Technology in Education
Deborah L. Sopczyk
CHAPTER HIGHLIGHTS
Health Education in the Information Age
The Impact of Technology on the Teacher and the Learner
Strategies for Using Technology in Healthcare Education
The World Wide Web
Healthcare Consumer Education and the World Wide Web
Professional Education and the World Wide Web
Social Media
Webcasts and Webinars
Mobile Learning
The Internet
E-Mail
Electronic Discussion Groups
Mailing Lists
Other Forms of Online Discussion
Online Chats
Issues Related to the Use of Technology
Technology for Professional Development in Nursing
Workforce Training/Staff Development
Distance Education
State of the Evidence
KEY TERMS
Information Age
consumer informatics
World Wide Web
Internet
information literacy
social media
blogs
wiki
asynchronous
webcasts
webinars
mobile learning (m-learning)
digital divide
e-learning
distance learning
OBJECTIVES
After completing this chapter, the reader will be able to
Describe changes in education that have occurred as a result of Information Age technology.
Define the terms Information Age, consumer informatics, computer literacy, World Wide Web, Internet, information literacy, social media, digital divide, blog, e-learning, and distance learning.
Identify ways in which the resources of the Internet and World Wide Web could be incorporated into healthcare education.
Describe the role of the nurse educator in using technology in client, staff, and student education.
Recognize the issues related to the use of technology.
Discuss the effects that technology has had on professional education for nurses.
Life, as we know it today, was greatly influenced by technological advances of the last half century. The birth of the Internet and the World Wide Web, the development of information technology, the wide-scale production of computers, and the development of user-friendly software have all had an impact on every aspect of people’s lives. Some of the most dramatic changes have occurred in the field of education, where technology has transformed the way learners learn and the way teachers teach.
Today, learners and teachers alike have a world of information at their fingertips. Computers and the Internet have made it possible to get information from anyone, anywhere, anytime, with just a click of a mouse or a tap of the fingertip. In today’s world, virtually all children begin learning on computers when they are in nursery school and are as young as 3 years of age (National Center for Educational Statistics, 2006). As a result, children of today are often referred to as “digital natives,” as their lifelong exposure to digital technology has shaped the way they think and process information (Prensky, 2001). This is a very different beginning than that experienced by most adults who grew up in the 20th century.
Today, educational technologies, which were once viewed as rare and highly desirable resources, have become commonplace. Both on-site and distance learners now interact in a multidimensional learning environment. Like shiny new toys, educational technologies have captured the imagination of the world. At the same time, they have opened a new window for educators and learners alike.
This chapter explores the challenges and opportunities resulting from the use of technology as they pertain to health, health care, and professional nursing education. Technology in education has tremendous potential. Through wise use of technology, nurses can increase access, improve educational practices already in place, and create new strategies that transform teaching and learning experiences for both healthcare consumers and nursing professionals.
Of course, technology is not a magic solution that can be implemented without careful planning, monitoring, and evaluation. Even though technology has incredible power, users may find that it has given them results that they neither anticipated nor desired. To use these resources effectively, the nurse who adopts technology to enhance learning must not only have a basic understanding of the technology itself but must also be able to integrate the technology into an educational plan that is based on sound educational principles and addresses issues such as access, cost, support, equipment, process, and outcomes.
This chapter is designed as an introduction to the application of technology in education.
Because nurses provide both healthcare and professional education, it addresses technologybased resources and strategies appropriate for use with clients as well as with nurses and other healthcare professionals. Although it is not intended to give detailed instruction on the mechanics of computers and other types of hardware and software, the chapter presents a basic overview of the technology involved and its implications for the educator and the learner. Hence, this chapter focuses primarily on the Internet, the World Wide Web, and computer-based hardware and software applications that can be used to enhance learning with students in the classroom as well as with learners at a distance.
Because nurses provide both healthcare and professional education, it addresses technologybased resources and strategies appropriate for use with clients as well as with nurses and other healthcare professionals. Although it is not intended to give detailed instruction on the mechanics of computers and other types of hardware and software, the chapter presents a basic overview of the technology involved and its implications for the educator and the learner. Hence, this chapter focuses primarily on the Internet, the World Wide Web, and computer-based hardware and software applications that can be used to enhance learning with students in the classroom as well as with learners at a distance.
