatives. Social media also makes individuals feel more welcomed and accepted into society. 

However, there are factors that prevent some of the disabled population from accessing the Internet such as education and income. Education plays as a barrier to accessing the Internet where individuals cannot communicate with other people because they have a lower level of literacy. Income is another barrier since the lack of income can prevent an individual from obtaining Internet access, let alone enough money to buy a computer. In addition, income can also have an effect on the Internet speed, connectivity, and the amount of data that one can use. One last barrier that can inhibit or even prevent an individual from interacting or using the Internet is a physical barrier. The physical barrier includes assistive technological devices installed into the computer. If the assistive devices are not kept up to date, then they would not be running properly or operate at all. Without the use of assistive devices, the disabled population may not be able to enjoy using the Internet effectively as there is a barrier that prevents them from showcasing their abilities to interact with others. 

In conclusion, the issue of health inequity still remains in society as the social determinants of health play a negative impact towards a consumer's health. We are to be reminded that inequities are factors that are different in each individual and can only be prevented when there is an absence of health disparities. In order to rid the inequities of health, one must learn to advocate for necessities and educate those who are in need of health improvements. 

Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology and Community Health, 57(4), 254-258
Britz, J.J. (2004). To know or not to know: a Moral reflection on information poverty. Journal of Information Science, 30(3), 192-204. 
City of Portland, Oregon. (2013). The problem with "Equality". Retrieved from http://www.portlandoregon.gov/oehr/article/449547?
Ogunsola, L.A. (2009). Health information literacy: a Road map for poverty alleviation in the developing countries. Journal of Hospital Librarianship, 9, 59-72
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/ResourceFiles/Taylor_Social%20Media_feb2011%20(1)_1_2.pdf

Week 9: Electronic Health Technologies: eShift Model of Care

In class, we were taught that the increase in demand and the decrease in resources can promote workflow and happier relationships. 

Let's start off by viewing this YouTube video: 
HENRYandREL Supermarche: Meals Per Hour

The above YouTube video demonstrates how organization and teamwork can efficiently cut down the number of resources, while creating a less congested workflow and lend a helping hand to more families. At the beginning, George and Metro spent 3 minutes packing one box of food and necessities; however, they were able to pack one box in 11 seconds after creating a better system. In addition, the system allowed them to distribute the boxes to families in only 1.2 hours, which is less than half the time it took them before.
In cooperation with Toyota Production System and advice from other people, the system shifted from a disorganized environment to a workplace-efficient and organized environment. For instance, they reduced the sizes of the cardboard box so they could be easier to handle and allow for more space in the trucks. A conveyor belt also helped increase workflow in the environment because volunteers were able to stay in one place and handle one job instead of running around everywhere. 

During the second half of the class, we discussed the purpose, advantages, and disadvantages of E-Shift in nursing. According to South West Local Health Integration Network (2013), E-Shift is defined as "a technology-based initiative that connects an enhanced-skill Personal Support Worker (PSW) in the home with a registered nurse via a web-enabled iPhone." E-Shift is a movement that involves the use of technology to solve the issue of declining nurses in the health care industry. More importantly, E-Shift works to improve the quality of life for those in palliative care by decreasing the number of hospital visits and the burden of caregivers (Health Quality Ontario). It can alleviate financial, physical, emotional, and mental burdens on the caregivers of the patients. The caregivers suffer from physical burden when they are constantly awake and alert to care for the patients and mental burden for caring for a loved one who will soon be leaving them. Additionally, E-Shift creates a more flexible environment and empowers staffs to work with more than one patient. 

The E-Shift program ensures that each palliative patient receives the best optimal care during his/her last days by enhancing the skills of the health care providers involved in their care (Health Quality Ontario):

• PSWs receive intensive palliative training such as learning how to observe and report vital signs and symptoms to the registered palliative nurse that they are collaborating with
• PSWs are trained to operate Smartphones and computer technologies so that they can share and inform the RNs of the palliative patients' condition
• RNs are trained to provide virtual support and to effectively communicate with the PSWs involved in their patients' care 
• CCAC Supportive Care Team are trained to operate and view electronic patient records

According to Health Quality Ontario, the E-Shift program is successful in ways that hospital readmission or visits have been reduced as 92.3% of the participants had not visited the hospital during the last weeks of their lives. Additionally, "32.6% more clients died at home as per their wish" in comparison to the 52% of non-participant clients who died without the use of E-Shift. Furthermore, 92.3% of the caregivers explained that they did not experience caregiver burden because they seek help from E-Shift. 

