iPad 4.2 Software Features

I downloaded the software update for the iPad yesterday.  Wow! 

It took me a couple of minutes to figure out how to create folders.  Guess it was the Windows preconceived mindset that blocked the progress.  All I had to do was to drag one app over another.  The folder was automatically named by category, such as utilities, business, etc. 

The next feature was to take an advantage of the iPad locator feature.  Since the iPad is so small and black in color, it is easy to "lose" it or for it to be stolen.  The locator feature allows the used to log into http://me.com/ to find the missing iPad.  If the iPad was stolen, the owner can either "lock" or "wipe out" the device.  How cool is that?  Of course the bad guy would have to have the iPad on, but since it is such a cool device, why wouldn't it be turned on?  The security app is available commercially for laptops and desktops.  However, IMHO it should be a standard feature!!  A screenshot of the finder feature is noted below:

Finding the Dollars in What Nurse Do

Linda added the following to the textbook website:

Morris, K. (2010) Nursing Makes Cents: Finding the Dollars in What Nurses Do. An excellent article focusing mainly on the intensity of nursing care which is the one nursing specific item from the Nursing Minimum Data Set that none of the terminologies address. Links to some excellent resources at the end. (Added November 22, 2010)


http://www.ohnurses.org/AM/Template.cfm?Section=Nursing_Makes_Cents_The_Economic_Value_of_Registered_Nursing&Template=/CM/ContentDisplay.cfm&ContentID=5197

NLN Simulation Scenarios

SimMan Cases - Volume I
Nursing Surgical Core Case

• Lower Leg Fracture – Basic Assessment
• Preoperative Bowel Obstruction – Spiritual Needs
• Immediate Postoperative Abdominal Hysterectomy – Managing Nausea
• Postoperative Hemicolectomy – Preventing Respiratory Complications
• Postoperative Hip Arthroplasty – Blood Transfusion

Nursing Surgical Complex Cases

• Lower Leg Fracture – Compartment Syndrome
• Preoperative Bowel Obstruction – Fluid and Electrolyte Imbalance
• Immediate Postoperative Abdominal Hysterectomy – Opioid Intoxication
• Postoperative Hemicolectomy – Pulmonary Embolism
• Postoperative Hip Arthroplasty – Blood Transfusion Reaction

Nursing Medical Core Cases

• Acute Strep Throat – Mild Reaction to Antibiotic
• Mild Asthma
• Chronic Obstructive Pulmonary Disease – Oxygen Therapy
• Angina – Coronary Artery Disease
• Diabetic Insulin Administration
• Nursing Medical Complex Cases
• Pneumonia – Severe Reaction to Antibiotic
• Acute Severe Asthma
• Chronic Obstructive Pulmonary Disease – Spontaneous Pneumothorax
• Acute Myocardial Infarction
• Diabetic Hypoglycemia

Volume II Nursing Cases

Case 1 - Spinal Cord Injury - Brandon Sharp

• Core Case - Skin Integrity
• Complex Case - Autonomic Dysreflexia

 Case 2 - Cerebral Vascular Accident - Wiliam Edwards

• Core Case - Aspiration
• Complex Case - Ischemic Stroke

 Case 3 - AICD - Liling Sung

• Core Case - AICD Malfunction
• Complex Case - AICD Firing

 Case 4 - Congestive Heart Failure - Charles Jones

• Core Case - Medication Management
• Complex Case - Fluid Overload

 Case 5 - Sickle Cell Anemia - Tony Wallace

• Core Case - Mild Acute Exacerbation
• Complex Case - Fluid Acute Chest Syndrome

Case 6 - Renal Colic - Bobby Davis

• Core Case - Pain Management
• Complex Case - Acute Kidney Injury

 Case 7 - Gastrointestinal Bleeding - Valerie Jones

• Core Case - Assessment and Patient Teaching
• Complex Case - Ethical Considerations

 Case 8 - Pancreatitis - Maria Gonzales

• Core Case - Assessment and Symptom Management
• Complex Case - Hemodynamic and Respiratory Instability

Case 9 - Hip Fracture - Ruth Livingston

• Core Case - Impaired Mobility
• Complex Case - Altered Mental Status

 Case 10 - Liver Cirrhosis - Dale Mayman

• Core Case - Patient/Family Teaching
• Complex Case - End-Stage Disease

High-Fidelity Patient Simulation

Last week, I participated in a 2-day training for the Laerdal high-fidelity human simulator.  Late Saturday afternoon, our workgroup assisted DB to prepare a scenario for one of the med-surg classes.  Besides being able to share accurate information regarding simulation in the textbook, I also wanted to explore the use of simulation in courses that I teach and to develop some scenarios myself.

Clearly, I will have to practice what I teach and PRACTICE my learning :-)!  That is okay.  This weekend I explored the NLN (National League for Nursing) SIRC (Simulation Innovation Resource Center) website.  The GC School of Nursing has purchased Volumes I & II of the NLN materials. I was pleased to note that NLN is also posting resources developed by other faculty members at no charge.  As an example, Cynthia Reese, faculty at Lincoln Land Community College, developed four geriatric scenarios.  The scenario involve an 84-year old widow.  The scenarios, audio files, scripts, and debrief resources can be downloaded from http://www.nln.org/facultydevelopment/facultyresources/ACES/millie.htm

On a separate website, there is a scenario for massive pulmonary embolus and PEA (Pulseless Electrical Activity) at http://www.rhodeislandhospital.org/rih/services/simctr/training/modules/uss-case-1.pdf

Other resources that can be used to design the scenes for simulation training can be obtained from the Pocket Nurse website at http://www.pocketnurse.com/

Ethics and HIT

Last week a task force for AMIA (American Medical Informatics Association) released a report entitled "Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force."  The report provides clear direction to vendors and system purchasers regarding ethics and HIT. 
 
