Module 6

I generally like on-line courses because they are self paced. I sometimes have a problem with structuring my schedule between, work/school/family and appreciate the flexibility of doing the assignments in between my other responsibilities. I do, however, tend to put off assignments when the due date is scheduled 1-2 months out. This procrastination is one of the downfalls to an on-line course. 

The topic that I enjoyed most in this class was the module 3, teaching with technology. I found it to be the most bearable of the readings because I felt genuinely interesting in the material. I did appreciate the other material but I didn't have the interest in the other topics as much as module 3. I probably also learned the most from the teaching with technology topic but Module 1 & 3 also had some basic terms and general knowledge that I have heard before but just wasn't familiar enough with it until this semester. 

One of the most important aspects in any course and especially on-line courses is communication. A timely response and feedback to questions and concerns from students would be my priority if I were the instructor of an on-line course. 

MODULE 5

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 AHRQ website is a credible source and for that reason is a good resource for consumers and providers alike. I think it is important for patients to be able to feel like they play a part in their health decisions. This site allow them to navigate several different areas pertaining to healthcare including information on prescription drugs, prevention methods and information about diseases and conditions, based on evidenced resources. While it is important for the patient to take an active role in their health, it would also be crucial to have their concerns evaluated and validated, in person, by a healthcare provider. Of areas that I navigated on AHRQ, general information was provided which I am sure ties into their disclaimer, but patients need to be aware of this and that each case can vary and should not be used as a diagnosis tool. There is limitless information available in the Internet and most are not credible. Patients do need to be aware of this and educated on how to decide if the site they are navigating is credible. I thought the ehealth webcast guest (can't remember which one) provided a good explaination that we can give to our patients when they are inquiring about symptoms based on a web site. He stated that the web servers give information based on relevance to specific symptoms and not the liklihood of those symptoms actually being the diagnosis given the whole picture. The Internet can be a helpful tool, and the patient's concerns should be taken into consideration without devalueing their input, but we cannot take away the power of a physical examination, definitive lab tests, radiographic studies and individualization.   

March 16, 2009

Module 4 

How do the readings influence your perception of your clinical decision making?

I think that the CDSS can be useful in my clinical decision making in a lot of areas but not all. The areas that would be helpful that were mentioned in the article "Clinical Decision Support System in Nursing" were the systems that aided in wound care assessment and treatment and pain treatment in cancer patients. We need to be careful about what we are using the system for. It seemed that the system that guided nurses in dosing of oral anticoagulation treatment of in-hospital patients is over stepping our scope of practice as nurses. This particular system may be helpful in guiding the dosing, but I don't think that we should be able to change a coumadin dose  based on the systems recommendation. There are too many other factors involved, such as pharmicokinetics, drug-drug interactions and the patients current condition to just rely on a computer system throwing out a number based on just an INR. This particular example may have been relevant to APRN only. Over all I do think that CDSS can help us close the gap in evidence and practice, we just need to keep the nurse in the nursing practice to optimize patient care and critical thinking. 

How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?

In the article "Clinical Experience as Evidence in Evidence-Based Practice", the authors talk about the different techniques health-care workers use to make their daily decisions when it comes to patient care. The most common mistakes made, according to the authors, when making clinical decisions were: overconfidence, hindsight and neglecting to use prior probabilities of disease or conditions in the population.  Nurses tend to base their current decision on past experiences or other professionals opinions. I think this is most likely due to time constraints and the easiest answer is to either recall what worked best in the past or ask a trusted peer. This gives a quick and easy answer to our problem at hand. The article also mentioned that people fail to adhere to the normative model in real life decision making and I again think that we tend to take the easy way out. If it take less time and less effort, it sounds like the best choice. People are inherently lazy....including me!

How does nursing data quality relate to decision support? 

