1

MANAGEMENT INFORMATION AND EVALUATION SYSTEM

INTRODUCTION

The term "management information system" first appeared in a report by the US Navy
regarding computers' use to build a single integrated system to manage all navy resources. It
is synonymous with computer-based systems. It includes information system, information
management system, and information technology. Information technology is a tool used to
process data and information. An MIS, therefore, produces data that support the management
functions of an organization.

CONCEPT OF MANAGEMENT INFORMATION AND EVALUATION SYSTEM

Management information and evaluation system (MIES) is concerned with processing data
into information. It is a system of managing information to monitor progress, measure
performance, detect trends, evaluate alternatives, make decisions, and take corrective actions
(Duerch).

The MIES is a system of obtaining, classifying, storing, and analysing data to enable the
management to define objectives, to plan to meet those objectives, and to complete the cycle
by evaluating progress and redefine the goals. It is a formal system of gathering, integrating,
comparing, analysing, and dispensing information internal and external to the organization in
a timely, effective, and efficient manner (Koontz).

MANAGEMENT INFORMATION AND EVALUATION SYSTEM

Definition:

"Management information system: An array of components designed to transform a

collective set of data into knowledge that is directly useful and applicable in the process of
directing and controlling resources and their application to the achievement of specific
management objectives."

[Hanson 1982]

Evaluation System:

✓ "A periodic evaluation of system to assess its status in term of original and current
expectation and to chart its future direction."
 2

Health Information System:

"Health information is any quantifiable and non- quantifiable information that can be used by
health decision-makers and clinicians to better understand disease processes and health care
issues, and to prevent, diagnose or treat health problems. [WHO]

OBJECTIVES OF MIS:

 To enhance communication among employs.

 To provide a system for recording and aggregating information.
 Reduce expenses related to labour-intensive manual activities.
 To support the organization's strategic goals

IMPORTANCE OF MIS

 Planning systematically and coordinating activities

 Establishing databases on budgets, personnel, facilities and equipment.
 Providing guidance in choosing entry points for program interventions and
establishing active partnerships with other organizations.
 Providing information on the status of the population served, such as its health status
(Le. defines surveillance levels).
 Guiding prioritizing by identifying major problems.
 Providing indicators for monitoring and evaluation of performance.
 Assessing the impact or effectiveness of services
 Guiding the forecasting of Commodity or service needs.

IMPLEMENTATION METHOD OF MIS:

1. Parallel Approach
2. Direct Approach
3. Modular Approach

1. Direct Approach:

 Direct installation of the new system with immediate discontinuance of the old
existing system is referred as "cold turnkey" approach. This approach becomes useful
when these factors are considered.
 The new system does not replace the existing system.
 Old system is regarded absolutely of no value
 3

 New system is compact and simple.

 The design of the new system is inexpensive with more advantages and less risk
involved.

2. Parallel Approach:

 The selected new system is installed and operated with current system.
 This method is expensive because of duplicating facilities and personal to maintain
both the systems.
 In this approach a target date must be fixed when the operations of old system cease
and new one will operate on its own.

3. Modular Approach:

 This is generally recognized as "Pilot approach", means the implementation of a

system in the Organization on a piece-meal basis.

CLASSIFICATION OF MIES

1. Databank information system: system contains observed information. It classifies and

stores any observation of data potentially useful to the decision maker.

2. Predictive information system: The predictive: Information system has predictive

information. It draws inferences and predictions relevant to decision-making.

3. Decision-making information system: The system helps in the process of decision-

making. It added the criteria for choosing among alternatives and thus added value system of
the organization.

4. Decision-taking information system: It is a decision system in which the decision-maker

takes the decision as generated by the system and very confident to initiate action
accordingly.

OBJECTIVES OF MIES

The four main objectives of MIES are as follows:

1. To enhance communication among employees

2. To provide a method for recording and analysing information
3. To reduce the expenses of employees related activities
4. To support organizational goals and directions
 4

PURPOSES OF MIES

1. To provide management information to decision makers

2. To provide a base for analysing any internal and external threats to an organization
3. To regulate routine activities, thus avoiding human work in the processing tasks
4. To assist management in making everyday decisions
5. To provide the information necessary to make non routine decisions

ADVANTAGES OF MIES

 It supports and enhances the overall decision-making process

 It improves job performance throughout the organization
 It provides the means to monitor activities
 It provides feedback on the effectiveness of risk control.
 The risk of systems failure is localized
 The major problem can be easily identified and corrected before further
implementation.
 It provides the means through which the institutions activities are monitored and
information is distributed to management, employees and customers.
 It measures performance, manage resources
 It can also be used by management to provide feedback on the effectiveness of risk
controls.

LIMITATIONS:

 Technology also increases the potential for inaccurate reporting and flawed decision
making because data can be extracted from many financial and transaction systems,
appropriate control procedures must be set up to ensure that information is correct and
relevant.

NURSING MANAGEMENT INFORMATION SYSTEM(NMIS)

Nursing information systems (NIS) are computer systems that manage clinical data from a
variety of healthcare environments, and made available in a timely and orderly fashion to aid
nurses in improving patient care.

APPLICATIONS OF NMIS:
 5

1. Fiscal Resource Management

2. Workload Measurement and Staffing Requirements

3. Staff Scheduling

4. Personnel Management

1. Fiscal Resource Management:

 The information generated can be used to monitor past performance or to predict
future performance.
 Accumulated data can be analysed for the development of trends that can be used to
project future expenditures. Necessary reallocations and budgetary adjustments can
then be made on the basis of these projections.

2. Workload Measurement and Staffing Requirements:

 It helps to store, manipulate and retrieve large volumes of data. The information
generated assists nursing managers in planning, monitoring and evaluating use of
nursing resources on a daily basis and in the longer time frame.
 It is used to generate staff schedules with conjunction with personnel management.

3. Staff Scheduling:

 Nursing managers are able to plan schedules in advance with considerable time
savings. Staffs are informed well ahead of time.
 Staffing records, if maintained properly, provide useful information for monitoring
absenteeism, scheduled time off, and turn over.

4. Personnel Management:

 An employee with a special mix of skills can be located. Records are readily
accessible needed for accreditation purposes or to monitor contract compliance.
 The information may be retrieved on a daily basis for use in conjunction with
workload measurement and contract requirements to plan staffing assignments.

ADVANTAGES OF NMIS:

 In nursing administration: Evaluate quality assurance programs Defend resource

allocation to nursing Demonstrate the contribution nursing, makes to the care of the
patient. Identify outcomes of nursing care.
 6

 In nursing practice: Enhance documentation by nurses Provide data to enable

research directed at examining the inter relationships between data elements and
nursing outcomes. Facilitate development of the nursing process.
 Nursing research: To assess variables on multi levels including institutional, local,
regional, and national. Identify trends Integrate to build information and to further
synthesize to develop nursing knowledge.
 Nursing education: To develop body of knowledge with focus on nursing process. To
enable staff educational needs based on follow up care and outcomes. To enhance
student nurses’ accurate documentation.

EVALUATION SYSTEM

 Every organization needs to evaluate its performance and the impact of its efforts. In
many instances, organizations have multiple programs and will need to evaluate each
one from two perspectives:
1. How
2. whether it has achieved its specific objectives.
 Organizations should develop and implement a comprehensive evaluation plan that
outlines the time-frames and resources needed for mid-term and final evaluations of
each major program.

