CIT Certification Class

Question 1

Describe 7 of the roles that the clinical informatics nurse plays

Answer 1

1. Developing informatics theories -Assemble sort of data and how it should be analyzed
2. Analyzing the information needs of the organization -
3. Helping org choose computer systems - Assist in system requirements, now and in future
4. Customizing purchased computer systems - Assist IT
5. Designing computer information system -
   assist IT
6. Testing new or upgraded computer system - Test when changes or upgrades
7. Teaching other people to use the system

Question 2

Describe 8 of the informatics nurse responsibilities

Answer 2

1. Teaching policies involved with information systems - standard operating system and security features
2. Describe the effectiveness of the computer system - based on overall performance and how well system design is working
3. Making sure the system works as it was designed to - Verifying that system produces expected results and troubleshooting
4. Deciding when computer system needs to be upgraded - gauging the obsolescence of hardware and system compatibility with modern software
5. Finding new ways to use technology in nursing
6. Ensuring compliance in regulations regarding patient information - patient privacy regulations
7. Managing projects as needed
8. Conducting research into the field of nursing informatics

Question 3

Describe the differences between clinical nurses and those nurses who specialize in informatics.

Answer 3

Clinical nurse - revolves around taking care of the patient and use of the computerized system is limited to user level. Their concentration is on accuracy of information that they are interpreting to other caregivers. Trained to handle malfunctions and used as feedback source for informatics developers. Their opinion is key to the success of the system.
Nurses who specialize in informatics - focus on the information system. Worry about the security and stability of the systems. Very adept at troubleshooting. Assure that the system is as user-friendly as possible and that it reduces the number of tasks that the traditional clinical nurse has to perform. Proficiency and enhanced productivity are key goals.

Question 4

Describe the 4 elements in the practice of nursing informatics.

Answer 4

1. Focus - patients and their well-being
2. Healthcare in general, keeping up with latest state of the art in terms of nursing
3. Working environment - how things are laid out to decrease errors and increase efficiency
4. Working with others - other practitioners and co-workers

Question 5

What are the 4 terms of informatics, related to nursing informatics skills?

Answer 5

1. Knowledge of data structure, including metastructures
2. Knowledge of computer networking
3. Knowledge of computer hardware
4. Information system training

Question 6

What formal education (3) should the clinical informatics nurse have>

Answer 6

1. A Bachelors degree in Nursing
2. A minor (or second major) in computer science program
3. Information system training skills

Question 7

What are the standards based on for the informatics nurse specialist as defined by the American Nursing Association?

Answer 7

Based on the “problem-solving framework”, which includes both traditional aspects of nursing as well as those aspects more specific to the informatics nurse.

Question 8

W hat are the 5 standards for the informatics nurse specialist as defined by the ANA?

Answer 8

1. Assessment
2. Diagnosis
3. Identification of outcomes
   4, Planning implementation
4. System planning

Question 9

What are the 3 performance standards that informatics nurses should obtain according to the ANA?

Answer 9

1. Quality assurance review of performance evaluation methods, ensuring that the practice of nursing informatics is effective
2. Work to create guidelines for research, ethics, peer cooperation, allocation of resources, and effective communication
3. Willing to help other nurses who want to improve their skills in informatics and computer science

Question 10

Describe the role of chief information officer and what degree he/she generally holds.

Answer 10

Head of the information services department and is in charge of hiring information system staff, budgeting for maintenance of the system, and designing and implementing new systems as needed.
Holds a masters or doctorate degree in computer science

Question 11

Describe the role of Chief Privacy Officer and how does he/she get the position..

Answer 11

Federally mandated position at any facility that treats patients. Responsible for all forms of patient information. Generally bestowed on an employee already working for the org. rather than being an entirely spate job.

Question 12

Describe the role of Chief E-health Officer and why the position is created

Answer 12

Generally in charge of promoting and enabling the use of online interactive patient services.
Relatively new position created by the onset of interactive health websites.

Question 13

Describe the role of Compliance officer and who generally holds this role,

Answer 13

Keeps track of state and federal regulations and accrediting requirements to make sure that the org is in compliance.
Held by someone from the information systems department or one of the clinical member staff.

Question 14

Describe the role of Planning and Recovery Officer.

