NURSING INFORMATICS
 The term nursing informatics was initially seen in literature in
INTRODUCTION TO INFORMATICS
 We are in digital age. What does this mean to us as nurses?
 The convergence of the telecommunications and computer
industry has seen pervasive increase in how we communicate
and process information.
INTRODUCTION
 Integrated systems support evidence-based nursing practice
o Facilitate nurses‘ participation in the health care team
and document nurses contribution to patient care
outcomes.
NURSING INFORMATICS
AN OVERVIEW
The evolution of the terms informatics and nursing informatics as
follows:
 In 1957 – first coined by Karl Steinbuch as ―informatics‖
 In 1962 Philippe Dreyfus used the term ―informatique‖ ; Walter
Bauer translated it into ―informatics‖
 In 1980 Scholes and Barber coined the term ―nursing
informatics‖
the 1960‘s, including a definition of ―combining nursing,
information and computer sciences for managing and
processing data into knowledge for use in nursing practice‖
 In 1994, The American Nurses Association (ANA) began
developing a statement to describe and define the scope of
nursing informatics.
 The meaning of nursing informatics has evolved and been
refined with the American Nurses Association definition stated
as ― a specialty that integrates nursing science, computer
science and information science to manage and
communicate data, information, knowledge and wisdom in
nursing practice‖
 Another definition of nursing informatics comes from the
American Medical Informatics Association (AMIA), which
states — ―Nursing Informatics science and practice integrates
nursing. Its information and knowledge and their
management, with information and communication
technologies to promote the health of people, families and
communities worldwide.‖
 The Healthcare Information and Management Systems
Society (HIMSS) defines nursing informatics as "a specialty that
integrates nursing science, computer science, and
information science to manage and communicate data,
information, Knowledge, and wisdom in nursing practice.―
 Informatics is becoming increasingly present in our profession
due to rapidly changing technologic advances.
 Healthcare systems are assimilating technology into daily
practice at a quick pace.
 Security and patient privacy must be upheld while achieving
the goal of transforming data into useful knowledge.
 Integrating informatics with evidenced-based practice (EBP)
can only help improve the care we provide to our patients.
 The use of a template can remind nurses of important
information required in the documentation of patient care.
 Research studies, patient care data, and national and local
standards are used to develop informatics programs at
healthcare organizations.
Other measures include return on investment analysis, patient
preferences and/or needs, and infection control data.
 How's the need for technology addressed?

 For example, a high rate of medication errors is identified.

 Applying technology to knowledge may help potential
problems earlier.

 For example, with the use of electronic documentation,  Analysis of how and why the errors are occurring must be
identifying changes in patient status can occur quickly conducted.
because the information is readily available.

 Trending of patient vital signs is always accessible, and data

 The research can include collecting data from other facilities
are interpreted, systematized, and arranged.
in the area to determine if the same problem exists elsewhere.

 The nurse is able to use this knowledge to formalize an

appropriate plan of action.
 Following data collection, the findings are presented to a
 Standardizing nursing language will facilitate acceptance of review board.
new methods of documentation in the electronic health
record.

 A plan to improve the problem is implemented, such as the

 A template for nursing notes is one method of assisting with
use of bar code scanners.
our daily workload.

 Data collection continues to determine if implementation is
successful.
 The most important piece of implementation is presentation
of the evidence to staff to identify how the change will
improve actions of nurses.
 Staggers and Thompson (2002) believed that there were too
many definitions for nursing informatics (NI), which was
causing the specialty to grow without a solid foundation.
 They believed that without this foundation it was difficult to
build a solid informatics practice or the needed educational
base for this specialty practice. Staggers and Thompson
performed a critical
The new definition is as follows:
The goal of NI is to improve the health of populations,
communities, families, and individuals by optimizing information
management and communication. (Staggers and Thompson)
 These activities include the design and use of informatics
solutions and/or technology to support all areas of nursing,
including, but not limited to:
1. the direct provision of care,
2. establishing effective administrative systems,
3. designing useful decision support systems,
4. managing and delivering educational experiences,
5. enhancing supporting life- long learning, and
6. Supporting nursing research.
 The term individual refer to patients, healthcare consumers
and any other recipient of nursing care or informatics
solutions.
 The term patient refers to consumers in both a wellness and
illness model.
 NI is one example of a discipline-specific informatics practice
within the broader category of health informatics.
 NI has become well established within nursing since its
recognition as a specialty for registered nurses by the
American Nurses Association (ANA) in 1992.
 It focuses on the representation of nursing data, information,
knowledge and wisdom as well as the management and
communication of nursing information within the broader
context of health informatics
 DIKW
BENEFITS OF NURSING INFORMATICS IN HEALTHCARE 1. They understand the clinical language of efficient patient
care.
2. They translate knowledge and clinician feedback into the
Benefit#1: Nursing Informatics informs and influences IT systems technical language of business analysts and
programmers.
3. They communicate clinical and technical matters with
administrative leadership.
 Nursing informatics specialists spend much of their time
helping to develop, implement and optimized computerized
 It‘s not simple to speak effectively with clinical, technical, and
patient information system.
administrative people.
 It‘s their blend of clinical and technical knowledge and
 Still, nursing informatics specialists are qualified and have
experience that makes them perfect liaisons between the
proven to be indispensable to the development of superior
clinical and technical communities.
healthcare IT systems.
 One of the early contributions of nursing informatics was to
 ―Informatics professionals with a nursing background combine
help move healthcare away from paper forms and into
the best of both worlds: deep expertise in clinical care helps
electronic documentation.
nurse informaticists understand the needs and stresses of the
 Today, a nurse‘s standardized notes are immediately
clinical workflow, while their education and background with
available to physicians and other caregivers thru EHR systems.
information technology systems and data analytics helps
 Workflows and decisions are more informed and efficient.
them sculpt health IT infrastructure into a meaningful and
 Many EHR vendors recognized the value of hiring nurse
helpful tool.‖
informaticists to help design and build their system.
 EHR vendors acquired a double-barreled secret weapon
because nurse informaticists :
Benefit #2: Nursing Informatics leverages evidence-based clinical
A. Recommend the most practical layout of forms and reports, best practices
and the best processes for electronic medication
 Most clinicians want to apply their knowledge and
administration experience to improve patient care.
B. Prevent EHR mutiny because they can predict clinician
reactions to technically efficient-but clinically clumsy - The nurse informaticist takes it a few steps further by:
workflows, and shape EHRs that avoid these poor workflows
1. Researching clinical nursing practices outside of their own
experiences.
Nursing informatics specialists are trilingual. 2. Finding evidence to prove which clinical practices are best.
 3. Influencing the design of clinical systems to support and
promote the best evidence -based practices and workflows.
4. Training other nurses to use clinical IT systems.
Benefit #3: Nursing Informatics generates stronger nurse training in
clinical IT systems
 Clinical IT systems are complicated, and their interfaces and
workflows are not always intuitive.
 But nursing informatics specialists are well-suited to teach
other nurses how to get the full benefits of these systems.
 Because in some cases, nurse informaticists helped design
and create those very systems. But.. the very least , they
understand the reasons, from a nursing care perspective, for
the structure of each digital form and reach sequence of
clicks.
 They can explain built-in interoperability and behind-the-
scenes interfaces to other clinical systems in language that‘s
easily understood by nurses.
Benefit #4: Nursing Informatics leverages IT investments
 Every health facility - from the single-physician practice to the
large academic medical center invests a significant amount
of their budget on essential health information technology-
and services.
 These include patient care systems like the PACS and
electronic medical records system, communication
technologies like pagers and secure messaging systems, and
analytics tools.
 Nurse informaticists help get maximum value from these
investments in at least three ways:
1. They ensure that systems are designed to support
effective patient care workflow
2. They help train other nurses to use IT efficiently
3. They apply advanced analytics strategies to develop
predictive models.
 As an example of predictive models, consider Texas Health
Resources in Dallas-Fort Worth. Their informatics nurses use
analytics tools to identify the risk of sepsis, risk of read mission,
and potential benefit from palliative care.
Benefit #5: Nursing informatics contributes unique wisdom to clinical
care that is acquired through a deep understanding of both clinical
practice and data analysis
 ―Informatics nurse specialists work with leadership regarding
regulatory and quality initiatives and governance for
technology implementation and change. For example, they
work with the delivery-of-care team
 The chief nursing officer, chief medical officer, and quality'
leadership who might give us a directive based on improving
patient safety by decreasing readmission's.
 Informatics nurse specialists identify the key areas where
studies identify where problems arise inadequate discharge
education, a patient doesn't have support at home, poor
hearing or sight- or being on multiple medications.
 They‘ll take those variables and identify how and wherein the
system they should alert a nurse that this is a possible red flag
and give her the elements of a plan to decrease the risk for a
readmit.
 They explain to the technical and application team what
nurses need the system to do.
  They build it, and the nurses validate the build. Then nurses go
back to clinical leadership and demonstrate what was
designed and built.
 Because nurse informacists understand data analysis and
nursing practice, they immediately know which trends are
worth analyzing, and which anomalies are significant enough
to escalate.
Benefit #6: Nursing informatics enriches the evolving healthcare
delivery system
 Advances in healthcare technology launch new options for
healthcare delivery, and nurse informatics specialists are
helping ensure these new options are beneficial to both
patients and clinicians
 Two examples are developments in communication
technology and remote healthcare, known as telehealth.
 Regarding communication technology, vendors are using
Smartphones to transform the way communication in nursing
happens.
 Advanced applications - from secure messaging to EHR
integrations that push critical results to a physician‘s phone
just seconds after the results hit the EHR - are dramatically
improving the efficiency of healthcare delivery.
 Regarding the growing field of telehealth, patients are
receiving education and self-management training,
automatically storing and forwarding medical data, and
seeing their providers - from the other side of town, or the
other side of the world.
 And nurse informatics specialists are helping design and
implement telehealth systems, as well as training their fellow
nurses in how best to use the systems.
Benefit #7: Nursing Informatics Improves Patient Care, Patient Safety,
and Outcomes
 The more generalized field of healthcare informatics focuses
mainly on administrative issues, whereas nursing informatics
focuses on patient care.
 In fact, the substance of the first six benefits of nursing
informatics is all about improving care, safety, and outcomes
for patients.
 The nurse informaticists resume is like an endowment to
patients and their families:
o More efficient electronic health records
o Better IT systems
o Research and application of clinical best practices
o Training of other nurses
o Analytics-based predictive models
o New avenues for patient education
o Support for telehealth technology
HOW DO PATIENTS BENEFIT?
 Fewer medical errors
 More informed clinical decision-making
 Shorter hospital length of stay
 Lower admission and readmission rates
 Better self-management
 Application of informatics as an enabling mechanism that
improves operational tasks towards enriched jobs, increased
job satisfaction, and enhanced quality centric customer
service both in the hospital and in the academe is strongly
 supported by Locsin‘s Technological Competency as Caring
in Nursing: A Model.‖ Locsin, R. articulates that:
1) ―Technological Competency as Caring in Nursing‖ is
illustrated in the practice of nursing grounded in the
harmonious coexistence between technology and caring in
nursing
 Assumptions of the theory include the following among
others:
o Technology is used to know wholeness of persons
moment to moment
o ―Nurses value technological competency as an
expression of caring in nursing‖ (Locsin, 2013).
2) Dimensions of Technological Value in the Theory
 Technology as completing human beings to re-formulate the
ideal human being such as m replacement parts, both
mechanical (prostheses) and organic (transplantation of
Organs.
 Technology as machine technologies, e.g., computers and
gadgets enhancing nursing activities to provide quality
patient care such as Penelope or Da Vinci in the Operating
theaters.
 Technologies that mimic human beings and human activities
to meet the demands of nursing care practices, e.g., cyborgs
(cybernetic organisms) or anthropomorphic machines and
robots such as nurse bots
3) Technological Competency as Caring in Nursing
 Technological competency as Caring in nursing is the
harmonious coexistence between technologies and caring in
nursing.
 The harmonization of these concept can co-exist
 Technology brings the patient closer to the nurse. Conversely,
technology can also increase the gap between the nurse
and nursed
 IN CAPSULE: Locsin‘s ―Technological Competency as Caring
in Nursing Nursing: A Model for Practice‖ Dr. Locsin middle-
range nursing theory is an interesting discussion of the
correlation between hands on patient care and the use of
technology.
 Technology is defined as anything that makes things efficient-
from diagnostic technologies to therapeutic practices familiar
to all nurses.
 Specifically, he discusses the importance of understanding
the need of knowing ―high-tech‖ instruments e.g monitors,
implants, and devices that are a part of patient care as these
will provide opportunities for the nurse to know the patient
fully as person.
 Nurses use and encounter technology in nearly every aspect
of their profession. What does it mean to be technologically
competent? What does it mean to be a caring nurse? How
does technology support nursing work? How does it hinder
nursing work? How can nurses care for their patients as
technological advancements are introduced nearly every
day? Technological competency as Caring in Nursing: A
Model for Practice provides insight and answers into how
nurses can express their nursing by being technologically
 competent. As such, Locsin sustains the understanding that
being technological competent is being caring.
 Dr. Locsin‘s work is obviously guided by the question asked by
thoughtful nurses everywhere: How can I satisfactorily
reconcile the idea of competent use of technology with the
idea of caring in nursing? His theory significantly describes a
practical understanding of the solution enriching the practice
value of all of the general theories of nursing which are
grounded in caring. Technological competency as caring in
nursing informs nursing as a critical process of knowing
person‘s wholeness. Dr. Locsin‘s theory book explores, clarifies,
and advances the conception of technological competency
as caring in nursing. His theory is essential to modeling a
practice of (nursing from the perspective of caring. It is a
practical illumination of excellent nursing in a technological
aspect.
INFORMATION SCIENCE
 Information science is the science and practice dealing with
effective collection, storage, retrieval, and use of information.
 It is concerned with recordable information and knowledge,
and the technologies related services that facilitate their
management and use
 multidisciplinary science
 Involves aspect from computer science, cognitive science,
social science, communication science, and library science
to deal with obtaining, gathering, organizing, manipulating,
managing, storing, retrieving, recapturing disposing of,
distributing, or broadcasting information
 Studies everything that deals with information and can be
defined as the study of information systems.
 Originated as a sub-discipline of computer science, in an
attempt to understand and rationalize management of
technology within organizations.
 has matured into a major field management that is
increasingly being emphasized as an important area of
research in management studies,
 Has expanded to examine the human-computer interaction,
interfacing, and interaction of people, information systems,
and corporation.
 It is taught at all major universities and business school, around
the world.
 Organizations have become intensely aware of the fact that
information and knowledge are potent resources that must
be cultivated and honed to meet their needs.
 In the mid-1980‗s Blum (1986) introduced the concepts of
data, information knowledge as a framework for
understanding clinical information systems and their impact
health care.
 He did this by classifying the then-current clinical information
systems by the three types of objects that these systems
processed.
 These were: data, information and knowledge
INFORMATION SCIENCE
  These programs include:
o monitoring systems,
o order entry systems, and
o Laboratory radiology, and
o Pharmacy systems.

