Using Web Technologies to Promote Lactation Healthcare

Running head: USING WEB TECHNOLOGIES IN LACTATION HEALTHCARE 1

Using Web Technologies in Lactation Healthcare Promotion

Denise Breheny

Queen's University of Charlotte

USING WEB TECHNOLOGIES IN LACTATION HEALTHCARE 2

Abstract

The purpose of this paper is to elucidate how new technologies, and social media in
particular can be utilized by lactation health professionals in our promotion and support of
healthy infant feeding practices. This is an important topic because although there is a presence
of breastfeeding information on the Internet, there is a paucity of research articles describing or
surveying the range of information technology, particularly Web 2.0 interactive and social media
in the lactation field. The typical American woman of child bearing age is typified by either
Generation X or Y, the first generations to experience electronic technology at an early age. She
has come to rely on the convenience of the Internet for information. She will consult the Internet
regularly for information to assist with her infant feeding choice decision. She may also consult
the Internet when she has a question or is experiencing difficulties with breastfeeding. This paper
includes examples of how lactation health education can effectively be communicated to this
generation of women through the use of the new interactive Web technologies. Through Web
2.0, Blogs, Podcasts, YouTube, Social Networking, even Virtual Gaming, we must consider all
the information technologies currently available in our quest to educate and encourage
breastfeeding. Can the Internet’s interactive communication platforms provide a credible source
for breastfeeding information? A new paradigm is immerging to gain the attention and meet the
needs of these new generations on this important health topic.

Key words: Web health education technologies, lactation/breastfeeding: Web pages, blogs,
podcasts, social networking sites, Facebook, Twitter, YouTube.


Using Web Technologies in Lactation Healthcare Promotion

Introduction

Lactation healthcare education and promotion is focused on a specific population, those

women of childbearing age specifically the members of generations X (1961-1980) and Y

(1981-2000). Many defined by these generations are looking for and expect quick fixes; they are

regularly relying on gadgets and openly expect their own needs to be met first. We are at the age

where we need to be wired for new technologies as well as being able to speak the shorthand

defining each new medium. Beyond the information technology challenge, the younger adult

generations tend to turn a deaf ear to traditional health promotion marketing. As daily users of

electronic forms of communication, they are most likely to turn to this media first. These

generations are often doubtful of advice that comes from outside of their social contacts. In

order to reach out to these generations, the lactation professional needs a shift in thinking about

how we communicate to and with our audience. How can the utilization of technology,

specifically the Internet, elicit excitement in lactation among these new mothers?

Although there is a presence of information on breastfeeding and lactation on the

Internet, in performing the literature search for this paper it was found that there is a dearth of

research articles describing or surveying the range of information technology, particularly Web

2.0 interactive and social media technologies in the lactation field. In 2000, Riodan described

the development of teaching strategies for her university-based graduate breastfeeding Internet

course (Riordan, 2000). Although Dr. Riodan’s article did not discuss Web 2.0 technologies,

this is the first published article found that integrated breastfeeding education and the use of

Internet Web technology. In this article she described the Internet as having “great potential” for

lactation education. In 2002, Jordan & Jordan compiled a listing of Lactation Management


Resources on the Internet (Jordan & Jordan, 2002). Their article discussed the many Internet

sites which have emerged for the nursing mother and the lactation or other health professional.

These sites include topics ranging from the emotional and economic benefits of breastfeeding, to

the biology of milk production, to a number of organizations which support breastfeeding. In

2003, Cheng et al. discussed a Web-based breastfeeding education program developed for new

parents who looked at whether the inclusion of graphics in the breastfeeding learning tool was

preferred over a text-only program (Cheng, Thompson, Smith, Pugh, & Stanley, 2003). In an

article published by Nursing for Women’s Health, Miller et al. concluded that new mothers

continually consult public media in their search to gather information on infant feeding, and

therefore a versatile approach to breastfeeding education was needed which included the use of

the Internet to promote positive media messages (Miller, Cook, Brooks, Heine, & Curtis, 2007).

