Reflections on a blurrr.......... Wow the semester went by quickly ! I had never taken an online course so the early couple of weeks learning how to post things and maneuver the WebCT was a little stressful. I like being in a classroom and having real-time interaction so this was a little harder for me to adjust to. I learn so much from other people and the expression of their opinions. This method of teaching and learning has those opportunities, but reading posts and commentary is not quite the same as a juicy discussion in class. Online courses force you to stumble through some things and figure out problems on your own since you don't know when someone will get back to you. If you are in a classroom you just raise your hand and get your answer. I will adjust to online work and I enjoy the flexibility...but it is harder to pick the brains of your teachers online.
I think my favorite topics/modules were on ethics and heuristics. I also have a greater appreciation for how difficult it is to create a DSS that is actually useful! I have areas that I feel I have broadened my knowledge and understanding quite a bit, and others that I think a whole semester course would be needed to grasp! I really enjoyed looking into human information processing and its impact on how we make decisions. Most of the of the content stuck to the objectives pretty well so my expectations were met.
I like the module concept. I would rather have all the modules up front so I can assess where I need to focus time and have the opportunity to print all my reading material if I need to take it with me. To be honest, I don't care much about grades anymore...I care about what I learn, so the fact that I didn't always have grades back before I started another module was less bothersome to me than some others. Sometimes the list of "to do" was long so I might have liked things broken up into smaller modules. I learned not to start a module without having enough time to finish all the various tasks or it was more difficult to go back and recall readings, etc. On a couple of modules I had to reread and go back over things, but that was okay. Learning is adapting, and now I have learned how to do some new things. The links and exposure to the various resource websites were excellent and I know I will be using them in the future. By trial and error I finally got most of the technical difficulties squared away !
Sunday, November 30, 2008
Thursday, October 16, 2008
Module 4: Question 2
The impression I received by reading the materials is that nursing has a very long way to go in order to come up with a comprehensive mechanism/tool for decision support. Data quality has so many components to it, and the complexity of defining nursing activities, decisions, and how these interact or compete is quite complicated. Looking at how nurses define things compared to others in the medical profession is very problematic. I have always felt that we complicate things for some fundamentally political reasons. Nursing diagnosis is just one such area that confounds the problem. Sometimes I wanted to scream when I would write out... "alteration in cardiac output related to ...blah, blah, blah....ITS A MYOCARDIAL INFARCTION !, the docs know it, the lab knows it, and the EKG tech knows it...but we can't call it that. If we keep trying to separate ourselves this way- it will only make the utility of anything we come up with too esoteric for anyone else to use. (gee, I hope the love of nursing diagnoses isn't one of the professors doctoral dissertations....I guess I should have googled more on our teachers). Defining exactly what we do and how it relates to patient outcomes is going to be difficult. Some areas are more obvious than others. The quality and types of data we use in our DSS really has to have some other purposes despite the obvious (or legal) ones we are already used to.
I was dissappointed to see that nurses really don't access data to support their decisions proactively, rather they tend to "look things up" later- after the consequences are likely beyond repair. Because of this fact, and the realities of (bedside) nursing- we need good DSS now more than ever. We need more studies of nursing outcomes to evaluate the impact of what we do so we can tailor tools to be sure we do the things that create the best scenario for our patients. Athough the readings brought up most of these concerns, I left with the feeling that it will be a long time before we have all the pieces put together. It also made me feel bad for informaticists in nursing- uphill battle ahead!
I was dissappointed to see that nurses really don't access data to support their decisions proactively, rather they tend to "look things up" later- after the consequences are likely beyond repair. Because of this fact, and the realities of (bedside) nursing- we need good DSS now more than ever. We need more studies of nursing outcomes to evaluate the impact of what we do so we can tailor tools to be sure we do the things that create the best scenario for our patients. Athough the readings brought up most of these concerns, I left with the feeling that it will be a long time before we have all the pieces put together. It also made me feel bad for informaticists in nursing- uphill battle ahead!
