NURSING INFORMATICS

 The term nursing informatics was initially seen in literature in

the 1960‘s, including a definition of ―combining nursing,
INTRODUCTION TO INFORMATICS information and computer sciences for managing and
processing data into knowledge for use in nursing practice‖
 We are in digital age. What does this mean to us as nurses?
 The convergence of the telecommunications and computer  In 1994, The American Nurses Association (ANA) began
industry has seen pervasive increase in how we communicate developing a statement to describe and define the scope of
and process information. nursing informatics.

INTRODUCTION  The meaning of nursing informatics has evolved and been

refined with the American Nurses Association definition stated
 Integrated systems support evidence-based nursing practice as ― a specialty that integrates nursing science, computer
o Facilitate nurses‘ participation in the health care team science and information science to manage and
and document nurses contribution to patient care communicate data, information, knowledge and wisdom in
outcomes. nursing practice‖
 Another definition of nursing informatics comes from the
American Medical Informatics Association (AMIA), which
NURSING INFORMATICS states — ―Nursing Informatics science and practice integrates
nursing. Its information and knowledge and their
AN OVERVIEW management, with information and communication
technologies to promote the health of people, families and
communities worldwide.‖
The evolution of the terms informatics and nursing informatics as
follows:  The Healthcare Information and Management Systems
Society (HIMSS) defines nursing informatics as "a specialty that
 In 1957 – first coined by Karl Steinbuch as ―informatics‖ integrates nursing science, computer science, and
 In 1962 Philippe Dreyfus used the term ―informatique‖ ; Walter information science to manage and communicate data,
Bauer translated it into ―informatics‖ information, Knowledge, and wisdom in nursing practice.―

 In 1980 Scholes and Barber coined the term ―nursing

informatics‖
 Informatics is becoming increasingly present in our profession
due to rapidly changing technologic advances.  The use of a template can remind nurses of important
information required in the documentation of patient care.
 Healthcare systems are assimilating technology into daily
practice at a quick pace.  Research studies, patient care data, and national and local
standards are used to develop informatics programs at
healthcare organizations.
 Security and patient privacy must be upheld while achieving
the goal of transforming data into useful knowledge.
Other measures include return on investment analysis, patient
 Integrating informatics with evidenced-based practice (EBP) preferences and/or needs, and infection control data.
can only help improve the care we provide to our patients.
 How's the need for technology addressed?

 For example, a high rate of medication errors is identified.

 Applying technology to knowledge may help potential
problems earlier.

 For example, with the use of electronic documentation,  Analysis of how and why the errors are occurring must be
identifying changes in patient status can occur quickly conducted.
because the information is readily available.

 Trending of patient vital signs is always accessible, and data

 The research can include collecting data from other facilities
are interpreted, systematized, and arranged.
in the area to determine if the same problem exists elsewhere.

 The nurse is able to use this knowledge to formalize an

appropriate plan of action.
 Following data collection, the findings are presented to a
 Standardizing nursing language will facilitate acceptance of review board.
new methods of documentation in the electronic health
record.

 A plan to improve the problem is implemented, such as the

 A template for nursing notes is one method of assisting with
use of bar code scanners.
our daily workload.
 1. the direct provision of care,
 Data collection continues to determine if implementation is 2. establishing effective administrative systems,
successful.
3. designing useful decision support systems,
4. managing and delivering educational experiences,
5. enhancing supporting life- long learning, and
 The most important piece of implementation is presentation 6. Supporting nursing research.
of the evidence to staff to identify how the change will
improve actions of nurses.
 The term individual refer to patients, healthcare consumers
and any other recipient of nursing care or informatics
 Staggers and Thompson (2002) believed that there were too solutions.
many definitions for nursing informatics (NI), which was
causing the specialty to grow without a solid foundation.  The term patient refers to consumers in both a wellness and
illness model.

 They believed that without this foundation it was difficult to

build a solid informatics practice or the needed educational  NI is one example of a discipline-specific informatics practice
base for this specialty practice. Staggers and Thompson within the broader category of health informatics.
performed a critical
 NI has become well established within nursing since its
recognition as a specialty for registered nurses by the
American Nurses Association (ANA) in 1992.
The new definition is as follows:

The goal of NI is to improve the health of populations,

communities, families, and individuals by optimizing information  It focuses on the representation of nursing data, information,
management and communication. (Staggers and Thompson) knowledge and wisdom as well as the management and
communication of nursing information within the broader
context of health informatics

 These activities include the design and use of informatics

solutions and/or technology to support all areas of nursing,
 DIKW
including, but not limited to:
BENEFITS OF NURSING INFORMATICS IN HEALTHCARE 1. They understand the clinical language of efficient patient
care.
2. They translate knowledge and clinician feedback into the
Benefit#1: Nursing Informatics informs and influences IT systems technical language of business analysts and
programmers.
3. They communicate clinical and technical matters with
administrative leadership.
 Nursing informatics specialists spend much of their time
helping to develop, implement and optimized computerized
 It‘s not simple to speak effectively with clinical, technical, and
patient information system.
administrative people.
 It‘s their blend of clinical and technical knowledge and
 Still, nursing informatics specialists are qualified and have
experience that makes them perfect liaisons between the
proven to be indispensable to the development of superior
clinical and technical communities.
healthcare IT systems.
 One of the early contributions of nursing informatics was to
 ―Informatics professionals with a nursing background combine
help move healthcare away from paper forms and into
the best of both worlds: deep expertise in clinical care helps
electronic documentation.
nurse informaticists understand the needs and stresses of the
 Today, a nurse‘s standardized notes are immediately
clinical workflow, while their education and background with
available to physicians and other caregivers thru EHR systems.
information technology systems and data analytics helps
 Workflows and decisions are more informed and efficient.
them sculpt health IT infrastructure into a meaningful and
 Many EHR vendors recognized the value of hiring nurse
helpful tool.‖
informaticists to help design and build their system.
 EHR vendors acquired a double-barreled secret weapon
because nurse informaticists :
Benefit #2: Nursing Informatics leverages evidence-based clinical
A. Recommend the most practical layout of forms and reports, best practices
and the best processes for electronic medication
 Most clinicians want to apply their knowledge and
administration experience to improve patient care.
B. Prevent EHR mutiny because they can predict clinician
reactions to technically efficient-but clinically clumsy - The nurse informaticist takes it a few steps further by:
workflows, and shape EHRs that avoid these poor workflows
1. Researching clinical nursing practices outside of their own
experiences.
Nursing informatics specialists are trilingual. 2. Finding evidence to prove which clinical practices are best.
 3. Influencing the design of clinical systems to support and 1. They ensure that systems are designed to support
promote the best evidence -based practices and workflows. effective patient care workflow
4. Training other nurses to use clinical IT systems. 2. They help train other nurses to use IT efficiently
3. They apply advanced analytics strategies to develop
predictive models.
Benefit #3: Nursing Informatics generates stronger nurse training in  As an example of predictive models, consider Texas Health
clinical IT systems Resources in Dallas-Fort Worth. Their informatics nurses use
analytics tools to identify the risk of sepsis, risk of read mission,
and potential benefit from palliative care.

 Clinical IT systems are complicated, and their interfaces and

workflows are not always intuitive.
 But nursing informatics specialists are well-suited to teach Benefit #5: Nursing informatics contributes unique wisdom to clinical
other nurses how to get the full benefits of these systems. care that is acquired through a deep understanding of both clinical
 Because in some cases, nurse informaticists helped design practice and data analysis
and create those very systems. But.. the very least , they
understand the reasons, from a nursing care perspective, for
the structure of each digital form and reach sequence of  ―Informatics nurse specialists work with leadership regarding
clicks. regulatory and quality initiatives and governance for
 They can explain built-in interoperability and behind-the- technology implementation and change. For example, they
scenes interfaces to other clinical systems in language that‘s work with the delivery-of-care team
easily understood by nurses.  The chief nursing officer, chief medical officer, and quality'
leadership who might give us a directive based on improving
Benefit #4: Nursing Informatics leverages IT investments
patient safety by decreasing readmission's.
 Every health facility - from the single-physician practice to the  Informatics nurse specialists identify the key areas where
large academic medical center invests a significant amount studies identify where problems arise inadequate discharge
of their budget on essential health information technology- education, a patient doesn't have support at home, poor
and services. hearing or sight- or being on multiple medications.
 These include patient care systems like the PACS and  They‘ll take those variables and identify how and wherein the
electronic medical records system, communication system they should alert a nurse that this is a possible red flag
technologies like pagers and secure messaging systems, and and give her the elements of a plan to decrease the risk for a
analytics tools. readmit.
 Nurse informaticists help get maximum value from these  They explain to the technical and application team what
investments in at least three ways: nurses need the system to do.
  They build it, and the nurses validate the build. Then nurses go
back to clinical leadership and demonstrate what was
designed and built. Benefit #7: Nursing Informatics Improves Patient Care, Patient Safety,
and Outcomes
 Because nurse informacists understand data analysis and
nursing practice, they immediately know which trends are
worth analyzing, and which anomalies are significant enough
to escalate.  The more generalized field of healthcare informatics focuses
mainly on administrative issues, whereas nursing informatics
focuses on patient care.
 In fact, the substance of the first six benefits of nursing
Benefit #6: Nursing informatics enriches the evolving healthcare
delivery system informatics is all about improving care, safety, and outcomes
for patients.
 Advances in healthcare technology launch new options for  The nurse informaticists resume is like an endowment to
healthcare delivery, and nurse informatics specialists are patients and their families:
helping ensure these new options are beneficial to both o More efficient electronic health records
patients and clinicians o Better IT systems
 Two examples are developments in communication o Research and application of clinical best practices
technology and remote healthcare, known as telehealth. o Training of other nurses
 Regarding communication technology, vendors are using o Analytics-based predictive models
Smartphones to transform the way communication in nursing o New avenues for patient education
happens. o Support for telehealth technology
 Advanced applications - from secure messaging to EHR
integrations that push critical results to a physician‘s phone
HOW DO PATIENTS BENEFIT?
just seconds after the results hit the EHR - are dramatically
improving the efficiency of healthcare delivery.  Fewer medical errors
 Regarding the growing field of telehealth, patients are  More informed clinical decision-making
receiving education and self-management training,  Shorter hospital length of stay
automatically storing and forwarding medical data, and  Lower admission and readmission rates
seeing their providers - from the other side of town, or the  Better self-management
other side of the world.  Application of informatics as an enabling mechanism that
 And nurse informatics specialists are helping design and improves operational tasks towards enriched jobs, increased
implement telehealth systems, as well as training their fellow job satisfaction, and enhanced quality centric customer
nurses in how best to use the systems. service both in the hospital and in the academe is strongly
 supported by Locsin‘s Technological Competency as Caring  Technological competency as Caring in nursing is the
in Nursing: A Model.‖ Locsin, R. articulates that: harmonious coexistence between technologies and caring in
1) ―Technological Competency as Caring in Nursing‖ is nursing.
illustrated in the practice of nursing grounded in the  The harmonization of these concept can co-exist
harmonious coexistence between technology and caring in  Technology brings the patient closer to the nurse. Conversely,
nursing technology can also increase the gap between the nurse
 Assumptions of the theory include the following among and nursed
others:
o Technology is used to know wholeness of persons  IN CAPSULE: Locsin‘s ―Technological Competency as Caring
moment to moment in Nursing Nursing: A Model for Practice‖ Dr. Locsin middle-
o ―Nurses value technological competency as an range nursing theory is an interesting discussion of the
expression of caring in nursing‖ (Locsin, 2013). correlation between hands on patient care and the use of
technology.
2) Dimensions of Technological Value in the Theory
 Technology is defined as anything that makes things efficient-
 Technology as completing human beings to re-formulate the from diagnostic technologies to therapeutic practices familiar
ideal human being such as m replacement parts, both to all nurses.
mechanical (prostheses) and organic (transplantation of
Organs.  Specifically, he discusses the importance of understanding
 Technology as machine technologies, e.g., computers and the need of knowing ―high-tech‖ instruments e.g monitors,
gadgets enhancing nursing activities to provide quality implants, and devices that are a part of patient care as these
patient care such as Penelope or Da Vinci in the Operating will provide opportunities for the nurse to know the patient
theaters. fully as person.
 Technologies that mimic human beings and human activities
to meet the demands of nursing care practices, e.g., cyborgs  Nurses use and encounter technology in nearly every aspect
(cybernetic organisms) or anthropomorphic machines and of their profession. What does it mean to be technologically
robots such as nurse bots competent? What does it mean to be a caring nurse? How
does technology support nursing work? How does it hinder
nursing work? How can nurses care for their patients as
3) Technological Competency as Caring in Nursing technological advancements are introduced nearly every
day? Technological competency as Caring in Nursing: A
Model for Practice provides insight and answers into how
nurses can express their nursing by being technologically
 competent. As such, Locsin sustains the understanding that  Studies everything that deals with information and can be
being technological competent is being caring. defined as the study of information systems.
 Originated as a sub-discipline of computer science, in an
 Dr. Locsin‘s work is obviously guided by the question asked by attempt to understand and rationalize management of
thoughtful nurses everywhere: How can I satisfactorily technology within organizations.
reconcile the idea of competent use of technology with the  has matured into a major field management that is
idea of caring in nursing? His theory significantly describes a increasingly being emphasized as an important area of
practical understanding of the solution enriching the practice research in management studies,
value of all of the general theories of nursing which are  Has expanded to examine the human-computer interaction,
grounded in caring. Technological competency as caring in interfacing, and interaction of people, information systems,
nursing informs nursing as a critical process of knowing and corporation.
person‘s wholeness. Dr. Locsin‘s theory book explores, clarifies,  It is taught at all major universities and business school, around
and advances the conception of technological competency the world.
as caring in nursing. His theory is essential to modeling a  Organizations have become intensely aware of the fact that
practice of (nursing from the perspective of caring. It is a information and knowledge are potent resources that must
practical illumination of excellent nursing in a technological be cultivated and honed to meet their needs.
aspect.

