Nursing Informatics PDF

Nursing Informatics Third year First semester By Associate Professor DR/ Atyat Ahmed Soliman Nursing science Cognitive Computer science science Information science...

Nursing Informatics Third year First semester By Associate Professor DR/ Atyat Ahmed Soliman Nursing science Cognitive Computer science science Information science Nursing Informatics 2024/2025  Content Topic Page History of nursing informatics 1 Definitions 1 The main concepts in nursing informatics 1 theory. Importance of nursing informatics 3 The Role of Pediatric Nurse Informatics 4 The Technological Challenges for Nursing 5 Education Advantages of technology use in nursing 6 education Disadvantages of technology usage in 7 nursing education Application of nursing informatics 8 Consideration to facilitate the application of 10 nursing informatics in pediatric care nursing. Application of information technology in 16 hospitals (practice). Informatics Applications in Neonatology. 27 Application of informatics in pediatric 28 nursing education The impact of nursing informatics on the 39 health care system. Impact of nursing informatics on the nursing 39 profession Obstacles for application of nursing 40 informatics. History of nursing informatics Early name for informatics included medical computing, medical computer science and computer medicine. Beginning to start in 1950 in the united states, the earliest use of computer for medicine was for dental project in this year than in the mid of 1950 were the development of expert system. In 1965 the national library of medicine started to use those systems. The international medical informatics association (IMIA) has been done in 1970. In 1970 a growing number of commercial began to market practice management and electronic medical record systems. In 1976 the first issue of "journal of medical informatics" proposed that medical informatics was the complex processing of data but computer to produce new trend of information. In 1991 redefined medical informatics as "the field that concerns itself with cognitive, information process and communication task of medical practice, education and research including information science and technology to support these tasks. In 2001 defined as "Scientific field that deals with biomedical information, data and knowledge – Their storage and optimal use of problem – solving and decision making. Finally, Health informatics, health care informatics, medical and nursing informatics means the same definition because it focus attention on the recipient of care rather than on the discipline of caregiver. There are strong relationship between informatics and computer but the computer alone doesn't define informatics there are many other dimensions. 1 Technology: - Technology contributes to using accumulated knowledge to process resources to satisfy human needs and wants. Technologies are invented to make our lives easier and better. Informatics: Informatics generally can be defined as" the art and science of turning data into information". Nursing informatics: Nursing Informatics is a specialty that "integrates nursing science, computer science, and information science to manage and communicate date, information, knowledge and wisdom in nursing practice to support patient, nurses and other health care providers in their decision making in all roles and setting, to produce effective and efficient client outcomes for individuals and communities." Nursing informatics framework Nursing informatics is the integration of nursing science, computer science, and information science to communicate data, information, knowledge and wisdom in practice to support patients, nurses and other health care providers in their decision making in all roles and setting. The main concepts in nursing informatics theory: The main concepts in nursing informatics theory are : A. Data is a single observation or discrete entities that are described objectively without interpretation. For example, a systolic blood pressure is a datum Data integrity is a key issue in health care informatics. Measures to ensure data integrity include : 1) Education of personnel who collect and enter data. 1  2) Data verification techniques. 3) Measures to minimize the entry of fraudulent information. B. Information data processed into a structured form. Data that are interpreted, organized, structured and given meaning are referred to as information. Example: When combining 110 with other data, it becomes information. Systolic blood pressure of 110 mmHg and diastolic blood pressure of 70 mm Hg. This information can be captured in a form, on a graph on in a report. C. Knowledge synthesized information derived from the interpretation of data. It provides a logical basis for making decisions. Essential to decision-making and to new discoveries. Example: When the blood pressure reading is combined with information about anatomy and physiology, pharmacology, pathophysiology, knowledge is used to decide about further care and treatment. D. Wisdom is defined as the appropriate use of knowledge to manage and solve human problems. It is knowing when and how to apply knowledge to deal with complex problems or specific human. Pediatric Informatics: It has been defined as the systematic application of information and computer science and technology to pediatric nursing practice, research, and education. Pediatric Informatics explores how the management of biomedical data, information, and knowledge can optimize child health.  Data must be accurate, have utility and integrity which is a key issue in health care informatics. 2 Information must be:  Complete, accurate and clear in its descriptions with date and time.  Measurable, preferably by objective means such as numbers  Comprehensive, including all necessary information in sequence  Rapidly and easily available when needed  Objective, rather than subjective  Appropriate to each user's needs.  Easy and convenient form to interpret, classify, store, retrieve and update.  Correct spelling.  Legal prudence. Importance of nursing informatics 1- Support patients, nurses, and other providers in their decision-making in all roles and settings. 2- Provides tools to help to process, store, retrieve and analyze data and information to improve patient care. 3- Provide computerized assessment and documentation 4- Saves time and effort 6- Helps nurses in consultation, clinical, practice, administration, education and research 7- Improving quality of care. 8- Internet can provide marketing services such as advertisement of health services. 