In an editorial note for the Journal of Human Lactation (JHL), Heinig called for lactation

professionals to “lean how changing demographics may affect how we currently approach

breastfeeding promotion and support” (Heinig, 2009, p. 263). Dr. Heinig continued her

commentary in the subsequent JHL editor’s note, stating that the Internet, especially with the

new Web 2.0 technologies, provided opportunities for mass communication at a reduced cost

(Heinig, 2009). She discussed how we now are not restricted to educational systems for

learning, that new options have become relevant with the new interactive technologies available

through Web sites, social networking sites, e-mails, etc. which are engaged in both the

generation and receipt of information. She also expressed her concerns in “the ability of my

students and the public to discern fact from fiction (Heinig, 2009, p. 395).” Although this topic

has been ignored in the past publication of articles and research devoted to the integration of

information technologies specifically with the goal of increasing the incidence and duration of


breastfeeding, now is the time for this topic to be explored by lactation professionals. This paper

presents a few of the most popular Web 2.0 technologies available, we need to research how

these emerging technologies might be best utilized in the communication of breastfeeding

information to the nursing mother.

Breastfeeding

Breastfeeding is the preferred feeding method for infants and has been supported by

professional health organizations including the American Academy of Pediatrics (AAP) due to

its many health benefits to both the mother and the child. Breastfeeding first was included as an

element of the United States Healthy People (USHP) in 1978 (U.S. Department of Health and

Human Services [USDHHS], 2000). The current USHP goals for 2010 are that at least seventy-

five percent of mothers exclusively breastfeed during the postpartum period, at least fifty percent

of these women will continue for at least six months old, with twenty-five percent continuing on

until the infant is one year of age. Unfortunately, the exclusive breastfeeding rate among new

mothers has fallen short of these goals. According to the statistics available through the New

Mothers Survey last conducted by Ross Products in 2003; exclusive breastfeeding initiation was

merely sixty-six percent, and fewer then thirty-three percent of new mothers were still

exclusively breastfeeding at six months (Ross Products Division, Abbott Laboratories [Abbott],

2003). Hoyer & Pokorn, (1998) showed in their study that mothers who continued breastfeeding

longer were better informed on this health topic, and generally make this decision before giving

birth. Providing a means of easy access to information through information technologies could

have an impact on increasing the actual numbers of mothers meeting the goals of USHP2010.

Through the adoption of new and emerging information technologies (IT) such as: Web 2.0,

Blogs, Podcasts, Twitter, Social networks and other IT, we may be able to offer an revamped


health educational strategy to help mothers to gain the supportive and assistive breastfeeding

information necessary to encourage initiation as well as promote a longer duration of

breastfeeding.

Defining the User Population

Taking a look at the current demographics—those of the greatest number of childbearing

ages—have been defined as Generations X and Y. Generation X (X’ers) were born between the

1960s and the Mid- 1980s. This generation was raised as latchkey children because both parents

were likely to work outside the home. They were raised in the era of television and

communication which involves technology is appealing to them. Technology made major

advances during the period that X’ers were growing up, and has been embraced by this

generation. They were the first generation introduced to computers and became comfortable

with new electronic forms of communication (Kramer, 2010). Generation Y (also known as the

millennials) were born between the 1980’s and 2005. The millennial generation tends to come

from more protective environments having been shielded by their parents from economic

difficulties, violence and terrorism. They seek a personal touch for support, understanding,

communication and feedback. Multiculturalism, text messaging and the Internet have always

been a part of their lives (Kramer, 2010). Both the X’ers and millennials are considered digital

natives, a term coined to define “those who choose to use technology for numerous tasks; adapts

as the tools change; and may have either grown up with technology or adopted it as an adult”

(Herther, 2009, p. 16). As digital natives they often seek out the Internet as the first place to

gather information, especially health information and advice.