MAJOR KIND OF EVALUATION

1. Process Evaluation:
 Continuous monitoring and supervision are part of process evaluation, which
examines how well programme activities are being implemented. Specifically, process
evaluation focus on the development and strengthening of existing systems, protocols,
and guidelines necessary to support, standardize, and institutionalize service activities.
 These activities support planning, implementation and supervision to assess progress
against project goals and objectives.
 Process evaluation should also review what is working and what is not in order to
enable staff and managers to develop corrective actions; determine whether resources,
equipment, supplies and staff skills are adequate and used effectively; identify barriers
to program.
 7

2. Output Evaluation:
 The output evaluation assesses achievements on site by viewing defined, quantifiable
indicators of program performance such as access, quality and acceptability, number
of persons trained and use of services by the target populations. Output indicators are
usually quantitative.
3. Effects Evaluation:
 Effects measurement focuses on changes observed within the target population in the
catchment area, for example: observed changes in reproductive health attitudes,
changes in staff and skills, and changes in provider attitudes toward providing and
managing services.
4. Short term impact evaluation:
 The findings from the original baseline survey should be used to derive the indicators
for the short-term impact evaluation.
 This evaluation is conducted at a specified, predetermined time following the
introduction of a new program. Relevant data from reports, service statistics, and
training information systems contribute to the analysis of short – term impact.

CONCLUSION

A MIES helps a manager to collect and use information to make management decisions in a
timely manner. Managers also use MIS data to analyse, plan, make decisions, take actions
and evaluate. An effective MIES provides accurate, complete, and timely information. MIES
formats should include feedback mechanisms so that decisions made at all levels within the
organization.

RESEARCH REFERENCE

o Fang YW, Li CP, Wang MH. The development and evaluation of a nursing
information system for caring clinical in-patient. Technology and Health Care. 2016
Jan 1;24(s1):S401-6.
The research aimed to develop a nursing information system in order to simplify the
admission procedure for caring clinical in-patient, enhance the efficiency of medical
information documentation. Therefore, by correctly delivering patients’ health
records, and providing continues care, patient safety and care quality would be
effectively improved. The study method was to apply Spiral Model development
system to compose a nursing information team. By using strategies of data collection,
 8

working environment observation, applying use-case modelling, and conferences of

Joint Application Design (JAD) to complete the system requirement analysis and
design. The Admission Care Management Information System (ACMIS) mainly
included: (1) Admission nursing management information system. (2) Inter-shift
meeting information management system. (3) The linkage of drug management
system and physical examination record system. The framework contained qualitative
and quantitative components that provided both formative and summative elements of
the evaluation. System evaluation was to apply information success model, and
developed questionnaire of consisting nurses’ acceptance and satisfaction. The results
of questionnaires were users’ satisfaction, the perceived self-involvement, age and
information quality were positively to personal and organizational effectiveness.
According to the results of this study, the Admission Care Management Information
System was practical to simplifying clinic working procedure and effective in
communicating and documenting admission medical information.
 9

E- NURSING, TELEMEDICINE AND TELENURSING

Introduction:

Nursing profession is influenced by the changes and current trend in the health care delivery
system. Technological proficiency in nurses is a desirable attribute to function optimally in
our changing health care system: not as a substitute for nurses & apos; care, but as an actual
enhancement of care. Nurses are encountering lot of challenges as the new technologies are
emerging. These trends in information technology challenge the nurses to focus on new areas.
E nursing and telenursing is one area which needs nurse ‘s attention.

Technology 1999 vs. 2010

In just 10 short years, the face of technology, inside the classroom and out, has changed
dramatically. Here is a snapshot of some of those changes.

 THEN: 3 ½ inch floppy disks

 NOW: Mass volume storage drives and DVD ‘s, double DVD, BLUERAYS.
 THEN: Technology via the classroom was limited to TV replay classes, distance
learning and PowerPoint presentations. Students obtained readings and syllabi via
their local bookstore, in printed copy.
 NOW: Almost all students use the e-learning system to access their classes and have
some sort of Web-based component. Many students have only online classes and
many access all materials online.
 THEN: Music CDs were bought and listened to on your CD player
 NOW: Music can be downloaded online and saved to an I-Pod, which goes
everywhere.
 THEN: Taking pictures meant buying film and having it developed at local pharmacy.
 NOW: Digital cameras now allow instantaneous viewing of photos, downloading and
sharing them with millions on the Internet.
 THEN: About 69 million people owned a cell phone in the U.S.
 NOW: Today, more than 190 million people own cell phones. 39% of these are smart
phones, which allow access to email, the Internet, videos, and academic course
content.
 THEN: Most students using computers at visited the campus and waited for open
stations. •
 10

 NOW: students are required to own a personal computer and have a Gatorlink email
address, which faculty use to regularly communicate with students.

E-Health

 E-health is a client-centred World Wide Web-based network where clients and health
care providers collaborate through ICT mediums to research, seek, manage, deliver,
refer, arrange, and consult with others about health-related information and concerns.
 E-health networks have developed on the Internet at an amazing rate over the past
decade.
 The emphasis is genuinely Client focused.
 Client Driven as well…
 Clients driven by the need and urge to become informed health consumers.
 Health (also written e-health) is a relatively recent term for healthcare practice
supported by electronic processes and communication, dating back to at least 1999.

FORMS OF E-HEALTH

The term can encompass a range of services or systems that are at the edge of
medicine/healthcare and information technology, including:

 Electronic health records: enabling the communication of patient data between

different healthcare professionals (GPs, specialists etc.)
 Telemedicine: physical and psychological treatments at a distance
 Consumer health informatics: use of electronic resources on medical topics by
healthy individuals or patients
 Health knowledge management: e.g. in an overview of latest medical journals, best
practice guidelines or epidemiological tracking (examples include physician
resources such as Medscape and MDLinx)
 Virtual healthcare teams: consisting of healthcare professionals who collaborate and
share information on patients through digital equipment (for transmural care)
 mHealth or m-Health: includes the use of mobile devices in collecting aggregate and
patient level health data, providing healthcare information to practitioners,
researchers, and patients, real-time monitoring of patient vitals, and direct provision
of care (via mobile telemedicine)
 Medical research using Grids: powerful computing and data management
capabilities to handle large amounts of heterogeneous data.
 11

 Healthcare Information Systems: also, often refer to software solutions for

appointment scheduling, patient data management, work schedule management and
other administrative tasks surrounding health.

E-NURSING –INTERNET ACCESS

(Nursing practice in the year 2023 was vastly different from the days of Florence Nightingale
in the 1850's. Today's nurses literally have at their fingertips the power of the Internet)

Nowadays nurses are work in a variety of E – Health programme such as telephone triage.
They access online libraries and databases of clinical practice guidelines from computers in
their work places. Patient must be able to access information on best practices from expert
nurses or other professionals. Many nurses practice in remote and isolated regions where
accessing needed information and resources is difficult.

Internet access assists nurses in:

(a) Providing direct client care,

(b) Enhancing client teaching,

(c) Conducting job searches and continuing education.

(d) Collaborating with other health professionals worldwide.

