Module 6 Summary

I really appreciated the amount of time we had between modules and also liked that due dates were attached to pairs of modules. I like that it was self paced and that we could contact other students and instructors easily. Discussion boards are helpful because some students may get clarification for a topic or problem with which I was also having difficulty. I like the email component so that I can keep track of all correspondence with my instructors. Most of all I liked that I did not have to sit in a classroom. Online learning is my preference.

I loved the Blog. I liked learning about the other students and reading their perspectives. I have never blogged before and enjoyed it. I started writing a song about it. It’s called “Bloggin’ Now”….in D. I liked the assignment on clinical decision support systems as I knew very little about them. My favorite topic was the module on baises and heuristics. This is very valuable for me and will heighten my awareness both in the clinical setting and in the classroom as I work with students.

The part I disliked the most were the podcasts. I found them very time consuming and the voices from NPR very irritating. Because I could not see the expressions of the speakers, it was difficult for me to glean what was needed from them.

I would not change much about the structure of the course. Although the second module was the most challenging for me as I conquered PubMed and wrestled with endnote, I think it was very valuable and would keep it. Is there an easier tutorial? A very simplified and tangible step by step guide would be helpful. I liked how the modules were grouped and thought that all the basic elements of informatics were addressed. I don’t know how valuable that statement is since blogging, wikidocs, endnote, clinical decision support systems, etc were all pretty new to me. In summary, I felt that it was of appropriate content and difficulty for me and necessary for me in my practice. I have begun to incorporate many things I have learned into school and work.

Module 5

As described by the ethics podcast, a deluge of health information can awaken one’s inner hypochondriac. The information in search engines may not be reliable and may influence consumers to make unwise decisions. Diane Rehm made a point that the public needs to know how to do research and discern whether or not it is credible. Patients who utilize general search engines for self diagnosis and directing the course of their care may consume health care dollars by insisting on a plan of diagnosis or treatment that will not allow physicians to receive reimbursement. The AHRQ website, with its mission to improve health care outcomes, is a more reliable source for consumers providing evidence based information with which consumers can use to collaborate with physicians regarding their care.
Upon reviewing information under “ Research Findings”, “Clinical Information”, and “Consumers and Patients” , the consumer will be better informed as to why a physicain may not order a battery of diagnostic testing or medications they see advertised on TV. For example, research included in AHQR supports restrictions on anti ulcer drug prescribing. Patients insisting on deviating from these recommendations could be referred to the AHQR website to be reassured that decisions made by the physicians were legitimate and supported by regulatory bodies such as Medicaid. Conversely, they could question why a test was not ordered upon researching that its inclusion in a diagnostic workup is supported by evidence as well as reimbursed by a regulatory body. AHQR research findings can also influence accrediting bodies. For example, if new evidence is revealed regarding patient safety, this could result in practice changes for practitioners and institutions.
With the vast amount of reliable health care information available, new issues may develop. “Few professionals are prepared to make the transition to a more humble provision of assistance in decision making-the communicaton of support and guidance rather than authority and control” (Curtin, 2005, p350). Careful utilization on the AHQR website makes for a well informed patient who can plan trajectory of care with a health care provider. Will this newly “empowered” patient influence the care provider with his new found knowledge to make diagnostic decisions? What new ethical issues will arise that pose a threat to medicine’s paternalistic approach? Health care workers will need to be willing to collabrate with consumers but must also be able to determine who of their patients are truly well informed. Again, the information must be interpretted accurately. Considering the design of this website, can the average consumer, assuming a lower literacy level, navigate through the AHQR website? If the culture changes so that consumers are expected to be well informed, how will this reliable information be delivered in a format that is accesible and understood by the general population? The design of this website brings up more issues. This website is open to all consumers and allows them to complete searches without logging on with a secured password. I will let my paranoia run freely from here. What if I run searches on the AHRQ website under a chronic illness or certain medications? Then I sign up to receive “disability updates”? Can I be identified using my IP address and denied insurance, or employment? Do researchers seeking participants have access to these sites and can identify me by the searches I conduct? Regardless of the reasons someone would search my electronic trail, my privacy would be compromised. Even if I had no firm diagnosis, could this information be archived somewhere so that I could be grouped into a high risk population (despite having no documented diagnosis) when I apply for mortgage or long term care insurance?

