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.

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.   

Blog #4

1. What sort of teaching is done in your professional role?

Nursing is a profession that is based in teaching.  One role we teach in is when we mentor other nurses that are just beginning in the profession.  New nurses come from school with the basics, but there are several things that you learn as you gain experience.  This is actually an important aspect of our role in nurses.  If we help the new nurses to become proficient then we are helping to make sure that later on we will have someone taking care of us that are good at what they do.  It also ensures that we have a good team to work with.  Not only helping new nurses but also helping other professionals that are part of the interdisciplinary team so that we are able to provide the best care for our patients

The next role is the teaching we give our patients.  People are more involved in the decisions made in their health care.  We as nurses are the front line for learning for most of our patients.  We are called upon to clarify the teaching that the physicians have given them.  Medical professionals are constantly teaching patients about the laboratory tests and the procedures that they are going to experience.  When new medications are given to a patient in the hospital the nurses are teaching why they are getting the medication, how to take it, and the side effects to watch for.  In the clinics and physicians offices nurses and physicians are teaching patients about prevention from diseases.  We teach signs and symptoms of heart attacks and strokes so that patients have a better chance of getting care quickly.  School nurses teach children about the importance of hand washing.  At home nurses are asked by neighbors, friends and family members questions.  Usually there is some teaching that goes along with them. 

Then there is the learning that we as nurses receive from our patients.  Some of the experiences that I felt I have learned the most from are things I learned from those I am taking care of.  Other important learning is from other professions that also play a role in the patients stay.  These can include the physicians, respiratory therapist, the clerk and the housekeeper. 

2. Is there any nursing/health care provider role that does not involve teaching in some manner?

There is not a role in nursing or as a health care provider role that does not have teaching as part of it.   One of the biggest ways we teach is by example.  How we conduct ourselves, the caring we give, and the approachability that we have are all ways of teaching.  Even when we are not aware of it we are teaching.  In the NICU we have feedback from patients after they leave the hospital with their babies that they still bathe their children the same way we did, or they swaddle their patients the same way.  We should be aware as nurses and other health care professionals that people are always learning from us.  We also need to be aware of what they can teach us.

Blog Entry #3

1. You used an electronic index, a guideline index, and a web search engine to retrieve information relevant to your clinical problem. Compare and contrast your results. Which resources were useful/ not useful for your information retrieval task, and why?

I was looking up information about methadone use in pregnancy and it’s implication on neonatal abstinence syndrome.  I conducted searches through a web search (google.com) a guideline index (the National Guideline Clearinghouse), and an electronic index (Endnote). 

When I searched with google.com I obtained over 13,000 results including articles and books.  When I went into Google scholar I was able to find articles that were related to my search.  I was able to limit my search to the last 5 years and have it include the citations.  I went under preferences and was able to apply more limits.  I found several relevant research articles, but was not always able to read the full text since some of the different libraries online require subscriptions to access the articles.  These research articles are from scholarly resources.

I haven’t used the National Guideline Clearinghouse prior to this.  I did not find it difficult to use, but I was not able to get any guidelines that pertained to my search.  I found only one guideline that had to do with methadone in pregnancy and it had to do with decreasing dosing during pregnancy.  There was no guideline that had to do with the neonatal abstinence syndrome.  The good part of the search was that it gives you some MeSH terms that could be used in the electronic index search.

In my electronic index search through Endnote I was able to get results for articles through PubMed and one film from 1998 called Unborn Addicts.  Through PubMed I was able to get 194 article references.  Through Endnote I can search several libraries and can obtain the citations.  I can put the references into a group so that it is easy to find and they are all together in one place.  I can also use these references to cite in papers that I write for school. 

I found that my preference is the electronic index search because through the University I am able to get the articles without having to pay for several subscriptions.  I didn’t get any pertinent information about my topic on the National Guideline Clearinghouse.  I found relevant information on Google scholar, but I would have to write down the articles and go back through the University library to obtain the copies of them.  With Endnote I can look up to see if the articles are available online.  If not I can use those references to look them up in the library, but I don’t have to write it all down and keep track of the information.  It also allows me to make citations in Microsoft word.  It is very helpful, easy to use, and allows ways to share the information with others.

Module 2

1). What is one way you could become involved in designing, selecting, evaluating, or implementing an information system in your workplace?

Information systems are a big part of the workplace in the hospital.  We use web cams that allow the parents of NICU infants to see their babies.  We use computers to scan medications against the babies ID to assure that it is the right medication, right dose, and right baby.  One way to get involved in these and other information systems is to help when there is a glitch in the system.  Help look for ways to improve the system and make those suggestions.  Sometimes it just takes someone to see a change that will improve the system and make it more user friendly.  Although it seems like a small thing, it is an important role that each individual nurse or system user can make.

Another way that you can get involved with information systems is to volunteer.  When new systems are being looked the hospital will ask for people to become superusers and help teach the new system to the other employees.  As a superuser you are taught more in depth about the system and can help catch things that need to be changed before it is used hospital wide.  As a nurse that is doing patient care it is important to make sure that the information systems are working well with that setting.  Learning to use the system and helping to make it fit into the clinical setting is one of the best ways to help.

Another way that I think we can help with information systems is to make the hospital or clinic that you work for aware of a system that you used in another place that may work well.  If we as nurses try to make things better for ourselves and our patients. 

Introduction - module 1

Hi everyone,
I am Lyn Standing.  I am writing this blog as a class assignment for Nursing 6004 informatics class.  I have been a nurse for 17 years.  I am in the Neonatal Nurse Practitioner program at the University of Utah.  I live in Ogden, UT.  I am married with 5 beautiful children.  When not busy in school I am spending time at their activities, camping, or reading a good book.  This past summer I had the privilage to run both the Wasatch back ragnar and the Las Vegas ragnar with my family.  It was a great experience. 

As a graduate level nurse there is a great need to know about information management.  First there is a need for keeping records of each patient.  Computers can be used to keep a large amount of information in a small amount of space.  It also keeps the information accessible.  When information is on paper it is easily lost, destroyed, and hard to file in places that you can access easily.  Information has to be handled carefully since there are privacy and security issues.  Federal regulations have been set up through the HIPPA laws.  Some of the information that we have to keep track of are not only the medical records, but also being able to budget, maintain the needed supplies, and keep employee records of immunizations. 

Today IT has many uses.  We scan our medications prior to giving them to the infants.  This helps to ensure that the medication is the right one ordered, at the right time and being given to the right patient.  We have x-rays that are available to the doctors on the computer not only at our hospital, but also throughout the IHC system hospitals and clinics.  We order labs and get the results through the computer.  Our monitors can print out heart rhythms and vital signs onto a printer for a hard copy.  In the NICU we also have web cams.  This allows our parents to see their infants during care times when they aren't able to be at the hospital.  We have voceras that allow the nurses to communicate with each other and physicians without having to be in the same room.  It comes in handy when there is an emergency going on.

I am excited to learn more about informatics this semester.