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.

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.

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.

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!