Wednesday, October 21, 2015

Acquiring Previous Data

During rounds, Charles encounters a rare condition he personally has never seen and only vaguely remembers hearing about in nursing school. He takes a few moments to prepare himself by searching the internet. That evening, he researches further to learn how to treat, administer, and assess the patient safely. The sources he researches include online clinical databases and his own school textbooks. Most of the information seems consistent, yet some factors vary. Charles wants to provide the highest quality in patient safety. He wonders which resources are best.

What should Charles do when he encounters direct contradictions in information from two sources?

Charles should consider whether the websites he is researching are evidence-based and whether these websites are legitimately registered with HONcode.   

Which resources are the most trusted, and how do you determine this?
"The HONcode certification is an ethical standard aimed at offering quality health information" (HONcode, 2015) However HONcode cannot assure at any given time that the sites provide quality evidence-based information on their sites.  Websites that have the HONcode demonstrate their willingness to participate in legitimate and ethical programs.

Which resources are the most accurate, and how do you determine this?

The most accurate are the sites that are peer reviewed, and offer evidence-based research.  Government source websites are also a very valuable resource to research medical data. 

What criteria should Charles use to identify credible resources to enhance his clinical practice?

The criteria that Charles should use to identify credible resources to enhance his clinical practice would be to determine the level of study design used in the research.  Study designs are developed to reduce or eradicate bias. In order to ensure that Charles is gathering the highest quality information for his patients and himself, he should consider the level of evidence used in the research of data resources.

" Evidence Based Practice (EBP) can be defined as the conscientious integration of best research evidence with clinical expertise, patient values and needs in the delivery of high-quality, cost effective health care. Assessment tools are used on a regular basis by clinicians in clinical practice, and during research to ultimately improve patient care" (Ingham-Broomfield, 2015).


References:


 Ingham-Broomfield, R. (. (2015). A nurses’ guide to Qualitative Research. Australian Journal Of Advanced Nursing, 32(3), 34-40 7p.

Tuesday, October 13, 2015

Teaching Strategies for Educating Staff on Not using Shoe Covers in the OR
"The use of shoe covers has never been shown to decrease surgical site infection risk or decrease bacteria counts on the operating theatre floor.  However, it may protect team members from exposure to blood and other body fluids during an operation and is thus recommended" (Demir, 2009).

1.  Set Clear Lesson Goals

Provide staff with literature that supports the objective that you want to meet.  Once staff can identify with research that supports the change in practice, implement policies that to ensure change in practice.

2.  Question to Check for Understanding

Provide questions in open forum or by questionnaires to assess learning of staff.  Provide surveys to understanding and rationale of new clinical practice.

3.   Allow flexibility for Change of Practice

Reinforce policy supporting change in practice.  Ensure proper attire is being met in OR.  Follow up with staff on the change in practice. 

"Implementing a policy for surgical attire is one example of working together with a multidisciplinary team to make the perioperative environment safer for patients and providers.  A strategy based on a collaborative review of the evidence and acknowledgement of preference among provider groups will add to the success of the implementation" (Graling, 2013).

References:

Demir, F. (2009). A survey on prevention of surgical infections in operating theaters. Worldviews On Evidence-Based Nursing, 6(2), 102-113 12p. doi:10.1111/j.1741-6787.2009.00152.x

Graling, P. (2013). Surgical Attire Compliance for Safe Patients and Practitioners. AORN Journal, 97(4), 475-478e4 1p. doi:10.1016/j.aorn.2013.01.009


Identify two ways evidence-based practice is used in your institution.
Two ways that evidence-based practice is used in my current institution is through the implementation of new policies and procedures that impact clinical practices.  Another way that evidence-based practice is in the implementation of the electronic health record. 
Does Using the Pilot program and Phased Approach processes through information technology impact the use of EBP.
The application of evidence-based practices into information technology through a pilot program and phased approach increases the quality of patient care by providing reliable clinical research that promotes optimal health care outcomes.  The nurse will have the ability to exercise the most efficient clinical care to patients through the guided efforts of evidence-based practice that is incorporated into the patients plan of care through technology.   
What are two implications of using technology? How can it be improved?
Two implication of information technology in nursing practice is safety and quality in health care.  "Technologies used by nurses offer the means for preventing errors and adverse events (e.g., medication errors, miscommunications, delays in treatment, and adverse events—such as failure to rescue, nosocomial infections, pressure ulcers, falls, and complications of immobility" (NIH, 2015).
"Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care" (Peterson et al., 2014).

