Module 2, Question 3

The electronic index was helpful to find reviews and scientific studies on my topic. Through boolean operators and narrowing my topic I was able to locate relevant clinical trials and recommendations for practice. The guideline index is a great secondary source of information. It contains the current practice guidelines on hundreds of topics. I was able to find information on pain management in the elderly and depending on the reason, I would be able to use some of the guidelines I found. The search engine is a great way to see what is out there. Google Scholar helps to narrow the results to more "academic" topics but lacks the ability to narrow the search as efficiently as databases such as PubMed and Cochran. The Eccles library has a list of links to information indexes. These are wonderful alternate sources for information. Reference lists from articles of interest can also be used to find information. Context relevant information can be useful when formulating or modifying research questions, or when looking for keywords to narrow down or expand a search. "High-precision searching is the ideal method for the clinical nurse specialist" (Poynton, 2003, p. 182). Through practice using various types of information retrieval systems, we can conduct high-precision searches that save us time and find the relevant information we need for clinical practice.

Poynton, M.R. (2003) Recall to precision: Retrieving clinical information with medline. Clinical Nurse Specialist 17(4)182-184.

Module 2, Question 2

2. I joined the graduate school club and purchased EndNote through the University's software site. Between the tutorial the DNP students enrolled in N6000 got from Eccles library, and google I was able to import my retrieved citations from Cochran Library and add them to my list of sources for pain management information in EndNote. In the EndNote library I can sort my software by Author, date, Journal name, reference type, and create and label groups in which I can place my various citations so that I can work on more than one topic in my library. EndNote also will search for full text files and connect them (if able to access them)to the citation with a simple right-click, find full text command. EndNote can be used to "write and cite" in Word documents making proper citation within the paper simple and put citations and references in a whole host of formats including our beloved APA format.

Module 2 Information retrieval Question 1

"What, me, I didn't do anything!"

The clinical problem I chose to do my information search on is pain management in the elderly. I chose to use the Cochran Library so that I could gain more practice with their system. As Cochran Library is a well supported source for evidence based practice I want to feel comfortable in looking up information to answer my clinical questions. The Cochran index is rather complicated to use and I spent a few hours trying to narrow down my search and decide exactly how broad I wanted my topic of pain management to be. In time, as I become more familiar with MEsh terms and the keyword trees, I think that this data base will be an excellent source of information in daily practice. Between the included help information on the site and Google, I was able to obtain a fair amount of information on my topic that I can narrow down depending on what I am managing the pain from/or for. The only barriers I see to daily practice is time spent researching and access.

Module 1

First can I just say that some people are super-overachievers! I can't believe how many people have already posted on their blogs. It made for some interesting reading.

1. What can I say that I haven't said in a million of our classes? I am in the BS to DNP program, currently attending semester 3 of 8. I am in the Adult/Gerontology specialty not FNP like almost everyone else. I have kids, I love my kids, I just don't want to deal with sick kids all day. I can handle IV starts and painful procedures on adults but when it comes to children, I just can't take it emotionally. I put myself in the parents shoes and then I am a blubbering mess. I currently work as a Nurse at the University Hospital. I am on the Medical/Surgical unit (6 South) and have been there since I graduated from Nursing school in 2003. 6 South is definitely a floor that keeps you on your toes.

2. Information management is an integral part of health care. As Georgiou (2002) states, "Health informatics lies at the heart of medicine and health care itself, integrally bound up with the process of clinical decision-making." (p.129) Providing care includes being able to research and compile data on current best practice and diagnoses. With the myriad of forms that data is available in, a practitioner must be able to use technology to access data, make sense of that data and apply it to clinical practice. Becoming a practitioner on the doctorate level implies that one is competent and skilled in information technology, able to navigate the ever changing field of health care.

Georgiou, A. (2002). Data, information and knowledge: the health informatics model and its role in evidence-based medicine. Journal of Evaluation in Clinical Practice, 8(2), 127-130.

3. As mentioned by many of my cohort, the University of Utah has recently implemented Computerized provider order-entry. This has changed the way orders are given and processed. Instead of a paper chart which got put on a rack at the Health Unit Coordinators desk to be faxed and processed, the provider now enters the order electronically and it is sent automatically to the service requested. Medications, x-rays, labs, etc. are no longer missed by nursing, if an order is missing, it is because the provider neglected to place it. Extensive training was required before this process was put into place. Without understanding how the system works and how to navigate within it, you can not perform your job.

4. The University uses a system called Powerchart. There is a document for everything you do. It is rare that one must ever enter a free-texted Nursing Narrative Note. There are specific standards of charting that must be met. Protocols for monitoring and documenting procedures, medications, and patient cares. Based on responses in the patient assessment, tasks are automatically generated for skin care, and fall risk protocols. Certain procedures on the floor are covered separately from the room charge by insurance, when these are charted, charges are added to the patients final bill. Codes are used but due to the system set up, the nurse does not have to know them, she/he must only click a box and the system does the rest.

5. Structured/coded data allows for quality improvement generation and measurement, facilitates research, and standardizes care. Through research and QI, patient care is improved and Evidenced-Based medical practice is enhanced. Coded data can be accessed easily, shared among organizations, and used over and over again. The Medical Home Model will not succeed without structured/coded data that can be easily accessed by multiple providers. Kljakovic, Abernethy, and de Ruiter (2004) state, "the prompt and reliable flow of accurate information between primary and secondary health care is integral to the quality of continuity of care provided for patients in a health system." (p. 227)

Kljakovic, M., Abernethy, D., & de Ruiter, I. (2004). Quality of diagnostic coding and information flow from hospital to general practice. Informatics in Primary Care, 12(27), 227-234.