Module 4, Question 2

Outcomes based on decisions made from data that is gathered and documented by humans depends greatly on the accuracy of the data. Thompson (2003) states that the least reliable and valid form of evidence is the use of professional opinion without supplementary support or input. The article suggests and supports evidence based nursing practice for informed decision making via the use of clinical decision support systems. Androwich and Kraft describe a “push system” of clinical support where information is provided at the request of the clinician. These systems require current and expert information. If decision support systems are not based on current data based on valid and reliable studies, then decisions based on these systems will be outdated and inaccurate. Accuracy of patient diagnosis and recommended interventions suffers.

Nurses must also become proficient in summarizing, effectively phrasing, and capturing data in the appropriate location so that information can be retrieved for later use. This was been a problem at the Huntsman Cancer Hospital when a new computer charting system was implemented. In a “pull system” the clinician must enter data in order to initiate a request for information. Data that is entered inaccurately due to heuristics and biases generates information that cannot assist the patient as that patient has been represented inaccurately.

Module 4, Question 1

The readings on heuristics and biases helped me identify the root of potential flaws in human decision making. The biases that Tversky and Kahneman describe under “Representativeness” alone were enough to make me stop and think about various scenarios in which these biases can result in compromised patient care through poor assessment and diagnosis. For example insensitivity to sample size and misconceptions of chance can influence how we perceive statistics and the likelihood of outcomes. The article also describes insensitivity to predictability and the illusion of validity. Nurses can be influenced by a patient who is younger or appears physically fit, stoic, or is described favorably or positively by a previous practitioner instead of making a completely objective assessment. As a result, diagnoses can be delayed or incorrect. The remaining biases that were discussed that concern availability and adjustment and anchoring can also influence nursing decision in many aspects of daily work.

I feel that although years of experience can assist nursing in accelerated and more precise decision making, nurses must be aware of the potential of these innate biases to influence accuracy in decision making regarding patient care. Thompson (2003) discusses overconfidence which in my opinion can be more problematic as years of experience accumulate. I didn't give much thought to clinical decision support systems until now. I assumed that they were merely a short cut and a convenience. After researching one in detail and gaining an understanding of human biases and heuristics, I have come to appreciate their value as useful and important tools in health care.

Module 3

My results from the multiple intelligence test were congruent with other similar tests I have taken in the past. I am also finding that as I age, I am seeing a more even distribution of my learning stlyes/preferences and I wonder if this is due to repeated exposure to a variety of teaching styles and methods. I am pretty even across the board except for a dip in the visual spatial area (I can’t read a chart or map or drive in reverse to save my life) and a slight tendency toward musical and kinesthetic preferences.
I will likely remember things put to music and motion. I complete a considerable amount of schoolwork while pedalling on a trainer or doing another activity . I acquired an appendage a couple of years ago : my ipod. (and my laptop has a name!) Podcasts would fit perfectly into my active schedule and I would likely learn while exercising. Videos or power points are more likely to capture my attention if they are set to music. I enjoy computer based training that incorporates sound and interactive quizzes with a drag and drop feature (with the rewarding tones if you provide the correct answer). I think that I would do well in a virtual learning environment. With all this said, I still I wouldn’t limit myself by seeking out auditory and kinesthetic aspects in all technologies. Instructional methods should be appropriate for the content . Romiszowski advises using appropriate sensory channels for commmunicating information to be learned (Zwrin). In addition, if someone has a prevailing learning style and we tailor a distance, asynchonous, teaching/learning activity for that individual, it doesn’t ensure learning. The learner must also demonstrate motivation, discipline, and initiative to seek clarification when necessary in order to ensure optimal learning (Richardson).