Web 2.0

New interpretations of Internet informatics emerged with the concept of Web 2.0. Web

2.0 was first used by O’Reilly and others as a description for technologies which use the

collective input from the Web’s community towards maximizing the information available

through the provision of user based content (O’Reily, 2005). Along with Web 2.0 a new

paradigm emerged with the patient not as just a patient or client, but the patient as a consumer or

purchaser of health care and health care information. These new health consumers (gen X &Y)

have strong likes and dislikes which are influenced and shaped by the information available

through social communication. For these generations turning to the Internet has provided a

powerful importance on decision making, particularly health decisions because of the Internet’s

ability to provide social opinions and communications.

According to Craig Lefebvre, Web 2.0 isn’t a place where people visit, “but rather

destinations where they go to get things done—Flickr and YouTube to share photos and videos,

MySpace and Bolt2 to meet and network with people who share similar interests.” (Lefebvre,

2007, p. 33). With the advent of Web 2.0, particularly the participative Internet (known as

social media), Web sites became more dynamic and communication more participatory with

information sharing, video data, and text data and social media all supporting the format

provided by the originator. This provided a rich medium for health information and health

learning often sought by consumers because the Web offers privacy and flexibility for consumers

in meeting their educational needs.

Social networking participation has more than quadrupled in recent years according to

Jones and Fox (2009). Research comparing Web-based programs with traditional health learning

has shown that patient consumers enjoy interacting with computers, they also have better recall


of the information they were pursuing. The interactivity of Web based information, the instant

feedback and recommendations available can be especially helpful in reaching mothers-to-be

when they are making feeding choices, and mothers seeking information to sustain breastfeeding.

Social Media

Interactive social media includes: Podcasts, Blogs, Cell phones, Texting, Instant

Messaging and Social Networking. The new social medias are providing a wave of new

technology for healthcare as well as real-life examples of how media-based offering are getting

results. Social networking sites like MySpace, Facebook and YouTube are connecting billions of

network consumers. Today there are entire sites created to share health care information. Take

for example DailyStrength.org (DailyStrength.org, n.d.). This site offers more that 500 support

groups online, one for every health issue and life challenge from Abstinence to Zellweger

Syndrome, and yes even a support group for breastfeeding with more than 700 members (http://

www.dailystrength.org, accessed November 14th, 2010). Once registered, the new member has

access to the various support groups for commentary or advice. There is also additional

feedback available through links to their Facebook and Twitter sites.

A recent survey looked at the numbers of participants drawn purposely to various social

media sites for health related information. Social networking sites were shown to attract the

widest amount of utilization, accessed by twenty-three percent of Internet users (Chou, Hunt,

Beckjord, Moser, & Hesse, 2009). According to Eysenbach, these trends are expected to grow

especially as personal wireless devices become more mainstreamed (2008). Already with the

advent of smart phones and iPads, more and more individuals have Internet access within their

hands reach and are turning to social media sites on a regular basis.


With respect to influencing feeding decision making and increasing the duration of

breastfeeding, lactation professionals need to create incentives, reduce barriers, and open up

more opportunities to sustain healthy feeding behaviors. Social media as a medium of

communication to breastfeeding mothers provides the lactation professional with an excellent

platform for the dissemination of breastfeeding information and discussion while providing

commentary to posts. Since these sites are accessed continually this is an excellent place to

provide assistance to the mother-to-be, or breastfeeding mother as an intermediary, and

providing links to sites which can supply an additional credible network of breastfeeding

information.

Blogs

Mothers of Generation X may be more willing to listen to their peers than seek the advice

of older lactation professionals. For these women getting advice from blogs or discussion boards

may accommodate their needs. The Blog is one of the fastest-growing tools for communication

on the Web, Blog is short for Weblog (Jensen, 2003). The term "Weblog" was first coined by

Jorn Barger in 1997, and was shortened to the popular “Blog” a few years later (Wortham,

2007). Blogs encourage self reflection and therefore are generally anecdotal in any information

obtainable in this form. According to Susannah Fox, “e-communities and Blog sites are not just

about emotion but about maximizing the network to improve people’s health” (Fox, n.d.). She

believes it is why people are compelled to share personal information—that it is to benefit others

—to provide support for strangers, to help and connect.