 A monitoring system includes devices that automatically

monitor and record biometric measurements (e g vital signs,
oxygen saturation, cardiac index, and stroke volume) in
acute care, critical care and specialty areas.
INFORMATION SCIENCE  The devices electronically send measurements directly to the
nursing documentation
 A well-designed nursing clinical information system (NCIS)
incorporates the principles of nursing informatics to support
the work that nurses do by facilitating documentation of
nursing process activities and offering resources for managing
nursing care delivery.
 As a nurse you need to access a computer program easily,
review a patient's medical history and health care provider
orders, and then go to the patient‘s bedside to conduct a
comprehensive assessment.
 Once you complete an assessment, enter data into the
computer terminal at the patient's bedside and develop a
plan of care from the information gathered.

 This allows you to quickly share the plan of care with your
CLINICAL INFORMATION SYSTEM patient.
 Periodically return to the computer to check on laboratory
test results and document the care you deliver.
 The computer screens and optional popup windows make it
 All members of the inter professional health care team,
easy to locate information, enter and compare data, and
including nurse, physicians, pharmacists, social workers, and
make changes.
therapists, use programs available on Clinical Information
System(CIS).
NCISs have two designs.  With an electronic and connected system in place, much of
that waste can be curbed. From lab results that reach their
reach their destination sooner improving better and more
1. The nursing process design timely care delivery to reduced malpractice claims, health
informatics reduces errors, increases communication drives
o is the most traditional efficiency where before there was costly incompetence and
 More advanced systems incorporate standardized nursing obstruction
languages into the software such as:

A. North American Nursing Diagnosis Association-International 2. Shared Knowledge.

(NANDA) nursing diagnoses,
B. The Nursing Interactions Classification (NIC), and  Nursing informatics provides a way for knowledge about
C. The Nursing Outcomes Classification (NOC) patients, diseases, therapies medicines, and the like to be
more easily shared.

2. Protocol or Critical Pathway

 As knowledge is more readily passed back and forth between
o design facilities interdisciplinary management of providers and patients, the practice of medicine gets better
information because all health care providers used something that aids everyone within the chain of care, from
evidenced-based protocols or critical pathways to hospital administrators and physicians to nurses, pharmacists
document the care they provide. and patients.

WAYS INFORMATICS TRANSFORMING HEALTH CARE

3. Patient Participation
1. Dramatic Savings
 When patients have electronic access to their own health
 Health care isn‘t just expensive; its wasteful. It‘s estimated that history and recommendations, it empowers them to take their
half of all medical expenditures are squandered on account role in their own health care more seriously. Patients who
of repeat procedures, the expenses associated with more have access to care portals an able to educate themselves
traditional methods of sharing information, delays in care, more effectively about their diagnose and prognoses, while
errors in care of delivery and the like. also keeping better track of medications and symptoms.
 They are also able to interact with doctors and nurses more
easily, which yields better outcomes, as well. Informatics
allows individuals to feel like they are a valuable part of their
own health care team, because they are.
4. The Impersonalization of Care
 One criticism of approaching patient care though
information and technology is that care is becoming less
becoming and less personal. Instead of a doctor getting to
know a patient in real time and space in order to best offer
care, the job of ―knowing‖ is placed on data algorithms
 As data gathered regarding a patient, algorithms can be
used to sort it in order to determine what is wrong and what
care should be offered. It remains to be seen what effects this
data-driven approach will have over time, but regardless,
since care is getting less personal, having a valid and
accurate record that the patient and his care providers can
access remains vital.
5. Increased Coordination
Concepts, Principles and Theories in Nursing Informatics
 Health care is getting more and more specialized, which
means most patients receive care from as many as a dozen
different people in one hospital stay. This increase in specialist
requires increase coordination, and its health informatics that
provides the way forward. Pharmaceutical concerns, blood
levels, nutrition, physical therapy, X-rays, discharge instructions
- its‘ astonishing how many different conversations a single
patient may have with a team of people regarding care, and
unless those conversations and efforts are made in tandem
with one another, problems will arise and care will suffer.
Informatics makes the necessary coordination possible.
6. Improved Outcomes
 The most important way in which informatics is changing
health care is in improved outcomes. Electronic medical
records result in higher quality care and safer care as
coordinated teams provide better diagnoses and decrease
the chance for errors. Doctors and nurses are able to increase
efficiency, which frees up time to spend with patients, and
previously manual jobs and tasks are automated, which saves
time and money — not just for hospitals, clinics, and providers,
but for patients, insurance companies, and state and federal
governments, too.
 Health care is undergoing a massive renovation thanks to
technology, and informatics is helping to ensure that part of
the change results in greater efficiency, coordination, and
improved care.
 Informatics Theory
 Theories
A. Theories
 In nursing informatics, there are different theories, which help to
frame and inform this discipline. This include the:
o General systems theory,
o Change theory,
o Cybernetics theory and the
o Cognitive learning theory
 In addition
o Novice to Expert Theory and the
o DIKW Theory also supports the framework of Nursing
Informatics.
o All the theories support nursing informatics in different
ways
 Nursing practitioners can combine the knowledge they acquire
from the theories, with that they obtain from their nursing
practice to enhance their performance.
1. General Systems Theory
 Developed by biologist Ludwigvon Bertalanffy in 1936
 Includes purpose, content and process, breaking down the
―whole‖ and analyzing the parts
 The relationships between the parts of the whole are
examined to learn how they work together
 A system is made up of separate components. The parts rely
on one another, are interrelated, share a common purpose
and together form a whole
 Assumptions of General System Theory
 All systems must be goal directed
 A system is more than the sum of its parts
 A system is ever changing and any change in one part
affects the whole
 Boundaries are implicit and systems are open and dynamic
 Concepts and Definition
 Input – Energy & raw Material (Ex. Information, Money,
Energy, time)
 Throughput – processed used by the system to convert
raw materials to products (Ex. Thinking , planning, Decision
making, constructing, meeting
 Output – The product or service from throughput
 Feedback – Information about some aspect of data or
energy processing that can be used to evaluate and
monitor the system
 Subsystem – A system which is a part of a larger system.
They can work parallel to each other or in a series with
each other
 Static System – Neither system elements nor the system
itself changes much over time in relation to the
environment
 Dynamic system – The system constantly changes the
environment & is changed by the environment
 Closed systems – Fixed , automatic relationships among
system components no give or take with the environment
 Open Systems – Interacts with the environment trading
energy & raw material for goods & services produced by
the system
 Boundary – The line or point where a system or subsystem
can be differentiated from its environment or from other
subsystems
 Goal – The overall purpose for existence or the desired
outcomes. (mission statement)
 Entropy – The tendency for a system to develop order &
energy over time
  Negantropy – the tendency of system to lose energy &
dissolve chaos
 Control or cybernation – The activities and processes used
to evaluate input, throughput & output in order to make
corrections
 Equifinality – Objectives can be achieved with varying
inputs & in different ways
Basic Principles of a System Approach
1. A system is greater than the sum of its parts.
 Requires investigation of the whole situation rather than
one or two aspects of a problem.
 Mistakes can‘t be blamed on one person; rather a system
analyst would investigate how the mistakes occurred within a
subsystem and look for opportunities to make corrections in
the processes used.
2. The portion of the world studies (system) must exhibit
predictability.
3. Though each sub-system is a self-contained unit, it is part of wider
and higher order
4. The central objective of a system can be identified by the fact
that other objectives will be sacrificed in order to attain the
central objective.
5. Every system, living or mechanical, is an information system. Must
analyze how suitable the symbols used are for information
transmission.
6. An open system and its environment are highly interrelated
7. A highly complex system may have to be broken into subsystems
so each can be analyzed and understood before being
reassembled into a whole.
8. A system consists of a set of objectives and their relationships
9. A system is a dynamic network of interconnecting elements A
change in only one of the elements must produce change in all
the others.
10. When subsystems are arranged in a series, the output of one is
the input for another; therefore, process alterations in one
requires alterations in other subsystems
11. All systems tend toward equilibrium, which is a balance of
various forces within and outside of a system.
12. The boundary of a system can be redrawn at will by a system
analyst
13. To be viable, a system must be strongly goal-directed, governed
by feedback, and have the ability to adapt to changing
circumstances.
2. Change Theory
 Developed by Kurt Lewin who is considered the father of
Social Psychology
 Lewin‘s definition of behavior in this model is ―a dynamic
balance of forces working in opposite directions‖
 3 Major Concepts
1. Driving Forces – are those that push in a direction that
causes change to occur. They cause a shift in the
equilibrium towards change
2. Restraining Forces – are those forces that counter the driving
forces
3. Equilibrium – is a state of being where driving forces equal
restraining forces and no change occurs.
 3 Stages
1. Unfreezing – process which involves finding a method of
making it possible for people to let go of an old pattern that
was somehow counterproductive
2. Change Stage – ―moving to a new level‖ or ―movement‖.
Involves a process of change in thoughts, feeling, behavior, or
 all three, that is in some way more liberating or more
productive.
3. Refreezing Stage – establishing the change as the new habit.

 Major Assumptions
 People grow and change throughout their lives
 Change happens daily
 Reactions to change are grounded in the basic human needs
for self-esteem, safety and security
 Change involves modification or alteration.
 Cybernetics
 6 Components  is a trans disciplinary approach for exploring regulatory
1. Recognition of the area where change is needed systems, their structures, constraints and possibilities ―the
2. Analysis of a situation scientific study of control and communication in the animal,
3. Identification of methods by which change, can occur machine and society‖ as defined by Norbert Wiener.
4. Recognition of the influence of group mores or customs on  is applicable when a system being analyzed incorporates a
change. closed signaling loop-originally referred to as ―circular
5. Identification of the methods that the reference group uses to causal‖ relationship, that is where action by the system in
bring about change some manner (feedback) that triggers a system change.
6. The actual process of change  The essential goal of the broad field of cybernetics is to
 Kurt Lewin’s Model of Change understand and define the functions and processes of
systems that have goals and that participate in circular,
causal chains that move from action to sensing comparison
with the desired goal, and again to action.
 Its focus is how anything (digital, mechanical or biological)
processes information, reacts to information and changes or
can be changed to better accomplish the first two tasks.
 Comes from the Greek word ―Kubernetes‖ means ―steering‖
and ―governor‖ in Latin.
 Major Concepts
 Cybernetics introduces the concept of circularity and circular
causal systems
3. Cybernetics Theory  Systems are defined by boundaries
 Every system has a goal
  Environment affects aim
 Information returns to system- ―feedback‖
 System measures difference between state and goal
 Detects ―error‖
 System corrects action to aim toward goal
 Cycle Repeat
 Scope and Application of Cybernetics
 Basis of modern communication systems
 Application in cognitive science for modeling and learning
 Basic Concepts
 Application in management science
o Observational Learning
 Conclusion
o Reproduction
 Cybernetics is applicable in any discipline relying on
o Self-Efficacy
feedback processes including health sciences, sociology and
o Emotional Coping
psychology, which are based on communication process
o Self-regulatory Capability
4. Cognitive Learning Theory
B. Cognitive Behavioral Theory
 Explains why the brain is the most incredible network of
 Describes the role of cognition (knowing) to determining and
information processing and interpretation in the body as we
predicting the behavioral pattern of an individual.
learn things
 Developed by Aaron Beck
 2 specific Theories

