What did I like or dislike about taking an online course?
I find my attitude toward on-line courses has changed significantly since I first returned to graduate school. I appreciate the flecibility of being able to arranges my work/life activities to allow a sense of balance. The main problem I have with on-line courses is the brutal truth that on-line activities/deadlines are easier to delay and even neglect. On-line courses are not for everyone. FOr example, I continue to struggle with the use of discussion boards and blogs. I am hopeful, that after thes semester, I will utilize my blog for communication with family & friends. I am also interested in creating a blog for my unit.
What topic did I learn the most about and what was my favorite topic?
I really liked learning to use such tools as clinical decision-making software, and discovering how our APRNs utilize these programs in their daily practice. I am slowly realizing that although I was an RN in the times we documented everything on paper, there are multiple advantages to having an electronic health record.
If I was the instructor, and the IT course being the first for all DNP and Master students, what would I do the same or different?
I wish I had taken this IT course my first sememter of graduate school. The use of such tools as EndNote for reference managemnet; or the use of search engines for locating evidence based practice guidelines should have been strongly encouraged to enroll the first or cecond semester.
Thursday, April 30, 2009
Wednesday, April 29, 2009
Module 5
Obviously I am dating myself, but I used to utilize the AHRQ guidelines in print. I admit didn't get it any thought to look to their web site for information related to IT in health care. Even as I am typing I realize the how narrow minded I was in my thinking.
In the case of bar coding for medication administration, the AHRQ report helps illustrate the close relationship between accreditation requirements by Joint Commission and the need for medication administration policies in hospitals to improve patient safety. I have been told by one IT specialists, that he is working with administration on a plan to purchase the hardware/software which would allow us to begin using bar coding in the next 2 years. As a nurse amanger on a unit with nurses administering chemotherapies and other toxic therapies; I appreciate the report which identifies areas for improvement which we might not consider when setting up our hospital with bar coding. I find the report valuable in recognizing the need for nurse champions, or what I have come to know as early adoptors.
In the not so distant past, nurses documented everything on paper. If they got behind on their charting, it was not unusual to see nurses staying late after their shift to "chart". I can recall going back to chart and although the chart stated the notes were written at specific intervals, everyone knew the nurse did not put pen to paper until some 8-12 hours later. The paper form allowed all to write anything, without a way to capture falsification of the medical record. Now with the electronic record, the date and time are captured, and cannot be altered. This is true of medication delivery as well. There is no breach of ethics nor temptation of falsifying a record, when such uses of technology are in place, such as bar coding. As the AHRQ report states, when bar coding for medication adminstration, not only is the information (date, time, patient, med, route) collected, any errors are readily determined and the RN is able to remedy the error BEFORE an actual medical error occurs. Another benefit of the bar coding is there is a decreased risk of erroneously billing for medications not administered to a patient.
the more I explore the AHRQ site, I recognize what a valuable source of information is readily available via the touch of a button. I have added the site as a favorite on my computer.
In the case of bar coding for medication administration, the AHRQ report helps illustrate the close relationship between accreditation requirements by Joint Commission and the need for medication administration policies in hospitals to improve patient safety. I have been told by one IT specialists, that he is working with administration on a plan to purchase the hardware/software which would allow us to begin using bar coding in the next 2 years. As a nurse amanger on a unit with nurses administering chemotherapies and other toxic therapies; I appreciate the report which identifies areas for improvement which we might not consider when setting up our hospital with bar coding. I find the report valuable in recognizing the need for nurse champions, or what I have come to know as early adoptors.
In the not so distant past, nurses documented everything on paper. If they got behind on their charting, it was not unusual to see nurses staying late after their shift to "chart". I can recall going back to chart and although the chart stated the notes were written at specific intervals, everyone knew the nurse did not put pen to paper until some 8-12 hours later. The paper form allowed all to write anything, without a way to capture falsification of the medical record. Now with the electronic record, the date and time are captured, and cannot be altered. This is true of medication delivery as well. There is no breach of ethics nor temptation of falsifying a record, when such uses of technology are in place, such as bar coding. As the AHRQ report states, when bar coding for medication adminstration, not only is the information (date, time, patient, med, route) collected, any errors are readily determined and the RN is able to remedy the error BEFORE an actual medical error occurs. Another benefit of the bar coding is there is a decreased risk of erroneously billing for medications not administered to a patient.
the more I explore the AHRQ site, I recognize what a valuable source of information is readily available via the touch of a button. I have added the site as a favorite on my computer.
