IT and Healthcare: Key Concepts and Definitions, Exams of Nursing

Download IT and Healthcare: Key Concepts and Definitions and more Exams Nursing in PDF only on Docsity! Nurs 1400 final exam (265 Questions and Answers) Antivirus software - Correct answer Programs to detect and remove computer viruses Audit Trail - Correct answer Security system report that tracks a user's access, deletion or modification of data and the time at which each event happened. This includes user login, file access, other various activities, and whether any actual or attempted security violations occurred Authentication - Correct answer The verification of the identity of a person or process for purposes of accessing medical records, whether they are stored on paper or digitally. In the case of computerized systems, this typically involves entering a combination of account numbers and passwords or other personal information so that the identity of the person using the computer is verified and access can be enabled Biometrics - Correct answer automated methods of recognizing a person based on a physiological characteristic such as fingerprints, retina, voice, etc. Confidentiality - Correct answer ensure that information is not disclosed Consent - Correct answer process by which an individual authorizes healthcare personnel to process his or her information based on an informed understanding of how this information will be used. Cookie - Correct answer a small piece of information about you copyright - Correct answer exclusive legal right to reproduce De-identified data - Correct answer Health information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual is de-identified. Health information is considered de-identified (1) if stripped of all of the 18 direct identifiers defined under HIPAA (see the full list), or (2) if an expert in statistical and scientific method determines that there is a very small risk that the information could be used alone or in combination with other information to identify an individual. HIPAA does not apply to de-identified data Electronic protected health information (EPHI) - Correct answer All individually identifiable health information that is created, maintained or transmitted electronically Firewall - Correct answer type of gateway designed to protect private network resources from outside hackers, network damage, and theft or misuse of information Health Information - Correct answer Patient information collected by a health plan, health care provider, public health authority, employer, healthcare clearinghouse or other organization that falls under covered entity Healthcare Insurance Portability and Accountability act (HIPAA) - Correct answer Developed in 1996, the acronym HIPAA stands for Healthcare Insurance Portability and Accountability Act. Initially created to help the public with insurance portability, they eventually built administrative simplifications that involved electronic, medical record technology and other components. In addition, they built a series of privacy tools to protect healthcare data. Health Information Technology for Economic and Clinical Health (HITECH) - Correct answer In 2009, as part of the American Recovery and Reinvestment Act (ARRA), there was an act within that called HITECH, short for The Health Information Technology What happens when teams communicate effectively and back each other up? - Correct answer Dramatic reduce the consequences of human error What are the 4 teachable-learnable skills of TeamSTEPPS? - Correct answer Leadership, situation monitoring, mutual support, and communication Team structure - Correct answer delineates fundamentals such as team size, membership, leadership, composition, identification and distribution Leadership - Correct answer ability to coordinate activities of team members by ensuring team actions are understood, changes in info are shared, and team members have necessary resources Situation monitoring - Correct answer process of actively scanning and assessing situational elements to gain info, understanding, and maintain awareness to support functioning of team Mutual support - Correct answer ability to anticipate and support other team members' needs through accurate knowledge about their responsibilities and workload Communication - Correct answer process by which info is clearly and accurately exchanged among team members Multi-Team system for patient care pyramid (bottom to top) - Correct answer (bottom) Administration, coordinating team and ancillary & support services, core team/contingency teams, patient (top) What are the 3 team events? - Correct answer Planning (brief), problem solving (huddle), and process improvement (debrief) What occurs during a brief? - Correct answer Short session prior to start to discuss team formation; assign essential roles; establish expectations and climate; anticipate outcome and likely contingencies What occurs during a huddle? - Correct answer Ad hoc planning to reestablish situation awareness; reinforcing plans already in place; assessing need to adjust the plan What occurs during a debrief? - Correct answer Informal info exchange session designed to improve team performance and effectiveness; after action review What makes an effective team leader? - Correct answer 1) organize the team 2) articulate clear goals 3) make decisions through collective input of members 4) empower members to speak up & challenge, when appropriate 5) actively promote & facilitate good teamwork 6) skillful at conflict resolution What's on the brief checklist? - Correct answer 1) who is on the team? 2) all members understand and agree upon goals? 