NCM 110 - Nursing Informatics 1

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INTERNET TOOLS FOR ADVANCE NURSING PRACTICE

Basic and advanced Internet skills are needed to adapt to a frequently changing Internet
environment and to retrieve the wealth of internet information applicable to clinical practice
in an efficient manner.

The objectives of the Internet tools for advanced Nursing Practice

1. Employ basic and advanced internet search skills in retrieving information pertinent
to advance practice Nursing
2. Access a variety of clinical practice internet-available tools, including bio-terrorism
information, organized within nursing process categories

Regardless of the search engine used, certain search methodologies, if applied correctly,
increase the efficiency of retrieval if needed information. as mentioned, by using this the
searchers will go directly to the desired information that they want and less hassle. also,
instead of using words to search information we could use terms.

BASIC ADVANCED INTERNET SEARCH METHODS

Regardless of search engine used, certain search methodologies, if applied correctly,
increase the efficiency of needed information.
Basic to Advanced Strategies when searching:
 Name the precise information being sought. If the search terms used are
precisely chosen, the searcher goes directly to the desired information.
 Use search strings (one or more search terms) rather than single words to
increase the preciseness of a search.
 Enhance search strings by using BOOLEAN or natural language
methods.  Use the Boolean terms:
1.) AND- when search strings needed to be added together
2.) OR- when equivalent terms or synonyms are used to capture the information required
3.) NOT-  when a specific result for searching is not desired to be included          

TYPES OF DOMAINS

In the Domain Name System, there is a hierarchy of names. The root of system is unnamed.
There are a set of what are called “top-level domain names” (TLD’s). These are the generic
TLD’s (EDU, COM, NET, ORG, GOV, MIL, and INT), and the two letter country codes from ISO-
3166. It is extremely unlikely that any other TLD’s will be created (Jon Postel; Domain Name
System Structure and Delegation; RFC 1591; March 1994).

Internet domain names are the alphanumeric identifiers we use to refer to hosts on the
Internet. The structure of Internet domain names was first described in RFC 819, and their
syntax was first described in RFC 822.

This section on search methods concludes with tips on evaluating the quality of government
(gov), education (edu), organization (org), and commercial (com) domains.

When using web sites for clinical decisions support purposes, the clinician must understand
differences among these domains and evaluate the credibility  of the content retrieved. In
general, clinician information obtained from governmental domains is likely to be less
biased then information obtained from commercial sites. The credibility of content from
educational web sites varies and is likely to be directly related to the academic quality of
the university the web site represents. An organizational web site is likely to present
organizational interests and bias. It is therefore incumbent on the clinician to evaluate the
credibility of the information obtained.

Top-level domains.  Internet domain names are organized by their levels, with the higher
levels on the right.

For example, for the domain “mail.twenty.net” the top-level domain is “net”, the second-
level domain is “twenty.net”, and the third-level domain is “www.twenty.net”.

Originally, the top-level Internet domains were associated with organizations, mainly
“.arpa”, “.csnet”, “.bitnet”, and “.uucp”.
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Eight Subject-Specific Top-Level Domains

Second-level domains.  Top-level Internet domains like “.com” are shared by all the
organizations in the domain. Second-level domain names like “yahoo.com” and
“livinginternet.com” are registered by individuals and organizations. Second-level domains
are the addresses commonly used to host Internet applications like web hosting and email
addressing.

Third-level domains.  Third-level Internet domain names are created by those that own
second-level domains. Third-level domains can be used to set up individual domains for
specific purposes, such as a domain for web access and one for mail, or a separate site for a
special purpose.

Country domains. Each country in the world has its own top-level Internet domain with a
unique alphabetic designation. A few countries and example domains are shown below.

bitne
Used for computers on the BITNET network.
t
Originally stood for “commercial” to indicate a site used for commercial purposes, but it
.com has since become the most well-known top-level Internet domain, and is now used for
any kind of site.
.int Used by “International” sites.
.edu Used for educational institutions like universities.
.gov Used for US Government sites.
.mil Used for US Military sites.
Originally intended for sites related to the Internet itself, but now used for a wide
.net
variety of sites.
http://www.livinginternet.com/i/iw_mgmt_isoc.htmOriginally  intended for non-
.org commercial “organizations”, but now used for a wide variety of sites. Was managed by
the Internet Society for awhile.

