VSPM MADHURIBAI DESHMUKH INSTITUTE OF

NURSING EDUCATION AND RESEAECH CENTRE,

NAGPUR.

SUBJECT- NURSING MANAGEMENT

SEMINAR
ON
NURSING INFORMATICS

SUBMITTED TO,
MS. PRIYAL WAGHCHOURE
LECTURER
VSPM MDINE,
NAGPUR.

SUBMITTED BY,
MS. DEVYANI MESHRAM
FINAL YEAR M.SC. (NURSING)
VSPM MDINE,
NAGPUR.

SUBMITTED ON
11-09-2023
GENERAL OBJECTIVE:
At the end of the seminar student will able to understand about the nursing
informatics and they will able to use this knowledge in clinical and theoretical area.

SPECIFIC OBJECTIVE:
At the end of the seminar student will able to understand;
1. Introduce the nursing informatics
2. Define the nursing informatics
3. Explain trends in
4. Describe general purpose in
5. Explain use of computers in hospital and community
6. Enlist patient record system
7. Describe Management information and evaluation system (MIES)
8. Explain E- nursing, Telemedicine, telenursing
  NURSING INFORMATICS

 INTRODUCTION:

Informatics (informatics comes from the French word informatique which means computer
science). Informatics is defined as computer science + information science. Used in
conjunction with the name of a discipline, it denotes an application of computer science and
information science to the management and processing of data, information, and knowledge
in the named discipline. Thus we have, medical informatics, nursing informatics, pharmacy
informatics and so on.

 DEFINITIONS:

 Hebda (1998 p. 3), defines nursing informatics as "the use of computers technology to
support nursing, including clinical practice, administration, education, and research."

 American Nurses Association (ANA) (1994) has defined nursing informatics as "the
development and evaluation of applications, tools, processes, and structures which
assist nurses with the management of data in taking care of patients or supporting the
practice of nursing."
 1. TRENDS IN NURSING INFORMATICS

 INTRODUCTION

Nursing informatics is the specialty that integrates nursing science, computer science and
information science to manage and communicate data, information, and knowledge in
nursing practice. Nursing informatics facilitates the integration of data and knowledge to
support patients, nurses, and other providers in their decision making in all roles and
settings. This support is accomplished through the use of information structures, information
processes and information technology.

 CLINICAL INFORMATION SYSTEM

Clinical information system (CIS) is a computer-based system used to inform

clinicians about tests, procedures and treatment in an effort to improve the quality of care
through real-time assistance in decision-making and to increase efficiency and effectiveness
of care delivery.

 Computerized patient records

A computerized patient record or electric patient record (CPR) or electric patient record will
include all information about an individual’s lifetime health status and health care. The CPR
is a replacement for the paper medical record as the primary source of information for health
care, meeting all clinical, legal and administrative requirements. However, CPR is more than
the today’s medical record. Information technology permits much more data to be captured,
processed and integrated, which results in information than that found in a linear paper
record.

 Data capture
Data capture refers to the collection and entry of data into a computer system. The origin of
the data may be local or remote, with the data coming from patient-monitoring devices, from
telemedicine applications, directly from the individual recipient of health care, and even from
others who have information about the recipient’s health or environment, such as relatives,
friends and public health agencies. Data may be captured by multiple means, including entry,
pattern recognition (voice, handwriting, or biological characteristics), and medical device
transmission.

 INTERFACE BETWEEN THE INFORMATICS NURSE AND THE CLINICAL

INFORMATION SYSTEM
Information demands in health care systems are pushing the development of CISs and CPRs.
The ongoing development of computer technology- smaller, faster machines with extensive
storage capabilities and the ability for cross- platform communication-is making the goal of
an integrated electronic system a realistic option, not just a long-term dream. As these
systems evolve, informatics nurses will play an important role in their development,
implementation, and evaluation.

 TRENDS IN COMPUTING
Computers have moved from the realm of a “nice to know” luxury item to a “need to know”
essential resource for professional practice. Nurses are knowledge workers who require
accurate and up-to-date information for their professional work. The explosion in
information-some estimate that all information is replaced every 9 to 12 months-requires
nurses to be on the cutting edge of knowledge to practice ethically and safely. Trends in
computing will also affect the work of professional nurses and not just through the
development of CISs and CPRs. Research advances, new devices, monitoring equipment,
sensors, and “smart body parts” will all change the way that health care is conceptualized,
practices and delivered.

 THE INTERNET
Through internet information can be presented in different forms and in different languages.
It also provides different organizational structures for information storage and access to
accommodate the user’s preference and need. Even though computer stored and displayed
information resources are potentially very useful in relation to patient education, their
integration into nursing practice is rather inconsistent.
 2. GENERAL PURPOSE OF NURSING INFORMATICS

Definition:

In 2008, the American Nurses Association (ANA) defined this growing field in its Scope and
Standards for Nursing Informatics Practice as :
- a specialty that integrates nursing science, computer science, and information science to
manage and communicate data, information, knowledge and wisdom in nursing practice.

