Independent Study, Capstone Project Example

Abstract

The American Health Care system is experiencing a major transformation that is driven by the large-scale introduction of technological advances in healthcare practice, as well as mandates established by federal agencies accompanying the widespread utilization of the Electronic Medical Record (EMR). Informatics is a natural progression for nurses to engage and serve as the gatekeepers of medical/nursing care in the 21^st Century. Web 2.0 platforms, in particular unit-specific “blogs” or social media networks such as Facebook, are positioned to be an effective, free, open, accessible and bilateral communicative portal of the present and the future. Ultimately, this format will have a positive impact on patient health outcomes, diminish medical/nursing/pharmacologic errors, and promote greater cost efficiency across nursing units.

A number of educational models must be considered that reflect learning through knowledge generation and cognitive capacity. Educational theories such as Piaget’s Theory of Cognitive Development, Vygotsky’s Cultural Cognitive Theory, and Mayer’s Theory of Multimedia Learning must be addressed and their contribution to web-based learning in the nursing environment. Piaget, as a key facilitator of social cognitive theory, notes that infants are asocial upon birth with a form of “radial egocentrism” (Meltzoff, 2007). As human beings grow, however, their social development occurs in four stages, from sensori-motor up to formal operations, whereby they learn from others and from their surroundings, accompanied by the elements of maturation, experience, social transmission, and equilibration in the formation of knowledge (Gauvain and Cole, 1997).

Vygotsky recognizes the different social practices that support and enhance education, but also detract from potential success through competing perspectives (Smagorinsky, 2007). Finally, modern technology has fueled major changes in educational structures to encompass a variety of tools to enhance learning and stimulate knowledge generation. As proposed by Mayer in his Theory of Multimedia Learning, visual and verbal channels are employed using cognitive processing to recognize and retain words and pictures in different forms, such as in print and on videos (Mayer, 2008).

Each of the aforementioned models represents a challenge to the development of web-based and other innovative learning tools that nurses employ in order to improve their learning capacity. A combination of factors from all three theories is instilled in learners, including cognitive processing, social assimilation, and multimedia retention and processing. Therefore, nurses must ultimately determine how to integrate these theoretical perspectives into a working model that is likely to serve them well in adopting and successfully adapting to social media tools in the practice environment.

An appropriate teaching method should consider the role of social media as integrated into daily practice as a tool to promote continuous learning and communication with other nurses. Specifically, the Teach-Back and Ask-Me-3 formats relative to social media are instrumental to the teaching plan and support student engagement and growth. An evaluation of this teaching plan must also demonstrate its efficacy and viability to the nursing population selected to implement the plan.

Introduction to Capstone Project

In August 1981, the introduction of the IBM personal computer (PC), the IBM 5150, drove the field of information and communication technologies (ICT) towards a period of phenomenal and unprecedented growth (IBM, 2013). The PC’s greatest breakthrough was the transference of basic computer tools (i.e., document creation and management) from the hands of the information technology (IT) department to the fingertips of the layman worker at the desktop, and ultimately to the home or workplace. Much has been written regarding the introduction and expansion of informatics into the healthcare system and into various areas of nursing education. Without a doubt, the delivery of nursing and healthcare practice as a whole in the United States is being overhauled by a new paradigm driven by the growth of the Internet. As a result, change has been mandated in the hospital environment through the widespread introduction of the Electronic Health Record (EHR). Specifically, the U.S. federal government has established a deadline for establishing electronic patient records across all healthcare facilities by January 1, 2014 (University Alliance, 2013). The Institute of Medicine (IOM) has also determined that informatics should be one of the five core nursing competencies. Technological innovation is ever increasing and is becoming more diverse and complex within hospital environments. Registered Nurses (RNs) find themselves at the gateway of this technologic milieu. As is the case of healthcare in general, nursing is becoming more technically sophisticated and fragmented in the delivery of care. In addition, the nursing profession has the opportunity to incorporate health informatics (HI) innovative trends into its practice and forge a leadership role as the gatekeeper between the patient and the healthcare institution. By maximizing the tools of technology and electronic health (e. Health), nurses will significantly benefit through their own development and education.

In recent years, a strong cultural shift has transformed the manner in which individuals communicate. Nurses are able to recognize the benefits of innovative communication tools such as Facebook or blogging as a key component of their daily practice settings. The primary purpose of this capstone study is to offer information that could be used in the future to develop a technological bridge to enhance communication in the acute care setting and to develop a training program or lesson plan for nursing staff and leadership to promote this change and transform it into practice, using a viable educational module that is based upon the theoretical teachings of Piaget, Vygotsky, and Mayer. The formation of this knowledge must utilize Piaget’s model of social and cognitive development (Gauvain and Cole, 1997); Vygotsky’s consideration of socialization and its integration into the learning environment (Smagorinsky, 2007); and Mayer’s Theory of Multimedia Learning in order to compartmentalize and process information from both words and pictures (Mayer, 2008). Each of these models contributes to the demand for a nursing-based approach that is designed to stimulate learning and inspire nurses to achieve greater knowledge.

The continued fragmentation of patient care and a leading cause of injury in the hospital setting are most commonly attributed to untimely communication or miscommunication across different healthcare environments. The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation have made substantive recommendations and established significant regulations to promote quality of care and safety in hospitals. Communication is of critical importance in the promotion of quality and safety. The landmark 2001 IOM study, crossing the Quality Chasm, noted that “The health care environment should be safe for all patients, in all of its processes, all of the time.” Written handouts, as noted in the study, are frequently the first consequence to be realized when patient safety is compromised. In conjunction with these concerns, the professional duties of nurses include the transactions that occur among nurses, as well as the accuracy of the information and components of care processes that are dispersed to others. Part of daily nursing practice involves patient transfers from one environment to another (e.g., inter- and intra- institutional transfers of patients), from shift to shift, and/or communication from one clinician to another. Moreover, because of their continual contact with patients and their families, nurses are in pivotal positions to serve as conduits of information and to be educator and patient advocates to promote quality care and safety within these healthcare environments. In this context, clear communication underlies every health care transaction and is of paramount importance so that these channels are accessible and transparent to all healthcare personnel. Data collection and transmission is at the heart of many of these issues, and a significant amount of relevant health care information, such as diagnoses, lab results, vital signs, and prescriptions can be reduced to numeric data elements. Nonetheless, the U.S. health care system is notoriously limited and slow in standardizing the collection and transmission of important health data across different environments. It is important to note that technology-based systems such as electronic health records (EHRs) are able enhance this communication. However, even when all relevant health care providers use EHRs in the recommended fashion, it is likely that multiple EHR formats will be in use. Therefore, the need exists to obtain clear, easily accessible, and readily available channels of communication for all nurses across all patient care settings.