Module 2: Question 3

When comparing electronic indexes, a guideline index , and the web search engine I found that the common thread was accessibility. Each provides quick access to information. The prevailing difference is the quality and relevance of the search. The electronic index I used was Pub Med. It gave me the ability to make my search as broad or as narrow as I wanted by utilizing features such as the limits setting. Although the web search delivered the fastest results, the electronic index provided a more focused search on my topic that in the end saves time by providing exactly those topics for which I am searching rather than sifting through many results. The web search engine Google pulled up a plethora of information, much of which was too broad to suit my intended search. Google Scholar narrowed things down to scholarly articles and I could could further focus my search by completing an advanced search specifying author and date. In spite of the appealing velocity at which I can conduct a search, I prefer the electronic index as I feel that as stated in chapter 13 of our text, it provides a logical, systematic, efficient and effective means by which to obtain current and credible information. The credibliity issue was most important to me. I feel more confident with search results from the electronic index as it is updated more frequently. As well, web searches may not have full text available and at times you are required to pay a fee. The guideline index database was not helpful in my particular search as it seemed very limited. Something that impeded my search was that if I mispelled a word, I was not prompted as I was on Google to verify that that was the word I had intended. The tutorial was very easy to follow but still yeilded no results for my topic. This site would be helpful if I were researching recommended clinical practice for diseases, disorders, or treatments. I cannot see using this alone but would use it to compliment my electronic index results.
Another method I have used to complete searches is identifying a group of journals that I know will provide the evidence based information I need. I have used this feature on the Eccles Library site. I have also logged on websites of professional organizations such as the Oncology Nurrsing Society and the National League for Nursing that allow access to their journals with membership. This has sufficed when I needed to research something quickly and briefly for a presentation or to gain a better understanding of a topic. However, papers and other scholarly work would require a more exhaustive search. In this case I would use an electronic index coupled with a guideline index. I don’t think that I would go to a Web search unless I couldn’t find a specific article in the electronic index.

Module 2: Question 2

I used endnote with much apprehension as I have heard that it is very time consuming and difficult to learn. There was some truth in those statements but I will attribute that to my novice abilities with high precision searching and data management tools. Nonetheless, I was able to appreciate the benefits of endnote through my frustration. I especially like that it is connected to several databases from which I can quickly and easily import references. I like having everything in one place as opposed to my current situation with everything scattered in files and folders between 2 computers and 2 thumb drives. I also like that both the full text article and the citation (in APA format if you so desire!) is saved and organized by author or date with a touch of a button. The most important feature for me is having multiple libraries for different projects and being able to drag and drop between them. Along that line, I often covet other people’s reference lists and I find it cumbersome to share. We usually end up cutting and pasting them. With endnote I can transfer references from a colleague’s paper into my library and allow endnote to organize the additions for me. In the end I think it is a great tool that makes research, organization, and data sharing more efficient. I hope to become more proficient with its use.

Module 2: Question 1

My search was on “chemotherapy induced peripheral neuropathy”. I chose Pub Med as I have used it (far from its full potential) in the past. I intentionally chose a term which I knew would yield hundreds of results so that I could practice narrowing it down. The rudimentary search strategy described in the second paragraph of Poynton (2003) was the way I routinely carried out searches in the past. I would choose a term and try to make it as focused as I could, pull up a list, and then go through that massive list. The search tools found on Pub Med through the Captivate tutorial and on the Eccles site narrowed my search from hundreds to twenty. However, it was time consuming. If I were searching for something at work and had limited time, I might use a web search engine. Time is not the only barrier. With different auditory stimulus and interruptions (patients, staff, alarms), it would be difficult for me to conduct a search effectively at this level of computer and electronic index abilities. If I had no time restrictions and was conducting an exhaustive search on something very specific and needed reliable sources that were current and evidence based, I would use the electronic index. Prior to attacking the electronic index, however, I would plot out my search strategy (MeSH terms, subheadings, limits) as recommended by Poynton (2003). If I was able to compile the articles needed, I could quickly save them in Pub Med until I could retrieve them. In the end, I found that my search was focused to what I had intended however it took more time than I typically have in the workplace.