Goal:
The goal of Nursing Informatics is to improve the health of populations, communities,
families, and individuals by optimizing information management and communication. This
includes the use of technology in the direct provision of care, in establishing effective
administrative systems, in managing and delivering education experiences, in supporting life-
long learning, and in supporting nursing research.

History:
Early hospital computer systems developed from business computing systems in the late
1950s and early 1960s, and were used for accounting, billing, inventory and similar business-
related functions. Others were developed during the 1960s primarily for storing patient
information to be used by medical staff. Nurses have worked in informatics roles for over
twenty-five years, but the phrase ―nursing informatics‖ was not seen in the literature until
1984. Since 1984, nursing informatics has established itself as a specialty in the nursing field.
Nurses identified as informatics specialists numbered 15 in 1981; there were over 5,000 by
1991 (Saba& McCormick1996). In 1992, the American Nurses Association‘s Congress of
Nursing Practice supported the recommendation of the Council on Computer Applications in
Nursing to officially recognize NI as a nursing specialty.
A. APPLICATION OF NURSING INFORMATICS IN CLINICAL PRACTICE:

1. NURSING INFORMATICS AND NURSING PROCESS

The nursing process is the core of patient care delivery. In the nursing process continuum,
nurses are constantly faced with data and information. Data and information are integrated in
each step of the nursing process:
a. Assessment
b. Diagnosis
c. Planning
d. Implementation and
e. Evaluation
Nursing documentation, which is often identified as the sixth step in the nursing process, is
vital in information management. Hence, it is necessary for nurses to document accurately
and precisely to determine the desired outcome.

PRACTICAL APPLICATIONS:

 Monitoring System: Comprehensive patient monitoring systems that can be

configured to measure and display various patient parameters.
 Pulse Oximeter: Measure the arterial haemoglobin oxygen saturation of the patient's
blood.
 Intracranial Pressure Monitors: are connected to sensors inserted into the brain
through a cannula or bur hole.
 Apnoea Monitors: Use electrodes or sensors placed to detect cessation of breathing,
display respiration parameters, and trigger an alarm.
 Ventilators: Consist of a flexible breathing circuit, gas supply, heating/humidification
mechanism, monitors, and alarms.
 Infusion Pumps: Employ automatic, programmable pumping mechanisms to supply
the patient with fluids intravenously or epidurally through a catheter.
 Crash Carts: Also called resuscitation carts or code carts, are strategically located in
the ICU for immediate availability when a patient experiences cardio-respiratory
failure.
 Intra-Aortic Balloon Pump: Use a balloon placed in the patient's aorta to help the
heart pump. Clinical Information System: Consists of information technology that is
Applied at the point of clinical care. They include electronic medical records, clinical
data repositories, decision support programs, handheld devices for collecting data and
viewing reference material, imaging modalities and communication tools such as
electronic messaging system.
 Mobile Technology: Refers to portable devices to create, store, retrieve and transmit
data in real time between end users for the purpose of improving patient safety and
quality care.
 Wireless Area Networking: Mobile electronic health tools such as cell phones and
telemedicine technologies are rapidly transforming the face and context of health care
service delivery.
 Picture Archiving and Communication systems (PACS): Enables images as x-rays
and scans to be stored electronically and viewed on screen, creating a filmless process
and improved diagnosis.
 Method Single Sign-On (SSO): Is a mechanism whereby single action of user
authentication and authorization can permit a user to access all computers and systems
where he has permission without the need to enter multiple passwords.
 Computerized Provider Order Entry (CPOE): Are designed to replace a hospital‘s
paper based-ordering system.
 Virtual Reality: Is the simulation of a real or imagined environment that can be
experienced visually.
 Electronic health records (EHR): From paper to paper-less communication is the
mantra of Informatics. Repository of electronically maintained information about an
individual's lifetime health status and health care, stored such that it can serve the
multiple legitimate users of the record.
 Computer information system: Computer based system that is designed for
collecting, storing, manipulating and making available clinical information important
to the healthcare delivery process.
B. APPLICATION OF NURSING INFORMATICS IN NURSING
ADMINISTRATION:

Nursing Administration (Health Care Information Systems)

 Automated staff scheduling

 E-mail for improved communication

 Cost analysis and finding trends for budget purposes

 Quality assurance and outcomes analysis

C. APPLICATION OF NURSING INFORMATICS IN NURSING EDUCATION:

1. Computerized record-keeping
2. Computerized-assisted instruction
3. Interactive video technology
4. Distance Learning-Web based courses and degree programs
5. Internet resources-CEU's and formal nursing courses and degree programs
6. Presentation software for preparing slides and handouts- PowerPoint and MS