Answer 14

Ensure that disaster plans are up to date and that they are integrated between departments.
Aware of what would be required to recover the full functionality of the information system in the event of a disaster.

Question 15

Define the role of Interface Engineer and who generally holds the position.

Answer 15

Assures that information integrity is maintained when data is exchanged between different systems.
Should be an employee from the information system department.

Question 16

Describe a workgroup and describe one advantage and disadvantage of a workgroup..

Answer 16

Workgroup - small number of people working together toward a common goal.
Advantage
1. Allows for increased insight and creativity.
Disadvantage
1. Sometimes fail because members of the group allow personal conflicts to interfere with the group’s goal.

Question 17

Identify the 4 stages in group development and the inter-personal dynamics that generally occur in each stage.

Answer 17

1. Forming - Group is formed and members get to know each other. Typically individuals are polite to one another.
2. Storming - Conflicts normally arise, and effective communication must be occurring.
3. Norming - Conflicting factions make peace and come together. Less communication is occurring.
4. Performing - Group begins to work well together and communication is free-flowing.

Question 18

Discuss 8 communication skills needed for leading intra- and interdisciplinary teams.

Answer 18

1. Communicate openly and encourage all members to participate as valued members of the cooperative team.
2. Allow free flow of ideas by avoiding interrupting and interpreting the points another is trying to make.
3. Avoid jumping to conclusions since it effectively shuts off communication.
4. Actively listen - pay attention, ask questions for clarification, not challenging the ideas of others
5. Respect the opinions and ideas of others, even if it opposes your own.
6. React and respond to facts versus feelings, avoiding angry confrontations or diffuse anger.
7. Clarify information or opinions stated to avoid misunderstanding.
8. Keep unsolicited advice out of the conversation as a show of respect and as a way to allow others to solicit advice without feeling pressure.

Question 19

Disand cuss 5 dynamics of team building.

Answer 19

1. Initial interactions - Time when members begin to define their roles and develop relationships, determining if they are comfortable in the group.
2. Power issues - Members observe the leader and determine who controls the meeting and how control is exercised, beginning for form alliances.
3. Organizing - Methods to achieve work are clarified and team members begin to work together, gaining respect for each other’s contributions and working towards a common goal.
4. Team identification - Interactions often become less formal as members develop rapport, and members are more willing to help and support each other to achieve goals.
5. Excellence - Develops through a combination of good leadership, committed team members, clear goals, high standards, external recognition, spirit of collaboration, and a shared commitment to the process.

Question 20

Describe the International Council of Nurses (ICN) Code of Ethics for nurses in regards to patients.

Answer 20

1. Foremost, the nurse’s responsibility is to the patient. Patient must receive the best possible care and their rights and well-being are respected and maintained.
2. Respect and support patient rights, religious beliefs, values, and customs. The patient should be able to live their way of life while under care. This means that they should be allowed to follow their culture and traditions as best as possible.
3. Make sure that the patient gives informed consent for any treatment. The right of the patient to accept or refuse a given treatment through the informed consent process is essential.
4. Keep patient information confidential. The patient’s right to privacy is protected under law and should be respected.
5. In addition, nurses should be proponents for community health and act to promote environmentalism.

Question 21

Describe the International Council of Nurses (ICN) Code of Ethics for nurses in regards to coworkers. There are 8 points.

Answer 21

1. Interactions are all aimed towards the well-being of the patient, which requires effective communication with co-workers.
2. Keep relationships with co-workers cooperative and professional.
3. Make sure patients are safe and promptly deal with unprofessional or dangerous conduct from co-workers.
4. . Take care not to delegate more work than the person can handle.
5. Promote continuing education in the workplace.
6. Keep lines of communication open between departments, management, etc.
7. Constantly mentor in appropriate behavior, both workers and management..
8. Any drift from optimal conditions should be addressed before the patient is exposed to any negative effects of poor teamwork.

Question 22

Outline the International Council of Nurses (ICN) Code of Ethics in regard to practice and profession. 6 key points.

Answer 22

1. Keep up to date with the practice of nursing through continuing education by taking continuing education courses and adding certifications.
2. Look after one’s own health in order to maintain quality of care to the patient.
3. Do not take on more than can be reasonably handled.
4. Uphold a high standard of professional conduct.
5. Make sure that all new applications of technology are safe for use in treatment and do not compromise the dignity of the patient.
6. Develop and put in place ethical standards in clinical, management, education, and research.