Monday, March 23, 2009
Module 4 question 2
How does nursing data quality relate to decision support?
Until this course I never truly understood the value of having "quantifiable data". Being an older nurse, who documented on paper for years, the argument that so much of nurse's documentation is not quantifiable was not a viable reason to force me to chart using a check list method. The colorful descriptions painted a picture for the reader.
In contrast, the data that nurses can collect and document using electronic charting programs, can generate information for the institution related to specific diagnosis, treatments, and outcomes. In our institution, we have a Quality team which utilizes the data to answer quality questions such as how many patients have been offered smoking cessation information, or how many incidents of medication errors have occurred? Items can be further defined to determine time of day, specific causes, etc. The institution can also use the data to compare themselves with similar hospitals to benchmark themselves. For example, when there was an increase in CDifficile in our institution, we compared ourselves with others in the UHC database. We discovered we were exceedingly high; we could not simply blame the increase on the chemotherapy or antibiotics. We had to investigate the possible causes, and formulate a plan of action.
Until this course I never truly understood the value of having "quantifiable data". Being an older nurse, who documented on paper for years, the argument that so much of nurse's documentation is not quantifiable was not a viable reason to force me to chart using a check list method. The colorful descriptions painted a picture for the reader.
In contrast, the data that nurses can collect and document using electronic charting programs, can generate information for the institution related to specific diagnosis, treatments, and outcomes. In our institution, we have a Quality team which utilizes the data to answer quality questions such as how many patients have been offered smoking cessation information, or how many incidents of medication errors have occurred? Items can be further defined to determine time of day, specific causes, etc. The institution can also use the data to compare themselves with similar hospitals to benchmark themselves. For example, when there was an increase in CDifficile in our institution, we compared ourselves with others in the UHC database. We discovered we were exceedingly high; we could not simply blame the increase on the chemotherapy or antibiotics. We had to investigate the possible causes, and formulate a plan of action.
Module 4 question 1
I must admit, when I first read the title of Carl Thompson's article "Clinical experience as evidence in evidence-based practice" I thought back to the time I was a relatively new nurse. When I had a question, an older nurse would rattle off an answer. There was little thought or discussion of doing a literature search. Rather, the practice question was dealt with quickly, or given to the nurse manager to research, who later came back with an answer.
After reading his article, I recognized times when I have observed, and even made inappropriate clinical decisions due to overconfidence. Many of these times were during times I was the only oncology nurse on the unit for the entire shift. Having to be a constant resource to agency nurses is exhausting, and a time to be vigilant, not overconfident. In the recent past, our unit has had many changes in the culture. Many of the y ounger nurses feel the older ones are too abrupt, and not as nurturing as they would like. When exploring specific examples, I find the seasoned nurses are not simply making decisions on "gut feelings", they, as experienced as they are, still take the time to verify protocols, policies & procedures. When they discover a newer nurse is not following policies, and when questioned cannot support why they wavered, this creates a knowledge gap. This gap can grow if the younger nurses are more interested in protecting thier feelings, and not venturing to understand the rationale for clinical decisions.
Another example of the heuristic of hindsight is seen frequently on the unit. This involves the nurse forgetting to open the roller clamp to infuse IV medications. The clinical practice council was asked to determine ways to prevent medication errors due to the roller clamp concern. Recently graduated nurses tend to be hypervigilant, while the ones with 1-15 years experience tend to create the bulk of errors. Seasoned nurses, who have seen these errors time and again, are well aware of the risk, and make personal habits to verify the roller clamp is open and delivering the medication as ordered. These same nurses are the ones who ask appropriate questions to assure a thorough assessment of the patients when they suspect an acute change of condition. The y ounger nurses wait until the patient's clinical condition is grossly apparent. We have begun the task of having a debriefing after any unexpected acute change of condition, especially one that requires urgent transfer to a higher level of care. The debriefings are serving as a way to help overcome the bias of hindsight to better help the inexperiences nurses learn from one another.
After reading his article, I recognized times when I have observed, and even made inappropriate clinical decisions due to overconfidence. Many of these times were during times I was the only oncology nurse on the unit for the entire shift. Having to be a constant resource to agency nurses is exhausting, and a time to be vigilant, not overconfident. In the recent past, our unit has had many changes in the culture. Many of the y ounger nurses feel the older ones are too abrupt, and not as nurturing as they would like. When exploring specific examples, I find the seasoned nurses are not simply making decisions on "gut feelings", they, as experienced as they are, still take the time to verify protocols, policies & procedures. When they discover a newer nurse is not following policies, and when questioned cannot support why they wavered, this creates a knowledge gap. This gap can grow if the younger nurses are more interested in protecting thier feelings, and not venturing to understand the rationale for clinical decisions.
