New Things - Module 6

Hard to believe that 12 weeks and 6 modules are done.

*(Please note that the previous statement is merely commentary and should not be construed as a pining for the semester to continue.)

It is also hard to come up with only one thing  that I learned in this module. If I had to pick, I think that I would emphasize the realization that I had as to how powerful and ultimately necessary information technologies are, especially when we talk about healthcare reform, controlling healthcare costs and the role of support systems. I think I expected this to be a course more about charting and documentation storage systems (which would have been really boring) but instead the totality of informatics is much broader and more integral to healthcare than I anticipated it would be. I admit, I'm not going to run out and add an informatics degree to my education plan, my plate is full enough. But the role that informatics plays and the ways  that I can be involved with it as a provider were very pertinent to my future plans.

Now.... what to do with this blog?... I think it needs another re-purposing.

Module 5 - Decision Making

I consider myself good at making important decisions. The irony in this is that I'm actually pretty lousy at making small decisions. Important decisions usually have some amount of data or information associated with them that allows for comparison. When you are making the comparison you can give weight or credence to one aspect over another. A system of analysis can be put into place that ranks the data on importance and pertinence leading you to eliminate some choices and promote others as you ultimately make a final decision.

Small decisions on the other hand are problematic. I can almost never make up my mind (for example) on which restaurant  I ought to eat at without resorting to something like a coin toss. (By the way, if you grab what you think is a penny it behooves you to verify that it actually has a 'heads' and a 'tails' otherwise, as it turns out, you haven't made any real progress). I think this is because everything is weighted fairly equally in small decisions where bigger decisions actually have parts with some weight behind them. Equally weighted 'big' decisions are the stuff moral dilemmas are made up of.

From a clinical standpoint I realized that I have no significant objection to 'cookbook' medicine as the use of algorithms and decision systems is sometimes called. I think the competent, confident clinician can use their clinical judgement and be guided rather than threatened by the additional support provided by these systems. It was however, a bit of a wakeup call for me reading about Heuristics and Biases because I tend to be a very intuitive person when I have to make rapid decisions and according to our reading the majority of individuals don't actually 'get it right' when they rely on  these decision makine shortcuts; makes me want to brush up on my formal logic and be a little more careful in my critical thinking. This is not to say that all decsions should only be made in a logical fashion, but when it comes to important snap decisions I could probably be a little more prepared.

Unit 4 (and four weeks to go but whose counting?...)

There is a certain amount of symmetry that I felt just had to be acknowledged in the timing of this particular blog post. Really the fact that there is only 4 weeks and 3 days, 2 modules and 1... (well I'm sure there is one of something left this semester related to this class) also had to be pointed out. There. Pointed.

This weeks topic is two-fold. We want to have a short dialogue about the role of teaching in our profession and we also want some input on mobile devices (read: smart phones). Apparently I have Algernon in my pocket tonight, I can't think of any other reason why I'm speaking in the plural here... So, on to teaching.

My current professional role is as a team-lead on an inpatient psychiatry unit, and as a staff nurse in an ED. As a team lead I have been assigned to mentor 5 of the staff nurses so I assist them with their goals and encourage them to improve their clinical knowledge etc. This involves some teaching as does the primary role of a team-lead on any unit - putting out fires. This requires the ability to educate patients, family members and nursing staff as the primary strategy for defusing a situation. In the ED I get to provide ongoing education to my patients: the reason for a particular therapy, the interpretation (read: plain language) of their diagnostics, appropriate follow up, medications, etc. The truth is there isn't any nursing role that I can think of that doesn't require some teaching in some fashion even the occasional  nurse in the middle of nowhere who gets elected to be the County Coroner probably has some obligation to public health teaching (although technically you don't need any medical background to be a Coroner so technically it wouldn't be a nursing job, even if you were a nurse... Moving on...)

And on that note... on to 'mobile devices'. Just a quick reminder for anyone who needs it (or if you just need a good laugh) this is my phone. I'm baby-stepping into the 21st century and just added texting to my plan. I'm steeling myself for a data-plan addition this fall and then will embrace assimilation by the Borg having the internet in my pocket.

