Module 6: What Happens in Vegas Stays in Vegas!

As I was pondering on a fun title to describe this last module which deals with 'Policy and Ethical issues Related to Information Technology,' I thought of the above phrase that somehow presents the gist of this unit- the concepts of confidentiality and security of information. Hand-in-hand with the unabated progress in computer technology that gave impetus to the birth of  health care informatics is the potential of security breach and divulging of personal, private information. The readings both in the text, articles and powerpoint have taught me of the immensity of this topic and as a health care provider and consumer, I need to be not only careful with my own personal health record but also need to respect health information that I am privileged to access. Curtin's (2005) description of how technology and its power can either be used properly or misused/abused  made me ponder on how crucial it is for me as a nurse to respect the information I gather whenever I access a patient's file and to treat it with confidentiality. I believe that as nurses we have the unique role of 'being allowed' to enter our patients' personal realm to such an extent that is normally not given to other professions and we need to make ethical choices daily as we build therapeutic relationships with our clients. Such electronic health records, as described by Swartz(2004) can be positive tools not only to to contain cost or  reduce errors in medication and but also to provide quality and safe patient care and they should be treated with privacy.

This module has also reinforced in me the importance of improving my computer skills so that I can use this technology properly and wisely both for educational advancement and patient management. Reality is that there are people who can use this wonderful technology to destroy vital information or misuse it. The major WikiLeak breach of information that has showed government files related to international relations is a great example of  security breach  that can endanger a country's diplomatic stance.

As I write this last blog, I am truly grateful for the new great vista of healthcare informatics that opened before my eyes with this Nursing Informatuics class. I hope to progress as I step deeper into the cyber world in my 'Cyber Pedagogy' course next semester and use such knowledge and skills to be an effective teacher, nurse and clinician.

Module 5 A Wise Man Built His House Upon the Rock

As I was pondering on what to come up with in this blog in relation to our current module's focus on 'Decision Support for Care Delivery,' I immediately thought about the children's song for my title. It is quite fitting that the last step to completing this module is writing a blog about how the readings have influenced 'my perception of my own clinical decision-making' because I have learned a lot after going through each of the assigned readings and video by Daniel Kahneman. Our current topic was quite an abstract concept to me initially until slowly I got the gist of it and I have actually learned to appreciate the clinical decision support system! Graduating from a Philippine university about 5 years before the 2 'differential diagnosis systems' were even introduced (Meditel and DXplain as presented by Hammersley in a personal literature search), my concept of nursing management was based upon a theoretical framework of knowledge which, on many occasions, was not practical to implement because of limited resources and disconnect with what actually took place in hospital settings. I appreciated Tversky's study on how heuristic methods can lead to errors in judgment and this can impact our nursing decisions.

The combination of readings by Anderson, Brokel and Cortney  formidably build up a sound framework upon which a clinical decision support system can augment a clinician's ability to make sound decisions to effect quality care and patient safety. I remember writing a lot of nursing care plans based upon hours and hours of reading materials at school; I often  felt that these were just to satisfy the course requirements. How did  I reconcile what I've read about and what actually happened in the poverty-stricken hospital wards where aseptic techniques were more of the exception than the rule? Was I confident  that my patient's presenting symptoms were indicative of a particular diagnosis that the medical interns wrote down in the charts? Why was a patient being subjected to many lab tests and diagnostic procedures- was it because it was difficult to determine the principal diagnosis and a 'trial-and-error' method was the way to go, hoping that at some point we'd bump at the correct illness?

It was along these lines and  when I was reviewing for my US Nursing State Board in 1979 that I remember my husband coming up with the rudiments of  a clinical decision support system. He said that it would be really good if there was a computer application that can help with diagnosing illnesses based upon the input of symptoms. It was actually this idea that prompted me to critique DXplain for our assessment because my mind just went back to thirty years ago when he discussed this with me!

As I have expressed in my journal, the readings about clinical decision support systems have made me appreciate their role  in positioning nursing as an evidence-based practice. Speed and accuracy in obtaining information to make decisions in a clinical setting are crucial factors in delivering quality care and patient saftety. Unfortunately I have also read that inasmuch as medical and nursing clinicians and staff recognize the great help a CDSS provides, its adoption as a regular support system is not well taken because of several factors such as user competency and system acceptance as Cortney explained. I really hope that as nurses we can  recognize the role of informatics, an application of which is utilizing a decision support system,  in strengthening our knowledge base because it directly impacts our patient management. This way we can 'build' our nursing profession 'upon a rock' of evidence-based practice supported by a  vast knowledge base and consensus of experts. Nursing, then, becomes both an art and a science- a formidable tandem that impacts individuals, communities and  societies.

