Section 6: Education and Consumer Informatics: Education and Consumer Health Informatics

To report on recent efforts in the field of consumer health informatics (CHI) and education.

A review of the literature we selected on using search engines and Medline with terms from consumer health informatics and education. Twenty two articles match these criteria.

A great diversity of work spans the field of CHI. This relatively new field now faces challenges due to rapidly advancing technologies and the increasing empowerment of citizens connected over the worldwide web.

The benefits of enhancing CIH components within existing medical curricula are already being noted.. Additionally, updated recommendations on health and medical informatics should incorporate CHI.

Geissbuhler A, Haux R, Kulikowski C, editors. IMIA Yearbook of Medical Informatics 2007.

Measuring the User Acceptance of a Web-based Nursing Documentation System

Objectives: The development of an ICNP web-based nursing documentation system, and its evaluation for its usability, and its user acceptance.

Methods: A web-based nursing documentation system was designed and implemented by using the Greek translation of ICNP beta 2 version nursing terminology. The system integrates the steps of nursing process for providing and documenting nursing care, while ICNP terminology is used for the description of nursing concepts. The system was evaluated by nurses in a computer laboratory. We measured the user interaction satisfaction mainly by using questionnaires and scenarios.

Results: The nurses who evaluated the system possessed adequate basic computer skills; but low-to-moderate experience in clinical or hospital information systems; and insufficient experience with nursing vocabularies, and especially ICNP. Overall, they were satisfied enough with the system’s usability and usefulness, while the acceptance level increased as the level of their training in computers, nursing process and ICNP was also increased. The integration and use in the system of predefined, or standardized, nursing concepts and care plans seems to increase the acceptance of the documentation system and also the ICNP.

Conclusion: The subjective satisfaction and response of the users towards the system is specified. The described system was evaluated under “laboratory conditions” and revealed some of its strong and weak points and some of the factors that influenced its success and acceptance by its users.

Discussion of “Attitude of Physi -cians Towards Automatic Alerting in Computerized Physician Order Entry Systems”

With these comments on the paper “Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems”, written by Martin Jung and co authors, with Dr. Elske Ammenwerth as senior author [1], the journal wants to stimulate a broad discussion on computerized physi cian order entry systems. An international group of experts have been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.

The Effect of Interactive Multimedia on Preoperative Knowledge and Postoperative Recovery of Patients Undergoing Laparoscopic Cholecystectomy

Objectives: Aim of this study is the evaluation of the impact of a multimedia CD (MCD) on preoperative anxiety and postoperative recovery of patients undergoing elective laparoscopic cholecystectomy (LC).

Methods: Sixty consecutive candidates for elective LC were randomly assigned to four groups. Group A included 15 patients preoperatively informed regarding LC through the MCD presented by Registered Nurse (RN). Patients in group B(n = 15) were informed through a leaflet. Patients in group C(n = 15) were informed verbally from a RN. Finally, the control Group D included 15 patients informed conventionally bythe attending surgeon and anesthesiologist, as every other patient included in groups A, B, and C. Preoperative assessment of knowledge about LC was performed after each informative session through a questionnaire. Evaluation of preoperative anxiety was conducted using APAIS scale. Postoperative pain and nausea scores were measured using an NRS scale, 16 hours after the patient had returned to the ward.

Results: Statistical processing of the results (single linear regression) showed that patients in groups A, B, and C achieved a higher knowledge score, less preoperative anxiety score and less postoperative pain and nausea, compared to Group D. In multiple regression analysis, group A had a higher knowledge score compared to the four groups (p < 0.001 r2 = 0.41).

Conclusion: Informative sessions using MCD is an effective means of improving patient’s preoperative knowledge, especially in day-surgery cases, like LC.

The Impact of SOA for Achieving Healthcare Interoperability

Objectives: The evaluation of a service-oriented prototype implementation for healthcare interoperability.

Methods: A prototype framework was developed, aiming to exploit the use of service-oriented architecture (SOA) concepts for achieving healthcare interoperability and to move towards a virtual patient record (VPR) paradigm. The prototype implementation was evaluated for its hypothetical adoption. The evaluation strategy was based on the initial proposition of the DeLone and McLean model of information systems (IS) success [1], as modeled by Iivari [2]. A set of SOA and VPR characteristics were empirically encapsulated within the dimensions of IS success model, combined with measures from previous research works. The data gathered was analyzed using partial least squares (PLS).

Results: The results highlighted that system quality is a partial predictor of system use but not of user satisfaction. On the contrary, information quality proved to be a significant predictor of user satisfaction and partially a strong significant predictor of system use. Moreover, system use did not prove to be a significant predictor of individual impact whereas the bi-directional relation between use and user satisfaction did not confirm. Additionally, user satisfaction was found to be a strong significant predictor of individual impact. Finally, individual impact proved to be a strong significant predictor of organizational impact.

Conclusions: The empirical study attempted to obtain hypothetical, but still useful beliefs and perceptions regarding the SOA prototype implementation. The deduced observations can form the basis for further investigation regarding the adaptability of SOA implementations with VPR characteristics in the health-care domain.

