Health Informatics - Week 5: Consumer Health Informatics and eHealth

In class, we were shown a video about the spread of chlamydia as an example of how fast and easy information posted on the Internet can spread from one person to another. Another purpose of the video was to educate the class on eHealth. eHealth uses the Internet to allow individuals to access their health concerns and needs. Individuals can turn to blogs, credible sources, or not credible sources to evaluate their health concerns. Credible sources are sources that are reliable, objective, accessible, and accurate. 
To determine if a website or source is credible or not, an individual should look for these criteria: 

• Credibility: Does the source have an author? Who gets to edit the information? Contact information? Date of publication? How did the author gather the information? Is the source backed up by medical journals? Is the information up to date? 
• Content: Is the information complete and accurate? Is it objective or subjective? Is the information relevant to what you are looking for? Is the content easy to understand or are there 'big' words? 
• Disclosure: What is the purpose of the site? Is it to educate you or to sell you a product? Are you allowed to view information freely? Do you have to sign up/log in or subscribe for the information? 
• Links: Are there any ads on the site? What are they advertising and are they relevant to the information that you need or want? 
• Design: Is the information on the webpage easy to access and see? Does the site look professional to you? Are there any internal search engines that you can use? 
• Interactivity: Is feedback recommended on the site? Can you access or post feedback? Where can you voice your concerns and opinions on the site? Is it possible to interact with other users on the site?
• Caveats: Are there any disclaimers or clarification on the site? What is the purpose of the site? To sell or to educate? 

Click here for more information regarding the criteria for evaluating internet health information

Let Patients Help! Let Patients Help! Let Patients Help! 

Those are the words that e-Patient Dave from TED Talk plead at the end of his speech.

E-patient Dave advocates for individuals and patients in the world. He believes that patients should have access to their personal and health information because they are their own experts at health. Dave thinks that patients are being treated as third person in their health care and that they are not receiving patient-centered care. He talks about how the Internet has encouraged and taught him to understand his health and others health. He describes that the Internet is a place where patients can look for support from those who are suffering or coping with their health. 
Dave Debronkart: Meet E-Patient Dave

As a student nurse listening to Dave's speech, I feel inspired to advocate, understand, and communicate with my future patients. As a professional, I know that it will be a challenge for me to respect and listen to my patients' needs and wants because I tend to believe that I am the expert of their health. In order for me to provide the best possible care for my patients, I will need to work with them collaboratively and advocate with them to obtain their needs and wants. Although I will be aware of the side effects, benefits, and disadvantages of a drug or procedure, patients have the last say about what they wants to do with their body. I need to learn to work with the patients and not against them if they do not agree with what I offer. In addition, I can reassure my patients that they are the experts of their health and care by educating and including them in the care. For example, I can explain what I am doing, why I am doing this, and how this will help. Most importantly, I must remember to ask for my patients' consents and determine if they are comfortable with what I am doing to them before proceeding with their care. 

"We believe that when patients gain access to their own health records and information, their active decision-making will result in large improvements in health outcomes and extended overall health system benefits" (Leonard & Wiljer, 2007, p. 78)
I agree that if patients are given a chance to be more involved in their health, then there will be improvements in their health outcomes. Patients are the experts of their health and they are the only ones who can tell us what kind of symptoms they have and if the drug or procedure is working or not. 
We as health care professionals must remember that without patients, then we cannot work to develop or maintain health for anyone. Patients should be placed at the center of care because they are the experts who can help professionals improve their health and the health of others through experience. 

In conclusion, we as health care providers should ... 

.... Let Patients Help! 

References

Assessing the Quality of Internet Health Information: Summary. June 1999. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/data/infoqual.html

DeBronkart, D. (Performer) (2011). Dave debronkart: Meet e-patient dave [Web]. Retrieved from http://www.ted.com/talks/dave_debronkart_meet_e_patient_dave.html

Leonard, K.J., & Wiljer, D. (2007). Patients are destined to manage their care. Healthcare Quarterly, 10(3), 78

Health Informatics - Week 4: Evidence Informed Practice in a Technology Enhanced Workplace

In week 4 of my Health Informatics class, we compared evidence-based nursing practice with evidence-informed nursing practices. 

