LESSON 1 | MANAGING HEALTHCARE
INFORMATION
Informatics introduction
What is informatics? Isn't it just about
computers? Taking care of patients is nursing's
primary concern, not thinking about
computers! These are not unusual thoughts for
nurses to have. Transitions are always difficult,
and a transition to using more technology in
managing information is no exception. This use
of information technology in healthcare is
known as informatics, and its focus is
information management, not computers.
Whether nursing uses informatics effectively or
not will determine the quality of future patient
care as well as the future of nursing.
Information is an integral part of nursing. When
you are caring for patients, what besides the
knowledge that nursing education and
experience has provided do you depend on to
provide care? You need to know the patient's
history, medical conditions, medications,
laboratory results, and more. Could you walk
into a unit and care for a patient without this
information? How this information is organized
and presented to you affects the care that you
can provide as well as the time you spend
finding it.
The old way is to record and keep the
information for a patient's current admission in
a paper chart. Today, with several specialties,
consults, medications, laboratory reports, and
procedures, the paper chart is inadequate. A
well-designed information system, developed
with you and for you, can facilitate finding and
using information that you need for patient
care. Informatics skills enable you to
participate in and benefit from this process.
Informatics does not perform miracles; it
requires an investment by you, the clinician, to
assist those who design information systems so
the systems are helpful and do not impede
your workflow.
If healthcare is to improve, it is imperative that
there be a workforce that can innovate and
implement information technology (ahima &
amia, 2006). There are two roles in informatics:
the informatics specialist and the clinician who
must use health information technology. This
means that in essence every nurse has a role in
informatics. Information, the subject of
informatics, is the structure on which
healthcare is built. Except for purely technical
procedures (of which there are few if any), a
healthcare professional's work revolves around
information. Is the laboratory report available?
When is mrs. X scheduled for surgery? What are
the contraindications for the prescribed drug?
What is mr. Y's history? What orders did the
physician leave for ms. Z? Where is the latest x-
ray report?
An important part of healthcare information is
nursing documentation. When information
systems are designed for nursing, this
documentation can also be used to expand
our knowledge of what constitutes quality
healthcare. Have you ever wondered if the
patient for whom you provided care had an
outcome similar to others with the same
condition? From nursing documentation, are
you easily able to see the relationship between
nursing diagnoses, interventions, and
outcomes for your patients? Without
knowledge of these chain events, you have
only your intuition and old knowledge to use
when making decisions about the best
interventions in patient care. Because
observations tend to be self-selective, this is
often not the best information on which to
base patient care. Informatics can furnish the
information needed to see these relationships
and to provide care based on actual patient
data.
If florence nightingale were with us today, she
would be a champion of the push toward
more use of healthcare information
technology information in a paper chart
essentially disappears into a black hole after a
patient is discharged. Because we can't easily
access it, we can't learn from it and use it in
patient care.
This realization is international. Many countries,
especially those with a national health service,
have long realized the need be able to use
information buried in charts. In the united
states, the strategic plan for wider
implementation of health information
technology formulated four goals, all of which
will affect nurses and nursing. They are as
follows:
1. Inform clinical practice with use of ehrs
(electronic health records). The
strategies for achieving this goal are
a. Provide incentives for ehr adoption
b. Reduce risk of ehr investment
c. Promote the diffusion of ehr in rural
and underserved areas
2. Interconnect clinicians so that they can
exchange health information using
advanced and secure electronic
communication. The strategies for
achieving this goal are
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 a. Encourage regional collaborations
that reflect the needs and goals of
the region
b. Develop a national health
information network
c. Coordinate federal health
information systems
3. Personalize care with consumer-based
health records and better information
for consumers by
a. Encourage the use of personal ehrs
b. Enhance informed consumer choice
by providing information about
clinicians and institutions
c. Promote use of telehealth systems
4. Improve public health through
advanced biosurveillance methods and
streamlining the collection of datafor
quality measurement and research. This
requires the collection of detailed
clinical information and will be
accomplished by
a. Unify public health surveillance
architectures by making the systems
able to exchange information
b. Streamline quality and health status
monitoring to provide the ability to
look at quality at the point of care
and in real time
c. Provide tools to accelerate research
and dissemination of evidence into
clinically useful products,
applications, and knowledge
To fulfill these goals, information, which is the
structure on which healthcare is built, can no
longer be managed with paper. If we are to
provide evidence-based care, the mountains
of data that are hidden in medical records
must be made to reveal their secrets. Bakken
(2001) told us that there are five components
needed to provide evidence-based care:
1. Standardization of terminologies and
structures used in documentation
2. The use of digital information
3. Standards to permit healthcare data
exchange between heterogeneous
entities
4. The ability to capture data relevant to
the actual care provided, and
5. Competency among practitioners to
use this data. All of these are part of
informatics.
Information is a capital good with a value the
same as labor and materials (national advisory
council on nurse education and practice,
1997). The financial health of organizations
depends on effective and efficient information
management. Today, healthcare organizations
are waking up to the fact that how information
is handled and processed has a great effect
on both the outcomes for those who purchase
services and the economics of healthcare.
Manual recording and filing of information are
inadequate to manage today's healthcare
information. We have made some attempts to
use technology to manage information, but
these efforts often fall short as a result of our
inexperience in grasping the schemes of where
information originates, how it is used clinically
and administratively, and how it can be used
to improve practice.
The complexity of today's healthcare milieu,
added to the explosion of knowledge, makes it
impossible for any clinician to remember
everything needed to provide high-quality
patient care. Additionally, healthcare
consumers today want their healthcare
providers to integrate all known relevant
scientific knowledge in providing their care.
We have passed the time when the unaided
human mind can perform this feat: modern
information management tools are needed as
well as a commitment by healthcare
professionals to change practices when more
knowledge becomes available.
Questions
1. The component needed to provide
evidence-based care include all of the
following, except:
- development of new models and tools
needed in the delivery of efficient nursing
care
2. Personalized care with consumer-based
health records and better information for
consumers can be based achieved
through all of the following:
- promoting the use of tools to accelerate
research and dissemination of evidence
based care
3. All of the following are stated goals of the
strategic plan for the wider implementation
of health information technology in us,
except:
- promote the health of populations,
sentence communities, families and
individuals by providing them with
adequate medical care
Definitions
Informatics is about managing information. The
tendency to relate it to computers comes from
the fact that the ability to manage large
amounts of information was born with the
computer and progressed as computers
became more powerful and commonplace. It
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is, however, human ingenuity that is the crux of
informatics. The term "informatics" originated
from the russian term "informatika" (sackett &
erdley 2002). A russian publication, oznovy
informatiki (foundations of informatics),
published in 1968 is credited with the origins of
the general discipline of informatics (middle
east technical university, n.d.). At that time it
was described within the context of
computers. "medical informatics" was the first
term used to identify informatics in healthcare.
It was defined as the information technologies
that are concerned with patient care and the
medical decision making process. Another
definition stated that medical informatics is
complex data processing by the computer to
create new information. As with many
healthcare enterprises, there was debate
about whether "medical" referred only to
informatics focusing on physician concerns, or
if it refers to all healthcare disciplines.
Increasingly, it is seen that other disciplines
have a body of knowledge separate from
medicine, but part of healthcare, and the term
healthcare informatics is becoming more
commonly used. In essence, informatics is the
management of information, using cognitive
skills and the computer.
Health infomatics
Healthcare informatics focuses on managing
information in healthcare. It is an umbrella term
that describes the capture, retrieval, storage,
presenting, sharing, and use of biomedical
information, data, and knowledge for
providing care, problem solving, and decision
making (shortliffe & blois, 2001). The purpose is
to improve the use of healthcare data,
information, and knowledge in supporting
patient care, research, and education
(delaney, 2001). The focus is on the subject,
information, rather than the tool, the
computer. The distinction is not always obvious
as a result of the need to master computer skills
to enable one to manage this information. The
computer is used in acquiring, organizing,
manipulating, and presenting the information.
It will not produce anything of value without
human direction in how, when, and where the
data is acquired, how it is treated, interpreted,
manipulated, and presented. Informatics
provides that human direction.
Nursing informatics
Healthcare has many disciplines, thus it is not
surprising that healthcare informatics has many
specialties of which nursing is one. Nursing
informatics is also a subspecialty of nursing
which the american nurses association (ana)
recognized in 1992, with the first informatics
certification examination being given in the fall
of 1995 (newbold, 1996). Nursing informatics
has as its focus managing information
pertaining to nursing. Specialists in this area
look at how nursing information is acquired,
manipulated, stored, presented, and used.
Informatics nurses work with practicing nurses
to identify the needs of nurses for information
and support, and with system developers in the
development of systems that work to
complement the practice needs of nurses.
Nursing informatics specialists bring to system
development and implementation a viewpoint
that supports the needs of the clinical end user.
The objective is an information system that is
not only user friendly for data input, but
presents the clinical nurse with needed
information in a manner that is timely and
useful. This is not to say that nursing informatics
stands alone, it is an integral part of the
interdisciplinary field of healthcare informatics,
hence related to and responsible to all the
healthcare disciplines.
Definitions of nursing informatics
The term "nursing informatics," was probably
first used and defined by scholes and barber in
1980 in their address that year to the med-info
conference in tokyo. There is still no definitive
agreement on exactly what the term nursing
informatics means. As simpson once said
(simpson, 1998), defining nursing informatics is
difficult because it is a moving target. The
original definition said that nursing informatics
was the use of computer technology in all
nursing endeavors: nursing services, education,
and research. (scholes & barber, 1980) another
early definition that followed the broad
definition of scholes and barber was written by
hannah, ball & edwards (1994). They defined
nursing informatics as any use of information
technologies in carrying out nursing functions.
Like the scholes and barber definition, these
definitions focused on the technology and
could be interpreted to mean any use of the
computer from word processing to the
creation of artificial intelligence for nurses as
long as the computer use involved the
practice of professional nursing.
The shift from a technology orientation in
definitions to one that is more information
oriented started in the mid 1980s with schwirian
(staggers & thompson, 2002). She created a
model to be used as a framework for nursing
informatics investigators (schwirian, 1986). The
model consisted of four elements arranged in
a pyramid with a triangular base. The top of
the pyramid was the desired goal of the
nursing informatics activity and the base was
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composed of three elements: 1) users (nurses
and students), 2) raw material or nursing
information, and 3) the technology, which is
computer hardware and software. They all
interact in nursing informatics activity to
achieve a goal. The model was intended as a
stimulus for research.
The first widely circulated definition that moved
away from technology to concepts was from
graves and corcoran (staggers & thompson,
2002). They defined nursing informatics as "a
combination of computer science, information
science and nursing science designed to assist
in the management and processing of nursing
data, information and knowledge to support
the practice of nursing and the delivery of
nursing care" (graves & corcoran, 1989)(p.
227). This definition secured the position of
nursing informatics within the practice of
nursing and placed the emphasis on data,
information, and knowledge (staggers &
thompson, 2002). Many consider it the seminal
definition of nursing informatics.
Turley (turley, 1996), after analyzing previous
definitions, added another discipline, cognitive
science, to the base for nursing informatics.
Cognitive science emphasizes the human
factor in informatics. Its main focus is the nature
of knowledge, its components, development,
and use. Goossen (1996), thinking along the
same lines, used the graves and corcoran
definition as a basis and expanded the
meaning of nursing informatics to include the
thinking that is done by nurses to make
knowledge-based decisions and inferences for
patient care. Using this interpretation, he felt
that nursing informatics should focus on
analyzing and modeling the cognitive
processing for all areas of nursing practice.
Goossen also stated that nursing informatics
should look at the effects of computerized
systems on nursing care delivery
The first ana definition in 1992 added the role
of the informatics nursing specialist to the
graves and corcoran definition. The 2001 ana
definition stated that nursing informatics
combines nursing, information and computer
sciences for the purpose of managing and
communicating data, information, and
knowledge to support nurses and healthcare
providers in decision making (american nurses
association, 2001). Information structures,
processes, and technology are used to provide
this support. In the latest ana scope and
standards this definition was reiterated, albeit
in slightly different wording (american nurses
association, 2008) and with the addition of
wisdom to the data, information, and
knowledge conceptual framework. This most
recent definition emphasized again that the
goal of nursing informatics is to optimize
information management and communication
to improve the health of individuals, families,
populations, and communities.
Staggers and thompson (2002), who believe
that the evolution of definitions will continue,
pointed out that in all of the current definitions,
the role of the patient is under emphasized.
Some early definitions included the patient, but
as a passive recipient of care. With the advent
of the internet, more and more patients are
taking an active role in their healthcare. This
factor changes not only the dynamics of
healthcare, but permits a definition of nursing
informatics that recognizes that patients as well
as healthcare professionals are consumers of
healthcare information and that patients may
be participating in keeping their medical
records current. Staggers and thompson also
pointed out that the role of the nurse as an
integrator of information has been overlooked
and should be considered in future definitions.
Despite these definitions, the focus of much of
today's practice informatics is still on capturing
data at the point of care and presenting it in a
manner that facilitates the care of an
individual patient. Although this is a vital first
step, when designing patient care information
systems, thought needs to be given to
secondary data analysis, or analysis of data for
purposes other than for which it was originally
collected. Using aggregated data, or the
same piece(s) of data, for example, outcomes
of a given intervention for many patients, you
can make decisions based on actual patient
care data. Understanding how informatics can
serve you as an individual nurse, as well as the
profession, puts you in a position to work with
informatics specialists to make retrievable data
needed to improve patient care.
Questions
1. According to american nurses association,
nursing informatics:
- combines nursing, information, and
computer science for the purpose of
managing and communicating data,
information, and knowledge to support
nurses and health care provider in decision
making
2. Informatics in healthcare was formerly
known as:
- medical informatics
3. The focus of nursing informatics today is:
- capturing data at the point of care
History of computer and healthcare
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In 1850, it was possible for all the medical
knowledge known to the western world to be
put into two large volumes making it possible,
for one person to read and assimilate all this
information. The situation today is dramatically
different. The number of journals available in
healthcare and the research that fills them
have increased many times over. Even in the
early 1990s, if physicians read two journal
articles a day, by the end of a year they would
be 800 years behind in their reading
(mcdonald, 1994). A healthcare clinician may
be expected to know something about 10,000
different diseases and syndromes, 3,000
medications, 1,100 laboratory tests and the
information in the more than 400,000 articles
added to the biomedical information each
year (davenport & glaser, 2002). Additionally,
current knowledge is constantly changing: one
can expect much of their knowledge to be
obsolete in five years or less.
In healthcare, the increase in knowledge has
led to the development of many specialties
such as respiratory therapy, neonatology, and
gerontology, and subspecialties within each of
these. As these specialties have proliferated
and spawned the development of many
miraculous treatments, healthcare has too
often become fractionalized, resulting in
difficulty in gaining an overview of the entire
patient. The pressure of accomplishing the
tasks necessary for a patient's physical
recovery usually leaves little time for perusing a
patient's record and putting together the bits
and pieces so carefully charted by each
discipline. Even if time is available there is
simply so much data, in so many places, that it
is difficult to merge the data with the
knowledge that a healthcare provider has
learned, as well as with new knowledge
needed to provide the best patient care. We
are drowning in data but lack the time and
skills to transform it to useful information or
knowledge.
The development of the computer as a tool to
manage information can be seen in its history.
The first information management task
"computerized" was numeric manipulation.
Although not technically a computer by
today's terminology, the first successful
computerization tool was the abacus, which
was developed about 3000 bc. Although when
one developed skill, real speed in these tasks
was possible, the operator of the abacus still
had to mentally manipulate data. All the
abacus did was store the results step by step.
Slide rules came next in 1632, but like the
abacus required a great deal of skill on the
part of the operator. The first machine to add
and subtract by itself was blaise pascal's
"arithmetic machine," built in 1542. The first
"computer" to be a commercial success was
jacquard's weaving machine built in 1804. Its
efficiency so frightened workers at the mill
where it was built that they rioted, broke apart
the machine, and sold the parts. Despite this
setback, the machine proved a success
because it introduced a cost-effective way of
producing goods.
The difference and analytical engines, early
computers designed by charles babbage in
the mid 19th century, although never built, laid
the foundation for modern computers
(analytical engine, 2007). The first time that an
automatic calculating machine was
successfully used was in the 1900 census.
Herman hollerith (who later started ibm) used
the jacquard loom concept of punch cards to
create a machine that enabled the 1900
census takers to compile the results in one year
instead of the 10 (herman hollerith—punch
cards) required for the 1890 census. The first
computer by today's perception was the
electronic numerical integrator and computer
(eniac) built by people at the moore school of
engineering at the university of pennsylvania in
partnership with the u.s. Government. When
completed in 1946, it consisted of 18,000
vacuum tubes, 70,000 progresistors, and 5
million soldered joints. It consumed enough
energy to dim the lights in an entire section of
philadelphia (moye, 1996). The progress in
hardware since then is phenomenal; today's
"palmtop" computers have more processing
power than eniac did.
The use of computers in healthcare originated
in the late 1950s and early 1960s as a way to
manage financial information. This was
followed in the late 1960s by the development
of a few computerized patient care
applications (saba & erdeley 2006). Some of
these hospital information systems included
patient diagnoses and other patient
information as well as care plans based on
physician and nursing orders. Because of the
lack of processing power then available, these
systems were unable to deliver what was
needed and never became widely used.
Early healthcare informatics system
One of the interesting early uses of the
computer in patient care was the problem-
oriented medical information system (promis)
begun by dr. Lawrence weed at the university
medical center in burlington, vt (mcneill, 1979)
in 1968. The importance of this system is that it
was the first attempt at providing a total,
integrated system that covered all aspects of
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healthcare, including patient treatment. It was
patient oriented and used as its framework the
problem-oriented medical record (pomr). The
unit featured an interactive touch screen and
was known for fast responsiveness (problem-
oriented medical information system, n.d.). At
its height, it consisted of over 60,000 frames of
knowledge.
Promis was designed to overcome four
problems that are still with us today: lack of
care coordination, reliance on memory, lack
of recorded logic of delivered care, and lack
of an effective feedback loop (promis: the
problem-oriented medical information system,
1980). The system provided a wide array of
information to all healthcare providers. All
disciplines recorded their observations and
plans, and related them to a specific problem.
This broke down barriers between disciplines,
making it possible to see the relationship
between conditions, treatments, costs, and
outcomes. Unfortunately, this system did not
have wide acceptance. To embrace it meant
a change in the structure of healthcare,
something that did not begin to happen until
the 1990s, when managed care in all its
variations reinvigorated a push toward more
patient-centered information systems, a push
that is continuing as you read this.
Another early system that became functional
in 1967 and is still functioning, is the help
evaluation logical processing (help) system
developed by the informatics department at
the university of utah school of medicine. It was
first implemented in a heart catheterization
laboratory and a post open heart intensive
care unit. It is now hospital wide and
operational in many hospitals in the
intermountain healthcare system (gardner,
pryor, & warner, 1999). This is not only a hospital
information system, but integrates a
sophisticated clinical decision support system
that provides information to clinical areas. It
was the first hospital information system that
collected data for clinical decision making
and integrated it with a medical knowledge
base. It is well accepted by clinicians and has
demonstrated that a clinical support system is
feasible and that it reduces healthcare costs
without sacrificing quality.
Progression of information system
As the science of informatics has progressed,
there have been changes in information
systems. Originally computerized clinical
information systems were process oriented.
That is, they were implemented to computerize
a specific process, for example, billing, order
entry, or laboratory reports. This led to the
creation of different software systems for
different departments, which unfortunately
could not share data, creating a need for
clinicians to enter data more than once. An
attempt to share data by integrating data
from disparate systems is a difficult and
sometimes impossible task. Even when possible,
the results are often disappointing and can
leave negative impressions of computerization
in users' minds. These barriers are being slowly
overcome with the introduction of data
standards, both in terminology and in protocols
for passing data from one system to another.
Newer systems, however, are organized by
data and are designed to use the same piece
of data many times, thus requiring that the
entry be made only once. The primary design is
based on how data is gathered, stored, and
used in an entire institution rather than on a
specific process such as pharmacy or
laboratory. For example, when a medication
order is placed, the system can have access to
all the information about a patient including his
diagnosis, age, weight, allergies, and
eventually genomics, as well as the
medications he is currently taking. The order
and patient information can also be matched
against knowledge such as what drugs are
incompatible with the prescribed drug, the
dosage of the drug, and the appropriateness
of the drug for this patient. If there are
difficulties, the system can deliver warnings at
the time the medication is ordered instead of
requiring clinician intervention either in the
pharmacy or at the time of administration.
Another feature in a data-driven system is the
ability to make the same information available
to the dietician planning the patient's diet and
the nurse providing patient care and doing
discharge planning, thus enabling a more
complete picture of a patient than one that
would be available when separate systems
handle dietetics and nursing.
Evidence-based practice will result not only
from research and practice guidelines, but also
from unidentifiable (data minus any patient
identification) aggregated data from actual
patients. It will also be possible to see how
patients with a given genomics react to a
drug, thus helping the clinician in prescribing
drugs. This same aggregated data will help
clinicians make decisions by providing
information about treatments that are most
effective for given conditions, replacing the
current system, which is too often based on
"what we have always done" rather than
empirical information. These systems will use
computers that are powerful enough to
process data so that information is created "on
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the fly," or immediately when requested.
Systems that incorporate these features will
require a new way of thinking. Instead of
having all one's knowledge in memory, one
must be comfortable both with needing to
access information and with changing one's
practice to accommodate the new
knowledge.
Computerization will affect healthcare
professionals in other ways. Some jobs will
change focus. As nurses we may find that our
job as a patient care coordinator has shifted
from transcribing and checking orders to
accessing this information on the computer. To
preserve our ability to provide full care for our
patients, and as an information integrator for
other disciplines, we will need to make our
information needs known to those who design
the systems. To accomplish this we all need to
be aware of the value of both our data and
our experience and to be able to identify the
data we need to perform our job, as well as to
appreciate the value of the data that others
and we add to the healthcare system.
Questions
1. The difference and analytical engines were
designed by:
- charles babbage
2. All of the following statement about the
health evaluation logical processing (help)
system are true, except:
- it featured an interactive touch screen
and it was known for its responsiveness
3. Promis what's this side to solve all of the
following problems, except:
- lack of proper scheduling of clinical staff
Benefits of informatics
The information systems described previously
will bring many benefits to healthcare. These
benefits can be seen in the ability to create
and use aggregated data, prevent errors,
ease working conditions, and provide better
healthcare records.
For healthcare in general
One of the primary benefits of informatics is
that data that was previously buried in
inaccessible records becomes usable.
Informatics is not just about collecting data,
but about making it useful. When data is
captured electronically in a structured manner,
it can be retrieved and used in many different
ways, both to easily assimilate information
about one patient and as aggregated data.
Aggregated data is the same piece or pieces
of data for many patients. Table 1-1 shows
some aggregated data for postsurgical
infections sorted by physician and then by the
organism. Because infections for some patients
are caused by two different pathogens in
table 1-1, you see two entries for some
patients, however, this is all produced from
only one entry of the data. With just a few
clicks of a mouse, this same data could be
organized by unit to show the number of
infections on each unit. This is possible because
data that is structured as in table 1-1 and
standardized can be presented in many
different views.
When aggregated data is examined, patterns
can be seen that might otherwise take several
weeks or months to become evident, or might
never become evident. When patterns, such
as the prevalence of infections for dr. Smith
emerge (table 1-1), investigations into what
these patients have in common can begin.
Caution, however, should be observed. The
aggregated data in table 1-1 are insufficient
for drawing conclusions; the data only serves
as an indication of a problem and clues to
where to start investigating. Aggregated data
is a type of information or even knowledge,
but wisdom says that it is incomplete. If this
data were shared outside of an agency, or
with those who don't need to have personal
information about a patient, it would be de-
identified, that is, there would be no patient
names and probably no physician names.
Deciding who can see what data is one of the
current issues in informatics.
Informatics through information systems can
improve communication between all
healthcare providers, which will improve
patient care as well as reduce stress.
Additional benefits for healthcare include
making the storage and retrieval of healthcare
records much easier, quicker retrieval of test
results, printouts of needed information
organized to meet the needs of the user, and
fewer lost charges as a result of easier methods
of recording charges. The computerization of
administrative tasks such as staffing and
scheduling also saves time and money.
Benefits to the nursing profession
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Each healthcare discipline will benefit from its
investment in informatics. In nursing, informatics
will not only enhance practice, but also allow
nursing science to develop (fitzpatrick, 1988).
Informatics will improve documentation and,
when properly implemented, can reduce the
time spent in documentation. It is believed by
many nurses that they spend over 50% of their
time doing paperwork (womack et al, 2004).
Entering vital signs both in nursing notes and on
a flow sheet, wastes time and invites errors. In a
well-designed clinical documentation system,
this data will be entered once, retrieved, and
presented in many different forms to meet the
needs of the user.
Paper documentation methods create other
problems such as inconsistency and irregularity
in charting as well as the lack of data for
evaluation and research mentioned above.
An electronic clinical information system can
remind users of the need to provide data in
areas apt to be forgotten and provide a list of
terms that can be clicked to enter data. The
ability to use patient data for both quality
control and research is vastly improved when
documentation is complete and electronic.
Despite florence nightingale's emphasis on
data, for much of nursing's history, nursing data
has not been valued. It is either buried in paper
patient records that make retrieving it
economically infeasible or, worse, discarded
when a patient is discharged, hence
unavailable for building nursing science. With
the advent of electronic clinical
documentation, nursing data can be made a
part of the ehr and become available to
researchers for building evidence-based
nursing knowledge. The recent maryland
report on the use of technology to address the
nursing shortage demonstrated that
informatics can be used to improve staff
morale and patient care (womack et al.,
2004). For example, paper request forms can
be eliminated, work announcements can be
more easily communicated, the time for in-
services can be reduced, and empty shifts can
be filled using internet software.
In understanding the role and value that
informatics adds to nursing, it is necessary to
recognize that the profession is not confined to
tasks, but that it is cognitive. Providing the data
to support this is a joint function of nursing
informatics and clinicians. Identifying and
determining how to facilitate its collection is an
informatics skill that all nurses need.
Questions
1. All of the following are benefits of
informatics for healthcare, except:
- increased nursing competency and
satisfaction
2. Paper documentation in healthcare
creates all of the following problems,
except:
- overemphasis of clinical data
3. The benefits of informatics to the nursing
profession includes all of the following,
except:
- informatics will provide an ave. For
continuing education
Nursing informatics competencies and
information literacy
The need to manage complex amounts of
data in patient care demands that nurses,
regardless of specialty area, have informatics
skills (gaumer, koeniger-donohue, friel, &
sudbay, 2007; nelson, 2007; wilhoit, mustain, &
king, 2006). Informatics skills require basic
computer skills as one component (staggers,
gassert, & curran, 2002). A recent survey of
hospital administrators in three states in the
southeastern united states revealed that one
of the competencies that they wanted from
nurses dealt with the use of the computer
(uttley-smith, 2004). This supports an earlier
study by gravely, lust, & fullerton (1999) that
found that 83% of hospital recruiters indicated
the importance of computer skills. Another skill
needed for proficiency in informatics is
information literacy. Both these skills have also
been identified by the ana and national
league for nursing (nln) as necessary for
evidence-based practice.
Computer fluency
The term "computer literacy" is used broadly to
mean the ability to perform various tasks with a
computer. Given the rapid changes in
technology and in nursing, perhaps a better
perspective on computer use can be gained
by thinking in terms of computer fluency rather
than literacy. The term "fluency" implies that an
individual has a lifelong commitment to
acquiring new skills for the purpose of being
more effective in work and personal life
(committee on information technology
literacy, 1999). This necessitates a goal of
gaining sufficient foundational skills and
knowledge to enable one to independently
acquire new skills. Thus, computer literacy is a
temporary state, whereas computer fluency
involves being able to increase one's ability to
effectively use a computer when needed.
A perusal of listserv archives in informatics
reveals periodic requests for instruments to
measure the computer competency of staff.
Unfortunately there is little agreement on
NCM110A - PRELIM 8
specific competencies needed, let alone an
instrument to measure this, but there is a
consensus that it involves a positive attitude
toward computers, knowledge and
understanding of computer technology,
computer hardware and software skills, and
the ability to visualize the overall benefits to
nursing from this technology (hobbs, 2002).
Simpson (1998) pointed out the need for nurses
to master computers to avoid extinction. A
computer is a mind tool that frees us from the
mental drudgery of data processing, just as the
bulldozer frees us from the drudgery of digging
and moving dirt. Like, the bulldozer, however,
the computer must be used intelligently or
damage can result.
Given the forces moving healthcare toward
more use of informatics, it is important for
nurses to learn the skills associated with using a
computer for managing information.
Additionally, knowing how to use graphical
interfaces and application programs such as
word processing, spreadsheets, databases,
and presentation programs is as an important
an element in a professional career as
mastering technology skills (mccannon &
o'neal, 2003). Just as anatomy and physiology
provide a background for learning about
disease processes and treatments, computer
fluency skills are necessary to appreciate more
complex informatics concepts (mcneil &
odom, 2000) and for learning clinical
applications (nagelkerk, ritolo, & vandort,
1998).
Ronald and skiba (1987) were the first to look at
computer competencies required for nurses. In
the late 1990s and early part of this century this
issue was revisited, but the focus became the
use of computer skills as part of informatics skills
(mccannon & o'neal, 2003; mcneil et al., 2003;
pew health professions commissions, 1998;
staggers, gassert, & curran, 2001; staggers et
al., 2002; uttley-smith, 2004). One of the more
thorough studies is by staggers, gassert, and
curran (2001). They defined four levels of
informatics competencies for practicing nurses.
The first two pertain to all nurses, the last two to
informatics nurses.
 The beginning nurse should possess
basic information management and
computer technology skills.
Accomplishments should include the
ability to access data, use a computer
for communication, use basic desktop
software, and use decision support
systems.
 Experienced nurses should be highly
skilled in using information management
and computer technology to support
their major area of practice. Additional
skills for the experienced nurse include
being able to make judgments on the
basis of trends and patterns within data
elements and to collaborate with
nursing informatics nurses to suggest
improvements in nursing systems.
 The informatics nurse specialist should
be able to meet the information needs
of practicing nurses by integrating and
applying information, computer, and
nursing sciences.
 The informatics innovator will conduct
informatics research and generate
informatics theory.
Informatics literacy
Information literacy, or the ability to know
when one needs information and how to
locate, evaluate, and effectively use it
(national forum on information literacy, 2004) is
an informatics skill. Although it involves
computer skills, like informatics, it requires
critical thinking and problem solving.
Information literacy is part of the foundation for
evidence-based practice and provides nurses
with the ability to be intelligent information
consumers in today's electronic environment
(jacobs, rosenfeld, & haber, 2003).
The level of computer fluency needed by
nurses to be both information literate and
informatics capable in their practice is what is
expected of any educated nurse. In this
course, the lessons addressing basic computer
skills will emphasize concepts that promote the
ability to learn new applications. These lessons
provide information underlying the use of
informatics in professional life both on and off a
clinical unit, and to adapt to changes in
technology. In future lessons these principles
will be built upon to allow the reader to start to
develop beginning informatics skills, including
the ability to find and evaluate information
from electronic sources. Additional lessons will
allow the reader to develop skills necessary to
work with nursing informatics specialists in
providing effective information systems and
the use of nursing data.
NCM110A - PRELIM 9
Summary
Healthcare is in transition and nursing is being
affected by these changes. Part of these
changes involves informatics. Whether the
change will be positive or negative for patient
care and nursing depends on nurses. For the
change to be positive, nurses need to develop
skills in information management, known in
healthcare as informatics. To gain these skills, a
background in both computer and information
literacy skills is necessary.
As knowledge continues to expand
logarithmically, data and information can no
longer be managed solely by the human mind.
The use of tools to aid the human mind has
become mandatory. Although healthcare has
been behind most industries in using
technology to manage its data, there are
many forces, both at the governmental and
private levels that are working to change this.
With these pressures, healthcare informatics is
rapidly expanding. There are many
subspecialties in informatics, of which nursing is
one. Embracing informatics will allow nurses to
assess and evaluate practice just as a
stethoscope allows the evaluation and
assessment of a patient.
The use of computers in healthcare started in
the 1960s, mostly in financial areas, but with the
advance in computing power and the
demand for clinical data, computers are being
used more and more in clinical areas. With this
growth has come a change in focus for
information systems from providing solutions for
just one process, to an enterprise-wide patient-
centered system that focuses on data. This
new focus provides the functionality that
allows one piece of data to be used in multiple
ways. To understand and work with clinical
systems, as well as to fulfill other professional
responsibilities, nurses need to be computer
fluent, information literate, and informatics
knowledgeable.
