Module 4- Clinical Decision Making

I never really thought about my own personal decision-making process before doing this module and studying the things that influence that process. What the readings did the most for me was to critically evaluate my personal approach to decision making and to form new value sets in regards to this vital process. Being a very logical person in nature, I tend to approach problems and decisions in a very systematic way; relying on evidence and knowledge as a guide in my approach to care. I usually reserve intuition to when I am dealing with other aspects of care, such as general appearance of patient condition, emotional state of the patient, etc. Having said this, I have had experiences where intuition was the key factor in problem identification- had I not listened to my intuition, my patient could have potentially died. So, after critical reflection of my decision making process as a result of the reading, I have came to this conclusion that I stated in my discussion post: “the true expert will intricately weave experience, intuition, and evidence-based practice in making decisions that will result in the best possible outcomes. True wisdom is exemplified when an appropriate blend of experience, heuristics/intuition, and evidence/logic/equation is used in the decision making process; we should never apply one at the expense of or in the absence of the other. To rely solely on intuition would lead to inaccurate predictions, judgments, and choices, which could result in actions leading to inappropriate care and even harm to or the death of those we are trying to help.” I appreciate the opportunity of listening to Mr. Kahneman and for all the reading because it has helped me to be more in tune with my personal decision making process so that I can more appropriately apply this knowledge to that process; thus, making me a more effective practitioner.

Module 6- Mou nofo a (Goodbye)

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

I really like the convenience of working at my own pace, and the ability to work anywhere, anytime, 24 hours a day. This makes it possible to work my school around life, instead of life around school; this makes me a better father and husband. I also don’t miss all the driving- it takes me over 1 ½ hours to commute one direction to school; this has allowed more time to digest the content, to commit to assignments, and to spend time with my family; even though I am still spending the same amount of time, I am able to spend that time from home, which makes it feel like I am home more even if I am slaving away in the “dungeon” (as my wife calls it) ;). I also like the money that I saved from not having to commute- this will help me pay my outrageous tuition bill for the summer ;).

I do miss the face to face interaction that is offered by the traditional university experience; the interaction between colleagues and between professors. I learn so much from my peers and I feel like I miss that when we do things on our own. Since this is something I highly value, I think I still prefer traditional classes over online courses; however, I do appreciate all that I learn about technology and the experience I gain from having to be online so much.

I would say that I miss getting to know my professors this summer; but we both know why I cannot say that in regards to this class ;) I have really gotten to know you this semester, and I am sure you got to know me more than you ever wanted to. I just want to repeat again how much I appreciated your understanding this semester and how awesome I think both of you are. You are an example of what real teachers are, and others should look to and follow your example. Teaching is not just disseminating knowledge, it is about compassion, empathy, and an intense desire to see those you teach succeed and gain knowledge and experience. You have facilitated these things this semester despite all that I had to pass through this summer, and I appreciate it. I could not have done it without your kindness and compassion.

What topic did you learn the most about and what was your favorite topic? What did you like least?

I love teaching and so my favorite section was on teaching with technology. I currently teach a course that helps teachers to teach more effectively- although I do this for religious educators, many of the same vital principles to effective teaching are shared between secular and non-secular teaching. I really liked seeing and becoming familiar with much of the potential technology out there that can enhance my teaching; since I plan on teaching after receiving this degree, this came quite in handy. I also really liked learning how to evaluate websites and other sources of data- there is so much information out there and it is difficult at times to separate fact from fiction. I feel better equipped to be able disseminate the information now, and look forward to teaching my patients how to do this as well, so they are more empowered and can take an active role in their health care. I also loved the section on ethics and policy- I am a huge fan of policy, politics, and legislation; it was very insightful to see how technology has impacted and will impact these arenas in the future.

Although I can appreciate the purpose and potential purposes of social networking, I still do not like it and probably will not do it. I found the blogging activity insightful in that it taught me what it was and the basics of blogging- but I am not good at it and do not really like it that much. I am a redneck when it comes to certain things- this is one of them. I do not like blogging, twitter, facebook, myspace, etc. I have never had an account, nor do I want on. It is just something I have no desire for; I prefer the phone and the face-to-face communication because so much is lost in the information transfer when it is just words on a page. Like I said, I can understand and appreciate their potential; but I don’t have to personally like to do it. I prefer to stay “old-school” in that arena.   

Do you have any other comments for us?

Like I said, I think you are both amazing professors and I can honestly say that I would change nothing. I really like the asynchronous format; I think that the way you have it set up is a perfect balance between being able to work on our own pace and also having a certain time-frame/timeline to have work complete- this helps with those who struggle with procrastination. I think that this is a perfect class online since the purpose of this course is to learning how to effectively use information technology; what better way to teach this than to have this course online? Every concept that was taught brought me a greater appreciation of technology in health care and a desire to embrace it in my practice rather than fight it. It also provided several resources that I have bookmarked for future use in my practice. I feel this class has helped me on the path to becoming a true doctoral professional, and a leader in the use of technology as this module taught us we should be. I want to thank you again from the bottom of my heart for this course, for all that I learned, but mostly for your compassion, empathy, and kindness. I appreciate that you never made me feel like I was bothering you- it really made me feel comfortable and minimized the stress that I was feeling because of all that was happening. Thank you so much again- I cannot tell you enough. More professors need to be like you and need to learn from you awesome example. Thank you.

