Nursing Portal; a Nursing Informatics Solution for

Nursing Portal; a Nursing Informatics Solution for Iran, Lessons Learned from a Comparative Study Reza Safdari, PhD1, Niloufar Masoori, PhD1, Mashaallah Torabi, DDS2, Mohammad A. Cheraghi, RN, PhD3, Ahmadreza farzananejad, MSc1, Zahra Azadmanjir, MSc1 1 School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; 2 Innovation Center, Tehran University of Medical Sciences, Tehran, Iran; 3School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Abstract The nursing portal is an informatics solution in which services and capabilities supports the nursing staff in their practices and professional development with respect to the existing challenges for use of Internet by nurses at work. It can be considered as a creditable gateway for quick access to research-based evidence provided by reliable resources. Also it provide interactive virtual environment for knowledge exchange with experts or colleagues in different geographical area. Through a comparative study on specialized nursing portals in Iran and other three countries, the aim of this paper is defining desired content and structural specifications of nursing portals which support the practice of nurses in the workplace. Based on results of the present study, a set of recommendations provide for development of a comprehensive nursing portal in Iran. Introduction According to definition of International Medical Informatics Association (IMIA), nursing informatics is defined as “science and practice integrate nursing, its information and knowledge and their management with information and communication technologies to promote the health of people worldwide”1. Several studies conducted on nursing informatics solutions that only contributed to clinical practice from four practice of nursing. These solutions include nursing information systems2, automatics medication administration3 and wireless technologies4, but are not limited to them. Few studies conducted on solutions that simultaneously help to nurses for education, professional development, research, and also evidence based practice in their work. The portal is an example of these solutions. This paper is on value of portal technology for nursing community in each country and a comparative study on nursing portals in Iran and three other countries. The aim is extract the best practices and elements for success in selected countries and offer recommendations to the establishment of national nursing portal as an informatics solution for evidence-based nursing and the professional development of nurses in Iran. Background Nurses alike other health professionals need for accessing to contemporary knowledge sources5. Internet and webbased resources solve any problems for accessing to up-to-date information and research-based evidence for decision support5-6. Nevertheless, the results of previous studies on the use of Internet by nurses and other clinicians indicated that nurses use very little at work5, 7-9. Different studies conducted to identify the existing challenges for access to evidence in Internet at work. Such challenges can be classified in following two groups: First, problems related to the Internet such as quality and reliability associated with health information on Internet websites10-11, static specification of information in websites and scattering of the information on a specific domain12-13 and second, problems related to nurses or their work environment include nurse’s time constraints in workplace6,14and inadequate technological infrastructure for access to Internet in static or mobile point-of-care situations5. Besides, nursing staff should develop their knowledge parallel to science progress. Therefore, participation in programs of continuing education is necessary. However, today, application of traditional educational methods can not encourage nursing staff for attending to such programs due to time limitations or lack of interest in educational subjects15-16. Rutkowski notes that e-learning can adopt with work of nurses in their shifts17. Also, Lin notes, Internet based education increase motivation of practical nurses for attending to the continuing educational programs18. Portals which provide single point of access or gateway to different sources of information and services in Internet, Intranets or Extranets19have been served as a solution to this problems. As previously mentioned, in Internet environment, the quality control is difficult. According to Rigby and Esenbach, lack of regulation and evaluation of heath information on the Internet are major causes10, 20. Portal can provide access to quality-controlled collection of websites by content managers21. Also, it can facilitate access to the information in a specific domain by dynamic content and links22. Therefore, portal will solve the problems of static and scattered information in the Internet. Specialized portal for nurses can provide a gateway to integrated collection of validate information and applications on nursing issues and will facilitate access to evidence for nurses. In addition, it can provide access to online continuing education

