Module 6: Policy and Ethical Issues Related to IT

One of the new things that I learned in this module has to do with the different levels of computer threat. Worms, viruses, logic bombs, trojan horses, and bacteria. My computer is just as vulnerable to disease as a human. And just as a healthy immune system protects us from pathogens, so to does well designed software, firewalls, strong passwords and anti-virus software protect our computers from threat. But, probably it is also up to good luck...

Module 5 - Decision Support for Care Delivery

When I was in midwifery school one of the hardest things to learn how to make clinical decisions. My schooling up until that point had emphasized logic and reason. We were to make decisions based on a clear calculation of fact. But as a midwife we also have to use intuition. Dr. Daniel Kahneman in his 2008 lecture discusses 2 systems of the brain. System 1 uses intuition; system 2 uses reasoning. But how do you learn intuition? Kahneman (2008) reflects that with practice and time, skilled performance migrates from system 2 to system 1. It is only with repetition and exposure can expert clinicians shed the scaffolding of system 2 and make clinical decisions based on an informed system 1. Teaching system 1 thinking is not possible, it takes time and practice, expecting students to perform at this level is unreasonable (anyone using system 2 should know that!). 

Module 4 - Teaching with Technology

I teach every day. And every day I am challenged to find a new and innovative way to communicate information to my students, colleagues, patients, and trainees. This challenge excites me. Currently I am "obsessed" with simulation and debriefing. I think that simulation/debriefing is one of the best teaching innovations - it allows students and providers (no matter their clinical expertise) to learn in a non-judgemental, non-evaluative environment yet demands concentration, integration of principles, critical thinking and self-reflection. Participants in simulation are motivated to come to class prepared and to improve performance through team work and "group think." Although I can't use simulation in the same way with my patients as I do with my students, I do often ask patients who are facing difficult family conversations and or behavioral change to role play with me what they will do when faced with a  particular scenario, and it seems to work, the client often feels better about her ability to approach difficult subjects. Nursing is a teaching profession- we are good at it and we can't deny its centrality in our everyday interactions with patients, families, and other members of the health care team.

Check out this link: http://editthis.info/nurs_6004_mobile_devices/Main_Page

Module 3 - Information Retrieval

This module’s overview of the database search options (PubMed, Cochrane Database, CINAHL), the underlying principles of reference search (including the use of MESH terms in PubMed), the use of EndNote as a reference management tool, and the use of the existing web guideline clearinghouse has been as great reminder of the available resources. As I move forward in my career and graduate education the efficient and effective use of reference articles will help me not only with the complication of material and review of literature for my capstone project, but also in the clinical setting as I continue to practice evidence-based medicine. EndNote is a program that I have never used to its utmost. This overview along with the additional information (including the library class) will help me once and for all get my references organized and help me save time in the completion of articles and papers.

Happy Searching!

Susanna 

Module 2 - Information Systems at Work

As I alluded to in my last post, we are currently using Epic in our clinics. The first couple days back have been hard, but things are getting easier and I am getting more efficient. When we first started using Epic (we are a group practice of 13) each provider was doing her own thing, which made sharing patients difficult. We had to find a way to standardize the way that we looked at the patient's chart and the way that we charted our visits, otherwise we were worried we might miss something critical. The first thing I did was to sit down with our Tech support and learn the nuances of Epic. Then I wrote a 1 page reference sheet that was laminated and given to each provider. This sheet was a "Chart Review Guide." It instructed providers to first look at the communication tab, then the problem list, then the lab results and the the OB navigator. This way we were sure that small pieces of information were not lost from provider to provider. Next I created, with the input of each provider, a series of 12 smartphrases, this helped us standardize our charting and greatly reduced the amount of time that we spent typing. What we soon found out was that smartphrases alone were not sufficient (the were unstructured and thus did not allow us to query data and perform searches). We are currently in the process of redoing our charting to be more structured. Cross you fingers, it will be an interesting journey!

Module 1

Hello and welcome to my first ever blog! I am Susanna Cohen and I am a midwife. I am currently in full scope midwifery practice with BirthCare HealthCare the University of Utah, College of Nursing  faculty practice. In addition to this, and being a DNP student, I am the Director of Nurse Midwifery and Women's Health Nurse Practitioner Program at the U and I am the co-director of PRONTO International, a group of dedicated providers who do Obstetric and neonatal emergency simulation team-training in rural Mexico and soon in Northern Guatemala. Wow, was that a mouthful. I will be working on my web-writing this semester for sure.  I am originally from Berkeley, California and have been in Salt Lake City for almost 4 years.

Currently in my clinical practice we are experiencing a complete overhaul of our medical record system. We started out slowly, but now we are "almost" completely electronic. I have to admit that I was completely overwhelmed by the transition, and was convinced that we were going to kill a patient because we wouldn't be able to access information or because we didn't know where to look for information. My coping mechanism was to run away to Mexico for 6 months where doctors still carry  manual typewriters with them into the OR, and nurses chart (or rather rarely chart) on paper. My colleagues who have been using the EMR for 9 months, say they are just now beginning to see the time saving benefits, but I suspect my re-entry will not be so smooth.

Tomorrow is my first day back to clinic... here's hoping I won't be swallowed up by the tabs and smartpharses.

Cheers,
Susanna