Compared to social networking sites, Blogs attract a smaller audience (7% of Internet

users) for health related content (Chou et al., 2009). Never-the-less blogs with good information

and bad information will continue to be consulted by many viewers as evidenced by site visit


counters and feedback, which may provide a better assessment of blogosphere penetration.

Often gen X’ers and millennials tend to view a majority consensus of agreement as sufficient

evidence to support their infant feeding practice and beliefs (Heinig, 2009). Bloggers have been

observed to act as important communication stakeholders—not only for the dissemination of

information, but also for the capability of directing visitors through opinion and hyperlinks

(Lefebvre, 2007). A Blog, as a part of a professional lactation practice either private, physician

or hospital based, could provide useful information on current lactation promotions or events;

thus providing a more substantial presence in the web based community where the X’er and

millennial would be seeking information and where they routinely interact on a daily or weekly

basis. The Blog can be very influential in the choices these generations make about health

behaviors.

Twitter

In a systematic review conducted by Fry and Neff (2009) there were positive findings

that providing prompts via email, computer or telephone effectively enhanced diet, weight loss

and exercise behaviors (Fry & Neff, 2009). Even more positive effects were associated with the

use of messages specifically tailored to the receiver. Twitter could become a great tool for

lactation professionals. Twitter was started as an experiment in 2006 and incorporated in 2007

(www.twitter.com). Twitter permits short messages of a maximum of 140 characters which can

be sent to followers which are called Tweets. In the health field Tweets have already been

utilized by researchers to demonstrate patterns of flulike symptoms in communities prior to an

outbreak, allowing health systems to become more aware (Scanfeld, Scanfeld, & Larson, 2010).

Twitter can be used for direct messaging which is useful for health communications

which may be sensitive in nature. For example a lactation professional could moderate content


and intervene in the case of inappropriate or potentially hurtful messages. The lactation

professional could also utilize Twitter as a source for motivation and inspiration by providing

reinforcement for positive changes, motivation during weak moments or frustration with feeding

practices, and in celebration of successes. As an intervention a lactation professional could

provide structured Tweet messages or reminders to influence positive breastfeeding health

behaviors.

Pod Cast, YouTube

Lactation professionals can use audio or video presentations on the Web as another form

of breastfeeding health education. YouTube was created by three former PayPal employees in

2005 and was named Invention of the Year by Time magazine in 2007 (Hopkins, 2006).

YouTube provides incredible technology which allows for inexpensively produced short length

videos to become available on the Web. Many large health organizations are already utilizing the

power of social media sites such as YouTube, in response to economic pressure and competition,

there are already more than 421 hospital YouTube channels (Bennett, 2010). The beauty of this

social media is that it doesn’t need to be restricted to just the large corporation. Smaller and

private practices could utilize the power of a video to make a considerable contribution to the

already vast amount of information available on the Internet. By placing evidence based

information promoting the lactation professional and breastfeeding, these messages could

provide just the information someone needed to get through a tuff spot. Finding patients willing

to participate in a video which would be posted on the Internet could be a challenge, but

according to Ruth Ann Hale, Director of Media and Community Relations at Methodist

University, “most patients asked are quite willing to participate in events that will help educate

others with their medical condition.” (“Are you Twittering, getting friends on Facebook, and


YouTube? “, 2009). Of course it is important to take measures to protect the patient’s privacy

before positing a video on the Internet. It is also important to make sure the patient was fully

engaged and positively on board. There are also companies such as InJoy video productions that

can provide short video productions specifically tailored to individual needs (Personal

Conversation, 2010). Imagine videoing a snippet, a test weight for example, from a

consultation--this might be just what a mother needed to see to make the decision to actually

follow-up with a consultation. This is a great way to get across messages to the Xers and

Millennials.

