Technology Based World In Nursing Education and Healthcare Consumer Education
Healthcare Consumer Education in a Technology Based World
Given the growth of personal computing and smart technology, a pre-teaching assessment of a patient must include questions about computer use. It is important for the nurse to determine whether the patient has accessed web based information prior to a teaching session and whether the patient will be able to take advantage of online resources after the session has concluded.
Despite the widespread use of computers in our society, it is important to remember that not everyone has access to or interest in using a computer. Historically, adults older than the age of 65, African Americans, individuals who have less than a high school education, and individuals living in a home without children were less likely to be online than others (Fox & Madden, 2005; Horrigan, 2009) .
Although gaps still exist in some areas, both computer access and interesting using a computer has changed over time for many populations.Approximately one third of adults over the age of 65 years report never using the Internet, and an additional one third report not having broadband access. In other areas, older adults are making great strides. Smartphone ownership among older adults has quadrupled in recent years and Internet usage has increased by 55% in the last 20 years.
These data suggest that computer and web-based learning will become increasingly valuable for older adults. However, it is important to note that among the older adult population, computer usage decreases with age and remains limited among adults over the age of 75 years (Anderson & Perrin, 2017).
The black/white digital divide remains a problem in the United States where African Americans are less likely than whites to use the Internet and to have broadband access in their homes. However, like older adults, this population is making strides in the use of mobile technology (Smith, 2014a). Finally, people living with disabilities in the United States are three times less likely to go online than people without disabilities (Anderson & Perrin, 2017).
Because computer access is not universal, it is important to determine whether a patient has a home computer, smartphone, or other mobile devices; has access to the Internet; is knowledgeable about using a computer; and has interest in using a computer to obtain information and resources regarding his or her health care.
If a patient does not have a computer or mobile device but has interest in using one to access resources on the Web, places where he or she may gain access should be discussed. Libraries, senior centers, and community centers commonly have computers with Internet access for public use and typically offer instruction and assistance for new users.
Web Users Need to Find I Nursing Education
Given the resources available, including librarians skilled at finding information, libraries are commonly used by adults seeking health information (Horrigan, 2015). Patients who use computers should be asked about their use of the Web. Pew Research Center studies continue to find that web users in the United States found information on the Web that did one of the following:
1. Influenced their decisions about how to treat an illness.
2. Led them to ask questions.
3. Led them to seek a second medical opinion.
4. Affected their decision about whether to seek the assistance of a healthcare provider (Fox, 2006).
Because the Web can be so influential, it is imperative to determine that the information a patient has found is accurate, complete, and fully understood. Only 15% of web users report that they always check the source and date of the information found, and many report feeling overwhelmed, confused, or frightened by the complexity and amount of information presented (Fox, 2006; USDHHS, 2017).
These findings are not surprising. The World Wide Web contains information designed for both professional and consumer audiences. Health-care consumers may not have the background necessary to understand professional literature and other types of information designed for healthcare professionals. Wh
en healthcare consumers do a search on a topic, they will access websites designed for them as well as for health professionals. Consumers should not be discouraged from accessing these sites, but nurse educators must help patients find information written for them at their level of readability and comprehension. Even websites specifically designed for consumers may be difficult for the public to understand.
For example, in a review of 25 websites on menopause, Charbonneau (2012) found that the average reading level was grade 10, significantly higher than the recommended sixth-grade level.
The Web also contains information that may be biased, inaccurate, or misleading (Rehman, 2012; Wilkes, 2015). Many of the health-related websites are sponsored by commercial enterprises trying to sell a product. Others contain information posted by nonprofessionals and opinion maybe rather than fact based. Social me diasites with reports of misdiagnoses, complications, and medical errors can be frightening.
Because the Web has the potential to change so quickly, it is difficult to regulate. Even webpages sponsored by doctors, nurses, and university medical centers may contain errors or information that is misleading or difficult to decipher.
Patients may find that the Web has provided too much information; information they are not ready to handle because it is too graphic. too frank, or too discouraging; or information they do not fully understand. For example, a patient newly diagnosed with a serious illness may be overwhelmed with the detailed information found on the Web regarding the course of the disease, prognosis, and treatment.
