Archive for November, 2010

The Elderly and the Internet, comment

November 29, 2010

My mother lives with me and it is amazing how much time she spends on the internet. She shops and emails friends and family. She also has projects she researches online such as her family tree and growing roses for different companies. She loves the interaction and I feel it keeps her young!

Original Post
September 7, 2009
Title: The Elderly and the Internet, comment
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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Nurse charting in the hospital setting: Does electronic charting win? (comment)

November 29, 2010

We recently started electronic charting in the ED and it has been a challenge for all! One of the biggest pros in our ED are the decrease in patient complaints of never seeing a nurse or doctor. Our computers are stationary at each bedside so nurses are more visible and available for patients and families. It is so simple now to view patients charts without hunting down paper charts. Downtime is a problem but one that we are getting more accustom to.

Original Post
August 13, 2010
Title: Nurse charting in the hospital setting: Does electronic charting win?
Two years ago my hospital transitioned to electronic nurse charting. Adapting this new form of documentation caused a rumble amongst much of the staff. It seems there is always a natural fear that arises when something so new in form is implemented. At that time I had only been a nurse for a little over a year, so I was open to just about anything as I was not too set in my ways. I continue to hear the occasional comment reflecting back to the good ol’ days when charting involved nothing more than a pen and paper. Last week our computer system was out of service for three hours for upgrades and as I was charting, once again on paper, I began to contrast and compare the two different styles of documentation in my mind.

Electronic charting has many benefits. It’s legible, finite, organized, and consistent. For example, intake and output are entered and it automatically gives the nurses and doctors a net positive or negative daily fluid balance. With paper charting we had to painstakingly calculate intake and output hourly, which is basic math, but still remains time consuming. Patients’ lab values are automatically uploaded to their e-chart which also saves time. Vital signs automatically flow from the bedside monitor to the e-chart and simply need confirmation to be permanent. No longer are the days of placing triangles and dots for graphical depiction of vital signs.

There are some negatives to electronic charting. As stated above, down time for upgrades is always an annoyance. It causes inconsistencies in the patent record and is a hurdle for newer staff that never used our paper flowsheets. Some aspects are actually more time consuming than that of paper charting. Lags in servers and computer glitches often time cause sluggish operating systems. And of course there are always times when you have almost finished charting a long, detailed note, when the whole system crashes!

Grievances aside, I guess at the end of the day we all know that patient safety is the most important concern. With that said, I must admit that electronic charting is much safer than that of paper, therefore it wins my vote. As stated earlier, there is little room for misinterpretation. There is consistency among all staff, and patient records can be accessed by physicians anywhere in the hospital. Perhaps we are in the initial stages of developing a universal system that can be accessed by all institutions across the country. Wouldn’t that be nice!

Internet Education and a changing belief among traditional nurse educators, comment

November 29, 2010

I also have mixed feelings about online education. I feel it is beneficial for experienced nurses who are going back to college but not for nurses who are fairly new. Deciding experience and new is the difficult part. I know some experienced nurses who definitely need to sit in a class room and newer nurses who can grasp ideas without any problem. I think any nurse doing a online program should be actively working and should only be able to do an online program with the recommendation from there immediate supervisor.

Original Post
July 29, 2010
Title: Internet Education and a changing belief among traditional nurse educators, comment
I personally have mixed feelings about online education. I feel there are a variety of pros and cons dealing with this issue. The pros are that the student has high flexibility are far as the time constraints go and the student has the ability to take test and complete work according to their work schedule. The main negative is that the student has very limited amount of instructor interaction. Therefore if the student is having issues or a problem they can’t figure out they may become more anxious about completing assignments.

Advanced Physiological Nursing Course Via Internet Learning, Comment

November 29, 2010

In this day and age having an associate degree is becoming obsolete. More and more hospitals are looking for nurses who have a bachelor degree or higher. A recent comment by the Head of Nursing at the hospital where I work at says it all, “I would love to see master degree nurses as the bedside nurse!”.

