Archive for May, 2010

Advanced Physiological Nursing Course via Internet Learning, comment

May 20, 2010

I have to agree with the two previous posts regarding this the ability to take this course on line, at my own pace, in my own home and around my schedule. I have put off going back for my BSN because I work full time and have a family that needs my attention. There is no way I could concentrate in the classroom if I was worried about my family at home. By taking this course on line, I am able to work the quizzes in at times that are convenient for both me and my family. I can go through the units at my own pace, spending additional time on the concepts that are more difficult or require extra attention. It has been a long time since I sat in a class room. This course is very impressive. I love the website and the interactive learning. It is also wonderful to get quizzes graded immediately with feedback regarding areas to concentrate on for incorrectly answered questions. There is no grading on a curve or extra credit assignments to pull your grade up. On line learning puts accountability on the student – you get out of it what you put into it.

Original Post
March 8, 2010
Title: Advanced Physiological Nursing Course Via Internet Learning
I couldn’t agree more with the writer of this discussion forum. I have learned much more from this course than if I was sitting in a traditional classroom. I am able to proceed at my own speed. I can concentrate more on the systems of the body where my knowledge is lacking and less on the systems I know better. It is less stressful also to be able to take quizzes and tests when I actually have time as opposed to on a schedule set by someone else. I can do my readings when I am at my best instead staying up half the night trying to complete them in time for the next class. It has forced me to really utilize my time management skills.

Original Post
March 4, 2010
Title: Advanced Physiological Nursing Course Via Internet Learning
This was a great course, I feel as though I learned more than I would have sitting in a classroom because I not only had to do the reading but also had to research the Internet to find answers and explanations to questions I didn’t know, was unsure about, or didn’t understand. In many ways this course was harder than the past physiology course I took sitting in a classroom. I think in the classroom it is all too easy for instructors to teach to their test (either subtly or overtly) because their success is on the line. With an Internet course the ability to pass the class and do well rests with me. My goal was to come into this class and learn as much as I can, give more than 100% and achieve the highest possible grade I can earn. I feel as though I have accomplished the first goals and will await taking the final to see if I have achieved my last goal of an A in this course.

Online Advanced Physiological Nursing Course

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Assignments and Point of Care Testing, comment

May 19, 2010

I believe that point of care charting will end many of the current problems with the hand written medical record. Especially, difficulty in deciphering handwriting. Handwritten notes have historically been difficult to interpret and dependent on the writer’s penmanship, spelling, use of unaccepted or unknown abbreviations, or general use of the English language – all make for poor flow of care and communication. Inability to read/understand the notes written by staff that cared for the patient before I did leads to errors and exposes patients to risk for poor outcomes. As noted by others, point of care charting will end the longstanding problem of nurses writing on their hands, scribbling notes on scraps of paper hoping not to lose them before they find a minute to sit down and transcribe them onto a paper chart or mentally trying to remember minute details only to be overwhelmed while multi-taksing and totally forget to chart important information into the chart. We will be "going live" with computerized documentation in our unit in a few weeks. We have the luxury not being the first unit in the hospital to go live. So we have the benefits of learning from our peers and have been able to avoid, or so we think, some problems. We have had input in to the devices that will be installed into each cubicle as well as a voice into which COW (or WOW) is chosen for use in our busy area. We know it will not be the solution to all of our problems but it is, we think, a move in the right direction.

Original Post
May 3, 2010
Title: Assignments and Point of Care Testing
Assessments and point of care charting Assessing the patients and directly inputting the information electronically can help with many things. Obtaining correct information, location, description, improving and worsening data can improve if we are able to input all the information at the patients bedside. I agree with the other writer about the COWS. I have never used one in a patients room. Working in Emergency, we often write things down on a piece of paper and use our memory for what is not jotted down. The only time it is fitting for us in Emergency to use a COW is during a Code where inputting the medications and procedures as they are being done saves a lot of time. If you simply write down each step on a piece of paper, then sit down to chart on the computer after it can take up to 20-30 minutes. Another idea instead of COWS or small hand held devices is to give each nurse her own laptop to use for the day and give it to the next shift as they come in. Lap tops are not too small or too big. Charting at the bedside for assessments and having the MAR on hand to check at bedside is helpful.