The Internet, the World Wide Web, and computer-based technologies are developing at a rapid pace that is accelerating with each new generation of discoveries and applications (Cetron & Davies, 2001). Because of this phenomenon, consumers are often advised that the computers they buy today are not likely to reflect the state-of-the-art technology of tomorrow. The same caution must be given to readers of books on technology. Given the pace of technology and the development cycle of a textbook, it is impossible to capture all that is new and cutting edge in the world of educational technologies in a text such as this one. Rather, this chapter is meant to serve as a starting point from which readers can begin to investigate the wide array of educational technologies and resources available. Ideally, it will stimulate readers to continue to search for new and exciting ways to integrate technology into their teaching and learning activities.
HEALTH EDUCATION IN THE INFORMATION AGE
The use of technology in education is a reflection of what is happening on a much larger scale in our communities. Hence, it is useful to think of educational technology within the broader context of the environment in which we live and work. We are in a period of history often referred to as the Information Age. The Information Age is characterized by a change in focus from industry to information. Beginning in the 1970s, improvements in information technology and the decreasing cost of computers suddenly made information more accessible, resulting in a dramatically different world (Finnis, 2003). Although this new access to information may seem insignificant, it has had an enormous impact on the global economy, culture, and our way of life. New and powerful industries have sprung up, and the world has very quickly become a much smaller place as it is now possible to access people and services from around the world in a blink of an eye and at very low cost.
The demand for technology and for information continues to grow. In the 21st century, adults and children have come to depend on pocket-sized telephones, media players, electronic readers, and other computer-driven devices. If you think about the many ways in which technology has changed the world we live in, it is clear that computers have become more than tools to make life easier—they have become part of the culture of most societies.
Computers have also become part of the culture of education—as common in the educational environment today as chalk and blackboards were in years past. Perhaps the most significant effect of computers on our society and on education is related to their capacity to assist in the collection, management, transportation, and transformation of information at high speed. As a result of this newfound ability to handle information, the world has experienced an “information explosion.” As a society, Americans have increased both their use and their production of information of all kinds.
People living in this information-driven society benefit from the availability of information but also are challenged to keep up with the vast amounts of information that are continually bombarding them from all directions. Information and knowledge have become valuable commodities, and the ability to gather and evaluate information efficiently and effectively has become a 21st-century life skill.
How has the Information Age changed health education? For the first time, health and healthcare messages can easily reach beyond local communities to a worldwide audience and provide interactive learning experiences that extend far beyond what was imaginable in the recent past. Consider the following points:
As a result of technological advances, the infrastructure now exists to link people around the world to one another, to nurses and other healthcare professionals, and to a vast array of Web-based information.
Vast numbers of people have access to and are using the Internet. Internetworldstats.com (2012), an international website that provides comprehensive and current information on Internet usage, reports that the North American continent is home to approximately 375 million people, of whom 275 million are Internet users and 185 million are Facebook subscribers. However, it is important to recognize that access does not ensure use: One in five Americans reports not using the Internet (Zickuhr& Smith, 2012).
Once a slow and tedious process, connecting to the Internet has become easier with the advent of high-speed data services. Broadband service is available to approximately 94% of Americans. The remaining 6% of Americans without such access tend to reside in rural or tribal areas of the country (Federal Communications Commission, 2012).
The use of Information Age technology has had such a dramatic influence on health education that a unique and rapidly expanding field of study, consumer informatics (also referred to as consumer health informatics) has emerged. The American Medical Informatics Association (AMIA), one of the principal professional organizations for people working in the field of informatics, has established a consumer informatics working group to advance the field through collaboration and dialogue. This group has developed a definition of consumer informatics, which states that it is a field “devoted to informatics from multiple consumer or patient views including patient focused informatics, health literacy, and consumer education” (American Medical Informatics Association, 2012). Researchers and other professionals in the field of consumer informatics are striving to find ways to use technology to strengthen the relationship between client and healthcare provider as well as to teach and empower clients dealing with issues related to health and wellness. Although much attention has been given to computer-based educational systems, consumer informatics is not restricted to computer-based programs. It includes the study of a wide range of media that can be employed to deliver health-related information.
