That's all folks, . . .

Module 6

I have loved the flexibility that this asynchronous course offered, especially during the summer when I had several family reunions to attend and a family vacation planned, while continuing to work. I also thought that our professors were very helpful when it came to questions and clarifications. The content was well organized and clear. The expectations were also clearly laid out. This is not always the case with asynchronous classes, and therefore I was very grateful for the organized manner of this particular course. The organization made it easy for me to plan out my time so that I would finish all the required content/assignments on time while still allowing me to "have a life."

One of the drawbacks of having an asynchronous course is that I missed the face-to-face interaction with my classmates, . . . but I'm sure we will get enough of each other when school starts in the fall :).

I feel like I have learned a lot about Nursing Informatics during this course and am grateful that I had the opportunity to take the class. One of my favorite topics was learning about technology available for teaching. I have often thought of teaching nursing after I finish school and hope that I will be able to incorporate this new information about "Teaching with Technology" to supplement my teaching style.

I thought all the topics that we covered were applicable and useful. If I had to choose a "least favorite" topic, it would be "Information Retrieval" only because searching for sources is not one of my favorite things to do. However, the content was presented well and I still feel like I learned lot.

I would like to thank Professor Cheeseman and Sward for their hard work this semester. I have enjoyed the exercises and feedback received. It has been a great semester. Almost makes me want to certify in Informatics :)!

To blog, or not to blog, . . . that is the question!

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

Many patients that I know have created blogs to help keep their family and friends up-to-date with their condition. One of my husband's close friends was inundated with calls following his diagnosis of terminal cancer. He and his children chose to then create a blog. They did this for the following reasons:

a) To keep family and friends up to date with his progressive cancer
b) As a record of his thoughts, feelings, fears and hopes for his children and grandchildren.
c) To preserve time for their family to spend together by protecting their father's time that he had left and directing all queries to the blog.

The blog was updated daily in the beginning and then weekly. Several people commented and followed the blog. Our friend's wife did not enjoy the blog so much as she thought it was an invasion of privacy into their family's life, however, she was grateful to have a record of the events and it truly did fulfill the goal of cutting down on the number of calls that they received so that she could concentrate on caring for her sweet husband.

An unintended consequence of starting the blog was that there were several strangers that started following his blog. Many were people who lost family members from cancer. They offered support and encouragement.

Our friend battled his cancer bravely and through his blog, was an inspiration to many.

http://www.richardloser.blogspot.com

2. Why would a health care provider create a blog?

The following are several reasons I would think a health care provider might create a blog:

a) To keep patients and clients updated with the issues surrounding the health care provider's practice.
b) To provide a social media support group for patients.
c) As an educational tool to help teach patients about various conditions such as diabetes, high blood pressure, CHF, etc.
d) To network with other professionals.

The following is a link to an APRN blog:

http://arnp.blogspot.com

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

a) Anyone can get on the site and may possibly try to steal personal information from those participating in the blog.
b) It is not secure and personal information may be leaked without the people involved being aware of this breach of privacy.
c) Even when a blog is deleted, the information contained in the deleted blog still remains archived (University of Washington, n.d.).
d) The opinions and perspectives that we share online are open to everyone and can be misconstrued or misused without our knowledge which could have dire consequences (University of Washington, n.d.). One example that the University of Washington used was that a potential employer may "Google" a the job seeker and find something derogatory that the job seeker said on a personal network or blog that did not put that job seeker in a good light (University of Washington, n.d.).

There are many things that can be done to make blogging safe, such as making the blog private and using a nickname or some other name that would mask the true identity of the author. Overall however, I feel that blogging is an wonderful tool that can be utilized as a journal, or means of keeping in touch with family and friends. Professionally I think blogs may be useful for education and as a support group tool.

Reference:
University of Washington. (n.d.) Ethical issues of blogs. Retrieved July 27, 2010 from mywebspace.wisc.edu/avee/web/blog_ethics.html.

"To Err is Human" . . . and I am definitely human!

From the recent readings on clinical decision making--I would have to say that over my 10+ years of nursing, I have learned many very important things that help me make decisions in my nursing care. I would probably put myself in the category of proficient to expert nurse. I often look at the data and track important trends, work by experience and even follow intuition on occasion. I have learned how to read people and form collegial relationships with individuals in a very short period of time. However, I am not naive enough to say that all my decisions have been 100% accurate. I am grateful for the Clinical Decision Support (CDS) tools that are being developed for use by nurses. These CDS will help to keep the standard of care for patients consistent and take out the subjectivity that exists between nurses with varying degrees of experience. They help to guide our decisions and remind us of options that we may have overlooked. I am excited for the future of CDS in medicine and see the value that it will provide especially pertaining to patient safety and efficiency in patient care. Someday, perhaps I would be interested in developing such a system--someday when I have time . . . would be a great puzzle . . . and I love puzzles!

The Nurse/Teacher Role

Throughout my career as a nurse, teaching has always been pivotal in my care of patients and in my interaction with my colleagues. While sometimes it is difficult to do, I enjoy the opportunity that I have to sit down with my patients and discuss their disease process, plan of care and answer any questions that they have. I have also had the opportunity to be a mentor for several new nurses and have enjoyed that experience immensely. I hope to one day teach nursing.

"Without enough nursing educators,
those to train the next generation of nurses,
we cannot deal with the shortage."
-- Lois Capps

Module 2

You used an electronic index, a guideline index, and a web search engine to retrieve information relevant to your clinical problem. Compare and contrast your results. Which resources were useful/ not useful for your information retrieval task, and why? Identify some alternative strategies for retrieving relevant information - would context relevant information retrieval be useful? (You must be detailed enough here, so that your blog entry evidences your use of both NGC and Google).

