Archive for August, 2009

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Is online learning easier? (comment)

August 31, 2009

I am currently taking Advanced Health Assessment II with Dr. Johnson. This online learning has been a great learning experience for me!! I am used to the classroom setting but I agree that this way of learning helps with preparing for graduate school. I have just started graduate school and much of it is self-directed with deadlines. This course so far has taught me time management as well as self motivation. I look forward to future online course I may take in the future!

Original Post
August 20, 2009
Title: Is online learning easier? (comment)
After having many years of education under my belt I have decided that on-line education is like any type of education, you get out of it what you put into it. The student may work very hard toward the subject at hand and gather as much information as possible or the student may do the bare minimum to get by. The fact that there is so much information out on the Internet means you have the ability to locate a wide array of information; however the student must be leery of the information that is out online as verify it is from a reputable source. In order for an online course to be practical, especially in assessment, hands on education must be involved. It is important for the Nurse to be able integrate and to use the knowledge that they learned on their own, in a hands on situation where the assessment skills that they have read about come to fruition.

Original Post:
August 5, 2009
Is online learning easier? (comment)
I feel like the introduction of technology in education has greatly helped increase organizational skills. When you are part of an online class you must be very organized and independent. It requires a lot of good communication skills and requires one to be computer savvy. The student must read and acquire all of the information themselves from textbooks and other resources the course may provide. The instructor of the course is simply there to provide you with any questions you may have regarding the material. It is up to the student only to obtain the most important information from the reading material and to retain it for future use. I think that these skills will surely help me with graduate school when I start in the fall.

Original Post
August 3, 2009
Title: Is Online Learning Easier? (comment)
I agree that online learning is much more challenging than traditional classroom learning. Teachers do spoon-feed the students the information that is needed in order to pass the exams. Whereas online instruction is based on the assignments given and one must be prepared for every aspect of that assignment and not just focus on what the teacher says will be on the exam. Granted, you have some students who are more comfortable with having an instructor available immediately for any questions or unclear information. Online classes also offer access to the instructor as often as needed but much of online instruction requires the student to do the research and try to come up with the appropriate responses on their own before referring to the instructor. Online instruction requires individuals to become more independent and in charge of their own learning at their own pace. For me it has been a godsend.

AND

Original Post
August 3, 2009
Title: Is Online Learning Easier? (comment)
I believe that online classes prepare you to enter graduate school. Graduate students must be responsible for large amounts of information that must be self-taught. It would be impossible to expect to get everything you need for an exam, or eventually your career, from the classroom as a graduate student. I like that in NR534 Advanced Health Assessment (as taught by Dr. Johnson) I am responsible for reading the book, completely the interactive exercises, and memorizing the basic information. I then go to clinical and exam a patient using the knowledge I have taught myself along with guidance through the exam from my preceptor. I learn how to perform an assessment on a patient from information from the book and experience of my clinical faculty. I am forced to be productive at home because I am expected to report to clinical prepared to use the knowledge from the book without getting a lecture from my clinical preceptor. I feel better prepared for the graduate classes I will take in the fall knowing that I can guide my learning and get the information I need from the books at home.

Original Post:
July 20, 2009
Title: Is Online Learning Easier?
While at work last night we had a discussion of the different types of programs where nurses can earn their BSN and/or MSN. I was surprised that the majority of nurses said they preferred the traditional classroom over online or distance programs. The view was there would not be the instructor support to help with elements of a course that the student was not able to understand. I look at this experience totally opposite, with the entire Internet at my disposal; I can research any topic and find the answers myself. In a classroom I would be limited to what the instructor was putting forth. Yes, I can always later do the online research but how often will that happen. I think in the classroom, instructors consciously or subconsciously teach to how they will test to insure the success of their students. With online learning, I am responsible for learning the material and have no idea what specific topics will be on an exam. It isn’t that it is easier to do an online degree program; it requires the desire to look for and learn the information as opposed to having it spoon-fed.

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Nursing Assessment Meets Technology, comment

August 31, 2009

I currently work in a NICU where we don’t have a simulation lab but I wish we had one!!!! In my undergraduate nursing program, we used a sim lab and it was amazing!! You can actually feel the pressure and anxiety during a mock code which helps you to anticipate for a real code situation. When doing a mock code on a regular manikin it’s just not as intense to me… sometimes it seems like a goofing off situation. In my NICU, we do mock codes and ACLS scenarios on different sized infant/pediatric manikins (preemie to full term to pediatric) that only have the ability to inflate/deflate the lungs and practice cardiac compressions. Although we have an excellent team that calls out specific details of the code ie: heart rate is…, respiratory effort is…, color is…, and etc. there is nothing like the simulator manikin!! Enjoy the sim lab at your institution!!!