The entire field of consumer informatics is growing rapidly. Many colleges offer courses of study in which healthcare professionals can gain knowledge and skills related to technology to meet the information needs of healthcare consumers. Informaticians and healthcare professionals are conducting research on the use of technology in healthcare education to generate knowledge that will guide future educational endeavors. A review of the literature reveals a growing body of knowledge in the field. Nurses and other healthcare professionals are using this knowledge to guide practice and improve the quality of the education they provide to their clients.
Sophisticated technology will continue to make health and healthcare information more accessible and more meaningful to both healthcare consumers and health professionals. Educators in all health disciplines are identifying creative ways to use emerging technology to enhance the teachinglearning process. Nevertheless, a number of issues remain to be resolved. One significant area of concern is the limited oversight and control over
the content that is posted on the Internet and World Wide Web, two of the major vehicles for delivering information to a global audience. The increased interactivity and user control inherent in the emerging World Wide Web (Web 2.0) suggests that issues such as authorship disclosure, quality of information, and privacy and confidentiality are likely to be of concern for some time (Adams, 2010).
the content that is posted on the Internet and World Wide Web, two of the major vehicles for delivering information to a global audience. The increased interactivity and user control inherent in the emerging World Wide Web (Web 2.0) suggests that issues such as authorship disclosure, quality of information, and privacy and confidentiality are likely to be of concern for some time (Adams, 2010).
When the World Wide Web was first introduced, users were primarily consumers of content developed by organizations and commercial enterprises. Current technology has changed this dynamic. Web 2.0 allows users to become authors of content, through a relatively simple and straightforward process. The increased use of blogs, wikis, and social network sites—many of which are devoted to health and health-related topics—testify to this ease of use (Miller & Pole, 2010). Of course, as a result of Web 2.0, the amount of health information created by individuals without healthcare education or expertise has also increased. Many people believe that the lack of censorship on the World Wide Web is a freedom of speech issue. Nurses and other healthcare professionals, however, are concerned that consumers are making serious healthcare decisions based on information on the Web that has not been reviewed for accuracy, currency, or bias. According to a Pew study (Fox, 2011), 75% of all adults who use the Internet—which translates into 59% of all Americans—have looked online for health-related information. Other studies have revealed that most people who retrieve health-related information from the Web sometimes, hardly ever, or never check the source or date of the information they are retrieving.
Healthcare education and informatics professionals are working together to develop codes to guide practice and safeguard healthcare consumers who use educational information and services delivered via the World Wide Web and the Internet. For example, the Medical Library Association and the Consumer and Patient Health Information Section (CAPHIS) have compiled a list of the top 100 health-related websites that meet criteria for quality in areas such as content, currency, and credibility (CAPHIS, 2010). The Internet Healthcare Coalition (http://www.ihealthcoalition.org), a not-for-profit group, was founded in 1997 for the purpose of identifying and promoting quality educational resources on the Internet. One of this organization’s most significant accomplishments was the establishment of the e-Health Code of Ethics, displayed in six languages on its website. The purpose of this code is to ensure confident and informed use of the health-related information found on the Web. The e-Health Code of Ethics is based on the principles of candor, honesty, quality, informed consent, privacy, professionalism, responsible partnering, and accountability, as described in more detail in Table 13-1.
TABLE 13-1 Guiding Principles of the e-Health Code of Ethics | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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THE IMPACT OF TECHNOLOGY ON THE TEACHER AND THE LEARNER
Information Age technology has had a significant influence on educators and learners for a number of reasons. Most importantly, access to information bridges the gap between teacher and learner. When information is widely available, it is no longer necessary for the teacher to “find, filter and deliver” content (Warger, 2006, p. 3). Therefore, the teacher is no longer the person who holds all of the answers or the individual who is solely responsible for imparting knowledge.