Second Life

Second Life (SL) is an online virtual reality world created by Linden Research in 2003.

Users are called residents and can create their own virtual selves which are called avatars and can

interact within a simulated 3-D environment in their virtual “Second Life.” The residents can

explore their virtual world by visiting islands or virtual lands. The content of Second Life is all

user generated. In 2008 there were over 15 million registered users and over 1 million are active

users (Linden Research, Inc., 2009). The average age of the user is 32 (Beard, Wilson, Morra, &

Keelan, 2009). Anonymity and interactivity is encouraged by SL and because of this many

different health care agencies, organizations, companies and private groups have chosen SL for

one of their Web 2.0 communication strategies (Beard, Wilson, Morra, & Keelan, 2009). The

health related activities on SL are focused in education and awareness sites, support sites, health

training sites, marketing and promotion of health services sites and research. For lactation

establishing a presence in the education and awareness sites could provide an approach to

disseminating information through prepared messaged, bulletin boards, broadcast multi-media

productions including health videos, slideshows and presentations with links to Web pages.


An example can be found in the Women’s Health Center at the Ann Myers Medial Center

(http://slhealthy.wetpaint.com/page/Ann+Myers+Medical+Center). This was founded by Dr.

Ann Buchanan in honor of her mother Ann Myers. The site was originally developed to support

the education for medical students through virtual learning and has operated in SL since 2007.

The virtual hospital later added simulations open to the SL community, and is moderated by real

life physicians and nurses who donate their time. The open access areas provide information on

some medical equipment, conditions, procedures or departments. The Women’s Health Center

offers women who have or are worried about breast cancer, the possibility to experience some of

the diagnostics associated with breast cancer in a virtual environment. They offer a pink chair,

that guides a woman through a breast self exam. There are numbered question marks which the

client can click to ask the resident on duty for more information. This type of technology could

be applied toward the delivery of lactation information in a virtual world. A mother could

observe a virtual lactation consultation and click on questions that she might have that require

more personal attention or to gain a possible referral to a professional in her area.

In 2007 Second Health (SH) was established for public engagement research by the

Imperial College London. SH is spread out over 8 islands within SL as an experiment to provide

people with a vision for future healthcare delivery. Some sites within SL actually offer one-on-

one appointments with doctors, nurses, medical librarians, therapists, and other health care

professionals (Beard et al., 2009). Because of the anonymity this platform encourages, SL

provides an excellent forum for the discussion of health related materials through support groups

and moderated discussions.

The transfer of behaviors from SL to real life has implications for further advancing

breastfeeding rates in the future. As pointed out by in an article in Time Magazine our self


confidence is reflected into our Avatar, but having anonymity allows our confidence to flourish

and this can be reflected in our real world encounters (Dell, 2008). According to Dell, our

Avatar’s health behaviors in the virtual world transcend to real-life behaviors in the real world.

Research has shown that patients “primed” for health procedures through participation in virtual

experiences help to reduce anxiety and provide a better understanding of the health care system

prior to a clinic or hospital visit (Gustafson, Shaw, Isham, Dillon, & Spartz, 2008). One of the

major problems with promoting breastfeeding is its lack of visibility (therefore acceptance),

especially in Western cultures. Making it more visible even in a virtual world could increase and

promote its acceptability in the real world.

The Downside of Web Technologies

Despite the many positive aspects of Social Media for the promotion of breastfeeding

information, there is also a downside. For example a Google search of the keyword

“breastfeeding” on November 14, 2001, yielded over one million hits. Links could direct the

user to not only traditional Websites, but also images, videos, and breastfeeding blogs. The

advice available can range from credible to misleading and even dangerous. Although many

adults state that they would trust their doctors (or other health professional) more than they trust

the Internet, often the Internet is consulted first. When actually queried, only eleven percent of

patients actually went to their doctors, but a huge forty-eight percent consulted the Internet first

over their health question or need (Eysenbach, 2008). Most adults are aware that the credibility

of health information found on the Internet is important. According to the Pew Internet Survey

Report, health information seekers were shown to be vigilant in checking the source of the

information, and were concerned about getting unreliable information from an online source

(Eysenbach, 2008).