The search question that I wanted to search was: "What are the current practices/suggestions for diabetes management among the Pacific Islander population." Using the three various guideline indexes, I would have to say that the one that gave me the most promising results was the web search engine.

Using the LexisNexis database index (an electronic index) was tedious and time consuming. I am much more familiar with PubMed and CINAHL. The results from this search were also primarily from newspaper and news magazine sources. When I tried to export these sources to my EndNote reference manager, they were only exportable as RefWorks citations. The Boolean codes were also very difficult as they were different from PubMed and CINAHL. I did like the fact that the references were full text and you could view the results in list, expanded list and full text views.

Using the guideline index (specifically NCG) I was only able to 7 different guidelines regarding the management of diabetes, but not specifically geared towards Pacific Islanders. When viewing the results, the terms "Pacific Islanders" only showed up in the "risk factors" section in all of the guidelines. While the treatment and management of diabetes may be the same for adults regardless of race/ethnicity, I was interested to see if there were any interventions that were specifically geared towards this population because of their high risk.

The web search engine "Google Scholar" is one of my favorite searches to use. I have found that it is user friendly and can point me in the right direction. Of course we must always take into account that this is a "web" search and so we should always be wary of the sources (reader beware), however, it is a great starting point and I have learned some tricks including using the advanced search options in Google search. When searching in Google Scholar, without putting any limitations, it pulled up 16, 300 results. After putting limitations which included only the most recent publications over the last 5 years, including the exact phrase "Pacific Islanders" and excluding "children", the results were whittled down to 608. Immediately I was able to find an article that was exactly what I was looking for titled "Diabetes Training of Community Health Workers Serving Native Hawaiians and Pacific People" (Look, Bumhofer, Ng-Osorio, Furubayashi, and Kimata, 2008). This article talked about culturally customized education that could be used to help Pacific Islanders manage their diabetes.

Another web search engine that I like to use when looking for quality sources on the web is the "HONcode" search. I typed in the same Boolean as the Google Scholar search and the results were 10 articles from trusted sites which included a PubMed government article with a full-text option. The article was specifically geared towards a community based program specifically for Pacific Islanders ( Wang, Abbott, Goodbody, Hui, and Rausch, 1999).

I think that all of the search indexes and search engines have their place and merit. I think that as always, it is important to follow the guidelines outlined in our readings for analyzing the quality of the articles that we site.

Reference:

Look, M.A., Baumhofer, N.K., Ng-Osorio, J., Furubayashi, J.K., & Kimata, C. (2008). Diabetes Training of Community Health Workers Serving Native Hawaiians and Pacific People. The Diabetes Educator, 34; 834 DOI: 10.1177/0145721708323639.

Wang, C.-Y., Abbott, L., Goodbody, A. K., Hui, W.-T. Y., & Rausch, C. (1999). Development of a Community-Based Diabetes Management Program for Pacific Islanders. The Diabetes Educator, 25(5), 738-746. doi: 10.1177/014572179902500506

Genesis

1. Introduce yourself to the group. Include your graduate area (e.g., teaching, acute care NP, etc.).

My name is Liana Kinikini and I am currently in the DNP-GNP program. I feel at times like my life is a circus and I'm walking the tightrope. I'll explain this later but for now, here is some information about me. My interests are in caring for the geriatric population. I earned a bachelors in nursing from Brigham Young University and now that I'm attending the University of Utah I am unsure who to cheer for when football season comes around. I usually cheer for whoever is losing. I favor underdogs. I currently work as a float pool nurse for Intermountain Health Care and as a charge nurse for IASIS. For the float pool I work in the areas of acute care and women services. I used to work for the ICU float pool as well but realized I was ... not crazy (too many specialties).

Among my different scholastic endeavors I'm also a wife and mother. Like most nurses, balancing life (family, work, school) is a definite skill and I feel I am pretty good at doing it. Walking that tightrope has required a lot of concentration, but who can complain considering the views I get from way up here? I hope to continue helping people and working with populations both within the United States and abroad. I was raised on a small pacific island kingdom so the sea constantly beckons me to return. I would love to spend some time providing much needed services to third world countries.

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

British author, J.G. Ballard said, "Science and technology multiply around us. To an increasing extent they dictate the languages in which we speak and think. Either we use those languages, or we remain mute." The way we communicate and offer services are founded upon the way we keep, access and review information. Failing to understand information management will limit the effectiveness of any practitioner.

Information management is necessary to provide effective health care. We base our practice on our ability to gather and especially manage information. The use of electronic information methods are critical. Especially since all the information, past and present are now more readily available to health care professionals. The benefits of being able to retain information, especially crucial information that a patient may not disclose by mistake can prevent additional problems in treatment.

The ethics behind the availability and accessibility of this information can be a problem. Issues of confidentiality are important to understand for both the health care professional and the client. Understanding how information is dispersed and how information is shared would be essential to provide the best and more adequate care for patients. As a graduate level nurse, understanding the power and limitations of information management is literally a matter of life or death.

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

In one of the hospital systems in which I practice, although the vital signs and EKG waveforms are collected electronically, we are still paper charting in the NICU and Nursery units. That will soon change as the hospital is gearing up to train the personnel to use the established computer charting systems that will provide structured documentation. This will aid in future participation of empirical research.