With the use of Web 2.0 technology, nursing leadership may be able to influence transparency in nursing care on hospital specialty units where delivery of care is especially complex and fragmented, particularly in the use of Facebook and/or web logs. It is noted in the review of literature section that the introduction of nursing-specific blogs or Facebook sites facilitates and encourages improved communication among staff members in an open and freely accessible bilateral format, thereby promoting and forging a unified community within the nursing unit. It is also believed that a successful nursing unit-specific social media site delivered on a regular and timely basis will ultimately enhance improved nursing outcomes in patient care and greater efficiency as these sites allow for multiple avenues of communication with staff and management to broach questions regarding protocols of critical importance. This web-based format will result in fewer paperwork requirements, less redundancy, and fewer nursing errors. Web logging or Facebooking offer a medium by which colleagues are able to expand their learning horizons and exchange health-related information by way of hyperlinks within the blog or through their participation in journal clubs or CMEs. A well-informed professional nursing staff will offer substantial benefits to the institution and may contribute to significant monetary savings as patient outcomes are improved on a gradual yet consistent basis. As an educator, web blogging or Facebook interaction may prove to be the most feasible venue for nursing staff development.

Implementing a nursing-based lesson plan or model for social media instruction and integration into daily practice requires the implementation of two specific methods: 1) Teach-Back, which frames knowledge by requiring nurses to reiterate what they have learned from the instructional session and if there are problems with its delivery or the context of the material, the instructor will reiterate the information to ensure that processing and retention are both accurate and appropriate (Xu, 2012); and 2) Ask Me 3, which utilizes three questions to frame newly acquired knowledge, including the problem in question, what needs to be done to manage or solve the problem, and why it is necessary to follow this course of action to solve the problem (NPSF, 2013). Each of these tools must be integrated into the teaching plan and supported by a framework that will allow nurses in the student role to capture an effective understanding of social media formats as viable learning tools.

Literature Review

The establishment of a frame of reference for the proposed educational module requires supporting evidence and theoretical perspectives as a means of advancing the model to the next level. A web-based search generates significant research regarding such terms as cognitive theory, multimedia theory, and cultural cognitive theory generated thousands of results; however, the most relevant sources regarding these focus areas provide a theoretical framework for the implementation of an educational module that will provide effective education and learning for nurses in adopting and adapting to web-based technologies in the workplace setting, while exploring the aforementioned theories as evidentiary support. The following critiques will highlight a number of different research articles that will address the foundations of educational theory and its application to the development of a nursing educational module for web-based training and innovation.

Literature Review Critique

Blake, B., and Pope, T. (2008). Developmental psychology: incorporating Piaget’s and Vygotsky’s theories in classrooms. Journal of Cross-Disciplinary Perspectives in Education, 1(1), 59-67.

This informative and qualitative-based article compares and contrasts the theories of Piaget and Vygotsky. Piaget’s theory is incorporated into the classroom through expanded knowledge of students’ thought processes and their contribution to knowledge acquisition. Therefore, educators must provide an adequate framework or model under which individuals will thrive and benefit from the knowledge that they have acquired. In contrast, Vygotsky’s theory utilizes a concept known as the Zone of Proximal Development, whereby educational assistance is provided to students, based upon their level of achievement and potential to complete the assigned tasks (Blake and Pope, 2008). Each theory has its merits; however, the development of a theoretical perspective requires a greater understanding of the challenges that learners face so that they are able to reach their full potential in an effective manner.

Moreno, R., and Mayer, R.E. (1999). Cognitive principles of multimedia learning: the role of modality and contiguity. Journal of Educational Psychology, 91(2), 358-368.

This experimental study explores two separate experiments involving multimedia learning alternatives, both of which support Mayer’s theory and its key principles, the modality principle and the contiguity principle. The experiments included 41 participants in the narration group and 40 participants in the text group, both of which were categorized as low-experience learners (Moreno and Mayer, 1999). The experimental results demonstrated that multimedia education has a significant impact on learning when used with these principles in mind. At the same time, it is evident that the complexities yet the diversity of multimedia education are significant in enabling individuals to improve their learning skills using these tools on a consistent basis.

Chou, W, Hunt, Y., Beckjord, E, Moser, R. and Hesse, B. (2009). Social media use In the United States: Implications for health communications. Journal of Medical Internet Research, 11(4), e4.

A data-driven study was conducted by the National Cancer Institute in order to identify the socio-demographic and health factors associated with Internet social media research. The primary objective was to examine the demographic criteria coupled with healthcare issues which correlated with social media Internet use in the United States. The data was retrieved from the 2007 Health Information Nation Trends Study (HINTS). This study utilized a national representative cross–sectional survey, and the sample size for this study on health communication (N=7674) was obtained from American adult respondents dating from January 2008 – June 2008. Based upon the results of the survey, over 5000 respondents reported using the Internet. This group of Internet users was also questioned regarding their specific web 2.0 social media use. Internet users were asked if they participated in online support groups, had written a blog, or visited a social network site. Using a bivariate (chi-square) and multivariate logistic regression, a statistical analysis of the data predictions of specificity of social media use was identified for further evaluation.

The study results noted that approximately 70 percent of US adults accessed the Internet in 2007. From this pool of users, 25 percent visited social networks such as Facebook and My Space; seven percent had blogged on line, and only five percent of Internet users in 2007 had become involved with an online support group that encompassed a given subject area. The raw data collection from January 2008 – June 2008 was accumulated by a dual mode method as follows: 1) a random telephone survey using computer assisted interviews of a cross representation of American households with land-line phones (N=4100); and 2) mail-in questionnaires of US postal addresses, which intentionally over-sampled minority households (N=3600). The response rates were 25 percent on the phone survey and 30 percent from the mailings, respectively.

The variables in this national survey were cataloged into the following categories: 1) socio-demographic, 2) health related, and 3) Internet use. The socio-demographic variables that were evaluated included age, gender, education and race. The health variables included overall status, cancer exposure and health care access. The third category of variables included the three factors previously described that pertained to Internet status.

Even though the data survey that employed was reportedly a representative cross section of American households, the limitations of self-reporting shortchanges the study’s generalizability. Recall bias and survey comprehension calls into question the general accuracy of self-reporting surveys. The low survey response rate also imposes limitations to the validity of the study. However, implementing a dual mode format (phone and mail) increases the viability of the study and its overall impact on the research topic in question.

A specific limitation of this particular survey instrument is associated with blogging because due to the specificity of writing of blog, the survey appears to underestimate this activity, since most individuals engaged in this format do so by reading and commenting on existing blog sites that were written by other people. Finally, as with any national survey, the instrument validity is questionable due to the amount of time invested in collecting and the subsequent interpretation and reporting of the raw data results. The time that has lapsed since the survey was conducted also contributes to its failure to capture the latest emerging developments in social media, such as the emergence of Twitter and the explosion of wireless phone and tablet applications that are readily available across a wide variety of sites and devices.