A. Social Cognitive Theory

5. The Novice to Expert Theory
We consider 3 variables:
 A construct theory first proposed by Hubert and Stuart Dreyfus
1. Behavioral factors (1980) as the Dreyfus Model of Skill Acquisition and later
applied and modified to nursing by Patricia Benner (1984).
2. Environmental factors (extrinsic)
This Theory Can Be Applied to
3. Personal Factors (intrinsic)
 The development of nursing informatics skills, competencies,
knowledge and expertise in NI
 The development of technological system competencies in
Social Cognitive Illustration
practicing nurses working in an institution
  The education of nursing students, from first year to
graduation and
 Transition of graduate nurse to expert nurse
Novice to Expert
 The currently accepted five levels of development as
presented by Benner
 Novice-Competent-Proficient-Expertise-Mastery was initially
proposed by Hubert and Dreyfus
 Distinguishing Features
 Deliberate Practice – is a trait shown by people who use a
personal, goal-oriented approach to skill and knowledge
development.
 This requires years of sustained effort to continually improve
quality of practice and performance within the skill
 Taking Risks – Continuous climb to expert level – requires
people to move beyond the status quo of mere competence
through the levels of Proficiency then Expertise
 NOVICE
 A novice doesn‘t know anything about the subject he/she
approaching and has to memorize its context-free features.
 The novice is then given rules for determining an action on
the basis of this feature.
 To improve the novice needs monitoring either by self-
observation or instructional feedback.
 Advance Beginner
o Still dependent on rules, but as he/she gains more
experience with the real-life situations, he/she begins to
notice additional aspects that can be applied to related
conditions
 Competent
 The competent person grasps all relevant rules and facts of
the field and is, for the first time, able to bring his/her own
judgement to each case.
 This is the stage of learning that is often characterized by term
problem-solving.
 A competent level nurse would be able to use a hospital
information system with ease and know-how to solve
technical difficulties.
 Proficient
 Is called ―fluency‖ and is characterized by the progress of the
learner from the step-by-step analysis and solving of the
situation to the holistic perception of the entirety of the
situation.
 The proficient hospital information system learner would know
how to interpret data from all departmental information and
provide guidance to other disciplinary members as needed.
 Expert
 An expert‘s repertoire of experienced situation immediately
dictates an intuitively appropriate action.
  After a great deal of experience actually using a system in  Contextual Concept – one moves from a phase of gathering
everyday situations, the expert nurse discovers that without his data parts (data), the connection of raw data parts
consciously using any rules, situations simply elicit from him/her (information), formation of whole meaningful contents
appropriate responses. (knowledge), and conceptualizing and joining those whole
meaningful contents(wisdom)
6. The DIKW Theory
Understanding Concept

 the DIKW Pyramid can be viewed as a processing starting

with researching & absorbing, doing, interacting, and
reflecting

A. The ―Data‖ of DIKW

 The first step

 Collection of Raw data is the main requirement
 Any measurements, logging, tracking, records and many
others are all considered as data.
 Since the raw data is collected in bulk, it includes both useful
and not useful contents.
 Example: 300 Users visits a website daily to take online lessons
 When raw data is collected, it gets mixed up and the view
seems jumbled B. The ―Information‖ of DIKW
 Model by Fricke (2018) and Russell Ackoff (1989)
 Data that has been given meaning by defining relational
―D‖ = Data connections ―meaning‖ represents processed and
understandable data.
―I‖ = Information
 Example: 150 Users Visit Nursing Pharmacology section, 145 for
―K‖ = Knowledge Nursing Research , Out of them, 60% is in the age group of 18-
22 years old , 70% of our visitors between 9am – 11pm
―W‖ = Wisdom
B. The ―Information‖ of DIKW
 The DIKW model of transforming data into wisdom can be
viewed from two different concepts

 The information hierarchy stage of DIKW Pyramid reveals the
relationships in the data, and then the analysis is carried out
to find the answer to Who, What, When and Where questions.
C. The ―Knowledge‖ of DIKW
 is the third level of DIKW Model. Knowledge means the
appropriate collection of information that can make it be
useful.
 Knowledge stage of DIKW hierarchy is a deterministic process.
When someone "memorizes" information due to its usefulness,
then it can be said that they have accumulated knowledge.
 The knowledge step tries to find the answer to the "How"
question. Specific measures are pointed out, and the
information derived in the previous step is used to answer this
question.
 With respect to our scenario, we must find the answer that
―How do student nurses between the age group of 18-22
years old use our modular approach.
D. The ―Wisdom‖ of DIKW
The Wisdom is the fourth and the last step of the DIKW
Hierarchy. It is a process to get the final result by calculating
through extrapolation of knowledge. It considers the output
from all the previous levels of DIKW Model and processes
them through special types of human programming (such as
the moral, ethical codes, etc.).
 Therefore, Wisdom can be thought as the process by which
you can take a decision between the right and wrong, good
and bad, or any improvement decisions.
 Wisdom is the topmost level in the DIKW pyramid and answers
the questions related to "Why".
 In case of our example scenario, one example of wisdom
gained might be that due to 70 % of the working professionals
visit our tutorials to get help with their certifications and
technology needs.
 Analyzing Organizational Issues Using the DIKW Hierarchy
 Data: A way to identify the raw external inputs such as the
facts and figures that are yet to be interpreted.
 Information: Analyze the raw data to determine the
organizational needs. An important aspect of information
management is that apart from answering questions it can
also help to find other solutions in organizational contexts.
 Knowledge: Determines how something is remembered by an
individual or how information is applied by them.
 Wisdom: Uncover why the derived knowledge is applied by
individuals in a specific way. i.e. - finding the reason behind
any decision-making
 The Usage and Limitations of DIKW Model

 Same as all other models, DIKW Model also has its own limits.
You may have noticed that the DIKW Hierarchy is quite linear
and follows a logical sequence of steps to add more
meaning to data in every step forward. But the reality is often
quite different than that. The Knowledge stage, for example,
is practically more than just a next stage of information.
 One of the principal critiques of this DIKW Pyramid is that it‘s a
hierarchical process and misses several important aspects of
knowledge. In today's world, where we use various ways to
capture and process more and more unstructured data,
sometimes forces us to bypasses few steps of DIKW.
 Though the previous statement is quite true, however, the
result still stays the same, such as what we do with the data
warehouse and transforming data through big data analytics
into decisions and actions (Wisdom).
Information Technology System Applicable in Nursing Practice
 Introduction
 This unit discusses the information technology applicable in
nursing practice which includes hospital and critical care
applications such as different monitoring devices needed to
care for patients. The community health applications focus on
the health information system of the community, it is centered
on the majority part of the public which also emphasizes the
prevention of the disease, medical intervention, and public
awareness.
 PURPOSE & OBJECTIVES
At the end of this unit, students will be able to:
1. Describe the information technology applicable in nursing
practice.
2. Explain the application of nursing informatics in the community
health practice.
 HOSPITAL AND CRITICAL CARE APPLICATIONS
There are a lot of information technology applications applicable in
the hospital. It can be branched out based on the major functional
departments in the hospital such as in the Administration, Clinical,
and Nursing. In the administration department, let us say for
instance, the admission of the patient and retrieval of clinical
records uses computer applications to make the work effective and
efficient. In this discussion, we focus on the critical care aspects and
how the nursing division benefits from the information technology.
 Below is the list to sum up the various applications of information
technology in this setting particularly focusing on patient care:
❑ Process store and integrate physiological and diagnostic
information from various sources.
❑ Present deviations from pre-set ranges by an alarm or an alert.
❑ Accept and store patient care documentation in a lifetime‘s
clinical repository.
❑ Trend data in a graphical presentation.
❑ Provide clinical decision support through alerts alarms and
protocols.
❑ Provide access to vital patient information from any location both
inside and outside of the critical care setting.
❑ Comparatively evaluate patients from outcomes analysis. Present
clinical data based on concept- oriented views.
 PHYSIOLOGIC MONITORING SYSTEMS
 Physiological monitors were developed oversee the vital signs
of the astronauts. By the 1970‘s these monitors found their way
into the hospital setting. Physiologic systems consist of 5 basic
parts.
1. Sensors
2. Signal conditioners
3. File - rank and order information.
4. Computer processor - analyze data and direct reports.
5. Evaluation or controlling component - regulate the equipment or
alert the nurse.
 Microprocessors. Physiologic signals are typically of very small
amplitude and must be amplified, conditioned, and digitized
by the device in preparation for processing by its embedded
microprocessors. It analyzes information, store pertinent
information in specific places and controls the direction in
reporting. It also alerts nursing personnel through a report, an
alarm, or a visual notice.
 Monitoring systems also store various data elements with a
time stamp derived from the monitoring system‘s internal
clock.
 Physiologic monitoring systems typically have modern
platform allowing the selection of various monitoring
capabilities to match the needs of a variety of clinical
settings. More specialized monitoring capabilities such as
intracranial pressure or bispectral index monitoring are also in
modular format. Physiologic monitors are usually built to
incorporate both arrhythmia and hemodynamic monitoring
capabilities.
 PHYSIOLOGIC MONITORING SYSTEMS
o HEMODYNAMIC MONITORS
Machines under the human machine interface used specifically for
the following:
1. Measure hemodynamic parameters - closely examine
cardiovascular function.
2. Evaluate cardiac pump output and volume status.
3. Recognize patterns (arrhythmia analysis) and extract
features.
4. Assess vascular system integrity - evaluate the patient‘s
physiologic response to stimuli.
5. Continuously assess respiratory gases (capnography).
6. Continuously evaluate glucose levels.
7. Store waveforms.
8. Automatically transmit selected data to a computerized
patient database.