 In the mid-1980‗s Blum (1986) introduced the concepts of

INFORMATION SCIENCE data, information knowledge as a framework for
understanding clinical information systems and their impact
health care.
 Information science is the science and practice dealing with  He did this by classifying the then-current clinical information
effective collection, storage, retrieval, and use of information. systems by the three types of objects that these systems
 It is concerned with recordable information and knowledge, processed.
and the technologies related services that facilitate their  These were: data, information and knowledge
management and use
 multidisciplinary science
 Involves aspect from computer science, cognitive science, INFORMATION SCIENCE
social science, communication science, and library science
to deal with obtaining, gathering, organizing, manipulating,
managing, storing, retrieving, recapturing disposing of,
distributing, or broadcasting information
  These programs include:
o monitoring systems,
o order entry systems, and
o Laboratory radiology, and
o Pharmacy systems.

 A monitoring system includes devices that automatically

monitor and record biometric measurements (e g vital signs,
oxygen saturation, cardiac index, and stroke volume) in
acute care, critical care and specialty areas.
INFORMATION SCIENCE  The devices electronically send measurements directly to the
nursing documentation
 A well-designed nursing clinical information system (NCIS)
incorporates the principles of nursing informatics to support
the work that nurses do by facilitating documentation of
nursing process activities and offering resources for managing
nursing care delivery.
 As a nurse you need to access a computer program easily,
review a patient's medical history and health care provider
orders, and then go to the patient‘s bedside to conduct a
comprehensive assessment.
 Once you complete an assessment, enter data into the
computer terminal at the patient's bedside and develop a
plan of care from the information gathered.

 This allows you to quickly share the plan of care with your
CLINICAL INFORMATION SYSTEM patient.
 Periodically return to the computer to check on laboratory
test results and document the care you deliver.
 The computer screens and optional popup windows make it
 All members of the inter professional health care team,
easy to locate information, enter and compare data, and
including nurse, physicians, pharmacists, social workers, and
make changes.
therapists, use programs available on Clinical Information
System(CIS).
NCISs have two designs.  With an electronic and connected system in place, much of
that waste can be curbed. From lab results that reach their
reach their destination sooner improving better and more
1. The nursing process design timely care delivery to reduced malpractice claims, health
informatics reduces errors, increases communication drives
o is the most traditional efficiency where before there was costly incompetence and
 More advanced systems incorporate standardized nursing obstruction
languages into the software such as:

A. North American Nursing Diagnosis Association-International 2. Shared Knowledge.

(NANDA) nursing diagnoses,
B. The Nursing Interactions Classification (NIC), and  Nursing informatics provides a way for knowledge about
C. The Nursing Outcomes Classification (NOC) patients, diseases, therapies medicines, and the like to be
more easily shared.

2. Protocol or Critical Pathway

 As knowledge is more readily passed back and forth between
o design facilities interdisciplinary management of providers and patients, the practice of medicine gets better
information because all health care providers used something that aids everyone within the chain of care, from
evidenced-based protocols or critical pathways to hospital administrators and physicians to nurses, pharmacists
document the care they provide. and patients.

WAYS INFORMATICS TRANSFORMING HEALTH CARE

3. Patient Participation
1. Dramatic Savings
 When patients have electronic access to their own health
 Health care isn‘t just expensive; its wasteful. It‘s estimated that history and recommendations, it empowers them to take their
half of all medical expenditures are squandered on account role in their own health care more seriously. Patients who
of repeat procedures, the expenses associated with more have access to care portals an able to educate themselves
traditional methods of sharing information, delays in care, more effectively about their diagnose and prognoses, while
errors in care of delivery and the like. also keeping better track of medications and symptoms.
 They are also able to interact with doctors and nurses more patient may have with a team of people regarding care, and
easily, which yields better outcomes, as well. Informatics unless those conversations and efforts are made in tandem
allows individuals to feel like they are a valuable part of their with one another, problems will arise and care will suffer.
own health care team, because they are. Informatics makes the necessary coordination possible.

6. Improved Outcomes
4. The Impersonalization of Care
 The most important way in which informatics is changing
 One criticism of approaching patient care though health care is in improved outcomes. Electronic medical
information and technology is that care is becoming less records result in higher quality care and safer care as
becoming and less personal. Instead of a doctor getting to coordinated teams provide better diagnoses and decrease
know a patient in real time and space in order to best offer the chance for errors. Doctors and nurses are able to increase
care, the job of ―knowing‖ is placed on data algorithms efficiency, which frees up time to spend with patients, and
previously manual jobs and tasks are automated, which saves
 As data gathered regarding a patient, algorithms can be time and money — not just for hospitals, clinics, and providers,
used to sort it in order to determine what is wrong and what but for patients, insurance companies, and state and federal
care should be offered. It remains to be seen what effects this governments, too.
data-driven approach will have over time, but regardless,
since care is getting less personal, having a valid and  Health care is undergoing a massive renovation thanks to
accurate record that the patient and his care providers can technology, and informatics is helping to ensure that part of
access remains vital. the change results in greater efficiency, coordination, and
improved care.

5. Increased Coordination

Concepts, Principles and Theories in Nursing Informatics

 Health care is getting more and more specialized, which
means most patients receive care from as many as a dozen
different people in one hospital stay. This increase in specialist
requires increase coordination, and its health informatics that  Informatics Theory
provides the way forward. Pharmaceutical concerns, blood  Theories
levels, nutrition, physical therapy, X-rays, discharge instructions
- its‘ astonishing how many different conversations a single
A. Theories  Boundaries are implicit and systems are open and dynamic

 In nursing informatics, there are different theories, which help to  Concepts and Definition
frame and inform this discipline. This include the:
 Input – Energy & raw Material (Ex. Information, Money,
o General systems theory, Energy, time)
o Change theory,
 Throughput – processed used by the system to convert
o Cybernetics theory and the raw materials to products (Ex. Thinking , planning, Decision
o Cognitive learning theory making, constructing, meeting
 In addition  Output – The product or service from throughput
o Novice to Expert Theory and the  Feedback – Information about some aspect of data or
o DIKW Theory also supports the framework of Nursing energy processing that can be used to evaluate and
Informatics. monitor the system
o All the theories support nursing informatics in different
 Subsystem – A system which is a part of a larger system.
ways They can work parallel to each other or in a series with
 Nursing practitioners can combine the knowledge they acquire each other
from the theories, with that they obtain from their nursing
 Static System – Neither system elements nor the system
practice to enhance their performance. itself changes much over time in relation to the
1. General Systems Theory environment
 Dynamic system – The system constantly changes the
 Developed by biologist Ludwigvon Bertalanffy in 1936 environment & is changed by the environment
 Includes purpose, content and process, breaking down the  Closed systems – Fixed , automatic relationships among
―whole‖ and analyzing the parts system components no give or take with the environment
 The relationships between the parts of the whole are  Open Systems – Interacts with the environment trading
examined to learn how they work together energy & raw material for goods & services produced by
 A system is made up of separate components. The parts rely the system
on one another, are interrelated, share a common purpose  Boundary – The line or point where a system or subsystem
and together form a whole can be differentiated from its environment or from other
subsystems
 Assumptions of General System Theory  Goal – The overall purpose for existence or the desired
 All systems must be goal directed outcomes. (mission statement)
 A system is more than the sum of its parts  Entropy – The tendency for a system to develop order &
 A system is ever changing and any change in one part energy over time
affects the whole
  Negantropy – the tendency of system to lose energy & 9. A system is a dynamic network of interconnecting elements A
dissolve chaos change in only one of the elements must produce change in all
 Control or cybernation – The activities and processes used the others.
to evaluate input, throughput & output in order to make 10. When subsystems are arranged in a series, the output of one is
corrections the input for another; therefore, process alterations in one
 Equifinality – Objectives can be achieved with varying requires alterations in other subsystems
inputs & in different ways 11. All systems tend toward equilibrium, which is a balance of
various forces within and outside of a system.
Basic Principles of a System Approach 12. The boundary of a system can be redrawn at will by a system
1. A system is greater than the sum of its parts. analyst
 Requires investigation of the whole situation rather than 13. To be viable, a system must be strongly goal-directed, governed
one or two aspects of a problem. by feedback, and have the ability to adapt to changing
 Mistakes can‘t be blamed on one person; rather a system circumstances.
analyst would investigate how the mistakes occurred within a
2. Change Theory
subsystem and look for opportunities to make corrections in
the processes used.  Developed by Kurt Lewin who is considered the father of
2. The portion of the world studies (system) must exhibit Social Psychology
predictability.  Lewin‘s definition of behavior in this model is ―a dynamic
3. Though each sub-system is a self-contained unit, it is part of wider balance of forces working in opposite directions‖
and higher order  3 Major Concepts
4. The central objective of a system can be identified by the fact 1. Driving Forces – are those that push in a direction that
that other objectives will be sacrificed in order to attain the causes change to occur. They cause a shift in the
central objective. equilibrium towards change
5. Every system, living or mechanical, is an information system. Must 2. Restraining Forces – are those forces that counter the driving
analyze how suitable the symbols used are for information forces
transmission. 3. Equilibrium – is a state of being where driving forces equal
6. An open system and its environment are highly interrelated restraining forces and no change occurs.
7. A highly complex system may have to be broken into subsystems  3 Stages
so each can be analyzed and understood before being 1. Unfreezing – process which involves finding a method of
reassembled into a whole. making it possible for people to let go of an old pattern that
8. A system consists of a set of objectives and their relationships was somehow counterproductive
2. Change Stage – ―moving to a new level‖ or ―movement‖.
Involves a process of change in thoughts, feeling, behavior, or
 all three, that is in some way more liberating or more
productive.
3. Refreezing Stage – establishing the change as the new habit.

 Major Assumptions
 People grow and change throughout their lives
 Change happens daily
 Reactions to change are grounded in the basic human needs
for self-esteem, safety and security
 Change involves modification or alteration.
 Cybernetics
 6 Components  is a trans disciplinary approach for exploring regulatory
1. Recognition of the area where change is needed systems, their structures, constraints and possibilities ―the
2. Analysis of a situation scientific study of control and communication in the animal,
3. Identification of methods by which change, can occur machine and society‖ as defined by Norbert Wiener.
4. Recognition of the influence of group mores or customs on  is applicable when a system being analyzed incorporates a
change. closed signaling loop-originally referred to as ―circular
5. Identification of the methods that the reference group uses to causal‖ relationship, that is where action by the system in
bring about change some manner (feedback) that triggers a system change.
6. The actual process of change  The essential goal of the broad field of cybernetics is to
 Kurt Lewin’s Model of Change understand and define the functions and processes of
systems that have goals and that participate in circular,
causal chains that move from action to sensing comparison
with the desired goal, and again to action.
 Its focus is how anything (digital, mechanical or biological)
processes information, reacts to information and changes or
can be changed to better accomplish the first two tasks.
 Comes from the Greek word ―Kubernetes‖ means ―steering‖
and ―governor‖ in Latin.
 Major Concepts
 Cybernetics introduces the concept of circularity and circular
causal systems
3. Cybernetics Theory  Systems are defined by boundaries
 Every system has a goal
  Environment affects aim
 Information returns to system- ―feedback‖
 System measures difference between state and goal
 Detects ―error‖
 System corrects action to aim toward goal
 Cycle Repeat
 Scope and Application of Cybernetics
 Basis of modern communication systems
 Application in cognitive science for modeling and learning
 Basic Concepts
 Application in management science
o Observational Learning
 Conclusion
o Reproduction
 Cybernetics is applicable in any discipline relying on
o Self-Efficacy
feedback processes including health sciences, sociology and
o Emotional Coping
psychology, which are based on communication process
o Self-regulatory Capability
4. Cognitive Learning Theory
B. Cognitive Behavioral Theory
 Explains why the brain is the most incredible network of
 Describes the role of cognition (knowing) to determining and
information processing and interpretation in the body as we
predicting the behavioral pattern of an individual.
learn things
 Developed by Aaron Beck
 2 specific Theories