The conclusion derived from the analysis of the data provided with this survey is the rapid prevalence of Internet use and its impact and penetration on health care information dissemination. The empirical evidence from 2008 indicates that the American public, and most particularly young adults between the ages of 18-24 and 24-30, are poised to accept major growth in social media communication and utilization, irrespective of socio-demographic differences. In this context, these age groups are willing to embrace technological innovation and social media resources in order to realize the benefits of Internet use. These findings demonstrate the importance of social media in facilitating communication regarding important healthcare issues. In addition, additional expanded research regarding Internet penetration in healthcare delivery systems via the development of social media is critical and supports a greater understanding of the issues that are most relevant to nurses with respect to social media.

Black, E., Light, J., Paradise, N. and Thompson, L. (2013). On line social network use by healthcare providers in4.a high traffic patient care environment. Journal of Medical Internet Research, 15(5), e94.

Over the past decade, technology has infiltrated the health care front in many different ways. As informatics expands its presence in the hospital setting, researchers must examine how clinical practice outcomes are affected by these changes and the transitions that come about in the process. The recent study by Black et.al (2013) assessed the volume of personal social Internet use through Facebook by hospital personnel in an emergency room setting in correlation with clinical volume and severity. The study was undertaken in an acute care emergency and trauma center of an academic university medical center under the supervision of researchers at the University of Florida. The study enabled researchers to identify social behaviors that may influence health care delivery that are grounded in social media attitudes and behaviors. The study established greater insight into the social media attitudes of health care workers in the clinical arena. Utilizing social network information systems use, such as Facebook, enables researchers to identify how clinical practice is impacted by social media. Internet technology has been shown to facilitate communication among different health care teams and patients and to manage knowledge, diminish errors, and support clinical decision making. This study sought to identify how frequently social media was utilized by the health care worker in an acute setting. As nurse educators, the information retrieved from this study might help provide answers to how best to educate nurses in order to enhance their practice. In addition, this information may play an important role in establishing a basis for future directions in clinical practice and in determining how to best move forward in providing patients with optimal care and treatment through increased knowledge, communication, and insight into a variety of clinical areas.

For this study, only one clinical site, located in southeastern United States, was utilized and the project was funded by the University of Florida. The study design was random in nature and was fully anonymous. The project consisted of monitoring 68 computerized workstations located throughout the Emergency Department, excluding designated computers in break rooms. Utilization records by all personnel in the emergency room were analyzed over a period of 15 consecutive days. These computer workstations were freely accessible and without use limitations and were deemed completely anonymous. The researchers emphasized Web 2.0 media (i.e. Facebook) usage, which was calculated with the aid of a form of conceptual web filtering software (Surf-Control), and counted Internet personal use that emphasized a minimum of three minutes in duration.

In order to calculate the status of ED employees and the use of their time during the study, an EDWIN score was utilized. EDWIN is a reliable index using hourly ED work index of patient severity with ED patient volume reports. During the 15 day period, 72.5 hours, or 4350 min, was spent by employees browsing Facebook. There were 9,369 entries lasting 12 minutes on average. The researchers used a Variance Procedure Data Analysis, with p<.05 being significant for this study. It was determined from the data that there was a significant difference in Facebook use per shift (20 minutes spent on night shift 7pm-7am versus 4.5 minutes spent on day shift 7am-7pm for a p<. 001). The EDWIN scores were also significant (p<.001), demonstrating that the Emergency Department was busiest at night (0.51 rating) as opposed to the day rotations (0.29). Therefore, it was determined that a positive correlation existed between Facebook use and the EDWIN score (p<.001), and as the ED became busier with higher volume and acuity, Facebook browsing time within the unit significantly increased in tandem. The accumulated log time of 72.5 hours in a 15 day time span make the study valid in its scope and approach. The statistical analysis clearly demonstrates a correlation which requires further study to ascertain its true significance.

There are clearly some limitations which hampers the study’s generalizability. For example, due to the complete anonymity of the project, Facebook users were not associated specifically to any health care group. Therefore, anyone working in the ED, from clerks to administrative staff members was included in the study. No differentiation of computer users, regardless of job title, such as physician, nurse, technician, clerk, or other staff was made. Furthermore, no differentiation between the type of information and purpose of use was acknowledged. Furthermore, the Facebook use was not assessed as to whether the browsing events were personal or professional in nature, or if the user was “multitasking” while on Facebook. However, there was a clinical correlation that was confirmed between high acuity in the ER and increased Facebook use, which carries major implications in regards to patient care concerns. Therefore, the following question is posed: Is the increased Facebook activity reflective of a mode of distress in confronting severe acuity, or is it a convenient and readily accessible conduit of communication and information transfer? The study is further limited in that only one site was used and over a relatively brief span of time. Although the variables under study were not clearly defined, a basic lack of understanding of social media use in any clinical setting may pose issues in regards to safety and quality. The challenge appears to be that nursing researchers and educators must keep connected with emerging technologies and focus on how the use affects and challenges clinical practice. These efforts will provide a basis for the exploration of new ideas and approaches to ensure that the desired patient care outcomes are achieved, while also considering the role of social media in preserving the integrity of clinical practice methods.

Spector, N., and Kappel, D.M. (2012). Guidelines for using electronic and social media: the Regulatory perspective. The Online Journal of Issues in Nursing, 17(3), Manuscript 1, DOI: 10.3912/OJIN.Vol17No03Man01

This study explored the different approaches that nurses must take with respect to the utilization of social media in the workplace setting. It is important to exercise sound and reasonable judgment with respect to the utilization of social media and the development of new perspectives that encourage positive patient outcomes and that improve productivity for nurses (Spector and Kappel, 2012). It is known that “Social media can be a highly effective mechanism that allows for the cultivation of professional connections; promotes timely communication with patients and family members; and educates and informs consumers and health care professionals” (Spector and Kappel, 2012, p. 2). With these conditions in mind, it is likely that nurses must continue to explore the opportunities, challenges, and boundaries of social media in order to improve their practice settings and to recognize the importance of new perspectives that will encourage efficiency and increased knowledge in many areas of practice (Spector and Kappel, 2012). These conditions also represent a means of evaluating patient knowledge and exploring the dimensions of patient care as reflected in an expanded scope of practice that conveys the relevance of modern web-based resources (Spector and Kappel, 2012). It is also known that “Nurses who use blogs, social networking sites, video sites, online chat rooms, and forums to communicate both personally and professionally with other nurses can positively use social media in a responsible manner that fosters congenial interface with other professionals. An outlet where nurses can share workplace experiences, particularly those events that are challenging, can be as invaluable as journaling and reflective practice, which have been identified as effective tools in nursing practice” (Spector and Kappel, 2012, p. 2). These circumstances provide nurses with the benefits of web-based social media tools; however, these tools must be utilized properly and strive to be effective in offering useful and practical knowledge for nurses who are already experienced with some of these tools, as well as those without any real experience in this area (Spector and Kappel, 2012). The challenges of patient care are reflected in daily practice settings, and in some instances, guidance through social media outlets may provide new insight into common problems or other concerns that are less common to nurses (Spector and Kappel, 2012). Regardless of the circumstances, it is evident that social media is reflective of an opportunity to evaluate their own utilization of social media and recognize its positive impact, rather than to use these tools in a wasteful manner that reduces efficiency in the nursing workplace environment (Spector and Kappel, 2012).

