Module #6: The Final Blog Post

What did you like or dislike about taking an online course?

I liked and disliked the freedom in time management that an online course allows. Most of the time I stayed on schedule but there were a few times that I turned stuff in at the last possible minute and that was just way too stressful. The one thing that I've really disliked about all the online courses I've taken is the absence of the classroom. I enjoy the discussions and other interactions that occur in the classroom. I especially like seeing an instructor teach their class.

What topic did you learn the most about and what was your favoirte topic?

I found decision support systems to be fascinating. While looking into decision support systems to critique I came across some great resources. I really enjoyed ARUP's Clinical Consult and DiagnosisPro, not only because they were free but also because they were easy to use. Just about every pay-for-use decision support system I found had at least one component that I thought made it worth the yearly subscription fees. This class made me realize that decision support systems are going to play a major role in the future delivery of health care services. I also feel that I would like to help develop point-of-care decision support systems in the future. This is something that I may have to look into once I'm done with school and get a little clinical experience under my belt.

If you were the instructor, and this being the first course for all DNP and Master students, what would you do the same or different?

If I were the instructor I'd spend a little more time covering EndNote, literature searches, and decision support systems. I'm saying this because these are the subjects that I really enjoyed or struggled with and I know that a few of my classmates felt the same way. This course did a good job of sparking my interest in IT and laying a decent foundation for us to fall back on in the future. As I mentioned above, I'm definitely interested in helping to develop easy to use point-of-care decision support systems for clinicians and this class is responsible for this.

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

To start with, there's a ton of info on AHRQ's web page. We've had to explore this site in the past for other classes and I've always found it rather cumbersome and nowhere near as intuitive as some other web pages I've used. AHRQ has a resource center for health information technology. This resource center provides clinicians with information that's needed to institute and appropriately utilize health information technology. I found a lot of tools for planing, implementing, and evaluating the use of health information technology in many different clinical settings. I really found very little information on regulatory, accreditation, and reimbursement issues. While AHRQ appears to whole heartedly endorse the development and use of health information technology, they don't seem to be to be to caught up in some of the more salient issues out there. Who will oversee the use of health information technology? Who will determine whether or not a health information system is compliant with HIPAA and other health information guidelines? How will we pay for the mass adoption of health information technology by clinicians? How will CMS reimburse? How will insurance companies reimburse?
It is clear that health information technology will play a huge role in the overhaul of our current health delivery system. What is not clear is the type of role it will play. Will it help or hinder? Will it create new unanticipated issues at many levels in the system?

Module #4 Question #2

How does nursing data quality relate to decision support?

The quality of nursing data is closely related to the quality of the decision support system. The higher the quality of the data the higher the quality of the decision support system. The problem with most data used in decision support systems is that it relies heavily on quantitative sources and nursing data is not always in quantitative easily swallowed formats. Much of what we as nurses do is not measurable by quantitative means and this means that data must be collected via other methods. One such method is qualitative. How often is qualitative data included in decision support systems? After devoting a little time to searching for decison support systems that incorporate qualitative data, I came up empty handed.

Maybe the problem is not with the quality of nursing data. Maybe the problem lies with the type of data that is easiest to incorporate into todays decision support systems. I imagine that a decision support system designed to take into account the unique data collected by nurses could be quite useful and provide relevant up to date information to assist in the complex decisions nurses are faced with on a daily basis. What do you guys think?

Module #4 Question #1

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?

Until I completed the readings for this module, I fancied myself to be the kind of nurse who is up to date on the latest evidence based guidelines and could easily incorporate them into my clinical decision making. Now I see that I relied upon my own clinical experience, or the clinical experience of others, to shape the majority of my decisions. It appears that I am not that different from most nurses in that I "rely heavily on experience to meet the information needs associated with decision choices under conditions of uncertainty" (Thompson, 2003). The benefits to incorporating evidence based decision support systems (DSS) into my nursing practice are pretty clear. I just need to get over my technophobic ways and embrace some of the DSS that are currently in use and think about ways that I could contribute to the development of a nursing specific DSS.

Reconciling the value of nursing experience with known heuristics and biases used in human decision making looks to be quite an undertaking. Thompson offers the following suggestions for reconciling the effects that heuristics and bias can have on human decision making: avoid making predictions in unfamilliar domains; adjust your own personal confidence estimates downwards; look for objective sources of feedback on your decisions; don't get stuck in the past, explore alternative possible outcomes that could have occured; and learn how to use base rates appropriatley in your decision making (Thompson, 2003).

Reference:

Thompson, C.(2003). Clinical experience as evidence in evidence-based practice. Journal of Advanced Nursing, 43(3), 230-7.

Module #3

What strengths were highlighted in the results of your multiple intelligence test? How do you interpret these results? What technologies might you incorporate to augment your personal learning based on these results?

Highlighted strengths:
Musical
Spatial-Visual
Intrapersonal
Bodily-Kinesthetic
Logical Mathematical

Interpretation of results:
I feel that the results of the multiple intelligence are fairly close to how I see myself. The order was just off a bit. I kind of thought logical-mathematical would have ended up higher in the ranking. I like figuring out how things work and devising methods of improving their performance. I also really enjoy certain types of math (not biostatistics!) and problem solving. I was really surprised to see musical performance rank #1. I play guitar/bass, there is always music on at home, and I love music. None of the typical roles associated with this intelligence type sound appealing to me all. It was also quite interesting that interpersonal ranked so low for me, it was tied for last place with linguistic. The typical roles associated with interpersonal intelligence are pretty much what I am doing right now as nurse. Maybe I should abandon the DNP program and redirect all my energy towards becoming a musician.

