Friday, March 18, 2011

Module 6: Policy and Ethical Issues in IT

When listening to the podcast for module 6, I never truly realized how the definition and idea of plagiarism has changed throughout time. I was unaware that Shakespeare and other famous writers have been known to take ideas and works from other individuals. Isn’t it amazing that we do not accuse Shakespeare of plagiarism! Societal views related to plagiarism have changed throughout the course of history, becoming more of an issue in our present day.

I have always feared being accused of plagiarism. The speaker in the podcast introduces a concept that I have heard in the past, but have simply forgotten over time. Are we considered plagiarizing when we “take” ideas from others based on previous research that we have simply forgotten? During my graduate studies thus far, I feel as though I am continually trying to find where I obtained thoughts in my mind. Did I create this thought based on my knowledge base, or have I read it somewhere and simply cannot remember where the information was obtained? 

The speaker also discusses a play that was produced which was very similar to works from a well known writer without the writer’s permission (copyright infringement). I found it amazing that this writer did not accuse the producer of the play of plagiarism for “something new was created.” The producer took the idea of the writer and created something new with it. He also discusses “intellectual property” and that individuals “can’t claim to hang on forever.” I enjoyed listening to the writer’s perspective because I share many of his same beliefs related to plagiarism.

Wednesday, March 16, 2011

Module 5: Decision Support for Care Delivery

The readings for this module truly made me reassess how I make clinical decisions. Listening to the lecture by Daniel Kahneman, issues that were at one point in the back of my mind, "out of sight, out of mind mentality," were resurfaced. I enjoyed his representation of the nurses intuition. There are many times when I simply "know" something is not right with a child in the neonatal intensive care unit (NICU), even though there may not be direct clinical indicators. Is this intuition? Knowledge from experiences? Possibly something in the middle or both? When I first began working in the NICU, I had no clinical experience in this area. I had worked with adults in the cardiothoracic intensive care unit (CICU), but never this specialized population. When looking back, did I simply not recognize things as early as I do now? It is difficult to think about situations when you sit there and say, "What could I have done differently? What did I miss?" Unfortunately, this is part of medicine, and you may have had all your things in order and not missed a piece of the puzzle, but something unfortunate happened. I have learned not to dwell on such experiences, but take them in strides and learn from them. 

The use of clinical support decision systems may be extremely useful, depending on the appropriateness of the system. I examined the DXplain system for the assignment of this module, and concluded that this system may not be beneficial in the NICU. If systems were developed with the specialized population of those in the NICU, they may be extremely useful. 

Finally, appropriate education related to clinical decision support systems must be implemented. Personally, many coworkers "dread" implementing new and updated computerized medical charting. We must continue to educate each other regarding the need for such changes as well as the benefits associated. Not everything is going to be perfect the first time, but with appropriate communication, we can make the necessary modifications  in such systems that will benefit specialized populations of patients, such as the NICU.

Tuesday, February 8, 2011

Module 4: Teaching with Technology

The NICU offers many opportunities for teaching. As a RN in the NICU, teaching is involved in almost every aspect of care. It is also important to note that teaching in the NICU is reciprocal; nurses teach parents, parents teach nurses; NNP (neonatal nurse practitioners) teach nurses, nurses teach NNP’s, etc. Working in the university setting offers numerous experiences with teaching, even at times when you may least expect it!

I will discuss the teaching that occurs between nurses and families of patients in the NICU. To begin, if a child is born 29 weeks gestation of less, we implement the “minimal stimulation” protocol for seven days. This protocol was developed to reduce the risk of intraventricular hemorrhage (IVH) in this population. When a child is admitted and is placed on the protocol, we educate parents about the risks associated with IVH and why we are limiting potential stressors, such as light, sound, and touch. It is very difficult for parents to not be able to touch their child whenever they visit, but most parents want what is best for their child and respond very well to this protocol. 