A. Social Cognitive Theory

5. The Novice to Expert Theory
We consider 3 variables:
 A construct theory first proposed by Hubert and Stuart Dreyfus
1. Behavioral factors (1980) as the Dreyfus Model of Skill Acquisition and later
applied and modified to nursing by Patricia Benner (1984).
2. Environmental factors (extrinsic)
This Theory Can Be Applied to
3. Personal Factors (intrinsic)
 The development of nursing informatics skills, competencies,
knowledge and expertise in NI
 The development of technological system competencies in
Social Cognitive Illustration
practicing nurses working in an institution
  The education of nursing students, from first year to  NOVICE
graduation and  A novice doesn‘t know anything about the subject he/she
 Transition of graduate nurse to expert nurse approaching and has to memorize its context-free features.
 The novice is then given rules for determining an action on
the basis of this feature.
Novice to Expert  To improve the novice needs monitoring either by self-
observation or instructional feedback.
 Advance Beginner
o Still dependent on rules, but as he/she gains more
experience with the real-life situations, he/she begins to
notice additional aspects that can be applied to related
conditions
 Competent
 The competent person grasps all relevant rules and facts of
the field and is, for the first time, able to bring his/her own
judgement to each case.
 This is the stage of learning that is often characterized by term
problem-solving.
 A competent level nurse would be able to use a hospital
information system with ease and know-how to solve
 The currently accepted five levels of development as technical difficulties.
presented by Benner  Proficient
 Novice-Competent-Proficient-Expertise-Mastery was initially  Is called ―fluency‖ and is characterized by the progress of the
proposed by Hubert and Dreyfus learner from the step-by-step analysis and solving of the
situation to the holistic perception of the entirety of the
 Distinguishing Features situation.
 Deliberate Practice – is a trait shown by people who use a  The proficient hospital information system learner would know
personal, goal-oriented approach to skill and knowledge how to interpret data from all departmental information and
development. provide guidance to other disciplinary members as needed.
 This requires years of sustained effort to continually improve  Expert
quality of practice and performance within the skill  An expert‘s repertoire of experienced situation immediately
 Taking Risks – Continuous climb to expert level – requires dictates an intuitively appropriate action.
people to move beyond the status quo of mere competence
through the levels of Proficiency then Expertise
  After a great deal of experience actually using a system in  Contextual Concept – one moves from a phase of gathering
everyday situations, the expert nurse discovers that without his data parts (data), the connection of raw data parts
consciously using any rules, situations simply elicit from him/her (information), formation of whole meaningful contents
appropriate responses. (knowledge), and conceptualizing and joining those whole
meaningful contents(wisdom)
6. The DIKW Theory
Understanding Concept

 the DIKW Pyramid can be viewed as a processing starting

with researching & absorbing, doing, interacting, and
reflecting

A. The ―Data‖ of DIKW

 The first step

 Collection of Raw data is the main requirement
 Any measurements, logging, tracking, records and many
others are all considered as data.
 Since the raw data is collected in bulk, it includes both useful
and not useful contents.
 Example: 300 Users visits a website daily to take online lessons
 When raw data is collected, it gets mixed up and the view
seems jumbled B. The ―Information‖ of DIKW
 Model by Fricke (2018) and Russell Ackoff (1989)
 Data that has been given meaning by defining relational
―D‖ = Data connections ―meaning‖ represents processed and
understandable data.
―I‖ = Information
 Example: 150 Users Visit Nursing Pharmacology section, 145 for
―K‖ = Knowledge Nursing Research , Out of them, 60% is in the age group of 18-
22 years old , 70% of our visitors between 9am – 11pm
―W‖ = Wisdom
B. The ―Information‖ of DIKW
 The DIKW model of transforming data into wisdom can be
viewed from two different concepts
 D. The ―Wisdom‖ of DIKW

The Wisdom is the fourth and the last step of the DIKW
Hierarchy. It is a process to get the final result by calculating
through extrapolation of knowledge. It considers the output
from all the previous levels of DIKW Model and processes
them through special types of human programming (such as
the moral, ethical codes, etc.).
 Therefore, Wisdom can be thought as the process by which
you can take a decision between the right and wrong, good
and bad, or any improvement decisions.
 Wisdom is the topmost level in the DIKW pyramid and answers
the questions related to "Why".
 In case of our example scenario, one example of wisdom
gained might be that due to 70 % of the working professionals
 The information hierarchy stage of DIKW Pyramid reveals the visit our tutorials to get help with their certifications and
relationships in the data, and then the analysis is carried out technology needs.
to find the answer to Who, What, When and Where questions.  Analyzing Organizational Issues Using the DIKW Hierarchy
C. The ―Knowledge‖ of DIKW  Data: A way to identify the raw external inputs such as the
facts and figures that are yet to be interpreted.
 is the third level of DIKW Model. Knowledge means the  Information: Analyze the raw data to determine the
appropriate collection of information that can make it be organizational needs. An important aspect of information
useful. management is that apart from answering questions it can
 Knowledge stage of DIKW hierarchy is a deterministic process. also help to find other solutions in organizational contexts.
When someone "memorizes" information due to its usefulness,  Knowledge: Determines how something is remembered by an
then it can be said that they have accumulated knowledge. individual or how information is applied by them.
 The knowledge step tries to find the answer to the "How"  Wisdom: Uncover why the derived knowledge is applied by
question. Specific measures are pointed out, and the individuals in a specific way. i.e. - finding the reason behind
information derived in the previous step is used to answer this any decision-making
question.
 With respect to our scenario, we must find the answer that  The Usage and Limitations of DIKW Model
―How do student nurses between the age group of 18-22
years old use our modular approach.
  This unit discusses the information technology applicable in
nursing practice which includes hospital and critical care
applications such as different monitoring devices needed to
care for patients. The community health applications focus on
the health information system of the community, it is centered
on the majority part of the public which also emphasizes the
prevention of the disease, medical intervention, and public
awareness.
 PURPOSE & OBJECTIVES

At the end of this unit, students will be able to:

 Same as all other models, DIKW Model also has its own limits. 1. Describe the information technology applicable in nursing
You may have noticed that the DIKW Hierarchy is quite linear practice.
and follows a logical sequence of steps to add more
meaning to data in every step forward. But the reality is often 2. Explain the application of nursing informatics in the community
quite different than that. The Knowledge stage, for example, health practice.
is practically more than just a next stage of information.
 HOSPITAL AND CRITICAL CARE APPLICATIONS
 One of the principal critiques of this DIKW Pyramid is that it‘s a
hierarchical process and misses several important aspects of There are a lot of information technology applications applicable in
knowledge. In today's world, where we use various ways to the hospital. It can be branched out based on the major functional
capture and process more and more unstructured data, departments in the hospital such as in the Administration, Clinical,
sometimes forces us to bypasses few steps of DIKW. and Nursing. In the administration department, let us say for
 Though the previous statement is quite true, however, the instance, the admission of the patient and retrieval of clinical
result still stays the same, such as what we do with the data records uses computer applications to make the work effective and
warehouse and transforming data through big data analytics efficient. In this discussion, we focus on the critical care aspects and
into decisions and actions (Wisdom). how the nursing division benefits from the information technology.

Information Technology System Applicable in Nursing Practice  Below is the list to sum up the various applications of information
technology in this setting particularly focusing on patient care:

❑ Process store and integrate physiological and diagnostic

 Introduction information from various sources.
❑ Present deviations from pre-set ranges by an alarm or an alert. information in specific places and controls the direction in
reporting. It also alerts nursing personnel through a report, an
❑ Accept and store patient care documentation in a lifetime‘s alarm, or a visual notice.
clinical repository.  Monitoring systems also store various data elements with a
time stamp derived from the monitoring system‘s internal
❑ Trend data in a graphical presentation.
clock.
❑ Provide clinical decision support through alerts alarms and  Physiologic monitoring systems typically have modern
protocols. platform allowing the selection of various monitoring
capabilities to match the needs of a variety of clinical
❑ Provide access to vital patient information from any location both settings. More specialized monitoring capabilities such as
inside and outside of the critical care setting. intracranial pressure or bispectral index monitoring are also in
modular format. Physiologic monitors are usually built to
❑ Comparatively evaluate patients from outcomes analysis. Present
incorporate both arrhythmia and hemodynamic monitoring
clinical data based on concept- oriented views.
capabilities.
 PHYSIOLOGIC MONITORING SYSTEMS
 Physiological monitors were developed oversee the vital signs  PHYSIOLOGIC MONITORING SYSTEMS
of the astronauts. By the 1970‘s these monitors found their way o HEMODYNAMIC MONITORS
into the hospital setting. Physiologic systems consist of 5 basic
Machines under the human machine interface used specifically for
parts.
the following:
1. Sensors
1. Measure hemodynamic parameters - closely examine
2. Signal conditioners cardiovascular function.
2. Evaluate cardiac pump output and volume status.
3. File - rank and order information. 3. Recognize patterns (arrhythmia analysis) and extract
features.
4. Computer processor - analyze data and direct reports.
4. Assess vascular system integrity - evaluate the patient‘s
5. Evaluation or controlling component - regulate the equipment or physiologic response to stimuli.
alert the nurse. 5. Continuously assess respiratory gases (capnography).
6. Continuously evaluate glucose levels.
 Microprocessors. Physiologic signals are typically of very small 7. Store waveforms.
amplitude and must be amplified, conditioned, and digitized 8. Automatically transmit selected data to a computerized
by the device in preparation for processing by its embedded patient database.
microprocessors. It analyzes information, store pertinent
 Largest contributor to alarms in the ICU caused by:

 THERMODILUTION TECHNIQUE 1. Blood pressure cuff

 The bolus must be injected within 4 seconds. Amount solution 2. Tourniquet
must be accurate temperature of the injective. Must be 3. Air splint that may cause venous pulsations.
measured and accurately maintained. Catheter must be 4. Limits the sensors' ability to distinguish between arterial or
properly placed. venous blood pressure while pulse oximetry provides a
 Computer must have the appropriate computation. Constant measure of oxygen delivered to the tissue, mixed venous
bolus must be injected at the appropriate time in the oxygen saturation provides a measure of the amount of
respiratory cycle. oxygen used by the patient.
 THE PROCESS OF THERMODILUTION
o The influence of these user-related issues is negated by  ANTICIPATED PROBLEMS
using heat of a thermal filament embedded in the  These problems usually cause nurses to spend more time in
catheter to replace the injectate. An alternative means of troubleshooting and can lead to fewer hours doing the
measuring cardiac output noninvasively, if provided by necessary bedside care. To prevent these from happening, it is
thoracic electrical bioimpedance. Four sensors are important for nurses to become familiar with the user guide of the
positioned on the sides of the neck and thorax. Monitoring respective machines specifically on the trouble shooting part.
these changes permits measurement of stroke volume: Some pulse oximeters are more sensitive as compared to the
indices of contractility such as velocity an acceleration of others, some need specific charging times, and some are more
blood flow, supraventricular rhythm, and ind x. Using durable than the others.
bioimpedance as a factor integrated with analysis of the
finger blood pressure waveform has also been  TELEMETRY
demonstrated as a method of cardiac output  Hemodynamic monitoring can take place at the bedside of can
measurement. be conducted from a remote location via telemetry. Telemetry
 PULSE OXIMETER allows for the continuous monitoring of patients usually outside of
 A critical piece of hemodynamic information involves the the ICU. Telemetry monitoring is susceptible to signal loss.
availability of oxygen to bodily tissues. The standard for Remember that computer-based hemodynamic monitoring
measurement of blood‘s oxygen saturation is co-oximetry. Pulse offers the critical care nurse a wealth of information that does
oximetry is a noninvasive method of measuring oxygen saturation not replace clinical judgment.
that also uses spectrophotometry. Light is emitted through a
pulsatile arteriolar bed and then detected by photosensor.  PHYSIOLOGIC MONITORING SYSTEMS
 ARRHYTHMIA MONITOR
 ANTICIPATED PROBLEMS  Computerized monitoring and analysis of cardiac rhythm have
proved reliable and effective in detecting potentially lethal heart
 rhythms. A key functional element is the system‘s ability to detect and departments or be restricted to a single unit. CCIS include:
ventricular fibrillation and respond with an alarm. SYSTEM TYPES: Patient management service, length of stay, mortality,
Detection Surveillance Diagnostic or Interpretive. readmission rates.

 WHAT IS THE DIFFERENCE?

 In detection system, the criteria for a normal ECG are  VITAL SIGNS MONITORING
programmed into the computer. Interpretive systems search the  Vital signs and other physiologic data can be automatically
ECG complex for five parameters: location for QRS complex; acquired from bedside instruments and incorporated into the
time from the beginning to the end of the QRS; comparison of clinical database. Data can be incorporated into flow sheets
amplitude, duration, and rate of QRS complex with all limb leads with other data elements such as laboratory results body system
P and T waves; comparison of P and T waves with all limb leads. assessment findings problem lists.
 Basic Components of arrhythmia monitors  CLINICAL DOCUMENTATION
 Support the process of physical assessment findings. As the
1. Sensor
critical care environment requires frequent assessments, these
2. Signal conditioner flowsheets may be configured to ease this extensive data
collection. Flowsheets may also be organized by body system. All
3. Cardiographer
disciples can document patient assessment findings into the
4. Pattern recognition CCIS. Automatic calculation of physiologic indices can be
performed.
5. Rhythm analysis

6. Diagnosis written report.

 DECISION SUPPORT
 The CCIS can provide alerts and reminders to guide care in
accordance with evidence-based guidelines. Point of care
 CRITICAL CARE INFORMATION SYSTEM (CCIS)
access to knowledge bases that contain information on
 A system designed to collect, store, organize, retrieve, and
evidence-based guidelines of care, drug information,
manipulate all data related to care of the critically ill patient.
procedures, and policies. Data can be integrated with patient
CCIS is the organization of a patient‘s current and historical data.
information.
CCIS allows the free flow of data between the critical care unit
and other departments. Provides a rich repository of patient
information that can be integrated for use in outcomes
management. Each patient‘s data can be accessed from any  MEDICATION MANAGEMENT
terminal or workstation. This capability can extend across units
  Can facilitate the medication administration process.  PRIMARY FOCUS OF COMMUNITY HEALTH INFORMATION SYSTEM
Medication administrations of flow sheets incorporate the use  Preventing, identifying, investigating, and eliminating
of bar code\ technology. communicable health problems.
 INTERDISCIPLINARY PLANS OF CARE  Accessibility of data and information, through
 Special flow sheets incorporating required treatments and communication.
interventions may be provided. Workflow management  Educating and empowering individuals to adopt health
solutions that help orchestrate all the numerous, simultaneous lifestyle.
processes.  Facilitate the retrieval of data.
 PROVIDER ORDER ENTRY  Effective transformation of data into information.
 Electronic entry and communication of patient orders can  Effective integration of information to other disciplined to
help clinicians improve communication, streamline processes, concretized knowledge and creates better understanding.
facilitate care, and can help clinicians, all providers in  Creation of computerized patient records, medical
managing quality. information system
 Central repositions of all data such as data warehouse.
 Simple Graphical User Interface (GUI) for nurses and other
 COMMUNITY HEALTH APPLICATIONS healthcare provider, patient, and consumer.
o Focuses on the health information system of the  COMPUTER BASED SURVEY SYSTEM
community, it is centered on the majority part of the Health Statistical Surveys
public.
o Emphasizes the prevention of the disease, medical Are used to collect quantitative information about items in a
intervention, and public awareness. population to establish certain information from the obtained
o Fulfils a unique role in the community, promoting and data.
protect the health of the community at the same time  Focused on opinions or factual information depending on its
maintaining sustainability and integrity of health data and purpose and many surveys involve administering question to
information. individuals.
 GOAL OF COMMUNITY HEALTH INFORMATICS  ADVANTAGES
 Effective and timely assessment that involves monitoring and o Consistent exchange of response
tracking the health status of populations including identifying o Disease tracking
and controlling disease outbreaks and epidemics. o Data and information sharing. Building strategies
 COMMUNITY HEALTH APPLICATION SYSTEM o Early detection and monitoring of disease and sickness -
 Encourages optimal application of computer system, control of spread of disease.
computer programs and communication system for the o National alertness and preparedness – building strong
benefit of the majority of individuals, families and community. communication.
 o Maintaining strong relation between nurse and other 1. Facilitate collecting, managing, analyzing, interpreting, and
healthcare provider. disseminating health-related data for diseases designated as
o Continuous coordination of the healthcare professionals - nationally notifiable.
synchronization of the decisions.
o Streamlining of the process. 2. Develop and maintain national standards, such as consistent case
definitions for nationally notifiable diseases applicable across all the
o Effective management of data and information - optimal
operation of hospital and clinics. provinces and cities.