D. APPLICATION OF NURSING INFORMATICS IN NURSING RESEARCH:

1. Computerized literature searching-CINAHL, Medline and Web sources

2. The adoption of standardized language related to nursing terms-NANDA, etc.
3. The ability to find trends in aggregate data, that is data derived from large population
groups-Statistical Software, SPSS
4. Effective data management and trend-finding include the ability to provide historical or
current data reports.
5. Extensive financial information can be collected and analyzed for trends. An extremely
important benefit in this era of managed care and cost cutting.
6. Data related to treatment such as inpatient length of stay and the lowest level of care
provider required can be used to decrease costs

3. COMPUTER USES IN HOSPITAL AND COMMUNITY

A. Uses in community

When it comes to importance of computers in Hospitals, it is undoubtedly an important

aspect to keep in the pace of the technologically advanced world. Healthcare is again a field
where technology has made things lot better and increased the efficiency in patient care.
Below are some of the points which highlight the uses of computers in hospitals.

 Storage of Patient Data: For any organization proper and systematic storage of
information is a mandate requirement. Nurses can use computers to take down and
store notes of the patients, as they observe their condition while on rounds. As the
supervised rounds involve a lot of patients and a lot of information, using a
computerized personal digital assistant makes it easier to access the right medical
information at the right time instead of carrying a bunch of paper work and then take
time to search the piece of paper to access information when you need to be quick,
efficient and accurate.

 Computerized Presentations: We all would agree that computerized power point

presentations are much more efficient and has more impact on the receiver when it
comes to presenting data. Even in the field of nursing education, computers help the
nursing tutors/educators to present the large and complicated detailed form of data,
which of course is a part of the medical study, in a very simplified and effective form.
When speaking of uses of computers in medicine, features like power point
presentations, slide shows, and videos are used to present medical procedures and
techniques for better understanding of complex medical procedures and their
treatments.

 Teaching nurses through Simulations: The field of medicine involves the concept
of "hands-on work". I mean be it a doctor or a nurse, countless procedures are done on
 patients regularly. Nursing education therefore, must involve a lot of practice
programs to make the students efficient to face the real life scenario. Computer
programs which enable simulate such procedures therefore are of great use.

 Computerized Self Evaluation: Computers also contribute and help the students
know their strengths and weaknesses. There are many computerized quiz and medical
tests with immediate feedback that can help you brush and develop your medical facts
and requirements without any delay. Your queries are solved, you know the answers
and you know where you stand. A regular use of such computer applications definitely
makes you more equipped and well researched for your field.

 Interactive Learning: Among the uses of computers in education, the most appealing
and outstanding feature of computer based education is that it gives boost to
interactive learning.

 Improved Quality Automated hospital information systems can help improve quality
of care because of their far-reaching capabilities. Hospital information systems (HMS)
in a hospital can combine the use of computers for storing and transferring
information with using them for giving advice to solve clinical problems. In addition
to alerting physicians to abnormal and changing clinical values, computers can
generate reminders for physicians. For complex problems, computer workstations can
integrate patient records, research plans, and knowledge databases.

 Decreased Costs When a physician orders a test by computer, it can automatically

display information that promotes cost-effective testing and treatment.

B. Application of Computers in Hospitals

Importance of computers in medicine is growing and spreading rapidly. The only

disadvantage is that a full fledged installation of all the computerized systems in hospitals is a
lengthy and costly process. There are however, some hospital systems which already work on
the basis of computers. Here's an explanation to all such systems, which work on computer.
Uses of Computers in Hospitals:

 Medical Data
Every day hospitals and clinics which are attached to it churn out enormous volumes of
data regarding patients, ailments, prescriptions, medications, medical billing details, etc.
Such medical records, are now a day‘s recorded into medical billing software. Such
mammoth databases are known as Electronic Medical Records (EMR) and Electronic
Health Records (EHR). These databases are operated by a set of computers and servers,
and come in handy during medical alerts and emergencies. The concept of EHR is a bit
broader than the EMR, as the database is accessible from different clinics and hospitals.
Thus, a patient's medical history can be retrieved from any hospital by medical
practitioners.

 Medical Imaging
Tests' are medical procedures where specified components of the human body are
scanned. A test can be as simple as a regular blood test or it can be a complex CT /MRI
scan. This process is often referred to as a medical imagery. In order to increase the
precision of such procedures, computers have been adopted and integrated into the testing
equipment. The Ultrasound and the MRI are the best examples where computers have
been adopted, in order to make the process faster and precise. Thus medical tests and
tools have become more advanced as a result of the use of computers.

 Medical Examination
Many systems are underway for the development of medical monitoring which will help
humans to properly monitor their own health. In many cases doctors and surgeons also
use sophisticated computer aided equipment to treat their patients. Such systems and
procedures include, bone scan procedure, prenatal ultrasound imaging, blood glucose
monitors, advanced endoscopy which is used during surgery and blood pressure monitors.
Basically these medical tests and tools provide significant convenience to medical
 practitioners. You will find that major laboratory equipment and heart rate monitors have
already been computerized in many hospitals.

