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A toolbox of technical supports for nurses new to Web learning.

This article describes a number of strategies that have been used by an online Nurse Practitioner program to help learners and faculty become comfortable and proficient in the technical skills necessary for an Internet-based program. Various components of the "toolbox" of help strategies and how they have evolved over time are described. Results of a project to systematically develop and evaluate the toolbox are discussed.

Attitude of Health Personnel↗

Measurement of user performance and attitudes assists the initial design of a computer user display and orientation method.

OBJECTIVE: The objective of our study was to assess the acceptability of a proposed user interface to visually interfaced computer-assisted anesthesia record (VISI-CAARE), before the application was begun. The user interface was defined as the user display and its user orientation methods. METHODS: We designed methods to measure user performance and attitude toward two different anesthesia record procedures: (1) the traditional pen and paper anesthetic record procedure of our hospital, and (2) VISI-CAARE. Performance measurements included the reaction speed (identifying the type and time of an event) and completion speed (describing the event). Performance also included accuracy of the recorded time of the event and accuracy of the description. User attitude was measured by (1) the physician's rating on a scale of 0 to 9 of the potential usefulness of computers in anesthesia care; (2) willingness to use the future application in the clinical environment; and (3) user suggestions for change. These measurements were used in a randomized trial of 21 physicians, of which data from 20 were available. RESULTS: After exposure to VISI-CAARE, the experimental subjects' ranking of computer usefulness in anesthesia care improved significantly (4.2 +/- 1.1 to 7.6 +/- 1.5, p = 0.0001), as did controls' (5.2 +/- 2.6 to 8 +/- 1.5, p = 0.0019). All the volunteers were willing to try the proposed prototype clinically, when it was ready. VISI-CAARE exposure was associated with faster and more accurate reaction to events over the traditional pen and paper machine, and slower and more accurate description of events in an artificial mock setting. VISI-CAARE 1.1 demonstrated significant improvements in both reaction speed and completion speed over VISI-CAARE 1.0, after changes were made to the user display and orientation methods. CONCLUSION: With graphic user interface prototyping environments, one can obtain preliminary user attitude and performance data, even before application programming is begun. This may be helpful in revising initial display and orientation methods, while obtaining user interest and commitment before actual programming and clinical testing.

Anesthesia↗

Modeling computer interest in older adults: the role of age, education, computer knowledge, and computer anxiety.

We proposed a mediation model to examine the effects of age, education, computer knowledge, and computer anxiety on computer interest in older adults. We hypothesized that computer knowledge and computer anxiety would fully mediate the effects of age and education on computer interest. A sample of 330 older adults from local senior-citizen apartment buildings completed a survey that included an assessment of the constructs included in the model. Using structural equation modeling, we found that the results supported the hypothesized mediation model. In particular, the effect of computer knowledge operated on computer interest through computer anxiety. The effect of age was not fully mitigated by the other model variables, indicating the need for future research that identifies and models other correlates of age and computer interest. The most immediate application of this research is the finding that a simple 3-item instrument can be used to assess computer interest in older populations. This will help professionals plan and implement computer services in public-access settings for older adults. An additional application of this research is the information it provides for training program designers.

Age Factors↗

Address low literacy issues to improve Medicaid risk member compliance, reduce costs.

Low literacy linked to higher costs among managed medicaid patients: The evidence is mounting that low literacy levels may be linked to poor Medicaid risk patient compliance and higher medical costs. Here are the details on an important new study, plus some tips from literacy experts on how to improve verbal and written communication skills.

Aged↗

The RN-BSN bridge course: transitioning the re-entry learner.

BACKGROUND: Although most RN-to-BSN programs offer bridge courses, little can be found in the literature about common course objectives, content, or outcomes. METHOD: This article details course objectives, course content, course implementation, and preliminary outcomes of a primarily distance learning RN-to-BSN bridge course at a northern California university. RESULTS: Preliminary outcome assessments suggested greater than expected increases in role and campus socialization, as well as computer literacy, as a result of RN-to-BSN bridge course implementation. CONCLUSION: The RN-to-BSN bridge course can successfully be used to transition the re-entry student and may be the link allowing RN-to-BSN students to effectively face the concurrent challenges of role socialization and computer literacy while mastering course content and course objectives.

Adaptation, Psychological↗

The role of managed care pharmacy in reducing medication errors.

OBJECTIVE: To outline some of the causes of medication errors and recommend ways that managed care pharmacy organizations and managed care pharmacists can prevent some of these errors through practitioner and patient education. BACKGROUND: Patient safety has become a major concern since the November 1999 release of the Institute of Medicine (IOM) report, To Err Is Human. Errors involving prescription medications are responsible for up to 7,000 American deaths per year and the financial costs of drug-related morbidity and mortality may cost nearly $77 billion US dollars a year. The Institute for Safe Medication Practices (ISMP) collects and analyzes voluntary confidential medication error reports and makes recommendations on the prevention of these errors. This article uses the expertise of ISMP in medication error prevention to make recommendations on educational programs for patients and managed care and community pharmacists to reduce medication errors in the outpatient (community) setting. These educational areas focus on patient education, compliance, and health care literacy. CONCLUSION: Managed care pharmacy is well positioned to affect change in the health care system. Through information dissemination and education, managed care pharmacists should play a more active role in medication error-reduction activities by improving the patient education process and in assisting the pharmacy community in its goal of improving patient safety.

