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.

Module 2, Question 3 Response

Of the three strategies of information retrieval I used--PubMed, National Guideline Clearinghouse web site, and Google--PubMed was by far the most resourceful for me. As mentioned in question 1, PubMed is medically- and clinically-based, so it was able to offer me up-to-date, accurate, and relevant evidence based practice articles about intra-abdominal hypertension. Generally, since the articles available in Pubmed are reviewed, they should contain accurate information and findings. This doesn't take the place of individual review and criticism by the practitioner, however, it is a little safer and dependable than other methods available. 

For my specific topic, intra-abdominal hypertension, the National Guideline Clearinghouse web site was not very useful. There doesn't appear to be any general overall guidelines regarding intra-abdominal hypertension, abdominal hypertension, or intra-abdominal pressure. However, while reviewing information there on other topics, it appears to be a great method of information retrieval for other important topics and procedures. During my google search, I got back plenty of results, some relevant, others not so relevant. Many of the results I got back were links to journal articles, however, upon following the links, many sites only offer abstracts to the journals instead of the full-text articles, unless you are a member or want to pay for the article. Sometimes within Google searches, there are links to government sites such as the CDC. These sites are helpful for certain related topics, and they are reliable as well. A Google search for my topic offered me a few of the same results as that of the PubMed search, but the access is limited and the whole process is more time-consuming and less efficient. 

Other methods for information retrieval include text books, physical paper medical/nursing journals, hand held programs such as medication references on palm pilots, and facility-specific information retrieval sites, such as Clinical Pharmacology at my hospital. I think these types of information retrieval methods can be great resources as long as they are kept up-to-date with accurate information. The hand-held resources, such as for medication information, are specifically useful in the clinical setting where perhaps access to the internet is limited. Textbooks are good resources for long-standing data or facts, but can be outdated quickly with the rapid rate of change in the medical and clinical field. 

Module 2, Question 2 Response

As my reference management software, I decided to use Endnote, and can I just say that I love it! Endnote is a great tool, and although it requires just a little time to get used to it, once you discover its features it is a real time-saver. Within Endnote, there are various ways to sort and organize references. First off, you can choose to have one library or several libraries to sort the references, perhaps for different research projects. I, so far, have chosen to keep one library. Within each library, you can sort your references into different custom groups that you name according to its contents. This helps to keep track of project-specific searches. Also, within the groups, you can choose to list your references alphabetically or according to date, which is also helpful. 

Other features of Endnote that I love are the searching features. As long as you have access, Endnote allows you to search through various electronic indexes according to the topic of your specialty and subject. For me, Pubmed is one great choice seeing as how my topics are generally medically-based. There is either an internal search option, or you can search externally and import your results into Endnote for management. There are also options to search for articles already in the Endnote library. Another great feature is that you can choose your desired format, whether it be MLA or APA or some other. I also appreciate how you can attach the full-text articles directly into Endnote to have all the needed information in one place. The best feature I have come across so far is the Cite While You Write. I love this because it links to Word so I can import my citations within my text while writing, then have Endnote format a bibliography for me at the end in my chosen format output. This feature helps to save a ton of time on the fine details of periods and commas. Overall, Endnote is a great reference management tool and a real time-saver.

Module 2, Question 1 Response

The clinical problem I chose was intra-abdominal hypertension. I used Pubmed as my electronic search index and since Pubmed is specifically medical- and clinical-based, it had extensive results on the topic. When I simply searched "intra-abdominal hypertension," I got 511 results back because it was a pretty general search. That number of results is good because it offers me many options, however, trying to go through that many results is painstaking and time-consuming. So, I narrowed my search using a boolean operator and my final search was "intra-abdominal hypertension AND sepsis." This narrowed search offered me 32 results, which is a much more manageable number.

For my clinical problem, Pubmed was great because it offers a great number of relevant and recent evidence based practice findings. It appear that intra-abdominal hypertension is a subject that is gaining popularity and attention more in the recent decades, so Pubmed was great to give me up-to-date articles. I appreciate that Pubmed is updated often and that the articles are offered as "from the publisher" even before all the bibliographic details are reviewed. This allows me the newest information available for my research. I like all of the search options that Pubmed offers to be able to narrow or generalize my search, such as being able to choose authors, dates, genders, topics, etc. It appears that it is a great electronic index for most fairly general clinical problems. I imagine that if the clinical problem becomes fairly specific in way of geographic location, population, or rare diseases, etc, there might be some problems finding all the available literature. These very specialized clinical problems might present possible barriers in the use of Pubmed in daily practice. Also, if a practitioner does not have access to an affiliation with permission to receive all the full text articles, this might present another barrier.

Module 1, Question 2 Response

In the hospital where I work, there are clinical educators/IT specialists that are in charge of reviewing and improving our documentation system. Input from the nursing and other healthcare providers that use the system on a daily basis is also encouraged to continually better the system. In my hospital, we have structured charting and unstructured charting, as explained in the power point presentation of module one: Coding and Classification of Clinical Data. There are templates set up to aid in the documentation of the patient physical assessment performed at least once a shift and there are separate templates created for the use of other data entry, such as vital signs and specific nursing interventions. The nurse that admits the patient is initially in charge of creating a care plan for the patient, then each additional nurse that cares for the patient has the responsibility to alter the care plan according to the progress of the patient. For transfers or discharges of patients, there is a process set up as well including certain templates that need to be filled out. Aside from the pre-set templates, we are also encouraged to write free text nurses notes often. This option is helpful in offering plenty of space to describe events or document information without being limited by pre-set templates. In my undergrad nursing program, we were taught and encouraged to use NANDA approved nursing diagnoses, but where I work, the use of these diagnoses isn't explicitly stressed. As for coded data, I personally haven't had too much experience in that up to this point, but I know it exists as well in my hospital. I believe it is used more between the physicians and out-patient services to handle billing arrangements.  

The use of this type of standardized documentation system is beneficial for the patient in many ways. This helps to offer the patient quality care by assuring a continuity of care. The patient information is documented so that all healthcare providers can have access to it in case of questions about whether a certain intervention did or did not happen. It also allows healthcare providers to see trends in patient status, such as vital signs, wt, or urine output, to help track the patient progress or recognize need for intervention. If the documentation is standardized and computerized, the time spent by the healthcare provider documenting is often decreased, allowing more time for patient care. The documentation, if done properly, is a detailed history of everything that has happened to the patient and can act like a safety net for the patient.

Module 1, Question 1 Response

Hello! My name is Brittany Bushman and I am in my second semester of the Acute Care DNP program. Information management as a graduate level nurse and also as a undergraduate level nurse is absolutely essential to provide appropriate patient care. Nursing and patient care isn't possible without information management, and whether we realize it or not while we are working, we are constantly managing data, even if it is simply in our minds. From my understanding from module one, information management includes observing and describing, collecting, recording and reporting, planning, and synthesizing data to create optimal outcomes for the patient and for all involved. I need to know how to manage information in order to, perhaps, look up lab values of my patient, give a shift report to the oncoming nurse, provide effective nursing and medical care to my patients in way of medication administration and symptom management, and document patient care, findings and changes in patient status for appropriate continuity of care and planning, etc. I have been guilty of complaining about the amount of charting that is required by certain hospitals or institutions, but at the end of the day, the documentation is necessary because if it isn't charted, it wasn't done! Effective information management can aid in quickening the process of documentation or information retrieval and allow the nurse more time for quality patient care. Information management also aids in the research end of nursing by documenting trends in medication administration or certain events within a specific research project. There is no end to the important role that information management plays in advanced practice nursing.