PATIENT CENTERED CARE REPORT

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PATIENT CENTERED CARE REPORT

Patient Centered Care Report

Evidence-Based Practice for Patient-Centered Care and Population Health

Date: 07/11/2018

Overall Comments:

Thank you for this revision.  Unfortunately the requirements are still not being met because of not following the grading rubric completely for all required items.  I hope you can see the comments on your paper and can use them and follow the rubric for revising this paper if you choose to do so.   

1.  Introduction

2.  Evaluation of the outcomes of the PHII – not ones that were and were not met – all outcomes including missing information. 

3.  Using evidence-based research how can  you improve on the outcomes. 

4.  Identifying another PHII you were to develop approaches to personalizing patient care from the other PHII.  

5.  You were to provide research to validate information about personalizing patient care including a successful PHII.  Then you were to identify knowledge gaps from the research you used.

6.  In this section you were to identify a framework, which contains concepts, which would have been used to evaluate the outcomes of the PHII. You were to acknowledge the limitations of this proposal.  

7.  see paper for APA formatting issues, etc.  

This is a much better paper, but the main thing is to identify a successful PHII.  For example others have used Triple Aim but there are many others.  If you have questions please let me know.  

Patient Centered Care Report

Introduction

Population health improvement initiative is meant to bring some improvement in a certain health issue in the community (Hack et al., 2017). The initiative must have some outcomes at the end of the improvement process. These are the set goals or achievements that the initiative wishes to achieve at the end of the process.In the case at hand, the expected achievements of the population health improvement plan for elderly people with traumatic brain injury (TBI) and post traumatic stress disorder (PTSD) include; improvement in moods, memory, and muscle control. Most elderly people with TBI and PTSD have frequent cases of loss of memory. They tend to forget things easily (Winter et al., 2016). In addition, they also have issues with their moods. Their muscle control is also very low.

The Outcomes

Out of the above outcomesWhat outcomes? You have not identified any outcomes yet, but you stated – “Out of the above outcomes…” This is very confusing that the initiative wished to achieve, the achievements that were made are going to be focused in this section. The first one is improvement in memory. The initiative managed to improve the memory of the participants using various interventions. Exercise was the most effective treatment (Duzel, van Praag, & Sendtner, 2016). About four hundred people agreed to participate in the exercise therapy. This was about half the number of the total participants. They followed the Center incorrect name – Centers – not Centerfor Disease and Prevention’s recommendations for aerobics and after four weeks, there was a general improvement in mood, memory, and muscle control for all the four hundred participants. 75% of the four hundred participants continued with the therapy and after three weeks, they showed a great improvement in short to medium term memory (Winter et al,. 2016). Although there was an improvement in mood and muscle control, it was not as great as improvement in memory. How do you know this? There is no reference.

The second one was improvement in mood. The medication and therapy were very effective in the improvement of mood. While analyzing the needs of the population, it was discovered that most of the patients did not receive any form of psychotherapy immediately they were diagnosed with TBI and PTSD. Therefore, the healthcare health care is two words – not one. giver decided to introduce the patients to anti-depressant medication. Forty percent of the total population started the anti-depressant medication and nine percent started taking anti psychotics and the outcomes were measured after six months. They recorded a twenty-six percent improvement in mood and six percent improvement in memory. Again, no reference – where did you obtain this information?

The third outcome is improvement in muscle control. Elderly people generally become weak such that they can hardly control their muscles. To improve on this need, the patients were introduced to strength training which they preferred as compared to aerobics. This showed a great improvement in muscle control but did not have any impact on mood and memory. No references to validate this information

Outcomes that were not achieved

However, the following outcomes were not achieved as expected. The section was to identify outcomes and an evaluation of them. This section was not required.The initiative planned to use Sudoku and crossword puzzles as a therapy to improve on the memory of the elderly people. However, they did not how any gains even after the healthcare givers tried to take the patients through the therapy. Also, meditation is another intervention that the healthcare givers planned to use to improve health of the population. It is a very effective intervention when it comes to TBI and PTSD. However, it did not work as expected because only a few participants were willing to take part in it. For those who accepted the mediation intervention, they recorded more than seventy percent improvement in mood and memory and over thirty-two percent improvement in muscle control.

Evaluation of outcomes

The outcomes of the above interventions are a reflection of the most effective interventions that can be used for similar cases. Exercise is an effective intervention for people suffering from TBI and PTSD because in this case, seventy five percent of those who adhered to the rules of the exercise therapy showed great improvement in their muscle support and memory. Medication is also another strategy though it is not very effective. It has to go hand in hand with other therapies. No references to validate any of the information in this section.

Strategy for improving outcomes

Therefore, in order to ensure that all the outcomes are achieved, the plan should include a strategy to deal with the outcomes that were not achieved. For example, in order to ensure thatthe cases of people being unable to control their muscles, the population should be educated on the importance of body exercise. To ensure that there is a great improvement on moods; patients should be encouraged to embrace medication because its outcomes were excellent. Some people were disinterested in meditation because it seems boring and requires a lot of discipline and they did not know its outcome. Before beginning the initiative, the stakeholders should come together and make a plan and the steps to be followed and also define clearly the roles of each stakeholder. This will ensure that all the anticipated outcomes will be achieved by the end of the initiative. Where is the references to validate any of this information.

In the previous section, it was pointed out that Sudoku and crossword puzzles could not be helpful in improvement elder people’s memory. This can be improved, however, by ensuring that they are provided with periodic monitoring, providing lifestyle guidance, and training them on cognitive function. Training programs and cognitive activities that include Sudoku, novels, and crosswords puzzles should be provided to them more frequently to aid in slowing down cognitive decline and to improve their cognitive ability (Eshkoor et al., 2015).

Another strategy for improving the outcomes of the population health improvement plan is by involving the community so as to ensure that the initiative is patient-centered. The community members should be consulted on their preferences and their opinions towards improving the issue of TBI and PTSD (Wick et al., 2015). The community will give the initiative light on the areas and factors that need to be improved. The initiative should not come up with outcomes that are against the community members’ cultures, preferences, and beliefs. If the outcomes are not in line with the needs of the community members, they will not be effective in improving the situation. This aspect is correlated with patient-centered care where the nurse should evaluate the patient’s needs and preferences before providing care to the patient.

Community Needs

A shared-decision making intervention would be very helpful in ensuring that care provided for TBI and PTSD patients is personalized. This intervention primarily emphasizes on collaboration between the patient and the physician. It involves the sharing of information reading the pros and cons of the various available treatment options; exploration of the preferences and expectations of the patient; and formulating a treatment option that is mutually agreed on by both the patient and the health care provider (Raue & Sirey, 2011). This intervention is helpful in clarifying personal patient values to enhance more informed treatment options. This intervention would be delivered to the patients by nurses with the involved primary care settings. It would involve face-to-face sessions and telephone follow-ups (Raue & Sirey, 2011).

Communication strategy

Communication is also a very important factor when carrying out a population health improvement initiative. In cases of communication barriers, the initiative may not bear fruits as expected. Communication barriers may be as a result of illiteracy of the community members or difference in ethnicity among the stakeholders (Smith& Topham, 2016). The community is made up both literate and illiterate people and all of them should benefit from the initiative. Therefore, in order to find a solution for miscommunication, the initiative should include some members of the community to communicate the process to the community in a language that every person will understand (Davis Boykins, 2014). It is very important to involve community members in the initiative.

Conclusion

In conclusion, patient centered care includes involving the patient in the healthcare by listening to the patient and also informing the patient about the healthcare process. Patients have the rights to know about their illnesses, and the form of healthcare that the healthcare givers plan to give the patients. Patient-centered care provides care that is respectful to the preferences, the values, and the needs of the patient. The healthcare givers are guided by the preferences of the patient. This has improved the quality of healthcare given to the patients.

References

Davis Boykins, A. (2014). Core communication competencies in patient-centered care. ABNF Journal, 25(2).

Duzel, E., van Praag, H., & Sendtner, M. (2016). Can physical exercise in old age improve memory and hippocampal function? Brain, 139(3), 662–673. http://doi.org/10.1093/brain/awv407

Eshkoor, S. A., Hamid, T. A., Mun, C. Y., & Ng, C. K. (2015). Mild cognitive impairment and its management in older people. Clinical Interventions in Aging, 10, 687–693. http://doi.org/10.2147/CIA.S73922

Hack, S. M., Muralidharan, A., Brown, C. H., Lucksted, A. A., & Patterson, J. (2017). Provider behaviors or consumer participation: How should we measure person-centered care?.International Journal of Person Centered Medicine, 7(1), 14-20.

Raue, P. J., & Sirey, J. A. (2011). Designing Personalized Treatment Engagement Interventions for Depressed Older Adults. The Psychiatric Clinics of North America, 34(2), 489–500. http://doi.org/10.1016/j.psc.2011.02.011

Smith, K., & Topham, C. (2016). Patient-Centered Care. Journal of Medical Imaging and Radiation Sciences, 47(4), 373-375.

Wick, E. C., Galante, D. J., Hobson, D. B., Benson, A. R., Lee, K. K., Berenholtz, S. M., … & Wu, C. L. (2015). Organizational culture changes result in improvement in patient-centered outcomes: implementation of an integrated recovery pathway for surgical patients. Journal of the American College of Surgeons, 221(3), 669-677.

Winter, L., Moriarty, H. J., Robinson, K., Piersol, C. V., Vause-Earland, T., Newhart, B., … & Gitlin, L. N. (2016). Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial.Brain injury, 30(4), 373-387.

COMPETENCY:Evaluate the value and relative weight of available evidence upon which to make a clinical decision.

CRITERION:Justify the value and relevance of evidence used to support an approach to personalizing patient care.

BASIC

Basic

Presents a weak justification of the value and relevance of evidence used to support an approach to personalizing patient care.

Faculty Comments:“You were to provide research to validate information about personalizing patient care including a successful PHII. Then you were to identify knowledge gaps from the research you used.”

COMPETENCY:Evaluate outcomes of evidence-based interventions.

CRITERION:Propose a framework for evaluating the outcomes of an approach to personalizing patient care and determining what aspects of the approach could be applied to similar situations and patients.

BASIC

Basic

Attempts to propose a framework for evaluating the outcomes of an approach to personalizing patient care, but proposed criteria are not measurable or not relevant, or aspects of the approach are not likely to be transferable to other cases.

Faculty Comments:“In this section you were to identify a framework, which contains concepts, which would have been used to evaluate the outcomes of the PHII. You were to acknowledge the limitations of this proposal. ”

COMPETENCY:Apply evidence-based practice to design interventions to improve population health.

CRITERION:Propose a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence.

BASIC

Basic

Proposes a strategy that is not useful for improving outcomes or ensuring that all outcomes are being addressed, or the strategy is not based on the best available evidence.

Faculty Comments:“Did not use evidence-based information to validate the information in this evaluation. ”

COMPETENCY:Synthesize evidence-based practice and academic research to communicate effective solutions.

COMPETENCY:Apply evidence-based practice to plan patient-centered care.

CRITERION:Develop an approach to personalizing patient care that incorporates lessons learned from a population health improvement initiative.

BASIC

Basic

Develops an approach to personalizing patient care that does not clearly incorporate lessons learned from a population health improvement plan.

Faculty Comments:“Identifying another PHII you were to develop approaches to personalizing patient care from the other PHII. ”

Describe the pathogenesis, clinical manifestations, evaluation and management of common diseases and disorders

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PURPOSE

This assignment assists students in understanding the relationship between the pathophysiology of a disease process and its clinical presentation and treatment. The concept map allows students to indicate related pathophysiology and disease treatment.

COURSE OUTCOMES

This assignment enables the student to meet the following course outcomes:

CO1: Describe the pathogenesis, clinical manifestations, evaluation and management of common diseases and disorders. (PO1, 2)

CO2: Relate factors that influence the pathogenesis and clinical manifestation of diseases and disorders including lifespan, ethnicity, culture, environment, and socioeconomic status. (PO1, 2)

CO3: Explain the nurse’s role in the evaluation and management of selected diseases and disorders. (PO6, 7)

DUE DATE: See course calendar for exact dates.

POINTS POSSIBLE ON THE ASSIGNMENT: 100 pts REQUIREMENTS

1. Your Instructor will provide you with two disease pathologies covered in this course. Research the two disease processes using a minimum of 2 professional journal articles in addition to your textbook.

