Module 7 Question#4 Professional and Personal Influence

The content of this course as previously mentioned has influenced and will continue to influence my personal and professional life by not only the computer literacy abilities that it has provided but increased confidence in my computer skills. All of the learning that took place with each module from creating a blog to researching on line will be invaluable to me as parent, a practitioner, a healthcare provider and an educator.

Module 7 Questin#3 Least applicable content

The content area and technology that is least applicable to either my professional practice or personal life is difficult to assess because most of the information was either new or being used informally without a specific purpose or label. Therefore I don’t believe that I won’t use at least a fragment of each module in my everyday life personally or professionally.

Module 7 Question# 2 Content Integration

The content area and technology that I plan on integrating into my personal life is to continue to utilize all the computer skills that I have learned and were necessary to even navigate this course. I started at some very basic computer skills and have improved my computer literacy with each module and assignment.

The content area and technology that I would like to utilize more in my professional life is Healthcare Information Systems. I would like to be able to incorporate a system ideal for a private office setting that could include electronic charting, medication reminders, and patient follow-up and diagnostic capabilities individually significant to a patient’s profile. Ethically I will be faced with ensuring a secure and protected system that will protect my patient’s privacy.

module #7 post

Module 7 Question#1 MOST INTERESTING CONTENT

During the IT course the content area that I found most interesting was Module 3 Information Retrieval. This was probably most interesting to me because I feel it will be the most valuable for clinical practice and evidence based medicine. I also feel it will be very useful for my capstone project to aid in literature searches and professional organization of my topic and presentation. I even took an endnote class and used endnote to retrieve and organize my reference list of articlesfor this module. However I must add that Information Support Systems obviously are an easier way to quickly access information for clinical practice but information retrieval will always be necessary for documentation and validation.

Nursing data and decision support

Module 5 blog question #2

Available evidenced based nursing data is not only important for decision making and quality health care but can also justify intangible nursing functions. Nursing care is often difficult to justify, bill for and or receive credibility due to the “hand holding image” that it frequently is perceived as. I believe that nursing data that supports clinical decisions and specific nursing functions and diagnosis can also improve the image of the profession where nurses are caring individuals making critical decisions based upon scientific evidence.

Clinical decision making Module #5

Module 5 question# 1

The clinical decision support readings definitely made me aware of how I make a lot of my clinical decisions. I definitely draw on experiential knowledge when I make clinical decisions. I realize that this knowledge is helpful and is not all bad, but that there is another dimension of knowledge to be utilized. The 5 typology medical categories of physician types of uncertainty do apply to nurse practitioner care, but is only the tip of the iceberg when compared to the uncertainties that apply to my philosophical approach as a nurse. For example, when prescribing a medication I certainly want to utilize the best evidence based data regarding the effectiveness, dosage and side effects, but then rely on experiential knowledge regarding taste, ease of administration, cost and patients ability to pay. However this experiential knowledge also could be evidenced based practice that isn’t always recognized as critical to the outcome, but the right medicine not being administered or not affordable ultimately does affect the final results. This is where quality nursing data could be invaluable and incorporate nursing interventions based upon research and evidenced based practice.

As a seasoned nurse practitioner this literature also made me recognize that I frequently do utilize heuristics in making clinical decisions. I often use an approach of what has worked from patient feedback, a seminar I may have attended or a drug representative presentation. I then rationalize that this must be the best clinical decision because it has worked in the past.

Personally for me to reconcile the clinical decision gap between heuristics and biases used in human decision making is to be more committed to an evidenced based practice by utilizing the research available to me through the skills I have acquired to access and retrieve the information more efficiently. I can no longer use the excuse that the practice I am employed by doesn’t value the use of technology or provide available resources. It is up to me to be proactive and fundamental that I lead the way to achieve this goal.

Module 6 blog

If my practice were to get a new information system I feel my participation due to my limited experience in IT would probably be evaluating or just test driving already available systems versus being in on the ground floor of planning, analysis and design. I know this is probably a “wimp” way out, but currently being in a practice that doesn’t even have the basics such as electronic charting I need to start at the basics.Therefore the life cycle component where I would be most likely be involved is usability, including ease of implementation.

Module 4 question #3
The technologies I analyzed were blogs, newsgroups and power point. I probably chose these technologies because I thought they were more personable and interactive. According to my intelligence test profile my learning style is human contact, communications, cooperation and teamwork. I believe these technologies address that type of learning style the best.
The Adult learning theory focus is that learning is a lifelong process and the learner assumes responsibility for the learning process and use of resources to augment learning. Blogging, newsgroups, the world wide web are all mechanisms for the adult learner to continually use for new information and intellectual growth. The adult learner is assuming responsibility for his or her learning by seeking out those sources and sites that are of interest and then applying what is relevant to their particular learning need.

Module 4 question#2
In a provider patient relationship frequently a Pedagogical learning relationship occurs where the patient assumes the passive role and the provider is the transmitter of knowledge. As a Nurse Practitioner I need to be careful in my teaching so that my patients are not assuming a passive role, but are actively engaged in a two way learning process. Learning theories and learning needs within my sub specialty as a Pediatric Nurse Practitioner is two fold. In pediatrics you are initially teaching parents about the care of their child, yet at this same time you are incorporating learning theories and learning needs of infants and children and teaching parents how to be developmentally appropriately with their child. Toilet training is a good example of how you are teaching parents about their child’s developmental readiness and learning expectations of the child. Therefore an interactive CD-ROM might first engage the parents in a discussion about how to recognize physiological and cognitive signs of toilet training readiness in their child and then a step by step approach about how 2 and 3 year olds learn. This CD could also have an age appropriate story like presentation about another child’s experiences of learning to use the potty for the child learner.

