How did the readings influence my perception of my own clinical decision making?
It is amazing to me that more information has been discovered in the past five years than has ever existed in the history of humankind. How do we as simple carbon based units process this information when we are developing computers with the ability to store yottabytes of information? (Just how big is a yottabyte anyway?) Can we, or should we, as healthcare providers be expected to know it all and to keep up with one of the fastest changing professional fields? In our profession, when we don’t have all the pertinent facts and ability to synthesize information outcomes can be poor and people can die. Unfortunately, we are being held to the standards as if we were a precise, methodical, reliant computer. But we are human beings, capable of making decisions that are sometimes deemed as miracles and at other times less than humane.
This weighted responsibility impresses upon me just how dependent healthcare providers must become on today’s technology in order to provide the best possible care. However, I think Pat Benner’s five levels of nursing experience cannot be underestimated. No matter how much technology I have to support my decisions, it still will ultimately be up to me to make some decisions. Much like a compass directing us on a path, it is only a tool to be used by the wise traveler. If we are oblivious to the compass pointing us in a direction that leads to a cliff, then the technology is useless and can even become dangerous unless we apply our own wisdom in the decision making process. We must not lose ability to think on our own, for if all these wonderful tools come crashing down around us someday, we will need to be able to think on our feet. Realizing just how much I do not know about the uniqueness of each patient, the 8000+ medications, tens of thousands of disease processes, thousands of labs, radiographs, CTs MRI, et al. can be intimidating, but not knowing where to go for information, data, protocols, CPGs et al. can be outright neglectful of sound, competent patient care.
Saturday, 26 June 2010
Thursday, 24 June 2010
MODULE 3: TEACHING WITH TECHNOLOGY
What sort of teaching is done in your nursing role?
As an educator in a baccalaureate nursing program I have seen many styles and strategies of teaching...some good, others less than optimal. Today's learners encompass several generations with a diverse set of learning needs. Likewise, today's educator must be up to the challenge of teaching by using an equally diverse set of teaching strategies. As an educator, I have used interactive team building games, ppt presentations, reflective writing assignments, case studies, small group dialogue, internet activities, immersion experiences and assignments where I let the student design his/her own learning outcomes. It may not always be about what teaching is done.....but what learning is accomplished.
Is there any nursing role that does not involve teaching in some manner?
While I have not experienced every role in nursing I would find it rather difficult to believe that each role fulfilled by the professional nurse would not involve some aspect of teaching. While serving in the Navy Nurse Corps for 26 years I was afforded the opportunity to work in many settings from small community hospital environments, large trauma centers, ship board and in tents out in the field. In all, I have had the pleasure of working in more than 20 different nursing roles from a staff nurse on a cardiac stepdown unit to the acting CEO of a hospital. In ALL these roles I found myself an educator. Whether I was teaching corpsmen, nurses, doctors, ancillary staff or patients, I do not think a day went by without teaching someone something. In fact, when new nurses would come into the military the standing question would be, "What do you see your primary role as a Navy Nurse Corps Officer to be?" The answer would typically be, "to take care of the sailors". But in fact the more correct answer would be, " To teach corpsmen to do you job as a nurse so when they went into harm's way, they would be providing the best possible care to our sailors."
As an educator in a baccalaureate nursing program I have seen many styles and strategies of teaching...some good, others less than optimal. Today's learners encompass several generations with a diverse set of learning needs. Likewise, today's educator must be up to the challenge of teaching by using an equally diverse set of teaching strategies. As an educator, I have used interactive team building games, ppt presentations, reflective writing assignments, case studies, small group dialogue, internet activities, immersion experiences and assignments where I let the student design his/her own learning outcomes. It may not always be about what teaching is done.....but what learning is accomplished.
Is there any nursing role that does not involve teaching in some manner?