2. Create a concept map for each of the two disease pathologies provided by your instructor. Using Word or PowerPoint. If you wish to use another format, be sure you get it approved by your instructor PRIOR to creating it. Use position, color, arrows and other connectors to show relationships between the required elements in the Grading Criteria. Because this is a concept map and not text-based paper, APA style cannot apply so citations are not required. However, include APA style to reference page on the last slide of the PowerPoint Presentation.

3. Compare and Contrast the two disease pathologies covered in this course being sure to include the evaluation criteria described below. Save and upload your assignment on time.

4. Prepare a three to five minute presentation using PowerPoint to present your concept maps to be presented to your peers in class (see course calendar). Other methods of presentation may be acceptable; get prior approval from your instructor.

5. Focus your presentation on the relationships between the elements and not just “reading the map”.

6. You score for this assignment will be a total of the points earned on the concept map and the presentation.

NR 283 Concept Map Guidelines.pdf Revised 04/14/2018 1

Chamberlain College of Nursing NR 283 Pathophysiology

GRADING CRITERIA

Evaluation CriteriaPoints%Description
Pathophysiology2020%Listed key points of pathophysiology & linked them to risk factors, clinical manifestations, treatment./evaluation and patient teaching.
Risk Factors1010%Identified key risk factors & linked them to pathophysiology, treatment and patient teaching.
Clinical manifestations1515%Linked key signs & symptoms to the pathophysiology, treatment, evaluation and patient teaching.
Patient Teaching1010%Integrated teaching points into each required criteria.
Diagnostic tests and treatment55%List diagnostic tests and treatment.
Relationships appropriately indicated55%Used lines, arrows, colors and position to illustrate relationships.
Title & References55%References listed on last slide of the presentation in correct APA format. Use of two peer reviewed journal articles in addition to textbook.
Compare & Contrast of the two diseases/conditions1515%Explained important similarities and differences between the two diseases/conditions. Listed key points of pathophysiology & linked them to risk factors, clinical manifestations, and patient teaching.
Presentation1515%The PowerPoint presentation was well prepared, organized and flowed well. Presenter appeared to have practiced the presentation. Presentation completed in allotted time. The presentation was unique and reflected thoughtful creativity. Visually appealing and easy to see relationships. Student has to be in class to present.
Total100100A quality paper will meet or exceed all of the above requirements.

NR 283 Concept Map Guidelines.pdf Revised 04/14/2018 2

Motivation and Behavior

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Motivation and Behavior

You are in charge of developing a team-building activity to improve  collaboration and increased communication for your team members. You are  the newly promoted manager. Your department is closing for the day so  you have four hours together in a team environment.

Review the following details of team members:

  • Rosanna (46) and Mary (20) are two staff members who do not get  along. Rosanna is quiet and a loner. Mary is outspoken, and talks about  her personal life to friends.
  • Cindy, (35), and Lolita, (40), are part-time staff. They are  stressed due to economy. They interact with full time staff, but full  time staff think they complain too much and shouldn’t because they are  part time
  • Chip is a twenty-three-year-old maintenance worker who works  part-time job at night, in addition to full-time role. He is often  tired.
  • Samir is fifty-five, works full-time, and cannot wait until retirement.
  • Sarah (52) is a negative department manager who complains. She is a strong informal leader and has influence over the group.
  • Jerry is twenty-four and in graduate school. He has a positive  attitude and is not motivated because no one likes to work together.

You need to divide the team into three groups. Remember this is a team-building activity.

  • How will you make the determination which members to put together?
  • Should members, who have a negative attitude, be placed with members who are positive? Why or why not?
  • How will a negative manager affect the overall group dynamic as opposed to a positive leader who wants to see the team develop?
  • How influential can an informal leader be among team members?
  • What barriers to effective teamwork can you anticipate and how will it be addressed?

Submission Details:

  • Your presentation should consist of 12–15 professional color  Microsoft PowerPoint slides (not including the title and reference  slide) along with detailed speaker notes to include examples to support  each slide.
  • Support your responses with examples.
  • Cite any sources in APA format
  • Present the additional information in the Notes section.

Abuse and Misuse as Community Health Problems

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Definitions of Substance Abuse

Substance abuse: the use of any drug (alcohol, street drugs, prescription and over-the-counter medications) that results in a loss of control over the amount taken and when it is taken

Dependence or addiction: present when there are physiological symptoms that occur with withdrawal of the substance

Scope of Substance Abuse

Illicit drug use

Use of alcohol

Use of Tobacco

Impact of Substance Abuse on Society

Preventable morbidity and mortality

Healthcare costs

Costs to society

Impact of Substance Abuse on the Individual

Loss of job

Divorce

Health problems (acute and chronic)

Nutritional deficiences

Low self-esteem

Depression

Anxiety

Death

Risk Factors for Substance Abuse

Society’s influence

The family’s influence

The workplace’s influence

Personal factors

Nursing Assessment

Nurses’ attitude self-assessment

Drug history

Recognizing the signs of substance abuse

Interventions

Society’s response

Healthy People 2020

Primary prevention

Secondary prevention

Tertiary Prevention

Interventions with special populations

Violence and the Community

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From Criminal Justice to Public Health

Public health approach to prevent injuries

Multidisciplinary

Scientific

Use of epidemiology

Defining and Explaining Violence

Behavioral violence

Structural violence

Risk Factors for Violent Behavior

Microsystem

Individual

Family, peers, school, and religious

Mesosystem

Macrosystem

Types of Violence in U.S. Society

Violence in the family

Violence against women

Child maltreatment

Elder maltreatment

Workplace

Youth Violence

Scope of the problem

School violence

Gangs

Gun control

Dating violence

Causes of youth violence

Mass Violence and War

Epidemiology of war

Nightingale

Roles of nurses related to war

Interventions to Prevent Violence

Microlevel interventions with individuals and families

Primary prevention

Secondary prevention

Tertiary prevention

Interventions to Prevent Violence (cont.)

Mesolevel interventions: community structures

Community development

Action to enhance the ability of a community to meet the needs of its members

Community awareness

Collaboration and partnerships

Interventions to Prevent Violence (cont.)

Macrolevel interventions: society and culture

Policy issues

Action

Faith-based connections

Nursing organizations

SHORT TITLE OF PAPER

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SHORT TITLE OF PAPER (50 CHARACTERS OR LESS) 2

Paper Title

Author

Institutional Affiliation

Author Note

The author note is used to provide information about the author’s departmental affiliation, acknowledgments of assistance or financial support, and a mailing address for correspondence. An example follows:

Nelson L. Eby, Department of Computer Fraud Investigation, Columbian School of Arts and Sciences, the George Washington University; Douglas Degelman, Department of Psychology, Vanguard University of Southern California.

Correspondence concerning this article should be addressed to Douglas Degelman, Department of Psychology, Vanguard University of Southern California, Costa Mesa, CA 92626. E-mail: ddegelman@vanguard.edu

Abstract

The abstract (in block format) begins on the line following the Abstract heading. The abstract is a one-paragraph, self-contained summary of the most important elements of the paper. Nothing should appear in the abstract that is not included in the body of the paper. Word limits for abstracts are set by individual journals. Most journals have word limits for abstracts between 150 and 250 words. All numbers in the abstract (except those beginning a sentence) should be typed as digits rather than words. The abstract (in block format) begins on the line following the Abstract heading. This is an example. This is an example of what 150 words looks like. This is an example of what 150 words looks like. This is an example of what 150 words looks like. This is an example of what 150 words looks like. This is an example of what 150 words looks like.

Title of Paper

The introduction of the paper begins here. Double-space throughout the paper, including the title page, abstract, body of the document, and references. The body of the paper begins on a new page (page 3). Subsections of the body of the paper do not begin on a new page. The title of the paper (in uppercase and lowercase letters) is centered on the first line below the running head. The introduction (which is not labeled) begins on the line following the paper title. Headings are used to organize the document and reflect the relative importance of sections. For example, many empirical research articles utilize Methods, Results, Discussion, and References headings. In turn, the Method section often has subheadings of Participants, Apparatus, and Procedure. Main headings (when the paper has either one or two levels of headings) use centered, boldface, uppercase and lowercase letters (e.g., Method, Results). Subheadings (when the paper has two levels of headings) use flush left, boldface, uppercase and lowercase letters (e.g., Participants , Apparatus).

Text citations. Source material must be documented in the body of the paper by citing the author(s) and date(s) of the sources. This is to give proper credit to the ideas and words of others. The reader can obtain the full source citation from the list of references that follows the body of the paper. When the names of the authors of a source are part of the formal structure of the sentence, the year of the publication appears in parenthesis following the identification of the authors, e.g., Eby (2001). When the authors of a source are not part of the formal structure of the sentence, both the authors and years of publication appear in parentheses, separated by semicolons, e.g. (Eby and Mitchell, 2001; Passerallo, Pearson, & Brock, 2000). When a source that has three, four, or five authors is cited, all authors are included the first time the source is cited. When that source is cited again, the first authors’ surname and “et al.” are used.

When a source that has two authors is cited, both authors are cited every time. If there are six or more authors to be cited, use the first authors’ surname and “et al.” the first and each subsequent time it is cited. When a direct quotation is used, always include the author, year, and page number as part of the citation. A quotation of fewer than 40 words should be enclosed in double quotation marks and should be incorporated into the formal structure of the sentence. A longer quote of 40 or more words should appear (without quotes) in block format with each line indented five spaces from the left margin.

The references section begins on a new page. The heading is centered on the first line below the manuscript page header. The references (with hanging indent) begin on the line following the references heading. Entries are organized alphabetically by surnames of first authors. Most reference entries have three components:

1. Authors: Authors are listed in the same order as specified in the source, using surnames and initials. Commas separate all authors.

2. Year of Publication: In parentheses following authors, with a period following the closing parenthesis. If no publication date is identified, use “n.d.” in parentheses following the authors.

3. Source Reference: Includes title, journal, volume, pages (for journal article) or title, city of publication, publisher (for book).

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Degelman, D. (2009). APA style essentials. Retrieved from http://www.vanguard.edu/faculty/ddegelman/index.aspx?doc_id=796

Garrity, K., & Degelman, D. (1990). Effect of server introduction on restaurant tipping. Journal of Applied Social Psychology, 20, 168-172. doi:10.1111/j.1559-1816.1990.tb00405.x 

Hien, D., & Honeyman, T. (2000). A closer look at the drug abuse-maternal aggression link. Journal of Interpersonal Violence, 15, 503-522. Retrieved from http://jiv.sagepub.com/

Murzynski, J., & Degelman, D. (1996). Body language of women and judgments of vulnerability to sexual assault. Journal of Applied Social Psychology, 26, 1617-1626. doi:10.1111/j.1559-1816.1996.tb00088.x 

Nielsen, M. E. (n.d.). Notable people in psychology of religion. Retrieved from http://www.psywww.com/psyrelig/psyrelpr.htm

Paloutzian, R. F. (1996). Invitation to the psychology of religion (2nd ed.). Boston: Allyn and Bacon.

Shea, J. D. (1992). Religion and sexual adjustment. In J. F. Schumaker (Ed.), Religion and mental health (pp. 70-84). New York: Oxford University Press.

Template created by:

Nelson L. Eby – Graduate student of Computer Fraud Investigation

Columbian School of Arts and Sciences

The George Washington University

nelsoneby@hotmail.com

In collaboration with Dr. Douglas Degelman, Professor of Psychology, Vanguard University of Southern California

What is the significance of the subjective and objective data?

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The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

  • Complains of pain and heaviness in her leg.
  • States she cannot bear weight on her leg and has been in bed for 3 days.
  • Lives alone and has not had anyone to help her with meals.

Objective Data

  • Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage
  • Left leg red from knee to ankle
  • Calf measurement on left 3 in > than right
  • Temperature: 38.9 degrees C
  • Height: 160 cm; Weight: 83.7 kg

Laboratory Results

  • WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
  • Wound culture: Staphylococcus aureus

Critical Thinking Questions

  1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
  2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
  3. What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.
  4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

Summarize the History of US Healthcare

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Portfolio Assignment Description HE 362W Contemporary Health Issues Have these assignments in order:

• All the chapter assignments- see “text assignments” on Moodle. These include: Activity- 1-3, 3-3,4-3,5-3,8-3, 9-3, 14-3, 2-3.

• Study pages for the Frontline documentaries: “Sick Around the World”; “Sick Around

America”; “The Other Drug War”; “The High Price of Health”.

