Archive for September, 2009

Indicators, comment

September 14, 2009

I just finished reading a post on Monitoring of indicators, our facility received accreditation on the first round as well and I was shocked! The amount of work and prep that lead up to the survey was overwhelming and added to our already great time constraints. Not only were we trying to run our departments but now the added stress of putting together information and evidence  binders was astronomical. However I learned so much from the process and how valuable indicators were for improved patient outcomes I have added, modified or implemented new programs and made changes to the way I run my department. I even won a recognition award for Quality Insurance this past year.

Original Post
September 2, 2009
Title: Monitoring indicators
My current place of employment gained full accreditation in 2007; it was our first attempt. I understand it is rare to get full accreditation the first time. I did not realize how important the monitoring of health indicators and tracking progress was at that time. We (the staff) only saw it as time consuming; and is it really necessary to the outcomes of our patients? Tracking of data allows us to monitor our progress of goal achievement and the ability to improve programs to meet the needs of our patients. As a result we have added new programs based on the needs and requests of our patients. It has also enabled us to acquire more funding to increase staff. I guess what I am really trying to say, healthcare tracking, indicators and data collection provide much needed information to improve services, allocation of funds etc… It’s interesting how my views of unnecessary and time consuming work have changed.

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The use of the chapter learning aids

September 14, 2009

The use of the chapter learning aids for the Advanced Anatomy and Physiology course are excellent tools for any student, whether you are a novice or expert nurse. I am sure I am not the only student who has not done an in depth review on A& P for quite some time. The tables really help to summarize the information and the boxes give you a visual description of the illustrations; which definitely enables me to take the material I have read and apply it to the concepts. On line study is difficult at times, it allows the convenience of working at your own pace but at times the lack of classroom interaction proves challenging for me. I am more of a visual learner and I really appreciate all of the added material and tips this course has to offer. It is a lot of information to process but the aids definitely help!

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Documentation of Bedsores, comment

September 7, 2009

Having worked in the NICU for many years, we see several issues with skin breakdown. For the micro-preemies who are lacking the epidermis (or extremely thin epidermis)- it is especially hard to not have skin breakdown, anything that potentially touches their skin will cause breakdown. All of these babies are considered critically ill therefore require several EKG leads, pulse oximetry probes and other transcutaneous monitors. These monitors should be repositioned every couple of hours to minimize the damage and burns. Documenting and notifying the physician of skin breakdown is EXTREMELY important with these patients as they are at such high risk for infections.

Original Post
August 20, 2009
Title: Documentation of Bedsores, comment

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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The Elderly and The Internet, comment

September 7, 2009

Having my grandmother who lives in another state send all of us daily emails has had a positive effect on not only us, but also my grandmother. She is sick and unable to travel, she finds comfort in sending out emails and jokes to her family. She has even recently joined Facebook! Which was shocking to me at first. But the more the elderly do stay in touch with friends and family the better! I have read many articles in the past regarding the importance of keeping your mind stimulated as you age and never stop learning. So for the elderly to branch out and learn new technology, can only bring them a wealth of information, and keep there minds stimulated!

Original Post:
August 26, 2009
The Elderly and The Internet, comment
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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Is Online Learning Easier? (comment)

September 7, 2009

Many people think when you take an online course, its easier because you can use your books or other online resources whenever you need too. It is very easy get distracted when you are home. If you try to do school work with the TV on, or other distractions, you will not succeed. Some people need the structure of a class room to learn. I think it takes a disciplined, organized individual to do online learning. One person commented that some teacher "spoon feed" the class the information. I agree with her, when you take an online class, you have to teach and learn the information yourself. Although sometimes I get distracted at home, I force myself to stay in my office until my work is completed.

Original Post
August 31, 2009
Title: Is Online Learning Easier? (comment)
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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Health care informatics

September 7, 2009

Health care informatics applied to the Nursing process has been difficult for me to adjust to; from charting every detail to now entering data on a computer has been a challenge for me. I have met with a lot of frustrating moments from learning new computer programs to accepting the fact that a systematic data entry process of information is acceptable. The convergence of information technology with health care has enormous potential. Dramatic improvements in the quality and delivery of health care for patients and practitioners as a direct result of information technology are emerging and will play a significant long-term role in improving patient care as new technologies emerge.

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Monitoring indicators

September 2, 2009

My current place of employment gained full accreditation in 2007; it was our first attempt. I understand it is rare to get full accreditation the first time. I did not realize how important the monitoring of health indicators and tracking progress was at that time. We (the staff) only saw it as time consuming; and is it really necessary to the outcomes of our patients? Tracking of data allows us to monitor our progress of goal achievement and the ability to improve programs to meet the needs of our patients. As a result we have added new programs based on the needs and requests of our patients. It has also enabled us to acquire more funding to increase staff. I guess what I am really trying to say, healthcare tracking, indicators and data collection provide much needed information to improve services, allocation of funds etc… It’s interesting how my views of unnecessary and time consuming work have changed.

Online Health Care Informatics Certificate Program

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