Literature Evaluation Table Student Name: Summary of Clinical Issue (200-250 words): PICOT Question: Criteria Article 1 Article 2 Article 3 APA-Formatted Article Citation with Permalink How Does the Article Relate to the PICOT Question? Quantitative, Qualitative (How do you know?) Purpose Statement Research Question Outcome Setting (Where did the study take place?) Sample Method Key Findings of the Study Recommendations of the Researcher Criteria Article 4 Article 5 Article 6 APA-Formatted Article Citation with Permalink How Does the Article Relate to the PICOT Question? Quantitative, Qualitative (How do you know?) Purpose Statement Research Question Outcome Setting (Where did the study take place?) Sample Method Key Findings of the Study Recommendations of the Researcher © 2019. Grand Canyon University. All Rights Reserved. 2 C9-1 CASE STUDY 9 ST. LUKE'S HEALTH CARE SYSTEM Hospitals have been some of the earliest adopters of wireless local area networks (WLANs). The clinician user population is typically mobile and spread out across a number of buildings, with a need to enter and access data in real time. St. Luke's Episcopal Health System in Houston, Texas (www.stlukestexas.com) is a good example of a hospital that has made effective use wireless technologies to streamline clinical work processes. Their wireless network is distributed throughout several hospital buildings and is used in many different applications. The majority of the St. Luke’s staff uses wireless devices to access data in real-time, 24 hours a day. Examples include the following: • Diagnosing patients and charting their progress: Doctors and nurses use wireless laptops and tablet PCs to track and chart patient care data. • Prescriptions: Medications are dispensed from a cart that is wheeled from room to room. Clinician uses a wireless scanner to scan the patient's ID bracelet. If a prescription order has been changed or cancelled, the clinician will know immediately because the mobile device displays current patient data. http://www.stlukestexas.com/ C9-2 • Critical care units: These areas use the WLAN because running hard wires would mean moving ceiling panels. The dust and microbes that such work stirs up would pose a threat to patients. • Case management: The case managers in the Utilization Management Department use the WLAN to document patient reviews, insurance calls/authorization information, and denial information. The wireless session enables real time access to information that ensures the correct level of care for a patient and/or timely discharge. • Blood management: Blood management is a complex process that involves monitoring both patients and blood products during all stages of a treatment process. To ensure that blood products and patients are matched correctly, St. Luke’s uses a wireless bar code sca.

1. Literature Evaluation Table
Student Name:
Summary of Clinical Issue (200-250 words):
PICOT Question:
Criteria
Article 1
Article 2
Article 3
APA-Formatted Article Citation with Permalink
How Does the Article Relate to the PICOT Question?
Quantitative, Qualitative (How do you know?)
Purpose Statement
Research Question
Outcome

2. Setting
(Where did the study take place?)
Sample
Method
Key Findings of the Study
Recommendations of the Researcher
Criteria
Article 4
Article 5
Article 6
APA-Formatted Article Citation with Permalink
How Does the Article Relate to the PICOT Question?

3. Quantitative, Qualitative (How do you know?)
Purpose Statement
Research Question
Outcome
Setting
(Where did the study take place?)
Sample
Method
Key Findings of the Study
Recommendations of the Researcher

4. © 2019. Grand Canyon University. All Rights Reserved.
2
C9-1
CASE STUDY 9
ST. LUKE'S HEALTH CARE SYSTEM
Hospitals have been some of the earliest adopters of wireless
local area
networks (WLANs). The clinician user population is typically
mobile and
spread out across a number of buildings, with a need to enter
and access
data in real time. St. Luke's Episcopal Health System in
Houston, Texas
(www.stlukestexas.com) is a good example of a hospital that
has made
effective use wireless technologies to streamline clinical work