Günther Eysenbach has coined the phrase Apomediation which he feels characterizes the

way in which the Web 2.0 technologies allow its users to identify trustworthy and credible

information and services (Eysenbach, 2008). He feels that through the use of apomediation, that

there are tools for example: eBay feedback, or consumer ratings, which can help the user to

judge the credibility of the information being viewed. Through apomediation the user is

influenced by how others view the information as creditable, it also helps the user navigate

through an onslaught of information available today through digital medial. One problem with

apomediation is that mass opinion may be regarded as fact; however, it is still an open question

as to how much these “opinions” and “experiences” conflict with researched evidence, and in

how they may be misleading or helpful to the information seeker.

Health professionals are also using apomediation to guide them towards relevant

information on the Web according to Eysenbach (2008). Through the use of devices such as

shared bookmarks, and bookmarking tools lie CiteULike, Connotea or WebCite professionals

can share information or receive pointers to recently published relevant literature with other

professionals in pursuit of the same information. In the end, caveat emptor as all Web based

media is liable to fraud and scams.

Recommendations

According to the literature new mothers are consulting the Internet and utilizing the

social media obtainable through Web 2.0 technologies on a regular basis to gather information

on breastfeeding, and feeding choices. Promoting breastfeeding information on the platforms

most used by this age group can allow this information wider dissemination to the target

population. There needs to be more research into how these new technologies are currently


utilized and can be utilized in the future. We also need to look at the effectiveness of these

interactive Web technologies in impacting the numbers of women that exclusively breastfeed,

and in breastfeeding for a longer duration.

Summary

As developed in this paper various forms of Internet social media presents different

opportunities for health education and communication, this is particularly true for the lactation

professional. As health information of all kinds becomes increasingly accessible over the

Internet and as the mother-to-be or new mother seeks information on infant feeding choices, and

continued duration of breastfeeding increases; the likeliness increases that these mothers will

turn to the Internet as they seek and expect to receive more information about breastfeeding with

explicit instructions about the next steps in their care. About one-third of the existing sites on the

Internet are devoted to health care, and there already are many sites devoted to breastfeeding

information (Sandrich, 2000). This survey of social media available through Web 2.0 interactive

technology shows there is a significant potential in these social medias to improve the

communication of breastfeeding information to the expecting and new mothers. The role of the

lactation professional in providing quality information to this captive audience has been largely

unexplored, and there is a need to make a highly visible and credible presence, as well as study

the impact.

When considering novel applications, it is important to consider the target audience and

their fondness for the use of technology. Are we as the lactation professional harnessing the

ability to educate our population of mothers about the issues and problems that are relevant to

them? Are we engaging them in positive and meaningful ways? Is there any entertainment

value in what we offer? Have we empowered this mother-to-be or new mother as a result of


their experiences with our programs, products or services? Finally, are we taking advantage of

our now empowered consumer to become our web spokesperson or evangelist? These are the

five E’s (education, engagement, entertainment, empowerment and evangelist) needed for

adapting breastfeeding promotion to the next generations of consumers (Lefebvre, 2007).

Programs designed to utilize the emerging social media technologies are needed to increase

breastfeeding education through positive media messages. This might be the best new approach

for increasing breastfeeding rates among women in the United States.

Final Class Summary

I expected to learn a lot from this paper and I did. Up until this class I had heard all the

buzz words for Wiki, YouTube, Social Networking sites and Blogs, but never had really

explored content or possibilities that these types of media would be useful as a form of health

education. My use of the internet was primarily for shopping, school and research. Through the

research conducted for this project I realized the importance of Web 2.0 technologies, and how

these social medias are impacting every environment of our lives and are influencing our

learning preferences and how the delivery of information is changing.