DEFINITION

 E nursing involves the use of computers or electronic devices in some way o provide
training, education and learning materials.
 E nursing comprises of all forms of electronically supported learning and teaching.

GOALS OF E- NURSING

 To enhance nurses to benefit from all developments in information, communication,

and technology.
 To improve nursing and client outcome.
 To encounter challenge owing to emergence of new technology

MODALITIES OF E NURSING

1. Individualized self-paced e –learning online

2. Individualized self-paced e – learning offline
 12

3. Group based e – learning synchronously

4. Group based e – learning asynchronously

Individualized self-paced e – learning online

It refers to situations where an individual nurse accesses learning resources such as nursing
data base or course content online through internet.

E.g. a learner studying alone or conducting some research on the internet or a local network.

Individualized self-paced e – learning offline

This type of modality refers to situations where an individual learner is using learning
resources such as a database, offline CAL package, a hard drive, a CD, or DVD.

Synchronously group-based e-Learning:

Synchronously group-based e-Learning refers to an education strategy where groups of

learners are working together at the same time or in real time by using an intranet or the
Internet. It includes text- based conferencing and one- or two-way audio and
videoconferencing. For example, learners engaged in a real-time chat, audio, or
videoconference.

Group-based e-Learning asynchronously:

Asynchronously group-based learning refers to an education strategy where groups of

learners are working over an intranet or the Internet, and exchanges among participants occur
with a time delay or not in real time, e.g. online discussions via e-mailing lists and text-based
conferencing within learning management systems.

LEARNING PREFERENCES AND STYLES IN E-LEARNING

1. Offline and online activities: These are teaching- learning activities that take place
while offline, not connected to the Internet but online.
2. Synchronous and asynchronous activities: Within synchronous learning, learning
and teaching take place in real time or at the same time, while the trainer and learner
sit separately from each other, e.g. watching live television broadcast and listening to
a live radio broadcast, audio/videoconferencing, Internet telephony, online lectures,
two ways live satellite broadcast.
 13

Within asynchronous learning, the teaching-learning activities take place with a time
delay (time shift), while the trainer and learner sit separately from each other (place
shift), e.g. self-paced courses via Internet or CD-ROM, video-taped classes, Web
presentations, seminars.
3. Different multimedia: The clients can use more than one media to carry out activities.
They can combine both synchronized and asynchronized communication devices

Communication technologies used in learning.

Asynchronous Learning
 Fax
 E-mail
 Knowledge base forum
 Computer based training
 Quick reference guide
 Blogs, wikis, and discussion boards
Synchronous Learning
 Telephone
 Screen sharing
 Chat or a skype conversation
 Desktop conferencing
 Online seminar
4. Different didactical interactions: Different didactical approaches can use within e-
Learning, e.g. assignments, assessment, reading, presentations, video, workshop,
demonstration, and simulation.
5. Delivering lectures: Various ways to provide content are computers, personal digital
assistants (PDAS), TVs, mobile phones, or iPods. Every device has its characteristics,
advantages, and disadvantages.
6. Self-study and collaborative learning: Learning can be individualized and
collaborative in e-Learning.
7. Formal and informal learning: e-Learning has every day as well as a structured
learning activity. Informal learning is unstructured and unplanned, and structured
learning is a planned activity with specified learning objectives, a didactical approach,
and planning.
 14

KINDS OF E-LEARNING

1. Classroom aids such as overhead projectors, epidiascope, and PowerPoint slides.

2. Website courses: The learning takes place by using multiple types of websites.
3. Laptop programs: Learning takes place by using laptop educational programs.
4. Hybrid learning: Most of the time learning takes place through online.
5. Fully online learning and distance learning.

Elements of e-Learning Material

 The instructional designing of the material should be clear and consistent. It is not an
area to take shortcuts. Planning is an essential element in e-Learning.
 There should be an intuitive user interface, which should be easy to navigate.
 There should be ongoing and purposeful interaction with and by the learner.
 Real world applications, exercises, and examples are necessary
 There must be a practical and systematic assessment of learner progress and
achievement.
 Use multimedia to communicate and enhance learning.

IMPORTANCE OF E-LEARNING

Importance of e-Learning to organization

 It aids in improving training costs: Producing learning content is time-consuming,

whether it's online or not, but e-Learning promotes the overall cost through decreased
travel, reduced material, and hopefully improving performance.
 It decreases material costs: By creating the environment online and letting the learner
practice, the costs associated with setup will be negligible.
 It aids in increasing productivity: Because e-Learning is not bound by geography or
time, the learner can enhance his/her performance at any time.
 It helps in maintaining standards: e-Learning allows creating a standardized process
and consistency in the delivery of content. It also compresses delivery time.

Importance of e-Learning to learners or employees

 Real-time access: e-Learning courses provide an opportunity to access anytime,

anywhere even without Internet access, i.e. on-demand availability.
 15

 Use in continuing education: Continuing nursing education (CNE) is gaining

popularity without wasting time and money to attract employees to attend
conferences, seminars, etc.
 Improves interactivity of participants: Due to the use of e learning, participants in
educational activities become active in the learning process, increase retention, and
help in improving patient and employee safety and quality.
 Create a pleasant learning environment: use of multimedia in the class room, create
an excellent learning environment, and help in getting feedback from the learners.
 Improve retention: the combination of multimedia and instructional design can
produce a vibrant learning experience.
 Individualized learning: e-learning allows the learners to progress at their own pace.

Importance of e-Learning in organization and community

 Ongoing access to resources: e-Learning provides an opportunity to continue to have

access to the online content and resources to brush up and to update knowledge and
skills.
 Knowledge management: e-Learning includes all sorts of online technologies that
allow collaboration and conversation to capture organizational knowledge.
 Encourage sharing: e-Learning mode encourages the sharing of resources among the
learners.
 Exploring opportunities for learners: It allows employers to explore other
opportunities in the organization.
 Promotion of flexibility, autonomy, and collaboration: it helps in promoting
flexibility, independence, and coordination among users.

THEORETICAL BASES OF E-LEARNING

Andragogy and constructivism are the primary theoretical bases of e-Learning.

1. Andragogy:
 Andragogy is a teaching methodology that best facilitates learning among the
adult.
 The flexibility of anytime anywhere learning allows the adult to develop a
learning plan that fits their needs related to family, vocation, and other areas of
life.
 16

 The dynamic interactions with other learners can demonstrate relevance as

they work together to create newfound meaning.
2. Constructivism:
 Constructivism refers to the learning that occurs as a result of the learner
thinking about and by interacting with the subject matter.
 Constructivism focuses on the concept of knowledge construction versus
knowledge transmission.
 e-Learning is an instructional design that fits in constructivism. The flexibility
of the learning may allow the learner to remain in a natural environment
during the learning interaction.
 It also allows the instructor to bring in actual practitioners to interact with the
learners.
 Finally, the learner can construct their plan for achieving the learning
outcomes based on personal interests.

DESIGNING A PROGRAM THROUGH E-LEARNING

The following steps are involved in creating e-Learning program:

Strategic planning:

 The essential components of strategic planning are goal development, plan

development, resource analysis, plan implementation, and continuous evaluation.
 The goal development for e-Learning should include considerations of desired
learning outcomes, organizational outcomes, and understanding of learner needs.
 During planning, constitute a planning team and plan instructional design. Do
resource analysis for human and physical resources, physical infrastructure, and other
technology. Plan for implementation, and pilot the e-Learning process before the
actual implementation.