The potential contributions of social media alternatives must be balanced in conjunction with basic ethical frameworks and approaches to time utilization and efficiency (Spector and Kappel, 2012). In this context, nurses must utilize these resources wisely and with consideration of ethical responsibility so that they are used for the appropriate purpose and in an efficient manner at all times (Spector and Kappel, 2012). The challenges of web-based tools are many, as nurses must find a way to balance their efforts in direct patient care, teaching, education, and other areas, with the opportunities that are available to educate nurses when using these resources wisely (Spector and Kappel, 2012). Patient care outcomes must be the primary objective in the use of social media tools in the nursing practice environment; therefore, nurses must exercise caution when using these resources in order to preserve the integrity of nursing practice and to recognize the importance of new perspectives to ensure that resources are maximized and utilized in an efficient manner (Spector and Kappel, 2012).

The article demonstrates that it is important for nurses to have a voice in treating their patients, and that the use of social media tools may facilitate the use of that voice in different ways (Spector and Kappel, 2012). However, it is also important to recognize that web-based tools must be used wisely and sparingly so as not to disrupt the options available in treating patients and in providing a basis for facilitating effective outcomes for nurses and their patients (Spector and Kappel, 2012). Furthermore, legal consequences must be considered in the use of social media so that nurses are aware of the potential ramifications of using social media networks improperly or without consideration of the risks associated with exposing private information in different ways (Spector and Kappel, 2012).

Skiba, D.J. (2010). Nursing education 2.0: social networking and the WOTY. Nursing Education Perspectives, 31(1), 44-46.

This article offers greater insight into the challenges of social networking and the opportunities that are available for nurses to use social networks for the greater good of their practices (Skiba, 2010). In this context, an example is provided in regards to a blog that references the significance of a Facebook community that is designed to encourage idea generation and sharing for new and experienced nurses in order to accomplish the goals and objectives of nursing practice (Skiba, 2010). In this context, a mannequin serves as a “patient” who is designed to encourage nurses to openly communicate through a Facebook portal to improve learning and facilitate positive outcomes for nurses that lead to greater decision-making on behalf of patients (Skiba, 2010). This resource is instrumental in supporting the growth of nurses who require additional forms of knowledge and new approaches to a variety of problems that nurses face in the practice setting (Skiba, 2010). These elements are effective contributors to the overall direction and scope of nursing practice and in providing a basis for new directions and challenges to ensure that social media sources such as Facebook are utilized appropriately and for the greater good of nurses and their patients (Skiba, 2010).

The use of the mannequin named “Stella” offers a symbol of hope and encouragement for nurses as they conduct themselves in their practice settings, particularly as they are represented by the tools and resources that are set forth by positive patient experiences that may be a result of this interaction with the Facebook community (Skiba, 2010). It is often difficult to understand and recognize the true scope of nursing practice, but this example represents an opportunity to convey the importance of different perspectives that will be effective in supporting nursing success and achievement in the workplace setting through increased knowledge and an understanding of the dimensions of practice as evidenced in social media outlets (Skiba, 2010).

Bernardo, T.M., Rajic, A., and Funk, J.A. (2013). Scoping review on search queries and social Media for disease surveillance: a chronology of innovation. Journal of Medicine Internet Research, 15(7), e147.

This study utilized a scoping review method in order to capture a greater understanding of the elements associated with search queries and social media in examining disease surveillance methods (Bernardo et.al, 2013). The study utilized 32 research articles and 19 case studies as the basis for the scoping review (Bernardo et.al, 2013). It should be noted from the article that the challenges set forth by a technology-driven workplace environment are difficult and all-consuming in many ways. Therefore, it is important to identify key areas where there might be effective tools in place in order to ensure that web-based offerings provide effective means of knowledge and education for nurses. The aforementioned study addresses some of these concerns and provides a basis for the exploration of new ideas and approaches to conduct research regarding disease surveillance in order to obtain greater knowledge regarding this issue (Bernardo et.al, 2013). It is known that “Despite the emergence of disease surveillance as an innovative use of social media and search engine technologies, there is limited knowledge regarding the scope and efficacy of this novel application. With the potential to greatly improve disease surveillance and mitigation, there is a significant need to understand key chronological developments of the tools and methodologies in order to inform future endeavors and to assess this technology application for potential end-users” (Bernardo et.al, 2013, p. e147). With these conditions in mind, it is important to identify the resources and alternatives that are available to ensure that disease surveillance is captured in the appropriate manner and without delays (Bernardo et.al, 2013). Disease surveillance has become an increasingly relevant subject area, particularly as disease strains and other challenges are considered and supported through the initiatives provided by social media and web-based searches (Bernardo et.al, 2013).

The study sought to understand the relevance of social media and search engines in identifying relevant information in regards to disease surveillance, and it was determined that there are considerable opportunities available in evaluating and tracking different types of diseases, including influenza (Bernardo et.al, 2013). These conditions provide a basis for potentially increasing disease surveillance in the future and for addressing the importance of this method in tracking disease to promote a reduction of these illnesses through greater accuracy in identification and in other areas (Bernardo et.al, 2013). It is believed that this study provides a basis for the exploration of new insights into patient care and treatment that are based upon the alternatives available with the use of social media and search engines as a basic form of disease surveillance and possible prevention (Bernardo et.al, 2013).

Conceptual Framework (Learning Theory Basis)

Nursing students and nurses struggle to comprehend vast amounts of constantly expanding complex content (Bowles, 2006). Among recent nursing graduates there appears to be a crisis in comprehensive critical thinking (del Bueno, 2005). Employers are becoming aware of its corps of new nurses are lacking in clinical judgment (del Bueno, 2005) and are developing in-house programs addressing the deficiency. Del Bueno (2005) cites that the addition of content without consideration of its application is the source of this dilemma. Student learners must become active participants in the process (Beers 2005) and nurses need to embrace the changes brought forth by an uncertain healthcare environment. A significant aspect in this is the integration of informatics and the necessity to implement technology into the teaching/learning process. According to Dunlap (2005), this process can be engaged in a learning environment that develops collaborative problem-solving skills. It is further proposed by Dunlap (2005) that constructivist pedagogy, whereby learning is based on social and cognitive interaction, is an effective tool in achieving these skills.

Learning theory is broadly defined as a set of principles that explain learning and behavior. As per Rosenberg (2001), the central concept of learning is the acquisition of new skills or knowledge that enhances performance. The constructivist approach to learning emphasizes that learners must to be active in ascertaining and achieving their own educational needs and goals (Driscoll 2005). Cognitive development is dependent on the interaction of one’s social environment as per Piaget (1954) and it is through active involvement, a person’s understanding of the world is constructed. Piaget also sought to understand the impact of assimilation as part of recognition in an active learning environment (Gauvain and Cole, 1997).