Although the E-Shift program does serve as an advantage to patients in palliative care and the decline in nurses, there are disadvantages to participating in the program. For example, a lack of communication and understanding between PWSs and RNs can inhibit or negatively affect the palliative patients' health. Since the PWSs are only able to send photos or data via a smart phone, it is difficult for RNs to be able to make sense of the whole picture since they are not physically present to examine the patients. Additionally, if a blackout were to occur or if Privacy and professional accountability are two important factors as well. Since the PWSs will be caring for the patients in their homes, there is no doubt that the patients and their caregivers will feel invaded. The PSWs will need to be reminded to remain respectful and accountable for their actions. Furthermore, PSWs are reminded to maintain a professional boundary with their clients as it may be difficult for them to separate personal feelings from professional feelings. 

In reflection, in class we were presented with a case scenario in which we had to choose whether or not we would want to admit an important person in our lives to the palliative care unit in the hospital. We were physically and mentally burden from caring for the important person. In addition, we were aware that the person wished to die peacefully at home; however, we could no longer care for him/her while feeling burdened. 
In response, I would choose to care for the important person at home because as an individual I would like to fulfill that person's last wish- to die comfortably at home. Also, as a nurse I would need to respect my patient's desires and wishes as long as they do not interfere with or degrade the patient's health.  
However, I am aware that I cannot force my limits upon myself to care for someone I can no longer look after because of physical and mental burdens. Thus, if possible, I would choose to seek help in caring for the person while fulfilling their wish to die peacefully at home. At the end of the day, I will continue to care for the important person in his/her home. 

Furthermore, in reflection I will answer to the questions presented in the Learning Activities:
What are your thoughts regarding nursing care/service, whereby the nurse was never physically present? Does a nurse always have to be physically present to undertake the nursing role?
In my opinion, not all nurses need to be physically present in order to care for their patients. There are many nursing positions that do not require nurses to interact with patients at all such as a nursing professor who teaches theory courses in a nursing school. Other non-clinical nursing positions include nurse researchers, nurse advocators, or healthcare recruiters. 
Nurses do not need to be physically present in order to serve their role as nurses because different nurses have different roles but similar purposes: to promote health.     


Health Quality Ontario. Eshift -- Creating a virtual in home end of life care team. Retrieved from http://www.hqontario.ca/portals/0/Modals/pr/hc/en/pdf/success-story-south-west-en.pdf 
HENRYandREL Supermarche. (2013). Meals per hour [Web]. Retrieved from  http://www.youtube.com/watch?v=EedMmMedj3M
South West Local Integration Network. E-shift helps patients and south west CCAC. Retrieved from http://www.southwestlhin.on.ca/newsletter.aspx?id=60

Week 7: Electronic Health Technologies: eHealth Records

There is no doubt that the evolution of healthcare has come a long way. One such example is identified in the YouTube video shown below:

HTVnetwork: History of Healthcare


The History of Healthcare uploaded by HTVnetwork briefly touches upon the advances in the field of surgery over time. It is explained that surgeons were the barbers through the middle ages. Barbers would perform primitive procedures with the absence of anesthesia in people such as tooth extractions and bloodletting. Bloodletting is a procedure that draws blood out of people in hopes of curing them of their illnesses or diseases. 
In the mid 1800s, the introduction of anesthesia helped patients relieve pain and improve recovery rates, which allowed surgeons to perform more invasive procedures and caused the advancement in the field of surgery. 
In contemporary society, surgeons manipulate the use of medical technological devices to help them complete invasive and complex surgery procedures such as the da Vinci surgical system. The da Vinci surgical system is a robotic device that guides surgeons to perform complex procedures such as dealing with tiny incisions. The device can also view the surgical site in a high resolution 3-D magnified view for maximal accuracy (Intuitive Surgical, Inc., 2013). 

The field of surgery is one of the many areas in which healthcare has evolved in over time. Another evident example of improvement in healthcare is electronic health technologies.

In class, we discussed the differences between electronic medical records, electronic personal records, electronic health records, and personal health records.

An electronic medical record (EMR) is often used interchangeably with electronic personal record (EPR). EMRs and EPRs are less comprehensive and complete in comparison to electronic health records. They are "partial health record under the custodianship of a health care provider(s) that holds a portion of the relevant health information about a person over their life time" (Booth & Donelle, 2012, p.537). 