Course development:

 Course development can be similar to the strategic planning process. Formulate goals,
plan courses, activities, learning objects, and interactions. Develop an outline for the
course theory that supports the attainment of specific outcomes.
 17

Faculty development:

 It includes training needs for the faculty, methodology, technology, and computer
application, with e-Learning.

Learner needs:

 Identify learners' needs. Learners' needs should focus on technology competency, the
attitude of learners, and the difficulty level of learners.

Assessment and evaluation:

 It includes identifying and selecting assessment and evaluation criteria for instructors
and learners.
 It also provides the development of instructor to the learner, learner to learner, and
learner to instructor feedback.

Tools and skills required:

 Develop the course management systems in functionality as a grade book, discussion

board, chat room, e-mail, assignment submission tool, document delivery tool, Web
links, calendar, and activity tracking.
 It also has other features that allow textbook publishers to provide materials that can
be automatically integrated/ uploaded into the course.
 Other tools needed are as follows:
 Help desk: Plan to have a help desk. A help desk is a tool vital in e-Learning.
The instructor must understand the support available and make sure that
learners are aware of these resources.
 Administrative tools: The administrative tools include grade book, activity
tracking, assignment submission tools, and file delivery tools.
 Asynchronous discussion tools: One of the most critical tools in e-Learning is
the asynchronous discussion. It requires the discussion board, bulletin board,
etc.
 Communication tools: The communication tools in e-Learning include e-mail,
chat, and instant messaging. E-mail can be handy in communicating with
learners.
 Community building tools: Building an online learning community requires
training, practice, and continuous revision.
 18

 Evaluation tools: Exams and quizzes and paper grading can be through online
and by using other mechanisms of e-Learning.
 Information sources: It requires Web sites to have access to knowledge and
information.
 Learning objects: Learning objects include games, animations, case studies,
simulations, etc.
 Audio and video aids: Audio and video (AV) aids can enrich e-Learning. Or
record AV aids or use live programs to display on learner's computer, over the
Internet, or via DVD or CD-ROM.
 Simulation: Simulation encompasses different learning modalities and objects.
Simulation-based training with a human patient simulator (HPS) or computer-
based simulation is beneficial in teaching-learning.
 Psychomotor skill training: It includes asynchronous discussions, sharing of
experiences with admitted or discharged patients and learners.

SKILLS REQUIRED FOR E-LEARNING

a) Essential computing and communication skill: The computing skills needed are
word processing communicating via e-mail, using PowerPoint software to support
presentations, using the spreadsheet to display data, or phone conferencing or video
conferencing using desktop publishing packages.
b) Use of predesigned packages: The nursing personnel should predesign e-Learning
environment tools such as Blackboard, Web Course Tools (Web CT). It supports
online tools such as discussion forums, e-mail, live chat, and whiteboarding, as well
as content in various formats such as html documents, Web pages, etc. It is also
merged with Blackboard which is a leading provider of educational software.
c) Assembling Internet resources: It is essential to find the right search engine for
searching clinical guidelines, the database of published articles, etc.
d) Design courses and teaching material: It includes courses, modules, or session
materials.

BENEFITS OF E-LEARNING

 It encourages interactive, self-directed, and self-paced learning and innovative

teaching.
 It is very convenient, saves time and place for education.
 19

 It enhances data search by hyperlinks.

 It promotes Internet use as and when required.
 It builds confidence and interest among users.
 It improves learning retention and data application.
 It provides proof of completion and certification.

ADVANTAGES OF E-LEARNING

1. It increases the flexibility of learning, and it is fast and has no geographical barriers.
2. e-Learning technology offers a wide range of opportunities for education
development.
3. The use of e-Learning is independent of time and space and has easy access.
4. e-Learning is a quality-assured program and cost- effective in achieving service and
learning goals.
5. It is learner centred and provides easy access to information at any time and any
place.

DISADVANTAGES OF E-LEARNING

1. Some forms of e-Learning isolate learners from other learners.

2. Nurses may need training in IT skills to use e-Learning.

ISSUES OF E-NURSING

 Caring, (essence of nursing is contact and engagement with people, which involves
physical closeness, intimacy, and interpersonal sharing and caring that cannot be
approached with computer technology).
 Empowerment,
 Self-reflection And Expression,
 Computer Literacy,
 Confidentiality,
 Bioethical Decisions,
 Networking,
 Patient Education, Community Development And
 Cyber phobia
 20

TELEMEDICINE

Telemedicine is an invaluable tool in health care. It allows patients to visit physicians over
video for immediate care. It can capture video/still images and store patient data and send
data to physicians for diagnosis and follow-up treatment purposes.

DEFINITIONS OF RELATED TERMS

1. Telemedicine: Telemedicine is a strategy to provide interactive healthcare utilizing

modern technology and telecommunications, including satellite links, dedicated line
connections, interactive television systems, and Internet connections to provide
healthcare services to patients at some location away from the provider. It is a system
of healthcare delivery in which physicians examine distant patients through the use of
telecommunications technology (Preston Jane, 1993).
World Health Organization (1997) defined it as the delivery of healthcare services by
healthcare professionals using information and communication technologies to
people living in distant areas to exchange information for diagnosis, treatment, and
prevention of disease and injuries and also for the continuing education, research, and
evaluation of healthcare providers to advance the health of individuals and their
communities.
It is a branch of e-Health that uses communication networks for the delivery of
healthcare services, including medical specialties, such as telecardiology, etc. and
medical education from a distance (Sood et al., 2007).
It is the combined use of telecommunications and computer technologies to improve
the efficiency and effectiveness of healthcare services. It involves the use of
telephones, telehealth, internet, sensors, video, remote diagnostics, and other
interactive technologies, which allow exchange between patients and healthcare
providers.
2. Telecommunication: Telecommunication is the transmission, processing, and
receiving information in the form of signs, signals, writings, images, and sounds or
any other form, via satellite, sound waves, electromagnetic carrier waves, and light
waves through cables, radio, visual, or other electromagnetic systems.
3. Telehealth: Telehealth is the strategy of providing clinical healthcare, health-related
education support to patients and professionals, public health care, and health
administration from the long distance by using electronic information and
 21

telecommunication technologies. It is the health services' delivering system or

strategy to provide healthcare services by removing time and distance barriers using
telephones, computers, interactive video transmissions, direct links to healthcare
instruments, the transmission of images, and teleconferencing by telephone or video.
4. Telehealth care: Telehealth care includes all health services of all health disciplines
such as radiology, pharmacy, and psychology.
5. International Society for Telemedicine and e-Health (IsfTeH): IsfTeH is under
Swiss law and is dedicated to promoting telemedicine, telecare, telehealth, and e-
Health around the world.
6. m-Health or mobile health: The m-health is an efficient and high-quality healthcare
service for mobile citizens. It provides healthcare services by using mobiles to
exchange health-related information between the user and healthcare providers.
7. u-Health or ubiquitous health care: It has u-Health applications to provide health
care to people anywhere at any time using broadband and wireless mobile
technologies.

E-HEALTH

e-Health refers to the use of communication technology to meet the needs of people, health
professionals, providers, and policy makers.