Educators in the Information Age are becoming facilitators of learning rather than providers of information and are striving to create collaborative atmospheres in their teaching and learning environments. As information becomes more and more accessible, the need for memorization becomes less important than the ability to think critically. Hence, educators in the Information Age are helping individuals learn how to refine a problem, to find the information they need, and to critically evaluate the information they find.
Healthcare education can and should follow a similar path. Nurses must structure their approach to healthcare education to be consistent with the needs of Information Age clients. The first step is to reconceptualize the role of the nurse
educator as someone who does more than impart knowledge. The nurse must be prepared to be a facilitator of learning by helping clients to access, evaluate, and use the wide range of information that is available. He or she must be also willing to encourage and support clients in their attempts to seek the knowledge they require.
educator as someone who does more than impart knowledge. The nurse must be prepared to be a facilitator of learning by helping clients to access, evaluate, and use the wide range of information that is available. He or she must be also willing to encourage and support clients in their attempts to seek the knowledge they require.
The nurse must also keep current with new technology-based tools so as to optimize each learning experience. Although initially slow to embrace technology (Secco et al., 2006; Wilbright et al., 2006), nurses have made great strides in advancing their computer skills in recent years. In a survey of nurse managers, Thomas, Ryan, and Hodson (2011) found that new nurses were given a rating of 3 (advanced beginner) on a scale of 4 for computer literacy skills. However, to ensure continued competency of nurses in this realm, nursing faculty must incorporate computer and information technology skills in all curricula, nurse managers must provide easy access to computers with Internet access in clinical facilities, and ongoing training and computer support must be made available.
The Information Age has been witness to some dramatic changes in the behavior of healthcare consumers, making the role changes for clients and nurses discussed earlier inevitable. Technology and the increased accessibility to information it offers have empowered and enlightened these consumers, encouraging them to form new partnerships with their healthcare providers (Fox, 2011; Kaplan & Brennan, 2001; Shaw et al., 2006). Even those clients who are reluctant to assume more responsibility for managing their own health care are moving in that direction as changes in the health delivery system have forced them to assume more active roles. As a result, healthcare consumers in the Information Age are eager to learn about and make use of the many information resources available to them.
Today’s consumers often enter the healthcare arena with information in hand. They are prepared to engage in a dialogue with their healthcare providers about their diagnoses and treatments. Surveys of the 113 million clients who have gone online to find health information show that the information they found caused them to make decisions about treatment of a condition and made them more confident in asking questions of their care provider (Fox, 2006, 2011).
Given this trend, nurses can no longer assume that the clients they see in a hospital or clinic will have little information other than what educators have given them or that they will not have explored the treatment options available to them. Furthermore, nurses cannot assume that clients will unquestioningly accept what is told to them. Research studies have shown that twice as many online health information seekers go to the Web after a doctor’s visit than before such an encounter (Rainie, 2003).
Whereas healthcare consumers of the past were often isolated from others with similar diagnoses and were dependent upon healthcare providers for information, today’s e-consumers and e-caregivers have the means to easily access networks of other patients and healthcare providers worldwide. Online support groups, blogs, and discussion groups where healthcare consumers can share experiences are readily available. Consumers who are being treated for health problems can readily find detailed information about their diagnoses, treatments, and prognoses from myriad sources.
In this dynamic environment, it is not surprising that the teaching needs of today’s healthcare consumers and the expectations they hold for those who will be teaching them are changing. The role of the nurse educator has not been diminished, but it has changed. Nurses must now be prepared not only to use technology in education but also to help clients access information, evaluate the information they find, and engage in discussions about the information that is available.
In addition to altering the educational needs and expectations of healthcare consumers, the
Information Age has made a tremendous impact on professional education. Technology has given rise to a dramatic increase in educational opportunities for nurses and other healthcare providers. Nurses seeking advanced degrees and credentials or continuing education credits can now study at colleges and universities offering distance education programs in a wide range of subject areas.
Information Age has made a tremendous impact on professional education. Technology has given rise to a dramatic increase in educational opportunities for nurses and other healthcare providers. Nurses seeking advanced degrees and credentials or continuing education credits can now study at colleges and universities offering distance education programs in a wide range of subject areas.
