Module 4 Question 2

How does nursing data quality relate to decision support?

Nursing decision support systems improve nursing effectiveness, provide appropriate interventions, and support the safety of patients and quality improvement activities (Androwich & Kraft, n.d.). Decision support can help provide the evidence that supports quality care as being given. A hospital can set up a data system that places a certain number to keystrokes or words utilized by nursing. For instance, administration can determine the acuity of care needed by a patient if certain keystrokes or words are utilized on a nurse’s shift. The data provided can help administration determine how many nurses are needed on a given shift. Infection control nurse can track infections via the use of reflex technology. With a keystroke an email can be sent to the infection control nurse that alerts her to a patient that has say a central line, she can then track the patient and their hospital stay.

On the other hand, a good decision support system can provide a nurse to a plethora of knowledge by just stroking a few keys. By doing this a nurse is better able to support their decision for care.

Module 4 Part 1, Question 2

How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?

Well, with experience comes much knowledge. The only real way to reconcile the value of nursing experience is to take away those biases that detract from relying on experience. How do we do that? I think one of the problems with using only judgmental heuristics in practice is that mostly it is subjective in nature. Nursing or experience relies on both subjective and objective sources. According to Tversky & Kahneman (2003) the subjective nature of probability has led many students to the belief that consistency is the ONLY valid criterion by which judgments should be evaluated and people fail to infer from lifelong experiences and furthermore; statistical principles are not learned because they are not coded properly. Taking into account nursing experience and adding it to known and proven research methods is the best way to ensure that one means does not outweigh the other.

Module 4 Part 1, Question 1

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

The readings influenced my own clinical decision-making in various ways. Anderson & Willson (2008) brought up several interesting points, (1) we as clinicians do not adhere to CPG,(2) the system where I currently work is one of those systems that is used for evaluating the decisions that nurses make, not as a tool for helping nurses make clinical decisions, (3) we lag behind medicine, and I so wish we didn’t.
Above, I mention the system where I currently work. The beauty of this system is that it has potential. Recently we put in a new tool called the CIWA scale. It is a CDSS that allows the nurse to make a decision on how much Ativan an ETOH addicted patient needs in order to stay out of DT the danger zone, and when to call the physician. We have used it several times and so far it works awesome. The nurses feel empowered, the patient receives appropriate care and the physician is not called as frequently. Hopefully this will catch on in our hospital. I think nurses want to stick to CPG but are not empowered to do so by the facilities they work in or they have no time to see what CPG would determine as appropriate care because it is time consuming to find. Nurses may lack adequate computers and/or researching skills and the culture they work in may not support evidence-based change (Thompson, 2003). I know many physicians that use the Up-To-Date software program on a regular basis, I too have utilized this software and like it. If physicians are taking the time to find timely information in regard to patient care then so should nurses. Hopefully, with the advent of new nurses graduating from nursing schools who desire to practice using evidence-based nursing practice, our culture of not sticking with CPG guidelines will change.

Module 3

I took the intelligence test in Module 3 and learned that my top three high scorers were: #1 Bodily-Kinesthetic, #2 Interpersonal, and #3 Logical-Mathematical.

Since I am mostly Bodily-Kinesthetic this means that I have manual dexterity, physical agility and balance. One typical role mentioned in the “Intelligence Descriptions” section stated that I would make a great healer. I could also demonstrate a sports technique—which I really could. My preferred learning style is hands on and physical. All of these are so true!
Strengths for being Interpersonally Intelligent are: I perceive other people’s feeling well, I would make a great teacher, I am able to coach or counsel another person, and I believe in teamwork. I feel that I really do read people well, but I do lack in my own self-awareness meaning that I would rather read someone else’s thoughts and feelings more than focus on my own, this may be a little self-destructive.

Since I also scored fairly high in the Logical-Mathematical Intelligence range I decided to add a few of those attributes that I deem sum up the whole of what makes me, me. Those attributes are: I am a logical thinker (maybe this is why men tell me I think and act more like a man…ha-ha), I am a good trouble-shooter, I am good at mental math (just ask my husband), and my preferred learning style is through numbers and logic.

According to Richardson (2005) I am a Gen Xer, and because of this I am a very independent person who has developed excellent problem solving skills (hence the above mentioned descriptors of my intelligence). I could take all of these strengths and use them to help someone who maybe learns more readily through the use of pictures, shapes, and images. Because I am a hands-on demonstrative person I could teach via the use of drawings, or by using a model. I am also good at reading another person’s body language, so I should be able to gage how well the teaching is going just by watching the other person’s body language. After all, according to behavioral psychologists, learning can be understood by observable events, both behavioral and environmental (Driscoll, 200). I then would conclude by asking the person for a return demonstration of what was just taught and base how well the teaching went off of that (Driscoll, 2000).