References:

Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L., & Whiteman, K. (2014). Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence. Critical Care Nurse, 34(2), 58-68 11p. doi:10.4037/ccn2014411

http://www.ncbi.nlm.nih.gov/books/NBK2686/





Tuesday, October 6, 2015

Unit 6 Blog Part I - Consumer Research Technology

Today consumers carry out their own independent medical research and health based education through the internet.  This has become an all too familiar resource for consumers who no longer wait for appointments with their physicians as personal healthcare has become more accessible through the internet.  Consumers also use the internet to perform self diagnosis of medical symptoms with little to no medical expertise.  This new wave of medical information through technology has even gone as far as creating avenues where independent sources have now designed their own blogs or websites that disseminate information that is not supported by any evidenced based practice or reliable research.  While this continues to be a problem in internet technology, there are many accredited sites that are quality based through reliable research that is provided by actual medical practitioners.  In order for the consumer to determine which sites are accredited and qualified to provide accurate up to date medical information one can verify whether the site is certified by the HONcode, which is an ethical standard aimed at offering quality health information.  "The HONcode can be found on The Health on the Net Foundation (HON) website which is a non-governmental site that founded to encourage the dissemination of quality health information for patients and professionals and the general public, and to facilitate access to the latest and most relevant medical data through the use of the internet" (HON, 2015).  Most recently, a colleague of mines went on a quest researching medical information on the web regarding  Gastroesophageal Reflux Disease (GERD).  His reasoning behind this was because he had just been diagnosed with GERD upon having a esophagogastroduodenoscopy (EGD) test.  He asked me what my educated opinion was about the reliability and validity of Wikipedia, WebMD, and cdc.gov.  I gave him an oversight about how important it is to be aware of the unreliable medical web resources that are available and how to check for HONcode certifications, and well as fact checking web sources based on evidenced based practices and reliable research.  I informed him that the Wikipedia was a web source that provided information that was not necessarily supported by qualified research and that was predominantly based on consumers medical expertise and experiences.  WebMD is an accredited site and has four medical doctors permanently on its content board and has won many awards in the American medical community.  "WebMD itself has also been accredited by the Utilization Review and Accreditation Commission -- a non-profit organization dedicated to promoting quality healthcare and health information in the U.S. -- for every year since 2001" (WebMD Reliable, 2015).  However, the site is at times under scrutiny over questions of being too commercial.   The cdc.gov site is one of the highest in quality research and measurability of accurate medical information.  "CDC.gov is CDC's primary online communication channel. Annually, there are close to 500 million page views to the site, averaging 41 million page views per month. CDC.gov provides users with credible, reliable health information" (cdc.gov, 2015).

References:

Our commitment to reliable health and medical information. (n.d.). Retrieved October 6, 2015.

Is WebMD Reliable? - Learn for free at Techboomers. (n.d.). Retrieved October 6, 2015.

(2014, May 7). cdc.gov Retrieved October 7, 2015.


Unit 6 Blog Part II - SurveyMonkey Results

Upon reviewing the surveymonkey results, I was able to see that the survey tool was effective in describing the effectiveness of the presentation in terms of meeting the specific objectives that were intended to communicate to the audience.  I think that I could have implemented more visual and interactivity into the presentation.  I believe that I would try to implement more animation into my next presentation or graphics. 

