Final Blog

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

Likes:

I can work at my own pace, even at 3 am (which is a good time for us night owls).

I can go on family trips and continue with my course.

No commute.

Dislikes:

I can work at my own pace. I hate having to make my own deadlines. I would much rather go by and instructor’s pace. My poor time management, pursuit of a full life balance and overflowing list of responsibilities make too often interfere in my studies. If I leave and go to campus for an interactive class I am a better student.

No face to face interaction. No group discussions. Minimal auditory stimulation (I’m an auditory learner who likes to talk through my learning with questions). I loved using the Wimba classroom in previous classes.

The reality that more and more of the classes/curriculum will become asynchronous online. I long for the true university experience. The powerpoint on information systems reviewed IT’s impact on teaching and posed, “as space and time boundaries become porous, faculty role changes to facilitator and guide rather than imparter of knowledge.” I miss the forum discussion feel that used to be nursing school.

I feel cheated of time and money. I believe tuition should pay for a live real-time learning experience.

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

My most learned about topic was learning theories and instructional design. These were very hard for me to understand. At times I felt I was reading a different language, or at least reading a computer engineering book.

My favorite topic was telehealth. I am amazed to realize that as technology challenged as I am, I hope telehealth is in my future as a FNP. I wish we could have become more familiar with it, or have an opportunity to go to a lab or observation hour that is telehealth.

My least favorite was Excel. I am too new at Excel. I hope to take a class in the near future to better navigate and understand Excel. It is very hard, and I struggled with the Excel assignment.

Do you have any other comments for us?

For the most part this class was a challenging yet “doable” experience for my novice computer skills. The EHR assignment has thrown me for a loop---I am still hoping I can figure out how to log in with the same problems that other students have had per the discussion board. I have bookmarked many of the sites we have used in this class. Thanks for making computers and information systems more tangible for me. I have learned so much.

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

As I consider this question I am reminded that we are all patients or clients at some point. Each of us is a patient. So, I answer these questions personally.
Writing and journaling are thought provoking and insightful activities. They can be private affairs meant only for the writer to gain a sense of growth and an ability to reflect upon a journey or trial in his or her life. Blogging allows for that reflection, but is a non-private affair. Blogging allows an individual to create and write a thought and then throw it out to the world for viewing upon the internet. I consider blogging as a sort of public journaling.

Perhaps having a blog can put an individual under timeline/project pressure to complete such a writing and documenting accomplishment. I can guess or assume why a patient would want to create a blog, and then continue to blog. However, I am sure that there are millions of reasons for patients to blog; and perhaps there are many reasons for one individual patient to turn on their PC and open up for the world to read. My greatest reason to blog would be to document a journey and to allow those people I care about, and those who are interested, to watch my journey. I would also want to somehow make sure that my illness would not be in vain---and I believe blogging could help me share my human experience of illness with others. I am sure by doing this I would be able to gain a sense of peace, growth and accomplishment. I would also like to continue with my habit of educating those around me and sharing my life experiences with others. This would also give me and my coping with my illness a sense of purpose.

Why would a health care provider create a blog?

I think blogs can be very educational. Even I have used them in the past to get a better understanding of how individuals and families are able to cope with and experience certain illnesses and certain health care situations. The personal experiences of having two friends diagnosed with cancer at the ages of 36 and 38 this summer, having my brother diagnosed with DMII and HTN, and having witnessed my 72 year-old mother-in-law’s health deteriorate have made consider the benefit of blogs to patients and families. I think blogging regarding chronic illness, health care coverage, prevention and affordability of treatment would be very "relatable" to so many different individuals and families. A great sense of understanding by these patients that they are not alone in a struggle and that others have survived or prepared for a worse outcome could be derived from blogging. Much can be learned from the journaled and blogged experiences of others, especially insight into the unknown.

I have also found that when health care professionals experience illness and then share that experience with the public, then that illness is talked about more and better understanding can be achieved within a society. A health care provider could also consider using a blog to provide a discussion forum and to educate patients (Hebda & Czar, 2009, p. 110) . As a health care provider I would consider blogging about my own illness, or of an illness of a loved one. I think that this could be considered interesting and "relatable" to many people in need of information and comfort when faced with illness (either of themselves or of a loved one).


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

There are many ethical considerations when blogging on a public website. My greatest concerns would be privacy and liability. I am an individual who enjoys what little privacy I have, thus needing to open up and share my thoughts and experiences with anyone in the public is frightening. What if my insurance company discovered I have a pre-existing condition via my blog. I always wonder if Big Brother is watching me or reading this.

I also would hate to inspire some individual to make a wrong decision. I am sure there would be such a risk for any health care provider who opened up and attempted to educate the public. An individual could forego an appointment for a physical exam and miss being diagnosed with some awful disease due to self-diagnosis via information from a blog written by a health care provider.