For nurses, then, it is important to ask patients if they are using the Web to find health-related information and to explore the types of information they have found.Patients may or may not initially feel comfortable talking about information they have gathered. They may fear nurses will interpret their research as a lack of trust in the care they receive. Some may be embarrassed to talk about information they do not fully understand.
Others may be anxious about how to bring up information that conflicts with what they have been told or how they are being treated.
For these reasons, it is important for nurses to establish early in their relationships with patients that they are interested in talking with them about the information they have gathered from the Web or other resources they have available to them. Patients need to feel that nurses are open to discussing whatever information they find. They need to understand that nurses are their partners in seeking the best information available.
For patients who are being treated for a condition over an extended period in time, it is also important to continue the conversation about their Web searches throughout their treatment. Simply asking “What interesting information have you found on the Web lately?” will keep the dialogue open and provide the nurse educator with the opportunity to respond to whatever questions or concerns patients may have.
It is advantageous to conduct a teaching session in a place where there is computer access. Having a computer available during a teaching session can accomplish several goals. First, it will provide the nurse educator with the opportunity to review Web-based information with the patient. Not only can the nurse introduce websites that are relevant to the patient's needs, but he or she can also review some of the sites the patient has been using.
Nurse educators can then begin to determine the type and amount of information to which the individual has been exposed, assess the patient's knowledge, and identify areas in need of further teaching. Nurse educators may also find information that requires further discussion. For example, a patient may have visited a website that provides distressing information about side effects of treatment, prognosis, or disease progression.
Competencies Needed for Web Users
Looking at the site together will enable the nurse and patient to talk about what has been discovered and do additional teaching if needed.A second important advantage of reviewing websites with patients is that this activity provides a chance to teach them information literacy skills. There are many definitions of information literacy. Most agree that individuals who are information literate have the following four competencies:
1. The ability to identify the information they need
2. The skills to access the information they need
3. Knowledge of how to evaluate the information they find
4. The ability to use the information they deem valid
Essentially, if clients are to make effective use of the vast array of information on the Web. They must be able to identify the questions they need answered, find the information they are looking for, judge whether the information they find is trustworthy, and decide how they will use the information to meet their needs. Information literacy is not synonymous with computer literacy.
An individual who is information literate knows how to find the information needed and can evaluate the information found for accuracy, currency, and bias. By comparison, a person who is computer literate has the technical skills and knowledge of computers necessary to use contemporary hardware and software and can adapt to new technologies that emerge (Shipman, Kurtz Rossi, & Funk, 2009; Williams, 2003).
Literacy and Skill Needed for Nursing Students for Education
Although healthcare consumers may not have the background knowledge to evaluate information to the same extent as a healthcare professional, they can be taught some simple steps to develop their information literacy skills and to help them begin to identify which websites are useful and which are problematic. These steps include the following:
1. Reduce a problem or topic to a searchable command that can be used with a search engine or search directory. If clients do not know how to narrow their topics or problems to a few words, they will be unable to find the information they desire or to broaden a search to find comprehensive coverage.
Once the appropriate search command is identified, using a search engine or search directory is easy, especially if the help function available at most sites is used to solve problems. Using an advanced searching feature that allows the user to enter two terms, for example, “asthma and children,” will return more precise findings (Medical Library Association, 2017).
2.Categorize webpages according to their purpose. A client should be taught to look for the person or organization responsible for the website and then place the website into a category reflective of its purpose. For example, the purpose of a site created by a drug manufacturer could be categorized as marketing, sales, or promotion.
3.Other categories could include, but are not limited to, advocacy, promotion, informational/news, personal, or instructional/tutorial. Identify sources of potential bias that may influence the content or the man by which the content is presented. For example, an advocacy website is likely to present information that favors one side of a debate. A marketing or sales site tends to include information that is supportive of a particular product or service.
4. Make a judgment as to the likelihood that the information found on the webpage is accurate and reliable. Clients can be taught to look for the credentials of authors of reports or articles found on the Web. This information can help you determine whether supportive data are provided and look at more than one site to see if they can find similar claims or suggestions. Some of the more reliable health-related websites have links to other sites, such that the original site is not the sole source of information on a chosen topic.
