Friday, July 9, 2010

The end...


Module Six

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

I liked not having to commute to Salt Lake. I also liked being able to work on the modules when it was convenient for me. On the other hand I did not like not "knowing" my teachers. I think that meeting your professors face-to-face and getting to know their personalities helps when completing assignments. I also like the camaraderie of meeting with classmates, it is nice to hash out assignments with others in the class.

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

I learned the most from module 4 about Clinical Decision Supports. It was kind of a beastie one, but I learned the most. My favorite topic was information retrieval; this topic will come in handy in the future both in school and work. I don't know if there was a least favorite topic, Module 4 was challenging and took the most time, but I also learned the most!

Do you have any other comments for us?

I appreciated the fast responses to emails and was glad for the further direction I needed with some of the modules. I could tell that you both spent a lot of time organizing this class! I felt all the topics were relevant and will be applicable in the future.

Tuesday, July 6, 2010

Blogging...

Module Five

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

Patient’s create blog for a variety of reasons. Often they create blog after they have received a devastating diagnosis or when recovering from a tragic injury. Sometimes, a family blog turns into a blog about a family member’s recovery from illness or injury. For the most part I think blogging about illness is a way patients cope... a way to get the word out about a rare illness... a way to connect with others with the same illness... or a way to get others involved in finding a cure.

Blogs created by patients provide an interesting insight into the patient’s perspective. It is eye-opening to see what a patient thinks is “good” or “bad” care and what really made a difference in their hospital stay.

On that note...

I also think it is important for nonmedical people to realize that patients often have a different perspective on what happened. They sometimes do not have the whole picture and often have limited knowledge into the medical system. If a patient does not think something went exactly right or the way they thought it should have they are going to blog it. They are going to talk about how terrible the hospital, staff, nurses, etc... were. People need to remember this when reading blog posts written from a patient’s point of view and remember that there are two sides to every story.

Why would a health care provider create a blog?

Health care providers create blogs for different reasons. I have read several blogs created by nurses that simply talk about interesting things that happen to them at work. While funny... they provide little but a good laugh. I think blogs can be used for education and patient teaching. They can provide a forum to discuss health care issues through the comments section. Blogs can also help a new facility or provider get the word out about the services they provide. The nice thing about blogs is they are easy to access and free; a nicely designed blog can make a clinic or health care provider seem more personable and human.

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

Blogging and social networking websites have changed the way people communicate. These outlets gives people a sense of anonymity which leads to a loss of inhibition. Because of this people share personal information they would have never previously talked about or said face-to-face with someone else.

The problem with blogging and social networking is that even if you delete something it is never really gone. If you decide something was inappropriate or malicious and decide to delete it someone could have printed it, taken a screen shot of it, or taken a photograph of it before you had a chance to delete it. Even after you deleted it from your blog or Facebook you still cannot delete it from a person’s memory! People need to be more careful about what they say! We all need to remember the Golden Rule....Do unto others as we would have done unto us!

Friday, July 2, 2010

Wednesday, June 30, 2010

Recipes...



Module 4

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

Before this module I had never heard of Computerized Clinical Decision Support (CDS) systems. The concepts were completely new to me as I have never used this type of system in the clinical setting. CDS systems help to prevent mistakes and inconsistencies in care by standardizing interventions based on a patient’s specific data. This helps to eliminate bias in care based on the nurse’s past experiences or gut feelings.

The easiest way for me to think about a CDS system is to relate it to a recipe...

A recipe guides the cook to create a (hopefully) delicious meal-right. Now what happens when the cook decides, based on what they may have done with other recipes, to spice things up a bit and change the recipe...

The dish could turn out delicious! The best meal you ever made! The kids would bow down and praise you culinary genius, and your husband would finally declare that you are indeed a better cook than his mother.

Or...

The recipe could turn out disasterously (which is usually what happens to me). The kids would turn their noses up at it and your husband would decide to order pizza instead of eat your experimental meal.

Now...

Follow the recipe to a tee and you may not have genius, but you probably won’t end up with dog food either.