• Written Assignments (along with my notes and corrections)- 1-3- Summarize the History of US Healthcare, 3-3-Role of Stare and Local Health Departments, Analysis of Uninsured in America,(2) Analysis of Rising Costs of Healthcare,(3) “Is the Business Model Good for Healthcare Services”,, and the group assignments 2-3 “Stakeholders in (1)Healthcare” and “Is Healthcare a Right or a Commodity?”.

• The Formal Portfolio Paper: Answer each of the questions (in full sentences, paragraph form)

Introductory paragraph: 1. Explain the difference between a nation’s health and a nation’s healthcare system.

What are indicators of health (how we measure health in a community or nation)? What (indicators) do we measure in a healthcare system?

2. (Summarize) List and explain some factors contributing to the rising number of

uninsured in the USA? Cite facts, numbers and examples. What are the demographics of the uninsured before the ACA? Why do the numbers of uninsured rise and fall? How does being uninsured impact health? How does being uninsured impact healthcare?

3. (Summarize) List and explain some factors contributing to the rising costs of healthcare? How are healthcare costs measured, and how are these numbers increasing? What are the main areas of healthcare expenditures? Pharmaceutical companies- how do they justify their high prices? How is this contributing to rising costs? Cite facts, numbers and examples.

4. (Analyze) What strategies or policies do other countries use to address universal healthcare (access for all)? What strategies or policies do other countries use to address price controls? Explain and give examples from at least 3 countries.

5. (Evaluate) Concluding paragraph: Summary of views: a. How would you summarize the USA Healthcare system? Based on what you

have learned so far, what are the strengths and weaknesses of the US health care system?

6. Citations in text and a Work Cited page, APA styleAyman AlmalkiAyman AlmalkiAyman AlmalkiAyman AlmalkiJust answer questions 4 and 5 inside the red box

The purpose of this paper is to demonstrate your knowledge and understanding of the issues we have covered in class so far. Use the information from your readings, the videos, notes and papers we have already done in class to summarize information and synthesize answers to the questions. Cite facts, statistics, demographics and numbers. Give specific examples to answer each question. Remember, just identify the issues in our healthcare system, you don’t need to offer suggestions to fix anything. We will look at proposals to fix the system later.

(Analyze = identify, compare, distinguish, deduce, predict) (Evaluate = judge, justify, critique, verify)

Scoring Rubric Assignments And Study Pages

1-3,3-3,4-3,5-3,8-3, 9-3, 14-3, 2-3 -Sick Around the World -Sick Around America -Other Drug War -High Price of Health

Points 14 total

Written Assignments -Ch 1 Summary -Ch3 Group/Stakeholders -Ch4/5- Role of Fed,State and Local Health Dept, -Analysis of Uninsured, -Analysis of Rising Costs, -Opposing approaches –Right or Commodity?

Points 6 total

Final Portfolio Paper 1. Health and Healthcare 2.Uninsured 3. Rising Costs 4.Other Countries Strategies 5.Strengths and Weaknesses of USA Healthcare System 6.Citations/Works Cited Page

4 5 5 5 7 4____ 30 Total

Total

50 Total

EDUCATION AND RESEARCH

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Remember, you have been named the Administrative Director at  Happy Medical Center (HMC) and will be presenting your PPT to the Board of Directors at HMC for approval. HMC is restructuring to meet the current needs of their consumers. 

There are several roles in a health care organization. Often, interdisciplinary teams are created to brainstorm or make important decisions. The key is to develop a team that will interact with one another effectively and being diverse views to the forefront. 

Part 1: 

We have discussed several types of departments/roles in health care organization, (e.g., inpatient, outpatient, clinical, non-clinical, etc.)  For your Module 4 assignment you are to create an interdisciplinary team of 5 or 6 six individuals that will discuss and development an action plan for the restructuring of HMC. In 5 or 6 additional slides, you are to explain to the board the following: 

  1. Explain the importance of interdisciplinary teams
  2. Identify 5 or 6 individuals (titles of roles) and corresponding departments (i.e. Title: Inpatient Admission Director; Department: Inpatient) that you recommend to be a part of an interdisciplinary team to assist with the restructuring of HMC. 
  3. Justify why these select individuals will be beneficial part of the team. 

Part 2: 

To conclude your PPT to the board of directors, you are to develop a new Vision and Mission of HMC. Your Vision and Mission should support or be interrelated with the selected 5 (five) of the pillars of success from Module 3.

At this point (with the continuation of slides from Module 1, 2, and 3 assignments), your total presentation should be at least 20-25 slides (not including the title and reference slide). Speaker notes are required.

Assignment Expectations

Conduct additional research to gather sufficient information to support your responses.

  1. Limit your response to a maximum of 25 slides (not including the title or reference slides).
  2. Support your assignment with peer-reviewed articles, with at least 1-2 references. Use the following source for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.

Identify the role informatics plays in your professional responsibilities

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In this Discussion, you identify the role informatics plays in your professional responsibilities. You pinpoint personal gaps in skills and knowledge and then develop a plan for self-improvement.

To prepare:

· Review Nursing Informatics: Scope and Standards of Practice in this week’s Learning Resources, focusing on the different functional areas it describes. Consider which areas relate to your current nursing responsibilities or to a position you held in the past. For this Discussion, identify one or two of the most relevant functional areas.

· Review the list of competencies recommended by the TIGER Initiative. Identify at least one skill in each of the main areas (basic computer competencies, information literacy competencies, and information management competencies) that is pertinent to your functional area(s) and in which you need to strengthen your abilities. Consider how you could improve your skills in these areas and the resources within your organization that might provide training and support.

Post the key functional area(s) of nursing informatics relevant to your current position or to a position you recently held, and briefly describe why this area(s) is relevant. Identify the TIGER competencies you selected as essential to your functional area(s) in which you need improvement. Describe why these competencies are necessary and outline a plan for developing these competencies. Include any resources that are available to you within your organization and the ways you might access those resources. Assess how developing nursing informatics competencies would increase your effectiveness as a nurse.

Overview

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Informatics Competencies for Every Practicing Nurse: Recommendations from the TIGER Collaborative

www.thetigerinitiative.org

Overview

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The TIGER Initiative, an acronym for Technology Informatics Guiding Education Reform, was formed in 2004 to bring together nursing stakeholders to develop a shared vision, strategies, and specific actions for improving nursing practice, education, and the delivery of patient care through the use of health information technology (IT). In 2006, the TIGER Initiative convened a summit of nursing stakeholders to develop, publish, and commit to carrying out the action steps defined within this plan. The Summary Report titled Evidence and Informatics Transforming Nursing: 3-Year Action Steps toward a 10-Year Vision is available on the website at www.thetigerinitiative.org.

A COLLABORATIVE APPROACH Since 2007, hundreds of volunteers have joined the TIGER Initiative to continue the action steps defined at the Summit. The TIGER Initiative is focused on using informatics tools, principles, theories and practices to enable nurses to make healthcare safer, more effective, efficient, patient-centered, timely and equitable. This goal can only be achieved if such technologies are integrated transparently into nursing practice and education. Recognizing the demands of an increasingly electronic healthcare environment, nursing education must be redesigned to keep up with the rapidly changing technology environment.

Collaborative teams were formed to accelerate the action plan within nine key topic areas. All teams worked on identifying best practices from both education and practice related to their topic, so that this knowledge can be shared with others interested in enhancing the use of information technology capabilities for nurses. Each collaborative team researched their subject with the perspective of “What does every practicing need to know about this topic?” The teams identified resources, references, gaps, and areas that need further development, and provide recommendations for the industry to accelerate the adoption of IT for nursing. The TIGER Initiative builds upon and recognizes the work of organizations, programs, research, and related initiatives in the academic, practice, and government working together towards a common goal.

COLLABORATIVE REPORT This report provides the detailed findings and recommendations from the Informatics Competencies Collaborative Team. For a summary of the work of all nine TIGER Collaborative Teams, please review “Collaborating to Integrate Evidence and Informatics into Nursing Practice and Education” available on the website at www.thetigerinitiative.org. The TIGER Informatics Competencies Collaborative (TICC) Team was formed to develop informatics recommendations for all practicing nurses and graduating nursing students. TICC completed an extensive review of the literature as well as surveying nursing informatics education, research, and practice groups to obtain examples and identify gaps. This report describes the background, methodology, findings, and recommendations for future work in this area.

TABLE OF CONTENT

1. Overview (p. 2)

2. Executive Summary (p. 3)

3. Background (p. 4)

4. Methodology (p. 5)

5. Basic Computer Competencies (p. 7)

6. Information Literacy (p. 9)

7. Information Management (p. 11)

8. Implementation Strategies (p. 14)

9. References (p. 15)

10. Appendices (p. 18)

11. Acknowledgements (p. 32)http://www.thetigerinitiative.org/http://www.thetigerinitiative.org/

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Executive Summary

Nurses are expected to provide safe, competent, and compassionate care in an increasingly technical and digital environment. A major theme in this new healthcare environment is the use of information systems and technologies to improve the quality and safety of patient care. Nurses are directly engaged with information systems and technologies as the foundation for evidence-based practice, clinical-decision support tools, and the electronic health record (EHR). Unfortunately, not all nurses are fully prepared to use these tools to support patient care. The TIGER Informatics Competencies Collaborative sought to evaluate the current preparedness of the nursing workforce and propose a set of minimum informatics competencies that all nurses need to practice in today’s digital era.

A new specialty, called Nursing Informatics, has emerged over the past 20 years to help nurses fully use information technology to improve the delivery of care. The most recent 2008 American Nurses Association Nursing Informatics Scope and Standards defines nursing informatics as the integration of nursing science, computer and information science, and cognitive science to manage communication and expand the data, information, knowledge, and wisdom of nursing practice. Nurses certified in Nursing Informatics are: • skilled in the analysis, design, and implementation

of information systems that support • nursing in a variety of healthcare settings • function as translators between nurse clinicians and

information technology personnel • insure that information systems capture critical

nursing information

These specialized nurses add value to an organization by: • increasing the accuracy and completeness of

nursing documentation • improving the nurse’s workflow • eliminating redundant documentation • automating the collection and reuse of nursing data • facilitating the analysis of clinical data, including

Joint Commission indicators, Core Measures, federal or state mandated data and facility specific data

While Nursing Informatics is a highly specialized field, there are foundational informatics competencies that all practicing nurses and graduating nursing students should possess to meet the standards of providing safe, quality, and competent care. The Technology Informatics Guiding Education Reform (TIGER) Informatics Competency Collaborative was formed to develop the informatics recommendations for all practicing nurses and graduating nursing students. Following an extensive review of the literature and survey of nursing informatics education, research, and practice groups, the TIGER Nursing Informatics Competencies Model consists of three parts, detailed in this document:

• Basic Computer Competencies • Information Literacy • Information Management

The TIGER Informatics Competencies Collaborative (TICC) team identified a list of competencies for each of these categories, as well as the resources available to support the educational needs of nurses in achieving these competencies. TICC recognized that it may take some time to meet these competencies for all nursing staff, and has prioritized the minimum set of competencies to focus on in the first year, with the goal of achieving full competency by 2013. These recommendations are outlined within this report. The work of the TICC was foundational to several other TIGER Collaborative teams. Four other TIGER Collaborative teams focused on how to implement the TICC competency recommendations: within formal academic settings (the TIGER Education and Faculty Development Collaborative), within health care provider settings for nurses currently in practice (TIGER Staff Development Collaborative), for nursing leaders (TIGER Leadership Development Collaborative), and how to access HIT resources (TIGER Virtual Demonstration Collaborative). We recommend that you reference the Collaborative reports from these related TIGER Collaborative teams for recommendations on how to implement these strategies within your environment. These reports can be located on the TIGER website at www.thetigerinitiative.org.http://www.thetigerinitiative.org/

Background

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Nurses have always been at the forefront of patient care and focused on patient safety. The impetus for evaluating how prepared nurses are to use Electronic Health Records (EHRs) to improve patient care started in 2004. During President Bush’s State of the Union Address that year, he mandated that all Americans will be using electronic health records by the year 2014. As reported in Building the Workforce for Health Information Transformation (AHIMA, 2006), “A work force capable of innovating, implementing, and using health communications and information technology (HIT) will be critical to healthcare’s success.” President Obama continued this momentum when he took office in 2009, proposing to “Let us be the generation that reshapes healthcare to compete in the digital age.” Less than 30 days after taking office, President Obama signed the American Recovery and Reinvestment Act, earmarking $19 billion to develop an electronic health information technology infrastructure that will improve the efficiency and access of healthcare to all Americans. In addition to the substantial investment in capital, technology and resources, the success of delivering an electronic healthcare platform will require an investment in people— to build an informatics-aware healthcare workforce.

