Tuesday, September 1, 2009

NU501 - Unit 1, Assignment 1

Well, this one seems easy enough...

I conducted my search using the standard implementation of Google, and the search term nursing care end of life.

Here are the five sites that I selected from this search, based on my personal assessment of each site's overall usefulness in my clinical practice and area of interest. The criteria was simple - I asked myself, “Would I recommend this to a colleague who expressed an interest in learning more about this topic?”

I've included four sites where I answered “yes” without hesitation. I am less enthusiastic about the material described in number 5, from the Encyclopedia of Death and Dying. While my overall assessment of that content is that it is well-written, accurate, and appears to draw from reliable sources, I'm concerned about the lack of direct attribution for what it presents as clear statements of fact. The site's parent company also does not provide information about its sources of funding or privacy policy.

1. AACN – End of Life Care

This the End of Life Nursing Education Consortium (ELNEC) section of the main site for the American Association of Colleges of Nursing (AACN). ELNEC is a national initiative to improve care for patients and families at the end of life, jointly developed and overseen by AACN and the City of Hope National Medical Center.

This section of the AACN site is most suitable for nurses who wish to learn the details of caring for patients and families at the end of life, particularly those nurses who want to learn about and obtain ELNEC training in order to teach other nurses about the topics associated with comprehensive end of life care, using the ELNEC curriculum.

This section includes access to a variety of topics of particular interest to ELNEC trainers and nurse educators, including:

· the schedule for upcoming training sessions
· ELNEC-related news
· links to studies of ELNEC outcomes
· directories of ELNEC trainers, organized by state and country
· related resources for ELNEC trainers and nurse educators

The main AACN site provides access to a broad range of information and resources consistent with its stated mission - “Advancing Higher Education in Nursing.”

I am an ELNEC trainer.

There is no HON Code icon displayed on any of the AACN pages that I reviewed. An assessment of the site's compliance with HON criteria follows.

HON criteria

1. Authoritative - Indicate the qualifications of the authors.

The ELNEC-specific content at the site complies with this criterion.
See here. See also item #3 below re: contact with AACN staff members as compliance with criterion for overall site.

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable. The information is specifically directed to nurse educators, and not intended for consumers or other non-nursing professionals.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

Not applicable. There is no mechanism or requirement to provide personal data to register with the site or otherwise obtain information from the organization.

Contact with AACN staff members is via email, ground mail, and phone. Staff are identified by name, credential(s), functional responsibility, phone extension, ground mail address, and email address.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

The overall site complies with this criterion. As an example, see citation at the bottom here.

HTML links and page update information is consistently provided.

5. Justifiability - Site must back up claims relating to benefits and performance.

No specific claims are made, though there are extensive links to research and other material based on implementation of the ELNEC curriculum.

For example, see here, which provides links to a series on palliative care features in the American Journal of Nursing.

6. Transparency - Accessible presentation, accurate email contact.

Contact information is consistently provided. The material is logically organized by function. The link to a site map that is provided to supplement site navigation does not work.

7. Financial disclosure - Identify funding sources.

Funding for ELNEC is clearly identified here.
For AACN financial disclosures, see here. (pdf file)

8. Advertising policy - Clearly distinguish advertising from editorial content.

Not applicable to ELNEC content. Advertising for AACN's Professional Nursing Network is clearly identified – see here.
AACN policies for advertising and list rental are clearly identified here.

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2. Conference Report - Innovations in Hospice and Palliative Care

This search result links to the first of a multi-page report of a presentation at the 2nd Joint Clinical Conference and Exposition on Hospice and Palliative Care, held in Orlando, Florida on March 23-26, 2001.

The host site for this page is Medscape/Nurses, which is itself a service for health professionals provided by WebMD.

The introductory page, and the subsequent pages of the full conference report, as well as the pages related to the ELNEC presentation, would be of interest to nurses, and particularly to nurse educators, actively involved in training and education for nurses on caring for patients and families at the end of life.

Access to the full conference report requires a Medscape registration. There is no cost to become a registered Medscape user.

The 2001 conference was jointly sponsored by the American Academy of Hospice and Palliative Medicine (AAHPM), the National Hospice and Palliative Care Organization (NHPCO),and the Hospice and Palliative Nurses Association (HPNA).

The 2010 AAHPM/HPNA Annual Assembly, which grew from the 2001 conference associated with this search result, will be held March 3-6, in Boston.

From the conference report introduction - “Seventy concurrent sessions covering psychosocial concerns and bereavement; physical and spiritual issues; and system and clinical innovations were presented during the conference.”