programs in different issues for nurses. Moreover, it provides possibility of collaboration and knowledge sharing with colleagues through interactive tools. In these reasons, the nursing portal is the best informatics solution for nurse’s professional development. Unfortunately, no study has been done on nursing portals in different countries. Our study can both resolve this gap and provide guidelines for nursing portal of Iran. Methods This study was started on early of March 2011 and data gathered from several sources. First, review of literature by Google scholar, Pub Med, EBSCO and Ovid. Second, provide a checklist include desired functions and capabilities in a nursing portal. Reliability of the checklist was confirmed by 4 experts. Third, search in Internet with “nursing portal”, “nursing web portal”, “nursing gateway”, “nurse’s portal”, “nurse’s gateway” and “portal for nurses” key words to find the Internet address of nursing portals. Thus, portals were only studied which defined as a portal or gateway expressly by their names or mission statement. Fourth, observation of nursing portal parts in selected countries and completing the checklist. If required information not find by observation, we sent queries to edition board of the portal in order to answer to our questions. Canada, Australia and United Kingdom were studied. Results However, in e-health strategic plan of Iran, health portals are defined in three levels and healthcare provider’s portals are in third level23. But, the portals providers have not been developed. Currently, only website of Iranian Nursing Association recognized as a portal for nurses in the country24.In Canada, nursing portal which so called NurseONE, established by Canadian Nurses Association (CNA) and investment by government25. In Australia, the Elsevier Australia has been worked for set up Nurse Point as special gateway for nurses in the rest of Australia and New Zealand26. In UK also, the portals not created directly by governmental authorities. Nursing Portal designed by UK Nursing27 and Nursing Center designed by the Lippincott’s publishing company28. Purpose of this work in Canada defined support from professional development of nurses and help to they in deliver evidence-based care25, 29. The portal plays significant role both in CNA e-nursing strategy and nursing informatics strategy for Canada25. The purpose of Nursing Point in Australia is to provide high quality information. In UK, the purpose of Nursing Center portal is defined to providing clinical and professional informational needs and evidence-based practice resources to help nurses28. Also, the purpose of Nursing Portal is offering quick access to the highest quality online information and organizing all the best nursing resources in one comprehensive site. Primary audiences of nursing portals in all of countries are nurses. Nevertheless, all of these countries including Iran are provided general services for other users24,26-28,30-31.The capabilities and structural features of nursing portals have been showed in (Table 1)27-28,30-32. Table 1.Comparison of structural features and performances in nursing portals in selected countries Structural Features and Performances A- Possibility of registration

1. limited to nurses, researchers and policy makers in nursing 2.free for all B- Possibility of 1.Portal content personalization for 2. User interface and layout authorized users 3. Navigation C- Creating a user profile for authorized users D- Providing of general contents and performances for persons who are not authorized user E- Need to Authentication for use from special contents and performances F- Capability of Single Sign On(SSO) G- Providing of on role-based Access control H- Possibility of basic and advanced search in portal content by search engine I- Providing of directory for easy navigating J- Availability of static frame with key links or navigation bar in all of pages K- Availability of site map link L- Attention to cultural and language considerations 1. Multi language user interface 2. Multi language contents M- Providing of e-mail services for users N- Possibility of discussion in chat room O- Possibility of poll P- Providing of Web 2.0 tools 1.Blogs 2.RSS feeds

Studied Countries Canada Australia

UK

Iran

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Continued Q- Possibility of saving and visit of portal pages in disconnect (cashing) R- Possibility of transforming of pages to other formats (static content export) S- Platform-independent user interface for ability of presenting contents in hand-held devices T- Availability of privacy policy statements in portal U- Possibility of sand of feedbacks to portal editor1.Direct by on-line form board by users 2. Indirect by e-mail

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Comparison of nursing special content of portals in selected countries indicated that Canada and then UK have fairly comprehensive content. While, in other two countries including Iran it is limited26, 31, 33. Comparison of contents in nursing portals in selected countries showed in (Table 2). Table 2.Comparison of contents in nursing portals in selected countries General and Special Contents, Dynamic Links A- General Contents

B- Special Contents

C- Dynamic Links

1. Providing of news of health and nursing events 2. Providing of Job finding and job opportunity 3. Providing of Statistics 4. Events calendar 5. Publishing of e-Newsletter or Bulletin 6. Sending of alert on new and up- to- date contents for users by e-mail 1. Clinical guidelines 2. Best-practice protocols 3. Nursing codes of ethic 4. Professional standards and Practice Rules 5. Pharmaceutical information 6. Job descriptions 1. Providing of dynamic link to ministry of Health 2. Providing of dynamic link to national governmental nursing organizations 3. Providing of dynamic link to national nursing NGOs 4. Providing of dynamic link to international nursing regulatory bodies 5. Providing of dynamic link to international nursing NGOs 6. Providing of dynamic link to nursing schools and educational institutes