IMIA Accreditation of Biomedical and Health Informatics Education: Current State and Future Directions

Objectives: The educational activities initiated by the International Medical Informatics Association (IMIA) have had global impacts and influenced national societies and local academic programs in the field of Biomedical and Health Informatics (BMHI). After the successful publication and dissemination of its educational recommendations, IMIA launched an accreditation procedure for educational programs in BMHI. The accreditation procedure was pilot tested by several BMHI academic programs in different countries and continents to obtain a global perspective. Methods: This paper presents an overview of IMIA quality assurance and accreditation procedures along with feedback on issues and problems which emerged during the pilot. Results: It appears that IMIA quality assurance and procedures worked quite well in different countries of Europe, the Middle East, South America, and Asia. These first experiences provided adequate information for adapting, modifying, and optimizing the procedures and finally for the planning of future activities. Conclusions: IMIA accreditation framework comprises a single set of standards that apply at various levels to both academic and professional BMHI programs. The pilot phase confirmed the robustness and generalizability of quality assurance standards and associated procedures on which IMIA accreditation is based at an international level.

Biomedical and Health Informatics Education - the IMIA Years

OBJECTIVE

This paper presents the development of medical informatics education during the years from the establishment of the International Medical Informatics Association (IMIA) until today.

METHOD

A search in the literature was performed using search engines and appropriate keywords as well as a manual selection of papers. The search covered English language papers and was limited to search on papers title and abstract only.

RESULTS

The aggregated papers were analyzed on the basis of the subject area, origin, time span, and curriculum development, and conclusions were drawn.

CONCLUSIONS

From the results, it is evident that IMIA has played a major role in comparing and integrating the Biomedical and Health Informatics educational efforts across the different levels of education and the regional distribution of educators and institutions. A large selection of references is presented facilitating future work on the field of education in biomedical and health informatics.

Discussion of "Attitude of physicians towards automatic alerting in computerized physician order entry systems"

With these comments on the paper "Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems", written by Martin Jung and co-authors, with Dr. Elske Ammenwerth as senior author [1], the journal wants to stimulate a broad discussion on computerized physician order entry systems. An international group of experts have been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.

Trustworthy reuse of health data: a transnational perspective

BACKGROUND

The widespread adoption of electronic health records (EHRs) is accelerating the collection of sensitive clinical data. The availability of these data raises privacy concerns, yet sharing the data is essential for public health, longitudinal patient care, and clinical research.

METHOD

Following previous work in the United States [1,2], the International Medical Informatics Association convened the 2012 European Summit on Trustworthy Reuse of Health Data. Over 100 delegates representing national governments, academia, patient groups, industry, and the European Commission participated. In all, 21 countries were represented. The agenda was designed to solicit a wide range of perspectives on trustworthy reuse of health data from the participants.

RESULTS AND CONCLUSIONS

Delegates agreed that the "government" should provide oversight, that the reuse should be "fully regulated," and that the patient should be "fully informed." One important reflection was that doing nothing will have negative implications across the European Union (EU). First, continued fragmented parallel non-standards-based developments in multiple sectors entail a substantial duplication of costs and human effort. Second, a failure to work jointly across the stakeholders on common policy frameworks will forego a crucial opportunity to boost key EU markets (pharmaceuticals, health technology and devices, and eHealth solutions) and counter global competition. Finally, and crucially, the lack of harmonized policy across EU nations for trustworthy reuse of health data risks patient safety. The productive dialog, initiated with multiple stakeholders from government, academia, and industry, will have to continue, in order to address the many remaining issues outlined in this white paper.

Biomedical informatics--a confluence of disciplines?

BACKGROUND

Biomedical informatics is a broad discipline that borrows many methods and techniques from other disciplines.

OBJECTIVE

To reflect a) on the character of biomedical informatics and to determine whether it is multi-disciplinary or inter-disciplinary; b) on the question whether biomedical informatics is more than the sum of its supporting disciplines and c) on the position of biomedical informatics with respect to related disciplines.

METHOD

Inviting an international group of experts in biomedical informatics and related disciplines on the occasion of the 50th anniversary of Methods of Information in Medicine to present their viewpoints.

RESULTS AND CONCLUSIONS

This paper contains the reflections of a number of the invited experts on the character of biomedical informatics. Most of the authors agree that biomedical informatics is an interdisciplinary field of study where researchers with different scientific backgrounds alone or in combination carry out research. Biomedical informatics is a very broad scientific field and still expanding, yet comprised of a constructive aspect (designing and building systems). One author expressed that the essence of biomedical informatics, as opposed to related disciplines, lies in the modelling of the biomedical content. Interdisciplinarity also has consequences for education. Maintaining rigid disciplinary structures does not allow for sufficient adaptability to capitalize on important trends nor to leverage the influences these trends may have on biomedical informatics. It is therefore important for students to become aware of research findings in related disciplines. In this respect, it was also noted that the fact that many scientific fields use different languages and that the research findings are stored in separate bibliographic databases makes it possible that potentially connected findings will never be linked, despite the fact that these findings were published. Bridges between the sciences are needed for the success of biomedical informatics.