Technologies to consider incorporating for augmentation of my personal learning:
>Listen to music more often during my studies. Set up some Pandora stations with classical, jazz, and misc instrumental music. I'm pretty sure that I should avoid anything with lyrics while attempting to study. I can use the results of this test to justify getting an iPod Touch.
>Develop pictures, diagrams, symbols to synthesize concepts/information into a format I can remember easily. What technologies are available to help me with this? Word, Adobe, SmartDraw, etc.
>Create podcasts that cover relevant information for exam prep or content review. Listen to these while doing core work, hiking, biking to school, and running.

Module #2 Question #3

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? Identify some alternative strategies for retrieving relevant information - would context relevant information retrieval be useful?

Electronic Index:
I did not like using PubMed. I just prefer the features of other resources, like CINAHL or the Cochrane Library.

Guideline Index:
The NCG was really fast, easy to use, and provided quite relevant information for a practioner. My only complaint was the presentation of guidelines. They were difficult to read with a bunch of bold text and red text littering the page. I think goofing around with NCG made me like UpToDate and the Cochrane Library even more.

Web Search Engine:
When in doubt I end up using google or google scholar. When I searched "acute low back pain" in google I got a lot more results and had to whittle things down. I found a lot more full text offerings on google scholar than I did with PubMed.

Alternative Strategies:
Search eJournals at Eccles.
I would love to see something simplified for a PDA or iPod Touch that would enable clinicians to access quality info at the bedside. Most of these resources are just to clumsy to quickly access the pertinent info you made need at the bedside. I think an easy to use clinical guideline application set up like epocrates would be amazing.
I'm not sure I really understand context relevant information retrieval. Anybody care to bail me out on this?

Module #2 Question #2

What features in your chosen reference management software can be used to sort, classify, and otherwise organize references? Describe software functionality that allows you to better organize and share information for efficient retrieval and use.

I'm an EndNote virgin so I'm still learning the software. I spent about 3 hours figuring out how to import my references into EndNote and had very little time left to explore it's sorting, classifying, and organizing features. I'm also embarrassed to admit that I had to try 6 times to get EndNote installed. I did create a N6004 group to put all my references for this module, but beyond that I'm lost right now. All I need is some more time to familiarize myself with EndNote and I might be able to really answer this question. Sorry.

Module #2 Question #1

Describe your clinical problem and choice of electronic index. How did the index facilitate (or impede) your ability to construct an efficient search? How time consuming was your search? Would there be barriers to using the index in daily practice?

I see a lot of acute low back pain at work and was interested to see what info existed about different treatment modalities and their efficacy. I went with PubMed for this search because my old standby, CINAHL, wasn't on the approved list. I really don't like PubMed all that much. In another class we received a CINAHL tutorial so I'm feeling pretty comfortable with at least one search method. Looking this up "acute low back pain" in PubMed wasn't really that time consuming. I think I lucked out with the limits that I ended up using. The big barriers for me in using PubMed is the difficulty I found in tracking decent abstracts and full text for the references I found. PubMed would be a decent choice in my daily practice if it had better abstracts and links to full text.

Module #1

1. Introduce yourself to the group. Include your graduate area (e.g., teaching, acute care NP, etc.).
Hello everybody! This is Sam Sloan from the DNP-FNP program.

2. Why do you as a graduate level nurse need to know about information management?
I need to know about information management because health care delivery is becoming increasingly dependent upon technology and information management. In order to be an effective PCP you need to know more than just the basics. You should know how to integrate the latest evidence based practices, equipment, data collection/retrieval methods, and management techniques into your practice in a seamless manner. One should also know as much as possible about information management because Obama says so.

3. Describe what is happeing related to IT in your clinical or practice setting.
I work in the ED at the U and we are sort of the late technological bloomers in the hospital. The nursing staff in the ED do very little computer documentation compared to other units in the hospital. We do not use CPOE, PowerChart, etc. We use FirstNet to document triage assessments and access patient charts for labs, H&Ps, imaging, etc. Within the last 2 weeks we started documenting blood sugars and urine pregnancy screens in FirstNet. Management has said "We'll be going live with full computer charting by the end of the year" for the last 2 years. I wonder when we will really "go live".
The ED does have the distinction of being one of the only units in the hospital to use Vocera. We were the first to start using it and now xray, ct, and ekg techs are using them. Social work, interpreter services, and pharmacy are also using Vocera. Vocera is great when it works.

4. What structured documentation, standards, and/or coded terminologies do you see within your practice setting (if none--where might they be applicable)?
The MDs in the ED are using computer documentation for their charting. Their documentation is pretty slick. It's easy to access, interpret, and use. The format has standardized charts for different patient complaints and allows the physicians to use their own language through free-text options but , most importantly, it has standardized a great deal the vocabulary and made it easier to pull out data for future purposes.

5. How are structured/coded clinical data useful in promoting quality patient care?
Without structured/coded clinical data we would not have a quick way to review, interpret, utilize, and communicate patient data. One of the biggest challenges we face in delivering quality health care right now is the overabundance of information available. Much of this excessive information is not easily accessible due to differences in vendors, computer networks, terminology, and structure. Promoting a standardized structure/code for clinical data that is easily accessed and interpreted by health care providers would greatly increase the quality of care that patients receive. There would be no need to repeat labs, imaging, and other expensive diagnostic studies because the results would be readily available. PCPs could easily see what specialists were thinking. Patients would feel that all their providers were on the same page. Providers may feel less frustrated by the increased transparency standardization and structured/coded clinical data would yield. The bottom line is things will only get better for the patient and the patient is why we are all here.