Module 1: Question 2

Approximately 2 years ago we moved to the EMR. Literature has addressed apprehension and resistance from the older generation; however, I found that some of our “seasoned staff” knew that technology was upon them and there was no way out apart from retirement ( an unwise decision in a floundering economy?) and so many of them embraced this change by greeting technology and becoming superusers. To their credit, I think that they recognized the value in standardized documentation. CPOE is coming in the spring and again we are preparing our staff for the implementation of change. I am glad to see that a common thread in most conversations about CPOE is prevalent: patient safety.

When I began my nursing career, information was kept in three ring binders scattered around the unit. Now patient information, past and present health care records including labs, medications, progress, and interdisciplinary plan, is available from one location. Standards of practice, chemotherapy protocols and drug administration policy and procedures, patient incident reporting, etc are readily accessible. I trust the information that I retrieve is current. I trust that uniformly updating information systems is much more easily achieved today than locating every three ring binder.

Standards have been key in communicating with the main hospital and other facilities. Standards on cancer staging with the use of imaging is important as patients may be treated at different facilities over the course of their disease. The EMR has made the reconciliation of medication information easier. Patients going from the Huntsman to the main hospital or elsewhere in the community avoid omissions, duplication , dosing error, and drug interactions. I see daily use of NANDA terminologies that help nurses identify which patient care issues/diagnoses they can treat independently. I believe nursing is a profession so I am a fan. Gimme an “N”!

Advanced practice nurses and physicians deal with coding DRGs for billing and reimbursement purposes. My exposure is limited; however, after speaking with some physicians, I found that they felt that the retrieved information is too broad and did not accurately represent the interventions provided. Due to this, it was difficult to use any of the information with regard to research, public health, or policy development. On the other hand, some report that although accurate coding requires training and is dependent on the interpretation of the individual, auditors are able to identify who is being billed at higher levels than the care provided.

Module 1: Question 1

Nurse educators and nursing instructors need to be proficient with the information systems used by their staff and students. We must understand and anticipate the issues nurses face while working day to day in direct patient care: data recording, organization, retrieval, and interpretation. Nurse educators in a hospital facility also play an integral role in the training of staff in the implementation new information systems. We must deal with issues such acting as an advocate for nurses to have adequate and uninterrupted training time, providing input on training approaches, developing training resources and proficiency assessments, and follow up strategies for those with difficulty synthesizing the training. Nurse Educators are often among the superusers as well as act as their backup or resource. I see our role as mentors and leaders. Knowledge and proficiency on the use of information systems (electronic health record, education databases, drug databases, etc) affecting the daily lives of the nurses whom we support, contributes to the credibility of the Educator. Nurse Educators also utilize information systems when ensuring competency based training for staff. Instruction, evaluation and tracking through computer systems can effectively save time and resources.

As college instructors, knowledge of information management is vital when instructing large groups or when conducting distance learning. I currently use virtual learning environments to develop, manage and administer educational material. As the instructor for a 16 week course in oncology nursing, multimedia, web based learning, and various databases have made my staff education endeavors very rewarding. Podcasts, wikis, blogs, and effective the use of multimedia tools can assist audiences with a variety of learning styles. I heart technology.

Introduction

Here I am: Mary-Jean Austria- I’ve never been called that except by angered parents, the Sisters from St. Andrews, and immigration officers. Everyone calls me Gigi. I love playing acoustic guitar, mountain biking uphill, and teaching nursing. My program of study is obvious then….a graduate degree in cross country mountain biking: MCCMB. That would be a dream-come-true. Actually, I feel my (real) dream is being fufilled by obtaining a Masters in Teaching Nursing

I have been an Oncology Nurse for 17 years and currently work full-time at the Huntsman Cancer Hospital as a Nurse Educator. My commitment is to Oncology and the education of our future nursing workforce. In the future, I would consider a joint appointment with the CON while remaining as a Nurse Educator at Huntsman Cancer Hospital to keep a finger on the pulse of acute care oncology nursing.