9- promote and facilitate access to resources and references 10- Support for their mission to deliver high quality, evidence-based care. 11- Support for better service by facilitating true interdisciplinary care. 3 12- Improvement in key relationships with providers & care recipients. 13- Enhance continuity of care. 14- Provides content to standardized nursing language (i.e. Nursing Intervention Classification (NIC), NANDA -North American Nursing Diagnosis Association (NANDA), and Nursing Outcome Classification (NOC). The Role of pediatric Nurse Informatics  Nursing process application.  Administration, leadership, programmer.  Consultation.  Coordination, facilitation, and integration.  Educational and professional development.  Policy development and advocacy.  Research and evaluation. 4 The Technological Challenges for Nursing Education The complexity of the healthcare system. Lack of training for both students and educators on technology supported-teaching and learning. Lack of infrastructure that enables technology supported-teaching and learning. Lack of devices that are necessary for technology-supported teaching and learning. Optimal patient outcomes while addressing the diverse expectations of learners. There are still nurse managers and educators who feel that technology usage in nursing education is disruptive, especially when used at clinical settings. Some nurse educators prefer traditional teaching and learning than technology usage in teaching and learning Hardware and software issues, connectivity, security and safety of personal information. Lack of face-to-face interaction are some other challenges facing optimum use of technology in teaching and learning. Furthermore, non-proficiency regarding the use of Information and Communication Technology (ICT) and PDAs is also a challenge for technology usage in nursing education and also a factor contributing to its counter-productivity. This is seen mainly in students with little or no exposure to the use of computer during their basic schooling. Advantages of technology use in nursing education 5  The use of technology in nursing education is one of the facilitators of self-directed and life-long learning. Online discussion forums allowed students to study with their peers. Inclusion of information management and interactive technology facilitates learner engagement. Promoting critical thinking and improving clinical judgment. Fundamental to inclusion of technology in nursing education is information literacy and informatics. When using technology for teaching and learning, tasks are usually completed at their own time and pace and that facilitates learner independence. Its flexibility of the location and time when completing tasks. This implies that teaching and learning can happen at any time when either party is at the comfortable location because it is neither time nor space bound. To prepare nurses for the challenge of the complex, dynamic healthcare environment, the faculty envisioned curricula infused with technological innovations. Multiple interactive technologies such as personal response systems (PRS), human patient simulation (HPS) personal digital assistants, and web conferencing, podcasting, and course management systems were integrated within the curriculum. The use of applications, such as virtual reality and virtual patients, is perceived to be convenient, speed up the skills learning process and create a stress-free learning environment. Disadvantages of technology usage in nursing education 6  The shift to virtual approach of teaching and learning from traditional teaching overnight amidst COVID-19 lockdown regulations came as a huge challenge for many educational institutions to adapt to such sudden change. Network-related issues which include audio virtual disparities, interruption of sessions because of unexpected logging out from network and continuous buffering are amongst the challenges experienced when using technology for teaching and learning. Moreover, poor connectivity and technological illiteracy are also the challenges related to the use of technology for teaching and learning in nursing education. Participants reported lack of time management between family responsibilities and online learning amongst married couples, which was seen as a disadvantage of technology use in classroom nursing education. It seems to be lacking human interaction. This is seen as a disadvantage when using technology for clinical nursing education, in a sense that, in the nursing profession, nurse-patient interaction and relation is vital as it plays a role in facilitating the tridomains of competence, namely, psychomotor, affect, and cognitive 7  Application of nursing informatics Nursing informatics can be applied in all area of nursing practice, which includes; clinical practice, administration, education and research. 1. Nursing Practice 2. Nursing Education 3. Nursing Research 1. Nursing Practice Nursing practice is now an integral component of the electronic health record system alongside the documentation of other health care professionals. Systems are used to document assessments and interventions, and to measure the outcomes of care.  Computer-generated nursing care plans that are frequently embedded within inter-professional plans of care  Electronic monitoring devices that record and trend vital signs, as well as alert the nurse to patient conditions that fall outside of acceptable parameters  Patient-specific discharge instructions to assist the patient to provide self- care on home.  Admissions, discharge, transfer system that allows nurses to obtain basic biographical information on clients before they arrive to the unit.  Save nurses from many phone calls as when new admission, discharge, transfer data entered to the computer all appropriate departments (Dietary, housekeeping, pharmacy) are automatically notified.  Nursing documentation of patient assessment, client's care plans, medication administration records, nursing note and discharge plans. 8  2. Nursing Education Computer applications have almost revolutionized the educational process. A variety of media are used to educate nursing students in universities or colleges, and staff nurses who require ongoing professional development to stay current with changes in practices and processes.  