Below is the analysis of my surveymonkey.  Let me know what you think…


Tuesday, September 29, 2015

Survey Monkey Blog Unit 5


Please complete the attached survey by accessing the link below:

Sunday, September 20, 2015

Screencast Preview of EMR

Today, nurses are using technology more than ever in healthcare.  Technology has impacted the way and performance of healthcare impacts patients from day to day.  Below you will be able to access a screencast that gives a quick preview of the General Electric Centricity EMR that will be used for patient documentation.  The purpose of this preview is to give a quick synopsis of how the EMR will look and be used to input and retrieve patient data. "Electronic health records are expected to improve the quality of care provided to hospitalized patients. For nurses, use of electronic documentation sources becomes highly relevant because this is where they obtain the majority of necessary patient information"( Kelley, Brandon & Docherty, 2011).


References:
Kelley, T. F., Brandon, D. H., & Docherty, S. L. (2011). Electronic Nursing Documentation as a Strategy to Improve Quality of Patient Care. Journal Of Nursing Scholarship, 43(2), 154-162. doi:10.1111/j.1547-5069.2011.01397.x


http://www.softwareadvice.com/uk/medical/ge-centricity-emr-profile/#

Tuesday, September 15, 2015

EKG and EHR Training for Nurses

Using the Hybrid/Blended Learning model in combination with other learning strategies to educate nurses can be an effective training strategy. 

GE MAC 1200 ECG / EKG Machine

Training the use of any EKG machine is best done by the hybrid learning.  Hybrid learning uses face to face teaching followed by online instruction.  When using face to face teaching, the instructor can facilitate demonstrations to help enhance the learning capabilities of the student.  The instructor can give a short lecture of the description, use, and function of the equipment, followed by a quick demonstration which allows for interaction through participation.  Following this instruction, the educator can use online education on the function of the GE MAC 1200 ECG/EKG Machine.   Assigning a online tutorial video and quizzes would allow the student to demonstrate their response to the education provided.  This can provide the educator with feedback of the effectiveness of the hybrid learning strategy. 

Below is an example of the online tutorial:  


"In summary, after applying various learning theories in order to improve the teaching-and-learning process, it was found that there was a great opportunity to incorporate many of these learning theories into an integrated application. The further development of an integrated digital platform in this research has led to a successful hybrid e-learning model, and proved that there is great interest in integrating different learning theories into e-learning applications" (Tsai, 2011).

Training Nurses on a new Electronic Health Record (EHR) System

Training nurses on the use of a new EHR system can be challenging.  This in part is due to the generational diversity among nurses.  In lieu of this, learning strategies should be aimed at concentrating on the multidisciplinary approach of teaching.  In this case, using Gardner's Multiple Disciplines through auditory, visual, and kinesthetic learning tools in combination with the Hybrid Learning Model can be very effective.  During face to face lecture, the nurse informaticist can reinforce learning strategies through visual and hands on training.  The Informatics nurse can assess the whether the online teaching objectives were achieved by having nurses complete electronic health record applications by entering specific patient data into the EHR. 

"Training on HIT can influence providers’ willingness and ability to use EHRs effectively. Training helps providers understand how the system can be leveraged in clinical practice and introduces features and functionality with which providers may not be familiar. Training is associated with improved use of advanced electronic health record features such as templates and order sets" (Bredfeldt et al., 2013).


References:

TSAI, A. (2011). A HYBRID E-LEARNING MODEL INCORPORATING SOME OF THE PRINCIPAL LEARNING THEORIES. Social Behavior & Personality: An International Journal, 39(2), 145-152. doi:10.2224/sbp.2011.39.2.145

Bredfeldt, C. E., Awad, E. B., Joseph, K., & Snyder, M. H. (2013). Training providers: beyond the basics of electronic health records. BMC Health Services Research, 13(1), 1-14. doi:10.1186/1472-6963-13-503


Tuesday, September 8, 2015

Learning Objectives and Change Theories

Learning Objectives for the Electronic Medical Records

"The EMR represents the structure for the documentation of healthcare.  This documentation provides the basis for patient care decisions.  Clinical practitioners regularly contribute a great deal of information and data to the record to complete a multitude of tasks" (Penoyer et al., 2014).