5.Make decisions as to the completeness or comprehensiveness of the information presented. Because clients may not have the background knowledge needed to quickly recognize when information is missing, they should be encouraged to look at more than one site when researching an area of interest. If educators know that clients are using the Web to investigate a specific topic, they can help them identify a list of things to look for in articles or webpages addressing the topic.
6.Determine the currency of the information on a webpage. Consumers need to know the importance of looking for a creation or modification date or other signs that the information on a website is up to date.7. Identify resources to answer questions or verify assumptions made about the content of a webpage.
If questions arise, healthcare consumers should be encouraged to check out information: with their healthcare provider. If the provider does not have the answers or cannot verify assumptions made, he or she can refer the patient to other healthcare professionals.
Additionally, information literacy skills should include those behaviors one would expect of a responsible consumer. For example, consumers should know how and when to report information found on the Web that is potentially harmful to others (Lau, Gabarron , Fernandez-Luque, & Amoyones , 2012).
Also, consumers must know what steps are necessary to protect themselves from others who might use the questions or information they post about their health care in an undesirable way. Consumers need to understand how to protect their privacy if it is desired and the implications of posting health-related information on social media sites.
In years past, healthcare consumers were not encouraged to research health topics or to research options, but rather to rely on their healthcare providers for all their health related information. Providers, including nurses, feared that patients would not understand the information they found or that they would find information they would not be able to handle. Today, nurses have more confidence in consumers' ability to manage their own health care.
More and more nurses are empowering healthcare consumers by teaching and encouraging them to take advantage of the resources at their disposal. To do so, nurses are using a variety of means to encourage their patients to use the Web and to expose them to web-based resources. For example, computers set to appropriate websites are being placed in waiting rooms. Healthcare practices are creating websites designed to provide clients with relevant health information.
Also, teaching materials on how to use the Web are being distributed, including information on finding tools on general health topics, such as Health finder (http://www healthfinder.gov) where health consumers can locate credible sources quickly (Medical Library Association , 2017).
Given concerns about the quality of information available on the Web. some professionals are working together to create trusted websites that provide information and resources for specific patient populations ( eHealthMedia , 2015).
For many reasons it is good practice to teach people where to go on the Web to find information. Web-based information can be obtained quickly, the cost of Internet access in the home is minimal, and Web access is free in libraries and other community service organizations. Many healthcare consumers would benefit from having their questions answered quickly and inexpensively.
For example, families with young children are likely to have frequent questions related to childhood illnesses, growth and development, and behavior problems but they may not have the time or money to make a visit to the pediatrician to have such questions answered. Senior citizens may have questions about the health care problems encountered with aging but may have difficulty getting to a healthcare provider because of transportation and financial issues.
People with chronic illness may gain some sense of control over their lives when they are able to access information on the Web about their conditions. Healthy people may have many questions but few opportunities to talk with a health provider to get answers.
Even when healthcare consumers do have the opportunity to meet with a health provider, they often leave with unanswered questions. Sometimes they forget to ask, at times they are hesitant to ask, and in today's healthcare delivery system they may not be given sufficient time to ask the many questions that arise when people are dealing with health issues.
In the role of educator, the nurse can teach patients who access the Web to use this resource more effectively and can be proactive in encouraging others to give it a try. It may be helpful to compile lists of websites appropriate to the needs of different patient populations.
In selecting websites to share with consumers, it is important that the nurse review these sources carefully. In recent years, multiple rating scales have been developed to assist in the evaluation of such sites. Most scales include criteria that address the accuracy of the content, design, and aesthetics of the site; disclosure of the authors; sponsors of the site; currency of information; authority of the source; ease of use; and accessibility and availability of the site.
Finally, nurses can create their own websites to bring their healthcare messages to Web users around the world. Table 13-2 lists two websites that exemplify the types of roles nurses can play to bring health information to various consumers via the World Wide Web.
Band Aides and Blackboards is a creative site designed by a nurse to facilitate understanding of the problems faced by children growing up with health problems. This site is thought provoking rather than factual. The nurse who created it uses the words and drawings of children and parents to bring a real life perspective to the thoughts, feelings, and experiences of growing up with illness.
