Information Technology Training in Primary Care

Introduction

Summary

Nursing skills, IT training, and education are important factors having in-depth implications on the quality of health care. Many studies have been conducted on this topic, mostly in America and Canada. This paper has tried to bridge the gap between literature available on imparting information technology training in primary care settings and how it affects nursing skills to improve the delivery of health services.

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The article is very informative and discusses different technology uses in nursing care practice. Today new software and web tools allow organizations especially hospitals to effectively communicate with employees and customers. Technology offers a user-friendly environment for workers to accomplish a task. Authors, details about different software offered by different companies that hospitals and medical organizations can use to enhance their nursing care practice relationships. Some very good company’s software is available freely on the net for instant download. Article cover such software as Microsoft’s Sitebuilder, Sun Microsystem’s Java development tool kit, the PointCast, The Alliance Strategy, and the Lesson, – all of them offer different communication tools to build high-speed corporate intranets. By reading uses of different software one can gain the basic knowledge and uses of these different software and use them according to their needs. Every different software and website is described separately so that readers can easily understand their uses and benefits.

Critical review – Strengths and weaknesses

Strength of the article is that it throws light on core issues in imparting IT education among nurses. The West is falling into the trap of complacency. Being known as a develop nation sometimes indicates that hard work is not necessary to excel in the job market. Competition however, no longer rests by a few participants. Asia is a home of rapidly developing nations that churn out graduates by the minute. Due to stiff competition amongst their nurses, many work harder than nurses in the West. In India, for example, the Software Technology Park produces thousands of software engineers who are being employed all over the world due to their continuous learning curve in computer expertise. Their work forces can easily take-over back-end systems of multinational companies due to their competence and well-earned skills.

Competing with highly motivated individuals can be detrimental for those who have already become complacent in their ambitions.

Education institutions geared to producing competent graduates of the 21st Century must be able to motivate nurses to not only do well “in school,” but to do well as compared to other nurses who are enrolled in the same program across the globe. With globalization at its heights, it is highly likely that they would have to jostle for higher paying jobs with better qualified and skilled graduates.

Technology Education should be able to encourage nurses to open up on their skills and interests. There are plenty of courses available in local universities but many nurses still feel confused when it comes to their future. Nurses should be allowed to pick and choose the courses and societies that allow their skills to shine most. In fact, part of discovering one’s interests and skills is to provide a variety of focused courses that can be mixed and matched with one another to provide for a more effective learning curve. Nurses excel when they enjoy learning and when what they learn capitalizes on their strengths rather than weaknesses.

With a lot of adequate guidance and career counseling, it would be easier for nurses to excel at their courses by investigating into their skills and interests that will effectively complement a workforce. Allowing this to happen will create more opportunity for higher paying and effective positions for graduates who are enthusiastic about their interests. New graduates will also be recognised as unique individuals and this invokes confidence when entering the daunting world of employment.

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On the job training from a young age saves time and energy. It is more costly to train adults who are already working as compared to younger employees. They normally thrive on enthusiasm when it comes to learning. Training adults also requires allot of patience.

Job training will also build confidence in new graduates who enter the workforce. They would be able to communicate more effectively and present practical ideas that are not solely based on theories and academic research. Having new graduates at this new level of confidence will bring a breath of fresh air into what sometimes can be a stale environment. New blood is always required to bring in new ideas and understand new concepts.

IT education allows new graduates to adapt to the new organic hierarchical structure that most organizations have today. Being able to understand reporting lines and organizational culture will blur the lines of apprehension new graduates usually harbor when entering the employment market.

Nurses who adapt quicker are more likely to add-value to the health care services as compared to new nurses who are not much skilled for IT, and who are afraid of change and require further coaching and encouragement to move forward.

Nurses who are able to adapt to the workforce will find they have less problems fitting into working groups and teams. Ice-breaking sessions are shorter when shyness and apprehension is absent. New graduates can be taught to be more task-oriented without losing sight of personal etiquette.

IT education incorporates vital information that will benefit graduates immensely when entering the work-force. Allowing nursing graduates to prepare themselves of the dynamic environment many industries operate in will smoothen the transition between the academic world and the corporate world substantially.

