Module 6 Question Response

What did you like or dislike about taking an online course?

I like online courses because although there are some deadlines, I am able to work at my own pace. For this same reason, I often put off the work because there are more pressing deadlines. I find that I often learn more about a topic because I do my own learning and research. I am able to use my resources more to learn instead of sitting in a classroom listening to a professor lecture, so I am often apt to remember better what I learn. The online format is especially ideal for this type of class because we learn to better manage the very technology we are learning about.

What topic did you learn the most about and what was your favorite topic?

I think I learned the most about teaching with technology because that really interested me. I like computers and I like using them to learn. In this day and age, kids grow up on computers and they are a natural resource for information retrieval and learning. I like the idea of integrating podcasts, etc to learn, especially since I commute to school and like the idea of not wasting 2 hours of study time daily. The part of the course I enjoyed was the assessment we did of ourselves to find out how we learn best. I thought it was interesting and fun. I did like the blogging as well. It was a fun was to give responses rather than just emailing the teacher.

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?

If I were the instructor, I would keep the blogging and the other activities I mentioned in question 2. I liked how the tests were open book and unlimited in time because this allowed me to really learn and take my time finding the information instead of simply memorizing it. I liked that there were deadlines, but I might have each module have its own deadline. This might help students complete the work in a more timely manner. One thing I would have appreciated is more feedback on my assignments, especially where I was docked points. A rubic scoring sheet is better than nothing, but it actually tells me close to nothing about what I did wrong and how I might improve. 

Module 5 Question Response

Visit the U.S. Department of Health & Human Services Agency for Healthcare Research and Quality at http://www.ahrq.gov/.  What, if any relationship do you see between the information available on this webpage and regulatory, accreditation, and reimbursement issues and healthcare information system use and design?

The U.S. Department of Health & Human Services AHRQ website is an awesome resource for patients and healthcare providers alike. It is refreshing to have a reliable and trustworthy resource to give to those types of patients who are extremely involved in their own healthcare and are often doing their own research to stay informed. I loved the part titled For Your Health, and I learned a lot reading the information provided there too! There are great articles about choosing quality care including information about how to use the ER wisely, how to choose a good hospital and how to file grievances, or complaints and actually see some action. I would have loved to have known about this site a few months earlier to offer to the family of a patient of mine. The patient was elderly and couldn't take care of herself, but also couldn't be cared for 24/7 by her family. The family was suddenly presented with the responsibility of choosing a nursing home for their loved one, but had no experience in that or where to start. There is a link here to compare nursing homes and a tool to help you choose one that suites you best. These are great resources to help the patients and their families be involved in and informed about their own healthcare. Whenever patients feel like they have an active part in their own care, they feel more empowered and are more likely to want to do their part and help themselves as well. 

These are also great references and sources for healthcare providers. I liked reading about the barcode medication administration. I have worked in a couple of hospitals where this intervention is not yet implemented and a couple where it is. I can say from experience that I feel MUCH safer with the barcode method. 

This website is highly related to regulatory, accreditation, and reimbursement issues. These are issues that patients have a right to know about and should know about. Patients, as well as healthcare workers, who are also in a way consumers at healthcare facilities, should know the measures that their hospital is required to meet in order to gain accreditation. They should know the regulations so as to judge whether they feel their hospital is living up to its requirements. Patients deserve safe care and they deserve to feel like they have a choice in which facility to attend, and once there, that they will receive the best care possible. I think spreading this information, such as the measures required to meet accreditation, to the public and to patients will only encourage the healthcare facilities to improve and progress because there will be more informed people watching their actions. I, personally, am happy to have this as a source now so that I can stay up to date on the same issues.

Module 4, Response to Another Student's Post

Response to "Module 4 Part 2 Nursing Data Quality" post by Sue V. at http://suevongsikeo.blogspot.com

The point you mentioned about the Hebda reading that states that if staff are proficient in the input device used, then there are less data collection and entry errors is absolutely true. If one doesn't know how to use a computer charting system, for example, then it is not only possible, but likely, that an error will occur. This is negative for all involved, because not only is the computer chart part of the permanent record of the patient, but that information is generally used by other healthcare providers caring for the patient, such as other nurses, doctors, and ancillary staff. If the information is entered incorrectly, decisions could be made incorrectly. If the happens because the staff doesn't know how to use the system correctly, the error is absolutely inexcusable. Where I work, there are required proficiencies and classes that staff have to complete in  order to learn and understand how to correctly use the computer charting system. Even with the classes, errors still occur, however, I can't imagine what might happen if the classes weren't required. Sometimes one might know how to use the basics of a computer charting program, but not understand how to use certain additional features of the program that might help to better the patient care, such as adding patient-specific interventions to a computer charting care plan. Education should be mandatory for all staff where input devices are utilized to avoid these types of errors.