 THERMODILUTION TECHNIQUE
 The bolus must be injected within 4 seconds. Amount solution
must be accurate temperature of the injective. Must be
measured and accurately maintained. Catheter must be
properly placed.
 Computer must have the appropriate computation. Constant
bolus must be injected at the appropriate time in the
respiratory cycle.
 THE PROCESS OF THERMODILUTION
o The influence of these user-related issues is negated by
using heat of a thermal filament embedded in the
catheter to replace the injectate. An alternative means of
measuring cardiac output noninvasively, if provided by
thoracic electrical bioimpedance. Four sensors are
positioned on the sides of the neck and thorax. Monitoring
these changes permits measurement of stroke volume:
indices of contractility such as velocity an acceleration of
blood flow, supraventricular rhythm, and ind x. Using
bioimpedance as a factor integrated with analysis of the
finger blood pressure waveform has also been
demonstrated as a method of cardiac output
measurement.
 PULSE OXIMETER
 A critical piece of hemodynamic information involves the
availability of oxygen to bodily tissues. The standard for
measurement of blood‘s oxygen saturation is co-oximetry. Pulse
oximetry is a noninvasive method of measuring oxygen saturation
that also uses spectrophotometry. Light is emitted through a
pulsatile arteriolar bed and then detected by photosensor.
 ANTICIPATED PROBLEMS
Largest contributor to alarms in the ICU caused by:
1. Blood pressure cuff
2. Tourniquet
3. Air splint that may cause venous pulsations.
4. Limits the sensors' ability to distinguish between arterial or
venous blood pressure while pulse oximetry provides a
measure of oxygen delivered to the tissue, mixed venous
oxygen saturation provides a measure of the amount of
oxygen used by the patient.
 ANTICIPATED PROBLEMS
 These problems usually cause nurses to spend more time in
troubleshooting and can lead to fewer hours doing the
necessary bedside care. To prevent these from happening, it is
important for nurses to become familiar with the user guide of the
respective machines specifically on the trouble shooting part.
Some pulse oximeters are more sensitive as compared to the
others, some need specific charging times, and some are more
durable than the others.
 TELEMETRY
 Hemodynamic monitoring can take place at the bedside of can
be conducted from a remote location via telemetry. Telemetry
allows for the continuous monitoring of patients usually outside of
the ICU. Telemetry monitoring is susceptible to signal loss.
Remember that computer-based hemodynamic monitoring
offers the critical care nurse a wealth of information that does
not replace clinical judgment.
 PHYSIOLOGIC MONITORING SYSTEMS
 ARRHYTHMIA MONITOR
 Computerized monitoring and analysis of cardiac rhythm have
proved reliable and effective in detecting potentially lethal heart
 rhythms. A key functional element is the system‘s ability to detect
ventricular fibrillation and respond with an alarm. SYSTEM TYPES:
Detection Surveillance Diagnostic or Interpretive.
 WHAT IS THE DIFFERENCE?
 In detection system, the criteria for a normal ECG are
programmed into the computer. Interpretive systems search the
ECG complex for five parameters: location for QRS complex;
time from the beginning to the end of the QRS; comparison of
amplitude, duration, and rate of QRS complex with all limb leads
P and T waves; comparison of P and T waves with all limb leads.
 Basic Components of arrhythmia monitors
1. Sensor
2. Signal conditioner
3. Cardiographer
4. Pattern recognition
5. Rhythm analysis
6. Diagnosis written report.
 CRITICAL CARE INFORMATION SYSTEM (CCIS)
 A system designed to collect, store, organize, retrieve, and
manipulate all data related to care of the critically ill patient.
CCIS is the organization of a patient‘s current and historical data.
CCIS allows the free flow of data between the critical care unit
and other departments. Provides a rich repository of patient
information that can be integrated for use in outcomes
management. Each patient‘s data can be accessed from any
terminal or workstation. This capability can extend across units
and departments or be restricted to a single unit. CCIS include:
Patient management service, length of stay, mortality,
readmission rates.
 VITAL SIGNS MONITORING
 Vital signs and other physiologic data can be automatically
acquired from bedside instruments and incorporated into the
clinical database. Data can be incorporated into flow sheets
with other data elements such as laboratory results body system
assessment findings problem lists.
 CLINICAL DOCUMENTATION
 Support the process of physical assessment findings. As the
critical care environment requires frequent assessments, these
flowsheets may be configured to ease this extensive data
collection. Flowsheets may also be organized by body system. All
disciples can document patient assessment findings into the
CCIS. Automatic calculation of physiologic indices can be
performed.
 DECISION SUPPORT
 The CCIS can provide alerts and reminders to guide care in
accordance with evidence-based guidelines. Point of care
access to knowledge bases that contain information on
evidence-based guidelines of care, drug information,
procedures, and policies. Data can be integrated with patient
information.
 MEDICATION MANAGEMENT
  Can facilitate the medication administration process.
Medication administrations of flow sheets incorporate the use
of bar code\ technology.
 INTERDISCIPLINARY PLANS OF CARE
 Special flow sheets incorporating required treatments and
interventions may be provided. Workflow management
solutions that help orchestrate all the numerous, simultaneous
processes.
 PROVIDER ORDER ENTRY
 Electronic entry and communication of patient orders can
help clinicians improve communication, streamline processes,
facilitate care, and can help clinicians, all providers in
managing quality.
 COMMUNITY HEALTH APPLICATIONS
o Focuses on the health information system of the
community, it is centered on the majority part of the
public.
o Emphasizes the prevention of the disease, medical
intervention, and public awareness.
o Fulfils a unique role in the community, promoting and
protect the health of the community at the same time
maintaining sustainability and integrity of health data and
information.
 GOAL OF COMMUNITY HEALTH INFORMATICS
 Effective and timely assessment that involves monitoring and
tracking the health status of populations including identifying
and controlling disease outbreaks and epidemics.
 COMMUNITY HEALTH APPLICATION SYSTEM
 Encourages optimal application of computer system,
computer programs and communication system for the
benefit of the majority of individuals, families and community.
 PRIMARY FOCUS OF COMMUNITY HEALTH INFORMATION SYSTEM
 Preventing, identifying, investigating, and eliminating
communicable health problems.
 Accessibility of data and information, through
communication.
 Educating and empowering individuals to adopt health
lifestyle.
 Facilitate the retrieval of data.
 Effective transformation of data into information.
 Effective integration of information to other disciplined to
concretized knowledge and creates better understanding.
 Creation of computerized patient records, medical
information system
 Central repositions of all data such as data warehouse.
 Simple Graphical User Interface (GUI) for nurses and other
healthcare provider, patient, and consumer.
 COMPUTER BASED SURVEY SYSTEM
Health Statistical Surveys
Are used to collect quantitative information about items in a
population to establish certain information from the obtained
data.
 Focused on opinions or factual information depending on its
purpose and many surveys involve administering question to
individuals.
 ADVANTAGES
o Consistent exchange of response
o Disease tracking
o Data and information sharing. Building strategies
o Early detection and monitoring of disease and sickness -
control of spread of disease.
o National alertness and preparedness – building strong
communication.
 o Maintaining strong relation between nurse and other
healthcare provider.
o Continuous coordination of the healthcare professionals -
synchronization of the decisions.
o Streamlining of the process.
o Effective management of data and information - optimal
operation of hospital and clinics.
 PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE
(PIDSR)
 A multi-faceted public health disease surveillance system that
provides public health officials the capabilities to monitor the
occurrence and spread of diseases.
Goal
➢ Strengthen the surveillance and response capabilities at each
level of the health system by building local capacities and
leveraging strengths and areas of expertise through partnership and
coordination.
Vision
➢ To improve the availability and use of surveillance and laboratory
data so that public health managers and decision makers can plan
for and carry out more timely detection and response to the leading
causes of illness, death, and disability.
FUNCTIONS
Information from PIDSR is expected to be used for the following
purposes:
1. Facilitate collecting, managing, analyzing, interpreting, and
disseminating health-related data for diseases designated as
nationally notifiable.
2. Develop and maintain national standards, such as consistent case
definitions for nationally notifiable diseases applicable across all the
provinces and cities.
3. Maintain the official national notifiable diseases statistics.
4. Provide detailed data to control programs to facilitate the
identification of specific disease trends.
5. Work with cities and provinces and partners to implement and
assess prevention and control programs.
 AMBULATORY CARE SYSTEMS
 The ambulatory care nurse focuses on patient safety and the
quality of nursing care by applying appropriate nursing
interventions, such as identifying and clarifying patient needs,
performing procedures, conducting health education,
promoting patient advocacy, coordinating nursing and other
health services, assisting the patient to navigate the health
care system, and evaluating patient outcomes.
 The ambulatory care covers a wide range of services that
can be offered to patients that needs medical attention.by
integrating the ambulatory care information system in the
nursing practice will really help in making the work easy like
the processing of data and information and the billing and
charges etc.
 There are advantages of the ambulatory care information like
first, the access of medical records of patients to health care
providers, second, the nurses will be able to give quality care
and improve workflow, reduce medical errors, and lastly the
 management and monitoring of the billing, doctor‘s fees,
prescriptions and many more.
 One of the most important responsibility of a nurse is to make
sure that the patient receives the care that he/she needed
and with the use of this system I believe the quality of care
can be given.
 EMERGENCY PREPAREDNESS AND RESPONSE
 Same with the objective in the application of informatics in
community health the over-all objective is public health. The
only difference is the focus and level of prevention. In
Community Health, the focus of the use of informatics is on
the promotive and preventive side, while in emergency
preparedness and response focus in the mitigation and
control of emergencies. The use of informatics here is much
wider and critical. The need for information in real-time is very
crucial in saving the lives of many.
 Based on Weiner and Slepski (2012) the modern movement
toward HEI could go a long way to expanding information
outreach to victims of disasters and humanitarian crises.
Although not the primary reason for the legislation that has
provided such sanctioned growth in electronic health care
records, for once an unintended consequence has a possible
positive effect. Other efforts to expand and upgrade
communications to all populations have benefits for the
disaster community as well. As an example, radiofrequency
identification (RFID) technology holds such promise with early
prototypes tagging victims with treatment and other
information. Longer range RFID tags and readers will it
possible to continuously track victims as they move through
the system for evacuation to treatment facilities (National
Research Council, Committee on using Information
Technology to Enhance Disaster Management, 2007).
 Improved decision support and resource tracking/allocation
tools bring added intelligence to the disaster situation. For
example, better available collaboration software and file
sharing have benefited the recent business world and can
serve to better reduce duplication of efforts during times of
disaster. At the same time, distributed emergency operation
centers provide resources in a less centralized manner that
aids in the distribution of planning, coordination, and
scheduling. Computer assisted decision- making tools and
intelligent adaptive planning provide alternatives to decisions
that are typically made in a vacuum.
 Bio surveillance is a key capability of obtaining and
maintaining situational awareness before and during a health
emergency. Early recognition and understanding of
departures from human, animal, plant, and environmental
baselines, including detection of novel occurrences, is
necessary to give early warning and save lives; however,
detecting deviations from the norm is complicated because
of the complexities of systems and variables and the multiple
stovepipes that exist. Many efforts are underway to improve
data collection, sharing, and analysis. Informatics and
technology solutions such as smartphones, tablets, and other
wireless devices may help to gather signals to detect
potential incidents earlier, regardless of the cause, and
communicate early warning and critical updates and foster
electronic information exchange worldwide. Rapid detection
is critical to save lives and improve incident outcomes, and
the United States serves in a key role as part of global
surveillance network.
 TELEHEALTH
 According to Mayo Clinic (2020), telehealth is the use of
digital information and communication technologies, such as
 computers and mobile devices, to access health care
services remotely and manage your health care. These may
be technologies you use from home or that your doctor uses
to improve or support health care services.
 Consider for example the ways telehealth could help you if you
have diabetes. You could do some or all the following:
o Use a mobile phone or other device to upload food logs,
medications, dosing, and blood sugar levels for review for
a nurse who responds electronically.
o Watch a video on carbohydrate counting and download
an app for it to your phone.
o Use an app to estimate, based on your diet and exercise
level, how much insulin you need.
o Use an online patient portal to see your test results,
schedule appointments, request prescription refills or email
your doctor.
o Order testing supplies and medications online.
o Get a mobile retinal photo screening at your doctor‘s
office rather than scheduling an appointment with a
specialist.
o Get email, text, or phone reminders when you need a flu
shot, foot exam, or other preventive care.
 TELEHEALTH GOALS
Also called e-health or m-health (mobile health), include the
following:
 Make health care accessible to people who live in rural or
isolated communities.
 Make services more readily available or convenient for
people with limited mobility, time, or transportation options.
 Provide access to medical specialists.
 Improve communication and coordination of care among
members of a health care team and a patient.
 Provide support for self-management of health care.
TELEHEALTH
 In the Philippines, we have also adopted telehealth and have
become an increasing necessity with the emergence of the
pandemic and implementing the community quarantine
measures. To promote safety among the public, telehealth
has been adopted by private and government hospitals. The
University of the Philippines – Manila (UPM) is one of the
earliest in the Philippines who adopted the telehealth in 1998.
They established the UP National Telehealth Center with the
commitment is to engage people to use available
technologies to improve health care albeit distance barriers.
Since its conception, it continues to develop telehealth
applications derived from people‘s own problem-solving
contributions. Through research-cum-service activities, the
center helps both patients and health care providers
maximize widely available and cost-effective ICT tools to
improve delivery of health care.
INFORMATICS IN THE TIME OF COVID-19
 2020 has proven to be an unprecedented year in modern
history, and it has barely begun! The emergence of the
COVID-19 pandemic has caused major impacts on global
society, including huge challenges for health care. No one in
this planet is immune to these sweeping changes, as many
joins in the efforts to contain this virus. Informatics teams are a
critical part of these efforts, serving as support, facilitating
new methods of delivering care, and aiding in tracking and
 forecasting the related impact data. Let us look at some of
the major ways informatics shines during the critical time and
some resources to aid in these processes.
SUPPORTING THE DAY TO DAY
 Information Technology (IT) and informatics specialists (IS) are
integral to all emergency actions taken by health care
organizations during a pandemic. This includes addressing
supply chain and labor shortages, business partner
considerations, telecommuting, enhanced physical and
technological security, continuity, and disaster recovery
planning, and monitoring supplies of personal protective
equipment (PPE) (AEHIS Incident Response Committee, 2020).
Specific attention is also required from IT and IS to organize the
following:
 Mass Notifications - digital experts often spearhead
innovations in mass notification to ensure staffs are updated
immediately as the crisis evolves. ―Healthcare systems may
want to ensure that they test their mass communications
systems and procedures to ensure that they can get critical
information into the hands of staff as quickly and efficiently as
possible‖. (AEHIS Incident Response Committee, 2020).
 Client Information - IS experts have found innovative ways to
provide COVID-19 support to clients in some health
organizations. For instance, Siwicki (2020) described how the
Montefiore Health System in New York City harnessed chatbot
AI technology to support client information. ―Staff wanted to
offer patients the ability to be directed to Montefiore
information, but also be in a position to get answers to key
questions they had about COVID-19. Being in New York City,
they were facing an increasing volume of calls coming into
doctor‘s offices, an increased demand for services, and
worried patients coming into the emergency rooms and
hospitals. Chatbot technology was meant to be an offering to
provide value to patients and direct them to the care they
needed.\
 Client Teaching - IS experts may also be involved with the
development of client health promotion and prevention
teaching materials that target COVID-19, such as brochures,
info graphics, handouts, videos, games, and other interactive
and engaging productions. For instance, IS may work with
organizations such as the Public Health Agency of Canada to
produce infographics to educate the public on Social
Distancing.
 Privacy of Health Data - IS and IT also dedicates a lot of
energy to ensure staff and clients stay safe: this includes
protecting their personal health information (PHI) as well as
employee data. It also entails securing organizational systems
and educating staff about potential COVID-19 inspired scam
and malware attempts, as well, policies related to PIH in the
time of a pandemic should be reviewed and revise, as
necessary. One example of potential policy tips is available
through the US system, as a bulletin: HIPAA Privacy and Novel
Coronavirus.
 Equipment Disinfection - all equipment used within health
organizations must be protected and disinfected if used more
than once, including electronics. ―Particular attention is
needed to address sanitation of mobile devices that are
handed off by workers between shifts or handed from patient
to patient.‖ (AEHIS Incident Response Committee 2020).
 System Interoperability - EHR based rapid screening
processes, laboratory testing, clinical decision support,
reporting tools, and patient-facing technology related to
COVID-19 are all supported by system interoperability. A great
 paper addressing these functions is available from Reeves et
al., (2020).
 DIGITAL HEALTH CANADA
o Offers a comprehensive collection of resources to support
informatics specialists as they work to connect and
protect front-line workers. This includes links to important
contacts, recorded COVID-19 webinars, and a dynamic
forum for Canadian digital health professionals to support
each another during the COVID-19 outbreak. (Digital
Health Canada, 2020, p. 1).
 WEGREE ROBOTS
o Although novel, some organizations are taking advantage
of robotics to protect both staff and clients. An example is
the Wegree robot. ―Wegree, a company based in Poland,
makes humanoid robots that are typically designed to
greet people at stores, malls, and other consumer- facing
businesses, and to answer their questions. Now, Wegree
has adopted its robots to serve as check-in staff for
hospitals and clinics, alleviating the needs for humans to
interact with potentially infected individuals. The robots
can greet those presenting with symptoms, guide them to
sanitize their hands and put on a face mask and ask
relevant questions that can be used to triage those that
should receive medical attention‖ (Medgadget Editors,
2020).
 SUPPORTING VIRTUAL AND TELEHEALTH CARE
o Informatics specialists (IS) may well work with physicians,
nurse practitioners, and other professionals to provide
virtual and/or telehealth care. Most provinces now have
specific virtual and telehealth care codes for physicians to
use with clients. IT and informatics experts can help
support physicians and others to choose the best
technology and to ―consider how easy the technology is
for you to use, how easy it is for patients to use, how the
technology can help you keep patient information private
and secure, and that you must record the work in your
medical record‖ (OntarioMD, 2020). This includes
integrating COVID-19 specific tools into existing electronic
medical and health records.
o ―We need well defined and easy-to-understand
guidelines for the day-to-day use of telehealth
technologies in the context of COVID-19. We need these
to be adjusted to the most vulnerable (e.g., different age
groups) and their needs. Such guidelines need to keep the
expectations f the users, be it patients or health care
providers, realistic. They need to convey the message that
eHealth solutions are viable alternative in times of this
pandemic and beyond; however, probably not suitable
for all problems that arise and certainly not a full
replacement of traditional care‖ (NITTAS, 2020).
o However, telehealth can also facilitate the direct care of
COVID-19 clients being isolated within their own homes.
―Community paramedicine or mobile integrated health
care programs allow patients to be treated in their homes,
with higher level medical support virtually‖ (Holander and
Carr, 2020). Unless caregivers are equipped with virtual
diagnostic tools, telehealth does have its limits for general
practice. ―The biggest benefit of telehealth may be
preventing people who have been exposed to the
coronavirus from leaving their homes and spreading it to a
physician‘s practice or an entire emergency department,
putting patients at risk and potentially putting healthcare
workers out of commission for 14 days of quarantine‖
(Ostherr, 2020).
o Some health professionals and organizations have
resorted to using mass market software and platforms to
 facilitate virtual and telehealth care during the pandemic.
These include platforms like Zoom, Skype, Apple Facetime,
Google Hangouts, Microsoft Teams, Facebook Messenger,
and others. IS can facilitate private and secure access
and utilization of these platforms to support client virtual
care. ―Yet these platforms are not embedded into
electronic medical records (EMRs). As a result, physicians
find themselves toggling between their EMR holding
important lab results and consultation notes and their
video screens. The time spent moving between to
separate programs adds up and places an extra layer of
effort to an already exhausting overhaul‖ (The
Conversation, 2020).
 TRACKING AND FORECASTING IS
o have been instrumental in finding ways to track COVID-19
and forecast future events related to the outbreak. For
instance, informatics experts at the University of Alberta‘s
Centre for Health Informatics explained, ―Our experts at
CHI (data scientists, academics, clinicians, statisticians,
epidemiologists, and visualization specialists) teamed up
and developed an interactive and comprehensible
dashboard. We want to help all Albertans and Canadians
stay informed on the current COVID-19 situation, with the
best data that is available‖ (University of Calgary, Centre
for Health Informatics (CHI), 2020, p. 2).
o The CHI COVID-19 tracker form ―The Centre for Health
Informatics, working collaboratively with the province of
Alberta and the City of Calgary in partnership with Alberta
Health services (AHS) and Alberta Health (AH) to create a
data visualization dashboard with up-to-date information
tracking the progression of the COVID-19 across the
province and the country at large‖ (University of Calgary,
Centre Health Informatics (CHI), 2020, p. 1).
o The importance of informatics in global tracking of this
pandemic has been strongly emphasized at the highest
levels. ―It is critical to emphasize the use of health
informatics methodology and information and
communication technology to combat the current
pandemic COVID-19 and future outbreaks. The essential
role of biomedical and health informatics in pandemic
surveillance, notification and continued delivery of
evidence based best practices‖ (International Academy
for Health Sciences Informatics (IAHSI), 2020, p. 1).
o Of course, tracking can become a cause for concern,
especially if human rights for privacy and confidentiality
are breached. During a pandemic, these rights might
come into question. Thus, all IT and IS experts are
encouraged to consider the following recommendations
from Informatics Europe (2020, p. 1).
 Track individuals with their consent and under their direct
control, allowing them to switch tracking freely and easily on
and off even during the same day. To achieve this goal, we
recommend technical experts to develop software which is
not only GDPR-ready, but also dynamically reconfigurable by
the end users within the limits defined by the current
jurisdiction.
RECOMMENDATIONS FROM INFORMATICS EUROPE
 Track only aggregated data that cannot be traced back to
particular individuals if they have not given their explicit
consent.
 Keep the tracking process transparent and open to the
scrutiny of public opinion from the beginning of its use and
 rely on the evaluation by independent scientific advisors to
assess the impact of security measures taken.
 Make any software and hardware used open to examination
by the civil society.
 Specify the time limit for tracking without allowing for any
extension in absence of an independent evaluation of the
motivations.
TRACKING AND FORECASTING
- Some IT and IS experts have harnessed the power of artificial
intelligence (AI) to create screening tools that anyone can
use to decide if their symptoms are positive for COVID-19 and
whether further treatment is necessary. Whittbold et al. (2020)
described how the partners healthcare team in Boston used
AI bots to create the partners COVID-19 screener, that
―provides a simple, straightforward chat interface, presenting
patients with a series of questions based on content from the
US Centers for Disease Control and Prevention (CDC) and
partners healthcare experts. In this way, it too can screen
enormous numbers of people and rapidly differentiate
between those who might really be sick with COVID-19 and
those who are likely to be suffering from less threatening
ailments. We anticipate this AI bot will alleviate high volumes
of patient traffic to the hotline and extend and stratify the
system‘s care in ways that would have been unimaginable
until recently.‖
- HIMSS Media offers a great collection of tracking and
forecasting innovations in their article, Roundup: Tech‘s role in
tacking, testing, treating COVID-19. ―As the cases of COVID-
19 increase we are seeing a rise in digital epidemiology tools,
chatbot helpers, EHR guidance tools and rapid-response test
kits‖ (HIMSS Media, 2020).
- AI is also being used to forecast the trajectory and future of
the COVID-19 pandemic. ―Few would argue that AI is causing
a paradigm shift in health care and there might be value in
the application of AI to the current COVID-19 outbreak, for
example, in predicting the location of the next outbreak‖
(McCall, 2020). Unfortunately, in order for this to occur, high
quality data must be available, and the AI system must be
programmed to this data. ―As a result of lack of data, too
much outlier data and noisy social media, big data hubris,
and algorithmic dynamics, AI forecast of the spread of
COVID-19 are not yet very accurate or reliable. Hence, so far,
most models used for tracking and forecasting do not use AI
methods. Instead, most forecasters prefer established
epidemiological models, so called SIR models, the
abbreviation standing for the population of an area that is
susceptible, infected, and removed‖ (Naude, 2020).
- IT and IS can work together to harness the benefits of AI
during this pandemic in a number of ways. According to
Naude 2020, ―there are six areas where AI can contribute to
the fight against COVID-19: early warnings and alerts, tracking
and prediction, data dashboard, diagnosis and prognosis,
treatments, and cures and social control‖.
- Experts emphasize the importance of the humans the IT and
ARE experts who work with AI that make all the difference.
―Efforts to leverage AI tools in the time of COVID-19 will be
most effective when they involve the input and collaboration
of humans in several different roles. The data scientists who
code AI systems play an important role because they know
what AI can do and, just as importantly, what it cannot. we
also need domain experts who understand the nature of the
problem and can identify where fast training data might still
be relevant today. Finally, we need out-of-the-box thinkers
 who push us to move beyond our assumptions and can see
surprising connections‖ (Hollister, 2020).
- All in all, informatics is critical to the successful abatement of A. COMPUTER GENARATED NURSING CARE PLANS
the COVID-19 pandemic, and informatics specialists are the  Essential teaching tool to present the value of planning
heart of this support and innovation. We salute all our tireless patient care.
peers who are spearheading these initiatives that support the  reinforced by Joint Commission On Accreditation For Hospital
hard work and dedication of our front-line health care (JCAH)
professionals. May we all come through this crisis with  Problems in written care plan:
strength, vision, and collaborative success!! o incomplete
UNIT IV APPLICATION IN EVIDENCE – BASED NURSING PRACTICE o outdated
o rarely used for determining care
o infrequently relied upon as a means of communicating
problem management from one shift to another
EVIDENCE – BASED NURSING PRACTICE o viewed burdensome
Refers to the process of collecting, processing and
 o time-consuming paperwork preparation
implementing research findings for the improvement of o revision of plan is low in practice setting
patient‘s outcomes, clinical nursing practice and work or  Solution to the problem is:
environment. o Promotes the value of planning care
 Helps provide the highest possible quality care at the most o Address the burden of workload NCPs can consume from
cost -efficient manner the nurses
 Enables the nurses to incorporate clinical expertise and o Works by providing template that nurse can work on and
current research to the data and turn it into a useful basis in modify based on the individual cases of their clients.
the decision making process.
B. CRITICAL/CLINICAL/CARE PATHWAYS
 APPLICATION IN EVIDENCE – BASED NURSING PRACTICE
o The use of information technology in evidence-based  ALSO KNOWN AS:
nursing practice such as: o CARE PATHWAYS
A. Computerized Nursing Care Plan o CLINICAL PATHWAYS
B. Clinical Pathways
CARE PATHWAYS
C. Clinical Practice Guidelines And
D. e-journal - one of the best tools of hospital to standardized quality of
 Allows more efficient facilitation in evidence-based nursing care process
practice - promotes organized and efficient patient care based on
evidence
 - proven that the implementation reduces the variability in
clinical practice and improves outcomes.
- concept first appeared in1985 inspired by KAREN ZANDER and
KATHLEEN BOWER at the NEW ENGLAND MEDICAL CENTER in
BOSTON
- USUALLY PRESENTED AS GANTT CHART
oDevelopment and implementation involves a change in the
organizational culture at any setting.
 The activities to be done to develop and implement a care
pathway:
A. Preparing multidisciplinary documents