My informatics class has a 'Mobile Device' wiki. Right now it looks like a large directory of sites without much text, but they look worth using for some research.

Check out my poll on the right side of this page and help a guy out by giving me some input. If you select Droid and have a model I should seriously consider leave me a comment with your suggestion. If you select 'or...' please let me know what I'm missing out on by not considering it. If your name is CeCe please only vote for the IPhone once. I promise to count it as 10 votes if you leave me a comment (or at least leave me a comment saying how many times you voted eh?).

Anticipatory...

The emphasis from this weeks readings and assignments in N6004 - Intro to Information Technology center on the use of technology to access and manage information resources especially those related to the development of evidenced based practice.
The assignment for this weeks blog is to discuss how I anticipate this information will help me in my graduate coursework. I jumped right into the readings before I looked at the assignments so I've already developed a pretty good idea, based on prior experience and the course reading how information management and storage systems are going to benefit me throughout my coursework.
1) Efficient storage and retrieval systems are essential to manage the massive amount of data and information available to us via the electronic databases currently available. Learning the specific tools and rules of operation that each database employs means I will be able to spend less time digging and more time synthesizing information. Getting back 25 hits on a search topic rather than 2500 makes all the difference in the world.
2) Personal use reference management software such as EndNote, Biblioscape or Qiqqa  makes the writing, citation and referencing process smoother. There is a learning curve but I can see the benefit of a good program that applies the right citation and reference format as I type, leaving me free to focus on the analysis of information rather than what APA 6th edition says about the third citation in the same paragraph of an article written by 12 authors and 1 organization published on a website that no longer exists. Ok, probably even EndNote couldn't handle that scenario but you get the idea. I've tried two different strategies for hand insertion of references, the 'type citations as I go and edit later' option; as well as the 'go back and figure out the citations later' method. They are both tedious, produce iffy results and don't quite get to what the APA had in mind with regard to consistency in citation, at least, not without a lot of work.
With these ideas in place and anticipating the benefit that comes from understanding information management I am going to take the opportunity to explore some of the reference management software out there. I was required to use EndNote two semesters ago and was only moderately impressed with the user interface. It seemed like a powerful platform in desperate need of an update. I hope to take the time to look at a couple of the different software options although, truth be told I probably will stick with EndNote, at least for now as my schedule doesn't really accommodate learning curves very well right now.

Getting Involved - Module 2

The question posed at the close of this weeks module is What is one way you could become involved in designing, selecting, evaluating, or implementing an information system in your workplace?

I have known two people who have been actively involved in the design/selection/evaluation of an information system:

The first was a nurse that I worked with for maybe a month when I was a brand-new LPN. I have no idea how he was selected, all I know is he left for what he described as a cush corporate level job that would last at least 5 years. During that time he planned on pursuing a degree in informatics and leveraging the degree along with the hands-on experience of five years into a string of cushy system design/implementation jobs. At least, that was the plan. I guess I just answered at least part of the question. as to how he was selected - expressed interest in informatics. I'm pretty sure not very many of the nurses he worked with even really know what that was. I know that my brand new, temporary DOPL licensed LPN self had no idea what he was talking about at first.

The second individual is my wife who is on a CPOE committee for Intermountain Healthcare. Despite being a very part-time employee her attention to detail and follow through came to the attention of the director during the most recent round of Joint Commission preparations and it just so happened he had been requested by the corporation to furnish one Radiologic Technologist to the committee. Viola - my wife the CPOE committee member.

Since all my managers know about my current battle with the space-time continuum It is unlikely that I will be selected in this sort of fashion...Wait, wrong battle - this is the one... (Well actually, side by side these aren't that different are they?)

The truth is, almost every nurse practicing is going to be or already is involved in implementing information systems. The complex and intense process of getting these systems up and running necessitates (in most instances) a gradual role out or integration with the systems already in place. In the Emergency department that I work in we have reveled in the simplicity of paper based charting by exception for far too long. Over the last year we have been slowly incorporating more and more aspects of an electronic charting system with an announcement that this fall we will complete our transition and begin bedside computerized charting in the ED.

