Module 6 - Policy and Ethics

One of the most interesting parts of this module was the podcast on plagiarism.  I found the differing views caused me to think about plagiarism in a way I had not done before.  In particular the comment made by Malcom Gladwell - toward the end of the podcast - about creating things from scratch made me realize that no one really does create anything from scratch - we each build on what we've learned and experienced throughout a lifetime.  For example the advancements in medicine which are made today happen because of the advancements made a century ago, and so on.  How do we credit all those who have contributed to what we know?  

One thing I did not know prior to this module, was that patents expire in seventeen years.  I had no idea that patents even had an expiration date at all - I just figured those inventors were set for life, reaping the financial rewards of holding a patent.  Another new discovery - or maybe this was a reminder - was the vast number of ways that the electronic information is vulnerable.  In connection with this reminder was the restoration of my concerns over identity safety.  Because of this I continue to pay bills the old fashioned way - checks - and do little or no shopping on line.  My confidence in security vs my confidence in Hakers abilities lean toward the Hakers. 

Over-all, this module has been as enlightening as all the others.  Thanks to Sue and Kathy -  this course has been challenging and yet delightful as I have expanded my knowledge base and increased my confidence when faced with technology. 

Module 5 - clinical decision making

I found the lecture by Dr. Kahneman most fascinating.  It reaffirmed the need to critically examine why I think what I think.  Prior to gaining a secondary education I must admit I rarely thought about what I was thinking and why.  Now - after years of critical thinking lectures, I find myself asking why I decided what I just decided.  I actually think this is beneficial as it has allowed me to recognize prejudices and flaws in my thinking. The awareness of  prejudices and thinking flaws helps me to lesson their impact on the decisions I make.

How does this impact my clinical decisions?  I find myself asking those same questions - why am I thinking this or that?  The lecture by Dr. Kahneman and the readings for this unit have made me realize there in an impact from my own past experiences in the clinical decisions I make.  For example I know, from experience, that a patient who takes certain drugs will need more Propofol to achieve a sedated state.  This decision is based on experience not intuition. As I gain greater experience then my thinking moves from the slower reflective system into the fast system - the one Dr. Kahneman calls intuitive but I would rather call experience.

I also hope that there will be made available more decision support systems with a nursing focus.  I can always use suggestions in how to best treat my patients - even with the little things.

Module 4 - Teaching and Learning Styles

All nurses teach.  This is simply an important element that is present in any field of nursing.  Some nurses teach more than others.  For example when I did my clinical rotations on the floor there was a great deal more teaching than I did as an operating room nurse.  I currently do a limited amount of teaching as I work in an endoscopy facility.  We focus our teaching on what procedure is being done.  We teach our patients what to expect both before and after.  In addition we teach in the recovery area based on what has been found. There our teaching may include information handouts concerning a newly diagnosed disease.  These include support groups for celiac sprue and cancer diagnosis.  We also teach information about any new medications the physician has placed the patient on and include an information sheet concerning the drug.

Sometimes I have a very inquisitive patient who wants to know how the scope works and what we see.  This is often fun for me as I usually have a few minutes prior to beginning the procedure where I can show these patients the scope and how it works.  They often will ask questions about other equipment present in the procedure room and I can show them how the monitor works and explain what we watch for as we ensure our patients' safety.  I have found that I really enjoy teaching the interested patient and that what is taught will often decrease their anxiety levels.

FYI - in connection with this module please notice that I have added a link (see top of page) where you can access the nurs 6004 mobile device wiki.  Here you can read what other nursing students have published with regard to mobile devices.  You may also join this group and contribute to the site by editing or adding additional information.

Module 3 - CINAHL vs Endnote

Personally - I like CINAHL best.  Since I have to use remote access I tap into the Eccles Library through VPN.  This allows me to access whatever Eccles has subscribed to.  Using CINAHL allows me to change search terms easily.  This means that when I begin a search and get a few hundred results then I can narrow that search by not only changing the terms, or adding terms but also by using the advanced search parameters.  I usually click on peer review, English, and link to full text.  Using these usually limits the results down to a manageable number.  I also like the fact that I can export to Endnote and if it can't find the full text I can download the text from CINAHL to my desktop and move it into my Endnote file.

I have tried using Endnote for searches and have not been as successful.  First I found it harder to limit the search - maybe because I'm less familiar with the program.  But the one thing that I struggle with is the limited number of full text that Endnote seems to find. I like reading the full text and when appropriate using quotes from articles so I like having the full text available.

