Purpose of the Blog

The purpose of this blog is to fulfill the requirements of LIS 6260: Information Science in Librarianship. During the course, students are required to expand their knowledge on topics in information science and demonstrate communication of our ideas.

Final Post

In starting with the topic of evidence-based practice in nursing and healthcare, it was necessary to explain the need for information dissemination to healthcare professionals and why problems exist in their obtaining information. Patient care has become more complex and individuals accessing care demand the best care. With time constraints and limited knowledge in finding information of some health professionals, library and information science professionals need to continue find the best way to push information to health professionals.

Additionally during the development of this blog, a few observations were made that can be applied broadly. One observation is that information is dynamic and this is especially true in healthcare. In reflecting on the dynamic nature of information, libraries need to stay on abreast of the health care information and technology in order to provide the best methods of dissemination. RSS feeds, wikis, and podcasts are some of the newer technologies to push information to the reader. Blogs weren't specifically discussed but it is another means to disseminate as well as provide an arena for discourse on topics of interest.

Libraries have changed from a product orientation to a service orientation in their methods to assist the users. This change is from the focus on the user behavior. User behavior patterns have to be identified in order to provide the best service in providing information wherever and whenever it is wanted. In closing this is important to health professionals who have limited time demands when providing care and the increasing demands from health care consumers to have the current and best treatment available.

Theories and Models on Dissemination

Unsure why but in doing an extensive search on dissemination in the library literature, difficulty was encountered in finding specific, current theories and models on the topic of dissemination. If models and theories are considered to be the basic premise for knowledge development in science, then this area may be open for future development. Any literature found came from computer and information management science that went into technical detail.

Implications of Dissemination from Physician Habits

In surveys from 30,000 scientists and social scientists on using journals and journal articles between 2003-2006 in U.S. and Australia, Tenopir (2006) discussed how librarians need to be user centric in their focus when providing services to their patrons. Two facts caught my attention.

In a comparison to astronomers and academic faculty, 80% of physicians were more likely to read current journals than journals that were two years old.

Also for pediatricians in the preference for readings by source, preferred browsing (70%) to online searching (<10%), cited in other publications (<5%), colleague (<10%), and other sources (<5%).

The point of the article by this 2006 Miles Conrad Award Lecturer (given by the National Federation of Abstracting Services) was to inform on journal reading patterns. Advise that the author gives was to know your user behavior and work habits. The users also wanted convenience on their terms - any adoption of using a new tool that helps increase productivity but is needs to be intuitive for adoption. Also skimming and scanning appeared to be how reading was done.

Tenopir, C. (2006). Building bridges to information products and services. Information Services & Use, 26, 213-221.

Events Leading to Current Dissemination of Medical Information

When I was growing up, I had one way of accessing and receiving information - walking to the public library about a half mile away. Times have changed.

Starting with the 1960s, many developments through innovative thinkers led to the explosion of biomedical research and information. Computers, automated information systems, and the Internet provided the means to expand the dissemination of medical information. None of these accomplishments would have been possible without laws and grants to research institutions to develop the communication needed for information dissemination that we see today. In 1960, the libraries goal was to be an dynamic communication center that works with various information materials physically or virtually in all health care areas (Roderer, 1993).

National Network of Libraries of Medicine (NNLM) – Originally, National Library of Medicine (NLM) provided dissemination services through their Regional Medical Library Program, now known as NNLM. Funding was provided through Public Law 89-291, Medical Library Assistance Act (MLAA) of 1965. Its goal was to provide funding for linkage between U.S. health professionals and researchers through a national system of libraries regardless of location. NLM was the first provider of an online database, MEDLINE. GRATEFUL MED software for searching MEDLINE and LOANSOME DOC, an automatic document request service, provided individuals with information though the NNLM library (Roderer, 1993).

NNLM - http://nnlm.gov/

Integrated Academic Information Management Systems (IAIMS) – The National Library of Medicine had as its goal to create an integrated library system for management and access to medical information within the individual academic medical center. This concept originated through a report by the Association of American Medical Colleges in 1982 with NLM. The Matheson-Cooper report had long term effects on the current library information systems of today. The program is now known as the Integrated Advanced Information Management Systems with broader far reaching goals in the management of medical center information. Initial evidence from health science programs suggested that a more extensive use of information by the health profession if the information is distributed at a convenient work station with coordination among all departments. In all IAIMS programs, the library has played a fundamental but differing roles. The roles included principal investigator on grants, services for educational support materials bibliographic retrieval, curriculum support, clinical systems, and campus-wide information systems (Roderer, 1993).