Implementation and evaluation of the MSc course in health informatics in Greece

OBJECTIVES

Health informatics is a well established and important multi-disciplinary and inter-disciplinary field that not only involves informatics but also medicine, nursing, engineering, biology and other-related subjects. The program has been organized on the basis of an inter-university approach with the participation of five Greek universities. The paper aims at providing a current description of the academic program and a preliminary evaluation of the implementation phase.

METHODS

The paper presents a case study of a curriculum implementation from the phase of curriculum development to the phase of implementation and evaluation. Due to the interdisciplinary character of the course appropriate procedures were undertaken to ensure that mixed backgrounds can assimilate the broad spectrum of the teaching material taught. In the first stages of the implementation international students mainly from Europe attended the course. In addition, local graduates provided an extra dimension to the multi-layered difficulties and challenges of such a course implementation.

RESULTS

The students registered in the course were from different backgrounds and disciplines. They were mainly from health sciences and engineering schools. The interdisciplinary arrangement of the course facilitated the proper exchange of thoughts, skills, and knowledge among and between students and teachers.

CONCLUSIONS

The postgraduate course in health informatics at the University of Athens has now been running for more than fifteen consecutive years and is one of the first and longest standing courses in Europe. Continuous evaluation and adaptation is required to fit within the changing and evolving amazing field of biomedical and health informatics.

The development of an information system and installation of an Internet web database for the purposes of the occupational health and safety management system

This paper is based on the research on the possible structure of an information system for the purposes of occupational health and safety management. We initiated a questionnaire in order to find the possible interest on the part of potential users in the subject of occupational health and safety. The depiction of the potential interest is vital both for the software analysis cycle and development according to previous models. The evaluation of the results tends to create pilot applications among different enterprises. Documentation and process improvements ascertained quality of services, operational support, occupational health and safety advice are the basics of the above applications. Communication and codified information among intersted parts is the other target of the survey regarding health issues. Computer networks can offer such services. The network will consist of certain nodes responsible to inform executives on Occupational Health and Safety. A web database has been installed for inserting and searching documents. The submission of files to a server and the answers to questionnaires through the web help the experts to perform their activities. Based on the requirements of enterprises we have constructed a web file server. We submit files so that users can retrieve the files which they need. The access is limited to authorized users. Digital watermarks authenticate and protect digital objects.

Education and consumer health informatics

OBJECTIVES

To report on recent efforts in the field of consumer health informatics (CHI) and education.

METHODS

A review of the literature we selected on using search engines and Medline with terms from consumer health informatics and education. Twenty two articles match these criteria.

RESULTS

A great diversity of work spans the field of CHI. This relatively new field now faces challenges due to rapidly advancing technologies and the increasing empowerment of citizens connected over the worldwide web.

CONCLUSION

The benefits of enhancing CIH components within existing medical curricula are already being noted. Additionally, updated recommendations on health and medical informatics should incorporate CHI.

Implementation and Evaluation of the MSc Course in Health Informatics in Greece

Objectives: Health informatics is a well established and important multi-disciplinary and inter-disciplinary field that not only involves informatics but also medicine, nursing, engineering, biology and other-related subjects. The program has been organized on the basis of an inter-university approach with the participation of five Greek universities. The paper aims at providing a current description of the academic program and a preliminary evaluation of the implementation phase.

Methods: The paper presents a case study of a curriculum implementation from the phase of curriculum development to the phase of implementation and evaluation. Due to the interdisciplinary character of the course appropriate procedures were undertaken to ensure that mixed backgrounds can assimilate the broad spectrum of the teaching material taught. In the first stages of the implementation international students mainly from Europe attended the course. In addition, local graduates provided an extra dimension to the multi-layered difficulties and challenges of such a course implementation.

Results: The students registered in the course were from different backgrounds and disciplines. They were mainly from health sciences and engineering schools. The interdisciplinary arrangement of the course facilitated the proper exchange of thoughts, skills, and knowledge among and between students and teachers.

Conclusions: The postgraduate course in health informatics at the University of Athens has now been running for more than fifteen consecutive years and is one of the first and longest standing courses in Europe. Continuous evaluation and adaptation is required to fit within the changing and evolving amazing field of biomedical and health informatics.

A site of communication among enterprises for supporting occupational health and safety management system

The occupational health and safety management constitutes a field of increasing interest. Institutions in cooperation with enterprises make synchronized efforts to initiate quality management systems to this field. Computer networks can offer such services via TCP/IP which is a reliable protocol for workflow management between enterprises and institutions. A design of such network is based on several factors in order to achieve defined criteria and connectivity with other networks. The network will be consisted of certain nodes responsible to inform executive persons on Occupational Health and Safety. A web database has been planned for inserting and searching documents, for answering and processing questionnaires. The submission of files to a server and the answers to questionnaires through the web help the experts to make corrections and improvements on their activities. Based on the requirements of enterprises we have constructed a web file server. We submit files in purpose users could retrieve the files which need. The access is limited to authorized users and digital watermarks authenticate and protect digital objects. The Health and Safety Management System follows ISO 18001. The implementation of it, through the web site is an aim. The all application is developed and implemented on a pilot basis for the health services sector. It is all ready installed within a hospital, supporting health and safety management among different departments of the hospital and allowing communication through WEB with other hospitals.