Online registration, scheduling, attendance tracking, test administration and grade management of courses through learning management systems (Distance learning).  Remote access to libraries or online publications.  Presentation software.  Simulation labs with lifelike mannequins that mimic real patient scenarios and respond to nurses’ interventions and actions. 3. Nursing Research Nurse researchers are experts at gathering, analyzing and using data to inform practice and improve patient outcomes.  Computerized literature searches  Collaboration with other nurse researchers  Collect and analyze data, prepare research reports, and disseminate research findings. 9  Consideration to facilitate the application of nursing informatics in pediatric care nursing:  Computer software and hardware: The hospital administrator must develop the awareness of all health care teams (physicians and nurses) about the hardware and software before the implementation of information technology as it considered the corner stone and basic requirement for applying information technology in the hospital. Software: - is a generic term for organized collections of computer data and instructions, often broken into two major categories: system software that provides the basic non-task-specific functions of the computer, and application software which is used by users to accomplish specific tasks.  System software is responsible for controlling, integrating, and managing the individual hardware components of a computer system so that other software and the users of the system see it as a functional unit without having to be concerned with the low-level details such as transferring data from memory to disk or rendering text onto a display. Generally, system software consists of an operating system and some fundamental utilities such as disk formatters, file managers, display managers, text editors, user authentication (login) and management tools, and networking and device control software. Hardware: is a comprehensive term for all of the physical parts of a computer, as distinguished from the data it contains or operates on, and the software that provides instructions for the hardware to accomplish tasks. 10  A typical computer (Personal Computer, PC) contains in a desktop or tower case the following parts:  Motherboard which holds the CPU, main memory and other parts, and has slots for expansion cards  Power supply - a case that holds a transformer, voltage control and fan  Storage as floppy disk, CD-ROM and other drives  Graphics controller that produces the output for the monitor. Ethical principles in HIS Any health care institutions which apply the information system should follow the ethical principles that govern its conduct to protect from legal liability. General principles should be followed in application of HIS: 1. Non-malfeasance: We have a duty to prevent harm to others without undue harm to ourselves. All members of society are expected to value life and protect it, by not engaging in activities that cause harm. 2. Integrity: We have a duty to fulfill our obligations to the best of our abilities. Every member of society is expected to be honest. 3. Equality and justice: We have the right to be treated equally. Members of society ought to treat their fellow members equally, without discrimination. 4. Beneficence: We have a duty to advance the good of others. A member of society does not seek just his or her own good, but the general good and advancement of the society as a whole. 11  5. Autonomy: We have the right to self-determination. Members of society ought to be given independence in making decisions and judgments. Health informatics is about using computers to enhance the way health information is processed. There are three aspects of health informatics that can be identified: healthcare, information, software  Informatics Ethics 1. Privacy & confidentiality: the right to privacy of their own information. 2. Openness: Data collection about any person must be done transparently. 3. Security: Data collected must be protected. Once data is collected, it must be safeguarded against unauthorized access by other parties. 4. Access: Everyone has the right to access and correct their own data. 5. Legitimate infringement: The individual’s right to privacy and access may be infringed for the larger good of society. 6. Least intrusive alternatives: Any legitimate infringement must be done with minimum interference to the rights of the person affected. 7. Accountability: Any infringement of the privacy rights of the individual person must be justified to the affected person in good time and in an appropriate fashion.  Computer workstation ergonomic: The environment of HIS should be well organized in order to promote personal safety and eliminate physical & cognitive health problems 12 arising from use of computer for a long period of time such as eye strain, musculoskeletal disorders, disk amnesia and deficient communication, for this reason Ergonomics is a science concerned safe work place area by making products and tasks comfortable and efficient for the user. The computer workstation environment should have: 1. Suitable lighting without any bright glare on the computer screen. 2. Walls painted medium or dark color & not have a reflective finish. 3. Adequate fresh – air ventilation. 4. Quiet place with low-volume music to mask the hum of sound sources. Also The computer work station should be modified to include  monitor in the level of the user’ s eyes, away from direct light and from user’ s face by 18-24 inches with adjustable brightness and contrast and a protective filter should be used to display of infra- red and ultra violet radiations.  The keyboards should place directly in front of the monitor and at the same height as mouse. It should allow the user’s forearm to be parallel to floor without raising elbow and the wrists to be in line with forearm. It should include enough space to rest.  The chair should be in adjustable height, support back, have removable &adjustable armrests, a contoured seat with breathable fabric & rounded edges.  The table and desks should be in adjustable height. Wireless technology will have a growing role. Electronic bulletin boards, calendar filings and email enable rapid communication of nursing administrators with staff, nursing managers and support departments. 13   Use proper posture to reduce stress on the muscles, bones and tendons.  Use as little force as possible - avoid pounding the keys on the keyboard or holding the mouse or pens and pencils in a death grip.  