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[The computerized clinical record: merely an academic discussion or an essential technology?].

The publication of the results of a study on improving patient records, recently completed by the Institute of Medicine of the National Academy of Sciences, in the United States, where it was concluded that the Computer-Based Patient Record (CPR) was an essential technology for health care, witnesses the importance and expectations that patients, physicians and other health care professionals, hospital administrators and health systems managers, place on forms of management of clinical information that are more accurate, complete and efficient than what is possible with current methods. A large amount of work is in order, to develop standards for sharing clinical data between clinical information systems and for representing medical terminology and knowledge, to create legislation regarding data protection in CPR, and for the preparation of health care professionals for the information and technological demands of the future. Recent developments in database integration, and the experience of several CPR systems developed at academic institutions, have led to the progressive delineation of the architecture of modern CPR systems.

Computer Security↗

Assessment of computer learning needs and priorities of registered nurses practicing in hospitals.

The purpose of this study was to identify computer learning needs of practicing nurses at the bedside. Knowles' adult learning theory clearly implies that learners have a role in identifying their learning needs. Expert opinion is the second source of needs identification and complements learner input. This principle served to underpin the conceptual framework of this study. A Delphi technique was used to solicit expert opinions from nurse informaticians about the computer learning needs of practicing nurses. A 75 knowledge/skill item questionnaire was developed from the expert consensus of the Delphi and distributed to 150 registered nurses considered to be computer novices. Novices' responses were compared to the experts' responses to identify content essential for nurses to be able to use computers in their practice. Further, sequence for content delivery was postulated through the comparison of expert and novice opinion relative to the essential/nonessential nature of the content.

Clinical Competence↗

Work excitement among computer users in nursing.

An exploratory study of 268 nurses and their practice patterns has yielded a new dimension of work excitement--computer use. The convenience sample included staff nurses and clinical nurse managers. In this article, individual and organizational characteristics of nurses, their varying computer skills, and levels of work excitement are compared. Using the work excitement tool developed through the Practice Excitement Project, data were collected on self-perceived level of computer skill and work excitement; practice patterns; interest in work; exciting and frustrating experiences when using the computer at work; and overall exciting and frustrating aspects of nursing. Pairwise comparisons revealed that nurses who classify themselves as having expert skills had significantly higher levels of work excitement than nurses who were novices (F = 5.937, p < 0.05), or had no experience with the computer (F = 7.026, p < 0.01). Nurses with intermediate skills also had significantly higher levels of work excitement than novices (F = 5.289, p < 0.05), or non users (F = 5.740, p < 0.05). Computer users were found to be significantly less negative about their work. In addition, nurses overwhelmingly considered the computer a nursing technology capable of making their work easier. This reflects the positive orientation nurses have toward use of computers in nursing. The findings further suggest that the introduction of computers could not only improve unit morale but could also stimulate the learning of new skills related to effective and quality care delivery.

Adult↗

PEN&PAD (Elderly Care): designing a patient record system for elderly care.

Practical experiences in the work analysis and design of a computer-based patient record system for use by doctors on an elderly care ward are discussed. A diagrammatic technique named "Task Oriented Flow Diagrams" is briefly described. This technique enables designers to formalise their understanding of users work tasks in manner that is comprehensible to users, and thus can form the basis of a dialogue between designer and users. A prototype patient record system is described and the results of its evaluation with users presented.

Aged↗

"Pre-medical" informatics.

Many authors have presented arguments in the recent medical literature discussing the premedical preparation of medical students. Much of this work seems to center upon the need to balance the strong science concentration with an increased emphasis on humanities courses. This paper investigates another potential shortcoming of premedical education, that of information literacy. It defines the problem, argues its existence, and proposes the ready availability of a solution.

Computer Literacy↗

Supporting patient centered computing through an undergraduate nursing informatics curriculum stage III.

The patient has been one of the focal points of the process followed to design, implement, and evaluate an integrated informatics curriculum in a baccalaureate nursing program. This paper describes the third stage of a process to design the informatics nursing courses. A challenge is to structure the nursing informatics curriculum so as to enhance the patient care process. A number of strategies were used to focus the curriculum, students, and faculty around the patient. The basic components of the framework are information, technology, and clinical care process. The clinical care process which emphasizes the patient is an inherent part of the conceptual framework in all aspects of the curriculum. Therefore the faculty has ensured a blend of information, technology, and the clinical care process throughout the curriculum.

Computer Literacy↗

Educational implications of nurses' brain dominance, learning styles, and attitudes toward computerization.

Nurses have been described as exhibiting computer anxiety as hospitals become automated. Suggestions have been made to provide inservice education to decrease computer anxiety before systems installation. This study examined nurses' brain dominance profiles, learning styles, and attitudes toward computers. Results indicated that 95 staff nurses had 14 different learning styles and were willing to use computers to document nursing care. As hospital inservice education programs are developed, a variety of teaching-learning methods needs to be developed to facilitate learning this new technology.

Adult↗

[The individual characteristics of the physiological support for the activities of schoolchildren while learning to work on a computer].

The ECG was recorded by telemetry in schoolchildren when they learned computer tasks. Successfulness of learning was estimated. The EEG was recorded with the same psychophysiological parameters (simple and complex reaction times, search for orders of numbers in special tables and others) under the laboratory conditions. Neuroemotional stress (NES) during computer learning as measured by the heart rate parameters was shown to depend on the stable individual characteristics. NES was significantly higher in introverts than in extraverts (determined by Eysenck's questionnaire). The most prominent physiological signs of NES were revealed at the stages of computer task learning when mistakes in computer programs were searched for and corrected. The speed of learning of computer tasks was found to be proportional to a lability of autonomic heart rate regulation and to be correlated with such psychophysiological parameters as decision making time, the number of false preliminary reactions and others.

Child↗

Revitalizing primary care: a 10-point proposal.

Even if all Americans had medical insurance, many of them still would not have access to adequate medical care, largely because of the lack of primary care physicians. Increasing their numbers is one aspect of health care reform in which the medical community can have a resounding impact. Specific recommendations for shaping the next generation of physicians are offered.

Career Choice↗

Robo-Pill.

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Computer User Training↗

Computer utilization trends in biomedical illustration.

A national study was designed to determine computer utilization trends in biomedical art and illustration in North America. In the fall of 1991, 453 surveys were mailed to the Association of Medical Illustrators and the Association of Biomedical Communications Directors; 112 (25%) completed survey forms were returned. The survey compares similarities and differences between the groups with regard to the impact (e.g., staffing, time, cost, and quality control) of computer technology (e.g., hardware, software) on biomedical artwork in the health sciences.

Administrative Personnel↗

The health sciences librarian as Internet navigator and interpreter.

Over the past several years, thousands of networked information resources have become available to individuals and institutions with access to the Internet. Unfortunately, the dizzying array of computing and networking environments often frustrates end users' attempts to navigate the Internet. Librarians have begun to take responsibility not only for instructing users in the use of basic network tools such as file transfer, remote log-in, and electronic mail, but also for answering questions concerning network access and even information system design. The authors show how, by continuing to adapt to this new and volatile environment, health sciences librarians find themselves playing increasingly important roles in shaping the information policies and practices of their institutions. To illustrate these new roles, the authors review the experiences of health sciences librarians at the University of California, Los Angeles, and the University of California, San Diego. These institutions have varying and complex networking environments, and their biomedical libraries have taken lead roles in clarifying and interpreting their particular Internet features.

California↗