.ae United Arab Emirates http://www.abudhabi.ae/

.at Austria http://www.austria.at/
.au Australia http://www.morning.com.au/
.bb Barbados http://www.barbados.gov.bb/
.bm Bermuda http://www.kbb.bm/
.br Brazil http://home.iis.com.br/
.ca Canada http://www.canoe.ca/
.ch Switzerland http://www.badminton.ch
cl Chile http://www.santiago.cl/
.us United States http://www.co.maui.hi.us/;

Metasearch engines create what is known as a virtual database. They do not compile a

physical database or catalogue of the web. Instead, they take a user's request, pass it to
several other heterogeneous databases and then compile the results in a homogeneous
manner based on a specific algorithm.

Internet sites  that provide how-to information on adding a metasearch capability to a

website:

 Digital windmill (http://digitalwindmill.com/)

 eMetasearch (http://emetasearch.com/)

with the use of this tools, data sharing and messaging among health care provider is no
problem at all. also, this tools can be use in nursing process namely: the assessment,
diagnosis, and evaluation.

In Assessment, we have this assessment tools which can calculate a patient’s BMI, signs &
symptoms manifestations and etc. it helps us to save time and effort. These are just
example of what these tools can do in the nursing practice.
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Upon learning all of this, I realized that these tools are really helpful. They may be tools but
they make our work easier.

Internet-Available Clinical Practice Tools

This structured approach to clinical information database development is clinically useful,
helps clinicians organize their own knowledge databases, and facilitates ready access to
needed information

This section is divided into the most basic components of nursing process: assessment,
diagnosis, treatment, and outcome evaluation. These component provide the outward
structure for development of a clinical information database for advanced practice nursing.

1. Assessment
       - refers to the systemic collection of data needed to arrive at one or more Diagnoses.
- The tools included in this section include forms, miscellaneous screening tools, risk
assessment instrument, and information, and information of the manifestation of signs
and symptoms. These tools represent a sampling of assessment content available on
the internet.
- Nursing assessment is the first step in nursing process. The following site provides an
example of a comprehensive nursing assessment form:
·      http://www.hospitalsoup.com/public/nursinggassess2001.pdf
·      http://www.niaaa.nih.gov
·      http://www.state.vt.us/health/abuse.htm
·      http://www.ctclearinghouse.org/

GOVERNMENT DOMAINS:
www.fda.gov – Food and drug Administration
www.pubmed.gov– NLM Pubmed database
EDUCATIONAL DOMAINS:
http://medicine.iupui.edu/flockhart.htm- P450 Drug Interaction table
http://nhlbisupport.com/bmi/bmicalc.htm - body mass index calculator
http://www.yourcancerrisk.harvard.edu – cancer risk tools
http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof – coronary heart disease
risk
Calculator
(http://www.umm.edu/healthcalculators/)health risk calculators for 24 health
conditions.
NLM MEDLINE
The assessment of symptoms of illness and the education of patients regarding symptoms
are major responsibilities of the advance practice nurse. And outstanding resource for
consumers and health professionals in the information available through the following NLM
MEDLINE plus Health information hyperlink:  http://search.nlm.nih.gov/homepage/query?
FUNCTION=seach&PARAMETE=MEDLINE+Plus+ANS+symptoms+AND+manifestation&DISA
MBUGUATION=true&START=0&START=0&END=25&MAX=250&ASPECT=1

2. Diagnosis
- Treatment is diagnostic specific. Hence, diagnosis and treatment information
categories are frequently not discreet.
- The etymology of the word “diagnosis” is based in its Greek roots. “Dia” means
“through,” and “gnosis” means knowledge base of the person diagnosing.
- The section diagnosis is divided into following sections: new threats to health,
disease/ condition directories, examples of specific disease information, easy
diagnosis tools, standardized diagnosis terminologies, and the unified medical
language system (UMLS)

New Threats to Health – include mass trauma, biologic and biochemical warfare agents,
and emerging infectious diseases. Primary care and emergency department practitioners
need readily accessible information to facilitate diagnosis. The CDC’s emergency
Preparedness and Response web page is excellent source: http://www.bt.cdc.gov/

Mass Trauma Preparedness and Response – mass trauma hyperlinks, featured on the
CDC Emergency Preparedness and Response webpages include coping with a traumatic
event, a primer for clinicians
on dealing with explosions and blast injuries; fact sheets for injuries and mass trauma;
possible research studies; and rapid assessment of injuries.
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Bioterrorism Agents/Diseases – the CDC Emergency Preparedness and Response

webpages present information on approximately 30 diseases. Photographic images and/or
video presentations facilitate clinical decision making related to infectious agents that may
be used for bioterrorism purposes.