Evidence Based Practice	Evidence Informed Practice
o  Foundation of care o  Incorporating nursing theories into practice (ie. Tanner’s model) o  Nursing practice is based on the model/research; patients are treated based on what is found in the models or research o  Not client-centered care	o  Incorporating nursing theories or research into practice where applicable o  Knowing that each patient has his/her own needs; treating that specific need o  Drawing from experience and clinical judgement to provide best possible care o  Client-centered care

In class, we were to incorporate the evidence-based model into a case scenario. The case scenario focused on a 56 year old woman who may have atrial fibrillation. She described that the symptoms were preventing her from completing her daily runs and having fun with her grandchildren. She also stated her concern about going under invasive procedures and heard about anti-arrythmic drugs or nodal ablation. 
Based on the case scenario, the class discussed how to treat the woman based on her needs. 

During the second part of class, we were shown a video clip from speaker Eli Pariser on TED Talks about "filter bubbles" (TED2011). Filter bubbles describe how search engines such as Google and Facebook can selectively filter out topics that they deem are irrelevant to a person "based on information about the user (such as location, past click behaviour and search history)" (Wikipedia, 2013). 

Eli Pariser: Beware online "filter bubbles" 

In response to Pariser's speech on TED Talks, I somewhat agree on the advantages and disadvantages of filter bubbles that were presented.

Filter bubbles allow users to efficiently search for topics since the more relevant topics will appear on the first few pages. Without filter bubbles, users will need to use multiple search engines and click through many pages in order to find what they want. Though the absence of filter bubbles may act as a disadvantage, it can also be seen as an advantage. For example, non-filtered out search results challenge individuals' level of media literacy. Media literacy is "the application of critical thinking in assessing information gained from the mass media" (Booth & Donelle, 2014, p. 541). A user who is media literate will be able to categorize what information is useful and what is not. A user who is NOT media literate will click on the first few links available to them without analyzing the relevance of the literature or source. 
Pariser also mentioned that filter bubbles can shelter people from issues or news that they are not comfortable with, and that is both an advantage and disadvantage. The advantage encourages people to search within their comfort zone; however, it can prevent people from growing and knowing what the world is really like. Filter bubbles act as a restriction in the society that will always show people the 'good' things as opposed to the 'bad' things, or vice versa. When people are not given two perspectives to look at, then they cannot weigh out what is right or wrong in a situation (if any). In addition, since search engines and social media sites can accurately predict what a user favours due to filter bubbles, it may cause the user to feel insecure or watched over. 

In conclusion, filter bubbles can assist me to finding relevant information on the Internet; however, I believe that the cons do outweigh the pros. In addition, I am not completely disagreeing with the idea of the social media filtering out my dislikes. 
Though, no one likes the constant feeling of being watched and judged for what they post or do on the Internet. Furthermore, no one enjoys being judged and shaped into someone he/she does not want to be. By restricting what a person can see or learn in a certain situation, the social media is shaping the person into another being.  

What are strategies that you can implement with searching information to 'work around' filter bubbles? 
I can work around filter bubbles when searching information by using more than one type of search engine to get accurate search results. I can also rephrase my words and sentences in order to obtain different results. 

What are some misconceptions within nursing related to evidence-based nursing? 