Question 23

Advanced nursing practice: Discuss the 9 ethical principles in practice (Nursing Code of Ethics).

Answer 23

1. Nurse treats all individuals with respect and consideration, regardless of social circumstances or health conditions.
2. The nurse’s primary commitment is to the individual regardless of conflicts that may arise.
3. The nurse promotes and advocates for the individual’s health, safety, and rights, maintaining privacy an confidentiality and protecting him or her from questionable practice or care.
4. The nurse is responsible for his/her own care practices and determines appropriate delegation of care.
5. The nurse must retain respect for self and his/her own integrity and competence.
6. The nurse participates in ensuring that the health care environment is conducive to providing good health care that is consistent with professional and ethical values.
7. The nurse participates in education and knowledge development to advance the profession.
8. The nurse collaborates with others to promote efforts to meet health needs.
9. The nursing profession articulates values and promotes and maintains the integrity of the profession.

Question 24

Discuss the 7primary ethical principles in the Introduction in the International Medical Informatics Association Code of Ethics.

Answer 24

1. autonomy - self-determination
2. equality and justice - equal treatment
3. beneficence - promoting good
4. nonmalifeasance - preventing harm
5. impossibility - predicted on possibility
6. integrity - honesty and diligence

Question 25

Discuss the 7 general principles in the Introduction of the International Medical Informatics Association Code of Ethics.

Answer 25

1. Right to privacy, regarding sharing of personal information and control of collection, methods of collection, and storage.
2. Open process of data collection with patient informed.
3. Security of all data collection and protection from data manipulation.
4. Right to access of personal data.
5. Legitimate infringement or the consideration of the greater good of society in regard to individual’s right to privacy.
6. Infringement of right to privacy with minimum interference.
7. Accountability for infringement.

Question 26

Identify the 6 rules of ethical conduct in Part II of the International Medical Informatics Association Code of Ethics.

Answer 26

1. subject-centered duties
2. duties toward healthcare professionals
3. duties towards institution and employers
4. duties toward society
5. self-regarding duties
6. professional duties

Question 27

What does the fair distribution of health information access relate to and describe?

Answer 27

1. information specific to the individual (e.g., EHR)
2. data (aggregate and comparative)
3. knowledge-based information (journals and websites)

Question 28

What considerations must be included when dealing with the fair distribution of health information access?

Answer 28

1. Right to privacy
2. Regulations regarding intellectual property
3. Equitable access to information

Question 29

Discuss the problem associated with the fair distribution of health information access? How should it be overcome?

Answer 29

Many people are unaware of their rights or lack of training or tools to access information.
Providing public means of access, such as libraries, and through public health agencies and education to educate the general public. People in rural or isolated areas may be served through telehealth services, using telecommunication to provide information and Internet health resources

Question 30

Name 6 things to do to promote an environment for ethical decision-making and patient advocacy.

Answer 30

1. Org should clearly communicate that nurses are legally and morally responsible for assuring competent care and respecting the rights of patients and other shareholders.
2. Ethical issues should be identified and discussed as soon as they arise
3. Establish clearly defined procedures and policies for dealing with conflicts, including an active ethics committee, in-service training, and staff meetings.
4. Empower patients and family to be part of the ethical environment, by providing them with information that outlines patient rights and procedures for expressing their wishes and dealing with ethical conflicts
5. Establish an atmosphere that respects privacy and confidentiality
6. Create a non-punitive atmosphere.

Question 31

Define and identify the components of an EMR.

Answer 31

Created by a hospital or other health care delivery organization (CDO) and the CDO owns it.
Consists of: clinical documentation, orders. medications, treatments, and other clinical support.
It is a legal record.
Uses controlled medical vocabulary so that information will be comparable among providers and interested stakeholders.
Organizations receive incentives to install EMRs from healthcare reform.

Question 32

Define and identify components of an EHR.

Answer 32

Electronic Health Record.
Includes information from the EMRs, likely from multiple health delivery organizations.
Relies on information from the EMR to complete it.
Owned by the patient and stakeholders, which could include the government, insurance companies, and health care providers.
Limited EHRs due to limited EMRs with standardized medical vocabulary.
Organizations now receiving incentives to install EHRs from healthcare reform

Question 33

What is cloud computing and what are its strengths and weaknesses?