Measuring the user acceptance of a Web-based nursing documentation system

OBJECTIVES

The development of an ICNP web-based nursing documentation system, and its evaluation for its usability, and its user acceptance.

METHODS

A web-based nursing documentation system was designed and implemented by using the Greek translation of ICNP beta 2 version nursing terminology. The system integrates the steps of nursing process for providing and documenting nursing care, while ICNP terminology is used for the description of nursing concepts. The system was evaluated by nurses in a computer laboratory. We measured the user interaction satisfaction mainly by using questionnaires and scenarios.

RESULTS

The nurses who evaluated the system possessed adequate basic computer skills; but low-to-moderate experience in clinical or hospital information systems; and insufficient experience with nursing vocabularies, and especially ICNP. Overall, they were satisfied enough with the system's usability and usefulness, while the acceptance level increased as the level of their training in computers, nursing process and ICNP was also increased. The integration and use in the system of predefined, or standardized, nursing concepts and care plans seems to increase the acceptance of the documentation system and also the ICNP.

CONCLUSION

The subjective satisfaction and response of the users towards the system is specified. The described system was evaluated under "laboratory conditions" and revealed some of its strong and weak points and some of the factors that influenced its success and acceptance by its users.

Future trends in Health Informatics--theoretical and practical

The Health Informatics field is becoming more challenging as the globalization of economy, the advancement of the technology as well as innovative breakthroughs are being incorporated in the discipline. In Europe as well as in other countries the funding into the research areas of this field is increasing. In this chapter, a brief overview of the field as well the trends of Health Informatics are discussed with respect to the new dimensions that the education of the health care professionals has to tackle in the foreseeable future.

Comparative educational systems

During recent years Europe has been engaged in an educational reform that tends to change the whole educational system concerning higher education. The main issues of this reform are related to the free movement of labour and students across the member states. Hence, the need of comparative educational systems, levels, and degrees. The European Union and its executive bodies the European Council and European Commission have issued a series of declarations that are amalgamated in this chapter. The ideas behind these declarations formulate the framework of comparative educational systems that can have a significant impact on the global health informatics education.

Development and evaluation of a nursing service management and administration information system at district hospital

The rapid development of information technology and the multiple usage of Information Systems make indisputable their appliance in all the sectors including the Nursing Service area. Information Systems that have been developed for the Nursing Service Administration are extremely useful in the processing and the categorisation of a large number of information, providing significant advantages such as information storage, information availability, information precision and reliability. In addition, the appliance of Information Systems provides important advantages in the administration of the nursing personnel's data, contributing to the improvement of the operating effectiveness of the Nursing Service. This paper describes the development and the evaluation of an Information System for the Nursing Service Administration that classifies all the information related to the nursing personnel and helps the administration to handle the appropriate nursing data. The method of Life Cycle Model was decided as the most appropriate for the development of the System, because of the important advantages that it offers. For the evaluation of our own designed system we based on the standards, which are used for evaluating Information Systems in general. The evaluation of this Information System is carried out by a survey among the undergraduate and the postgraduate students of the Nursing Department of the University of Athens and the Nursing Personnel of a number of Hospitals. Useful conclusions have been derived concerning those characteristics, which should be fulfilled by the system. Important conclusions have been also drown out concerning the dependencies of the variables under study, the future readjustments of the system, and the general perception of the newcomers in health profession towards the application of the information technology.

Inter-university cooperation for establishing an M.Sc. course in health informatics aims at contributing to users' acceptance of health telematics applications

Health informatics is a recently established and important multi-disciplinary and inter-disciplinary field that not only involves informatics but also medicine, nursing, engineering, biology and other-related subjects. A coordination of this field at a postgraduate level becomes important now in Europe where other European Community programs such as the Telematics for Health Care will require at the Fourth Framework Programme (1994-1999) and the Fifth Framework Programme (2000-2006) adequate human resources of higher potential and knowledge. A European M.Sc. course met all the above objectives. The curriculum was developed according to previous experiences in similar programmes. Recently the course has been organised on the basis of an Inter-University nature with the participation of 5 Greek Universities. The paper aims at providing a description of the new academic programme and a brief evaluation of the implementation phase.

Simulation model for educating the general public for the AIDS epidemic

In the Health field, there is an increasing need to give the Health professional the opportunity to experiment on real situations without necessarily having to be in contact with the patient. In order for this to be achieved, there must be a virtual reality representation via a safe and user friendly system, such as a computer. This means that by using Simulation and modelling techniques new models have to be constructed which will portray the reality. The scope of this paper is to present a Simulation Model and Practical for Educating the General Public for the AIDS Epidemic. The model and the practical were developed by using the tools and applications created under the COAST project.

