Sunday, December 27, 2009

NU501, final project feedback

NU 501, Nursing Informatics, Assignment 5, Grade A
You did an excellent job with your Blog! The content is thorough and describes many aspects for nurses that deal with end of life issues. The appearance is well organized and easy to read. The font and color were also appealing and easy to read. Your content is provocative and through provoking in an area that needs much attention and gets very little. Nice job!

Why, thank you very much.

Now I just need to finish that paper for assignment 4...

Sunday, December 20, 2009

NU 501 Leapfrog to Assignment 5

Blogging about blogging...

It's been taking me much more time to finish assignment #4, which is a research paper that complies with the APA format. I'm writing about blogging, and though I've got the general structure and what I want to say pretty much established, along with the supporting material and sources, it's just a freaking slog.

So, last week I took a chance and wrapped up the report to accompany my final project, which was Assignment #5 -

I first proposed developing my other blog to complete the final project requirements back at the start of the course, and promptly got the go-ahead from Sharon, my instructor:



I can't help but chuckle now at my hubris - I really did think I'd be able to submit the first four assignments in a single month, and then coast to a finish sometime before Halloween with the assignment you're reading now.

Ah, ha ha ha!

I guess life just got in the way, and this course turned out to be more work than I anticipated. But I mean more work in a good way. It's really been a challenge and a lot of fun. I love this stuff, and it takes time to do things right. So, here we are looking at Christmas and I'm still tying up loose ends.

Anywhoozle...

I even heard from my overall advisor the other day, wondering what was up:
On Thu, Dec 17, 2009 at 3:45 PM, Holly XXXXX wrote:
Hi Jerry,

I was just reviewing your course progress and noticed that Unit IV is missing….please contact me soon. We are also still waiting for your official transcripts the University of Mass @ Boston.

~Holly

Holly XXXXX, Academic Advisor
Saint Joseph's College of Maine
Graduate and Professional Studies
Oops. Here's what I replied:
Jerry Soucy to Holly XXXXX, Sharon XXXXXX
Dec 17

Hi, Holly:
I submitted the Unit V assignment earlier this week, and noted to Sharon in the accompanying email that I had leapfrogged Unit IV to submit a written report to accompany my final project. I'm working on the Unit IV assignment - a research paper that complies with APA formatting requorements - but it's proven to be a long, hard slog.

Sharon approved my final project proposal early in the course, and since the project has been ongoing (see it here), I was in a better position to develop the project report quickly. I didn't want to be sitting here with two missing assignments at this point.

I haven't heard back from Sharon yet - either her feedback on the project report, or her response to my leapfrogging Unit IV.

I'll follow up with UMass/Boston and my transcript request after the holidays.

Thanks, Jerry
So, I'll let the chips fall where they fall, and will get back to wrapping up that APA-formatted paper right after I post this material.

- - - - -
Implementing Information Technology Into My Practice: A report on my blog, Death Club for Cuties

Introduction

This report describes my experience to date with Death Club for Cuties (‘the blog’). It includes an analysis of the material I have written, as well as the visibility I have earned and the interactions I have had with others who share my interests.

This report also identifies potential objectives for the blog’s continued development.

Objective

I started the blog on February 15, 2009 as a way to explore several topics of personal and professional interest – nursing education, end of life care, and the use of blogging as an information technology tool for professional development.

I also planned to explore ways that the blog could support a project I am undertaking at work, namely to develop a core team of nurses skilled in providing end of life care to patients and families on our 20-bed neurosciences intensive care unit.

Summary – Blog posts, readers, and reader comments

As of this writing I have submitted (“posted”) 27 separate essays (“blog posts”). Eleven (11) of the blog posts have generated a total of 34 reader comments, 5 of which are mine. The remaining 29 comments were posted by 15 different readers.

Gail Rae has posted 9 individual comments, the most of any reader. Five (5) of Gail Rae’s comments were posted on the same day. The reader who signs herself ‘risaden’ has posted 5 comments, while Wounded Healer and Christian Sinclair, MD have each posted 2 comments. The remaining readers who have posted a single comment are: Jan Henderson; Karen; RB; LeighSW; Jessica Knapp; Sally; Øystein; Marty Tousley, CNS-BC, FT, DCC; JerseyRN; Eric Widera; and Angel.

The reader comments are most often expressions of support and encouragement. Some readers have also noted their own experiences and reflections, related to the tone or subject of my original blog post; and/or have highlighted their own material, or that written by others, related to the subject or tone of my original blog post.

The first reader comment was posted by risaden on June 4, 2009 in response to the very brief blog post “One small step at a time,” which I posted on May 30, 2009. Her comment was, “Yes, keep posting.”

Most of the people who have left comments at my blog are themselves bloggers who write about palliative care, end of life, health care policy, grief and bereavement, and other matters related to health care.

The following readers are also bloggers:

A review of blog posts, by month

My blog posts can be grouped into 3 general categories:
  • Meta – These are blog posts about blogging itself, and about the interests and motivations that led me to blogging. The purpose of meta posts have often been to explain and explore the status of my blogging efforts, as well as the status of the companion project to develop an end of life care team that I submitted to my manager, and that was subsequently approved. The general focus is one of self-reflection, processes, and relationships.
  • Topical – These blog posts explore one or more subjects or issues directly related to end of life care, nursing education, and general health care policy and delivery. They are based on original material that I have either developed specifically for the blog, or that I originally developed for some other purpose or audience, but have adapted to the blog’s format and purpose.
  • Links – These are blog posts that may contain little original material, but that reference material developed by others for online or traditional media which I find personally interesting, and which I wish to share with my readers.
Some blog posts combine characteristics of more than one catergory. In the following section, I identify and briefly discuss the 27 individual blog posts that I have developed to date.

February

2/15/09 meta, link, topical

I had already been planning to begin a blog on end of life care and nursing education for some time when I read a blog post, known as a ‘diary’ at DailyKos, by the blogger and community member memfromsomerville (‘mem’) about Ted Kennedy. mem’s diary, simply titled ‘Teddy,’ prompted me to first post a comment there in response. I subsequently took the opportunity to adapt that comment with very minor changes as the first post on my new blog.

March

3/28/09 meta, link

I posted my second blog entry a little more than one month after my first, again in response to a diary at DailyKos. This one was simply titled, ‘Wife,’ by the writer who calls himself ‘The National Gadfly.’ It’s a moving and deeply personal account of his visit to her grave, and a reflection upon her life. I also used the opportunity to post a brief meta reflection on my proposal and blogging.

April

4/23/09 meta, link

At this point, I was on a roll to post a single blog entry each month, the focus of which was to reflect upon the status of my proposal. In this particular post I also noted for the first time the existence of other bloggers writing about end of life and palliative care, and linked to them.

May

5/30/09 meta, link

Another month, another brief meta post accompanied by a link to related content that had been more fully developed by someone else. There was a twist this time around though – my first reader comment (by risaden)!

June

6/24/09 meta

Again, a single brief meta post as the only post for the month, though this one is a bit more developed and touches on the issue of humor.