Module 5- Policy and Ethics in Health Care Technology

Why would a patient want to create a blog? What might they gain from this?

A patient could use a blog for a variety of purposes. One would be as a way to share personal experiences they are having with a particular issue- almost like a therapeutic journal of sorts that could help with coping and provide a forum for expression. Doing this also could place the individual in a community of others who are going through a similar problem or condition, linking them with a support system that provides support and information. I know of a burn victim who started blogging as a means of dealing with her struggles; not only has this website helped her in her condition, but it has also inspired millions around the world struggling with the same disability and provided a forum of information transfer/sharing and support. It also provides a way for a practitioner to see how their patients really feel and what they are really experiencing, providing greater insight that could be used to better care for the patient. It can also be a means for updating family and friends about your condition, rather than having to repeat yourself a million times about what is happening. Really, the opportunity that blogging provide are endless.

-Why would a health care provider create a blog?

I think a blog would be a very effective marketing and education tool. In marketing, a practitioner could use this forum to present his philosophy, mission, values, goals, ambitions, and activities. He/she could tell people about themselves, allowing persons to get a better understanding of who they are and the principles they practice on. A blog could also be a means for interdisciplinary collaboration, a way to network among professionals. It could also be a way to disseminate educational information to patients, including the latest information on a variety of conditions and diseases, technological break-throughs, and so forth. It could be a place where the practitioner can answer frequently asked questions, show what is happening in the office, what is going on in health care, link patients with ways they can be active in their health care, provide links to health care legislation and how to be active in such activities, provide office information- again the possibilities are endless.

 
-What are ethical considerations when blogging on a public website, such as we've used for this class?

In blogging on a public website, we must understand that the information that we reveal is exactly that- public; everyone can read it, see it, use it, etc. We must also understand that once we put it up, it is out there forever; thus we must think critically about everything we say and do before we put it on the website because it is permanent. 2 comments that really struck me about how important this is were in the article on Ethics in informatics. The first was the comment the author made on the ability of technology to make more information, more available, faster than ever and with very little effort. The author also commented that this information “spreads farther faster,” that it “compresses time but dramatically increases the impact of error”(Curtin, 2005, p. 349)- with this in mind, imagine what could happen if we presented erroneous information; in our field especially it literally could have deadly effects. We must also consider all the potential implications, intended and unintended, that could come from something we post; we must also be ready to accept the consequences of that choice. As Curtin (2005) also said, we have freedom of choice, but not freedom from the responsibility of that choice. We also need to make sure that, although blogs are an informal communication method, we need to avoid plagiarizing, properly citing all information presented. Ethics also surround our presentation of values. It is okay to have values- we all have them; but we should present them in a way that is considerate of others values, is non-discriminatory, kind, and professional. Our ability to do so will determine our professional success. For example, what if you have a personal value against gay marriage- if you present your value in a hurtful, judgmental, spiteful way, this could impact your ability to effectively care for and provide care to this population; plus, you have severely damaged the trust and relationship between you and a patient who is gay. Thus, although we may have our personal opinions and values, we need to be ethical on how we present them and the activities we choose to engage in. We also need to be careful in the way that we present this information because not everyone who accesses the internet possesses skills in critical thinking and discernment- thus information we provide could lead them to act or think in inappropriate ways based on that information. We also need to be cognizant of the principles of privacy and the importance of protecting certain information. Like the podcast stated, we need to be “careful and cautious,” but we must also embrace it as a means for enhancing and transforming health care delivery.     

References

Curtin, L.L. (2005). Ethics in informatics: The intersection of nursing, ethics, and information technology. Nursing Administration Quarterly, 29(4), 349 – 352.

Module 3- Teaching with Technology

What sort of teaching is done in your nursing role? Is there any nursing role that does not involve teaching in some manner?

Teaching is involved in every facet of nursing, from training new staff, mentoring, patient education, shadowing nursing students, leadership, and so forth; to "Nurse" is to teach. It is important for each nurse to realize that we teach mostly through who we are and what we do, not necessarily through what we say. One of my favorite quotes on this subject is that "what you are doing speaks so loudly that I cannot hear what you are saying." We can teach and preach all day long till we are blue in the face, but if we do not exemplify what we say or teach, at the end of the day it will mean nothing. As nurses it is our duty to our profession, our colleagues, and our patients that we teach through our example of clinical excellence, honesty, professionalism, confidence, caring/compassion, integrity, and knowledgeable health care delivery. If a nurse does not demonstrate these things, it is possible to still teach, but the teaching will not be as effective or enduring and you will not have as big of an influence on those around you. Truly there is no nursing role that does not involve teaching in some way or another, so it is imperative that every nurse make teaching effectively a priority in their practice.

Module 2- Information Retrieval

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? (You must be detailed enough here, so that your blog entry evidences your use of both NGC and Google).