A quote from the report abstract is below - although I took the liberty to bullet and emphasize statements to make them clear to the reader.  The full 5-page report is available online at http://jamia.bmj.com/site/icons/amiajnl8946.pdf
 
"Task Force findings and recommendations include:

• patient safety should trump all other values; corporate concerns about liability and intellectual property ownership may be valid but should not over-ride all other considerations;
• transparency and a commitment to patient safety should govern vendor contracts;
• institutions are duty-bound to provide ethics education to purchasers and users, and should commit publicly to standards of corporate conduct; and
• vendors, system purchasers, and users should encourage and assist in each others’ efforts to adopt best practices.

Finally, the HIT community should re-examine whether and how regulation of electronic health applications could foster improved care, public health, and patient safety."

iStethoscope

Read an article at http://newslite.tv/2010/08/31/istethoscope-iphone-app-used-i.html that discussed how the iStethoscope is being used at hospitals.  I tried it out (will not trade my stethoscope for the app).  I had to activate the app first - and received the following message:
"Your iphone may interfere with implanted medical equipment such as pacemakers or defibrillators.  By activating the iStethoscope Pro you agee not to use you iphone near paople with such implanted equipment..."

Also read that FDA is going to get involved with approving this type of app.  Bottom line is that either I am technologically impaired or that the app is not ready for prime time.  I will let you make the decision :)

Pay for Performance and Nursing Care

Is nursing getting recognition because of pay for performance?  Some suggest that is the case.  For example, consider the issue associated with Central-line Associated Bloodstream Infection (CLABI).  While it is a "mixed bag" regarding the reason patients with central lines get infections, nursing is an important part of the equation because we manage the lines after insertion.

I read this morning about the Maryland Healthcare Commission posting the CLABI rates, compared with the national average for all of the hospitals in the state (http://mhcc.maryland.gov/consumerinfo/hospitalguide/hospital_guide/reports/find_a_hospital/clabsi_all_hospital_table.asp?icu_id=AdPed).  I was saddened to see that a hospital where I worked for 13 years 5th from the bottom of the list with a CLABI rate twice the national average.  What was even worse, is that the smaller hospital 50 miles up the road in Easton had a rate that was almost 5 times the national average. 

Reflecting on the problem makes me remember taking a healthcare finance course at the University of Maryland when I was shocked to see the differences in outcomes from a financial perspective.  In that particular case it was looking at hospital length of care days and co-morbitity associated with hysterectomy.  I was shocked to see that a hospital on the southern Eastern Shore of Maryland had LOS that was double of where I worked and a higher morbility rate.  That was when "I got it."

It saddens to see healthcare stimulated to make improvements only because of pay for performance.  That said, on the other hand, before benchmarking data, hospitals really did not have the information to assist in making care improvements. Yes, nursing is getting recognition for performance.  A comparison of hospitals is something that nurses should consider when applying for jobs.  A good place to start is to examine the Department of Health and Human Services Hospital Compare web site at http://www.hospitalcompare.hhs.gov/

Online Statistics Resources

Information on using online resources to learn and use statistics applications is in Chapter 25, Informatics and Research.  Included are links to free information and applications, such as Brightstat.  If you want to brush up on statistics, take a few moments to explore the links below.

Links:

• Statsoft e-book- http://www.statsoft.com/textbook/
• Online Statistics:  An Interactive Multimedia Course - http://onlinestatbook.com/
• Rice Virtual Lab in Statistics - http://onlinestatbook.com/rvls.html
• Research Methods Knowledge Database - http://www.socialresearchmethods.net/kb/
• Brightstat free statistical analysis software - http://www.brightstat.com/
• Brightstat video tutorials on YouTube - http://www.youtube.com/user/brightstat

Data Analysis and Extraction Tool - DataFerrett

Chapter 25, Informatics and Research, in the textbook has information on an application called Data Ferrett(Federated Electronic Research, Review, Extration, and Tabulation Tool).  The application is available for the PC and Mac.  The  user first downloads the applet tool from the internet.  Once it is installed it can be used to recode data, analyze public microdata (individual responses), and create customized spreadsheets. 
DataFerrett is used to locate and retrieve the data from the web.  The application is still in beta form and can be downloaded from http://dataferrett.census.gov/

The website includes tutorials and videos.  A step-by-step tutorial is available at http://www.thedataweb.org/dataferret_tour/start_tour00.htm

To view the video that has an explanation re the use of the application, go to http://dataferrett.census.gov/DataFerrett_video.mov  The screenshot below shows the applet menu.

Merging Two Documents Using Word

Some days it doesn't take much to make me happy and today (a drizzly, rainy day) is one of those days! I received a document that was revised without using the Review menu in Word, but I needed to be able to make the changes visible.  Not a problem!! :) I checked the Help feature in Word only to find that the menu was right under my nose on the Review menu - the Compare function.

The first step I took was to open the original file and click Track Changes in the Tracking menu.  Next, I clicked on Compare in the menu.  A window popped up asking me to select the two files that I wanted to compare.  I selected the original document with Track Changes activated and the revised document. The next step prompted me to select which document to use to combine the changes.  I selected the original document.  A final click and the process was complete!  Amazing and so simple!!

A screenshot of the final "Combine" window is displayed below.