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Introduction
Telenursing is the utilization of technology to conduct nursing practice and deliver nursing care. The use of technology has changed the delivery medium of nursing care. It has necessitated competencies related to its use to deliver nursing care. Practitioners engaged in telenursing plan, assess, evaluate and intervene the outcomes of nursing care. Technologies commonly used in this practice include computers, Internet, telephones, telemonitoring equipment and digital assessment tools. The term telehealth is used to describe the breadth of health services provided through communication technologies. The paper will explore telenursing as a specialty of telehealth. Advantages and disadvantages for the patient and legal and ethical principles for the nurse of this technology will be explored. These will be used as the basis for decision-making and whether it is a good fit for me.

Advantages and disadvantages for the patient
Advantages
Diagnosis and Consultation
Research evidence shows increased success of diagnosis of diseases. Telenursing has productively been used as a tool for diagnosing acute conditions including leukemia. In addition to diagnosis, nurses can provide educational sessions or other patient education efforts. Telenursing has been shown to be a successful undertaking for nurses in patient education as it offers two-way video and audio technology. Nurses also have benefited from consultations through telehealth tools. Just as in patient education, nurses can use the two-way audio and video technology to consult with other providers. For example, home health nurses may use technology to consult with physicians or specialists regarding a particular patient (Hebda & Czar, 2013).

Monitoring and Surveillance
Adherence and compliance problems are among the various issues that are essential to achieving patient safety. After patients leave a facility, they take responsibility for their own health care at home. Patients may not always follow treatment plans as directed by providers or physician due to various factors, including wrong understanding and miscommunication of the treatment plan, complex treatment schedule that requires additional guidance for the patients to comprehend and the lack of access to facilities required for the treatment plan. This can cause negative outcomes and creates safety issues for the patient. Therefore, these technologies provide nurses with efficient tools of caring for patients. The use of these technologies improves adherence or compliance to the prescribed regimen of care. They also allow effective symptom management. Telenursing is one strategy that nurses currently use to monitor and communicate with patients beyond the acute care setting. It also reduces health care utilization rates for acute care services by reducing visits to the Emergency Department (Hebda & Czar, 2013).

Clinical and Health Services outcomes
Telenursing has been associated with an improvement in clinical and health service outcomes. Technologies have been used in the management of chronic conditions such as chronic obstructive pulmonary disease, congestive heart failure and diabetes. Mortality and morbidity are the outcomes measured for these patients. Telenursing shows better outcomes in these areas. More specifically, telenursing technology has been shown to be an important tool in health intervention. For example, nurses can induce communication to help patient reduce HbA1c levels. They may also offer assistance to patients with traumatic brain injury in their transitioning from the hospital to the community. In addition to these technologies, other devices and applications are also making a difference in patient health care and safety. Essentially, telehealth technologies have replaced traditional care as practical alternatives (Hebda & Czar, 2013).

Reduction of cost
With telephone-based telenursing, there is relatively no technical setup required for interaction or cost to the patient. Many individuals own a cell phone in their home that can be utilized during sessions. Often, nurses limit telephone discussions to education or counseling as there are no visual cues for the telenurse. Technologies offer more and broader potential for telenursing practice. With telehealth technologies, patient access to care is improved; adherence to care increases and providers network with each other improves. Nurses can also closely monitor safety of patients at homes or alternative living facilities. The evident improvement in patient’s outcome has an indirect impact on cost of delivery of services (Hebda & Czar, 2013).

Disadvantages
As the use of technology increases in nursing profession, cost, privacy, autonomy, security and confidentiality issues have emerged. Facilities invest heavily in the security of patient information. These measures call for significant allocation of resources interms of human resources and money. Thus, the use of telecommunication increases the costs of purchase and operations of these equipments. These costs are passed on to consumers of health. Patients meet these costs through charges to health services. Health organizations are also faced with continued threat of as the need for confidentiality and security of patient data remain in the forefront of telenursing. On the other hand, Laws and regulations continue to place requirements for the protection of personal information. Data breach incidents have more impact than government fines, publicized lawsuits, and labor or union disputes. Breaches also have an impact on patients. Another disadvantage of telenursing is the technicality associated with the use of specific technologies. Telehealth technology differs and can range from telephone calls postoperatively to live, interactive voice and video patient education to using a popular video game system and downloadable data devices (Schlachta et al., 2010).