Adolescent↗

Two-year comparison of income, education, and depression among parents participating in regular Head Start or supplementary Family Service Center Services.

Changes after 2 years in a Head Start Family Service Center Demonstration Project were assessed through pre-implementation and post-implementation interviews with 80 parents of Head Start children to evaluate changes during the project noted for the children's parents. Compared with parents in regular Head Start, parents in the supplementary Family Service Center project reported more contact with staff, increased their functional literacy scores, and increased their family incomes. The percentage of these parents with high depression scores decreased. These changes encourage implementation of more intensive social services within Head Start programs as a means of effectively assisting Head Start parents.

Adult↗

HIV/AIDS epidemic in India: risk factors, risk behaviour & strategies for prevention & control.

Since the first report of HIV infection in India in 1986, the virus has spread all over the country although there is geographic variation. There are estimated 5.1 million people infected with HIV with an overall estimated adult prevalence below 1 per cent. Surveys carried out in different sub-populations have yielded prevalence estimates, but data on HIV incidence are limited. Both HIV serotypes 1 and 2 exist in India and HIV-1 C is the commonest subtype reported. Sexual transmission of HIV is most predominant. Spread of HIV in intravenous drug use settings is localized mostly in the north eastern region and metropolitan cities and parent to child transmission is on the rise. Dual epidemics of HIV and tuberculosis, increase in the number of infected women, stigma and discrimination are the main concerns in the Indian HIV/AIDS scenario. There is an increasing political will and commitment for HIV prevention and control efforts in India. A multi-disciplinary approach combining targeted interventions like early identification and treatment of STDs, condom promotion, blood safety, drug de-addiction programs and expanding and strengthening VCTCs and long-term strategies like awareness oriented to behavioural change especially among vulnerable populations, young people and women, steps towards improvement of literacy, status of women and overall development, reduction in poverty and development of primary prevention interventions like vaccines and microbicides will have to be considered for effective prevention and control of AIDS in India.

Female↗

Graduate students' experiences in web site development: a project assignment for nursing informatics class.

As healthcare delivery systems' requirements change, nurses will not only have to process and communicate more information, but the nature and types of this information as well as the communication methods will also dramatically change. Nurses must comprehend that information technology is the key to these changes. Korean nurses and nursing students need to enhance their computer technology knowledge and skills as the Korean health delivery system rapidly embraces technological innovations. Yonsei University College of Nursing in Seoul, Korea has the longest history in nursing education and the first graduate nursing programs in Korea. It offered its first nursing informatics (NI) class in 1998, making it one of the first informatics programs in Korean nursing education. The purposes of this project were to develop nursing informatics coursework that enabled students to build skills in developing Web sites, and to measure the effect of the coursework in terms of the students' satisfaction and their confidence level. The author believes that this experience could be a helpful model for an international audience, although this is not an innovative project for some more advanced countries.

Attitude of Health Personnel↗

RWMODEL II: computer simulation of the Rescorla-Wagner model of Pavlovian conditioning.

RWMODEL II simulates the Rescorla-Wagner model of Pavlovian conditioning. It is written in Delphi and runs under Windows 3.1 and Windows 95. The program was designed for novice and expert users and can be employed in teaching, as well as in research. It is user friendly and requires a minimal level of computer literacy but is sufficiently flexible to permit a wide range of simulations. It allows the display of empirical data, against which predictions from the model can be validated.

Animals↗

Chick-embryo culture techniques employed at Karnatak University in Dharwad, India, for studying cellular and molecular aspects of morphogenesis.

The objective of the courses which this syllabus describes is to expose developmental biologists to embryo culture and embryo manipulation techniques and applications in quantitative analyses. The laboratory program complements classroom teaching by exposure to both inductive and deductive methodologies. Developmental biology teaching requires good background in cell biology, molecular biology and genetics. Developmental biology research requires computer literacy and an aptitude for quantitative methodology and graphics.

Animals↗

Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): a tool to screen adolescents for below-grade reading in health care settings.

