Educational Informatics: e-

learning
Onesmus Marete
 e-learning Terminologies
• e-learning is another of the “e-words” that has crept
into our language.
• It indicates a marriage between electronics, generally
a computer, and educational software.
• It includes many different types of computerized
instruction, from instruction using only the text
portion of a computer to internet-based distance
learning using a multimedia capable computer.
• There are many older terms that are used to refer to
e-learning such as computer-assisted instruction (CAI).
Computer-based learning (CBL), and computer-based
instruction (CBI)
 Instructional Methodologies
• In any learning situation, it is important that 4 goals be
considered.
• Information must be presented,
• Students must be guided in their learning,
• They must be allowed to practice using the
information, and
• Some means of assessing the learning needs to occur.
• Some types of e-learning do not accomplish all these
goals and must be supplemented with other modes of
teaching.
•There are 5 approaches to designing e-learning:
•Drill & practice,
•Tutorials,
•Simulations,
•Instructional games, and
•Tests.
Many programs combine these approaches.
 Drill and Practice
• Among the 1st educational software introduced
• It was easy to produce & freed teachers
repetitive teaching
• In one format it emulates a teacher using flash
cards
• Other formats include MCQs that students can
use to review previously learned material
• The best use of drill & practice is to aid
memorization
 Tutorials
• A program designed to impart knowledge to
learners
• Information is imparted & questions asked
• Explanation for wrong answers is given
• Tutorials do not tell the learner what they
need to know & learners proceed at their own
pace
 Simulations
• Simulations take the form of case studies
• They are designed to allow the learner to
practice a patient encounter by providing care
to a simulated patient
• A simulation has many different uses. It could
be used as part of an orientation or in-service,
or with a computer projector in a classroom
 Instructional Games
• Games can be very similar to simulations, or
they can be used in a drill & practice mode.
• Their purpose is to provide motivation
• They are characterized by completion among
opponents
• Games that are successful must meet
instructional requirements and be enjoyable
for players
 Computerized tests
• Computers can be used to score tests, create
them, or administer them
 Nursing Informatics
• Through nursing informatics, the health care
information systems that are being developed will
include the nursing data needed to show the value
that nurses add to health care
• The overall focus of nursing informatics in the
clinical area is to integrate information from all
areas into a usable whole that provides the clinical
nurse with easy access to pertinent data and
information so the nurse can provide high quality
care
 Main Sources of Patient
Information Needed for Patient
Care
1. Information about the patient – includes not
only data pertinent to immediate physical care,
such as the results of the history & physical,
medications, & lab reports, but also
demographic information & information about
the patient’s support system.
2. Institutional information – includes data of
immediate concern, such as tracking a piece of
equipment or a person as well as agency’s
policies concerning admission criteria, release of
information & confidentiality
3. Domain knowledge – pertains to nursing
knowledge as well as to knowledge from
related disciplines. It includes knowledge
from literature review & clinical experiences
4. Procedural knowledge – focuses on the
procedure for performing eg starting an IV
line
 Standardized Terminologies
• With the introduction of computerized
information systems, the need for nursing to
identify its data & agree on the terminology to
use for documentation has become of
paramount importance
• When nurses do not use standardized
terminologies for documentation, their
contribution to patient care does not allow for
the multiple uses of health care data, placing the
survival of the profession at risk
• A standard is a documented agreement containing precise
criteria & definitions that must be used consistently.
• Given the international nature of health care, it is
imperative that standards be used to record health care
documentation
• A nonprofit group known as the International Organization
for Standards (ISO) overseas all international
standardization.
• The purpose of ISO is to expedite standardization to
facilitate international commerce & to promote
cooperation in intellectual, technological, scientific, and
economic activities
 Nursing’s Need for Standards
• Standards have been developed in all fields,
including health care, because the benefits of
having them in place outweigh any
disadvantages
• Using standards improves communication,
facilitates research, & improves the ability to
predict resource needs
• Nurses, & even those involved in informatics,
have little knowledge of our present standardized
terminologies. This problem exists worldwide,
resulting in several problems
1. Nursing care is inadequately funded and billed
2. Nursing resources are inadequately planned &
allocated
3. The contribution of nursing to health care cannot
be calculated
4. It is very difficult to design decision support
systems
 Historical Nursing Classification
• In the past, we believed that the data needed
for coding outcomes were strictly based on
medical requirements.
• The need for data from the nursing point of
view becomes apparent when one considers
the situation in the following table
 Comparisons of medical & Nursing data
68-Year old woman
Medical data Nursing data
Osteoporosis, mild Physical injury, potential due to:
1.Loose carpet edges
2.Bathtub without hand grips
3.Inadequate lighting in bedroom
Treatment Treatment
Calcium 500 mg tid Fix carpet edges
Install hand grips in shower
Use higher wattage bulb in bedroom
Outcome Outcome
Fractured hip from fall Freedom from falls
•Where will the emphasis of planning be with just medical data?