3. Maintain the official national notifiable diseases statistics.

4. Provide detailed data to control programs to facilitate the

 PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE
(PIDSR) identification of specific disease trends.
 A multi-faceted public health disease surveillance system that 5. Work with cities and provinces and partners to implement and
provides public health officials the capabilities to monitor the assess prevention and control programs.
occurrence and spread of diseases.

Goal
 AMBULATORY CARE SYSTEMS
➢ Strengthen the surveillance and response capabilities at each  The ambulatory care nurse focuses on patient safety and the
level of the health system by building local capacities and quality of nursing care by applying appropriate nursing
leveraging strengths and areas of expertise through partnership and interventions, such as identifying and clarifying patient needs,
coordination. performing procedures, conducting health education,
promoting patient advocacy, coordinating nursing and other
Vision
health services, assisting the patient to navigate the health
➢ To improve the availability and use of surveillance and laboratory care system, and evaluating patient outcomes.
data so that public health managers and decision makers can plan  The ambulatory care covers a wide range of services that
for and carry out more timely detection and response to the leading can be offered to patients that needs medical attention.by
causes of illness, death, and disability. integrating the ambulatory care information system in the
nursing practice will really help in making the work easy like
FUNCTIONS the processing of data and information and the billing and
charges etc.
Information from PIDSR is expected to be used for the following
 There are advantages of the ambulatory care information like
purposes:
first, the access of medical records of patients to health care
providers, second, the nurses will be able to give quality care
and improve workflow, reduce medical errors, and lastly the
 management and monitoring of the billing, doctor‘s fees,  Improved decision support and resource tracking/allocation
prescriptions and many more. tools bring added intelligence to the disaster situation. For
 One of the most important responsibility of a nurse is to make example, better available collaboration software and file
sure that the patient receives the care that he/she needed sharing have benefited the recent business world and can
and with the use of this system I believe the quality of care serve to better reduce duplication of efforts during times of
can be given. disaster. At the same time, distributed emergency operation
 EMERGENCY PREPAREDNESS AND RESPONSE centers provide resources in a less centralized manner that
 Same with the objective in the application of informatics in aids in the distribution of planning, coordination, and
community health the over-all objective is public health. The scheduling. Computer assisted decision- making tools and
only difference is the focus and level of prevention. In intelligent adaptive planning provide alternatives to decisions
Community Health, the focus of the use of informatics is on that are typically made in a vacuum.
the promotive and preventive side, while in emergency  Bio surveillance is a key capability of obtaining and
preparedness and response focus in the mitigation and maintaining situational awareness before and during a health
control of emergencies. The use of informatics here is much emergency. Early recognition and understanding of
wider and critical. The need for information in real-time is very departures from human, animal, plant, and environmental
crucial in saving the lives of many. baselines, including detection of novel occurrences, is
 Based on Weiner and Slepski (2012) the modern movement necessary to give early warning and save lives; however,
toward HEI could go a long way to expanding information detecting deviations from the norm is complicated because
outreach to victims of disasters and humanitarian crises. of the complexities of systems and variables and the multiple
Although not the primary reason for the legislation that has stovepipes that exist. Many efforts are underway to improve
provided such sanctioned growth in electronic health care data collection, sharing, and analysis. Informatics and
records, for once an unintended consequence has a possible technology solutions such as smartphones, tablets, and other
positive effect. Other efforts to expand and upgrade wireless devices may help to gather signals to detect
communications to all populations have benefits for the potential incidents earlier, regardless of the cause, and
disaster community as well. As an example, radiofrequency communicate early warning and critical updates and foster
identification (RFID) technology holds such promise with early electronic information exchange worldwide. Rapid detection
prototypes tagging victims with treatment and other is critical to save lives and improve incident outcomes, and
information. Longer range RFID tags and readers will it the United States serves in a key role as part of global
possible to continuously track victims as they move through surveillance network.
the system for evacuation to treatment facilities (National
Research Council, Committee on using Information  TELEHEALTH
Technology to Enhance Disaster Management, 2007).  According to Mayo Clinic (2020), telehealth is the use of
digital information and communication technologies, such as
 computers and mobile devices, to access health care  Improve communication and coordination of care among
services remotely and manage your health care. These may members of a health care team and a patient.
be technologies you use from home or that your doctor uses  Provide support for self-management of health care.
to improve or support health care services.
TELEHEALTH