Use a telephone headset or a shoulder rest on the telephone receiver to avoid bending the neck and raising the shoulder to hold the phone.  Keep the shoulders and arms relaxed while typing. Keep your whole body as relaxed as possible.  Breathe regularly and deeply. This can help keep you relaxed and alert.  Alternate non-computer jobs with computer jobs to keep your work routine varied and give yourself a break from computer use.  Try to relax mentally. Stress can make your body tense and your work less efficient.  Use your eyes properly: blink, see more than the computer screen, and look into the distance frequently. Your Body and Mind:  Maintaining a healthy physical and mental condition is important in the prevention of workplace injury.  Engage in a regular exercise program, with the advice of your doctor.  Eat a healthy diet.  Drink lots of water to keep joints and tendons lubricated.  Get plenty of rest.. Short 'micro breaks' should be taken frequently, at least every 15 minutes to 30 minutes  Explore ways to relieve stress, such as meditation or massage in addition to exercise. 14  I. Application of information technology in hospitals (practice) Health care setting can develop Hospital information system through using different strategies as electronic medical record, clinical pathway, Tele-health, Tele-medicine and Tele-nursing, distance learning, electronic portfolio, Virtual reality and simulation, and finally rubric. 1- Telehealth Definition: Telemedicine (telehealth) is “the use of electronic information and telecommunication technologies to support long-distance clinical health care patient and professional health-related education, public health, and health administration”. Advantages: Teaching telehealth techniques in nursing programs has both short- and long-term benefits: 16   Some nursing students have reported using telehealth has improved their clinical experience and patient care.  Students’ using of telehealth enhanced their care performance Improving the quality and effectiveness of performing tasks.  Decreasing errors in communication and information sharing.  Once nursing students graduate, they will have telehealth skills that enhance their job performance because they had theoretical and clinical fundamental of telehealth technique in nursing school.  This level of familiarity adds to their comfort in using telehealth  The use of telehealth can reduce barriers to health care such as cost, transportation, long wait times at clinics, and disease transmission.  It increases access to care for patients who are unable to leave their homes if they are immunocompromised and/or immobile.  Telehealth usage has increased during the COVID-19 because of its ability to decrease face-to-face interaction and potentially limit the spread of infection while providing vital care for patients.  The use of telemonitoring interventions have reduced hospital admissions and mortality associated with heart failure and chronic disease among older individuals.  People with disabilities and mental health disorders in rural and urban areas have also reported improved quality of health care as a result of telehealth services.  Telehealth in nursing has contributed to efficient, quality services and better health outcomes. Example: 17 Asthma Academy: A student nurse-led telehealth education program for low-income family caregivers of children with asthma  The Asthma Academy involved two parts. First, a nurse educator provided mothers (N = 18) a one-hour, virtual education session about asthma. The education session covered the pathophysiology of asthma, asthma triggers, rescue medication versus controller medication, communication, and how to navigate the healthcare system. Then, half of the family caregivers (n = 9) were offered telehealth visits led by supervised doctoral nursing students. Some mothers used their computers, and others used their smartphones for the telehealth visit. The postgraduate students conducted the telehealth visits via Zoom HIPAA-compliant software (Zoom Video Communications). One doctoral student led the visit with the family caregiver, while two doctoral-prepared nurse faculty members supervised the visit. Students were guided by an interview script, and the telehealth visits lasted approximately 30 min. In the visits, students would ask family caregivers questions about their home environment, presence of symptoms, understanding of medications and ask about the child's asthma action plan. Family caregivers had opportunity to ask questions specific to their child. The student answered these questions and then provided individualized and tailored education as part of the telehealth visit. Home Tele-monitoring for Chronic Disease Congestive Heart Failure (CHF) and the home use of Tele-monitoring equipment is an area that has recently been explored in an effort collectively known as vital signs (vs), this information can then be transmitted automatically to a central reporting station that is attended by clinical personnel such as a registered nurse 18 Advantages 1- Tele-onitors with home health visits by clinicians reduced the length of stay (LOS). 2- Reduce rehospitalization and Emergency Room (ER) visits for CHF exacerbation. 3- The management of patient symptoms on a daily basis in the home focused on providing quality care and enhancing patient outcomes. The home health clinician was better able to focus one-on-one care by actually reducing the daily visit schedule and eliminating unnecessary visits. 5- The CHF/Telemed committee was meeting monthly to discuss the ongoing deployment of this device. 6- Internal analysis by clinical staff changes were implemented in the deployment of telemonitoring and discuss diagnostic parameters for the use of home monitoring Disadvantages 1- Depersonalization from the lack of nurse to patient interaction. 2- A patient may loose their sense of security. 