Answer 33

Using the internet to store and access files as opposed to a business network or a computer hard drive. Healthcare organizations are utilizing the cloud to store information, both EHR and non-EHR related.
Strengths - Multiple providers can access records at the same time from different locations, increasing collaboration and decreasing costs.
Disadvantages - Since patients’ personal information is being stored on the internet, security from cybercriminals becomes an issue. However, providers are coming up with new agreements to protect private information

Question 34

Name the 3 types of support personnel as part of information systems.

Answer 34

1. Analysts
2. Liaisons
3. Programmers

Question 35

Describe the role of an analyst. What education do they require?

Answer 35

They define the way in which clinical data is entered into and processed by the information system.
Background in healthcare information systems. Degree in medical field with certificates in computer studies.

Question 36

Describe the role of liaison. What education do they require?

Answer 36

Act as a conduit between the clinical and information systems staff.
Hospital employees chosen to work with the information system team while remaining at their primary clinical post.

Question 37

Describe the role of programmer. What background do they require?

Answer 37

Write the code necessary for system functions and work with the analyst and liaison in order to accomplish the task.
May be full-time hospital staff but are normally contract workers or employees of the software vendor.

Question 38

Describe the role of security officer for information systems.

Answer 38

Responsible for assigning system codes, making sure passwords are kept secret and updated, and monitoring the overall use of the system. May also be in charge of the physical security of the computers and peripherals.
Works with information systems department and management to create org policies and procedures, describing the proper and ethical use of equipment and information.

Question 39

List the 7 steps in Conflict Resolution.

Answer 39

1. Allow both sides to present their side of conflict, without bias, maintaining a focus on opinions rather than individuals.
2. Encourage cooperation through cooperation and compromise.
3. Maintain focus, providing guidance to keep the discussions on track and avoid arguments.
4. Evaluate the need for renegotiation, formal resolution process, or third party.
5. Utilize humor and empathy to diffuse escalating tensions.
6. Summarize the issues, outlining key arguments.
7. Avoid forcing resolution if possible.

Question 40

Describe high-fidelity simulations.
List pros and cons.
Provide an example.

Answer 40

Uses real or realistic equipment or materials as part of learning to practice tasks or procedures that they will carry out as part of their jobs.
Pro - Most helpful for the learner
Con - Most costly; training that involves practice and assessment of performance is more time-consuming.
Example - mannequins

Question 41

Describe low-fidelity simulations.
List pros and cons.
Provide an example.

Answer 41

Rely on verbal, print, video, or audio descriptions and often involve discussion of potential actions rather than actual practice.
Pros - less expensive; can be completed quickly
Con - Evaluation may not adequately measure clinical expertise.
Example - Case study or scenario with specific problems and asked to describe the process for dealing with the problem.

Question 42

Describe virtual reality.

Answer 42

Involves participation in computer-simulated environments in which participants often have an avatar and may only be viewed on a screen or may require the use of special equipment. Allows the person to interact and have a life-like experience in a learning environment.

Question 43

What is it called when tactile stimulation is simulated in virtual reality in the health care environment?

Answer 43

Force feedback

Question 44

How is virtual reality used in medicine or the healthcare environment?

Answer 44

Practice medical techniques like insertion of intravenous lines or catheters
Used as part of therapy in some treatments, like in the case of phobias.

Question 45

What is Second Life and who uses it?

Answer 45

Virtual online world that has been incorporated into healthcare educational programs, allowing students to interact in the medical community.
CDC has a Second Life site that provides information to visitors about the CDC.

Question 46

What is over-the-shoulder technology?

Name the advantages and disadvantages.

Answer 46

Learner-centered strategy in which the instructor moves about the classroom monitoring the learner’s progress, rather than standing at the front of the classroom and lecturing and is best used in technology instruction.
Advantages - allows one-on-one instruction with individual learners as instructor identifies a need or learner requests assistance; instructor is better able to monitor progress.
Disadvantages - Many learners may have the same questions so the instructor may waste time answering the same question multiple times to individual students; in a large group, the instructor may not be able to address the needs or questions of all students; may seem impersonal because of less interaction with instructor

Question 47

Discuss pros and cons of one-on-one discussion.