Misconceptions

Fact

o  Evidence-based nursing is a new approach o  Evidence-based nursing is cookbook nursing o  Randomised controlled trials and systematic reviews are over-emphasised in evidence-based care -     RCT is flawed and not effective in practice in comparison to clinical experience

o  Evidence-based nursing has been known for more than 15 years. It has been working to identify its barriers and create solutions. -  “barriers include time constraints, limited access to the literature, lack of training in information seeking and critical appraisal skills, a professional ideology that emphasises practical rather than intellectual knowledge, and a work environment that does not encourage information seeking” (DiCenso, Cullum & Ciliska, 1998, p.38). o  Nurses use clinical expertise to balance out the risk and benefits of caring for each patient based on his/her needs o  Randomised controlled trials are research studies that are “abstracted, quantified, coded, and assembled” to present statistically analyzed data (DiCenso, Cullum & Ciliska, 1998, p.39). This procedure allows for accurate and more effective results. o  Nurses and other health care providers want to incorporate evidence-based care into their practice, but there is a lack of research for them to work with

References

Booth, R., & Donelle, L. (2012). Nursing Informatics and Technology, Chapter 25. In B. Kozier, G. Erb, A. Berman, S. Snyder, M. Buck, L. Yiu, & L. Stamler (Eds.). Fundamentals of Canadian nursing: Concepts, process, and practice, 3rd Edition (p. 541-545). Toronto: Pearson. 

DiCenso, A., Cullum, N., & Cilliska, D. (1998). Implementing evidence-based nursing: Some misconceptions. Evidence Based Nursing, 1(2), 38-40.

Praiser, E. (Performer) (2011). Eli pariser: Beware online "filter bubbles" [Web]. Retrieved from                                  http://www.ted.com/talks/eli_pariser_beware_online_filter_bubbles.html
Wikipedia. (2013, October 7). Filter bubble. Retrieved from http://en.wikipedia.org/wiki/Filter_bubble

Health Informatics - Week 3: Ethical Practice and Privacy

"Ethics is not definable, is not implementable, because it is not conscious; it involves not only our thinking, but also our feeling." 

- Valdemar W. Setzer

Everyday we are challenged to live life in our personal standard of ethics. To me, ethics does not draw a clear line between the right from the wrong; there will always be a grey area in a situation that will challenge me to reconsider what is truly ethical. 

In week 3 of my Health Informatics class, we discussed the ethical and privacy issues that may be brought up during our professional practice in the future. We focused on two cases. The first case involves a nursing student using her phone to take notes, search up medications, and connect on social media in a hospital unit. The second case involves a nurse Google searching her client's information on social media because a co-worker told her that her client has been convicted for rape and abuse. I will now be responding and reflecting on these two cases in addition to what was discussed in class. 

Case 1: Student Nurse using her phone while on shift 

Describe	Interpret	Evaluate
- a new nursing student has recently been placed at a hospital unit - the nursing student.... - uses her phone while she is on her shift despite the hospital not having a 'bring-your-own-device' policy - uses her phone during patient care (distributing medication and interacting with patient) - uses her phone to search up drug interactions and dosage requirements - describes that she uses her phone to document her findings about her patients, and then she transfers the records onto the database - also uses her phone for social media purposes such as going on Twitter to share her experiences - has 604 followers on Twitter	- the nursing student is... - breaking the hospital's policy - not treating the patient therapeutically - eager to learn more about distributing the right dosage and medications - breaching her patients' confidentiality and privacy - acting unprofessional while working	- the nursing student is breaking the hospital's policy because she is using her cell phone while she is on her shift and the hospital does not permit employees from using cellular devices. She should ask her supervisor if she can use a cellular device. - the nursing student is not treating her patients therapeutically because instead of interacting with her patients, she is busy on her phone (documenting, searching up medications, etc..) the nursing student should be engaged with her patients to learn more about their health* - the nursing student appears to be eager about knowing more about the medication she is distributing to her patients because she is searching them up on her phone.** -  the nursing student may be breaching her patients' privacy by recording her findings on her phone. I think that the nursing student should ask her supervisor if she is allowed to document on her phone. In addition, she should set up a password on her notepad so no one can assess it - the nursing student is unprofessional because she is using her phone for social media purposes while she is on her shift. She should not be sharing her experiences on any social media to avoid breaching confidentiality. In order to prevent the breach of confidentiality, the nursing student can be vague in her messages. ie. "I closed up a patient's wound with stitches" should be used as opposed to "Today, I closed up a patient's wound on her forehead with 5 stitches" - the nursing student can avoid misunderstanding between herself and her patients by informing them why she is on her cell phone. If I were the nursing student's patient, I would feel that she is unprofessional because she does not seem interested in my care.