 Advantages of Computers in Hospitals:

There are significant advantages of using computers in hospitals. The importance of
computers in hospitals has also increased drastically due to the fact that the procedures have
to be speedy to cater to a larger population and the medical services have to be more precise.
To sum up, the advantages of computers in hospitals can be summarized as follows:
 Precise 'tests' and medical examinations
 Faster medical alerts, which are more accurate time-wise
 Enhanced data about a patient‘s medical history
 Precision in diagnosis
 Precision in billing
 Automated updating of medical history

The possibility of computers uses in the medical field are endless, facilitating medical help to
hospitals and clinics all across the globe. I hope that the elaboration of the uses of computers
in hospitals is resourceful.
 4. PATIENT RECORD SYSTEM

 Electronic patient record system

The EMR can be defined as the legal patient record created in hospitals and ambulatory
environments that is the data source for the EHR. It is important to note that an EHR is
generated and maintained within an institution, such as a hospital, integrated delivery
network, clinic, or physician office, to give patients, physicians and other health care
providers, employers, and payers or insurers access to a patient's medical records across
facilities.

The 2003 Patient Safety Report describes an EMR as encompassing:

 A longitudinal collection of electronic health information for and about persons

 Immediate electronic access to person- and population-level information by
authorized users;
 Provision of knowledge and decision-support systems [that enhance the quality,
safety, and efficiency of patient care] and
 Support for efficient processes for health care delivery.

Need of an hour
 If there's one constant in the healthcare industry, its change. Healthcare providers are
driven to find new ways to cut costs while improving care.
 To meet these challenges, healthcare is turning to information systems to control
costs, improve overall efficiency and enhance patient care.

Need of an hour
A case in point in the medical records arena is the completion of patient charts. While greatly
improved through imaging, this remains a costly, laborious process which has a tremendous
impact on healthcare enterprises. Systems must evolve to find a way to automate the
identification of deficiencies in patient charts. They must also enable electronic routing of
incomplete documents to appropriate medical and administrative personnel for on-line
processing, completion and reporting and include advanced features like electronic signature.
Integrated health care delivery system-need of efficient and accurate ways of capturing,
managing and analyzing clinical data. Payers and regulators asking the report card on clinical
process and outcome.

Need for CPR

To manage escalating health care cost Evolving role of primary health care Guidelines are
being promoted to reduce the variances of clinical practices Integrated delivery system
Key Capabilities of an Electronic Health Record System
• To capture data at the point of care
• To integrate data from multiple internal and external sources
• To support caregiver decision making. core capabilities

 Health information and data:

Having immediate access to key information - such as patients' diagnoses, allergies, lab
test results, and medications - would improve caregivers' ability to make sound clinical
decisions in a timely manner.

 Result management:
The ability for all providers participating in the care of a patient in multiple settings to
quickly access new and past test results would increase patient safety and the
effectiveness of care.

 Order management:
The ability to enter and store orders for prescriptions, tests, and other services in a
computer-based system should enhance legibility, reduce duplication, and improve the
speed with which orders are executed.

 Decision support:
Using reminders prompts, and alerts, computerized decision-support systems would help
improve compliance with best clinical practices, ensure regular screenings and other
 preventive practices, identify possible drug interactions, and facilitate diagnoses and
treatments.

 Electronic communication and connectivity:

Efficient, secure, and readily accessible communication among providers and patients
would improve the continuity of care, increase the timeliness of diagnoses and treatments,
and reduce the frequency of adverse events.

 Patient support:
Tools that give patients access to their health records, provide interactive patient
education, and help them carry out home-monitoring and self-testing can improve control
of chronic conditions, such as diabetes.

 Administrative processes:
Computerized administrative tools, such as scheduling systems, would greatly improve
hospitals' and clinics' efficiency and provide more timely service to patients.

 Reporting:
Electronic data storage that employs uniform data standards will enable health care
organizations to respond more quickly to federal, state, and private reporting
requirements, including those that support patient safety and disease surveillance."

 ADVANTAGES

 Improve quality of care

1. The implementation of electronic health records (EHR) can help lessen patient sufferance
due to medical errors and the inability of analysts to assess quality.
2. EHR systems are claimed to help reduce medical errors by providing healthcare workers
with decision support.
3. Computerized Physician Order Entry (CPOE)—one component of EHR—increases patient
safety by listing instructions for physicians to follow when they prescribe drugs to patients.
Naturally,
4. Promote evidence-based medicine
5. EHRs provide access to unprecedented amounts of clinical data for research that can
accelerate the level of knowledge of effective medical practices.
6. Realistically, these benefits may only be realized if the EHR systems are interoperable and
wide spread (for example, national or regional level) so that various systems can easily share
information.