 It includes e-Care, e-Learning, e-Surveillance, and e-administration.

 It is the strategy to provide health by using information and communication
technology.
 The main objective of e-Health is to provide health and medical facilities available to
all at any time of the day through mobile services, Web services, and short message
service (SMS).
 It intends to cover all online medical consultations, medical records, management of
supply of medicines online, and PAN (Presence Across Nation) India.
 It includes almost everything which is spread and related to India exchange for
patient-related information.
 22

The advantages of e-Health are the following:

 Efficiency: It brings efficiency in health care by reducing costs in unnecessary and

duplicate references to diagnostic tests. It improves communication between different
health organizations.
 Enhance quality care: The consumers can compare and analyze the cost and quality
of services provided by different establishments through communication technology
and decide where to seek the best quality medical services.
 Evidence-based services: The communication technology made it possible to evaluate
the services from time to time. m-Health interventions are factual and cannot be
assumed.
 Empowerment: Advanced communication technology such as personal electronic
records made the consumers access their health records over the internet.
 Encouragement: The consumers and professionals develop mutual trust as they
decide the health care in a shared manner.
 Education: The communication technology has a scope to provide health education
and health-related information and to professionals to use online resources for training
and education purposes.
 Enabling: It enables the exchange of information in a systematic and standard way
between consumers and healthcare providers.
 Extending: The technology extended its conventional boundaries globally.
consumers can access health services online from global providers.
 Ethics: It involves a threat to many ethical issues such as informed consent, privacy,
practices, etc.
 Equity: There is problem with equal distribution of health services. Many people do
not have access to modern communication technologies.

TYPES OF TELEMEDICINE

Telemedicine can be broken into three main categories

1. Store" and" forward (asynchronous)

2. Remote monitoring
3. Interactive services (synchronous) (real time)
 23

Store- And-forward

 Involves acquiring medical data (medical images, bio signals) and then transmitting
this data to the doctor or medical specialist at a convenient time for assessment
offline.
 It does not require both the parties at the same time.
 Medical specialties like dermatology, pathology etc is conducive to this kind.
 Most beneficial for population living in isolated communities and remote regions

Remote Monitoring

 Remote monitoring also known as self" monitoring / testing.

 It enables medical professionals to monitor a patient remotely using various
technological devices.
 It manages chronic diseases or specific conditions, such as heart disease, diabetes
mellitus or asthma.
 It gives greater satisfaction to patients.
 It is cost-effective.

Interactive Services

 Interactive telemedicine services provide real-time interactions between patient and

provider.
 It includes phone conversations, online communication and home visits.
 face-to-face visits.
 In clinician interactive telemedicine services may be less costly than in - person
clinical visits.

Many activities such as history review, physical examination, psychiatric evaluations and
ophthalmology assessments can be conducted comparably to those done in traditional

PROCESS AND THE RE1UIREMENTS NEEDED

a) Nodal hospital
A patient getting treated
A doctor
A remote telemedicine console having audio visual and data conferencing facilities.
b) Referral hospital
 24

An expert / specialized doctor.

A central telemedicine server having audio visual and date conferencing facility.

THE DATA: -

•Data related to patients’ personal information.

•Data related to a patient’s medical information.
•Data of patient management in telemedicine.
•Data related to the doctors.
•Data for system management.

PERSONNEL INVOLVED

Referral end -A group of specialist doctor

-System Administrator

-Studio Technician

Nodal end -A group of general physicians

-System operator

-Data entry operator

-Studio Technician.

DATA RELEATD TO THE DOCTOR

Doctors’ personal information.

Unique identification key.

DATA FOR SYSTEM MANAGEMENT

Users list
Password file
Log files

APPLICATION
 25

 Tele-health care: it is the use of information and communication technology for

prevention, promotion and to provide health care facilities across distance. It can be
divided in the following activities
- Teleconsultation
- Tele follow-up
 Tele-education: Tele-education should be understood as the development of the
process of distance education (regulated or unregulated), based on the use of
information and telecommunication technologies, that make interactive, flexible and
accessible learning possible for any potential recipient.
 Disaster Management: Telemedicine can play an important role to provide health
care facilities to the victims of natural disasters such as earthquake, tsunami, tornado,
etc and man-made disaster such as war, riots etc. During disaster, most of the
terrestrial communication links either do not work properly or get damaged so a
mobile and portable telemedicine system with satellite connectivity and customized
telemedicine software is ideal for disaster relief.
 Tele- home health care: Telemedicine technology can be applied to provide home
health care to elderly or underserved, homebound patients with chronic illness. It
allows home health care professionals to monitor patients from a central station rather
than travelling to remote areas chronically ill or recuperating patients for routine
check-ups. Remote patient monitoring is less expensive, more time savings, and
efficient methodology. Tele-home care virtual visits might lead to improved home
health care quality at reduced costs, greater patient satisfaction with care, increased
access to health care providers and fewer patients needing transfer to higher, more
costly levels of care. A computer Telephone integrated (CTI) system can monitor vital
functions of patients twenty-four hours a day and give immediate warnings.

USES OF TELEMEDICINE

o Telemedicine is most beneficial for populations living in isolated communities and

remote regions and is currently being applied in virtually all medical domains.
Specialties that use telemedicine often use a tele prefix; for example, telemedicine as
applied by radiologists is called Teleradiology. Similarly, telemedicine as applied by
cardiologists is termed as telecardiology etc.
o Telemedicine is also useful as a communication tool between a general practitioner
and a specialist available at a remote location.
 26

o The first interactive telemedicine system, operating over standard telephone lines, for
remotely diagnosing and treating patients requiring cardiac resuscitation
(defibrillation) was developed and marketed by Med Phone corporation in 1989 in the
U.S served as receiving and treatment enters.
o Monitoring a patient at home using known devices like blood pressure monitors and
transferring the information to a caregiver is a fast-growing emerging service. These
remote monitoring solutions have a focus on current high morbidity chronic diseases
and are mainly deployed for the First World, Glucometer.

BARRIER IN TELEMEDICINE

Physician / patient acceptance: It has been found that patients have no difficulty in accepting
telemedicine program. A survey done in Orissa revealed that 90% patients were satisfied with
using telemedicine technology. In almost all the cases the patients are more than happy and
satisfied as they don’t have to travel long distance to show their diagnostic reports to their
doctors and also, they got the specialist consultation and their cases has been seen by some
expert doctors. Some resistance is seen amongst doctors. They see telemedicine as an
additional duty or workload. Therefore, there is a need to weave telemedicine into the routine
duties of the doctors. Some private doctors fear that telemedicine is likely to reduce their
practice. They need to realise that this technology enhances their reach and exposure and is
only likely to increase their practice further.

Availability of technology at a reasonable cost: There is a myth that establishment of a

telemedicine platform is expensive. The basic system needs hardware, software and the
telecommunication link. In all the areas there is a significant reduction in the price. Most of
these costs are well within the reach of most of the hospitals, and can be recovered by
nominal charge to the patient and student in case of tele education.

Accessibility: Although information technology has reached in all corner of the country but
the accessibility of people living in remote and rural area to the nearest health centre (PHC’s,
CHC’s or district hospital) may not be easy due to poor infrastructure of road and transport. It
may be possible that the available telemedicine system in theses health centred may not
function because of the interruption in power supply / technical problems.