Module 4 blog questions

Module 4 question #1
Multiple Intelligence test strengths were Interpersonal and Intrapersonal with Bodily Kinesthetic right behind. I guess as a nurse these results shouldn’t be a surprise. Unfortunately as a generation x I did not grow up on computer technology, I still have reservations with computer technology and not receiving that face to face interaction, therefore a more interactive technology would probably augment my learning. I believe stimulating power point presentations and interactive web videos would be two technologies that could help me with my personal learning. These modalities offer auditory and visual cues which would aid in my learning. Also Interpersonal Intelligence shows a need for human contact, communication and cooperation as a preferred learning style so blogging, newsgroups and web ct with active discussions would also address that need and augment my learning.

Blog entry module 3
Question#3 INDEX EXPERIENCES
First I must admit that I was a little intimidated by the database process, I believe it was just a confidence mindset, but once I started progressing through the steps I felt a sense of relief and accomplishment. Of course when asked to use google that felt a lot more comfortable and something that I was used to using, but not necessarily for clinical information. However, I believe that one must be more vigilant in monitoring the credibility of the references that appear with a google search. Since this is probably the primary source that patients go to when they want clinical information I need to be aware of information available to the public from this site. The National Guideline clearing house would be another site that I feel is quite user friendly and possibly give patients more credible sources of information. Also I liked the side bar categories such as organizations, measures/tools etc. not only for myself but for patients.
For me personally an info button to retrieve relevant information would be a dream come true. If I had a mechanism to quickly access accurate data specific to patient management I certainly would take advantage of this program. The key words here are quickly and accurate. The reference article discussed such a tool and that in this particular study demonstrated the median retrieval session was 21 seconds and answered the user’s questions 84% of the time. That’s a lot quicker then looking medications up in the PDR! I see this as a cost effective time saving device that could improve patient outcomes without compromising personal interactions. Other areas where I see this type of context-sensitive information being efficient is with patient directed questions and also as a tool that office support help could use to field some of the patient questions and inquiries before needing to utilize the health care provider.

Blog entry module 3
Question # 2 REFERENCE MANAGEMENT SOFTWARE
The chosen reference organizer that I used was EndNote web. Eccles library informed me of this free site without needing to purchase the software. After using this web tool I realized that it would be easier to purchase the software so that I can save my organized references to my personal files. EndNote web was fairly easy to use after I read the tutorial and because I was importing from PubMed it seemed very compatible with that index. The features of the software that I used for this assignment were import, create new folder and manage my folders. I look forward to using the bibliography, and format paper for future research paper assignments. Because I haven’t been in school for quite some time these features seem like they will make the research paper organization and citation requirements much easier, more efficient and less room for error then the old hard copy way that I last used. (Yes, I am aging myself and admitting to being a product from the past) Definitely by organizing the references I will be able to retrieve this information more efficiently. For example when I used the National Guide Clearing house web site I immediately was able to recognize that some of the same references came up because of the alphabetized Author list that I had just compiled on EndNote.

Blog entry module 3
Question# 1 CLINICAL PROBLEM
My choice of clinical problem first was the CHIP program; I searched this because that is what I was doing my fact sheet on for the leadership class and is something that I regularly follow. However the search did not yield 10 pages as needed for the assignment so I then searched Cystic fibrosis which is another interest of mine and which I thought would be useful information to have for the upcoming Genetics class. My choice of index was PubMed. The first search I did with the CHIP program was more difficult to conduct because of the Acronyms it first gave me a lot of scientific data about scientific chip devices. Once I put in the whole program name it was easier but there was also some confusion as a federally funded program. The cystic fibrosis search was definitely straight forward, even when I narrowed the search to such areas as genetics and diagnosis, and management, however, the list was long and still multifaceted. I think the use of PubMed would be reasonable to use for more doing a literature research review and when I wanted a lot of information from multiple sources. However to use this for quick retrieval of information relevant to clinical practice would not be reasonable. Even when I narrowed down my search to include management there was too much information to sift in order to find that one relevant article that may address my specific management inquiry.

Module 2 Blog question
Currently in my clinical practice I am an employee versus an independent contractor so the practice bills services under CPT (procedure codes) and ICD9 diagnosis codes.

I beleive that coded clinical data that is consitant can document trends and outcomes which then leads to a collection of information. This information then can become evidenced based knowledge that can be used to improve patient care and clinical outcomes.

Blog questions for N60004

#2 As a DNP it will be essential to have IT competence in order to maintain my nursing competence. Nursing competence relies on acquiring clinical knowledge and skills, and now in the 21st Century accessing the data to acquire knowledge requires IT competence. Two recent personal examples were; a patient quoted recent Internet medical information and wanted to know if we should change treatment based upon that information. Then I had a insurance company deny coverage for a medication that wasn't a formulary benefit, but when I provided some evidence based research documenting that this would be the best drug of choice for the condition I was treating funding was approved.

#3 Engaging current partners with NI might be more of a challenge in my current practice. Like my partners we were educated and practicing before IT was even introduced so you could say unlike our children we did not grow up with computers. Overcoming fear would be the first step in introducing NI into the practice. Then people are more willing to make change if they realize the benefits. Therefore maybe where a time saving benefit or enhanced patient relationships could be modeled then the willingness and need for change would be seen as an advantage and not one more thing to do!

Blackboard Learning System

Blackboard Learning System

Blog questions

#1 I am in a private practice with 4 other pediatricians who aren't real excited about IT in the office. It took alot of begging from the office manager just to get electronic billing sheets, however they are still hand submitted. We do have several computers in the office and can look up our IHC patients labs and certain clinical notes, which has helped in not waiting for values or x-rays to be faxed. So as you can see my IT is therefore limited. I do have some web sites I access for articles and research and I personally e-mail a few of my clients. So I have alot to LEARN!