This analogy could be used to describe a CDS. A nurse can decide to make decisions about their patient based on their past experiences or what they “feel” their patient needs instead of what the evidence says. This type of care may turn out to be genius! They may write a paper about your fabulous nursing care and even name a new procedure after you. Or... the care could turn out to be very detrimental to your patient and you! But if the nurse uses a CDS as a guide more than likely the patient will be receive consistent and appropriate care.

This module has helped me realize how important consistent nursing care is to reducing medical errors. I will be sure to more regularly refer to CPGs and standardized policies and procedures when giving patient care instead of going with my gut instinct or what I have done in the past.

Sunday, June 20, 2010

What the heck...

France can't score against Uruguay and then looses 2-0 to Mexico. USA ties England (and is robbed against Slovenia) Paraguay ties Italy. Portugal, with Ronaldo, can't score against Ivory Coast. Switzerland defeats Spain (the favorite) and Germany looses to Serbia. Blame the vuvuzela?! If you are not watching you might want to tune in. Things are getting interesting.

Saturday, June 12, 2010

Gooooooooooool!!!!

Some of you may be unaware that the biggest sporting event of the year is happening right now.

No, I'm not talking about the NBA finals!

In honor of this blessed event we have rotating flags hanging at our house. Yesterday we had the Mexico flag, today the US flag, Monday will be the Nederlands flag. Still don't know what I am talking about? Maybe this will help...





... my money is on the mighty orange!

p.s think real football is boring try watching it on the spanish channel.

Teacher...

No greater calling!

Module Three

What sort of teaching is done in your nursing role?

I teach on a daily basis in my current role. I am not a formal educator, but I seek out teacher opportunities. There are teaching moments all around us. I love teaching my patients, it is one of my favorite aspects of nursing. I teach patients about labor, fetal heart tones, breastfeeding (which can be so frustrating), their new babies and postpartum care. I use the same corny jokes and cheesy analogies but my patients seem to respond... and learn.

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

Teaching is ingrained in nursing. They are inter twined. Siamese twins of sorts. Every aspect of nursing requires teaching. Even if the nurse works behind the scenes (managers, case workers, informatics) they still teach. They teach administrators about what nurses need to do their jobs well, they teach fellow nurses about new technologies, they advocate for nurses by teaching others outside of healthcare about what we do. Teaching is vital to the advancement of the nursing profession! It is a shame that nursing educators are paid so little because their job has far greater value.

Wednesday, June 2, 2010

To Clamp or Not to Clamp...


Module Two

In recent months I have cared for a number of patients who have requested that the physician not clamp or cut their baby’s umbilical cord until it stopped “pulsating.” I used PubMed to search full text articles to determine if their were any maternal or fetal complications from delayed cord clamping/cutting. I was able to narrow my search in PubMed to include only randomized control trails and articles which were published in the last ten years. PubMed was also useful because it allowed me to use MeSH terms to help narrow my search. I used the MeSH term search feature in PubMed and was surprised to find out that clamping was the same as the MeSH term constricting.

When I initially searched the NCG guidelines for delayed cord clamping I was unable to find any guidelines. I tried a second time broadening my search to just “cord clamping” and was surprised to find only one guideline. Interestingly, the recommendation was labeled as a weak recommendation with low quality of evidence.

Searching Google produced a variety of information. There were multiple websites that talked about the benefits of delayed cord clamping and many that were very strange stating that you should not clamp or cut the cord until the placenta had detached. I even found a YouTube video produced by a physician talking about delayed cord clamping. Much of the information found by performing a quick Google search fits into the category “propaganda” and is unreliable because it is very slanted towards delayed cord clamping. Google scholar would be a more reliable search mechanism to finding research articles.

After performing my searches I was surprised to find that the majority of reliable information finds that delayed cord clamping is beneficial to the baby and is not harmful to the mother. Specifically, delayed cord clamping is associated with improved hemoglobin levels in infants up to six months old. I have to admit that I have been a skeptic of delayed cord clamping, however after reading multiple articles about its benefits I am beginning to change my tune. Now keep in mind that the articles only recommend delaying clamping the cord for about two minutes after delivery (not until the cord has stopped pulsating) and do not recommend it if the baby is very lethargic or appears compromised. I was so surprised by the wealth of information I found that I am going to pass on some articles to the nurse educator on our unit!