Original Post
March 1, 2010
Title: Assessments and point of care charting
I absolutely agree with all the comments presented in the below link. Being that computerized documentation is less than 6 months old in our main facility, bedside point of care charting is a relatively new concept. It used to be that the only documentation performed at the bedside was the patient database and even then, most of that information was gathered on initial assessment and we would then go out to the desk to complete the paperwork. I think as more organizations embrace technology, more thought needs to go into the purchasing of equipment. At our facility, the managers for each unit were given a budget to purchase the style of computer they thought would be best suited for that particular unit. Pods were designed with central computers, handheld devices were purchased as well as COWs (computer on wheels). Many units after the fact discovered that the COWS were too big to get to the second bed in the room. This caused non-compliance with The Joint Commission standard stating that the e-mar must be at the bedside when administering medications. Other units found the hand held devices to small to use – the type to difficult to read. Pods are great for the primary nursing concept but takes the nurse away from the bedside. Many areas discovered just how few available outlets they had how short a battery life really is. We even had to become politically correct when a patient complained to administration that she overheard a nurse in the ER referring to "that stupid COW that had died in the hallway" – not realizing the nurse was frustrated that no one had bothered to plug the computer in to charge. We now refer to COWS as WOWS – work stations on wheels. With all that aside, we are finding that wall based point of care computers work best allowing optimal contact with the patient while gathering crucial information to be utilized in their treatment of care – as long as the computer is not on a wall that forces your back to the patient the entire time you are typing!

Original Post
December 14, 2009
Title: Assessments and Point of Care Charting
Charting patient assessments is often a time consuming task, but vital to the care of the patient and record keeping. Nursing often jot notes down on a piece of paper, to only later record them into the computer system. Much may be lost in the translation. In addition, actions may be taken on the charting that in currently in the computer, though it may not always be the most current reflection of the patent’s status. Point of care systems have become paramount for charting in acute care settings, especially on critical care units. They often interface with medical devices to collect data automatically. These systems are often flowsheet orientated and provide graphing and trending capabilities. Optimally these systems create less redundancy, offer quick responses and interface with other clinical operations such as the laboratory and pharmacy departments. The computer availability is also an important consideration. Central computers have not always enhanced charting as they may take nurse from the bedside. Point of care charting should be convenient points of access to the system. Computers on Wheels (COWS) are found in many organizations. The portable, efficient system allows the nurse to chart in the patients room when appropriate. Bedside systems at the point of care focus on quickly capturing information that a nurse may otherwise jot down on their notes. Computer location should be given thoughtful consideration before investments are made in addition to the device’s speed and ease of use.

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Patient Education Matters

May 5, 2010

In researching a request by our hospital staff for a new Coumadin video to be used for patient education, I came across and wonderful website.  It is Patient Education Matters and is found at http://patienteducationmatters.blogspot.com/  . This blog spot was developed to assist healthcare professionals in the development, sharing and use of patient education materials.  The format is a biweekly newsletter, to which I will now subscribe, is totally dedicated to matters of patient education.  Patient education topics and resources are featured with each publication with links to education materials.  In this week’s edition Warfarin or Coumadin is featured as a resource.

In the case of Coumadin education, Patient Education Matters have linked to the Agency for Healthcare Research and Quality (AHRQ) where I found many Coumadin resources for patients and families.  “Your Guide to Coumadin/Warfarin Therapy” is a video available in both English and Spanish.  There were other education resources for patients available including a comprehensive patient handout.  These resources can be downloaded at no cost or in the case of the handout ordered as single copies free of cost. 

In addition to Coumadin education, Patient Education Matters has a topic index for a host of patient education topics.  Links are provided to the actual education source.  If the education topic needed is not listed they also have a Google search engine that searches across multiple patient education websites at once. 