Computers have made it possible to provide anytime, anywhere access to job training and continuing education. Virtual reality and computer simulation can open up opportunities to learn hands-on skills and develop competencies in areas such as diagnostic reasoning and problem solving. Like consumers, health professionals in the Information Age can use the Internet and the World Wide Web as vehicles for sharing resources and for gaining access to the most current information in their fields of practice.
STRATEGIES FOR USING TECHNOLOGY IN HEALTHCARE EDUCATION
The World Wide Web
The technology-based educational resource that is familiar to most people is the World Wide Web. A report produced by the Pew Foundation revealed that almost 60% of all Americans have accessed the World Wide Web to obtain health-related information (Fox, 2011). Healthcare consumers can find websites ranging from those that present videos of surgical procedures to those where they can ask questions as well as receive information. The number of healthcare sites on the World Wide Web is difficult to capture with any accuracy, as new sites are being introduced on a daily basis. Nevertheless, there are clearly thousands of health-related websites available to consumers offering a wide range of information, products, and services.
It is clear that the World Wide Web is an exceptionally rich educational resource for both professional and consumer use. However, despite people’s familiarity with the Web, there is some confusion regarding terminology. Therefore, it may be helpful to clarify some commonly used terms.
The World Wide Web was first conceived by Tim Berners-Lee and Robert Cailliau, two scientists working at a laboratory in Switzerland (Livinginternet.com, 2007). From a technical perspective, it comprises a network of information servers around the world that are connected to the Internet. The servers that make up the World Wide Web support a special type of document called a webpage. Web documents or webpages are written using HTML (Hypertext Markup Language).
In simple terms, the World Wide Web is a virtual space for information. It is almost impossible to track its size because there are billions of webpages in existence, with several million new pages being added every month. These webpages cover a wide range of topics and display a variety of formats, including text, audio, graphic, and video.
Links on a webpage allow the user to easily move from one webpage to another with the click of a mouse. A user moves around the World Wide Web by way of a web browser, a special software program that locates and displays webpages. Netscape Navigator, Mozilla, Firefox, Safari, and Microsoft Internet Explorer are examples of web browsers.
Search engines and search directories are computer programs that allow the user to search the Web for particular subject areas. Search engines are robots that scour the Web for new websites, read them, and put text from them into a database they can access with queries. Search directories are hierarchical directories compiled by humans with references to websites; these directories are then accessed with a user query. Google is an example of a search engine, and Yahoo! is
an example of a search directory. The Web is so large that any single search engine or directory can cover only a small percentage of the webpages available (Pandia.com, 2006).
an example of a search directory. The Web is so large that any single search engine or directory can cover only a small percentage of the webpages available (Pandia.com, 2006).
A common misconception is that the World Wide Web and the Internet are two names that describe the same entity. In fact, the World Wide Web and the Internet are related but different. The Internet is a huge global network of computers established to allow the transfer of information from one computer to another. Unlike the World Wide Web, which was created to display information, the Internet was created to exchange information. That is not to imply that information cannot be exchanged on the Web. Although originally created to display information, the World Wide Web is evolving from the simple static information delivery system of its early days to a more interactive platform that provides varying degrees of user control and interaction. This evolving version of the Web is sometimes referred to as Web 2.0.
The World Wide Web resides on a small section of the Internet and would not exist without the Internet’s computer network. Conversely, the Internet could exist without the World Wide Web and, in fact, flourished for many years before the World Wide Web was ever conceived. Despite the immense size of both the Internet and the World Wide Web, the two are relative newcomers to the world of technology.
The Internet was originally commissioned in 1969 as a program of the Department of Defense. The first experimental version of the World Wide Web was released in the late 1980s. Since their inception, both the Internet and the World Wide Web have grown dramatically in size and functionality.
Nurses or healthcare consumers need to go no farther than their computers if they wish to learn how to use the Internet or the World Wide Web. Getting into the Internet or the World Wide Web requires a computer with a telecommunication link and software to connect to an Internet service provider (ISP). Once a person is connected, it is simple to find a wide range of websites devoted to teaching Internet or World Wide Web navigation skills. With a properly worded search term (e.g., “World Wide Web and tutorial”), a search engine will uncover a number of self-paced tutorials designed to teach novice or intermediate users the desired skills. Most search engines even provide guidance in creating commands that will elicit the information needed.