Module 4, Question 2 Response

Nursing data quality is absolutely critical in proper decision support. A good decision is based on evidence and usually that evidence is in the form of data. If the data collected is not correct, complete, or thorough, this opens the doors for errors in decision making and could result in an unwanted or unplanned outcome. In some situations, inaccurate data could even lead to disability or death if the situation is critical enough. Errors in data collection occur easily, whether they be from improper transfer from paper documents to computer charts, poor handwriting on paper charts, wrong patient errors, miscommunications, or other forms. I believe it is the responsibility of each healthcare provider working with each patient to review the most recent data and assure accuracy and completeness. It there is a mistake made due to poor data quality, it is the mistake of all involved. It is also important to assure that data collected from each patient is correct. For example, if a patient is a poor historian, it is important to ask a close family member or friend about medical history, or is a patient can't remember exactly their home medications, the bottles should be brought in so that correct data is collected and correct medication therapy is implemented in the hospital. High data quality and correct data collection and recording is necessary to make appropriate decisions that best benefit each patient.

Module 4, Question 1 Response

The reading helped me to simply pay more attention to the clinical decisions I make. Sometimes as an RN, I feel like the most important and critical clinical decisions are the responsibility of the physician in charge, however, that is not necessarily true. The RN is the health care provider that is with the patient the most and usually the first to recognize the need for an intervention, therefore, I must make critical decisions to care for my patients and know when to involve the physicians for further intervention. Clinical decision making cannot be taken lightly because the life of a patient is on the line. Especially in my area of critical care, one decision can change the status of a patient very quickly. It is important to know how to make appropriate clinical decisions and if answers aren't known, it is critical to know where to find the answers, whether it be from resources such as a clinical decision support system, or another source. I realize that the more experience I have as a RN, the more my clinical decision making skills will improve because I will be exposed to more situations with time, but I must also be aware of the possible heuristics and biases as are discussed below. I also realize that as I transition from the role of RN to ACNP, clinical decision making will be even more critical, as with more hierarchy comes more responsibility.

I believe that nursing experience is a tool that in invaluable and cannot be replaced. I have always learned best and been able to remember details better when I have experienced a situation or patient case and treatment personally. With that said, one has to be cautious to not let previous experience narrow the way of thinking or decision making. Sometimes, if a healthcare provider feels too comfortable and experienced in certain areas, there can be misdiagnoses because the clinician simply assumes a certain diagnosis due to a few obvious signs and symptoms without exploring fully the full set of signs and symptoms with which the patient presents. Tversky and Kahneman (1974) mention this idea, representativeness, as one of three hueristics which can possibly lead to biases in decision making. This idea could also be described as overconfidence, as described by Thompson (2003). As mentioned, nursing experience is critical in clinical decision making. It is obvious the difference in ability in clinical decision making between a new graduate RN and one that has working in the ICU for 20 years, or even 1 year, however, the biases need to be kept in mind and avoided when possible. Also, it is crucial to always be implementing evidence based practice in clinical decisions. Sometimes, when clinicians have been in the business for awhile, they make decisions based on past experience because that is the way they have always done it, however, it is necessary to stay informed on current evidence based practice and implement new findings into decision making in order to better treat the patients. For some, this might require using other resources, such as a CDSS, or studying recent research literature, or possibly a little humility in order to be willing to deviate a little from they way things have always been done in the past.

Module 3, Question 1 Response

The results of my multiple intelligence test were very interesting to me. I scored 30 or above in every intelligence type, except one, which was musical. I don't know if this means I am well-rounded or just indecisive! My highest score was a 37 in the interpersonal intelligence. This makes a lot of sense to me because I love being with people and I love teaching. Aside from clinical practice (which also involves, or SHOULD involve an enormous amount of teaching), I want teach at the university level after graduating. Throughout all my years of schooling, teachers have had a huge impact on my life, either positively or negatively. We can all think of that certain jr. high school teacher that put us to sleep everyday or was disrespectful to the students, or perhaps that high school teacher that everyone loved who made going to class each day worth while. Some of my biggest role models in my life have been good teachers and I hope to be the same someday. Effective teacher-student relationships in the classroom are absolutely essential.  

In the linguistic category, I scored a 34. I don't consider myself a person with an extensive vocabulary and English never was my favorite subject in school, but I have always paid a lot of attention to words and grammar. I love to edit documents, and without intention, my eyes are drawn to typos in whatever I read. This attention to word-choice has increased even more since I have learned Spanish, because that is a critical part of learning another language. In the classroom, I learn well through reading, but I sometimes seem to get distracted. I can understand what I read well, however, discussion is the tool that helps me retain that information for long periods of time. I don't appreciate the professor that stands up every class simply to read the lectures slides. If were weren't able to read, we wouldn't be in a graduate program. I appreciate the instructor that engages me in conversation and makes me think and apply and intertwine ideas to have those "ahh ha" moments that stick with me so long. 

I also got a 34 in the intrapersonal category. I think to be effective in anything, knowing and understanding yourself and your role in relating to others is important. I got a 33 in the bodily-kinesthetic category, which explains why I learn so well by doing and through hands-on activities. 

There are few things I can to do change the teaching techniques of my professors, aside from suggestions and evaluations. As far as my personal learning, I could study with another individual or two to promote interpersonal learning and discussion, and we could learn through quizzing each other. This would be a linguistic strategy as well. As far as ideas for teaching, I like to incorporate games, student interactions, memorizations helps such as rhymes, etc, question/answer times and as much hands-on activities as possible. 

Module 2, Response to Another Student's Post

I commented on a post by Susan VanBeuge, susanvanbeuge.blogspot.com, labeled Module 2, Question 3. Thanks.