Original Post
August 20, 2009
Title: Nursing Assessment Meets Technology – Nursing Education, comment
I too work in a hospital with the "SIM" man, as he (the manikin) is known to us. This is a wonderful tool for everyone that comes in contact with patients. As an ICU nurse it is valuable to hone our skills and be able to react to the emergency at hand by using our nursing assessments and education. Shortly after using the SIM man during our mock code, I had to run a true code in which the MD was not available, she was at a another Code in the hospital. When I arrived to the code the pt was unresponsive still had a qrs complex on the monitor. I checked a pulse and it was absent, PEA. This simple and basic assessment was not previously done by the primary RN(disturbing I know.) However my code team mate and I began work immediately on the pt. Having the technology to train on, the nursing education and assessment skills allowed the team to complete the code and successfully resuscitate the patient. The MD was able to finally show up and thanked us for being able to use our nursing skills and quick reactions.

Original Post:
July 30, 2009
Title: Nursing Assessment Meets Technology – Nursing Education, comment
I work at an institution that received a federal grant to start up a simulation lab. This lab has three manikins that are very lifelike. One is an obstetric manikin and can simulate vaginal births. One is pediatric. The last manikin is an adult and we have sent over 1000 nurses thru this lab this year. We do ACLS scenarios and mock Code Blue. The program can be written to do anything. You can hear the lung fields and heart. When you feel the pedal area, you can even feel a pedal pulse. It is an awesome way to train students and new graduates as well as the experienced nurses. I am impressed that your institution was able to obtain a federal grant in this day and time of economic hardship to establish an innovative simulation lab. This technology is truly awesome in that it gives students who come into the nursing field having no idea about basic assessment skills, which have never experienced actually hearing a real heartbeat, or breathe sounds let alone participate in an actual code blue situation. This lab will allow the students to establish some level of comfort prior to entering the clinical area for their first encounter with real patients. Although I am sure this technology is as close to simulating a real patient as possible remembrance of those first day jitters in the clinical area is something that will stay with you for a lifetime.

Original Post:
June 4, 2009
Title: Nursing Assessment Meets Technology
I work at an institution that received a federal grant to start up a simulation lab. This lab has three manikins that are very lifelike. One is an obstetric manikin and can simulate vaginal births. One is pediatric. The last manikin is an adult and we have sent over 1000 nurses thru this lab this year. We do ACLS scenarios and mock Code Blue. The program can be written to do anything. You can hear the lung fields and heart. When you feel the pedal area, you can even feel a pedal pulse. It is an awesome way to train students and new graduates as well as the experienced nurses.

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The wonders of electronic documentation

August 26, 2009

Despite the fact that many hospitals have not yet made the transition to electronic health records (EHR), I feel as though this is definitely the preferred means of documentation for several reasons. First, you can customize EHRs to capture whatever information your facility deems necessary. Although electronic documentation presents flexibility problems (for example, once set up, electronic documentation templates can be difficult to alter), it promotes the capture of uniform documentation. Although the cost associated with transitioning to an EHR can be a major drawback, especially in this economy, it eliminates filing loose paper and retrieving records. In discussing this topic with management, I learned that EHRs are optimal for dealing with litigation, audits, and patient care. With paper records, medical records and health information management have the burden of maintaining, filing, and retrieving charts as well as tracking the paper records’ location when in use. With the paper method, the doctors have the charts, and you may not have that immediate opportunity to document, so you forget it and more oftentimes than not, you just don’t do it. With electronic charting, I find that you just go to a computer screen view the chart and document anything right then and there. Everybody has access immediately, which makes the process more efficient and prevents lost documentation, which, for obvious reasons, is a key to exceptional clinical patient care.

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My Favorite Aspect of Online Learning, comment

August 26, 2009

My favorite thing about online learning is that I can participate in any class, any time day or night. When I returned to graduate school, I was required to attend a traditional NP program, which is only based in a classroom setting. Although returning to graduate school meant probably being in the presence of more mature and experienced nurses, there would also be those novice who just finished their BSN and decided to go right into graduate school without ever experiencing what actual nursing is all about. So these younger, unseasoned, newly graduated with their BSN nurses bring their usual way of learning into this arena where they have had to memorize all the details the professor spills out just in case it will be on the test. Therefore, they ask tons of questions about every little thing because they have no firsthand knowledge about nursing only knowledge gained from whatever the book said. Although I feel that new graduates should get out and get a feel for bedside nursing before they declare what area of nursing will be their life’s work. At the same time the thought of going ahead and finishing your education while in your youth is probably foremost on their minds as opposed to working full time just to get experience and then returning to school at a later date. Either way it is a personal choice and their chosen ways of learning have to be accepted and understood by those of us who actually pay attention to the lectures and not try to write down everything that is said in the classroom and miss the essence of the lecture.

