Module 7: Influence on my life

This course on informatics and technology has been an eye-opener. I have enjoyed learning about technologies that I use every day, such as the internet, powerpoint, and Web CT. I feel that I now know more about the field of nursing informatics and what that scope of practice entails. It was also interesting to me to learn about different types of intelligence and how people can use technologies to learn in their optimal way. Also, I thought that the lesson on heuristics showed how people make mental shortcuts, and I became more aware of this in my personal practice. I am currently trying to combat against this. Overall, there have been several gems that I have gleaned from this course, and they have taught me to look around at the different technologies that I could be using.

Module 7: Least applicable technology

For me, I think that some of the structured terminologies are least applicable to my professional life. Although there are some that I use (such as the forms on Powerchart at the University Hospital), I find that there are also some that I do not often see, such as the ICD-9 nomenclature. Because I work in conjunction with case managers and others who use the standardized terminologies, there are many that I do not use personally, such as for placing codes on my patients' diagnosis and treatment.

Module 7: use of technology in my life and ethical implications

I will be most likely to incorporate online research databases into my personal life. I find that the information in PubMed is reliable, and many of the articles that are found there have been peer reviewed. Also, I like the fact that I can save a search and can receive e-mails when new articles are published on a certain topic. This technology will help me keep abreast of the latest findings on a given topic, and this will help me to better implement evidence-based practice.
Online research databases may cause ethical concerns in a couple of ways. First, if I find an article that indicates that a certain practice is the most effective, yet my workplace encourages doing it a different way, I would have to decide between doing the best practice and pleasing my superiors or complying with the hospital policy. To address this concern, it may be best to talk to my manager pr nurse educator and show her the article. This ay lead to the newer practice being adopted later on. Another ethical concern would be with researching topics for my patients. If a patient wants to learn about a certain topic, I would be in a position that would allow me to help her. However, because research must be analyzed for its credibility, and patients might just believe every article they read, I would need to carefully sift through information in order not to misinform my patients.

Module 7: Most interesting technology

This semester, the technology that I found to be the most interesting was the decision support (I researched Iliad). I had never known that such a thing existed, and I enjoyed learning about it. It seems that this type of technology would be useful in the clinical setting in diagnosing patients based on certain criteria. However, I don't think that I would ever use it just because I will not be responsible for diagnosing patients as a clinical nurse leader.

Module 5-Decision Support: Nursing data

From learning about decision support systems (I researched Iliad), have found that in order for them to work properly, the correct data need to be entered into them. They are used in many cases by physicians or nurse practitioners, who are responsible for making vital decisions about patient care. Because the data are gathered and entered into electronic records by nurses, we have a great responsibility to enter quality data, so that accurate data can be entered into the systems, whatever they are. It is only with correct data that the decision support systems can actually help the care providers reach appropriate decisions.

Module 5-Decision Support: heuristics

The readings for this section (especially those by Thompson) rang true with me. I have found that the more time that I have been a nurse, the more I naturally depend on past experiences to make clinical decisions. I remember being a new RN on my orthopedic med-surg floor, stuggling with every decision I made because everything was so new to me. I was overwhelmed with all of the new information about procedures and policies. Now that I have been in this role for a couple of years, a lot of what I do and a lot of what I tell patients comes from mental shortcuts that I have made. It is almost as though I go on autopilot sometimes. Reading these articles, I understand why this way of doing things maks me vulnrable to biases. For example, if a patient's condition reminds me of another patient I once had, I may fall into the trap of thinking that the two patients have the same needs. I may also feel that I know the patient's condition better than I actually do (overconfidence). Two total hip patients may actually have medical issues that make thm very different. Relying too much on mental shortcuts (heuristics) can be dangerous.
However, I am also sure that experience makes us better nurses. If we are aware of the biases that we bring to the patient rooms, we may be able to keep ourselves from falling into them. While the natural way for humans to use information is to create shortcuts, we can make the extra effort to use evidence-based practice. If we continually try to learn about new and better ways of doing a procedure, for example, we can prevent overconfidence. We will realize that medicine is always changing and we will poise ourselves to change with it.

Module 6- Healthcare Information Systems and Devices

If the University Hospital were to start using a new IS component, I think that my primary responsibility as an RN would be to learn how to use it (if it applied to my practice). There would probably be instructional inservices available, and I could attend them and encourage other staff members to go with me. This would help the new system to catch on more quickly and be used to our advantage. Another responsibiliy would be for me to use the new techology after I have been taught. The hospital administrators and information systems specialists would have probably decided to adopt the program because it would help with my job, and I should accept this fact.