2-Hospital information system hospital information systems (HIS) is a computerized system that is designed to manage all the hospital’s medical and administrative information in order to enable health professional perform their jobs effectively and efficiently. Benefits of Hospital Information System (HIS): 19  o Comfortable access to patient data: HIS helps keep tracks of various patients, their records, including classification depending on demographic, age, gender, previous history and so on. o It’s cost effective: as its application results in better performances and improved functions which consequently decrease costs. o Betters interaction with patients: Through images and graphics, HIS helps doctors to educate patients about their ailments, their surgical procedures. These in turn, improves the doctor patient communication. o Improves efficiency: HIS upgrades the level of efficiency both on the cost and the clinical care viewpoint. This is accomplished by shunning duplications, repetitions, delays, missing records and confusions. Not only that, it also aids well-organized and precise administration offinance, diet of various patient according to specific needs, engineering, and distribution of medical aid. o Lessens scope for error: With the help of HIS nurses and caretakers monitor drug usage more effectively. This leads to the decrease of unfavorable drug deliverable while encouraging more fitting utilization of medicines. Components of HIS Components of a hospital information system consist of two or more of the following:  Clinical Information System (CIS).  Financial Information System (FIS).  Laboratory Information System (LIS).  Nursing Information Systems (NIS).  Pharmacy Information System (PIS). 20   Picture Archiving Communication System (PACS).  Radiology Information System (RIS). Nursing information system Nursing information systems (NIS) are computer systems that manage clinical data from a variety of healthcare environments, and made available in a timely and orderly fashion to aid nurses in improving patient care.  Some of the features that are provided by Nursing Information Systems include:  Patient Charting: A patient’s vital signs, admission and nursing assessments, care plan and nursing notes can be entered into the system either as structured or free text. These are the stored in a central repository and retrieved when needed.  Staff Schedules: Nurses can self-schedule their shifts using scheduling rules provided in shift modules. The shifts can later be confirmed or changed by a scheduling coordinator or manager. Shift modules are designed to handle absences, overtime, staffing levels and cost-effective staffing.  Clinical Data Integration: Here clinical information from all the disciplines can be retrieved, viewed and analyzed by nursing staff and then integrated into a patient’s care plan.  Decision Support: Decision support module can be added to Nursing Information Systems, and they provide prompts and reminders, along with guides to disease linkages between 21  signs/symptoms, etiologies/related factors and patient populations. Online access to medical resources can also be made available.  There are benefits to be enjoyed by implementing Nursing Information Systems and they include:  Improved workload functionality: Staffing levels and appropriate skill mix per shift can be more easily determined by the shift modules. This leads to less time spent in designing and amending rosters.  Better care planning: Time spent on care planning is reduced, while the quality of what is recorded is improved. This makes for more complete care plans and more complete assessments and evaluations.  Better drug administration: Electronically prescribed drugs are more legible, thus making it less likely that drugs would be wrongly administered to patients.  3-Electronic medical record Electronic medical record is the electronic version of the client data found in traditional paper record Benefits from electronic medical record 1- Easily access to patient's medical data. 2- Decreased redundancy (repetitions) of data entry. 3- Decrease time spent in documentation 4- Increase time for client care. More time is available for client care because time required for documentation and transcription of physicians' order. 5- Facilitate data collection for research. 22  6- Improve communication between the health care teams 7- Enhance and facilitate collaboration among all health care teams. 8- Help the staff to achieve goals and the standard of care. Pediatric Electronic medical record Special form of EMR software designed for the use in pediatric care (Pediatric EMR is tailored to the pediatrician and pediatric nurses input ) contains items related to children care such as Demographics and family structures  Medication orders  VIS (Vaccine Information Sheet)  Pediatric protocols for pediatric triage  Behavioral tools  Age Specific  School & Daycare  Sports  Demographics and family structures  Birth Data  Immunization administration and management  Growth Charts  Reportable Communicable Disease management  Child abuse reporting forms  Referral entry and tracking 23  Pediatric EMR Physical examination (Palpation sires) 5-Robots Definitions: The robot is a mechanical device that resembles humans, and it can perform human tasks or can behave in a human manner while working automatically or by remote control. In robot patients, human likeness, voice recognition, eye and face tracking, gesture, and speech processing, as well as movement and reasoning abilities, are embedded allowing for an accurate 24  reproduction of several human clinical conditions and emotions when compared to high-fidelity patient simulators. Types of Educational Robots: In the last ten years, three type of robotic technologies have been applied in nursing education: Humanoid Robot Patient (HRP), the Humanoid Rehabilitation Robot (HRR), and the Remote Presence Robot (RPR). 1- Both HRP and HRR are humanoid robots with the body shape built to resemble the human body. They are prototypes utilized for the acquisition of practical skills, they generally embedded voice recognition, speech processing, and movement abilities. In one study, visual abilities, eye and head movements, as well as facial expressions have been embedded in the robot, in order to reproduce recognition abilities and emotional states. 