The specific content sections of the report are:

· Introduction
· Upstreaming Hospice Care
· Use of Advanced Illness Care Coordinators
· A Palliative Care Manual
· Clinical Practice Improvements
· Pain Management: Barriers and Approaches
· Nonpain Symptom Management
· Depression and Terminal Illness
· Total Sedation
· Discontinuation of Ventilator Support
· End-of-Life Nursing Education Consortium (ELNEC) **selected for analysis
· Summary

From the section, End-of-Life Nursing Education Consortium (ELNEC):

"Betty Ferrell, PhD, RN, FAAN, from the City of Hope National Medical Center in Los Angeles, California, presented an overview of the much-anticipated End-of-Life Nursing Education Consortium (ELNEC) Project, sponsored by the American Association of Colleges of Nursing.[12] This program is comparable to and compliments Education for Physicians on End of Life Care (EPEC). The curriculum is divided into 9 modules:

· Nursing care at the end of life
· Pain management
· Symptom management
· Cultural considerations
· Ethical and legal issues
· Communication
· Grief, loss, and bereavement
· Preparation and care for the time of death
· Achieving quality care at the end of life

Common threads found throughout the modules include: the role of the nurse as advocate; the family as the unit of care; the importance of culture; attention to special populations; critical financial issues; and interdisciplinary care. Five ELNEC training sessions will be offered over a 12-month period beginning in Denver in September 2001.”

There is no HON Code icon displayed on any of the MedScape pages that I reviewed. An assessment of the site's compliance with HON criteria follows.

HON criteria

The criteria are applied to MedScape as the host site.

1. Authoritative - Indicate the qualifications of the authors.

The site complies with this criterion. Clicking the link “Authors and Disclosures” activates a pop-up window identifying the author's credentials and affiliation(s).

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable. The information is specifically directed to nurse educators, and not intended for consumers or other non-nursing professionals.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

A link to the organization's Privacy Policy is clearly identified at the bottom of each page. See here.

Registration is required to access full content. There is no charge for registration.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

The overall site complies with this criterion.

HTML links and page update information is consistently provided.

5. Justifiability - Site must back up claims relating to benefits and performance.

No specific claims are made, though there are extensive links to research and other material based on the information presented.

6. Transparency - Accessible presentation, accurate email contact.

Contact information is consistently provided. The material is logically organized by topic area.

7. Financial disclosure - Identify funding sources.

Information about MedScape is readily accessed here.

As a publicly-traded company subject to federal regulation, full financial information about WebMD is readily available through a link labeled WebMD Corporate at the bottom of each page.

8. Advertising policy - Clearly distinguish advertising from editorial content.

Display ads are clearly identifiable and consistently positioned on each page. There is also a clearly-identified link labeled “Information from Industry,” to differentiate sponsored content from editorial content (example here).

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3. Growth House: Guide to Death, Dying, Grief, Bereavement, and End of Life Resources

This is a substantial web site on the topic of end of life care, in terms of the volume of site pages and overall information. The site map page notes:

"Our site includes over 4,000 pages, so we can't list them all here. Instead, we have organized our content into major groupings. When you move to one of these areas more detailed navigation controls will appear. All pages have a context-sensitive navigation bar that will show related content. Pages are extensively cross indexed in hypertext form. You can search our database to find items not specifically listed here.”

Growth House describes itself as “portal” providing access “to resources for life-threatening illness and end of life care.” Authors and organizations in the end of life care field can syndicate their content through Growth House as a way to reach a larger potential audience.

The syndication process is described in more detail here.

"Content syndication is a general term for the idea that content on the Internet can be shared among multiple web sites. Content producers can make their information available in ways that other web sites can import directly and feature as part of their own offerings. There are many different ways to do content syndication. The content may be shown to readers at many places but it's always clearly identified as coming from some original source.”

The Growth House web site includes a bookstore featuring selections addressing subjects appropriate for nursing and medical professionals, as well as for the general public. The books are sold through Amazon.com. Growth House acts as an Amazon Sales Associate, earning a percentage of each sale.

There is an HON Code icon displayed on the 'Awards and Affiliations' page of the Growth House website.

The Growth House site's compliance with each HON criterion is validated by clicking on the HON Code icon on the page noted above. Growth House's compliance with the HON code is also verified by entering the term 'Growth House' at the HON search page.

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4. National Health Statistics Reports Number 9 (October 2008):
End-of-Life Care in Nursing Homes: 2004 National Nursing Home Survey
(pdf document)

This detailed document describes the objectives, methods, and findings of one of the annual surveys (National Health Care Surveys, NHCS) conducted by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC).

The CDC is an agency of the United States Department of Health and Human Services (HHS). HHS is the “United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.” Kathleen Sebelius is the current HHS Secretary.