Our organization is fortunate to have a video on demand education system for our patients.  However patient education such as is available from Patient Education Matters could be utilized in some of the outlying clinic areas or by patients once discharged to refresh knowledge. 

Health Promotion/Disease Prevention Online Class

Patient Education & Counseling Online Class

Health Care Informatics Online Certificate Program

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Asthma Patient Education

May 5, 2010

In researching the Internet for asthma education, I came across an excellent patient education website located at http://www.asthmacure.com  that I wish to review.  I feel that it serves as a good example of what patient education can be.  A patient would need to have the ability to read and basic computer skills to utilize this education site independently.  Alternately portions of the material such as the movie could be used for children and non reading adults. 

The education begins with an overview of asthma; discussing what it is and the fundamental information one would need to understand the disease.  The next section contains a movie.  The graphics are colorful and the language easy to understand.  The movie would be suitable for children age 8 or older as well as adults.  The movie is a wonderful option for those patients who learn best visually or have limited reading skills.

The third section deals with understanding asthma’s warning signals.  To teach the concepts they use a colorful picture and concepts of a traffic light.

 The green light is described as Congrats! Stable Asthma zone; symptom free with PEFR > 80% of personal best.  There is a link explaining what PEFR is and how to measure it using a peak flow meter if the patient needs this information.

 The yellow light called the “caution zone”, discusses the signals and symptoms of asthma that indicate varying degrees of airway obstruction with a PEFR of 50-80.  The advice is to avoid triggers and to add medicines in effort to come back again in the green zone. 

The red light is the “crisis zone”.  Patients are encouraged not to delay medications and to seek medical care.  They discuss emergency signals that indicate urgent care needs.

The colorful pictures and analogy using a traffic signal, something most can relate to, as well easy to read language catch the learner’s attention while providing very valuable information.  This is an excellent example of patient education, useful to many.

Health Promotion/Disease Prevention Online Class

Patient Education & Counseling Online Class

Health Care Informatics Online Certificate Program

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Assessments and point of care charting, comment

May 3, 2010

Assessments and point of care charting Assessing the patients and directly inputting the information electronically can help with many things. Obtaining correct information, location, description, improving and worsening data can improve if we are able to input all the information at the patients bedside. I agree with the other writer about the COWS. I have never used one in a patients room. Working in Emergency, we often write things down on a piece of paper and use our memory for what is not jotted down. The only time it is fitting for us in Emergency to use a COW is during a Code where inputting the medications and procedures as they are being done saves a lot of time. If you simply write down each step on a piece of paper, then sit down to chart on the computer after it can take up to 20-30 minutes. Another idea instead of COWS or small hand held devices is to give each nurse her own laptop to use for the day and give it to the next shift as they come in. Lap tops are not too small or too big. Charting at the bedside for assessments and having the MAR on hand to check at bedside is helpful.

Original Post
March 1, 2010
Title: Assessments and point of care charting
I absolutely agree with all the comments presented in the below link. Being that computerized documentation is less than 6 months old in our main facility, bedside point of care charting is a relatively new concept. It used to be that the only documentation performed at the bedside was the patient database and even then, most of that information was gathered on initial assessment and we would then go out to the desk to complete the paperwork. I think as more organizations embrace technology, more thought needs to go into the purchasing of equipment. At our facility, the managers for each unit were given a budget to purchase the style of computer they thought would be best suited for that particular unit. Pods were designed with central computers, handheld devices were purchased as well as COWs (computer on wheels). Many units after the fact discovered that the COWS were too big to get to the second bed in the room. This caused non-compliance with The Joint Commission standard stating that the e-mar must be at the bedside when administering medications. Other units found the hand held devices to small to use – the type to difficult to read. Pods are great for the primary nursing concept but takes the nurse away from the bedside. Many areas discovered just how few available outlets they had how short a battery life really is. We even had to become politically correct when a patient complained to administration that she overheard a nurse in the ER referring to "that stupid COW that had died in the hallway" – not realizing the nurse was frustrated that no one had bothered to plug the computer in to charge. We now refer to COWS as WOWS – work stations on wheels. With all that aside, we are finding that wall based point of care computers work best allowing optimal contact with the patient while gathering crucial information to be utilized in their treatment of care – as long as the computer is not on a wall that forces your back to the patient the entire time you are typing!