IAIMS - http://www.iaimscons.org/
University of Cinncinati - http://medcenter.uc.edu/iaims/


National Research and Education Network (NREN) – The goal of NREN was to bring rapid and widespread dissemination of biomedical information. The platform for this rapidity was achieved via the Internet by the bibliographic database, MEDLINE. National networking had to be achieved first as mandated through the High Performance Computing and Communications Program ( Roderer, 1993). In 1991, High Performance Computing and Communications Program authorization came under P.L. 102-194 introduced by Senator Al Gore. This law was amended in 1998, now Next Generation Internet Research Act (P.L. 105-135). These laws helped to develop and expand the Information Superhighway (Wikipedia, 2008).

Unified Medical Language System (UMLS)

Originally, distribution of scientific material was through library or database vendors for bibliographic materials with direct distribution and indirect distribution for physical access. The NLM had as its goal to provide easy access to machine readable information from scientific literature, patient records, factual databases, and knowledge-expert systems. Initiated in 1990, the UMLS was to have three knowledge sources: Metathesaurus, Semantic Network, and an Information Sources Map. These sources continue to be worked on today for improvement. Libraries were one of the key users in the development of UMLS experimental versions ( Roderer, 1990).

UMLS - http://www.nlm.nih.gov/research/umls/

References

Roderer, N.K., (1993). Dissemination of medical information: Organizational and technological issues in health sciences libraries. Library Trends, 42(1), 108-26.

Wikipedia (2008, July 7). High performance computing and communication act of 1991. Retrieved July 11, 2008 from http://en.wikipedia.org/wiki/High_Performance_Computing_and_Communication_Act_of_1991

Podcasting

With the rapid changes in healthcare, health care professionals are encouraged to be lifelong learners to provide quality care. This past year, I personally have seen increasing offers for podcasts that brings information to me in my car, on the beach, home and workplace. This tool for disseminating information is simple, and dynamic as the other tools discussed in previous postings. Podcasts can be used on an MP3 player, on a computer, or a mobile phone. It also enhances the process of chunking information which is a useful in information processing. The capability of seeing and hearing provides fertile ground for educating health professionals when attending a conference or meeting may be impossible. With the current views of library no longer a physical place to seek and find information, the podcast offers innovative ways for the librarian to disseminate information anytime and anywhere. Remote communities can have access to current information. All that is needed is a microphone, a computer, audio software – free from the web, music, copy right permission, webpage to publish the podcasts, a podcast feed, and a place to record (Ralph & Olsen, 2007). Another tool to place in a librarians repetoire at providing information anytime and anywhere.

References
Ralph, J., & Olsen, S. (2007). Podcasting as an educational building block in academic libraries. Australian Academic & Research Libraries, 38(4), 270 – 279.

Wikis

Most of what I am writing applies across the board to information science and librarianship. The concept of wiki is another tool to disseminate and share new information. The term “wiki” was invented by Ward Cunningham in 1994. it is Hawaiian for quick or super fast. In this fast paced world of medicine, it is an appropriate tool for dissemination that is built on Web 2.0. Information can be shared and exchanged without coding languages. Pages can be created and tracked on a back end database (Barsky & Giustini, 2007).

Characteristics associated with wikis are: sharing original content and link to existing information to expand knowledge development, focuses on the combined effort among users rather than an individual author, open access for anyone to edit (for health wikis, one should have to register – this is important since incorrect information may potentially harm an individual if advise is not given by a health professional), simple to use in creating and editing pages, and the wiki is dynamic rather than static in providing information as in a textbook or journal article. Although the wiki is extremely helpful in disseminating new information for health professionals, it can be helpful to the general public as well with their increasing demands for information on health care. Barsky and Giustini (2007) described the wiki as an evidence-based collaboration tool.

References
Barsky, E., & Giustini, D. (2007). Introducing Web 2.0: Wikis for health librarians. JCHLA/JABSC, 28, 147-150.