It is amazing to me how much things have changed.  When I first started doing research papers - 30 years ago I spent hours in the library reading through journals. Then I'd have to make copies of the article and be sure that I had enough information for the citation. Sometimes I'd find a reference to an article that was 'just what I wanted' only to find that the library didn't subscribe to that journal.  This can still happen but it is much less frequent and the time I spend researching is significantly decreased.  Also the ease with which we can cite while we write using Endnote is wonderful, not to mention the replacing of the typewriter with the word processor - you of the younger generation just don't know the advantages you have.  I have an old electric typewriter if anyone wants to try out the 'good old days'.

module 2 - evaluating an electronic information system

We just did this!  At my workplace we use electronic charting exclusively.  However we (the nurses) have found several "holes" in the information requested.  So we began by making a list of what we'd like to see added to our system.  They were just little things like reporting abdominal pain as a reason for having an EGD (esophageal-gastro-duodenal) endoscopy exam.  There were other choices like anemia, nausea, vomiting, dysphagia... but not pain which is a fairly common reason. (We had to type this into the notes section.)   So we made our wish list which included about 25 items.  At our staff meeting the other day we were told that those items would be added along with a better design of our medication reconciliation screen (a much needed change).  The cost would be about $5,000 and it would take 90 days.  Wow, was I surprised.  Not only did the cost surprise me but the time frame needed.  I must admit I've never done any computer programing.  Now I have a bit more respect for the guys who do this.  It must take more than I imagined.

Technology is amazing

As I was reading the assigned reading I was really surprised at how much is involved in controlling, creating, and regulating the internet.  I guess I hadn't really thought about it prior to this class.  It's just been there, available to use and I suppose abuse to a certain extent.  For example; how many of you have seen the movie Eagle Eye?  When I read the text I kept thinking about this movie and how this wonderful technology was used to track individuals' movements.  It made me a little nervous.

On the other hand I realized that the potential for good is terrific.  For example in disease management; the ability to check on or have patients check in on a regular basis, to offer tutorials for newly diagnosed patients, updated information for established patients, educational sites, and ability to follow up on care without having to actually see the patient - just to name a few.

We've come a long way from when I was young - I still remember black and white TV and when our phones were party lines - okay I just showed my age.

Introducing myself

I thought I could tell you a little about myself.  I am currently married for the second time.  My former spouse and I had one son who is now 26 and just got married.  My husband has two boys - one is 21 and the youngest is 18 and still living with us at home.  His wife - their mom- died in a car accident when they were 9 and 6. 

I like to do things outside but with school beginning again I don't get out much.  I work part time (20-24 hours/week).  I try to get in an early morning run each day and succeed at least 5 days/week.

I finally feel like I will survive this semester.  That first day or so is so overwhelming especially when I was looking at the whole semester and the corresponding assignments.  Once I got them all calendared I just look at one day at a time - it's easier and doable.

Class Begins

I'm new at this so try to be a bit patient with me :)

 I am just beginning course work toward a Masters Degree in Teaching Nursing.  This is both an exciting and overwhelming experience.  There is a large amount of new information to assimilate and then figure out how to put it to the best use.  I took a moment to put together a calendar where I listed the due dates for all things required for my three classes.  How will I ever get it all accomplished?

 I have been a nurse for just over 10 years.  The majority of my experience has been in the operating room.  I find I enjoy the fact that I have one patient - and only one patient - who gets my undivided attention.  I have just recently changed jobs and am working in endoscopy - scoping colons and esophagus/stomach/duodenum.  Still only one patient at a time. 
 
We use technology almost exclusively.  In fact the power went out the other day and we hardly knew what to do until the generator kicked on and our systems were all up and running again.  The doc's can access, electronically, patient records they have generated along with records from many other sources.  There are times when the information has not been recorded electronically and we try to recreate information based on the information given to us by the patient.  We also use technology to create a hard copy report to send home with each patient along with a copy sent to their referring physician.  (I suspect that eventually we'll send electronic reports to the referring physician.)  We have also accessed web information and created information sheets concerning the different problems we find in patients with suggestions on how to make lifestyle changes, different drug choices and what the drugs do, and often include support groups for some of the diseases.

All of our  in office communications are done via e-mail.  Our schedules are posted on our email sites and we use an electronic computer based company for our time cards which we can access from home if needed.

Since this is my first attempt at blogging I may have overdone things - given you too much information - or maybe it's really boring - I suspect with some experience I'll get better at this.