While I have not experienced every role in nursing I would find it rather difficult to believe that each role fulfilled by the professional nurse would not involve some aspect of teaching. While serving in the Navy Nurse Corps for 26 years I was afforded the opportunity to work in many settings from small community hospital environments, large trauma centers, ship board and in tents out in the field. In all, I have had the pleasure of working in more than 20 different nursing roles from a staff nurse on a cardiac stepdown unit to the acting CEO of a hospital. In ALL these roles I found myself an educator. Whether I was teaching corpsmen, nurses, doctors, ancillary staff or patients, I do not think a day went by without teaching someone something. In fact, when new nurses would come into the military the standing question would be, "What do you see your primary role as a Navy Nurse Corps Officer to be?" The answer would typically be, "to take care of the sailors". But in fact the more correct answer would be, " To teach corpsmen to do you job as a nurse so when they went into harm's way, they would be providing the best possible care to our sailors."
Monday, 7 June 2010
Module 2
MODULE 2: Using an electronic index, a guideline index, and a web search engine to retrieve information relevant to your clinical problem, compare and contrast your results. Which resources were useful/ not useful for your information retrieval task, and why? Identify some alternative strategies for retrieving relevant information - would context relevant information retrieval be useful?
As I once again date myself, I remember back to the time when I would sit in the library, pad and pencil in hand, combing through the hard bound volumes of MicroMedex searching for journals that matched my interest. Feverishly scribbling the information I needed I would then proceed to the “stacks” looking for the journal in print. If I was fortunate, the library would have the journal in their collection. Then, the decision…to read it all or spend money on copying the article. Now at the touch of keypad from the comfort of my own home I can access a wealth of information far exceeding what those old dusty volumes could ever hope to contain. We live in a marvelous time where the world is literally at our fingertips.
Recently, I had the pleasure of observing clinical practices in an intensive care unit in Taiwan. One noticeable difference which struck me immediately was the lack of sequential compression devices and the minimum use of low molecular weight heparin to prevent deep vein thrombosis. With a DVT rate similar, or less than incidence of DVT compared to that in the US, the question begged to be asked….what are the benefits of these two therapies in the prevention of DVT?
Three major sources of information retrieval were used to search the answer to this question. Each of the information sources comes with advantages and disadvantages. For example, when using Google or Yahoo, a general search using the search term “DVT prevention” will net the reader over 75,000 results with one click of a button. While this certainly is a wealth of information, it would take months to shift through the important pieces separating them from the irrelevant pieces of information. If the topic one searches for is not highlighted in the titles within the first few pages of the search the researcher will often abandon using this strategy. Both Google and Yahoo searches do allow for “advanced search” strategies but they are not specific as those found in PubMed. For example, the most you can limit a search strategy is by using “all of the words, the exact phrase, any of the words or none of the words”. These can be applied to any part of the page, in the title of the page or in the URL of the page. Using this strategy limited the results to still a non-manageable number of 9000. One can also distinguish between .com and .gov domains. Google also allows a “wildcard” feature which essentially tells the system to look for any unknown terms and then finds a best match when you use a * as a placeholder. Beyond these strategies the advanced search mode is not very useful. The credibility of the information obtained from Google or Yahoo must also be evaluated by the investigator, whereas electronic indexes and guideline indexes have typically undergone more rigorous peer review processes.
Electronic indexes such as PubMed and MEDLINE allow for what Poynton (2003) calls high-precision searches directed toward the minimization of irrelevant and less useful citations. Bibliographic databases such as PubMed have more advantages over generalized search engines like Yahoo and Google in that they offer more selective search filters, e-mailing of search updates and storage of search histories and records. I found PubMed, MEDLINE and UpToDate very valuable resources when searching for EBM. The articles come from peer reviewed journals and have “limits” or “filters” that help one conduct a high-precision search.
When I entered my query into the National Guideline Clearinghouse (NGC), the search tools were clear and easy to navigate but led me to guidelines that were too specific and did not really address the clinical question. Instead of examples of RCTs to support clinical practice, the NGC is more devoted to guidelines and practices. I found it difficult to identify the studies upon which these guidelines are based. While each of the above strategies have value, use of the systems will be based on what question is being asked, how much time one has to devote to the exploration of the answer and how thorough one needs to be in assuming they have the answer to their question.