Questions
1. Informatics skill require:
- basic computer skills and information
literacy
2. The novice nurses should possess basic
information management and computer
technology skills, including all of the
following, except:
- how to generate informatics theories
3. The term “computer literacy” is used
broadly to mean:
- the ability to perform various tasks with a
computer
LESSON 1 : POST-QUIZ
1. The ability to know one needs information
and how to locate, evaluate, and
effectively use this information is referred to
as:
- information literacy
2. The first machine to add and subtract by
itself was the
- arithmetic machine
3. All of the following statements about health
care informatics are true, except:
- it is a subspecialty of medical informatics
and has its focus on managing information
pertaining to nursing
4. Computers were first used in the healthcare
to:
- manage financial information
5. The use of information technology in
healthcare is known as:
- informatics
Lesson 2 | Foundation of nursing
Introduction
We have entered the information age. Home
computers, laptops, handheld computers, and
ipods are pervasive. Banks and stock markets
move and track billions of dollars around the
world every day through information systems.
Factories and stores buy, build, sell, and
account for the products in our lives through
information systems. In schools, computers are
being used as teaching tools and as
instructional resources for students in such
varied disciplines as astronomy, chinese, and
chemistry. The airline industry uses information
systems to book seats, calculate loads, order
meals, determine flight plans, determine fuel
requirements, and even fly the planes and
control air traffic.
The information age has not left the health
industry untouched. Moving beyond standard
data processing for administrative functions
common to all organizations such as human
resources, payroll, and financial information
systems now play an important role in patient
care by interpreting electrocardiograms,
scheduling, entering orders, reporting results,
and preventing drug interactions (by cross-
referencing drug compatibility and warning
appropriate stall). We are beginning to see the
advent of lifetime electronic health records in
many countries. In addition, information
systems are now being more widely used in
support of population health and public health
activities related to health protection (e.g.,
immunization), health promotion (e.g., well
baby clinics), disease prevention (e.g., smoking
cessation or needle exchange programs), and
health monitoring or surveillance (e.g.,
restaurant inspection or air quality monitoring).
NCM110A - PRELIM 10
Nurses have always had a major
communication role at the interface between
the patient/client and the health system. This
role is now labeled information management,
and nurses are increasingly using information
systems to assist them to fulfill this role in clinical
practice, administration, research, and
education. Before attempting to talk about the
role of nursing in informatics, let us first establish
definitions of "nursing" and "nursing informatics."
What is nursing?
Nursing is emerging as a professional practice
discipline. Based on the work of theorists,
nursing practitioners see its goals as the
promotion of adaptation in health and illness
and the facilitation of achievement of the
highest possible individual state of health
(rogers, 1970; roy, 1976). These early theoretical
models have provided the impetus for the
development of current approaches to the
classification of phenomena of concern to
nursing care.
The practitioner of nursing has many roles and
responsibilities. Among these roles are those of
an interface between the client and the
healthcare system and that of client advocate
in the healthcare system. Nursing functions can
be considered under three major categories.
 Managerial, which includes establishing
nursing care plans, keeping charts,
transcribing orders and requisitions, and
scheduling patient appointments for
diagnostic procedures or therapy;
 Delegated tasks, which include physical
treatments and administration of
medications under the direction of a
physician;
 Autonomous nursing functions, which
include interpersonal communication
skills, application of the psychological
principles of client care, and providing
physical care to patients.
It is the third category of nursing activities that
is the core of nursing practice. In this category
of autonomous activity nurses use their
knowledge, skills, judgment, and experience to
exercise independent decision making related
to the phenomena for which nurses provide
care and the nursing interventions that effect
those phenomena and influence patient care
outcomes.
Questions
1. The communication role of a nurse at the
interface between the client and the
health system is referred to as:
- information management
2. The core of nursing practice is:
- to provide care and interventions that
influence patient care outcomes
3. This is an example of a managerial nursing
function:
- transcribing orders and requisitions
4. Example of autonomous nursing function
include all of the following, except:
- scheduling patient appointments for
diagnostic procedures
5. This nursing function includes physical
treatments and administration of
medication under the direction of a
physician:
- delegated task
What is “medical/healthcare informatics?”
Before we explore the nature of hospital and
nursing information systems, we need to review
the definitions of health, medical, and nursing
informatics. Francois gremy of france is widely
credited with coining the term informatique
medical, which was translated into english as
medical informatics. Early on, the term medical
informatics was used to describe "those
collected informational technologies which
concern themselves with the patient care,
medical decision making process" (greenburg,
1975). Another early definition, in the first issue
of the journal of medical informatics, proposed
that medical informatics was "the complex
processing of data by a computer to produce
new kinds of information" (anderson, 1976). As
our understanding of this discipline developed,
greenes and shortliffe (1990) redefined
medical informatics as "the field that concerns
itself with the cognitive, information processing
and communication tasks of medical practice,
education, and research, including the
information science and the technology to
support these tasks. An intrinsically
interdisciplinary field... [with] an applied focus...
[addressing] a number of fundamental
research problems as well as planning and
policy issues," more recently, shortliffe et al.
(2001) defined medical informatics as "the
scientific field that deals with biomedical
information, data, and knowledge their
storage, retrieval and optimal use for problem-
solving and decision-making,"
One question consistently arose: "does the
word medical refer only to physicians, or does
it refer to all healthcare professions?" the
premise was that medical referred to all
healthcare professions and that a parallel
definition of medical informatics might be
"those collected informational technologies
that concern themselves with the patient care
decision-making process performed by
NCM110A - PRELIM 11
healthcare practitioners." thus, because nurses
are healthcare practitioners who are involved
in the patient care and the decision-making
process that uses information captured by and
extracted from the information technologies,
there clearly was a place for nursing in medical
informatics. Increasingly, as research was
conducted and medical informatics evolved,
nurses realized there was a discrete body of
knowledge related to nursing and the use of
informatics. During the early 1990s, other health
professions began to explore the use of
informatics in their disciplines. Mandil (1989)
coined the phrase "health informatics," which
he defined as the use of information
technology (including both hardware and
software) in combination with information
management concepts and methods to
support the delivery of healthcare. Thus, health
informatics has become the umbrella term
encompassing medical, nursing, dental, and
pharmacy informatics among others. Health
informatics focuses attention on the recipient
of care rather than on the discipline of the
caregiver,
Nursing’s early role in medical informatics
The nurse's early role in medical informatics was
that of a consumer. The literature clearly shows
the contributions of medical informatics to the
practice of nursing and patient care. Early
developments in medical informatics and their
advantages to nursing have been thoroughly
documented (hannah, 1976). These initial
developments were fragmentary and
generally restricted to automating existing
functions or activities such as automated
charting of nurses' notes, automated nursing
care plans, automated patient monitoring,
automated personnel time assignment, and
the gathering of epidemiological and
administrative statistics. Subsequently, an
integrated approach to medical informatics
resulted in the development and marketing of
sophisticated hospital information systems that
included nursing applications or modules. As
models of health services delivery have shifted
toward integrated care delivery across the
entire spectrum of health services, integrated
information systems have developed. These
enterprise systems provided an integrated
clinical record within a complex integrated
healthcare organization. Such systems support
evidence-based nursing practice, facilitate
nurses' participation in the healthcare team,
and document nurses' contribution to patient
care outcomes. They have failed, however, to
meet the challenge of providing a nationwide
comprehensive, lifelong, electronic health
record that integrates the information
generated by all of a person's contacts with
the healthcare system.
Questions
1. The early role of a nurse in medical
informatics was that of a/an:
- consumer
2. Health informatics focuses on:
- the recipient of care
3. All of the following are appropriate
definitions of medical informatics, except:
- the specialized application of information
technology aimed at optimizing laboratory
operations
Development of nursing informatics
Nursing informatics, as originally defined
(hannah, 1985, p. 181) referred to the use of
information technologies in relation to those
functions within the purview of nursing that are
carried out by nurses when performing their
duties. Therefore, any use of information
technologies by nurses in relation to the care
of patients, the administration of healthcare
facilities, or the educational preparation of
individuals to practice the discipline is
considered nursing informatics. For example,
nursing informatics would include, but not be
limited to the following.
 Use of artificial intelligence or decision-
making systems to support the use of the
nursing process
 Use of a computer-based scheduling
package to allocate staff in a hospital
or healthcare organization
 Use of computers for patient education
 Use of computer-assisted learning in
nursing education
 Nursing use of a hospital information
system
 Research related to what information
nurses use when making patient care
decisions and how those decisions are
made
As the field of nursing informatics has evolved,
the definition of nursing informatics has been
elaborated and refined. Graves and corcoran
(1989) suggested that nursing informatics is "a
combination of computer science, information
science, and nursing science designed to assist
in the management and processing of nursing
data, information, and knowledge to support
the practice of nursing and the delivery of
nursing care." an expert panel of the american
nurses association (2001) promoted nursing
informatics as a specialty that integrates
nursing science, computer science, and
information science to manage and
communicate data, information, and
NCM110A - PRELIM 12
knowledge in nursing practice. Nursing
informatics facilitates the integration of data,
information and knowledge to support
patients, nurses and other providers in their
decision-making in all roles and settings. This
support is accomplished through the use of
information structures and information
technology.
In an extensive review and analysis of the
evolution of definitions of nursing informatics,
staggers and thompson (2002, p. 259)
concluded that after three decades as a
specialty there was still a proliferation of
definitions for nursing informatics. Staggers and
thompson (2002) modified the ana definition
and proposed a revised definition of nursing
informatics as a specialty that integrates
nursing science, computer science, and
information science to manage and
communicate data, information and
knowledge to support patients, nurses and
other providers in their decision making in all
roles and settings. This support is accomplished
through the use of information structures,
information processes and information
technology.
Furthermore, staggers and thompson (2002, p.
259-260) built on the ana work to propose that
the goal of nursing informatics is to improve the
health of populations, communities, families
and individuals by optimizing information
management and communication. This
includes the use of information and technology
in the direct provision of care, in establishing
effective administrative systems, in managing
and delivering educational experiences, in
supporting lifelong learning, and in supporting
nursing research.
Questions
1. All of the following statement about nursing
informatics are true, except:
- It constitute the establishment of
administrative systems to electronically
communicate with consumer
2. Examples of nursing informatics include all
of the following, except:
- use of pen- and paper-based
documentation to facilitate patient care
3. This statement best describes nursing
informatics:
- the use of any information technologies
with nurses in relation to the care of patient,
of health care facilities, or the educational
preparation of nurses
4. The stated goal of nursing informatics is to:
- promote the health of populations,
communities, families and individual by
optimizing information management and
communication
IMPACT OF INFORMATICS ON NURSING
As we mentioned earlier, nursing informatics
has moved beyond merely the use of
computers and is increasingly referring to the
impact of information and information
management on the discipline of nursing.
Staggers and Thompson (2002) affirmed our
long-held position that nurses are "information
integrators at the patient level." Nurses form the
largest group of healthcare professionals in any
setting to have a health information system.
Therefore, when providing patient care, nurses
make use of information management more
often than any other group of healthcare
professionals.
The nursing profession is recognizing the
potential of informatics to improve nursing
practice and the quality of patient care. New
roles are evolving for nurses. The American
Nurses Association (2001) recognized nursing
informatics as a nursing specialty in 2001.
Hospitals and other healthcare organizations
are now hiring informatics nurse specialists and
informatics nurse consultants to help in the
design and implementation of information
systems. Nurse educators are using information
systems to manage the educational
environment. Computer-based information
systems are used to instruct, evaluate, and
identify problem areas of specific students;
gather data on how each student learns;
process data for research purposes; and carry
out continued education. Nurse researchers,
who have been using computerized software
for data manipulation for years, are turning
their attention to the problems of identifying
variables for data sets essential to the
diagnosing of nursing problems, choosing
nursing actions, and evaluating patient care.
There is no doubt that we have reached the
information age in nursing. We must now
prepare for the full impact of informatics on
nursing.
Questions
1. The American Nurses Association
recognized nursing informatics as a nursing
specialty in:
- 2001
NCM110A - PRELIM 13
2. They make use of information management
more often than any other group of
healthcare professionals when providing
care:
- nurses
3. They are the information integrators at the
patient level:
- nurses
FUTURE IMPLICATIONS
Technology has historically relieved people of
backbreaking drudgery and dreary monotony,
providing them with more free time to pursue
personal relations and creative activities.
Nurses, too, when relieved of routine and time-
consuming clerical or managerial paper
handling chores, can devote more time to the
unique problems and needs of individual
patients or clients. Increasingly, across the
world, the managerial and clerical paper-
handling tasks of nursing are being performed
by information systems. In addition, robotics
(e.g., lifting and turning patients, delivering
medications or meals, and recording
temperature, pulse, and other physiological
measurements) might assist with the physical
care category of nursing tasks. Similarly,
decision support systems may actively assist
with nursing judgments.
Relieved of routine and less complex chores,
the professional nurse having enhanced
information management skills and working in
an environment enhanced by information
systems will be expected to carry out higher
level, more complex activities that cannot be
programmed. Nurses are being held
responsible and accountable for the
systematic planning of holistic and humanistic
nursing care for patients and their families.
Nurses are also increasingly responsible for the
continual review and examination of nursing
practice (using innovative, continuous quality
improvement approaches), as well as applying
basic research to finding creative solutions for
patient care problems and the development
of new models for the delivery of nursing care.
Increasingly, nurses will provide more primary
care through community-based programs
providing health, promotion and early
recognition and prevention of illness. Nurses'
role as patient educator is being extended by
means of multimedia programs and the
Internet. At the same time nurses must assume
greater responsibility for assisting the public to
become discriminating users of information as
they select, sort, interpret, evaluate, and use
the vast volumes of facts available across the
Internet.
Nurses still must assess, plan, carry out, and
evaluate patient care, but advances in the
use of information management, information
processes, and technology will continue to
create a more scientific, complex approach to
the nursing care process. They will have to be
better equipped by their education and
preparation to have a more inquiring and
investigative approach to patient care.
Evidence-based nursing practice is becoming
the standard. As information systems assume
more routine clerical functions, nurses will have
more time for direct patient care. Accordingly,
nursing must be part of future developments in
nursing informatics with strong input regarding
such decisions as the following.
1. Which patient care-related nursing
functions could be accomplished by
nursing informatics?
2. What information do nurses require to
make patient care decisions?
3. What information do caregivers from
other health professions require from
nursing?
4. To what extent can nursing informatics
support improvements in the quality of
nursing care received by patients?
5. How can the financial and emotional
costs of care to patients be reduced
using nursing informatics?
6. What is the impact of nursing on client
outcomes?
7. What do nursing interventions contribute
to patient outcomes?
The implication is that nursing must continually
reassess its status and reward systems.
Presently, a nurse gains status and financial
reward by moving away from the bedside into
supervisory and managerial roles. If more of
these coordinating functions are taken over by
the computer, nursing must reappraise its value
system and reward quality of care at the
bedside with prestige and money. Some
movement in this direction is already beginning
for example, the movement toward
employment of clinical nurse specialists
prepared at the master's degree level to work
at the bedside. However, currently this
movement seems to be too little and too slow.
Questions
1. All of the following are capabilities of
robotics in regards to physical nursing tasks,
except:
- planning and evaluating patient care
2. Nurses should be part of future
developments in nursing informatics with
strong input regarding all of the following,
except:
NCM110A - PRELIM 14
 - nursing nomenclature and interdisciplinary
dependencies
3. All of the following are responsibilities of
nurses, except:
- make a diagnosis based on physical
assessments and medical history
SUMMARY
The role of the nurse will intensify and diversify
with the widespread integration of computer
technology and information science into
healthcare agencies and institutions.
Redefinition, refinement, and modification of
the practice of nursing will intensify the nurse's
role in the delivery of patient care. At the same
time, nurses will have greater diversity by virtue
of employment opportunities in the nursing
informatics field.
Nursing's contributions can and will influence
the evolution of healthcare informatics. Nursing
will also be influenced by informatics, resulting
in a better understanding of our knowledge
and a closer link of that knowledge to nursing
practice (Turley, 1997). As a profession, nursing
must anticipate the expansion and
development of nursing informatics.
Leadership and direction must be provided to
ensure that nursing informatics expands and
improves the quality of healthcare received by
patients within the collaborative
interdisciplinary venue of health informatics.
Questions
1. All of the following will help to intensify the
nurses role in the delivery of patient care,
except:
- delineation of nursing responsibilities
2. In regard to nursing informatics, all of the
following statements are true, except:
- adequate fiscal resources will ensure that
nursing informatics expands and improves
the quality of health care
LESSON 2 : POST-QUIZ
1. The nursing profession is recognizing the
potential of informatics to improve nursing
practice and regulatory compliance:
- false
2. Any use of information technologies by
nurses in relation to the care of patients is
considered telehealth:
- false
3. The core of nursing practice is the
managerial rule nurses perform:
- false
4. The ultimate goal of nursing is to educate
clients:
- false
5. Nurses are information integrators at the
hospital level:
- false
LESSON 3 | HISTORICAL OVERVIEW OF NURSING
COMPUTER
INTRODUCTION
Since the beginning of time, people have
invented tools to help them. Tracing the
evolution of computers gives us a clearer
historical vantage point from which to view our
rapidly changing world. This approach also
identifies informatics as a tool that can
advance the goal of high quality nursing care.
From a historical perspective, however, it is
difficult to identify the true origin of computers.
For instance, we could go back in time to the
devices introduced by Moslem scientists and to
the mathematicians of the fifteenth century.
An example is Al-Kashi, who designed his plate
of conjunctions to calculate the exact hour at
which two planets would have the same
longitude (De and Price, 1959; Goldstine, 1972).
A more familiar example is the first rudimentary
calculating tool, the Chinese abacus. This is still
a rapid and efficient method of handling
addition and subtraction.
Questions
1. The first rudimentary calculating tool is
the:
- Chinese abavus
2. the plate of conjunction was designed
by:
- Al-Kashi
3. the plate of conjunction was designed
to:
- Calculate the exact hour at which
planetary conjunctions will occur
The 1950s
The transistor, invented by Shockley in 1947
(WGBH, 2004), was used to develop a second
generation of computers and ultimately the
transistor lead to the silicon chip. Second-
generation computers were smaller, produced
less heat, were more reliable, and were much
easier to operate and maintain. Second-
generation computers moved into the business
and industrial world where they were used for
data-processing functions such as payroll and
accounting. The rapidly expanding healthcare
industry began using computers to track
patient charges, calculate payrolls, control
inventory, and analyze medical statistics.
During the 1950s, Blumberg (1958) foresaw the
possibilities of automating selected nursing
activities and records. Little action was taken
then because the existing computer programs
NCM110A - PRELIM 15
were inflexible, computer manufacturers had a
general lack of interest in the healthcare
market, and hospital administrators and nursing
management had a general lack of interest
and knowledge about such equipment.
The 1960s
During the 1960s, universities were bursting at
the seams as members of the post-World War II
baby boom entered college. The philosophy of
"education for all" left educators searching for
a way to provide more individualized and self-
paced instruction. The computer seemed to
hold great promise. At the University of Illinois,
Dr. Donald Bitzer was working on a display
screen that would increase the graphics
resolution available on. The PLATO
(programmed logic for automated teaching
operations) computer system he developed.
During 1965 and 1966, the "third generation" of
computers was introduced. These third-
generation computers were identifiable by
their modular components, increased speed,
ability to service multiple users simultaneously,
inexpensive bulk storage devices that allowed
more data to be immediately accessible, and
rapid development of systems.
The 1970s
The development of the silicon chip paved the
way for the development of minicomputers
and personal computers. The silicon chip
allowed large amounts of data to be stored in
an extremely small space. This development
allowed the total size of computers to be
significantly reduced. The first mass-market
personal computer, the MITS Altair 3800, was
sold in 1975 as a hobbyist kit; the Apple I,
another personal computer kit marketed to
hobbyists by Stephen Wozniak and Steve Jobs,
followed in 1976.
Soon the vision of connecting computers to
share information began to spread, and many
computer networks were being developed all
over the world, but they could not
communicate with one another because they
used different protocols, or standards, for
transmitting data. In 1974, Vint Cerf (sometimes
known as the "father of the Internet"), along
with Bob Kahn, wrote a new protocol, TCP
(transmission control protocol), which became
the accepted international standard. The
implementation of TCP allowed the various
networks to connect and become the Internet
as we know it.
Questions
1. The transmission control protocol (TCP) was
invented in the:
- 1970s
2. he is known as the father of the Internet:
- Vin Cerf
3. during the 1960s, third generation
computers were identifiable by all of the
following characteristics, except:
- lower heat production
The 1980s
Personal computer technology augmented
and replaced the large, cumbersome
hardware of the 1970s. In 1981 IBM debuted
the PC with an Intel 8088 microprocessor, 16K
of RAM, and a 5.25 disk drive with two choices
of operating system. The Apple Mac was
launched in 1984, and in 1986 Intel introduced
the 486 Processor. Research and development
in computer technology was aimed at "open
systems." This additional technological
advance served the nursing profession
because it systematized and simplified the
process of data entry, storage, and retrieval.
The 1990s
During the 1990s, information technologies,
including personal computers and
workstations, combined with
telecommunications technologies such as
local and wide area networks to create
client/server architectures. Client/server
architecture integrated and capitalized on the
strengths of the hardware, software, and
telecommunications capacities, allowing users
to navigate through data across many
systems. These linkages were vital to breaking
the barriers between different systems. The
open flow of information among systems
contributed to many developments in nursing
informatics.
In 1990 Tim Berners-Lee created a new way to
interact with the Internet the World Wide Web.
His system made it much easier to share and
find data on the Internet. Others augmented
the World Wide Web by creating new software
and technologies to make it more functional.
For example, Marc Andreesen led the team
that created Netscape Navigator (Griffin,
2000).
The New Millennium (2000)
The dawning of the twenty-first century saw
pervasive digital proliferation. Digital cameras,
music players, and videos became widely
available. Handheld devices of all sorts and for
highly diverse purposes multiplied and became
widely available and affordable. Handheld
wireless communication devices such as
NCM110A - PRELIM 16
Blackberry are bringing convergence
telecommunications.
Questions
1. The 486 professors was introduced in the:
- 1980s
2. The apple Mac was launched in the:
- 1980s
3. The Berners-Lee created:
- World Wide Web
Introduction of Computers into Healthcare
Healthcare trailed government and industry in
the initial exploration of the feasibility of
computer usage and in installation of
computers. One reason for the delay was that
first and second-generation computers were
not well suited for the data processing needs
of hospitals. A second reason was that only
about 250 of the largest hospitals had in-
hospital punch card installations. These
hospitals were usually the first targets of
computer salesmen. The computer
manufacturers simply did not understand the
potential of the hospital market or ultimately
the healthcare market.
When focusing on the use of computers in
healthcare, computers traditionally gained
entry through the accounting area, where
most hospital computer systems still have their
roots. Patient care requires continuous and
instantaneous response in contrast to the fiscal
methodology where timing is less critical. To
achieve successful utilization of computers in
healthcare, both needs must be addressed.
The 1950s
During the late 1950s a few pioneering
hospitals installed computers and began to
develop their application software. Some
hospitals had help from computer
manufacturers, especially IBM. Then, in 1958-
1959, John Diebold and Associates undertook
an in-depth feasibility study of hospital
computing at Baylor University Medical Center.
The final report identified two major hospital
wide needs for computerization: (1) a set of
business and financial applications, and (2) a
set of hospital-medical applications that would
require on-line terminals at nursing stations and
departments throughout the hospital. Such a
system could be used for the following
purposes.
 As a communications and message-
switching device to route physicians'
orders and test results to their proper
destinations
 As a data-gathering device to capture
charges and patient medical
information
 As a scheduler to prepare such items as
nursing station medication schedules
 As a database manager with report
preparation and inquiry capabilities
These functions are often collectively called
hospital information systems (HISs), medical
information systems (MISs), and sometimes
hospital-medical information systems (HMISs).
The first term (or its acronym, HIS) is used in this
book.
Questions
1. The first hospital computer system were
used in:
- accounting
2. functions of hospital information system
include all of the following, except:
- an expert system that can diagnose
certain diseases
3. during the 1950s, one of the reasons for
delay in the exploration of feasibility of
computer usage in healthcare was that:
- 1st and 2nd generation computers
were not well suited for the data
processing needs of hospital
The 1960s
Although a few hardware manufacturers
offered some business and financial
application packages for in-hospital
processing during the early 1960s, it was not
until the mid-1960s that other vendors began to
see the potential of the hospital data-
processing market. The hardware vendors
during the 1960s (e.g., IBM, Burroughs,
Honeywell, UNIVAC, NCR, CDC) were
committed primarily to selling large general-
purpose computers to support clinical,
administrative, communication, and financial
systems of the hospitals.
The 200 to 400 bed hospitals that installed
computers during the late 1960s for
accounting applications found their
environments growing more complex, which
resulted in a constant battle just to maintain
and update existing systems to keep pace with
regulating agencies. Many hospitals of this size
turned to shared computer services.
In 1966, Honeywell announced the availability
of a business and financial package for a
shared hospital data-processing center. IBM
followed quickly the next year with SHAS
(shared hospital accounting system). The
availability of this software was an important
factor in establishing not-for-profit and for-
profit shared centers during the next 5 years.
NCM110A - PRELIM 17
There are still many shared-service companies
(e.g., SMS, McAuto) specializing in hospital
data processing. These companies continue to
provide useful services, particularly to smaller
hospitals. The companies prospered not only
because of their computer and systems
products and services but because smaller,
single hospitals were unable to justify, employ,
and retain the varied technical and
management skills required for this complex
and constantly changing environment.
The first hospital computer systems for other
than accounting services were developed
during the late 1960s. The technology that
attempted to address clinical applications was
unsuccessful. Terminal devices such as
keyboard overlays, early cathode-ray tubes,
and a variety of keyboard and card systems
were expensive, unreliable, and unwieldy. Also,
hardware and software were scarce,
expensive, and inflexible. Database
management systems, which are at the heart
of good information software today, had not
yet appeared. During this period, some
hospitals installed computers in offices to do
specific jobs (Ball and Jacobs, 1980). The most
successful of these early clinical systems were
installed in the clinical pathology laboratory
(Ball, 1973). Most of the hospitals that
embarked on these dedicated clinical
programs were large teaching institutions with
access to federal funding or foundation
research money. Limited attempts were made
to integrate the accounting computer with
these stand-alone systems.
During the mid-1960s, Lockheed Missile and
Space Company and National Data
Communications (then known as Reach)
began the development of HISs that would
require little or no modification by individual
hospitals. This was the forerunner to the
product that is now marketed by Eclipsys.
About 1965, the American Hospital Association
(AHA) began to conduct four or five
conferences per year to acquaint hospital
executives with the potential the computer
holds for improving hospital administration. The
AHA also devoted two issues of its journal solely
to data processing. These AHA activities served
to crystallize a market (i.e., hospitals ready for
data processing) and to encourage existing
and new firms to enter the marketplace.
Questions
1. the first hospital computer system that
perform function other than accounting
were developed during the:
- late 1960s
2. hospital information system that require
little or no modification by individual
hospitals were developed during the:
- mid 1960s
3. shared hospital accounting system were
developed in the:
- 1960s
The 1970s
During the early 1970s, with inflation problems
and with cost reimbursement becoming
stricter, some large hospitals that had installed
their own computers with marginal success
changed to the shared service. By this time the
shared companies had improved earlier
accounting software and could carry out
tighter audit controls. Most importantly,
however, the companies developed personnel
who understood hospital operations and could
communicate and translate the use of
computer systems into results in their client
hospitals. This added a dimension of service
that is seldom offered or understood by the
major hardware vendors. As a result, the
business opportunities for the service
companies increased. Over time, these
companies have expanded their scope of
services from fiscal applications and
administrative services to clinical and
communication applications.
Major hardware changes took place as the
minicomputer entered the scene. This was
quickly followed by the introduction of the
personal computer during the late 1970s,
Technologic developments have resulted in a
steady trend toward microminiaturization of
computers. Personal computers are now more
powerful than the original ENIAC. These
personal computers have invaded homes,
schools, offices, nursing stations, and
administrative offices to a degree never
dreamed possible. The linking of these personal
computers, using local area networking
technology, provided a better alternative to
many of the processes formerly carried out by
one large general-purpose computer.
Many major mainframe hardware companies
moved rapidly into the personal computer field
as well. Simultaneously, the service companies
began to develop on-site networking systems
to handle data, communications and
specialized nonfinancial applications. They
began to expand their scope of data retention
to support clinical applications that required a
historical patient database
The 1980s
During the 1980s, specific personal computer-
based systems were developed. These systems
NCM110A - PRELIM 18
did not replace but, instead, complemented a
variety of alternatives in various healthcare
environments. Thus, awareness of computer
concepts by healthcare professionals became
even more essential.
The 1990s
During the 1990s, the advent of powerful,
affordable, portable personal computers
made information management tools
accessible to support highly mobile, remote
activities, especially in community health. At
the same time, the power of networks and
database technology has made possible
linkages of health data in widely separated
locations. There also was a growing emphasis
on information management across health
enterprises. Accompanying this was
recognition of the importance of
patient/client-centered, integrated data in
contrast to departmental focused data. Such
linkages and shift in focus created the
possibility of a longitudinal, lifelong health
record encompassing healthcare encounters
by individuals with all sectors of the healthcare
system.
Questions
1. Portable personal computers were
invented in the:
- 1990s
2. Information management across health
enterprises prospered during the:
- 1990s
3. Personal computers were introduced during
the:
- Late 1970s
4. On site no working system were developed
in the:
- 1970s
HISTORY OF NURSING USE OF COMPUTERS
Nursing Education
The seminal work in the use of computers in
nursing education was conducted by Maryann
Drost Bitzer. During the early 1960s, Bitzer wrote
a program that was used to teach obstetric
nursing. Her program was a simulation exercise.
It was the first simulation in nursing and one of
the first in the healthcare field. (Bitzer's 1963)
master's thesis showed that students learned
and retained the same amount of material
using the computer simulation in one-third the
time it would take using the classic lecture
method. This thesis (Bitzer, 1963) has become a
classic model for subsequent work by her and
many others, including two of the authors
(K.J.H. and M.J.E.) of this volume. Bitzer's early
findings have been consistently confirmed. She
was later project director on two Department
of Health Education and Welfare (HEW)-
funded research projects. These projects
undertook evaluative studies that documented
the efficacy of teaching nursing content using
a computer. Until 1976 Bitzer was associated
with the Computer-Based Education Research
Laboratory at the University of Illinois in Urbana,
where she continued to develop computer-
assisted instruction lessons to teach nursing.
During the 1970s many individual nursing
faculties, schools, and units developed and
evaluated computer-assisted instruction (CAI)
lessons to meet specific institutional student
needs. Most of the software created was used
solely by the developing institution.
The use of computers to teach nursing content
has been a focal point of informatics activity in
nursing education. However, the need to
prepare nurses to use informatics in nursing
practice is just as important. This aspect was
pioneered in 1975 by Judith Ronald of the
School of Nursing, State University of New York
at Buffalo. Ronald developed the course that
served as a model and inspiration for courses
developed later. Ronald's enthusiasm and her
willingness to share her course materials and
experiences have greatly facilitated the
implementation of other such courses
throughout North America.
In Scotland, Christine Henney of the University
of Dundee undertook similar activities aimed at
promoting computer literacy among nurses.
Nursing Administration
The use of computers to provide management
information to nurse managers in hospitals has
been promoted on both sides of the Atlantic.
Marilyn Plomann of the Hospital Research and
Educational Trust (an affiliate of the American
Hospital Association) in Chicago was actively
involved for many years in the design,
development, and demonstration of a
planning, budgeting, and control system. (PB
CS) for use by hospital managers. In Glasgow
(Scotland) Catherine Cunningham was
actively involved in the development of nurse-
manpower planning projects on
microcomputers. Similarly, Elly Pluyter-Wenting
(from 1976 to 1983 in Leiden, Holland), Christine
Henney (from 1974 to 1983 in. Dundee,
Scotland), Phyllis Giovanetti (from. 1978 to the
time of writing in Edmonton, Canada), and
Elizabeth Butler (from 1973 to 1983 in London,
England) have been instrumental in
developing and implementing nurse
scheduling and staffing systems for hospitals in
their areas.
NCM110A - PRELIM 19
In the public health area of nursing practice,
Virginia Saba (a nurse consultant to the Division
of Nursing, Bureau of Health Manpower, Health
Resources Administration, Public Health
Service, Department of Health and Human
Services) was instrumental in promoting the use
of management information systems for public
health nursing services. The objective of all
these projects has been to use computers to
provide management information to help in
decision-making by nurse administrators.