* According to the Professional Standards from the College of Nurses of Ontario (2009), the nursing student is not being accountable for her actions. A nurse should show accountability in her practice by "identifying her/himself and explaining her/his role to clients" (p. 4). The nursing student is not explaining her purpose for using her phone during clinical practice because the nurse is unaware of the student's actions.  
** The student nurse is demonstrating continuing competency in her practice because she is enhancing her practice by being knowledgeable of what kind of medications are distributed and why (College of Nurses of Ontario, 2009). 
Although the nursing student may be educating herself and documenting on her cell phone, she is not truly meeting her patients' needs and providing a therapeutic relationship. A nurse-client therapeutic relationship is based on respect, empathy, trust, and power-with decision making (College of Nurses of Ontario, 2009). The nursing student does not show respect or empathy when caring for her patient because she is busy on her phone.

Case 2: Nurse Google Searching her Client 

Describe	Interpret	Evaluate
- nurse works at a clinic that is addressed towards vulnerable women, mainly sex workers - a male client who has been convicted of rape and abuse happens to visit this clinic; he is described as a predator in the clinic - after the nurse cares for the male client, she Google searches him and finds that he has had previous convictions of rape and abuse - nurse believes that the male client should be banned from the organization to ensure safety for both staffs and other clients	- nurse is judging her male client by Google searching him and wanting him banned from the clinic - nurse is behaving unethically in this situation	- nurse is making unethical decisions because she wants the male client banned from the clinic* - nurse is breaching her client's confidentiality and privacy - nurse is acting unprofessional because she is breaching professional conduct such as terminating her care for the male client**

*The nurse is behaving unethically because she wants the male client banned from the clinic since she believes that she will be keeping everyone safer that way. This is an unethical approach to resolving the issue because the nurse should confront the male client of intentions of visiting the clinic instead of judging his past. According to the CNO, the nurse is unable to identify appropriate options to resolve the issue (College of Nurses of Ontario, 2009).

**The nurse is unprofessional because she is terminating her care for the male client since she believes that he is a threat to the clinic. If the nurse does consider the male client a threat, then she should inform her supervisor of her actions and confront the client. The CNO states that if a nurse is to terminate her client's care, then she must arrange for an alternative service for the client and provide an explanation to the client (College of Nurses of Ontario, 2013). 

I think that it is legally and ethically right for the nurse to Google search her client for the safety of the staff and patients. However, it is unethical of the nurse to base biases on her male client. The nurse does not know if the information she found on Google has been fabricated, nor does she know if he has changed for the better. The nurse should use her clinical judgement skills to understand the male client. Instead of banning him from the clinic without giving him a second chance, the nurse should confront him of his intentions for visiting the clinic. In addition, the nurse should also refer her client to another clinic that may be more suitable for his care. 

Are you concerned about your social media profile? 

No, I am not too concerned about my social media profile. There are privacy settings that I can adjust to limit the amount of viewers from browsing through my profile. I am consciously aware of what I post and say online, and for that reason, I do not post things that are too personal to share on social media. 

If you are concerned about others invading your social media profile, then you should be consciously aware of what you post and what the consequences of disclosing the information, if any. If you feel uncomfortable that another user may be reading your posts, then you can readjust your privacy settings or do not post at all. 

In short, a person should think before he/she acts.

References

College of Nurses of Ontario. (2009). Professional standards. Toronto, ON: Retrieved from www.cno.org/Global/docs/prac/41006_ProfStds.pdf

                College of Nurses of Ontario. (2013). Reference document: Professional conduct professional misconduct. Retrieved from http://www.cno.org/Global/docs/ih/42007_misconduct.pdf

Thinkexist.com. (2013). Valdemar w. setzer quotes. Retrieved from http://thinkexist.com/quotes/valdemar_w._setzer/