Technology Evaluation

For my technology evaluation activity, I analyzed online learning, distance learning (oncluding Web CT), and power point. I selected these three technologies because I have used all of them in various learning situations. I personally learn best from online learning because it is available in varying situations, whereas Web CT is only available to students enrolled in a formal class (as far as I know), and power point is most helpful in my learning when there is an instructor to explain the power point slides to me.
However, all three of the technologies would be helpful in different situations, and would be helpful for a variety of types of adult learners. Because of the multi-media that is available in all three of these learning resources, the learning possibilities are expanding from what they have been in the past. I think that for adult learners who are enrolled in a formal class and are seeking a degree, distance learning would be helpful for a busy schedule and would help the learner learn and do assignments to meet a deadline. For those more interested in learning in general, online learning would be helpful. It is available at all times, to anyone with access to the internet. There is a lot of information available online, and it is important to evaluate the sources of this information.

Theory and patient education

Learning is defined as a “persisting change in human performance or performance potential” (Driscoll, 2000, p. 11). I think that by using teaching methods that build on the intelligence strengths, I (or anyone else) can better process and remember information. Bruner states that as people learn, we process information and understand our world through action, imagery (visual), and logic/reason (Driscoll, 2000). These are three of Gardner’s types of intelligence. Therefore, as we incorporate data into these areas, it will become a part of me and my patients, and we will become more independent thinkers. In my work as an RN on an orthopedics floor, I have multiple patient interactions and many opportunities to teach them. Patients are inundated with massive amounts of information during their hospital stay. I should understand that different people use different forms of intelligence, and these should be utilized in order to help them remember the information they need to.

Multiple Intelligence Test

By taking the multiple intelligences test, I found that my intelligence strengths are musical, logical-mathematical, and intrapersonal. The descriptions of these areas show that my preferred learning styles would involve logic or numbers and musical sounds or rhythms. Therefore, one technology that could help me to learn would be listening to books on tape with music in the background, or anything that sets a set of information/words to music. Multimedia presentations or CD-ROMs would be an example of this. Also, any book or other technology that uses logic to teach would help me because I logic is another one of my strengths.

Module 3: Electronic Index, Guideline Index, Search Engine

I was able to use an electronic index (PubMed), a guideline index (National Guideline Clearinghouse web site), and a web search engine (Google) to research diabetic amputations. I found that these three techniques have some similarities and differences, and some strengths and weaknesses. The electronic index is unique in that it provides articles about all of the information available about a given topic (unlike the guideline index which just offers practice guidelines). It would be useful in writing a resarch paper. However, if I were at work and trying to discover the best way to perform a certain procedure, the guideline index would be the most convenient. I would have less information through which to filter. The web search engine is useful in that it is available from any computer that has the internet, unlike the electronic index, which is only available in some libraries. It provides a lot of information about a given topic, and a search can be narrowed as in the other two indices. However, the sources of the information should be researched to make sure the information they contain is valid. An added benefit of the web search engines is that a lot of the information is written in language that would be understood by patients; they could therefore be printed out and given to patients for educational material.
All three information sources were useful for my information retrieval. Their usefulness simply depends on the reason that I am conducting the search. I preferred PubMed for my own learning purposes, simply because I find that research articles can be critiqued for their validity. However, if I wanted to provide educational material for my patients, I might use a web search engine. If I wanted to determine if my floor uses the most up-to-date practices, I would look at the national guideline clearinghouse. An alternative research method would be to look at textbooks or books about certain topics (the "old-fashioned" way), by using a library index. Because I want to find different types of information in different situations, context-relevant information retrieval would definitely be useful.

Module 3: Reference Management Software

I chose to use Endnote as my reference management software. Although it was a struggle for me to access it (I was able to find it on the computers in the Health Sciences Library), it seems that this software would be useful in referencing works. It includes the option of creating your own libraries of articles, organized by topics. I could create libraries on a variety of topics, and I could organize the articles by publication year or alphabetically. I could search online for articles through endnote. Also, articles and references can be directly imported from a variety of electronic indexes (including PubMed) to my library. By clicking on the articles within my library, I could access the abstracts of these articles, which would be useful in remembering what their findings are. This would be especially useful as my library expands. This program can be used to reference the articles in a research paper, and it includes styles of referencing text (such as APA) depending on my needs. If I include articles in my research paper, I would be able to keep my references organized with footnotes or endnotes. A librarian even told me that I could e-mail my library references to someone else, and that if they had Endnote, they would be able to access the article abstracts in the same way that I can. Although it was somewhat hard for me to figure the program out, I feel that it would become user-friendly as I used it more.