Knowledge of the World Wide Web is critical for nurses who work with and educate healthcare consumers. This is true for the following reasons:
Nurses can expect to see clients enter the healthcare arena, having already searched the Web for information. In fact, a Pew study found that many consumers go to the Web to seek information about a problem they are experiencing to help them decide whether it is necessary to see a healthcare provider (Rainie, 2003). Therefore, familiarity with the type of information found on the Web helps direct the assessment of clients prior to teaching to identify the needs of the learner and to determine whether follow-up is necessary.
The World Wide Web is a tremendous resource for both consumer and professional education. To use the Web effectively, nurses must possess information literacy skills and be prepared to teach these same skills to clients, including how to access the information on the Web and how to evaluate the information found.
The World Wide Web provides a powerful mechanism for nurses to offer healthcare education to a worldwide audience. An increasing number of health organizations are creating websites with pages dedicated to presenting healthcare information for consumers. Although nurses may not
be responsible for actually creating the HTML document that will be placed on the Web, they may work with the website designers to develop the information it contains, evaluate the accuracy of the information presented, and interact with healthcare consumers who access the site.
The World Wide Web is a vital tool for nurses. It is a mechanism for keeping up-to-date on professional and practice issues as well as a resource to be shared with clients. If it is to be used effectively, however, a plan to incorporate the World Wide Web into practice must be set in place.
Healthcare Consumer Education and the World Wide Web
A preteaching assessment of a client in the Information Age must begin with questions about computer use. Despite the widespread use of computers in our society, not everyone has access to a computer or has interest in using a computer. Although the percentage of people with computer access is increasing across the board, adults older than the age of 65, African Americans, individuals who have less than a high school education, and individuals living in a home without children remain less likely to be online than others (Fox & Madden, 2005; Horrigan, 2009). Therefore, it is important to determine whether a client has a computer in his or her home, has access to the Internet, is knowledgeable about using a computer, and has interest in using a computer to obtain information and resources regarding his or her health care.
If a client does not have a computer but has interest in using one to access resources on the Web, places where he or she may access a computer should be discussed. Libraries, senior centers, and community centers commonly have computers with Internet access for public use and typically offer instruction and assistance for new users.
Clients who use computers should be asked about their use of the Web. A Pew Foundation study revealed that Web users in the United States found information on the Web that did one of the following:
1. Influenced their decisions about how to treat an illness
2. Led them to ask questions
3. Led them to seek a second medical opinion
4. Affected their decision about whether to seek the assistance of a healthcare provider (Fox, 2006)
Because the Web can be so influential, it is imperative to determine that the information a client has found is accurate, complete, and fully understood. Only 15% of Web users report that they always check the source and date of the information found, and many report feeling overwhelmed, confused, or frightened by the complexity and amount of information presented (Fox, 2006).
These findings are not surprising. The World Wide Web contains information designed for both professional and consumer audiences. Healthcare consumers may not have the background necessary to comprehend professional literature and other types of information designed for healthcare professionals. When healthcare consumers do a search on a topic, they will access websites designed for them as well as for health professionals. Consumers should not be discouraged from accessing these sites, but nurse educators must help clients find information written for them at their level of readability and comprehension. Even websites specifically designed for consumers may be difficult for the general public to understand. For example, in a review of 25 websites on menopause, Charbonneau (2012) found that the average reading level was grade 10, significantly higher than the recommended 6th grade level.
The Web also contains information that may be biased, inaccurate, or misleading (Lewis, Gundwardena, & Saadawi, 2005). Many of the health-related websites are sponsored by commercial enterprises trying to sell a product. Others contain information posted by nonprofessionals and may be opinion rather than fact based. Because the Web has the potential to change so quickly, it is difficult to regulate. Even webpages sponsored by physicians, nurses, and university medical centers may contain errors or information that is misleading or difficult to decipher.