Another example of the heuristic of hindsight is seen frequently on the unit. This involves the nurse forgetting to open the roller clamp to infuse IV medications. The clinical practice council was asked to determine ways to prevent medication errors due to the roller clamp concern. Recently graduated nurses tend to be hypervigilant, while the ones with 1-15 years experience tend to create the bulk of errors. Seasoned nurses, who have seen these errors time and again, are well aware of the risk, and make personal habits to verify the roller clamp is open and delivering the medication as ordered. These same nurses are the ones who ask appropriate questions to assure a thorough assessment of the patients when they suspect an acute change of condition. The y ounger nurses wait until the patient's clinical condition is grossly apparent. We have begun the task of having a debriefing after any unexpected acute change of condition, especially one that requires urgent transfer to a higher level of care. The debriefings are serving as a way to help overcome the bias of hindsight to better help the inexperiences nurses learn from one another.
Module 3
According to my Multiple Intelligence (MI) test I tend to be more inclined toward "spacial-visual" resources, followed closely by "music". (I scored 35 in spacial-visual, and 34 in musical tendencies). These scores were closely followed by my scores for "logical-mathematical" (32) and "interpersonal" (31) preferences. In preparing to complete this assignment, I took the MI test two times before fully understanding the need to first save the document, so I could submit it for credit. I found it interesting to see I had differing scores, not dramatic, but different. I recall the first time I rated my preferences using the MI test, spacial-visual remained the highest while interpersonal was a close second. I vividly recall being frustrated with the current events at work and home; feeling overwhelmed, as though I was letting others down. It appears the results can be impacted by the individual's mood, or sense of well-bling. I believe the MI test is a nice tool, but is only a rough guide to help direct learning.
Of note, I have always considered my self a visual learner, and even my peers and family are quick to verify this. Even my speech reflects this through the use of words such as "envision", "looks like", "appears" and "I see what you mean". In the description of typical roles it states artist, designer,photographer, inventor, etc. As a young child, I delighted in the notion of being an artist, and found the joy of creating things with my hands, using colors and textures to bring the project to life. I took high level art classes, and discovered the majority of artists do hont have viable incomes. The highly competitive students were bound for careers in advertising. Not being a competive type, I found creating gifts of handmade beauty to then give away to loved ones more rewarding. This further added value to the actual act of creating the project.
The interpersonal realm is one that I tend to spend a fair amount of time in. As an oncology nurse for many years, I have had the fortune of working with phenomenal patients. We have been able to form bounds to discuss very intimate issues. I have found this very rewarding over the years. Now in my newer role as Nurse Manager, I find myself removed from the bedside, and working with peers on interdiscilplinary project teams. Knowing that not everyone thinks like I do, I am careful when conducting meetings to try to include various dimensions. I often have a group activity to break the ice and start off with some energy.
Of note, I have always considered my self a visual learner, and even my peers and family are quick to verify this. Even my speech reflects this through the use of words such as "envision", "looks like", "appears" and "I see what you mean". In the description of typical roles it states artist, designer,photographer, inventor, etc. As a young child, I delighted in the notion of being an artist, and found the joy of creating things with my hands, using colors and textures to bring the project to life. I took high level art classes, and discovered the majority of artists do hont have viable incomes. The highly competitive students were bound for careers in advertising. Not being a competive type, I found creating gifts of handmade beauty to then give away to loved ones more rewarding. This further added value to the actual act of creating the project.
The interpersonal realm is one that I tend to spend a fair amount of time in. As an oncology nurse for many years, I have had the fortune of working with phenomenal patients. We have been able to form bounds to discuss very intimate issues. I have found this very rewarding over the years. Now in my newer role as Nurse Manager, I find myself removed from the bedside, and working with peers on interdiscilplinary project teams. Knowing that not everyone thinks like I do, I am careful when conducting meetings to try to include various dimensions. I often have a group activity to break the ice and start off with some energy.
Friday, February 13, 2009
Module 2 Question 3
In this module I had the opportunity to use the CINAHL electronic index, the National Guideline Clearinghouse (NGC) index, and Google Scholar search engine.