Wikis in Health Care–

The Joint Commission – accrediting agency for health care organizations, formerly known as JCAHO - http://wikihealthcare.jointcommission.org/twiki/bin/view/Home/WebHome

Health Impact Assessment Community Wiki - http://www.seedwiki.com/wiki/health_impact_assessment_hia_community_wiki/

University of Buffalo Health Science Library Wiki – extensive list of wikis - http://libweb.lib.buffalo.edu/dokuwiki/hslwiki/doku.php

Ask Dr. Wiki - http://askdrwiki.com/mediawiki/index.php?title=Physician_Medical_Wiki

Nursing Wiki - http://en.nursingwiki.org/wiki/Main_Page

PubDrug - http://smbrower.com/mediawiki/index.php/Main_Page

Two Steps Forward, One Step Back

A question came to mind while trying to absorb some of the reading– how does the Web 2.0 (basis for RSS, fPDAs, etc.) play a role in diffusion in the information and library environment ?

Needleman (2007, p. 203) sums it up pretty well:

• Services should be available at the point of need and not the other way around. Library services should be embedded.
  
• Data should be exposed, discovered, and manipulated in a variety of ways from the original reason the data came about.
  
• Applications should make available a number of resources. These applications should have rapid deployment and responsive to the user’s needs.
  
• We are facilitators for communication, community, and user participation. We need to be user centric.
  
• Enrich data and expose hidden collections.

Needleman was speaking in generalities but it is most appropriate for the health care professions.

References

Needleman, M. (2007). Web 2.0/Lib 2.0 – what is it? Serials Review, 33, 202-203.

Diffusion While Mobile

PDAs are an extremely useful tool for diffusing information for the health care clinician always being on the go. Being lightweight and portable, this reference tool provides evidence-based practice references at the point of care. Collaboration of librarians with health care professionals is important. Technical support for faculty and students is required. Librarians need to find those super users to encourage the concept of the PDA as a reference tool. Faculty need to provide role modeling and also promote its use in assignments with the students. Predictable access if using the main campus library for loading, resynching, troubleshooting, and updating the PDAs and their databases is needed (Scollin, Callahan, Mehta, & Garcia, 2006).
Other services that need to be offered are: demonstrations and workshops. Be cautioned though that there area wide variety of skills in this type of educational delivery. Medicine appears to be the forerunner in using PDAs with dentistry, pharmacy, and nursing following. What is being accessed is drug databases, reference books, patient care, and in some cases patient tracking as well. The library can be helpful in disseminating what resources are available for PDAs and how to use them. Clearly, PDAs are not being used to their potential.

Librarians role in dissemination can focus on:
Product and purchasing information
Loaner services
Fairs with computer vendors
Links for the particular health care discipline
Demonstrations in using the PDA
Workshops to focus on increasing skill levels

Bottom line by librarians is pro-activity in providing consistent and knowledgeable support (De Groote & Doranski, 2004).

Supplying Content Via PDA
Webclipper software is available for downloading web content when not connected to the Internet. Examples of both free and pay for service are: AvantGo, Plucker, SunRise XP, iSilo, Namo HandStory, or RepliGo – this works on both PDAs and pocket PCs RSS links may be provided as well. (Cuddyy, 2006).

Examples of Health Science Libraries with PDA Support

Drexel University Health Sciences Library - http://www.library.drexel.edu/resources/guides/healthpda.html
Duke University Medical Center Library - http://www.mclibrary.duke.edu/training/pda
Loyola University, Health Sciences Library - http://library.luhs.org/wwwlinks/pdas11-21-04.htm
University of California, Irvine, Grunigen Medical Library - http://grunigen.lib.uci.edu/pda-resources.html
University of Connecticut Health Center, Lyman Maynard Stowe Library - http://library.uchc.edu/pda/
University of Pennsylvania - http://gethelp.library.upenn.edu/guides/biomed/updated_pda_resources.html
Yale University, Harvey Cushing/John Hay Whitney Medical Library - http://www.med.yale.edu/library/technology/PDA/PDAWiFi.html#iphone

Interesting ResourceWebsite: Libraries on the Go by Megan Fox, We and Electronic Resource Librarian, Simmons College Library (Revised 2007, November)- http://web.simmons.edu/~fox/pda/


References
Cuddy, C. (2006). How to serve content to PDA Users on-the-Go. Computers in Libraries, 26(4), 10-12, 14-15.