A few years ago we switched over to a barcode scanning system. I vaguely remember the days of having only a med cup in the one hand, the patient's wristband in the other and the five rights on the tip of my tongue (my LPN clinical instructor was famous for bedside pop-quizzes). No juggling the med cup, and wrist band with the addition of a (set your phaser to 'wristband') scanner in hand. Anyone who has been through this kind of transition and says that they weren't intimately involved with the integration process should have their narcotic wastes triple checked. The bedside nurse is the key player in the final product rolling out and actually making a difference in the clinical setting. In the end we all get to be involved.

Why Informatics

This semester is chock-full of classes that I thought were going to be pretty irrelevant in the grand scheme of things. Just more hoops to jump through. However, after getting into the assigned readings this reasonably tech-savvy guy felt like it might be a miracle that I've been able to function in our society and an even bigger miracle that I've been able to function as a nurse. Ok, I might be indulging in hyperbole here - but if you took the course pre-test/questionnaire for N6006 at the University of Utah you know exactly what I'm talking about. Turns out that you can function in our information tech world in one of two ways (at least there are two that I have employed) and fake it present as reasonably competent.

1) Avoid tech you don't understand, just don't use it.

This works pretty well at least until you are confronted with a mandatory use scenario. Like when our unit implemented a mass text message policy to communicate shift needs. I found myself - a very accomplished text-avoider (this is my phone, check out that display) responsible for sending out 70 some odd text messages via the text groups function on the Charge Nurse cell phone. It only took me 45 minutes the first time. Clearly I can't thoroughly endorse coping mechanism number 1 whole-heartedly.

2) Use you intuition (and only your intuition).

This works if you have a basic idea of how computer systems and tech gadgets work, what they are intended for and can be kind of creative with setting expectations for your usage of those software/computer/gadget packages. It goes something like this: I want to chart a treatment team meeting in our computerized charting software. No one has ever charted treatment team meeting on the computer before, so we don't even know if there is a spot for it. But I think there should be a spot for it. And then I go looking, find a place under 'problem/event - new problem - Conference - Interdisciplinary conference'. Well there you go; what is treatment team if it isn't an interdisciplinary conference? This is the same approach I have take toward word processing programs, presentation programs, even this blog when I first started it.

The down-side to this is that functionality and use is limited to your imagination and expectations. And, lets be honest, anymore most programs and gadgets are way more complex and featured than we can imagine which means we are leaving a lot of untapped potential on the table using this approach.

With all this in mind it stands to reason that taking the time to learn about why systems were built and a little about how, you can tap into the imagination and expectations that the creators had for their systems; and now we're on track to really use a program/system/gadget to its full potential. This continuum contains learning and acknowledging the difference between the internet and the World Wide Web (never thought about that one before) at one end to exploring the world of electronic patient identifiers, E-prescribing and Computerized Physician Order Entry (CPOE). Just this week my wife came home from work and revealed that she is going to be working on Intermountain Healthcare's CPOE committee as a voice for General Radiology as they begin to incorporate imaging order sets later this year. Looks like I get a front-row seat to this.

As a major stake-holder in the future of health care it looks like this course is just in time to save me from my ineffective technology coping. It also means maybe I will eventually embrace texting as a legitimate form of communication...

A Repurposing

In the spring of 2010 I was accepted into the D.N.P. program for Family Nurse Practitioner at the University of Utah in Salt Lake City, Utah. Now in my third semester, with two years left, I find myself taking an informatics course with a requirement to blog some specific exercises throughout the semester.
I must admit to being excited pleased with the idea that I can resurrect this project blog and give it a little face-lift.(Ok, I'm excited, I just didn't want to seem like too much of geek)

Robert Wilensky's qoute at the top of this page summed up how I felt about the information I found regarding graduate school for nurses. Now, I find it equally apropos as I stumble my way through course syllabi, new platforms for education delivery and the general madness that is graduate school. I am also happy to find that the title I created for this blog 2+ years ago might still apply to the current use.

Welcome {back} to a window on Graduate Nursing.