Questions
1. She was instrumental in promoting the use
of management information system for
public health nursing service:
- Virginia Saba
2. In Glasgow, Scotland, Catherine
Cunningham was actively involved in the:
- development of nurse manpower
planning projects on microcomputers
3. The first Seminal work in the use of
computers in nursing education occurred
during the early:
- 1960s
4. Nurse scheduling and staffing system in
England were developed and
implemented by:
- Elizabeth Butler
Nursing Care
Much research on the development of
computer applications for use in patient care
was conducted during the 1960s. Projects were
designed to provide justification for the initial
costs of automation and to show improved
patient care. Hospital administrators became
aware of the possibilities of automating
healthcare activities other than business office
procedures. Equipment became more refined
and sophisticated. Healthcare professionals
began to develop patient care applications,
and the manufacturers recognized the sales
potential in the healthcare market.
Nurse pioneers who have contributed to the
use of computers in patient care activities
have been active on both sides of the Atlantic.
In the United Kingdom, Maureen Scholes, chief
nursing officer at The London Hospital
(Whitechapel), began her involvement with
computers and nursing in 1967 as the nurse
member of the steering team that directed
and monitored The London Hospital Real-Time
Computer Project. This project resulted in a
hospital communication system that provided
patient administration services, laboratory
services, and radiography services using 105
visual display units in all hospital wards and
departments.
Elizabeth Butler was associated with the Kings
College Hospital from 1970 to 1973. As the
nursing officer on a medical unit, Butler was
involved in developing and implementing the
computerized nursing care plan system for the
Professional Medical Unit and for the nursing
care plan system for all wards and specialties
in the 500-bed general area of the hospital. In
Dundee, Scotland, Christine Henney worked
with James Crooks (from 1974) on the design
and implementation of a real-time nursing
system at Ninewells Hospital.
In the United States, Carol Ostrowski and
Donna Gane McNeill were both associated
with the development of the Problem Oriented
Medical Information System (PROMIS) at
Medical Center Hospital of Vermont under the
direction of Lawrence Weed. From 1969 to
1979, Donna Gane McNeill was a nurse
clinician on the PROMIS project. As such,
McNeill managed the first computerized
nursing unit, developed content for PROMIS,
and developed functions and tasks for the
computer. She also conducted a comparison
between computerized and noncomputerized
units. From June 1976 to December 1977, Carol
Ostrowski served as director of audit for the
PROMIS system. She was responsible for
implementing the components that supported
concurrent audit of medical and nursing care
and the environment that guided and
evaluated patient care.
In the United States, Margo Cook also began
her association with computers in nursing in
1970 when she was employed at El Camino
Hospital, Mountain View, California. Cook
participated as the nursing representative on
the team that developed and implemented
the Medical Information System (still marketed
by Elipsys). As nursing implementation
coordinator, Cook was responsible for
identifying and addressing the needs of all
nursing units at El Camino. Often she
functioned as interpreter between the
computer analysts and nurses. Eventually she
assumed senior level responsibility for the MIS
maintenance and development. In 1983 Cook
left El Camino to become senior consultant of
Hospital Productivity Management Services.
In 1976 Dickey Johnson became computer
coordinator at Latter Day Saints Hospital in Salt
Lake City, Utah. Johnson's responsibilities
involved coordination between the computer
department and other hospital users in
planning, development, implementation, and
maintenance of all programs either used by, or
affecting nursing personnel. In 1983, Johnson
was the nursing representative on the hospital's
NCM110A - PRELIM 20
Computer Committee, which was actively
involved in planning, designing, and
implementing a hospital-wide computer
system. Johnson was responsible for projects
that included order entries, nursing care plans,
nurse acuity, and nurse staffing.
In Canada, from 1978 to 1983, Joy Brown and
Marjorie Wright, systems coordinators at York
Central Hospital in Richmond Hill, Ontario, were
actively involved in designing, coding, and
implementing the computerized patient care
system at their hospital. They were also
responsible for training many nurse users on the
system. Beginning in 1982 at Calgary General
Hospital in Calgary Alberta, Wendy Harper,
assistant director, Nursing Systems, was
responsible for all aspects of the nursing
applications on the hospital information system
being installed in that hospital.
Nurses have recognized the potential for
improving nursing practice and the quality of
patient care through nursing informatics. These
applications facilitate charting, care planning,
patient monitoring, interdepartmental
scheduling, and communication with the
hospital's other computers. New roles for nurses
have emerged. Nurses have formed computer
and nursing informatics interest groups to
provide a forum through which information
about computers and information systems is
communicated worldwide.
Questions
1. This project resulted in a hospital
communication system that provided
patient administration services, laboratory
services, and radiography services using
105 visual display unit in all hospital wards
and departments:
- London Hospital Real-Time Computer
Project
2. The design and implementation of real time
nursing system at Ninewells Hospital where
pure headed by:
- Christine Henney and James Crooks
3. The problem oriented medical information
system (PROMIS) was introduced by:
- Lawrence Weed
Communicating Nursing Developments
Kathryn Hannah, of the University of Calgary,
was the first nurse elected to the Board of
Directors of the Canadian Organization for the
Advancement of Computers in Health
(COACH). In that capacity, with the assistance
of David Shires of Dalhousie University (and at
that time program chairman for the
International Medical Informatics Association),
Hannah was instrumental in establishing the first
separate nursing section at an International
Medical Informatics Association (IMIA) meeting
(Medinfo '80, Tokyo). Previously, nursing
presentations at this international conference
had been integrated within other sections. In
1982, based on the success of this Tokyo
workshop, which Hannah also chaired, a
contingent of British nurses led by Maureen
Scholes mounted an International Open Forum
and Working Conference on "The Impact of
Computers on Nursing." The international
symposium on the impact of computers on
nursing was convened in London, England, in
the fall of 1982, followed immediately by an
IMIA-sponsored working conference. One
outcome of the working conference was a
book that documented the developments
related to nursing uses of computers from their
beginning until 1982. The second outcome was
a consensus that nurses needed a structure
within an international organization to promote
future regular international exchanges of ideas
related to the use of computers in nursing and
healthcare. Consequently, in the spring of
1983, a proposal to establish a permanent
nursing working group (Group 8) was
approved by the General Assembly of IMIA. In
August 1983, the inaugural meeting of the IMIA
Working Group on Nursing Informatics (Group
8) was held in Amsterdam.
In 1992, the working group recommended a
change of bylaws and began its
transformation to a nursing informatics society
within the IMIA. This society continues the
organization of symposia every 3 years for
exchange of ideas about nursing informatics,
dissemination of new ideas about nursing
informatics through its publications, provision of
leadership in the development of nursing
informatics internationally, and promotion of
awareness and education of nurses about
nursing informatics.
In the United States in 1981, Virginia Saba was
instrumental in establishing a nursing presence
at the Symposium on Computer Applications in
Medical Care (SCAMC). This annual
symposium, although not a professional
organization, provided opportunities for nurses
in the United States to share their experiences.
In 1982 the American Association for Medical
Systems and Informatics (AAMSI) established a
Nursing Professional Specialty Group. This
group, which was chaired by Carol Ostrowski,
provided the benefits of a national professional
organization as a focal point for discussion,
exchange of ideas, and leadership for nurses
involved in the use of computers.
Subsequently, AAMSI merged with SCAMC to
become the American Medical Informatics
NCM110A - PRELIM 21
Association (AMIA). This organization continues
to have a highly active nursing professional
specialty group.
Question
1. During the 1980s, Kathryn Hannah was
instrumental in:
- Establishing the first separate nursing
section at an international medical
informatics association (IMIA) meeting
2. The first international symposium on the
impact of computers on nursing was
covered in London, England in:
- 1982
3. Develop in 1982, this group provided the
benefits of a national professional
organization as a focal point for discussion,
exchange of ideas, and leadership for
nurses involved in the use of computers:
- Nursing Professional Specialty Group
Summary
Despite their wide usage, computers are
historically young and did not come into
prominence until 1944 when the IBM-Harvard
project called Mark I was completed. This was
followed closely by the development, in 1946
at the University of Pennsylvania, of the ENIAC
I, the first electronic computer with no moving
parts. Subsequent refinement of computer
technology, development of the silicon chip in
1976, development of the Internet, and the
World Wide Web have made personal
computers as common in our homes as
television sets. Handheld wireless digital
telecommunications devices are now
pervasive.
During the 1950s computers entered the
healthcare professions. They were primarily
used for the purposes of tabulating patient
charges, calculating payrolls, controlling
inventory, and analyzing medical statistics. A
few farsighted individuals saw the possibilities
of automating selected nursing activities and
records. However, little action was taken
because of the inflexibility and slowness of the
equipment, the general disinterest of the
manufacturers in the healthcare market, and
the lack of knowledge concerning such
equipment among hospital management,
hospital administrators, and nursing
management.
By the 1960s, hospital administrators had been
exposed to the possibility of automating
healthcare activities; in addition to existing
business office automation, equipment had
become more refined and sophisticated, and
the manufacturers had recognized the sales
potential in the healthcare market. The
major focus during the 1960s was on the
research aspect of computer applications for
patient care; the business applications for
auditing functions in the healthcare industry
were becoming well established. Projects were
designed to provide justification for the initial
costs of automation and to display the variety
of areas in which computers could be used to
facilitate and improve patient care. Nurses
began to recognize the potential of computers
for improving nursing practice and the quality
of patient care, especially in the areas of
charting, care plans, patient monitoring,
interdepartmental scheduling and
communication, and personnel time
assignment. These individual computer
applications or modules, which were
developed to support selected nursing
activities, were later integrated in modular
fashion into various hospital information
systems. Today these hospital information
systems are widely promoted and marketed by
computer vendors.
Simultaneously, advances in the uses of
computers in educational environments were
initiated during the 1960s. The major focus
during this decade was on showing the
efficacy of computers as teaching methods.
During the 1970s, many projects were designed
to compare student learning via computer
with learning via traditional teaching methods.
The mid-1970s also saw the development of
the personal microcomputer and during the
latter years of that decade their widespread
dissemination throughout society. During the
1980s nursing educators were scrambling to
develop software for use with this technology.
In fact, the hardware technology has
advanced beyond nursing educators'
capacity to use it all.
Major contributions by nurses to developments
leading to the use of computers in nursing
were also discussed. Our apologies to those
nurses whose activities were unknown to us. If
readers know of other nurses whose
contributions merit inclusion in future editions,
the authors would be pleased to receive such
information.
The future demands that computer technology
be integrated into the clinical practice
environment, education, and research
domains of the nursing profession. The ultimate
goal is always the best possible care for the
patient.
Question
1. This is the first electronic computer with no
moving parts:
- ENIAC I
NCM110A - PRELIM 22
2. The functions of computers in the
healthcare profession during the 1950s
include all of the following, except:
- Storing patient information
3. The ultimate goal of using computer
technology in Healthcare is to:
- Provide the best possible care for the
patient
LESSON 3 : POST-QUIZ
1. Informatics as a tool can advance the goal
of high quality nursing care:
- true
2. In the 1950s, open system systemized and
simplified the process of data entry, storage
and retrieval:
- false
3. The rapidly expanding healthcare industry
began using computers in the 1990s the
truck patient charges, calculate payrolls,
control inventory, and analyze medical
statistics:
- false
4. The first hospital computer system for
activities other than accounting services
were developed during the late 1960s:
- true
5. The development of the silicon chip paved
the way for the development of
minicomputers and personal computers:
- true
LESSON 4 | ANATOMY AND PHYSIOLOGY OF
COMPUTERS
INTRODUCTION
Introducing the use of a stethoscope precedes
learning how to listen to heart and lung sounds.
To be effective in using the stethoscope, a
clinician needs to know when to use the bell
and when to use the diaphragm. In the same
way, it is imperative to have some
understanding of how and when to use the
tool of informatics, the computer.
A complete computer system is the integration
of human input and information resources
using hardware and software. In computer
terms, hardware refers to objects such as disks,
disk drives, monitors, keyboards, speakers,
printers, mice, boards, chips, and the
computer itself. Software includes programs
that give instructions to the computer that
make the machine useful. Information
resources are data that the computer
manipulates. Human input refers to the entire
spectrum of human involvement, including
deciding what is to be input and how it is to be
processed as well as evaluating output and
deciding how it should be used. In this chapter,
we look at the computer, and in the next, at
software.
COMPUTER MISCONCEPTIONS
When computers were new, there were many
fears and misconceptions about using them.
Some of these were computers can think,
computers require a mathematical genius to
use, and computers make mistakes (Perry,
1982). Today there are other misconceptions,
perhaps born of familiarity, which can be
dangerous to users. It is important to
understand that computers cannot think, and
they are not smart. Incidents like the one in
which Deep Blue (the nickname given to an
IBM computer specially designed to play
chess) won a chess game against world
champion Garry Kasparov led to such
misperceptions. Consider the game of chess.
Although there are many possible
combinations, there are a given set of moves,
rules, and goals that make it a perfect stage to
display the potential of computers. Deep Blue
is a very powerful computer, capable of
quickly analyzing hundreds of millions of
possible moves and responding according to
rules (known as algorithms) that were part of
the software that beat Kasparov. It made use
of these qualities to beat Kasparov. It did not
use thinking in the human sense.
The thought that only mathematical geniuses
can use computers, although just as false,
continues to flourish. This belief is linked to the
development of the first computers as a means
to "crunch numbers," or process mathematical
equations. Hence, in colleges and universities,
many computer departments are still housed
in, or closely related to, the departments of
mathematics. It did not take experts long to
translate the mathematical concepts into
everyday language, an accomplishment that
made the computer available to everyone,
regardless of level of proficiency in math.
The last myth, that computers make mistakes,
makes it a wonderful excuse for human error.
This was well illustrated by a cartoon in the
early 1990s that showed a man saying, "It's
wonderful to be able to blame my mistakes at
the office on the computer, I think I'll get a
personal computer." Computers act on the
information they are given. As one humorist
said, "Computers are designed to DWIS, or Do
What I Say" As many a user will tell you, they
resist with great determination any inclination
to DWIM, or "Do What I Mean!" Unlike a
colleague to whom you only need to give
partial instructions because the person is able
to fill in the rest, a computer requires complete,
definitive, black-and-white directions. Unlike
NCM110A - PRELIM 23
humans, computers cannot perceive that a McBride & Nagle, 1996; Simpson & Kenrick,
colon and semicolon are closely related, and 1997). Today, these studies look at the attitudes
in many cases, a computer believes that an and anxiety toward the electronic health
uppercase letter and a lower case letter are as record (Chan, 2007; Dillon, Blankenship, &
different as the letter A from the letter X. This is Crews, 2005). It is highly likely that the same
known as case sensitivity. There are no type of anxieties were present when the
"almosts" with a computer. general population found it necessary to learn
to drive. There are, however, no known studies
COMPUTER CHARACTERISTICS of this phenomena dating from that time (Box
A computer accomplishes many things that 2-1).
are impossible without it. When programmed Addressing these fears takes time for both a
properly, it is superb in remembering and trainer and the individual experiencing the
processing details, calculating accurately,
fears. One- on-one sessions for the person
printing reports, facilitating editing documents, affected may be necessary and save time in
and sparing users many repetitive, tedious the long run by preventing frantic calls to the
tasks, which frees time for more productive help center. Studies show that the learning
endeavors. Remember, however, that patterns of those afraid of computers can be
computers are not infallible. Being electronic, improved by treating the bodily symptoms of
they are subject to electrical problems.
anxiety and providing distracting thought
Humans build computers, program them, and patterns (Bloom, 1985). Techniques, such as
enter data into them. For these reasons, many teaching relaxation methods before starting
situations can cause error and frustration. Two any hands- on training, often helps, as does
of the most common challenges with giving the anxious trainee something to repeat
computers are "glitches" and the "garbage in, internally such as, "You're in control, not the
garbage out" (GIGO) principle. That is, if data
computer."
input has errors, then the output will be
erroneous. Other helpful techniques include recognizing
and accepting fear. One method is to have
Anyone, who had been using a computer
trainees check off from a list of possible feelings
when it crashed or "went down" may have
(e.g. panicky, lost, curious) those that they are
experienced a guilty feeling that she or he did feeling, a practice that can help them face
something wrong. If the person actually did their fears. Inherent in all these terrors is the fear
create the crash, unless she or he were of failure and of looking incompetent in front of
purposely engaged in something destructive, their peers. This may be especially evident in
that person did not cause the crash; she or he people who see themselves as having a high
just found a flaw in the system that was
degree of competence in their profession and
inadvertently created by the to whom people look for answers. Therefore,
programmer(s).There are times, however, when placing themselves in a learning situation can
crashes occur for seemingly no reason.
be very threatening to their self- image.
Computers, regardless of their manufacturer,
will at some time, for unknown reasons, perform
in a totally unexpected manner (Perry, 1982).
This is as true today as when computers were
new. The good news is that this is much less apt
to happen despite the complexity of today's
computers.
OVERCOMING COMPUTER ANXIETY
The attitudes people have toward computers
range from complete dislike and frustration to
curiosity and excitement. Although the mass
media and personal acquaintances convey
both perceptions, people seem to remember
the negative points more clearly. As with all
new experiences, becoming acquainted with
a computer or learning a new computer
application can produce anxiety. When
computers in healthcare were fairly new, many
studies were done that looked at the attitude
of nurses toward computers (Focus, 1995;

NCM110A - PRELIM 24

TYPES OF COMPUTERS
The progress in computers is measured by
generations, each of which grew out of a new
innovation. Computer sizes vary from
supercomputers intended to process large
amounts of data for one user at a time to small
palmtop computers. Each type has its niche in
healthcare. However, it is becoming
increasingly difficult to classify the different
types of computers, because smaller ones take
on the characteristics of their bigger brothers
as the amount of space needed for processing
lessens.
Supercomputers
Technically, supercomputers are the most
powerful type of computer, if power is judged
by the ability to do numerical calculations.
Supercomputers can process hundreds of
millions of instructions per second. They are
used in applications that require extensive
mathematical calculations, such as weather
forecasts, fluid dynamic calculations, and
nuclear energy research. Supercomputers are
designed to execute only one task at a time;
hence, they devote all their resources to this
one situation. This gives them the speed they
need for their tasks.
Mainframes
The first computers were large, often taking up
an entire room. They were known as
mainframes and were designed to serve many
users and run many programs at the same
time. These computers formed the backbone
of many hospital information systems. Users
used what were technically called videotext
terminals, but often referred to as "dumb
terminals." A videotext terminal consisted of a
display screen, keyboard, and modem or
device that connected it to the mainframe.
Information was entered on the keyboard and
transmitted to the mainframe, which was
located somewhere else, often in the
basement in a secure, temperature-controlled
room. Any processing done to the information
was done by the mainframe, which returns the
results to the screen of the videotext terminal.
This is why you still find the IS departments in the
basement of hospitals.
Minicomputers
As computers became more powerful, their
size was reduced. The same work done by a
mainframe became amenable to being
accomplished on what was termed a
minicomputer. Minicomputers were like
mainframes (i.e., they were multiuser machines
that originally served videotext terminals), but
they were smaller and less costly unlike larger
mainframes, they did not require a special
temperature-controlled room and were useful
in situations with fewer users. As computers
started to be built in many sizes, it became
impossible to classify one as a mainframe or
another as a minicomputer; these terms are
seldom used today.
Servers
The functions served by mainframes and
minicomputers today are performed by
computers of varying sizes, which are referred
to as servers. The functions performed by
servers and their powers are as varied as the
needs of the users. These functions vary from
servers that operate in the mainframe/video
text format especially in hospital information
systems to those that are just a repository for
files (a user-created item) that are "served" to
users who have software that does the
processing on their personal computer (PC).
Some servers in the middle of this continuum
may also store the programs that a user needs
and provide them as needed by the user.
Thin Clients
Thin clients are today's version of the video-text
terminal. These are computers without a hard
drive and with limited, if any, processing
power. Besides costing much less, thin clients
do not need to be upgraded when new
software is made available because they do
not contain any applications. Because they do
NCM110A - PRELIM 25
no processing, older PCs can function in this
capacity instead of being retired.
Personal or Single-User Computers
PCs are designed for one individual to use at a
time. PCs are based on microprocessor
technology that enables manufacturers to put
an entire processing (controlling) unit on one
chip, thus permitting the small size. When PCs
were adopted in business, they freed users
from the resource limitations of the mainframe
computer and allowed data processing staff
to concentrate on tasks that needed a large
system. Today, although capable of
functioning without being connected to a
network, in businesses including healthcare,
PCs are usually connected or networked to
either other PCs or servers. They still process
information, but when networked, they can
also share data. In information systems, PCs
often replace the old videotext terminal and
handle the tasks of entering and retrieving
information from the central computer or
server, although thin clients may be used for
this purpose instead. When a full PC is available
on the unit, personnel can use application
programs such as word processing. PCs are
available in many different formats such as a
desktop or tower model, laptops, and tablet
computers.
Desktop and Towers. The original PC was a
desktop model. You are probably familiar with
these. They were placed horizontally on a desk
and a monitor was placed on top of them. As
the use of computers became more common,
users were reluctant to give up desk space to
their computer, and computers that stood
upright, known as towers, were developed.
With these, only the monitor needed was on
the desk, while the computer itself stood on the
floor, often under the desk.
Laptops/Notebooks. As computer usage
became popular, people found that they
needed the files and software on their
computer to accomplish tasks away from their
desks. The first computer that made this
practical was really more transportable than
portable. Developed in the 1980s, it was about
the size of a desktop and had a built-in
monitor. Toward the end of the 1980s, the
transportables were replaced by true
portables: laptops, or computers small enough
to fit on one's lap. As technology continued to
place more information on a chip, laptops
became smaller. They are now referred to as
notebook computers. Some healthcare
organizations use notebook computers for
point-of-care (POC) data entry at the bedside
or anyplace where care is delivered.
Notebook computers do have some
drawbacks. The screen is usually smaller than
the one in a desktop, and the resolution may
not be as crisp. Keyboards are also smaller. The
mouse, or pointing and selecting device, can
be a button the size of a pencil eraser in the
middle of the keyboard, or a small square on
the user end of the keyboard, or a small ball
embedded in the keyboard. Some users
purchase docking stations for their notebook
computers. The computer can be placed in
the docking station (may be called a port
replicator, or notebook extender), which is
connected to hardware such as a larger
monitor, keyboard, and regular mouse. This
enables the user to have access to these
devices when at their desk, but makes it easy
to remove the computer and enjoy its
portability, albeit, without the hardware
connected to the docking station.
Other Mobile Computers. Again, as the
processing power and storage capacity of
computers increased, there was a demand for
mobile computers that were more versatile
than laptops. The subnotebook and tablet
computer are some of these as are personal
digital assistants (PDAs).
Questions
The technical innovation that enables the first
generation of computers (from 1940 to 1956)
was:
- The vacuum tube
These our computers without a hard drive and
with limited, if any, processing power:
- Thin client
Fears and misconception about using
computer include all of the following, except:
- Computers can increase efficiency
All of the following are examples of hardware
devices, except:
- Word processors
Basic Computer Ideas
For most people the inner workings of a
television are a mystery, but that does not stop
them from using and enjoying television. In the
same way, it is not necessary to understand all
the details of computer technology before it
can be used to great advantage. This lesson is
intended to give an adequate but not
exhaustive understanding of computers, thus
enabling the student to take confident
advantage of whatever computer technology
is available. There are generally two main parts
to any computer system.
NCM110A - PRELIM 26

Hardware is the term that describes the
physical pieces of the computer, commonly
grouped into five categories.
1. Input - Data must be placed into the
computer before the computer can be useful.
2. Memory - All data processing takes place in
memory.
3. Central processing unit (CPU) - This is the
"brain" of the computer, which coordinates all
the activities and does the actual data
processing.
4. Storage - The data and programs can be
saved for future use.
5. Output - Processed data are of little value to
people unless they can see the data in some
form.
Hardware can be considered the anatomy of
a computer, its physical, mechanical portion.
Software is the term that describes the
nonphysical pieces. It can be grouped into
two categories.
1. Operating system - This is the collection of
standard computer activities that need to be
done consistently and reliably. These processes
are the building blocks for computer functions
and programs. Well known examples include
Microsoft Windows, Apple OS X, and the open
source Linux flavors.
2. Application programs - These are packages
of instructions that combine logic and
mathematical processing using the building
blocks of the computer. Programs are what
make computers valuable to people by
transforming raw data into information.
Examples of applications include spreadsheets,
word processing, games, photo managers, etc
Software can be considered the physiology of
a computer, the instructions that make its
anatomy function properly. These pieces of a
computer are described later in more detail,
but it is important to have a mental picture of
a "computer" before we proceed. It is also
helpful to understand some computer
terminology (or jargon) that often overwhelms
or confuses.
Common Computer Terms
• Chip refers to a small piece of silicon that has
electronic logic circuits built into it. A chip can
hold thousands of circuits in something that is
about one-quarter of an inch on each side.
The chip is the fundamental physical piece
used for computer memory and central
processing units.
• RAM and ROM are the two types of memory
that a computer uses. ROM stands for Read-
Only Memory. This memory has information
already stored in it by the computer
manufacturer, and nothing is allowed to
change that information. RAM stands for
Random-Access Memory. This memory has no
information in it but is available for any
program to store information.
• Bit is the smallest part of computer memory. It
can hold exactly one piece of information that
has only two possible values, either a one (1) or
a zero (0). This "two-value" system is called a
binary system.
• Byte is the fundamental grouping of bits used
to make up computer memory. By grouping
bits together and setting these bits to either 0
or 1 in different combinations, a coding
scheme can be built to represent information.
The byte is the basic measuring unit for
memory capacity or storage capacity.
• Kilo, mega, and giga are prefixes that
represent certain multipliers. Although "kilo" in
scientific notation means "1000" (103), its value
is changed to "1024" (210) when talking about
computer memory or storage. Numbers that
are powers of 2 (e.g., 4 is a power of 2, being
22) are chosen because the computer uses a
binary system. Thus, one kilobyte of computer
memory represents 1024 (1 x 1024) bytes, two
NCM110A - PRELIM 27
kilobytes represent 2048 (2 x 1024) bytes, and
so on. One megabyte represents 1,048,576
(1024 x 1024) bytes, and one gigabyte
represents 1,073,741,824 bytes (1024 x 1024 x
1024). Although it is not accurate, most people
tend to still give kilo, mega, and giga their
normal values of 103,106, and 109 when
referring to computers.
• Megahertz (MHz) and gigahertz (GHz)
describe the frequency that the central
processing unit's internal clock uses for its timing
control.
Computer technology has had an explosive
growth during the past several decades. The
large computers that used to fill their own
special purpose rooms have in many cases
been replaced by computers small enough to
fit on a desk ("desktop" model), on one's lap
("laptop" model), or in the palm of one's hand
("palmtop" computers). This trend is expected
to continue.
Questions
1. A collection of standard computer activities
that are the building blocks for computer
function and programs best describes:
- Operating system
2. this refers to the physical piece of the
computer:
- Hardware
3. the basic measuring unit for memory
capacity or storage capacity is the:
- Byte
Keyboard
The keyboard is the primary data entry tool for
every computer. Commonly, keyboards consist
of an alpha, typewriter formatted layout. Most
have an accounting/calculator type of
numeric pad to the right of the alpha layout for
easy financial information entry. Additionally,
there is a numeric/symbols row across the top
of the alpha layout, very similar to a typewriter.
Between the alpha and the
calculator/numeric pad on a keyboard is a set
of page command keys. These usually control
the page, such as Insert, Delete, Home, End,
Page Up and Page Down. In this general area
of the keyboard, also reside directional arrow
keys that help you to navigate around the
page of your document or website.
Across the very top of the keyboard is a row of
Function Keys, usually designated as such with
labels such as F1, F2, F3, etc. These keys are
used to accomplish specific functions within
the context of each software program. When
using a new software package, it is best to
read the Commands & Function Keys pages of
the manual to learn how the F Keys work inside
of the particular program. And finally, there are
keys along either side of the alpha layout
which, similar to a typewriter, help to navigate
around the document. The Tab key helps to
insert indents; the Caps Lock will put you into
an all bold mode; the Backspace key will
simultaneously back up your cursor and erase
the text you just typed; the Shift key is a
temporary capitalization or upper case
character of the key; and the Enter key is also
known as a hard return and designates a
deliberate line space.
Questions
1. The function served by mainframes and
minicomputers today are performed by
computers of varying sizes, which are
referred to as:
- Servers
2. Fears and misconception about using
computer include all of the following,
except:
- Computers can increase efficiency
3. The technical innovation that enabled the
first-generation computers (from 1940 to
1956) was:
- The Vacuum tube
Mouse
The Mouse or clicker as it is known in some
places, is the small, palm sized device created
by the industry to help the user short cut
command keys on the keyboard, and to
navigate around computer software, an
internet page, or a document.
Click is the primary function of the mouse. The
user simply points and clicks onto whatever
they desire to see. On the internet and in
software documents, a double click is required
to open the page or document. Most mouse
designs have a left button, right button, and a
roll button on the top center of the mouse. The
left button is for the click and the double click
functions, and the right button is for Reveal or
Copy codes in internet pages and software
screens.
NCM110A - PRELIM 28

The roll button on the top and center of your
mouse is for quick scrolling through a page. This
saves the operator grief when using the scroll
bar on the right side of the monitor. Some scroll
bars can be awkward. It is also helpful when
copying large amounts of text that require
rolling the page down, since it makes it easier
to copy and scroll without having to use the
side scroll bar.
Questions
1. This is the primary function of the mouse:
- clicking
2. A double click on the mouse will:
- open a page or a document
3. This part of the mouse is used for quick
scrolling:
- roll button
Central Processing Unit
The CPU of a computer is often referred to as
the brains or the brain center. Technically, the
term CPU is an abbreviation for Central
Processing Unit. Also known among computer
geeks as the box, the CPU is housed inside of
metal housing which usually includes floppy
drives, hard drives and other peripheral.
The CPU itself includes what is known as the
motherboard of the computer - the central
board which holds all of the computer's RAM
[random access memory] and all of the
related components such as cooling fans,
resistors and other electronic parts which
cause the computer to function properly. The
computer's RAM size determines the size of
programs the computer can use. Generally, a
software package will have a RAM quote on it
- that is, the amount of RAM necessary to
operate the program. A computer operator
must check the software requirements for RAM
against the system's known size. Most programs
today require no more than 512MB [mega
bytes] of RAM to operate.
Also contained in the CPU and the
motherboard, is the computer's ROM [read
only memory], another essential component of
the computer's brains. The ROM functions in
the motherboard to contain or store the
program or programs which boot-up [or start
up] the computer. Anytime the ROM in a
computer is damaged on the motherboard,
then the computer will not start up correctly
and possibly not at all.
Questions
1. The primary function of ROM in the CPU is
to:
- Store the programs which boot-up the
computer
2. A computer’s RAM::
- Determines the size of programs the
computer can use
3. The CPU is often referred to us:
- The brain center
Processors
Memory
The two basic types of memory, ROM and
RAM, were defined earlier. Generally, a
computer has a sufficient amount of ROM built
in by the manufacturer. ROM is preloaded with
the low-level logic and processes needed to
start the computer when its power is turned on
(a process called "booting up"). Most
computers also have a starting amount of RAM
preinstalled. RAM can be purchased
separately, though, and installed as needed.
Application programs are loaded, when called
for, into RAM. The program executes there and
stores information in other parts of RAM as is
needed. Today, application programs have
growing RAM requirements as more logic and
functions are packed in them.
Central Processing Unit
The CPU of a computer is often referred to as
the brains or the brain center. Technically, the
term CPU is an abbreviation for Central
Processing Unit. Also known among computer
geeks as the box, the CPU is housed inside of
metal housing which usually includes floppy
drives, hard drives and other peripheral.
The CPU itself includes what is known as the
motherboard of the computer the central
board which holds all of the computer's RAM
[random access memory] and all of the
related components such as cooling fans,
resistors and other electronic parts which
cause the computer to function properly. The
computer's RAM size determines the size of
programs the computer can use. Generally, a
software package will have a RAM quote on it
- that is, the amount of RAM necessary to
operate the program. A computer operator
must check the software requirements for RAM
against the system's known size. Most programs
today require no more 512MG [mega bytes] of
RAM to operate.
NCM110A - PRELIM 29
Also contained in the CPU and the
motherboard, is the computer's ROM [read
only memory], another essential component of
the computer's brains. The ROM functions in
the motherboard to contain or store the
program or programs which boot-up [or start
up] the computer. Anytime the ROM in a
computer is damaged on the motherboard,
then the computer will not start up correctly
and possibly not at all.
There are several types of CPU chips. In the
personal computer world, the Intel Corporation
is probably the most recognized manufacturer
with, first, its 80 x 86 series of CPU chips (i.e..
80386,80486,...) and then its Pentium chip (i.e.,
Pentium 4 or P4) series. In the large computer
world, IBM (International Business Machines) is
probably the most recognized name.
One measure of CPU processing capacity is
called MIPS ("millions of instructions per
second.") Although not a totally accurate
measure, it is useful to see the growth of
processing capacity over time. Intel's 80386
chip, produced in 1985, was rated at 5 MIPS.
