Module #6 The END

Question #1 What did you like or dislike about taking an online course?
Answer- I usually enjoy taking online courses. I like the ability to be self-paced, do a little here and there and then you are done. What I did not like about the course... I was very difficult to understand some of the requirements needed for assignments. Then when I asked one of the instructors for help it was not given. Instead I was basically told they could not make it clearer and I would just need to work it out on my own. I felt this was very rude and impersonal. Why tell students you are there to help and then don't. This type of learning experience is very impersonal to begin with. Then to add an I don't care atmosphere. This is not the best combination to encourage learning. It is really sad to say this happened during the first part of the course. From that point on this class just seemed to be a thorn in my side.
Question #2 What topic did you learn the most about and what was your favorite?
Answer- I really enjoyed bloging. I had no clue how before I started this class. Kinda funny for the first questions I was upset from the lack of support given to students in this class, but there was no need to for the blog section and it turned out to be my favorite one. Interesting, what a difference clear instructions make.
Question #3 If you were the instructor, and this being the first course what would you do the same or different?
Answer- I think I have already stated from the above questions- that student interaction and feed back is very important. I think I would change and have a group project on direct interaction between students. Some of the information given was rather dry and hard to digest. They could have been presented in a different format other than memorize and test. This course could be done it encourage hands on interaction to encourage learning. I also don't think the wiki edit was needed. That was a mess. It is very difficult to edit another persons work, let alone 4 or 5 people doing the same thing.
I have tried to find a real value from this course and have not. When I read the class description I got a completely different picture in my mind. I thought I would be taught ways to enhance the use of the computer. I guess I was but not in the way I wanted. I could have definitely used a entire module on the use of EndNote.
I guess that is enough ranting, I will just chock this class up to one of the requirements needed to graduate.

Module #5's Question

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? Post your ethical considerations as a message in your blog.

I think there is a strong relationship between the information available on the U.S. Department of Health and Human services web page AHRQ and regulatory, accreditation, and reimbursement. The first correlation is in the first section under clinical information there are guide lines for clinical practice. Having guidelines for clinical practice is extremely important when it comes to best practice. Without establishing a standard of care providers are unable compare their practice standards with others. Or they lack the opportunity to improve the care being provided. There are several regulatory commissions that have input on quality of care within this web site.
After looking at several sub-headings on this web site it appears that several sections have information provided by a regulatory commission. It probably seems within the scope of regulatory commissions to provide information to providers to ensure the standard of care is met.
Ethically is feels a little harsh to be told how to practice according to an established standard. I understand why regulatory commissions are involved with creating a standard of scare related to clinical practice. Reimbursement will always be an issue for providers. In our society health care is lacking in rudimentary areas. Providers feel they should be paid more. The government and insurance agencies feel that providers are expecting too much money for their services. This will be a never ending battle. The days of fee for service medicine are over. Now wed are moving to payment for outcome, this type of payment is a bit insane. Not every patient is going to have the same outcome. People are individuals and should be treated as such. With establishing a standard of care we are saying in part, every patient should be treated the same. From this foundation then we are saying that every patient should have the same outcome. Furthermore we (the insurance companies are not going to pay if the outcome is not. This limits the ability of the provider in such a way that it makes it very difficult to provide care. I see this leading to unnecessary tests to ensure the outcome to secure payment.
I can see both sides of the coin on this one. As a wife, and mother of people needing extensive medical treatment I do not want to pay for a poor outcome due to lack of knowledge on behalf of the provider. Nor do I want to pay for unnecessary testing ordered by the provider to ensure a good outcome. As a provider I can’t guarantee that every outcome will be the same.

How does nursing data quality relate to decision support?

I put a lot of value in nursing data quality. However, where I worked (for about 2 seconds) I don’t think they know how to read the latest studies correctly. It is very apparent that individuals will read a study and take it as gospel. Within the next couple of week s they are trying to implement the study findings without finding supporting data. This is a real scary practice to me. So far noting to instrumental has changed just little things such as using washcloths instead of baby-wipes. I am just glad they ship out the really sick babies.

How did the readings influence your perception of your own clinical decision-making? How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?
As I was reading the articles I could not believe how high the statistics were for filling the gap nursing. In everyday practice nurses are required to be extremely versatile and all knowing. There are several times when I am the “begin and end all” of care for my patients. There are many of nights when I call a doctor and ask for directions and am told do whatever until their regular doctor is back in the morning. Without a firm nursing base this would be an impossible task. Now it make me a little unsure of my skill due to the readings stating there is not much value in nursing experience.