Through my learning experiences in class discussions and reading I have received a

better knowledge of how information is acquired, processed and disseminated, which is the

foundation of informatics. I first only thought of computers, when I thought of nursing

informatics. I now have a better understanding of how informatics does include computer

technology, but it is more than just an understanding of the use of software and interpretation of

data obtained from computers. Informatics is the interpretation of information from data into

usable information from all sources of information including technology and research based data.


I was able to understand more fully how I can utilize informatics and technology in my current

role as a lactation consultant, and in my current track as a Clinical Nurse Leader.

Through our discussions I have learned that we need to become more competent in

informatics as a part of our practice. With the governmental goal that all medical records will be

electronic by the year 2014 and nurses will need to be ready and competent in working with

electronically based media. Not only do we need to plan for computer competency by providing

these components as a foundation of nursing education, practicing nurses will need to assess

their current competencies and seek improvements in their overall information literacy skills. As

we are mastering these skills we become more fluent with technology and are able to understand

the underlying concepts and apply problem solving and critical thinking (ACRL: Information

Literacy Competency Standards for Higher Education, 2000).

As nurses we need to find our voice and take more initiative in the development and

design of systems which we are going to utilize in day to day practice. Tools should be useful

and not cumbersome or awkward, they also should be efficient and cost effective. As a class we

discussed what happens when provided with new equipment which is inefficient to our duties as

nurses. We provide workarounds, which may be more dangerous to our patient’s care. As

nurses we should be engaged in the process of planning, design and implementation. We should

also be more vocal when clearly the product is not producing the desired outcome. This may

require us as nurses to be more personally involved in research which can support our thesis and

provide a plan based on facts and evidence and not just on feelings, or the way something has

always been done. One suggestion brought up in our weekly forums by a classmate was the

development of an IT nursing council. I agree that involving nurses in a hospital IT council

would give nurses a larger voice in the decision process over IT policies initiatives, development,


system designs and selection. Since nurses are fundamental in the utilization of this equipment,

they should be actively involved in decisions concerning IT in nursing applications.

One key learning experience was our discussions and reading about telehealth nursing. I

never really realized the impact of this medium to our nursing profession. It became clear

through our discussions and readings that as health care becomes more and more expensive to

deliver, telehealth options will become more available and reimbursable. In my CNL track and

as a stakeholder in improved patient outcomes, I feel that telehealth is vital for patient care

management. For acute care management, having telephone support may enable the patient to be

discharged sooner, for chronic care continued follow-up with patients may help a patient to be

more compliant in their health care activities. Monitoring equipment which provides real time

data will allow for more timely and accurate decisions. Then care plans can be designed to help

the patient with optimizing their health situation. Because this can be done remotely, telehealth

can not only be cost effective but also a tremendous time saver for quality outcomes.

There are several future learning objectives identified within this course. One of the

largest is our need for continued nursing science. We discussed how many of us utilize

workarounds; however, we are not completing research which could provide data that could

change the practice. As nurses we need to discover the best and most effective uses of

technology for promoting our various nursing missions. As a CNL research is integral to our

leadership role. As a CNL we need to provide evidence through research in continued support of

evidenced based practice as our foundation of practice. The use of evidence based factual data

allows us to advance practice based on knowledge generated from research.

Utilization of informatics is considered one of the five core competencies for health

professionals (Greiner & Knebel, 2003). This competency needs to be addressed in nursing


educational program. Curriculums must be constantly evaluated to see if they foster the use of

information literacy skills. Nurses should not wait until they are in the workplace to acquire

these critical skills. Likewise, nurses in practice need to maintain a competency in the

technology they utilize on a day to day basis. This competency should be continually assessed

and remediated when the needs arise. As professionals we should all strive to advance our skill

levels beyond the baseline competency levels. We are stakeholders and as such we should

actively participate in becoming fluent in the information technologies that we come in contact

with and remain current with the ideas presented in nursing and scientific literature towards

incorporating this information into practice.


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