Module 6

• What did you like or dislike about taking an online course?
  I really liked the flexibility of being able to complete the modules on my own schedule around other class deadlines. But I also missed being able to visually see demonstrations and hear/ask questions in an open class setting. I especially would have liked to see/hear the demos/critiques on the other clinical decision support tools available.
  I tend to be quiet in classes because I like to internally reflect on and analyze the information. So posting to the blog & discussion questions work better for me than responding in a class setting.


• What topic did you learn the most about and what was your favorite topic?
  It’s hard for me to narrow down to one favorite topic! I experienced a lot of new exposures with technology & information management that I’ll be able to apply in my professional role and even my personal life. As an educator and future CNS, I found the Teaching with Technology module very interesting. It seems as if the topic of plagiarism within the Policy & Ethical Issues module was a favorite among most of the class, based on the volume of discussion board commentary. I really enjoyed reading everyone’s comments & perspectives – very interesting topic! Learning how to use the information retrieval system of PubMed has come in handy. I’m sure I’ll be using the IBIS-PH website more in the future. I also learned how to set up a blog!


• If you were the instructor, and this being the first course for all DNP and Master students, what would you do the same or different?
  As a first course, I would provide more frequent feedback & reinforcement along with timely grade posting. Any time an assignment doesn’t receive full credit, I would provide an explanation for the missed points to encourage corrections and improvements in future assignments. If possible, I would hold 1-2 workshops for some group hands-on learning, for example to cover the clinical decision support systems and possibly more in depth on information retrieval. I would definitely keep the variety of creative teaching methods and the topics – all very applicable to both Masters & DNP students. The incorporation of a Blog was great too.
  
  Thanks Allen, Mollie, and Matt! I’m sure it was a lot of work to develop the course and handle the large number of students this semester. Thanks for all your time and effort -- I learned a ton of information that I’ve already started applying in practice…extremely valuable content!

Module 4 - Question #2

Nurses are human, and it’s not humanly possible to collect, organize, store, and readily recall all the data that could be used to best serve our patients….not to mention also keeping up with all the latest evidence developments! Thompson (2003) described that many nursing clinical decisions are made from the ‘evidence’ of their experiential knowledge. And, Kahneman & Tversky (1974) mention how more frequent/common occurrences are easier & quicker to recall than less common ones. These situations (plus lack of time) can lead to errors in judgment. Clinical errors have lead to many of the regulations we face in healthcare today.

A clinical decision support system (CDSS) has an advantage over the human brain in that it has the capability to hold a tremendous amount of organized/categorized data. The application of this tool can provide reminders and assist with decision-making, but it can only provide data based on its programming and may lack the necessary variables to handle a complex patient. The data from a CDSS may have the potential to save nursing time in a one-stop search, but would still need to be used in combination with nursing experience and judgment.

Module 4 - Question #1

The readings were interesting and really got me reflecting about my past clinical decision making and how I’m now having to adapt for my advance practice position. I’ve been a nurse for 26 years, so over the years I’ve acquired experiential knowledge that I’ve used to make various clinical decisions. I think the combination of past experience with evidence based guidelines points toward best patient outcomes today.

I’m now aware of the overconfidence and hindsight heuristics & biases that I have applied in my past. I actually didn’t recognize that I used hindsight until I read about it. However, starting an advanced role where I get to more fully participate in problem-identification and management gives me a whole new outlook…including much more responsibility. It requires an expanded experiential knowledge base, so I currently don’t feel ‘overconfident’ about my abilities at all. I’m excited to learn about the availability of a CDSS and feel it will greatly benefit my practice. I can see that heuristics awareness and use of a decision support system will help me as I develop in my new role.

Module 3 - MIT

My Multiple Intelligences Test scored the following as my top three intelligence types: Logical-Mathematical, Spatial-Visual, and Intrapersonal. One technology that I have found helpful to my learning is an on-line webcast. These are presented in a logical/sequential format with audio & visual capabilities. They are much like attending a conference or workshop but in the comfort of sitting in front of your own computer! Computer-Based Training (CBT) would be a second choice, as long as it was well-planned and organized. Another technology that really helps me to learn is simply searching the internet. In my searches, I’m able to build upon my discoveries in a way that is logical to me.
I think an important benefit of completing these tests are to be more understanding of the variety of learning needs of those we teach – whether it’s a patient, staff member, or student in the academic environment. By understanding the different types of teaching methods that benefit the different learning styles (intelligence types), I can be a more effective teacher in my Clinical Nurse Specialist role.

