Monday, April 25, 2011

Module 6

  1. What is one new thing you learned in this module, or something that you knew but had forgotten?
One new thing that I learned in module 6 was how many ethical issues are involved as information technology changes.  Some of the ethical issues are things that have been around for many years like not getting into information for patients you are not taking care of, making sure that you don’t give out your own personal password, and logging out when you leave the computer.  Ethical issues are becoming more complex than that now.  There are more ways to use technology in medicine.  X-rays and medical records can be viewed at home by physicians, personal medical records can be accessed not just in the hospital but also in clinics, and there are copious amounts of information in one place to keep private and confidential.  Ethical issues include what is available and to whom.  Although having personal health information in one place can be essential in providing good care it can also be disastrous if that information goes to the wrong person.  Insurance rates and coverage are all dependent on our health.  Discrimination and bias can be established from the same information. 
This semester I have learned at how much technology really can help us in the medical field.  Information found at work in the CPG database is more than I was aware was available to me.  The use for technology seems more of a good thing rather than just another computer program to have to learn.  I find that I am using them more in my everyday practice.  However it has been also eye opening at how many problems can come.  I am sure that as technology advances it will get worse.  Some ongoing questions are who has a right to have the information, can a patient deny access to their records, and when is it appropriate for the information to be given out.  Accuracy in the data is another ethical area.  If the information is put in the record but is inaccurate how do you change that?  What if a patient is treated off the inaccurate data and new problems are created for that patient. 
This semester my appreciation for this technology and the positives and the negatives that go with it has been increased.

Monday, April 11, 2011

Blog #5

How did the readings influence your perception of your own clinical decision-making?
I have been a nurse for over 17 years.  The readings in this module have made me reexamine the way that I make my decisions.  I feel pretty confident in my clinical decision making skills from many years of making them.  However, now I am finding myself paying more attention to why I am making the decisions the way that I am.  I worked as an adult nurse for 12 of the 17 years.  Some of that time I spent on a CCU and the Thoracic ICU.  I found it interesting in the lecture by Daniel Kahneman when he talked about a nurse knowing something was wrong by just looking at a patient.  I found that there were many times in the ICU that you could tell who was going to code on you that night just by looking at them from the hall.  I had never bothered to break it down to why like Mr. Kahneman did but I know it happens.  Now that I have read a little more about this I am trying to find what the reason is that I make the decisions that I make.  It is easy to do things because we are using our nursing “intuition” but there are times that it is wrong or based on tradition.  I think it is a rut that many can get trapped in.  Taking the time to decide why I am making the decisions that I am will help me to make sure I have appropriate information to base it on
I was also impressed with the CPG system that IHC has one of the CDSS out there.  I have to look at it for updates each month, but I haven’t really spent time reading it.  Most of the time I don’t have the time to look things up, but I think that taking time before things happen, and after an incident is over can be helpful in learning from each situation.  It is a great reference to find best practice information.  References are available to read and from the references you can get other articles that cover the same information.  I think too often we are not up to date with the current information out there.  I know when I first came to the unit that I work on that there were differing opinions on how things should be done.  Some of the older nurses had “always done it that way” and “never gotten in trouble for it” so they continued in the same way.  The newer nurses were more up to date, but it was hard to decipher the proper way to do it.  With CPG you can know what is expected, what documentation is required, and be assured that you are following company policy.  Continued education for the staff so they get used to performing searches can make it easier for the staff to find the information they are looking for.  With continued success finding the information they we are more willing to use the CPG system.  I know as I use it more my clinical decisions will become more in line with current evidence based practice which will make me a better clinician.