 ISSUES

1. Integrated systems require consistent use of standards in e.g. medical terminologies and
high quality data to support information sharing across wide networks
2. Ethical, legal and technical issues linked to accuracy, security confidentiality and access
rights are set to increase as national EMR systems come online.
3. Common record architectures, structures
4. Clinical information standards and communications protocols
5. Security and confidentiality of information
6. Patient data quality; data sets, data dictionaries

Storage of records
The required length of storage of an individual electronic health record will depend on
national and state regulations, which are subject to change over time. While it is currently
unknown precisely how long EHRs will be preserved, it is certain that length of time will
exceed the average shelf-life of paper records.
 6. E-nursing

 Introduction:

Nursing profession is influenced by the changes and current trend in the health care delivery
system. Technological proficiency in nurses is a desirable attribute to function optimally in
our changing health care system: not as a substitute for nurses & apos; care, but as an actual
enhancement of care. Nurses are encountering lot of challenges as the new technologies are
emerging.
These trends in information technology challenge the nurses to focus on new areas. E nursing
and telenursing is one area which needs nurse‘s attention

 Technology 1999 vs. 2010

In just 10 short years, the face of technology, inside the classroom and out, has changed
dramatically. Here is a snapshot of some of those changes.
• THEN : 3 ½ inch floppy disks
• NOW: Mass volume storage drives and DVD‘s, double DVD, BLUERAYS.
• THEN: Technology via the classroom was limited to TV replay classes, distance learning
and PowerPoint presentations.
• Students obtained readings and syllabi via their local bookstore, in printed copy.
• NOW: Almost all students use the e-learning system to access their classes and have some
sort of Web-based component. Many students have only online classes and many access all
materials online.
• THEN: Music CDs were bought and listened to on your CD player
• NOW : Music can be downloaded online and saved to an I-Pod, which goes everywhere.
• THEN: Taking pictures meant buying film and having it developed at local pharmacy.
• NOW: Digital cameras now allow instantaneous viewing of photos, downloading and
sharing them with millions on the Internet.
• THEN: About 69 million people owned a cell phone in the U.S.
• NOW: Today, more than 190 million people own cell phones. 39% of these are smart
phones, which allow access to email, the Internet, videos, and academic course content.
• THEN: Most students using computers at visited the campus and waited for open stations.
• NOW: students are required to own a personal computer and have a Gatorlink email
address, which faculty use to regularly communicate with students.

 E- Health:
India where have we reached? Health care delivery system is facing emerging revolutions in
the field of information and communication technology .
E-Health
 E-health is a client-centered World Wide Web-based network where clients and
health care providers collaborate through ICT mediums to research, seek, manage,
deliver, refer, arrange, and consult with others about health related information and
concerns.
 E-health networks have developed on the Internet at an amazing rate over the past
decade.
 The emphasis is genuinely Client focused.
 Client Driven as well…
 Clients driven by the need and urge to become informed health consumers.

 Forms of e-health
The term can encompass a range of services or systems that are at the edge of
medicine/healthcare and information technology, including:

• Electronic health records: enabling the communication of patient data between different
healthcare professionals (GPs, specialists etc.);

• Telemedicine: physical and psychological treatments at a distance;

• Consumer health informatics: use of electronic resources on medical topics by healthy
individuals or patients;

• Health knowledge management: e.g. in an overview of latest medical journals, best

practice guidelines or epidemiological tracking (examples include physician resources such
as Medscape and MDLinx)

• Virtual healthcare teams: consisting of healthcare professionals who collaborate and share
information on patients through digital equipment (for transmural care);

• mHealth or m-Health: includes the use of mobile devices in collecting aggregate and
patient level health data, providing healthcare information to practitioners, researchers, and
patients, real-time monitoring of patient vitals, and direct provision of care (via mobile
telemedicine);

• Medical research using Grids: powerful computing and data management capabilities to
handle large amounts of heterogeneous data.

• Healthcare Information Systems: also often refer to software solutions for appointment
scheduling, patient data management, work schedule management and other administrative
tasks surrounding health.

 Nurses can be primary actors in the virtual arena of E-health, serving as

– Health advisors,

– Internet guides to help clients select reliable information resources,

– Support group liaisons,

– Web information providers, and so on.

E-Strategy Goals
• Advocating for nurses; access to ICT and the resources required to integrate ICT into
nursing practice;
• Supporting the development and implementation of nursing informatics competencies
required for entry-to-practice and continuing competence;
• Advocating for the involvement of nurses in decision-making about information technology
and information systems.

E-nursing –internet access

(Nursing practice in the year 2003 is vastly different from the days of Florence Nightingale in
the 1850's. Today's nurses literally have at their fingertips the power of the Internet)

Internet access assists nurses in

(a) Providing direct client care,
(b) Enhancing client teaching,
(c) Conducting job searches and continuing education.
(d) Collaborating with other health professionals worldwide.