It was very hard for me to get my associate degree due to the fact that I am older, work full time, have a husband and three children at home, and then there is all the responsibilities that go hand in hand with these.

At the same time, if I desire to move forward in my career I need a bachelor degree or master’s degree. So as with the commenter before me, I chose to return to college via the internet, it has been extremely enjoyable, being able sit in my living room and do the class work, take tests ect. Without having to leave my teenagers alone for hours at a time or brave the weather in winter.

I also feel accomplished and proud of the progress I have made that would not have been possible for me at this time in my life without the online classroom.

Original Post
May 20, 2010
Title: Advanced Physiological Nursing Course via Internet Learning, comment
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.

Would it be helpful for nurses to have actual X-rays on the computer? (comment)

November 29, 2010

I have worked ICU and currently in the ER. I can not see this being a useful tool in the ER.  In the ICU we where responsible for looking at X-rays and having some idea of what we where looking at. It helped us to better understand what was going on with you patient and what to expect as far as treatment.  Working in a busy ER there is no way a nurse could have time to view x-rays.  Yes there are interesting cases and we do look at those films but that is all you have time for. Taking on the task of reading x-rays is opening a huge can of worms not necessary for nursing! Understanding x-rays is for the trained eye.  I think as nurses we need to stick with what we are trained to do and remember that we did not go to medical or radiology school.

Original Post
October 9, 2009
Title: Would it be helpful for nurses to have actual X-rays on the computer? (comment)

In some cases it would be very helpful for nurses to have access to xrays on computer. In critical areas such as ER and ICU this would be very helpful, however, we must use caution and educate nurses into what they are actually viewing. It is important to know how to deconstruct a CXR from the cspine down to the diaphragm. Know where the level of the carina is. Has anyone ever tried to Google “level of carina”? Try it and see what you get. It would be helpful for Critical Care RNs to be taught how to read xrays, not by other nurses, but by Radiologists, to show us how THEY break down a film. Many questions arise when looking at CXRs. What is too dark, what is too light? Does over- or under-penetration even matter? Depends on what you are looking for. Having quick access to xrays would assist the nurse who is proactive in their patient care. You can prepare for certain treatments if you have a basic understanding of radiologic exams. What does free air look like? What should you be looking for when following an NG tube down below the diaphragm? Nurses should use caution though. Too much knowledge can be harmful also. Take care with reading xrays, and ask for assistance.

Original Post
April 20, 2009
Title: Would it be helpful for nurses to have actual X-rays on the computer? (comment)
As a nurse who has worked in various settings, I believe it would be beneficial for nurses to have access to the actual film. Most hospitals and some smaller facilities are now able to place these films online so that the physicians can review them from anywhere. Agreeably most nurses do not know how to read xrays but some are able to look at the xray and see a broken rib, a white out or such. This would be helpful to the nurse to understand the patients problem and to anticipate treatment. The other part of this is if the nurse has access and it is in an area where she could show it to the family and TEACH and INSTRUCT them as to what is wrong with their loved one it may
decrease anxiety and assist with the treatment of that patient. I don’t
believe nurses should be the first one to observe the xray and share it
with others because this would be above their scope of practice.
However, to be able to utilize these tools to learn and teach others
would be a great asset.

Original Post:
April 7, 2009
Digital images, such as X-rays and scans, will be stored on computer –
enabling them to be sent by email or stored in a USB device. This ends
the need to physically transfer X-rays or scans by hand from hospital
department to another. This is extremely important that the diagnosis
could be made faster and so as the treatment. Also, other health
professional could share the same information and of course we need the patient’s consent. This will also eventually see patient records
being stored electronically and all GPs making hospital appointments
for their patients from computers in their surgeries. People in
rural areas will especially benefit because it will save many journeys
to hospital. The digital image will follow the patient wherever they go
and will be able to be recalled whenever and wherever they need to be
accessed by a patient’s healthcare professional. In addition to
patients not having to wait whilst their X-rays are processed and
delivered by hand from one department to another, clinicians will no
longer have to hold X-rays up to a light box in A and E to make a
diagnosis. There will be improved staff and patient safety due to
reductions in radiation dosages from X-rays and avoiding the use of
hazardous chemicals for film processing. Apart from that, health
professionals should learn to read the X-rays and scans so this would
be more beneficial to patients through different other therapies.
Although, protection of client’s private details would be another issue
to be considered.