This has accelerated the need to ensure that healthcare providers obtain competencies needed to work with electronic records, including basic computer skills, information literacy, and an understanding of informatics and information management capabilities. A comprehensive approach to education reform is necessary to reach the current workforce of nearly 3 million practicing nurses. The average age of a practicing nurse in the U.S. is 47 years. These individuals are “digital immigrants,” as they grew up without digital technology, had to adopt it later, and some may not have had the opportunity to be educated on its use or be comfortable with technology. This is opposed to “digital natives”: younger individuals that have grown up with digital technology such as

computers, the Internet, mobile phones, and MP3 (Prensky, 2001). There are a number of digital immigrants in the nursing workforce who have not mastered basic computer competencies, let alone information literacy and how to use HIT effectively and efficiently to enhance nursing practice. The TIGER Summit, “Evidence and Informatics Transforming Nursing,” held in November of 2006, revealed an aggressive agenda that consisted of a 10-year vision and 3-year action plan for nurses to carry forward into the digital age. TIGER ‘s primary objective is to develop a U.S. nursing workforce capable of using electronic health records to improve the delivery of healthcare. For the TIGER Vision to be realized, the profession must master a minimum set of informatics competencies that allow nurses to use EHRs to deliver safer, more efficient, effective, timely and patient-centered care. This education will determine how well evidence and informatics is integrated into day- to-day practice. Since the TIGER Summit, five TIGER collaborative teams were formed to identify how to integrate informatics education into nurses competencies and nursing school developed recommendations focused on how to prepare nurses to practice in this digital era (see Figure 1). The TIGER Informatics Competencies Collaborative (TICC) team helped develop a minimum set of informatics competencies that all nurses need to have to practice today.

Figure 1 – TIGER Collaborative Teams involved in Workforce Recommendations:

1. Informatics Competencies

2. Education and Faculty Development

3. Staff Development

4. Leadership Development

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Methodology

The TIGER Informatics Competencies Collaborative was charged with the following goals:

Define the minimum set of informatics competencies that all nurses need to succeed in practice or education in today’s digital era.

Fortunately, there was a significant amount of nursing research completed on informatics competencies, well ahead of most other healthcare professions. The TIGER Informatics Competency Collaborative (TICC) started by completing an extensive review of the literature for informatics competencies for practicing nurses and nursing students. TICC also collected informatics competencies for nurses from over 50 healthcare delivery organizations. The results of these efforts are available on the TICC Wiki at http://tigercompetencies.pbwiki.com. This resulted in over 1000 individual competency statements.

Much of the work involved synthesizing this extensive list of competencies into a list of competencies that was realistic for the nearly 3 million practicing nurses. This body of competencies was evaluated and condensed to create the three parts of the TIGER Nursing Informatics Competencies Model:

1. Basic Computer Competencies 2. Information Literacy 3. Information Management

Once the competency categories were established, each was aligned with an existing set of competencies maintained by standard development organizations or defacto standards. For example, excellent alignment was found with the existing standards of the European Computer Driving Licence Foundation for basic computer competencies; the Health Level 7’s EHR functional model clinical care components for information management competencies; and the American Library Association’s information literacy standards. All of these sets of

competencies are standards maintained by existing industry organizations or standards development organizations. Leveraging existing competencies that are maintained by standards development organizations allow the TIGER Informatics Competency Collaborative (TICC) to recommend standards that are relevant to nurses and ones that will be sustainable as these bodies evolve the standards as necessary. Of equal or perhaps greater importance, these standard-setting bodies all have put tremendous thought, energy and expertise into there recommended competencies. When those competencies aligned with the informatics competency needs for nurses, we adopted theirs, thus adding strength, rigor, and validity to the TICC recommendations. Figure 2 illustrates the relationship between the competency category and the standard development organization. As like all of the TIGER Collaborative teams, TICC completed their research with the use of conference calls and web meetings, electronic survey tools, and conducted interviews. Their conclusions are published in this report and were shared with colleagues through webinars that were held in 2008. In addition, numerous presentations on this topic were given at local, national and international conferences.http://tigercompetencies.pbwiki.com/

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Methodology

TIGER Nursing Informatics Competencies Model

Component of the Model Standard Source (Standard-Setting Body)

Basic Computer Competencies European Computer Driving License

European Computer Driving License Foundation www.ecdl.org

Information Literacy Information Literacy Competency Standards

American Library Association www.ala.org

Information Management Electronic Health Record Functional Model – Clinical Care Components

International Computer Driving License – Health

Health Level Seven (HL7) www.hl7.org European Computer Driving License Foundation www.ecdl.org

Figure 2http://www.ecdl.org/http://www.ala.org/http://www.hl7.org/http://www.ecdl.org/

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Basic Computer Competencies

A “digital native” has grown up with digital technology such as computers, the Internet, mobile phones, and MP3. A “digital immigrant” grew up without digital technology and adopted it later (Presnky, 2001). There are a substantial number of digital immigrants in the nursing workforce who have not mastered basic computer competencies. Many digital natives have gaps in their basic computer competency skill set.

Europeans realized this shortcoming in the workforce across many industries and acted on it. The European Computer Driving Licence (ECDL) Foundation set basic computer competencies in the late 1990s and again in this decade. About seven million Europeans have now taken the ECDL exam and become certified in basic computer competencies. The ECDL syllabus is effectively a global standard in basic computer competencies (see list of modules below). ECDL has developed extensive training materials, including a certification exam.

ECDL Modules

1. Concepts of Information and Communication Technology (ICT)

2. Using the Computer and Managing Files

3. Word Processing 4. Spreadsheets 5. Using Databases 6. Presentation 7. Web Browsing and

Communication

RECOMMENDATIONS The TIGER Informatics Competency Collaborative (TICC) has adopted the ECDL competencies and is recommending them for all practicing nurses and graduating nursing students. ECDL certification requires 30+ hours of study and costs more than some institutions may be able to afford. Therefore, we have ranked the relative importance of ECDL syllabus items and recommend the following as a first step to basic computer proficiency for all practicing nurses and graduating nursing students. These are feasible and affordable and will provide basic computer competencies for nurses and allow them to go on to obtain other TICC competencies (see Figure 2). Module 1: Concepts of Information and Communication Technology (ICT) Module 2: Using the Computer and Managing Files Module 3, Section 3.1: Word Processing: “Using the application” Module 7: Web Browsing and Communication

A detailed description of these three modules including the related competency statements can be found in Appendix A.

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Basic Computer Competencies

Figure 2 – Basic Computer Competencies Timeline

Recommendation Timeline for Adoption

All practicing nurses and graduating nursing students gain or demonstrate proficiency in ECDL modules 1, 2 and 7, as well as ECDL Category 3.1

By January 2011

All practicing nurses and graduating nursing students become ECDL certified or hold a substantially equivalent certification

By January 2013

RESOURCES

European Computer Driving Licence (ECDL) Foundation http://ecdl.com The ECDL syllabus is maintained and periodically updated by the not-for-profit ECDL Foundation. The ECDL Foundation makes arrangements with entities in various countries to localize the ECDL syllabus. Outside of Europe, ECDL is known as International Computer Driving Licence. ICDL is available in the United States through CSPlacement.

CSPlacement www.csplacement.com CSPlacement is the official distributor of ECDL within the United States. They offer CSP Basic, an e- learning course and a certification exam that is substantially equivalent to the TICC recommendation of a first and significant step towards basic computer competency for 2011. In addition, they also offer CSP, an e-learning course and a certification exam that is substantially equivalent to the entire ECDL syllabus that will meet the TICC recommendations for 2013.

Healthcare Information and Management System Society (HIMSS) www.himss.org HIMSS has a certificate called Health Informatics Training System (HITS). The HITS program of e-learning, testing, and certification contains content that is substantially equivalent to the TICC recommendation of a first and significant step towards basic computer competency, as well as other content.http://ecdl.com/http://www.csplacement.com/http://www.himss.org/

Information Literacy Competencies

The Association of Colleges and Research Libraries (2000) defines Information literacy as “a set of abilities allowing individuals to recognize when information is needed and to locate, evaluate and use that information appropriately”. Information literacy builds on computer literacy. Information literacy is the ability to:

• identify information needed for a specific purpose

• locate pertinent information • evaluate the information • apply it correctly

Information literacy is critical to incorporating evidence-based practice into nursing practice. The nurse or healthcare provider must be able to determine what information is needed. This involves critical thinking and assessment skills. Finding the information is based on the resources available, which can include colleagues, policies, and literature in various formats. Evaluating or appraising the information also involves critical thinking and the ability to determine the validity of the source. The actual implementation of the information results in putting the information into practice or applying the information. The evaluation process

is necessary to determine whether the information and its application resulted in improvements. Thus, information literacy competencies are fundamental to nursing and evidence-based practice. The components of information literacy are defined in Figure 3.

INFORMATION LITERACY

1. Determine the nature and extent of the information needed

2. Access needed information effectively and efficiently

3. Evaluate information and its sources critically and incorporates selected information into his or her knowledge base and value system

4. Individually or as a member of a group, use information effectively to accomplish a specific purpose

5. Evaluate outcomes of the use of information

Figure 3 – Information Literacy Components

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Information Literacy Competencies

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Figure 4 – Information Literacy Competencies Timeline

Recommendation Timeline for Adoption

All practicing nurses and graduating nursing students will have the ability to demonstrate Information Literacy steps 1 through 3

By January 2011

All practicing nurses and graduating nursing students will have the ability to demonstrate all 5 Information Literacy steps

By January 2013

As some institutions may find these competencies difficult to implement in their entirety immediately, as a first and significant step towards information literacy in nurses, the TICC recommends focusing on the first three competencies for the first year. Once these are achieved by nurses in a particular organization, the other two can be added so that by January 2013, all nurses have all five competencies and incoming nurses demonstrate or are helped to obtain all five.

RESOURCES American Library Association The ALA’s report “Information Literacy Competency Standards for Higher Education” identifies the competencies recommended above as standards. The report also lists performance indicators and outcomes for each standard. A faculty member or instructor can effectively use this report to create a more detailed syllabus and or lesson plan(s) to implement the TICC information literacy competencies. http://www.ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfm

The Information Literacy in Technology http://www.ilitassessment.com The iLIT test assesses a student’s ability to access, evaluate, incorporate, and use information. It is a commercially available test and may be of use in demonstrating proficiency in information literacy.

Examples of competency statements related to each of the Information Literacy

steps can be found in Appendix B of this report.http://www.ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfmhttp://www.ilitassessment.com/

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Information Management Competencies

Information management is the underlying principle upon which TICC Clinical Information Management Competencies are built. Information management is a process consisting of 1) collecting data, 2) processing the data, and 3) presenting and communicating the processed data as information or knowledge.

An underlying concept for information management is the data-information-knowledge continuum. Data are discrete, atomic-level symbols, for example, the number 120. Information is data that is grouped or organized or processed in such a way that the data has meaning, for example a blood pressure of 120/80. Knowledge is information transformed or combined to be truly useful in making judgments and decisions. An example of knowledge is that a blood pressure of 120/80 is dangerously hypertensive in a neonate.

Information is managed by nurses in a variety of ways, but more and more the preferred or required method is through information systems. We define an information system as being composed of human and computer elements that work interdependently to process data into information. The most relevant, important, and fundamental information management competencies for nurses are those that relate to the electronic health record system (EHRs).

Using an EHRs will be the way nurses manage clinical information for the foreseeable future. However, nursing responsibilities are not changing in the shift to increased use of EHRs. For example, nurses are still required to exercise due care in protecting patient privacy. But the manner in which these responsibilities to patients and communities are upheld may be different. Therefore, all practicing nurses and graduating nursing students are therefore strongly encouraged to learn, demonstrate, and use information management competencies to carry out their fundamental clinical responsibilities in an increasingly safe,

effective, and efficient manner. The most rigorous as well as practical work on enumerating the relevant parts of the EHRs for clinicians was done by Health Level 7 (HL7) EHR Technical Committee and was published in February 2007. This approved American National Standard (ANSI) publication is titled The HL7 EHR System Functional Model, Release 1, otherwise known as ANSI/HL7 EHR, R1-2007. The direct care component of the HL7 EHR System Functional Model serves as a basis of information management competencies for practicing nurses and graduating nursing students (see Appendix C). Although these clinical information management competencies are numerous, they merely make explicit competencies for proficient use of EHRS clinical nursing responsibilities that practicing nurses and graduating nursing students are responsible for today in a paper information management environment or a mixed paper and electronic environment. However, the direct care component of the HL7 EHR System Functional Model is not quite sufficient by itself to cover the information management responsibilities of nurses in the digital era. What is needed is to translate these items into a set of competencies that address both the purpose and intended use of the HIT system (EHR in this case) and the “due care “ that nurses need to take in managing information via these systems. For example, electronic information is accessed and used in different ways than on paper, and it is important for the user (nurse) to understand these differences as well as the subsequent workflow and policies and procedures. Fortunately, the European Computer Driving Licence Foundation has come up with a set of items that address these concerns, called ECDL- Health. The following chart (figure 5) illustrates how the ECDL-Health item can be linked to a competency statement.