According the the article "Judgement Under Uncertainty" the higher the data quality given, the better the decision that is made is supported. (that sounds so obvious) I found it interesting, as mentioned by the authors, that when given no evidence, we use prior probabilities and when poor or worthless evidence is given, we ignore prior probabilities. I would contribute this to the fact that our intuitive judgements are dominated and we rely on biases. We go with what we know and can recall quickly. This was not necessarily a good thing according to the authors. People rely on a limited number of heuristic principles and that decreases the complexity of the task when we are trying to solve problems. We try to simplify our problems or tasks. When given a set of data, we process it the easiest way, which did not always turn out to be the right way. It just seemed like the obvious way.   

Module 3

The strengths that were highlighted in my multiple intelligence test was mathematics. I have always enjoyed math. I like to problem solve and complete tasks that I can check off on my "to do list" I think that math makes me feel accomplished when I am done. It is gratifying for me to have a problem set out in front of me, solve it and move on. It is even more gratifying for me to know that I understand the problem set before me. 

I scored pretty even across the board on the test. All of my scores were above 30 except for musical and bodily-kinesthetics.  I think this has to do with my non-creative side. I feel that I have no creativity. Linguistics was right at 30 and think this has to do with my poor communication skills. I do not verbalize or express myself well. This is the area that I would like to improve most. Assignments like these that require interactions and self reflection definitely help as well as networking, like on facebook and texting. As silly as it seems to think that the latter two improve communication, that kind of interaction encourages us to be clever and clear in our thoughts as well as accurate spellers. (is that really a word?) - Jill

Module 2

The topic I chose is "pain perception and treatments among Asian cultures". I am using this topic in my social medicine class and thought I would use my time management skills as well. I started using the Cochrane index and ran into some problems with importing articles from that database to Endnote. I ended up using PubMed, which is my first choice indexing database because I feel it is very user friendly. 

The impediment with Cochrane was a filter that was necessary for Mac OS. I have ran into several software incompatibilities when using electronic indexes that are usually fixable but time consuming. My search for the articles was relatively short since PubMed has such a large database and so many tools to search for key words; although I spent several hours trying to resolve my filter problem with Cochrane before moving on. Software incompatibilities can certainly take time out of daily practice. Computer technology has enabled us to retrieve vast amounts of information in seconds, until technical difficulties arise. 

I purchased Endnote reference manager last semester and have found it very helpful in searches and organization of information. Endnote enables a researcher to access hundreds of electronic databases and save them to a personal library. More than one library can be managed as well as groups within each library to ease the organization of information. My favorite feature of Endnote is "cite while you write". This tool inserts the reference right into your document, in the format of your choice, as your writing. This tool is a huge time saver, especially when multiple references are used.

I felt that all three tools I used for retrieval and management were very helpful in my search. The guideline index is always good for me to review prior to any searches. It reminds me shortcuts to use and aids in trouble shooting. The search engine for retrieval and the electronic index are incredibly useful. It makes thousands of articles available to me at my convenience, and organizes the material, all in a few minutes.

Alternative resources for retrieval, as archaic as it sounds, would be manual retrieval from a library. Another source might be your employer's library. Both of these resources would be limited in the information available and current materials.

Module 1 

Hi, I'm Jill Wilson. I'm in the Acute Care DNP program 2nd semester. I work at Timpanogos Hospital in the ICU. I have worked there almost 6 years. I am married and have one daughter who is 15 years old and one on the way that is due right after finals in May!  

It is very important to keep current on information management skills in order to manage patient care more efficiently. Patient charts can be easily organized, stored and accessed for healthcare providers use in a manner that promotes safe practices and privacy of the patient.  

The hospital I work at uses electronic charting. It is an older system that has it's glitches but we are working on integrating a new program that will hopefully be more user friendly. Technology advances so quickly that programs need constant maintenance and up dates in order to remain compatible with it's surrounding networks. Structured or coded clinical data provides a standard to the health care practice that can make health care provider communication easier. It also promotes safer practices which improves patient outcomes.