A prototype design of cardiological computerized nursing care plans for an electronic patient care record

The purpose of this paper is to describe the design and the process of Cardiological Nursing Care Plans proposed to be used within an electronic patient record that can fulfill both nursing science and experience. The project is focused on the development of a clinical database capable of analysis to link control of nursing process with clinical outcome.

GALEN-IN-USE: application in Greek and influences on education

GALEN-IN-USE is a European project that aims to promote greater European harmonization and to overcome the problems encountered in using traditional coding and classification systems. This paper presents the work done by the Greek Centre of Medical Informatics and Terminology, as a collaborating centre of GALEN-IN-USE(GIU), in order to apply GIU's tools to Greek Health Care System as well as the affect of this application in education.

Security of electronic patient record and education

The evolution of the paper-based to Computer-based Patient Records (CPR) or Electronic Patient Records (EPR) changes the way in which we have to perceive and deal with privacy and security issues. The education and awareness of the users and public of the selfsame issues hold a very important role. A survey was conducted by the Laboratory of Health Informatics of the University of Athens concerning the awareness of future health care professionals. The results are discussed further down and an attempt to define profiles of training courses on security is made.

M.Sc. course in health informatics--an inter-university cooperation success story in Greece

Health informatics is a recently established and important multi-disciplinary and inter-disciplinary field that not only involves informatics but also medicine, nursing, engineering, biology and other-related subjects. A co-ordination of this field at a postgraduate level becomes important now in Europe where other European Community programs such as the Telematics for Health Care will require at the Fourth Framework Programme (1994-1999) and the Fifth Framework Programme (2000-2006) adequate human resources of higher potential and knowledge. A European M.Sc. course met all the above objectives. The curriculum was developed according to previous experiences in similar programmes. Recently the course has been organised on the basis of an Inter-University nature with the participation of 5 Greek Universities. The paper aims at providing a description of the new academic programme and a brief evaluation of the implementation phase.

A search engine for virtual patient records

Virtual patient records provide a means for integrated access to patient information that may be scattered around different healthcare settings. Within the boundaries of a health district providing all levels of care, this concept can be implemented in an Intranet environment to support longitudinal patient care activities across the participating healthcare providers. Since medical information is stored on multiple Intranet sites in various forms (e.g. codified data, transcribed documents, and images), a suite of appropriate tools is needed to enable access to such information in combined form. In most cases, however, access to medical information should be restricted to authorized users. To serve this purpose, a prototype search engine incorporating an authorization and access control functionality has been developed and presented in this paper. The system is based on the signature file access method and an experimental implementation written in JAVA is also described.

Curriculum development and courseware implementation using World Wide Web technology

The curriculum development of medical informatics related courses and their adoption into the faculty curriculum is one of the main tasks of the present day educators. To this end the Internet technology has supported this task. The Internet was born in December of 1969 and has grown phenomenally since. Its graphically interactive, user-friendly modality, the World Wide Web (WWW), is younger and growing even more explosively. By its nature, the WWW is a tool ideally and uniquely suited for the advancement education. This paper describes the design, development and the implementation of a Web Site for supporting the education of the students in the Faculty of Nursing at the University of Athens. The application will be used also in the European project Nightingale.

Health and nursing informatics education

In Europe, coordinated activities in healthcare informatics education started in the late 1980's with the establishment of European Courses in Health Telematics. At the same time the European Commission foresaw the need for spreading the knowledge of IT in the Healthcare Sector. Therefore the EC, since then, have supported the initiatives that aim to create awareness, stimulate diffusion, educate and train the users (healthcare professionals) in the application of Information Technology to the Healthcare Sector. Such initiatives are the NIGHTINGALE project, which is an essential project in the planning and implementation of strategy in training the Nursing profession in using and applying healthcare information systems, the IT EDUCTRA project, which is a very practical project in the field of the education and training of the Healthcare Professionals in Information Technologies, and the ERASMUS Master's Course, which is aiming at giving those working, or intending to work in the health service and related activities a broad, advanced postgraduate education in Health Informatics.

Nursing manpower development and strategic planning in Greece

PURPOSE

A national study to register all working nursing personnel and nursing students; to estimate the nursing needs of the Greek population beyond the year 2000; to design a nursing resource master plan for the nursing needs of Greece.

DESIGN

First, a questionnaire was distributed to register all nursing personnel. Second, required personnel were estimated according to the population of each of the country's regions. Third, a master plan for developing nursing personnel to the year 2010 was developed.

RESULTS

The number of nursing personnel was found to be 35,715 which included 11,497 RNs and health visitors, 22,318 assistant nurses, 1,900 midwives. The number of students was 9,252. The majority of nursing personnel work in areas with the highest population. The need for nursing personnel was estimated to be 62,000: 36,300 RNs, 21,700 assistant nurses and 4,000 midwives.

CONCLUSIONS

There is a serious shortage of RNs in the Greek health services resulting in a downgrading of nursing care quality.