2- The RPR is a multicomponent roaming remote-controlled droid (robot that look like a box) equipped with wheels. It is topped with a computer screen that allows 2-way video conferencing between the controller, that control the robot through a joystick, and students located in a remote location. It is in an advanced stage of development and are used to gain cognitive learning outcomes. The controller is generally a teacher while in some cases it could be a postgraduate student. The RPR is also equipped with lenses allowing the teacher to zoom in, zoom out, take video, photo, and use a pointer for give instructions. In addition, through dedicated jacks is also possible to connect medical devices such as 25  stethoscopes, otoscopes, and other equipment allowing a remote clinical assessment. Advantages: RPR seems to facilitate the collaboration between students, faculty, and clinical instructors  Improving learning experiences Allowing students to familiarize with novel evidence-based educational technologies to be used in clinical settings. Pediatric Robot for Education of Nursing Students  Gaumard Scientific company designed a robot called Pediatric HAL, which simulates a 5-year-old boy, is typically deployed in a six-hour-long class that enables six to eight nursing students to each interact with the robot. Students observe symptoms, take vital signs, connect HAL to diagnostic equipment, administer medications and observe how the patient responds to treatment. HAL is controlled with a tablet, so the instructor can easily switch things up, change scenarios or repeat a process with a mouse click. HAL is capable of facial expressions and eye movements. He  cries real tears, his pupils can dilate, his eyes track movement,  and he can sweat. The robot can appear lethargic, worried, or in pain. His airway is capable of being intubated, he simulates heart, lung and bowel sounds, produces a pulse and nurses can conduct a variety of activities on HAL, including taking blood via a finger prick or administering an IV. 26   HAL has a lifelike appearance, but under the skin he’s a mass of complex circuitry, sensors, pumps, compressors, liquids, and more. Informatics Applications in Neonatology  Physiological monitoring equipment is used extensively along with web-based information tools and knowledge.  Follow-up of NICU patients after discharge.  Enhances parents care skills and self-confidence during a usually stressful period such as the one of post-discharge from NICU.  Promotes a higher involvement of parents in their baby's care  Allow parents to ask periodically about the newborn’s health status (weight, feeding, sleep, etc.).  communicate online with parents to advise them about good baby care  Special educational training programs for pediatric care  Neonatal databases assist with collecting, displaying, and analyzing data from a number of sources.  Accessing to a personal area on the website,  Reduce hospitalization and improve parents’ satisfaction.  Provide support during breastfeeding  Providing high-quality educational contents about neonatal care to parents, telenursing offers to nurses a valuable and easy procedure at home  Understand the health care needs of children that can be supported by the telehealth.  Identify opportunities for collaboration in international outreach to improve the health of children worldwide  Encourage the development of a researches agenda related to pediatric applications of telehealth 27 II. Application of informatics in pediatric nursing education  Virtual simulation  Distance learning/ E-learning course  Electronic portfolio  Simulation in pediatric nursing education. 1- Virtual Simulation Definitions: As defined as “a dynamic process involving the creation of a hypothetical opportunity that incorporates an authentic representation of reality, facilitates active student engagement, and integrates the complexities of practical and theoretical learning with opportunity for repetition, feedback, evaluation, and reflection”. Virtual simulation is defined as “a screen-based simulation where the graphics, sound, and navigation emphasize the three-dimensional (3D) nature of the environment” Uses: Recently, VS has been widely integrated in many procedures:  Surgical procedural training  Emergency and pediatric emergency medicine training  Teaching of basic medical sciences  Medical radiation and imaging  Puncture or catheterization training  Interprofessional medical education, and other case-based learning experiences. 28  According to the Healthcare Simulation Dictionary, virtual simulation is “the recreation of reality depicted on a computer screen.” When participating in virtual simulations, learners experience simulated clinical scenarios from a computer screen while often using a mouse or keyboard to interact with the environment and maneuver their avatars. Learners often select actions and communications from a menu as they provide nursing care to the virtual patient. Upon completion of the simulation, an automated report provides standardized feedback on whether the student met the scenario learning objectives. Example: Virtual Simulation for Last-Year Nursing Graduate Students in Times of Covid-19:  The intervention group received training through the vSim® for Nursing platform. The platform was developed through a collaboration between Wolters Kluwer, Laerdal and the National League for Nursing (NLN). vSim® has peer-reviewed clinical cases and the simulations are based on high-fidelity manikins adapted for use in a virtual environment.  This web-based VS measures the students’ actions in terms of low, moderate and high risk for patient harm. In addition, it calculates a score based on correctly performed nursing activities.  The intervention process consisted of three phases and five steps: Phase 1. Checking and preparatory 1) Pretraining knowledge evaluation: before starting the 29  training with the virtual platform, the intervention group was given a test on basic concepts of pharmacology, pathophysiology and nursing interventions. The intention was to establish the baseline in terms of knowledge of the topics to be treated in the clinical cases. 