5. processes.
Their wireless network is distributed throughout several
hospital buildings
and is used in many different applications. The majority of the
St. Luke’s
staff uses wireless devices to access data in real-time, 24 hours
a day.
Examples include the following:
• Diagnosing patients and charting their progress: Doctors and
nurses use wireless laptops and tablet PCs to track and chart
patient
care data.
• Prescriptions: Medications are dispensed from a cart that is
wheeled
from room to room. Clinician uses a wireless scanner to scan
the
patient's ID bracelet. If a prescription order has been changed or
cancelled, the clinician will know immediately because the
mobile device
displays current patient data.
http://www.stlukestexas.com/

6. C9-2
• Critical care units: These areas use the WLAN because
running hard
wires would mean moving ceiling panels. The dust and microbes
that
such work stirs up would pose a threat to patients.
• Case management: The case managers in the Utilization
Management
Department use the WLAN to document patient reviews,
insurance
calls/authorization information, and denial information. The
wireless
session enables real time access to information that ensures the
correct
level of care for a patient and/or timely discharge.
• Blood management: Blood management is a complex process
that
involves monitoring both patients and blood products during all
stages of
a treatment process. To ensure that blood products and patients
are
matched correctly, St. Luke’s uses a wireless bar code scanning
process

7. that involves scanning both patient and blood product bar codes
during
the infusion process. This enables clinicians to confirm patient
and blood
product identification before proceeding with treatment.
• Nutrition and diet: Dietary service representatives collect
patient
menus at each nursing unit and enter them as they go. This
allows more
menus to be submitted before the cutoff time, giving more
patients
more choice. The dietitian can also see current patient
information, such
as supplement or tube feeding data, and view what the patient
actually
received for a certain meal.
• Mobile x-ray and neurologic units: St. Luke’s has
implemented the
wireless network infrastructure necessary to enable doctors and
clinicians to use mobile x-ray and neurologic scanning units.
This makes
it possible to take x-rays or to perform neurological studies in
patient

8. rooms. This minimizes the need to schedule patients for
neurology or
radiology lab visits. The mobile units also enable equipment to
be
brought to the bedside of patients that cannot be easily moved.
The
wireless neurology and x-ray units have also helped to reduce
the time
between diagnosis and the beginning patient care.
C9-3
Original WLAN
St. Luke's first WLAN was deployed in January 1998 and made
the hospital
an early pioneer in wireless health care applications. St. Luke’s
first wireless
LAN was implemented in a single building using access points
(APs) made by
Proxim (www.proxim.com).
A principal goal of this initial installation was to improve
efficiency.
However, sometimes the WLAN had the opposite effect. The

9. main problem
was dropped connections. As a user moved about the building,
there was a
tendency for the WLAN to drop the connection rather than
performing the
desired handoff to another access point. As a result, a user had
to
reestablish the connection, log into the application again, and
reenter
whatever data might have been lost.
There were physical problems as well. The walls in part of the
building
were constructed around chicken wire, which interfered with
radio waves.
Some patients' rooms were located in pockets with weak radio
signals. For
these rooms, a nurse or doctor would sometimes lose a
connection and have
to step out into the hallway to reconnect. Microwave ovens in
the
kitchenettes on each floor were also a source of interference.
Finally, as more users were added to the system, the Proxim
APs, with a

10. capacity of 1.2 Mbps, became increasingly inadequate, causing
ongoing
performance issues.
Enhanced LAN
To overcome the problems with their original WLAN and reap
the potential
benefits listed earlier in this case study, St. Luke's made two
changes
[CONR03, NETM03]. First, the hospital phased out the Proxim
APs and
replaced them with Cisco Aironet (www.cisco.com) APs. The
Cisco APs, using
IEEE 802.11b, operated at 11 Mbps. Also, the Cisco APs used
direct
C9-4
sequence spread spectrum (DSSS), which is more reliable than
the
frequency-hopping technique used in the Proxim APs.
The second measure taken by St Luke's was to acquire a
software