Wednesday, October 15, 2008
Module 4: Question 1
WOW- what an eye opener. I will admit that this module was a brain stretcher for me. Three of the articles were eye-openers, one was sadistically brutal to endure (I much preferred watching Daniel Kahneman speak on YouTube for an hour than read the Tversky/Kahneman article). If your brain is exploding as you start to read it- go watch the video, then pick it up again. Okay- now lets answer the REAL question and stop editorializing......
This particular module has given me a one of the most profound experiences of self-reflection about how I practice as an NP! I spent the last three days working 10 hour shifts paying very close attention to what I was doing and how I was making my clinical decisions (except the flu shots which required little mental effort). I was amazed at how I picked up on what cues were directing me toward the "expected" diagnosis and how my formation of questions affected the patients responses. I became very aware of how I made assumptions based on (truly) very little information. I will even confess to finally giving in to pressure to write an antibiotic RX for a guy who I KNOW ( from an EBM standpoint) was probably too early for a sinus infection- but I allowed other cues to interfere. Social cues, social expectations, overconfidence, and a host of other problems definitely interfere with accuracy in clinical diagnoses. Having been an ICU nurse for many years, I have had experience of "sensing" something was wrong with a patient, even when I could not put my finger on it. I understand that, in a sociological sense, we nurses place a value on the experienced nurse and the "intuition" that comes with years of exposure to patients and disease conditions.
In my self-asssessment, I found evidence of what Tversky and Kahneman called the "representative heuristic", and the "illusion of validity". My errors of judgment, although not intentional (and probably not medically deleterious), are still worrisome. Understanding that these fundamental prolems in how humans process information ( Intuition versus Reasoning) was somewhat depressing in that it blatently exposed how fallible even the "experts" are! I looked up the book "Blink" that Kahneman referred to in his lecture to get the other point of view on this issue and thought to myself "nurses woud really like to have their experiences validated" but the evidence is just not there. I think that if at the core, nurses are advocates for patients, then we must be advocates for evidence-based medicine and nursing practice. This will mean reconciling the "touchy-feely" part of our profession with the realities of what we are tasked to do on a daily basis with regard to patient care and decision-making.
This particular module has given me a one of the most profound experiences of self-reflection about how I practice as an NP! I spent the last three days working 10 hour shifts paying very close attention to what I was doing and how I was making my clinical decisions (except the flu shots which required little mental effort). I was amazed at how I picked up on what cues were directing me toward the "expected" diagnosis and how my formation of questions affected the patients responses. I became very aware of how I made assumptions based on (truly) very little information. I will even confess to finally giving in to pressure to write an antibiotic RX for a guy who I KNOW ( from an EBM standpoint) was probably too early for a sinus infection- but I allowed other cues to interfere. Social cues, social expectations, overconfidence, and a host of other problems definitely interfere with accuracy in clinical diagnoses. Having been an ICU nurse for many years, I have had experience of "sensing" something was wrong with a patient, even when I could not put my finger on it. I understand that, in a sociological sense, we nurses place a value on the experienced nurse and the "intuition" that comes with years of exposure to patients and disease conditions.
In my self-asssessment, I found evidence of what Tversky and Kahneman called the "representative heuristic", and the "illusion of validity". My errors of judgment, although not intentional (and probably not medically deleterious), are still worrisome. Understanding that these fundamental prolems in how humans process information ( Intuition versus Reasoning) was somewhat depressing in that it blatently exposed how fallible even the "experts" are! I looked up the book "Blink" that Kahneman referred to in his lecture to get the other point of view on this issue and thought to myself "nurses woud really like to have their experiences validated" but the evidence is just not there. I think that if at the core, nurses are advocates for patients, then we must be advocates for evidence-based medicine and nursing practice. This will mean reconciling the "touchy-feely" part of our profession with the realities of what we are tasked to do on a daily basis with regard to patient care and decision-making.
Monday, October 6, 2008
Yahoooo....there's a documentary!
Okay....I was joking about the movie on Lev Vygotsky, but there are a couple of powerpoint slideshows (one in spanish so I could only understand part of it) and a documentary ! I'm going to go looking for Jerome Bruner now....wish me happy hunting !