Module 3: Electronic Index

I chose to research diabetic amputations, which I see a lot in my practice. I looked for prevention and treatments on PubMed. After completing the tutorial, I found that there are a lot of options that can help with research. For example, after doing my search using keywords, I was able to create (and save) a clipboard that included only the articles that I thought would be of interest. Also, there was an option of viewing the articles' abstracts online, and I was even able to create a clipboard of articles that included full text online. This would be a definite time saver. There is also the option of having the National Library of Medicine (the information source) e-mail me any new articles that are published. This would be a great way to keep abreast of new developments so that I could continue to use evidence-based practice. I felt that the search was very efficient; it did not take long to find articles once I had chosen and narrowed my topic. The only barrier that I can think of in using this index in daily practice is that I would need to have access to a computer that has access to PubMed. The computers on campus (which are the ones that I use) all have it, so this currently would not be a barrier to me.

Module 2- Structured Terminologies

Honestly, as a registered nurse working on my floor, I was unaware of structured terminologies. However, I have done some research and found out that they are, in fact, used. An RN case manager and a billing employee told me that the physicians who visit patients on the floor use the ICD-9 coding system, which ensures that their patients' insurance will be charged. Also, the case manager told me that they use a system called Interqual, which has a list of diagnoses and criteria that are applied to patients so that their insurance will process their claim. I also talked with an admissions employee, who said that when patients are admitted to the hospital, they (or a family member) fill out a form that includes all of the necessary data that the hospital requires (such as demographics, phone number, employment, an emergency number, etc.). Although the employee did not know of a name for this information, it is possible that this may be part of the nursing minimum data set. As far as structured terminologies that I use in my nursing practice, I use the NANDA terminology for nursing diagnoses. These nursing diagnoses are sometimes listed on the patients' cardex, and the nurses perform interventions based on these nursing diagnoses. I do not know of any place that they can be found in the new computer system that we have been using.
Structured clinical data can be useful in providing quality patient care because it promotes communication among the people who work for a specific patient. All of the care providers know something about the patient's background (such as with the minimum data set). Also, if all of the data is in structured terminologies, all providers "speak the same language" and can provide treatment while keeping in mind the various diagnoses and treatments the patient is experiencing.

Nursing Informatics module 1.3

Because of the necessity of informatics which I mentioned previously, it seems that it would be highly beneficial to partner with nursing informatics colleagues. Although nursing informatics competencies are being framed for nurse practitioners (and other graduate-level nurses), informatics seems like a complex field. It will be difficult to be an expert on informatics at the same time as being an expert on patient outcome management. As we move to different jobs, or as our workplaces offer new advances in information technology, we may need some serious help to understand and maximize the new technologies. An NI associate would be helpful in these cases.

Nursing Informatics module 1.2

Skills in information management and IT will be vital for graduate level nurses in the future. I will be graduating as a clinical nurse leader in two years. One major focus of a clinical nurse leader, as defined by the AACN, is to improve patient outcomes in a variety of care settings, and for a variety of patient populations. In order to manage these outcomes, it will be important to gather all of the information available about each patient. Clinical nurse leaders (and APRNs and DNPs) will have to deal with huge amounts of information in order to make appropriate decisions regarding a patient's care. Curran (2003) states that "with an increased understanding of informatics, an individual gains knowledge concerning the possibilities and limitations of sysematically processing data, information, and knowledge, and concerning the consequent impact on quality decision making" (321). We will be better able to gather information, and process it, for our patients' ultimate benefit.

Nursing Informatics module 1.1

I currently work at the University of Utah Hospital, as an RN. I work on 6 North, which is an orthopedic med-surg unit. In the two years that I have worked there, I have noticed dramatic changes in the informatics of the floor and hospital. When I started my job, I was surprised to learn that our charting was done on paper. However, as of June first of this year, we have moved on to electronic charting called Powerchart. This change has had a huge effect on the health care on my floor. Some of the benefits are that health care workers (nurses, health care assistants, APRNs, physicians, and others) are able to view various aspects of any patient's care summary from any computer in the hospital, instead of having to hunt down the patient's chart. This includes nurses notes, vital signs, medications given, etc. Also, for us night nurses, chart checks have been made easier. A drawback of the new system is that for nurses and aides who are accustomed to paper charting, the computerized charting takes a lot longer, and we are still learning how to chart certain things. Also, it seems that there are some glitches still to be worked out (sometimes the computers do not allow us to chart what we need to). In the near future, we have been told that the physicians and APRNs will "go live" and that they will write their orders electronically. This will hopefully help reduce transcription errors and will help ensure that their orders will be carried out. Also, they will be writing progress notes electronically, which will be a relief to a lot of people who have trouble reading doctors' handwriting!