11. solution from NetMotion Wireless (netmotionwireless.com)
called Mobility.
The basic layout of the Mobility solution is shown in Figure
C9.1. Mobility
software is installed in each wireless client device (typically a
laptop,
handheld, or tablet PC) and in two NetMotion servers whose
task is to
maintain connections. The two servers provide a backup
capability in case
C9-5
one server fails. The Mobility software maintains the state of an
application
even if a wireless device moves out of range, experiences
interference, or
switches to standby mode. When a user comes back into range
or switches
into active mode, the user's application resumes where it left
off.
In essence, Mobility works as follows: Upon connecting, each
Mobility
client is assigned a virtual IP address by the Mobility server on

12. the wired
network. The Mobility server manages network traffic on behalf
of the client,
intercepting packets destined for the client's virtual address and
forwarding
them to the client's current POP (point of presence) address.
While the POP
address may change when the device moves to a different
subnet, from one
coverage area to another, or even from one network to another,
the virtual
address remains constant while any connections are active.
Thus, the
Mobility server is a proxy device inserted between a client
device and an
application server.
Enhancing WLAN Security
In 2007, St. Luke’s upgraded to Mobility XE mobile VPN
solution [NETM07].
This migration was undertaken to enhance security and
compliance with
HIPPA data transmission and privacy requirements. Mobility
XE server

13. software was deployed in the IT department’s data center and
client
software was installed on laptops, handheld devices, and tablet
PCs.
With Mobility XE running on both clients and servers, all
transmitted
data passed between them is encrypted using AES (Advanced
Encryption
Standard) 128-bit encryption. Mobility XE also serves as an
additional
firewall; devices that are not recognized by the Mobility XE
server are not
allowed to access the network. This arrangement helped St.
Luke’s achieve
its IT goal of having encryption for all wireless data
communications.
Mobility XE also enables the IT department to centrally
manage all
wireless devices used by clinicians. This allows them to monitor
the
C9-6
applications currently being used by any device or user, the
amount of data

14. being transmitted, and even the remaining battery life of the
wireless device.
If a Mobility XE device is stolen or lost, it can be immediately
quarantined by
network managers.
IT executives at St. Luke’s view wireless networking as key
lever in their
quest to increase clinician productivity and improved patient
care. Mobile
EKG units have been deployed bringing the total of wireless
devices in use to
nearly a 1,000.
Discussion Questions
1. Visit the NetMotion Web site (www.netmotionwireless.com)
and access
and read other Mobility XE success stories. Discuss the patterns
that
can be observed in the benefits that Mobility XE users have
realized via
its deployment and use.
2. Do some Internet research on the security implications of
HIPPA
requirements for hospital networks. Discuss the major types of

15. security mechanisms that must be in place to ensure hospital
compliance with HIPPA requirements.
3. Do some Internet research on the use of VLANs in hospitals.
Summarize the benefits of using VLANs in hospitals and
identify
examples of how St. Luke’s could further enhance its wireless
network
by implementing VLANs.
Sources
[CONR03] Conery-Murray, A. “Hospital Cures Wireless LAN
of Dropped
Connections.” Network Magazine, January 2003.
[NETM03] Netmotion Wireless, Inc. “NetMotion Mobility:
Curing the
Wireless LAN at St. Luke’s Episcopal Hospital. Case Study,
2003.
Netmotionwireless.com/resources/case_studies.aspx.
[NETM07] Netmotion Wireless, Inc. “St. Luke’s Episcopal
Health System: A
Case Study in Healthcare Productivity.” 2007. Retrieved online
at:
http://www.netmotionwireless.com/st-lukes-case-study.aspx
http://www.netmotionwireless.com/
http://www.netmotionwireless.com/st-lukes-case-
study.aspxCASE STUDY 9Original WLANEnhanced
LANEnhancing WLAN SecurityDiscussion QuestionsSources
Rubic_Print_FormatCourse CodeClass CodeAssignment

