The Last Blog!!!!!!!!!!

I learned two things in this module I would like to discuss.  One is the fact that President Bush was very involved in the push to make health records of individuals electronic.  I was rather disappointed in President Bush’s presidency but I did not know that he played a major part in getting us where we are today with regards to electronic medical records.  Second, I did not realize the costs that could be saved when implementing electronic medical records; it is into the billions of dollars nationwide.  It stands to reason that this is the case. There will be fewer medication errors, fewer tests being ordered multiple times, fewer mistakes, the correct tests and films being ordered in appropriate time frames.  Diagnosis will be made in more of a timely manner and the list goes on.  I have always been an advocate for electronic health records but now I am even more so.  So, kudos to Pres. Bush for his goals and success in the area of electronic health records and with the money we save we could use that to fund the changes in national health care as pertaining to President Obama’s administration.

Module 5 To err is HUMAN!!

Nursing 6004 Module 5 Blog Entry

Question:  How did the readings influence your perceptions of your own decision making?

Scary! I know that I am not perfect and like anybody, I have my good and bad days but I did not realize the possible variability in my own decision making. I knew that variability was there but not to such a great extent.  I was thinking of this today when I was in the clinic giving a consultation to a new patient.  I have a fairly rigid approach to my health care delivery with regards to decision making, but with minor adjustments, my communication can be slightly different and greatly alter the outcome of patient care.  I do think that with this increased awareness of my own susceptibility to err, I will be more careful.  For quite some time now, I have wanted to write a template for patient care, a check off list if you will, to help me remember all the things I should do in certain patient visits.  I would need a new consult template, this would have to be a different template for new consults seeking options for neck, back, leg or arm pain.  I would also need templates for follow-up visits for each one of these issues, post operative visits, etc. They would have to be adjustable and mobile.  I can't imagine doing this for a family practice office but it would be even more of a necessity there!  It just seems like a mammoth task when you think of all the variables that would have to be addressed.   The readings point out many of the weakness that we as providers have and I addressed these in my Journal. They also address the importance of tools that help guide our clinical thinking. So, to answer the question, how did the readings influence your perceptions of your own decisions making? I would have to say, it brought into clear view the possibility for err.  The pitfalls of relying solely on experience and gut instincts, have helped me to consider tools that I can use to protect myself from such error.

Module 4 Blog Post

In my clinical area I do a lot of patient teaching.  In the course of 1-2 patient visits I am usually able to diagnose the patient and develop a treatment plan.  Once the treatment plan is complete there is often a large amount of patient teaching that needs to be done.  I find the lay public to be very unfamiliar with disease of the spine and worse yet there is a great deal of misinformation. Consequently I spend a great deal of time teaching anatomy, physiology, pharmacology, surgical procedures etc. For the most part I really enjoy this part of my job.  Most people are very quick to assimilate the information and seem to be relieved once they know what is going on and how it could effect them. 

Occasionally I will have a student follow me.  I find this very enjoyable depending on the interest of the student.  If the student is simply there to fill the credit as was the case with my last student, then it can drag a bit.  If the student is there to learn as much as possible and asks a lot of questions then I find I trust the student more, and want to help them as much as I can.

I do not believe that there is a nursing role that does not include teaching of some kind.  I work in the OR and often consider the role of circulating nurse.  They have a very technical job that is done mostly with charts, equipment and sleeping patients.  Even in this case there is a copious amount of teaching that takes place.  They have to teach the patient pre-operatively, they have to teach the OR staff, they have to teach nursing assistance and orderlies. So, I dont think there is any nursing role or provider role that teaching is not a mojor portiong of that job.

Module 3 Blog Entry 6004

In this exercise we were asked to explore 3 different avenues for obtaining data on a given subject.  We were asked to use an electronic index a guideline index and a Google web search.  For the electronic index I chose PubMed and for the guideline index we were asked to use National Guideline Clearinghouse or (NCG).  I will be comparing and contrasting each of these. 

PubMed, the electronic index I chose, was very useful.  In a very short period of time I was able to find 19 relevant articles that were current.  I started out with a much larger number but was able to use the provided tools to quickly narrow my search. The specific tools such as the use of MeSH terms and advanced search proved to be very efficient. I really liked the citation management features; the ability to send references or save search results was very useful.  It interfaces well with other software and after understanding some basic lingo was able to navigate quite well.  I am sure there is still a lot to learn but I do now understand the basic functions. After I was able to modify my search, the quality of the material produced was very high. The answer to my clinical question was evident with significant support material.

National Guideline Clearinghouse was also useful but for different reasons. I did not find it quite as user friendly but this may be because I have already had some exposure to PubMed and have not with the NGC. As the name implies it is a guideline clearinghouse.  The purpose of this site is to give direction.  This purpose is different with PubMed. Depending on what you enter as search criteria PubMed could render a very similar search result.  NGC does not have the same capacity as PubMed. I found this resource to be quite limited, at least in the area of my query. I found some of the search results to be rather dated. There were a number of good resources here but my first stop would be with PubMed for this type of search.

Lastly, I investigated Google. This is at the opposite end of the scale as far as results.  By using the same search criteria I was able to find many more references, close to 340,000.  The problem here is that the quality is very low and it would take significantly more time to find what I was looking for and it may not be from credible sources.  I have had a lot of experience with Google and other search engines in the past so I found the features to be very user friendly.  With my access to PubMed I am able to get full text articles without extra cost, many of the findings on Google are for additional cost.  It is also true that it is a rather biased search were people pay significant sums to have their name or product appear close to the top of the search it has nothing to do with merit or significance.

In summary, I am finding research to be an art form.  Similar to the paint on an artist’s palette we have an almost unlimited number of options for research.  These options are constantly increasing.  As with most things in life the more we do something the more proficient we become.  It is important to know first what it is you are looking for, second, where you would most likely find that information and then be astute enough to know when you have found good quality data.  Even more importantly, once you have found what you are looking for, be able to synthesize that material and skillfully use it in the clinical setting.

Health information system

I wish I would have had this class about 5 years ago.  It would have really been helpful as we prepared to implement our EMR system in our office. Some of the power point presentations were very well done and would have been good to have. One thing I would like to stress about selecting and EMR or being evolved in the process is that you have to first, know what you want, and second voice that opinion. As an end user, you are the one that is going to spend a significant amount of time interfacing with the EMR and is is very importing that you select one that you can live with.  Ask if you can be on a steering committee or help with the research portion of the process.  These efforts in time will pay you back repeatedly.

This is Me!

Hi my name is Ryan Church I am an FNP-C and am currently enrolled in the MSN-DNP program.  I have loved nursing and nursing has been very good to me.  I have been working as a NP now for 7 years.  I have spent the majority of my time in spine related areas.  The first 2 years I was in pain management and the last 5 years in spine surgery.  It has been and exciting experience. 

In my clinical setting we use an EMR, we have no paper charts at all.  This has had it pluses and minuses. Mostly it has been a good experience. We use an instant message service in the office to communicate and we have an office website that is currently under re-construction.  We do receive emails from patients and family through the web site via email but this is limited.

I have learned a great deal already and have enjoyed getting acquainted with more technological tools.  I look forward to reading your posts and having you help teach me......See ya soon....

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