Indicators and Opportunities for Internet Based Patient Education In Nursing

Internet Based Patient Education In Nursing and their Indicators and Opportunities

Emerging Opportunities with Internet Based Patient Education In Nursing, System Indicators of Delivery Of Patient Education Services In Nursing

Emerging Opportunities with Internet Based Patient Education In Nursing

    Much of the patient education oriented literature on the Internet decries the variable quality of the content. In 1996 the Health on the Net Foundation Code of Conduct (HON code) was established to designate those sites with high quality information with its logo. A study of 99 sites so designated found their average readability level to be more than 10th grade. 

    Average reading levels of US residents is grade 8 and of those in Medicare and Medicaid programs grade 5; thus,87% of HONCode designated sites could be expected to be difficult for the average adult population to read (Kusec, Brborovic, & Schillinger, 2003).

    As persistent as these difficulties with content and readability are, there have been significant advances in patient education using the Internet, frequently fully integrated with ongoing care. 

Four Examples are Cited Here.

    An interactive Internet site for management of patients with congestive heart failure is described by Delgado, Costigan, Wu, and Ross (2003). Because these patients are best managed by close follow up, an Internet communicative website was used as a daily communication method between patients and health care providers. 

   Patients were instructed to enter their first morning weight, heart rate, and blood pressure, and each day a research nurse examined this information, instructing whether to increase or decrease the diuretic according to weights and symptoms, asking the patient to obtain blood work, and reinforcing patients' education.

    Many patients with type 1 diabetes are treated with intensive insulin regimens that they can adjust on a day-to-day basis according to food intake, activity levels, and other factors such as alcohol intake. These individuals can consume a relatively normal diet as long as they assess their carbohydrate intake in order to titrate their insulin doses. 

    A patient education program utilizing Dias Net computer model (a decision support system) to display and manipulate patient data can be used as a training exercise in carbohydrate assessment and insulin dose adjustment. On their PCs, patients enter blood glucose values, insulin doses, and a food diary. 

    From the data entered, a computer model generates a simulation of the blood glucose concentrations for the date collection period. I could then suggest alternative insulin doses or regimens or meal sizes to decrease the risk of hypo and hyperglycemia. This system can highlight possible causes for erratic control. 

    The educational program position about absence of a doctor patient relationship, patient confidentiality, and the institution's right to delete messages that fail to comply with established standards. 

    At Health Boards.com, individuals have a choice of communicating through more than a hundred message boards, all concerned with health issues (Schultz, Stava, Beck, & Vassilopoulos-Sellin, 2003). These examples are experimental programs, not routinely available. 

System Indicators of Delivery Of Patient Education Services In Nursing

    Some local surveys in the United States show worsening of patient educational care. Even though national guidelines published in 1997 for the diagnosis and management of asthma emphasized patient education, a survey of teaching hospitals with training programs in pulmonary and critical-care medicine showed only 64% having a formal asthma patient education program (Peterson, Strommer Pace , & Dayton, 2001).

     Between 1996 and 2001, a survey of asthma services in emergency departments (EDs) in Chicago found a significant decrease in use of instruction to inform patients what to do in the event of inability to attend their follow-up appointment (a written asthma action plan ). 

    While ED care in metropolitan. Chicago had improved in some areas of care and worsened in others; most aspects of asthma care had continued to fall short of national asthma guidelines. It is likely that formal education according to a protocol was given to fewer than half of all patients. 

    A similar portion received a written asthma action plan. The reasons for lack of more widespread ED asthma care improvements are not clear, although the increase in utilization and overcrowding of EDs may be a factor (Lenhardt, Malone, Grant, & Weiss, 2003). 

    These are only examples of groups in need of patient education and of roles developing to meet these needs. They represent research studies documenting effectiveness of teaching interventions; Little is known about how widely available these services are.