Clients may find that the Web has provided too much information, information they are not ready to handle, or information they do not fully understand. For example, a patient newly diagnosed with a serious illness may be overwhelmed with the detailed information found on the Web regarding the course of the disease, prognosis, and treatment. For nurses, then, it is important to ask clients if they are using the Web to find healthrelated information and to explore the types of information they have found.
Clients may or may not initially feel comfortable talking about information they have gathered. They may fear nurses will interpret their research as a lack of trust in the care they receive. Some may be embarrassed to talk about information they do not fully understand. Others may be anxious about how to bring up information that conflicts with what they have been told or how they are being treated.
For these reasons, it is important for nurses to establish early in their relationships with clients that they are interested in talking with them about the information they have gathered from the Web or other resources they have available to them. Clients need to feel that nurses are open to discussing whatever information they find. They need to understand that nurses are their partners in seeking the best information available.
For clients who are being treated for a condition over an extended period of time, it is also important to continue the conversation about their Web searches throughout their treatment. Simply asking “What interesting information have you found on the Web lately?” will keep the dialogue open and provide the nurse educator with the opportunity to respond to whatever questions or concerns clients may have.
It is advantageous to conduct a teaching session in a place where there is computer access. Having a computer available during a teaching session can accomplish several goals. First, it will provide the nurse educator with the opportunity to review Web-based information with the client. Not only can the nurse introduce websites that are relevant to the client’s needs, but he or she can also review some of the sites the client has been using. Nurse educators can then begin to determine the type and amount of information to which the client has been exposed, assess the client’s knowledge, and identify areas in which the client may have need for further teaching. Nurse educators may also find information that needs further discussion. For example, a client may have visited a website that provides distressing information about side effects of treatment, prognosis, or disease progression. Looking at the site together will enable the nurse and client to talk about what the client has discovered and do additional teaching if needed.
A second important advantage of reviewing websites with a client is that this activity provides a chance to teach clients information literacy skills. There are many definitions of information literacy. Most agree that individuals who are information literate have the following four competencies:
1. The ability to identify the information they need
2. The skills to access the information they need
3. Knowledge of how to evaluate the information they find
4. The ability to use the information they deem valid
In essence, if clients are to make effective use of the vast array of information on the Web, they must be able to identify the questions they need answered, find the information they are looking for, judge whether the information they find is trustworthy, and decide how they will use the information to meet their needs.
Information literacy is not synonymous with computer literacy. A client who is information literate knows how to find the information needed and can evaluate the information found for accuracy, currency, and bias. By comparison, a client who is computer literate has the technical skills and knowledge of computers necessary to use contemporary hardware and software and can adapt to new technologies that emerge (Williams, 2003).
Although healthcare consumers may not have the background knowledge to evaluate information to the same extent as a healthcare professional, they can be taught some simple steps to develop their information literacy skills and to help them begin to identify which websites are useful and which are problematic. These steps include the following:
1. Reduce a problem or topic to a searchable command that can be used with a search engine or search directory. If clients do not know how to narrow their topics or problems to a few words, they will be unable to find the information they desire or to broaden a search to find comprehensive coverage. Once the appropriate search command is identified, using a search engine or search directory is easy, especially if the help function available at most sites is used to solve problems.
2. Categorize webpages according to their purpose. A client should be taught to look for the person or organization responsible for the website and then place the website into a category reflective of its purpose. For example, the purpose of a site created by a drug manufacturer could be categorized as marketing, sales, or promotion. Other categories could include, but are not limited to, advocacy, promotion, informational/news, personal, or instructional/tutorial.
3. Identify sources of potential bias that may influence the content or the manner in which the content is presented. For example, an advocacy website is likely to present information that favors one side of a debate. A marketing or sales site will have a tendency to include information that is supportive of a particular product or service.
4. Make a judgment as to the likelihood that the information found on the webpage is accurate and reliable. Clients can be taught to look for the credentials of authors of reports or articles found on the Web. This information can help them determine whether supportive data are provided and look at more than one site to see if they can find similar claims or suggestions. Some of the more reliable health-related websites have links to other sites, such that the original site is not the sole source of information on a particular topic.