Legal and ethical principles for the nurse
With telenursing, confidentiality remains a concern that must always be addressed. Telehealth sessions must remain confidential interaction between a provider and a patient. Information privacy is the relationship between technology, collection and sharing of data, the public expectation of privacy, and the legal and related issues surrounding them. Privacy concerns exist when there is sensitive information or personally identifiable information that might be of interest to other parties. Maintenance of information privacy is a risk management issue for any organization (Greenberg, 2000).

The security risks increase with the extraordinary utilization of internet services due to the advent of cloud computing. Hence, training is a necessary component of an organization’s security practices. Hospitals are forced to instead focus on making information system users intrinsic to the security processes through awareness, training and information rather than focusing purely on implementing technologies. Technologies such as firewalls, intrusion detection system, intrusion prevention system, antivirus content filtering and encryption are commonly implemented to reduce the risk of cyber attacks. While such technologies are widely available to help hospitals mitigate the risk of intentional and unintentional threats, their effectiveness is limited if security threats and risks fail to focus on user intrinsic components of the organization’s ICT system. Computer dependency, false sense of entitlement and ethical flexibility increases the security risk to the disadvantage of the medical facility. This exposes health facilities to risks of security and data breach. In the long run, this may compromise patients’ safety (Greenberg, 2000).

Conclusion and Recommendations
Innovative technologies are employed in nursing practice to improve patient care and thus improve safety. Technologies range from the ubiquitous computing to simple telephone and only promise more in the future. The research on telenursing practice shows significant benefits related to consultations, diagnosis surveillance and monitoring of patients, technology advancement and clinical and health services outcomes. These areas have considerable patient safety concerns. On the other hand, special concerns in relation to patient safety have emerged with this method of health care delivery. As the use of technology increases in nursing profession, cost, privacy, autonomy, security and confidentiality issues have emerged. A job in telenursing is in my future. The pro of this decision is that I will get to work in a field that has shown high potential of growth in the future. The con of this decision is that ability to safeguard data is important as personal information increasingly continues to be collected.

Plan

Training is an essential activity to a programmer as it gets one equipped with the required skills and good knowledge of acquiring competence in the field of programming. I got my iteration of training into several tiers. I began with preparation for the upcoming training. The preparation defined the first division of my activities during the implementation of the training program. The process took a duration of three days where I got involved in reviewing the concepts related to.NET technology. Alongside that, I had to have a good understanding of what it entails a.NET programmer to possess, so that to get acknowledged according to his/her competency.

The second phase of the iteration was the development of the training which was outlined in five typical stages. I began with defining the needs that had purposed me to conduct the training on.NET programming. The needs were the major inputs for me to determine the training objectives easily. The training objectives were defined to enable me to have the good knowledge of what I am supposed to gather during the training session. And this was the second stage of the training program

The follow –up sub-session of the training session was the individual assessment of what I have before getting into the actual training process. This phase was once more a session that was conducted to outline the aspects I understand about the.NET programming career. The activities prepared me well for the actual training. After that, I got to the fourth stage where I was trained of all that entails.NET programming. I finalized the session by measuring or rather assessing myself over the knowledge acquired. The training process took the duration of seven days.

Action
The training was undertaken with the aim of getting me with the knowledge and good understanding of.NET programming. I began the implementation of the iteration by undertaking a preparation towards the actual training. I went to the nearby cyber café in the city center where I had to surf the internet for the.NET programming tutorials. In supplement to that, I consulted the.NET programmers who provided the guideline on the things that I have to make sure that I possess to get regarded as a competent.NET programmer.