As a child progresses/deteriorates, education is continually provided. We discuss common issues such as patent ductus arteriosus (PDA’s), necrotizing enterocolitis (NEC), IVH, periventricular leukomalacia (PVL), hyperbilirubinemia, and many more. Many families have not experienced a child in the NICU; therefore many of the common things we see are completely foreign to parents. It is essential that we take the time to explain in detail and in a language that is acceptable to allow families to understand and express concerns associated with their child’s care/course. 

Before being discharged from the NICU, our parents/caregivers must attend a discharge class. This class discusses the basic care of a child, such as bathing, feeds, diapering, etc. It briefly discusses developmental milestones and provides families with a handout. Finally, CPR is taught using video and demonstration. Parents/caregivers are required to perform the required steps in CPR on CPR doll as well as completion of a quiz. Other topics that are discussed in the discharge class include “back-to-sleep,” the period of PURPLE crying, RSV, car seats, and much more. If parents/caregivers are unable to attend a discharge class, the discharge instructions/demonstrations are performed at the child’s bedside before discharge. It is wonderful for parents to attend this class because at times it is very difficult to perform all of the necessary education at the bedside if the nurse has two other children to care for. It is very time consuming, which is why we continually remind our families to attend the discharge class! The discharge class is taught in English and Spanish due to our high diversity of patients. 

As stated above, teaching occurs during every interaction in the NICU at the University of Utah. There is not a day that goes by that I do not learn something new or educate another individual. I believe this is one of the reasons that I absolutely love working in healthcare. 

I do not believe that there is any nursing/health care provider role that does not involve teaching in some manner. We can all learn from each other and educate others in the process. In my opinion, if one believes that education is not necessary in the healthcare field, I believe they have chosen the wrong profession! Without the use of education, healthcare would not be where it is today, and it would not be able to grow.

Friday, January 28, 2011

Module 3: Information Retrieval

I conducted a search regarding the use of Erythropoietin in premature infants. Upon conducting the searches through an electronic index (EndNote), guideline index (National Guideline Clearinghouse), and web search (, I found the electronic index to be most beneficial. This area of interest is new and upcoming in this population; therefore I did not obtain a significant amount of results when conducting a search through EndNote. When conducting a search through NGC, I obtained numerous results that did not relate directly to this specific population. A Google search resulted in a large volume of results that were not necessary pertinent to this population. 

I feel as though using a web search such as Google is useful when basic information is needed. If in-depth, detailed information is needed, I believe that more reliable sources should be used. I use Google when I am unsure of the meaning and need a basic definition for a given topic area. The use of web searches typically results in thousands of “hits.” I find it extremely difficult to apply necessary limits in a web search to obtain the most pertinent and reliable sources. The inability to obtain scholarly journal articles through web searches is the largest reason I choose not to use such searches. Many of the scholarly articles published can only be obtained by purchasing through the journal. This is extremely frustrating when you “find” something you have interest and cannot obtain the article because of the cost. 

This was my first experience using a guideline index to search for scholarly information. I found the NGC site to be useful, but not necessary useful for my topic of interest. Upon searching the site, I found numerous guidelines and updates regarding the use of erythropoietin in populations other than my area of interest. This may be due to the lack of studies to support this therapy in this population and lack of necessary research. 

I prefer using EndNote for scholarly searches. The use of EndNote has become a major component of information retrieval thus far in my graduate studies. I feel comfortable using this software and believe that it is extremely easy to navigate. This program also allows for searches to be conducted in reliable databases, such as PubMed. EndNote allows for retrieval of search references and can use easily incorporated into Word documentation.

Wednesday, January 19, 2011

Module 2: Healthcare Informations Systems and Devices

Working in the newborn intensive care unit (NICU) at the University of Utah has allowed me to become proficient with working with different information systems and devices. The use of the Electronic Health Record (EHR) is a main source of information systems within my current setting. I have taken part in evaluating the charting that is available regarding our premature and sick infants and have performed numerous evaluations in order to improve the current systems. The nursing staff have requested many areas be added to the EHR in order to improve the quality of charting for our patient population.