Intel's Pentium chip, introduced 8 years later in
1993, was rated at 100 MIPS-about 20 times
faster. Intel's Pentium 4 chip, made 7 years later
in 2000, was rated at 1700 MIPS.
All CPUs have three basic elements: a control
unit, an arithmetic logic unit (ALU), and an
internal memory unit. The ALU performs all the
mathematical operations, the control unit
determines where and when to send
information being used by the ALU, and the
internal memory is used to hold and store
information for those operations. The CPU has
an internal system clock that it uses to keep
everything in synchronized order. The clock's
speed is described in terms of frequency, using
megahertz (MHz) or gigahertz (GHz), so a CPU
might be described as having a clock speed
of 450 MHz or 2.4 GHz. Generally, the faster the
clock, the faster the CPU can process
information.
Questions
1. This element of the central processing unit
holds and store all the mathematical
operation:
- internal memory unit
2. this element of central processing unit
perform all mathematical operations:
- arithmetic logic unit
3. the basic elements of a CPU include all of
the following, except:
- special purpose register
Storage
The memory of a computer is not the place to
store information and programs for a long time.
ROM is read-only (unwritable) and therefore
not of any use. RAM holds programs and
information but only so long as the computer is
turned on; once turned off; all information in
RAM is gone. Therefore other means are used
for long-term storage, the most common
technologies being magnetic, optical, and
special nonvolatile memory.
 Hard Drive is the computer's primary data
storage unit. The hard drive generally holds
all of your programs and all of your
created, downloaded and saved data.
 A flash drive is a small, portable drive that
can hold as much as small hard drives
[internal drive]. Most flash drives are the size
of a small cigarette lighter and fit in the
palm of your hand. They come in several
popular sizes, most commonly: 512MB; 1GB;
and 2GB. They range on average from
$19.95 to $99.95 and are popular among
the jet set, executive crowd. Memorex
gives theirs a standard dog-tag styled neck
rope similar to company security passes
that makes it easy to carry and access.
Flash drives have replaced the older floppy
drives, they are easier to use and they hold a
lot more information on them. They are quickly
inserted, accessed, and removed from most
small and personal computers. Older
computers have their USB ports in the rear of
the CPU [where the power cord plugs in], while
the newer computers have the USB port in the
front, next to the CD drive. The USB port is what
the flash drive plugs into directly.
NCM110A - PRELIM 30
The cool thing about the flash drive, other than
its portability, is that when you plug it in you do
not have to go searching to find it in the
computer. The USB port on any computer will
automatically prompt the computer to pull up
the flash drive for the user. From that point, you
simply click and select your file to use or save.
 CD drives read documents saved on CDs
[compact disk]. A CD will hold up to 700MB
of information on it. Most CDs are not
erasable, so they do not yet have the
flexibility of the earlier floppy drive.
However, the CD is a more reliable storage
tool because it is sealed into a digital
format. Unless you break your CD, the
information is relatively safe.
Most computer programs and teaching
programs are sold on CD. When you buy a
new computer program, you download it from
a CD and the CD serves as your backup
information. If your computer has a CD burner
in it, then you can also make CDs of anything
you create. You create the file, save it, and
burn it into a new CD. Then it is available to
share with others on their computers.
 Floppy Drive is an older type of information
saving device that is still peripherally in use.
Generally, a floppy disk is a 3.5 inch disk
encased in plastic with a sliding access
panel for the computer to read the
information from. Users insert a floppy disk
into the floppy drive, usually located on the
front panel of your CPU, and save data
onto the floppy for use at their
convenience and in other locations.
Today, the CD drive and the flash drive are
replacing the floppy drive. However, there are
still quite a number of small businesses and
personal computer users which rely on floppy
drives to save their creations and company
information.
 Removable Disk Drive is the same kind of
device as a hard disk drive with similar
storage capabilities. The difference is that
the magnetic storage media can be
removed and replaced, just as with a
floppy disk.
 Tape describes a medium that can
magnetically encode a lot of information.
In many ways, tape in a computer system is
used like audio tape. Computer tape is
typically used to store a copy of important
information, to be recovered in case of a
major problem with the computer. Tape is
packaged in various ways, from large reels
to small cartridges. Tape is reusable.
Questions
1. All of the following are storage devices that
store information magnetically, except:
- Compact disc-recordable
2. A flash drive is plugged into a/an:
- USB port
3. A computer's primary data storage unit is
the:
- Hard drive
Output
 Monitor is the visual display screen for the
contents of the computer and the data
being worked on or viewed. It is similar to a
television screen and it displays the
computer's content at a comfortable
brightness and resolution.
The older monitors are large and bulky like
a small office machine. Jokingly referred to
by geeks as "boat anchors", the older, large
monitors are on their way out of popular
use. The newer monitors are similar to the
newer televisions in that they are light
weight and slim. Generally, the newer
monitors weight under 3 pounds, are 4
inches or less in thickness, and are referred
to as flat screens. The most common sized
monitors used in small business and home
computer operations are 15", 17" and 19"
screens.
Monitors can be adjusted internally to
accommodate the operator's comfort level for
viewing. The lower the resolution selected, the
larger the lettering is on the screen. Most
monitors can be adjusted for a resolution level
between 600 * 800 pixels [micro dots per inch]
to 1280 * 1024 pixels. There are two reasons to
adjust the resolution:
1. Size and/or use of the monitor - larger
screens require smaller resolution, and
gaming programs require smaller
resolution for the best experience.
2. To make the user more visually
comfortable - smaller resolution will
cause the letters in any screen to
appear larger.
To find the adjustment page screen for a
Windows XP computer, go to the Start button
on the bottom left of the Task Bar, click onto
the Start button and go to Settings, and then
to Control Panel and click. You will open the
Control Panel's selection of options. Double
NCM110A - PRELIM 31
 click onto Display, and you will open the
Display Properties. From this point, you want
to select the Settings tab. On the left side of
this screen, about midway down, you will see
a slide bar which will allow you to adjust the
resolution. Slide to smaller or larger,
according to your need, and then click onto
Apply. From here you can close out of the
entire Control Panel and your computer will
automatically update according to your
changes.
Visually impaired individuals now have options
not available 10 years ago for their computer
use. Included in these options are:
o Screen readers - which will read the
information displayed on the screen to the
visually impaired user.
o Text readers - which will read text out loud
that is typed into the user's keyboard, a text
reader also reads out loud emails and
common word processed documents, and
o Screen magnifiers - which magnify the
content of the screen from 2X to 16X its
original size.
Monitor is the most common way a person sees
the information and instructions on a
computer. Historically, on desktop computers
the monitor looks like a television screen and
uses the same display technology as a
television. On laptop computers ("small enough
to fit in your lap"), the monitor is a flat screen
that uses liquid crystal display (LCD)
technology. This LCD technology is increasingly
being used in desktop monitors as well. Some
other names for the monitor are VDT (video
display terminal), CRT (cathode ray tube),
screen, and display.
 Printers and plotters are two ways by which
the computer can put the processed
information, such as a report or a chart,
onto paper for people. The most common
output device in offices is the laser printer,
capable of putting either text (e.g., a
report) or graphics (e.g., a chart) onto
standard-size paper.
Questions
1. The lower the resolution, the:
- Larger the letters
2. All of the following are possible alternate
names for a computer monitor, except:
- Graphics engine
3. Light weight and slim computer monitors
are commonly referred to as:
- Flat screens
Types of Operating Systems
Operating Systems
There are (5) five basic types of operating
systems (OS) used in small office and home
computer systems today. They are:
1. DOS - Disk Operating System. This is the
system of most home computers.
2. MS DOS - Microsoft's version of DOS. If the
home computer is made by Microsoft, or if
it operates on a Microsoft based system
such as Windows XP or any of the Windows
series, then it operates on MS DOS.
3. UNIX - A widespread operating system used
primarily in businesses. Originally developed
by engineers at Bell South in the late 1960's.
4. Linux - A derivative of the UNIX system,
developed into a more flexible system in
the early 1990's. This is an up and coming
OS that is starting to take hold in the
marketplace.
5. The Mac OS series - Used by owners of
Apple's Macintosh series of computers
a.k.a. Apple or Mac.
Although operating systems experienced
growth, transitions and transformations since
the early days of the 1960's when they began
to develop in competitive avenues of the
marketplace, those listed above dominate the
marketplace today.
Questions
1. Linus is a derivative of:
- UNIX
2. Window XP operates on:
- MS DOS
3. All of the following are example of
operating systems, excepts:
- Apple
Microsoft Windows Operating System
Because GUIs are easy to use, most healthcare
information systems use a GUI operating
system, usually a version of Microsoft Windows.
For this reason, as well as the computer fluency
demanded of healthcare professionals, it is
appropriate to review some basics of using
Windows. When a PC is turned on and finishes
booting (often a three- to five-minute
process!), the screen that appears is called the
desktop. The desktop has icons representing
many of the application programs that are
installed on the computer. Below these icons is
the name of the application that the icon
represents. When "clicked" (putting the mouse
pointer on the icon and left clicking), the
program the icon represents will open.
OPENING A PROGRAM IN A PC
NCM110A - PRELIM 32
As with all things with Microsoft Windows, there In the context of a PC, the term "windows" may
are several ways to start a program when using refer to the operating system or to the various
a PC. Clicking the icon on the desktop, content boxes that appear on the screen.
mentioned earlier, is often used when the Each program that is open creates its own
computer is first turned on. If an icon for the window and places a tab on the task bar on
desired program is not on the desktop, the user the bottom of the screen. If a word processor
should click the Start button, then click All and a spreadsheet program are open
Programs and click the name of the program simultaneously, two program windows are
on that list. The Start button, so called because open; both may or may not be visible on the
it "starts" processes, is located in the lower left screen at the same time. Closing the window in
corner of the screen. In Windows Vista, the start any program involves clicking on an X in the
button is the Windows logo surrounded by a upper right corner of the screen. In some
blue circle. Some programs that are together programs you will see two Xs, one on top of the
in a suite such as Corel Office, Lotus SmartSuite, other (see Figure 3-3). In these cases clicking
or Microsoft Office may require that the folder the top one, which is usually red, will close the
containing all of them be opened, then the program itself and all the files that are open in
program selected from the secondary menu that program, while clicking the lower one will
contained in the folder. In XP, this will be close only the file that is open, leaving the
indicated by a black triangle mark pointing to application itself open. If there is only one X,
the right. In Windows 7, a container or more clicking it will close that file and instance of the
programs will be the folder icon as seen in program.
Figure 3-1. In either case, clicking the container
Looking at the task bar at the bottom of the
will show the programs with that folder, and
you can make your selection from there. screen tells you how many instances of each
Microsoft program are open, and any other
WORKING WITH A PROGRAM IN A PC programs that are open. When so many
programs are open that there is no room on
Once a program is opened, you will see the the task bar, multiple instances of the same
work screen, which may look like any of those program will be grouped under one icon
in Figure 3-2. The choices on the menu bar can meaning that you will have to click that tab
be clicked for a menu of features classified by
and select which file you wish to use for that
that choice. If you are using Microsoft Word
program.
2007, the menu bar is replaced with tabs,
which when clicked have icons for the features
classified under that tab. When first starting to
use a new application program, or a major
update, using Help to find the feature you
want is often necessary.
All programs will have a symbol, which
represents the mouse pointer, the shape of
which may vary according to the task and the
program. In some cases it can be changed by
the user. In word processing software it is often
a vertical "I" bar; in spreadsheets it may be a
large plus sign; and in a presentation or
graphics program, an arrow. Although many
choices on the top of the screen may be
represented by icons, if you rest the mouse
pointer on an icon, after a few seconds words
describing what the icon is will appear.
MULTIPLE WINDOWS
One of the advances of GUIs over DOS
included the ability to have multiple programs
open at the same time and to easily move
data between them. This makes it possible to
copy a graph from a spreadsheet into a word
processor.
Closing Files and Programs

NCM110A - PRELIM 33

Navigating Between Programs and Files
One of the hardest things to grasp for new
users of GUIs is that not only is it possible to
have many different windows open at one
time, but using this option is an aid to
productivity. As mentioned earlier, when you
have more than one program or file open, the
program name will be on the task bar, which is
at the bottom of the screen. If this line is not
visible, place your mouse pointer on the
bottom of the screen, and it will appear.
Part of the left side of the task bar is the Quick
Launch bar to which you can drag icons either
from the desktop or the program list for
programs that you frequently use. Then instead
of using the desktop or All Programs from the
Start button to open a program you can click
the icon in the Quick Launch bar that
represents the program you wish to open. If
you can't remember what the icons represent,
rest your mouse pointer a second or two on it
and the name of the program will appear.
MAXIMIZING AND MINIMIZING A WINDOW
Not only does Windows allow you to have
more than one window open at a time, it lets
you see multiple windows at the same time.
Often when you open a program, you will see
that it does not take up the entire screen. You
may even see another program, or the
desktop behind it. In this format, the window is
said to be "minimized." This holds true whether it
takes up almost the entire screen or is reduced
to just the title bar (see Figure 3-4). You can
maximize it by clicking the square in the upper
right corner of the screen and minimize it by
clicking the 3D square that replaces the
original square when the window is maximized.
In a minimized format, you can place your
mouse pointer on the sides of the window until
it becomes a double-edged arrow, then drag
the side to change the size of the window. To
move a window, place the mouse pointer in
the title bar, or the top line of the window that
has the name of the program and often of the
file itself, and drag the window wherever you
want it. If the windows overlap, the window
that is the active window, or the window in
which you are working, will be on top. Clicking
in a window makes it the active window. If the
windows are side by side, the active window is
the one where the mouse pointer is, although
sometimes the title bar will be a little darker in
color in the active window. Placing windows
side by side or one on top of the other can be
very useful when working on two files in the
same program, or needing to synchronize files
from different programs.
ACCESSORIES AND UTILITIES
Operating systems usually come with some
utilities and built-in software. Certain utilities are
helpful with disk maintenance, such as the disk
utilities ScanDisk and Disk Defragmenter.
Additional accessories such as Paint, a simple
drawing program, allow a user to create
drawings or various shapes, such as circles,
squares, or triangles, in any of the colors
available in the program. Also available are
writing accessories such as Notepad, a
product that is useful in creating files in ASCII
(American Standard Code for Information
Interchange), which is a format that can be
read by many different programs.
EXITING WINDOWS
In the earlier sections we have discussed how
to close a file on which you are working, and
how to close a program. Before shutting down
NCM110A - PRELIM 34
a computer, it is necessary to exit Windows.
Although invisible to users, Microsoft Windows,
like all operating systems, actually works very
hard behind the scenes to provide its many
functions, as do many of the application
programs. To do this, application programs
and Microsoft Windows have to have easy
access to specific information. Often, this is
accomplished by creating files on the hard disk
of the information that the application needs
to use. These files are temporary and unknown
to the users. They are created, changed, and
deleted as users change what they are doing.
Before quitting Windows, the application
programs need to be able to shut these files
down. If users do not exit all programs and
close Microsoft Windows properly, these
temporary files are left on the disk and can
cause problems as well as fill up your hard disk.
To exit Windows and shut down your computer,
click the Start button in the lower left corner of
the screen, select Shut Down from the menu
and let the computer go through the
shutdown process, which may take a minute or
more. If during the time you have used the
computer, a program or the operating system
has downloaded some updates, you may see
a message that files are being updated,
please don't turn off the computer. This
message may or may not add that the
computer will be turned off by the program,
when the installation is complete, but in most
cases this will occur.
Questions
1. This term may refer to the operating system
or to the various content boxes that appear
on the screen:
- Windows
2. All of the following are built-in software
bundled with most operating systems,
except:
- A spreadsheet application
3. This show how many instances of each
Microsoft program are open:
- Task bar
Types of Software
 Application Programs are packages of
instructions and operations that take raw
data and process them into information.
Applications focus on working with people
to produce information that is important to
them. Some examples of applications are
word processing, spreadsheets, and
desktop publishing.
 Graphical User Interface (GUI) Software - is
a special type of software in common use
today. It can be part of the operating
system software, or it can be a complete
application program on its own; at times, a
GUI (pronounced "gooey") seems to
straddle the line between operating and
application software. The basic design of
any GUI is that it stands between the
operator of the computer and the
computer itself and acts as the go
between. Any GUI has two primary goals:
(1) to shield the operator from needing a
great amount of technical knowledge to
use the computer effectively and correctly;
and (2) to give a consistent "look-and-feel"
to application programs (if they are
designed for it).
Accomplishing the first goal means that an
operator can perform all necessary technical
tasks (e.g., copying data files between disks,
backing up information) by pointing at icons
(small pictures) on the screen. These icons
represent tasks that can be done. For example,
by pointing to an icon that represents a
desired data file and then dragging that icon
over onto another icon that represents a
printer, a person can print the file.
Note that because of the GUI's capabilities, the
person did not have to know the correct
operating system commands to print the file.
Accomplishing the second goal means that
any application program can be designed so
it is less difficult for a person to learn how to use
it. Basically, the GUI defines a standard set of
functions that it can provide (e.g., open a
data file, save a data file, print a data file) and
gives standard ways for application programs
to use these functions. If application programs
are designed and built to use these functions,
a person has to learn only once how to open a
data file. Any other program that uses the GUI
functions has the same "look-and-feel" that is, a
person can open a data file in the same
manner. Doing things in a consistent,
predictable way not only reduces a person's
learning time but increases a person's comfort
level and productivity.
 Databases and Relational Database
Management Systems - A database is a
data file whose information is stored and
organized so it can be easily searched and
NCM110A - PRELIM 35
 retrieved. A simple analogy is a filing
cabinet drawer.
The difference between a file and a database
is the same difference between a file drawer
that has reports dumped into it in any old way
and a drawer that has neatly labeled file
folders, arranged in meaningful order, with an
index that shows where to store a report. In
both cases, we know the information we need
is in the file drawer-only in the second case
(i.e., the database) we are confident that we
can find that information quickly and easily.
A database management system (DBMS) is a
set of functions that application programs use
to store and retrieve information in an
organized way. Over the years, various ways to
organize information have been used (e.g.,
hierarchical, network, indexed). The way it is
used most frequently now is called relational. A
relational DBMS stores information in tables
(i.e., rows and columns of information). This
approach allows powerful searches to be
done quite easily.
 Operating systems are the basic control
programs for a computer. All the basic
logic required for using a computer's
hardware, such as the monitor, the printer,
and the hard drive, is contained in the
operating system. Because the operating
system handles those computer parts, it is
unnecessary for application programs to do
so. An example in the personal computer
world is Microsoft Corporation's Windows
operating system.
1. DOS - Disk Operating System. This is the
system of most home computers.
2. MS DOS - Microsoft's version of DOS. If the
home computer is made by Microsoft, or if
it operates on a Microsoft based system
such as Windows XP or any of the Windows
series, then it operates on MS DOS.
3. UNIX - A widespread operating system used
primarily in businesses. Originally developed
by engineers at Bell South in the late 1960's.
4. Linux - A derivative of the UNIX system,
developed into a more flexible system in
the early 1990's. This is an up and coming
OS that is starting to take hold in the
marketplace.
5. The Mac OS series - Used by owners of
Apple's Macintosh series of computers
a.k.a. Apple or Mac.
Questions
1. All of the following are examples of
application programs, except:
- Windows 7
2. Database management system can be
best defined as:
- A set of functions that are used and
retrieve information in an organized way
3. Packages of instructions and operations
that take raw data and processes them
into information best describes:
- Application programs
Most Commonly Used Computer Terms
The terms listed in this lesson are meant to be
beginner's terms only. Reference for more
advanced studies of terms and computer
jargon are listed at the end of the lesson.
Included in some of the term's definitions are
helpful information and tips, particularly for
those terms which require more details.
Backup- A saved copy of your computer hard
drive, temporary files or current project.
Generally, a backup is a digitally saved copy
[on CD] of everything on your hard drive.
Programs such as Ghost will also handle this
task automatically although most home
operators perform the task manually
themselves. It is essential to anyone who
seriously works on computers to backup their
work. Computers crash, accidents happen,
files get erased by the unsuspecting, and work
can be forever lost without a backup.
Boot up- To start up your computer is to boot
up your computer. If your computer crashes
you may need to use your boot disk, the one
NCM110A - PRELIM 36
that came with your computer system, in order
to restore your system.
Bug- A bug is an error in programming that was
overlooked. Bugs are the primary reason for
updates that have to be downloaded from the
internet to keep your system up to date and
running smoothly.
Burn- To copy your file or information onto a
CD is to burn a CD. This requires a CD burner
since not all CD drives have burners in them.
Bytes- Eight bits is a byte. Each bit is designated
by a 1 or zero; this is the basis of all written
computer code. Technically, there are
differences, but to the novice, the easy way to
think of it is that a byte is most commonly a
letter, punctuation or space.
CD- Compact disk; a small, plastic disk which
retains information in a digital format [there are
a variety of digital formats which can be
recorded on a CD]. The CD superceded the
floppy disk because it encases the saved
information in a hard plastic that is
impenetrable without excessive force. It is
virtually weatherproof and cannot be easily
destroyed.
Chat Room- An online forum in which people
[usually adults although some young adult
forums exist] can talk to one another instantly
via a login and password system. Most chat
rooms cover specific topics: consumer advice
or advocacy; dating; politics; religion;
technical information; and others.
Crash- For the computer to crash is to have it
suddenly stop working and refuse to restart.
Indications of this are that you cannot get it to
boot up, you cannot get it to reboot, you
cannot access your files, or it will not give you a
prompt in DOS. Usually, if your system crashes,
the information on your hard drive is gone
forever unless it is backed up somewhere.
Doc File- A doc file is usually a reference to the
Microsoft Word program in which a document
is saved with a file extension of .doc. Doc files
are some of the most common files sent in
emails and used to transfer information from
person to person in the internet.
Download- A download is a program, a
program update, a file, or anything transferred
via email. Some of the big search engines like
Google and Yahoo have downloads for their
customers on a regular basis to update the
customer's version of the search engine
program. A file sent from one person to
another in the internet is generally called a
download. A download can also be a file that
you paid for such as an MP3 music file. If you
go out to the internet, capture a file, and save
it on your computer, then it is a download.
DOS- The abbreviation for "Disk Operating
System"; also known as THE Microsoft language.
Every product produced by Microsoft is written
in DOS.
DVD- An abbreviation for "Digital Versatile Disk".
It is currently the most high powered portable
storage disk available on the market. The
current maximum storage for a DVD is 4.7GB
which is more than 5 times the storage space
on a CD.
e-Book- A book made available online in a
digital format; also known as an "electronic
book". The e- Book is the most progressive
format for the book publishing industry, yet it
suffers certain obstacles such as appeal to
those over 30, portability, and the comfort
factor to name a few.
Email- Online electronic communication
between people in different locations. Most
commonly email is provided for and supported
by large search engines, individual websites
and public library accounts. Some of the best
places to look for free email providers are:
 Google - http://mail.google.com
 Yahoo - http://www.yahoo.com
 Free ----- Email ----- Provider's ----- Guide -
http://www.fepg.net/providers.html
 EmailAddresses.com -
http://www.emailaddresses.com
Flash Drive- A flash drive is a small, portable
drive that can hold as much as small hard
drives [internal drive]. Most flash drives are the
size of a small cigarette lighter and fit in the
palm of your hand. They come in several
popular sizes, most commonly: 512MB; 1GB;
and 2GB.
Folder- A file; a place to store your documents.
Located in the directory of your hard drive
[a.k.a. C drive].
Format a drive- To prepare a disk for use.
Gigabytes- 1024 megabytes or approximately
1 billion bytes [characters].
Questions
1. Online electronic communication between
people in different location is best
described by:
- Email
2. This is a book made available online in a
digital format:
- e-Books
NCM110A - PRELIM 37
3. Bugs refers to:
- Errors in a computer program
Computer Terms II
Hard Drive- The hard drive is the computer's
primary data storage unit. The hard drive
generally holds all of your programs and all of
your created, downloaded and saved data.
Hardware- Hardware is all of the physical,
tangible elements of your computer.
ISP- Information Services Provider; the
company that brings your computer services to
your house or business. ISPs are very similar to
your phone or electric company in that they
provide a specific service. Most ISPs utilize your
current phone cabling or your
satellite/television cabling to provide their
services.
JPEG File- Joint Photographic Experts Group is
the name of the committee that wrote the file
format that is now in widespread use for most
online photos that are shared or posted on
public sites. This is a file type in which you will
save most of the photos that you use in your
computer.
Laptop- A small, self-contained computer that
can fit in your lap. Generally used for mobile
purposes such as business or travel.
Megabytes- 1024 kilobytes; 1 kilobyte is 1024
bytes.
Modem
A communications medium between your
computer and the ISP, most commonly
contained in a box that connects to your
computer with Ethernet cables and phone
cables. The exception to this is the FIOS [fiber
optic cable] services available from Verizon.
Network- The computers in your home or
business which are all connected together.
PDA- Also known as a personal digital assistant;
the most popular ones are the Palm Pilot and
the Blackberry. You can send and receive
email and other documents via your PDA.
PDF File- Technically, it means portable
document format. The .pdf format is used
primarily on Adobe's Acrobat programs.
Adobe owns the market on this format, and
provides free readers to anyone online.
Without the current Acrobat reader you
cannot see a .pdf file unless you purchase the
Acrobat program for about $450. The .pdf file is
a common and popular file type for business
forms, e-Books and general mainstream
documents.
Phish- Hackers and others bait email users to try
to attain the user's personal identity and credit
card information for the purposes of
perpetrating fraud and/or identity theft.
Phishers also post fake websites that look
identical to the real ones so they can trick users
into giving their credit card information.
Program- Also known as software, a program is
a set of commands, written in a computer
language, which instructs the computer to
function in certain ways. Examples of common
programs include the Windows collection of
popularly used products such as, MS Word for
everyday document production, MS Excel for
everyday accounting calculations and
spreadsheets, and MS Access for everyday
database creations for small offices.
Reboot- Reboot is what a computer operator
does when his or her computer crashes or
suddenly shuts down and stops working.
Snail Mail- Snail mail is opposed to email which
is fast, almost instantly and electronically. Snail
mail is your regular paper delivery mail service
in your country.
Surfing- Surfing is what computer operators do
when they go online via the internet and do
searches for various needs or topics. Surfing is
what you are doing when you are looking for
what you need; similar to shopping, except it is
the web version.
Text File- A text file [.txt] is the most common
file used. It is also the most adaptable for
anything you want to use the contents for in
the future.
Trojan- A Trojan is a hidden program inside of
another program, usually serving a good
purpose. However, in reference to email and
the internet, a Trojan is commonly a particularly
nasty type of virus that comes in via a hidden
method.
Virus- In computer usage, a virus is computer
code [as a computer user, your concern is for
the harmful ones] that is transferred from one
computer to another without your knowledge
or permission. Most commonly, the harmful
viruses that circulate on the internet come into
your computer [to destroy it or take personal
information from it, etc.] via your email.
Questions
1. This file format is used in Adobe’s Acrobat
programs:
- PDF
2. A program is best described as:
- A set of commands written in a computer
language
NCM110A - PRELIM 38
3. Trojan refers to:
- A hidden program inside of a another
program
Your Data
Backup Systems
The most traditional method of backing up
your data is the disk system. For home
computers and small home offices a floppy
disk. CD disk, or flash drive is the best method
for saving a backup copy of your created
data.
Innumerable computer operators, authors,
artists, creators of original works, and others
have lost their work due to the simple oversight
of a basic backup system. Any creation of
yours, in which you take time to build it and
store it, is worth saving to a recoverable file.
Preserving Your Data
The method of backup and storage that you
decide to use will determine the quality of
preservation for your data. How well your data
is preserved determines its use in the future.
Therefore, it is worth the effort to keep your
data backed up and preserved in systems that
have longevity and can be accessed easily for
many years.
To the average home computer operator, I
would suggest that you preserve your files in
CD backups at least once every 3 months or in
a flash drive every month. Be sure to store your
backup copies in a location off of the premises
of your computer, preferably a safe deposit
box or a relative's safe in their home. If your
home or office were severely vandalized or
caught on fire, you want your data in an off-
site location so that you can recover your
work.
The same is true for small business operations,
except that the backups should be weekly
and definitely stored in a safe deposit box in
your bank or similar financial institution.
Protecting Your Data
Data is best protected by a number of factors
such as passwords, encryption, storage
location and method. Passwords protect
accessibility to your data, encryption protects
your data from being used by unscrupulous or
unauthorized individuals, storage method will
determine your data's ability to survive natural
disasters and weather fluctuations, and
location will help to secure your data in dire
emergency situations and other similar
instances.
Small businesses are usually more concerned
than individuals about these factors, although
freelancers, independent contractors and
others who earn their living in a more
independent way than normal employment
will also find protection a central concern for
them.
Questions
1. Backups for small businesses operation
should be done:
- Weekly
2. For an average home computer operator,
file should be preserved in:
- CD backups at least once every 3 months
3. Data is best protected by a number of
factors, which include all of the following,
except:
- Portability
Terminals, Workstations, Stand-alone
Terminals
In the early days of computer technology, an
organization usually required only a single
large-capacity computer to handle its
information needs. These computers were
called "mainframes." They required a trained
staff to maintain and run them and were quite
expensive to purchase and upgrade (e.g., add
more memory, more disk storage). People
gave information and commands to the
mainframe through a "terminal," essentially just
a keyboard and monitor; the terminal had no
processing capability of its own. The number of
terminals a mainframe could handle was
limited, which created lineups of people
waiting their turn to submit computer requests.
Workstations
Advances in computer technology, such as
IBM's personal computer introduced in 1981,
dramatically changed this situation. Now it was
possible to have a powerful computer right in
the office and for far less money. What is more,
all its resources and power were under the
control of, and totally available to, its user. As
people began to move toward personal
computing, computer manufacturers built
more powerful workstations. Soon, these
powerful workstations became small enough
to be easily moved, promoting the idea of
"mobile computing." Today, laptop computers
easily allow computer technology to be
available at the point of care.
Stand-alone
By "stand-alone" we mean that all the pieces
of a computer that are needed to gather,
process, display, possibly store, and provide an
output of the information are physically
connected; moreover, if needed, they can be
NCM110A - PRELIM 39
moved as a complete unit to another location.
This is the usual setup for most home and small
business computer systems. Such a setup is
inexpensive and quite simple to manage.
Although it makes sense to use a "stand-alone"
computer, it is often better for a computer to
be part of a network.
Questions
The usual setup for most home computer is:
- Stand-alone
A stand alone is a computer:
- That can be easily moved as a complete unit
to another location
This was a single, - large capacity computer
use for bulk data processing during the early
days of computer technology:
- Mainframe
Peripherals and Ergonomics
Peripherals
A peripheral is any external device such as a
keyboard, monitor, or mouse, which is
connected to the computer. Because they are
external in desktops, it is easy to see that these
are peripherals. On laptops, however, the
connection of keyboards and monitors is
internal. In general, peripherals are the devices
that allow inputting of data to a computer and
outputting of information from a computer.
Besides these obvious peripherals, there are
many others such as printers (output) and
scanners (input) that allow humans to use
computers. Although the CPU would happily
complete any instructions it received without
any visible output, users generally want some
type of output, such as what is seen on a
monitor or video screen. There are also devices
that both input and output information to a
computer such as the port to which a printer is
connected.
 DIGITAL CAMERAS are finding a place in
healthcare for purposes such as recording
the healing progress of wounds. Text
descriptions cannot compare with a
picture in letting clinicians and patients see
healing progress.
 SCANNERS take a picture of a document
and then allow users to save this as a file.
Unless there is character recognition
software available, any text that is scanned
will be in a picture format and uneditable.
Additionally some healthcare agencies are
inputting clinical records to electronic
health records by scanning free text. Even
when character recognition software is
used to translate the words in the "picture"
to text, the result needs to be checked for
accuracy. Further, unless the form that is
scanned is especially designed for
scanning, this free text is unstructured and
not easily used for reporting information
from data.
 CLINICAL MONITORS can be part of a
network and monitored at a central
location. They can also be programmed to
provide alarms, either at the central station
or to individual pagers, when the monitor
shows something beyond the norm. Clinical
monitors whether attached to a network, or
not, can allow patient data such as that
produced by cardiology or fetal monitors to
be directly input to a computer. The
advantage of computerized clinical
monitoring is that it allows one person to
monitor many patients at once as well as
provide notification of problems. It should
never be allowed to reduce nurse-patient
interaction.
Connecting Peripherals
A peripheral is connected to a computer
through a port. Although today the USB port is
the de facto standard for PCs, in the past there
were other types of ports such as serial and
parallel. Computers manufactured in the last
few years do not have serial or parallel ports.
