N6004 Module 6

What is one new thing you learned in this module, or something that you knew but had forgotten?
I learned many useful things in this course, but the one thing that stands out in my mind was the information we learned about Clinical Decision-Support Systems (CDSS). This is definitely something that I can envision using as a nurse practitioner. In fact, I found a CDSS that relates to mental health and is based on the Texas Medication Algorithm Project!
I would like to say thank you to Allen and Seraphine for a great class and for quick email responses when I had questions. I still wish I had taken this course during my first semester (it would have saved me hours of time and days of headaches!) I wish you the best…have a great summer!

Module 5 blog

Before I started this module, I had never heard of Clinical Decision Support Systems. In the birth center I work in, we don't use these types of programs. I do think it is unfortunate, however...just because our patients tend to be young and healthy doesn't mean that we don't get patients who have acute and chronic illnesses. I think a CDSS would be a wonderful nursing support for times that we have patients we don't 'typically' care for.

When we turn to our dated nursing manuals, we find that they are of little help to us. We end up spending time doing internet searches for information, hoping that we are using sources that are current and reliable.

The way I have increased my nursing knowledge is to keep up with reading my professional journals, attending 1-2 seminars per year, and earning 30+ hours of CEU's per year, even though my state does not require that much. I really believe in the value of evidence-based medicine and I try to use that to my advantage with my patients. I found the Tversky & Kahneman article interesting...but I know using my intuition and following my 'gut' over the years has been very important for my patients' health and safety. I agree, however, that there is a need to balance intuition with evidence-based practice.

Because of this module, I have been looking into psychiatric/mental health CDSS's and have started to compare them so that when I graduate I have one or more of these wonderful tools at my fingertips for every patient encounter. I am also excited about using a PDA, which can be a wonderful tool as well.

Module 4 blog

1. What kind of teaching is done in your professional role? Working in a family birth center requires that the nursing staff know a lot about birth, newborns, breastfeeding, and self-care of the mothers. I currently work in postpartum or ‘couplet care’, where we take care of 3-4 mother-baby couplets after delivery and transition. Mothers with vaginal deliveries typically stay for 24-56 hours and those with C-sections stay for an average of 72 hours.
There is a wide variation of teaching that we provide. Some examples include:

a) Discussion-from the time a family comes into labor until they go home, our staff have conversations and answer questions from new moms, dads, siblings, grandparents, and visitors. Important discussions revolve around safety, infection control, pain management, self-care, breastfeeding, what to do in case of an emergency, and care of the infant. In these discussions we frequently ask the patient and family to repeat back what they have learned so that we can evaluate any important teaching needs before discharge.

b) Written-as soon as the mother-baby couplet arrives to postpartum, they are given a discharge packet. This includes information on newborn and early infant care, breastfeeding, and other important topics. We created these packets to educate at a sixth grade level and to be culturally sensitive; we have Spanish packets for our Hispanic patients. We encourage the mothers to begin reading through the packets at admission so they have time to ask questions about the material. When the family discharges home they are given a ‘Logicare’, which is a computer-generated list of educational material that the nurses create by choosing appropriate topics. They also receive a medication reconciliation, so they know exactly what meds to take upon discharge. We also provide teaching about prescriptions written by the doctors.

c) Diagrams and photos-a lot of the breastfeeding information given to the mothers includes pictures and diagrams about how to deal with a poor latch, sore nipples, using a breast pump, waking a sleepy baby, and kangaroo care.

d) Demonstration-we offer mothers the use of a breast pump (if needed). Each pump kit has detailed written instructions and a hand pump for home use; however, we teach the use of the pump at the bedside and let the mother return demonstrate how to use it.

e) Demonstration/discussion/support-one of our main types of teaching involves hands-on education about how to breastfeed. We try to deal with problems as soon as possible to encourage a mother to continue breastfeeding. Because we are a healing hospital, this is one of our priorities because we want every breastfeeding mom and baby to be successful long after discharge. Our lactation consultants follow up daily with moms over the phone, offer office consults after discharge, and run a very popular breastfeeding support group every week.

f) Demonstration-we teach families how to care for moms and babies by the way that we care for their needs. We encourage return demonstrations with pericare and incision care…or clothing and diapering infants, for example.

g) Videos-we now offer our discharge class as videos in the room that moms and families may watch at their convenience. We have eight videos, including an amazing 2.5 hour breastfeeding video that we turn on while moms are breastfeeding or resting in bed; they are able to pause the video if they have visitors or other interruptions.

Overall, our unit uses a variety of teaching methods that are useful to any type of learner, and for any combination of multiple intelligences.