July

7/8/09 meta, link

I didn’t know it at the time, but I had entered the first month where I would post more than a single entry. This started as another meta ‘I need to post more posts’ type of post, though I also referenced the recent sudden death of a colleague at work, and included a link to a site that I found largely as a result of my interest in the works of the artist Sheperd Fairey. The reader risaden also left a comment of encouragement in response.

7/11/09 link, topical

This was my first true non-meta blog post, based on a concept I had developed to help provide context for the family members of my patients. This post was selected by risaden when she hosted the August edition of Palliative Care Grand Rounds, a monthly summary of material in online and traditional media for end of life and palliative care profesionals.


7/21/09 meta, link, topical

This post directly references a series I developed at DailyKos that drew on poetry and wire service photographs associated with the invasion and occupation in Iraq as a way to explore and witness grief. This post was an attempt to establish a theme or structure that could be repeated as a regular feature in my blog.

August

8/4/09 meta, link, topical

Essentially identical to the previous post, though this one prompted a comment by Gail Rae.

8/21/09 meta, link, topical

Though I have never hesitated from expressing my personal political and policy views in strong, even confrontational, language in other blogs, I explicitly decided not to do so in this one. I think it’s because I want Death Club for Cuties to be regarded as a source of somewhat more objective, or perhaps less polarizing, information. This post comes the closest of any to contradicting my decision.

8/25/09 meta

More thoughts about, and descriptions of, the status of my proposed projectl at work. Hindsight is a funny thing, because though this blog post identifies the month of October as the official starting point for my project, here we are in mid-December and it still hasn’t happened. This post does note that I had established a connection with two other ELNEC trainers at work, and that I’d be contributing content to the course they were supervising. That event did happen, and the material I developed for my class was the subject for a subsequent post.

8/26/09 meta, link, topical

This was posted in response to the death of Ted Kennedy, and points back to my opening post in February. I also drew extensively from others commenting on Kennedy’s death, most notably colleagues at DailyKos, as well as several video links.

September

9/1/09 meta, link

Here I link to the first assignment I completed for NU501. Seems like a long time ago. Seems like yesterday.

9/3/09 link

I’ve followed the blog called ‘Bag News Notes’ for several years, and have had the chance to meet and talk with Michael Shaw, the clinical psychologist who developed the blog and writes much of its content. The Bag is dedicated to the analysis of visual media, and Shaw’s approach is unique and powerful. Here I feature an image and link to a photo essay at the Bag about end of life.

9/6/09 link, topical

I’m proud of this piece for several reasons, most notably because I wrote it carefully, to protect confidentialty, as a case based on personal experience. The post was selected for the October edition of Palliative Care Grand Rounds.

9/8/09 meta, link, topical

This is another piece that I’m proud of for its form, content, and focus.

9/10/09 meta, link, topical

This was another post associated with Ted Kennedy, as well as with the larger discussion of the current attempts to reform health financing policy.

9/15/09 meta, link, topical

This piece is probably best appreciated as a companion to one I developed for my other blog at about the same time. That post is called ‘This will probably come in handy later.’

Both pieces relate to the slow health decline most often associated with aging. It was influenced by the readings I had begun at the blog, GeriPal, which itself focuses most closely on end of life as it relates to aging (as opposed to terminal illness or sudden injury).

9/22/09 meta, link

This post represents a significant milestone in the life of my blog, because it marks the point at which I was asked to host December’s Palliative Care Grand Rounds. That moment was kind of like being brought up from a minor league team to play in the World Series.

9/28/09 meta

A long post that simply reproduced the lengthy email sent to my colleagues, inviting them to join the end of life care team I had proposed earlier in the year.

October

10/21/09 meta, link

Here, I try to explain why I’m not posting more frequently to my blog (and why it’s taken me so long to complete another NU501 assignment).

10/24/09 link, topical

This is another favorite post, because the original story that I linked to is very compelling, and because the subject of that story came by and left a comment. That’s precisely the kind of interaction and connection that blogging makes possible.

10/31/09 link, topical

I’m sorry that nobody left any comments, because I’m really invested in this piece. That’s as true now as when I originally developed it several years ago as part of an online course for first-year students in an associates’ degree in nursing program.

November

11/2/09 meta, link, topical

This post was featured in November’s Palliative Care Grand Rounds. I’m still waiting to hear if my proposal’s been accepted. Any day now…

12/20/09 Update: Sadly, No!

11/13/09 link, topical

This is the script and slides that I used in a class on the subject of ethics, which I presented to the participants at an ELNEC course conducted at my hospital by two colleagues. I also subsequently presented this same material to first year/first semester nursing students in an associates’ degree in nursing program. The class preparation took a substantial amount of time and effort, and is offered up as another excuse for why it’s taken me so long to complete my remaining NU501 assignments, and for why my pace of blog posts has continued to be so spotty.

This post also generated the most substantial response of any, both in the form of a detailed comment in my blog by Gail Rae, and in the form of a lengthy and well-thought out piece at her own blog.

11/26/09 topical

On Thanksgiving Day, it somehow seemed appropriate to recycle the eulogy I delivered at my mom’s funeral 9 years ago.

December

12/1/09 meta, link, topical

I worked as hard and as long on this post as I’ve worked on just about anything I’ve ever written. My first challenge was to compile worthwhile material developed by others. My next was to assemble that material into a cohesive unit, with a unifying theme and enough context to have it all make some sort of sense. I’m very pleased with the response it generated, and with the recognition I received as a result.

The rest of the blog – what’s on the right side?

These components include an assortment of original text, links, and other material of interest that supplement the posts and support my blogging objectives. Some of the material is relatively permanent, while other components are subject to change and revision as required.

  • This Blog is for… - This is a brief statement of purpose, an introduction to help new readers determine their interest in the subject matter, and in my perspective.
  • About me - A very brief biography to convey my perspective and establish credibility.
  • Important Note - Here I invite readers to participate, and ask for attribution in the event that anyone wants to draw upon my material
  • Guiding Vision – A companion to the statement of purpose that draws upon a quote which mirrors my own view of my profession.
  • What’s With the Name? - Just in case anybody’s wondering.
  • End of Life and Palliative Care Resources – A list of links to individuals and organizations where others who are specifically interested in end of life care and/or nursing education can obtain helpful tools and information.
  • End of Life and Palliative Care Blogs – Similar to EOL Resources, though the focus here is on a specific category of blogs and bloggers.
  • Life, Death, Healthcare, etc - A looser list of organizations, individuals, sites, blogs, and bloggers than the others, though still within a defined set of themes.
  • For Good Self Care – Blogs and bloggers who have nothing to do with end of life care, but that I enjoy and want to share with others – particularly with regard to enjoying a good time and having a laugh. We can’t be all death all the time.
  • I Support – This is where I direct my charitable giving.
  • Fair Use – I adapted this text from Michael Shaw at Bag News Notes, and use it along with the enbedded links to preempt charges of copyright infringement.
  • Confidential Health Information – In the same spirit, I developed this text and its embedded links to convey my adherence to HIPAA regulations.
  • Archive – For access to prior blog posts, organized in reverse chronological order.
  • My Other Blogging – It’s kind of like potato chips. Who can eat just one?
What the data shows – comments and illustrations on blog traffic and other useful parameters

After I had decided to blog about end of life care and nursing education, I had to ask myself – Who’s going to read this stuff?