Recently, I was involved in adding a criteria within the EHR. Many nurses within the unit felt as though there needed to be an addition to the EHR regarding the infants stability/lability in regards to oxygen saturation's. The health educator of the unit requested the new criteria: Stable/Labile to be added in our vital signs tab. When this idea was brought forth during a staff meeting, I was extremely hesitant. My concerns in the addition of this new area was that staff members would no longer document desaturations, which is associated with an infant being labile. Many infants drop saturation's down into the low 80's/high 70's. Unfortunately, when a child is dropping down into the 40-60s, I find this more problematic. When we are charting labile without continue charting of desaturations, key changes in the infant's status may be missed! This new area in charting was applied on Friday January 14 and I have already noticed that individuals are not charting the exact desaturation value and simply clicking labile. Based on my assessments of the addition in charting, I do not find it beneficial in trending. This is an excellent example of how I have taken part in implementing, evaluating, and improving the information system within my institution.

Wednesday, January 12, 2011

Module 1

My name is Rachel Cobeaga. I currently live in West Point, UT and work at the University Hospital in SLC. I moved to Utah approximately three years ago due to my husband being stationed at Hill AFB. I obtained a Bachelor's of Science degree in Nursing from Wayne State University. Throughout my undergraduate education, I worked in a cardiothoracic ICU as a student nurse (also obtained experience in medical/neuro/surgical ICU's). I absolutely loved working in the ICU, but have always known that my specialty area would be within the neonatal intensive care unit (NICU). Upon graduating, I moved to Utah and began working in the newborn ICU at the University of Utah.

I absolutely love my job and would not change it for anything! I work with extremely low birth weight infants to those that are post-term (23-40+ weeks). It is extremely challenging at times, but the job is rewarding to say the least! As stated above, I have always known this was going to be my specialty area. Upon beginning my undergraduate education, I decided that I would continue my education. That is where I am today! My area of interest is Neonatal Nurse Practitioning, and I am currently in my second semester of graduate school (BS-DNP).

The most recent developments in technology in my work area (NICU) is the implementation of electronic medical records. When working in Detroit, MI, we began electronic medical records. Upon moving to Utah, the University began using electronic charting. I was a bit ahead of the game since it was the same system that was used back home, therefore I was able to assist others in computer issues. Due to technical issues, implementation of specific areas, such as orders, did not go live until last year. To date, all orders and charting are completed through electronic medical records.

Within the last 6 months, our unit has obtained new and improved monitoring systems. Before installment of the monitors, we were required to attend an in-service to learn the "ins-and-outs" of the electronic systems.

A bit more about me... I am the youngest of two (17 months difference between sister). I have three stepbrothers and one stepsister. My father and step-mother live in Arizona and my mother and stepfather live in Michigan. Most of my family is in Michigan and Indiana, which is very difficult at times. I miss my family dearly! My husband, Paul, and I met four years ago while visiting a high school friend in Hawaii. We spent five days together, and it was truly "love at first sight!" We did the whole long distance relationship for a year and a half before I moved to Utah. We wed in March and he deployed for 7 months a month later! Upon returning, I found out that I was accepted to graduate school and he decided that he would stay in the Air Force and take on his next assignment. Unfortunately, we moved him to Las Vegas in August, and we have been separated since. Fortunately, we live 500 miles away, which is better than a 10 hour flight! We are able to see each other approximately once or twice a month for about 5 days at a time. It is difficult, but we have been through it before, and it is basically "what we do!" You have to love the benefits of the military! Our babies are our three dogs. They our are pride and joy, and we love them unconditionally!

I am looking forward to the blogging throughout the semester, for I have never taken part in the process. I have observed and followed some of the children that I have taken care of in the past, which is always a joy to watch them and their families grow!