Module 2 - Question #3

In comparing the results of my searches, I found the PubMed search provided medical articles that were most useful in meeting my requested search. The National Guideline Clearinghouse provided the recommended adult immunization schedule, reviewed the patients at high risk of developing severe pneumonia, and provided a link to the CDC guidelines. This is valuable baseline information for why we should administer the vaccine, but it doesn’t address “how” to implement a successful program. The Google search was the least helpful even though it also includes an advance search option. This is because it isn’t specific to medical information retrieval, so it pulled from everywhere – news articles, definitions, pharmaceutical companies, drug websites, etc. An alternate strategy for retrieving relevant information could include delegating the search to an expert – like the Medical Librarian!
The assigned articles, Bakken, S. et al (2004) and Maviglia, S. et al (2006) mention improving information access through context-specific search strategies. Although the application of “infobuttons” sounds like it would help in developing the ideal approach for a successful vaccine program and facilitate best practice, I don’t see this technology helping to retrieve the collective data I’m searching.

Module 2 - Question #2

I chose to use EndNote software. I love the “groups” feature of categorizing a selected list of references for a specific topic. I created a group name for this new list. However, I didn’t know how to import the PubMed citations. I remembered that Paulina asked this question on the Discussion Board, so I followed the advice of one of the responses and used the “Help” feature available in EndNote. I followed the instructions on how to import references…and it worked! After importing, it was easy to just click on the title of the column that said “Author” to organize the list in alphabetical order. I selected “Find Duplicates” and noticed that I had imported 2 articles twice, so I cleaned up the list. In EndNote, it’s even possible to attach the article to have available with the citation. I’ve only used the APA 5th style, but it’s possible to select other styles to meet journal publication requirements.
I’m thinking that I might try my next PubMed search through EndNote to avoid the extra work it takes to import the citations – maybe I’ll do a search through EndNote and another through PubMed on the same topic to see how the search results compare…then only conduct searches through EndNote if the search lists are similar. (I don’t want to risk missing out on information retrieval just for the benefit of convenience).

Module 2 - Question #1

I conducted my search on inpatient pneumovax programs, because I’m interested in improving our rate of administration to patients that meet criteria. I wanted to see what has been published on the topic as a guide for conducting a program evaluation – and a search for best practices. I had never used PubMed, but I felt more confident in trying it after watching the tutorial. After setting limits and trying a variety of Boolean operators, I was able to get my search number down to 29 then narrowed further by selecting only the ones that sounded the most applicable.
The search was time-consuming mostly because of my lack of familiarity with this index, so I needed to refer to the tutorial occasionally. PubMed is an electronic reference that is available at my workplace, so I don’t foresee any barriers, especially as I use it more often and gain more confidence in all the available features.

Module 1 - Question #2

The use of technology and informatics continues to expand. I can remember when VS were performed manually, tests were ordered by paper requisitions, and there was only paper charting. We’ve now used computer documentation for several years. It took awhile, but I can see how it promotes more than just data extraction. It also supports documenting to requirements that are based on best practices and includes prompts to aid nursing. For example, the documentation is programmed to provide a reminder ‘pop-up’ for all the admission assessment requirements, such as vaccine assessment, fall risk score, tobacco use, Braden score, etc…plus the ‘pop-up’ returns at pre-programmed timeframes if the information isn’t complete or requires additional assessment based on standards. This is a great job aid for the busy nurse, plus it would be too difficult to rely on memory for all the documentation requirements we have today. Later this year, our Infusion pumps are being upgraded to WiFi capability so that any programming to the pump will automatically transfer to the documentation system. The IV pumps already have “smart pump” technology that includes a drug library with pre-set safety parameters programmed by pharmacy. The vast computerized documentation data is retrieved in many report forms that meet the needs of the various disciplines, and the data can be extracted for audits. A new enterprise clinical information system (ESIS) is being developed that will incorporate the parameters of clinical guidelines and protocols as prompts within the documentation tool to aid in the standardization of practice patterns based on EBP. Computerized physician order entry will also be a part of this.
Other IT applications being used that ultimately benefit patient care include bar-code medication administration; glucose meters that transmit the patient result into their electronic record that can be accessed by the MD/NP from any computer…along with access to any procedure report and accompanying image; another application are wireless communication systems – we use an on-line paging system to send pages to an individual or set up to a group, and the nurses have wireless phones that the patient can call directly by-passing a call-light system; and the extracted documentation is useful for process improvement initiatives. Wow, I’m stopping here but I can think of even more ways that we use IT in everyday patient care and others currently in development. This is definitely a day where technology has a major impact in providing patient care….and promotes quality patient care.

Module 1 - Question #1

Hi group! My name is Kelleen Brown and I’m in the Acute Care NP/Clinical Nurse Specialist Master’s program – my focus is in the CNS track and plan to graduate Aug ‘09. I’ve been a nurse for 26 years, so I’ve witnessed a constant, gradual increase in technology.
"Why do you as a graduate level nurse need to know about information management?"... As a graduate-level nurse, I need to know about information management to keep up with the times! Information management is integrated into our practice today. I need to be able to look up national guidelines and do a literature search for the evidence in order to provide current references toward the development of practice guidelines, to be a credible resource and role model, and to back up the recommendations that I’ll make for the care of patients. Quality audits and literature searches will also be important as I pursue program evaluations and research. Plus, since technology is ever growing in nursing practice, there is a need for nursing input on development teams, so having an understanding of information management and technology will help in providing more valuable input.