I didn’t act in any concrete way to begin answering this and related questions until I embedded a small software program (‘code’) known as Google Analytics into the body of my blog template.

Important side note – I’ve intentionally stayed away from engaging in any form of ‘how to’ set up a blog. It would be very easy to conduct a quick search to locate and review materials that provide clear and detailed instructions.

More importantly, my own approach to such aspects of blogging, and one that the technology supports, is to simply get started and figure things out for myself as I go along. While this may seem careless to some readers, it’s an attitude very much in keeping with the form.

My interest is in developing the content and the relationships, not in the underlying mechanics that make them possible. In other words, a blog is like a paper-based form. The real challenge, in my opinion, is to fill out the form well enough so that others want to read it.

So, at the risk of provoking the question, “But how do you do that?” let’s just say that by following the simple instructions on embedding Google Analytics code, I’m able to look at who’s visiting my blog, where they came from, and how long they stayed, among other things.

I’ll just focus on a couple of basic metrics that provide useful insights into my blog to date, and that illustrate how establishing a credible blog within a larger network can generate activity.

Note also that though I began this blog with my first post on February 25, 2009 I did not embed the Google Analytics code until August 26th. That latter date marks the start of my ability to analyze my blog’s traffic and visitors.

This chart above shows blog traffic, as a measure of all visitors who’ve come to the blog during the identified date range. The large spike on the right labeled December 2 indicates the substantial boost in traffic as a result of hosting Palliative Care Grand Rounds for December. Those visitors were pointed to my blog by several other blogs. This chart also notes a total of 1,167 visits for the measured period, along with a calculated daily average.

This second chart also shows blog traffic, though this time as a measure of the unique visitors during the date range. The distinction is a subtle but important one, as it counts each unique visitor only once, regardless of the number of return visits any one visitor may have made in a given day. The large spike on the right labeled December 2 again indicates the substantial boost in traffic as a result of hosting Palliative Care Grand Rounds for December.

Here are the top ten (10) referral sources to my blog. The sources numbered 2, 3, 4, 7, and 10 are other blogs. Source #9 is the nursing student/faculty communication site at a local community college where I recently taught 2 classes. Source #1 is actually not a source, and indicates that 127 of the 528 tracked visits arrived directly at the blog without benefit of a referral. The 3+ minute average time on the site is a fair measure of site ‘stickiness,’ and indicates that visitors stay at the blog long enough to read the relatively short posts. The majority of the visits for this time period were by people who had not previously been to the blog, and the bounce rate indicates that the majority of readers did not explore multiple posts.

This chart shows the top 25 referring sites for a different time period.

Some conclusions

To restate the objectives I identified at the outset: I began this blog as a way to explore several topics of personal and professional interest – nursing education, end of life care, and the use of blogging as an information technology tool for professional development.

I also planned to explore ways that the blog could support a project I am undertaking at work, namely to develop a core team of nurses skilled in providing end of life care to patients and families on our 20-bed neurosciences intensive care unit.

I believe that I have met, or have at least begun to meet, these objectives. This project is far from over.

I have begun to explore end of life care and nursing education by writing original material and assessing materials written by others. I have learned more about blogging technology, and about the process of blogging, through this project.

I have also begun to develop and participate in a network of professionals with similar interests, and have seen where that network has helped to build readership at my blog. This blog has the potential to serve as a forum from which I can continue to build my professional knowledge and expand my credibility and reach.

It’s not yet clear to me how this blog can be used to support the needs of an end of life care team that I will be developing at work after the holidays.

I’m very glad that I started, and I look forward to whatever may lie ahead.

Wednesday, November 4, 2009

NU501 Assignment #3 Feedback

NU 501, Nursing Informatics, Assignment 3, Grade A

In this assignment you demonstrated an understanding of the information systems in your institution and how they are integrated. You described the systems involved thoroughly and in an organized manner. Isn’t it amazing the number of applications there are and how at least some of them are able to communicate and share data with each other? I really enjoyed reading about your previous experiences and the historical perspective of some of the IT activities in the Boston area. One of the best papers I have read!

I could not have said it better myself ;^)

Tuesday, October 20, 2009

NU501 Assignment 3

This one took a bit longer than I had planned, but I'm glad that I took the time.


Some personal context


I work as a staff nurse in the neurosciences intensive care unit at the Brigham and Women's Hospital (BWH) in Boston. My primary clinical interest is caring for patients and families at end of life. I am also very interested in how information technology can be used to support patient care and nursing education.


My professional experience is split between my clinical work, which has been spent practicing in a range of critical care settings, and with patients receiving hemodialysis for end stage renal disease; and my work with patient care information systems, and with systems used more broadly as tools for individuals and organizations.


Many key advances in health care information technology occurred in the Boston-area. I've met and worked with some of the people who have played important roles in this industry, and I have incorporated a few personal recollections and observations in this assignment.

Brigham and Women's Hospital (BWH)


BWH is a 747-bed nonprofit teaching affiliate of Harvard Medical School, and one of the two founding member of Partners HealthCare System (Partners), an integrated health care delivery network.

source 2008 AnnualReport, Partners HealthCare (pdf)

BWH provides medical and surgical services, and has established clinical centers of excellence for oncology, and women's and reproductive health, cardiovascular/thoracic, neurosciences, orthopedics, and arthritis.

BWH has over thirteen thousand (13,000+) employees, of which over two thousand (2,000+) are staff physicians, and over twenty-eight hundred (2,800+) are registered nurses.

According to the most recent data from the American Hospital Directory, Partners member hospitals account for over sixteen percent (16%) of staffed beds, and over twenty-seven percent (27%) of gross patient revenue in Massachusetts.

BWH accounts for approximately 5 percent (5%) of the staffed beds, and approximately 8 and a half percent (8.5%) of gross patient revenue.



The foundation for information technology at BWH

This paper does not consider BWH's use of information technology prior to the formation of Partners in 1994.

Massachusetts General Hospital (MGH) has a notable history of computerization dating back over 40 years, which directly influenced the implementation and use of information teachnology at BWH. When Partners was established, the department responsible for developing and supporting information systems at MGH was reorganized as a corporate service to meet the needs the new organization's member hospitals. The core systems currently in use at BWH were developed and are maintained by this corporate services group, Partners/IT.

The systems currently in use at BWH can be appreciated in the context of the history of computerization at MGH. The impact of this history is most clearly seen in the development of the Massachusetts General Hospital Utility Multi-Programming System (MUMPS) by Neil Pappalardo and Kurt Marble, working under under G. Octo Barnett at the MGH Laboratory of Computer Sciences.

Pappalardo and colleagues developed MUMPS in 1966 and 1967 specifically to provide a set of programming and data management tools best suited for patient care computer systems. MUMPS was developed as an alternative to the tools and systems then in use to support commercial and scientific organizations.