The problem that I chose to investigate was the effect that nurse-patient ratios have on patient outcomes. I did my research in PubMed, the Guideline Index, and in Google, each with varying and strikingly different results. After getting the hang of the PubMed database enough to do a search, I was able to locate over 120 credible scientific, peer-reviewed, and published journals on the problem I was investigating. The great thing was that the type of information that I was able to retrieve; the not so great thing, how long it took me to get it. It would be a real struggle to find the time necessary to complete such an activity in a busy clinic or hospital setting. Since I went into detail on this subject in my discussion, I have kept my comments limited here, choosing to focus my post on the other 2 methods used; but for additional information on this database, I invite you to read my discussion for this module.

As far as the Guidelines Index, I got absolutely no help from it; I tried to be very broad in my search and still got no results on my subject. I have heard how awesome this database is, so I research the site itself to see what exactly this database has to offer me. I did this so that I would be better equipped to use it in the future for other topics that I might investigate. Based on what I learned, it seems that this could potentially provide very quick access to information on a particular subject; the problem: hoping your subject is included and having to learn how to operate another database. It seems that you have to use just the right words in order to get what you are looking for and your subject might not even be included. It also seemed to retrieve a bunch of unrelated information as well, taking just as much time to weed through this information as it does to weed through the information in PubMed or CINAHL; because of this, I would be more apt to choose the PubMed or CINAHL databases first.

Google was probably the easiest and quickest access to information of them all, including Google Scholar; however, that ease of access comes at a price. Google provided 234,000 results in 0.41 seconds, but many of these sources were questionable according to the guide provided in this week’s readings. So even this search engine required critical analysis to weed through unreliable sources of information, propaganda, and other websites being influenced by outside sources and hidden agendas. Google scholar provided a more reliable search approach, but you have no control of the information presented to you because you lack the ability to place limitations on your search; also, many of the articles cannot be accessed unless you pay for them or have memberships to the companies publishing them. I like Google because of it is a very quick way to gain access to a ton of information, but you must take that extra step to ensure the information you are accessing is reliable, based in science, and from reliable sources. This is even more critical because people are getting pretty sly these days and can produce counterfeit websites that look official in order to influence you to meet their agendas; something you can avoid by using databases such as PubMed and CINAHL.  You also cannot export your citations to a resource management program for effective storage, retrieval, and organization of the information you collect when you search in Google; the ability to do this has proven valuable to me time and time again throughout my educational experience and my professional life, and you lose this ability when you use Google to access information.

Module 1- Me and Information Management and Technology

My name is Nathaniel Gay and I am a born and bred Utah Redneck. I am married to a gorgeous woman named Emily, and together we have 3 awesome little boys: Layne, Grant, and Wyatt. As you can see, their names alone illustrate the redneckness of our whole fam damily- we are pure rednecks through and through, and are proud of it. I am in the process of becomin’ and soundin’ educated, but still, to the chagrin of some of my professors, speak my own language, don’t pronounce things correctly, and I use double negatives. I am in my 3^rd semester of the Family/Geriatric NP program, and should graduate May of 2012- hopefully before the Mayan Calendar runs out so that I can actually benefit from this educatin’ ;). I look forward to learning from all of you and for the chance to develop a commodore/friendship with each of you. I have been a nurse for 4 years now and have spent the past 6 years on a Medical/Surgical unit (2 years as a CNA); sometimes I wonder if this has crippled me because being in all ya’lls company makes me feel like I know very little. But I am learn so much from all of you and am grateful for your wealth of knowledge.

As nurses and future APN’s, we are faced with a daily onslaught of information from a myriad of sources. Understanding and being able to apply the principles of information management is crucial to our successfully collecting, analyzing, applying, and disseminating that information; it is also important in our ability to determine if that information is based in science and research, or if it is based in the less reliable source of opinion or expertise. Not only are we bombarded with information, but we are also required to understand and be able to operate the various methods of information delivery, such as the computer, the internet, and other technologies. Effective utilization of these tools results in effective information management and our subsequent ability to effectively treat our patients. Truly, information management is at the heart of our profession.

There is much happening in relation to IT in my clinical setting at the hospital. Many of us know how the computer is becoming the hub of all activities, from charting to information retrieval, from data gathering to data analysis, and so much more than can be written here. At my work, our charting system is constantly being updated in order to keep up with new technologies; we are constantly required to receive training on these updates so that we can effectively navigate the system and keep up with the wealth of information at our disposal. A new intranet feature was added to our system that allows us to read and understand all protocols and procedures on everything we do in the hospital, lets us look up clinical best practice recommendations for all procedures and treatments, allows us to look up diagnoses and clinical recommendations and education based on those diagnosis, permits us to look up medications to see what they are for, interact with, and special education and administration functions; these are only a few of the things that this system has done. I am excited about all of this because it demands us to be more accountable, aids us in our professional development, assists in gaining a larger knowledge base, places us in a network with other health professionals, and most importantly is vital to continuity of care and the delivery of ethical and evidence based care. Some have complained about the transition and the need to be constantly updated and to learn the new system- change is hard for everyone. But we should embrace this technology because it will only help us to be better health professionals and provide better care to those we serve.