Original Post:
August 20, 2009
My Favorite Aspect of Online Learning
My favorite part of online learning is that there are no stupid questions asked. I get very impatient in class when students ask questions that are relative only to them or that have already been answered earlier in the class. It seems that the people who ask the most questions are those that pay the least amount of attention. Often times the answer to their question has either already been reviewed or is located on a power point/email somewhere. It can be very annoying. It has been 2 and ½ years since I have been in school and I am about to rejoin the classroom setting; I am not excited for the "question students." This is why professors put together lectures and send out emails, to prepare students for the exams, quizzes, clinicals, etc. I hope that in graduate school the students read a little more carefully. To summarize, thank you Dr. Johnson for providing me with an advanced health assessment class that lacks obnoxious question sessions.

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The Elderly and the Internet, comment

August 26, 2009

While I agree that the Internet has enabled the elderly as well as many others an opportunity to research health information. The elderly must be aware that all sites do not contain quality accurate medical information and that the researchers should use caution. Information should be taken from sites with long established history for providing credible and reliable medical information. Now, from a purely mental health prospective, the Internet provides an opportunity for the elderly to connect with family, senior citizen groups, and other outside activities that they would otherwise not have any access. In this day of modern technology, not many family members are reachable by home phones; therefore cell phones, email, and text messages are the norms for communication. In fact, if one wants to keep in touch with family and especially the teenaged family members, email and text messages are their best chance for communication. In addition, with the limited amount of patience and attention teenagers’ exhibit, a brief and not so personal interaction with elderly relatives is about all they can stand. So if text messaging is the chosen method of communication, one must become well informed about the text language. In addition, for many elderly people having the ability to stay in regular contact with family members does as much or more for their psyche than anything else does.

Original Post
April 29, 2009
The Elderly and the Internet
The Internet has become not only a useful tool for the elderly by providing a lifeline to friends and family, but also offers a source of references for those seeking health information. Health Promotion (2006) notes: “because individuals will be increasingly responsible for their own health, they will need access to quality information that has not been readily available in the past.” They also go on to recommend “Net Wellness, an electronic consumer health information services that provides the best possible health information to the broadest possible populations.” This site not only provides consumers with information on health topics, they also assists in locating health centers and provides a reference library. In addition, the site will respond to health related questions, drawing upon a panel of almost 500 experts. It has become a one-stop shopping mall for the health information consumer. As long as the resources are available (computer and hook-up), the ease of using a computer is readily mastered for most, regardless of age. My mother has been proficient on her PC for many years, and in the Human Resource office of the organization where I work, Bob, a 94-year old volunteer, has assisted customers with filling out on-line applications for several years. I think he is always amazed by the number of younger people that are not comfortable on the computer and takes a sense of pride in his skill level. By using the computer to broaden one’s knowledge of health promotion, we all become wiser consumers, including those of all ages.

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Documentation of Bedsores, comment

August 20, 2009

This is very true about the documentation of bed sores being incorrect. In the ICU where I work at, we actually document initially if there are any sores as soon as the patient arrives. It is located in the admission assessment. After that it is up to the nurses top document if there have been any changes in the skin integrity of the patient. Multiple time we see a skin assessment documented with a stage one/two pressure ulcer when reality is that it is incontinence associated dermatitis. Most time the IAD can resolved by either timely cleansing of the person, the insertion of a rectal tube and foley catheter (if not previously present) and some type of barrier ointment. In a way prevention is the best medicine for IAD and Pressure Ulcers, in companied with good core and forensic assessment skills. If the pt is having large loose stools, create a prevention to keep the skin intact.

Original Post
August 3, 2009
Title: Documentation of Bedsores, comment

The hospital where I currently work also includes documentation of existing pressure ulcers on admission of a patient. However, the protocol asks you to assess the patient’s skin then to document on paper what the ulcer looks like, stage, size, drainage, etc. The paper charting does not require a picture of the pressure ulcer that was found by assessment of the RN. I think this leaves a wide margin for error. It is probable that some ulcers will not be documented correctly. I believe that a photo would be advantageous to the medical record along with perhaps a computerized charting system where you can label with an X any area of the body that has breakdown and then attach a photograph to the document. Also the documentation I work with does not allow for updates on how the pressure ulcer heals or worsens. This also leaves room for criticism and error. I think my place of work would benefit from photo/computerized documentation of pressure ulcers.