As Henry Heffernan noted in his presentation at the 1980 meeting of the MUMPS Users Group (MUG) in Washington, DC:
“The data management and communications needs of clinical care and health care management were quite different from the business batch processing and large scale scientific computation tasks that had dominated the software system design thinking of the previous decade. The lesson…was that software systems should be designed to fit the paradigms of information usage in medical applications, instead of medical applications being twisted and stretched to fit batch processing paradigms.”

Pappalardo later founded MEDITECH, a company that continues to sell and support a wide range of integrated applications for hospitals and other health care organizations. He still heads the company as chairman. One industry observer has noted:
"...the talent involved in the founding of MEDITECH is astronomical. These are some very, very smart and successful people who made extensive contributions...I'm in awe of the influence these pioneers have had, not only in healthcare automation, but in healthcare in general...the story of MEDITECH and its founders is, to me, the most fascinating and awe-inspiring of any firm in our industry. Someone should write a book."

I worked at MEDITECH from January to October, 1986, and though I probably won't be the one to write that book, I did gain some insights into the company, its values, and its leadership role in the industry. There were about 350 people working at MEDITECH while I was there. The current count likely exceeds 3,500, just one indication of the company's steady growth.

I personally found MEDITECH's management culture too restrictive, which prompted my decision to leave. But nothing succeeds like success.

I left MEDITECH for a sales position at Collaborative Medical Systems (CoMED), where I worked for the next 8 years selling CoPATH, the best-of-breed anatomic pathology system. My customers included MGH, the Lahey Clinic, the University of Kentucky Medical Center, the University of Tennessee Medical Center, the University of Maryland Medical System, the Cleveland Clinic Foundation, University Hospitals of Cleveland, the Toledo Hospital, Children’s Hospital of Columbus, Mercy Health System, and other leading institutions throughout the country. I also sold a copy of CoMED's clinical laboratory system, CoLAB, to MGH as a replacement for an internally developed system used by the hematology and chemistry departments there.

CoPATH and CoLAB were written in MUMPS, and three of CoMED’s four founders had worked at MEDITECH earlier in their careers. One of CoMED's founders had developed MEDITECH's first commercial clinical laboratory system, and was responsible for hiring Howard Messing, who now serves as MEDITECH's president. All four CoMED founders were graduates of the Massachusetts Institute of Technology (MIT), as were Neil Pappalardo and Kurt Marble.

Another company bought CoMED shortly after I left in 1995. That company was, in turn, later acquired by Cerner Corp. CoPATH is still in wide use, including at U.S. Military hospitals around the world. That sale of CoPath to the U.S. Department of Defense was my final contribution and the company's largest sale ever.

It was a nice way to go out.


Information technology at BWH

The patient care systems currently deployed at the Brigham and Women’s Hospital include a mix of applications developed by Partners/IT, along with applications obtained from vendors.

The core inpatient care system is called BICSBrigham Integrated Computer System. It supports key administrative and patient demographic functions to support inpatient admissions and includes a master patient index (MPI), a permanent repository of information associated all admitted inpatients and registered outpatients.

BICS is also the mechanism for provider order entry (POE), where physicians and advanced practice nurses request a range of ancillary services including clinical lab tests and medications; and through which clinical staff access findings and results. Though POE does not provide all of the elements for a fully automated patient electronic medical record (EMR), it serves as an important component of the base from which an EMR is built.

Finally, BICS supports the complex needs of the BWH clinical laboratory and pharmacy departments, including the full range of each department’s functional processing and internal control requirements.

BICS was developed and is supported by Partners/IT using a toolset called Cache, provided by InterSystems of Cambridge, Massachusetts. Like MEDITECH, InterSystems is a leading vendor still headed by its founder, and whose history can be traced directly back to the initial development of MUMPS; though InterSystems evolved into a developer and provider of programming tools for others to use when building application systems.

This illustration shows the patient care applications most frequently used by clinicians and ancillary personnel at the Brigham and Women’s Hospital, and indicates the central role played by BICS.




Partners/IT has also developed an inpatient system for nurses and house staff called eMAR – the Electronic Medication Administration Record – though its capabilities go beyond administering and recording inpatient medications. eMAR is the main system used by staff nurses with mobile notebook computers during the course of most patient care, and is the conduit for access to other systems that include word processing and email, web browsing, facility and departmental policies and procedures, and BICS.

The following illustration depicts core eMAR functions, along with the interaction between BICS and eMAR.



Inpatient medication ordering and administration at BWH is controlled by several interacting information systems
  • BICS OE subsystem for provider order entry
  • BICS Pharmacy subsystem for pharmacy staff review/approval, drug-interaction and formulary check, and other internal controls
  • eMAR for scheduling medications
  • Omnicell for medication inventory management
  • Omnicell for medication access by nursing staff
  • BICS results reporting for nursing staff to review pertinent laboratory and related patient data
  • eMAR for patient/medication reconciliation by nursing staff using handheld scanner to identify the patient and the medication
  • eMAR for quick communication between nursing and pharmacy staff
Partners/IT has also developed a system for outpatient care called LMR – the Longitudinal Medical Record – which has been deployed throughout the Partners network at outpatient clinics and in provider offices. LMR supports continuity of care with access for authorized users, incuding primary care providers, to the full range of an individual’s inpatient and outpatient data.



The combination of systems developed by Partners/IT and obtained from vendors places BWH firmly within the very small minority of institutions found by reserachers to have comprehensive systems.
“On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals.”

from Use of Electronic Health Records in U.S. Hospitals

Similarly, the widespread application of information technology to support patient care establishes the Partners network as well along towards meeting national goals.


source 2008 AnnualReport, Partners HealthCare (pdf)

Other considerations

BWH house staff independently acquire and use their preferred personal digital assistant (PDA). These devices can be synchronized with various medical department schedules, as well as provide access to the Partners email system through Microsoft Exchange Server.

Partners attending physicians and house staff use online telehealth to review radiology images at affiliated sites, an application I’m personally familiar with as a member of an accredited stroke center.

Finally, the near-term system development objectives for BWH includes replacing the current paper chart used for written inpatient progress notes and other patient care charting with a fully computerized electronic medical record.

BWH is the most fully automated patient care setting I have ever worked in. The systems here meet my professional needs and support quality patient care.

Tuesday, September 22, 2009

A great invitation

I noted in a previous post that I've got the OK to use my other blog on nursing education for end of life care to meet the final project requirements for NU501.

I'm developing a brief paper on the general subject of blogging to go along with the blog and its content, and one of the issues in that paper is the value of links and related forms of recognition from like-minded bloggers and other media.

In that spirit, here's an email I just got today from Christian Sinclair, a hospice and palliative care physician, and co-editor of Pallimed.
We have the December slot (for Palliative Care Grand Rounds) open if you think your Death Club blog would be up for it?

Great job writing so far. I have been meaning to highlight a few of your posts but have not gotten to it yet. I plan on submitting some for the upcoming PC Grand Rounds at Geripal.

I most certainly am up for it! I'm grateful for the chance.

