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.

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.

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.