16. TitleTotal PointsNRS-433VNRS-433V-O501PICOT Question
and Literature Search120.0CriteriaPercentage1: Unsatisfactory
(0.00%)2: Less Than Satisfactory (75.00%)3: Satisfactory
(83.00%)4: Good (94.00%)5: Excellent
(100.00%)CommentsPoints EarnedContent80.0%Summary of
Clinical Issue5.0%A clinical issue is omitted or is not relevant
to nursing practice.A clinical issue is partially presented. It is
unclear how the clinical issue relates to nursing practice.
Significant aspects are missing, or there are inaccuracies.A
clinical issue is summarized. The issue generally relates to
nursing practice.A clinical issue is presented. The issue relates
to nursing practice. Minor detail is needed for clarity.A clinical
issue is thoroughly described. The issue relates to nursing
practice.PICOT Question10.0%A PICOT question is not
included.A PICOT question is provided but is incomplete. The
PICOT question format is used incorrectly.A PICOT question is
provided. The PICOT question format is generally applied.
Some information or revision is needed.A PICOT question is
provided. The PICOT question format is applied accurately.
Some detail is need for support or clarity.A PICOT question is
clearly presented. The PICOT question format is applied
accurately and presents an answerable and researchable
question.APA-Formatted Article Citations With
Permalinks5.0%Article citations and permalinks are
omitted.Article citations and permalinks are presented. There
are significant errors in the APA format. One or more links do
not lead to the intended article.Article citations and permalinks
are presented. Article citations are presented in APA format, but
there are errors.Article citations and permalinks are presented.
Article citations are presented in APA format. There are minor
errors.Article citations and permalinks are presented. Article
citations are accurately presented in APA format.Relationship
of Articles to the PICOT Question10.0%Three or more articles
do not relate to the PICOT question.At least two articles do not
relate to the PICOT question. The remaining articles provide a
small degree of support for the PICOT question. Different

17. articles are needed to provide better support for the PICOT
question.At least one articles does not relate to the PICOT
question. The remaining articles provide general support for the
PICOT question. One or two different articles are needed to
provide better support for the PICOT question.Each article
relates to the PICOT question. The articles provide support for
the PICOT question.Each article clearly relates to the PICOT
question. The articles provide strong support for the PICOT
question.Quantitative and Qualitative Articles10.0%Fewer than
six research articles are presented. Four or more articles do not
meet the assignment criteria for a quantitative, qualitative,Six
research articles are presented. Three articles do not meet the
assignment criteria for a quantitative, qualitativeSix research
articles are presented. Two articles do not meet the assignment
criteria for a quantitative, qualitative, or mixed study. Some
ability to identify the type of research design used in a study is
demonstrated.Six research articles are presented. One article
does not meet the assignment criteria for a quantitative,
qualitative, or mixed study. A general ability to identify the
type of research design used in a study is demonstrated.Six
research articles are presented. Each article meets the
assignment criteria for a quantitative, qualitative, or mixed
study. An ability to identify the different types of research
design used in a study is consistently demonstrated.Purpose
Statements5.0%Purpose statements are omitted or are
incomplete overall.Purpose statements are referenced but are
incomplete in some areas.Purpose statements are presented.
There are minor omissions in some areas, or major
inaccuracies.Purpose statements summarized. There are some
minor inaccuracies in some.Purpose statements are accurate and
clearly summarized.Research Questions5.0%Research questions
are omitted or are incomplete overall.Research question is
presented for each article. The research question has been
misidentified or misinterpreted for at least two of the articles.
Additional information is needed to fully illustrate the research
question for several of the articles.Research questions are