Original Post:
March 6, 2009
Currently physicians can pull up the actual x rays and ct scans on the computer but nurses can only pull up the report. Now I agree not all nurses can read X rays but in the ER, ICU and Recovery Room seasoned nurses can read basic films (chest x ray, bones for fractures, etc). I was taught this skill when I first trained in critical care. As a nurse I always appreciate the ability to look at a film and be able to see if my patient has fractured ribs, which would prepare me to understand the complications for this type of fracture. Or to see a pneumo following central line placement and have a chest tube set up at the bedside when the physician arrives. In the ER I can set up for a closed reduction if I have access to the films. Most of the time a nurse has more time to keep checking for results than do physicians. Additionally, printed reports are, in most cases, not downloaded into the computer system until long after the patient receives treatment. I am an advocate for electronic documentation and medical records however nursing education and the level of knowledge we have these days is under estimated. Yes, the radiologist reads the results and the physician orders the treatment but most nurses can anticipate what the treatment will be which in turn decreases both patient and physician wait time and decreases the risks associated with those wait times.

Advanded Physiological Nursing Course via Internet Learning, comment

November 18, 2010

I have made two attempts to go back to college and get my BSN and both times just could not do it. Sitting a classroom for three to four hours two nights a week was impossible. Now I’m able to work at my own pace in the comfort of my home.  I have to have my BSN in order to advance in my current job and this Advanced Physiological Nursing online program has been wonderful.

Original Post

May 20, 2010

Title: Advanded Physiological Nursing Course via Internet Learning, comment

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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Ethics, comment

November 18, 2010

As an emergency room nurse issues dealing with ethics occurs every day.  Doctors who prescribe pain medications through the ER to patients who are “frequent flyers” several times a week with various complaints are enablers.  We now can access a patients prescription history on line to see if multiple prescriptions are being written but doctors have to take the time to use it.  Reporting doctors to our director has helped but we have a long way to go.  This is very frustrating from a nursing stand point.

Original Post

December 28, 2009

Title: Ethics, comment

Review of Health Care Informatics, An Interdisciplinary Approach by Englebardt and Nelson.

Ethical dilemmas in the workplace can be a very difficult situation to deal with as a nurse. We are often put in the position to be the patient’s advocate and that can be a very tough place to be for the nurse. I, too, have been in a situation where my doctor made a decision on an occupational drug test that was clearly unethical. I had to go to our Medical Director to get advice and when he became involved, the original doctor became very upset. However, that being said, I did the right thing and the outcome was correct. It is very difficulty to make a decision to “go over the doctor’s head” but I was being ethical and I slept much better because I had done it. Unlike the previous poster, the doctor did not understand even after much discussion.

Original Post
May 18, 2009
Title: Ethics

https://healthcare-informatics-resources.com/2009/05/18/ethics/
Really enjoyed the chapter on ethics from my textbook in Dr. Johnson’s class; I was lucky enough to attend a 2 day seminar in Ottawa that was mostly focused on ethical dilemma’s in the workplace. We presented different scenario’s which were really useful for future guidance. Of particular interest was the Nurse-Doctor relationship; when to step out of bounds as a patient advocate. We are often faced with difficult decisions regarding treatment of our pts. Do we agree or disagree with what the Dr. has prescribed? In one case I knew if I followed through on the treatment plan that the pt. could suffer undue harm therefore I was left with no choice but to report the problem to a senior medical advisor. It caused an uncomfortable situation for the Dr., and myself however after much discussion he was able to understand I was only acting on behalf of the pt. The chapter really gave me some knowledge of how to handle these situations.