Issues of E-nursing :

• Caring, (essence of nursing is contact and engagement with people, which involves physical
closeness, intimacy, and interpersonal sharing and caring that cannot be approached with
computer technology).
• Empowerment,
• Self-reflection And Expression,
• Computer Literacy,
• Confidentiality,
• Bioethical Decisions,
• Networking,
• Patient Education, Community Development And
• Cyber phobia

 ELECTRONIC GAMES AND SIMULATIONS :

1. Audio/Video Conferencing
2. Virtual Classroom: * VIRTUAL REALITY
3. Threaded discussions
4. Other (Groove, etc.)

E-Learning Aliases
• Online learning/Training
• Web-based learning/training
• Virtual learning
• Distributed learning
• Distance learning
• Asynchronous Learning Networks
• Technology-Supported/Mediated/Facilitated Learning
• Networked Learning
• Electronic learning
• Collaborative electronic learning
• Electronic Performance Support
• Workflow-based learning
 7. TELENURSING

 INTRODUCTION:

Telenursing is a component of telemedicine. Telenursing is the branch of telehealth that

involves actual nursing and client interaction through the medium of information technology.
Offers health-related activities at a distance between two or more locations using information
and communication technologies (ICT).

 DEFINITION:

Telenursing refers to the use of telecommunications and information technology for

providing nursing services in health care whenever a large physical distance exists between
patient and nurse, or between any numbers of nurses.

 OBJECTIVE:
• to deliver care and expertise,

• for curative, preventive and rehabilitation

• For training and information

The two key dimensions of telenursing are distance and electronic mediation. The distance
between participants may be very large or relatively small, but usually is greater than a public
distance of 6 to 8 feet and the electronic component may be evident or concealed.
• One part of telenursing involves the use of electronic networks, in the form of intranets,
such as hospital-and community-based local area networks and wide area networks, while the
other is found in Internet, which is a prime example of a global area network.

 TYPES:
• In synchronous (real time) or
• Asynchronous (differed time) mode
• Direct (nurse-person encounter)
• indirect (nurse-caregiver encounter)

 SCOPE OF PRACTICE :

Assistance to physicians in the implementation of medical treatment protocols. For E.g.)

Immediate post-surgical situations (the care of wounds, atomies, handicapped individuals).
Nurses can -
 Actually view healing wounds,
 Can access physiological monitoring equipment to measure physical indicators such
as vital signs.
 Provider outine assessment and follow-up care without the client having to travel to
the health care agency for an appointment.
 New technologies have added a visual component to the interactions that augments
the historic audio exchange
• Helps patients and families to be active participants in care, (self management of chronic
illness).
• Home care – In normal home health care, one nurse is able to visit up to 5-7 patients per
day. Using telenursing, one nurse can ―visit‖ 12-16 patients in the same amount of time.
• Immobile patients, patients with chronic or degenerative diseases are "visited" and
assisted regularly by a nurse via videoconferencing, internet, videophone, etc.
• Scope of practice
• For educating the clients,
• Nursing Teleconsultation,

 ADVANTAGES
• With all of the new diseases and health issues emerging this is a way to learn faster in an
effort to save lives and minimize risk or discomfort to the patient.
• Helps to keep patients out of hospital.
• Sharing valuable medical information with doctors and nurses in other countries around the
world and in all areas of the profession.
• Greater job satisfaction among telenurses.
• Help solve increasing shortages of nurses.
• Telenursing is cost efficient, timesaving and increases patient‘s ability to self-care.
• Minimises the length of hospital stay.
• Reduce distances and save travel time.
• Improvement of resource and time allocation.
• Another valuable way telenursing can be of use is for military personnel. They are often
times located in areas of the world that telemedicine is the only way to diagnose and treat
them.
• The fact is that telenursing can go anywhere. It is both versatile and effective.

 DISADVANTAGES

• First of all, one problem is that many fear that it will take away from personal one on one
time.
• Conferences and video can‘t replace valuable time between nurse and patient or more
personal discussion that nurses and clients might otherwise have with each other.
• Legal complications are raising another red flag. Laws and a set code of rules and ethics
will first need to be applied before telenursing can be used regularly in various capacities.
This alone might take some time.
• Services and how nurses get paid for them will all need to be resolved as telenursing
becomes a more fluent practice. This can prove to be a difficult determination.
• Technical problems in 3-D imaging
• Lack of standardisation and legislation
• Problems in assessing qualifications
• Problems with security and identification
• Missing clinical anamnesis and examination
• False diagnosis
• Lack of ability to touch or direct delivery of care to a patient by nurse.
• Technical skill is needed by nurses.
• Network connection error / failure / delay.
• Reliability of networks
• Then we have clinical risk and over dependence on this telenursing system.
• Due to the risks involved with what is reliable vs. unreliable information and over
dependence or over use of telenursing can easily get out of control until more uniformed
strategies and procedures are put into play.
• Telemedicine is not yet all worked out where it can be utilized constantly or flexibly.
• But, it has enormous potential to be a tremendous asset to the world and all its civilizations.
• More time and effort will be needed to organize telenursing for it to be confidently
accepted.
8. TELEMEDICINE

 INTRODUCTION

The state of health of a population is a direct determinant of development. Access to better

health services reduces poverty and increases productivity. Investment in health is a
prerequisite to economic and social progress. Developing countries face various problems in
the provision of medical services and health care, including funds, expertise and resources.
To meet this challenge, governments and private health care providers must make use of
existing resources and the benefits of modern technology.