3) roles and responsibilities are understood? 4) what is our plan of care? 5) staff and provider's availability throughout the shift? 6) workload among the team members? 7) availability of resources? What's on the debrief checklist? - Correct answer 1) communication clear? 2) roles and responsibilities understood? 3) situation awareness maintained? 4) workload distribution equitable? 5) task assistance requested or offered? 6) were errors made or avoided? availability of resources? 7) what went well, what should change, what should improve? What is situation monitoring? - Correct answer The process of continually scanning and assessing what's going on around you to maintain situation awareness. "Knowing what's going on around you." What is cross monitoring? - Correct answer An error reduction strategy What are the components of cross monitoring? - Correct answer 1) monitoring actions of other team members 2) providing safety net within the team 3) ensuring mistakes or oversights are caught quickly and easily 4) "watching each other's back" What is STEP used for? - Correct answer A tool for monitoring situations in the delivery of health care What does STEP stand for? - Correct answer Status of patient Team members Environment Progress toward goal What are the components for "Status of patient?" - Correct answer Patient hx Vital signs Meds PE Plan of care Psychosocial What are the components for "team members?" - Correct answer Fatigue Workload Task Performance Skill Stress What are the components of "environment?" - Correct answer Facility info Administrative info Human resources Triage acuity Equipment What are the components of "progress toward the goal?" - Correct answer Status of Team's Patient(s) Established goals of team Tasks/actions of team Plan still appropriate What does the I'M SAFE checklist stand for? - Correct answer I = illness M = medication S = stress A = alcohol and drugs F = fatigue E = eating and elimination What is iSBAR? - Correct answer -a technique used for communicating critical information that requires immediate attention and action concerning a pt's condition What does the S in iSBAR stand for? - Correct answer -what is going on with the pt? What does the B in iSBAR stand for? - Correct answer -what is the clinical background or context? What does the A in iSBAR stand for? - Correct answer -what do i think the problem is? What does the R in iSBAR stand for? - Correct answer -what would i do to correct it? What is call out? - Correct answer -strategy used to communicate important information What does call out do? - Correct answer -informs all team members during emergent situations -helps team members anticipate next steps -important to direct responsibility to a specific individual responsible for carrying out the task What is check back? - Correct answer -process of employing closed loop communication to ensure that info conveyed by the sender is understood by the receiver as intended What are the steps for check back? - Correct answer 1. sender initiates the message 2. receiver accepts the message and provide feedback 3. sender double checks to ensure that the message was received What is hand-off? - Correct answer -the transfer of information during transitions in care across the continuum; to include an opportunity to ask questions, clarify, and confirm What does I PASS THE BATON stand for? - Correct answer Introduction Patient Assessment Situation Safety Concerns Background Actions Timing Ownership Next Adverse Defice Effect - Correct answer an adverse event related to the use of an investigational medical device. NOTE 1: This definition includes adverse events resulting from insufficient or inadequate instructions for use, deployment, implantation, installation, or operation, or any malfunction of the investigational medical device. NOTE 2: This definition includes any event resulting from use error or from intentional misuse of the investigational medical device Adverse Event - Correct answer is either a malfunction or a deterioration in the characteristics or performance of a sold medical device [including accessory(s) and labelling] or use error, which either has caused or could have caused or contributed to death, or serious injury to health of patients or other persons. CAPA - Correct answer (Corrective and Preventative Action) action taken by the manufacturer to correct an issue, and/or to prevent such an issue from recurring. FDA's Center for Devices and Radiological Health (CDRH) - Correct answer is responsible for regulating firms who manufacture, repackage, relabel, and/or import medical devices sold in the United States. Design Error - Correct answer is a mistake made during the design phase of the production process. Specifications are not appropriate for the conditions or environment in which the device is to be used. Device Design - Correct answer the combination of details or features of a medical device.Another error concerned noninvasive blood pressure (BP) tubing that was mistakenly connected to I.V. tubing. The patient, who was being monitored in theED with a noninvasive automatic BP device, also had an I.V. catheter. The BP cuff tubing was disconnected when the patient went to the bathroom, and it was reconnected upon his return. The patient's wife found the patient "blue from the neck up." Despite resuscitation efforts, he died. The BP cuff tubing had been connected to the I.V. catheter and had delivered about 15 mL of air. An autopsy confirmed a fatal air embolus. Environmental Error - Correct