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Information Management Competencies

ECDL-Health Syllabus Item

Concepts

Health Information Systems

HIS Types

TICC-related Competency Statement The Nurse will: Verbalize the importance of Health Information Systems to clinical practice Have knowledge of various types of Health Information Systems and their clinical and administrative uses

Due Care

Confidentiality Assure Confidentiality of protected patient health information when using Health Information Systems under his or her control.

Access Control Assure Access Control in the use of Health Information Systems under his or her control

Security Assure the Security of Health Information Systems under his or her control

User Skills Navigation Have the User Skills as outlined in direct care component of the HL7 EHRS Decision Support Output Reports

Policy and Procedure

Principles

model, which includes all of the ECDL-Health User Skills of Navigation, Decision Support, Output Reports and more. Understand the Principles upon which organizational and professional Health Information System use by healthcare professionals and consumers are based.

Figure 5 – ECDL-Health Topics linked to TICC Competency Statements

This list of competencies came from the Direct Care components of the HL7 EHR System Functional Model. In some cases functional statements were not changed as they can also serve as competencies. For example, the HL7 EHR System Functional Model statement of “Access Healthcare Guidance” was unchanged, except for the preamble that applies to all Clinical Information Management Competencies, as “Using an EHRS, the nurse can: Access Healthcare Guidance.” An example of a change to the HL7 EHR System Functional Model statements is ‘Communication with Medical Devices’ where “Communication with Medical Devices” was changed to “Facilitate Communication with Medical Devices” to make it a Clinical Information Management Competency.

Information Management Competencies

RECOMMENDATIONS As with the other categories of informatics competencies, the TICC developed a timeline to adopt and integrate these competencies into nursing practice and education settings. Figure 5 illustrates these recommendations for adoption.

Figure 5 – Information Management Competencies Timeline

Recommendation Timeline for Adoption

Schools of nursing and healthcare delivery organizations will implement the information competencies listed in Appendix.

By January 2012

Schools of nursing and healthcare delivery organizations will implement the transformed ECDL-Health syllabus items listed above.

By January 2012

RESOURCES

HL7 EHR System Functional Model http://www.hl7.org/EHR/ This ANSI standard can be used by nursing instructors in schools of nursing and healthcare delivery organizations to develop curriculum to impart the recommended information management competencies to all practicing nurses and graduating nursing students.

ICDL-Health Syllabus http://www.ecdl.com A significant portion of the HL7 EHR System Functional Model is covered by the ECDL-Health Syllabus. The ECDL-Health Syllabus was developed by the ECDL Foundation to extend the foundation of basic computer competency skills that are not industry specific into the healthcare industry.

Digital Patient Record Certification (DPRC) http://dprcertification.com The DPRC Program was developed with a panel of U.S. informatics subject matter experts and is endorsed by the American Medical Informatics Association. The DPRC web site states that it assesses a healthcare professional’s ability to accurately, dependably, and legally manage patient records in a digital environment.

Healthcare Information and Management Systems Society www.himss.org The HITS program, sponsored in the United States by the Healthcare Information and Management Systems Society, uses a more international version of the ICDL-Health syllabus. Both the DPRC and HITS certifications are a substantial first step towards achieving clinical information management competencies for U.S. nurses and graduating nursing students.

13http://www.hl7.org/EHR/http://www.ecdl.com/http://dprcertification.com/http://www.himss.org/

Implementation Strategies

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In summary, Federal initiatives mandate the use of EHRs on all patients in the U.S. necessitates the need for all practicing and graduate nurses to master a minimum set of informatics competencies. This report describes the recommended competencies, and provides recommendations for resources that have already developed related educational material, and recommends a timeline for completion.

There are several other resources that might be helpful in developing competency-based training programs for informatics. The Quality Safety Education For Nurses (QSEN) project is one such resource. QSEN, a program funded by the Robert Wood Johnson Foundation since 2006, is primarily focused on developing the knowledge, skills and attitudes (KSAs) necessary to improve the quality and safety of the healthcare systems within which they work. One of the KSAs within QSEN is informatics. The QSEN project believes that nurses need to “Use information and technology to communicate, manage knowledge, mitigate error, and support decision making” (www.qsen.org). Faculty development as well as curricular resources have been developed through QSEN and are available for dissemination on their website at http://www.qsen.org .

Another beneficial resource that has developed tools for nurses to assess their competencies related to informatics can be found online at http://www.nursing- informatics.com/niassess/index.html. This website also offers tools to help develop a “Personal development plan” to improve informatics competencies (see http://www.nursing- informatics.com/niassess/Personal_Plan_2 007.pdf). Other tools available include quick informatics tutorials as well as self- tests:

http://www.nursing- informatics.com/niassess/tutorials.html

http://www.nursing- informatics.com/niassess/tests.html

As mentioned previously, four other TIGER Collaborative teams developed recommendations on how to implement the TICC competencies. Please refer to their reports for additional suggestions. These four teams include:

1. TIGER Education and Faculty

Development 2. TIGER Staff Development

3. TIGER Leadership Development

4. TIGER Virtual Demonstration Center

These TIGER Collaborative reports are accessible on the TIGER website at www.thetigerinitiative.org.http://www.qsen.org/

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References

AHIMA/Fore and AMIA (2006). Building the workforce. Accessed on November 20, 2009 at www.ahima.org/emerging_issues/

American Library Association (2000) Information Literacy Competency Standards for Higher Education. Accessed on November 20, 2009 at http://www.ala.org/ala/mgrps/divs/acrl/standar ds/informationliteracycompetency.cfm

Arnold JM (1996) Nursing informatics educational needs. Computers in Nursing 14(6):333-339

Axford R, McGuiness B (1994) Nursing informatics core curriculum: perspectives for consideration & debate. Informatics in Healthcare Australia 3(1):5-10

Bakken S, Cook SS, Curtis L et al (2004) Promoting patient safety through informatics- basednursing education. International Journal of Medical Informatics, 73, 581-589

Barton AJ (2005) Cultivating informatics competencies in a Community of Practice. Nursing Administration Quarterly 29(4):323-328

Bickford CJ, Smith K et al (2005) Evaluation of a nursing informatics training program shows significant changes in nurses’ perception of their knowledge of information technology. Health Informatics Journal 11(3):225-35

Booth RG (2006) Educating the future eHealth professional nurse. International Journal of Nursing Education Scholarship 3(1):1-10

Connors HR, Weaver C, Warren JJ, Miller K (2002) An academic-business partnership for advancing clinical informatics. Nursing Education Perspectives 23(5):228-233

Curran CR (2003) Informatics competencies for nurse practitioners. AACN Clinical

Issues: Advanced Practice in Acute and Critical Care 14(3):320-30 Desjardins KS, Cook SS, Jenkins M, Bakken S (2005) Effect of an informatics evidence-based practice curriculum on nursing informatics competence. International Journal of Medical Informatics 74:1012-1020 HL7 EHR Technical Committee (2007) Electronic Health Record – System Functional Model, Release 1 Chapter Three: Direct Care Functions. Accessed on November 20, 2009 at http://www.hl7.org/EHR/ European Computer Driving Licence Foundation (2008) EUROPEAN COMPUTER DRIVING LICENCE / INTERNATIONAL COMPUTER DRIVING LICENCE SYLLABUS VERSION 5.0. Accessed on November 20, 2009 at http://www.ecdl.com/programmes/files/2009/p rogrammes/docs/20090507100415_ECDL_ICDL_ Syllabus_Version_5.p.pdf European Computer Driving Licence Foundation (2008) ECDL / ICDL Health Syllabus. Accessed on November 20, 2009 at http://www.ecdl.com//programmes/index.jsp?p =102&n=764A Hobbs SD (2002) Measuring nurses’ computer competency: An analysis of published instruments. Computers Informatics Nursing 20(2):63-73. Gassert CA (1998) The challenge of meeting patients’ needs with a national nursing informatics agenda. Journal of the American Medical Informatics Association 5(3):263- 268 Gassert CA (2008) Technology and informatics competencies. In: Weiner B (ed), Nursing Clinics: Technology Use in Nursing Education Grobe SJ (1989) Nursing informatics competencies. Methods Inf Med 28(4):267-269http://www.ahima.org/emerging_issues/http://www.ala.org/ala/mgrps/divs/acrl/standarhttp://www.hl7.org/EHR/http://www.ecdl.com/programmes/files/2009/phttp://www.ecdl.com/programmes/index.jsp?p

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McNeil BJ, Elfrink VL et al (2006). Computer literacy study: report of qualitative findings. Journal of Professional Nursing 22(1):52-59

McNeil BJ, Elfrink VL et al (2003) Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: A U.S. survey. Journal of Nursing Education 42(8):341-349

McNeil BJ, Elfrink VL, Pierce ST et al (2005) Nursing informatics knowledge and competencies: A national survey of nursing education programs in the United States. International Journal of Medical Informatics 74:1021-1030

National Forum on Information Literacy (2007) Information Literacy Competency Standards for Higher Education. Accessed on November 20, 2009 at www.infolit.org

Ndiwane, A (2005) Teaching with the Nightingale Tracker technology in communitybased nursing educations: A pilot study. Journal of Nursing Education 44(1):40-42

Prensky, M (2001, October). Digital natives, digital immigrants. On the Horizon. Accessed on November 2, 2009 at www.marcpresnsky.com/writing

Roberts, JM (2000) Developing new competencies in healthcare practitioners in the field. Stud Health Technol Inform 72:73-6

Sackett K, Jones J, Erdley, WS (2005) Incorporating healthcare informatics into the strategic planning process in nursing education. Nursing Leadership Forum 9(9):98-104

Saranto K, Leino-Kilpi H (1997) Computer literacy in nursing: Developing the information technology syllabus in nursing education. Journal of Advanced Nursing 25:377-385 Simpson RL (2005) Practice to evidence to practice: Closing the loop with IT. Nursing Management 36(9):12-17 Skiba DJ (2004) Informatics competencies. Nursing Education Perspectives 25(6):312 Smedley A (2005) The importance of informatics competencies in nursing: An Australian perspective. CIN: Computers, Informatics, Nursing 23(2):106-110. Smith K, Bickford CJ (2004) Lifelong learning, professional development, and informatics certification. CIN: Computers, Informatics, Nursing 22(3): 172-178 Staggers N, Gassert CA, Curran C (2001) Informatics competencies for nurses at four levels of practice. Journal of Nursing Education 40(7):303-316 Staggers N, Gassert CA, Curran C (2002) A Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing Research 51(6): 383-390 Staggers N, Gassert CA, Skiba DJ (2000) Health professionals’ view of informatics education: Findings from the AMIA 1999 Spring Conference. Journal of the American Medical Informatics Association 7(6):550-558. (AMIA Education Task Force report, 2000) Staggers N, Lasome CM (2005) RN, CIO: an executive informatics career. CIN: Computers, Informatics, Nursing 23(4):201-206 Staggers N, Thompson CB (2002) The evolution of definitions for nursing informatics: A critical analysis and revised definition. Journal of thehttp://www.infolit.org/http://www.marcpresnsky.com/writing

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TIGER Informatics Competencies Collaborative (2007) Wiki. Accessed on November 20, 2009 at http://tigercompetencies.pbwiki.com

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Appendix A – Basic Computer Competencies

TIGER Informatics Competencies Recommendations – Basic Computer Competencies

1. Basic Computer Competency 1.1 Hardware

1.1.1. Concepts 1.1.1.1 Understand the term hardware.

Understand what a personal computer is. Distinguish between desktop, laptop (notebook), tablet P C in 1.1.1.2

1.1.1.3

1.1.1.4

terms of typical users. Identify common handheld portabledigital devices like: personal digital assistant (PDA), mobile phone, smartphone, multimedia player and know their main features. Know the main parts of a computer like: central processing unit (CPU), types of memory, hard disk, common input and output devices.