2) Familiarization with the platform: since none of the students had used vSim®, all of them received training on the use of the platform through video conferencing by a vSim® instructor. For this purpose, a case was used that was not included in the training afterwards. All commands of the simulator and the operation of the system were explained. A document was provided with all commands adjusted to the native language of the participants, so as to facilitate navigation through the platform. Phase 2. Experimental 3) Clinical cases: each student was given individually five clinical scenarios: two fundamental nursing cases (hip fracture and pneumonia) and three medical-surgical cases (asthma, diabetes and intestinal obstruction). Before carrying out each case, the students had to review the case and study its contents provided by the platform. These contents are based on various Wolters Kluwers publications. The platform provides different external links so that the student can access updated content. They then proceeded to perform the simulation for a maximum of 30 minutes. Finally, the program gave feedback on those aspects that were done properly and on those that could be improved. The targets were: each case had to be repeated until a score of at least 80% was achieved and the students were not allowed to have any error classified as high or moderate risk to the patient. Each case could be carried out for 30  six days. 4) Online debriefing: these were programmed on the seventh day of each case by the simulation instructor. The debriefing format proposed by the platform was used: opening questions, scenario analysis questions and concluding questions. Each session lasted approximately 90 minutes. Advantages:  Simulation-based learning (SBL) experiences are helpful in integrating theoretical knowledge with practice, and gaining skills necessary for independent practice  It helps in increasing practice skills and higher order thinking.  The use of SBL can expose medical students in ethically safe environments without risk of jeopardizing real patients  Let them feel safe to make mistakes  Enhance their confidence  Developing professional knowledge, critical thinking skills, comprehensive decision-making skills, clinical judgment, better clinical preparation, as well as self-efficacy, satisfaction and emotions.  Moreover, SBL as a form of education offers repeated practice opportunities especially for less common conditions, and reduces the time consuming to reach professional and clinical competence. Challenges:  Accessibility of VS instructional resources and the low supply of simulators, 31   Lack of infrastructure  Decoupling users from reality  Shortages of funding and simulator technologies  The lack of full-time trained staff  The poor motivation and experience limitations of instructors  How to increase students’ motivation and engagement, should be addressed  The time-intensive characteristic. 2- Distance learning Distance education, or distance learning, is a field of education that focuses on the technology, and instructional system designs that aim to deliver education to students who are not physically "on site" in a traditional classroom or campus. It has been described as "a process to create and provide access to learning when the source of information and the learners are separated by time and distance, or both These Technologies are divided into:- -Synchronous technologies. -Asynchronous technologies.  Synchronous technologies   Is a mode of online delivery where all participants are "present" at the same time. So it requires a timetable to be organized.  For example: 1. Telephone. 2. Videoconferencing. 3. Web Conferencing. 32   Asynchronous technologies.  Is a mode of online delivery where participants access course materials on their own schedule. Students are not required to be together at the same time.  For example: 1. Audiocassette. 2. E-mail. 3. Message Board Forums 4. Printed Materials. 5. Voice Mail/fax. 6. Videocassette. Major benefits of use Distance education provides major benefits to at least six main markets or categories, such as:  Expanding access: Distance education can reach underserved populations of students who cannot attend a school.  Cost reduction: As most material can be packaged in an easy to deliver "just-in-time" format.   Emerging market opportunities: Distance education provide access to lifelong learning.   Adapting to new technology and environments: Educational institutions may adapt to the rapid changes in technology being used in education today.   New fund-raising opportunities: Distance education creates new graduates who might be willing to donate money to the school.  Flexibility for students: Some distance learning programs allow students to tailor their curriculum to meet their individual needs. The importance of distance learning for disabled children. Students with physical disability usually are unable to attend common classes due to health problems. A child in a wheelchair may have a 33  great deal of difficulties if try to attend his school with ordinary classes. Distance learning classes ; allow disabled children get higher education. And provide opportunity to study at home. All materials are available online, the communication with a tutor is also provided through the Internet. 3- Electronic portfolio  Portfolio is a purposeful collection of person’s work that exhibits the person’s efforts, progress, and achievements.  E- Portfolio can also defined as " personalized, web-based collections of work, and reflections that are used to demonstrate accomplishments and time period.  A professional portfolio is a collection of carefully selected material that documents the nurse's competencies and expertise. It provides a way of monitoring professional development. By periodically reviewing the portfolio, nurses can assess their progress in meeting personal and professional goals and can better plan their careers in nursing. Portfolio Structure (content of Portfolio in pediatric nursing):  Title Page: personal information, name, age, graduation date, qualifications, etc.….  Table of Contents: contain the sections & evidences of personal.  Department mission & vision  Course Objectives: contain goal & objectives of e-portfolio.   Clinical areas: ILOs of each clinical area- plan of work- minimum requirement 34   Artifacts or evidences: examples of student work, including documents, images, video – mother class- case study- child study.  Observational checklists: which were used in evaluating nursing procedures.  Rubric: can be used to assess student work. A rubric is a criterion –rating scale, which provides the instructor with a tool to track student performance  Reflections: self-evaluation. Benefits of E- portfolio: 1. Provides a mean for documentation and saving information related to patients, staff, and organization within any HIS. 2. Portfolio as a mirror: the reflective nature of the portfolio allow the persons to see themselves over time. 3. Portfolio as a map: creating plan and setting goal. 4. Considered an important source for staff promotion and understanding their strengths and weaknesses for development. 4- Simulation in pediatric nursing Definition of Simulations: Simulation are scenarios or environments designed to closely approximate real-world situations. Simulation can be defined as a strategy – not a technology –to mirror, anticipate, or amplify real situations with guided experiences in a fully interactive way. Simulator: Replicates a task environment with sufficient realism to serve a desired purpose. 