answer an error in calculations that are being a part of observations due to environment. A safety issue was reported when newly purchased ventilators were placed into service in a trauma ICU. Staff immediately noted that the ventilators had an alarm that was not audible when the patient-room door was closed. Although the devices were not defective, they weren't suited to the environment where they were being used. Global Medical Device Nomenclature (GMDN) - Correct answer is a system of internationally agreed generic descriptors used to identify all medical device products. The main purpose of the GMDN is to provide health authorities / regulators, health care providers, medical device manufacturers and suppliers, conformity assessment bodies and others with a single generic naming system that will support patient safety. GMP - Correct answer Good Manufacturing Practice refers to the quality system requirements for medical device (and other) companies outlined by the US FDA in 21 CFR Part 820. Also referred to as the Quality System Regulation (QSR). Human Error - Correct answer is when a person makes a mistake. As opposed to being confused or influenced by other factors of the design. Human error includes: Failing to perform or omitting a task Performing the task incorrectly Performing an extra or non-required task Performing tasks out of sequence Failing to perform the task within the time limit associated with it ergonomics - Correct answer an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely. —called also biotechnology, human engineering, human factors. ATM (asynchronous Transfer Mode) - Correct answer A way of transmission where a start signal precedes individual characters and one or more stop signals follow it. Due to this start/stop system, delays may occur between characters Call Centers - Correct answer Registered nurse-staffed facilities at which nurses typically act as case managers for callers or perform patient triage. Data Capture - Correct answer Acquire or capture data from sources for the purpose of transmitting such data, as in telehealth. Some telehealth devices capture both objective data and through the use of interactive self- reporting devices also capture subjective information on how a patient "feels" eICU - Correct answer Electronic Intensive Care Unit. eICU or tele-ICU is a form of telemedicine that uses state of the art technology to provide an additional layer of critical care service. An eICU support center can provide care to patients in multiple hospitals eMentalHealth - Correct answer the provision of mental health services, including counseling and psychological services, through the use of technology ePrescribing - Correct answer a technology framework that allows physicians and other medical practitioners to write and send prescriptions to participating pharmacies electronically rather than using handwritten or faxed notes. Patient Informed Consent - Correct answer Document that a patient signs to agree to treatment; document which a home healthcare patient signs to agree to receive telehealthcare services in addition to conventional home healthcare. Payor Organization - Correct answer Those organizations that contract with health care agencies and service providers to attempt to manage health care costs. Payors have the greatest incentive to use this technology as the cost savings associated with home telemonitoring accrue to their benefit. mHealth - Correct answer abbreviation for mobile health. A term used for the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and PDAs, and wearable devices such as smart watches, for health services, information, and data collection PERS - Correct answer Personal Emergency Response Systems. Signaling devices for patients to access emergency and other care needs. Personalized text messaging - Correct answer personalizing or tailoring text messages with names, contact information, or custom fields to add an extra personal touch to the text message. Real Time - Correct answer The capture, processing, and presentation of data, audio, and/or video signals at the time the data is originated on one end and received at the other end. When signals are received at rates of 30 frames per second, real time is achieved. Peripheral Device - Correct answer Device used in home telehealth can include any item with a digital readout. Generally, this equipment is "self- administrated" by the patient or family caregiver. Examples of the most commonly used peripheral devices include: Weight Scale, Blood Pressure Monitor, Pulse Oximeter, Thermometer, Glucometer, Spirometer, Prothrombin Meters(PT/INR), Digital Camera (to capture images of wounds), PDA based or telephonic self-reporting devices. Store-and-forward - Correct answer Transmission of static images or audio-video clips to a remote data storage device, from which they can be retrieved by a medical practitioner for review and consultation at any time, obviating the need for the simultaneous availability of the consulting parties and reducing transmission costs due to low bandwidth requirements. Streaming - Correct answer A technique for transferring data (usually over the Internet) in a continuous flow to allow large multimedia files to be viewed before the entire file has been downloaded to a clients computer. Syncronous transmission - Correct answer The process by which bits are transmitted at a fixed rate with the transmitter and receiver synchronized, eliminating the need for start/stop elements, thus providing greater efficiency. Real Environment Data - Correct answer