In some industries, hierarchy does not exist. Some industries deal with cross-cultural clients only. There are industries where is no definition of working hours. Some industries are more likely subjected to frequent changes in regulation as compared to others. Though there is no definitive culture of any certain industry, graduates who are aware of the different dynamics pertinent to different sectors of the work force will be able to appreciate the challenges that lie ahead.

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Being caught blind-sighted a few weeks into a job is not a good starting point for a career. It can be intimidating to start a new job in a new environment with only an academic qualification to the name, but information technology learning should be able to give nurses the extra edge who wishes to enter the employment market with a fair amount of preparation.

Understanding and being able to use technology save a lot of time, manual labour and energy as compared to working in a paperless environment. Documents can be safekept perpetually and communication is borderless. On top of that, information no longer remains a grave mystery and there are plenty of methods to construct and reconstruct data.

With IT education graduate are more likely to adapt to changes in new technology as compared to those who have been in the job market for a longer period of time. New technology is an inevitable phenomenon that will continue to evolve and introduce new concepts that require new learning tasks. Fresh graduates are more inept to get acquainted with new technology as the general consensus is that latest technological knowledge represents a change for the better. Manual work is limited and jobs are made easier. Expanding their technological know-how also represents new skills and understanding for future direction.

Today a nursing graduate understands how technology is and can be applied to the work-force. They also understand that technology can make an employee redundant should he or she fail to upgrade his or her skills. New graduates, who enter the workforce with the motivation to learn and improve will in fact, contribute to ever-changing technology to stay-ahead of their game.

Evaluation

Ayre et al 2007 report that Singapore has one of the world’s best health care facilities. The public health care system is providing 80% most of the healthcare facilities and these facilities are under strict control of the national level audit body.

There are almost 20 thousand nurses, comprising of 73.3% registered nurses (RNs), 24.4% enrolled nurses (ENs) in Singapore, also including this count are health care assistants (HCAs) which help nursing staff in carrying of non-technical tasks. The nursing force mostly has females, 65% of whom are not more than 39 years of age- which is very young as compared to the data of US and Canada where many nurses are in the age of 45-54 years (Canadian Institute for Health Information 2005).

Resources and Services Administration 2005). 75% of nurse in Singapore work fulltime which is more than the percentage of either US or Canada. The nursing profile of Singapore is very diverse; many foreign nurses are also employed to compensate for the shortage of domestic work force. Foreign nurses have to pass an examination and also had to go through a competency assessment of three months before commencing duty at a health care facility. Most of the foreign nurses come from Philippines, china, India and Malaysia (B.C. Ang, personal communication, 14 November 2005). The proportion of foreign nurses in Singapore (18%) is again very high as compared to those of US (4%) or Canada (6%).

Nursing education for registered nurse in Singapore is either a 2 year accelerated diploma program or a 3-year diploma program. Baccalaureate degree attaining percentage for Singapore nurses is only about 13% as compared with 47% in USA and 32% in Canada.

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(Canadian Institute for Health Information 2005; Health Resources and Services Administration 2005; B.C. Ang, personal communication, 14 November 2005)Enrolled Nurses undergo a 2-year certificate programme in which, technical nursing skills building is emphasized. Health care assistants normally undergo a 1 year vocational training program for learning basic nursing skills along with theory.

Model for skill mix is the same in Singapore as is in US or Canada i.e. teams of RN/EN/HCA mix, a RN/EN mix, or a RN/HCA and possibly an all RNs (McGillis Hall, 1997; Unruh 2003). The nurse to patient ratio is calculated manually by the ward nurse managers as opposed to the computerized workload calculations used in US and Canada. The staff mix has not yet been researched in Singapore for an optimum proportion of RNs and ENs and HCA.

A rich skill mix (especially of higher proportion of RNs) has been found to be more useful in patient outcome and resulted in lower mortality (Estabrooks et al. 2005). Higher share of RNs have also been found to have resulted in reduction of different infections. Medication errors were also reduced with greater RNs in the mix (Blegen et al. 1998). Another study indicated a better health care outcome and discharge to be related to the proportion of RNs in the skill mix. Similarly lower levels of pain, better-perceived self care ability and health status, and increased post-discharge Satisfaction appeared to be related to higher percentage of RN hours of nursing care.