 DEFINITION OF TELEMEDICINE:

The definition adopted by an international consultation group convened by the WHO in

Geneva in December 1997 to draft a health telematics policy for the WHO is as follows:

Telemedicine is the delivery of health-care services, where distance is a critical factor, by

health-care professionals using information and communication technologies for the
exchange of valid information for diagnosis, treatment and prevention of disease and injuries,
and for the continuing education of health-care providers as well as research and evaluation,
all in the interest of advancing the health of individuals and their communities.
  THE OBJECTIVES OF TELEMEDICINE:

One of the basic ideas of telemedicine can be expressed by the saying: ―Move the
information, not the patient‖. When a patient needs to consult a specialist, information about
the patient could be obtained locally and exchanged through a network to a specialist. In
many situations this can replace transporting the patient or the specialist to a given location.
This exchange of information and expertise for medical diagnosing and treatment is a basic
concept of telemedicine.

 TECHNOLOGIES INVOLVED IN TELEMEDICINE:

Developing countries can benefit from using information technology and telecommunications
networks to improve health care in remote and rural areas. Although advanced telemedicine
applications may require a sophisticated and expensive telecommunications infrastructure,
some solutions require only a basic infrastructure to provide health-care services to remote
areas.
The two types of technologies, most commonly used today, are

 STORE AND FORWARD:

In this text, audio, static and video images can be captured, stored and then
forwarded to another location for review and / or consultation by a physician. This
technology is less expensive and well suited for non-emergency situations in radiology,
pathology and dermatology.

 IATV (two-way Interactive TV):

In emergency medical situations such as a trauma service, video-conferencing

equipment at both ends allows real time or near real time consultation. The key feature of
telemedicine equipment which distinguishes it from simple video conferencing units is the
use of peripheral devices: electronic versions of examination tools such as stethoscopes
which allow the distant cardiologist to listen to the heart-beat of the patient. Services such as
specialist-assisted surgery or psychiatric consultations usually require live audio. If live, real-
time transfer of information is not required, such as in radiology and pathology, the use of
store-and-forward technology can be more convenient and much more cost-effective.

 PRACTICE OF TELEMEDICINE:

A telemedicine system can be as simple as a computer hook-up or as advanced as ―robotics-

surgery‖ facility. Varied branches of medical specialities such as cardiology, pathology,
radiology, neurology, psychiatry, dentistry, nursing, geriatrics, dermatology, ophthalmology,
otolaryngology, endoscopy, emergency care, home health care and rural tele-medicine are at
present in practice in telemedicine. The telemed specialists make either elective applications
for making diagnosis or tackle medical emergencies by inter-physician communication or by
direct physician – patient contact.

 Tele-Cardiology has been in practice for the last two decades and includes trans-
telephonic electro-cardiography, echocardiography, angiography, stethoscopy and
tele-transfer of haemodynamic, blood gas and bio-chemistry parameters for intensive
cardiac care services. Tele-cardiology centres are expanding all over the world
including India.

 Trans-Telephonic Electro-Cardiographic Monitoring (TTEM):

Einthoven investigated transmission of an ECG over a telephone line in 1906.
SodiPallers in 1984, introduced this technique in Mexico using one-lead
transmission. It is well known that majority of deaths due to acute myocardial
infarction are related to time factor as 60% of mortality is within first 4 hours of the
event. The time-delay between onset of symptoms to accurate diagnosis and initiation
of therapy is the most important determining factor for patient survival. For initiating
pre-hospital care and thrombolysis, time is of essence as the best results are obtained
when cardiac muscle is salvaged within the ―Golden Hour‖. TTEM was started at
Escorts Heart Alert Centre (EHAC) at New Delhi, on 17th May 1996. The accuracy
of ECG recorded by cardio-beeper in comparison with conventional ECG has been
accepted. Life-long TTEM is recommended in patients with pacemakers to detect
 possible battery depletion, lead or electrode malfunction that may need
reprogramming or battery replacement and to follow patients with Automatic
Implantable Cardioverter Defibrillators (AICD). Other applications are diagnoses of
arrhythmias that are difficult to detect by Holter, follow up of arrhythmia treatment,
evaluation of syncope, transient symptomatic event detection, patients with high risk
of sudden cardiac death, home-rehabilitation programme, patients after coronary
artery bypass graft surgery (CABG) or after coronary angioplasty.

