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The Internet is changing the profession

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Web Site Scrutiny

With issues of privacy and credibility casting a shadow over the Internet, how do you know if the information you download is accurate and that your personal information will remain private?

George West, director of online services and new media for the American Nurses Association, says the key is the first images the user sees on the site.

"Some health sites are blatantly commercial," he said. "[Users] need to look at how content-rich the site is. They have to examine the message in the first frame. If you see sales, you know you’re at a used car lot."

West adds that most Web sites feature banner advertisements on their home pages, which doesn’t necessarily mean the site is pushing a product. But he said quality sites prominently feature search tools. "Doing a generic search, such as punching in the word nurse, will reveal the quality of a Web site," he said. "If nothing comes up, then you’re better off going somewhere else."

And when it comes to privacy, West says to watch for third-party banner ads—advertisements produced by another company—because they have the capability of tracking a user’s personal information.

Nurses interested in recommending a Web site to a patient should look for some basic things, said June Badal, RN, manager and health educator of the Community Health Resources Center of the Palo Alto Medical Foundation in California.

"Does the article have a date? Is there a reference to the author? What are the author’s credentials? How often is the Web site revised? These are some of the things people should look for," she said, adding that government- or university-based Web sites are often more trustworthy than consumer sites.

R.M. Guthrie, RN, a certified emergency nurse, has a list of sites she recommends to patients as part of the discharge process, but adds that the list has to be approved by her employer. Generally, hospital administrators have played a limited role in monitoring what Web sites staff recommends.

Mark Carraway, RN, founder of NursingNet.org, says employers should be doing more. "Hospitals should come up with guidelines for patients and staff that will train them on how to judge the credibility and privacy of a Web site. Nurses are getting online and seeking information as a way to make patient care better," he said. "Everyone is offering information, but not showing you how to get the right information."

~ Curtis Pond
 

By Curtis Pond
April 3, 2000
Illustration: Comstock/William Jacoby

As a nursing student in Salt Lake City, Linda K. Anderson, RN, had treated a patient with stiff man syndrome, a rare disorder with about 100 documented cases in medical history. As part of her studies, Anderson collected literature on the disorder. A few months later, while visiting a NursingNet chat room on the Internet, she came across a message from a nurse in Louisiana: "We’ve just had a patient diagnosed with stiff man syndrome. Does anyone have any information on this?"

"Can you believe it?" Anderson recalls. "I was able to fax her 35 to 40 pages of research articles within a few hours. The nurse and her patient were so appreciative of the information; it allowed the patient to qualify for disability benefits previously unavailable because the syndrome was so rare and misunderstood."

Linda Lueck, LPN, remembers a time when the Internet saved her in a pinch. "A patient had a form of facial myalgia I knew nothing about," she said. "I went to the Web, punched in the keyword, and found what I was looking for. For very obscure stuff, I use the Internet."

Such incidents are not uncommon and are increasing. The Internet is changing nursing practice and the way nurses interact with their patients. But with more than 100,000 health-related Web sites to choose from, finding the best sources of information isn’t an easy task for nurses or their patients.

Online quackery

"Any idiot can make a professional-looking Internet site that may contain only a tiny bit of factual information and a whole lot of nonfactual information," said Katherine Crowe, a nursing student at Presbyterian Hospital School of Nursing in Charlotte, N.C.

Many nurses can cite examples of how the Internet has helped them when they needed information quickly. Exploring medical sites also can be a handy way for nurses to follow research, take online courses for continuing education credits, or reach out to colleagues.

But nurses also have learned that some Web sites are constantly changing content in an effort to lure more visitors, and that gimmicks and medicine aren’t a good mix.

This online quackery is one reason why nurses are hesitant to refer patients to the Internet to gather information. Even the most Web-savvy nurses are uncomfortable recommending sites because of how quickly the content can change.

"I would feel funny recommending a Web site because I feel like I’m taking responsibility for the content," Lueck said. "In print, you can always see the author’s name by the credentials, but on the Web that’s not always the case."

But the possibility of obtaining inaccurate information has not stopped patients from walking into exam rooms armed with medical advice printed from the Web.

"The Internet is a hypochondriac’s dream," Crowe said. "They think, ‘This person had this, so I must have this,’ even though they have no real way to make a diagnosis. It can take away from the care that they really need."

Christine Amara, FNP, RN, of the Palo Alto Medical Foundation in California, has found that misinformation spreads like a disease over the Internet. "In a span of six months, I had three patients come in thinking gin and white raisins might be a cure for arthritis," she said. "One patient said his dad was really happy with the results. Who wouldn’t feel better after drinking gin?"

Still, a barrage of health-related Internet sites beckon users with promises of a quick diagnosis and remedies for all aches and pains.

Web designers

And while nurses may be considered less Web-savvy than other professionals, there is a growing number of nurses who are addressing the need for better health information and services by designing their own Web sites.

Mark Callaway, RN, started NursingNet.org to help nurses communicate with their peers. Since its inception six years ago, he has seen an increase in the number of nurses who visit his site. "When nurses first discover the Internet, they play with it for about six months before they realize what a powerful tool it can be for treating patients," he said.

Karen Landeck, RN, an AIDS certified registered nurse, co-created HIVliving.org when she saw how difficult it was for HIV patients to access medical information on the Internet.

Landeck’s site uses sophisticated tools to allow patients to chart and graph their T-cells, viral load counts, and weight. Users also can record their medical history and monitor medications they are taking.

"The Internet has put some freedom back into the lives of HIV patients because we can help them keep track of their medications," she said.

Of course, not all health-related Web sites are operated by people with medical credentials. "I tell my patients if they get specific medical advice they are likely looking at a questionable site," said R.M. Guthrie, RN, a certified emergency nurse. "No Web presence can fully assess a condition without subjective and objective input. I’ve not found a computer yet that allows me to feel, smell, touch someone—integral parts of patient assessment."