1.1.1.5 Identify common input/output ports like: USB, serial, parallel, network port, FireWire.

1.1.2 Computer Performance Know some of the factors that impact on a computer’s performance like: CPU speed, RAM size, graphics

1.1.2.1 card processor and memory, the number of applications running.

1.1.2.2 Know that the speed (operating frequency) of the CPU is measured in megahertz (MHz) or gigahertz (GHz).

1.1.3 Memory and Storage Know what computer memory is: RAM (random-access memory), ROM (readonly memory) and distinguish

1.1.3.1 between them. 1.1.3.2 Know storage capacity measurements: bit, byte, KB, MB, GB, TB.

Know the main types of storage media like: internal hard disk, external hard disk, network drive, CD, DVD, 1.1.3.3 USB flash drive, memory card, online file storage.

1.1.4 Input, Output Devices

Identify some of the main input devices like: mouse, keyboard, trackball, scanner, touchpad, stylus, joystick, 1.1.4.1 web camera (webcam), digital camera, microphone.

1.1.4.2 Know some of the main output devices like: screens/monitors, printers, speakers, headphones.

1.1.4.3 Understand some devices are both input and output devices like: touch screens. 1.2 Software

1.2.1 Concepts 1.2.1.1 Understand the term software. 1.2.1.2 Understand what an operating system is and name some common operating systems.

1.2.1.3 Identify and know the uses of some common software applications: word processing, spreadsheet, database, presentation, e-mail, web browsing, photo editing, computer games.

1.2.1.4 Distinguish between operating systems software and applications software. Know some options available for enhancing accessibility like: voice recognition software, screen reader,

1.2.1.5 screen magnifier, on-screen keyboard.

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TIGER Informatics Competencies Recommendations – Basic Computer Competencies

1.3 Networks 1.3.1 Network Types

1.3.1.1 Understand the terms local area network (LAN), wireless local area network (WLAN), wide area network (WAN).

1.3.1.2 Understand the term client/server. 1.3.1.3 Understand what the Internet is and know some of its main uses. 1.3.1.4 Understand what an intranet, extranet is.

1.3.2 Data Transfer 1.3.2.1 Understand the concepts of downloading from, uploading to a network.

1.3.2.2 Understand what transfer rate means. Understand how it is measured: bits per second (bps), kilobits per second (kbps), megabits per second (mbps).

1.3.2.3 Know about different Internet connection services: dial-up, broadband.

1.3.2.4 Know about different options for connecting to the Internet like: phone line, mobile phone, cable, wireless, satellite.

1.3.2.5 Understand some of the characteristics of broadband: always on, typically a flat fee, high speed, higher risk of intruder attack.

1.4 ICT in Everyday Life 1.4.1 Electronic World

1.4.1.1 Understand the term Information and Communication Technology (ICT).

1.4.1.2 Know about different Internet services for consumers like: e-commerce, ebanking, e- government.

1.4.1.3 Understand the term e-learning. Know some of its features like: flexible learning time, flexible learning location, multimedia learning experience, cost effectiveness. Understand the term teleworking. Know some of the advantages of teleworking like: reduced

1.4.1.4 or no commuting time, greater ability to focus on one task, flexible schedules, reduced company space requirements. Know some disadvantages of teleworking like: lack of human contact, less emphasis on teamwork.

1.4.2 Communication 1.4.2.1 Understand the term electronic mail (email). 1.4.2.2 Understand the term instant messaging (IM). 1.4.2.3 Understand the term Voice over Internet Protocol (VoIP). 1.4.2.4 Understand the term Really Simple Syndication (RSS) feed. 1.4.2.5 Understand the term web log (blog). 1.4.2.6 Understand the term podcast.

1.4.3 Virtual Communities

1.4.3.1 Understand the concept of an online (virtual) community. Recognize examples like: social networking websites, Internet forums, chat rooms, online computer games.

1.4.3.2 Know ways that users can publish and share content online: web log (blog), podcast, photos, video and audio clips. Know the importance of taking precautions when using online communities: make your

1.4.3.3 profile private, limit the amount of personal information you post, be aware that posted information is publicly available, be wary of strangers.

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TIGER Informatics Competencies Recommendations – Basic Computer Competencies 1.4.4 Health

1.4.4.1 Understand the term ergonomics.

1.4.4.2 Recognize that lighting is a health factor in computer use. Be aware that use of artificial light, amount of light, direction of light are all important considerations.

1.4.4.3 Understand that correct positioning of the computer, desk and seat can help maintain a good posture.

1.4.4.4 Recognize ways to help ensure a user’s wellbeing while using a computer like: take regular stretches, have breaks, use eye relaxation techniques.

1.4.5 Environment 1.4.5.1 Know about the option of recycling computer components, printer cartridges and paper

1.4.5.2 Know about computer energy saving options: applying settings to automatically turn off the screen/monitor, to automatically put the computer to sleep, switching off the computer.

1.5 Security

1.5.1 Identity/Authentication

1.5.1.1 Understand that for security reasons a user name (ID) and password are needed for users to identify themselves when logging on to a computer.

1.5.1.2 Know about good password policies like: not sharing passwords, changing them regularly, adequate password length, adequate letter and number mix.

1.5.2 Data Security 1.5.2.1 Understand the importance of having an off-site backup copy of files. 1.5.2.2 Understand what a firewall is.

1.5.2.3 Know ways to prevent data theft like: using a user name and password, locking computer and hardware using a security cable.

1.5.3 Viruses 1.5.3.1 Understand the term computer virus. 1.5.3.2 Be aware how viruses can enter a computer system.

1.5.3.3 Know how to protect against viruses and the importance of updating antivirus software regularly.

1.6 Law 1.6.1 Copyright

1.6.1.1 Understand the term copyright.

1.6.1.2 Know how to recognize licensed software: by checking product ID, product registration, by viewing the software licence.

1.6.1.3 Understand the term end-user license agreement. 1.6.1.4 Understand the terms shareware, freeware, open source.

1.6.2 Data Protection

1.6.2.1 Identify the main purposes of data protection legislation or conventions: to protect the rights of the data subject, to set out the responsibilities of the data controller.

1.6.2.2 Identify the main data protection rights for a data subject in your country. 1.6.2.3 Identify the main data protection responsibilities for a data controller in your country.

Appendix A – Basic Computer Competencies

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TIGER Informatics Competencies Recommendations – Basic Computer Competencies 2.1 Operating System

2.1.1 First Steps 2.1.1.1 Start the computer and log on securely using a user name and password. 2.1.1.2 Restart the computer using an appropriate routine. 2.1.1.3 Shut down a non-responding application. 2.1.1.4 Shut down the computer using an appropriate routine. 2.1.1.5 Use available Help functions.

2.1.2 Setup

2.1.2.1 View the computer’s basic system information: operating system name and version number, installed RAM (random- access memory).

2.1.2.2 Change the computer’s desktop configuration: date & time, volume settings, desktop display options (color settings, desktop background, screen pixel resolution, screen saver options).

2.1.2.3 Set, add keyboard language. 2.1.2.4 Install, uninstall a software application. 2.1.2.5 Use keyboard print screen facility to capture a full screen, active window.

2.1.3 Working with Icons

2.1.3.1 Identify common icons like those representing: files, folders, applications, printers, drives, recycle bin/wastebasket/trash.

2.1.3.2 Select and move icons. 2.1.3.3 Create, remove a desktop shortcut icon, make an alias. 2.1.3.4 Use an icon to open a file, folder, application.

2.1.4 Using Windows

2.1.4.1 Identify the different parts of a window: title bar, menu bar, toolbar or ribbon, status bar, scroll bar. 2.1.4.2 Collapse, expand, restore, resize, move, close a window. 2.1.4.3 Switch between open windows.

2.2 File Management 2.2.1 Main Concepts

2.2.1.1 Understand how an operating system organizes drives, folders, files in a hierarchical structure.

2.2.1.2 Know devices used by an operating system to store files and folders like: hard disk, network drives, USB flash drive, CD-RW, DVD-RW.

2.2.1.3 Know how files, folders are measured: KB, MB, GB.

2.2.1.4 Understand the purpose of regularly backing up data to a removable storage device for off- site storage. 2.2.1.5 Understand the benefits of online file storage: convenient access, ability to share files.

2.2.2 Files and Folders 2.2.2.1 Open a window to display folder name, size, location on a drive. 2.2.2.2 Expand, collapse views of drives, folders. 2.2.2.3 Navigate to a folder, file on a drive. 2.2.2.4 Create a folder and a further subfolder.

2.2.3 Working with Files Identify common file types: word processing files, spreadsheet files, database files,

2.2.3.1 presentation files, portable document format files, image files, audio files, video files, compressed files, temporary files, executable files.

2.2.3.2 Open a text editing application. Enter text into a file, name and save the file to a location on a drive.

Appendix A – Basic Computer Competencies

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TIGER Informatics Competencies Recommendations – Basic Computer Competencies 2.2.3.3 2.2.3.4

Change file status: read-only/locked, read-write. Sort files in ascending order by name, size, type, date modified.

2.2.3.5 Recognize good practice in folder, file naming: use meaningful names for folders and files to help with recall and organization.

2.2.3.6 Rename files, folders. 2.2.4 Copy, Move

2.2.4.1 Select a file, folder individually or as a group of adjacent, non-adjacent files, folders. 2.2.4.2 Copy files, folders between folders and between drives. 2.2.4.3 Move files, folders between folders and between drives.

2.2.5 Delete, Restore 2.2.5.1 Delete files, folders to the recycle bin/wastebasket/trash. 2.2.5.2 Restore files, folders from the recycle bin/wastebasket/trash. 2.2.5.3 Empty the recycle bin/wastebasket/trash

2.2.6 Searching 2.2.6.1 Use the Find tool to locate a file, folder. 2.2.6.2 Search for files by all or part of file name, by content. 2.2.6.3 Search for files by date modified, by date created, by size. 2.2.6.4 Search for files by using wildcards: file type, first letter of file name. 2.2.6.5 View list of recently used files.

2.3Utilities 2.3.1 File Compression

2.3.1.1 Understand what file compression means. 2.3.1.2 Compress files in a folder on a drive. 2.3.1.3 Extract compressed files from a location on a drive.

2.3.2 Anti-Virus 2.3.2.1 Understand what a virus is and the ways a virus can be transmitted onto a computer. 2.3.2.2 Use anti-virus software to scan specific drives, folders, files. 2.3.2.3 Understand why anti-virus software needs to be updated regularly.

2.4 Print Management 2.4.1 Printer Options

2.4.1.1 Change the default printer from an installed printer list. 2.4.1.2 Install a new printer on the computer.

2.4.2 Print 2.4.2.1 Print a document from a text editing application. 2.4.2.2 View a print job’s progress in a queue using a desktop print manager. 2.4.2.3 Pause, re-start, delete a print job using a desktop print manager.

3.1 Using the Application 3.1.1 Working with Documents

3.1.1.1 Open, close a word processing application. Open, close documents.

3.1.1.2 Create a new document based on default template, other available template like: memo, fax, agenda.

3.1.1.3 Save a document to a location on a drive. Save a document under another name to a location on a drive.

3.1.1.4 Save a document as another file type like: text file, Rich Text Format, template, software specific file extension, version number.

3.1.1.5 Switch between open documents.

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TIGER Informatics Competencies Recommendations – Basic Computer Competencies 7.1 The Internet

7.1.1 Concepts/Terms 7.1.1.1 Understand what the Internet is. 7.1.1.2 Understand what the World Wide Web (WWW) is.

7.1.1.3 Define and understand the terms: Internet Service Provider (ISP), Uniform Resource Locator (URL), hyperlink.

7.1.1.4 Understand the make-up and structure of a web address. 7.1.1.5 Understand what a web browser is and name different web browsers. 7.1.1.6 Know what a search engine is.

7.1.1.7 Understand the term Really Simple Syndication (RSS) feed. Understand the purpose of subscribing to an RSS feed.

7.1.1.8 Understand the term podcast. Understand the purpose of subscribing to a podcast. 7.1.2 Security Considerations

7.1.2.1 Know how to identify a secure web site: https, lock symbol. 7.1.2.2 Know what a digital certificate for a web site is. 7.1.2.3 Understand the term encryption.

7.1.2.4 Know about security threats from web sites like: viruses, worms, Trojan horses, spyware. Understand the term malware.