Whereas Piaget focuses on meaning to derive from environmental manipulation, Vygotsky’s (1978) theory of cognitive development is social in nature. The construction of knowledge is attainable by a process of social and cultural interaction. Cognitive development relies on people interacting with each other and in context of their cultural environment. Hence, the learning process is a byproduct of existing social and cultural factors (1978). With Vygotsky’s theory, learning is comprised of a largely social context that frames intelligence and communication among human beings (Moll and Tomasello, 2007). Furthermore, this theory represents the notion of conscious awareness in order to reflect upon the foundations of cognitive development (Au, 2007).

As previously stated, a constructivist approach to learning emphasizes the student as an active participant learning from their experiences and actively pursuing their own goals in a realistic relevant environment and providing social interaction to guide the search for knowledge.

The guidelines for constructivist teaching are enumerated and discussed by Honebein (1996):

1. Give students the responsibility to determine the topics to be discussed.
2. Engage students in activities that help them to see multiple solutions for any one problem.
3. Make topics embedded in complex realities.
4. Encourage students to take ownership of their learning.
5. Learning should be a collaborative endeavor.
6. Transmit knowledge not only through oral and written communication, but through multimedia sources as well, in order to provide a richer learning environment.

“A paradigm shift has occurred from traditional literacy to twenty-first-century multiliteracies” (Borsheim, Merritt, & Reed, 2008). The computer age and the Internet have changed how learning takes place with present-day students. Learning is accomplished by discovery and exploration in lieu of information dissemination (Brown, 2002). Students are now generally experiential learners rather than passive information absorbers, the digital age learner acquire understanding of concepts by the ability to navigate through confusing complex information algorithms. Reasoning has shifted from the linear, deductive and abstract to learning by exploration via trial and error methodology (Brown, 2002) and instant access. By proposing a multimedia approach, discovery learning is achieved by using a strategy that enables students to utilize a variety of forms of media, often at the same time, in order to accomplish learning in this manner (Alferi et.al, 2010).

The Internet and the emerging Web 2.0 technologies have made available a wider range of alternative educational tools. Web 2.0 platform refer to second-generation world-wide web applications such as blogging, podcasts, wikis, search engines and social networking (MySpace, Facebook, LinkedUp, Twitter, and YouTube). These emerging web tools enable for a significantly greater degree of interactivity between users than the first-generation of web applications (e-mail, chat rooms and discussion boards). The concept of learning in a multimedia format also requires an understanding of electronic instruction and its true role in education by expanding research in this area (Cook, 2009).

Whereas constructivist learning principles are founded on an active individualistic collaborative learning approach embedded in a relevant social environment; a second cognitive learning theory picks up where constructivism tails off and may enhance opportunities offered by the digital age: Mayer’s (2001) multimedia learning theory. Technology is a prime tool to engage and facilitate information retrieval, learning construction and knowledge acquisition. Little research has been applied on the use of technology in stimulating comprehension by adult learners or how new technology can enhance collaborative learning formats. Multimedia learning must reflect the utilization of specific devices such as computer screens and pictorial representations in the form of moving pictures or animation (Mayer).

Multimedia learning theory picks up where constructivism suggests what learning environments should develop by employing all educational strategies including the latest emerging technologies. Mayer’s Theory of Multimedia Learning is founded upon Paivio (1986) Learning Theory of Dual Cognitive Coding. Paivio posits that there are two independent but interconnected coding systems in the brain. Human learning is progressed through either a verbal or a nonverbal pathway. Our senses detect the verbal and visual stimuli encountered and then encode the information and selectively organize the data in separate but interconnected systems. Images and text are recognized and stored in the brain’s visual system and sound, speech and music is encoded by the verbal pathway. Thus learning is the result of a dual-coding system which either retrieves data from short-term memory or from storage in long-term memory banks (Paivio, 1986).

Mayer’s (2001) model also integrates information processing via a two-coded system of audio and visual channels. However, Mayer’s theory expands on how the human mind processes information that correlates well with computer and digital learning formats. His multimedia-learning model hypothesizes dual channeling coupled with active processing, whereby information is filtered so that data is organized and comprehensible, allowing for easy retrieval and retention, and most interestingly, the concept of limited brain capacity is introduced.

The fundamental premise underlying the cognitive theory of multimedia learning is that meaningful learning is more likely to succeed if instruction is provided which enhances how the human brain processes stimuli. Communication is delivered using multiple channels of perception to foster higher learning. The rationale of this learning approach is the “multimedia principle”: the assertion that “people learn more deeply from words and pictures than from words alone” (Mayer, 2001, p. 3). Multimedia learning is a demanding process that requires active coordinated cognitive selection systems. The learner must be an active participant in deciphering the information delivered. Otherwise due to limitations on the capacity of the network, learning may be overwhelmed and blocked in a phenomenon known as “cognitive overload” (Mayer and Moreno, 2003). It is Moreno’s (2003) contention that the central challenge facing designers of multimedia instruction is sensitivity to the potential of information overload. Informational instruction must be processed evenly via the dual channels of perception stimuli and not overstress any one system in particular or overwhelm the learner’s capacity limitations.

The question remains as to whether the principles of multimedia cognitive learning actually result in enhanced learning environments. Studies at the University of California, Santa Barbara under the supervision of Mayer (2010) applied the tenets of the science of learning to medical education. Using instructional parameters set by multimedia theory, Mayer was able to demonstrate that medical education benefited and improved along cognitive theory goal setting.

Issa et.al (2011) at Northwestern University further delineated the effectiveness of multimedia instruction. Design principles of multimedia teaching were implemented on third-year medical students undergoing their surgical clerkship. A pre/post-test control group was established using traditional lecture-based teaching on the management of shock. A modified design group was exposed to the same lecture material using a multimedia approach in accordance with Mayer’s principles. The students progressed into their surgical rotations and were then evaluated upon completion. Both groups demonstrated equivalent levels of pre-lecture knowledge as per the result of the pre-test. Both groups also showed significant knowledge acquisition immediately after the lecture material presentation as exemplified in retention, transfer and total scores. Data analysis though clearly demonstrated statistically significant and of greater improvement on retention and total scores upon completion of the clerkship by the group instructed by multimedia design principles over the traditional design. The study confirmed Mayer’s assertion that multimedia cognitive modalities result in improved short-term memory retention of complex educational material (Mayer, 2001).

The authors above (Issa et al, 2011) proceeded to expand the study to test long=term memory retention. Traditional teaching was again the control group using an expanded pre/post-exam criteria and a more extensive multimedia format was utilized and was tested similarly as the control group, a comprehensive examination upon graduation was added to the mix to specifically evaluate long-term retention. The initial results duplicated the outcomes of the first study statistically. However, the traditional study group was at a significant disadvantage upon graduation with the students exposed to multimedia module scoring much higher in retention. Although it is just one study with a small number of participants, the focused study confirmed the benefits of multimedia instruction in enhancing long-term memory.