Answer 47

Pros - More interaction with instructor; learners have more control of the environment by asking questions or having the instructor repeat explanations or demonstrations
Greatly valuable when learners must master certain skills or confidentiality is important
Cons- most costly because it is time sensitive

Question 48

Discuss the pros and cons of group instruction.

Answer 48

Pros- More structured and allotted a certain amount of time so less costly;
Especially useful for general types of instruction. such as managing diet or other lifestyle choices
Cons- Less costly because the needs of the learners can be met at one time; Because time-sensitive, learners have less control with limited questioning allowed and usually only at the end of the presentation; less learner interaction

Question 49

What are just-in-time presentations? Provide an example

List the advantages of this.

Answer 49

It is used when learners need to use the information immediately; may include information given immediately before practice and dispersed throughout the session
Example - Only when learners need to access data is the presentation about data is given.
Advantages- Learners are allowed to draw on information immediately without the typical memory loss that occurs when people try to retrieve info that they learned earlier
Especially useful with procedural information that is not very complex and that assists people in mastering a specific task

Question 50

Who developed problem-based learning and when?

What is problem-based learning?

Answer 50

McMaster University in the 1960s
Learner-centered with instructor serving as facilitator where students are presented with a problem and must search for the solution, while facilitator guides the learners by helping them to ask questions to lead to a solution

Question 51

What does problem-based learning focus on and how is the process of learning enhanced through this method?
What is a disadvantage to problem-based learning?

Answer 51

Focuses on the learner’s ability to use critical thinking and problem-solving skills, increasing motivation. It enhances transfer so that information learned in one context is internalized and can then be used in other contexts
Requires lots of preparation time and may require an extended learning period

Question 52

List and describe 12 teaching methods.

Answer 52

1. Individual tutorials - effective for supplemental materials and independent study
2. Independent study - geared towards the needs of the individual so they can self-pace; may include web-based, paper, or audiovisual material
3. Goal-focused - Learners are presented with a goal and all materials and activities are aimed at meeting that goal
4. Guided-focused - Learning takes place outside of the formal classroom with materials provided or recommended by the instructor
5. Anchored - Activities are based on problem-solving in relation to realistic case studies
6. Collaborative - Learners work together to complete a learning activity
7. Project-based - Learners develop materials (videos, web pages, pamphlets) regarding a topic
8. Problem-based - Learners work in teams to solve problems
9. Cognitive apprenticeship - Instructors model, and learners analyze and apply processes
10. Simulations - Learners actively participate in simulated activities
11. Direct instruction - An instructor-focused presentation
12. Cooperative - Small teams work together through a variety of activities to master a subject, with each member responsible for self-learning and learning from others on the team

Question 53

What is blended/hybrid learning?

How does the instructor accomplish this type of learning?

Answer 53

Encompasses a wide range of teaching methodologies, combining traditional lecture-type, instructor-focused delivery with more modern approaches such as computer-based instruction.
Instructor often balances classroom learning with out-of-classroom learning, using various technologies, such as smart phones, IPods, and IPads to access web-based, computerized modules or applications
Generally begins with an introduction and then moves to other formats, such as computer-based learning, while the instructor assumes the role of facilitator, using just-in-time presentations and combining over-the-shoulder, one-on-one, and group instruction as necessary to meet class goals

Question 54

What are the 3 considerations when selecting teaching materials and resources?

Answer 54

1. Price - free to hundreds to thousands of dollars
   Nurse must first consider the budget and then look for materials within those monetary restraints
2. Quality - Nurse should consider the goals and objectives before choosing materials and the materials should be evaluated to determine if they cover all needed information in a clear and engaging manner
3. Currency - If material will soon be outdated because of changes in regulations, than it will have to be replaced

Question 55

Where can you find free teaching materials?

Answer 55

Government agencies, such as the CDC, have posters, handouts, PP presentations, and videos for download online for free

Question 56

What should be done while teaching to make written handouts and paper materials more valuable?

Answer 56

1. If handing out PPs, use a revised version of the PP that only covers main points; PPs with all information on them are less helpful
2. Handouts should be placed in a folder or binder and passed out before the class meets so students can peruse them in advance; giving out handouts immediately before a discussion ensures that most of the class will be looking at the handout instead of the speaker
3. Handouts can be used to provide guidance or worksheets for small group discussion
4. Posters (with drawings and pictures) can be placed on bulletin boards to be useful
5. Handouts should be easily readable and not smudged copies of newspaper articles or small print text

Question 57

Discuss the best physical environment when using electronic or audiovisual materials.