Refers to patient data collected in the home during telehealth monitoring. This data is typically more reflective of the true patient situation because it is collected in the 'real' environment and not the 'artificial' environment of a health care agency. Telecare - Correct answer Telecare designs systems and services capable of social alert and social services. Telecare is used mainly to monitor the situation of people dependent on external help, e.g. elderly or disabled people in the home setting Teleconsultation - Correct answer a medical act which is carried out in the presence of the patient who dialogues with the physician and/or the physicians consulting at distance as necessary Telediagnosis - Correct answer The detection of a disease as a result of evaluating data transmitted to a receiving station from instruments monitoring a remote patient. Telehealth - Correct answer as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Telemedicine - Correct answer Health services delivered by telecommunications-ready tools supervised or directed by a physician. Telemetry - Correct answer automated communications process by which measurements and other data are collected at remote or inaccessible points and transmitted to receiving equipment for monitoring Cognitive computing - Correct answer software that succeeds at specific tasks previously thought to be limited to human cognition. Computer vision - Correct answer the field of A.I. concerned with teaching machines how to interpret the visual world Dark data - Correct answer is operational data that is not used. It is captured and stored, but not analyzed, providing no tactical value or insights. According to Lucidworks, we create 7.5 septillion (7,700,000,000,000,000,000,000) gigabytes of data worldwide every day. Businesses typically analyze approximately 10% of the data they collect Data crunching - Correct answer The automated analysis of vast amounts of data originating from Big Data. Once imported into a system, the data is sorted, structured, processed informed decisions. Data mining - Correct answer the computational process of discovering patterns in large data sets Deep learning - Correct answer the application of artificial neural networks (ANNs) to learning tasks that contain more than one hidden layer. Expert systems - Correct answer AI paradigm based on representations of human, domain-specific knowledge to replicate specific aspects of human decision making Embodied A.I. - Correct answer A fancy way of saying "robots with A.I. capabilities." Forward chaining - Correct answer A situation where an AI system must work "forward" from a problem to find a solution. Using a rule-based system, the AI would determine which "if" rules it would apply to the problem Human-computer interaction - Correct answer commonly referred to as (HCI) researches the design and use of computer technology, focused on the interfaces between people (users) and computers. Explainable A.I. (X.A.I.) - Correct answer A.I. that can tell or show its human operators how it came to its conclusions Natural language processing - Correct answer (NLP) is a way for computers to analyze and understand human language. Few-shot learning - Correct answer One-shot and few-shot learning try to create a system that can be taught to do something with far less training. It's similar to how toddlers might learn a new concept or task Optical character recognition - Correct answer (OCR) the mechanical or electronic conversion of images of typed, handwritten or printed text into machine-encoded text, whether from a scanned document, a photo of a document, a scene-photo or from subtitle text superimposed on an image. Planning - Correct answer A branch of AI dealing with planned sequences or strategies to be performed by an AI-powered machine. Things such as actions to take, variable to account for, and duration of performance are accounted for Pruining - Correct answer The use of a search algorithm to cut off undesirable solutions to a problem in an AI system. It reduces the number of decisions that can be made by the AI system Machine learning - Correct answer (ML) is a type of artificial intelligence in which a machine is trained to learn from past experiences and make decisions when exposed to new information without being explicitly programmed to do so. Reinforcement learning - Correct answer A process where machines learn to do a new task like humans do — through a system of rewards and punishments — starting as a novice and improving with practice and feedback. Strong AI - Correct answer functions like a human mind. It can think, reason, understand, and act as a human should Supervised learning - Correct answer A technique that teaches a machine-learning algorithm to solve a specific task using data that has been carefully labeled by a human. Everyday examples include most weather prediction and spam detection. Symbolic reasoning systems - Correct answer AI paradigm based on orchestration of complex logical structures (GOFAI) Transfer learning - Correct answer This method tries to take training data used for one thing and reused it for a new set of tasks, without having to retrain the system from scratch. TURING test - Correct answer developed by Alan Turing (the father of artificial intelligence) in the 1950s to test a machine's ability to exhibit behavior indistinguishable from that of a human Unsupervised learning - Correct answer An approach that gives A.I. unlabeled data and has to make sense of it without any instruction. In essence, it is when machines "teach themselves." Watson - Correct answer the world's first cognitive computing system Weak A.I. - Correct answer can do just one thing at a time, like play chess or recognize breeds of cats. Appears to think and understand, but it can only do what it is programmed to do. It is bound by rules and is not conscious. CHIWG - Correct answer Consumer Health Informatics Working Group Connected health - Correct answer a model of health care delivery using technology to provide services including information and education. Consumer empowerment - Correct answer means that patients are provided with enough information so that they can make informed decisions. They become consumers not patients. Consumer health informatics - Correct answer is the field devoted to informatics from multiple consumer or patient views. These include patient- focused informatics, health literacy and consumer education. The focus is on information structures and processes that empower consumers to manage their own health--for example health information literacy, Online Community - Correct answer is a virtual community whose members interact with each other primarily via the Internet. For many, online communities may feel like home, consisting of a "family of invisible friends" Participatory medicine - Correct answer also called shared decision- making, is a process in which both the patient and physician contribute to the medical decision-making process. Health care providers explain treatments and alternatives to patients to provide the necessary resources for patients to choose the treatment option that best aligns with their unique cultural and personal beliefs. [1] Participatory medicine, [2] patient-centered care, [3] and health consumerism [4] are all synonyms for patient participation. Patient-centered care - Correct answer providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Patient engagement - Correct answer encouraging patients to take responsibility for their own health, including helping them to acquire knowledge about their health challenges and ways to promote and maintain health. Patient Portal - Correct answer a secure online website that gives patients convenient 24 hour access to personal health information from anywhere within internet connection (4). Peripheral biometric (medical) devices - Correct answer a variety of telecommunications-ready measurement devices, such a blood pressure cuffs and blood glucose meters. Examples of commonly used peripheral devices include a weight scale, blood pressure monitor, pulse oximeter, thermometer, glucometer, spirometer, digital camera (to capture images of wounds). Symptom checker - Correct answer help you understand your medical symptoms and what they could mean and possible causes. Sensor and activity monitoring systems - Correct answer systems for tracking activities of daily living of seniors and other at-risk individuals in their places of residence. Additional applications' use of sensors to deter anomalies or problems such as faucet or stoves left turned on. Antivirus software - Correct answer Programs to detect and remove computer viruses Audit Trail - Correct answer Security system report that tracks a user's access, deletion or modification of data and the time at which each event happened. This includes user login, file access, other various activities, and whether any actual or attempted security violations occurred Authentication - Correct answer The verification of the identity of a person or process for purposes of accessing medical records, whether they are stored on paper or digitally. In the case of computerized systems, this typically involves entering a combination of account numbers and passwords or other personal information so that the identity of the person using the computer is verified and access can be enabled Biometrics - Correct answer automated methods of recognizing a person based on a physiological characteristic such as fingerprints, retina, voice, etc. Confidentiality - Correct answer ensure that information is not disclosed Consent - Correct answer process by which an individual authorizes healthcare personnel to process his or her information based on an informed understanding of how this information will be used. Cookie - Correct answer a small piece of information about you Copyright - Correct answer exclusive legal right to reproduce De-identified data - Correct answer Health information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual is de- identified. Health information is considered de-identified (1) if stripped of all of the 18 direct identifiers defined under HIPAA (see the full list), or (2) if an expert in statistical and scientific method determines that there is a very small risk that the information could be used alone or in combination with other information to identify an individual. HIPAA does not apply to de- identified data Electronic protected health information (EPHHI) - Correct answer All individually identifiable health information that is created, maintained or transmitted electronically Firewall - Correct answer type of gateway designed to protect private network resources from outside hackers, network damage, and theft or misuse of information Health Information - Correct answer Patient information collected by a health plan, health care provider, public health authority, employer, healthcare clearinghouse or other organization that falls under covered entity Healthcare Insurance Portability and Accountability Act (HIPAA) - Correct answer Developed in 1996, the acronym HIPAA stands for Healthcare Insurance Portability and