Educational Module

In proposing education using social media and other forms of web-based technology, it is important to identify the areas where there is a greater potential for student engagement and the ability to recognize the importance of learning. Nurses must be educated throughout their careers and not exclusively in the classroom setting; therefore, it is necessary to evaluate these conditions on the basis of new perspectives that are designed to encourage the use of web-based tools and technologies in order to satisfy learning needs and expectations. Learning theories represent an opportunity to explore the different dimensions of learning from a student-based perspective, as well as an educator’s perspective. Although some might argue that social media tools may promote isolation and limited communication because of no face-to-face interaction (Cook, 2007), these tools will provide a framework for the development of enhanced learning opportunities for nurses requiring continuous knowledge to improve performance (Cook, 2007).

The development of a successful educational module for web-based instruction in the nursing work environment requires a palpable and user-friendly approach that will encourage nurses to utilize web-based tools in a manner that is consistent with promoting efficiency and advanced knowledge in the nursing practice environment. The Teach-Back approach is one such model that offers a strategic approach whereby information is provided and students are required to repeat the information back to the instructor in order to promote greater retention and understanding of the material under discussion (Baker et.al, 2008). This is an important tool that supports minimal cognitive confusion so that nurses are provided with a framework for education that supports their growth and understanding of web-based tools (Baker et.al, 2008).

Another educational module to consider is Ask Me 3, which involves the ability of individuals to ask three specific questions that will have the greatest benefit in knowledge retention and compliance within the nursing environment (NPSF, 2013). These three questions include the following: 1) what is my current problem? 2) What are the steps that are required? 3) Why do I need to take action? (NPSF, 2013). Each of these criteria is essential to the discovery of new insight towards the development of a feasible educational module to address web-based education and strategies to incorporate these efforts as part of the educational strategy (NPSF, 2013). The Ask Me 3 program is likely to have a positive impact on nurses who otherwise might not retain the knowledge that they are receiving without focusing on the task at hand within the framework that is being provided (NPSF, 2013).

The proposed educational module may be described as an interactive multimedia PowerPoint presentation that may be uploaded to Facebook or You Tube. This presentation will be designed for the nursing audience and will provide basic instruction regarding the Teach-Back and Ask-Me-3 strategies. This presentation will be used in conjunction with a control group that is based in a standard classroom that provides traditional instruction. This module will employ the theories established by Piaget, Vygotsky, and Mayer and will offer a multimedia approach to encourage nurses to participate and embrace this format as a primary form of educational instruction. It is also recommended that the multimedia instruction module also include the assessment of a nurse or a simulated scenario involving patient instruction using the Ask Me-3 and Teach-Back strategies in action. This approach will provide a clearer representation of the multimedia technology and its advantages and assets for nurses versus traditional classroom instruction.

Evidence-Based Teaching Plan (Methodology, Implementation, and Evaluation Tool)

The adoption of an evidence-based teaching plan to promote and encourage nursing success throughout all areas of practice requires an understanding of the challenges and considerations of nursing education through the use of web-based portals such as social media and networks. It is expected that upon review and implementation of these tools, there will be a number of alternatives that are available to support the continued growth and development of nursing practice models that will encourage the use of social media and other web-based alternatives as part of the educational framework within the nursing unit. It is expected that in using web-based social networking tools in nursing practice under specific conditions, there is a greater likelihood that nurses will take advantage of these tools, even if they are being monitored and recorded, as a means of expanding their professional knowledge in new and existing areas. In addition, it is believed that these concerns will be further explored through the development of a successful methodology that is designed to encourage the development of new ideas and approaches to nursing education using tools that are readily available online and throughout nursing units. It is believed that these tools will also be readily accessible for all nurses, but that there is a greater likelihood that younger nurses who have a better grasp of modern technologies will take advantage of these efficiencies more openly and more frequently. However, nurses across all age groups will be encouraged to use these tools as promoted by the research-based team.

The implementation of the proposed educational module in the workplace setting will offer nursing professionals an opportunity to explore the alternatives that are available through multimedia in order to enhance their personal education and to expand their knowledge in different ways. These elements play a significant role in shaping nursing outcomes and in providing nurses with an important framework for the development of practice objectives in a manner that is consistent with achieving optimal patient care outcomes. These elements will also support the continued development and expansion of social networks and communities on Facebook, You Tube, and on other sites as a means of sharing nursing-based knowledge and information to the masses. These alternatives will also provide a basis for the exploration of new ideas and approaches to nursing practice that will also demonstrate new perspectives and guidance in supporting and enhancing nursing education throughout all areas of practice.

The proposed evidence-based practice approach must also consider a means of implementation that will satisfy the original objectives sought and the creation of an environment that supports nursing growth and education in an organized manner. It is important to provide these tools as a basis for experimentation in order to determine if they serve as effective learning tools and also in evaluating their application to advanced nursing knowledge. The ability of nurses to utilize these tools in an effective manner requires a greater understanding of their application across different subject areas and their ability to have a measurable impact on nursing knowledge and patient outcomes over a period of time. However, these measures must also be evaluated in an effective manner in order to accomplish the objectives sought through the evidence-based strategy.

An evaluation of the proposed multimedia instruction module will include pre-course testing prior to the implementation of the module. Furthermore, post-course testing will be utilized in order to determine if the information provided in the module is retained and is accurate. Finally, a post-course questionnaire will be disseminated as a means of evaluating the two specific approaches and their effectiveness in relaying the subject matter. This will determine the effectiveness of the strategy and whether or not it had a significant impact on the nurses that were involved.

Statistical measurements must be implemented in accordance with the evaluation method. This is best achieved by utilizing a common format such as a t-test. It is expected that a positive outcome will be a result of rejection of a null hypothesis relative to no relationship between two specific parameters (Sirkin, 2005). The p value must be measured in order to determine if the effect is random or is statistically significant (Sirkin, 2005). The tool that is employed must determine the validity of a research question based on key variables and their relationship to the controlled environment (Sirkin, 2005). Therefore, the t-test is most appropriate because it is a relatively simple test in the measurement of a small number of variables, while a chi-square, linear regression, or covariance analysis would be useful when larger numbers of variables are present (Sirkin, 2005).

A combination of the aforementioned factors must be considered in this process and must demonstrate the importance of developing new tools and frameworks in order to incorporate multimedia tools and technologies on a more frequent basis into nursing practice as opposed to classroom lectures in order to expand knowledge and provide greater insight into these tools and their ability to be effective in providing nurses with much-needed knowledge. As needs change, these tools must also reflect these challenges and must provide considerable support for the continued development of expanded knowledge and education using web-based tools in this manner.