Answer 57

1. Everyone in the room must be able to hear and see.
2. If the projector has low-resolution, requiring that the lights need to be turned off, dimmed, or windows covered, a small portable light at a speaker podium or an alternate presentation can be used. Turning the lights on and off can be distracting.
3. PPs or other presentations that need text must be of sufficient size to be read from the back of the room.

Question 58

Describe active and passive video presentations.

Answer 58

Active video presentations are useful adjunct tools where the instructor can discuss the video before and after the video and passive video presentations are watched without any instructor guidance.

Question 59

Discuss the advantages of video presentations.

Answer 59

Can reduce the time needed for one-on-one instruction, increasing cost effectiveness
Effective for demonstrating patient care techniques
Can be placed on course or learning management systems for anytime access, with focused questions for use during the presentation.

Question 60

Discuss the advantages of videoconferencing and teleconferencing.

Answer 60

Allows for audiovisual collaboration at a distance
Provides access to experts without the transportation costs.
Students can be at multiple sites while interacting with one another and instructor.

Question 61

How can Hospital Information Systems (HIS) be used for teaching or training? Identify 4.
What are some security concerns that must be addressed?

Answer 61

1. Provides real practice for students and trainees sing hardware and software programs that they need when caring for patients
2. Nursing students can use HIS to generate care plans and do mapping rather than in the traditional time-consuming paper method
3. Can practice and apply knowledge using fictitious patients patient files and retrieve and enter information
4. Can teach nurse managers and other essential staff how to access data from patient census records and EHRs, plan staffing, organize care, and promote patient safety.

The concern is not to violate the Health Insurance Portability and Accountability Act (HIPAA) regulations by incorporating methods to ensure data security and patient confidentiality.

Question 62

What is the electronic classroom response system (CRS)?

What are its advantages?

Answer 62

It includes the use of clickers to respond to questions and educational content. An instructor can ask a question and all students can answer with the clicker, which beams responses wirelessly to a computer, so the instructor can immediately determine if the students understand the question and respond appropriately. Responses can be projected from the computer onto a screen and, in some cases, graphed, so that students can see the results of the questions visually.
Advantages - all members of a large group can add input; shy students who normally would not respond can provide input; students remain more actively engaged in the learning process

Question 63

List 5 help tools that are available for education.

Answer 63

1. Learning aids - Questions, guides, maps, pictures, charts, illustrations, outlines, or diagrams can be used to support lecture or computer-based training
2. Web tools - Can include websites that provide specific educational content and information updates and interactive websites; chat tools and message boards
3. Software applications - software is available for training on almost every health care topic and usually includes interactivity and audiovisual presentations; many are available on portable devices
4. Books - many are available in electronic versions, making access less expensive and more easily transportable
5. Multimedia - Compact discs, DVDs, and streaming videos combine sound and images with hardware/software to deliver educational content

Question 64

When training in informatics competencies among end-users and informatics staff, what must 13 things must be included?

Answer 64

1. Policies regarding computers, including privacy issues, penalties, and failures to comply with policies
2. Access policies and issues regarding misuse.
3. Pre-implementation steps to prepare end-users for changes and inform and educate informatics staff
4. Basic computer literacy information
5. Workflow diagrams outlining changes occurring with the transition from manual to automatic systems
6. Scenarios with step-by-step instructions
7. Access and use of help documents and on-line tutorials
8. Generation of error messages, including avoidance and error correlation
9. Causes of screen and system freezing and troubleshooting methods
10. Elements specific to the org’s system
11. Maintenance and troubleshooting for hardware and software
12. Methods of information retrieval
13. Managing downtimes (both scheduled and non-scheduled) and back-up systems

Question 65

Define computer science.
List subfields in computer science.
What other field, apart from IT, influences computer science?
What is the most common education that computer scientists receive?

Answer 65

Computer science is the study of how information is manipulated to solve problems or answer questions; may be thought of as the study of computation and its associated principles
Subfields include: computer graphics, computational complexity theory, programming language theory, computer programming, and human/computer interaction to interface
Mathematics
Computer scientists often receive education on programming and the specific computational problems found in association with software engineering