Original Post
December 14, 2009
Title: Assessments and Point of Care Charting
Charting patient assessments is often a time consuming task, but vital to the care of the patient and record keeping. Nursing often jot notes down on a piece of paper, to only later record them into the computer system. Much may be lost in the translation. In addition, actions may be taken on the charting that in currently in the computer, though it may not always be the most current reflection of the patent’s status. Point of care systems have become paramount for charting in acute care settings, especially on critical care units. They often interface with medical devices to collect data automatically. These systems are often flowsheet orientated and provide graphing and trending capabilities. Optimally these systems create less redundancy, offer quick responses and interface with other clinical operations such as the laboratory and pharmacy departments. The computer availability is also an important consideration. Central computers have not always enhanced charting as they may take nurse from the bedside. Point of care charting should be convenient points of access to the system. Computers on Wheels (COWS) are found in many organizations. The portable, efficient system allows the nurse to chart in the patients room when appropriate. Bedside systems at the point of care focus on quickly capturing information that a nurse may otherwise jot down on their notes. Computer location should be given thoughtful consideration before investments are made in addition to the device’s speed and ease of use.

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Dehumanized provider relationships

May 3, 2010

Taking a full head to toe assessment is vital in the care and treatment of patients. Sometimes having someone listen to your problems, make eye contact, touch your hand during conversation, smile, or even make a joke can make patients feel better. I use all of the above when it comes to assessing patients. When providers or nurses are harsh and have poor interpersonal skills, patients sense this. Even if you resolve the patients problems and give them the best medication, the patient will forever remember that healthcare worker as "not nice". When an interaction is formed between the provider and patient that is positive, it may make the patient feel better instantly. Countless times I have cared for an anxious, worried, or even angry patient and was able to turn the situation into a positive one by listening and providing care tailored to each individual patient. What if that interaction is taken away? When a provider enters a patients room and only makes eye contact at the start then directly looks at a laptop for the whole assessment, the interpersonal connection with the patient significantly changes. I would even say there is no connection at all. I have seen this take place at the hospital I currently work at. The younger, more savvy doctor walks in with his cool laptop and begins his interview. Business transactions are sometimes warmer than this technique in the hospital. Then I have seen the older providers grab a seat, cross their legs, lean in and listen to the patients. What a difference it makes! The patients feel special, listened to, and this may even help the provider obtain more information from the patients. Although there are many reasons electronic charting is beneficial, the way of going about obtaining the information is crucial. Maintaining eye contact, smiling, therapeutic touch are all vital during an interview, even when the laptop is the focus of attention.

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Computer based education programs

May 3, 2010

Computer based education for patients is a unique way to try and bridge the gap on health disparities.  Many patients are seen in a diverse population that are not understanding their medical care.  For example, the doctor enters the room quickly bolts out the diagnosis and a prescription for a new medication and leaves the room.  Often I have seen this happen and the patients are left confused.  I have even had a patient say, “I didn’t understand one word the doctor said”.  I inquired why he didn’t ask the doctor to repeat himself or explain in a different manner, but he didn’t have an answer.  Often times, nurses are incorporated in the education of a patient and discharge instructions.

When a patient comes from a different cultural background than the doctor or nurse, it may be more challenging to teach them.  Some cultures have a tremendous amount of respect towards doctors: to not interrupt, argue, say no, or challenge them.  Others simply nod and say yes to everything, come to learn they speak not one word of English.  There are many more challenges when it comes to varying cultures, but to be able to provide education in a language that suits the patient, with a representative from their country on the computer, taking into account their cultural needs would be an excellent tool.  If the patients are not ready to learn in the hospital setting, providing access  to the information online when they are home and feeling better would be another benefit to computer based education.

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