7.1.2.5 Understand that regularly updated anti-virus software helps to protect the computer against security threats.

7.1.2.6 Understand that a firewall helps to protect the computer against intrusion. 7.1.2.7 Know that networks should be secured by user names and passwords.

7.1.2.8 Identify some risks associated with online activity like: unintentional disclosure of personal information, bullying or harassment, targeting of users by predators.

7.1.2.9 Identify parental control options like: supervision, web browsing restrictions, computer games restrictions, computer usage time limits.

7.2 Using the Browser 7.2.1 Basic Browsing

7.2.1.1 Open, close a web browsing application. 7.2.1.2 Enter a URL in the address bar and go to the URL. 7.2.1.3 Display a web page in a new window, tab. 7.2.1.4 Stop a web page from downloading. 7.2.1.5 Refresh a web page. 7.2.1.6 Use available Help functions.

7.2.2 Settings

7.2.2.1 Set the web browser Home Page/Start page. 7.2.2.2 Delete part, all browsing history. 7.2.2.3 Allow, block pop-ups. 7.2.2.4 Allow, block cookies. 7.2.2.5 Delete cache/temporary Internet files. 7.2.2.6 Display, hide built-in toolbars.

7.2.3 Navigation 7.2.3.1 Activate a hyperlink. 7.2.3.2 Navigate backwards and forwards between previously visited web pages. 7.2.3.3 Navigate to the Home page.

Appendix A – Basic Computer Competencies

24

TIGER Informatics Competencies Recommendations – Basic Computer Competencies 7.2.4 Bookmarks

7.2.4.1 Bookmark a web page. Delete a bookmark. 7.2.4.2 Display a bookmarked web page. 7.2.4.3 Create, delete a bookmark folder. 7.2.4.4 Add web pages to a bookmark folder.

7.3 Using the Web 7.3.1 Forms

7.3.1.1 Complete a web-based form using: text boxes, drop-down menus, list boxes, check boxes, radio buttons.

7.3.1.2 Submit, reset a web-based form. 7.3.2 Searching

7.3.2.1 Select a specific search engine. 7.3.2.2 Carry out a search for specific information using a keyword, phrase.

7.3.2.3 Use advanced search features to refine a search: by exact phrase, by excluding words, by date, by file format.

7.3.2.4 Search a web based encyclopedia, dictionary. 7.4 Web Outputs

7.4.1 Saving Files 7.4.1.1 Save a web page to a location on a drive. 7.4.1.2 Download files from a web page to a location on a drive. 7.4.1.3 Copy text, image, URL from a web page to a document.

7.4.2 Prepare and Print

7.4.2.1 Prepare a web page for printing: change printed page orientation, paper size, printed page margins.

7.4.2.2 Preview a web page.

7.4.2.3 Choose web page print output options like: entire web page, specific page(s), selected text, number of copies and print.

7.5 Electronic Communication 7.5.1 Concepts/Terms

7.5.1.1 Understand the term e-mail and know its main uses. 7.5.1.2 Understand the make-up and structure of an e-mail address. 7.5.1.3 Understand the term short message service (SMS). 7.5.1.4 Understand the term Voice over Internet Protocol (VoIP) and know its main benefits.

7.5.1.5 Understand the main benefits of instant messaging (IM) like: real-time communication, knowing whether contacts are online, low cost, ability to transfer files.

7.5.1.6 Understand the concept of an online (virtual) community. Recognize examples like: social networking websites, Internet forums, chat rooms, online computer games.

7.5.2 Security Considerations 7.5.2.1 Be aware of the possibility of receiving fraudulent and unsolicited email. 7.5.2.2 Understand the term phishing. Recognize attempted phishing.

7.5.2.3 Be aware of the danger of infecting the computer with a virus by opening an unrecognized e- mail message, by opening an attachment.

7.5.2.4 Understand what a digital signature is.

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TIGER Informatics Competencies Recommendations – Basic Computer Competencies 7.5.3 E-mail Theory

7.5.3.1 Understand the advantages of e-mail systems like: speed of delivery, low cost, flexibility of using a web-based e-mail account in different locations. Understand the importance of network etiquette (netiquette) like: using accurate and brief

7.5.3.2 descriptions in e-mail message subject fields, brevity in e-mail responses, spell checking outgoing e- mail.

7.5.3.3 Be aware of possible problems when sending file attachments like: file size limits, file type restrictions (for example, executable files).

7.5.3.4 Understand the difference between the To, Copy (Cc), Blind copy (Bcc) fields.

7.6 Using e-mail 7.6.1 Send an e-mail

7.6.1.1 Open, close an e-mail application. Open, close an e-mail. 7.6.1.2 Create a new e-mail. 7.6.1.3 Enter an e-mail address in the To, Copy (Cc), Blind copy (Bcc) fields. 7.6.1.4 Enter a title in the Subject field. 7.6.1.5 Copy text from another source into an e-mail. 7.6.1.6 Insert, remove a file attachment. 7.6.1.7 Save a draft of an e-mail. 7.6.1.8 Use a spell checking tool and correct spelling errors. 7.6.1.9 Send an e-mail, send an e-mail with a low, high priority.

7.6.2 Receiving e-mail 7.6.2.1 Use the reply, reply to all function. 7.6.2.2 Forward an e-mail. 7.6.2.3 Save a file attachment to a location on a drive and open the file. 7.6.2.4 Preview, print a message using available printing options.

7.6.3 Enhancing Productivity 7.6.3.1 Add, remove message inbox headings like: sender, subject, date received. 7.6.3.2 Apply a setting to reply with, without original message insertion. 7.6.3.3 Flag an e-mail. Remove a flag mark from an e-mail. 7.6.3.4 Identify an e-mail as read, unread. Mark an e-mail as unread, read. 7.6.3.5 Display, hide built-in toolbars. Restore, minimize the ribbon. 7.6.3.6 Use available Help functions.

7.7 e-mail Management 7.7.1 Organize

7.7.1.1 Search for an e-mail by sender, subject, e-mail content. 7.7.1.2 Sort e-mails by name, by date, by size. 7.7.1.3 Create, delete an e-mail folder. 7.7.1.4 Move e-mails to an e-mail folder. 7.7.1.5 Delete an e-mail. 7.7.1.6 Restore a deleted e-mail. 7.7.1.7 Empty the e-mail bin/deleted items/trash folder.

7.7.2 Address Book 7.7.2.1 Add contact details to an address book. Delete contact details from an address book. 7.7.2.2 Update an address book from incoming e-mail. 7.7.2.3 Create, update a distribution list/mailing list.

Appendix B – Information Literacy Competencies

TIGER Recommendations -Information Literacy Competencies

[Source: Modified from American Library Association’s Information Literacy Competency Standards for Higher Education (2000).]

Information Literacy Competencies

All practicing nurses and graduating nursing students will have the ability to:

1. Knowledge – Determine the nature and extent of the information needed.

1.1 Recognize a specific information need

1.2 Focus and articulate the information need into a researchable question.

1.3 Understand that the type and amount of information selected is determined in part by the parameters of the need, as well as by the information available.

2. Access – Access needed information effectively and efficiently

2.1 Recognize the availability of a variety of sources and of assistance with using them.

2.2 Identify types of information resources in a variety of formats (e.g., primary or secondary, journals, policies and procedures, electronic references) and understand their characteristics.

2.3 Select types of information resources appropriate to a specific information need.

2.4 Understand that different information sources and formats require different searching techniques, including browsing.

2.5 Select the search strategies appropriate to the topic and resource.

2.5 Understand that various resources may use different controlled vocabularies to refer to the same topic.

2.6

Use search language appropriate to the source, such as a controlled vocabulary, key words, natural language, author and title searches to locate relevant items in print and electronic resources.

2.7 Use online search techniques and tools to locate relevant citations and to further refine the search.

2.8 Understand that the Internet may be a useful resource for locating, retrieving and transferring information electronically.

2.9 Understand how to use classification systems and their rationale.

26

Appendix B – Information Literacy Competencies

27

TIGER Recommendations -Information Literacy Competencies

[Source: Modified from American Library Association’s Information Literacy Competency Standards for Higher Education (2000).]

3. Evaluate information and its sources critically and incorporates selected information into his or her knowledge base and value system

3.1 Understand that search results may be presented according to various ordering principles (e.g., relevance ranking, author, title, date, or publisher).

3.2 Assess the number and relevance of sources cited to determine whether the search strategy must be refined.

3.3 Use the components of a citation (e.g., currency, reputation of author or source, format, or elements of a URL) to choose those most suitable for the information need.

3.4 Perceive gaps in information retrieved and determine whether the search should be refined.

3.5 Understand that the Internet may be a useful resource for locating, retrieving and transferring information electronically.

3.6 Use a variety of criteria, such as author’s credentials, peer review, and reputation of the publisher, to assess the authority of the source.

3.7 Assess the relevancy of a source to an information need by examining publication date, purpose, and intended audience.

3.8 Recognize omission in the coverage of a topic.

3.9 Distinguish between primary and secondary sources in different disciplines and evaluate their appropriateness to the information need.

3.10 Apply evaluation criteria to all information formats.

3.11 Integrate the new information into existing body of knowledge.

4. Individually or as a member of a group, use information effectively to accomplish a specific purpose

4.1 Recognize and evaluate documentation for the information source, such as research methodology, bibliography or footnotes.

4.2 Use appropriate documentation style to cite sources used.

4.3 Summarize the information retrieved (e.g., write an abstract or construct an outline).

4.4 Recognize and accept the ambiguity of multiple points of view.

Appendix B – Information Literacy Competencies

28

TIGER Recommendations -Information Literacy Competencies

[Source: Modified from American Library Association’s Information Literacy Competency Standards for Higher Education (2000).]

4.5 Organize the information in a logical and useful manner.

4.6 Synthesize the ideas and concepts from the information sources collected.

4.7 Determine the extent to which the information can be applied to the information need.

4.8 Create a logical argument based on information retrieved.

5. Evaluate outcomes of the use of information

5.1 Describe the criteria used to make decisions and choices at each step of the particular process used.

5.2 Assess effectiveness of each step of the process and refine the search process in order to make it more effective.

5.3 Understand that many of the components of an information seeking process are transferable and, therefore, are applicable to a variety of information needs.

5.4 Understand the structure of the information environment and the process by which both scholarly and popular information is produced, organized and disseminated.

5.5

Understand the ethics of information use, such as knowing how and when to give credit to information and ideas gleaned from others by appropriately citing sources in order to avoid plagiarism.

5.6 Respect intellectual property rights by respecting copyright.

5.7 Understand concepts and issues relating to censorship, intellectual freedom, and respect for differing points of view.

5.8 Understand the social/political issues affecting information, such as:

a) privacy

b) privatization and access to government information

c) electronic access to information

d) the exponential growth of information

e) equal access to information

Appendix C – Information Management Competencies

29

TIGER Recommendations – Information Management Competencies [Source: Modified from the Health Language 7 (HL7) EHRs Functional Model]

3. Clinical Information Management Competencies

Concepts

Verbalize the importance of Health Information Systems to clinical practice

Have knowledge of various types of Health Information Systems and their clinical and administrative uses

Due Care Assure Confidentiality of protected patient health information when using Health Information Systems under his or her control Assure Access Control in the use of Health Information Systems under his or her control

Assure the Security of Health Information Systems under his or her control

Policy and Procedure

Understand the Principles upon which organizational and professional Health Information System use by healthcare professionals and consumers are based.