 USB PORT or universal serial bus is a standard
that was originally created to connect
phones to PCs in the mid-1990s ("Everything
USB... We Mean Everything!"). Lately, it has
become the standard port for connecting
peripherals to PCs. These ports are a thin
slot, about half inch by one fourth of an
inch, which are found on the sides of
laptops and on the front of newer desktops
or towers. The port is designed with a solid
piece in one part, usually the top, so that
USB device can only be inserted one way.
The original USB port was capable of
transmitting data at only 12 megabits
(Remember, it takes 8 bits to form a byte,
which is required to transfer one letter) per
second, which made it useful for only mice
and keyboards ("Everything USB... We Mean
Everything!"). This easy connection method,
however, created a revolution that resulted
in devices such as flash drives, external hard
drives, and webcams, which needed faster
transmission speeds. This need was met by
a new standard, the USB2.0 port, which
transmits information at 480 megabits per
second. The USB connection has largely
replaced older serial and parallel
connectors.
NCM110A - PRELIM 40
 FIREWIRE originated in the mid-1980s as a
high-speed data transfer method for
Macintosh internal hard drives (Nathanael,
2006). Apple presented this technology to
the Institute of Electrical and Electronics
Engineers (IEEE) who in December 1995
released IEEE 1394, which is an official
Firewire standard. It was often referred to as
Firewire 400 and had transfer speeds of 100
to 400 megabits per second. In April 2002,
the IEEE released a new standard for
Firewire 800, which can theoretically
transfer data at up to 3.2 gigabits per
second. Although its speed is faster than
USB ports, it is impractical for low-bandwidth
devices. This fact, together with the
knowledge that only Macintoshes include
Firewire ports by default, has kept it out of
the mainstream. Because of its superior
ability to transfer uncompressed video from
digital camcorders, it is now found in all
modern digital camcorders. Most digital
cameras, however, still use USB to transfer
images because USB ports are today
standard equipment on computers.
 INFRARED PORT is a connection on a
computer that uses IR signals to wirelessly
transmit information between devices such
as a PDA and a computer. It has a range of
about 5 to 10 feet. Most handheld devices
have the capability to communicate via IR
ports that allow the device to directly
interface with another device to exchange
data.
Ergonomics
Ergonomics is the science of designing a work
environment so that it is convenient to use and
does not prove injurious to health. Although it is
an important consideration for preventive
health, it is too often overlooked when setting
up computer hardware. This despite the fact
that using a keyboard injures more workers in
the United States than any other workplace
tool (Bailin, 1995) Even nurses who do not
spend all day at the computer are affected.
One study from a Scandinavian journal,
reported by Nielsen and Trinkoff (Nielsen &
Trinkoff, 2003) found that some nurses, even
those who use a computer less than four hours
a day, had a 32% prevalence of upper arm
repetitive stress injury, 60% of which was carpal
tunnel syndrome.
Healthcare agencies, which should be very
concerned about preventing injuries
associated with any repetitive activity such as
typing, could save money by focusing more on
ergonomics. Computers are supposed to
facilitate data recording, not impose
additional burdens on healthcare personnel.
Those planning a system should walk a day in
the shoes of a user or several days in the shoes
of several users before making firm decisions
about computer placement. Asking staff
nurses and other clinical computer users to
participate in determining computer
workstation design is another way of improving
ergonomics (Nielsen & Trinkoff, 2003).
Unfortunately, few studies have been done on
nursing use of computers with most research
concentrating on seated workstations (Nielsen
& Trinkoff, 2003). Some simple things could
improve the work environment of nurses who
document with or otherwise use computers. For
nurses who are on their feet all day, if they are
to chart at the point of care, they need a way
to be able to sit while using the computer. If
the computer is also used by those standing,
an adjustable computer stand could be
employed so that a user who is standing does
not have to stoop. Additionally, if the
computer is fixed at a height for users who are
standing, a stool should be provided for the
nurse who uses the computer extensively.
Touch screens and light pens may be ideal for
quick entry, but for extended entries, they are
very tiring to the arm. Providing dual means of
entry may solve this situation. Resolution of a
screen is also important. The higher the
resolution, the easier the screen is on the eyes.
It is also important to prevent glare on the
screen. In situations where this is impossible, it is
possible to purchase screen filters that will cut
down the glare.
More thought also needs to be given to how a
workstation is designed for those who will use a
computer for more than four hours a day.
Consideration needs to be given to the posture
the user will be forced to adopt. The best chairs
have adequate support for the outward curve
of the lumbar spine and the inward curve of
the thoracic spine. Studies have shown that a
100 to 110 reclined position is better than an
upright posture (Cornell University Ergonomics
Web, 2007). The feet should be flat on the floor,
or a footrest should be provided (Figure 2-3).
Wrists, knuckles, and the top of the forearm
should fall into a straight line while typing
(Bailin, 1995). To promote circulation to the
lower arm and hand, the elbow angle should
be open. Both of these can be accomplished
with a negative tilt keyboard (Cornell University
Ergonomics Web). The monitor should be
placed directly in front of the user to avoid
neck twisting. Studies have found that the best
position for the monitor is for the center of the
screen to be about 17.5 degrees below eye
level and about an arm's length away. The
NCM110A - PRELIM 41
ideal placement of a mouse is on a flat,
movable mouse platform positioned one to
two inches above the numeric keypad.
Laptops, under most use conditions, violate all
ergonomic requirements for computers
(Cornell University Ergonomics Web, 2004). This
is caused by the connection between the
keyboard, screen, and computer. If the
computer rests on a table, the keyboard will be
too high for proper arm positioning. If the
computer is lower, the monitor placement may
require that the head be tilted forward for use.
For these reasons, if a laptop is your primary
computer, to provide more ergonomic working
conditions you should invest in a docking
station. If you carry the laptop and all the
required accessories such as spare battery,
power cord, or external drive weighing 10
pounds or more, consider a wheeled carrying
case.
Computerese
Many computer-related terms are used in
discussion, instruction, and advertising.
Although they are not strictly hardware terms,
they can often be confusing. If one watches a
computer when it has just been turned on, one
will see different types of information flashing
across the screen. This information is produced
by what is called the "booting" process.
Booting refers to all the self-tests that a
computer performs and the process of
retrieving, either from the BIOS or a disk, the
instructions necessary to allow the user to start
using the computer. The term "reboot" means
to restart the computer. A warm boot is
restarting the computer without turning it off, a
selection that is offered when one elects to
start turning off the computer. A cold boot is
starting the computer when the power is
completely off. Avoid cold boots if you can,
because the jolt of electricity received each
time the computer is turned on may shorten its
life span. Warm boots are often used when a
computer freezes or crashes. It erases
information in RAM, which often eliminates
memory conflicts that may have caused the
problem. These conflicts can be caused by
different programs trying to store data in the
same location. If a warm boot fails to notify the
programs that it is time to stop fighting for the
same space and give control back to the user,
the machine must be turned off for a cold
boot.
A bug is a defect in either the program or
hardware that causes a malfunction. It may be
as simple as presenting the user with a blood
pressure chart when a weight chart was
requested, to a more serious defect that
causes the entire system to crash.
Compatibility refers to whether programs
designed for one chip will work with an older or
newer chip, or whether files created with one
version of a program will work with another
version of the same program. Most computer
chips and software are backward compatible,
that is, they will work with older versions of a
program or files created with an older version
of a program. Some are not, however, forward
compatible, or the situation in which an older
program does not recognize files created by a
newer version of the same program. This is
particularly true of spreadsheets, databases
and presentation programs.
A driver is a software program that allows data
to be transmitted between the computer and
a device that is connected to the computer.
Drivers are generally specific to the brand and
model of the device. They may come with a
new peripheral, or can often be downloaded
from the vendor's Web site.
Although the term hacker originally meant a
person who enjoyed learning about computer
systems and was often considered an expert
on the subject, mass media have turned it into
a term to refer to individuals who gain
unauthorized access to computer systems for
the purpose of stealing and corrupting data.
The original term for such a person was
cracker. Today, differentiations may be made
by using the term white hat hacker for a person
who uses his or her computer knowledge to
benefit others. Black hat hacker is the term
used for those who use their computer skills
maliciously.
When used with a computer the terms logical
and physical refer to where data are located
in the computer. The physical structure is the
actual location, whereas a logical structure is
how users see the data. For example, when a
user requests information about laboratory
tests, he or she may see the indications for the
test, the normal values, the cost of a test, and
the patient's test results. Although this
NCM110A - PRELIM 42
information may be presented as one screen,
which is a logical structure, different pieces will
have been retrieved from different files in
different locations, which is the physical
structure of the information.
Another potentially confusing computer term is
object. Although the more common use of the
term "object" is for a physical entity, or at least
a picture on the screen, to a computer, an
object is anything the computer can
manipulate. That is, an object can be a letter,
word, sentence, paragraph, piece of a
document, or an entire document. Objects
can be nested, that is, a word is an object
nested within a sentence object. A paragraph
is an object that is contained in a document.
When an object is selected, clicking the right
mouse button presents a menu of properties of
that object that can be changed.
Questions
1. This refers to the self-tests that the computer
performed in process of retrieving, either
from the BIOS or a disk, the instruction
necessary to allow the user to start using the
computer:
- booting
2. This is a software program that allows data
to be transmitted between the computer
and a device that is connected to the
computer:
- driver
3. Computer peripheral is:
- any external device, such as keyboard,
monitor, or mouse, that allows input of data
into a computer and output of information
from computer
Networks
A nurse encounters a patient with an unfamiliar
disease. From an email message, the nurse
learns that a document on a computer in
another country has information about caring
for patients with this disease. Within 60 seconds
of logging on to the Internet, the nurse prints
out the document. This ability to exchange
information on a global scale is changing the
world. No longer do healthcare professionals
have to wait for information to become
available in a journal in the country in which
they live. Nurses and other healthcare
professionals can and do use computers to
network with colleagues all over the world.
Healthcare depends on communication:
communication between the nurse and the
patient, communication between healthcare
professionals, communication about
organizational issues, and communication with
the general public. As you can see from the
previous paragraph, the methods used to
communicate in healthcare are today being
augmented with computer networking. Since
the first computers talked to each other in the
late 1960s, networking has progressed to the
point where not only computers in an
organization are connected to each other, but
also institutions are connected to a worldwide
network known as the Internet.
A network can range in size from a connection
between a palmtop and a personal computer
(PC) to the worldwide, multiuser computer
connection - the Internet. Variation in network
size or the number and location of connected
computers is often seen in the name used to
denote the network, such as a local area
network (LAN) or a wide area network (WAN).
A LAN is a network in which the connected
computers are physically close to one another,
such as in the same department or building. A
WAN is a network in which the connections are
farther apart. Often, a WAN is an internetwork
of LANs. WANS are sometimes referred to as
enterprise networks because they connect all
the computer networks throughout the entire
organization or enterprise.
NETWORK ARCHITECTURE
There are many different variations in how
networks are constructed, or what is referred to
as their architecture, often depending on the
purpose of the network. For a home network, a
peer-to-peer network in which each
connected computer is a workstation is a
normal approach. In this scheme, each
computer can have a shared folder that is
accessible by the other computers. Often, the
network is primarily for connecting to the
Internet or for sharing hardware such as a
printer.
Another type of architecture, often seen in
healthcare agencies, is client/server
architecture. The principles behind this model
vary, but for most healthcare applications they
are similar to the "dumb terminal" model. A
client computer has software that allows it to
request and receive information from the
server. The server has software that can
accept these requests, find the appropriate
information, and transmit it back to the client
(Figure 5-1). The client views the information,
enters data, and sends it back to the server for
processing. Under this model, the client
computer does no processing. Beyond making
the initial request, rarely is any of this process
visible to the user. Users sometimes have the
misperception that the software and data
reside on the computer/terminal that they are
using, instead of the server.
NCM110A - PRELIM 43

There are other variations for networks. A
computer in a healthcare facility may function
as a client for the patient care information
system, but may have application software
that allows users to do things like word
processing, in which case it acts like a regular
computer. This computer may also be
networked to another server that stores the files
created by the networked computer, or the
files may be stored on the computer that was
used to create them. This computer may even
be connected to the Internet through another
server. Printers are usually connected to a
network so that more than one
computer/client can use them. Managing
networks is an ongoing maintenance task
performed by the network administrator.
CONNECTIONS
Networks are connected physically with a
variety of materials such as twisted-wire cables,
phone lines, fiber optic lines, or radio waves.
Computers that are wired together are said to
be hard wired. When you see the term "hard"
with another item, this means that the item is
permanent, or that it physically exists. Most
healthcare agency networks, even those that
use wireless, are hard wired to some extent.
Wireless transmissions are limited in distance, so
they do not compete with other radio traffic.
When a wireless system is installed, nodes are
placed at strategic locations throughout the
institution, locations that are determined after
a thorough assessment of the building. A node
in a wireless connection is a single point on the
network that consists of a tiny router with a few
wireless cards and antennas. These nodes pick
up the signals sent by a user and transmit them
to the central server, or even to another node
for rebreed-cast, and transmit signals back to
the user's computer. Successful wireless
communication depends on an adequate
number of nodes or hardware that send or
rebroadcast the signal and on their
placement. The distance of a device from the
node will affect both the speed of transmission
and whether one can use the network.
Wireless transmission is less secure than hard-
wired transmission because the signal is
available for use for anyone in range. Security
depends on the network administrators who
follow procedures to secure the transmission.
Many wireless networks, including those at
home, use wired equivalent privacy (WEP), the
goal of which is to prevent disclosure or
modifications of messages in transit. When this
is employed, to connect to a network, a user
must have the WEP key to enter before being
allowed to use the network. In many cases,
once a WEP key is entered on a computer, the
computer remembers it and will automatically
find it any time a user is in range of that
network. Another newer, more secure form of
protection is WPA (Wi-Fi Protected Access)
(Webopedia, 2007). It features improved data
encryption and better user authentication.
PROTOCOLS
For networks to function correctly, it is
necessary that there be agreements known as
protocols, which prescribe how data will be
exchanged between participating computers.
These protocols include standards for tasks
such as how the system will check for
transmission errors, whether to use data
compression, and if so how, how the sending
machine will indicate that the message it has
sent is complete, and how the receiving
machine will indicate that it has received the
message.
 Internet Protocol and Transmission Control
Protocol - To ensure interoperable data
transmission on the Internet, the Internet
Protocol (IP) and the Transmission Control
Protocol (TCP), sometimes referred to as
TCP/IP, were introduced in 1974 and are still
in use, although consideration is being
given to moving beyond the capabilities of
these two protocols. The IP enables
computers to find each other, and the TCP
controls the tasks associated with data
transmission. Although invisible to the user,
messages sent on the Internet are not sent
as a whole. Instead they are broken up into
what are called packets. Each packet may
even take a different route to its
destination. For each packet, a device
called a router scans the routes available
to the final destination, selects what is the
shortest and the least congested route at
that moment, and then sends the packet
to another router that again makes a
NCM110A - PRELIM 44
 decision about the best route at that
moment. This process continues for each
packet until all the packets in a message
reach their final destination. Under this
process, it is not uncommon for packets in a
message to take different routes to their
destination.
 File Transfer Protocol - Another process used
on the Internet is the file transfer protocol
(FTP). This is the method used to download
files (as opposed to retrieving a page from
the Web) from another computer. Until the
early 1990s, this was a manual process and
users had to learn commands to do it.
Today, Web browsers have automated this
process for files that are retrieved from the
World Wide Web (WWW/W3). People who
create pages for the WWW on their own
computers use an FTP program to place
their files on the server.
Questions
1. This is sometimes referred to as an enterprise
network because it connects all the
computer networks throughout the entire
organization or enterprise:
- Wide area network (WAN)
2. most networks are physically connected by
a variety of materials, including all of the
following, except:
- Electrical cables
3. This is a single point on a network that
consists of a tiny router which a few wireless
card and antennas:
- Node
Local Area Networks
Definition
A network is a way to connect computers so
several benefits can be realized. Local Area
Networks (LANs) connect computers that are
physically close together (i.e., in the same local
area). This means not only in the same room
but also in the same building, or in several
buildings that are close together. LANs use
three things to connect computers: a physical
connection (e.g., wire), a network operating
system, and a communication scheme.
There are several ways to connect computers
physically. The most common method is to use
category 5 cable and the latest way uses fiber
optic cable (light is used in place of electricity).
The very latest methods are wireless; they use
either radio transmission or infrared light for the
connection. Each method is suited for different
situations and is part of the consideration when
a network is built.
There are several network operating systems
available today that provide the necessary
processes to allow computers to talk with each
other and to share information and programs.
The communication schemes are properly
called protocols. This is a standard method by
which the computers in a network to talk with
each other and pass information around. There
are three main ways to connect computers in
a network: star, ring, and bus configurations.
These are called network topologies and
represent different physical arrangements of
the computers. As with the physical
connecting medium, each topology has its
strengths and weaknesses, which must be
considered when a network is built.
Benefits of a Network
The important benefits of a network are shared
information, shared programs, shared
equipment, and easier administration. It is
technically possible for any computer on a
network to read and write information that
another computer has in its storage (i.e., its
hard disk). Whether that computer is allowed
to do so is an administrative matter. This means,
though, that information can be shared
among the computers on the network.
Programs can also be used by computers on
the network, regardless of where those
programs are physically stored. It is also
possible (and usually desirable) for computers
on a network to share equipment such as
printers.
Technically, any computer on the network can
print its information on a printer that is
physically connected to another computer
somewhere else. By sharing expensive office
equipment, an organization reduces its
expenses. Finally, administration of computers
on a network is simplified because all the other
computers can be examined, helped, and
maintained from one computer.
Questions
Local area networks need all of the following
to connect computers, except:
- Mainframes
this refers to a computer network that
connects computers which are physically close
together:
- Local Area Networks (LAN)
all of the following are common network
topologies: except:
- Square
Wide Area Networks
Wide Area Networks (WANs) are extensions of
Local Area Networks. There are two kinds of
WAN. The first one attaches or connects a
NCM110A - PRELIM 45
single computer to a preexisting LAN; this kind
is called "remote LAN attachment." The second
one connects, or "bridges," two or more
preexisting LANs. Both WANs allow a computer
to use information or equipment no matter
where they are located in the organization. An
interesting point about WANs is the options that
can be used to connect the LANs. Instead of
being limited by the length of cable that can
be placed between computers, WANs can
communicate via satellite and earth stations.
This literally means that a person could be
using a computer in Africa and working with
information that is on a computer in Iceland—
without knowing or caring about its origin. To
that person, the information appears to be on
his or her computer.
Open Systems
"Open systems" is the idea that it should be
possible to do two things: run a particular
program on any brand of computer and
connect any collection of computers together
in a network. However, because of the
development of computer technology, this is
difficult to accomplish.
Most computers were initially developed as
"closed" systems; that is, a manufacturer built
the computer, wrote the operating system,
and wrote the application programs to run on
the computer. Each computer manufacturer
saw tremendous sales advantage from this
strategy. The result was several computers that
were similar in function but very different in
how those functions were executed. It was not
easy to buy an application program from a
vendor and run it on two different brands of
computers. It was a torturous exercise to get
any two computer brands to "talk" with each
other.
For people who simply want to buy and use
computer technology, "plug and play" is the
ideal mode. This means that a computer could
be purchased from vendor X, a second
computer from vendor Y, a program from
vendor Z, and a printer from vendor A, and all
these parts could be connected and used with
the same ease that people expect with stereo
system components. The way to achieve this
ideal is through standards. Just as stereo
components are built to use a standard
voltage, produce or use a standard type of
signal, and connect with standard plugs and
cables, computers and application programs
need to use certain standards for
communication protocols and file access. This
"plug and play" mode is getting closer today
because of vendors and manufacturers'
support and adoption of standards.
Client/Server Computing
As we have seen, computers come in a variety
of sizes and with various processing capacities.
Some computers are better suited than others
for different tasks. For example, personal
computers, because of the physical size of
their hard drives, have a limit to their storage
capacity. On the other hand, the large,
mainframe-type computer was designed to
handle tremendous amounts of information
and therefore has large storage capacity.
Where does it make more sense to store a
large data set?
This brings us to client/server computing. The
essence of "client/server computing" is to
assign to each computer the tasks for which it
is best qualified or, in other words, to use the
right tool for the job. Capitalize on the strengths
of one computer for task A and use a different
computer more suited for task B. A personal
computer works well with people; it is fast and
has color and good graphics display
capability. It could be the primary interface
device for people and computer systems.
Mainframe computers have huge storage
capacity, great speed, and large processing
power. This could be the place to store,
process, and retrieve information from the vast
amount of data accumulated by a large
organization. In a network, client/server
computing makes sense.
Remote Access Computing
Computers can be connected together in a
network; but, increasingly, mobile computing
requires that computers be able to access and
connect to other computers from almost
anywhere. This is possible through the use of
telephone or cable systems and special
computer communication devices called
modems. "Modem" is short for "modulate-
demodulate." The computer that, at the
moment, is sending information uses its modem
to "modulate" its electronic signal into a form
that can be carried over the telephone or
cable system; the computer receiving that
information uses its modem to "demodulate"
the signal. Information can be exchanged at
speeds that allow effective long-distance
computing.
Questions
1. Client/server computing is best described
as:
- assigning to each computer the tasks it is
best qualified to do
2. This refers to a computer network that
connects computers across a large
NCM110A - PRELIM 46
 geographical area:
- wide area network (wan)
3. Remote access computing is made
possible with the use of a:
- modem
Short Cuts and Tips
This is a small section of miscellaneous short
cuts and computer navigation tips. They are in
no particular order, but will help you as you go
along in your computer learning.
JPEG Files
If you scan a photo into a .jpg file or .jpeg file,
many times you will find that it is too large [too
many pixels] to use on public sites [like
MySpace, eHarmony and others] where you
would want to use it. The quick way to solve
this issue is to resize the .jpeg file using one of
the online services such as Shrink Pictures.
Simply go to: http://www.shrinkpictures.com/
and follow their directions. When you finish
shrinking and saving your new .jpeg file, their
page gives you an option to delete the file
from their server which makes the entire
practice fairly safe as far as services on the
internet.
Acrobat Reader
You will not be able to read an Adobe
Acrobat file without the current reader. Since
Acrobat is one of the more popular files used
on the internet, this will prove to be an essential
part of your computer system. Acrobat files are
all the files you will ever see which have a file
name extension [the part of the file name on
the other side of the period] of .pdf. To
download the current Acrobat reader, go to:
http://www.adobe.com/products/acrobat/re
adstep2.html
Reboot
If the computer is still on, the easy way to
reboot is to quickly and sequentially press your
CTRL + ALT + Delete keys on your keyboard. This
is the most common reboot command to give
a personal computer. If the computer is not on,
then reboot will occur when you turn it back
on.
Text File
If you copy text from something on the internet
because you intend to post it in another place,
the best file to save it to is a .txt file. In the
Windows programs, the .txt files can be
created in Notepad usually under the
Accessory panel under your Start button. The
reason.txt is the best file to save to is because
when you go to copy and paste the content
to another site, document or format, all of the
previous program's formatting will be stripped
out of it and will not confuse the new site or
document. In other words, you will transfer only
content, not programming. You can then
easier re-format the text to fit the current
program you choose to use.
Virus
When using email, use an email system that will
first scan your incoming attachments for
viruses. If you open an email attachment and it
contains a virus, then you will have to clean
your entire computer.
Secured internet pages - a.k.a. "Secured for
financial transactions" pages
The quickest way to tell if you are on a
"secured" page is to look at the top of your
page for an "s" in the internet address line. The
"s" should appear behind the "http" and before
the colon. Example: The Pay Pal site is
https://www.paypal.com. If there is no "s" in this
location on the address line, then you are not
on a secured page regardless of what the
page states in its content. If you post your
personal data to such a page, then you are a
sitting target for identity theft. This is another
common way online thieves phish for your
credit card information and personal identity;
they make an exact copy of the real website,
but they change the address by one or two
characters leading you to believe it is just
another page of the real site so you will
disclose your information. Look for the "s" in the
address line behind the http.
Your Online Pseudonym
It may be best to establish a pseudonym for
yourself, complete with an assumed date of
birth, mailing address and phone number. For
many folks this can be accomplished with a
PO Box and a cell phone number. The point is
that the fewer places you put your real
information, the more secure you are on the
net and less likely someone could use your
information for gaining false credit or
purchases.
Questions
1. An easy way to reboot our filter is to:
- Sequentially press CTRL + ALT + Delete
2. the quickest way to check if you are on a
secured page is to:
- Look for the ‘s’ in the address line behind
the http
3. if you copy text from the internet, it is best
to save it as a:
- .txt file
NCM110A - PRELIM 47
File Saving Tip
When you save any file in your hard drive, you
want to be able to easily locate the file at a
later date. You will eventually have files in your
drive that are older, outdated or have limited
current use for you. Over the years I have
created shortcuts for myself in the file name.
Some of those short cuts include:
1. business acronym in file name;
2. addressee's initials in file name;
3. version of the document in the file name;
and
4. date of the file's creation in the file name.
Example:
My business name is XYZ Corporation
Person I am writing the document to is
named John Smith
This is the third version [or third edit] of
the original document
Original document is saved/named as:
Business Plan for John Smith
Today's date is March 31, 2008
For this example, I am saving a Word
document
---------------------------------------------------------------------
Here is how I would name/save the file:
XYZ.JS.v.3.Business Plan.033108.doc
At a glance in my file directory I can later tell
the "who, what, when and document type" of
the file. This helps to later sort files according to
timing and relevancy without having to open
lots of files to find the most recent or most
appropriate file.
Common File Extensions
To help you quickly identify file types, this is a
small list of the most common types of file
extensions used in file names, and which
program they indicate has been used by the
file creator:
 .doc - MS Word
 .pdf - Adobe Acrobat
 .xls - MS Excel
 .rtf - [rich text file] - created most often in
Word - keeps the document formatting
[such as fonts, sizes, layout, etc.]
 .jpg - [a.k.a. jpeg] - created in a JPEG
supported program
 .txt - [text file] - created most often in
Notepad or similar tool of Microsoft - strips
out the document formatting.
Questions
1. The file extension of an Adobe Acrobat
document is:
- .pdf
2. The file extension of an Ms. Excel document
is:
- .xls
3. A notepad document is saved as a:
- .txt file
Computer doesn’t start up
ICE - In Case of Emergency
This lesson is a small run down of how to handle
emergency issues which can occur. The ones
listed here are those that are most likely to
create panic for new users. Techniques to solve
each problem are offered; if they do not work
in your situation, then you will need to seek a
local geek to help you.
Computer doesn't start up
Every computer has an OS disk to use for
reboot in cases where a crash happens.
Always insert your OS CD/DVD to reboot if your
computer doesn't start up as normal. If you are
using a laptop or a PDA and are away from
your disk source, then you will need to take
other measures to reboot in cases of
emergency.
 Windows - When you turn your computer
on, immediately begin pressing your F8 key
repeatedly until a screen pops up. When
the screen pops up it will give you several
options. You want to select Restart in Safe
Mode. This will allow the computer to
reboot and start up [so you can find your
document(s) on the spot]. You do not want
to create documents in Safe Mode, and
you do not want to perform any complex
tasks while on the blink. When you return
home, or wherever you have your OS disk,
then you can use it to reinstall your OS if
necessary.
 MAC - To reboot in Safe Mode on a Mac,
hold down the Shift key as you reboot, or
hold down the "S" key to reboot in Single
User Mode to look through your files and
find your problem. If you are away from
home, it is best to wait until you have
access to your OS disk before digging
through the files to find the problem.
Questions
1. If your computer doesn't start up and you
are using Windows, you should:
- turn the computer on then press F8
repeatedly until a screen pops up
NCM110A - PRELIM 48
2. If your computer doesn't start up, the first
thing to do is:
- do you use the OS disk to boot up
3. To reboot in safe mode on a Mac:
- hold down the shift key as you reboot
Computer takes too long to move/think
If your computer sounds like it is grinding or
thinking and it takes too long to move from
one point to another, then you have system
problems. The specific problem referred to
here will prevent you from opening a
document, or it will take 15 minutes for the
system to boot up, or some similarly extreme
delay in achieving your decided command to
the computer.
• You have contracted through the internet, or
through another person's file which you have
opened, a virus, Trojan, worm or some other
destructive tool and it has corrupted your
computer's OS. In this instance, the virus or
worm, etc. is achieving its goal. You will have
to immediately run a clean up program on
your computer or risk it freezing up completely.
Programs such as Ghost or Norton 360 provide
ways to regularly backup your work, so you
should already have your information secured
and available for emergency retrieval. If you
haven't installed a program to backup your
data, then you may lose your documents. The
first thing you should do is reboot in Safe Mode,
and then perform a virus scan in your system.
Most of the antivirus and firewall products now
have a systematic way to isolate viruses in your
system. Use this program tool and you should
get back to normal.
• You have installed a program or tool that
requires more RAM than your system currently
has on it. Large or complex programs use a lot
of RAM when your system is up and running,
and even more when the particular program is
open and being used. Too little RAM will freeze
up your system. For today's home computers
and small business computers, the very
minimum RAM a system should have is 512MB.
If you install between 2GB and 4GB of RAM on
your system, then you should be somewhat
safe from RAM freezes. Keep in mind that the
amount of RAM your system can safely hold is
determined by the computer's motherboard
and processor. If you are running on say an
older Pentium III processor, then the most your
motherboard will operate with is 512MB of
RAM. On the Windows system, you can find
your processor and RAM information by
clicking through the Start button, and then the
following sequence of clicks: Settings/Control
Panel/Administrative Tools/My Computer/View
System Information/General Tab. At the
bottom of the General Tab is the information
on your processor and RAM. Close out of these
by clicking the X in the top right corner of each
box. This process is for viewing only. Do not
make any changes to anything when you
open this up to find it.
The good news about RAM is that it is fairly
inexpensive to purchase [about $60 per
512MB]. The bad news is that unless and until
you become fairly experienced with opening
up your computer and making hardware
changes to it, you will need to pay a service
center to install the RAM so that you do not
inadvertently fry your motherboard or the RAM.
This is one area where it is good to heed the
warning: If you do not know anything about
the insides of a computer, then do not attempt
to install the RAM.
Questions
1. The best thing to do when you're OS has
been infected by a virus or Trojan is to:
- immediately I'll clean up program on your
computer
2. The amount of RAM the system can safely
hold is determined by the:
- computers motherboard and processor
3. generate the minimum RAM requirement
for home computers and small business
computer use:
- 512 MB
Other Emergency Cases
Display screen turns sideways
If your data or visual changes from vertical to
horizontal, then you most likely have given your
computer conflicting commands. This can
happen when trying to use the CTRL + ALT +
Delete sequence for rebooting. If you
accidentally hit any other buttons, you may
mess up your display screen. If you find you are
reading your screen sideways, then use the
command CTRL + ALT + Up Arrow, and your
visuals should return to normal.
None of my programs will start
The first thing to do is try to reboot. If after
rebooting you still cannot get your programs to
come up, then you have most likely
experienced a hard drive crash. The drive will
either need repair or replacement. Either way,
you will need a tech to help fix the problem
and to extract or recover your files. This is a
time to find your backup CDs.
Exclamation sign in my internet signal/monitors
You are disconnected from your internet.
Usually this will happen from traffic in your
computer area. People will tend to trip over
NCM110A - PRELIM 49
and disconnect your Ethernet connection. If
you have kids, it is especially good to tack up
your Ethernet wire out of the main traffic area;
be sure not to use a staple gun on the Ethernet
cable as you could short out your internet
services. If you experience the no signal sign in
your window often, then it could be because
you have a very long cable from your box to
your computer or it could be that you have a
faulty Ethernet cable and it needs replacing.
Questions
1. This command is used to flip your display
screen back to its original position:
- CTRL + Shift +Esc
2. The first thing to do when none of your
programs will start is:
- Reboot your computer
3. An exclamation sign in the Internet monitor
means:
- You are disconnected from the internet
LESSON 4 : POST-QUIZ
1. Network topology refers to the
communication scheme of computers in a
local area network:
- FALSE
2. When a PC is turned on and finishes
booting, the screen that appears is called
the:
- Desktop
3. You can load as much RAM on your
computer as you can afford:
- FALSE
4. If your display screen goes sideways, the
quick solution is to press CTRL + ALT + Up
Arrow:
- TRUE
5. This refers to a network in which the
connected computer are physically close
to one another:
- local area network (LAN)
6. This most specifically controls the task
associated with data transmission:
- Transmission Control Protocol
7. Local area networks connect computers
that are physically far from each other:
- FALSE
8. This is a product that is useful in creating files
in ASCII format that can be read by many
different programs:
- notepad
9. The taskbar in windows is by default
located:
- at the bottom of the screen
10. The method used to download files from
another computer is called:
- file transfer protocol
LESSON 5 | INTERNET FUNDAMENTALS
Introduction
Internet Fundamentals
Introduction
"The Internet is a worldwide system of
computer networks - a network of networks
in which users at any one computer can, if
they have permission, get information from
any other computer (and sometimes talk
directly to users at other computers)"
Our world has changed dramatically as the
Internet has become more available to the
majority of the citizens of Earth. As non-
technicians, what we were able to accomplish
at our desks a mere thirty years ago cannot
even compare with what we are capable of
today. When we thought we were in the jet
age - using photocopiers in place of carbon
sheets, and making long distance calls via
satellite we were only on the edge of the true
age of information, and a technology that
would change absolutely everything.