Module 4: Teaching with Technology: Sign of the Times

I walked down the concrete steps of my college Alma Mater over 30 years ago, excited to embark on a career that took me 5 years to complete because it was a BSN program. I was immersed in real patient care, community health experiences and lectures as a teaching strategy where I must have dozed in-between due to the lengthiness that somehow cradled my fatigue due to bus rides. Over the years I find that concepts that I learned have come in handily and I am grateful to my teachers who, despite the absence of computers and other technological gadgets so common now, have tried to teach us to the best of their abilities.

Fast forwarding to my current situation   as a professional nurse, I believe that teaching is as much a vital component of my role  as my skills. I manage a residential treatment facility's Infection Prevention and Control Program and because our focus is on prevention and wellness, teaching is a crucial component of our program. I deal with both the staff (approximately 350) and the student (numbering around 150) populations because these are the two sectors that comprise our school community.  Because our goal is to reduce the risks of acquiring and transmitting infection in our facility, education of both sectors in carrying out our Infection Control bundle of health practices  is a MUST. I enjoy my role of a teacher as I plan the format of my staff in-services and utilize ways to facilitate learning of the concepts needed to be taught. My teaching occurs in a group setting as well as on a one-on-one situation especially during my immunization clinics. In fact I jump-started my annual flu vaccine campaign two weeks ago with the skill I've learned in my Nursing 6010.  I constructed a creative, eye-catching, colorful and fun powerpoint presentation about influenza and the importance of vaccination and non-pharmaceutical interventions. It was meant for our adolescent audience whose ages range from 12-18 years old whose level of knowledge about proper health practices is quite inadequate. I promoted active learning through questions-and-answers with their favorite 'cool' Ticonderoga pencils as perks. Based on audience participation and feedbacks, this was a positive learning experience for them.  I also developed an Infection Prevention and Control educational checklist for each student where different topics needed to be addressed are discussed by either me or the nursing case manager and checked off when done. I did this instead of a plain lecture of the 'do's-and-don'ts' of infection control which will definitely bore my adolescent audience. Before I vaccinate a student, I do a mini teaching of what immunization does in a simple and understandable way- i.e. the virus in this solution is killed, will not hurt you and in the next several days, it will trigger your body to react to it and build its own soldier cells to fight it, so that when the real virus comes along, your body is already prepared to deal with it.'  I believe that teaching them about the importance of vaccination prior to the actual procedure not only allays their fear but helps them integrate wellness measures as a life skill. The use of powerpoint in my in-service has definitely enhanced my teaching role to our adolescents, a technology that is way notches above the projector we used over 30 years ago which  necessitated adjustments and didn't have color at all!

I really enjoy the teaching component of my professional role. I believe that THERE IS NO nursing/health care provider role that does not involve teaching in one way or another because it is an inherent component involved in a patient-nurse relationship. Teaching is involved every step of the way as we take care of our patient- from the basic and simple teaching of  the what's, why's, when's and how's of his  medication to what the cardiac monitor does and why he's attached to it or to plainly just holding his hand as we support him through his pain- these are all teaching moments that tell him that we value him and we want to help him. With breakthroughs in technology that can be utilized in teaching us, students, patients and our colleagues, the teaching component of our nursing role is inevitably enhanced and made more effective.

http://editthis.info/nurs 6004 mobile devices/Main page

Module 3: ' Do you know the way to San Jose'?

As I was working on our present module on Information Retrieval, including the use of  Reference Management Software,  a favorite song in the 70's sung by Dionne Warwick just kept on playing in my mind and it goes..."Do you know the way to San Jose, I've been away so long I might lose my way....' 
I guess that it's because I've really spent a lot of time 'finding my way' through the technical challenges of presenting the 'screen shots' of the 2 assignments. Establishing my EndNote was quite a challenge as I went through the licensing and registration with the assistance of my spouse and a dear friend. However, after these 'challenging' steps, I actually enjoyed the 2 activities. I found the information retrieval very productive and meaningful especially so that I chose a topic that I am really interested in and will actually utilize the articles to help me build a stronger infection prevention and control program at our facility. The use of the EndNote is no longer foreign to me as it was in the beginning!

I utilized our school's library to access the electronic index for CINAHL and HEALTHSOURCE in order to obtain pertinent researches about my chosen topic. I also utilized the guideline index through the National Guide Clearinghouse(NGC) as well as the regular web search engine. I actually regularly use the latter whenever I need to find out information about ANY topic.

What's interesting is that all of these three sources of information present a huge initial volume of information, perhaps with the guideline index providing the most number of searches (as high as 406!) when I typed 'infection control program.' It narrowed down to 280 when I further specified education  and training. The web search engine also gave different articles pertaining to the same topic. However the common thread that runs among these 3 sources is the provision of vast information about a chosen topic; there are more differences than there are similarities and although they are useful, there are distinct differences that are crucial to consider in order to focus on the research topic.