When implementing a new Electronic Medical Record (EMR), the Informatics Nurse may use various learning tools to assist in the learning process.  This may include incorporating Bloom's Taxonomy in order to assist in developing the required learning skills that support nurses as they become familiar with information technology.

"Bloom's taxonomy contains six categories of cognitive skills ranging from lower-order skills that require less cognitive processing to higher-order skills that require deeper learning and a greater degree of cognitive learning" (Adams, 2015).
The six categories of cognitive skills that range from lower-order skills to higher-order skills are remembering, understanding, applying, analyzing, evaluating, and creating.


Three learning objectives that demonstrates successful training of the EMR by the staff nurse are:

-  the staff nurse will be able to explain the purpose of meaningful use and how it impacts healthcare

-  the staff nurse will be able to manipulate the system to access and apply data in the EMR 

-  the staff nurse will be able to evaluate patient data in the EMR to develop care plans that promote patient education and provide positive patient care outcomes.    

References:

Penoyer, D. A., Cortelyou-Ward, K. H., Noblin, A. M., Bullard, T., Talbert, S., Wilson, J., & ... Briscoe, J. G. (2014). Use of electronic health record documentation by healthcare workers in an acute care hospital system. Journal Of Healthcare Management / American College Of Healthcare Executives, 59(2), 130-144.

Adams, N. E. (2015). Bloom's taxonomy of cognitive learning objectives. Journal Of The Medical Library Association, 103(3), 152-153. doi:10.3163/1536-5050.103.3.010




CPOE Application Training
The Kurt Lewin Change Management Model was selected for the application of a change theory used to train physicians to using a CPOE system that was implemented into a healthcare facility.  The Kurt Lewin Change Management Model is a three stage theory of change that is composed of the unfreeze, change/transition, and refreeze.

The change that occurs is considered a process of learning.  Lewin uses this theory to transition one from a unlearned phase to a learned phase of development.  "Change is better defined as learning, why cultures change through enlarging and broadening, not through destruction of elements, and why the involvement of the learner is so crucial to any kind of planned change or, as we might better conceptualize it -- managed learning" (Schein, 1999).

To train physicians to use a new CPOE system in the EMR the following should take place in each phase:

Unfreezing Stage
In this stage of learning the physician needs to be educated on why change is necessary.  This could be done through open forums where discussions could be held with Informaticists and Information Technology teams as well as Administration to give physicians all the necessary information to explain where the system is currently without change to where the system will be once implementation of the new CPOE system.  In this phase, demonstrations should be shown to simplify the process or to give practical examples of how the system will operate to give a visual guidance of the CPOE.  This would help to decrease any anxiety and misinterpretation of how the CPOE system will function.

Change/Transition Stage
In the change/transition Stage, physicians should be given individual training on usage of the CPOE.  Simplified demonstrations of physician ordering should be demonstrated with a return demonstration by physicians.  This will capture what learning the needs are of the physicians so that further education in those specific areas can be provided.  Training should be individualized or in groups of one to three.  This should be a repetitive process until the physician can independently navigate the CPOE and manipulate functions efficiently.

Refreezing Stage
In the refreezing stage, physicians should be given final assessments with open discussion to the learning process.  This would allow physicians to express any learning deficits that they may have with the CPOE system.  In addition, further educational needs can be assessed, as well as any clarifications of the CPOE functions.
"Change is vital to progress, yet the nursing literature identifies numerous complexities associated with transforming plans into action, and attempts at change often fail because change agents take an unstructured approach to implementation.  It is important, therefore, that managers, or change agents, identify an appropriate change theory or model to provide a framework for implementing, managing and evaluating change" (Mitchell, 2013).


References:


Schein, E. H. (1999). Kurt Lewin's Change Theory in the Field and in the Classroom: Notes Toward a Model of Managed Learning. Reflections, 1(1), 59-74. doi:10.1162/152417399570287


Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management - UK, 20(1), 32-37.

Tuesday, September 1, 2015

Hi Class,

This is my new blog.  Hope to communicate with you soon.

Sandra