And what if my writing offended those around me? What if a patient assumed I was blogging about them, and felt their trust had been violated? What if someone took my work and then copied it and then used it for a project of which I would not want to be involved? What if someone stole my work and then took credit for it?
Thus, blogging makes me too nervous. I appreciate that blogs exist, and even follow a friend’s blog regularly. Yet, there are too many reasons for me not want to create and continue my own. Privacy, confidentiality, security, and liability are too many reasons to kill the blogger in me.


References
Hebda, T., Czar, P. (2009). Handbook of Informatics for Nurses & Healthcare Professionals (4th ed.). Upper Saddle River, NJ: Pearson-Prentice Hall.

My Own Clincal Decision-Making

How did the readings influence your perception of your own clinical decision-making?

These readings were thought provoking and gave me a greater self awareness as I critiqued my RN practice and my attitude regarding Evidence Based Practice. As I considered these readings my opinion and value of EBP has improved and grown. I actually regret the many shifts I have not considered EBP as I coasted through my RN professional experience.

The power point “Decision Support for Care Delivery: A few high points…” by Katherine Sward had me consider where I fall on the levels of nursing experience. I find that I am a proficient nurse for the most part, even though I do exhibit intuition as a natural result from experience. It has been years since I evaluated and rated my own personal nurse level; and I have never stepped back and considered how I come to a professional decision. It was enlightening to discover that there are biases that are truly inconsistent as I make decisions and provide what I had hoped was the best possible patient care. I find that I have always appreciated the if-then application of logarithms that are commonly used in my RN practice settings (i.e. ACLS, neonatal hypoglycemia, and adult diabetic insulin sliding scales). These practical decision loops allow me to take my bias out of my practice and act with objectivity as I treat numbers that are dynamic levels. These dynamic levels represent what a patient is doing, and how a patient needs interventions. Considering my present practice as an RN had me realize the safety and consistency of Clinical Decision Support Systems and the relationship of Evidence Based Practice. I realized the power and validity of these combined tools for the bedside nurse and for the practicing Family Nurse Practitioner.

The article “Judgment under Uncertainty: Heuristics and Biases” by Tversky and Kahneman was quite informative and introduced me to heuristics---a world of beliefs I had not realized I was a part of. I was particularly impressed by my own overused bias that is “due to the retrievability of instances” and I was shocked as I reflected on my practice as a RN and realized how often I use this bias unknowingly out of habit and even professional laziness.

The article “Clinical Decision Support Systems in Nursing: Synthesis of the Science for Evidence-Based Practice” by Anderson and Willson was a strong demonstration to me of the need of RNs and NPs to incorporate Evidence Based Practice via logical decision making methods into practice via clinical decision support systems. I was impressed by the arenas where CDSSs demonstrated their effectiveness (i.e. Toowoomba Adult Triage Trauma Tool (TATTT) and the Pressure Ulcer Prevention and Management System (PUPMS)). This article had me consider if I would use such tools to make effective and consistent decisions in the future as a FNP.

The article “Infusing Clinical Decision Support Interventions into Electronic Health Records” by Brokel had me consider what areas of clinical decision support I have used in my past years of experience as a RN. I was not aware how the clinical knowledge I received via numbers that represented levels I was monitoring (i.e. glucose or hormone levels) was the beginning of a complex system of patient related information in which I was actively participating. My participation in these systems, or CDS interventions, allowed me to unknowingly “support nursing care processes across shifts and settings” (Brokel, p.350, 2009).

My greatest understanding I received from the readings was my need to be a more conscientious bedside nurse and nurse practitioner. My clinical decisions, clinical decision making techniques, and practice need to be crisper and need to be more knowledge-based, i.e. need to be evidence based practice. This consistency will benefit my practice, my patients and nursing as a whole.

Teaching and My Nursing Role

What sort of teaching is done in your nursing role?

My present nursing role is that of a bedside RN (in a psychiatric hospital). This role requires me to consistently teach and inform those around me. I teach patients, parents, staff members, administrators and even psychologists and psychiatrists via my view as the bedside RN. I teach these members of my team regarding that which I witness and have responsibility for as a nurse and as a team member with consideration for the patient as an individual and for the patient as a member of a residential community. Much of my teaching is done for the patient and their family, especially as we draw closer to discharge.

My future nursing role, the one for which I am working so hard, will be that of a Family Nurse Practitioner (most likely in the primary care setting). I see myself continuing to teach patient, family, staff members and colleagues per my view as a nurse and as a doctoral prepared Family Nurse Practitioner. I plan to incorporate education into my movements and phases of patient and care provider interaction, as I consolidate my moves to effectively and efficiently meet the needs of my patients.

Is there any nursing role that does not involve teaching in some manner?