An electronic health record (EHR) is a complete and comprehensive health record of an individual's. It is only accessible under proper authorization of the custodianship of the health care provider. Properly defined by Canada Health Infoway, electronic health record is "a complete health record under the custodianship of a health care provider(s) that holds all relevant health information about a person over their lifetime. This is often described as a personcentric health record, which can be used by many approved health care providers or health care organizations" (Booth & Donelle, 2012, p.536). 

The advantages of EHR include reducing medication errors and promoting collaboration between health care providers and the patients. Medication errors can be reduced via computer provider order entry (CPOE) system. CPOE enables health care providers to electronically input medication and treatment orders into the system (Booth & Donelle, 2012). The use of EHR also eliminates the limitation of health information stored by only one health care provider since information can now be shared among the people who are involved in the patients' care. 

However, there are disadvantages of EHR such as sharing health information between health care providers and patients. Studies have shown that the use of EHR can lead to poor communication and understanding between health care providers and their patients because of how they were trained to use EHR (Lynott, Kooienga & Stewart, 2012). The study was demonstrated to examine how the use of computer to input data affects a patient-provider relationship. It was concluded that the participants (providers) in the study who had a longer training period made their patients more comfortable. For example, the participants noticed that the positioning of their laptops or computer monitors played a major role in communication between themselves and their patients. Thus, the providers were able to communicate with their patients in ways that both parties could understand and see what is documented (Lynott, Kooienga & Stewart, 2012). In conclusion, the study found that the positioning of the computer and the level of communication skills and openness between the provider and patient can greatly impact the patient's comfort level and health. 

In reflection, I do agree that poor communication between a health care provider and his/her patient is a huge factor that can inhibit a patient's care. Last summer when I visited my doctor, the first thing that I had noticed when I walked into her office was the office setting. Here is a basic idea of what her office was like: 

During the interaction with my family doctor, I noticed that she was too engaged with documenting on her computer that she had neglected my presence. She hardly made any eye contact with me and that made me feel uncomfortable and not cared for. For example, she would read off her computer screen and type while I was talking. 

To conclude, I would most certainly rate my doctor visit as non-therapeutic. 

Pesonal health record (PHR) is defined by Kim & Nahm (2012) as "an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual" (Definition of PHR section, para. 1). The purpose of PHR is to ensure that the patients are involved in their care since they have control over their PHRs. PHRs allow patients to share selected health information to selected people. 

The greatest advantage of PHR is that the patient has complete control over his/her care because he/she is the one who is managing the PHR. This way, the health providers are forced to work at the patients' pace and accordingly to what information is revealed to them. In InfoButton, the Patient Clinical Information System (PatCIS) is incorporated in the patients' PHR (Kim & Nahm, 2012). The PatCIS allows patients to understand medical terminology and medical data such as test results.  

In contrary, there are many disadvantages to PHR. For one, since PHR is handled by the patient, the health care providers may not be able to understand what the patient is describing in his/her PHR since he/she would not be using correct medical terminology. In addition, the patient may also leave out important and/or relevant health information, which can inhibit the patient's care. 

Telehealth is another example of health technology. Its purpose is to remotely serve patients based on these four ways (Booth & Donelle, 2012): 
1. teleconsultation
2. health education and training
3. health information transfer to/from health care providers 
4. healthcare information for clients
Telehealth can improve patients' health and well-being by ensuring continuing care, reducing geographical and financial barriers (such as transportation fees), allowing for health education, collaboration, and participation with other health care providers in the patients' care (Booth & Donelle, 2012). 

There is no doubt that the shift in healthcare has brought along tremendous discoveries in technologies and studies through research and experiments to help cure diseases and save lives. However, it is unfortunate that there are some underlying factors that can prevent patients or other individuals from receiving maximal care. A few prominent issues that affects one from utilizing electronic health technologies include not having the literacy to do so and the financial stability to maintain Internet access at home, let alone purchasing a computer. Users can be affected by health literacy and an adequate literacy level to read and type the language that the PHR is provided in. 

