Module 6 Policy and Ethics

One thing I learned in this module that I did not already know is that secure e-mail does exist. If you put "phi" into the subject line of an e-mail at the University of Utah it will send the message via a system that is encrypted and secure. After my yahoo account was hacked into a few weeks ago, sending an attachment with a virus to all on my address list, I realized first hand how vulnerable we all are to those who would deliberately introduce viruses and other malicious programs into others computers.

As part of this module I also learned the terms for malicious programs, including worms, trojan horses, logic bombs and bacteria. Now when I hear our IT guys use these terms, I will know that they are not just making stuff up to make the rest of us look dumb (but, really, don't we all feel this way around IT guys?). I also was reminded of the ways to avoid these malicious programs including using only licensed software, never opening any file attachment from an unfamiliar source, and using the latest version of virus detection software routinely (Hebda & Czar, 2009). Maybe someday the people who have way too much leisure time on their hands will find another hobby that actually benefits others.

Module 5 Clinical Decision-Making

The readings for this module had a big impact on my perception of my own clinical decision-making. The articles caused me to reflect on not only how I make decisions but on what motivates me to make those decisions. In my 20 years of nursing experience I have encountered many instances where I did use heuristics in making judgments. As Kahneman (2008)notes, often those judgments were correct, but a few times I can recall them being way off base. No serious injury was caused by my actions, but in hindsight I realized that I may have not given the best care possible. The more experience one has as a nurse the more heuristics can come into play. This can result in serious negative consequences to our patients and to our profession. But, also with more experience I believe we as nurses have the unique opportunity to gain a lot of insight into how we make judgments and this should influence us to make better decisions.

To help us make those critical decisions it is paramount that we have access to a clinical decision support system. After reading the articles and researching my chosen computer-based decision support system I am confident that the future of nursing lies in implementing these types of systems. For evidence-based practice to be fully realized, nurses must have access to systems that aid in diagnosis and treatment at the point of care. This will help the nursing profession to gain proper recognition for their unique contribution to health care and ultimately improve patient outcomes.

Module 4 Teaching in Nursing

Teaching is a major part of nursing no matter where you work. Everyday nurses are asked a myriad of questions (that often don't have anything to do with the current situation).  I worked as a labor and delivery nurse for many years and most of the day was spent teaching about plan of care, fetal monitoring, pushing, vital signs, medications, breastfeeding, infant bathing, use of bulb syringe, diet, exercise, etc...  I believe that nurses are teachers because we have to be, and also because we want to share out knowledge to help our patients fully understand and make better informed decisions.  With more knowledge, our patients are encouraged to be more involved in their own health care.  We are at the bedside and are available literally at the push of a button, so we are asked all of the questions that the doctor may not have time to answer.  We must be approachable to our patients and co-workers so that they will feel comfortable coming to us with various questions.    

In my current job as a legal nurse consultant I teach everyday.  My job entails researching specific medical issues and then educating the attorneys and legal secretaries and clients regarding those issues.  It has been an interesting and educating good job for me also as I learn a lot during the research phase to add to my bank of knowledge.  There are many new medications and  diagnoses I am not familiar with and, when I am finished with my research, I know much more than I did in the beginning.  I am also asked advice on a daily basis to evaluate something (suspicious mole?) or to discuss possible causes of certain symptoms.

 No matter where you work, as a nurse you are also a teacher, whether you are interacting with patients, staff, colleagues, or administration. Or even if you don't work as a nurse, your neighbors, family and friends (and often strangers, once they find out you are a nurse) will ask for your advice on a wide range of topics. 

Module 3 Searching for Information

For this module I searched in CINAHL, PubMed, National Guideline Clearinghouse and Google.   My search objective was to compare the use of heparin and aspirin versus IVIG in the treatment of recurrent miscarriage associated with antiphospholipid antibody syndrome.  Both CINAHL and PubMed returned many favorable results.  I had used PubMed before but not with the added controlled vocabulary of MeSH and using it made the search much more focused and more relevant.  CINAHL is a great resource with an easy way to export to EndNote.  I had not used the NGC webiste and found it to be useful and one that I will use with future research.  With NGC I didn't get nearly as many articles with my search, however, those that I did get were relevant to my research topic.

For my web search I used Google and, as I have experienced before, found many articles that were completely irrelevant to my research.  While Google is a good way to access general information about a topic, it does not allow for accessing many scholarly articles or full text articles as most require payment.  Being a student at the University of Utah, I am able to access full text articles in CINAHL easily as a link automatically comes up to do so.

This was a great research experience for me and will assist me with my future research strategies.

Still feeling the pressure...Module Two

This is the second week of classes and I still feel like I am just getting a handle on things.  With all of the due dates looming I am feeling a little anxious and that is working partly as a stimulus to get me moving and partly as a deterrent due to the amount of work I have.   Hopefully the former will win out.  I am learning a lot about information technology and why it is important in the hospital, classroom and community setting.

As I mentioned in a prior post, the last hospital I worked at had an awful computer charting system that was not made by nurses but was made by some computer whiz who didn't realize that you have to actually care for patients and not spend the entire day charting.  I would often spend two hours after my shift charting everything, as the computer system did not interface, so you had to double and triple chart.  After a while the proposed solution to the problem was to have the nurses chart on paper and in the computer (of course, decided by those who didn't have to do it).  It was one of the main instigators in my seeking employment elsewhere.

I now work for a law firm as a Legal Nurse Consultant.  I review medical records, research medical-legal issues, consult with experts and educate the attorneys on a variety of medical issues.  It is completely different from the patient care arena and I have enjoyed the challenge it presents.  I do a fair amount of research on-line, mostly on PubMed and on various university websites.  I dictate all of my memos and they are typed by legal secretaries, so I have gotten a little rusty with Word and APA format (that will have to change very quickly with my classes this semester).  I do miss patient care sometimes, but this job works for me and my family right now (and I do have to admit, I love not having to work on Christmas or Thanksgiving).

One way I could become involved in designing and implementing an information system in my current workplace would be to assist with the restructuring of our expert list.  It is very outdated and in need of updating.  It would also be helpful to the other nurses an attorneys if we were to add specific information unique to each one, so that we would have full access to credentials before making contact.  This is something we are currently working on updating and once it is complete it will be much more useful.  

First Week Module One

Well, this has been a stressful week so far.  Getting myself and my three kids back into school, back into the routine of getting up early, making lunches, buying endless school supplies, new clothes, etc.  Lastnight was the culmination of that stress when my daughter's pet mouse escaped from the cage and it took us two hours to catch her  (two hours I was going to devote to school work).    But, today is a new day, the kids are at school,  I am getting into my school work and the house is quiet and peaceful.

Module One

I have a lot of experience with sending and receiving e-mails, catching up with friends on facebook and attaching pictures and documents to mailings.  I have also used several different computer charting systems, some of which were user friendly and others that raised my blood pressure to dangerously high levels.   However I feel like a novice when people start talking tech.  I do believe the future is information technology and I know I need to get up to speed with everyone else and that is my plan with this class.