Nevertheless, research outcome so far has not yet been able to suggest an optimum level of RN percentage as different studies suggest different percentages ranging from 46% to 96% (Blegen et al. 1998; Cho et al. 2003; McGillis Hall et al. 2001; Needleman et al. 2002). Nursing skill mix studies has received a lot of criticism also because of the methods employed and assumptions made. There is also a need of standardizing or defining of what should be considered as an appropriate outcome. More variables also need to be taken into consideration such as the qualification of nurses, partition between technical nurses and managerial nurses and the work environment.

Diversity is an important characteristic that has been almost ignored when studying the nursing culture mix. The diversity of the nursing team can affect the through put as foreign and local nursing will have many differences in their experiences, training and communication skills. Diversity is believed to decrease the unit effectiveness. The training of foreign nurses in Singapore before actual job will reduce the differences but still this diversity will be of importance to the outcome of the team.

The background of education of the nurses also is an important variable affecting the performance of the team. Special training/education of nurses rationally seems to result in better outcome. Studies need to consider this fact and should split ‘specially trained nurses’ from normal nurses.

The role of ENs and HCAs in Singapore is changing as the scope of work of RNs is getting bigger. As RNs are allowed into doing more complex tasks the HCAs are forced into taking more of the role of RNs i.e. directs patient care activities. This role shift is inevitable because of the nurse shortage, but very alarming as the quality of health care will reduced with this role overlap. This role overlapping also should be studies against the outcome of the teams. A survey in Singapore as found that 70% of the work hours of RNs and ENs are spent in commencing non technical duties, which will definitely affect the quality of direct health care activities. A study of US also indicated spending of less time on direct health care activities by RNs and more on non-technical tasks.

Research is still required into investigating the nursing skill mix and the outcome. Many more variables and factors i.e. educational background, ratio of foreign and local staff, distribution of their time etc. need to be taken into consideration for more solid conclusions.

Increasing Use of online libraries as source of information in nursing care practice. The research article lacks discussion about the benefits and uses of online libraries. There is no debate that libraries are very important sources of information especially for academics and scholarly audience. In today’s globalization and technology era, where diseases are spreading without boundaries, and in places where there is shortage of health care services, online libraries play important role not only for the academic and scholarly audience but also for the non-scholarly audience.

With the extensive use of computer technology, online libraries gives people around the world equal access to similar information and it benefits both the libraries and users.

On page one of his abstract, Vrana says, “The advent of digital information resources changed library organization and management intensely.”

The initial changes from printed form to digital form is in the conjuction with the growth of online higher learning even in medical specialization. If online higher learning institutions cannot provide prompt and adequate access to digital format, students would be in trouble so is the credential of the institution. Consequently, the quantity of digital format information is increasing, so are the automated and digital libraries. Commercial publishers as well are trying to enhance their existing services by developing online access services to meet the increasing needs of their users for full text scholarly and non-scholarly information.

Since the demand of the users for both scholarly and non-scholarly information in digital format are increasing, libraries are increasing their collection of digital information to meet this demand. Nonprofit organizations as well are providing services for online libraries that contain health information.

Journals represent scholarly communication can be easily available to people around the world at an instant access. They come in different forms such as data table, multi media, or other part of information that is not included in the printed form.

Seeing the change in the way consumers’ need for information and the sophisticated technology and its usage, libraries find that online provision needs to be expanded a long with the growing service of online higher learning. As digital format information is growing in its importance, so is its acceptance among the academics and scholars. Michaelson & Garret find that even America Physical Society declares that online journals are just as official as the printed journal. This indicates that the content of online libraries are credible source of information on health issue.

Some of the benefits of online libraries are, according to Michaelson and Garret, cheaper cost compare to the printed form in terms of binding and storing; convenient access for the users because they can access the information from anywhere around the world and at any time possible.

Different from the traditional libraries, there is no potential that the information is not available because it is rented out. The information is also searchable and people can searh for the information more effectively without reading through all the pages.

The McNeese State University describes that the advantages of online libraries are its standard classification system which makes the information to be easily located; the quality of material is purchased based on selection criteria; and the information available are in historial format.