As stated in the opening paragraph of the report:

The purpose of this report is consistent with that of other national health care surveys conducted by NCHS, specifically “to answer key questions of interest to health care policy makers, public health professionals, and researchers. These can include the factors that influence the use of health care resources, the quality of health care, including safety, and disparities in health care services provided to population subgroups in the United States.”

The data obtained in 2004 for this report represents the most current year available in the National Nursing Home Survey (NNHS).

This document, and others such as the 2007 National Home and Hospice Care Survey (NHHCS) are of great value to nurses, and others interested in exploring comprehensive data sets and analyses, to understand and influence policies regarding end of life care.

There is no HON Code icon displayed on any of the pages that I reviewed. An assessment of the site's compliance with each HON criterion follows.


HON criteria

1. Authoritative - Indicate the qualifications of the authors.

The authors and their credentials are listed in the report. Their affiliations and qualifications are not included. The agency responsible for issuing the report is clearly identified, as are its key personnel. The CDC also maintains an advisory body on health statistics that “fulfills important review and advisory functions relative to health data and statistical problems of national and international interest, stimulates or conducts studies of such problems and makes proposals for improvement of the Nation’s health statistics and information systems.” There is substantial accountability and transparency associated with this advisory body and its activities.

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable. The purpose of the report is to inform professionals, researches, and policy makers.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

There is no mechanism or requirement that site visitors submit identifying information. There is an extensive description of NCHS policies regarding overall information confidentiality and security.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

Sources are clearly cited in footnotes and an extensive bibliography.

5. Justifiability - Site must back up claims relating to benefits and performance No such claims are made.

6. Transparency - Accessible presentation, accurate email contact.

Reports are provided in readily accessible document formats, as well as in readily accessible multimedia formats, where applicable. Contact information is provided with email, ground mail, telephone, and fax access.

7. Financial disclosure - Identify funding sources.

The report was prepared by the National Center for Health Statistics (NCHS), an agency funded by Congressional appropriation to the Centers for Disease Control and Prevention.

8. Advertising policy - Clearly distinguish advertising from editorial content.

There is no advertising at this resource.

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5. Nursing Education - Challenges to eol care, Improving eol care, End-of-life nursing consortium

This is the Nursing Education page from the Nu – Pu section (Nursing Education to Purgatory) of the Encyclopedia of Death and Dying.

The Nursing Education page describes the issues and conditions that led to the development of the ELNEC curriculum, stating:

"Studies have documented that nurses and other members of the health care team are inadequately prepared to care for patients with pain at the EOL.”

The author(s) of this page is (are) not identified. The above noted statement, though presented as clear statement of fact, is not cited directly. Other similar statements are similarly unattributed.

A short bibliography is included, and features four articles from professional journals authored by Dr. Betty Ferrell, an acknowledged leader in the field of nursing education for end of life care. The landmark 1997 book by Fields and Cassels, Approaching Death: Improving Care at the End of Life, is also included in the bibliography.

My overall assessment of the content on this particular site, based on my own knowledge in the field, is that it is well-written, accurate, and appears to draw from reliable sources. However, I'm concerned about the lack of direct attribution for statements presented as fact. I'm also concerned that no author for the piece is identified.

There is a small notice at the bottom of the page, “Copyright © 2007 - Advameg Inc.” A Google search for the term “Advameg” found this page, which notes, “Advameg, Inc. is a fast growing Illinois-based company. Our websites reach over 14 million unique visitors per month and are frequently referenced by the media.” The Encyclopedia of Death and Dying is included on a large list of other sites claimed by the company, including several on a range of health topics.

There is no HON Code icon displayed on any of the pages that I reviewed. An assessment of the site's compliance with HON criteria follows.


HON criteria

1. Authoritative - Indicate the qualifications of the authors.

No author is identified.

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

A form for submitting information is included at the bottom of the page. The form requires the user to provide a name and email address, along with the code displayed in a 'CAPTCHA.' There is no privacy policy at the Encyclopedia of Death and Dying, or at the home site of Advameg, Inc.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

A bibliography featuring material by known experts is included, though there are no direct citations to material presented as clear statements of fact.

5. Justifiability - Site must back up claims relating to benefits and performance.

No such claims are made.

6. Transparency - Accessible presentation, accurate email contact.

No contact information for the Encyclopedia of Death and Dying is provided.

7. Financial disclosure - Identify funding sources.

Funding sources are not identified.

8. Advertising policy - Clearly distinguish advertising from editorial content.

Ads are clearly labeled and set apart from editorial content. The ads are served by Google's AdSense system.


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[Zeerp] “Hello, dum-dums.”

Acknowledgement: I could not have done this assignment without my dearest friend, the Great Gazoogle! Thanks, Great Gazoogle!

And a big hanx to Gavin at Sadly, No!

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