B. Reviewing the process by all the concerned staff

 Different systematization tools were being used for the clinical
process: C. Holding care pathway meetings to facilitate the exchange of
o Oldest are: opinions about patient care by different professionals
 Medical and Nursing protocols
o Then: D. Conducting periodic reviews to monitor some defined indicators
 Standartized Care Maps and Clinical Practice
E. Analyzing variances or deviations
Guide lines
F. Preparing common record documents for all the staff
CARE PATHWAYS:

 Main goal is based on the improvement of the following areas:

o Quality in health care  Barriers in developing and implementing a pathway:
o Coordination/cooperation among health professionals
o Efficiency and patient satisfaction A. The heterogeneity of patients and diagnosis,
 Purpose:
B. The common reluctance among organizations and professionals
o Enhancement of care processes in the 3 areas:
to change.
 Quality
 Safety NOTE: Hospital managers must consider these barriers since they
 Efficiency may threaten a successful implementation of care pathways.
o Powerful tool for care management process
 Permit to check the compliance of all interventions
including the healthcare plans
B. CRITICAL PATHWAYS
 Fix care standard
 Introduce clinical audits as a part of the process  How to document variances? (Institutional guidelines may apply
o Useful to identify improvement areas in the standard care and not strictly confined to the guidelines below)
process for Continuous Quality Improvement culture.
1. Similar to DAR (Data, Action, and Response) format, we utilize
VAO (Variance, Action, and Outcome) to document variances.
2. Variance - includes all subjective and objective data observed by
the nurse to be outside of the pathway management of the
patient's case.
3. Action - includes all interventions used to address the variance
4. Outcome -- includes all patient care outcomes after the
interventions were performed to address the variance.
 Important Note:
o Variances are not something to be taken negatively.
o It may increase health care costs due to the
management of these variances that are outside of the
clinical pathway, but over time as these variances
become common and established a pattern, then it can
be included in the clinical pathway depending on the
institution's approval and analysis of the situation.
o If sooner or later it becomes part of the clinical pathway,
then the health care costs will be controlled.
o Remember, the clinical pathways are not final. It always
gets revised frequently depending on the institution, as
our healthcare environment is dynamic.
o Collaboration within all members of the healthcare team
is a must to ensure a smooth and proper implementation
of these clinical pathways.
Sample Document Using Clinical Pathway ( SHOWN IN WORD DOC.)
C. CLINICAL GUIDELINES
 Clinical Practice Guidelines are statements that include
recommendations intended to optimize patient care.
 Informed by a systematic review of evidence, and an
assessment of the benefits and harms of alternative care
options.
 CPGs should follow a sound, transparent methodology to
translate best evidence into clinical practice for improved
patient outcomes.
 Additionally, evidence-based CPGs are a key aspect of
patient-centered care.
 Clinical practice guidelines should be feasible, measurable,
and achievable.
 Clinical performance measures may be developed from
clinical practice guidelines and used in quality improvement
initiatives. When these performance measures are
incorporated into public reporting, accountability, or pay for
performance programs, the strength of evidence and
magnitude of benefit should be sufficient to justify the burden
of implementation.
 Sample of the clinical practice guideline for pneumonia by
the Philippine College of Chest Physician( shown in word doc)
D. E-JOURNALS
- E-journals or electronic journals are scholarly publications in
digital form, which are accessible on the web.
D. E-JOURNALS
 In the Philippines, we have the Philippine E-journals
(ejournals.ph) where you can find an online bibliographic
 database & repository of academic journals in different
disciplines from various resources.
 These are often used as acceptable review of related
literatures for research projects and evidence-based nursing
practice.
 Sample of the clinical practice guideline for pneumonia by the Philippine College of
Chest Physician
Figure 1. Algorithm for the management-oriented risk stratification of CAP among
immunocompetent adults

CAP

Any of the following:

1. RR ≥ 30/min
2. PR ≥ 125/min
3.Temp ≥ 40°C of ≤ YES YES
36°C Any of the following:
4. SBP≤90mmHg or High-risk CAP
DBP≤60mmHg 1. Severe sepsis and
5. Altered mental septio shook
status of acute onset
6.Suspected 2. Need for mechanical
aspiration ventilation
7. Unstable co-
morbid conditions ICU Admission
8. Chest x-ray NO
multilobar, pleural
etfusion, abscess
Moderate-risk
CAP
NO