•With only nursing data?
•Will the outcome of planning considering both yield a better outcome?
• Unfortunately, data like these are not routinely
collected; thus, they are not available for outcome
studies or to demonstrate the savings in heath care
costs
• For nursing data to be routinely captured & routinely
used in other measurements requires the use of
standardized terminologies. Three tasks are involved in
standardizing nursing terminology
1. Identifying the necessary data elements
2. Developing the terminology
3. Classifying the terminology
 Nursing Minimum Data Set
• The nursing minimum data set (NMDS) identifies
the data elements needed, whereas standardized
terminologies provide the classification &
vocabulary to use in recording these data elements
• A minimum data set is a list of data elements with
uniform definitions & categories that specifies the
minimum set of items that will meet the essential
needs of multiple data users in a specified area
 A minimum data set must meet
the following criteria:
• The data set must be useful to most potential
users, eg legislators, health care professionals,
administrators, & regulatory bodies
• The items in the set must be readily
collectable with reasonable accuracy
• The items should not duplicate other available
data
• Confidentiality must not be violated
• The absence of nursing-sensitive data sets mandated
for collection & used in healthcare planning was noted
in the early 1970s by several leaders in nursing. The
concept of NMDS originated in discussions at the 1977
Nursing Informatics Conference. The concept,
however, was not quick to catch on – few nurses had
much background in research, & of those, few saw the
value in everyday nursing data.
• Nevertheless, in 1985 a conference was convened to
determine which items to include in the NMDS, &
came up with the present set of 16 items in 3
categories: demographics, Nursing care, & Service
elements
 Elements of the Nursing Minimum Data Set (NMDS)
Nursing Care Elements Patient/Client Service Elements
Demographic Elements
1. Nursing diagnosis 1. Personal identification 1. Unique facility or
2. Nursing interventions 2. Date of birth service agency number
3. Nursing outcomes 3. Sex 2. Unique health record
4. Intensity of nursing 4. Race & ethnicity number of
care 5. residence patient/client
3. Unique number or
primary nurse provider
4. Episode admission or
encounter date
5. Discharge or
termination date
6. Disposition of
patient/client
7. Expected payer or
guardian
 Purpose of the NMDS
• Make it possible to compare data from different clinical
settings, populations, & geographical areas
• Describe nursing care in a variety of settings, including
institutional & non institutional settings
• Show or project trends regarding nursing care & resources
needed for clients with various nursing diagnosis
• Stimulate nursing research by providing links to data
• Provide nursing data to influence clinical, administrative, &
healthcare-policy decision making
Because there is no mandatory collection of the NMDS,
nursing is still invisible in data used for health care planning
and policies
 Standardized Nursing
Terminologies
• The present NMDS designates those elements that
need to be collected but does not specify the
terminology that is needed to collect this data
• This task can be accomplished by using the
standardized nursing terminologies
• At present, many terminologies are in use. Many
are locally determined & are thus not available for
data comparison purposes outside those agencies
 Role of the American Nurses
Association (ANA)
• The ANA has been a prime mover in the US (and in
extension the World) in the recognition of the value of
nursing data. In 1989, it created a steering committee
to support clinical practice.
• One of its activities has been to set criteria for the data
sets & classification systems that support nursing
practice & to recognize those that meet these criteria
• The criteria state that the data set, classification or
nomenclature must provide a rationale for its
development & support nursing practice by providing
clinically useful terminology
North American Nursing Diagnosis
Association (NANDA)
• This organization was initiated by two nurses
who in a project requiring patient data to be
computerized became frustrated that nursing
data could not be computerized
• They convened a conference whose objective
was to identify terminologies that emphasized
the unique role of the nurse. These have been
modified over time
 Challenges and Issues in
Informatics
Concerns about health care data
• In the present, patient care records are seen as the
property of the health care provider that created them, as
is the responsibility for their accuracy
• The issue of responsibility for the record will have to be
resolved.
• Should the consumer be ultimately responsible for the
contents of the record?
• Should there be a healthcare professional designated by
the consumer in carrying out this responsibility.
• To meet the requirement of client access to personal
records, it will be necessary for consumers to have access
to their electronic records
 Protection of healthcare data
• When paper records were (are) used, healthcare
providers sealed them away in file cabinets.
• Laws that governed the use & disclosure of this
information left many gaps that became evident
when computerization arrived.
• As a result, this information has sometimes been
shared inappropriately, as with drug suppliers
who used this information to target their
marketing efforts
 Other concerns
• Protection from outside intrusions
• Protection from data loss
• Legal issues
• Ethics
END