Original Post:
July 31, 2009
Title: Documentation of Bedsores, comment

I found this post and other comments relative to my new nursing job. As an experienced ER nurse, we found little time to assess or document pressure ulcers. With the new CMS guidelines that came out this past October, Medicare will not longer be reimbursing for facility acquired pressure ulcers. My new nursing role focuses on prevention and education. I was very surprised how little I knew about pressure ulcers from working in the ED. Yet it is so vital that our assessment starts there. The photo proof documentation mentioned in this Post sounds like an excellent idea. One of the hospitals I work with, just installed a whole new soft ware program for nursing documentation. It is really easy to chart your skin assessments and pressure ulcers. With drop down choices, body diagrams. But the wound care nurse still has to validate the floor nurses documentation with her own patient assessment every month. I helped her with this, and it was very time consuming. It was double the work in my eyes. Yet we did find, many pressure ulcers that were resolved and many that were staged incorrectly, as well as several that were missed by the RN. Even though we have many different technologies to help us with our documentation and assessment, it still comes down to basic education.

Original Post:
June 17, 2009
Title: Documentation of Bedsores
Joint Commission and CMS (Medicare) has set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

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Patient Interaction with their Disease

August 20, 2009

Wouldn’t it be cool if patients who are admitted to the hospital for a chronic illness could be connected with an online program that teaches them about their disease? Maybe the patient could check out a laptop for a few hours and then there could be information given to them about their disease. Medications and the important information that goes along with them could be reviewed (this could be tailored specifically to the medications the patient is taking/will be sent home with). Also a little pathophysiology lesson could be given in an interactive exercise that reviewed anatomy and then changes at the cellular level due to the chronic disease. The program could then go into warning signs of an exacerbation of the disease and when to contact their health care provider or call 911. At the end it could talk about how the patient can work to control their illness at home. The program could include print offs of the medications and disease information. If the patient had questions they could take notes and ask their health care provider before their discharge. I think it is so important for a patient to feel that they can have control over their chronic illness. I think that if patients were better educated about their disease processes that hospital admissions/exacerbations would decrease. I firmly believe in educating patients about their illnesses and believe that a user-friendly computer program would greatly benefit patients.

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Abdominal Assessment

August 20, 2009

The type of assessment skills presented by the book and video clips is rapidly becoming a dying breed. Palpation is still used frequently (for hepato-splenomegaly, to feel for ‘the olive’ in pyloric stenosis, RLQ exam for r/o appy, etc) but percussion has definitely fallen of the clinical pathway. The use of CT scans and bedside ultrasound have replaced percussion for establishing +/- free fluid in the abdomen, liver size, masses, etc. These high-tech tools are fast and easy. Images are transferable to clinicians miles away within minutes, allowing for better clinical decision making for the benefit of the patient. However, with the loss of the hands-on skill come the increased cost of the test – which burdens our health care system even more.

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Scanning Patients’ Armbands

August 20, 2009

I miss scanning patients’ armbands. The hospital where I worked in the ICU we scanned armbands as a safety measure when administering medications. It was very helpful in the ICU because most patients were sedated and unable to give the nurse their name and birth date. It was very helpful. I felt safe in checking my patient’s armband at the beginning of my shift then scanning their armband later as an identifier. At the hospital I work at now you have paper charting, paper MARs, then you go into the patient’s room and ask them to identify themselves. Many patients are unresponsive or confused and it is not a reliable check. One time I was in a male patient’s room and it was semi-private and both men were sitting up in chairs and I almost administered an IV antibiotic to the wrong patient. The patient was confused and his armband was taped to his bed so it was very unclear. I ended up going to the other patient and asking him to identify himself because I could not get a clear answer from the first patient. It turned out that the second patient was the correct patient. It made me a little tachy for a while. It was scary to think that I could have wrongly administered a medication. I want to keep my patients safe and I really miss the scanner. I felt much more comfortable with it. It also scanned the meds to approve them as well instead of relying on human eyes to misread something. You could rely on your eyes AND the scanner.

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E-Learning

August 20, 2009

I have definitely used e-learning and the Internet to educate myself and my colleagues. I place peripherally inserted central catheters as one of my jobs. In that, the latest research show that mid-clavicular lines should be a thing of the past due to their increased risk for increased clotting/thrombosus, which was a simply 2 1/2 page online CEU I recently completed. This was not known by even experienced PICC nurses and was brought to their attention for a change in practice. I have encouraged the nurses I work with (as a second job in an ICU) to review their pt’s morning X-rays’s, to assess proper placement and to question the order that allows Mid-Clavicular lines to be allowed as practice. A simple X-ray assessment of the line could prevent a healthy lawsuit and more importantly save your pt’s life.

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