The electronic index presented a vast number of databases that provide evidence-based researches that enabled me to choose selectively with 'high precision' as described by Poynton. Such index also enabled me to import the article to an organized library such as the EndNote. The guideline index, though, despite the voluminious searches that came out by also utilizing the same words, is not as focused on the topic chosen despite that the words of "education" and 'training" were used for more clarity. It's interesting that several non-related topics came up, such as 'addiction,'  and' detoxification' under the mentioned topics. It seems that the guideline index didn't specify if there is a capability for the researches to be imported, leaving a  student like me to print the entries for information. The web search engine suggests different related topics and is comprised of  a narrative text that does not  allow a user to import the article to an organized collection like the electronic index. Most of the information is not evidence-based research and are more of references and information.

Among these three sources of information, I choose the electronic index to be my prime choice for retrieval of information because of the vast but well-organized searches I am able to do through different databases. It responded well to the use of MeSH and minimized citations that are not pertinent. I also like its capacity for the article to be imported to a folder and be organized in a reference management software like the EndNote.

Indeed, searching through the maze of information is like my favorite 70's song of a person finding her way back to a specific place, just like navigating through all the sources of information, hoping to find the pertinent ones that are relevant and useful.

Module 2: ' Being One with the System'

As I'm getting deeper into 'the woods,' it's fascinating that I'm actually finding that there is a vast clearing within. I guess that what I'm trying to say is that despite the vastness of technology where I oftentimes  feel so handicapped due to my unsavviness in computers, I am continually amazed at what I am learning each day that are so beneficial to me. I worked at a small community hospital in Hawaii 31 years ago where we utilized paper charting; I proceeded to Utah where I worked at two facilities that did the same. From there our young family moved to New Jersey and then to Pennsylvania where the  4 medical facilities I worked at had utilized computers at very limited levels. Studying about healthcare information systems now, including the utilization of the electronic health record, simply just faze me. The access to pertinent data to improve patient care is simply exciting.

What I'm so enthused about now is that my current work place has been working on obtaining an electronic charting/information system that will synchronize all the various aspects of our nursing care. Because I work closely with our nursing management, I have the opportunity to become involved in evaluating the information system being proposed and hopefully provide some insights that will help in customizing such system to fit our unique needs. Implementing the Infection Prevention & Control Program in a school setting is different from that of a hospital setting because of the type of clientelle being dealt with- ours is a well population where I focus on preventive measures whereas the hospital deals with sick clients who's already dealing with a compromised medical condition. Nevertheless, the implementation of an information system at my school will be very beneficial so that surveillance measures can be streamlined and interfaced with student data. I need to get involved in the designing and selection of such information system because the program I am involved in is part and parcel of the medical and nursing care of the students.

This module is actually the impetus behind my increased interest in evaluating an information system that we can use at my facility--I need to be one with the system.

Mod. 2 Save the trees!

I can't imagine how many thousands of trees we've been salvaging every year just by switching to electronic systems. I don't know how the paper industry is being impacted by the shift to electronic correspondence or e-systems pervading the country but what I know is that such change has brought efficiency into the health care system. Time is of the essence; it has a value and utilizing information systems in the healthcare industry has revolutionized so many vital aspects of caring for a patient that would normally entail so much time to access. Having such information at your fingertips is simply amazing. All of these translate to the bottomline of improved quality of care.

My facility is heading towards utilizing an information system that will help the nurses in nursing documentations and other aspects of care. I realize that switching from the old school of paper-and-pencil system may cause anxiety among staff that are used to the traditional charting but I believe that familiarity with the system will alleviate such initial stress, just like the transformation happening within me as I get more used to online instruction.

'Going green' is the key word and utilizing information systems is definitely helping the planet!

Mod. 1 Social Media-It Works for me, too!

If there's anything that at this point has enthused me about Nursing Informatics, it is learning about the social media and its impact upon the health care industry. I am enthusiastically realizing that the social media can be utilized to help both the providers and consumers of health care. I don't use Facebook despite its popularity- simply because I don't have time for it (it sounds like it can really preoccupy people's time in keeping up with what's happening with friends and associates!) . But I'm quite impressed with Mayo Clinic's initiative to utilize social media to interact with their patients, their families, staff and community members through interesting updates and information about health. It gave a 'face' and a 'heart' to a very reputable hospital known for its valuable researches and high end treatments.

I guess that in this age of financial pressures augmented by illnesses that we experience, it's gratifying to know that slowly hospitals out there are realizing that they need to 'interact' with people outside their walls and promote humanism. Utilizing the social medial enable them to connect to people and send a message of genuine concern.