Reliability: Some healthcare professionals have a doubt about the quality of images
transmitted for tele consultation and tele diagnosis. In tele radiology, tele pathology, tele
dermatology the quality of image (color, resolution, field of view, etc) should be of
 27

international standard to avoid any wrong interpretation of data may be of critical importance
in tele-monitoring and robotic surgery and have to be reduced to the minimum.

Lack of trained manpower: Telemedicine is a new emerging field there is lack of training
facilities with regard to application of telemedicine. Most of the healthcare and IT
professionals are not familiar with the program. Telemedicine is not the part of course
curriculum of medical students.

ADVANTAGES OF TELEMEDICINE

For the patients:

o People at remote areas get top class medical facility from reputed hospitals.
o Reduces travel cost and save time for the rural patients.
o Reduces lot of inconvenience for the rural patients.

For the hospitals:

o Hospitals can spread their reach in remote villages and serve people without much
investment on the infrastructure.
o The hospitals get revenue from the reference made from the remote locations.
o After care or post operated care patients need not come to the main hospital for minor
consultation.
o Primary diagnosis can be done with the use of telemedicine and patient can come to
the main hospital for major surgery.
o Hospitals can have CME programmes with other hospitals and medical colleges.
o Hospital can run training programme from their hospitals to doctors of other hospitals.
o A rare operation or a diagnosis can be broadcast to other hospitals.
o Doctors can learn new techniques by connecting to foreign hospitals. Overseas
consultation and second opinion can be got.
o Job interviews can be conducted.
o Live images like ECG, USG, CT scan, Echo, X-rays and any video output from
medical instruments can be transmitted.
o Screen captures software- use of graphic image.
o Clip art - commonly used in library as graphical image such as computer, flowers,
building, a nurse etc.
 28

Others:

o Animation
o Audio, recording
o Video
o Multimedia application- conferencing, video games.
o Advertisement
o Practicum- invitation preparation, collect data and display in graphic form.

DISADVANTAGES

o Do rural homes have PC

o Cost of telecom infrastructure
o Lack of standards
o Difficulty in trained users
o Difficulty in maintaining equipments
o Patients’ confidentiality

ENDEAVOURS IN TELEMEDICINE IN INDIA

 Apollo Hospital Groups

 Telemedicine Project by Bharat Electronics Limited
 Telemedicine Project by National Informatics Centre (NIC) Ministry of Information
Technology Cardiovascular Technology Institute, Hyderabad, in Association with
Defence Organizations
 Department of Information Technology at Ministry of Communication and IT
(Government of India) in 1999 (as Pilot Project) to link AllMS New Delhi, Post
Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sanjay
Gandhi Post Graduate Institute of Medical Sciences (SGPG) Lucknow, for realizing
telediagnosis, tele consultancy and tele-education
 Telemedicine programs supported by Department of IT (DIT), Indian Space Research
Organization (ISRO) North Eastern Space Applications Centre NACI Telemedicine
Program. Apollo Hospitals, Asia Heart Foundation, state governments, some private
organization

SUCCESS STORIES OF TELEMEDICINE

 29

 During Kumbh Mela in Uttar Pradesh (UP) through Online Telemedicine Research
Institute of India (OTR), for transferring the specific data and monitoring the level of
cholera in water
 Asia Heart Foundation, Bengaluru practices Interstate link between Bengaluru and
eastern India and educating paramedics for lifesaving procedures through
videoconferencing.
 The telemedicine software system developed by the Centre for Development of
Advancement Computing. The Centre for Development of Advanced Computing (C-
DAC) using Integrated Services Digital Network (ISDN). A very small aperture
terminal (VSAT), POTS (plain old telephone service) to connect them and being
connected to include medical centers in Rohtak, Shimla, and Cuttack
 Telemedicine system installed in Calcutta School of Tropical Medicine (CSTM)
 First international conference organized by ISRO at Bangalore in March 2005
 There are many more telemedicine centers in the country

BENEFITS OF TELEMEDICINE, E-HEALTH, AND HEALTH INFORMATION

TECHNOLOGY

 It helps the patient to make decisions and enhances the quality of care.
 It saves lives through remote consultations, whether urgent or diagnostic.
 It creates a more efficient, convenient, and potentially more cost-effective delivery of
care.
 It facilitates earlier and accurate diagnoses.
 It provides higher and faster access toa patients medical history, reducing the risk of
adverse drug interactions or inadequate response to a course of treatment.
 It improves administrative efficiency and coordination.
 It allows patients to receive expert diagnosis and treatment from distant medical
centers.
 It increases the timeliness of treatment and decreases transfer rates, while reducing
medical costs through video technology.
 It supports real time treatment by first responders through the use of wireless devices.
 It enhances care through telemedicine and remote in-home monitoring.
 It improves quality of care by:
 Facilitating equitable access to our specialists for all patients regardless of
their location.
 30

 Increasing active participation in inpatient/ family education

 Enhancing family satisfaction by reducing the cost and time incurred
traveling.
 Improving quality time with their specialist.
 Reducing duplicate testing.
 Improving continuity of patient care by health care providers.
 Enhancing specialist comfort by reducing the need for physician travel to
underserviced areas.

TELENURSING

Tele-nursing-to boldly go where no one has gone before. -ICN

Telenursing is an emerging field in nursing and gaining popularity. It uses telecommunication

technology and electromagnetic channels (e.g. wire, radio, optical) to transmit voice, data,
and video communications signals. Its applications enhance patient care in nursing.

Tele is a prefix meaning "at a distance" and used in telescope, the term scope means an
instrument for viewing phenomena at a distance. The term "tele" is being used in healthcare
services such as telemedicine, telehealth, telenursing, etc. The common denominators are
distance and technology. The developed countries are using the telenursing strategy to
provide nursing care, which is found feasible and cost-effective. In the Indian scenario, it is
still in the infancy stage. It needs to be planned carefully, keeping in mind the scope for
monitoring, accreditation, and the quality of nursing practice.

DEFINITIONS

 Telenursing refers to the use of telecommunication devices and information

technology to provide nursing care from a distance to isolated groups of people. It is a
subset of telehealth focusing on delivery, management, and coordination of services
and care via telecommunications.
 Telenursing is the use of telemedicine or telehealth technology to deliver nursing care
and conduct nursing practice. It uses electromagnetic channels such as wire, radio,
and optical to transmit voice, data, and video communications signals. It is a distance
communication strategy achieved using electrical or optical transmissions between
 31

users and computers (ICN, 2001, 2007). It is the e-health application to professional
nursing practice.
 Telenursing is a strategy in which nurses deliver, manage and coordinate patient care
and services via telecommunication technology. Telephone nursing was first used by
the nurses in the late 1800s.