 In the Philippines, we have also adopted telehealth and have

 Consider for example the ways telehealth could help you if you become an increasing necessity with the emergence of the
have diabetes. You could do some or all the following: pandemic and implementing the community quarantine
o Use a mobile phone or other device to upload food logs, measures. To promote safety among the public, telehealth
medications, dosing, and blood sugar levels for review for has been adopted by private and government hospitals. The
a nurse who responds electronically. University of the Philippines – Manila (UPM) is one of the
o Watch a video on carbohydrate counting and download earliest in the Philippines who adopted the telehealth in 1998.
an app for it to your phone. They established the UP National Telehealth Center with the
o Use an app to estimate, based on your diet and exercise commitment is to engage people to use available
level, how much insulin you need. technologies to improve health care albeit distance barriers.
o Use an online patient portal to see your test results, Since its conception, it continues to develop telehealth
schedule appointments, request prescription refills or email applications derived from people‘s own problem-solving
your doctor. contributions. Through research-cum-service activities, the
o Order testing supplies and medications online. center helps both patients and health care providers
o Get a mobile retinal photo screening at your doctor‘s maximize widely available and cost-effective ICT tools to
office rather than scheduling an appointment with a improve delivery of health care.
specialist.
o Get email, text, or phone reminders when you need a flu
shot, foot exam, or other preventive care. INFORMATICS IN THE TIME OF COVID-19
 TELEHEALTH GOALS
 2020 has proven to be an unprecedented year in modern
Also called e-health or m-health (mobile health), include the history, and it has barely begun! The emergence of the
following: COVID-19 pandemic has caused major impacts on global
society, including huge challenges for health care. No one in
 Make health care accessible to people who live in rural or
this planet is immune to these sweeping changes, as many
isolated communities.
joins in the efforts to contain this virus. Informatics teams are a
 Make services more readily available or convenient for
critical part of these efforts, serving as support, facilitating
people with limited mobility, time, or transportation options.
 Provide access to medical specialists. new methods of delivering care, and aiding in tracking and
 forecasting the related impact data. Let us look at some of worried patients coming into the emergency rooms and
the major ways informatics shines during the critical time and hospitals. Chatbot technology was meant to be an offering to
some resources to aid in these processes. provide value to patients and direct them to the care they
needed.\
SUPPORTING THE DAY TO DAY  Client Teaching - IS experts may also be involved with the
 Information Technology (IT) and informatics specialists (IS) are development of client health promotion and prevention
integral to all emergency actions taken by health care teaching materials that target COVID-19, such as brochures,
organizations during a pandemic. This includes addressing info graphics, handouts, videos, games, and other interactive
supply chain and labor shortages, business partner and engaging productions. For instance, IS may work with
considerations, telecommuting, enhanced physical and organizations such as the Public Health Agency of Canada to
technological security, continuity, and disaster recovery produce infographics to educate the public on Social
planning, and monitoring supplies of personal protective Distancing.
equipment (PPE) (AEHIS Incident Response Committee, 2020).  Privacy of Health Data - IS and IT also dedicates a lot of
energy to ensure staff and clients stay safe: this includes
Specific attention is also required from IT and IS to organize the protecting their personal health information (PHI) as well as
following: employee data. It also entails securing organizational systems
and educating staff about potential COVID-19 inspired scam
 Mass Notifications - digital experts often spearhead
and malware attempts, as well, policies related to PIH in the
innovations in mass notification to ensure staffs are updated
time of a pandemic should be reviewed and revise, as
immediately as the crisis evolves. ―Healthcare systems may
necessary. One example of potential policy tips is available
want to ensure that they test their mass communications
through the US system, as a bulletin: HIPAA Privacy and Novel
systems and procedures to ensure that they can get critical
Coronavirus.
information into the hands of staff as quickly and efficiently as
 Equipment Disinfection - all equipment used within health
possible‖. (AEHIS Incident Response Committee, 2020).
organizations must be protected and disinfected if used more
 Client Information - IS experts have found innovative ways to
than once, including electronics. ―Particular attention is
provide COVID-19 support to clients in some health
needed to address sanitation of mobile devices that are
organizations. For instance, Siwicki (2020) described how the
handed off by workers between shifts or handed from patient
Montefiore Health System in New York City harnessed chatbot
to patient.‖ (AEHIS Incident Response Committee 2020).
AI technology to support client information. ―Staff wanted to
 System Interoperability - EHR based rapid screening
offer patients the ability to be directed to Montefiore
processes, laboratory testing, clinical decision support,
information, but also be in a position to get answers to key
reporting tools, and patient-facing technology related to
questions they had about COVID-19. Being in New York City,
COVID-19 are all supported by system interoperability. A great
they were facing an increasing volume of calls coming into
doctor‘s offices, an increased demand for services, and
 paper addressing these functions is available from Reeves et for you to use, how easy it is for patients to use, how the
al., (2020). technology can help you keep patient information private
 DIGITAL HEALTH CANADA and secure, and that you must record the work in your
o Offers a comprehensive collection of resources to support medical record‖ (OntarioMD, 2020). This includes
informatics specialists as they work to connect and integrating COVID-19 specific tools into existing electronic
protect front-line workers. This includes links to important medical and health records.
contacts, recorded COVID-19 webinars, and a dynamic o ―We need well defined and easy-to-understand
forum for Canadian digital health professionals to support guidelines for the day-to-day use of telehealth
each another during the COVID-19 outbreak. (Digital technologies in the context of COVID-19. We need these
Health Canada, 2020, p. 1). to be adjusted to the most vulnerable (e.g., different age
 WEGREE ROBOTS groups) and their needs. Such guidelines need to keep the
o Although novel, some organizations are taking advantage expectations f the users, be it patients or health care
of robotics to protect both staff and clients. An example is providers, realistic. They need to convey the message that
the Wegree robot. ―Wegree, a company based in Poland, eHealth solutions are viable alternative in times of this
makes humanoid robots that are typically designed to pandemic and beyond; however, probably not suitable
greet people at stores, malls, and other consumer- facing for all problems that arise and certainly not a full
businesses, and to answer their questions. Now, Wegree replacement of traditional care‖ (NITTAS, 2020).
has adopted its robots to serve as check-in staff for o However, telehealth can also facilitate the direct care of
hospitals and clinics, alleviating the needs for humans to COVID-19 clients being isolated within their own homes.
interact with potentially infected individuals. The robots ―Community paramedicine or mobile integrated health
can greet those presenting with symptoms, guide them to care programs allow patients to be treated in their homes,
sanitize their hands and put on a face mask and ask with higher level medical support virtually‖ (Holander and
relevant questions that can be used to triage those that Carr, 2020). Unless caregivers are equipped with virtual
should receive medical attention‖ (Medgadget Editors, diagnostic tools, telehealth does have its limits for general
2020). practice. ―The biggest benefit of telehealth may be
 SUPPORTING VIRTUAL AND TELEHEALTH CARE preventing people who have been exposed to the
o Informatics specialists (IS) may well work with physicians, coronavirus from leaving their homes and spreading it to a
nurse practitioners, and other professionals to provide physician‘s practice or an entire emergency department,
virtual and/or telehealth care. Most provinces now have putting patients at risk and potentially putting healthcare
specific virtual and telehealth care codes for physicians to workers out of commission for 14 days of quarantine‖
use with clients. IT and informatics experts can help (Ostherr, 2020).
support physicians and others to choose the best o Some health professionals and organizations have
technology and to ―consider how easy the technology is resorted to using mass market software and platforms to
 facilitate virtual and telehealth care during the pandemic. o The importance of informatics in global tracking of this
These include platforms like Zoom, Skype, Apple Facetime, pandemic has been strongly emphasized at the highest
Google Hangouts, Microsoft Teams, Facebook Messenger, levels. ―It is critical to emphasize the use of health
and others. IS can facilitate private and secure access informatics methodology and information and
and utilization of these platforms to support client virtual communication technology to combat the current
care. ―Yet these platforms are not embedded into pandemic COVID-19 and future outbreaks. The essential
electronic medical records (EMRs). As a result, physicians role of biomedical and health informatics in pandemic
find themselves toggling between their EMR holding surveillance, notification and continued delivery of
important lab results and consultation notes and their evidence based best practices‖ (International Academy
video screens. The time spent moving between to for Health Sciences Informatics (IAHSI), 2020, p. 1).
separate programs adds up and places an extra layer of o Of course, tracking can become a cause for concern,
effort to an already exhausting overhaul‖ (The especially if human rights for privacy and confidentiality
Conversation, 2020). are breached. During a pandemic, these rights might
 TRACKING AND FORECASTING IS come into question. Thus, all IT and IS experts are
o have been instrumental in finding ways to track COVID-19 encouraged to consider the following recommendations
and forecast future events related to the outbreak. For from Informatics Europe (2020, p. 1).
instance, informatics experts at the University of Alberta‘s  Track individuals with their consent and under their direct
Centre for Health Informatics explained, ―Our experts at control, allowing them to switch tracking freely and easily on
CHI (data scientists, academics, clinicians, statisticians, and off even during the same day. To achieve this goal, we
epidemiologists, and visualization specialists) teamed up recommend technical experts to develop software which is
and developed an interactive and comprehensible not only GDPR-ready, but also dynamically reconfigurable by
dashboard. We want to help all Albertans and Canadians the end users within the limits defined by the current
stay informed on the current COVID-19 situation, with the jurisdiction.
best data that is available‖ (University of Calgary, Centre
for Health Informatics (CHI), 2020, p. 2).
o The CHI COVID-19 tracker form ―The Centre for Health RECOMMENDATIONS FROM INFORMATICS EUROPE
Informatics, working collaboratively with the province of
Alberta and the City of Calgary in partnership with Alberta  Track only aggregated data that cannot be traced back to
Health services (AHS) and Alberta Health (AH) to create a particular individuals if they have not given their explicit
data visualization dashboard with up-to-date information consent.
tracking the progression of the COVID-19 across the  Keep the tracking process transparent and open to the
province and the country at large‖ (University of Calgary, scrutiny of public opinion from the beginning of its use and
Centre Health Informatics (CHI), 2020, p. 1).
 rely on the evaluation by independent scientific advisors to - AI is also being used to forecast the trajectory and future of
assess the impact of security measures taken. the COVID-19 pandemic. ―Few would argue that AI is causing
 Make any software and hardware used open to examination a paradigm shift in health care and there might be value in
by the civil society. the application of AI to the current COVID-19 outbreak, for
 Specify the time limit for tracking without allowing for any example, in predicting the location of the next outbreak‖
extension in absence of an independent evaluation of the (McCall, 2020). Unfortunately, in order for this to occur, high
motivations. quality data must be available, and the AI system must be
programmed to this data. ―As a result of lack of data, too
TRACKING AND FORECASTING much outlier data and noisy social media, big data hubris,
- Some IT and IS experts have harnessed the power of artificial and algorithmic dynamics, AI forecast of the spread of
intelligence (AI) to create screening tools that anyone can COVID-19 are not yet very accurate or reliable. Hence, so far,
use to decide if their symptoms are positive for COVID-19 and most models used for tracking and forecasting do not use AI
whether further treatment is necessary. Whittbold et al. (2020) methods. Instead, most forecasters prefer established
described how the partners healthcare team in Boston used epidemiological models, so called SIR models, the
AI bots to create the partners COVID-19 screener, that abbreviation standing for the population of an area that is
―provides a simple, straightforward chat interface, presenting susceptible, infected, and removed‖ (Naude, 2020).
patients with a series of questions based on content from the - IT and IS can work together to harness the benefits of AI
US Centers for Disease Control and Prevention (CDC) and during this pandemic in a number of ways. According to
partners healthcare experts. In this way, it too can screen Naude 2020, ―there are six areas where AI can contribute to
enormous numbers of people and rapidly differentiate the fight against COVID-19: early warnings and alerts, tracking
between those who might really be sick with COVID-19 and and prediction, data dashboard, diagnosis and prognosis,
those who are likely to be suffering from less threatening treatments, and cures and social control‖.
ailments. We anticipate this AI bot will alleviate high volumes - Experts emphasize the importance of the humans the IT and
of patient traffic to the hotline and extend and stratify the ARE experts who work with AI that make all the difference.
system‘s care in ways that would have been unimaginable ―Efforts to leverage AI tools in the time of COVID-19 will be
until recently.‖ most effective when they involve the input and collaboration
- HIMSS Media offers a great collection of tracking and of humans in several different roles. The data scientists who
forecasting innovations in their article, Roundup: Tech‘s role in code AI systems play an important role because they know
tacking, testing, treating COVID-19. ―As the cases of COVID- what AI can do and, just as importantly, what it cannot. we
19 increase we are seeing a rise in digital epidemiology tools, also need domain experts who understand the nature of the
chatbot helpers, EHR guidance tools and rapid-response test problem and can identify where fast training data might still
kits‖ (HIMSS Media, 2020). be relevant today. Finally, we need out-of-the-box thinkers
 who push us to move beyond our assumptions and can see
surprising connections‖ (Hollister, 2020).
- All in all, informatics is critical to the successful abatement of A. COMPUTER GENARATED NURSING CARE PLANS
the COVID-19 pandemic, and informatics specialists are the  Essential teaching tool to present the value of planning
heart of this support and innovation. We salute all our tireless patient care.
peers who are spearheading these initiatives that support the  reinforced by Joint Commission On Accreditation For Hospital
hard work and dedication of our front-line health care (JCAH)
professionals. May we all come through this crisis with  Problems in written care plan:
strength, vision, and collaborative success!! o incomplete
UNIT IV APPLICATION IN EVIDENCE – BASED NURSING PRACTICE o outdated
o rarely used for determining care
o infrequently relied upon as a means of communicating
problem management from one shift to another
EVIDENCE – BASED NURSING PRACTICE o viewed burdensome
Refers to the process of collecting, processing and
 o time-consuming paperwork preparation
implementing research findings for the improvement of o revision of plan is low in practice setting
patient‘s outcomes, clinical nursing practice and work or  Solution to the problem is:
environment. o Promotes the value of planning care
 Helps provide the highest possible quality care at the most o Address the burden of workload NCPs can consume from
cost -efficient manner the nurses
 Enables the nurses to incorporate clinical expertise and o Works by providing template that nurse can work on and
current research to the data and turn it into a useful basis in modify based on the individual cases of their clients.
the decision making process.
B. CRITICAL/CLINICAL/CARE PATHWAYS
 APPLICATION IN EVIDENCE – BASED NURSING PRACTICE
o The use of information technology in evidence-based  ALSO KNOWN AS:
nursing practice such as: o CARE PATHWAYS
A. Computerized Nursing Care Plan o CLINICAL PATHWAYS
B. Clinical Pathways
CARE PATHWAYS
C. Clinical Practice Guidelines And
D. e-journal - one of the best tools of hospital to standardized quality of
 Allows more efficient facilitation in evidence-based nursing care process
practice - promotes organized and efficient patient care based on
evidence
 - proven that the implementation reduces the variability in oDevelopment and implementation involves a change in the
clinical practice and improves outcomes. organizational culture at any setting.
- concept first appeared in1985 inspired by KAREN ZANDER and  The activities to be done to develop and implement a care
KATHLEEN BOWER at the NEW ENGLAND MEDICAL CENTER in pathway:
BOSTON
- USUALLY PRESENTED AS GANTT CHART
A. Preparing multidisciplinary documents

B. Reviewing the process by all the concerned staff

 Different systematization tools were being used for the clinical
process: C. Holding care pathway meetings to facilitate the exchange of
o Oldest are: opinions about patient care by different professionals
 Medical and Nursing protocols
o Then: D. Conducting periodic reviews to monitor some defined indicators
 Standartized Care Maps and Clinical Practice
E. Analyzing variances or deviations
Guide lines
F. Preparing common record documents for all the staff
CARE PATHWAYS:

 Main goal is based on the improvement of the following areas:

o Quality in health care  Barriers in developing and implementing a pathway:
o Coordination/cooperation among health professionals
o Efficiency and patient satisfaction A. The heterogeneity of patients and diagnosis,
 Purpose:
B. The common reluctance among organizations and professionals
o Enhancement of care processes in the 3 areas:
to change.
 Quality
 Safety NOTE: Hospital managers must consider these barriers since they
 Efficiency may threaten a successful implementation of care pathways.
o Powerful tool for care management process
 Permit to check the compliance of all interventions
including the healthcare plans
B. CRITICAL PATHWAYS
 Fix care standard
 Introduce clinical audits as a part of the process  How to document variances? (Institutional guidelines may apply
o Useful to identify improvement areas in the standard care and not strictly confined to the guidelines below)
process for Continuous Quality Improvement culture.
1. Similar to DAR (Data, Action, and Response) format, we utilize  Clinical Practice Guidelines are statements that include
VAO (Variance, Action, and Outcome) to document variances. recommendations intended to optimize patient care.
 Informed by a systematic review of evidence, and an
2. Variance - includes all subjective and objective data observed by
assessment of the benefits and harms of alternative care
the nurse to be outside of the pathway management of the options.
patient's case.
 CPGs should follow a sound, transparent methodology to
3. Action - includes all interventions used to address the variance translate best evidence into clinical practice for improved
patient outcomes.
4. Outcome -- includes all patient care outcomes after the  Additionally, evidence-based CPGs are a key aspect of
interventions were performed to address the variance. patient-centered care.
 Clinical practice guidelines should be feasible, measurable,
 Important Note:
and achievable.
o Variances are not something to be taken negatively.
 Clinical performance measures may be developed from
o It may increase health care costs due to the
clinical practice guidelines and used in quality improvement
management of these variances that are outside of the
initiatives. When these performance measures are
clinical pathway, but over time as these variances
incorporated into public reporting, accountability, or pay for
become common and established a pattern, then it can
performance programs, the strength of evidence and
be included in the clinical pathway depending on the
magnitude of benefit should be sufficient to justify the burden
institution's approval and analysis of the situation.
of implementation.
o If sooner or later it becomes part of the clinical pathway,
 Sample of the clinical practice guideline for pneumonia by
then the health care costs will be controlled.
the Philippine College of Chest Physician( shown in word doc)
o Remember, the clinical pathways are not final. It always
gets revised frequently depending on the institution, as
our healthcare environment is dynamic.
o Collaboration within all members of the healthcare team D. E-JOURNALS
is a must to ensure a smooth and proper implementation
- E-journals or electronic journals are scholarly publications in
of these clinical pathways. digital form, which are accessible on the web.

Sample Document Using Clinical Pathway ( SHOWN IN WORD DOC.) D. E-JOURNALS

 In the Philippines, we have the Philippine E-journals

C. CLINICAL GUIDELINES (ejournals.ph) where you can find an online bibliographic
 database & repository of academic journals in different
disciplines from various resources.
 These are often used as acceptable review of related
literatures for research projects and evidence-based nursing
practice.
 Sample of the clinical practice guideline for pneumonia by the Philippine College of
Chest Physician
Figure 1. Algorithm for the management-oriented risk stratification of CAP among
immunocompetent adults

CAP

Any of the following:

1. RR ≥ 30/min
2. PR ≥ 125/min
3.Temp ≥ 40°C of ≤ YES YES
36°C Any of the following:
4. SBP≤90mmHg or High-risk CAP
DBP≤60mmHg 1. Severe sepsis and
5. Altered mental septio shook
status of acute onset
6.Suspected 2. Need for mechanical
aspiration ventilation
7. Unstable co-
morbid conditions ICU Admission
8. Chest x-ray NO
multilobar, pleural
etfusion, abscess
Moderate-risk
CAP
NO