A result of certain advances in technology that
were initially developed to connect smallish,
institutional networks to one another, the
Internet became widely available for general
use in the United States in the 1980s. The
concept, alone, is astonishing, and its actual
implementation even more incredible.
It is tempting to try to describe this global
phenomenon in material, tangible terms. For
instance, the ageing former Alaska senator,
Ted Stevens once described the Internet as a
"series of tubes." For those without a basic
understanding of the technology, the Internet
is a mystery too deep to fathom. This course will
provide you with comfortable and user-friendly
information that will dissolve some of the
mystery, and give you the ability to speak and
think intelligently about the World Wide Web.
Before we address the ins and outs of using the
Internet, it is very useful to first understand its
inception and, in a basic way, how and why it
functions. As we go along, different
terminology will be introduced to you, and will
also be incorporated at the end of each lesson
for reference.
This course is designed with the assumption
that the user is already familiar with computers
and is seeking to gain a better knowledge and
grasp of the Internet and its workings.
Therefore, general computer terminology and
instructions are not part of the course. If you
are seeking basic operating instruction, refer to
your computer's or Windows' tutorial.
NCM110A - PRELIM 50
Questions
1. This statement best describes the Internet:
- it is a worldwide system of computer
networks
2. important innovations in the Internet
generally make:
- the Internet is here to use and faster
3. the Internet first became widely available
for general use in the United states in the:
- 1980s
History
Our ancestors would be awestruck by our
ability to communicate almost instantly with
people in every part of the globe without a
telephone or telegraph, or even a wire at to
bridge the connection. We are able to look up
businesses in remote countries; the answer to
almost any question we can think of is at our
very fingertips. We can exchange money and
products, and conduct business without ever
leaving our desks; we can study and obtain a
degree in higher education, invest in the stock
market and trace our genealogy with the
touch of a button. We play video games with
people on other continents and, sometimes,
find unprecedented wealth using this small
plastic-encased artificial brain, and its
connections to the largest system of networks
in the world, which links us to others around the
globe.
After the Soviet Union sent Sputnik to the moon,
the United States government, not to be left
behind, began to step up its efforts toward
science and research in order to stay ahead of
the game.
But, the development of the Internet did not
happen overnight. The idea of a "Galactic
Network" was introduced back in 1962 by
J.C.R. Licklider, a head of the computer
science department at MIT who was involved
in the US government's Defense Advanced
Research Projects Agency (DARPA). He was
able to convince some of his colleagues of the
feasibility of his idea, but what began to
generate the reality of it was the development,
by Paul Barand, of packets of data that could
switch back and forth between networks.
Initially, the objective of the research was to
find a way to keep our communication systems
intact in the event of an attack on us by a
nuclear weapon. The government wanted to
be certain that there was a way to maintain
control of our ability to strike back.
The first packet switching among networks in
1968 connected four major institutions:
University of California at Los Angeles, SRI (in
Stanford), University of California at Santa
Barbara, and University of Utah.
With the invention of the Ethernet in 1976,
connecting Local Area Networks, or LANs
together became possible. A LAN is a network
within in a location that connects its
computers. For instance, your local hardware
store probably has a LAN a system that
connects its computers together. Later, of
course, Wide Area Networks, or WANS, which
connected users over larger geographical
areas.
In the early 1990's HTTP (Hypertext Transfer
Protocol) was developed. HTTP is a set of rules
that "...defines how messages are formatted
and transmitted, and what actions Web servers
and browsers should take in response to
various commands. For example, when you
enter a URL in your browser, this actually sends
an HTTP command to the Web server directing
it to fetch and transmit the requested Web
page".
In other words, http provides another set of
rules that served to make the Internet easier to
use for the non- technological user.
You can imagine that each technological
piece of the Internet puzzle was developed
and implemented fairly rapidly, once the idea
caught fire. We will look more closely at the
nuts and bolts of connections later in the
course, but for now, it is enough to know that
each piece of the development puzzle served
to make the Internet more efficient and more
accessible to people like us!
The Internet is certainly not a series of tubes,
however, it also is not simply a magical system
of ethereal energy. Massive super-computers,
connected with thousands of smaller networks,
in cooperation with one another, form an
enormous worldwide network that allows us to
interconnect globally.
Glossary
A programmable machine
that responds to a specific set
of instructions
in a well-defined manner and
can execute a prerecorded
list of
Computer instructions (a program).
Electronic and digital, the
actual machinery --
wires, transistors, and circuits --
is called hardware; the
instructions
and data are called software.
The most common local area
Ethernet
networking (LAN) standard
NCM110A - PRELIM 51
 Hypertext Transfer Protocol -
Rules that define the way web
HTTP browsers and web servers
communicate with each
other
Local Area Network - A
network that connects
computers together in a
relatively small area using
LAN
private owned
communication channels (not
public satellites or telephone
lines)
A group of two or more
Network computer systems linked
together
A piece of data broken down
into pieces for transmitting
Packet
over the Internet or another
network
-The application of science,
especially to industrial or
commercial objectives.
-The scientific method and
material used to achieve a
Technology
commercial or industrial
objective.
-Electronic or digital products
and systems considered as a
group
Uniform resource locator - An
address on the Internet, such
URL as http://www.aznet.com,
which enables computers and
other devices to visit it.
Wide Area Network - a
network that connects
WAN
networks over a large
geographic area
A document on the World
Wide Web identified by a
Web Page
unique URL(Uniform Resource
Locator).
Questions
1. “Http” means:
- Hypertext transfer protocol
2. LAN stands for:
- local area network
3. The set of rules that defines how many
messages are formatted and transmitted
and what option web servers and browsers
should take in response to various
commands is referred to as:
- HTTP
THE WORLD WIDE WEB
Introduction
Web pages are what make up the World Wide
Web. These documents are written in HTML
(hypertext markup language) and are
translated by your Web browser. Please note
that a Web page is not the same thing as a
Web site. A Web site is a collection of pages. A
Web page is an individual HTML document.
This is a good distinction to know, as most
techies have little tolerance for people who
mix up the two terms.
http://www.techterms.com/definition/webpag
e
The browser is a program like Internet Explorer
or Firefox. A web address, or URL, is the specific
"location" of a website, and looks something
like this: http://www.yahoo.com. We will define
a URL further below.
Browsers and search engines, such as Google,
can be seen as vehicles installed on your
computer which help you travel to the URL
address on the Internet that you have
specified - something like getting into a taxi
and giving the driver an address.
NOTE: We will use the word "Google"
throughout this course, as we refer to searching
for something. For example, we may suggest to
"try Googling rabbit hutch,"or some other
terminology. Because Google is such a popular
search engine, it is commonly used as both a
noun and verb!
What is the difference between a search
engine and a browser? Sometimes the two are
used interchangeably and can be confusing.
Here are Wikipedia's definitions of both
SEARCH ENGINE: A program that searches
documents for specified keywords and
returns a list of the documents where the
keywords were found. Although search
engine is really a general class of programs,
the term is often used to specifically describe
systems like Google™, Alta Vista and Excite
that enable users to search for documents
on the World Wide Web and USENET
newsgroups.
Typically, a search engine works by sending
out a spider to fetch as many documents as
possible. Another program called an indexer
then reads these documents and creates an
index based on the words contained in each
document. Each search engine uses a
proprietary algorithm to create its indices
such that, ideally, only meaningful results are
returned for each query.
BROWSER: Short for Web browser, a software
application used to locate and display Web
pages. The two most popular browsers are
Microsoft Internet Explorer and Firefox. Both
NCM110A - PRELIM 52
 of these are graphical browsers, which
means that they can display graphics as well
as text. In addition, most modern browsers
can present multimedia information,
including sound and video, though they
require plug-ins for some formats.
www.Wikipedia.com
Question
1. A search engine can:
- search for keywords and generate
relevant links
2. Google is an example of a/an:
- search engine
3. A URL is:
- the address of a website
Smart Spiders
Your browser has transported you to a search
engine. A search engine looks at your chosen
keywords and sends out an electronic "spider"
that crawls the internet, searching through
thousands of databases to find the websites
that are most relevant to your keywords, and
then lists them in order of relevance to help
you find the site that is closest as possible to
what you are looking for.
The address is where? You have seen the
following rectangular box image at the top of
your screen, and may be able to look at it right
now. It is the field in your browser that accepts
an "address" to travel to your destination on
the Internet. URL stands for UNIFORM RESOURCE
LOCATOR. The "http" part refers to the
"protocol," which we will discuss a bit later. The
"www, of course," stands for the World Wide
Web.
http://www.doggiecoupon.com
This box, or field displays the address of
wherever you currently are on the web. But
you can also simply type an address like the
one above, or copy and paste it into the URL
field, then press Enter, and you will magically
be flown to that "address" on the Internet.
Remember that when you are typing in a URL,
it must be exact in order for the browser to find
the site. So, when someone asks you for a URL,
you will know they simply want a website
address!
To find Google™, you would type into your
browser's URL field www.Google.com. When
Google™ comes up on your screen, it offers
you a simple window wherein you will type
your key words.
Once you have typed the keywords "dog food
coupon," into this field, Google's™ "spiders" will
look all over the web to choose web pages
that make the most sense, and will then list
them for you. Here is what a typical search
result looks like when your search engine
(Google™) "finds" what you are searching for:
See that the search engine was able to locate
an entry that contains the exact same words
as your keywords, and this entry is number one
on the indexed list. In Google™, you could
click your mouse on the dark blue hyperlink
that the search engine offers, and you would
be whisked off to the web address, or URL, that
is displayed in red at the bottom of the entry. In
this case, the website Google™ has suggested
is www.doggiecoupon.com.
Questions
1. A URL is a:
- website address
2. WWW in the world of computers means:
- World Wide Web
3. URL stands for:
- uniform resource locator
Keywords & Hot Links
Is it a "hot" link? How can you tell if a word or
sentence or image is an active "link?" Links
usually show up in a royal blue color. Another
way to tell is when you place your mouse's
cursor over the text or image, the cursor
symbol changes from an arrow to a hand. This
is your indication that clicking your cursor will
transport you to another spot.
What is spider?
A spider is "software that gathers information
from the Web and places it into a large
database that it can be searched by search
engines" (Gralla p. 395).
In other words, a spider is a shopper that
picks out and sorts data that is most relevant
to your keywords, and then turns it over to
your search engine. Easy!
Thinking of the best search terms, or keywords:
NCM110A - PRELIM 53
When you want to search for something on the
Internet, try to think of the most basic specific
words that describe the data you want. Search
engines are smart, but they cannot read your
mind. Be as succinct as possible, without going
into great detail. For instance, "inflatable
beach ball" is better than "12-inch colored
blowup ball for playing at the beach," and far
better than just "ball." If you experiment for a
while with key words, you will begin to see how
the search engine takes your requests quite
literally. It's a good idea to "surf" the Internet in
the beginning, to get the feel of how it is set up
and how to find what you want.
Glossary
Short for Web browser, a software
Browser application used to locate and
display Web pages
Hyper-text Markup Language -
Short for Hypertext Markup
Language, the authoring
HTML
language used to create
documents on the World Wide
Web
A link on a web page that sends
Hyperlink you to another web page or
resource
Search words used for sorting and
Key Words locating information on the
Internet
In hypertext systems, such as the
World Wide Web, a link is a
reference to another document
Link Links are sometimes called hot
links because they take you to
other document when you click
on them.
A website that allows you to
Search
perform searches throughout the
engine
Internet
Software that gathers information
from the Web and puts it into a
Spider
large database that can be
searched by search engines
To move from place to place on
Surfing the Internet searching for topics
of interest
A site (location) on the World
Wide Web that contains a home
page, which is the first document
users see when they enter the
Website site, and may also contain
additional documents and files
Each site is owned and managed
by an individual, company or
organization
Questions
1. A hyperlink is:
- a word or sentence that takes you to the
website when clicked
2. Surfing refers to:
- the act of moving from place to place on
the Internet searching for topics of interest
3. This is a software that gathers information
from the web and places it into a large
database that can be searched by search
engine:
- Spider
Hubs & Routers
As we discussed earlier, when we create and
send data, or electronic information, on the
Internet, it is broken down into smaller packets
to make it compatible with all the places it
needs to travel in order to reach its target.
Packets can be imagined as chunks of data,
each carry along signals which allow them to
cross hubs, routers and other directional
hardware, as they quickly make their way to
their final destination. (We will discuss packets
in more depth later in the course.) The
discovery of packet technology was really
what gave birth to the Internet as we know it.
The following excerpt from the Internet Society
reflects the point at which a real Internet
began to take form.
"The objective was to develop communication
protocols which would allow networked
computers to communicate transparently
across multiple, linked packet networks. This
was called the Internetting project and the
system of networks which emerged from the
research was known as the 'Internet"
(http://www.isoc.org/internet/history/cerf.shtml
).
The set of scientific rules for the transport of
these packets are the Transmission Control
Protocol (TCP) and Internet Protocol (IP). You
can think of Protocols as simply the rules that
govern the transportation of data.
The set of scientific rules for the transport of
these packets are the Transmission Control
Protocol (TCP) and Internet Protocol (IP). You
can think of Protocols as simply the rules that
govern the transportation of data.
Hubs and Routers are Hardware:
You have probably heard the term "hub" if you
work in an office with inter-connected
computers, or a LAN. The hub is simply a piece
of hardware that connects all the computers
to each other on one network. If one
computer is not connected to the hub, it is off
the network and cannot communicate with
NCM110A - PRELIM 54
the others. A hub is generally just a central
board containing as many outlets as the
network has nodes. The outlets look like a mass
of telephone line plug-ins. In an office, it is
normally in a special room where the network's
server resides.
A router, on the other hand, is most often used
to connect networks together. Routers are
smart. They examine data packets to
determine where they are headed. They then
take a look at the volume of activity that is
taking place on the Internet, and make the
decision to transfer the data to another router
closer to the packet's final destination. Routers
are traffic cops of the Internet. They ensure
that all data gets sent to where it's supposed to
go via the most efficient route. (Gralla)
What are Backbones? The National Science
Foundation, where this packet technology was
developed, became one of the largest
backbones (or vBNS - very high-speed
Backbone Network Services) for the Internet.
Super-computers developed by colossal
organizations, generally the government,
academia, and the military, form the
"backbones" for thousands of internet service
providers (ISPs). While our personal computers
continue to shrink in size, make no mistake
these super-computers that form backbones of
the internet take up the space of large rooms
and consist of rows and rows of encased
technology. Regional commercial internet
providers like American Online and Microsoft
and large utilities such as telephone
companies -- as well as smaller, regional
networks of private and public agencies form
a "loosely organized alliance," each one
funded under different circumstances and for
different consumption (Gralla).
Questions
1. These are sets of scientific rules used to
transport packets:
- TCP and IP
2. These are often used to connect networks:
- Routers
3. A pocket is a:
- Segment of data
ISP AND URL
INTERNET SERVICE PROVIDERS-ISPs
The major internet service providers are folks
whose names may be familiar to you. There
are providers like Yahoo, America Online (AOL)
and telephone companies such as Verizon
and AT&T, who buy access, on a large scale. In
turn, they often sell to smaller providers, like
local providers who provide connections to a
region or city. So, the next time someone asks
you who your ISP is, just tell them who it is that
you pay for Internet services.
WORLD WIDE WEB
Do not be confused by the term World Wide
Web. It is not technically synonymous with the
word "Internet," and yet, it is part of the
Internet. The Web is a system of interlinked
"hypertext" documents that provide a format
for Internet browsing. Wikipedia quotes a
description of the web as a ""web of nodes"
storing "hypertext pages" viewed by "browsers"
on a network." Simply put, the World Wide Web
is a format that allows us to easily view pages
with text, graphics, sound, video and all kinds
of amazing things.
Domain Name
A domain name is part of a URL, and is a name
that is chosen by the owner of a web page or
web site. Many domain names represent more
than one IP address. What that means is that
when a browser takes you to a domain name
such as the one we have been looking at, it is
often taking you just to the first page, or
landing page, of a website. Each additional
"page" within site is labeled differently.
TLD Extensions, or Suffixes
Let's look more closely at a URL and its
components. When you see a URL that looks
like this, you can assume that this is a business.
Why? Your clue is the extension, or suffix, which
in this case is ".com" or dot com. What.com
means is that this is a "commercial "web page
and you can be sure that a commercial site is
in the business of selling something.
If you see a web address that looks like this:
www.puppylove.org, you will know that the
".org" extension, or suffix, indicates this site is an
organization of some kind whose goal is not
profit-making. Likewise, a "gov" extension
indicates a government agency site, an ".edu"
extension indicates an educational institution
site, a ".net" extension indicates that the site
accommodates a network. Here is a quick list
of some of the more common extensions, or
suffixes you may see in a URL:
.ca - Canada
NCM110A - PRELIM 55
.com - Commercial business
.edu - Educational institution
.gov - Government agency
.mil - Military
.net - Network organization
.org - Organization (nonprofit)
.th - Thailand
These suffixes indicate which "top level
domain" or TLD an IP address belongs to, and
there are only a limited number of these top
level domains.
HTTP
We briefly discussed HTTP in Lesson One, which
means Hypertext Transfer Protocol. It has no
visible effect on your Internet activities, but you
should remember that HTTP defines how a
message is transmitted and formatted - it is a
set of rules that gives a message to the web
server and tells it to transmit data. A complete
URL often, then, looks like this:
http://www.thepuppyshop.com
Glossary
vBNS or Some paid for by the federal
Backbone government, large agencies,
such as the National Science
Foundation, provide
infrastructure to connect
supercomputer centers
around the world
Data and Distinct pieces of information,
Programs usually formatted in a special
way. All software is divided into
two general categories, data
and programs. Programs are
collections of instructions for
manipulating data. Data can
exist in a variety of forms -- as
numbers or text on pieces of
paper, as bits and bytes stored
in electronic memory, or as
facts stored in a person's mind
Hub A device that connects
several computers to one
another on a network
ISP A device that connects
several computers to one
another on a network
Petaflop A petaflop is the ability of a
computer to do one
quadrillion floating point
operations per second
Router Hardware that sends packets
to their proper destinations
along the Internet.
Super- An extremely fast computer
Computer that can perform hundreds of
millions of instructions per
second
TCP/IP Transmission Control
Protocol/internet Protocol - The
communications that underlie
the Internet
TLD Top-Level Domain- refers to the
Extension suffix attached to Internet
domain names, such as net,
com, org, etc
Questions
1. The suffix, or extension of a URL indicates:
- the top level domain of the web page
2. A domain name is chosen by:
- the owner of the web page
3. Petaflop refers to:
- the ability of a computer to perform one
quadrillion floating point operations per
second
Connecting to the Internet
Obviously, you have already connected to be
able to take this course. But connections are
an important part of Internet knowledge, and
we will discuss them in this lesson. Whether you
are sitting at a computer that is connected to
a LAN, or you are at your private computer at
home, there is a connection being made that
is much more complex and fascinating than it
might seem.
Modem
Just because it is interesting to know, the word
modem came from the words "modulator" and
"demodulator," which gives you an idea of the
modem's job. A modem enables your
computer to transmit its data to telephone or
cable lines, which connect you to the Internet.
Why do we need a modem? It has to do with
storage of data.
Digital/Analog
Your computer is only able to store its data as
digital information, while data that is
transported over telephone and cable lines is
done so in analog waves. The modem acts as
a mediator, changing your data's digital
structure to allow it to travel in analog form. A
clearly elegant explanation of the difference
between digital and analog is as follows:
Computers are digital machines because at
their most basic level they can distinguish
between just two values, O and 1, or off and
NCM110A - PRELIM 56
 on. There is no simple way to represent all the
values in between, such as 0.25. All data that
a computer processes must be encoded
digitally, as a series of zeroes and ones.
The opposite of digital is analog. A typical
analog device is a clock in which the hands
move continuously around the face. Such a
clock is capable of indicating every possible
time of day. In contrast, a digital clock is
capable of representing only a finite number
of times (every tenth of a second, for
example).
In general, humans experience the world
analogically. Vision, for example, is an
analog experience because we perceive
infinitely smooth gradations of shapes and
colors. Most analog events, however, can be
simulated digitally.
Photographs in newspapers, for instance,
consist of an array of dots that are either
black or white. From afar, the viewer does
not see the dots (the digital form), but only
lines and shading, which appear to be
continuous.
Although digital representations are
approximations of analog events, they are
useful because they are relatively easy to
store and manipulate electronically. The trick
is in converting from analog to digital, and
back again. www.webopedia.com
In other words, a digital format is a limited one
that involves encoding with numbers, while
that same data in analog form becomes free
to travel electromagnetically over waves.
When the data finally reaches its destination
another computer, it is transformed by that
computer's modem demodulated -- back into
the more mundane digital format.
Questions
1. The data is transported over telephone and
cable line via:
- Analog waves
2. This enable a computer to transmit its data
to telephone or cable lines, which connects
it to the Internet:
- Modem
3. Computer save data as:
- Digital information
Other Internet Connections
Broadband Connections:
A broadband connection is a very fast Internet
connection, such as cable modem or DSL.
Although these terms may sound confusing,
once you have a basic understanding of the
modem, it is easier to understand how data
travels on the Internet through different kinds of
connections.
Coaxial:
The "coaxial" cable used by cable television
companies provides a greater bandwidth than
telephone lines, thus allowing a much quicker
connection to the Internet. Coaxial cable's
central wire is surrounded by insulation, as well
as by braided grounding wire. All that
insulation forms a shield which protects from
interference by other electromagnetic waves,
and makes for a fast, efficient transmission. It is
also the cable used for Ethernet connections.
Cable Modem:
Although not a true modem, cable internet is a
very fast Internet connection and perhaps the
most popular, especially in cities and more
populated areas. Cable modem uses a
network card inside your computer to connect
to the cable line. At this time, Cable Modem is
likely to be your best choice for a fast, efficient
Internet connection.
Satellite Connections:
You still need coaxial cable to get Satellite
Internet service, but it needs only to stretch
between your computer location and the dish
that you have specially installed outside your
home. Your satellite company will install the
dish and very meticulously "point" it at the
proper location in the sky for optimum
reception. In some cases, a satellite television
company will provide Internet access on the
same dish, but more often, a special satellite
Internet company requires its own equipment
and setup.
Your Internet request travels to the satellite
company's NOC, or Network Operations
Station, which launches it up into the sky to its
satellite. The satellite hurls the info to the dish
outside your home, which transmits it over the
cable and attached modem, which forwards it
to a network card in your computer. Looking at
it this way, it sounds like the process of using
satellite Internet would involve a day's wait.
Not at all. You will be receiving data at 400
Kbps rather than the typical 28.8Kbps.
What is Kbps? Short for kilobits per second, this
is simply a measure of data transfer speed. For
the purposes of this course, we will not delve
too deeply into transfer speeds, but it is good
to know that there are differences in speed,
depending upon your equipment and your
connection.
NCM110A - PRELIM 57
The fax machine gave us an indication of how Ap Access Point for wireless
modems work. Everyone knows the somewhat connections
obnoxious sounds of a fax being sent. But the Analog A system of transmission that is
sounds mean something: When a modem first able to handle continuous,
sends a signal to another modem, there is a unlimited, changing,
steady signal that tells us the two modems are modulating data
"talking," and have connected. The warbling Bandwidth A measure of the amount of
tone that follows is called a "handshake" data that can be sent over an
between the two modems, which are, in a Internet connection within a
sense, making an agreement about how the unit of time.
information will be handled, at what speed, Broadband A very fast internet
and other factors. The sending modem then connection such as cable
transforms the digital information to analog modem of DSL
form and sends it; the receiving modem Cable A network card inside a
receives it and transforms it back to digital modem computer that is used to
form. Amazing!! connect to cable TV lines for
Internet access
World of Wireless: Coaxial Cable that is ideal for
Any computer network that has no physical cable television and high speed
wired connection between the sender and Internet connections via
receiver of data is called wireless. The network cable modem.
is, instead, connected by "radio waves and/or Dial-up Internet connection that is
microwaves". Although wireless technology made directly through
does not use copper or fiber optic lines, it is telephone lines.
nonetheless, reliant on a physical wired Digital Computers are digital
network, somewhere along the line. Wireless machines because at their
devices depend on Radio Frequency (RF) most basic level they can
waves that project a signal which is able to distinguish between just two
detect a wired network. values, 0 and 1, or off and on.
There is no simple way to
How can it find what it is looking for? Simply represent all the values in
put, when a radio frequency is applied to an between, such as 0 25 All
antenna, an electromagnetic field is created data that a computer
that is able to speed itself through space. The processes must be encoded
radio wave usually finds an Access Point (AP), digitally, as a series of zeroes
which sends out its own detectable signal, and and ones.
then re-directs the wave to a wired network DSL Digital Subscriber Line - Allows
somewhere. high-speed Internet access
If you have no other options, dial-up Internet through existing telephone
service is an easy way to connect to the lines
Internet. Your computer is connected directly Handshake The indication that two
to a telephone line, and makes its "call" to a modems are making an
local access number provided by your ISP, agreement about the terms of
using tones. Compared with other transfer of data
connections, dial-up can be painfully slow, Kbps Kilobits per second - a
and is not always able to handle the measure of data transfer
downloading of graphics, music and video. speed
Another disadvantage to dialup is that while NOC Network Operations Center -
the Internet is in use, you are not able to use a central location for satellite
your landline telephone. Further, in a less Internet companies
expensive package, your minutes on the Rf Radio frequency - waves used
Internet are counted and charged, rather than in wireless technology
allowing unlimited access. Dial-up was a great
way to access the Internet prior to DSL and Questions
cable, but is no longer a desirable connection 1. Coaxial cable is used in:
if it can be avoided. - ethernet connection
2. Data is converted from digital to analog by:
Glossary - a modem
3. Kbps is:
- a measure of data transfer speed

NCM110A - PRELIM 58
BLOGS, SOCIAL NETWORKS, AND EMAIL reference. Email is ideal for communicating
across time zones, particularly those where
EMAIL night and day are opposite, not only because
Sending and receiving email on the computer the sender and receiver can respond at times
is one of the primary uses of the Internet. Email that are most convenient for them, but also
offers many advantages to nurses and other because it saves postage and telephone
healthcare professionals. Before 1995, only expenses.
those who shared the same network
EMAIL ACCOUNTS
connection could exchange email. For
instance, those using CompuServe as their Access to the Internet is through an ISP, either
Internet service provider (ISP) could only email a private one at home or through a college,
others who also used CompuServe. Today, with work, or establishment that offers free Wi-Fi.
most computer networks being part of the There are many ways to create an email
Internet, the exchange of email is possible with account and get an email address. ISPs
anyone in the world who has an Internet email provide email accounts, usually two to five per
address. Being knowledgeable about how to account, for their customers. Colleges also
use and manage email makes you a more provide email accounts for their students, and
efficient professional communicator. many healthcare agencies create email
accounts for their employees. It is also possible
Email enhances communication with speed to get a free email account at Google,
and convenience. Most messages arrive at Microsoft, or Yahoo by visiting their home page
their destination only a few moments after they
and opening an account.
have been sent, even if the destination is
halfway around the globe. Email offers a way
to avoid "telephone tag" and to create a
written message that the receiver can read
several times, convert into voice with special
software, or save. To use email, you need email
software (called an email client) and an email
account.
EMAIL SOFTWARE
An email client is software used to access
email from an email server so it can be viewed
and read. An email server is simply a computer
that uses server software to receive and make
email available for those who have an
account on that server. Operating systems
come with email software such as Windows
Mail (formerly, Outlook Express). Other free
email clients usable by both personal
computers (PCs) and Macs can be found at
Eudora, or Mozilla's Thunderbird. There are
similarities in the menus for all of the email
clients. Figure 6-2 shows an example of the
Microsoft Outlook 2007 window. Email addresses

Email software can keep a copy of all
messages that are sent and received, however
the default is to delete these messages when
the email software is closed. Many people like
to be able to search and view these messages
after more than one session. To accommodate
this, the default is easily set to keep the
messages. Because these folders can become
huge, if the default is reset to keep the
messages, one needs to open and delete the
messages on a regular schedule, perhaps
every month. Email software also provides a
way to create folders so that incoming mail
can be saved into a specific folder for future
Like postal mail, email requires sender and
receiver addresses. At first glance, an email
address may look forbidding, but a closer look
at the address will reveal the formatting rules.
An email address has two parts separated by
the @ sign. The first part, or the letters before
the @ sign, is called the user name (sometimes
called the login name) and identifies the
sender. The part after the @ is the name of the
email server where the email is received. The
characters after the last dot in an email
address constitute the suffix that identifies the
domain or main subdivision of the Internet to
which the computer belongs (see Figure 6-3).

NCM110A - PRELIM 59
User Name
The computer name and domain suffix are
dependent on which email server you are
using; these are assigned by the ISP that hosts
the email account. Most institutions assign a
login name (user id), which includes at least
part of the user's name. If you create an
account for yourself, remember that the user
name reflects on you. Email messages can be
forwarded anywhere, and the email address of
the person who created it, as well as anyone
who receives it, is also forwarded. For this
reason, healthcare providers should always
select a user name that conveys their
profession appropriately; cutesy names are
never appropriate.
Configuring an Email Client
To configure an email client that is on your PC
to send and receive email, you need just five
pieces of information: the email account type,
the name of the incoming server, the name of
the outgoing server, your login user name, and
your logon password. The account type and
name of the incoming and outgoing server are
assigned by the ISP where you have your
account. The type of email account is usually
POP3 (Post Office Protocol), but may also be
IMAP (Internet Mail Access Protocol). Outgoing
servers use SMTP (Simple Mail Transfer Protocol).
In private accounts such as one from your own
PC or one created with one of the free email
clients, you select your own login or user name
and password when you open an account.
The logon user name and password allow you
to retrieve your email from your account. To
simplify this process, Outlook 2007
automatically configures the email accounts
using the email address and email server
password.
PLANNING EMAIL ACCOUNTS
Email users should consider having several
email accounts, each with a different purpose.
One email account should be used for official
communication with coworkers and
colleagues. Students should use an account
dedicated to official school communication
with other students and faculty. A third email
account, using free online email software or a
home ISP, should be used for personal
communication. In addition, a fourth email
account might be used for online shopping to
trap potential resulting spam.
If you have more than one email address, you
may want to configure your email client to
download from more than one server. For
example, if you create a free email account at
Google or Yahoo, you can set your email client
to download mail from there by using the
account settings. Unless you are an expert, use
only one outgoing server.
CREATING AND SENDING EMAIL
When you activate the Write feature of your
email client, your address will already be on
the "From" line. Your first step is to enter the
address(es) of the receiver(s) on the "To" line. If
you have put the recipient's name in your
email client's address book, when you start to
enter the beginning of the name, the address
book will automatically finish it for you. After
entering the recipient's name, enter a brief
word or phrase about the message on the
subject line. Emails with no subject line may be
classified as junk mail by the user's email server
and not be received by the recipient. Finally,
create your message and add a signature that
clearly identifies you.
There may be times when you want to send
the same message to more than one person.
This is simple if the message is a reply to a
message that was also addressed to others to
whom you wish the reply to be sent; select
"Reply All" to start your message instead of
"Reply." If you routinely send email to the same
group of people, such as to members of a
committee that you are on, you can use the
address book to create a group. With a group,
you then place the name of the group on the
"To" line, instead of each name. Use Help to
learn how to create a group of recipients.
When sending a duplicate of a message to
others, you have the option of using "Cc" or
"Bcc." The acronym "Cc" is derived from earlier
days of the typewriter carbon copy. The "Bcc"
indicates a blind copy where the receiver is
unaware that others have also received a
copy of the message. Blind carbon copies
should be used judiciously; the sender must
consider the ethics of secrecy when using the
function.
Sometimes you want to forward a message
that you have received to someone else.
Before forwarding a message, give thoughtful
consideration to the sender and receiver. In
consideration to the sender, send a copy of
the email to the original sender when
forwarding the email to others. When
forwarding a message, edit the message to
remove the email addresses of prior recipients.
NCM110A - PRELIM 60
Avoid passing on chain letters; most people do
not want them, and many agencies will
terminate your account if you do this.
Messages warning about viruses or other dire
things that will happen to your computer if you
don't do something are generally hoaxes.
EMAIL SIGNATURE
Email written by professionals should always
include a signature with the sender's name,
title, company name, and geographical
location. A signature is similar to the return
address on a postal letter; however, personal
information such as street addresses and home
phone numbers should be avoided. Most
signatures are one to five lines; a signature may
be personalized by including a favorite
quotation.