I moved to the actual training session. During the program, I outlined the need for the training and it was revealed to be a guideline to getting the knowledge.

I defined the objectives of the training process. These objectives were obtained from a brainstorming session where I analyzed the information from the.NET programming experts and the research undertaken. I extended my assessment through outlining what I know and understand about.NET programming. The activities enabled a good preparation for train session. I got into the training processes where I began with understanding the.NET technology concepts. I moved to outlining and studying the tools applied by the.NET programmers. Subsequently, I got trained in the skills that I have to possess as a.NET programmer as well as the roles, duties and responsibilities that are undertaken by a.NET programmer.

After finishing the training, I went ahead to have an assessment of what I had learned. The trainers gave me some testing scenarios where I had to respond to an approach as a.NET programmer. The training had equipped me with the mechanism of coding and approaching different situations. The assessment defined the end of my training session that was concentrated on the programming mechanisms as far as.NET technology is concerned. Alongside that, I moved to undertake the personal practice of the knowledge acquired.

Observation
The training was educative as I acquired very useful knowledge that I believe can get me grow well in my career. The prior action of training preparation got me to discover that the organization had a well-organized archive that had good guiding materials to trainees. The materials obtained outlined the basics and details of expectations of the.NET programmer. The.NET programming had a major concentrate on designing applications that are internetworked oriented. The applications were focused on their accessibility to the network, and it meant that the skills required must have to do with internetworking.

The training process began with the appreciation of the.NET technology where the trainers described the Java technology, the ASP. NET, XML and extended to the.Net programming languages such as the Java language, Javascript, PHP, CSS, HTML and others. It was a very educative session. They coding procedures were also described and they instead on having a pseudo codes and flowcharts to easy the task of coding as they describe the modules and utilities of the application.

The desirable skills that a.The net programmer should possess included the database working skills, good knowledge of design patterns, programming analytical skills, strong ability with object oriented programming (Wallen, 2005), skill sin SQL server. Good skills with scripting languages such as the HTML, DHTML, CSS, XML, JavaScript, VBscript, Ajax and others. In-depth knowledge in software development lifecycle. Also, good analyzing, communication, presentation, reporting and interpersonal skills are desirable.

A.NET programmer has some distinctive roles, duties and responsibilities. They got defined and implemented according to the competency of the candidate. However, the main responsibility and duty are to develop applications, implement and support the software and the web pages.

Reflection
The.NET programmer training was a good mechanism for getting me equipped with the required knowledge that can get me determined in undertaking the responsibilities and the overall growth of application developing a career (Mattwriter, 2015). The entire training process got associated with some challenges such as the difficulty in outlining some aspects during the practical session. The theory part was concentrated much than the practical, and this got me some difficulties in responding to the scenarios assigned. However, I appreciate the advice of Mr. Kim, the company.NET senior programmer who requested me to have a good study and understanding of aspects relating to the topics of study.

The definition of the training objective process was easily handled as I began with describing the basic need for the training. The training needs to be described the objectives. The assessment of my understanding was also a good and enjoying session that got me enough courage in handling aspects as well as other technical utilities. The IT department ensured the availability of development and practice tools. The tools made the activities much friendly and easily handled.

In my opinion, the entire process was successful by it was my wish that the senior and professional persons in the developing section were our trainers. This could have got the process more friendlily and much could have been gathered as the world is dynamic and diversifying in all directions. The training was not enough, and I had to interact with the experts in the field to have a good understanding of the required skills.

Introduction
SDLC is a conceptual model integrated into the system development process that consists of a series of phases to plan, analyze, design, implement and support an information system.