Studied Countries Canada Australia

UK

Iran

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In all three countries, portal offers educational services and access to evidence-based practice resources for authorized users. There aren’t such services in Iran. The detailed results of comparison of educational and research services in the nursing portals in selected countries and Iran showed in (Table 3). Table 3.Comparison of education and research services in nursing portals in selected countries E-Learning and Evidence-based practice services A- Providing of continuing education programs B- Offering and use of specialized forums and virtual discussion groups for collaboration C- Possibility of visual and audio conferencing for exchange of knowledge D- Offering of information on conferences related to health and nursing E- Offering of scientific literatures and research articles F- Possibility of open access to bibliographic databases such as for authorized users G- Providing of book shop

Studied Countries Canada Australia

UK

Iran

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Discussion According to the research findings, only in Canada develop of nursing portal is regarded as a nursing informatics strategic solution25. It seems that, primary purpose for establishment of this system is to facilitate of using evidencebased practice approach for nurses. In a research in USA on development of nursing portal, noted that purpose of this project is to enhance evidence-based practice34. In all of three countries, the structure of portals was designed so that those provide customizing, user profile, search services, platform-independent user interface and SSO capability. In this reason, can be state that these performances are necessary in a desired nursing portal. According to Polgar, these performances are minimum features of a real portal35. In respect of security mechanisms in portal, results indicated that all of studied countries emphasized on authentication and role-based access control. In a research in Canada these two mechanisms is defined as minimum mechanisms of security in health portals36. In another study on methods of access control in health portals demonstrate that the role-based approach is better than other methods37. Furthermore, best practice protocols and clinical guidelines are specialized components that will

increase using of portal in evidence-based activities by nurses. The results of a research in USA demonstrate that the best practice protocols were one of important causes for using from nursing portal by nurses34. Beside, providing of access to databases and journals on nursing issues will reduce the required time to find evidences. In studies conducted by Gilmour and Estenbrook specified that CINAHL and Medline are used two database by nurses at workplace5-6. Nursing portals should to provide pharmacy information, professional standards, codes of ethics, policy and regulations as useful specialized contents. Several studies indicated that these contents are causes of using the Internet by nurses for their practice5-6. Continuing education programs, specialized forums and virtual discussion groups for collaboration offered through nursing portal are as proper solutions for professional development that all of three countries emphasize on them. In a research in Singapore related to nurses requirements assessment for establishment of nursing portal, specified that learning modules and collaboration tools were important needs38. Dynamic links are integral part of the portal. They should provide at least access to related websites in national domain and also in ideal level provide access to international websites. In the study in USA showed that nursing links 14.24% used by nurses that was more than other sections of nursing portal34. As hole, according to the findings of the present study, content and structure of Canadian portal is comprehensive rather than the other studied countries. The factors that affected on this success may be are direct role of a governmental authority such as CNA in developing process of the portal and also requirement analysis carried out before design. In the study was done by Remus showed that top management support as a strategic factors and requirements analysis as tactical factors are two critical success factors for the implementation of portals39. Conclusion As our results show, the nursing portal in Iran is still in its infancy. Regarding to defects in portal of nurses in Iran, it is more like a nursing website rather than a nursing portal. Therefore, desired features specified in this paper on a comprehensive nursing portal should be considered in Iran. In addition the following steps proposed before the nursing portal design in Iran: (i) to formulate purpose and objectives (ii) to support the government from nursing portal development and (iii) to identify all active institutions and organizations in different fields of nursing domain including education, research, management and legislation (iv) to define the requirements of nursing community including students, nursing staff in care facilities, nursing managers, policy makers and other stakeholders. Acknowledgment We appreciate from all experts who cooperated in this research, specialty Michelin jaworsky RN, B.A., B.Ed, NurseONE Program Manager for providing information about NurseOne portal. References: 1.

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