5. Make a decision as to the completeness or comprehensiveness of the information presented. Because clients may not have the background knowledge needed to quickly recognize when information is missing, they should be encouraged to look at more than one site when researching an area of interest. If educators know that clients are using the Web to investigate a particular topic, they can help them identify a list of things to look for in articles or webpages addressing the topic.
6. Determine the currency of the information on a webpage. Consumers need to know
the importance of looking for a creation or modification date or other signs that the information on a website is up-to-date.
the importance of looking for a creation or modification date or other signs that the information on a website is up-to-date.
7. Identify resources to answer questions or verify assumptions made about the content of a webpage. If questions arise, healthcare consumers should be encouraged to check out information with their healthcare provider. If the provider does not have the answers or cannot verify assumptions made, he or she can refer the client to other healthcare professionals.
Additionally, information literacy skills should include those behaviors one would expect of a responsible consumer. For example, consumers should know how and when to report information found on the Web that is potentially harmful to others (Lau, Gabarron, Fernandez-Luque, & Amoyones, 2012).
In years past, healthcare consumers were not encouraged to research health topics or to research options, but rather to rely on their healthcare providers for all of their health-related information. Providers, including nurses, feared that clients would not understand the information they found or that they would find information they would not be able to handle. Today, nurses have more confidence in consumers’ ability to manage their own health care.
More and more nurses are empowering their clients by teaching and encouraging them to take advantage of the resources at their disposal. To do so, nurses are using a variety of means to expose their clients to the resources on the Web. For example, computers are being placed in waiting rooms set to appropriate websites. Also, teaching materials on how to use the Web are being distributed and websites are being created for client use. Given concerns about the quality of information available on the Web, some professionals are working together to create trusted websites that provide information and resources for specific client populations (Lewis et al., 2005).
There are many reasons why teaching clients where to go on the Web to find information is good practice. Web-based information can be obtained quickly, the cost of Internet access in the home is minimal, and Web access is free in libraries and other community service organizations. Many healthcare consumers would benefit from having their questions answered quickly and inexpensively.
For example, families with young children are likely to have frequent questions related to childhood illnesses, growth and development, and behavior problems, but they may not have the time or money to make a visit to the pediatrician to have such questions answered. Senior citizens may have questions about the healthcare problems encountered with aging but may have difficulty getting to a healthcare provider because of transportation and financial issues. People with chronic illness may gain some sense of control over their lives when they are able to access information on the Web about their conditions. Healthy people may have many questions but few opportunities to talk with a health provider to get answers.
Even when healthcare consumers do have the opportunity to meet with a health provider, they often leave with unanswered questions. Sometimes they forget to ask, at times they are hesitant to ask, and in today’s healthcare delivery system they may not be given sufficient time to ask the many questions that arise when people are dealing with health issues.
In the role of educator, the nurse can teach clients who access the Web to use this resource more effectively and can be proactive in encouraging others to give it a try. It may be helpful to compile lists of websites appropriate to the needs of different client populations. Table 13-2 provides examples of the various types of websites that are available for consumer use. As illustrated in Table 13-2, a variety of types of websites exist, ranging from general sites covering a broad range of topics to sites with a specific focus or theme.
TABLE 13-2 Sample Websites for Healthcare Consumers | ||||||||||||||||||||||||||||
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In selecting websites to share with clients, it is important that the nurse review these sources carefully. In recent years, multiple rating scales have been developed to assist in the evaluation of such sites. Most scales include criteria that address the accuracy of the content, design, and aesthetics of the site; disclosure of the authors; sponsors of the site; currency of information; authority of the source; ease of use; and accessibility and availability of the site. Table 13-3 summarizes the questions that should be asked in evaluating a health-related website. Resource lists made up of quality sites will not only serve as references for clients but also provide examples of the types of sites they should be accessing.
TABLE 13-3 Criteria for Evaluating Health-Related Websites | |||||
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Finally, nurses can create their own websites to bring their healthcare messages to Web users around the world. Table 13-2 provides two examples of websites that exemplify the types of roles nurses can play to bring health information to various consumers via the World Wide Web.
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