De Groote, S. L., & Doranski, M. (2004). The use of personal digital assistants in the health sciences: Results of a survey. Journal of the Medical Library Association, 92(3), 341-348.

Scollin, P., Callahan, J., Mehta, A., & Garcia, E. (2006). The PDA as a reference tool. CIN: Computers, Informatics, Nursing, 24(4), 208-213.

SDI History

In a number of readings, I came across selective dissemination of information (SDI). Though the term is somewhat dated, it can be manual or electronic. Selective Dissemination of Information (SDI) was a concept introduced by H.T. Luhn in 1958. His paper described an automatic method in providing currency in library service to scientists.. This feature allows revising a subscriber’s references as a database is updated. What can be accomplished via a user profile with SDI is : email notices of a current journal’s table of contents with links to full-text; access to a web-based received journal list with links to a table of contents of issues and full-text; and custom email notices of newly received books.


University of South Carolina. (1998, January 14). Hans Peter Luhn. Index of Information Science Pioneers. http://www.libsci.sc.edu/BOB/ISP/luhn.htm

RSS and Health Sciences

I find the RSS capability especially intriguing with the increasing use of Blackberries, PDAs, iPods, and MP3 player capabilities. I had no idea it existed so forgive my ignorance.

RSS (Really Simple Syndication, Rich Site Summary, or RDF Site Summary) is a broadcast service to subscribers by providing updates on new acquisitions, library events, exhibits, and other important information. The library can also harvest sites of interest to the reader through links.

Though limited to headlines and minimal text, updates can be sent to PDAs and cell phones to disseminate information (Boss, 2006). Advantages include: information is fed when it is available and no searched for, privacy is assured, SPAM is not possible, and feeds can be cancelled with only a few keystrokes. RSS 2.0 is the easiest to use and and RSS icon can easily be added to a Web page. Both directories and aggregators are available for identifying RSS feeds. If libraries have large acquisitions then it is a good idea to group new acquisitions into broad subjects group. Feedreader and Bloglines are open source free products that are aggregators to read the feed.

Boss, R. W. (2006, March 17). Libraries and rss. Retrieved June 25, 2008 from http://www.ala.org/ala/pla/plapubs/technotes/LibrariesandRSS.pdf

Are Nurses Ready for Evidence-Based Practice?

As the saying goes, you can lead a horse to water but getting them to drink it is another matter. Selected studies by nurses found problems exist in nursing programs and healthcare organizations that may preclude current dissemination methods of information from being effective.

Survey of Nursing Schools in the U.S. Show Lack of Readiness
At the time of survey, many nursing programs indicated that programs mainly focused on computer literacy skills. Competency skills were integrated into the program courses. Few programs checked for information literacy skills. Programs are beginning to check on information literacy skills. Gaps exist between programs on requirements for these skills. Faculty are not skilled in managing information for daily clinical practice. A perceived need exists for these skills. A champion person needs to be identified to promote the skills to faculty. Funding for continuing education of faculty is an issue.

McNeil, B. J. et al. (2005). Nursing informatics knowledge and competencies: A national survey of nursing education programs in the United States. International Journal of Medical Informatics, 74(11-12), 1021 – 1030.

Preference of Peers or Colleagues for Information
In a study of 3,000 registered nurses on perceptions of accessing tools, Pravikoff, Tanner, & Pierce ( 2005) found that clinical nurses sought out peers or colleagues and using the Internet and World Wide Web than using bibliographic databases. Besides little value being placed on research in clinical practice, lack of training in using tools is a problem.
Other individual barriers exist that include: difficulty in understanding research articles, lack of access to the library, lack of search skills, and lack of skills to critique articles. Institutional barriers exist that mainly focused on higher priorities, budgets for information resources and training, and lack of perception for the need of information literate nurses.
One other problem that exists is that the majority of nurses are still trained at the associate degree level. At this level of education, nurses do not receive courses on research in nursing.

Pravikoff, D.S., Tanner, A.B., & Pierce, S.T. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40 – 51.

Implications for Educators on Evidence-Based Practice
Lack of role modeling by faculty can be a major problem in implementing evidence-based practice. Currently, most clinical faculty members focused on the assessment of skills, time management, and affective behaviors for patient care in nursing students. Factors that inhibit implementation of evidence-based practice with students are: time constraints, lack of appropriate access to information and resources at clinical sites, need for enhancement of research skills particularly information, and lack of clinical organizational support for valuing behaviors needed for evidence-based practice.