Low-Risk CAP Cap

Ward Admission

Outpatient

Sample of the clinical practice guideline for pneumonia by the Philippine College
of Chest Physician
Netiquette Rules and Guidelines
- Netiquette is short for "Internet etiquette." Just like etiquette is a
code of polite behavior in society, netiquette is a code of good
behavior on the Internet. This includes several aspects of the
Internet, such as email, social media, online chat, web forums,
website comments, multiplayer gaming, and other types of online
communication.
Examples of rules to follow for good netiquette:
1. Avoid posting inflammatory or offensive comments online (a.k.a
flaming).
2. Respect others' privacy by not sharing personal information, photos,
or videos that another person may not want published online.
3. Never spam others by sending large amounts of unsolicited email.
4. Show good sportsmanship when playing online games, whether you
win or lose.
5. Don't troll people in web forums or website comments by
repeatedly nagging or annoying them.
6. Stick to the topic when posting in online forums or when
commenting on photos or videos, such as YouTube or Facebook
comments.
7. Don't swear or use offensive language.
8. Avoid replying to negative comments with more negative
comments. Instead, break the cycle with a positive post.
9. If someone asks a question and you know the answer, offer to help.
10. Thank others who help you online.
10 Netiquette Guidelines Online Students need to know
1. NO YELLING, PLEASE
- There‘s a time and a place for everything—BUT IN MOST SITUATIONS
TYPING IN ALL CAPS IS INAPPROPRIATE. Most readers tend to
perceive it as shouting and will have a hard time taking what you
say seriously, no matter how intelligent your response may be. If you
have vision issues, there are ways to adjust how text displays so you
can still see without coming across as angry or upset.
2 Sarcasm can (and will) backfire.
- Sarcasm has been the source of plenty of misguided arguments
online, as it can be incredibly difficult to understand the
commenter‘s intent. What may seem like an obvious joke to you
could come across as off-putting or rude to those who don‘t know
you personally. As a rule of thumb, it‘s best to avoid sarcasm
altogether in an online classroom. Instead, lean toward being polite
and direct in the way you communicate to avoid these issues.
3. Don’t abuse the chat box
- Chat boxes are incorporated into many online classes as a place
for students to share ideas and ask questions related to the lesson. It
can be a helpful resource or a major distraction—it all depends on
how well students know their classroom netiquette. ―Rather than
asking relevant questions or giving clear answers, students might use
the chat box to ask questions irrelevant to the discussion, or to talk
about an unrelated topic,‖ says Erin Lynch, senior educator at Test
Innovators. The class chat box isn‘t an instant messenger like you‘d
use with friends. Treat it like the learning tool it‘s meant to be, and try
not to distract your classmates with off-topic discussions. Use it
instead to ask relevant questions and participate in class when the
professor asks.
4. Attempt to find your own answer
- If you‘re confused or stuck on an assignment, your first instinct may
be to immediately ask your instructor a question. But before you ask,
take the time to try to figure it out on your own. For questions related
to class structure, such as due dates or policies, refer to your syllabus
and course FAQ. Attempt to find the answers to any other questions
on your own using a search engine. If your questions remain
unanswered after a bit of effort, feel free to bring them up with your
instructor.
5. Stop ... grammar time!
- Always make an effort to use proper punctuation, spelling and
grammar. Trying to decipher a string of misspelled words with erratic
punctuation frustrates the reader and distracts from the point of
your message
6. Set a respectful tone
- Every day may feel like casual Friday in an online classroom where
you don‘t see anyone in person, but a certain level of formality is still
expected in your communication with instructors. In addition to
proper punctuation and spelling, it‘s good netiquette to use
respectful greetings and signatures, full sentences and even the
same old ―please‖ and ―thank you‖ you use in real life.
7. Submit files the right way
- You won‘t be printing assignments and handing to them to your
teacher in person, so knowing how to properly submit your work
online is key to your success as an online student. Online course
instructors often establish ground rules for file assignment
submissions, like naming conventions that help them keep things
organized or acceptable file formats. Ignoring these instructions is a
common example of bad netiquette.
8. Read first
- Take some time to read through each of the previous discussion
post responses before writing your own response. If the original post
asked a specific question, there‘s a good chance someone has
already answered it. Submitting an answer that is eerily similar to a
classmate‘s indicates to the instructor that you haven‘t paid
attention to the conversation thus far. Remember, discussions can
move fairly quickly so it‘s important to absorb all of the information
before crafting your reply. Building upon a classmate‘s thought or
attempting to add something new to the conversation will show
your instructor you‘ve been paying attention.
9. Think before you type
- A passing comment spoken in class can be forgotten a few minutes
later, but what you share in an online classroom is part of a
permanent digital record. Not only is it good practice to be
guarded when it comes to personal information, you always want to
be just as respectful toward others as you would be if you were
sitting in the same room together. Zink says a good rule of thumb to
follow is if you‘re comfortable standing up in front of a classroom
and saying your message, then it‘s most likely okay to share.
10. Be kind and professional
 Online communication comes with a level of anonymity that
doesn‘t exist when you‘re talking to someone face-to-face.
Sometimes this leads people to behave rudely when they disagree
with one another. Online students probably don‘t have the
complete anonymity that comes with using a screen name, but you
could still fall prey to treating someone poorly because of the
distance between screens. Make a point to be kind and respectful
in your comments—even if you disagree with someone.
Recommendations for Social Media Use in hospitals and health Care
Facilities
Social Media is the new avenue for creating connections and sharing of
information. Through social media, one can reach a global community. In
recent years, we have seen how social media has changed the way we do
things. Social Media has been extensively utilized for health education and
promotion, proving itself to be an invaluable tool for public health,
professional networking and patient care benefit.
The challenge has been to use the power afforded by social media
responsibly, and to define the line between use and abuse. While there
may be laws, implementation proves to be a challenge in the digital age.
Therefore, self-regulation and institutional policy remain a critical part. It is
therefore urged that hospitals and health care facilities adopt their own
social media use policy appropriate for the institution. Below are proposed
rules that could guide institutions in developing their own policy for social
media use:
Sec. 1. Declaration of Policy. The health facility recognizes that the exercise
of the freedom of expression comes with a responsibility and a duty to
respect the rights of others. The health facility likewise acknowledges the
fundamental right to privacy of every individual. This policy shall provide
rules for responsible social media use.
Sec. 2. Definition. For purposes of this policy, the following definitions shall
be used:
a) Social Media refers to electronic communication, websites or
applications through which users connect, interact or share
information or other content with other individuals, collectively part
of an online community. This includes Facebook, Twitter, Google+,
Instagram, LinkedIn, Pinterest, Blogs, Social Networking sites.
b) Health facility shall refer to the hospital or other health care facilities,
including training and educational institutions.
c) Individual shall refer to physicians, employees, other health facility
staff, residents, or students to which this policy would apply.
Sec. 3. Applicability. This policy shall apply to all physicians, health
professionals, employees and other health facility staff, including students or
residents in training, practicing their profession, working, or fulfilling
academic and clinical requirements within the health facility, whether
temporary or permanent.
Sec. 4. General Principles. Social media use shall be guided by the
following principles:
a) In using social media, an individual should always be mindful of his
or her duties to the patient and community, his profession and his
colleagues.
b) The individual should always be conscious of his or her online image
and how it impacts his or her profession, or the institution where he
or she is professionally employed, affiliated or otherwise connected.
c) Responsible social media use also requires the individual to ensure
that in his or her social media activity, there is no law violated,
including copyright, libel and cybercrime laws. At all times, the
individual shall respect the right of privacy of others.
d) Use of social media requires a personal commitment to uphold the
ethical standards required of those providing health services, upon
which patient trust is built.
Sec. 5. Social Media for Health Education or Promotion
a) The individual using social media for health education or promotion
must be well-informed of the matter subject of the social media
post, comment or other activity. The individual shall refrain from any
activity which spreads or tends to spread misinformation.
b) An article written by an individual and posted in social media must
be evidence-based and disclose connections with pharmaceutical
or health product companies or other sources of possible conflict of
interest.
c) Social media shall not be used to dispense specific medical
diagnosis, advice, treatment or projection but shall consist of
general opinions only. Use of social media should include
statements that a person should not rely on the advice given online,
and that medical concerns are best addressed in the appropriate
setting.
d) The individual shall be careful in posting or publishing his or her
opinion and shall ensure that such opinion will not propagate
misinformation or constitute a misrepresentation. The individual shall
not make any misrepresentations in his or her social media activity
relating to content, his or her employment or credentials, and any
other information that may be misconstrued or taken out of context.
Sec. 6. Professionalism in Social Media Use
a) Individuals are discouraged from using a single account for both
professional and private use. Be mindful that an electronic mail
 address used professionally may readily be linked to a social media
site used privately.
b) The individual shall conduct himself or herself in social media or
online the same way that he would in the public, mindful of acting
in a manner befitting his profession, or that would inspire trust in the
service he or she provides, especially if the individual has not
separated his or her professional and personal accounts in social
media.
c) The individual shall likewise refrain from using the name, logo or
other symbol of an institution without prior authority in his or her
social media activity. An individual shall not identify himself or herself
as a representative of an institution in social media without being
authorized to do so.
d) Individuals shall not accept former or current patients as friends or
contacts in their personal accounts, unless there is justification to do
so, such as a pre-existing relationship or when unavoidable for
patient care. In case of online interaction with patients, this should
be limited to matters related to the patient‘s treatment and
management, and which could be properly disclosed.
e) Informal and personal information concerning a patient, colleague
or the health facility shall not be posted, shared or otherwise used in
social media.
f) Social media shall not be used to establish inappropriate
relationships with patients or colleagues, and shall not be used to
obtain information that would negatively impact on the provision of
services and professional management of the patient.
g) An individual shall refrain from posting, sharing or otherwise using
photos or videos taken within the health facility, which would give
the impression of unprofessionalism, show parts of the health facility
where there is an expectation of privacy, or those which includes
colleagues, employees, other health facility staff, or patients without
their express consent. The consent requirement shall apply even if
the other individuals included are not readily identifiable.
Sec. 7. Responsible Social Media Activity
a) In using social media, the individual shall respect the dignity,
personality, privacy and peace of mind of another.
b) The individual shall not post, share or otherwise use social media
with the intent of damaging the reputation of any other individual or
institution, especially if the subject is identified or identifiable.
c) Derogatory comments about patients, colleagues, employers and
institutions or companies should be avoided. An individual may
―like‖ a defamatory post but he or she must use caution when
sharing, retweeting or contributing anything that might be
construed as a new defamatory statement. A post, comment or
other social media activity is considered defamatory if:
1) The activity imputes a discreditable act or condition to
another
2) The activity is viewed or seen by any other person
3) The person or institution defamed is identified or readily
identifiable
4) There is malice or intent to damage the reputation of
another.
d). He or she shall be careful of sharing posts or other contents that
are unverified, particularly if it discredits another person or institution, or
imputes the commission of a crime or violation of law even before trial and
judgment, and violates the privacy of another. Fair and true reporting on
matters of public concern shall be allowed provided that the content was
obtained lawfully and with due respect for the right of privacy.
e. An individual shall not use copyrighted materials other than for fair use
where there is proper citation of source and author. Use of copyrighted
material for purpose of criticism, comment, news, reporting, teaching,
scholarship, research, and similar purposes is compatible with fair use.
f. An individual is prohibited from:
1) Social media activities that defame, harass, stalk, or bully another person
or institution.
2) The use or access of personal social media accounts of others without
authority.
3) Posting, sharing or otherwise using any information intended to be
private or obtained through access to electronic data messages or
documents.
4) Posting, sharing or otherwise using recorded conversations between
doctors, individuals or patients, when such recording, whether audio or
video, was obtained without consent of all the parties to the conversation
g. Individuals should use conservative privacy settings in their social media
account used professionally. The individual should also practice due
diligence in keeping their social media accounts safe such as through
regular password change and logging out after social media use.
Sec. 8. Health Information Privacy
a. The individual shall respect the right to privacy of others and shall not
collect, use, access or disclose information, pictures and other personal or
sensitive information without obtaining consent from the individual
concerned. Physicians, health facility employees and other health staff shall
have the duty of protecting patient confidentiality in their social media
activity.
b. Personal health information, including photos or videos of patients, shall
not be posted, shared or otherwise used in social media without consent of
patient. Consent shall be obtained after explaining to the patient the
purpose of the intended collection, use, access and disclosure. Consent for
use of personal health information shall be written or evidenced by
electronic means.
c. An individual shall not post, share or otherwise use any information which
could be used to identify patients without their consent, including patient‘s
location, room numbers, and photographs or videos of patients or their
body parts, including code names referring to patients.
d. The individual shall not post, share or otherwise use any other information
acquired in attending to a patient in a professional capacity, and which
would blacken the reputation of the patient. The duty of maintaining
patient confidentiality remains even after patient‘s death.
e. An individual shall not post, share or otherwise use any information
relating to the identity, status and personal details of persons with HIV, those
who have undergone drug rehabilitation, and victims of domestic violence,
rape and child abuse.
Sec. 9. Compliance and Reporting.
a. An individual shall strive to develop, support and maintain a privacy
culture in the health facility. He or she shall abide by the social media use
policy of the institution.
b. An individual who becomes aware of unprofessional behavior,
misinformation or privacy violations in social media shall report the matter
to the hospital‘s privacy officer or the proper office or authority within the
facility.
c. Health facilities shall in so far as practicable monitor the social media
activity of all physicians, employees and other health facility staff, including
students or residents in training, practicing their profession, working, or
fulfilling academic and clinical requirements within the health facility,
whether temporary or permanent.
Sec. 10. Penalty. A violation of this policy may constitute a violation of the
code of ethics of physicians and other professions, and other applicable
laws.
a. Health Professionals, employees and other Health Facility Staff. Any
person found violating this policy will be considered in violation of health
facility rules and regulations, and shall be subjected to health facility
administrative proceedings, which after notice and hearing, and
depending on the severity of the violation, could result to termination of
service or withdrawal of privileges. A lighter penalty may likewise be
imposed. In determining the severity of the violation, the following factors
may be considered: previous violation, if any, the nature of the violation,
and the extent of injury or damage. The penalty imposed by the health
facility shall be without prejudice to the filing of a complaint before the Civil
Service Commission, the Professional Regulations Commission, the Office of
the Prosecutor or Ombudsman, or proper courts.
b. Students. In case of students, they shall be reported to the college
wherein they are enrolled and shall be subjected to disciplinary
proceedings, which could result to expulsion, depending on the severity of
the violation, and in accordance with the applicable University and
respective College rules. A lighter penalty may likewise be imposed. The
disciplinary proceedings shall be without prejudice to other applicable
legal remedies.
SURGICAL SAFETY CHECKLIST
 Objectives of this presentation
 This topic will explain what a surgical safety checklist is and
 Why it is important.
 A surgical safety checklist was designed to improve team
communication and consistency of care would reduce
complications and deaths associated with surgery.
Background cont…
 Surgery is performed in every community: wealthy and poor, rural
and urban, and in all regions.
 Although surgical care can prevent loss of life or limb, it is also
associated with a considerable risk of complications and death.
 The risk of complications is poorly characterized in many parts of the
world, but studies in industrialized countries have shown a
perioperative rate of death from inpatient surgery of 0.4 to 0.8% and
a rate of major complications of 3 to 17%
 Data suggest that at least half of all surgical complications are
avoidable.