Monday, September 21, 2009

This will probably come in handy later

I posted a piece in my end of life care blog last week, called "Closer to dying, far from dead." The piece was prompted by some discussion and thought about the process of aging and its relation to end of life.

At about the same time, a friend who teaches at an associates degree in nursing program told me about her need to revise an assignment that had previously been called 'the well elder paper.' In that assignment, the first year/first semester nursing students were charged with interviewing an older adult who was not in an acute or long-term care setting.

My friend and her colleagues had decided to modify the assignment, to make it possible for the students to conduct the interview in the clinical setting to which they had been assigned. Some students have been assigned to acute care hospitals, while others have been assigned to rehabilitation and long-term care facilities, for their first clinical rotations of the program.

It has fallen on my friend to draft the details of the assignment, and the due date loomed near. I offered to help, and she gratefully accepted.

Since nursing education is my area of concentration in the online program at Ol' Saint Joe's, I figured I'd get a head start on some future assignment in one upcoming course or another. This is what I came up with.
- - - - -
Assignment
Interview and assess an older adult who has been assigned to you, paying primary attention to their functional health status; and to how their current functional health status affects their perceived quality of life, ability for self care, and subjective independence. Focus on their activities of daily living and instrumental activities of daily living. Consider how their current acute illness or injury, if applicable, has affected their functional status; identify the prognosis and plan for recovery and rehabilitation, if applicable; and identify the presence or absence of support from family, friends, community, and other resources. Finally, conduct a physical assessment of your patient's feet, and identify any actual or possible relationships between this specific aspect of your physical assessment and the patient's overall level of independence and functional health status.

Reporting requirements
  • Minimum 3 pages, maximum 5 pages, typed, single-spaced, no title/cover page
  • Due date: Month/date
Important terms and concepts
  • Health assessment, primary data
  • Functional health status, functional health assessment
  • Aging, the older adult
  • Quality of life
  • Self-care, independence
  • Activities of daily living (ADL's)
  • Instrumental activities of daily living (IADL's)
  • Lawton and Brody IADL Scale
I tried to think what could be accomplished in this visit. She was in good condition for her age, but she faced everything from advancing arthritis and incontinence to what might be metastatic colon cancer. It seemed to me that, with just a forty-minute visit, Bludau needed to triage by zeroing in on either the most potentially life-threatening problem (the possible metastasis) or the problem that bothered her the most (the back pain). But this was evidently not what he thought. He asked almost nothing about either issue. Instead, he spent much of the exam looking at her feet.

“Is that really necessary?” she asked, when he instructed her to take off her shoes and socks.

“Yes,” he said. After she’d left, he told me, “You must always examine the feet.” He described a bow-tied gentleman who seemed dapper and fit, until his feet revealed the truth: he couldn’t bend down to reach them, and they turned out not to have been cleaned in weeks, suggesting neglect and real danger.

Gavrilles had difficulty taking her shoes off, and, after watching her struggle a bit, Bludau leaned in to help. When he got her socks off, he took her feet in his hands, one at a time. He inspected them inch by inch—the soles, the toes, the web spaces. Then he helped her get her socks and shoes back on and gave her and her daughter his assessment.

from The Way We Age Nowby Atul Gawande
- - - - -
Required reading, tools, and resources

Craven and Hirnle (their selected text for nursing fundamentals)
  • Chapter 25 “Health Assessment of Human Functions”
    - p. 378, table 25-1 “Comparison of Functional Health, Head to Toe, and Body Systems Frameworks”
    - pp. 381-388, “Obtaining Subjective Data: the Interview”
    - pp. 409-411, “Lifespan Considerations – Adult and Older Adult”
  • Chapter 19 “The Older Adult”
  • Chapter 33 “Self-Care and Hygiene”
    - p. 710, Table 33-1 “Levels of Self-Care”
    - p. 711, Table 33-2 “Index of Independence in Activities of Daily Living”
    - p. 720, Table 33-5 “Common Foot Problems”
- - - - -

Sunday, September 20, 2009

NU501, second feedback

I just got my instructor's feedback on the two part Unit 2 assignment that I've posted here and here.
"Assignment 2, Grade A

You did an excellent job with this assignment. You demonstrated proficiency in Word, Excel and PowerPoint. Your proposal was clear, concise and compelling and was supported by data. I liked you format it (sic) posed and answered questions that come up during presentations of proposals. I also liked your creative approach. You did a great job with the Excel spreadsheet using formulas appropriately to calculate costs and percentages. I liked your PowerPoint presentation it had an appropriate background and was very readable."

I guess that sez it all.

Monday, September 14, 2009

NU501 - Unit 2, Assignment Part 2


So, let's get down to bidness...

Improving Patient Education – A Proposal from the Patient Education Working Group

Executive Summary

Monthly patient satisfaction surveys demonstrate that patient education is the consistently lowest measure of our unit's clinical effectiveness. Survey respondents are not satisfied with either the time we spend discussing information that is important to them, or with the quality of the information we provide.

Education and teaching have long been recognized as vital components of the nursing process. The central role of nurses in providing patient education is especially important in a busy acute care setting like ours, where we have many opportunities for planned as well as spontaneous teaching in the course of delivering patient care each day.

The Patient Education Working Group has developed this proposal because our patients depend on us for timely and reliable health information. This proposal details one of the methods that will help us meet our responsibility more effectively – a dedicated patient education resource center (the Center).

We propose to house the Center in an existing space that is grossly underutilized, the 9CD storage closet off the main corridor. The 9CD storage closet has almost 300 square feet of well-lighted space that includes functioning grounded electrical outlets and a large screened window overlooking the Prouty Gardens, but it is currently used only to store six pieces of outdated equipment that can no longer be safely used for its original purpose.

We propose to renovate and equip the Center with computers and associated devices to support research and individual/group teaching, as well as with a selection of software, books, and other printed materials specifically chosen to address the health issues that have been identified as most important by our patients and staff.

The initial equipment costs for the Center are $17,000. Once the outdated equipment has been removed by the appropriate hospital personnel, the 9CD storage closet space will be cleaned and refurbished at no cost by volunteer members of the unit's staff – that is how strongly we all believe in this endeavor.

The Patient Education Working Group has also identified members who are qualified to conduct initial training sessions, both on the basis of their work experience and academic preparation, to help remaining nursing staff become more skilled and confident providing individual and group education to patients and families at the Center, and to assess the Center's ongoing effectiveness.

The Center will be open at designated times under the supervision of a staff nurse who is already scheduled to work on the unit, and who has undergone the initial training. That nurse's patient assignment will be covered by co-workers – again indicating our shared belief in the importance of this project.

We do not propose to use the Center's patient education activities to generate any revenue to offset costs at this time. The Center may serve as a venue for professional education that could generate revenue at some future date, though that activity is not directly addressed in this proposal.

What's the problem?

Quite bluntly, the problem is that our patients say we're doing a lousy job teaching them. The following chart shows that the percentage of patients who say they're satisfied with the time we spend providing them with health information, and with the quality of the information we provide, ranked at or below 65% for 9 of the 12 months surveyed most recently.