Module 3: Teaching with Technology:Multiple Intelligence Test
The MIT test was very interesting and indicated that my "strengths" were in the "interpersonal" and "Spatial-Visual" areas. This indicates that I tend to learn best by seeing things in visual/pictorial form. I retain information better by creating a mental image or a way to connect the information to something I can see in my head. I can remember things I have read by remembering where it is on a page, or what the teacher was wearing when they talked about it. The interpersonal intelligence seems to fit in many areas, since I can play "devils advocate" pretty well and see how things may be perceived from many different perspectives. To augment my personal learning I need to use multiple visual cues to retain information- viewing information in many formats may be helpful. I also would benefit from having discussions with others about what I have read. I don't think there are any great movies out there on Jerome Bruner or Lev Vygotsky- but I'll google it when I finish this blog !
Sunday, September 28, 2008
Module 2: question 3
There are many ways to garner information on a topic- but one must be clear about understanding what types of information are trustworthy. Most of us wold recognize that the "National Institutes of Health" is a reasonably trustworthy source, but a layperson might just thing the National Health Initiative is good source ( I made that up). Anyone can pay to have a website developed and push their own agenda - as well as make it look "official" these days so we must be very careful. I personally liked seeing what was available just doing a Google search, but I also recognize that I need to go to websites that lead to scholarly work. The National Clearing House is a familiar site to me because I have had to work on protocols before and needed to collect data from multiple sources to defend a position for why certain care processes should be adhered to. All of them are useful in one way or another- even if it just gives you an idea or link to pursue another search.
I think one could look for professional organizations and specialty groups to find further data on a topic. Interviews can always give one ideas for further exploration- but it is so easy to get at a significant amount of information with a few keystrokes these days. I remember the days of going to the library and pulling articles, copying them and ordering them in from other libraries! Fine tuning search skills is probably going to be the best way to decrease time wasted in finding irrelevant information and citations.
I think one could look for professional organizations and specialty groups to find further data on a topic. Interviews can always give one ideas for further exploration- but it is so easy to get at a significant amount of information with a few keystrokes these days. I remember the days of going to the library and pulling articles, copying them and ordering them in from other libraries! Fine tuning search skills is probably going to be the best way to decrease time wasted in finding irrelevant information and citations.
Module 2: question 2
I purchased the ENDNOTE software about three weeks ago (after playing intermittently with the online free version) and attended the EndNote class offered by Jeanne at the library. I learned how to use many of the key functions better, but I still feel like an idiot (is that scholarly enough??). I have spent lots of time emailing the U's web support staff and finally had to bring my computer up to the library because I had so many error messages every time I used it. I was the proud owner of the "errors we've never seen before" award by the support staff so I didn't feel so bad. I really like the "custom groups" function to organize my lit searches. I also like how you can click and get full text downloads if you see something that really interests you. I still have some trouble trying to use the "cite while you write" function, but I believe I will get better with it the more I use it.
I also looked at ProCite and PERRLA and tried the tutorials. I actually like the PERRLA APA format templates better since it it so intuitive. You end up having to put in more of your data initially- but it does so many other things automatically. In EndNote- you may not recognize that something is not formatted correctly ans you still have to go clean it up. Well....if I knew APA format by heart then I would not need a data tool to help me....but they are good resources. For paper writing I think I may end up using PERRLA until I get a better handle on things and then learn how to import and export things better.
My recommendation for this course in the future is that incoming new DNP students are instructed to go get EndNote and begin taking classes before they begin the program (summer) so that they have more time to play with it before actual papers are due (and you don't have the time to endure the learning curve.)
I also looked at ProCite and PERRLA and tried the tutorials. I actually like the PERRLA APA format templates better since it it so intuitive. You end up having to put in more of your data initially- but it does so many other things automatically. In EndNote- you may not recognize that something is not formatted correctly ans you still have to go clean it up. Well....if I knew APA format by heart then I would not need a data tool to help me....but they are good resources. For paper writing I think I may end up using PERRLA until I get a better handle on things and then learn how to import and export things better.
My recommendation for this course in the future is that incoming new DNP students are instructed to go get EndNote and begin taking classes before they begin the program (summer) so that they have more time to play with it before actual papers are due (and you don't have the time to endure the learning curve.)
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