Low-Risk CAP Cap

Ward Admission

Outpatient

Sample of the clinical practice guideline for pneumonia by the Philippine College
of Chest Physician
Netiquette Rules and Guidelines have vision issues, there are ways to adjust how text displays so you
can still see without coming across as angry or upset.
- Netiquette is short for "Internet etiquette." Just like etiquette is a
code of polite behavior in society, netiquette is a code of good 2 Sarcasm can (and will) backfire.
behavior on the Internet. This includes several aspects of the
Internet, such as email, social media, online chat, web forums, - Sarcasm has been the source of plenty of misguided arguments
website comments, multiplayer gaming, and other types of online online, as it can be incredibly difficult to understand the
communication. commenter‘s intent. What may seem like an obvious joke to you
could come across as off-putting or rude to those who don‘t know
Examples of rules to follow for good netiquette: you personally. As a rule of thumb, it‘s best to avoid sarcasm
altogether in an online classroom. Instead, lean toward being polite
1. Avoid posting inflammatory or offensive comments online (a.k.a and direct in the way you communicate to avoid these issues.
flaming).
2. Respect others' privacy by not sharing personal information, photos, 3. Don’t abuse the chat box
or videos that another person may not want published online.
3. Never spam others by sending large amounts of unsolicited email. - Chat boxes are incorporated into many online classes as a place
4. Show good sportsmanship when playing online games, whether you for students to share ideas and ask questions related to the lesson. It
win or lose. can be a helpful resource or a major distraction—it all depends on
5. Don't troll people in web forums or website comments by how well students know their classroom netiquette. ―Rather than
repeatedly nagging or annoying them. asking relevant questions or giving clear answers, students might use
6. Stick to the topic when posting in online forums or when the chat box to ask questions irrelevant to the discussion, or to talk
commenting on photos or videos, such as YouTube or Facebook about an unrelated topic,‖ says Erin Lynch, senior educator at Test
comments. Innovators. The class chat box isn‘t an instant messenger like you‘d
7. Don't swear or use offensive language. use with friends. Treat it like the learning tool it‘s meant to be, and try
8. Avoid replying to negative comments with more negative not to distract your classmates with off-topic discussions. Use it
comments. Instead, break the cycle with a positive post. instead to ask relevant questions and participate in class when the
9. If someone asks a question and you know the answer, offer to help. professor asks.
10. Thank others who help you online.
4. Attempt to find your own answer
10 Netiquette Guidelines Online Students need to know
- If you‘re confused or stuck on an assignment, your first instinct may
1. NO YELLING, PLEASE be to immediately ask your instructor a question. But before you ask,
take the time to try to figure it out on your own. For questions related
- There‘s a time and a place for everything—BUT IN MOST SITUATIONS to class structure, such as due dates or policies, refer to your syllabus
TYPING IN ALL CAPS IS INAPPROPRIATE. Most readers tend to and course FAQ. Attempt to find the answers to any other questions
perceive it as shouting and will have a hard time taking what you on your own using a search engine. If your questions remain
say seriously, no matter how intelligent your response may be. If you unanswered after a bit of effort, feel free to bring them up with your
instructor.
5. Stop ... grammar time! 9. Think before you type

- Always make an effort to use proper punctuation, spelling and - A passing comment spoken in class can be forgotten a few minutes
grammar. Trying to decipher a string of misspelled words with erratic later, but what you share in an online classroom is part of a
punctuation frustrates the reader and distracts from the point of permanent digital record. Not only is it good practice to be
your message guarded when it comes to personal information, you always want to
be just as respectful toward others as you would be if you were
6. Set a respectful tone sitting in the same room together. Zink says a good rule of thumb to
follow is if you‘re comfortable standing up in front of a classroom
- Every day may feel like casual Friday in an online classroom where
and saying your message, then it‘s most likely okay to share.
you don‘t see anyone in person, but a certain level of formality is still
expected in your communication with instructors. In addition to 10. Be kind and professional
proper punctuation and spelling, it‘s good netiquette to use
respectful greetings and signatures, full sentences and even the  Online communication comes with a level of anonymity that
same old ―please‖ and ―thank you‖ you use in real life. doesn‘t exist when you‘re talking to someone face-to-face.
Sometimes this leads people to behave rudely when they disagree
7. Submit files the right way with one another. Online students probably don‘t have the
complete anonymity that comes with using a screen name, but you
- You won‘t be printing assignments and handing to them to your
could still fall prey to treating someone poorly because of the
teacher in person, so knowing how to properly submit your work
distance between screens. Make a point to be kind and respectful
online is key to your success as an online student. Online course
in your comments—even if you disagree with someone.
instructors often establish ground rules for file assignment
submissions, like naming conventions that help them keep things Recommendations for Social Media Use in hospitals and health Care
organized or acceptable file formats. Ignoring these instructions is a Facilities
common example of bad netiquette.

8. Read first
Social Media is the new avenue for creating connections and sharing of
- Take some time to read through each of the previous discussion information. Through social media, one can reach a global community. In
post responses before writing your own response. If the original post recent years, we have seen how social media has changed the way we do
asked a specific question, there‘s a good chance someone has things. Social Media has been extensively utilized for health education and
already answered it. Submitting an answer that is eerily similar to a promotion, proving itself to be an invaluable tool for public health,
classmate‘s indicates to the instructor that you haven‘t paid professional networking and patient care benefit.
attention to the conversation thus far. Remember, discussions can
move fairly quickly so it‘s important to absorb all of the information The challenge has been to use the power afforded by social media
before crafting your reply. Building upon a classmate‘s thought or responsibly, and to define the line between use and abuse. While there
attempting to add something new to the conversation will show may be laws, implementation proves to be a challenge in the digital age.
your instructor you‘ve been paying attention. Therefore, self-regulation and institutional policy remain a critical part. It is
therefore urged that hospitals and health care facilities adopt their own
social media use policy appropriate for the institution. Below are proposed b) The individual should always be conscious of his or her online image
rules that could guide institutions in developing their own policy for social and how it impacts his or her profession, or the institution where he
media use: or she is professionally employed, affiliated or otherwise connected.
c) Responsible social media use also requires the individual to ensure
that in his or her social media activity, there is no law violated,
including copyright, libel and cybercrime laws. At all times, the
Sec. 1. Declaration of Policy. The health facility recognizes that the exercise
individual shall respect the right of privacy of others.
of the freedom of expression comes with a responsibility and a duty to
d) Use of social media requires a personal commitment to uphold the
respect the rights of others. The health facility likewise acknowledges the
ethical standards required of those providing health services, upon
fundamental right to privacy of every individual. This policy shall provide
which patient trust is built.
rules for responsible social media use.
Sec. 5. Social Media for Health Education or Promotion
Sec. 2. Definition. For purposes of this policy, the following definitions shall
be used: a) The individual using social media for health education or promotion
must be well-informed of the matter subject of the social media
a) Social Media refers to electronic communication, websites or
post, comment or other activity. The individual shall refrain from any
applications through which users connect, interact or share
activity which spreads or tends to spread misinformation.
information or other content with other individuals, collectively part
b) An article written by an individual and posted in social media must
of an online community. This includes Facebook, Twitter, Google+,
be evidence-based and disclose connections with pharmaceutical
Instagram, LinkedIn, Pinterest, Blogs, Social Networking sites.
or health product companies or other sources of possible conflict of
b) Health facility shall refer to the hospital or other health care facilities,
interest.
including training and educational institutions.
c) Social media shall not be used to dispense specific medical
c) Individual shall refer to physicians, employees, other health facility
diagnosis, advice, treatment or projection but shall consist of
staff, residents, or students to which this policy would apply.
general opinions only. Use of social media should include
Sec. 3. Applicability. This policy shall apply to all physicians, health statements that a person should not rely on the advice given online,
professionals, employees and other health facility staff, including students or and that medical concerns are best addressed in the appropriate
residents in training, practicing their profession, working, or fulfilling setting.
academic and clinical requirements within the health facility, whether d) The individual shall be careful in posting or publishing his or her
temporary or permanent. opinion and shall ensure that such opinion will not propagate
misinformation or constitute a misrepresentation. The individual shall
Sec. 4. General Principles. Social media use shall be guided by the not make any misrepresentations in his or her social media activity
following principles: relating to content, his or her employment or credentials, and any
other information that may be misconstrued or taken out of context.
a) In using social media, an individual should always be mindful of his
or her duties to the patient and community, his profession and his Sec. 6. Professionalism in Social Media Use
colleagues.
a) Individuals are discouraged from using a single account for both
professional and private use. Be mindful that an electronic mail
 address used professionally may readily be linked to a social media a) In using social media, the individual shall respect the dignity,
site used privately. personality, privacy and peace of mind of another.
b) The individual shall conduct himself or herself in social media or b) The individual shall not post, share or otherwise use social media
online the same way that he would in the public, mindful of acting with the intent of damaging the reputation of any other individual or
in a manner befitting his profession, or that would inspire trust in the institution, especially if the subject is identified or identifiable.
service he or she provides, especially if the individual has not c) Derogatory comments about patients, colleagues, employers and
separated his or her professional and personal accounts in social institutions or companies should be avoided. An individual may
media. ―like‖ a defamatory post but he or she must use caution when
c) The individual shall likewise refrain from using the name, logo or sharing, retweeting or contributing anything that might be
other symbol of an institution without prior authority in his or her construed as a new defamatory statement. A post, comment or
social media activity. An individual shall not identify himself or herself other social media activity is considered defamatory if:
as a representative of an institution in social media without being
authorized to do so. 1) The activity imputes a discreditable act or condition to
d) Individuals shall not accept former or current patients as friends or another
contacts in their personal accounts, unless there is justification to do 2) The activity is viewed or seen by any other person
so, such as a pre-existing relationship or when unavoidable for 3) The person or institution defamed is identified or readily
patient care. In case of online interaction with patients, this should identifiable
be limited to matters related to the patient‘s treatment and 4) There is malice or intent to damage the reputation of
management, and which could be properly disclosed. another.
e) Informal and personal information concerning a patient, colleague
or the health facility shall not be posted, shared or otherwise used in d). He or she shall be careful of sharing posts or other contents that
social media. are unverified, particularly if it discredits another person or institution, or
f) Social media shall not be used to establish inappropriate imputes the commission of a crime or violation of law even before trial and
relationships with patients or colleagues, and shall not be used to judgment, and violates the privacy of another. Fair and true reporting on
obtain information that would negatively impact on the provision of matters of public concern shall be allowed provided that the content was
services and professional management of the patient. obtained lawfully and with due respect for the right of privacy.
g) An individual shall refrain from posting, sharing or otherwise using
e. An individual shall not use copyrighted materials other than for fair use
photos or videos taken within the health facility, which would give
where there is proper citation of source and author. Use of copyrighted
the impression of unprofessionalism, show parts of the health facility
material for purpose of criticism, comment, news, reporting, teaching,
where there is an expectation of privacy, or those which includes
scholarship, research, and similar purposes is compatible with fair use.
colleagues, employees, other health facility staff, or patients without
their express consent. The consent requirement shall apply even if f. An individual is prohibited from:
the other individuals included are not readily identifiable.
1) Social media activities that defame, harass, stalk, or bully another person
Sec. 7. Responsible Social Media Activity or institution.
2) The use or access of personal social media accounts of others without would blacken the reputation of the patient. The duty of maintaining
authority. patient confidentiality remains even after patient‘s death.

3) Posting, sharing or otherwise using any information intended to be e. An individual shall not post, share or otherwise use any information
private or obtained through access to electronic data messages or relating to the identity, status and personal details of persons with HIV, those
documents. who have undergone drug rehabilitation, and victims of domestic violence,
rape and child abuse.
4) Posting, sharing or otherwise using recorded conversations between
doctors, individuals or patients, when such recording, whether audio or Sec. 9. Compliance and Reporting.
video, was obtained without consent of all the parties to the conversation
a. An individual shall strive to develop, support and maintain a privacy
g. Individuals should use conservative privacy settings in their social media culture in the health facility. He or she shall abide by the social media use
account used professionally. The individual should also practice due policy of the institution.
diligence in keeping their social media accounts safe such as through
regular password change and logging out after social media use. b. An individual who becomes aware of unprofessional behavior,
misinformation or privacy violations in social media shall report the matter
Sec. 8. Health Information Privacy to the hospital‘s privacy officer or the proper office or authority within the
facility.
a. The individual shall respect the right to privacy of others and shall not
collect, use, access or disclose information, pictures and other personal or c. Health facilities shall in so far as practicable monitor the social media
sensitive information without obtaining consent from the individual activity of all physicians, employees and other health facility staff, including
concerned. Physicians, health facility employees and other health staff shall students or residents in training, practicing their profession, working, or
have the duty of protecting patient confidentiality in their social media fulfilling academic and clinical requirements within the health facility,
activity. whether temporary or permanent.

b. Personal health information, including photos or videos of patients, shall Sec. 10. Penalty. A violation of this policy may constitute a violation of the
not be posted, shared or otherwise used in social media without consent of code of ethics of physicians and other professions, and other applicable
patient. Consent shall be obtained after explaining to the patient the laws.
purpose of the intended collection, use, access and disclosure. Consent for
use of personal health information shall be written or evidenced by a. Health Professionals, employees and other Health Facility Staff. Any
electronic means. person found violating this policy will be considered in violation of health
facility rules and regulations, and shall be subjected to health facility
c. An individual shall not post, share or otherwise use any information which administrative proceedings, which after notice and hearing, and
could be used to identify patients without their consent, including patient‘s depending on the severity of the violation, could result to termination of
location, room numbers, and photographs or videos of patients or their service or withdrawal of privileges. A lighter penalty may likewise be
body parts, including code names referring to patients. imposed. In determining the severity of the violation, the following factors
may be considered: previous violation, if any, the nature of the violation,
d. The individual shall not post, share or otherwise use any other information and the extent of injury or damage. The penalty imposed by the health
acquired in attending to a patient in a professional capacity, and which facility shall be without prejudice to the filing of a complaint before the Civil
Service Commission, the Professional Regulations Commission, the Office of  A surgical safety checklist was designed to improve team
the Prosecutor or Ombudsman, or proper courts. communication and consistency of care would reduce
complications and deaths associated with surgery.
b. Students. In case of students, they shall be reported to the college
wherein they are enrolled and shall be subjected to disciplinary Background cont…
proceedings, which could result to expulsion, depending on the severity of
the violation, and in accordance with the applicable University and  Surgery is performed in every community: wealthy and poor, rural
respective College rules. A lighter penalty may likewise be imposed. The and urban, and in all regions.
disciplinary proceedings shall be without prejudice to other applicable  Although surgical care can prevent loss of life or limb, it is also
legal remedies. associated with a considerable risk of complications and death.
 The risk of complications is poorly characterized in many parts of the
SURGICAL SAFETY CHECKLIST
world, but studies in industrialized countries have shown a
perioperative rate of death from inpatient surgery of 0.4 to 0.8% and
 Objectives of this presentation a rate of major complications of 3 to 17%
 This topic will explain what a surgical safety checklist is and  Data suggest that at least half of all surgical complications are
 Why it is important. avoidable.