User Skills

Have the User Skills as outlined in direct care component of the HL7 EHRS model (see below: Using and EHRS, the nurse can:) , which includes all of the ECDL-Health User Skills of Navigation, Decision Support,

Appendix C – Information Management Competencies

30

TIGER Recommendations – Information Management Competencies [Source: Modified from the Health Language 7 (HL7) EHRs Functional Model]

Example Competency Statements: Using an EHR, the nurse can: 1.0 Demographic/patient info

1.1 Identify and Maintain a Patient Record 1.2 Manage Patient Demographics 1.3 Capture Data and Documentation from External Clinical Sources 1.4 Capture Patient-Originated Data 1.5 Capture Patient Health Data Derived from Administrative and 1.6 Interact with Financial Data and Documentation 1.7 Produce a Summary Record of Care 1.8 Present Ad Hoc Views of the Health Record

1.9 Manage Patient History 2.0 Consents and Authorizations

2.1 Manage Patient and Family Preferences 2.2 Manage Patient Advance Directives

2.3 Manage Consents and Authorizations 3.0 Medication Management

3.1 Manage Allergy, Intolerance and Adverse Reaction Lists 3.2 Manage Medication Lists 3.3 Manage Problem Lists 3.4 Manage Immunization Lists 3.5 Manage Medication Administration 3.6 Manage Immunization Administration 3.7 Manage Medication Orders as appropriate for her scope of practice

4.0 Planning Care 4.1 Interact with Guidelines and Protocols for Planning Care 4.2 Manage Patient-Specific Care and Treatment Plans 4.3 Interact with Clinical Workflow Tasking 4.4 Interact with Clinical Task Assignment and Routing 4.5 Interact with Clinical Task Linking 4.6 Interact with Clinical Task Tracking

5.0 Order/Results Management 5.1 Manage Non-Medication Patient Care Orders 5.2 Manage Orders for Diagnostic Tests 5.3 Manage Orders for Blood Products and Other Biologics 5.4 Manage Referrals 5.5 Manage Order Sets 5.6 Manage Results

6.0 Care Documentation 6.1 Manage Patient Clinical Measurements 6.2 Manage Clinical Documents and Notes 6.3 Manage Documentation of Clinician Response to Decision Support Prompts 6.4 Generate and Record Patient-Specific Instructions

Appendix C – Information Management Competencies

31

TIGER Recommendations – Information Management Competencies [Source: Modified from the Health Language 7 (HL7) EHRs Functional Model] Example Competency Statements: Using an EHR, the nurse can: 7.0 Decision Support

7.1 Manage Health Information to Provide Decision Support for Standard Assessments

7.2 Manage Health Information to Provide Decision Support for Patient Context- Driven assessments

7.3 Manage Health Information to Provide Decision Support for Identification of Potential Problems and Trends 7.4 Manage Health Information to Provide Decision Support for Patient and Family Preferences 7.5 Interact with decision Support for Standard Care Plans, Guidelines, and Protocols 7.6 Interact with decision Support for Context-Sensitive Care Plans, Guidelines, and Protocols 7.7 Manage Health Information to Provide Decision Support Consistent Healthcare 7.8 Management of Patient Groups or Populations

7.9 Manage Health Information to Provide Decision Support for Research Protocols Relative to Individual Patient Care 7.10 Manage Health Information to Provide Decision Support for Self-Care

7.11 Interact with decision support for Medication and Immunization Ordering as appropriate for her scope of practice 7.12 Interact with decision Support for Drug Interaction Checking 7.13 Interact with decision Support for Patient Specific Dosing and Warnings 7.14 Interact with decision Support for Medication Recommendations 7.15 Interact with decision Support for Medication and Immunization Administration 7.16 Interact with decision Support for Non-Medication Ordering 7.17 Interact with decision Support for Result Interpretation 7.18 Interact with decision Support for Referral Process 7.19 Interact with decision Support for Referral Recommendations 7.20 Interact with decision Support for Safe Blood Administration 7.21 Interact with decision Support for Accurate Specimen Collection

8.0 Notifications 8.1 Interact with decision support that Presents Alerts for Preventive Services and Wellness

8.2 Interact with decision Support for Notifications and Reminders for Preventive Services and Wellness

8.3 Manage Health Information to Provide Decision Support for Epidemiological 8.4 Investigations of Clinical Health Within a Population.

8.5 Manage Health Information to Provide Decision Support for Notification and Response regarding population health issues 8.6 Manage Health Information to Provide Decision Support for Monitoring Response 8.7 Notifications Regarding a Specific Patient’s Health 8.8 Access Healthcare Guidance

9.0 Facilita 9.1

ting Communications Facilitate Inter-Provider Communication

9.2 Facilitate Provider -Pharmacy Communication 9.3 Facilitate Communications Between Provider and Patient and/or the Patient Representative 9.4 Facilitate Patient, Family and Care Giver Education 9.5 Facilitate Communication with Medical Devices

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Acknowledgements

The TIGER Initiative would like to acknowledge and extend its thanks to the hundreds of volunteers and nursing professional organizations who lent their leadership, expertise, and support to the development of the TIGER Initiative Collaborative Reports. The TIGER Usability and Clinical Application Development Collaborative was led by two industry expert co-chairs:

CO-CHAIRS Brian Gugerty DNS, RN Clinical Informatician Principal Consultant Gugerty Consulting, LLC

Connie Delaney PhD, RN, FAAN, FACMI Dean and Professor School of Nursing University of Minnesota

Their efforts were supported by the TIGER Executive Program Director.

PROGRAM DIRECTOR Donna DuLong, BSN TIGER Initiative

Special thanks are also in order to the following individual who provided significant leadership and contributions to the various sub-components of this report:

CONTRIBUTING AUTHORS P. Ann Coleman, EdD, RN, MPA, PMP Texas Woman’s University

Wanda Kelley, RN, MSN Catholic Healthcare Initiatives

Denise Tyler, RN-BC, MSN, MBA Kaweah Delta Health Care District

Sarah Tupper Taylor-Tupper and Associates

EDITORS Marie McCarren, not a TICC member, is gratefully acknowledged for her editing and editorial guidance. Sunmoo Yoon, Columbia University Graduate Student, helped to create the appendices of competencies listed within this document. COLLABORATIVE PARTICIPANTS We would also like to thank and acknowledge all of the participants of the TIGER Usability Collaborative team. The richness of their expertise and contributions not only facilitated the development of this report but their willingness to share their experiences with others will add to further development related to usability and clinical application development. Deborah Aldridge, Stanly Medical Services; Christel Anderson, HIMSS; Tami Austin, OSF Healthcare; Donna Bailey, University of North Carolina; Janet Baker, Ursuline College; Marion Ball, IBM; A. Barry, TJUH; Melissa Foster Barthold, Homestead Hospital; Estelle Bartley, Redland Hospital; Susan Boedefeld, Good Samaritan Hospital; Charles Boicey, City of Hope; Ken Bowman, Lancaster General Hospital; Victoria Bradley, Eclipsys; Phyllis Brenner, Madonna University; Jane Brokel, University of Iowa; Robyn Carr, IMIA-NI; Pam Charney, University of Washington; Hardy T. Clark, Baton Rouge General Medical Center; P. Ann Coleman, Texas Woman’s University; Karen Colorafi, Apollo College; Phyllis M. Connolly, San Jose State University; Deborah Cremin, Littleton Regional Hospital; Jessie S. Cristobal, Kaiser Permanente; Joan Culley, University of Massachusetts Amherst; Chris Curran, Ohio State; Nina Darisse, Philips Healthcare; Janice Unruh Davidson, Covenant Consulting Services; Connie Delaney, University of Minnesota; Brian Dixon, AHRQ; Penny Dodson, Arkansas Children’s Hospital; Donna DuLong, TIGER; Lisa Easterly, Our Lady of Lourdes School of Nursing; Peggy Esch, Citizens Memorial; Sharon Eshelman, Montrose Memorial Hospital; Rosario Estrada,

Acknowledgements

UMDNJ; Eva Feldman, St. Agnes Hospital; Melissa Finnegan, Philips Healthcare/American Radiology Nurses Society; Joleen Frank, Beaver Dam Community Hospital; Susan Fulginiti, Kennedy Health System; Danniele J. Fullard, The Children’s Institute; Colette Garton, AORN; Carole A. Gassert, ANI; Michael Gay; Denise Goldsmith, Brigham and Women’s Hospital; Anita Ground; Margaret Groves, Asante Health System; Kelly Grube, DuBois Regional Medical Center; Brian Gugerty, Gugerty Consulting LLC; Cheryl Hager, Advocate Christ Medical Center; Cynthia Hake, Capital Region Medical Center; Diane K. Heine, Queen of the Valley Medical Center; Helen Heiskell, Medical College of Georgia; Lori Hendrickx, American Association of Critical Care Nurses; Sylvia Suszka Hildebrandt, Group Health Cooperative; Katherine Holzmacher, Stony Brook University Medical Center; Elaine Hooper, Ontario Nursing Informatics Association; Patricia Hinton Walker, USUHS; Christine A. Hudak, Case Western Reserve University; Krysia Hudson, Johns Hopkins University; Dolly Ireland, Mount Clemens Regional Medical Center/ASPAN; Cathy Ivory, Tennessee AWHONN; Susan Jacobs, New York University; Berit Jasion, Duke University Health System; Constance Johnson, Duke University; Josette Jones, IUPUI; Eva Karp, Cerner Corporation; Wanda Kelley, Catholic Health Initiatives, Julie Kenney, Advocate Christ Medical Center; Nicole Kerkenbush, US Army; Charles Killingsworth, California Pacific Medical Center; Julie Kliewer, Alameda County Medical Center; Nancy Kranawetter, Southeast Hospital; Dina Krenzischek, American Society of PeriAnesthesia Nurses;Caterina Lasome, Tricare Management Activity; Margaret Louis, UNLV; Gary Loving, University of Oklahoma; Abdel latif Marini, American University of Beirut Medical Center; Sherri Martin; Iredell Memorial Hospital; Debi Martoccio, University Community Hospital; Patricia McCartney, AWHONN; Cindy McCoy, Troy University; Jacqueline McDonald, Stony Brook University Medical Center; Shannon McIntire, Iowa Veterans Home; Lois McMahon, Sanford Health; Brenda Meyer, Mille Lacs Health Ssytem; Bonna Miller, New Hanover Regional

Medical Center; Theresa A. Miller, VA LB Healthcare System; Vicki Morgan-Cramer, Catholic Health System of WNY; Liz Morris, Kettering Medical Center; Beth Morrissette, Baptist Medical Center South; Susan Newbold, Vanderbilt/CARING; Donna M. Mickitas, Hunter College, CUNY; Anthony Norcio, UMBC; Ogo Nwosu, CARING; Sue Olenick, Saint Clares Health System; Carolyn Padovano, CAP; Karen Pancheri, TWU & PVAM; Joel Parker, NNMC; Karen Peddicord, AWHONN; Daniel Pesut, Indiana University School of Nursing; Joanne Pohl, NONPF; Lisa Rabideau, CVPH Medical Center; Patrick Riley, Healthia Consulting; Susan Rosenberg, McKesson; Nancy Rothman, National Nursing Centers Consortium; Kay Sackett, University at Buffalo, SUNY; Kathryn Sapnas, Miami VA Healthcare System; Shirley Schiavone, South Jersey Healthcare; Ruth Schleyer, Providence Health & Services; Tess Settergren, Minnesota Nursing Informatics Group (MINING); Pamela Sherwill-Navarro, University of Florida; Florence Shrager, Gulfside Regional Hospice; Diane J. Skiba, UC Denver; Linda J. Smith, Portland VA Medical Center; Ann Smith-Flango, Altoona VAMC; Lena Sorensen, NYU College of Nursing; Lee Stabler, Cape Canaveral Hospital/Health First; Nancy Staggers, University of Utah; Edward Stern, NothingBEtter; Linda J. Stierle, American Nurses Association; Cynthia Struk, INFO; Darinda Sutton, Cerner Corporation; Margaret Swanson, OSF Saint Anthony Medical Center; Laura Taylor, Johns Hopkins University School of Nursing; Kathy Terman, BHHS; Beth A. Tomasek, Perot Systems; Portia Towns, Keane; Trish Trangenstein, Vanderbilt University School of Nursing; Sarah Tupper, Taylor -Tupper Consulting; Denise Tyler, Kaweah Delta/ANIA; Judy Underwood, HCA; Barbara Van de Castle, Johns Hopkins Cancer Center; Susan Vaughn, Bloomington Hospital; Judith J. Warren, University of Kansas School of Nursing; Kirby Wilkerson, North Kansas City Hospital; Barbara Wroblewski, Cooley Dickinson Hospital; Sharon Yearous, Mount Mercy College; Sunmoo Yoon, Columbia University; Mary Zasada, Saint Mary’s Hospital; and Kevin Zimmerman, Kaiser Permanente.

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Acknowledgements

34

For additional information, please contact:

Brian Gugerty, RN, DNS Gugerty Consulting, LLC brian_gugerty@hotmail.com

Connie Delaney, RN, PhD, FACMI, FAAN University of Minnesota delaney@umn.com

Pat Hinton Walker, PhD, RN, FAAN, PCC TIGER Initiative Phase III phintonwalker@comcast.net

TIGER Website www.thetigerinitiative.orgmailto:brian_gugerty@hotmail.commailto:delaney@umn.commailto:donna@tigersummit.comhttp://www.thetigerinitiative.org/