Our Department's goal, as stated by Jane Hamsher, RN, Senior Vice President for Nursing and Patient Care Services, is “to exceed 95% patient satisfaction in all categories, each and every month.”

It's important to note that for the month of June, when we came closest to meeting that goal with a patient satisfaction score of 84.4%, a member of the Patient Education Working Group brought her personal laptop computer onto the unit for the specific purpose of using it as a tool to conduct individual and group sessions for patients and families on three selected topics:

  • Managing multiple medications at home
  • The most common post-surgical problems, and how you can cope with them
  • Using relaxation techniques to help manage your pain
Here are just a few of the 20 positive comments from patients and families who participated in those structured sessions in June, and who completed patient satisfaction surveys that month:
“Thank you for taking the time to make sure that my husband and I both understood his medications, and for giving us a specific way to organize them. I was very nervous about the thought of him coming home, and me not being able to make sure that he took them on time. God bless you.”

“I was very afraid that I would not be able to manage my pain at home, and that I would end up being 'zonked out' on too many medications. Now I know how to help myself relax with some simple techniques, and that will help me a lot. Thanks!”

“You nurses are terrific. Nobody every talked to me before in a language that I could understand, or took the time to answer my questions, but you sure did. I feel much more comfortable about going home now.”

We believe that our experience with that simple pilot project supports the value of the Center we have proposed.

What will we do, and how?

When this proposal is accepted and approved, the following actions will take place:

  • Hospital maintenance staff will remove outdated equipment from 9CD storage closet
  • Volunteer nursing staff will clean, paint, decorate, and furnish the vacant space with donated materials and items, at no cost to the hospital or department
  • Designated members of the Patient Education Working Group will work with the hospital's Purchasing and Materials Management Department to acquire the approved computer equipment and other budgeted items
  • Volunteer nursing staff will complete the Center's set-up
  • Open for business!
Designated members of the Patient Education Working Group will simultaneously finalize the development of topics and materials that have been identified as being the highest priority, based on surveys conducted through the course of the past year. These members will work closely with the Department of Nursing Education for course development and final approval of all materials.

How long will this project take?

We anticipate that all of the steps identified above can be completed within four (4) weeks of final approval.

What will this project cost?

The only direct dollar costs are those associated with acquiring computer hardware and associated equipment, along with selected educational software and printed materials, as follows:


As noted previously, with the exception of the removal of outdated equipment by personnel from the hospital's Maintenance Department, all other costs will be borne by volunteers who have agreed to donate their time, materials, and furnishings.

The cost to staff the Center will be covered within the unit's existing payroll budget, without the need for additional nursing personnel or allocated hours.

How will we measure our success?

Our goal is simple – to exceed 95% patient satisfaction in the category of patient education within 4 months of opening the Center, the goal articulated for our Nursing Department by Ms. Hamsher.

Attachments

  • Excel worksheets with proposed project budget and patient satisfaction scores
  • PowerPoint Presentation for the Nursing Department's Executive Committee
And now, the pitch...








Have I said how much I hate PowerPoint?

NU501 - Unit 2, Assignment Part 1

As Pavlov said, "Does the term 'no-brainer' ring a bell?"

I'm comfortable with my proficiency. Here are some of the many available sites providing tutorials for these products:

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Access

Addendum - I haven't bought a copy of Microsoft Office since about 1999 or so, when I picked up a gray market CD of Office 97 on eBay for $20. I've re-installed it on my latest computer, so that I can double-check the assignment files I've written in OpenOffice before turning them in.

As for the use of PowerPoint, well, let's just say that my opinion of the tool is entirely consistent with Edward Tufte's. As Tufte said in an essay that appeared in a 2003 issue of Wired magazine:

"The standard PowerPoint presentation elevates format over content, betraying an attitude of commercialism that turns everything into a sales pitch...PowerPoint's pushy style seeks to set up a speaker's dominance over the audience. The speaker, after all, is making power points with bullets to followers. Could any metaphor be worse? Voicemail menu systems? Billboards? Television? Stalin?"

For anybody who might be interested - here's Edward Tufte's own site.

I seriously recommend him and his work to anyone who's planning to teach, or who otherwise might need to provide others with information through a report or presentation.

I stumbled across Tufte while doing an online search for information that was critical of PowerPoint. He conducts workshops in major cities throughout the country, and I attended one last year when he came to Boston. It literally changed my professional life.

I also recommend this article by Ian Parker, which appeared in a 2001 issue of the New Yorker magazine.

"The usual metaphor for everyday software is the tool, but that doesn’t seem to be right here. PowerPoint is more like a suit of clothes, or a car, or plastic surgery. You take it out with you. You are judged by it—you insist on being judged by it. It is by definition a social instrument, turning middle managers into bullet-point dandies.

But PowerPoint also has a private, interior influence. It edits ideas. It is, almost surreptitiously, a business manual as well as a business suit, with an opinion—an oddly pedantic, prescriptive opinion—about the way we should think. It helps you make a case, but it also makes its own case: about how to organize information, how much information to organize, how to look at the world."
Less PowerPoint! More teaching and learning!

Saturday, September 5, 2009

Looking ahead

Nailed

With one unit down, I've looked at the remaining assignments and have plotted out my plan to submit one each week and complete the course quickly.

I reviewed the options for a final project (Unit 5 - Implementing Information Technology Into Your Practice), and suggested my other blog in an email to my instructor:
Looking ahead to the final project for Unit 5, I propose one along the lines of option #4, specifically a project that integrates information technology into my practice to benefit colleagues and patients, and that contributes to my professional growth. I propose to further develop a blog that I began in February on end of life care and nursing education. It's available for your initial review here.

If you think this is a viable final project, I'll develop a more detailed set of objectives and evaluation criteria for us to review. One of my goals in starting that site was to fold it into my school work. Another was to develop it as a support tool for a project at work to develop an end of life care team on my unit.

I look forward to hearing your feedback on this idea.
Her response was prompt and direct:

That sounds like a very intriguing idea for your last assignment. I think it will be fine, and I am looking forward to viewing it. Thanks
My subsequent response:
Great. Thanks.

I'll provide some supporting information, including objectives, methods, and assessments when I submit it as my final project.
I'll provide those details here when I submit them, but if anybody's interested and wants to do something similar - just get a free Blogger Account and jump right in.

Blogging's easy. The hard part is having something to say.

Wednesday, September 2, 2009

NU501, first feedback

I just got the following email from my instructor regarding my first assignment for this course:
NU 501, Nursing Informatics, Assignment 1, Grade A. You did an excellent job with Assignment 1! You demonstrated that you could surf the web and find some interesting web sites. You were able to use criteria to evaluate the web sites logically and clearly. The web sites you found were very informative and I could see where they would be useful in your practice. You were very thorough and I enjoyed reading about the sites you chose. You did a great job posting your favorite website to the discussion board.
And, just for posterity's sake, here's what I posted to the course discussion board:

One assignment down, four more to go for the course. Once this course is done, just thirteen left for that credential declaring me a master.

Go, Weasels!

Tuesday, September 1, 2009

NU501 - Unit 1, Assignment 1

Well, this one seems easy enough...