Time is a valuable commodity when seeing patients. Maviglia, Yoon, Bates and Kuperman (2006) note that if a provider has to spend more than 30 seconds trying to find the answer to a clinical question, the information will most likely not be adopted into practice. Sources of information need to be readily available to the provider instead of conducting hours of online searching. Context sensitive information retrieval may be one approach to help solve this challenge. As with any great endeavor, a well thought out plan can be advantageous. One alternative strategy is outlined by Poynton (2003), where she counsels the researcher to strategize with paper and pencil, outlining the topic needed and orienting yourself to what it is you exactly want. It is easy to click buttons one after another, but like any road map you have to orient it first or you can easily get lost.
As I once again date myself, I remember back to the time when I would sit in the library, pad and pencil in hand, combing through the hard bound volumes of MicroMedex searching for journals that matched my interest. Feverishly scribbling the information I needed I would then proceed to the “stacks” looking for the journal in print. If I was fortunate, the library would have the journal in their collection. Then, the decision…to read it all or spend money on copying the article. Now at the touch of keypad from the comfort of my own home I can access a wealth of information far exceeding what those old dusty volumes could ever hope to contain. We live in a marvelous time where the world is literally at our fingertips.
Recently, I had the pleasure of observing clinical practices in an intensive care unit in Taiwan. One noticeable difference which struck me immediately was the lack of sequential compression devices and the minimum use of low molecular weight heparin to prevent deep vein thrombosis. With a DVT rate similar, or less than incidence of DVT compared to that in the US, the question begged to be asked….what are the benefits of these two therapies in the prevention of DVT?
Three major sources of information retrieval were used to search the answer to this question. Each of the information sources comes with advantages and disadvantages. For example, when using Google or Yahoo, a general search using the search term “DVT prevention” will net the reader over 75,000 results with one click of a button. While this certainly is a wealth of information, it would take months to shift through the important pieces separating them from the irrelevant pieces of information. If the topic one searches for is not highlighted in the titles within the first few pages of the search the researcher will often abandon using this strategy. Both Google and Yahoo searches do allow for “advanced search” strategies but they are not specific as those found in PubMed. For example, the most you can limit a search strategy is by using “all of the words, the exact phrase, any of the words or none of the words”. These can be applied to any part of the page, in the title of the page or in the URL of the page. Using this strategy limited the results to still a non-manageable number of 9000. One can also distinguish between .com and .gov domains. Google also allows a “wildcard” feature which essentially tells the system to look for any unknown terms and then finds a best match when you use a * as a placeholder. Beyond these strategies the advanced search mode is not very useful. The credibility of the information obtained from Google or Yahoo must also be evaluated by the investigator, whereas electronic indexes and guideline indexes have typically undergone more rigorous peer review processes.
Electronic indexes such as PubMed and MEDLINE allow for what Poynton (2003) calls high-precision searches directed toward the minimization of irrelevant and less useful citations. Bibliographic databases such as PubMed have more advantages over generalized search engines like Yahoo and Google in that they offer more selective search filters, e-mailing of search updates and storage of search histories and records. I found PubMed, MEDLINE and UpToDate very valuable resources when searching for EBM. The articles come from peer reviewed journals and have “limits” or “filters” that help one conduct a high-precision search.
When I entered my query into the National Guideline Clearinghouse (NGC), the search tools were clear and easy to navigate but led me to guidelines that were too specific and did not really address the clinical question. Instead of examples of RCTs to support clinical practice, the NGC is more devoted to guidelines and practices. I found it difficult to identify the studies upon which these guidelines are based. While each of the above strategies have value, use of the systems will be based on what question is being asked, how much time one has to devote to the exploration of the answer and how thorough one needs to be in assuming they have the answer to their question.
Time is a valuable commodity when seeing patients. Maviglia, Yoon, Bates and Kuperman (2006) note that if a provider has to spend more than 30 seconds trying to find the answer to a clinical question, the information will most likely not be adopted into practice. Sources of information need to be readily available to the provider instead of conducting hours of online searching. Context sensitive information retrieval may be one approach to help solve this challenge. As with any great endeavor, a well thought out plan can be advantageous. One alternative strategy is outlined by Poynton (2003), where she counsels the researcher to strategize with paper and pencil, outlining the topic needed and orienting yourself to what it is you exactly want. It is easy to click buttons one after another, but like any road map you have to orient it first or you can easily get lost.
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