18. presented. The research question has been misidentified or
misinterpreted for one of the articles. Some detail is needed to
fully illustrate the research question for one or two
articles.Research questions are presented. Minor detail is
needed for clarity in some areas.Research questions are accurate
and capture the fundamental question posed by the researchers
in each study.Outcome5.0%Research outcomes are omitted or
are incomplete overall.Research outcome is presented for each
article. The research outcome has been misidentified or
misinterpreted for at least two of the articles. Additional
information is needed to fully illustrate the research outcomes
for several of the articles.Research outcomes are presented. The
research outcome has been misidentified or misinterpreted for
one of the articles. Some detail is needed to fully illustrate the
research outcomes for one or two articles.Research outcomes
are presented. Minor detail is needed for clarity in some
areas.Research outcomes are accurate and described in detail for
each article.Setting5.0%The setting is omitted for one or more
of the articles. The setting described for three or more articles
is inaccurate or incomplete.The setting is indicated for each
article. The setting described for two of the articles is
inaccurate or incomplete.The setting is indicated for each
article. The setting described for one article is inaccurate or
incomplete.The setting is indicated for each article. Some detail
is needed to fully illustrate the physical, social, or cultural site
in which the researcher conducted the study.The setting in
which the researcher conducted the study is detailed and
accurate for each article.Sample5.0%The sample is omitted for
one or more of the articles. The sample described for three or
more articles is inaccurate or incomplete.The sample is
indicated for each article. The sample described for at least two
of the articles is inaccurate or incomplete.The sample is
indicated for each article. The sample described for one article
is inaccurate or incomplete.The sample is indicated for each
article. Minor detail is needed for accuracy.The sample is
indicated and accurate for each article.Method5.0%Method of

19. study for one or more articles is omitted. Overall, the methods
of study are incomplete.The method of study is partially
presented for each article. Key information is consistently
omitted. Overall, the methods reported contain inaccuracies.The
method of study for each article is presented. Some key aspects
are missing for one or two articles, or there are some
inaccuracies for the methods reported.A discussion on the
method of study for each article is presented.A thorough
discussion on the method of study for each article is
presented.Key Findings of the Study5.0%Discussion of study
results, including findings and implications for nursing practice,
is incomplete.A summary of the study results includes findings
and implications for nursing practice but lacks relevant details
and explanation. There are some omissions or
inaccuracies.Discussion of study results, including findings and
implications for nursing practice, is generally presented for
each article. Overall, the discussion includes some relevant
details and explanation.Discussion of study results, including
findings and implications for nursing practice, is complete and
includes relevant details and explanation.Discussion of study
results, including findings and implications for nursing practice,
is thorough with relevant details and extensive
explanation.Recommendations of the Researcher5.0%Researcher
recommendations are omitted for one or more of the articles.
The recommendations described for three or more articles are
inaccurate or incomplete.Researcher recommendations are
indicated for each article. The researcher recommendations
described for two of the articles are inaccurate or
incomplete.Researcher recommendations for each article are
presented. Researcher recommendations described for one
article are inaccurate or incomplete.Researcher
recommendations for each article are accurately presented.
Minor detail is needed for accuracy.Researcher
recommendations accurate are thoroughly described for each
article.Organization and Effectiveness10.0%Mechanics of
Writing (includes spelling, punctuation, grammar, language

20. use)10.0%Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.Frequent and repetitive
mechanical errors distract the reader. Inconsistencies in
language choice (register), sentence structure, or word choice
are present.Some mechanical errors or typos are present, but
they are not overly distracting to the reader. Correct sentence
structure and audience-appropriate language are used.Prose is
largely free of mechanical errors, although a few may be
present. A variety of sentence structures and effective figures of
speech are used.Writer is clearly in command of standard,
written, academic English.Format10.0%Documentation of
Sources (citations, footnotes, references, bibliography, etc., as
appropriate to assignment and style)10.0%Sources are not
documented.Documentation of sources is inconsistent or
incorrect, as appropriate to assignment and style, with numerous
formatting errors.Sources are documented, as appropriate to
assignment and style, although some formatting errors may be
present.Sources are documented, as appropriate to assignment
and style, and format is mostly correct.Sources are completely
and correctly documented, as appropriate to assignment and
style, and format is free of error.Total Weightage100%