EMAIL FILE FORMATTING
There are three main file formats for creating
and sending messages: plain text (TXT), rich
text file (RTF), and hypertext markup language
(HTML). TXT files have no formatting, which
makes them ideal for electronic mailing lists
because any email client can read them. RTF
files allow for some formatting, but not the
robust features of a word processor. HTML files
use HTML tags to display formatting of text. Not
all email software can read HTML messages,
especially in less developed nations. For file
formats that are either rtf or html, you can use
the formatting functions, such as bold, italics,
and bullets in your email client.
THE DOS AND DO NOTS OF EMAIL CONTENT
As convenient as email is, it must be used
appropriately. Care must be taken in deciding
what is included in a message that is sent via
email; contents of email must always adhere to
common decency. Email should never be used
to give bad news, such as a poor evaluation,
work layoff, or pay decrease. A rule of thumb is
not to include anything in an email message
that you wouldn't want to read on the front
page of the newspaper since it is very easy for
a recipient to either accidentally or purposely
forward your message to someone else. All
messages carry headers that can be traced to
the original sender. Even if the sender uses a
remailer, a service that strips the identifying
header so that email can be sent
anonymously, sender information can be
traced by contacting the remailer service
(Freeman, 2007).
EMAIL PRIVACY ISSUES
There is no guarantee that email that is sent
using an educational facility or employer email
server or email provider service will be private.
A growing trend is for institutions to monitor
email to avoid potential litigation and
investigations from government agencies
(AMA/ePolicy Institute, 2008; Clearinghouse,
2006). There is still no definitive case law on
whether students or employees have the right
to privacy in email. This includes situations in
which the institution has said that your email is
private because if the message can be
construed as damaging to the institution,
privacy promises may be legally invalidated.
There are several court cases that have set
precedence and ruled in favor of the
employer (Bourke v. Nissan Motor Corporation
in the United States, 1993; Smyth v. The Pillsbury
Company, 1996 Sykes, 2000).
Questions
1. This is a software used to access e-mail from
an e-mail server so it can be viewed and
read:
- Email client
2. This indicates a blind copy where the
receiver of an e-mail is unaware that others
have also received a copy of the message:
- Bcc
3. This main file formats for creating and
sending messages include all of the
following, except:
- Extensible markup language (XML)
EMAIL ETIQUETTE
Email etiquette, like regular mail letter
etiquette, is essential for professional
communication (Jones, 2006). The rules for
creating email are important. First of all, always
include a short pertinent subject line. When
replying to email, make sure to include
appropriate information from the prior
message in the reply. Email is a special form of
communication, not as interactive as the
telephone, but more interactive than written
communication. Because it often seems very
personal and quick, there is a tendency to
regard it as a verbal conversation and forget
that the recipient may have been involved in
many complicated matters since he or she last
sent you a message. For this reason, mailers
provide an option to include the prior message
with the original when you reply. To prevent
messages that rapidly become too large and
uncommunicative, edit the prior message so
that only the parts pertinent to your reply are
included. In general, email should be short and
to the point, but not too short. A message that
is too short may be misinterpreted by the
recipient, who may feel that the sender was
being abrupt or curt.
NCM110A - PRELIM 61
Use the appropriate font and case when
writing email. According to email etiquette,
use of all uppercase letters (all caps) indicates
that the user is shouting, so all caps should
never be used for sentence construction. Use
font colors thoughtfully. Depending on the
message, a red-colored font may be
interpreted as swearing (Cleary & Freeman,
2005). Finally, email should always be signed.
Professional email should include a signature,
title, and contact information, such as a
mailing address of the agency, phone number,
and home page URL. (see Box 6-1).
There are some major differences between
email and letters sent by postal mail. Postal
mail letters generally have the reader's full,
undivided attention. In contrast, because of
the sheer volume of email, the reader may not
read the message thoroughly, causing
misunderstandings resulting in problems in
relationships. If there is a chance for
disagreement, or email messages seem to be
causing disagreements, use email to set up a
time for either a person-to-person meeting or a
telephone conversation.
ACRONYMS AND EMOTICONS
Email is devoid of the nonverbal commands of
face-to-face communication. Thus, expressions
of subtle meaning and tone are easily lost. With
the informality of much email and the limited
typing skills of many who send email messages,
it is only natural that common acronyms and
icons have developed. They are only valuable
when the recipients understand them.
Acronyms use the first letter of words or word
parts to communicate a common phrase (see
Table 6-1). They are commonly used in informal
email and instant messaging. Acronyms are
not appropriate for professional
communication.
To provide the appropriate body language
tone, telecommunicators have devised icons
called emoticons (emotional icons), sometimes
called smileys, which can be created on the
keyboard. For example, one that is frequently
used is :-). When tilting your head to the left,
which is the position for "reading" keyboard
character emoticons, you can see a smiling
face (see Table 6-2). Some email clients
include graphic emoticons. A classic graphic
emoticon is a round, yellow button with two
dots for eyes and half circle for a smile. Use
emoticons sparingly, if at all, in professional
business communication.
ATTACHMENTS
Many people use email to send files created
with other software, such as a word processor
or spreadsheet. When including attachments in
your email, use the following guidelines. First,
always alert the receiver before sending an
attachment and verify that the receiver has
the software that can view the attachment.
For example, if a file is created and saved with
Publisher with the Publisher file extension ".pub,"
the recipient will not be able to view the file
unless he or she has Publisher on their
computer. Be sure that the recipient has the
appropriate version of the software that you
are using; many file formats from the same
vendor's program are not backwardly
compatible.
Attaching files to email messages increases the
size of the message, which in turn increases the
time required to both send and receive it. If the
attached file is large, consider "zipping" it.
Zipping a file involves using a piece of software
that compresses the file to make it smaller. In
general, text files can be compressed much
more than graphics files. Files may be zipped
separately or as a group (archived). Before
zipping a file, make sure that the recipient has
unzip software in his or her computer and that
the person's email server allows for zipped
attachments (some email servers remove
attachments with certain file formats, such as a
zipped file, to prevent the spread of potentially
harmful viruses). Most of today's operating
systems include some type of zip/unzip
software. Use the Help feature to learn to use it.
An alternative for attaching a large file or
zipped file is to use file transfer Internet Web
sites. Examples include YouSendit, SendThisFile,
and LogMein. The file transfer Web sites
provide free as well as fee- based services;
both require the user to register to receive a
login and password. To send a file, go to the
Web site, log in, enter the recipient's email
address and an email subject, browse (find in
your folders) to the file, select it, click open on
that window, and click Send It. The recipient
NCM110A - PRELIM 62
receives an email with a Web address (URL) to
download the file. If you are in the habit of
exchanging large files with someone whose
email account is limited in sending or receiving
large files or if you are limited in this respect,
one or both of you may want to get a free
email account where the size of attachments is
not as limited.
MANAGING EMAIL
Taking a few minutes to organize and manage
email can save you much time and energy
later (see Table 6-3). Whether you use a
standalone or Web-based client, the email
management processes are similar. All email
clients have Help menus to guide you through
the process of organizing email. You can use
email alerts to assist in prioritizing email. Alerts
include flags, stars, and font colors. Use email
filters to automatically file incoming email into
designated folders and send you personal
alerts for email from certain senders. You can
also use filters to filter unwanted mail such as
spam (unsolicited commercial email) to the
deleted items folder.
OUT-OF-OFFICE REPLIES
There are times when you will not be answering
email, such as when out of town. This, however,
does not stop your email. When you do not
answer, your correspondents may become
upset. To show consideration for them, it is
smart to have an automatic response sent to
them informing them that you are unable to
read and respond to their message and letting
them know when you will be able to do so.
Most ISPs provide this service; to activate it go
to your account on their server and use Help to
learn how to do this. If you are using Gmail,
look for "Vacation Responder" in the Settings
menu.
SPAM
Spam (junk email) is not only a nuisance, it is
potentially harmful. As annoying as junk email
can be, it is important to recognize it to
proactively limit or eliminate it. A first clue of
junk is the sender's email address. If you don't
know the sender, the email is probably junk. To
proactively limit or eliminate junk mail, learn
how to develop email filters and rules. In
Windows Mail 2007, using the junk email
options on the Tools menu can be used to filter
spam to the junk folder to decide what to do
with mail determined to be junk. In Gmail the
"Filters" window can be used to discard spam.
Some online email clients allow the user to
report spam with the click of a button.
Spam is the electronic version of junk postal
mail, except that it shifts the costs of
advertising to the receiver; it exists because it is
a cheap way to advertise. It also fills the
Internet with unwanted messages. Usually,
spam originates from a false address, so
replying is a waste of time. If, however, you
receive a spam message and you know from
the email address that the ISP exists, such as
one of the online services, you can forward it
to postmaster online.service (substitute the
name of the service for online.service). Most
services and ISPs take a very dim view of
spamming and terminate the account of
anyone who sends junk email, or if someone's
identity has been illegally assumed, the ISP will
look for ways to prevent this from happening
again.
All email users must be knowledgeable about
spamming practices and malware, such as
phishing and pharming. One of the best ways
to avoid spam is to not give out an email
address to any Web site. An alternative is to
acquire a free mailbox site and use that email
address when completing online forms, for
example, when shopping online. Records of
online shopping are then emailed to the free
designated account along with any
advertisements that they might send. When
visiting the free email account, legitimate
email can be forwarded to another address
and spam can be deleted. Users should never
open a known spam message! Finally, users
should never purchase a product or service
advertised from unsolicited email (Project,
2007).
RETRIEVING EMAIL FROM A REMOTE EMAIL
ACCOUNT
Perhaps you normally use a stand-alone email
client such as Outlook, Windows Mail, or Mozilla
Thunderbird to retrieve email, but you want to
check your email when you are not at the
computer that you usually use. Many ISPs will
NCM110A - PRELIM 63
allow you to retrieve your mail directly from the
server. Or, you can configure a Web-based
client such as Gmail, Hotmail, or Yahoo to
retrieve the email from your server when asked.
Web-based email clients may also offer
software designed for mobile devices. Mobile
email clients allow users to retrieve and
download remote email to handheld devices
such as personal digital assistants (PDAs) and
smartphones.
Questions
1. All of the following are examples of a
standalone e-mail clients, except:
- Yahoo mail
2. Professional emails should include all of the
following, except:
- primary address
3. These are words form from the 1st letter of
words or word parts to communicate
common phrase that is commonly used in
informal e-mail and instant messaging:
- acronyms
4. All of the following are things to consider
when using e-mail for business, except:
- Email should be checked at least 10 times
per day
List Servs
Email Discussion Lists (Listservs)
An email discussion list, sometimes referred to
as a listserv (no "e" at the end) from the first
software that was used to create one, is made
up of a group of subscribers with a common
interest. The software allows subscribers to
receive discussion postings via email.
Subscribing, or joining, a list is generally free.
Instructions for subscribing are specific to a list
and are generally found on the Web site for
the list or as a click at a place where you find
information about the list. Once subscribed to
a group, copies of any message posted to the
group are sent to all members mailboxes (see
Figure 6-4). Members can reply to any of the
messages or send an entirely new message to
the group. The tasks of keeping track of
subscribers and sending copies of messages
are accomplished by a software program.
Other kinds of email list software include
Majordomo, Mailbase, and Listproc.
Most lists are automated, that is, the software
immediately sends out any messages posted
to the group's posting address; some groups
are moderated, that is, the message is first
vetted by the list owner before posting.
Most mailing list software offer many options for
subscribers beyond just sending messages. For
this reason, there are two addresses for each
group: one that manages the list, performing
such tasks as subscribing a new member or
evoking the available options such as
temporarily suspending mail from the group;
and another address that is used only when
one posts a message to the group. This
information is included in the information that is
sent to all new subscribers. It is important to
save this message because it not only provides
you with the administrative address but also
tells you how to unsubscribe, find the names of
other participants, digest your mail (so that you
receive one message per day with all of that
day's postings), and temporarily stop your mail
from the list (*very* important if you are not
able to check your mail for a while). The
instructions for use of email lists vary. When
replying to a list message pay particular
attention to whether you need to use reply or
Reply All. With some lists, the Reply feature will
permit you to reply to all list participants; with
other lists, you need to use "Reply All" to send
the reply to more than the person who wrote
the last message. Make sure that you sign the
email posted to mailing lists with a standard
"signature" that includes at least your name
and email address. Some lists "strip" the email
address of the participants in the header.
FINDING A NURSING DISCUSSION LIST
There are electronic mailing lists for just about
every nursing and other healthcare specialty
imaginable; finding the right one is not always
easy. Although you can search the Web using
the term "nursing discussion lists" or "nursing
listserv," staying up-to-date on what mailing lists
are active is almost impossible. Examples of
popular nursing discussion lists are as follows:
 Student nurse listserv
atlistserv.buffalo.edu/archives/snurse-l.html
 Nursing informatics listserv at
mailman.amia.org/mailman/listinfo/nrsing-1
NCM110A - PRELIM 64
 Nursing educator listserv at
lists.uvic.ca/mailman/listinfo/nrsinged
THREADED DISCUSSION LIST MESSAGES
Threaded messages are organized by the
topic of the message. The first message for a
topic starts the thread followed by the other
messages about the topic. Often the number
of other messages on the topic is noted in
parentheses after the topic of the group. If you
receive list mail in the digest format, the
messages are often threaded. You can also
organize your personal email by topic to have
threaded messages.
Regular listserv messages are not threaded, but
if the group has an archives page, the
messages are usually threaded on that page.
The threading concept works only when
posters preserve the original subject, either by
using the Reply or Reply All function or by
copying and pasting the original subject on
the subject line prefaced by "Re:". It breaks
down when posters use the Reply function to
start a new topic without changing the subject
line. In online courses, messages are also
threaded, so learning to use threaded
messages is an important skill.
DISCUSSION LIST ETIQUETTE
Listserv etiquette is similar to that used for
standard email. It is extremely important to be
respectful of the other group members.
Discussion list members represent an invisible
number of individuals with a variety of
experiences who may live anywhere in the
world. Thus, messages need to be
understandable to all. In messages avoid
acronyms, which are often not understood
even by people in your own area. Keep
messages on the topic of the list; information
about the allowable topics is provided in the
welcoming message.
Lists are maintained or "owned" by the person
who is responsible for the list. It is a thankless
task for which there is no payment. For this
reason, as well as consideration of the other
members, you should consider being a
member of a list, a privilege that conveys
responsibilities. Send nothing except messages
to be posted to the group to the email address
that is used to send you group messages. For
all other requests, like unsubscribing, use the
administrative address or Web page of the
group; information about how to implement
these features is in the welcoming message. If
you are going to be away for a while, either
unsubscribe from the list or set the mail to no-
mail (called noack in some list software). This is
important to prevent a "full mailbox error,"
which is not happily received by the list owner
who must then take the time to manually
unsubscribe you. If you want to receive only
one message from a list a day, you can use the
Web page or administrative address to set the
mail to digest. If you receive messages in the
digest mode and use the reply function of your
email to reply to a message, delete the subject
that is automatically on the subject line and
copy and paste the subject of the message to
which you wish to reply on that line prefaced
by "Re:".
New list users may think that a list is a way to
avoid doing a needed literature search. Don't
expect other list members to do this for you. If
you want information about a topic, when
asking for help indicate the sources you have
found. When a member indicates that he or
she has done homework and is willing to share,
other members are very happy to provide
more help. Do remember to sign your email
and use a contact signature, which includes
your email address and the name and address
of your affiliating organization.
FLAME WARS
Messages sent to an electronic mailing list go
to many people whom the sender does not
know. The messages will be read under a
variety of conditions, by people in different
moods. Given these circumstances, it is not
surprising that occasionally a member takes
umbrage at what another says and posts an
overheated message. A message of this sort,
called a flame, can easily deteriorate into a
flame war when others respond derogatorily
with other positions on the disputed topic. In
most groups, this ends on a conciliatory note
when cooler heads prevail. Flame wars can
happen in any group, but tend to be more
common in groups with controversial topics.
Questions
1. In regard to listservs, when signing your e-
mail, all of the following should be included
in the contact signature, except:
- website of the organization
2. All of the following are types of e-mail lists
software, except:
- Mailerdaemon
3. All of the following why are things the ones
either when using listservs, except:
- use threaded messages
4. In regard to listservs, if you are going to be
away for a while, is there unsubscribe from
the list or set the mail to no mail. This is
important to prevent:
- Full mailbox error
Blogs and Blogging
NCM110A - PRELIM 65
A rather awkward word, "blog" came from the
term "weblog," which provides a clue as to its
nature. A blog is a column or diary that is often
updated daily. There are blogs on almost every
subject and every aspect of every subject.
Blogs give people a chance to vent their ideas
and opinions, as well as practice their writing
skills, while entertaining those who read them.
Blogging has become so popular that many
news reporters and editors use this format to
influence and inform the public. Blogging has
had an impressive impact on political elections
and public opinion over the last few years, and
is now an accepted part of Internet
participation. Blog topics range from very
personal reflections to music, art, travel,
fashion, education, and corporate life.
You can read and join blogs in virtually every
area in which you are interested. But, you do
not need to go to each blog several times a
day to see what has been updated or added.
Technology called RSS, which stands for "Really
Simple Syndication," will feed to your computer
the updates from the blogs you choose to
subscribe to, every time there is an update.
Questions
1. RSS stands for:
- really simple syndication
2. A blog is a:
- column or diary that is often updated
daily
3. Blood came from the term:
- weblog
Social Networks
Few people have not heard of Facebook or
MySpace. Most of us know of these social sites
through word of mouth, the news media or
other stories of relationships made, broken or
restarted through these incredible electronic
hangout sites. They are certainly not just for
kids; many business professionals and
companies have their own page on Facebook
or MySpace.
On March 11, 2009, Reuters reported that
"Networking and blogging sites account for
almost ten percent of time spent on the
internet -- more than on email." The article
goes on to say, "The biggest growth in
Facebook membership comes from the 35-49
year old set. Facebook has added twice as
many 50-64 year old visitors as it has visitors
under 18.
A social network provides the user with a
personal page, upon which he or she can post
anything and everything about himself, his life,
his likes, interests, his poetry or any other
expression of self, and especially, his friends!
On your page, you can "link" with "friends" who
also have their own pages. Those friends will
show up on other friends' pages, and perhaps,
those people will link up, as well. Thus, the
"network" concept. Wikipedia's description,
although wordier, is, perhaps, more
sophisticated:
Social Networks can increase the feeling of
community among people. An ISN is a
closed/private community that consists of a
group of people within a company,
association, society, education provider and
organization or even an "invite only" group
created by a user in an ESN. An ESN is
open/public and available to all web users
to communicate and are designed to
attract advertisers. ESN's can be smaller
specialized communities (i.e.
.TheSocialGolfer, ACountryLife.Com, Great
Cooks Community) or they can be large
generic social networking sites (eg.
MySpace, Facebook etc).
However, whether specialized or generic
there is commonality across the general
approach of social networking sites. Users
can upload pictures of themselves, create
their 'profile' and can often be "friends" with
other users. In most social networking
services, both users must confirm that they
are friends before they are linked. For
example, if Alice lists Bob as a friend, then
Bob would have to approve Alice's friend
request before they are listed as friends.
Some social networking sites have a
"favorites" feature that does not need
approval from the other user. Social networks
usually have privacy controls that allow the
user to choose who can view their profile or
contact them.
All you need to do to join one of these
networks is to go to one on the Internet, and
sign up, using their format, a username and a
password. You can add as much or as little
about yourself as you'd like. You may find the
practice addictive, as you see the things that
people "post" on your "wall," and the photos of
people you may or may not have heard of.
Questions
1. All of the following statements about social
networks are true, except:
- they often require a paid subscription
2. This is an example of social networking site:
- Myspace
3. In regard to social networks, this is a
close/private community that consists of a
group of people within a company,
association, education provider or
NCM110A - PRELIM 66
 organization:
- ISN
Downloads
Downloading: Downloading is the process of
copying files from a larger network to a smaller
system, like from the Internet to your PC. For the
most part, downloading has been made easy
for the average user. We click a link, and wait
for a file to load onto our local computers
without having to do much else. But there is a
different system in operation for a download.
Behind the scenes, the Internet's File Transfer
Protocol (FTP) software is what allows us to
download, as well as upload, to the Internet.
FTP is simply another set of rules, or protocols,
which governs an Internet process. We will
discuss FTP again later when we learn about
setting up a website.
Most files are compressed in order to save time
in the download process, and must be
opened, or unzipped, once they reach their
destination. Not to worry - it is a rare Internet
site that demands we know all about FTP and
its workings. For now, just remember that some
downloads can damage your computer if they
are infected with a virus. Also, consider the fact
that your computer needs sufficient memory
and disk space to handle whatever you are
bringing from the Internet.
We can now easily download music, graphics,
text and video, following the instructions
provided with the download link.
Patches, Service Packs and Drivers: As
developments in technology continuously hum
along, software developers are constantly
having to create adjustments, repairs and
compatibility fixes, to take into account any
problems their product may be causing its
users. The companies provide these in the form
of downloads, which can usually be easily
found on their company websites. Sometimes
the service packs and patches are simply
improvements to the product. These can all be
easily downloaded, and in the case of
Windows, should be downloaded, as they
come along. Do not hesitate to download
updates from Microsoft for Windows, as well as
any other major pieces of software that might
provide them. They will help your computer run
more smoothly, and are worth a few minutes.
A driver is software that controls a device, such
as a printer, a disk drive, a monitor or a mouse.
Most drivers are already installed when you get
a new system. But, if you get a new piece of
hardware, or you want to install something on
your system that needs a driver, and you don't
have the software that comes with it, it is easy
to go to the company's website, find the
model number of your new toy, and download
the driver for it.
Downloads are prepared with instructions for
installation; they generally pretty much take
care of themselves, with a few simple clicks
from you, and they know the best places to
store themselves once they reach your
computer.
Some of the popular games at this time are
World of Warcraft, Rock Star and Halo-3; many
games require a game console, such as X-box
or Play Station, and charge a monthly fee to
join the adventure.
Virtual Reality
A virtual reality is an artificially created "world"
or "environment" that can be experienced on
a computer. To a certain degree, virtual reality
is already available on the Internet, on sites
that allow us to walk through virtual worlds.
Preston Gralla tells us we can "walk through a
giant computer, explore bizarre art galleries,
visit outer space, go to the sites of what seem
like ancient ruins, explore inside the human
brain, and much more" (Gralla p. 275). Virtual
reality, for the average Internet user, is still on
the horizon. Loading entire worlds, as you can
imagine, takes a lot of memory because of the
humungous graphics involved, but it is coming.
In the meantime, it is already being used in
medicine and education, allowing scientists to
learn about worlds we cannot see with the
human eye, and "territories," ranging from a
molecule to the cosmos. Currently, we can
experience virtual reality with special gloves,
goggles and other gadgets that are usually
available in entertainment centers. Virtual
reality is definitely the wave of the future.
Glossary
A weblog in diary or column
Blog
format
A cyberspace location where
Chatroom
people can converse
Files formatted to be smaller
Compress
than usual for ease in
Data
transporting
A metaphor for describing the
Cyberspace non-physical environment
created by the Internet
A website where one can find
compatible dating prospects,
Dating Site and communicate
electronically before meeting
in person
Transfer information from the
Download
Internet to your PC
NCM110A - PRELIM 67
 A program that controls a
device Every device whether
Driver it be a printer, disk drive, or
keyboard, must have a driver
program
eBay™ ts an online
marketplace that enable
local, national and
international trade eBay™
offers an online platform
where millions of items are
Ebay™
traded each day through
Online Auction Formats, also
called auction-style listings, or
through immediate "Buy It
Now" Fixed Pnce and eBay™
Store listings
Email Electronic mail
File Transfer Protocol - a way
FTP of downloading files from the
Internet
A device that plugs into your
Game
computer for playing
Console
interactive games
A processing location, such as
Nodes
a computer
A virtual auction where buyers
Online
can bid and sellers can sell
Auction
products over the Internet
Also called a service patch, a
fix to a program bug. Patches
Patch
typically are available as
downloads over the Internet.
Really Simple Syndication - a
technology that will alert a
RSS subscriber when new
information is added to a fog
or web page
Immediately - events
simulated by a computer at
Real Time
the same speed that they
would occur in real life
An update lo a software
version that fixes an existing
problem, such as a bug, or
provides enhancements to
the product that will appear in
the next version of the
Service
product When the new
Pack
product version is released,
usually contains the fixes and
updates from the service
pack Service packs can either
be downloaded or ordered
directly from the company
A social structure of nodes
that are generally individuals
Social
or organizations Asocial
Network
network represents
relationships and flows among
people, groups, and
organizations on the Internet
An artificial environment
created with computer
hardware and software and
presented to the user in such
Virtual a way that it appears and
Reality feels like a real environment
The term is sometimes used
more generally to refer to any
virtual world represented in a
computer.
A website that is created and
Wiki edited by volunteers working
together, such as "Wikipedia"
Questions
1. This refers to a website that is built as a
collaboration of contributors who volunteer
information:
- wiki
2. This is a software that control a device, such
as a printer, at disk drive, a monitor or a
mouse:
- driver
3. This allows us to download from and upload
to the Internet:
- file transfer protocol
4. This is a process of copying files from a
larger network to a smaller system, like from
the Internet to your PC:
- downloading
Introduction
The Internet has given us inexpensive
asynchronous discussions, synchronous instant
communication, email, electronic mailing lists,
and the library known as the World Wide Web
(WWW). Creative users, not content to have
the WWW as just a repository of information,
have given us social networking, interactive
sites, instant news, and personal opinions not
regulated by traditional media.
The networking thus provided allows us to
communicate with colleagues worldwide and
to stay abreast of standards of care and
practice. History has taught us through recent
devastating disasters that electronic
networking can provide a means for
organizing and delivering healthcare provider
volunteer assistance, pharmaceuticals and
medical supplies, as well as a way to provide
care to those in need. Nurses trapped within
the disasters have been able to connect to the
Internet and chronicle events using email and
online blogs.
Synchronous Internet Communication
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Synchronous Internet Communication refers to
communication that is done in real time, just
like a telephone or face-to-face conversation.
There are several different types: text-based
instant messaging, telephony, and Web
conferencing.
TEXT-BASED INSTANT MESSAGING
Instant messaging (IM) is becoming a
transparent part of email and an optional
feature in most course learning management
systems (LMSs). You can see "who else is online"
and then send them a text message. IM has
been controversial in the classroom because
students instant message each other in class
similar to the days when some of us passed
paper notes. Text messaging (short message
service [SMS]) and multimedia messaging
(MMS) are similar features that are standard on
mobile phones.
Chat is interactive email that has been around
for a long time, but it has morphed into newer
types of instant communication. Chat is an
optional feature that is available in course
LMSs. In this milieu, the computer screen shows
a list of the participants as they enter the chat
room. Chat users use their real names or a
"handle or alias," type their conversation, and
tap the Enter key to send the message. Others
in the chat room respond with their replies.
TELEPHONY
Telephony refers to computer software and
hardware that can perform functions usually
associated with a telephone. Telephony
products are often referred to as voice over
the Internet protocol (VoIP). VoIP provides a
means to make a telephone call anywhere in
the world with voice and video using the
Internet, thereby bypassing the phone
company. The free versions provide phone
communication from computer to computer.
All you need is a microphone, speakers, and a
sound card. If you have a video camera, you
can have video calls. Some VoIP software
include conference and video calls. The
connection, computer processor, and software
determine the number of people and quality
of the connection. For a small fee, you can
choose to call telephone numbers on mobile
phones and landlines using the Internet.
TELECONFERENCING VIA THE INTERNET
Conference calls using the telephone have
become a way of life for those belonging to
committees whose members live in different
geographical locations. In Web conferencing,
videos such as slideshows and other visuals can
be added to the meeting. Some Web
conferencing software feature the ability of
participants to mark up documents or images,
as well as "chat" using a keyboard. Web
conferencing is similar to an open telephone
call, but with the added element of video. A
Webcast is generally a one-way presentation,
usually with video, to an audience who may
be present either in a room or in a different
geographical location. Methods for the distant
audience to ask questions are usually provided
(Molay 2007). A Webinar, on the other hand, is
more like a live seminar. Although there is a
speaker, the audience can ask questions, and
the speaker can ask for feedback as the
information is delivered.
Questions
1. This provides a mean to me a telephone
call anywhere in the world with voice and
video using the Internet:
- voice over the Internet Protocol (volp)
2. This is generally a one-way presentation,
usually with video, to an audience who
may be present either in a room or in a
difficult geographical location:
- webcast
3. Synchronous Internet communication refers
to:
- communication that is done in real time,
just like a telephone or face to face
conversation
4. Computer software and hardware that can
perform function usually associated with a
voice communication is known as:
- telephony
Web 2.0
In the quest to make the Web function in a
more personal manner, a concept called Web
2.0 was born. It does not have strict boundaries
from the original Web but is about people
interacting, sharing, and collaborating. The
term "Web 2.0" was first coined by O'Reilly and
others to describe what online
companies/services that survived the dot.com
bubble burst in 2000 had in common (O'Reilly,
2005). Web 2.0 is more of a philosophy than a
technology and has many interpretations. It is
based on a common vision of its user
community. The objective of all Web 2.0
services is to mutually maximize the collective
intelligence of the participants and add value
for each participant by formalized and
dynamic information sharing and creation
(Hogg, Meckel, Stanoevska-Slabeva, &
Martignoni, 2006).
Web 2.0 services are an interactive
development process (Hogg et al, 2006).
Information sharing can be video, data, text, or
metadata such as annotations of history. The
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format is determined by the provider, with the
basic idea being that information is created
and shared among many users maximizing the
collective intelligence. The results can be
commonly accepted content or opinion. This
type of intelligence requires some type of
regulating, often from users of the site. User
recommendations on eBay are one example
as are reviews of various travel facilities by
those who have used them.
Web 2.0 provides a rich medium to nurses and
other healthcare professionals for interactive
networking. A professional networking Web site
is like a visit to one's colleague's office or home
where one can see personal pictures and
other decor that reflect his or her ideas and
personality.
COLLECTIVE INTELLIGENCE TOOLS
Collective intelligence is defined as knowledge
and understanding that emerges from large
groups of people (The Horizon Report, 2008).
Analysis of data that is collected over time will
allow new patterns to emerge and in turn will
result in new knowledge. The notion of
collective intelligence has implications for
changes in the educational process and the
nursing profession. Use of collective intelligence
applications in nursing education provides
opportunities for grassroots problem solving
and knowledge construction by students
worldwide.
Wikis
A Wiki is one example of a collective
intelligence application. A "Wiki" is a piece of
server software that allows users to freely
create and edit a Web page's content using
any Web browser. Wiki supports hyperlinks and
has a simple text syntax for creating new
pages and crosslinks between internal pages
on the fly (What is Wiki, 2002). Wikis are Web
sites designed for sharing and collaborative
work on documents. They are used for
committee work, clubs, classrooms, and
knowledge management. Wikis can be private
or public, for example, a Wiki designed for
committee work would be private. The Wiki
administrator identifies the membership using
email addresses, and the Wiki automatically
emails members with information on how to
register for the Wikispace.
The culture of the group is a factor that affects
the effectiveness of collaboration (Watson &
Harper, 2008). Users must be willing to share
knowledge and exchange ideas. They must be
open-minded and willing to seek new
knowledge. When Wikis are used as an
updatable knowledge management
repository, users must have the technical skills
to upload and edit documents.
Wikipedia is an example of a public Wiki. It is a
popular, free, online encyclopedia, which
began in 2001. Within the first six months of
development, users had contributed 6000
articles (Neus, 2001); as of November 2008,
there were over two and a half million articles
written in English (Wikipedia, 2008). Wikipedia
articles are collaboratively created and
improved by users. To make any changes to
Wikipedia articles, users must register and then
log in to the site. Tabs at the top of the article
provide a means for collaborative discussion
on the topic, editing the topic, or viewing the
history of changes (an audit trail). All changes
are recorded and can always be undone. The
strength of Wikipedia is that it provides
information on an ever-expanding number of
topics. Critics are quick to point out that the
quality of the articles is inconsistent. For
technical information, it is often one of the
most up-to-date and best source.
Web 2.0 Office Suites
With Web 2.0 have come many tools that allow
groups of users to work together virtually. Many
of the tools are free and very easy to use. The
only requirement is the use of a computer with
an Internet connection. Two examples of
online office suites that allow group
collaboration are Google Docs and Zoho
Office. Google Docs includes word processing,
spreadsheet, and presentation software. The
documents are usually created off-site and
then uploaded where they can be shared and
edited by others. The documents can also be
downloaded and saved. Zoho provides
collaborative access to word processing,
spreadsheets, presentation tools, an online
notebook, an online planner, a Wiki, Web
conferencing, Web application creation, and
chat. The Web site allows users to import files
from other office applications. Joining either of
these is free; all one has to do is create an
account.