Chemical Agents – the CDC Emergency Preparedness and Response webpages hyperlink
information to more than 70 chemical agents. •Recent Outbreaks and Incidents – the
Emergency Preparedness and Response page also includes information on outbreaks, e.g.,
severe acute respiratory syndrome (SARS), West Nile Virus, monkey pox, and mad cow
disease; this site also includes information on incidents, e.g., wild fires, winter storms and
power outages.

Bioterrorism Information Available through Academic Health Science Centers

http://www.bioterrorism.uab.edu/ - bioterrorism education
http://www.gmu.edu/centers/biodfense/- biodefense
http://bioterrorism.slu.edu/ - Bioterrorism and Emerging Infections
http://www.upmc-biosecurity.org/- Biosecurity DISEASE DIAGNOSIS
http://www.cms.hhs.gov/medlearn/icd9code.asp - International Classification of Disease
www.cdc.gov – disease directories
http://cancer-web.ncl.ac.uk/omd - online medical dictionary
http://noah-health.org – A-Z index of health information of uncommon illnesses.
http://www.cdc.gov/genomics/default.htm - information on genomics and disease
prevention    

DISEASE DIAGNOSIS
http://www.cms.hhs.gov/medlearn/icd9code.asp - International Classification of Disease
www.cdc.gov – disease directorie
shttp://cancer-web.ncl.ac.uk/omd - online medical dictionary
http://noah-health.org – A-Z index of health information of uncommon illnesses.
http://www.cdc.gov/genomics/default.htm - information on genomics and disease
prevention.

HUMAN RESPONSE TO ILLNESS/HEALTH DIAGNOSES

http://www.aorn.org/research/pnds.htm - perioperative nursing data set
Nanda.org – listing nursing diagnoses
http://www.nlinks.org/research_main.phtml- evidence-based nursing diagnoses

METHODS OF CONTRIBUTING TO TERMINOLOGY REVISION AND DEVELOPMENT

http://nlinks.org/cac_introduction.phtml - network for Language in Nursing Knowledge
System

THE INTERNATIONAL CLASSIFICATION OF FUNCTONING, DISABILITY, AND HEALTH

(ICF)
- Standardized nursing diagnosis terminologies do not encompass the entire field. As a
result, subsets from the ICD are used, especially in the provision of primary care
services by advanced practice nurses. Another terminology of interest to nursing
practice is the ICF.
- consist of four domains: body functions, body structures, activity and participation,
and
environmental factors.
- ICF may assist nursing terminology developers in generating revised and new
diagnose. It may also serve as a tool facilitating collaboration among leaders in the
field of nursing diagnosis classifications
- Kearney and Pryor (22004) found it to be a useful conceptual framework for practice,
education, and research.
- Lehman (2003) concluded that it provides a useful framework in researching health
conditions, body structures and function, activity and participation, and
environmental influences on patients with idiopathic intracranial
hypertension.
- http://www3.who.int/icf/onlinebrowser/icf.cfm- ICF browser

3. TREATMENT
-the term “treatment” is used here in lieu of interventions and nursing actions, because it
expresses more precisely the broad clinical management focus of this section.
NURSING TREATMENT
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 www.sabacare.com– Home Health Care Classification

 http://www.nursing.uiwo.edu/centers/cncce/nic/index.htm- Nursing
Intervention
Classification
 http://www.aorn.org.research/pnds.htm- Perioperative nursing data set

CALCULATORS
 http://www.martindalecenter.com/Calculators1B_4_Nut.html-Martindale’s
Calculators Online Part I:Nutrition
 http://www.manuelsweb.com/nrs_calculators.htm- Nursing Calculators for
Drug Administration
 http://www_users.med.cornell.edu/-spon/picu/calc/medcalc.htm-Medical
calculators