Conclusion and Implications

The integration of web-based technologies into nursing education and practice settings requires a greater understanding of these technologies, including social media and networks, as a means of approaching knowledge and education in a new light. It is important to identify these concerns and to recognize the importance of specific factors that are represented throughout nursing practice. It is expected that the evolution of different events within nursing education will require a greater understanding and an acknowledgement of web-based alternatives and tools in expanding frameworks and promoting guidance regarding the desired objectives. Social media has been in existence for several years its popularity has grown exponentially; however, the scope of its relevance to nursing education and practice has yet to be fully discovered. Therefore, it is important to recognize the value of social media and web-based technologies in order to establish an expanded framework for education and growth throughout the nursing profession. It is proposed that by using the objectives offered through specific learning theories, there will be a greater acceptance of these tools and the issues that are most important to nurses so that their contributions to practice are successful and comprehensive in nature. The efforts that are made by nurse educators and students of the nursing profession must be unique and flexible in responding to the needs of patients in the modern era, and this includes the development of new approaches that aim to satisfy nursing-based objectives in a manner that is consistent with the desired outcomes of expanded learning and recognition of key nursing principles.

The integration of informatics into nursing practice continues to be relevant and provides a basis for the evaluation of new ideas and approaches that will encourage nurses to be successful in expanding their own level of knowledge across different areas and in providing their patients with the best possible outcomes for recovery and wellbeing. In this context, it is important to distinguish between the different web-based tools and social media alternatives that are available in order to accomplish the expansion of education in this manner through the utilization of these tools on a consistent basis. At the same time, nurses must exercise some degree of caution in order to accomplish these objectives and to demonstrate the importance of new ideas to encourage nurses to use these technologies in an ethically responsible and appropriate manner at all times. It is believed that nursing practice objectives will improve patient outcomes and generate new forms of efficiency that will be integrated into current practice settings for the foreseeable future across all practice areas that will support the utilization of these tools on a regular basis to enhance education and overall success of the practice.

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Annotated Bibliography

Adams, S. (2010). Blog-based applications and health information: Two case studies that illustrate important questions for consumer health informatics (CHI) research. International Journal of Medical Informatics, 79(1), 89-96.

The aforementioned study utilized an analysis of two case studies of Internet web logging applications by the public lay domain. The first site was a weight loss promotion application of a general health concern, and the second active web site examined was, by contrast, more medically oriented and specific, a patient blogging site of rare disease therapies recording experiences with experimental medication protocols. The comparison of these two diverse web logs revealed possible strengths of this new technology in the empowerment of patients by the free flow of information which had otherwise been inaccessible.

Bakken, S., Stone, P. and Larson, E. (2008). A nursing informatics research agenda for 2008-18: Contextual influences and key components. Nursing Outlook, 56 (5), 206-214.

The authors of this scholarly paper are members of the Columbia University School of Nursing Department of Informatics Research. They identified three major issues that, in their opinion, are of prominent importance in the field of nursing informatics: genomic health care, shifting research paradigms, and the development of social (Web 2.0) technologies. The authors describe a key theory as how these three distinct contexts interrelate to successfully promote an agenda for advancing nursing informatics into the new century. Although they do readily admit that social Internet web-stream media is in its infancy stages in healthcare application and additional research is required in this arena. But they do propose that the principles behind Web 2.0 technologies will indeed change the basic core of all of research studies in a dramatic fashion.

Black, E., Light, J., Paradise, N. and Thompson, L. (2013). On line social network use by healthcare providers in a high traffic patient care environment. Journal of Medical Internet Research, 15(5), e94.

This study was undertaken by the University of Florida to determine the extent to which the Internet was utilized for social media browsing in active clinical settings by hospital personnel. The study took place in an active acute emergency and trauma center over a time span of 15 days. Computer workstations were monitored throughout the emergency department and were readily accessible to all hospital staff members. Using a specific software filter, Facebook use was analyzed in conjunction with time and duration and in association with clinical volume and severity. It was determined that there was a direct positive correlation between ER patient volume and acuity with Facebook browsing activity within the unit.

Boyd, C. (2010). Mock webpage: An innovative assignment for second-degree nursing students. Nursing Forum, 45 (3), 159-165.

The development of independent critical thinking in nursing education has been a significant paradigm over the past decade. Incorporating advanced technological formats into the nursing curriculum has been a major focus in nursing schools throughout the United States. It is important to recognize how technology is integrated into a classroom setting to facilitate academic assignments for the nursing student in a challenging, meaningful, and interesting environment. At the Quinnipiac University School of Nursing in Connecticut, students and faculty have engaged in developing a “mock webpage” to successfully learn and master a nursing course in pediatric growth and development. Professor Boyd offers the specifics of the assignment, as well as the goals and outcomes of this project. The paper is comprehensive and meticulous that it could serve as a blueprint for similar courses in other academics subjects to be developed.

Chou, W., Hunt,Y., Beckjord, E., Moser, R. and Hesse, B. (2009). Social media in the United States: Implications for health communications. Journal of Medical Internet Research, 11(4), e48.

The National Cancer Institute undertook a study to identify factors which correlated social media use in the United States in conjunction with health issues and socio-demographics. The data was retrieved from a national representative survey known as the 2007 Health Information Nation Trends Study (HINTS). The purpose of the study was to determine if Internet use, in particular Web 2.0 social media use, had made any inroads in regards to healthcare information access. The socio-demographic factors were coupled with health status issues, which in turn, were correlated with specific Internet social networking activities. The researchers determined from the data that major access to healthcare information via the Internet was beginning to have a significant impact, especially with young adults.

Clinch, T. (2012). Nursing practice question: Is texting/receiving patient information a HIPAA rules violation? Texas Nurses Association Newsletter.

The author, a nursing director of the Texas Nurses Association, wrote a concise, terse and direct response in regards to the issue of the legality of texting of patient information within a hospital academic environment. Her unequivocal answer is that it is a clear violation of the HIPAA rules and that the practice must cease forthwith. The author quotes the specific passages of the “privacy rule” that pertain to the argument in support of her stance regarding this issue. This opinion paper has been reproduced in multiple nursing journals and newsletters throughout the United States and Canada due to its significance and framework for the scope of nursing practice, both in the present and in the future.

DeGagne, J., Bisanar,W.,Makowski,J. and Newman,J. (2010). Integrating informatics into the BSN curriculum: A review of the literature. Nursing Education Today, 32, 675-682.

Health informatics has emerged as an important component of the undergraduate nursing curriculum. The authors undertook an examination of the literature of educational health informatics in order to identify the future direction of nursing education. The implications for nursing education encompass four separate themes: the lack of consensus on what constitutes health informatics (HI); the need for faculty development in HI education; disparities of HI education in particular with regards to the global theater; and the impact of HI on patient outcomes. The authors concluded, after analyzing the literature, that there is a great need to enhance nursing competencies in regards to computer skills and that faculty must expand and improve teaching strategies in this area so that health informatics may reach its full potential and become fully integrated and pervasive throughout the nursing curriculum.

Goldberg,L., Lide,B.,Lowry,S.,Massett,H.,Preece,J. and Schneiderun,B. (2011). Usability and accessibility in consumer health informatics: Current trends and future challenges. American Journal of Preventative Medicine, 40 (5S2), 187-197.