2. Is there any nursing/health care provider role that does not involve teaching in some manner? We have many health care providers that have direct contact with the patients (nursing staff and charge nurses, medical doctors, certified nurse aids, lactation consultants, lab techs, scrub techs, and social workers). While lab techs generally do not teach at the bedside, they do discuss what labs they are drawing on the patient if the patient asks, but they defer any questions to the nursing staff. We have unit secretaries that generally don’t have any patient contact in the rooms, because they sit at the front desk of labor and delivery. The unit secretaries control who may come into our locked unit. They don’t do any formal patient teaching; however, they do answer questions for visitors and patients walking in the hallways. In a limited capacity, they are able to review unit ‘rules’ and safety precautions related to the safety of babies and infection control. They also monitor latex balloons from coming into the unit. This upsets visitors and requires educating them about the risks of latex to patients and several of our staff who have severe latex allergies. Scrub techs generally don’t do patient teaching, because they work with equipment, stocking, and taking care of the operating rooms and sterile areas. However, if they are in the main areas and hallways, they may be questioned by visitors and patients. They usually help to find the staff person that they need to talk to.

Module 3 blog

I chose two electronic indexes: PubMed and CINAHL. Once you do the tutorial for them, they are very user-friendly. It is helpful to use the 'advanced search' to quickly decrease your results from thousands to just a handful of very specific articles. For evidence-based practice, this is probably the fastest and easiest way to come up with exactly what you need for research and literature reviews. You can also list articles by most recent first, which is a great way of simplifying the search as well. I found all the articles I needed for my topic, which was nurse practitioner education (related to preceptors and preceptorship).

Next, I used the guideline index to look up a different topic, because the National Guideline Clearinghouse is more specific to diseases and treatments or interventions than it is to education for NP's. I chose NMS (neuroleptic malignant syndrome) because I had a patient last week who had experienced this life-threatening and life-altering condition. Unfortunately, after several searches including an advanced search, I was unable to find treatments/ interventions. It does, however, have information about many different medical conditions and 'grades' interventions based on evidence-based research.

Finally, I did a basic Google search on my original topic of nurse practitioner education relating to preceptorship. I found one interesting article, but it was not research or evidence-based information. Most of what I found were websites of online nursing schools. While Google can lead you to Wikipedia, which offers a lot of basic information on just about any topic, this information is not necessarily evidence-based. It can, however, lead you to other websites that have more information on your topic. The caveat is that it may be difficult to determine if the information you find is from a reliable source.

Streamlining nursing report...(Module 2 blog)

Picture this...a crowded room with five chairs, standing room only for two dozen nurses and ancillary staff, a noisy icemaker, talking, interrupting, loud laughter, last shift's crumbs and trash on the table, and trying to listen to report about the entire birth center. Add in a nice dose of claustrophobia and not being able to go out to the unit until 0712 to receive report on your own patients: four mother-baby couplets...just as the call lights start ringing incessantly. Furthermore, by the time the entire unit has finished report, it is late enough that couplet care nurses from the previous shift are not getting out on time. This is basically how report has been going on for years in my unit, and to my knowledge there have been no attempts or discussions on how to make it faster and less stressful.

First of all, if I could design and implement a way to streamline report, I would completely separate couplet care from L&D and nursery.

1. Nursery needs to go to report with L&D so they know the patient census and impending deliveries they will be attending. It is important that the nursery nurses know of any risk factors before deliveries, and if there are any scheduled c-sections to prepare for. They helps them plan their assignments.

2. L&D will be able to look at the patient census on the computer 'chalkboard' in the main report room, and discuss their patients, nurse assignments, and who will attend to triage and the OR. They will be advised of the couplet census and expected number of discharges (r/t room availability). If they have a delivery, the chalkboards have the room number their couplet will move to as well as the name of the couplet nurse for report. Nursery will discuss their plans r/t assignments and special care babies.

3. Couplet care will use a different report room to view the chalkboard for census and discharges, as well as impending deliveries and which nurses are expected to take the first few admissions. They will receive their paperwork/patient profiles. Any discrepencies or nurse/room changes can be worked out in a quieter, calmer atmosphere. This report will enable them to be out of the group report more quickly and to get their individual patient's report from the nurses on the previous shift.

4. Important notices: nurses will be notified by the charge nurses if there are patient name alerts, visitor issues, risk for violence, computer problems, maintenance in room 301 today, etc.

5. Not-so-important notices: Will be written in a binder in both report rooms. Each nurse is expected to sign or initial that she read them each day that she works. (Typically these include topics such as "sign your timecards", "there is a staff meeting next week", "we are taking up donations for our 'adopted family' for Christmas", etc. This would be very helpful to nurses in our unit because we work 12-hour shifts and many nurses are part-time or PRN. Often we are off for three or more days and don't know what has been going on.

Because the number of our staff has increased significantly over the past four years which causes space and communication issues, I believe that this could be implemented by our unit.