Accountability Act. Initially created to help the public with insurance portability, they eventually built administrative simplifications that involved electronic, medical record technology and other components. In addition, they built a series of privacy tools to protect healthcare data. Health Information Technology for Economic and Clinical Health (HITECH) - Correct answer In 2009, as part of the American Recovery and Reinvestment Act (ARRA), there was an act within that called HITECH, short for The Health Information Technology for Economic and Clinical Health Act. The act included incentives offered to physicians in private practices, as well as institutional practices to implement and adopt electronic medical records. Ethical & Legal Issues Terminology In addition to incentives, the act included a series of fines to help enforce HIPAA rules. HITECH also mandated that business associates of covered entities, as well as the covered entities themselves, were responsible for the same level of HIPAA compliance HIPAA Audit - Correct answer A HIPAA audit is based off a set of regulations, standards and implementation specifications. The audit is an environment. Known generically as a "wired glove" deformable object technology Environment - Correct answer In VR terms, this is a computer-generated model that can be experienced by an observer as if it were a place. exoskeleton: mechanically linked structure for control of feedback from an application. Eye tracking - Correct answer Measurement of the direction of gaze. A metaphor for visualized tracking where the tracker is held in the hand and is connected to motion of the projection point of the display. Fidelity - Correct answer the extent to which a simulation mimics the processes of a real environment Gesture - Correct answer Hand motion that can be interpreted as a sign, signal, or symbol Haptic Interfaces - Correct answer Use of physical sensors to provide users with a sense of touch at the skin level, and force feedback information from muscles and joints Head mounted display (HMD) - Correct answer A set of goggles or a helmet with tiny monitors in front of each eye to generate images seen by the wearer as three-dimensional. Often the HMD is combined with a head tracker so that the images displayed in the HMD change as the head moves. Immersion - Correct answer the observer's emotional reaction to the virtual world as being a part of it Latency - Correct answer If you've ever tried a VR experience and noticed that when you turn your head, the visuals don't quite keep up, that's latency. It's unpleasant, because that's not something that happens in the real world. That lag is an oft-cited complaint about VR experiences that aren't up to par for a variety of reasons. Presence - Correct answer If virtual reality strives to takes users and immerse them in new environments, presence is what's achieved when that happens. Plain and simple, users feel like they're there, wherever "there" is Refresh Rate - Correct answer If you're looking at a virtual reality experience, you're looking at a series of images. The refresh rate is how fast those images get updated. Higher refresh rates cut down on lag, and cutting down on lag means there's less of a chance of getting sick. It also means more responsive experiences Simulation - Correct answer an imitation of a real-life event or circumstance, in nursing education, the replication of a clinical scenario developed to provide an opportunity for practice in a mock situation. Simulator - Correct answer a mechanical or electronic device that provides an environment in which a situation can occur. Some of these may be quite large. Simulator sickness - Correct answer various disturbances, ranging in degree form a feeling of unpleasantness, disorientation, and headaches to extreme nausea, caused by various aspects of a simulator. Simulator sickness is a conflict of sorts between what your brain and body think they're doing. Your eyes say "we're moving!" And your brain says "Nope! Let's get nauseated". Science Magazine suggests that this disparity is interpreted as a toxin, and the human body does what it can to get that toxin out, ergo, vomiting. As much as people look at virtual reality and want to do things like fly or jump, for many folks, it's the beginning of a bad idea. But, as everyone has different thresholds, not everyone gets sick, or as sick as someone else might. This is one of the big challenges for developers — figuring out how to move people without making them ill. 'SixthSense' - Correct answer a wearable interface that augments the physical world with digital information and lets us use natural hand gestures to interact with that information Virtual Virtual Environments (VE) - Correct answer completely replaces the real world Virtual Healthcare - Correct answer a method, or methods, by which physicians and other healthcare providers, such as nurses or medical assistants, communicate with patients without physically seeing them in the office Virtual Reality - Correct answer A computer system used to create an artificial world in which the user has the impression of being in that world with the ability to navigate through the world and manipulate objects in the world Virtual visit - Correct answer doctor-patient interactions that occur via e- mail or through a Web-based portal Virtual world - Correct answer world that exists in cyberspace where people can establish avatars, purchase land, and interact with others. Emerging virtual worlds such as Second Life are changing the meaning of social networking