Another advantage of online libraries may also include the simplicity of cataloguing and classification system, which are a little different from that of the traditional system. The traditional cataloguing and classification are without links which tend to add to research time, while online libraries, if properly designed, may offer links that make users’ research time is more efficient. In addition, modern automated libraries, says Vrana, transform “their card catalogues first into online public access catalogues (OPACs), and then to Web public access catalogues (WebPACCs) offering means of information discovery by giving access to bibliographic records about information resources, which are part of library holdings.”

Moreover, online libraries provide digital links to different sites that are related to the state information with search and retrieval tools that make it easy for the users to obtain the information at a click of the mouse. If the links are designed in such a way that would cover a global grid, the opportunity for the users to increase their knowledge in terms of qualitative research.globally also increase.

For the above advantages, universities in Western Europe, North America, and Japan have offered the delivery of their courses material in digitalized format including courses in health care.

Online libraries do have some disadvantages, though. For example, the information acquired is based on planned acquisitions. Reynolds & Wilson describe that, though not exactly accurate, online materials compiled are often less up-to-date, for the historical data, they tend to have no explanatory notes, and no apparatus criticus.

The McNeese State University describes that the disadvantages of online libraries are that not all information are available because others, especially the important ones are available only in printed form. Similarly, digital format is not as complete as traditional format unless the online libraries are willing to extend their service to produce online information in the book format where users have access to complete information. Vrana also indicates that the problem in some online libraries is that they do not have “dynamic links between bibliographic records and information” associated with the references they are giving.

Unfortunately, says Vrana, digital libraries are still outnumbered by automated libraries because automated libraries are offering more diverse and aggregate information to both commercial and non-commercial audience, particularly to academic community.

In addition, online libraries open all the time and the material borrowed is not returnable or that users would not be penalized for late return. Since digital libraries are growing in demand for its services and content, and whose services are very important to academic and scientific worlds, Vrana suggests that it is important for online libraries to extend its contents by providing additional services such as direct linkage to citation or reference to the information in the form of full text stored in the database of either the library or in the database of different library.

Conclusion

Education requires nurses to develop interpersonal skills that will allow their work to be brought to the next level. Interpersonal skills has evolved from the basic speaking and writing to a whole new interesting spectrum of channels.

Speaking would include understanding others and learning how to get along with one another to optimize the effectiveness of the team. Furthermore, with the melting pot of cultures around the world, it would not be surprising for many graduates to move on into the international arenas, for example, through Multinational Corporations. When there is a need to interact with people of other cultures and countries, it would be wise for new graduates to understand sensitive matters and / or beliefs that perhaps were not at all important during college.

Writing would be the same too. With the advent of technology, communication amongst peers, colleagues, supervisors, subordinates, clients and even suppliers are all transparent. Anyone can talk to everyone nowadays. With this new concept of immediate transmission of messages, it is important for new graduates to acknowledge the disposition they should be in at all times.

It is vital for the education system to allocate sufficient resources for training programs with respects to communication both written and oral. Other training workshops that would boost interpersonal skills would include leadership programs, teambuilding get-aways, cross-cultural exchange programs and other seminars that are geared to improving relationships with others.

Reference

Blegen, M., Goode, C. & Reed, L. (1998) Nurse staffing and patient outcomes. Nursing Research 47, 43–50.

Canadian Institute for Health Information (2005) Workforce trends of registered nurses in Canada, 2004. Web.

Estabrooks, C.A., et al. (2005) The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, 54, 74–84.

Lankshear, A., Sheldon, T. & Maynard, A. (2005) Nurse staffing and healthcare outcomes: a systematic review of the international research evidence. Advances in Nursing Science, 28, 163–174.

McGillis Hall, L. (1997) Staff mix models: complementary or substitution roles for nurses. Nursing Administration Quarterly, 21, 31–39.

Needleman, J., et al. (2002) Nurse staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346, 1715–1722.

The McNeseese State University Library. The Advantages and Disadvantages of Online Library. 2008. Web.

Unruh, L. (2003) Licensed nurse staffing and adverse events in hospitals. Medical Care ,41, 142–152.

Vrana, Radovan M.Sc. (2003). Advantages and disadvantages of current reference and digital objects linking models. Department for information sciences – Faculty of philosophy. 2007. Web.

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