Ohio Surgeon Trail of errors led to 3 Surgical Safety checklist

Performs wrong brain surgeries.
Wrong-Site Surgery Surgeons' ego at  In 2008, the World Health Organization (WHO) published guidelines
on R.I.P. hospital may identifying multiple recommended practices to ensure the safety of
surgical patients worldwide.
Four- Year-Old have led to
 On the basis of these guidelines, a checklist intended to be globally
carelessness. applicable and to reduce the rate of major surgical complications.
 The implementation of this checklist and the associated culture
Wrong kidney removed at changes it signified would reduce the rates of death and major
Medical Center complications after surgery in diverse settings.
The role of surgical safety checklist
Background The checklist consists of an oral confirmation by surgical teams of
the completion of the basic steps for ensuring:
 Surgery has become an integral part of global health care, with an
estimated 234 million operations performed yearly. Each week in the
US wrong-site surgery occur over 40 times.
 Foreign objects are left inside patient‘s body 39 times, and these
mistakes and their associated complications are common and
preventable.
Safe Site Surgery will help the surgical team to avoid:
 •All members of the team are aware of whether the patient has a known
 Surgical deaths and errors allergy
 The adverse legal issues •The patient‘s airway and risk of aspiration have been evaluated and
 Surgical infection appropriate equipment and assistance are available
 Poor communication among surgical team members •If there is a risk of blood loss of at least 500 ml (or 7 ml/kg of body weight, in
How the checklist is used. children), appropriate access and fluids are available
 It is used at three critical junctures in care:
Before anesthesia is administered, 2. Time out (Surgical pause):
Immediately before incision, and Before skin incision, the entire team (nurses, surgeons, anesthesia
Before the patient is taken out of the operating room. professionals, and any others participating in the care of the patient) orally:
 The WHO surgical safety checklist represents a simple set of surgical
safety operating room standards that are applicable in all countries  Confirms that all team members have been introduced by name
and settings. and role
 The checklist is not intended to be comprehensive. Additions and  Confirms the patient‘s identity, surgical site, and procedure
modifications to fit local practices are encouraged.  Reviews the anticipated critical events
 Surgeon reviews critical and unexpected steps, operative duration,
A set of Safety Checks has been assembled to reduce the number and and anticipated blood loss
severity of adverse events involving:  Anesthesia staff review concerns specific to the patient
 Surgeons  Nursing staff review confirmation of sterility, equipment availability,
 Anesthesiologists and other concerns
 Nurses  Confirms that prophylactic antibiotics have been administered ≤60
 Public health experts min before incision is made or that antibiotics are not indicated
Three elements of the Surgical Safety Checklist:  Confirms that all essential imaging results for the correct patient are
•Sign In displayed in the operating room
•Time Out  The Wrong way to do a Time Out
•Sign Out  Successful Time Out Process

1. Sign in (Briefing):
Before induction of anesthesia, members of the team (at least the nurse
and an anesthesia professional) orally confirm that:
•The patient has verified his or her identity, the surgical site and procedure,
and consent
•The surgical site is marked or site marking is not applicable
•The pulse oximeter is on the patient and functioning
3. Sign out
Before the patient leaves the operating room:
 Nurse reviews items aloud with the team
 Name of the procedure as recorded
 That the needle, sponge, and instrument counts are complete (or
not applicable)
 That the specimen (if any) is correctly labeled, including with the
patient‘s name
 Whether there are any issues with equipment to be addressed
  The surgeon, nurse, and anesthesia professional review aloud the
key concerns for the recovery and care of the patient
 The WHO checklist format
Some important considerations for the nurse
 Is the patient fasting (Nil Per Oral – NPO)? When did the
patient eat last?
 Is the necessary imaging displayed?
 Are the surgical items that you have ―pulled‖ what the
surgeon needs? Do you need to check with the surgeon
first?
 Is the patient situated on the table without unnecessary
pressure that could cause nerve damage? How long will the
procedure take?
 Are all members of the team ready to start?
Outcomes of the checklist
 Introduction of the WHO Surgical Safety Checklist into operating
rooms in various hospitals around the world was associated with
marked improvements in surgical outcomes.
 Postoperative complication rates fell by 36% on average, and
death rates fell by a similar amount.
 The reduction in the rates of death and complications suggests that
the checklist program can improve the safety of surgical patients in
diverse clinical and economic environments.
Conclusions
 A common theme in cases of wrong-site surgery involves failed
communication between the surgeon(s), the other members of the
health care team, and the patient.
 Communication is crucial throughout the surgical process,
particularly during the preoperative assessment of the patient and
the procedures used to verify the operative site.
 Effective preoperative patient assessment includes a review of the
medical record or imaging studies immediately before starting
surgery.
 To facilitate this step, all relevant information sources, verified by a
predetermined checklist, should be available in the operating room
and rechecked by the entire surgical team before the operation
begins.
Conclusion cont…
 A briefing is important for assigning essential roles and establishing
expectations.
 Introduction of each person in the operating room by name and
role, even if team members are familiar, is recommended for
improved communication. Whenever possible, the patient (or the
patient's designee) should be involved in the process of identifying
the correct surgical site, both during the informed consent process
and in the physical act of marking the intended surgical site in the
preoperative area.
 A formal procedure for final confirmation of the correct patient and
surgical site (a ―time out‖) that requires the participation of all
members of the surgical team may be helpful. Time outs may
include not only verification of the patient and the surgical site, but
also relevant medical history, allergies, administration of appropriate
preoperative antibiotics, and deep vein thrombosis prophylaxis.
 Use of the checklist involved both changes in systems and changes
in the behavior of individual surgical teams.
 To implement the checklist, all sites had to introduce a formal pause
in care during surgery for preoperative team introductions and
briefings and postoperative debriefings, team practices that have
previously been shown to be associated with improved safety
processes and attitudes and with a rate of complications and
death reduced by as much as 80%.

The philosophy of ensuring the correct identity of the patient and site
through preoperative site marking, oral confirmation in the operating room,
and other measures proved to be new to most of the study hospitals.
REMEMBER
EVERY CHECK CAN SAVE LIFE
THIS CHECKLIST IS A DOCUMENT BUT ALSO A MATERIAL (TOOL) FOR
OPERATING ROOMS, THAT CAN HELP US TO BE SAFE FOR OUR WORK AND
SAFE FOR OUR PATIENTS.
UNIT 7 STANDARDS OF NURSING INFORMATICS PRACTICE
Standards of Nursing Informatics Practice According to American Nurses
Association
 Significance of the Standards
The Standards are based on the Standard of Professional Nursing Practice
 They are authoritative statements of the duties that all registered
nurses, regardless of role, population, or specialty, are expected to
perform competently.
 The standards published are utilized as evidence of the care, with
the understanding that application of the standards is context
dependent.
 The standards are subject to change with the dynamics of the
nursing profession, as new patterns of professional practice are
developed and accepted by the nursing profession and the public.
 In addition, specific conditions and clinical circumstances may
affect the application of the standards at a given time (e.g., during
a natural disaster).
 The standards are subject to formal, periodic review and revision.
 The competencies that accompany each standard may be
evidence of compliance with the corresponding standard.
 The list of competencies is not exhaustive.
 Whether a particular standard or competency applies depends on
the circumstances.
Standard 1. Assessment
 The informatics nurse collects comprehensive data, information,
and emerging evidence pertinent to the situation.
Competencies
The informatics nurse:
 Uses evidence-based assessment techniques, instruments, tools, and
effective communication strategies in collecting pertinent data to
define the issue or problem.
 Uses workflow analyses to examine current practice, workflow, and
the potential impact of an informatics solution on that workflow.
 Conducts a needs analysis to refine the issue or problem when
necessary.
 Involves the healthcare consumer, family, interprofessional team,
and key stakeholders, as appropriate, in relevant data collection.
 Prioritizes data collection activities.
 Uses analytical models, algorithms, and tools that facilitate
assessment.
 One example of an assessment algorithm is PIECES:
o Performance--throughput or response time;
 o Information-outputs, inputs, and/or stored data;
o Economics-costs versus profits;
o Control-too little security or control or too much control or
security;
o Efficiency-people, machines, or computers waste time, and;
o Service--inaccurate, inconsistent, unreliable, hard to learn,
difficult to use, inflexible, incompatible, not coordinated with
other systems (Wetherbe, 1994).
 Synthesizes available data, information, evidence, and knowledge
relevant to the situation to identify patterns and variances.
 Applies ethical, legal, and privacy regulations and policies for the
collection, maintenance, use, and dissemination of data and
information.
 Documents relevant data in a retrievable format.
Standard 2. Diagnosis, Problems, and Issues Identification
 The informatics nurse analyzes assessment data to identify
diagnoses, problems, issues, and opportunities for improvement.
Competencies
The informatics nurse:
 Derives diagnoses, problems, needs, issues, and opportunities for
improvement based on assessment data.
 Validates the diagnoses, problems, needs, issues, and opportunities
for improvement with the healthcare consumer, family,
interprofessional team, and key stakeholders when possible and
appropriate.
 Identifies actual or potential risks to the healthcare consumer‘s
health and safety, or barriers to health, which may include, but are
not limited to, interpersonal, systematic or environmental
circumstances.
 Uses standardized clinical terminologies, taxonomies, and decision
support tools, when available, to identify problems, needs, issues,
and opportunities for improvement.
 Documents problems, needs, issues, and opportunities for
improvement in a manner that facilities the discovery of expected
outcomes and development of a plan.
Standard 3. Outcome Identification
 The informatics nurse identifies expected outcomes for a plan
individualized to the healthcare consumer of the situation.
Competencies
The informatics nurse:
 Involves the healthcare consumer, family, healthcare provider and
key stakeholder in formulating expected outcome when possible
and appropriate.
 Defines expected outcome in terms of the healthcare consumer,
health-care worker, and other stakeholder; their values; ethical; and
environmental, organizational, or situational considerations
 Formulates expected outcomes after considering associated risks,
benefits, costs, available, expertise, evidence-based knowledge,
and environmental factors.
 Develops expected outcomes that provide direction for project
team members, the healthcare team, and key stakeholders.
 Includes a time estimate for the attainment of expected outcomes.
 Modifies expected outcome based on changes in the status or
evaluation of the situation.
 Documents expected outcomes as measurable goals.
Standard 4. Planning
  The informatics nurse develops a plan that describes strategies,
alternatives and recommendations to attain expected outcomes.
Competencies
Competencies
The informatics nurse:
The informatics nurse:
 Develops a customized plan considering clinical and business
characteristics of the environment and situation.
 Develops the plan in collaboration with the healthcare consumer,
family, healthcare team, key, stakeholders, and others as
appropriate.
 Establishes the plan priorities with key stakeholders and others as
appropriate.
 Incorporates strategies in the plan address each of the identified
diagnoses, problems, needs, and issues.
 Incorporates planes strategies addressing health and wholeness
across life span.
 Incorporates an implementation pathway or timeline within the plan
 Considers the clinical, financial, social and economic impact of the
plan on the stakeholders
 Integrate current scientific evidence, trends, and research into the
planning process
 Utilizes the plan to provide direction for the healthcare team and
other stakeholders.
 Integrates current status, rules and regulations, and standards within
the planning process and plan.
 Modifies the plan according to the ongoing assessment of the
healthcare consumer‘s response and other outcome indicators.
 Integrates informatics principles in the design of interprofessional
processes to address identified situations or issues.
 Documents the plan in a manner that uses standardized
terminologies and taxonomies.
Standard 5. Implementation
 The informatics nurse implements the identified plan
 Partners with healthcare consumer, healthcare team, and others, as
appropriate, to implement the plan on time, within the budget, and
within plan requirements.
 Utilizes health information technology to measure, record, and
retrieve healthcare consumer data, implement and support the
nursing process, and improve overall healthcare outcomes.
 Uses specific evidence-based actions and processes to resolve
diagnoses, problems, or issues to achieve the defined outcomes.
 Advocates for health care that is sensitive to the needs of
healthcare consumers, with emphasis on the need of diverse
populations and use of self-theory
 Applies available healthcare technologies to maximize access and
optimize outcomes for healthcare consumers.
 Uses community and organizational resources systematically to
implement the plan.
 Collaborate with the healthcare team and other stakeholder from
diverse backgrounds to implement and integrate the plan
 Accommodates different styles of communication used by
healthcare consumers, families, healthcare providers, and others
 Implements the plan using principle and concepts of enterprise
management, project management and system change theory
 Promotes the healthcare consumer‘s capacity for the optimal level
of participation and problem-solving.
 Fosters an organizational culture that support implementation of the
plan
 Incorporates new information and strategies to initiate change if
desired outcomes are not achieved
 Documents implementation and any modifications, including
changes or omissions, of the identified plan

Standard 5a. Coordination of Activities
 The informatics nurse coordinates planned activities
Standard 5b. Health Teaching and Health Promotion
 The informatics nurse employs informatics solutions and strategies for
education and teaching to promote health and a safe environment
Standard 5c, Consultation
 The informatics nurse provides consultation to influence the
identified plan, enhance the abilities of others, and effect change.
Standard 6. Evaluation
 The informatics nurse evaluates progress toward attainment of
outcomes
Competencies
The informatics nurse:
 Conducts a systematic, ongoing and criterion-based evaluation of
the outcomes in relation to the structure and processes prescribed
by the project plan and indicated timeline.
 Collaborates with the healthcare consumer, health care team
members and other key stakeholders involved in the plan or
situation in the evaluation process,
 Evaluates in partnership with the key stakeholders, the effectiveness
of the planned strategies in relation to attainment of the expected
outcomes.
 Evaluates the link between outcomes and evidence- based
methods, tools, and guidelines
 Documents the results of the evaluation.
 Disseminates the results to key stakeholders and others involved,
accordance with organizational requirements and federal and
state regulations
 Standards of Professional Performance for Nursing Informatics
 The standards of professional performance express the role
performance requirements for the informatics nurse and informatics
nurse specialist
Standard 7. Ethics
 Identifies the informatics nurse practices ethically, with further
detailing of associated competencies, such as the use of the Code
of Ethics for Nurses with Interpretive Statements to guide practice
Standard 8. Education
 Addresses the need for the informatics nurse to attain knowledge
and competence, including the competency associated with
demonstration of a commitment to lifelong learning
Standard 9. Evidence-based Practice and Research
 Confirms that the informatics nurse integrative evidence and
research findings into practice
Standard 10. Quality of Practice
 Describes the expectation for the informatics nurse‘s contribution
related to the quality and effectiveness of both nursing and
informatics practice.
Standard 11. Communication
 Explains that the information nurse communicates effectively
through a variety of formats, with several accompanying
competencies delineating specific requisite knowledge, skills, and
abilities for demonstrated success in this area.
Standard 12. Leadership
  Promotes that the informatics nurse leads in the professional
practice setting, as well as the profession. Accompanying
competencies address such skills as mentoring, problem-solving,
and promoting the organization‘s vision, goals, and strategic plan.