As previously mentioned in an earlier response, I originally searched with PubMed. Given my topic (neutropenia and dietary restrictions) was more relevant to nursing I discovered CINAHL to be better suited for nursing interventions. The use of MeSH topics helped to further my search to include related subjects. I also liked the ease of use for even the most novice nurse to be albe to readily add to my folder and later choose to either export to ENDNOTE or email my self a copy of the text. I believe this index would be relative easy to refer to for frontline nurses.
In comparison, I found Google scholar did not provide me as much assistance in narrowing my search. I also felt there was less evidence of reliable research in this search engine. For example, I found it difficult to determine if entries were peer reviewed. Many of the links were books for purchase from a variety of vendors, and fewer entriess were linked to journal articles. This was a dissatisfier for me. I do not want to join a multitude of libraries, or pay for copies I may not find useful.
I was excited to discover the NGC. In our work setting we have unit-based clinical practice councils comprised of frontline nurses. Often, as a result of this forum, the nurses are given the task of performing a literatire review. It is a useful tool to have written guidelines for specific diseases, interventions, or national measures from the Agency for Healthcare Research and Quality (AHRQ). It was not so long ago I used to have to refer to specific AHRQ guidelines in multiple paperback books. Another thing I found user friendly about the NGC site was the ability to view the data in a simple outline form, clearly divided in sections which help identify the scope, methodology, supporting evidence, and even the risk vs benefits of the intervention. In addition, if you desire to discover what does a particular organization, such as the American Cancer Society recommend, you can even look up a guideline from their organization's posted list.
In summary, I am embarrassed to admit I was fearsul of this assignment, due to the difficulties I have experienced in the past with search engines. I recognize the need to be open to using a variety of electronic indexes and not limit myself to using only MEDLINE as I have done in the past. I further understand the way I set up the search strategy will determine the sensitivity of the result to context of a specific clinical problem. Narrowing the search using related topics, MeSH terms, and the correct index will retrieve relevant reference data.
As previously mentioned in an earlier response, I originally searched with PubMed. Given my topic (neutropenia and dietary restrictions) was more relevant to nursing I discovered CINAHL to be better suited for nursing interventions. The use of MeSH topics helped to further my search to include related subjects. I also liked the ease of use for even the most novice nurse to be albe to readily add to my folder and later choose to either export to ENDNOTE or email my self a copy of the text. I believe this index would be relative easy to refer to for frontline nurses.
In comparison, I found Google scholar did not provide me as much assistance in narrowing my search. I also felt there was less evidence of reliable research in this search engine. For example, I found it difficult to determine if entries were peer reviewed. Many of the links were books for purchase from a variety of vendors, and fewer entriess were linked to journal articles. This was a dissatisfier for me. I do not want to join a multitude of libraries, or pay for copies I may not find useful.
I was excited to discover the NGC. In our work setting we have unit-based clinical practice councils comprised of frontline nurses. Often, as a result of this forum, the nurses are given the task of performing a literatire review. It is a useful tool to have written guidelines for specific diseases, interventions, or national measures from the Agency for Healthcare Research and Quality (AHRQ). It was not so long ago I used to have to refer to specific AHRQ guidelines in multiple paperback books. Another thing I found user friendly about the NGC site was the ability to view the data in a simple outline form, clearly divided in sections which help identify the scope, methodology, supporting evidence, and even the risk vs benefits of the intervention. In addition, if you desire to discover what does a particular organization, such as the American Cancer Society recommend, you can even look up a guideline from their organization's posted list.
In summary, I am embarrassed to admit I was fearsul of this assignment, due to the difficulties I have experienced in the past with search engines. I recognize the need to be open to using a variety of electronic indexes and not limit myself to using only MEDLINE as I have done in the past. I further understand the way I set up the search strategy will determine the sensitivity of the result to context of a specific clinical problem. Narrowing the search using related topics, MeSH terms, and the correct index will retrieve relevant reference data.
Thursday, February 12, 2009
Module 2 Question 2
CINAHL has several features which I found helpful such as being able to ask for full text, dates, application to specific pupulations, ages, as well as types of articles (research verses review). As a nurse manager of an inpatient unit, I really appreciate the filter for inpatients. The ability to further narrow the search by adding more rows seems much easier to me than remembering to aype in AND/OR in the search. Another feature I found interesting was the "Cited References" which drew me to other articles realted to my subject. The simplicity of clicking on the ADD to FOLDER button was very easy so I did not have to remember to send to my clipboard first. when I open my folder view the references are easily exported to Endnote via the use of icons at the top of the screen.