COMMUNICATION AND INFORMATION TECHNOLOGY DEVICES IN

TELENURSING

1. Hardware: It includes telephone, telehealth hardware, PC or laptop, power supply,

and access to Web sites.
a) Telephone: The telehealth system requires the patient's telephone system for
operation. There should be a working telephone to connect the monitor directly to
avoid any interruption in phone service.
b) Telehealth hardware: It consists of equipment such as a monitor, electronic blood
pressure cuff, pulse oximeter, scale, electrocardiogram (ECG) leads, video camera,
blood glucose, and peak flow capabilities. Many companies design wireless versions
of these pieces of equipment for convenience.
c) The PC or laptop computer: There should be a PC or laptop with Internet access to
reach the patient data. It requires a power source with a wall outlet.
d) Power supply and Web access: There should be a provision of an uninterrupted power
supply or backup system. The users must have access to healthcare-related Web sites.
2. Telehealth monitors: These are vital sign monitors, pulse oximeter, and glucose
monitors. There should be a provision of feeding measurements and peak flow
readings monitor. The interpretations of the monitor must be easy to read by the
consumers. It should have large print, some have prompted voice, the monitors should
be easy to use, and user-friendly.
3. Software: These are the operating systems-Linux, national database, security
technology and firewalls, and rewritable flash memory.
a) Operating system: It is an operating system such as Windows XP; this is a free
operating system that users can access. Linux system is one of the examples of such
an operating system used by the telehealth companies.
b) National database: A national database system uses technology to ensure compliance
and privacy standards. It has a user password to access the data. It stores patients
Information and trends. The users can access at any time by entering passwords.
 32

c) Flash drive: The flash drive can use to store data by the patient to hand over to
healthcare facilities. The monitor has the facility for reprogramming the database
when the patient is no longer using the system.
d) Firewalls and other security devices: The system has the facility of security devices
as firewalls to provide security of data.
e) Monitors: There are two types of monitors-top monitors and bottom monitors.
Multiple patients can use top monitors, and the bottom monitor is only for individual
patients and the information is transmitted via POTS (old telephone system), the
router, and fire- walls to the Internet servers, flowing to the application server stores
in the database.
4. Software program: Many software programs are available to us in telehealth, such as
Cerner software and Misys Healthcare Systems. The Cerner software system allows
users of telehealth to view patient information in a single application. It has an
electronic medical record consisting of demographics, vital signs, various tests,
clinical note entries, etc. sections. Misys Healthcare Systems include patient
registration, discharge, and updating patient information by the healthcare provider
via computer access.

ADVANTAGES OF TELENURSING

1. Provide remote care: Telehealth nursing bridges the distance between the nurse and
the patient and a new strategy to provide the round- the- clock care. It aids in
monitoring patients suffering from chronic diseases and coordinating care to patients
with comorbidities from remote and distant areas. The telenursing provides an
opportunity to teach patients to manage their disease symptoms, improve their
compliance for treatment, and follow-up.
2. Reduces patient visit: Telenursing aids in reducing the hospital visits of the patient by
rendering care from a distance. They can communicate with patients via many
telecommunication facilities.
3. Reduces distances: Telenursing can provide remote care to patients. The healthcare
providers and patients can talk from miles or from states to countries.
4. Data sharing: Telehealth provides an opportunity to render care and share data by the
healthcare professionals for an individual who can share data via a secure Web- based
data system. The healthcare providers can view the data collected on the Web site, and
the data the patient has saved on a flash drive, fax, or e-mail.
 33

5. Rapid response time: Telecommunication and information system have the provision
of having fast response time according to the patient's needs to provide timely
intervention to improve patient care for patients with chronic health issues.
6. Improve access, costs, and outcomes: Telehealth gives an avenue to provide access to
needed care. It results in reducing the cost of care and improving care. It also reduces
the workforce and traveling expenses to achieve the desired goal.
7. Enhances patients' decision-making: The patients and families get the opportunity to
make their own decisions regarding their health. They can directly interact with
healthcare providers to make decisions on their health issues. Telenursing provides a
means to educate patients and families on their illness, medications, etc.
8. Proximity to care: It brings closeness to the nursing care, shortens hospitalization,
and reduces the workload. The telenurses can participate virtually in all the practice
settings for public health, family practice, outpatient department, emergency
department for providing health services to the clients using protocols, use
videoconferencing, can monitor the status of early discharge patients over telephone,
e-mails, by developing Web sites to provide health information.

EVIDENCE BASED BENEFITS OF TELENURSING

Care related

 Uses triage from centralized room, thus reducing the use of emergency rooms.
 Increase access to services to widely dispersed populations through
videoconferencing, internet, videophone, e-mail consultation, short message service
(SMS) in home nursing is especially useful
 Care of elderly, children, and adults with chronic conditions and debilitating illnesses,
postsurgical situations, mothers with difficult infants reduced fatigue and distress,
women with pregnancy induced hypertension.
 Home monitoring of physiologic parameters, providing accurate and timely
information and support online
 Examination of test results and monitoring of daily life and symptoms for home
oxygen therapy clients
 Helps patients and families to be active participants in care, particularly in the chronic
illness, change a dressing, give an insulin injection, or discuss increasing shortness of
breath
 34

 Reducing the requirement for, or the length of, hospital stays

Professional education

 Sharing of clinical information with national and international experts

 Access to literature and research used extensively in continuing education
 Enhancing and practicing clinical skills through patient simulation modelling
 Offering a doctorate in nursing completely via online distance education
 Providing opportunities for senior nurses to work in the clinical arena
 Allowing a nursing student to access a clinical data repository, a faculty supervisor,
and the Web.
 Disseminating educational and other materials by using Web

Increase satisfaction among nurses

By creating more collaborative and autonomous roles

IMPLICATIONS FOR NURSING

1. It helps in delivering, managing, and coordinating care to patients in many geographic

areas.
2. It makes it easy to use many technologies available to view and share patient
information providing prompt and effective care.
3. It plays a vital role in disease management and improving patient outcomes through
distant care.

DISADVANTAGES OF TELENURSING

1. Dehumanizing effects: There are healthcare professionals who feel the telehealth
system has dehumanization effects. With the lack of staff, they are providing the best
nursing care possible. It is not possible to give the human touch to do an assessment.
Many professionals feel without direct patient contact, triaging may be difficult.
2. Cost: Telenursing is quite costly due to the value of the monitor and equipment.
3. Inability to use equipment: Caregivers and health professionals sometimes do not
feel confident to use this equipment. Many patients hesitate to use electronic
equipment.
4. Lack of telehealth knowledge of the nurses: Sometimes nurses may not be skilled
enough to handle the monitors or may lack knowledge of its functioning. The
 35

knowledge base of the nurse and clinical competence is vital to interpret data of the
patient to provide appropriate interventions. Clinical guidelines are needed to ensure
the consistency of care.
5. Equipment malfunction: Broken and malfunctioning equipment could be detrimental
to our home-bound patients. The system cannot operate if the patient does not have a
working phone or phone. If there is no Internet service for the nurse to retrieve the
data from the Web site, the data become useless.

PROBLEMS IN IMPLEMENTING TELENURSING

1. Acceptability by patients: The patients who prefer to see health care providers face to
face. Reimbursing providers may be challenging to track and prove.
2. Patient understanding: Patient understanding of how to use the equipment, when to
use the system, and how it may impact their health is a vital element in the success of
the program. Proper patient and provider education are imperative.
3. Software knowledge: Problem exists with any new procedure, piece of equipment, or
technology. With the implementation of telehealth, nurses must learn how to use the
technology that is the foundation of the system.
4. System errors: System errors can occur with software applications and Internet
service, and equipment malfunctions may also occur.
5. Cost: Cost is a factor that many do not like to consider when quality patient care is the
concern. Initial cost outlay may be prohibitively high.
6. Security and privacy of data: There is a risk of data security, i.e. anyone can track the
password to access the information. Privacy is an ongoing concern.