Electronic health technologies have their advantages and disadvantages. The factors vary for every user because not everyone suffer from the same health conditions or physical and social barriers in life. For example, in class we discussed various factors that can affect the older generation and the new generation from obtaining optimal health via electronic health technologies. The older generations stress that computer literacy is their biggest underlying factor as they may not want to learn how to operate a computer. However, there are many programs that encourage elders to learn how to operate a computer. In addition, the younger generations do not see any obvious barriers that can inhibit their care since they believe that they manage well with computers.


Booth, R., & Donelle, L. (2012). Nursing Informatics and Technology, Chapter 25. In B. Kozier, G. Erb, A. Berman, S. Synder, M. Buck, L. Yiu, & L. Stamler (eds.). Fundamentals of Canadian nursing: Concepts, process, and practice, 3rd Edition (p.536-539). Toronto: Pearson.
HTVNetwork. (2010). History of healthcare [Web]. Retrieved from http://www.youtube.com/watch?v=i2mpgwGRJyw&feature=youtu.be
Intuitive Surgical, Inc. (2013). The da Vinci surgical system. Retrieved from http://www.davincisurgery.com/da-vinci-surgery/da-vinci-surgical-system
Kim, K. & Nahm, E. (2012). Benefits of and barriers to the use of personal health records (PHR) for haelth management among adults. Online Journal of Nursing Informatics. 16(3).
Lynott, M.H., Kooienga, S.A., & Stewart V.T. (2012). Communication and the electronic health recording training: a Comparison of three healthcare systems. Informatics in Primary Care. 20:7-12.

Health Informatics - Week 6: Consumer Health Informatics and eHeath (cont.)

"These days, one witty tweet, one clever blog post, one devastating video-- forwarded to hundreds of friends at the click of a mouse-- can snowball and kill a product or damage a company's share price."

- Tim Weber (as cited in Kietzmann, Hermkens, McCarthy & Silvestre, 2011)

Agree or disagree? In contemporary society, social media is becoming an increasingly large and wide-spread trend. Many people now turn to social media for various reasons such as communication, games, opinions, purchases, and other online activities. Below are examples of social media that users may engage in: 

Top left: a form of communication on social media - Facebook        Top right: online game on the Internet - World of Warcraft        

Bottom left: a form of communication on social media - reddit          Bottom right: purchasing and selling goods on the Internet - ebay

I will now focus on the strengths of the following social media in relation to how they can positively affect a consumer's health: Facebook, online games, forums, and ebay. 

Facebook is an online social network that strives to "give people the power to share and make the world more open and connected" (Facebook, 2013). Facebook (2013) explains that its purpose is to allow users to connect with friends and families, to discover and keep up-to-date with society and the world, and to share and express their thoughts and opinions freely. Facebook is also a place where health and other concerns are addressed and discussed. For example, Facebook encourages users to update their profile status which includes one's work and education, relationship, families, places lived, basic information, contact information, and life events. Under life events, there is a category in which users can update their health and wellness status. Under this category, users can identify themselves as potential donors and share their story as to why they chose to become donors. 

(Facebook, 2013)

In addition, within Facebook lies many communities that advocate for health. There are many groups and pages created to promote health and wellness such as "Healthy Blender Recipes" and "Daily Health Tips". Both groups allow Facebook users to interact with the group administer by commenting, sharing, and liking posts. 

Online video game playing forms a community of players who come together to communicate, play, and learn. Furthermore, research has proven that video games can promote a player's health by boosting their educational and developmental growth (Gumulak & Webber, 2011). Education and social environment are two determinants of health that can affect a person's quality of life. By enhancing one's educational status through literacy and developmental growth through interaction by playing video games, one can improve his or her health. 
Educationally, video games test for players' literacy level and critical thinking skills. For instance, since games come with limited speech or tutorials, players are encouraged to read lines of text to understand and process the information in order to find the purpose of their mission and how to complete the challenge (Gumulak & Webber, 2011).

Furthermore, online video game playing can promote a player's developmental growth since some online games set up online forums for players to interact from outside the game. 

Forums are used for the sole purpose of interaction between online users. Players can engage in conversations to seek opinions or solutions to follow in order to complete a mission. However, forums are not limited to conversations regarding the video game; players can also post discussions on forums about anything such as health, relationships, life, education, and hobbies. In regards to health related forums, they can act as an empowering or disappointing tool to certain participants. For example, a study demonstrated that parents of children with genetic condition often turn to the online community for advice, support, and information instead of doctors (Ziebland & Wyke, 2012). The parents or patients believe that other people who are suffering from similar conditions hold more accurate information than doctors since they are able to experience the signs, symptoms, and the hardships of enduring the condition. The ability to read and hear other patients speak of their experiences can "affect decision making, one's sense of isolation or support, and adjustment to the illness or health condition" (Ziebland & Wyke, 2012, p.221).  