35   Types of simulation 1. Screen-based/PC-based simulation 2. Virtual patients 3. Partial task trainers 4. Human patient simulator 5. Standardized patients 6. Integrated models The need of simulation in pediatric nursing education: Pediatric events are infrequent; child patients can have good outcomes if successfully managed. Although many practicing health care providers will at some point be required to manage acutely ill or injured children, very few opportunities to learn and practice the necessary skills are encountered during nursing hospital round training. These will affect on pediatric nurse confidence, adversely affects their performance, and increases the possibility of nursing errors or an adverse the child health care outcome. Until now, opportunities for hands-on practice have either been left to chance or have been created using static mannequins with indirect patient feedback from an instructor. Because these experiences lacked the realism of actually assessing and treating an acutely ill or injured child, there are significant limitations in terms of the knowledge, clinical skills and confidence. By comparison, the immersive nature of simulation training allows participants to practice in an environment that closely mimics the assessment and treatment of real patients. Fidelity is the term used in simulation domain to describe degree of realism. Simulator fidelity ranges from: 36 a. Low fidelity: Allows user to practice skills in isolation, such as administration of an intramuscular injection into an orange or injection pillow. b. Moderate fidelity: Offers more realism but does not have user completely immersed in situation, static mannequins and partial task- trainers (designed to teach one specific skill such as intubations. c. High fidelity: Provides user with cues necessary to be immersed in hands-on scenarios. Such as simulators with life-like mannequins connected to computer systems designed to control the mannequin’s physical and physiological responses. These high-fidelity simulators facilitate student interaction by providing direct feedback and response to provided nursing interventions in the form of physical findings such as heart sounds, breath sounds, palpable pulses, blinking eyes and even speech. Benefits of simulation for pediatric nursing students: The significant benefits of the simulation experience include : 1. Practice in a risk-free environment 2. Allowing errors to occur and reaching a conclusion 3. Presentation of uncommon disease presentations or atypical presentations of common diseases 4. Practice of complex clinical situations 5. The ability to evaluate new equipment, interventions, treatment protocols and procedures. Purposes of simulation: For learners (Students)  Simulation allows learners to function in an environment that is as close as possible to an actual clinical situation. 37   Simulation incorporates the cognitive, psychomotor, and affective domains of learning in which emphasis is on the development of student knowledge.  Allows for ongoing direction, feedback& collaboration among students.  Simulation Increases student confidence through. Acquire Skills After learning a breadth of skills in lab, students apply & practice these in a simulation experience. Be Safe and Comfortable -Students feel comfortable asking questions of faculty or peers -Students practice hands-on, but on a simulator rather than a real patient for the first time -Students can repeat skills to achieve proficiency, make errors, and self-correct, all without patient harm. Critical Thinking - Application of what is learned in class and skills labs to a scenario. For educators 1. Integrate the use of technology in the learning experience. 2. Improve quality and consistency of the clinical experience 3. Provide each student with the same learning opportunity and give immediate feedback. 4. Assess the student’s progress or competency with a certain skill or nursing intervention (use as evaluation tool). 38 The impact of nursing informatics on the health care system 1-Nursing Informatics digitizes paper charting into interoperable electric charting hence decreasing documentation time which relieves nurses from writing on and handling of papers thus creating a paperless environment. 2. Nursing informatics eliminates ambiguity, redundancy and the tedious process of documentation 3. Nursing informatics reduces turnaround time. The turnaround time starts from the time a request is made to the time it is fully accomplished. For example laboratory results can be sent directly to the nurses’ station with the use of an E-mail, so there is more time available for client care. 4. Nursing informatics impacts quality and cost of health care. 5. Optimizes information management and communication among health care providers. Impact of nursing informatics on the nursing profession 1. Computer information systems prevent nurses from making medication errors. 39 2. Computer order entry systems help nurses easily interpret orders from physician in the management of a patient. 3. There is better collaboration and sharing of patient information with other health care providers. 4. Nurses perform better assessments and monitoring of patients diseases 5. Helps nurses utilize research to provide evidence based care. 6. Helps nurses work faster, smarter and more competent in whatever they do. Obstacles for application of nursing informatics. There is a need to further emphasize on the importance of evidence-based practice. There is a need for convenient access to literature resources. Education to use technology to access and retrieve information relevant to clinical practice. There is a need to instill an information-seeking modeling behavior. 40 References : 1. Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2),51-56. 2. Brosco, J. P., Sanders, L. M., Guez, G., & Lantos, J. D. (2010). Historical trends in low birth weight. Archives of Pediatrics & Adolescent Medicine, 164,99−100. 3. Jeffries PR. Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing 2007. 4. Leigh, G. High-fidelity patient simulation and nursing students’ self-efficacy: A review of the literature. International Journal of Nursing Education Scholarship 2008; 5(1):1-17. 5. 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