Standard 13. Collaboration

 Encompasses the informatics nurse‘s collaborative efforts with the

healthcare consumer, family, and others in the conduct of nursing
and informatics practice

Standard 14. Professional Practice Evaluation

 Identifies that the informatics nurse conducts evaluation of their own

nursing practice considering professional practice standard and
guidelines, relevant statutes, rules and regulations

Standard 15. Resource Utilization

 Addresses that the informatics nurse uses appropriate resources to

plan and implement safe, effective, and fiscally responsible
informatics and associated services

Standard 16. Environment Health

 Close out the list of professional performance standards by

describing that the informatics nurse supports practice in a safe and
healthy environment.
PREPARING THE FINAL COPY OF THE THESIS PROPOSAL d) Proponent/s
e) Month and year of graduation
I. General format
2. Approval sheet. It is placed immediately after the
1. Margins
title page.
a. Left- 1.5
a) Generally it contains statements of
b. Top. Bottom. Right- 1 inch recommendation and acceptance.
2. Font type and size- times new roman or arial, size 12 b) The approval of the adviser that the thesis
3. Spacing – double spacing except for figures. , proposal is complete and the recommendation
tables and abstract (single spacing) of the same for oral examination.
4. Paragraph indention five letter spaces c) The approval of the panel of the examiners that

5. Pagination- one inch from the right edge of the the thesis proposal has been examined
paper on the 1st line of every page d) The acceptance of the department of nursing
and of the academic office.

II. Preliminary parts

1. Title page- it is center- justified and ALL CAPS, 3. Acknowledgement sheet. This reflects the
follows the inverted pyramid style and is single- researcher/s expression of appreciation for the
spaced. assistance and encouragement extended to
Contents: him/them in making the research paper. Pronouns
used must be in third person
a) Title
b) Classification of paper: Thesis proposal 4. Abstract
c) Name/s of the research
 a) It is brief yet comprehensive summary of the f) Opposite each chapter title is the corresponding
paper. page number led by dots.
b) It describes the g) Chapter and section titles should not extend
 Problem research on beyond the right margin of the leaders(dots). If a
 The number and kind of participants or chapter/ section tittles occupies more than one
respondents, line, the second line on wards must align- left
 The hypothesis, with the first.
 Summary of procedures and methods
 Instrumentation, Results, Conclusion,
Implication, recommendation 6. List of tables. It appears on the page immediately
following the table of contents.
5. Table of contents
a) LIST OF TABLES should be typed centered and in
 This is an ordered and paginated listing of the
all capital letters.
different parts of the thesis.
b) The heading Table should be typed three lines
 It must show the chapter and section titles in full
spaces below the title and flushed to the left
and must have entries for the references and
margin; opposite the word Page which is flushed
appendices sections.
to the right margin.
a) The heading TABLE OF CONTENTS should be
c) Arabic numerals are used for the table numbers
typed centered and in all capital letters.
which are placed right under the heading Table.
b) Spacing should be 1.5 in. throughout
A tab\ is inserted after each table number, then
c) Preliminaries should be listed first.
the little of the table appears.
d) The heading Chapter should be flushed left on
the same line with Page flushed right. Only the 7. List of Figures
first letters of the words are capitalized.
 It is placed on the separate page right after the
e) Below the heading Chapter are the tittles of the
list of the tables
different chapters in upper case.
 a) LIST OF FIGURES is typed centered and in upper
case.
b) The heading Figure should be typed three line
spaces below the title and flushed to the left
margin: opposite is the heading Page which is
flushed to the right margin.
c) Arabic numerals are used for the table numbers,
which are placed right under the heading
Figure. A tab is inserted after each table
number, followed by the title of the figure from
the corresponding page number.
All should appear on the new page, separate from
the body of the thesis.
All references cited on the body of the research
paper must appear on the References section.
The heading References is centered –justified on the
first line below the page header.
The entries with changing indentions, begin on the
line following the heading References

Entries begins with the surnames of the authors and

are arrange alphabetically.
III. The body of the proposal

1. Each chapter should have heading that is center

justified. The chapter numbers should be in Arabic Components of a reference entry;
numerals, e.g., ―Chapter I.‖

2. The chapter number is followed by the title in all

capital letters and encoded at the center.
3. All element/s title should be flushed left.
IV. End Matters
1) Author‘s Name- type the surname first followed by
a comma, then the first name and the middle initial. If
there are to six authors, all their names are written. If
they are more than six, the remaining authors can be
represented by the words ―et al‖

References
2) Year Of Publication. It should follow the period after Burns, n. & Grove, S. K. (2005). The practice of nursing
the author‘s name and should be enclosed in research: Conduct, critique and utilization (Rev.
parenthesis ed.).Philadelphia: Saunders.

3) Book Title. The complete title and book edition Example 2.

should be written. The entire book title must be
Smeltzer, S. C., Bare, B. G., Hinkler, J. L., & Cheeves, K.
italicized. Only the first letter of the first word and of
H. (2008). Brunner and Suddart‘s text book of medical-
proper names must be capitalized.
surgical nursing (11th ed). Philadelphia: Lippincott
4) Journal title. The title of the article, in roman face
Williams and Wilkins.
and sentence case( only the first letter of the first
word and of proper names are capitalized), appears
first. The title of the journal itself appears in italics and
Journal Supplement
in the title case ( the first letter of each substantial
word is capitalized. Example :

5) Place of publication. The city where the book is
published should be written followed by a colon.
6) Publishing house. The name of the publishing house
follows the place of publication
Houinard, M. C.,& Robichaud-Ekstrand, S (2005)The
effectiveness of a nursing impatient smoking
cessation program in individuals with cardiovascular
disease. Journal of Nursing Research, 54(4), 243-254

2. Examples of reference entries:

Research Paper
Book revised edition
Good to know in making a Thesis Proposal
Example 1:
6 Things You Should Know About Thesis Writing
  Create a timetable and stick to it as much as
possible. (Save your\ time and help you
1. Choosing the topic/ problem. Choosing the right
organize the work properly.)
topic or problem for your thesis paper is an
important component of success, so start Outline and thesis structure
thinking early on what you want to write about.
 To write a logical and effective thesis paper, you
...
need to create an outline.
2. Planning the research. ...
 It will show you the right direction and the next
3. Outline and thesis structure. ...
step to make.
4. Appropriate academic style. ...
 Consult your supervisor regarding the structure of
5. Editing and proofreading
your thesis, as there are several possible
6. Choosing the topic/problem
variations, and include all the required sections
Choosing the topic/ problem in your outline.

 An important component of success, Appropriate academic style

 Start thinking early on what you want to write
 A thesis paper is the most important academic
about.
paper and needs to be written in good
 Main goal:: find a really good problem you
academic English and appropriate academic
can\ research / solve.
style.
 Consult your supervisor or the thesis coordinator
 Avoid using any slang, contractions,
and ask them for professional advice.
colloquialisms, etc.
Planning the research  However, it doesn‘t mean that you need to use
complex words from an over-formal vocabulary.
 Thesis is a very long project based on your own
 Everything you write should be clear and
ideas and research,
understandable to the reader.
 You need to thoroughly plan its every stage.
Referencing
  Plagiarism (presenting someone else's work or  Used for storing, organizing and manipulating
ideas as your own, with or without their consent, data
by incorporating it into your work without full  Composed of grid rows and columns
acknowledgement) - a NO NO  The horizontal row are identified by numbers
 You need to properly cite every source you use. (1,2.3) the vertical column with letters of the
 Stick to the required referencing style and strictly alphabet(A,B,C).
follow it.  For columns beyond 26, columns are identified
 Remember, extensive and proper referencing by two or more letters such as AA, AB,AC.
indicates a correct approach to writing a thesis
paper.
Cell
Editing and proofreading
 The intersection point between a column is a
 Wait at least a day after your thesis is complete
small rectangular box
and then edit and proofread it.
 The basic unit for sorting in the spread sheet
 Check your writing for style, structure, lexical
 An excel spreadsheet contains thousands of cell
coherence, unity, readability, grammar, spelling,
 Each is given a cell reference or address to
and punctuation.
identify it.
 Do not hesitate to ask your friend or family
member to proofread your paper once again.
 You can always hire a professional editor who
A. MOVING AROUND
will help you polish your paper to perfection.
1. Open up a new spread sheet and click your
cursor in the cell B2.
Microsoft excel 2. Note that the cell B2 is seen in the left hand
corner
 Electronic Spreadsheet Computer program
3. Type 1 into the cell and press the enter key
created by Microsoft inc.
Or: You can move around the spreadsheet by either
clicking on the cell with your mouse cursor or by using
the arrow keys on the key board.
Note: Texts are on the left hand side of the cell and
numbers are on the right side of the cell.
B. THE DRAG HANDLE
 A feature that allows the user to extend ( and fill)
a series of numbers, dates or even text to a
desired number of cells. In an active cell of the
spreadsheet, the drag handle is a small black
box at the bottom right corner.
A. Dragging to copy cells
 In the bottom right corner of the highlighted cell
is a small square.
 By clicking and holding down the left mouse
button you can drag the contents of the cell
across other cells and copy into the new cells.
B. Filling numbers in the cell
 not only can you copy cells across cells, you
can also have numbers added consecutively
across cells
 To do this the computer needs to know how
much you want the numbers to increase. For
example: 1,2,3, or 1,3,5 or more
C. CHANGING CELL WIDTHS BY DRAGGING
 Changing cell widths by dragging moving your
cursor between A and B on the Column row as
shown left.
 Click and hold down your left mouse button and
drag the cell A out to make more room in the
cell.
a. Changing cell widths by dragging
Note: What happens if you move the cell
boundary in too far and the words cannot fit into the
cell?
What happens when you move the cells with
the numbers too close?
b. Changing cells with automatically
By double clicking on the lines between the columns
A and B. The columns then will increase or decrease
to fit the biggest entry
D. MOVING DATA ON THE SPREAD SHEET Inserting a new row/s

a) Cut and copy 1. Click row marker to highlight the entire column.
b) Click and drag 2. Right click your mouse button and choose insert.
3. A new row will be inserted, moving the total row
1. Mark a whole column from the heading to what‘s
over one.
written bellow.

b. Click and drag

E. DELETE ROWS AND COLUMNS.
2. Move your cursor to the edge, or boundary of the
highlighted area. Deleting a column/s

3. Click and hold down the left mouse button and 1. Click column/s marker to highlight\ the entire
drag the cells back into their original place. column.
2. Right click your mouse button and choose
delete.
3. Click row/s marker to highlight the entire
column.
4. Right click your mouse button and choose
E. INSERTING ROWS AND COLUMNS. delete.

Inserting a new column

1. Click column marker to highlight the entire D. Formulas.

column.
 Are calculation created on the spreadsheets.
2. Right click your mouse button and choose insert.
 Formulas range in complexity from to extremely
3. A new column will be inserted, moving the total
complicated to easy ones
column over one.
  Use the following buttons to create 1. Type in the formulas into the formula bar
mathematical symbols In the spreadsheet. 2. Always include an = before the formula.

 + to add
 To subtract Formulas with cell reference
 / to divide
a. Inserting cell references automatically
 to multiply
b. Formulas with cell reference
 = to make equals

It is important to note the order of the symbols when

creating formula; a. Inserting cell references automatically
b. Auto sum/averagec
 () brackets are the 1st priority
c. If- then
 / division is next
d. ranking
 Multiplication
 + addition
 - Subtraction
E. RANKING
D. Formulas.
=RANK(F3,$F$3:$F$7)
 = 3+ 10 / 2
BMI
 = 4+2 *6
 = (3+4)/5 Formula: weight (kg) / [height (m)]2
 =(5-3) + (9-6)/3
With the metric system, the formula for BMI is weight in
 = ((5-3) + (3+1))/2
kilograms divided by height in meters squared. Since
 = ((4 +5)/2)/(8-3)
height is commonly measured in centimeters, divide
 = (6-1)(2+3)
height in centimeters by 100 to obtain height in
Formulas with numbers meters.
Example: Weight = 68 kg, Height = 165 cm

(1.65 m) Calculation: 68 ÷ (1.65)2 = 24.98

BMI

Formula: weight (kg) / [height (m)]2

Example: Weight = 68 kg, Height =

165 cm (1.65 m)

Calculation: 68 ÷ (1.65)2 = 24.98