This study provides a technical analysis of what makes health information technology (HIT) successful. It analyzes factors that allow for different platforms to be accessible and user-friendly, not only to the clinician but most essentially to the patient. The authors propose that in order for HIT to be accepted, it must not only be available to all and intuitively applicable, but also in the healthcare field of operations, HIT must be accurate and cost efficient. The research that currently exists in web site development by the National Cancer Institute (NCI) is used as a case study in successfully achieving the above-stated parameters and additionally promotes the possible challenges and future trends for HIT.

Hobson,E., Haines,S. and Van Amburgh,J. (2011). Meeting the challenges of public health information delivery in the digital age. Journal of the American Pharmacists Association, 50 (2), 214-217.

This article addresses the issue of public health messaging and increased access by delivering messages via social (web 2.0) media, in particular public video access platforms known as vid-casting (YouTube, Facebook, etc.). Public health has lagged in embracing this new area of media promotion. To investigate further, students at the Northeastern University School of Pharmacy developed several video-casts (vid-casts) regarding multiple public health issues. It was observed that these Internet-streaming video projects are educational tools that enhance learning, clinical and professional skills (i.e. critical thinking, team-based learning, audience analysis and marketing, health literacy assessment) and also encourage students to accept their professional roles as patient advocates. The authors were surprised regarding the immediate impact once these vid-casts were aired. The messages received thousands of hits, and since they were Internet based, they were also seen internationally. Due to its format, there was also immediate feedback from the viewers, mostly positive, but also in some instances, instructive and constructively critical. The feedback input resulted in editing some of the video casts. The authors concluded that this is a powerful media resource which requires further development.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21^st Century. Committee on Health Care in America & Institute of Medicine. Washington, DC: National Academics Press.

Lober, W. and Flowers, J. (2011). Consumer empowerment in health care amid the Internet and social media. Seminars in Oncology Nursing, 27 (3), 169-182.

As healthcare in the United States is being reshaped from provider-centered to patient-centered care, the patient has become increasingly empowered in the new role of consumer. This newly formed consumer-driven directive is given greater authority when coupled with the Internet-based social (web 2.0) media. The authors contend that this symbiosis of consumer health empowerment and the manifestation of the full spectrum of HIT will completely reshape healthcare delivery in many ways. This alternative promotes greater transparency of the system and enhances the free communication of information with the patient and provider, as well as patient-to-patient information, which adds pressure to the provider relationship. The impact of consumer activism and the integration of HIT into healthcare are especially prominent in the cancer care community, where blogging communities are extremely prevalent, active and well-developed. The article concludes that the realities of social media antagonize the established healthcare structure, but they are here to stay and will direct the future of healthcare delivery.

McBride, A. and Detmer, D. (2008). Using informatics to go beyond technologic thinking. Nursing Outlook, 56 (5), 195-196.

This article submitted by the Dean of Indiana University School of Nursing notes that nursing practice must assume a leadership role in delivering informatics to patient-centered care. Dr. McBride reminds the reader that informatics has been cited as one of five core competencies. The reader is also informed that it has been 25 years since the University of Maryland opened the first graduate program in nursing informatics. However, the author cautions that embracing technology should not overlook nursing’s traditional competencies, such as problem solving, assessment, evaluation, communication, and critical thinking.

McDaniel, A., Schutte, D. and Keller, L. (2008). Consumer health informatics: From genomics to population health. Nursing Outlook, 56 (5), 216-223.

The central focus of consumer health informatics (CHI) is the improvement of healthcare by way of emerging information technology use. The evolution of CHI has transformed the traditional patient-provider roles from a paternalistic domain to a model of mutual participation and shared decision-making. The Internet, and most particularly the new social (web 2.0) media, has led to the emergence of the “E-patient.” The pervasive availability of information has also facilitated consumer autonomy. It is believed that interactive health communication applications improve health outcomes by increasing self-efficacy. In addition, issues regarding the privacy and security of personal health records were also addressed as was ethical concerns of the pervasiveness of technology in the conduct of research in general.

Ozbalt, J. and Saba, V. (2008). A brief history of nursing informatics in the United States of America. Nursing Outlook, 56 (5), 216-223.

The Director of Nursing Informatics at the University of Maryland offers a concise history of the development of informatics within the nursing profession. She states that its roots lie in the foundations of modern nursing, for it was Florence Nightingale who advocated the standardization of clinical records in order to improve patient outcomes. With this framework in mind, the progress of nursing informatics began with the first reports of computer applications in the 1970s, and it gained momentum with the introduction of the IBM personal computer in the 1980s, reaching its fruition with the advent of the Internet age in the 1990s. While Dr. Ozbalt is one of the pioneers in enabling nursing informatics research to be an essential discipline within the profession, she calls out for leadership in the 21^st Century to provide a multidisciplinary approach.

Renor, C. (2012). Blogging about “it”.Whisteirea Nursing Journal, 19 (1), 59-62.

The author proposes that blogging, such as Internet web logs on social media, is an easy venue for adult learners to acquire the skills necessary to learn information technology (IT). As nursing demands increase the pursuit of ongoing education, in order to keep on pace with the explosion of technological advances, as well as the introduction of new pharmaceuticals and medical/nursing protocols, a new paradigm of learning is critical. Blogging allows nurses to learn at leisure on one’s own timetable. The use of blogs creates opportunities to share information and provide feedback and criticism while enhancing computer literacy and social networking skills.

Shafer, S., Lackey, S. and Bolling, G. (2006). Blogging as a venue for nurse faculty development. Nursing Education Perspectives, 27 (3), 126-128.

One of the crucial issues encountered in what has prevented informatics from being fully accepted within the nursing profession has been faculty apprehension in regards to these emerging technologies. The authors advocate that blogging is an ideal environment for faculty to overcome their fears in mastering new informatics platforms. Blogs are readily accessible, easy to use, and communication may be described as fun. The format is unintimidating and blogs were found to be a versatile medium to connect faculty into learning activities. The author proceeds to describe in detail the development of an online faculty study group using blogging as a platform format with much success.

Silversides, A. (2012). Blogging: The nursing life. Canadian Nurse, 108 (1), 22-27.

A freelance journalist conducts interviews with various nurses and their blog sites. The common thread with these interviews is that these nurse bloggers are very serious and devoted to their profession. These sites shed some light regarding the lives of professional nurses, their concerns, their outlook, and their compassion. The general public also obtains a glimpse of the emotional component and pressures of being a nurse. Nursing students are able to ascertain the realities they will confront upon graduation. For the professional nurse, blogging is a community which serves multiple purposes. Due to its immediacy and interactivity, professional nursing blog sites are primarily educational in orientation. However, they also serve as an outlet for stress relief and act as a form of social media. The article emphasizes that blogging within the nursing profession is diverse and overwhelming in the United States and is expanding exponentially.