Ohio Surgeon Trail of errors led to 3 Surgical Safety checklist

Performs wrong brain surgeries.
Wrong-Site Surgery Surgeons' ego at  In 2008, the World Health Organization (WHO) published guidelines
on R.I.P. hospital may identifying multiple recommended practices to ensure the safety of
surgical patients worldwide.
Four- Year-Old have led to
 On the basis of these guidelines, a checklist intended to be globally
carelessness. applicable and to reduce the rate of major surgical complications.
 The implementation of this checklist and the associated culture
Wrong kidney removed at changes it signified would reduce the rates of death and major
Medical Center complications after surgery in diverse settings.
The role of surgical safety checklist
Background The checklist consists of an oral confirmation by surgical teams of
the completion of the basic steps for ensuring:
 Surgery has become an integral part of global health care, with an
estimated 234 million operations performed yearly. Each week in the
US wrong-site surgery occur over 40 times.
 Foreign objects are left inside patient‘s body 39 times, and these
mistakes and their associated complications are common and
preventable.
Safe Site Surgery will help the surgical team to avoid:
 •All members of the team are aware of whether the patient has a known
 Surgical deaths and errors allergy
 The adverse legal issues •The patient‘s airway and risk of aspiration have been evaluated and
 Surgical infection appropriate equipment and assistance are available
 Poor communication among surgical team members •If there is a risk of blood loss of at least 500 ml (or 7 ml/kg of body weight, in
How the checklist is used. children), appropriate access and fluids are available
 It is used at three critical junctures in care:
Before anesthesia is administered, 2. Time out (Surgical pause):
Immediately before incision, and Before skin incision, the entire team (nurses, surgeons, anesthesia
Before the patient is taken out of the operating room. professionals, and any others participating in the care of the patient) orally:
 The WHO surgical safety checklist represents a simple set of surgical
safety operating room standards that are applicable in all countries  Confirms that all team members have been introduced by name
and settings. and role
 The checklist is not intended to be comprehensive. Additions and  Confirms the patient‘s identity, surgical site, and procedure
modifications to fit local practices are encouraged.  Reviews the anticipated critical events
 Surgeon reviews critical and unexpected steps, operative duration,
A set of Safety Checks has been assembled to reduce the number and and anticipated blood loss
severity of adverse events involving:  Anesthesia staff review concerns specific to the patient
 Surgeons  Nursing staff review confirmation of sterility, equipment availability,
 Anesthesiologists and other concerns
 Nurses  Confirms that prophylactic antibiotics have been administered ≤60
 Public health experts min before incision is made or that antibiotics are not indicated
Three elements of the Surgical Safety Checklist:  Confirms that all essential imaging results for the correct patient are
•Sign In displayed in the operating room
•Time Out  The Wrong way to do a Time Out
•Sign Out  Successful Time Out Process

3. Sign out
1. Sign in (Briefing): Before the patient leaves the operating room:
Before induction of anesthesia, members of the team (at least the nurse
and an anesthesia professional) orally confirm that:  Nurse reviews items aloud with the team
 Name of the procedure as recorded
•The patient has verified his or her identity, the surgical site and procedure,  That the needle, sponge, and instrument counts are complete (or
and consent not applicable)
•The surgical site is marked or site marking is not applicable  That the specimen (if any) is correctly labeled, including with the
•The pulse oximeter is on the patient and functioning patient‘s name
 Whether there are any issues with equipment to be addressed
  The surgeon, nurse, and anesthesia professional review aloud the  Effective preoperative patient assessment includes a review of the
key concerns for the recovery and care of the patient medical record or imaging studies immediately before starting
 The WHO checklist format surgery.
 To facilitate this step, all relevant information sources, verified by a
Some important considerations for the nurse predetermined checklist, should be available in the operating room
 Is the patient fasting (Nil Per Oral – NPO)? When did the and rechecked by the entire surgical team before the operation
patient eat last? begins.
 Is the necessary imaging displayed?
 Are the surgical items that you have ―pulled‖ what the Conclusion cont…
surgeon needs? Do you need to check with the surgeon
first?  A briefing is important for assigning essential roles and establishing
 Is the patient situated on the table without unnecessary expectations.
pressure that could cause nerve damage? How long will the
procedure take?  Introduction of each person in the operating room by name and
 Are all members of the team ready to start? role, even if team members are familiar, is recommended for
improved communication. Whenever possible, the patient (or the
Outcomes of the checklist patient's designee) should be involved in the process of identifying
the correct surgical site, both during the informed consent process
 Introduction of the WHO Surgical Safety Checklist into operating and in the physical act of marking the intended surgical site in the
rooms in various hospitals around the world was associated with preoperative area.
marked improvements in surgical outcomes.
 Postoperative complication rates fell by 36% on average, and  A formal procedure for final confirmation of the correct patient and
death rates fell by a similar amount. surgical site (a ―time out‖) that requires the participation of all
 The reduction in the rates of death and complications suggests that members of the surgical team may be helpful. Time outs may
the checklist program can improve the safety of surgical patients in include not only verification of the patient and the surgical site, but
diverse clinical and economic environments. also relevant medical history, allergies, administration of appropriate
preoperative antibiotics, and deep vein thrombosis prophylaxis.
Conclusions
 Use of the checklist involved both changes in systems and changes
 A common theme in cases of wrong-site surgery involves failed in the behavior of individual surgical teams.
communication between the surgeon(s), the other members of the
health care team, and the patient.  To implement the checklist, all sites had to introduce a formal pause
 Communication is crucial throughout the surgical process, in care during surgery for preoperative team introductions and
particularly during the preoperative assessment of the patient and briefings and postoperative debriefings, team practices that have
the procedures used to verify the operative site. previously been shown to be associated with improved safety
processes and attitudes and with a rate of complications and
death reduced by as much as 80%.
  The standards are subject to change with the dynamics of the
The philosophy of ensuring the correct identity of the patient and site nursing profession, as new patterns of professional practice are
through preoperative site marking, oral confirmation in the operating room, developed and accepted by the nursing profession and the public.
and other measures proved to be new to most of the study hospitals.  In addition, specific conditions and clinical circumstances may
affect the application of the standards at a given time (e.g., during
REMEMBER a natural disaster).
 The standards are subject to formal, periodic review and revision.
EVERY CHECK CAN SAVE LIFE  The competencies that accompany each standard may be
evidence of compliance with the corresponding standard.
THIS CHECKLIST IS A DOCUMENT BUT ALSO A MATERIAL (TOOL) FOR
 The list of competencies is not exhaustive.
OPERATING ROOMS, THAT CAN HELP US TO BE SAFE FOR OUR WORK AND
 Whether a particular standard or competency applies depends on
SAFE FOR OUR PATIENTS.
the circumstances.

Standard 1. Assessment

UNIT 7 STANDARDS OF NURSING INFORMATICS PRACTICE  The informatics nurse collects comprehensive data, information,
and emerging evidence pertinent to the situation.

Competencies
Standards of Nursing Informatics Practice According to American Nurses
Association The informatics nurse:

 Uses evidence-based assessment techniques, instruments, tools, and

effective communication strategies in collecting pertinent data to
 Significance of the Standards define the issue or problem.
 Uses workflow analyses to examine current practice, workflow, and
The Standards are based on the Standard of Professional Nursing Practice
the potential impact of an informatics solution on that workflow.
 Conducts a needs analysis to refine the issue or problem when
 They are authoritative statements of the duties that all registered
necessary.
nurses, regardless of role, population, or specialty, are expected to
 Involves the healthcare consumer, family, interprofessional team,
perform competently.
and key stakeholders, as appropriate, in relevant data collection.
 The standards published are utilized as evidence of the care, with
 Prioritizes data collection activities.
the understanding that application of the standards is context
 Uses analytical models, algorithms, and tools that facilitate
dependent.
assessment.
 One example of an assessment algorithm is PIECES:
o Performance--throughput or response time;
 o Information-outputs, inputs, and/or stored data;  Uses standardized clinical terminologies, taxonomies, and decision
o Economics-costs versus profits; support tools, when available, to identify problems, needs, issues,
o Control-too little security or control or too much control or and opportunities for improvement.
security;  Documents problems, needs, issues, and opportunities for
o Efficiency-people, machines, or computers waste time, and; improvement in a manner that facilities the discovery of expected
o Service--inaccurate, inconsistent, unreliable, hard to learn, outcomes and development of a plan.
difficult to use, inflexible, incompatible, not coordinated with
other systems (Wetherbe, 1994).

Standard 3. Outcome Identification

 Synthesizes available data, information, evidence, and knowledge  The informatics nurse identifies expected outcomes for a plan
relevant to the situation to identify patterns and variances. individualized to the healthcare consumer of the situation.
 Applies ethical, legal, and privacy regulations and policies for the
Competencies
collection, maintenance, use, and dissemination of data and
information. The informatics nurse:
 Documents relevant data in a retrievable format.
 Involves the healthcare consumer, family, healthcare provider and
key stakeholder in formulating expected outcome when possible
and appropriate.
Standard 2. Diagnosis, Problems, and Issues Identification
 Defines expected outcome in terms of the healthcare consumer,
 The informatics nurse analyzes assessment data to identify health-care worker, and other stakeholder; their values; ethical; and
diagnoses, problems, issues, and opportunities for improvement. environmental, organizational, or situational considerations
 Formulates expected outcomes after considering associated risks,
Competencies benefits, costs, available, expertise, evidence-based knowledge,
and environmental factors.
The informatics nurse:  Develops expected outcomes that provide direction for project
team members, the healthcare team, and key stakeholders.
 Derives diagnoses, problems, needs, issues, and opportunities for
 Includes a time estimate for the attainment of expected outcomes.
improvement based on assessment data.
 Modifies expected outcome based on changes in the status or
 Validates the diagnoses, problems, needs, issues, and opportunities
evaluation of the situation.
for improvement with the healthcare consumer, family,
 Documents expected outcomes as measurable goals.
interprofessional team, and key stakeholders when possible and
appropriate.
 Identifies actual or potential risks to the healthcare consumer‘s
health and safety, or barriers to health, which may include, but are Standard 4. Planning
not limited to, interpersonal, systematic or environmental
circumstances.
  The informatics nurse develops a plan that describes strategies,  The informatics nurse implements the identified plan
alternatives and recommendations to attain expected outcomes.
Competencies
Competencies
The informatics nurse:
The informatics nurse:

 Develops a customized plan considering clinical and business

characteristics of the environment and situation.  Partners with healthcare consumer, healthcare team, and others, as
 Develops the plan in collaboration with the healthcare consumer, appropriate, to implement the plan on time, within the budget, and
family, healthcare team, key, stakeholders, and others as within plan requirements.
appropriate.  Utilizes health information technology to measure, record, and
 Establishes the plan priorities with key stakeholders and others as retrieve healthcare consumer data, implement and support the
appropriate. nursing process, and improve overall healthcare outcomes.
 Incorporates strategies in the plan address each of the identified  Uses specific evidence-based actions and processes to resolve
diagnoses, problems, needs, and issues. diagnoses, problems, or issues to achieve the defined outcomes.
 Incorporates planes strategies addressing health and wholeness  Advocates for health care that is sensitive to the needs of
across life span. healthcare consumers, with emphasis on the need of diverse
 Incorporates an implementation pathway or timeline within the plan populations and use of self-theory
 Considers the clinical, financial, social and economic impact of the  Applies available healthcare technologies to maximize access and
plan on the stakeholders optimize outcomes for healthcare consumers.
 Integrate current scientific evidence, trends, and research into the  Uses community and organizational resources systematically to
planning process implement the plan.
 Utilizes the plan to provide direction for the healthcare team and  Collaborate with the healthcare team and other stakeholder from
other stakeholders. diverse backgrounds to implement and integrate the plan
 Integrates current status, rules and regulations, and standards within  Accommodates different styles of communication used by
the planning process and plan. healthcare consumers, families, healthcare providers, and others
 Modifies the plan according to the ongoing assessment of the  Implements the plan using principle and concepts of enterprise
healthcare consumer‘s response and other outcome indicators. management, project management and system change theory
 Integrates informatics principles in the design of interprofessional  Promotes the healthcare consumer‘s capacity for the optimal level
processes to address identified situations or issues. of participation and problem-solving.
 Documents the plan in a manner that uses standardized  Fosters an organizational culture that support implementation of the
terminologies and taxonomies. plan
 Incorporates new information and strategies to initiate change if
desired outcomes are not achieved
 Documents implementation and any modifications, including
Standard 5. Implementation changes or omissions, of the identified plan
  Disseminates the results to key stakeholders and others involved,
accordance with organizational requirements and federal and
Standard 5a. Coordination of Activities state regulations
 Standards of Professional Performance for Nursing Informatics
 The informatics nurse coordinates planned activities
 The standards of professional performance express the role
Standard 5b. Health Teaching and Health Promotion performance requirements for the informatics nurse and informatics
nurse specialist
 The informatics nurse employs informatics solutions and strategies for
education and teaching to promote health and a safe environment Standard 7. Ethics

Standard 5c, Consultation  Identifies the informatics nurse practices ethically, with further
detailing of associated competencies, such as the use of the Code
 The informatics nurse provides consultation to influence the of Ethics for Nurses with Interpretive Statements to guide practice
identified plan, enhance the abilities of others, and effect change.
Standard 8. Education
Standard 6. Evaluation
 Addresses the need for the informatics nurse to attain knowledge
 The informatics nurse evaluates progress toward attainment of and competence, including the competency associated with
outcomes demonstration of a commitment to lifelong learning

Competencies Standard 9. Evidence-based Practice and Research

The informatics nurse:  Confirms that the informatics nurse integrative evidence and
research findings into practice

Standard 10. Quality of Practice

 Conducts a systematic, ongoing and criterion-based evaluation of
the outcomes in relation to the structure and processes prescribed  Describes the expectation for the informatics nurse‘s contribution
by the project plan and indicated timeline. related to the quality and effectiveness of both nursing and
 Collaborates with the healthcare consumer, health care team informatics practice.
members and other key stakeholders involved in the plan or
situation in the evaluation process, Standard 11. Communication
 Evaluates in partnership with the key stakeholders, the effectiveness
 Explains that the information nurse communicates effectively
of the planned strategies in relation to attainment of the expected
through a variety of formats, with several accompanying
outcomes.
competencies delineating specific requisite knowledge, skills, and
 Evaluates the link between outcomes and evidence- based
abilities for demonstrated success in this area.
methods, tools, and guidelines
 Documents the results of the evaluation. Standard 12. Leadership
  Promotes that the informatics nurse leads in the professional
practice setting, as well as the profession. Accompanying
competencies address such skills as mentoring, problem-solving,
and promoting the organization‘s vision, goals, and strategic plan.