Strengths- It appears to me that I am an equal opportunity learner. My results were pretty much equal, all within a range of ten points. The highest category was Interpersonal, only three points above a tie for second. I have always been able to perceive people’s feelings. It makes me feel weird when someone is uncomfortable around me because I try to make them feel at ease but end up making them feel even more uncomfortable. So, now I don’t even try anymore and come off as an authoritarian.
I am a pretty good reader of body language I find it interesting to watch people expecally when they are trying to communicate something they are uncomfortable with or delivering bad news. I am also pretty good at knowing when someone is not telling me the truth. My kids hate it, I don’t get too mad at them I just ask them if they would like to rethink their answer.
How would I interpret the results? - This could mean one of two things either I am a chameleon or have no specific interests. I find it very interesting at how close all of my scores are; maybe I have multiple-personalities.
What technologies that I could incorporate to augment my learning? - Spell check for one. Video lectures, it would feel like a one on one with the professor. I also love to have music playing in the background. When I am studying or working I like to listen to classical, I find it stimulating. When I clean or do a craft project such a quilting I like to listen to hard rock. I have also used an MP3 player to record lectures to listen to again. I have used my work cell phone to take pictures of wounds that I wanted to discuss with another nurse. I love technology, I feel like I am a visual and auditory person.

In conducting a search on the web for a clinical issue be prepared for a horrendous amount of useless information. Most of the information was not applicable for clinical use. The data that was retrieved for the web search was more for informational use for the layman. There were several pharmaceutical sites with small bits of information related to my topic. The pharmaceutical sites resembled web based infomercials trying to entice me to buy their product. There was really no way to narrow the search to only needed information, it was an all or nothing search.
Searching by using a guideline index was very difficult to retrieve information on my subject. If you were looking for general information this would be a fairly convenient way to find information. Clicking a category within a box and getting a response is immediately is rather gratifying. However, the information retrieved was very informative but not exactly what I needed. I did love clicking the box and awaiting a return, it was like Christmas. I found myself mesmerized awaiting the return. In fact I just started clicking different things just to see the results. However, I did not find anything relevant to my topic.
Using PubMed was the most effective of the three. I found it more effective or mentally effective to be able to search the key words that seemed relevant to my topic. Having the ability to narrow the search to only full-text articles, and adding limits made using PubMed more applicable. The information retrieved was based toward a clinical mind. If not able to narrow your search the data retrieval could become overwhelming. This is where having the ability to sort and add a limit is key. Knowing how to navigate effectively will add to the success of your search.

I chose to use EndNote. EndNote has the capability of retrieving data back to a library. In the library window it displays headings for groups, trash, and online search. Under the Group heading create custom subsections to store references in. However, EndNote has a limit of 500 specific groups per library. Also a reference can only be added to a library once, to eliminate duplication of references in a library. Although, a particular reference can be added to as many libraries as you wish. If you accidently delete a reference it is not completely deleted from EndNote, it can be retrieved from the trash if necessary. EndNote also will manage your resources in several different formats such as MLA, APA ect. This allows for ease in using for works cited. Once you have stored a reference into EndNote it is stored and available for use when needed.

I chose to search Pub Med for my clinical question. My clinical problem is how much exercise do children with ADHD receive in a day. It was very confusing at the beginning of my search. As I typed in keywords I would end up with thousands of articles about ADHD. Then I started to limit the parameters of the search. I looked for ADHD and exercise. I still received over a thousand articles. I then set limits to children aged 12 to 18. That took a few hundred off of the thousands. When I got very specific on what exactly I wanted I could not find a single article. My search was very time consuming, I spent a total of 5 hrs looking for information and trying to import it to EndNote. I never did figure out how to import. Having to broad and to narrow of searches will bring you nothing but wasted time. Having a specific item you want to search for does not always work out; there may not have been studies. For example I just wanted to know; if studies have been conducted about using exercise as an alternative to medication for children diagnosed with ADHD. At first I had over 40 thousand articles. Then I narrowed my search using keywords. The problem is I narrowed my search too much and only came up with six hits.
A couple of the barriers would be time and ease of use. Using a Pub Med search in daily practice would be applicable only if you knew how to use it effectively. There is a very time consuming factor in narrowing down a search to a reasonable amount of information. If this resource was used frequently the application would not seem so tricky. Time would be a huge factor in implementing a search for information. There would be no way to spend 5 hours a day doing research. When a search is done it needs to be quick and to the point. Setting limits helps but does not solve the problem of retrieving information that you don’t really need.

Hi,
I am Dawn; my graduate area is Ped-NP.
In the world of Pediatrics there is constantly new information on just about anything. It is relativity important to be able to know where to go find the latest information. Computer charting is popping up everywhere. If you are not comfortable using a one it is way past time you learn. Paper charting will soon be a thing of the past. We as graduate nurses will be expected to know how to use the latest in technology. There are lots of practical uses for information management. The ability to track trends and fluctuation of data to follow the progress of our patients is just wonderful. I personally hated to write on the growth charts for children. Now it is all clean and well preserved at your finger tips, no more need to leave eraser marks or trying to fit small changes on the graph, it’s all done on the computer.
Where I work I have been pushing for a jump in IT. The clinical program we are using now has the ability to use cell phones to chart in real time. This means that what I am doing at a patients home can now be viewed by office staff as I am doing it. No more calling for a list of patients that need to be seen. I will have access to it via the phone in a data text. No more 30 min conversations for a 5 min question. Working in real time is a huge jump in technology. This program even has the capabilities of flagging parameters outside of the normal limits. You could also get a text notifying you that a change has been made with your schedule. Track and trend data all with a couple touches of the screen. It will reduce duplication of duties by about 20%.