The construction of a simulation-based system for the development of powerful and realistic models and practicals for healthcare professionals

The aim of this paper is to examine the importance of computer-based simulation by the demonstration and study of complex systems and the presentation of essential tools and applications that can help health professionals deliver good quality practicals, which is now impeded by cost and/or technical constrains. The tools that have been developed in the framework of the Courseware Authoring for Scientific Training (COAST) project are the "modeler environment," which is used to describe the different tools and mathematical functions available for building models, and the "simulation author environment," which is used for building simulation sequences and providing the required tools and functions. This effort provides scientists with new technological and cost-effective means, specifically based on multimedia simulation, for preparing educational material, so as to gradually replace laboratory practicals that are gradually becoming more expensive, and improves student's understanding of complex systems.

Health Informatics Education and Research at the University of Athens

In Europe, coordinated activities in healthcare informatics education started in the late 1980s with the establishment of European courses in health telematics. At the same time the European Commission foresaw the need for spreading the knowledge of Information Technology (IT) in the healthcare sector. Therefore the EC, since then, has supported the initiatives that aim to create awareness, stimulate diffusion, and educate and train the users (healthcare professionals) in the application of IT in health care [I] Initiatives, such as the NIGHTINGALE project, are essential for the planning and implementation of strategies for training the nursing profession in using and applying healthcare information systems. Other projects are the IT EDUCTRA project, which is a practical project in the field of education and training of healthcare professionals in information technologies, and the ERASMUS Master’s Course, which aims at giving those working (or intending to work) in the health service and related activities, a broad advanced postgraduate education in health informatics.

Developing curriculum in nursing informatics in Europe

The NIGHTINGALE Project (NIGHTINGALE Project: HC1109 DGXIII Contract and Technical Annex, European Commission, December 1995) which started on the 1st of January, 1996, after the approval of the European Commission, has a 36 month duration. It is essential in planning and implementing a strategy in training the nursing profession in using and applying healthcare information systems. NIGHTINGALE contributes towards the appropriate use of the developed telematics infrastructure across Europe by educating and training nurses in a harmonious way across Europe in the upcoming field of nursing informatics. NIGHTINGALE develops courseware material based on the curriculum development process using multimedia technologies. Computer based training software packages in nursing informatics will be the basis of the training material and the corresponding courses. CD-ROM based training and reference material will also be provided in the courses whereas the traditional booklets, teaching material and textbooks can also play an adequate role in training. NIGHTINGALE will disseminate all information and courseware material freely to all interested parties through the publications of the proceedings of the conferences, through the establishment of the world wide web (WWW) server in nursing informatics for Europe (http://www.dn.uoa.gr/nightingale), which will become a depository of nursing information knowledge across Europe as well as a dissemination node of nursing informatics throughout the European members states for the benefit and welfare of the European citizen.

Assessing the progress of the M.Sc. course in health informatics under the ERASMUS programme

Health informatics is an emerging and important multi-disciplinary field that involves, informatics but also medicine, nursing, engineering, biology and other-related subjects. A co-ordination of this field at a postgraduate level becomes important now in Europe where other European Community programs such as the 'Telematics for Health Care' will require at the Fourth Framework Programme (94-99) adequate human resources of higher potential and knowledge. This European M.Sc. course meets all the above objectives. The Curriculum was developed according to the results of the ERASMUS Workshop, which was held in Athens on 13-15 September 1990 under the ERASMUS Contract number ICP-90-G-0009/12. The implementation now runs under the contract ICP-95-G-1038/12. The 6-year evaluation of the course based both on staff and student evaluation proved that the M.Sc. course in health informatics has been successful.

Health Informatics Education and Research at the University of Athens

In Europe, coordinated activities in healthcare informatics education started in the late 1980s with the establishment of European courses in health telematics. At the same time the European Commission foresaw the need for spreading the knowledge of Information Technology (IT) in the healthcare sector. Therefore the EC, since then, has supported the initiatives that aim to create awareness, stimulate diffusion, and educated and train the users (healthcare professionals) in the application of IT in health care [I]. Initiatives, such as the NIGHTINGALE project, are essential for the planning and implementation of strategies for training the nursing profession in using and applying healthcare information systems. Other projects are the IT EDUCTRA project, which is a practical project in the field of education and training of healthcare professionals in information technologies, and the ERASMUS Master's Course, which aims at giving those working (or intending to work) in the health service and related activities, a broad, advanced postgraduate education in health informatics.