Lastly, online purchasing and selling have been a trend that many consumers take part in for convenience. There are websites that allow users to purchase and sell goods locally or internationally. eBay is one such website that attracts many business-seeking individuals to buy and sell securely, easily, and quickly (eBay, 2013). Consumers can purchase health-related products such as novels, knee and back braces, and arthritis gloves. 

Social media networks are created under a framework of a honeycomb of seven functional building blocks: identity, conversations, sharing, presence, relationships, reputation, and groups (Kietzmann, Hermkens, McCarthy & Silvestre, 2011). 
Identity: a functional block where users identify themselves on social media websites by either their name, gender, age, date of birth, location, profession, and other personal information. By sharing one's identity on the Internet, it allows others to find or connect with the user. However, identities should be protected to some extent, such as adjusting privacy settings, to avoid being a target of cyber bullying. 
Conversations: conversations enable users to communicate with others on social media. In social media, users can converse with individuals or in groups through group chats or forums. Conversations on social media have some limitations such as waiting for another user to reply. 
Sharing: sharing on social media is another form of communication among users. Users can share information via photos, videos, text, or links. Sharing information online can be hazardous because information on the Internet can spread quickly and be manipulated. 
Presence: a user's presence in social media calls for their availability and accessibility on social networks such as Skype and Facebook. Users can conceal their online presence by appearing 'offline' or 'away' to avoid other users from contacting them. 
Relationships: relationships on social media can be found on a user's profile by identifying who 'follows', 'friends', or 'subscribes' to the user on social media such as Twitter, Facebook, and YouTube, respectively. Relationships allow users to connect and share common interests. 
Reputation: reputation on social media is based on trust and popularity. For example, reputation plays a huge role on online merchandising sites such as ebay and amazon. Buyers often review the sellers' feedback and ratings before purchasing from them. Popularity comes into play in the YouTube community and forums. 
Groups: groups are formed within communities of social media such as Facebook groups, friends, and gaming groups. Groups allow users with common interests to share information and have fun together.    

Social network, online game play, forums, and the online markets are some of the places that a user may want to visit. In addition, users with health concerns may visit social networks and forums for advice from professional figures or experienced individuals. In this case, the user who seeks health advice from third party sources as opposed to visiting a health professional for answers demonstrates the shift from an intermediation environment to an apomediation environment.  

Apomediation is one of the five major aspects of Web 2.0. The other four aspects include social networking, participation, collaboration, and openness (Eysenbach, 2008). 

Intermediation is a form of information seeking strategy where people rely on information given by traditional experts or authorities such as their family physician or other health care providers. On the other hand, apomediation is a form of information seeking strategy where people rely less on traditional experts or authorities (licensed doctors, nurses, or other health care professionals), and instead rely on experienced individuals and nontraditional experts such as health 'gurus' (Eysenbach, 2008). In health care, patients may refer to both the intermediation and apomediation environments. Firstly, a patient may go online and self-diagnose by researching what health condition is associated with his/her health signs and symptoms (apomediation). Then, the same patient may seek a health professional for reassurance (intermediation). Finally, after the patient is diagnosed by the health professional, he/she may seek further guidance on the Internet (apomediation). Additionally, the comparison between intermediation and apomediation can be found below: 

