Module 4, Question 2

The quality of nursing data is extremely important in relation to decision support. To accurately utilize the tools available, accurate information needs to be obtained. The success and validity of the tool depends upon the accuracy of the objective information. Without this, the systems and tools are useless. As nurses and providers, we should strive to obtain accurate and objective information that will improve patient diagnosis, treatment, and outcomes. It is vital to focus on quality, objective data and realize the impact our own biases could have on healthcare.

Module 4, Question 1

In contemplating my own clinical decision-making, these readings made me examine my decisions that I make on a daily basis at work. Many decisions I make about necessary treatments and evaluation are done based on past experiences. I found the information provided to be very interesting and informative. I can understand how overconfidence plays a large role in determining interventions. Perhaps those situations where overconfidence occurs is when a person has vast amounts of experience in any given situation. To combat overconfidence, I must constantly be thinking critically and support my decisions with evidence, not experience. Not to say that experience is not helpful, just that evidence and interventions change frequently with improved research.

Other considerations that must be taken when making clinical decisions include examining objective data to develop an accurate diagnosis while attempting to eliminate hindsight. Also, as important, is placing sufficient weight on prior probabilities associated with the condition. Reading this information will allow me to develop better decision making skills, provided I keep these concepts in mind.

Decision-making in clinical practice should not be based on bias or heuristics. They can be effective but can lead to errors in practice. Paying conscious attention to personal bias and heuristics will make us better practitioners.

Module 3, Questions

Based on the Multiple Intelligences Test, I discovered that my two areas highlighted were Musical and Spatial/Visual. Based on these results, I can understand avenues that could assist in my learning. My strength noted in the Musical area is not a surprise to me, as it is such a large part of my life. I know that Music holds strong connotations and memories. The Spatial/Visual category shows that I am able to better learn and understand when observing or visualizing the information. As I think about how I learn, I can see how I benefit from these areas. Technologies that I can utilize to augment my personal learning would include my Ipod and podcasts as well as videos. Information accessed online is also helpful to me as a visual learner, if there are diagrams and pictures involved. It provides an easier way for me to remember concepts and information.

Module 2, Question 3

Based on my subject for Critical Access Hospitals and Medicare reimbursement, I found that PubMed (the electronic index) to be the most beneficial. I was searching for specific information on the topic that was up-to-date. Unfortunately, frequently I was unable to access the text for the desired resource. Consulting the guideline index was not helpful for this subject. I can see how it could assist someone that was looking specifically for procedures based on evidence. The web-search provided the most information but it was difficult to sift through the irrelevant and unreliable data. It is also difficult to narrow the search as well as through PubMed.

At times, when I have discovered a reference that I cannot retrieve from PubMed, I am able to locate it on another website that I have discovered through Google. These three different sites each have their individual benefits, depending on what one is searching for. When results are obtained, depending on the source, validity must be determined by the reader.

Module 2, Question 2

The reference management software that I chose was EndNote. This software allows for importing of references for utilization in all future papers that I may write. It allows the user to categorize them based on subject, in multiple categories. I like the feature that allows for attaching the article to the reference within EndNote. An additional benefit of EndNote is the features for developing bibliographies in the format of your choice. It is unfortunate that many full text is unavailable, and if one is able to retrieve it, you must manually attach it. I haven't found the search feature through EndNote extremely beneficial. For citing references within a paper, though, it is a must have! Already, I have used the same references numerous times. Just a steep learning curve....

Module 2 Question 1

The clinical topic of my choice was obtaining information on Critical Access Hospitals and Medicare funding. The electronic index that I chose was PubMed. After completing the tutorial (in addition to the course taught by Jean LeBer), I was able to develop a decent search strategy to obtain oodles of information. Based upon the vast amount of information available, it was necessary to really narrow the search using several limits and dates. PubMed, once I used it a few times, has become easier; however, it is somewhat overwhelming initially. Even to narrow my subject and search information, I had to repeat sections of the tutorial. Now that I have utilized it several times, I feel that it is an easy index to search. One problem that I have found in obtaining information is that I am unable to obtain text articles on all of the references. Articles that are not available can be requested---which has been extremely helpful--but, to use in a daily practice one would need the information immediately. I have realized that I am able to obtain more articles using the University account than I can individually. So, to sum it up, it was somewhat difficult to learn but now that I know what a search entails and how to retrieve various articles, I feel that it is a necessary index to use.

Module 1, Question 2

In my current practice, information technology is used in almost all aspects of patient care. Recently, the facility in which I work changed to computer charting, which improves the documentation standards tremendously. It is also much easier to generate reports and information. In addition to current use, this allows providers to always have instant access to all medical records. No more searching for paper charts after hours! This allows for improved efficiency and improved care by the ability to access previous history and diagnostics.

In addition to computer charting, all laboratory, radiology, and clinical notes are available online. In the Emergency Room, this is very important. Many times patients are unable to communicate their history and it allows for pertinent treatment based on patient history. Medication lists and allergies are documented, as well, in one central location. Structured clinical data improves patient care by providing continuity, improved diagnosis, and more specific treatment.