GUIDELINES

There should be practice standards guidelines

o To address the quality-of-care issues for providing the nursing services through
distance.
o Practice standards guidelines should be directed to promote safe, competent and
ethical nursing practice and in term of structure, process and outcome with indicators.
o Telenurse should have special license, specially trained for Telenursing.
 36

o There should also be a provision for continuing education to update their level of
performance. Telenursing practice standard guidelines should be within the
competency framework
o The core competencies related to technology, proper working of equipments,
clinical/technical, education and knowledge and code of ethics are required to be
defined for the telenurses.
o Policies for the safe and ethical Telenursing practice need to be focused on
accountability, client choice regarding, informed consent to treatment/care, seat-
liability, and confidentiality and privacy

ISSUES IN TELENURSING

 Societal: Acceptance by society, patients, specialists, administrators, and the

government
 Technical: Telecommunication infrastructure
 Standards: Safety standards standardizing, certifying, authenticating, and registering
telenursing
 Regulatory issues: Credentialing and certification
 Professional liability: Administrative liability and civil liability
 Professional: Standards of practice and competencies designed by the regulatory
bodies
 Legal issues: Regarding the care of patients
 Security: Privacy, confidentiality, and data security
 Financial: Payments and reimbursement issues.

COMPETENCIES FOR PROFESSIONAL PRACTICE IN TELENURSING

Competency Competency description

Competency 1 Telenurses demonstrates a sound level of judgement, discretion, and
decision making when communicating with each caller
Competency 2 Telenurse practices nursing in a manner that the caller determines as
being culturally safe
Competency 3 Telenurse demonstrates sound clinical nursing leadership
Competency 4 Telenurse monitors and improves the standards of telenursing through
active involvement in quality improvement and risk management
 37

processes
Competency 5 Telenurse develops nursing practice through research and scholarship

TELENURSING PRACTICING STANDARDS

The standards must be consistent with the Indian Nursing Council (INC) practice standards,
code of ethics, state registration act. These must address the following:

a) Quality-of-care issues for providing nursing services through distance

b) Promote the safe, competent, and ethical nursing practice, in terms of structure,
process, and outcome with indicators
 License for the nurses after attaining skill in telenursing
 There should be a plan for continuing education to update the nurses' level of
performance
 Focus on policies for the safe and ethical telenursing practice, locus of accountability,
client choice regarding telenursing, informed consent to treatment/ care, security,
confidentiality and privacy, liability, and protection of client.

ROLE OF NURSE IN TELENURSING

 Ensure proper and accurate documentation in electronic or paper format

 Carry out only the activities you are competent and authorized to perform
 Ensure the privacy, security of patient information
 Establish client-nurse relationship so as to establish a duty of care
 Take into account client’s spiritual and psychosocial needs and preferences as
everybody is unique

CONCLUSION

Telenursing is one of the various innovative and improved methods of providing nursing care
that directly affects registered nurses and expands their capacity to practice nursing in a
relatively new arena as well as directly affecting clients. Nurses have a key role to play and
implementation of telenursing services. It is therefore expected of them to understand their
role so as not to go beyond their locus of duty.

RESEARCH REFERENCE
 38

 Kalia R, Saggi M. Telenursing and challenges in India. Asian Journal of Nursing

Education and Research. 2019;9(4):573-6.
The delivery of healthcare services, where distance is a critical factor, by all
healthcare professionals using information and communication technologies for the
exchange of valid information for diagnosis, treatment and prevention of disease and
injuries, research and evaluation, and for continuing education of healthcare
providers, all in the interests of advancing the health of individuals and their
communities. Tele nursing refers to the use of telecommunication and information
technology for providing nursing services in health care whenever a large physical
distance exists between patient and nurse. Tele-nursing can reduce the requirement
for, or the length of hospital stays. Adults with chronic conditions who need frequent
monitoring, assessment, and maintenance but do not meet home care criteria or have
no money to pay for services can be benefitted from technology. The result is a
decrease in total health care costs and increased access to health care with more
appropriate use of resources. Although telenursing brings great advantages for both
patients and personnel in the form of, for example, resource and time allocation and
improved patient access, it might also entail ethical difficulties.
o Kats S, Shmueli L. Nurses' perceptions of videoconferencing telenursing: comparing
frontal learning vs. online learning before and after the COVID-19 pandemic.
medRxiv. 2023:2023-05.
This study examined nurses' willingness to use telenursing through
videoconferencing, comparing frontal vs. online training in post-basic nursing
courses, using the Technology Acceptance Model (TAM) and Theory of Planned
Behavior (TPB). Findings revealed nurses' favourable attitudes regardless of training
format. Willingness was significantly influenced by perceived ease of use and
subjective norms. To enhance telenursing adoption, managerial encouragement,
adequate training, and resource provisions are imperative for nurses to use this
technology for remote patient care.

BIBLIOGRAPHY

1. BT Basavanthappa, "nursing management in service and education", published by

Manivannan C, Manivannan T Latha, Baskaran J, page no: 224
 39

2. I. clement, "management of nursing services and education", second edition, publish

by Elsevier, page no: 107
3. Vati Jogindra, "principles and practice of nursing administration", 2013, Published by
Jaypee brothers, page no: 254
4. www.wikipedia.com
5. www.slideshare.com
6. https://www.scribd.com/document/272640756/E-nursing-Telemedicine-and-
Telenursing
40
 M.O.S.C MEDICAL COLLEGE, KOLENCHERY

NURSING MANAGEMENT

SEMINAR ON
MANAGEMENT INFORMATION
AND EVALUATION SYSTEM

E- NURSING, TELEMEDICINE &

TELENURSING

Submitted To: submitted by:

Dr. Preethi Jawahar Josephine Jojo

Professor IInd Year MSc. Nursing

M.O.S.C College of Nursing 2022 – 24 Batch

Kolenchery

Submitted On: 01/01/2024

 Index
Sl no Content Page No
Management information and evaluation system
1. Introduction 1
2. Concept 1
3. Definition 1
4. Objectives 2
5. Importance 2
6. Implementation Methods 2
7. Classification 3
8. Purposes 4
9. Advantages 4
10. Limitations 4
11. Nursing Management Information System 4
12. Evaluation System 6
13. Conclusion 7
14. Research Reference 7
E- Nursing, Telemedicine & Telenursing
15. Introduction 9
E – Nursing
16. Definition 11
17. Modalities 11
18. Styles 12
19. Kinds 14
20. Importance 14
21. Theoretical Base 15
22. Skills required in e-nursing 18
23. Advantages 19
24. Issues 19
Telemedicine
25. Definition 20
26. Types 22
27. Process 23
28. Application 25
29. Uses 25
30. Barriers 26
31. Advantages 27
32. Disadvantages 28
33. Endeavours 28
Telenursing
34. Definition 31
35. Devises 32
36. Advantages 32
37. Evidence based Benefits 33
38. Implications 34
39. Disadvantages 34
40. Problems in implementation 35
41. Guidelines 35
42. Issues in Telenursing 36
43. Competencies required 36
44. Practice standards 37
45. Role of nurse 37
46. Conclusion 37
47. Research Reference 38
48. Bibliography 39