Dimension	Intermediation Environment	Disintermediation/Apomediation Environment
Overarching Issues
Environment	Managed	Autonomous
Power	Centralized; power held by intermediaries (experts, authorities)	Decentralized; empowerment of information seekers
Dependence	Information seekers dependent on intermediaries (physicians, parents); intermediaries are necessary	Information seekers are emancipated from intermediaries as apomediaries (peers, technology) provide guidance; apomediaries are optional
Nature of Information Consumption	Consumers tend to be passive receivers of information	Consumers are “prosumers” (ie,, co-producers of information)
Nature of interaction	Traditional 1:1 interaction between intermediary and information seeker	Complex individual- and group-based interactions in a networked environment
Information filtering	“upstream” filtering with top-down quality assurance mechanisms	“downstream filtering” with bottom-up quality assurance mechanisms
Learning	More formal; learning through consumption of information	More informal; learning through participation, application, and information production
Cognitive Elaboration	Lower cognitive elaboration required by information receivers	Higher elaboration required by information seekers; higher cognitive load unless assistance through intelligent tools
User	More suitable for and/or desired by preadolescents, inexperienced or less information literate consumers, or patients with acute illness	More suitable for and/or desired by older adolescents and adults, experienced of information literate consumers, or patients with chronic conditions
Credibility issues
Expertise	Based on traditional credential (eg, seniority, professional degrees)	Based on first-hand experience or that of peers
Bias	May promote facts over opinions, but opportunity for intermediary to introduce biases	May bestow more credibility to opinions rather than facts
Source credibility	Based on the believability of the source’s authority; source credibility is more important than message credibility	Based on believability of apomediaries; message credibility and credibility of apomediaries are more important than source credibility
Message credibility	Based on professional and precise language, comprehensiveness, use of citations, etc.	Based on understandable language, knowing or having experienced issues personally
Credibility hubs	Static (experts)	Dynamic (opinion leaders)
Credibility evaluations	Binary	Spectral

Table 1. Issues in an apomediation vs intermediation environment. Adopted from "Medicine 2.0: Social networking, collaboration, participation, apomediation, and openess," by Eysenbach, G, 2008, Journal of Medical Internet Research, 10(3), p.6.  

In addition, we also incorporated the use of apomediation during our class facilitation. We were divided into five groups of health care providers who would join a chat room. In the chat room, users would talk about their profession (nurse practitioner, midwifery nurse, clinical nurse specialist, critical care nurse, and occupational health nurse). In the discussion, I learned that information was exchanged by many students who obtained their information from various websites that could have been credible or not credible. Which led me to believe that I should take the information that I was given with a grain of salt instead of believing every single word since I would not know how credible the information is. 
  Social networking in Web 2.0 allows users to connect with people to facilitate collaboration. It also allows for communication, demonstrates trust, reputation, and the accountability and quality of the information shared among users (Eysenbach, 2008). In regards to health care, social networking can enable patients to communicate with their health care providers and access their electronic health records. 

Participation in Medicine 2.0 enables patients to be involved in their care electronically. Patients can "access and control their personal health information and provide the possibility of consent" via the Internet instead of visiting their health care providers (Eysenbach, 2008, p. 4). In addition, patients can also adjust their privacy settings on their electronic health records. 

Collaboration is the involvement and interaction between health care professionals, researchers, and the patients in the patients' care. Collaboration is an important component in Medicine 2.0 because it promotes "possibilities for knowledge translation" and understanding of health between patients and the people involved in their care (Eysenbach, 2008, p. 7).

Lastly, there is openness. Openness allows patients and the people involved in their care to have open access to data and information that has been limited to the general public. This serves as an advantage because it calls for participation and collaboration between individuals to have access to research processes and information (Eysenbach, 2008).

Web 2.0 and Medicine 2.0 have their advantages and disadvantages. An advantage of Medicine 2.0 is that the approach eliminates the hierarchy in health care where power is distributed unevenly. The new approach allows for participation and for individuals to place in equal effort into their care. Medicine 2.0 also allows individuals to have equal access to their personal health records. However, there are limitations to Web 2.0 and Medicine 2.0. The sharing of personal health information electronically raises a huge question of whether or not the process is professional or credible. Will the health care provider approach the patient professionally and where is the professional boundary? Another question raised is credibility. Since patients are allowed to view and input their own health information into their electronic records, then how reliable will the information be? Patients may not use appropriate medical terminologies or input accurate information into their health record, which may inhibit their point of care. 

Overall, the Internet plays a part in many people's lives. People use the Internet for social networking, playing games, purchasing or selling goods, communicating with one another, and understanding and participating in their health. In all scenarios, there are advantages and disadvantages of going on social media, and accessing and sharing information online. With this said, one can only reflect on Weber's quote mentioned at the beginning of the blog: 

"These days, one witty tweet, one clever blog post, one devastating video-- forwarded to hundreds of friends at the click of a mouse-- can snowball and kill a product or damage a company's share price."

                                                                  - Tim Weber (as cited in Kietzmann, Hermkens, McCarthy & Silvestre, 2011)


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Ziebland, S., & Wyke, S. (2012). Health and illness in a connected world: How might sharing experiences on the internet affect people's health? A multidisciplinary journal of population health and health policy, 90(2), 219-249.