DRUG MANAGEMENT
 www.dea.gov– Drug Enforcement Agency
 http://www.fda.gov/medwatch/safety/vaers1.pdf- Vaccine Adverse Event
Reporting System
 www.nida.nih.gov– National Institute on Drug Abuse
 www.medscape.com– Medscapewww.rxlist.com– Rx list

EVIDENCE-BASED PRACTICE GUIDELINES
 http://www.cdc.gov/std/treatment- Sexually Transmitted Diseases
Treatment
 www.ngc.gov– National Guidelines Clearinghouse
 http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm- Diagnosis and
Management for Asthma
 http://www.nhbli.nih.gov/guidelines/cholesterol/index.htm- evaluation and
treatment of high blood cholesterol in adults
 http://www.nhbli.nih.gov/guidelines/hypertension/index.htm- High blood
pressure Guidelines

PRACTICE AND TREATMENT GUIDELINES: PROFESSIONAL ORGANIZATION

SITES
-many of the professional association or societies include clinical practice guidelines
or
recommendations.
 http://www.diabetes.org/fot-health-professionals-and-scientists/cpr.jsp
-American Diabetes Association
 http://www.diabetes.org/for-health-professionals-and-scientists/cpr.jsp-
American cancer Society Guidelines for Screening, Surveillance, and Early
Detection of Adenomatous Polyps and Colorectal Cancer
 http://www.aafp.org/x132.xml - American Academy of Family Physicians

4. OUTCOMES
-outcomes measurement is a tradition within nursing practice.
-categories of patient outcomes:
•Patient safety
•Nursing outcomes
•Nursing home and home healthcare setting outcomes
•Health plan outcomes
•Short form health survey

PATIENT SAFETY
http://www.webmm.ahrq.gov– presentation and discussion of medical errors.
http://www.ihi.org/ihi- Institute for Healthcare Improvement
NURSING OUTCOMES
http://www.nursing.uiowa.edu/centers/cncce - Information of NOC
NURSING HOME AND HOME HEALTHCARE SETTING OUTCOMES-related to
nursing outcomes are those measures that evaluate the quality of care within
nursing homes and home healthcare setting.
www.cms.hhs.gov – Centers for Medicare and Medicaid
OASIS (outcomes assessment information set – measures are used to evaluate
quality within home healthcare settings.
HEALTH PLAN OUTCOMES
http://www.ncqa.org/Programs/HEIDIS/index.htm- HEDIS ( health plan employer
data and information set
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OFFICE TOOLS: Online Healthcare Record Audit and Patient Satisfaction Forms
-First, both the quality of the health care record and patient satisfaction reflect upon
the quality of the care provided, a healthcare outcome.
-Second, patient satisfaction variables provide clinicians with criteria to evaluate
their own performance and that of the office in which they are practicing.
http://www.geomedics.com/downloads/pss4.rtf- Patient Satisfaction Form

SHORT FORM HEALTH SURVEY

http://www.outcomes-trust.org– Medical Outcomes Trust
http://www.sf-36.org - SF-36.org

OUTCOMES MEASUREMENT: INTERNET-AVAILABLE BIOSTATISTICAL AND

ANALYTICAL TOOLS
http://www.cdc.gov/hiv/software/ez-text.htm– Qualitative data creation,
management and analysis software
http://www.cdc.gov/hiv/software/answr/howto.htm- Qualitative database software
http://www.cdc.gov/epiinfo/- Epidemiologic analysis software

eCLINICALOG ( http://www.eclinicalog.org) , A Web-Based Clinical Encounter

Database
 Part of an educational strategy, initially designed to build data entry, analysis,
and synthesis skills in nurse practitioner students.
 Started out as a paper and pencil format-First version was a spiral-bound,
legal-sized, two-page grid of boxes that student filled in.
 Second, addressed issues of retrievability, familiarity, availability, student
acceptance, curricular congruence and contribution to the discipline
 Consist of three categories:
•Patient
•Program
•Demographic
 Guides students through an informatics skill building and refinement process
and assists professional development.