Seven-Step SDLC Model
Planning
Planning is the first phase of the seven-step SDLC model and is essential in determining the necessity of a proposed system so as to achieve efficiently and effectively the organization’s strategic goals. Planning phase entails of determining the project scope and the IT specialists and analysts define the location for the execution of the system functions. (Ahituv, Neumann & Zviran 2002)

System analysis
System analysis involves the IT specialists and analysts, and the end-users to work together to identify the need for change or the source of the problem. (Babers, 2015) The development team that got identified in the planning phase works together with the system users in modeling and the definition of the business process in detail.

Design
This phase involves the determination of the information requirements of the new system. (Shim, 2000) Simply the description of the necessary features, specifications, and operations of the new system get done in detail.

Development
The development phase involves the transformation of the design documents into the actual system. (Ruparelia 2010) System designers build and program information technologies and information system projects at this stage.

Testing
The purpose of integration and systems testing is to determine whether the new system meets the set of business objectives set out in the planning phase and to check for bugs, errors, and interoperability. The typical approach to testing of the design is to move from an individual element to the view of the entire system. (Norton, & McGraw-Hill, 2002)

Implementation
The implementation phase entails of the distribution of the new system to all the organization’s personnel and installation in the various departments. After installation in the departments, the workers get training on the operation of the new system. (Crnkovic, & Larsson, 2002) They also receive documentation such as system manuals and user guide to instruct them on the use of the system.

Operation and Maintenance

The final phase of the seven-step SDLC model involves the evaluation and maintenance of the new system. During the systems support and security phase, the IT staff is responsible for the maintenance, improvement, and protection of the new system. Maintenance involves correction of errors and adaptation to the changes of the environment. Improvement involves the alterations to provide new features and benefits while protection includes the safeguarding the new system from internal and external threats. (Shelly, & Rosenblatt, 2011)

Four-step SDLC Model
Definition Phase
The definition phase is the initial phase of the four-step model and consists of preliminary analysis, feasibility study, information analysis, and system design. The preliminary analysis gets used to determine the problem that requires a new system or system modification in an organization. The feasibility study also determines the necessity of the project and draws a preliminary plan on how it should proceed if justified. The information analysis consists of an analysis of the present system, the determination of the information requirements and the conceptual design of the proposed system. The system design entails of developing a program and procedure specifications that would get used by IT specialists and developers of the proposed system.

Construction Phase
The construction phase comprises of the programming, procedure and development. (Ruparelia, 2010) The programming activity involves the coding and testing of the computer programs on the computer system. The procedure and development include writing and the testing of procedures for various users and operators. The programming results in computer instructions whereas the procedure and development results in instructions meant to guide the people involved in the proposed system.

Implementation Phase
The third phase is the implementation phase that involves conversion in Information systems technologies. The implementation phase involves the training of the workers that will operate and use the new system, breaking the system in, and finally acceptance testing by the end-user. (Li, 1990)

Operation and Testing Phase

The last step of the four-step model comprises of operation and maintenance, post audit, and termination. The new system at this stage operates as a production facility, processing and producing information, and at the same time undergoing maintenance. Throughout the functioning of the system, periodic post audit review forms control points. The purpose of the reviews is to indicate when the operation cycle of the current system approaches the end, and a new cycle life get indicated. The current system gets terminated when its operation in the organization is not worthwhile. (Ahituv, Neumann & Zviran 2002)

Compare and Contrast the seven-step and four-step SDLC Models
The seven-step and four-step models are systematic processes used in system development by organizations and businesses. They also have closely related processes though with different activities at each phase. Both processes are used to produce new systems that assist in corporate transactions, the connection of businesses and office data, and also support users in the architecture of strategy. The life cycle of the two models starts at initiation and ends after termination. (Isaias & Issa 2015) However, there are several differences between the two SDLC models. The seven-step model is highly preferable and produces high-quality systems because it entails of more stages that allow the solving of complex problems, end-user involvement, and flexibility. Unlike the four-step SDLC model, the seven-step SDLC model consumes more time and resources in building, implementation, and construction of information systems. The suitability of the seven-step SDLC model is handling complex problems that require more concentration. The four-step SDLC model gets suited for the less complex issues that get needed in a short period.