I conducted my search using the standard implementation of Google, and the search term nursing care end of life.

Here are the five sites that I selected from this search, based on my personal assessment of each site's overall usefulness in my clinical practice and area of interest. The criteria was simple - I asked myself, “Would I recommend this to a colleague who expressed an interest in learning more about this topic?”

I've included four sites where I answered “yes” without hesitation. I am less enthusiastic about the material described in number 5, from the Encyclopedia of Death and Dying. While my overall assessment of that content is that it is well-written, accurate, and appears to draw from reliable sources, I'm concerned about the lack of direct attribution for what it presents as clear statements of fact. The site's parent company also does not provide information about its sources of funding or privacy policy.

1. AACN – End of Life Care

This the End of Life Nursing Education Consortium (ELNEC) section of the main site for the American Association of Colleges of Nursing (AACN). ELNEC is a national initiative to improve care for patients and families at the end of life, jointly developed and overseen by AACN and the City of Hope National Medical Center.

This section of the AACN site is most suitable for nurses who wish to learn the details of caring for patients and families at the end of life, particularly those nurses who want to learn about and obtain ELNEC training in order to teach other nurses about the topics associated with comprehensive end of life care, using the ELNEC curriculum.

This section includes access to a variety of topics of particular interest to ELNEC trainers and nurse educators, including:

· the schedule for upcoming training sessions
· ELNEC-related news
· links to studies of ELNEC outcomes
· directories of ELNEC trainers, organized by state and country
· related resources for ELNEC trainers and nurse educators

The main AACN site provides access to a broad range of information and resources consistent with its stated mission - “Advancing Higher Education in Nursing.”

I am an ELNEC trainer.

There is no HON Code icon displayed on any of the AACN pages that I reviewed. An assessment of the site's compliance with HON criteria follows.

HON criteria

1. Authoritative - Indicate the qualifications of the authors.

The ELNEC-specific content at the site complies with this criterion.
See here. See also item #3 below re: contact with AACN staff members as compliance with criterion for overall site.

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable. The information is specifically directed to nurse educators, and not intended for consumers or other non-nursing professionals.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

Not applicable. There is no mechanism or requirement to provide personal data to register with the site or otherwise obtain information from the organization.

Contact with AACN staff members is via email, ground mail, and phone. Staff are identified by name, credential(s), functional responsibility, phone extension, ground mail address, and email address.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

The overall site complies with this criterion. As an example, see citation at the bottom here.

HTML links and page update information is consistently provided.

5. Justifiability - Site must back up claims relating to benefits and performance.

No specific claims are made, though there are extensive links to research and other material based on implementation of the ELNEC curriculum.

For example, see here, which provides links to a series on palliative care features in the American Journal of Nursing.

6. Transparency - Accessible presentation, accurate email contact.

Contact information is consistently provided. The material is logically organized by function. The link to a site map that is provided to supplement site navigation does not work.

7. Financial disclosure - Identify funding sources.

Funding for ELNEC is clearly identified here.
For AACN financial disclosures, see here. (pdf file)

8. Advertising policy - Clearly distinguish advertising from editorial content.

Not applicable to ELNEC content. Advertising for AACN's Professional Nursing Network is clearly identified – see here.
AACN policies for advertising and list rental are clearly identified here.

- - - - -

2. Conference Report - Innovations in Hospice and Palliative Care

This search result links to the first of a multi-page report of a presentation at the 2nd Joint Clinical Conference and Exposition on Hospice and Palliative Care, held in Orlando, Florida on March 23-26, 2001.

The host site for this page is Medscape/Nurses, which is itself a service for health professionals provided by WebMD.

The introductory page, and the subsequent pages of the full conference report, as well as the pages related to the ELNEC presentation, would be of interest to nurses, and particularly to nurse educators, actively involved in training and education for nurses on caring for patients and families at the end of life.

Access to the full conference report requires a Medscape registration. There is no cost to become a registered Medscape user.

The 2001 conference was jointly sponsored by the American Academy of Hospice and Palliative Medicine (AAHPM), the National Hospice and Palliative Care Organization (NHPCO),and the Hospice and Palliative Nurses Association (HPNA).

The 2010 AAHPM/HPNA Annual Assembly, which grew from the 2001 conference associated with this search result, will be held March 3-6, in Boston.

From the conference report introduction - “Seventy concurrent sessions covering psychosocial concerns and bereavement; physical and spiritual issues; and system and clinical innovations were presented during the conference.”

The specific content sections of the report are:

· Introduction
· Upstreaming Hospice Care
· Use of Advanced Illness Care Coordinators
· A Palliative Care Manual
· Clinical Practice Improvements
· Pain Management: Barriers and Approaches
· Nonpain Symptom Management
· Depression and Terminal Illness
· Total Sedation
· Discontinuation of Ventilator Support
· End-of-Life Nursing Education Consortium (ELNEC) **selected for analysis
· Summary

From the section, End-of-Life Nursing Education Consortium (ELNEC):

"Betty Ferrell, PhD, RN, FAAN, from the City of Hope National Medical Center in Los Angeles, California, presented an overview of the much-anticipated End-of-Life Nursing Education Consortium (ELNEC) Project, sponsored by the American Association of Colleges of Nursing.[12] This program is comparable to and compliments Education for Physicians on End of Life Care (EPEC). The curriculum is divided into 9 modules:

· Nursing care at the end of life
· Pain management
· Symptom management
· Cultural considerations
· Ethical and legal issues
· Communication
· Grief, loss, and bereavement
· Preparation and care for the time of death
· Achieving quality care at the end of life

Common threads found throughout the modules include: the role of the nurse as advocate; the family as the unit of care; the importance of culture; attention to special populations; critical financial issues; and interdisciplinary care. Five ELNEC training sessions will be offered over a 12-month period beginning in Denver in September 2001.”

There is no HON Code icon displayed on any of the MedScape pages that I reviewed. An assessment of the site's compliance with HON criteria follows.

HON criteria

The criteria are applied to MedScape as the host site.

1. Authoritative - Indicate the qualifications of the authors.

The site complies with this criterion. Clicking the link “Authors and Disclosures” activates a pop-up window identifying the author's credentials and affiliation(s).

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable. The information is specifically directed to nurse educators, and not intended for consumers or other non-nursing professionals.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

A link to the organization's Privacy Policy is clearly identified at the bottom of each page. See here.

Registration is required to access full content. There is no charge for registration.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

The overall site complies with this criterion.

HTML links and page update information is consistently provided.

5. Justifiability - Site must back up claims relating to benefits and performance.

No specific claims are made, though there are extensive links to research and other material based on the information presented.

6. Transparency - Accessible presentation, accurate email contact.

Contact information is consistently provided. The material is logically organized by topic area.

7. Financial disclosure - Identify funding sources.

Information about MedScape is readily accessed here.

As a publicly-traded company subject to federal regulation, full financial information about WebMD is readily available through a link labeled WebMD Corporate at the bottom of each page.