 Tele-Echocardiography: Tele-transmitting 2-D echocardiogram and color Doppler

flow images, from remote areas to referral centres has become possible with use of
special technology, viz., broad band, Integrated Services Digital Network (ISDN),
fractional T-1 and standard phone lines. Video-conferencing equipment utilizing
ISDN technology is a reliable method for transmitting full echo-data, which is
particularly helpful in pediatric cardiology practice, where rapid and accurate
diagnosis of complex congenital cardiac lesions is lifesaving.

 Tele-Pathology: Tele-pathology services have enhanced the ability to confer, educate

and communicate to the referring physician, which in turn provides better service to
increase the consultation base. Equally important is the decreased expense and time
investment. Earlier consultation could take many days for reports to be prepared.
Many times, the consult slides were lost, broken, mixed up or not returned. Tele-
pathology services provide a direct contact; the images can be stored permanently
and are available for repeat consultation. They can be sent to many experts at the
same time who can make real-time interactions among themselves.

 Tele-Radiology: Tele-radiology is claimed as most mature telemedicine application.

In late 1950, the work started in Montreal and by 1990 technology was largely tested
and found acceptable for all but a small subset of cases with very high-resolution
demands such as mammography.

 Tele-Psychiatry: Increasing number of studies has identified, essential issues, related

to the utility, quality and reliability of video-conferencing i.e. interactive television in
mental health care in Scandinavian countries and in Australia. Better resource
utilization; have been established by saving expense and travel time of patients and
 psychiatrists. The issue of ―diffusion‖ has been raised i.e. to what extent the
psychiatrist, will accept and integrate this technology in their day-to-day clinical
practice.

 Tele-Neurology: 20 channels, digital electro-encephalograms, using data

compression have been successfully transmitted telephonically. The guidelines to be
followed for transmission, interpretation and storage of EEG have been laid down by
American electro-encephalographic society.

 Tele-Dermatology: The UK multicentre Tele dermatology trial, in which centres

from Ireland, Manchester and New Zealand participated, has recommended that
clinical management of dermatological conditions is possible via real-time tele-
dermatology. The final phase of this trial is under process, which aims for evaluating
cost of management and mismanagement, both to the patient and National Health
Service.

 Tele-Medicine and Army: The US Army‘s first portable telemedicine unit was
started in 1993 comprising ―Ruggedish‖ video-conferencing unit. The unit was
operating under the United Nations in Macedonia in 1994 and later in Haiti. These
experiences have proved to be adequate for majority of clinical telemedicine cases
and provide major benefit to the commanders in the field, by reducing evacuation
rate and air-lifting-which are hard on men and materials particularly in times of
hostilities.

 Rural (Community) Tele-Medicine:

Telemedicine has the potential to provide routine and specialist services to both
patients and physicians in rural areas. The technique is particularly valuable in
pediatric patients, in patients with acute medical emergencies and those suffering
from accidental injuries. Since specialist – facilities are located in large cities,
physicians in remote areas feel diffident in handling serious patients, due to lack of
experience and expertise.

 Medical Video-Conferencing: provides live interaction between physicians situated

at distant hospitals.The equipment involves video cameras at peripheral and referral
 institutions, linked by ISDN digital lines or satellite links with a central station. In
1998, National Health Service in UK has started medical video-conferencing
programmes for providing emergency care services. Seniors faculty provides ―face-
to-face‖ consultations from Royal Brompton hospital to the patients at Harefield
hospital and to hospitals in Greece and Portugal. This has ensured that patients
receive expert advice irrespective of distances from a centre of excellence.

 BENEFITS OF TELEMEDICINE:

Everyone benefits from telemedicine from the patient to the community, as well as the
physician team. Benefits can be classified according to the target group:-

a. Benefits to patients includes faster diagnosis and treatment; reduction of additional

examinations; seamless care; avoidance of the inconvenience of traveling to another
hospital or physician; easier scientific and statistical analysis; better management of
the populations‘ health by governments.

b. Benefits to clinicians’ new opportunities to consult experts, broader base for decision
making, avoidance of the inconvenience of traveling, improved image quality and the
opportunity to manipulate images. Increased collegial support to medical personnel
working in remote and isolated areas (Continuing Medical Education), resulting in
improved teaching and learning possibilities and opportunities, access to virtual
medical libraries and increased job satisfaction.

c. Benefits to hospital includes reduced risk of images getting lost, faster and more
precise diagnosis and treatment, better communication between sites, transport sites,
transport savings, more efficient use of equipment.
SUMMARY :

In the above topic we have seen the following points which contains trends, general purpose,
use of computers in hospital and community, patient record system, nursing records and
reports, management information and evaluation system (mies), e- nursing, telemedicine,
telenursing.
CONCLUSION:

The field of nursing informatics has helped drive healthcare’s application of technologies
such as EMRs and computerized provider order entry. Nursing informatics professionals
work with a diverse group of stakeholders across the care continuum, ultimately helping to
bridge the gap between clinical and technical perspectives. Their number one priority is
maintaining focus on patient safety.
BIBLIOGRAPHY:

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