Standard 13. Collaboration

 Encompasses the informatics nurse‘s collaborative efforts with the

healthcare consumer, family, and others in the conduct of nursing
and informatics practice

Standard 14. Professional Practice Evaluation

 Identifies that the informatics nurse conducts evaluation of their own

nursing practice considering professional practice standard and
guidelines, relevant statutes, rules and regulations

Standard 15. Resource Utilization

 Addresses that the informatics nurse uses appropriate resources to

plan and implement safe, effective, and fiscally responsible
informatics and associated services

Standard 16. Environment Health

 Close out the list of professional performance standards by

describing that the informatics nurse supports practice in a safe and
healthy environment.
PREPARING THE FINAL COPY OF THE THESIS PROPOSAL d) Proponent/s
e) Month and year of graduation
I. General format
2. Approval sheet. It is placed immediately after the
1. Margins
title page.
a. Left- 1.5
a) Generally it contains statements of
b. Top. Bottom. Right- 1 inch recommendation and acceptance.
2. Font type and size- times new roman or arial, size 12 b) The approval of the adviser that the thesis
3. Spacing – double spacing except for figures. , proposal is complete and the recommendation
tables and abstract (single spacing) of the same for oral examination.
4. Paragraph indention five letter spaces c) The approval of the panel of the examiners that

5. Pagination- one inch from the right edge of the the thesis proposal has been examined
paper on the 1st line of every page d) The acceptance of the department of nursing
and of the academic office.

II. Preliminary parts

1. Title page- it is center- justified and ALL CAPS, 3. Acknowledgement sheet. This reflects the
follows the inverted pyramid style and is single- researcher/s expression of appreciation for the
spaced. assistance and encouragement extended to
Contents: him/them in making the research paper. Pronouns
used must be in third person
a) Title
b) Classification of paper: Thesis proposal 4. Abstract
c) Name/s of the research
 a) It is brief yet comprehensive summary of the f) Opposite each chapter title is the corresponding
paper. page number led by dots.
b) It describes the g) Chapter and section titles should not extend
 Problem research on beyond the right margin of the leaders(dots). If a
 The number and kind of participants or chapter/ section tittles occupies more than one
respondents, line, the second line on wards must align- left
 The hypothesis, with the first.
 Summary of procedures and methods
 Instrumentation, Results, Conclusion,
Implication, recommendation 6. List of tables. It appears on the page immediately
following the table of contents.
5. Table of contents
a) LIST OF TABLES should be typed centered and in
 This is an ordered and paginated listing of the
all capital letters.
different parts of the thesis.
b) The heading Table should be typed three lines
 It must show the chapter and section titles in full
spaces below the title and flushed to the left
and must have entries for the references and
margin; opposite the word Page which is flushed
appendices sections.
to the right margin.
a) The heading TABLE OF CONTENTS should be
c) Arabic numerals are used for the table numbers
typed centered and in all capital letters.
which are placed right under the heading Table.
b) Spacing should be 1.5 in. throughout
A tab\ is inserted after each table number, then
c) Preliminaries should be listed first.
the little of the table appears.
d) The heading Chapter should be flushed left on
the same line with Page flushed right. Only the 7. List of Figures
first letters of the words are capitalized.
 It is placed on the separate page right after the
e) Below the heading Chapter are the tittles of the
list of the tables
different chapters in upper case.
 a) LIST OF FIGURES is typed centered and in upper All should appear on the new page, separate from
case. the body of the thesis.
b) The heading Figure should be typed three line
spaces below the title and flushed to the left
margin: opposite is the heading Page which is All references cited on the body of the research
flushed to the right margin. paper must appear on the References section.
c) Arabic numerals are used for the table numbers,
The heading References is centered –justified on the
which are placed right under the heading
first line below the page header.
Figure. A tab is inserted after each table
number, followed by the title of the figure from The entries with changing indentions, begin on the
the corresponding page number. line following the heading References

Entries begins with the surnames of the authors and

are arrange alphabetically.
III. The body of the proposal

1. Each chapter should have heading that is center

justified. The chapter numbers should be in Arabic Components of a reference entry;
numerals, e.g., ―Chapter I.‖

2. The chapter number is followed by the title in all

1) Author‘s Name- type the surname first followed by
capital letters and encoded at the center.
a comma, then the first name and the middle initial. If
3. All element/s title should be flushed left. there are to six authors, all their names are written. If
they are more than six, the remaining authors can be
represented by the words ―et al‖
IV. End Matters

References
2) Year Of Publication. It should follow the period after Burns, n. & Grove, S. K. (2005). The practice of nursing
the author‘s name and should be enclosed in research: Conduct, critique and utilization (Rev.
parenthesis ed.).Philadelphia: Saunders.

3) Book Title. The complete title and book edition Example 2.

should be written. The entire book title must be
Smeltzer, S. C., Bare, B. G., Hinkler, J. L., & Cheeves, K.
italicized. Only the first letter of the first word and of
H. (2008). Brunner and Suddart‘s text book of medical-
proper names must be capitalized.
surgical nursing (11th ed). Philadelphia: Lippincott
4) Journal title. The title of the article, in roman face
Williams and Wilkins.
and sentence case( only the first letter of the first
word and of proper names are capitalized), appears
first. The title of the journal itself appears in italics and
Journal Supplement
in the title case ( the first letter of each substantial
word is capitalized. Example :

5) Place of publication. The city where the book is Houinard, M. C.,& Robichaud-Ekstrand, S (2005)The
published should be written followed by a colon. effectiveness of a nursing impatient smoking
cessation program in individuals with cardiovascular
6) Publishing house. The name of the publishing house
disease. Journal of Nursing Research, 54(4), 243-254
follows the place of publication

2. Examples of reference entries:

Research Paper
Book revised edition
Good to know in making a Thesis Proposal
Example 1:
6 Things You Should Know About Thesis Writing
  Create a timetable and stick to it as much as
possible. (Save your\ time and help you
1. Choosing the topic/ problem. Choosing the right
organize the work properly.)
topic or problem for your thesis paper is an
important component of success, so start Outline and thesis structure
thinking early on what you want to write about.
 To write a logical and effective thesis paper, you
...
need to create an outline.
2. Planning the research. ...
 It will show you the right direction and the next
3. Outline and thesis structure. ...
step to make.
4. Appropriate academic style. ...
 Consult your supervisor regarding the structure of
5. Editing and proofreading
your thesis, as there are several possible
6. Choosing the topic/problem
variations, and include all the required sections
Choosing the topic/ problem in your outline.

 An important component of success, Appropriate academic style

 Start thinking early on what you want to write
 A thesis paper is the most important academic
about.
paper and needs to be written in good
 Main goal:: find a really good problem you
academic English and appropriate academic
can\ research / solve.
style.
 Consult your supervisor or the thesis coordinator
 Avoid using any slang, contractions,
and ask them for professional advice.
colloquialisms, etc.
Planning the research  However, it doesn‘t mean that you need to use
complex words from an over-formal vocabulary.
 Thesis is a very long project based on your own
 Everything you write should be clear and
ideas and research,
understandable to the reader.
 You need to thoroughly plan its every stage.
Referencing
  Plagiarism (presenting someone else's work or  Used for storing, organizing and manipulating
ideas as your own, with or without their consent, data
by incorporating it into your work without full  Composed of grid rows and columns
acknowledgement) - a NO NO  The horizontal row are identified by numbers
 You need to properly cite every source you use. (1,2.3) the vertical column with letters of the
 Stick to the required referencing style and strictly alphabet(A,B,C).
follow it.  For columns beyond 26, columns are identified
 Remember, extensive and proper referencing by two or more letters such as AA, AB,AC.
indicates a correct approach to writing a thesis
paper.
Cell
Editing and proofreading
 The intersection point between a column is a
 Wait at least a day after your thesis is complete
small rectangular box
and then edit and proofread it.
 The basic unit for sorting in the spread sheet
 Check your writing for style, structure, lexical
 An excel spreadsheet contains thousands of cell
coherence, unity, readability, grammar, spelling,
 Each is given a cell reference or address to
and punctuation.
identify it.
 Do not hesitate to ask your friend or family
member to proofread your paper once again.
 You can always hire a professional editor who
A. MOVING AROUND
will help you polish your paper to perfection.
1. Open up a new spread sheet and click your
cursor in the cell B2.
Microsoft excel 2. Note that the cell B2 is seen in the left hand
corner
 Electronic Spreadsheet Computer program
3. Type 1 into the cell and press the enter key
created by Microsoft inc.
Or: You can move around the spreadsheet by either  not only can you copy cells across cells, you
clicking on the cell with your mouse cursor or by using can also have numbers added consecutively
the arrow keys on the key board. across cells
 To do this the computer needs to know how
Note: Texts are on the left hand side of the cell and
much you want the numbers to increase. For
numbers are on the right side of the cell.
example: 1,2,3, or 1,3,5 or more

C. CHANGING CELL WIDTHS BY DRAGGING

B. THE DRAG HANDLE
 Changing cell widths by dragging moving your
 A feature that allows the user to extend ( and fill) cursor between A and B on the Column row as
a series of numbers, dates or even text to a shown left.
desired number of cells. In an active cell of the  Click and hold down your left mouse button and
spreadsheet, the drag handle is a small black drag the cell A out to make more room in the
box at the bottom right corner. cell.

a. Changing cell widths by dragging

A. Dragging to copy cells Note: What happens if you move the cell
boundary in too far and the words cannot fit into the
 In the bottom right corner of the highlighted cell
cell?
is a small square.
 By clicking and holding down the left mouse What happens when you move the cells with
button you can drag the contents of the cell the numbers too close?
across other cells and copy into the new cells.
b. Changing cells with automatically
B. Filling numbers in the cell
By double clicking on the lines between the columns
A and B. The columns then will increase or decrease
to fit the biggest entry
D. MOVING DATA ON THE SPREAD SHEET Inserting a new row/s

a) Cut and copy 1. Click row marker to highlight the entire column.
b) Click and drag 2. Right click your mouse button and choose insert.
3. A new row will be inserted, moving the total row
1. Mark a whole column from the heading to what‘s
over one.
written bellow.

b. Click and drag

E. DELETE ROWS AND COLUMNS.
2. Move your cursor to the edge, or boundary of the
highlighted area. Deleting a column/s

3. Click and hold down the left mouse button and 1. Click column/s marker to highlight\ the entire
drag the cells back into their original place. column.
2. Right click your mouse button and choose
delete.
3. Click row/s marker to highlight the entire
column.
4. Right click your mouse button and choose
E. INSERTING ROWS AND COLUMNS. delete.

Inserting a new column

1. Click column marker to highlight the entire D. Formulas.

column.
 Are calculation created on the spreadsheets.
2. Right click your mouse button and choose insert.
 Formulas range in complexity from to extremely
3. A new column will be inserted, moving the total
complicated to easy ones
column over one.
  Use the following buttons to create 1. Type in the formulas into the formula bar
mathematical symbols In the spreadsheet. 2. Always include an = before the formula.

 + to add
 To subtract Formulas with cell reference
 / to divide
a. Inserting cell references automatically
 to multiply
b. Formulas with cell reference
 = to make equals

It is important to note the order of the symbols when

creating formula; a. Inserting cell references automatically
b. Auto sum/averagec
 () brackets are the 1st priority
c. If- then
 / division is next
d. ranking
 Multiplication
 + addition
 - Subtraction
E. RANKING
D. Formulas.
=RANK(F3,$F$3:$F$7)
 = 3+ 10 / 2
BMI
 = 4+2 *6
 = (3+4)/5 Formula: weight (kg) / [height (m)]2
 =(5-3) + (9-6)/3
With the metric system, the formula for BMI is weight in
 = ((5-3) + (3+1))/2
kilograms divided by height in meters squared. Since
 = ((4 +5)/2)/(8-3)
height is commonly measured in centimeters, divide
 = (6-1)(2+3)
height in centimeters by 100 to obtain height in
Formulas with numbers meters.
Example: Weight = 68 kg, Height = 165 cm

(1.65 m) Calculation: 68 ÷ (1.65)2 = 24.98

BMI

Formula: weight (kg) / [height (m)]2

Example: Weight = 68 kg, Height =

165 cm (1.65 m)

Calculation: 68 ÷ (1.65)2 = 24.98