The Bright Side Of The Electronic Medical Record

November 18, 2010

Clients and their families having satisfaction with their hospital experience has taken it’s place at the forefront of patient care. Although this is not a new concept, it is having more emphasis placed upon it than ever before.

With the emergence of the electronic medical record there have also emerged new ways to bring satisfaction to our clients. Nurses have much more information at their fingertips than ever before, we rarely have to leave a patient’s bedside to answer their questions. If they have a question concerning one of their medications, the nurse can click the icon on their computer and find the answer the patient seeks, and can just as easily print out this information for the client to refer to. A client that is on a fluid restriction who wants to know how many more glasses of water they are able to have can have their answer instantly with a click on the input and output tab, where an up to the minute tally is readily available.

In many instances the nurse also benefits, if a client asks for pain medication, there is now a colored line that shows up next to the medication as to what time the medication can be given, there is no more searching for the last dose and counting the hours between doses.

The newer versions of the electronic medical record have a client’s lab values and allergies, not only a click away, but automatically have a pop up box that warns the doctor or nurse who orders or is about to administer a medication, such as potassium, that there is a contraindication with the daily lab results or the clients allergies.

As a profession, nurses go through many transitions in the daily care of their clients. Some of these transitions may be difficult to adjust to, others have flaws and need to be adjusted to better serve the nurse and client. Our attitude can make all the difference, looking at the bright side with a positive attitude can make our work experience a more positive one. One thing is for certain the electronic age is not going to go away, it is here to stay.

Nutrition Web Resources for the School Age Child, comment

November 15, 2010

These websites are great! We have to remember that the generation viewing these websites are very computer “savvy” and pay attention to the information provided. As parents we need to look at the site and make sure it is suitable for our children. Our school nurses and pediatricians in my state also provided good nutrition information. The best education starts at home!

Original Post
April 23, 2009
Title: Nutrition Web Resources for the School Age Child
Nutritional web sites; what a wonderful resource for parents to have at their fingertips. Sites such as HealthLinks (http://www.healthlink.com), and keepkidshealthly (http:www.keepkidshealthy.com) provide useful information on topics such as healthy snacks, slim down plans, food pyramids and daily intake needs based upon the child’s age. Health Promotion (2006) states: “with more school age children accessing the Internet, child-friendly sites(noted above), may help children focus on ways to improve their nutrition and avoid obesity”. This has merit, however, the sites listed in the text are not kid-friendly web sites, rather they are geared toward adult reading levels and comprehension. I endorse kid friendly sites; sites where children can explore on their own the basics of nutrition, its impact on their health, and healthy food choices, all in a fun and engaging method. However, these sites are limited on the web, with the majority of information geared towards the adult population. This would be a great undertaking for a pediatric dietitian to create, as the need exists.

Nursing And The Electronic Invasion

November 15, 2010

I started my medical career as a Care Attendant, then a Licensed Practical Nurse, and finally a Registered Nurse. Over this time I have worked in two different states and seen many changes in the continuing evolution of the nursing profession.

The most recent changes have been primarily within the way we record our care. Over the past few years electronic charting has overtaken more and more aspects of our daily routines, not only do we record each patients vital signs within the electronic record, we record whatever they eat and drink, each use of the ladies and gentleman’s room, and most stressful for nurses, the exact times we medicate. We are given an hour, half our prior and half hour after the scheduled time of a medication to administer it. That doesn’t sound hard to do, but when staffing is short a nurse or a nurse assistant, more is expected to be done by each nurse on the floor. It is not always possible to adhere to this tight timeline, and all the time in the back of your mind you know that each day a printout is generated and sent to each nurse manager showing who was late with their medications, and each floor is sent a monthly record that is hung in the medication room showing each floor within the hospital and the percentage of times medications are administered on time, and when they are late.

We find that our computers on wheels are never more than a fingertip away, and the information that we put within the electronic record is growing with each passing day. It is an electronic strangle hold that has the floor nurse’s attention rather than the patient having the attention.


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