Technologoes I would incorporate into my learning style would be a PDA--I already have one, it has a built in calculator, ePocrates, the World Wide Web, Excel, and Microsoft Word, plus a phone, and yes a txt message. I also like games that challenge my mind (brainteasers) so I tend to go to the Merriam-Webster website that has the "Chickens" wordsearch; it is challenging and physical (especially if you do it with a friend). I would like to learn how to use my computer to build colorful graphs as I am a visual person who likes to create.

Module 2 Question 3

Module 2 Question 3

I found the electronic index (PubMed) user friendly in that with time and some precision a great database could be created. In contrast, I thought the NGC website was a little more difficult to use as I found very little information there and really had to twist my words around to get it to retrieve anything useful. A lot of the info gathered through this tool mentioned AIDS and/or Homeless. It just now came to me that I could have tried the word not and then attached AIDS or Homeless, but still I think that would have narrowed my search to three whole items. On the other hand, NGC had the best “How to Search” information, even better than the readings. I also added this site to “my favorites.” The Google search for “prevalence of adult prescription drug abuse + rural community” provided way too much info (like over 20,000 publishing’s). However, it did list “Scholarly Articles” as the first link to information. When I chose this link I had approximately 7,010 articles to choose from in less than 0.08 seconds. I attempted to narrow this search via the use of the “+” sign (like, prevalence + rural prescription drug abuse + adult and prescription drug abuse + rural community+ adult) and it didn’t seem to help much.

Context relevant information retrieval would be useful. I noticed that in PubMed, my articles contained many MeSH words that one could choose to either broaden or modify their search. MeSH takes the word “drug” and associates it to other words within the same context, i.e., oxycodone, and opiods. A skilled user could easily develop a great library/database.

Module 2 Question 2

Module 2 Question 2

I chose to utilize EndNote…as was suggested. I think I’m really going to like this tool. I found it very easy to retrieve my citation list from PubMed. First, I registered myself in PubMed, and added it to my favorites list. PubMed saved all of my searches (yahoo)! Second, I opened EndNote, on the left side toolbar I chose PubMed as my online search method. Third, I re-opened my PubMed account on a separate web page, and low-and- behold!, there was all of my saved info. Four, on the EndNote bottom search toolbar, I chose “PMID” from the left- hand drop down box that always is defaulted to say “author”. Then after PMID was chosen I went back to my PubMed directory webpage, at the bottom of every cited article there is verbiage that says “PMID: 1999887”, (or PMID: and a number association). I high-lighted then copied the number associated with PMID, in this case the number 14999887, and pasted it into my EndNote search directory at the bottom of the page, in the square just adjacent to PMID (to the box on the right). So easy! It imported all of my citations into my library. I then chose to make a “Group” called “Rural Rx Drug Abuse” and sorted all of my just retrieved info there.

I just need to give a little shout out to Jean LeBer! I am so grateful I received her (brief) training on EndNote. I found myself a little tentative to try it and now am feeling more confident with its applications. I touched on only a smidge of what this software can do. You can arrange your articles by date, or author; import selected articles, export selected articles; it will automatically cite (in APA format as well as others) for you; you can locate parts of text in your library, copy and paste what you find important there, add your own note to this section and it will save it for you. This will come in handy for research paper writing…no need to re-read an article just copy and past what is important to you!

Module 2 Question 1

Module 2 Question 1

I am in a family nurse practitioner program that focuses on substance abuse and addiction; I live in a rural area and have noticed a problem with prescription drug abuse especially in the adult population. I decided to search for information regarding the prevalence of prescription drug abuse in adults in the rural setting. I chose PubMed for my electronic index, and followed the simple tutorials available. I felt this index was easy to use, and user friendly. It has links upon links as far as where you can take your search. This part can be time consuming if you allow it. PubMed kept a history of my search terms along with how many references were retrieved, I found this useful. Setting the “limits” was EXTREMELY helpful. I felt this search process was a little time consuming, but I’m not sure if it was because I am still learning this “search” concept or not. I found myself twisting my words around and around trying to find more info.

The only barriers to using this simple tool are lack of experience in searching and navigating this website for new users (like me). I feel that this is a website that I will use in the future. I loved all of the links available, like in the MeSH and “Related Topics” category.