Monday, May 24, 2010

Getting to Know You...

Module One

My name is Stacy. I am known by many different titles: daughter, mother, sister, aunt, niece, dog walker, runner, nurse, but for the purpose of this blog my title is student. I am in a Family Nurse Practitioner Doctor of Nursing Practice program. This is my third semester and look forward with excitement and anticipation to graduating in Spring 2012.

I have been a Registered Nurse for six years and have worked the entire time in Labor and Delivery. I love my job and have become quite skilled at feeding patients ice chips while laying down, holding emesis basins, taking family pictures, and occasionally delivering babies.

Here are some interesting facts about me that you may not have known:

1. I come from a family of four girls.
2. I have three boys.
3. I bowled in a youth bowling league until I was in the 7th grade.
4. I have a “champion” line bulldog.
5. I enjoy running. This summer I am attempting what I have affectionately coined “The Triple Crown” which is three half marathons in six weeks.
6. In my spare time (which is none) I sew.
7. I hate cooking. When my sister asked me for recipes for the family cook book I sent her all my take out menus.
8. I love reality TV. My favorite summer reality shows starts up in a few weeks...Bring on the Big Balls!!

Why do you as a graduate level nurse need to know about information management?

Lets face it computers are not going anywhere. More and more hospital and clinics are using electronic medical records. Graduate level nurses need to know how to access electronic information about their patients. Technological advances are helping nurses utilize and synthesis data more easily which translates to being able to spend more time at the bedside. I noticed in the reading that there was a strong emphasis on evidence based medicine. Graduate level nurses need to know how to access electronic databases and utilize the latests evidence in their practices.

Describe what is happening related to IT in your clinical or practice setting.

Our unit has also recently implemented a Fetal Heart Tone Remote Monitoring Program. Nurses on my unit use computers to remotely monitor fetal heart tones in rural or small Intermountain hospitals. The goal is to improve maternal and fetal outcomes by having an extra set of “eyes” watching the electronic fetal heart tones for any signs of maternal or fetal distress. This program started as a pilot study last years and showed promise in reducing complications. The program was implemented full scale this month through out several Utah and Idaho Intermountain facilities.

Lost...


About Lost. There are very few shows that I watch religiously. Lost happened to be one of them. I watched from the beginning. The first three seasons were intriguing. The next three were frustrating (glad I have TiVo).

Even in its "bad" times I still watched. Every...single...episode. In total I have spent approximately 125 hours watching Lost. That's five days, five days of my life that I will never get back. Was it worth it... Maybe.

Now that it has ended I still have tons of unanswered questions. I guess that was the point. The writers of the show left the ending open to interpretation, letting the viewer decide what was really going on. So here is my take on Lost in the form of a Tweet:

Hot people on plane. Plane crashes. Weird things happen. Hot people die. More hot people show up. Cycle continues. Everyone dies but still hot!

The final scene of the show was poignant and thought provoking. You see the wreckage of the plane on the beach, but no survivors. Were they all dead from the beginning. Was the show about lost souls of sorts; spirits in limbo, purgatory, trying to make it to heaven or hell? Who knows! All I know now is my schedule just cleared up on Tuesday nights so if anyone wants to do anything I'm available, until the next show comes along.

Saturday, May 22, 2010

This is a test...

I've never done this before, so I'm trying out my blogging experience by telling you about the amazing lunch I had yesterday. I ate at the Red Iguana in downtown Salt Lake (check out their menu here).

I ordered the lunch special: Mango Mole Enchiladas. Mango Mole what's that? Let me tell you! It was sweet and spicy deliciousness. So good I wanted to lick the plate clean, but then that would not have been proper restaurant etiquette. My husband was jealous, drool was running down his chin the entire time as he watched me devour the enchiladas. He ordered flautas, and while good, they did not exceed the expectations of my Mango Mole Enchiladas.

So if the next time you are in Salt Lake and wondering where to score some delicious and authentic Mexican food I highly recommend the Red Iguana. And if the Mango Mole Enchiladas are the special for sure order them, just remember spicy in spicy out.