OBJECTIVE: The magnitude and consequences of low literacy in adolescent health and health care are unknown. The purpose of this study was to validate the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen), a word-recognition test in English that can be used as a brief literacy-screening tool in health care settings. PATIENTS AND METHODS: A total of 1533 adolescents aged 10 to 19 years attending 1 of 5 middle schools, 3 high schools, 1 pediatric clinic, or 2 summer programs in Louisiana and North Carolina participated in face-to-face interviews. Demographic information was solicited, and participants were administered a battery of reading tests, including the REALM-Teen, Wide Range Achievement Test-Revised (WRAT-3), and Slosson Oral Reading Test-Revised (SORT-R). Internal consistency for the REALM-Teen was determined using Cronbach's alpha, and criterion validity was established through correlations with both the WRAT-R and SORT-R. Using reading below grade level (according to SORT-R scores) as an outcome, instrument accuracy and corresponding cutoff scores were calculated by plotting receiver operating characteristic curves and stratum-specific likelihood ratios. RESULTS: Participants were 50% black and 53% female; 34% were enrolled in middle school and 66% in high school. The average time required to administer the REALM-Teen was 3 minutes. Internal consistency was excellent, as was test-retest reliability. The REALM-Teen is strongly correlated with both the WRAT-R and SORT-R. Five reading level categories were identified: 3rd grade and below, 4th to 5th grade, 6th to 7th grade, 8th to 9th grade, and 10th grade and above. Forty-six percent of participants were reading below grade level according to the SORT-R and 28% had repeated at least 1 grade. CONCLUSION: The REALM-Teen is a brief, reliable instrument for assessing adolescent literacy skills and reading below grade level.

Adolescent↗

Diet therapy for minority patients with diabetes.

Diet therapy for minority diabetic patients must be directed to NIDDM, the most prominent form of diabetes in minority populations. Diet programs must be tailored to the cultural framework, and traditional foods with desirable characteristics can be encouraged. To teach patients about diet, educators must use educational techniques appropriate to culture and literacy of the patient and family. Single-concept messages such as "eat less fat" or "eat less food" promote learning and minimize failure. Nutrition information can be divided into sequenced manageable steps that can then be individualized to the patient's setting. No single set of exchange lists will suffice for all minority groups, nor are exchange lists themselves appropriate for all situations. To meet the needs of minority patients, nutrition educators must use a variety of tools and techniques relating to the foods of a particular ethnic group. Sound education strategies and simplified materials for NIDDM patients should also be employed.

Diabetes Mellitus, Type 2↗

Food security: what the community wants. Learning through focus groups.

We used focus groups to learn the range of issues threatening food security of low income residents in our community. Five major themes emerged from the discussions: literacy, money, time, mental health and self-esteem, suggesting several approaches that could help ensure food security: 1) education, 2) sharing of resources, 3) coalition building, and 4) advocacy. Education programs have to be practical, allowing for demonstrations and hands-on learning while emphasizing skill building and problem solving. Incorporating a social aspect into learning may compensate for the social isolation and would capitalize on the impressive mutual support we witnessed. Strategies based on self-help and peer assistance may counteract low self-esteem and overcome suspicion of health professionals. A community-wide effort is needed to address the factors contributing to food insecurity. We envision the formation of a coalition of professionals, agencies, and low income people to develop a comprehensive strategy for achieving food security.

Community Health Planning↗

Oncology nurses' use of the Internet for continuing education: a survey of Oncology Nursing Society Congress attendees.

A publication and continuing education company conducted a survey at the 23rd Annual Oncology Nursing Society Congress to determine whether nurses are using the Internet and, if so, for what purposes. Survey results revealed that oncology nurses are using the Internet for a variety of educational purposes, which include drug information, literature searches, academic information, continuing education, and patient education. Continuing education providers should continue to pursue the Internet as a means of meeting the needs of oncology nurses for quick, up-to-date information in their field. There is a need for further documentation on the use of the Internet by nurses for continuing education, including topics and program formats that would be most beneficial.

Attitude of Health Personnel↗

Health sector in India--progress, challenges and the way forward.

Health is a priority goal in its own right and a central input into economic development and poverty reduction. Significant achievements have been made in a number of areas which include health parameters, legislation, research and technology and disease control. The life expectancy has gone up by 17% since 1981. In disease control significant achievements are in sight. Some new programmes have been introduced with the changes in disease profile. Significant progress can be seen in leprosy control, blindness control, TB control and iodine deficiency disorder control. Some legislations were also enacted to protect life and personal liberty as the constitution holds the right to healthcare as a fundamental one. Immediate medical relief and preventing major outbreak following disasters is another area to fight with. There are some challenges to face with like propulation stabilisation, to reduce infant and maternal matality, mobilisationof funds on health, to increase manpower, to increase female literacy and so on. Control of some diseases like HIV/AIDS, vector borne ones, cancer, cardiovascular diseases, diabetes, trauma related injuries, mental disorders is another point to improve healthcare delivery. To meet challenges to the health system the way forward has to be multipronged, focusing on finance, manpower, research and social factors like sanitation, drainking water availability, female literacy, etc.

Developing Countries↗

The evolution of undergraduate medical informatics programmes.

This article summarizes developments in the teaching of medical informatics to undergraduate health care professionals. Whilst clinical schools are adopting quite different approaches to informatics education and training, there seem to be a number of common factors shaping educational policies and the resultant programmes. Different professional schools face similar problems in relation to resources and staff development. At the same time, examination of different syllabuses suggests the existence of divergent models as to what medical informatics should encompass, as well as different views as to what elements of the domain should be included in preliminary or undergraduate courses. The relevance of these trends to health libraries is briefly considered.

Attitude to Computers↗