Hyperlinked Lexicon in Nursing Informatics--a tool for navigating through Nursing Informatics Terminology

The Evolution of Information Technology is rapid. Electronic circuits substitute mental activities and new Technology invades to all aspects of life. Nursing, which is like all the other Health related professions information-intensive, could use the new Technology to be facilitated. The implementation of Informatics to Nursing was supported by the growing information that Nursing has to manage. The definition of Nursing Informatics was put on 1980 and since then a lot attempts to define Nursing Informatics have followed. The applications of Nursing Informatics are focused on four fields of Nursing: Administration of Nursing, Clinical Practice, Education, and Research. The first applications of Nursing Informatics made visible the need for the development of a Unified Language System. The efforts, today, are focused on two fields: to establish a standard definition of the terms of or related to Nursing Informatics, to establish standard definitions and Classification Schemes for the Nursing Phenomena and Practice so that they can be processed by Nursing Informatics. In solving these problems important role plays the study of Linguistics. Another important factor that should be taken into account is the Development of International Standards of general acceptance that enhances communication aspects. Apart from the International Standardisation Organisations, other non-profit organisations have constituted Special Groups that are dealing with the promotion of Nursing Informatics. Final Nursing Informatics should follow the previous attempts of Nursing to establish a Unified Language System. All the steps of the development of the application are described. In particular subjects that are covered are: the scope of the application, the collection of the material, the designing and building up of the Database, the development of a User Interface and the characteristics of the Application.

Building nursing informatics courses on the Web

The Information Technology is rapidly being integrated into Educational Institutions and Health Care Environments. Although the use of computer for education and training is not new to the academic society, further prospects are available through the use of emerging technologies as the Multimedia and the World Wide Web. In today's rapidly changing healthcare environment, the need for high quality, cost effective education for employees, consumers, and students is gaining increased attention. The development of customised computer-based training programs has long been beyond the capabilities or financial resources of most healthcare organisations; however, with recent advancements in technology, this situation is rapidly changing. The Nurses represent the greater part of the Health Care Professionals thus the education of this group is of outmost importance for the health-care environments. The World Wide Web can be used as an educational tool in order to have better-educated Nurses not only by supporting the Academic institutions but also by providing Distance Learning Education covering new aspects of the Nursing Science. The purpose of this paper is to increase the understanding of the ways in which the emerging technologies of Multimedia and the World Wide Web can enhance the learning process, and also provide education at a distance.

NIGHTINGALE--a new perspective in nursing informatics education in Europe

The NIGHTINGALE project, which is an EU financed project, is considered as essential in planning and implementation of strategy in training the nursing profession in using and applying healthcare information systems. Therefore, NIGHTINGALE gives a new perspective in Nursing Informatics Education in Europe. In 1997 some major goals of the NIGHTINGALE project were accomplished. These achievements are described in this document.

The WISECARE Project and the impact of information technology on nursing knowledge

The European Union retained the WISECARE project "Work flow Information Systems for European nursing CARE" for funding. The project focuses on the use of telematics technology for clinical and resource management in oncology care in hospitals. This paper outlines the impact of introducing this kind of advanced nursing informatics application on the management of nursing knowledge. Three shift in knowledge management that will get high attention in WISECARE, are identified. The first is the shift from knowledge dissemination to knowledge sharing. The second is the shift from individual knowledge to organisational knowledge. The third is the shift from deductive, prescriptive knowledge as seen in guidelines, protocols to more inductive, experience based knowledge. The paper emphasizes that the real impact of information technology is not in the automation of existing processes but on the discovery of new ways of organisation and living.

Using World Wide Web technology for educating students in the health care sector

The Internet was born in December of 1969 and has grown phenomenally since. Its graphically interactive, user-friendly modality, the World Wide Web (WWW), is younger and growing even more explosively. By its nature, the WWW is a tool ideally and uniquely suited for the advancement education. This paper describes the design, development and the implementation of a Web Site for supporting the education of the students in the Faculty of Nursing at the University of Athens.

The intensive care units in greater Athens: needs and resources

The purpose of this study was to investigate the availability of intensive care unit (ICU) beds and the number of requests, the number and categories of nursing staff, the nursing care required, and the time spent in various nursing activities.

METHODS

19 district general hospitals were studied. The characteristics of the units and their nursing personnel were recorded. The availability of ICU beds, the frequency of bed requests, and the way of patient admission in the ICUs were studied retrospectively for 1 year and prospectively for 2 weeks. The staffing level of direct care for 36 patients was studied to determine the time required for direct nursing care.

RESULTS

the distribution of intensive care beds was: GICU 108, CICU 114, PSICU 30. During 1991, 12363 patients were admitted and 12172 of them were discharged; 3 628 patients stayed less than 2 days while the average length of stay was 12.5 days. In 1992, during the 2-week period, there were 303 requests for an admission to ICUs and of these 150 requests could not be met because of lack of ICU beds. The mean staffing level was 2.3 nurses per bed (to cover the three shifts). The mean nursing time required for direct nursing care of each patient per shift was found to be 6 hours for GICU patients, 5.3 for CICU, and 6.0 for PSICU patients.

Allocation of nursing time

The purpose of this study was to examine the allocation of nursing time to various activities of registered and assistant nurses during the day shift. Twenty-three registered (RN) and eighteen assistant nurses (AN) working in medical and surgical wards of five large hospitals were studied. The findings have shown that the most frequent activities performed were; indirect care representing 35.6% of the time, direct care representing 23.8% of the time, personal activities representing 16.8% of the time, and direct nursing interventions representing 8.2% of the time. Cross-tabulation revealed that RNs provided direct care less frequently and indirect care more frequently than ANs (25.3 activities per RN and 27.5 per AN, 62.1 activities per RN and 32.6 per AN, respectively). Many indirect care activities were found to be the responsibility of the head nurse (64), secretary (465), and others (104). Less expected results were the minimal amounts of time spent on both education and research activities (1.3% and 0.0% respectively). Nurse managers have to free nurses from subsidiary work and to find mechanisms to distribute nursing valuable time more efficiently.