8. Advertising policy - Clearly distinguish advertising from editorial content.

Display ads are clearly identifiable and consistently positioned on each page. There is also a clearly-identified link labeled “Information from Industry,” to differentiate sponsored content from editorial content (example here).

- - - - -

3. Growth House: Guide to Death, Dying, Grief, Bereavement, and End of Life Resources

This is a substantial web site on the topic of end of life care, in terms of the volume of site pages and overall information. The site map page notes:

"Our site includes over 4,000 pages, so we can't list them all here. Instead, we have organized our content into major groupings. When you move to one of these areas more detailed navigation controls will appear. All pages have a context-sensitive navigation bar that will show related content. Pages are extensively cross indexed in hypertext form. You can search our database to find items not specifically listed here.”

Growth House describes itself as “portal” providing access “to resources for life-threatening illness and end of life care.” Authors and organizations in the end of life care field can syndicate their content through Growth House as a way to reach a larger potential audience.

The syndication process is described in more detail here.

"Content syndication is a general term for the idea that content on the Internet can be shared among multiple web sites. Content producers can make their information available in ways that other web sites can import directly and feature as part of their own offerings. There are many different ways to do content syndication. The content may be shown to readers at many places but it's always clearly identified as coming from some original source.”

The Growth House web site includes a bookstore featuring selections addressing subjects appropriate for nursing and medical professionals, as well as for the general public. The books are sold through Amazon.com. Growth House acts as an Amazon Sales Associate, earning a percentage of each sale.

There is an HON Code icon displayed on the 'Awards and Affiliations' page of the Growth House website.

The Growth House site's compliance with each HON criterion is validated by clicking on the HON Code icon on the page noted above. Growth House's compliance with the HON code is also verified by entering the term 'Growth House' at the HON search page.

- - - - -

4. National Health Statistics Reports Number 9 (October 2008):
End-of-Life Care in Nursing Homes: 2004 National Nursing Home Survey
(pdf document)

This detailed document describes the objectives, methods, and findings of one of the annual surveys (National Health Care Surveys, NHCS) conducted by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC).

The CDC is an agency of the United States Department of Health and Human Services (HHS). HHS is the “United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.” Kathleen Sebelius is the current HHS Secretary.

As stated in the opening paragraph of the report:

The purpose of this report is consistent with that of other national health care surveys conducted by NCHS, specifically “to answer key questions of interest to health care policy makers, public health professionals, and researchers. These can include the factors that influence the use of health care resources, the quality of health care, including safety, and disparities in health care services provided to population subgroups in the United States.”

The data obtained in 2004 for this report represents the most current year available in the National Nursing Home Survey (NNHS).

This document, and others such as the 2007 National Home and Hospice Care Survey (NHHCS) are of great value to nurses, and others interested in exploring comprehensive data sets and analyses, to understand and influence policies regarding end of life care.

There is no HON Code icon displayed on any of the pages that I reviewed. An assessment of the site's compliance with each HON criterion follows.


HON criteria

1. Authoritative - Indicate the qualifications of the authors.

The authors and their credentials are listed in the report. Their affiliations and qualifications are not included. The agency responsible for issuing the report is clearly identified, as are its key personnel. The CDC also maintains an advisory body on health statistics that “fulfills important review and advisory functions relative to health data and statistical problems of national and international interest, stimulates or conducts studies of such problems and makes proposals for improvement of the Nation’s health statistics and information systems.” There is substantial accountability and transparency associated with this advisory body and its activities.

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable. The purpose of the report is to inform professionals, researches, and policy makers.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

There is no mechanism or requirement that site visitors submit identifying information. There is an extensive description of NCHS policies regarding overall information confidentiality and security.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

Sources are clearly cited in footnotes and an extensive bibliography.

5. Justifiability - Site must back up claims relating to benefits and performance No such claims are made.

6. Transparency - Accessible presentation, accurate email contact.

Reports are provided in readily accessible document formats, as well as in readily accessible multimedia formats, where applicable. Contact information is provided with email, ground mail, telephone, and fax access.

7. Financial disclosure - Identify funding sources.

The report was prepared by the National Center for Health Statistics (NCHS), an agency funded by Congressional appropriation to the Centers for Disease Control and Prevention.

8. Advertising policy - Clearly distinguish advertising from editorial content.

There is no advertising at this resource.

- - - - -

5. Nursing Education - Challenges to eol care, Improving eol care, End-of-life nursing consortium

This is the Nursing Education page from the Nu – Pu section (Nursing Education to Purgatory) of the Encyclopedia of Death and Dying.

The Nursing Education page describes the issues and conditions that led to the development of the ELNEC curriculum, stating:

"Studies have documented that nurses and other members of the health care team are inadequately prepared to care for patients with pain at the EOL.”

The author(s) of this page is (are) not identified. The above noted statement, though presented as clear statement of fact, is not cited directly. Other similar statements are similarly unattributed.

A short bibliography is included, and features four articles from professional journals authored by Dr. Betty Ferrell, an acknowledged leader in the field of nursing education for end of life care. The landmark 1997 book by Fields and Cassels, Approaching Death: Improving Care at the End of Life, is also included in the bibliography.

My overall assessment of the content on this particular site, based on my own knowledge in the field, is that it is well-written, accurate, and appears to draw from reliable sources. However, I'm concerned about the lack of direct attribution for statements presented as fact. I'm also concerned that no author for the piece is identified.

There is a small notice at the bottom of the page, “Copyright © 2007 - Advameg Inc.” A Google search for the term “Advameg” found this page, which notes, “Advameg, Inc. is a fast growing Illinois-based company. Our websites reach over 14 million unique visitors per month and are frequently referenced by the media.” The Encyclopedia of Death and Dying is included on a large list of other sites claimed by the company, including several on a range of health topics.

There is no HON Code icon displayed on any of the pages that I reviewed. An assessment of the site's compliance with HON criteria follows.


HON criteria

1. Authoritative - Indicate the qualifications of the authors.

No author is identified.

2. Complementarity - Information should support, not replace, the doctor-patient relationship.

Not applicable.

3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor.

A form for submitting information is included at the bottom of the page. The form requires the user to provide a name and email address, along with the code displayed in a 'CAPTCHA.' There is no privacy policy at the Encyclopedia of Death and Dying, or at the home site of Advameg, Inc.

4. Attribution - Cite the source(s) of published information, date and medical and health pages.

A bibliography featuring material by known experts is included, though there are no direct citations to material presented as clear statements of fact.

5. Justifiability - Site must back up claims relating to benefits and performance.

No such claims are made.

6. Transparency - Accessible presentation, accurate email contact.

No contact information for the Encyclopedia of Death and Dying is provided.

7. Financial disclosure - Identify funding sources.

Funding sources are not identified.

8. Advertising policy - Clearly distinguish advertising from editorial content.

Ads are clearly labeled and set apart from editorial content. The ads are served by Google's AdSense system.


- - - - -


[Zeerp] “Hello, dum-dums.”

Acknowledgement: I could not have done this assignment without my dearest friend, the Great Gazoogle! Thanks, Great Gazoogle!

And a big hanx to Gavin at Sadly, No!