Band Aides and Blackboards teach important messages about not being alone, about ways to solve common problems, and about what really matters to this population.Net Wellness, another site in which nurses play a predominant role, is a very different site than Band Aides and Blackboards. Net Wellness is a noncommercial, “electronic consumer health information service” that has been in existence for more than 17 years.
Information on the website is created and evaluated in collaboration by more than 500 multidisciplinary professionals from the University of Cincinnati, Ohio State University, and Case Western Reserve University. Information on this site is checked for accuracy, and each revision made is stamped with its date so that users can easily determine its currency.
Net Wellness continues to be a wonderful web resource for healthcare consumers. Individuals can submit health related questions to the site's “panel of experts,” with nurses and other healthcare professionals then responding to these queries. The panel of experts also provides information for the section of the site dedicated to hot topics.
Development of a website is typically a team effort. In addition to content experts such as nurses who contribute the material to be included on the site, Web designers with technical and layout expertise can provide valuable assistance with practical aspects of the site's development. Many resources are available to healthcare professionals interested in developing websites.
For example, the HHS Web Standards and Usability Guidelines website (https://guidelines.usability.gov/) is sponsored by the US Department of Health and Human Services. This resource contains guidelines that can be used in designing health-related websites. Not only are the guidelines provided here based on research studies and supporting information from the field, but ratings also are assigned to each guideline according to the strength of the evidence available.
For instance, a guideline that is given a rating of 5 is one that is supported by two or more research studies where hypotheses were tested and the guideline was shown to be effective. A score of 0 indicates that although the guideline may be routinely followed on webpages, there is no hard evidence to support its effectiveness.
Many issues must be considered before engaging in health education via a website. Websites have the potential to reach millions of users over an extended period of time. The healthcare consumers who use the Web have varying levels of sophistication, and they may or may not know to check the dates on which the website was created and modified.
Given the diversity of the audience, it is very important that the information on the site be accurate and updated as often as necessary. Depending on the topics covered, it may be necessary to include a disclaimer about the importance of checking with a healthcare provider.
If the site is interactive and health providers will be responding to questions submitted by users of the site, liability issues must be carefully considered. Nurses and other health professionals who respond to questions from Web users are providing advice and guidance to people whom they do not see and cannot assess. Nurses and their colleagues need to determine whether their malpractice insurance covers this type of activity.
They also need policies and procedures for responding to questions that might be considered “urgent” (Dizon et al., 2012; Ventola, 2014). Depending on the nature of the site, it may be advisable to include an attorney on the website development and maintenance team to provide advice when needed. It is important to determine whether there are relevant legal issues related to practice inherent in the activities of the nursing and other health professionals on the website.
Although new technology has opened the door to many unique and exciting opportunities, it also has raised many questions about telepractice and licensure. Because technology makes it so easy to provide healthcare services to patients across state lines, the provision of nursing, medical, and other types of technology facilitated healthcare services to patients at a distance has been thrust into the spotlight.
Multi state licensure and other types of legislation have been and will continue to be proposed, and new practice guidelines are likely to be enacted.Another issue to be considered is ease of use. For example, patient portals hold great promise for engaging patients in their care and improving long-term outcomes but only if designed in such a way that they can use them fully (Devkota, Salas, Sayavong, & Scherer, 2016).
The client perspective must be accounted for in the design. Consumers of various levels of health and computer literacy are likely to use portals and, therefore, the design and navigation must be simple. For example, if test results are to be shared with patients via the portal, the data must be presented in a way that they will understand (Baldwin, Singh, Sittig, & Giardina, 2016).
Finally, the time commitment required to respond to questions from Web users cannot be under estimated. If a website provides an opportunity for consumers to ask questions, responses must be researched and checked for accuracy before they are posted. Healthcare consumers are online 24 hours a day, 7 days a week.
Therefore, consumers must be advised how long they will likely wait before a response to their questions is posted. Adequate coverage must be arranged so that questions are answered on a regular basis and service is not interrupted for long periods of time.
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