Module 2 Question 1
Being a long time oncology nurse, I felt the need to research the question of whether or not dietary restrictions are effective for neutropenic patients. I originally searched PubMed, but discovered more nursing information was available on CINAHL. Having never used this index, I was challenged and found myself having to go back and forth to fully appreciate the value the advanced search options. I appreciated the first screen asking me what other libraries or sources of information I would like to search. I did not notice this the first two times I tried and couldn't figure out why there was no references, only to learn I was only searching "business" topics. Given my novice level with this index, my search was rather time consuming, but I believe this was due to my inexperience. I also found there was less information available than I had anticipated.
I believe this is an excellent index for use in daily practice for nurses. The other indexes I tried were not as helpful in finding literature on my subject. I also attempted a Google Scholar search, but found this more frustrating as there were less opportunities to narrow down the search to my defined population (neutropenic).
I believe this is an excellent index for use in daily practice for nurses. The other indexes I tried were not as helpful in finding literature on my subject. I also attempted a Google Scholar search, but found this more frustrating as there were less opportunities to narrow down the search to my defined population (neutropenic).
Friday, February 6, 2009
N6004 Module 1
1. Introduction:
A quick glance to my profile shows I am no "Spring chicken"! I have a keen interest in medical oncology and have chosen to work towards my master's degree in the Clinical Nurse Leader (CNL) program. As a nurse manager in the ever changing world of healthcare, I am acutely aware of the need for information management. Nurse leaders must not only value the use of information technology (IT), but also be able to understand how the nurses workflow can be changed (hopefully for the better) to allow more time to be spent with the patients.
2. IT in our clinical setting:
We are anxiously awaiting the "go-live" date (May 2nd) for our Computerized Provider Order Entry (CPOE) system. Last March the insitution had to pull the plug on the system the evening before our intended date of implementation. Recognizing the need to assure patient safety, the use of the computerized system for provider orders is our next giant step to eliminating unnecessary medical errors due to illegible handwriting, use of unappproved abbreviations, etc. About 20 months ago, nursing documentation was converted to electronic charting. This documentation allows for more standardized documentation through use of checklists whenever possible, with minimal narrative entries. This was a rather difficult transition initially, especially for those of us (aged 50 and up) who had mastered the paper forms. The hardest concept for the nurse to fully understand was the need to help us quantify patient outcomes. Once it was recognized that reports could be generated to assist with quality improvement initiatives, they have become less resistant to this change in their workflow.
Another thing we are doing is trying to become more and more "green" in our immediate work area. For example, instead of having multiple paper copies of our unit's newsletter or other notices, I am developing our own website which will provide a secured access for such private information as employee contact numbers. I have been helping staff utilize the functions of the electronic scheduling system so RNs can assist in self-scheduling on-line. Ridding ourselves of the paper copies of the everchanging unit schedule has improved staff morale due to reduced errors.
A quick glance to my profile shows I am no "Spring chicken"! I have a keen interest in medical oncology and have chosen to work towards my master's degree in the Clinical Nurse Leader (CNL) program. As a nurse manager in the ever changing world of healthcare, I am acutely aware of the need for information management. Nurse leaders must not only value the use of information technology (IT), but also be able to understand how the nurses workflow can be changed (hopefully for the better) to allow more time to be spent with the patients.
2. IT in our clinical setting:
We are anxiously awaiting the "go-live" date (May 2nd) for our Computerized Provider Order Entry (CPOE) system. Last March the insitution had to pull the plug on the system the evening before our intended date of implementation. Recognizing the need to assure patient safety, the use of the computerized system for provider orders is our next giant step to eliminating unnecessary medical errors due to illegible handwriting, use of unappproved abbreviations, etc. About 20 months ago, nursing documentation was converted to electronic charting. This documentation allows for more standardized documentation through use of checklists whenever possible, with minimal narrative entries. This was a rather difficult transition initially, especially for those of us (aged 50 and up) who had mastered the paper forms. The hardest concept for the nurse to fully understand was the need to help us quantify patient outcomes. Once it was recognized that reports could be generated to assist with quality improvement initiatives, they have become less resistant to this change in their workflow.
Another thing we are doing is trying to become more and more "green" in our immediate work area. For example, instead of having multiple paper copies of our unit's newsletter or other notices, I am developing our own website which will provide a secured access for such private information as employee contact numbers. I have been helping staff utilize the functions of the electronic scheduling system so RNs can assist in self-scheduling on-line. Ridding ourselves of the paper copies of the everchanging unit schedule has improved staff morale due to reduced errors.
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