Sharing Media
The Sketchcast tool allows a registered user to
draw and narrate an idea and then share it via
a Web page or blog. Slideshare allows users to
embed a slideshow into a Web site or a blog,
synch audio to slides, and join groups who
share the same interests. Presentations can be
downloaded to the user's computer or shared
with others. The search terms "nursing" and
"nursing research" at this site will find slideshows
pertinent to the nursing profession. "Slide" at
http://www.slide.com/ also allows you to
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create online slideshows including music videos
as well as create a guest book for your site on
which friends can share their pictures.
Evolving Collective Intelligence Applications
New collective intelligence applications are on
the horizon. Freebase is an open shared
knowledge database. The Web site provides
an introductory video designed to guide new
users to efficiently search the database. To
contribute you must register and receive a
login and password. The Google Image
Labeler uses a gaming strategy to improve the
quality of Google images search term results.
Users are randomly paired with an online
partner. The players are shown a set of images
over a two minute period and asked to
describe the image with as many labels as
possible. When the two players agree on a
label, the players receive points.
RSS FEEDS
Because blogs are updated, but generally not
on a fixed schedule, you can subscribe to an
RSS feed, which will notify you when there is
new information on a blog. RSS feed is an
acronym for both Real Simple Syndication and
Rich Site Summary (your choice). RSS feeds are
not confined to blogs. You can have RSS feeds
of new items from Web sites including
electronic library searches, news, and blogs
sent to your personalized Web browser home
Web page, such as iGoogle or My Yahoo. The
signal that a Web site is amenable to being
subscribed to is the orange icon on the page
itself, or in the location bar (see Figure 6-1).
Since December 2005, this icon has become
the industry standard denoting RSS feed
availability. Using the Help menu in your Web
browser or email application you can easily
create an RSS feed for any site where you see
the icon.
MASHUPS
A mashup is a Web application that takes data
from more than one source and combines it
into a single, integrated tool (Merrill, 2006).
There are several varieties of mashups. One
type involves mapping, in which data is
overlaid on a map. This type of mashup was
given a push with the advent of Google Maps,
which, developers discovered, could be
overlaid with current data from various sources.
This type of mashup could be used in
healthcare to place cases of infectious
diseases on a geographical area. In a smaller
example, overlaying data about infections on
a unit over a blueprint of rooms would provide
more information than the data alone.
Another type of mashup involves associating
videos or photos with the metadata about the
picture such as who took the picture and the
location where it was taken. There are also
search and shopping mashups such as the
comparative shopping tools that draw data
from various sources. News mashups are
another variety in which news from various
sources is synthesized into personalized news.
GOOGLE GROUPS
Google Groups discussion forums, similar to
Wikispaces, allow for sharing of documents as
well as a group discussion. Unlike Wikispaces,
all Google Group users must have a Gmail
address. Google Groups can be private or
public, or serve as an electronic bulletin board.
Private Google Groups has a feature that alerts
all the members when there is a change to the
workspace. Google Groups are also used for
collaborative work such as committee work,
classrooms, and clubs. Yahoo also provides the
same service.
GRASS ROOTS MEDIA
The ability to share photographs and videos is
a rapidly growing trend! The term Grass Roots
Media refers to the widespread creation and
posting to the Web of media such as videos,
slides, and blogs by nonprofessionals. There are
multiple ways to create digital photos or videos
that can be posted to the Web. Many cell
phones include both the ability to take photos
and videos. Inexpensive but "good- enough"
digital camcorders are also available. One
inexpensive digital video camera is even small
enough to fit inside a pocket (Pure Digital
Technologies, n.d.). There are also disposable
camcorders that take up to 20 minutes of
audio and video Money.com., 2005).
Online Photos
Web sites such as Flickr and Shutterfly are
specifically designed for photo sharing. They
both allow photos to be shared privately and
publically. Shared photos is an excellent way of
sharing experiences from professional meetings
and conferences.
Online Personal Videos
Video-on-demand Web sites, such as YouTube,
allow users to upload, view, and broadcast
videos to a worldwide audience at no charge.
To find and view a video from YouTube, enter
a search term in the search box. To upload a
video, register for an account, complete a
short form where you indicate your account
type, contact information, gender, and age,
and agree to the Web site terms of use.
NCM110A - PRELIM 71
Although free online videos vary in quality and
length, users are guided to useful resources
such as the ratings of other users. Faculty and
healthcare professionals are using the video-
on-demand sites to deliver lecture material.
When uploading video on healthcare topics,
users must adhere to all privacy guidelines to
protect patient confidentiality.
Podcasts and Vodcasts
Podcasts, or audio messages available online,
and vodcasts, video and audio online, allow
anyone with the appropriate hardware and
software to create and publish audio and
video contents on the Web. Some developers
publish these as a theme series on a specific
subject that are available as an RSS feed. They
can be identified by the orange icon with the
word "POD." There are three ways through
which you can listen to a podcast: using an
MP3 player, listening on a computer with
special software such as the Windows Media
Player, and with VoIP by dialing a number
(Little, 2007).
Although podcasts and vodcasts are often
referred to with only the term "podcast," they
are in different file formats. Many MP3 players
play both. Podcasts, like blogs, are available at
just about every news Web site. Educators are
taking advantage of podcasting by recording
their lectures and then uploading them as a
podcast to the iTunes store or other places. To
subscribe to a podcast, open the command to
subscribe in podcatching software and then
copy and paste the URL for the podcast.
Questions
1. This is a web application that takes data
from more than one source and combines
it into a single, integrated tool:
- mashup
2. This refers to the widespread t creation and
posting to the web of media such as
videos, slides, end blogs by non
professionals:
- grass roots media
3. This allows a registered user to draw and
narrate an idea and then share it via web
page or blog:
- sketchcast
4. A piece of server software that allows user
to freely create and edit a web page's
content using any browser is a/an:
- Wiki
HTML
You On the Web
Introduction
Consider building your own website! You can
have a family website that contains photos
and information about your family, or a
business website that helps you sell the gadget
you invented. You can establish a website that
is focused on frogs or pears, or Aunt Mary's
needlepoint -- just about anything that interests
you and that you want to share, sell, promote
or flaunt.
If you Google™ the words "make a website"
you will be astonished by the number of
companies that will help you build a site, host it
and give you a webpage and some for free!
But, don't be confused about this - free only
goes so far. There are conditions in most cases,
and there is almost never a truly free website.
But, before you get started, it is a good idea to
know what is involved, and plan a little for the
creation of your very own web site and for
owning your own domain name.
HTML
Hypertext Markup Language (HTML) is the most
commonly used authoring language for
creating websites. It is relatively easy to learn
and far less complicated than learning other
programming languages. It is based on
embedding tags and attributes within your
page. That may sound confusing, but it is
basically quite simple.
Before a web-page becomes a web page, it is
put together just like a regular document,
EXCEPT that it has certain codes embedded in
it that tell the document how it is going to look
when it's online.
These codes, or tags, are enclosed in the
carrot-shaped angled brackets, (carrot-marks)
that you can see on your keyboard that look
like < and >, usually the upper case characters
on your comma and period keys.
Writing HTML can be fun. For example, if you
are about to write some text that you want to
appear online as bold, you would type in the
tag that looks like this: <bold>. and from that
point on, the text will appear bold when it's
online. At the point where you want the bold
formatting to end, you would simply type
</bold>.inserting a slash in the tag.
In this way you can create an entire web
page, using graphics, different colors and sizes
of font, hyperlinks, and even animation. Of
course there are lots of tags to learn, and a
range of colors and tools to choose from. If this
interests you, take an online course in HTML,
and learn how easy it is to create your own
web pages - when you know how.
NCM110A - PRELIM 72
If you own a copy of software such as
Microsoft's "Frontpage™" you can easily create
professional, custom web pages with lots of
help and instruction at your fingertips.
However, it is still quite helpful to know HTML
when using these packages.
Tip: If you want to see what a web page looks
like in its raw HTML form, go to your VIEW menu
and click on "SOURCE." This option lets you see
everything that went into making that web
page.
Questions
1. HTML is used to:
- build a custom web page
2. HTML is:
a programming language
3. If you want to see what a web page look
like in its raw HTML form, you should:
- go to your view menu and click on source
Site builders
If you are not particularly interested in learning
HTML, but still want to build a website, consider
visiting a site that offers "site builder" tools.
These authoring tools allow you to type in
regular format, and create your website just
like you would create any document, and it
embeds the tags for you, giving you choices of
all kinds. Obviously, this is a much simpler way
to build a website, and unless you are wanting
to do something extremely fancy, these site
builders are the way to go. Just Google™
website builder, and see all the choices!
Obtaining a Domain Name
We discussed earlier in the course how domain
names are issued through registrars, and have
different TDLs, or extensions that coincide with
the type of website you want. If the software
you have used to create your website does not
offer this service, search for "obtain domain
name," and you will find hundreds of sites
offering to establish and register a domain
name for you.
You will be taken to a screen that allows you to
try out your domain name to see if it has
already been claimed. Since there are millions
of websites now on the Internet, you may need
to be very creative to find one that is original
and not already spoken for!
Be prepared to pay a fee for the use of your
domain name, and also be prepared to pay
each year to maintain it. Some cost less than
others. Also, be aware that you cannot violate
copyright laws with your domain name. An
example is - you cannot use domain names
like www.proctor&gamblegames.com, or
colsanderskentuckyfriedblues.com, or any
other domain name that would infringe on
someone else's copyright or trademark. Nor
can you use a double set of golden arches as
your logo - you get the idea! (We will discuss
copyrights in more depth in the next lesson.)
It is better not to use extras in your domain
name, such as a hyphen, if you can avoid it.
Websites with URLs such as www.rubber-duck-
place.com are a little more difficult for people
to remember and type in, than
www.rubberducky.com. However, if you are
forced to use a hyphen, don't panic. Your site
will still be searchable on the web. Keep
thinking and trying out domain names until you
come up with one that is most suited to your
needs or products.
Remember that a website is made up of web
pages, so technically, what you are creating is
web pages that each have a specific
purposes and are linked to one another by
hyperlinks.
What kind of site do you want? Remember that
if your website is going to be a place to
purchase a product of any kind, you must
choose a .com domain name. If you want to
set up an organization, you might want to
consider an.org or .net site.
Questions
1. What pages of a website are linked to one
another by:
- hyperlinks
2. All of the following are general
consideration when obtaining a domain
name, except:
- be prepared to use site builder tools
3. You should choose a .com domain name if:
- your website sells products
Website Components
Most websites have an email link so that
people can send you a message, an order or
other communication. Commercial sites often
include a "shopping cart" and/or "storefront"
that allow your visitors to feel like they are
shopping for your products. It also allows them
an easy way to check out and pay you. Most
pre-packaged site builders include these
features, and nowadays often contain a
blogging feature and other conveniences that
will help you make the best use of your
website.
When planning your website, consider the
following components before you start:
 Domain name
 Logo
NCM110A - PRELIM 73
  Content - text and photos about your
subject
 Colors-background and text
 Design scheme - sketch out your pages
 Contact Us feature and Email capture
 About Us page
 Testimonials about what you are selling, if
applicable
 Samples/photos
 Copyright information
 Links to other sites
 Secure purchasing function and
shopping cart
 Any free links, information or tools you
can provide relative to your subject
Shelley Lowery's article on www.twospots.com
describes some basic considerations about
choosing colors for your web pages:
 Use caution when selecting your
background and text colors. Busy
backgrounds make text difficult to read
and draw the attention away from the text.
In addition, always be consistent with your
background theme on each page of your
site.
 Select your colors very carefully, as colors
affect your mood and will have an effect
on your visitors as well.
 Bright colors, such as yellow and orange,
cause you to become more cheerful or
happy. Colors such as blue and purple
have a calming effect. Dark colors, such as
brown and black, have a depressing
effect.
 A good rule of thumb is to use colors based
on the type of effect you're trying to
achieve. However, it's always best for your
text areas to have a white background with
black text.
So, planning ahead for your website is
essential. Use search engines, books and
instructional materials to make as many
decisions as possible before you begin to build
your website. Look at sites that are similar to
your subject areas and get ideas
(remembering to respect copyright and
plagiarism laws and rules).
Questions
1. All of the following are basic considerations
when choosing colors for web pages,
except:
- it's always best for your text areas to have
a black background with white text
2. All of the following should be considered
when planning your website, except:
- page numbers
3. All of the following should be considered
when planning a website, except:
- Internet service providers
Copyrights, Trademarks and Plagiarism
As with any created material, the material is
owned by the person who created it, whether
it is a piece of writing, a piece of art, or a toy. A
piece of original writing assumes natural
copyrights to the person who thought and
wrote those ideas. Therefore, when you use
someone else's writing verbatim without
crediting them, or steal their ideas as your own,
you are in violation of copyright laws and have
plagiarized their material.
When you use another person's words, you
must always provide the name of the owner of
the material and where you got the
information. If you do not do this, you will be
considered to have plagiarized the work, and
will be in violation of copyright laws, whether
the copyright has been registered by the
creator or not. In the world of writing, there are
different formats for doing this. For our purposes
here, just know that you MUST credit the
creator of the work, as you have seen
throughout this course.
When you use an image or term that has been
created by someone else, you may be
infringing on trademark rights. Maybe you do
not believe these rules apply to you, especially
if you are just a regular person trying to set up a
modest website. However, think twice about
this. You can be sued for infringing on others'
rights, not to mention the fact that you can be
forced to remove the offending material.
There are certain texts, images and music that
are considered to be in the "public domain,"
meaning that, due to age, familiarity or other
circumstances, they simply belong to
everyone.
The following information, borrowed from
http://cyfair.lonestar.edu, will provide you with
a basic reference to consult while you are
setting up a website and will help prevent you
from breaking rules as you create your
masterpiece:
NCM110A - PRELIM 74

Questions
1. When you use someone's work, you should
most significantly cite:
- the author's name
2. Public domain works belong to:
- everyone
3. When you use an image or term that has
been created by someone else, you may
be infringing to:
- trademark rights
4. This is a form of protection to the authors of
original work of authorship, including
literary, dramatic, musical, artistic, inserting
other intellectual works:
- copyright
WHO'S THE BOSS?
Who is in charge of the Internet?
A fascinating fact about the Internet is that
there is really no one in charge. There are
"registrars," and an agency that is responsible
for general oversight, but the Internet is simply
run on the basis of self-governing agreement
and cooperation. It is up to us, the users, to
make sure that we treat the Internet with
respect, and behave appropriately in our use
of it.
In certain cases, national governments have
imposed certain restrictions on the content of
the Internet for cultural and political purposes,
but generally speaking, it is a free network
where freedom of speech and expression
reigns supreme.
There are many established organizations that
play a role in maintaining the integrity of the
Internet, both in terms of technology and the
guidelines and operating principles.
InterNic
The InterNIC, or Network Information Center, is
a group of registrars who maintain all the
domains that are registered on the Internet.
They are part of our country's department of
commerce, and they are responsible for all of
the domain names that are registered.
InterNIC is the head honcho when it comes to
filing complaints about domain name or
trademark theft, viruses or other problems. Of
course, these kinds of complaints should first be
made to your ISP, but ultimately, InterNIC is the
governing body for Internet problems.
ISOC
The Internet Society is a non-profit organization
dedicated to monitor, improve and keep tabs
on Internet Standards. Following is the
organization's description of itself:
The Internet Society (ISOC) is a nonprofit
organization founded in 1992 to provide
leadership in Internet related standards,
education, and policy. With offices in
Washington, USA, and Geneva, Switzerland, it is
dedicated to ensuring the open development,
evolution and use of the Internet for the benefit
of people throughout the world.
Again, this is not an agency that profits from or
governs the Internet, but one that voluntarily
oversees the general standards of how the
Internet is used. Groups that determine and
advise on standards for the Internet's
infrastructure are members of this society.
ICANN
The Internet Corporation for Assigned Names
and Numbers is an organization that accredits
Registrars who sell domain names to ISPs. It is
getting a little complicated now, but really, all
it means is that there are organizational bodies
that have formed just to handle the numbers of
companies, organizations and people who
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participate in the use and upkeep of the
Internet.
Registrars
Registrars are private companies who register
Internet domain names. There is a limited
number of registrars, however, the list has
grown tremendously since the early 1990s.
ICANN keeps a current list of accredited
registrars and TLDs on their web page.
WWWC
The World Wide Web Consortium, headed by
Tim Berners-Lee, one of the web inventors,
describes itself as follows: "The World Wide Web
Consortium (W3C) develops interoperable
technologies (specifications, guidelines,
software, and tools) to lead the Web to its full
potential. W3C is a forum for information,
commerce, communication, and collective
understanding". In other words, this is a group
that tries to keep the Internet operating at its
maximum potential technologically, as well as
monitoring and improving web standards.
The folks at www.Netcomm.com in Australia
answer our question as follows:
Who Manages the Internet?
The Internet has always been the result of
collaborative effort. Although it was initially
sponsored by the US Department of Defense,
from the outset it has involved experts from
many fields and many institutions, who have
developed a unique collaborative model to
build this most dynamic of systems.
The ultimate answer to the question of who
runs the Internet is that there are hundreds,
or thousands, or tens of thousands, of
organizations involved in provisioning for,
and shaping, the Internet. These include
commercial companies, universities,
statutory bodies, government departments,
Internet Service Providers, and many more.
So, who is really in charge? Ultimately, as we
continue to use the Internet with behaviors of
integrity and respect, we all are.
Vocabulary
InterNIC Internet Network Information
Center - A department of
commerce organization
consisting of registrars who
maintain all the domains that
are registered on the Internet
ISOC Internet Society - a non-profit
organization dedicated to
monitor, improve and keep
tabs on Internet Standards.
ICANN Internet Corporation for
Assigned Names and Numbers -
an organization that accredits
Registrars who sell domain
names to ISPs.
WWC, or World Wide Web Consortium -
WC3 develops specifications,
guidelines, software, and tools
to lead the Web to its full
potential.
Questions
1. The Internet Society (ISOC) is:
- a nonprofit organization
2. The interNIC is responsible for:
- maintaining all the domains that are
registered on the Internet
3. This organization develops specifications,
guidelines, software, and tools to lead the
web to its full potential:
- world wide web consortium
Malware
The Shady Side
As with everything in the world, there is a dual
reality with the Internet. Dangers lurk on the
Internet that everyone needs to be aware of.
Some of them pose a threat to the technology,
some of them pose a threat to individuals.
However, knowing how to recognize potential
problems and knowing how to deal with them
before they become problems is key to being
a responsible Internet user.
Viruses and malicious software:
"Malware," or malicious software, is any
software that uploaded to a network or
Internet that disrupts, alters, steals, damages or
changes the data stored on the computer or
network. We often use the generic term "virus,"
however, there are different kinds of malicious
software that do different things.
In the early days of software programming,
viruses usually occurred as accidents or
mistakes in program code. A virus is able to
spread from one computer to another over a
network, and often causes inconvenience and
even damage to a computer's operating
system. A virus that is sent over the Internet,
such as by way of email, can spread to
thousands of computers in a very short time.
What is a worm? The difference between a
generic virus and a worm virus is that a worm
does not require anyone to press a key or send
an email. An email virus, for instance, will die
out if everyone deletes it and it is no longer
allowed to spread. However, a worm does not
depend upon any actions of a user, and can
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infect thousands of systems simultaneously
since it uses the internet to do its free- wheeling
damage.
Trojan? Remember the Trojan horse? A Trojan
virus is wrapped up in what appears to be a
legitimate program and when it is installed, its
damaging contents liberated into your
computer system or network!
For the purposes of this course, we will not go
into depth about how many viruses are out
there on the Internet and how many kinds exist.
Instead, you need to know that your computer
must be protected from the constant
onslaught of new viruses that can be "caught"
over the Internet!
Paul Bocij tells us in his book, The Dark Side of
the Internet, that people create viruses for
several reasons. Some virus writers actually feel
they are helping educate those in the world of
technology, who are challenged to figure out
how to prevent the virus. Others simply enjoy
doing something that will cause many people
harm or inconvenience. Still others are looking
to elevate themselves as better virus writers
than others. Another common reason for the
creation of viruses has been to achieve some
political goal, such as spreading a belief
system or propaganda by reaching thousands
of people with a certain message. Finally,
some people want revenge for one reason or
another, and find that sending a virus
accomplishes some sort of win (Bocij).
Solutions:
1. Purchase one of the most popular virus
prevention software packages available. It
is best to go to Google™ and search for the
best anti-virus software, since there are new
companies with improved technology that
may be available by the time you take this
course. These software packages not only
clean your system of viruses, but will also
allow you to periodically download the
repairs for new viruses as they appear on
the Internet.
2. Go to the security settings in the Tools
section of your Browser, and make sure your
browser does not automatically download
and install ActiveX components. Also, it is
important when on the Internet to be sure
you have a firewall in place, whether it is
through your security software or
Windows™.
3. If you receive email that is not
automatically deposited into your SPAM
folder, but which comes from an unfamiliar
sender, delete it! Some viruses cannot
spread into your system unless you open
the email that has delivered them.
Questions
1. A good way to avoid viruses on your
computer is to:
- purchase and install antivirus software
2. A trojan virus is different from others
because it:
- is disguise as legitimate program
3. Malware is best described as:
- any type of malicious software
Spyware, Adware
Naturally, if something as effective as a virus
becomes common knowledge, someone is
going to figure out how to make money from
the idea. Thus, we now have Adware and
Spyware invading our computer systems via
the Internet.
Spyware has the capability of monitoring your
activities, as well as obtaining data and
information from your computer system.
Spyware is often difficult to detect and
eliminate. It can collect information about your
credit cards, bank account numbers and
financial dealings, leaving you vulnerable to
identity theft. However, its primary purpose is to
target specific advertising to you, based on
what it perceives to be your interests and
habits.
Adware is similar to spyware, but the
information it gathers is used to target potential
customers by monitoring your Internet
activities. It may detect which Internet pages
you have visited and determine what products
you might be attracted to so that the
appropriate ads will pop up on your system.
Adware and spyware are often secretly
attached to legitimate-seeming software that
you might purchase or download.
The main purpose of creating adware and
spyware is the potential for money and free
marketing research. How much adware and
spyware is out there? Again, Paul Bocij gives a
great example to contemplate:
"In 2005, [researchers] took a brand new
computer without any security software
installed, connected it to the Internet, and then
browsed a number of Web sites aimed at
children. After just one hour, the machine was
examined for malware, and it was reported
that a total of 359 pieces of adware were
found. Although unscientific, this experiment
suggests that some adware producers are
deliberately targeting young people" (Bocij).
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Considering that this little experiment was
carried out in 2005, try to imagine the growth
of this activity in the last few years!
It is probable that every time you search the
Internet you are inadvertently picking up some
kind of adware or spyware. What should you
do?
There are too many varieties of web bugs to
describe them all, but you can prevent them
from doing major harm to you or your system.
Solutions
Most anti-virus software now comes with anti-
spyware and anti-adware features. However,
there are specific programs available for
download from the Internet that can
effectively keep your system clean and free
from this garbage. However - beware - some
of the products, especially free ones, may
come with their own hidden adware and
spyware. Make sure that you search for a
reputable product that has been tested by
outside sources and has been proven not to
include these insidious freeloaders.
Cookies
Cookies are chunks of data that a web server
places on your computer's hard drive, for
several reasons. The cookies store information
about forms you fill out, sites that you have
"registered" on, and goods you have
purchased over the Internet. Cookies actually
have the effect of smoothing transactions that
you make on the web, and are not particularly
harmful.
Delete Your Temps and Cookies
When your search engine is open, there is a
menu option called Tools. At the bottom of
that menu is the choice of "Internet Options."
Opening that tab will show you how to delete
your temp files, as well as the "cookies" that
have been placed on your system by a web
server. You can also get to this menu through
your Windows Control Panel, choosing the
Internet option. You should do this occasionally
if, for no other reason, to keep your system
running smoothly.
Spam
If you have an email account, you will get
Spam. Spam is a slang term for unsolicited
emails, which are intended to either involve
you in some kind of scheme or sell you
something. Of course, it does not refer to all
unsolicited emails, but generally, it is simply
electronic junk mail advertising something.
Spam filter
Almost all email programs have spam filters
which help detect emails that have been sent
to a mailing list or newsgroup. When you
receive unwanted emails, send them to your
spam file, and the filter will catch it the next
time an email comes from that spammer. Right
now, there is no real way to avoid receiving
spam if you use the internet, so, although it is
annoying, deleting it or letting your spam filter
catch it may be your only remedy.
Hackers or Crackers
Hackers are "individuals who gain unauthorized
access to computer systems for the purpose of
stealing and corrupting data. Hackers,
themselves, maintain that the proper term for
such individuals is cracker"
(www.webopedia.com). Government and
military agencies have spent thousands of
dollars recovering and repairing their networks
and security systems due to hacking. Large
agencies are constantly on the lookout for
breaches to their computer systems due to
hacking by people whose computer skills are
outstanding, and whose intentions are not
good. Unless you are running a high-level
organization through your computer, hacking is
not necessarily a worry.
Should you be afraid to use the Internet?
Absolutely not! But you should practice a great
deal of care in protecting your computer's
system and integrity by taking the precautions
of installing protective software. The next lesson
addresses personal safety issues.
Glossary
Questions
1. The primary purpose of adware is to:
- gather information about your buying
habits
2. A spam filter's function is to:
- remove spam to a separate file
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3. A computer virus is best described as:
- a small program that attempts to copy
itself from one computer to another
4. Disarmed small files that are legitimately
saved to a user's hard disk when a website
is visited:
- cookies
The Dark Side- Predators, Scams, Hoaxes
We discussed the shady side of the Internet
involving threats to computer systems and
invasion of privacy through software programs
and hackers. However, more serious threats to
Internet users involve scams, hoaxes, and
predators who prey on our vulnerability,
gullibility or youthfulness. This lesson deals with
the truly dark side of our technological age.
Although it is not necessary to avoid the
Internet or be afraid of it, there are precautions
to be taken, particularly with our children, to
make it a safe "place" to play.
Predators
When your children are playing for hours on
the Internet, it is important to know what they
are doing. and with whom they are "chatting."
Somewhat prevalent in chat rooms and social
networks are predators who hope to get to
know children through communicating with
them on the Internet. Once they establish a
friendship and gain the child's trust, if they are
truly a predator, they may arrange to meet
with the child for perverted or dangerous
reasons. Children who have met with Internet
friends have been kidnapped, molested,
brainwashed and mistreated in other
unspeakable ways. This is not to imply that
there is a predator around every corner, but it
is worth being very aware of what your
children are up to on the web.
Adolescents can be particularly vulnerable to
the dark side of the Internet. Often feeling
isolated and misunderstood, there are often
cult members and rescuers who want to help
them overcome their unhappiness with
themselves or their home lives. Young women
who put out the message that they are in
distress are often sought by recruiters in the sex
trade.
Dating websites come with their share of
hazards, as well. Never, ever agree to meet
personally with someone you have just met on
the Internet. In fact, unless and until you are
completely positive that this person is for real,
don't meet at all. If you do get to the point of
wanting to meet someone, make sure you
 take along a friend, and tell someone
where you are going,
 meet in the daytime for coffee only, and
 do this several times before ever going
on a nighttime date.
We all want to think that we can trust our
intuition regarding our judgment of others, but
people who are ill or deviant can be extremely
convincing. There are, of course, horror stories
that do not need to be told here. Just be
smart!
Cyberstalking:
People sometimes use the Internet to harass or
terrorize others. In addition, social networks
have been breeding grounds for what
resembles gang activities, ganging up on one
vulnerable person and ridiculing the victim,
even to the point of suicide. Cyberstalkers
have also been known to claim that their
victim is harassing them as a way to avoid
prosecution. Never allow yourself to get too
involved with people you do not know,
especially if you feel vulnerable. And, certainly,
always monitor your children's actions on the
web.
Clubs and Bad Apples:
There are sites and online groups on the
Internet that encourage and instruct people
on ways to commit suicide. There are those
who explain how to make a bomb, how to buy
a fake license or degree, how to make
poisons, cheat, or commit the perfect crime.
The dark side of freedom is that there is danger
for those who are not discerning. If your child is
depressed or angry, take special note of his
Internet activities, just to be safe.
Parental Control Software:
Most Internet Service Providers offer the option
to parents of blocking undesirable material,
including pornography, foul language and
violence. However, it does not block
everything, and does not preclude a watchful
eye over children using the Internet. Never
assume that these things could not happen to
your child.
Questions
1. Cyberstalkers used the Internet to:
- harass or terrorize others
2. Parental control software is capable of:
- blocking access to undesirable material
on the Internet
3. A predator can do harm to your child by:
- gaining his / her trust
HOAXES
Fraud
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One of the Internet's most commonly known
hoaxes is called "419 fraud," and involves offers
of a large commission to the receiver in
exchange for your help in getting money out
of Nigeria or other African nations (Bocij p.
211). This scheme is so elaborate that the
perpetrators provide telephone numbers in the
Netherlands of their attorneys and photos of
wealthy "victims" in Africa who are somehow
being prevented from getting their money.
Email Hoax
One of the most detested email hoaxes
involves pleas for help for a dying child. These
can be quite convincing, and the perpetrators
are often able to collect thousands of dollars
from sympathetic users before they suddenly
disappear.
A milder, less destructive email hoax is the
chain email, which promises large sums of
money only if you do not break the chain,
which requires you to forward the email on to
many others. Know that this is only a
convenient way of gathering information -
delete it!
An annoying email hoax is the sappy message
of kindness or good wishes that threaten to turn
your luck if you do not forward them to a
certain number of people within a certain span
of time.
Other hoaxes involve identity theft, where
confidential financial information is sold to
those who steal credit and debit card account
numbers and spend money that does not
belong to them. We discussed earlier the kinds
of spyware that can gather information from
your computer, as well. Always be cautious
when providing information over the Internet. It
is a good idea to have one credit card that
you use for Internet purchases; try to find one
that protects you from fraud, and limit its use to
the Internet.
Scams
The recently prosecuted Ponzi scheme is one
that is carried out on the Internet every day. A
Ponzi scheme is one that takes money from
new investors and uses to pay older investors at
high rates of interest. Beware of sites
encouraging you to invest.
This is a short description of some of the darker
aspects of the Internet. Fortunately, they can
all be avoided, and they don't stop millions of
people from using the Internet every day for
constructive purposes. So, jump in, and enjoy
the freedom to connect with the world.
Vocabulary
Questions
1. This is an example of an email hoax:
- chain email
2. Identity theft refers to:
- therefore a user's personal information for
criminal purposes
3. If you are threatened with bad luck as a
penalty for not forwarding an e-mail, you
should:
- delete it
Ethics and Netiquette
It turns out that there are many people
concerned about ethics when it comes to
using the Internet. With a system so wide open
to every kind of culture and individual, it
becomes important to come to some kind of
consensus about what considerate and ethical
behavior on the Internet actually looks like. We
will address abuses of the Internet in the
following lesson, but for now, let's take a look at
the standards and ethics that have been at
the core of discussions about the Internet.
Basic courtesies
Respecting others' privacy on the Internet, or
using "netiquette," is an important aspect of
practicing ethics.
For instance, do not stand behind someone
and watch them enter a password. This is
called "shoulder surfing" and is frowned upon
by most Internet users as an annoying invasion
of privacy.
Do not post someone's photo on your social
networking site without asking permission.
Do not engage in gossip about others or use
the Internet to do emotional harm.
Do report fraudulent sites, products and
behaviors.
Choose unpredictable passwords that cannot
easily be guessed.
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 USE COMMON SENSE.
 If you see someone being harassed or
stalked on a social networking site, do not
participate in any way. If it becomes
serious, notify authorities.
 Never offer false information or bogus
products online.
 Never do anything intentionally to disrupt or
damage someone's computer system, their
emotions, or their lives.
 Do not use the Internet for any kind of
abuse of others, regardless of whether there
is potential money involved.
 If you know you have received a scam
email, delete it - do not bait the person and
lead them to believe you are falling for it.
 Do not illegally copy or download the
intellectual property of others' that you
know is copyrighted. Do not download
pirated music.
 Do not visit sites that have ill or destructive
intent.
Questions
1. Basic courtesies when using the Internet
include all of the following, except:
- blocking pop up advertisements
2. In regard to netiquette, shoulder surfing
refers to:
- standing behind someone and watching
them enter a password
3. All of the following should be practiced
when using the Internet, except:
- to maintain security, visit only large and
well known sites

LESSON 5 : POST-QUIZ
1. The Internet is a series of jobs:
- true
2. www.doggiecoupon.com is an example of
web address:
- true
3. Ted Stevens played a fundamental role in
developing the Internet:
- true
4. We can now play video games with people
in other continents because of the Internet:
- true
5. Ethernet provided a way to connect local
area networks:
- true

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