The authors suggest that a change agent be utilized to promote the use of evidence-based practice. The clinical nurse educator on the unit would be the ideal person to establish a relationship. Incorporation could possibly take place in post –clinical conferences if facilities are available.

Penz, K. L., & Bassendowski, S. L. (2006). Evidence-based nursing in clinical practice: Implications for nurse educators. The Journal of Continuing Education in Nursing, 37(6), 250 – 254.

Observation and Interviews of Critical Care Nurses
McKnight (2006) further emphasized that on-duty critical care nurses did not seek out information from published resources. With the emphasis on constant assessment and evaluation of the patient, interactions with people on the unit were the main means of acquiring information – patients, nurses, family, physicians, and health care workers. Verbal and written reports were taken and given by the nurses on the various patient issues. The unit secretary was seen as a gatekeeper of information flow on the unit. Patient charts were the main access of information. Technology was not seen as a barrier. Interestingly, the author points out that the physician rarely accessed the information system. Published print information was sought out two times during the fifty hour observation period. Any research that they might seek on a particular problem was completed off duty. The conclusion was that the daily requirements of patient care do not allow time to accessing published information.

McKnight, M. (2006). The information seeking of off-duty critical care nurses: Evidence from participant observation and in-context interviews. Journal of the Medical Library Association, 94(2), 145- 151.


Observations: Healthcare professionals have been directed to implement evidence-based practice (EBP) but currently they lack the tools needed for EBP. Healthcare professionals do not have the time for published information. Current means of disseminating published healht care information is may not be accessible nor valued at work. Peers or collegaues are still the preferred means to acquire information. Access of published resources is not done at work. Nursing schools understand the need to teach students information literacy skills but have limited resources and time constraints. A better means of dissemination might need to occur for practicing nurses to utilize published information at work.

Impetus for Evidence-Based Practice in Health Care

Unsure if any of my fellow classmates are familiar with nursing and health care so I wanted to start by giving some background information.

In 2003, the Institute of Medicine issued a report discussing the need for health care professionals to use best evidence in providing patient centric care. What this means is that all health care professionals need to be able to find information to support best practices in taking care of patients and including the patient in all decision- making of their care. Changes in the way clinicians are taking care of patients have started to occur. All clinicians are being encouraged to find information at the bedside to support their decisions. Both physicians and nurses need to be able to access information. However, factors were found exist that prevent real time use of information.

Institute of Medicine. (2003). Chapter 3. The core competencies of health care
Professionals. In Health professions education: A bridge to quality (pp. 45 – 73). National Academy Press.

Introduction

Dissemination is one of the main functions in library and information science. Information distribution is provided in whatever context is needed. With my focus on nursing, this blog will tend to focus on issues related to dissemination of information in health care and nursing. Health care itself is information intensive as we are always answering questions and giving out information.

So how do nurses distribute information? If out in the field such as in community and public health, they may be constantly bombarded with questions related to their health problems. Information is imparted verbally or through distribution of written materials. Another way that nurses distribute information is through data collected on patients and then recorded on a record and verbally to the physician. In the past this data was basically collected and then selectively stored on optical disks with infrequent retrieval on re-admission to the hospital. Now this data is collected in order to gather information on nursing phenomena in clinical areas and build nursing knowledge. Additionally, nurses are now focused on evidence-based practice for providing quality patient care. They want to know what are the best practices for quality care.

As an educator, they need to provide up-to-date information to both students and patients. Anyone involved in research knows that they need to broadcast their findings through publication and presentations at conferences. Managers also propagate information in their policies and procedures that are reviewed and developed in providing patient care and employment.

So terms that you may see in my postings that are synonymous with dissemination are: broadcasting, distribution, diffusion, spreading, propagation, and giving out.

Organizations in Nursing and Health Care

American Nurses Association (ANA) - http://www.nursingworld.org/

American Medical Informatics Association (AMIA) - http://www.amia.org/

American Nursing Informatics Association (ANIA) - http://www.ania.org/

American Health Information Management Association (AHIMA) - http://www.ahima.org/

Health Information And Management Systems Society (HIMSS) - http://www.himss.org/ASP/index.asp

TIGER Initiative (Technology Informatics Guiding Education Reform) - https://www.tigersummit.com/