Formulation and testing of a nursing assessment form for mental patients as a basis for individualized nursing care

The study described here was designed to develop and test a form of nursing assessment of mental patients for use as a basis for individualized holistic nursing care in any setting. Nursing assessment was made of 581 mental patients receiving care in either mental hospitals, psychiatric departments of general hospitals or in mental health centres. Subjects were observed, interviewed and asked to complete a structured assessment form. Major variables studied were physical nursing problems/needs with nine categories, psychosocial nursing problems/needs with nine categories, sex, age, and physical and psychiatric disorders. Data were analysed with frequency distribution and comparative techniques, correlational procedures, and the multiple linear regression statistical procedure. The frequency distribution of psychiatric diagnoses showed that schizophrenic disorders were the most frequent in the total sample. However, there were more depressive patients in the general hospital group. Physical nursing problems/needs were significantly related with psychosocial nursing problems/needs, affective-depressive disorders, sex and age as well as negatively related with psychotic and anxiety disorders. Psychosocial nursing problems/needs were significantly related with schizophrenic and psychotic disorders, physical disorders and with the younger age groups. It was concluded that the psychiatric nursing assessment should encompass the areas of personal characteristics, and physical and psychological problems of the patient, and thus lead to practicing psychiatric nursing, that is, holistic psychosomatic nursing.

Nursing absenteeism--one determining factor for the staffing plan

The purpose of the present study was to quantify factors which contribute to the absenteeism of nursing personnel and affect staffing patterns. Absenteeism in a general hospital was studied for the period 1975-1990 in relation to the number and level of nursing personnel, the number of discharged patients in the same period, and the existing relevant policy. The variables were analyzed by the multiple regression method having an initial estimator the existing situation in 1990 and what is expected for the year 2000. The results showed that the mean value days of absenteeism for each registered and assistant nurse in 1975 was 22.4 days and in 1990, 51.9 days, sickness raised from 12.6 days in 1975 to 16.6 in 1990, maternity from 9.1 in 1975 to 25.3 in 1990, educational leave for registered nurses was 0.02 in 1975 and 3.8 in 1990 and for assistants 2.1 in 1985 and 17.3 in 1990 due to the new policy, and social fringe benefits raised from 0.71 days in 1975 to 3.65 in 1990. The expected rate of absenteeism by the year 2000 will be 67 to 83 days per person, an increase by 56% in relation to 1990 data.

Risk factors responsible for patients' falls

The study determined intrinsic factors which contributed to the falls of adults hospitalized in a general hospital during 1987-88. Two hundred and fourteen patients were studied in two groups. Group A consisted of 108 patients who fell during their hospitalization and control Group B consisted of 106 patients with the same characteristics also hospitalized during the same period who did not fall. Of the 23 variables which have been analyzed by the multivariate logistic regression method, seven present statistically significant incidence and increased risk of patients' falls: (1) gender: the number of accidents occurring among male patients was higher than that among females (p = 0.0022); (2) age: the majority of accidents occurred in the 65 greater than or equal to years old age group (p = 0.00426); (3) general pathological conditions: mostly patients with cardiac problems (p = 0.0062); (4) neoplasms (p = 0.0334); (5) anaemias (p = 0.0128); (6) post-operative conditions (p = 0.0063); and the taking of hypnotic/tranquilizer drugs (p = 0.0486). Other significant findings were: the highest incidence of falls occurred during the first 4 days of the patients' admission to hospital and most during the early morning hours (5-6 am). Injuries incurred were bruises (32.4%), minor injuries (24%), major injuries (16.7%) and fractures (10.2%). The high correlation between patients' falls and (1) specific diseases, namely neoplasms, anaemias, cardiac and post-operative conditions and (2) the taking of hypnotic/tranquilizer drugs are risk factors in relation to patients' falls in general hospitals.

Psychosomatic nursing assessment of psychiatric patients

This article presents the results of a research study on 547 mental patients testing a form of nursing assessment of mental patients in psychiatric and in general hospitals, as a means to assess their nursing needs and as a basis for planning, implementation and evaluation of their personalized holistic nursing care. The study showed that more depressive than schizophrenic patients went to the general hospital for help. The reverse was observed in the psychiatric hospital. The psychological nursing needs of the patients were significantly correlated with their somatic nursing needs. The psychological as well as the somatic nursing needs of the patients were significantly correlated with sex, age, somatic health state and mental health state in general, and not with their concrete psychiatric diagnosis. It is concluded that the psychiatric nursing assessment should be oriented towards the investigation of the patient's psychosomatic nursing needs rather than be based on his medical diagnosis.