As I have contemplated this question these past couple of weeks I must say there is no nursing role that truly does not involve teaching in some manner. I thought about if I were to care for a comatose patient and how I would still educate family or friends with each interaction. And I thought of some isolated informatics nurse who would continuously need to teach herself and her department updates in technology and methods. Thus, I believe teaching is an essential part of nursing.

Useful versus Not Useful Resources

The electronic index I used was PubMed, which I found to be even bigger than I remembered when I have tried to navigate it in the past via Google Scholar. My PubMed search, which utilized MeSH terms and activated limits, provided ample citations. However, the citations would all need to have their abstracts read and noted to develop a more thorough search.

The guideline index I used, National Guideline Clearinghouse, was interesting but not very helpful. As a web search engine, National Guideline Clearinghouse, was not as bountiful when I attempted to use it as I approached the problem of yeast infections and treatment options. I was able to consider this site to improve how I should state my problem. I wish this site was more user friendly via offering an index menu listing the guideline summaries prior to throwing an individual in front of so many guideline summaries. I needed to scroll down and read pages of the index before I found “American College of Obstetricians and Gynecologists.” However, I found that many useful topics which were interesting could be of high quality of reading material at another time.

Context relevant information retrieval could be useful to incorporate better organized, faster and more efficient search methods. I am sure the technology is around the corner to make this retrieval more user friendly, i.e. similar to the updates made to improve PubMed. Google would be even a bigger Cyber Giant if they developed a simple site for context relevant information retrieval that presented easy access to legitimate articles for research by professionals and the public.
Google Scholar is different from Google. These two similar web search engines work in the same manner and have made information so much more tangible. However, I wonder how credible these sources may be. I am concerned by how Google and Google Scholar rate and list their articles. I appreciate how Google and Google Scholar highlight the items I have opened up when I am performing a broad review of articles. I discovered that Google will bring me to sites that do not charge for each journal to which I am given access. Thus, I actually prefer Google over Google Scholar due to it being a better place to start with my search. It is good for me to brainstorm and contemplate how I should word a search and what MeSH terms I should incorporate. I think Google Scholar is still very limiting, and I do not want to have to pay for each new journal I come across or belong to dozens of different sites in order to reap the benefit of using this method as my primary research strategy portal.

Module 1: Introduction

1. Introduce yourself to the group. Include your graduate area (e.g., teaching, acute care NP, etc.).
My name is Gigi Whaley-Pryor. I am in the DNP-FNP program. I started the program as a part-time student in 2008. I want to work with patient populations that include women and children that are low income or part of migrant worker families. I live in Syracuse, Utah and enjoy not having to commute one way for an hour (on a good day) in order to get to my graduate intro to informatics class. Even though an online course is not my preferred choice for a learning medium, I can definitely appreciate not having to come up on campus every week during this summer.

2. Why do you as a graduate level nurse need to know about information management?
I need to know about information management because technology is part of our lives and technology is the vital connection within health care. We are moving towards a paperless system and I need to be able to function in such a system. I have worked mainly with paper charts and I need to learn how to synthesize this data into modern technology. IT is part of my future in Nursing. Perhaps after I graduate I may investigate Telehealth as a viable option to include within my practice. In order for me to develop the skills to become a Telehealth FNP to meet all of my patients' needs I will of course need to learn how to use technology if Telehealth is something I want to pursue. Thus, like it or not, this dinosaur (me) must step up and take a seat on the information highway and establish skills I have long avoided due to my computer anxiety.

3. Describe what is happeing related to IT in your clinical or practice setting.
I am currently working in a local psychiatric hospital as a charge nurse and we have minimal IT. A small percentage of our education is done on-line via the intranet. Hopefully, by the end of the summer we will have Best Notes added to our system. As I contemplate Nursing Informatics and Medical Informatics in general and all that President Obama is trying to do with health care reform, I know that IT is the key and connection that will push health care and practice to the next level and IT will reduce costs and IT will allow information to be connected between different providers. Much fear will need to be overcome in order for us to get to the next level. I have fears I need to overcome, such as fear of change and of the discomfort of the dreaded learning curve. I see fear when I discuss the technological changes that will happen in health care with neighbors and friends. They seem so scared of their personal information being exploited, and they are so hesitant of change in our broken and out-dated health care system. I see this fear and acceptance of the status quo at my little psychiatric hospital. This is how we are preventing ourselves from advancing in technology and all of technology's benefits. Thus, continued change via IT will impact all of health care and all of our society.

First Blog

I am a nursing student getting my doctorate as a Family Nurse Practitioner. I have always been interested and fascinated with health care. I have never however been very interested in computers nor blogging. Hence for this class, I have been introduced to the idea of blogging. My aim and goal is to learn more about blogging and the social connections in can create. I will be learning how the tech stuff actually works.