Module 3 - Multiple Intelligence Test

"Music is the electrical soil in which the spirit lives, thinks and invents." --Ludwig van Beethoven

My highest score was MUSIC! Supercalifragilisticexpialidocious!
No surprise there...could have guessed after I posted this.

A skilled composer can have great impact on the learning pathways of the brain, as well as emotions and mood. Many studies confirm the positive effect of music on cognitive domains such as language, spatial-rotation temporal tasks and mathematics (Trainor, Shahin, & Roberts, 2009). This is sometimes referred to as the "Mozart Effect." Additionally music promotes concentration and focus when large amounts of information must be processed and assimilated. This happens through the stabilization of mental, physical and emotional alpha brain wave rhythms. For example, music played at 50-80 beats per minute creates an atmosphere highly conducive to learning, memorizing, and reading (Brewer, 2005).

It is true in my case. Music is not only my passion but it helps me learn. If information is combined with rhythm, rhyme and melody, I will remember it for life. (For example, I learned the names of all the American states in 5th grade and still know the song and the states.) I also think those with music intelligence learn through animation and drama. I like watching bands, people, instructors, performers who are animated in their speech and use a variety of movement, voice inflection and a sing-song tone in their voice. Give me monotone, give me death.

The next highest intelligences that tied for second place were: Linguistic and Spatial / Visual. This also came as no surprise. I am a lover of words: writing and reading. I thrive in an environment where the interpretation and explanation of ideas is explored through language. I have always felt that a carefully constructed discourse that is precise, vigorous, smooth and dense is our strongest ally and our most formidable weapon. Written or oral communication delivered with stylistic and substantive finesse has the power to change a singular human being as well as a nation.

Additionally, I learn better when I can see pictures or diagrams. For example, I may read about the location of a body part but can't conceptualize it until I see a picture. I pay much more attention to the powerpoints of instructors when they include pictures, even if the pictures are not instructive but more entertaining in nature.

Augment personal learning?
After taking the Gardner Intelligence Test and reviewing my dominant learning intelligences, I can focus on skills that will enhance, enrich and aid my own learning. According to Kolb's Model of Experiential Learning, I am an accommodative learner (Richardson, nd) and learn best with concrete experiences and active experimentation. So, one learning tool I can use is to play classical music in the background when doing high stakes studying or trying to grasp a new challenging concept.

The use of background music is a cornerstone of accelerated learning techniques. There are two specific ways developed by Dr. Georgi Lozanov to use background music. These are called Concerts. The active concert actually sets learning in motion while the passive concert relaxes the brain enhancing increased absorption of material. Both increase memory retention. Whichever concert you "attend" depends on the background music selection. I can also write little silly songs to help memorize lists or other wrote information.

It would be a wise teacher indeed who tries to cater to as many learning styles as possible in the delivery of content, using andragogical rather than pedagogical techniques. Not only that, but take into consideration the era of birth. For example, I am a GenX'er and have learned with, and am comfortable with, technology (Richardson, nd).

Since I love music and since this is a blog afterall, I thought it appropriate to share a happy song from my high school days. It makes me think about dance as a metaphor for many things in life!

 References

Brewer, C. (2005). Music and learning. Retrieved on 29 September 2009 from http://www.newhorizons.org/strategies/arts/brewer.htm

 Richardson, V. (nd). Diverse learning needs of students. Teaching in Nursing: A Guide for Faculty. Elseveir Saunders (2nd Ed).

Trainor, L. J., Shahin, A. J., & Roberts, L. E.. (2009). Understanding the benefits of musical training: effects on oscillatory brain activity. Annals of the New York Academy of Sciences, 1169, 133-142.

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Module II Part 3: Compare and Contrast

Each of the ways to retrieve information has pros and cons. And whichever one is chosen depends upon the question asked, the purpose of the question, and what the results will be used for. It also depends to a certain extent on the amount of time one has to search. As I mentioned in my previous post, the web search engine seems fast, intuitive, easy to use for the most novice of searchers. But the speed is relevant. The initial searching itself may be quicker, but the evaluation of the findings takes longer because as one of our articles stated, the internet epitomizes the concept Caveat Lector: let the reader beware. In order to establish reliability and credibility, there are several things to consider such as authorship, the publishing body, the point of view or bias, accuracy, verifiability and currency. All of this takse time.

When using an electronic index, much of this background work has already taken place before the article can even be published. The internet is full of propaganda, misinformation and disinformation. Although there are articles with poorly performed research, one can be fairly assured that the chances of getting propaganda and misinformation are much less in an electronic database with a fairly rigid filtering system.

Electronic databases use much more highly sophisticated search functions, updated often, has a staggering amount of records. DynaMed for example, goes through a rigorous point of care evidence-based evaluation process. That is a comfort and saves the searcher a great deal of time from having to do that preliminary weeding-out process. The Cochrane library, although only updated quarterly, is "the single most reliable source for evidence on the effects of health care" (LeBar, 2009). And of course, one of the best features of the electronic database is the absence of advertising.

The guideline index is more specific and very useful if you know exactly what you are searching for.

So I view the three databases as a heirarchy: the broadest search for general information can begin with a web-based search. Narrowing down a topic, getting more reliable information and getting a sense of what research is going in in a particular area are all reasons to utilize an electronic database. If needing an answer to a very specific problem, a guideline database is an excellent resource.

Each have their place. I am thankful for each one. I think the world wide web and the world of information technology is a marvel and a miracle!!!

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Module II Part II: Reference Management

What features in your chosen reference management software can be used to sort, classify, and otherwise organize references? Describe software functionality that allows you to better organize and share information for efficient retrieval and use.

The management software I am currently using is EndNote. I used it all throughout my Master's Program, but I am also going to try out RefWorks. I have requested a free trial version. I like the idea of RefWorks being online and accessible from anywhere if I happen to be on another computer, and would like to look at my library. In EndNote, there are several features to sort, classify and organize the references. One of the things you can do is create subgroups or folders within endnote (ie: article yet to read, RCT, Editorials, etc). EndNote has an extensive sorting feature, allowing a sort based on many, many different characteristics such as date, author, publication type, etc. I find the ability to search within EndNote itself quite limiting and I rarely use that feature. I usually go right to PubMed and then import the references into EndNote.

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Module II Part I: The Search

Problem and Index
My problem was not necessary a clinical problem. But I was interested in a current hot topic in healthcare. My question was this: Does the current literature show positive quality outcomes usisng a pay-for-performance model? Although this questions is very amenable to RCT and other research methodologies, I thought that PubMed might not be the only source for good information, so I also searched in EBSCO as well, as there are other resources beyond medical journals.

Did Index Facilitate or Impede Search?
I don't think the specific index impeded my search as much as I impeded my search. I watched the tutorial for PubMed which was very helpful. I loved learning how to use the Advanced Search and MeSH headings which I never really understood before. I am also starting to get the hand of the Boolean operators AND, OR. The tutorial was useful when using quantifiers or identifiers in the search such as medications (beta blockers, aspirin), but did not seem applicable in my particular search. I played around with various search strategies, and the one that yielded the best return used the boolean operator AND. I typed in pay AND performance AND healthcare. In the EBSCO search, this gave me articles from USA Today, NYTimes, etc. Although those articles would not be appropriate for a scholarly article, it was interesting that I had access to them and could read them to further understand the scope of the issue.

Time?
My search was time consuming because I am still getting the hang of it. I understand how to do a search, but for me the difficulty is knowing the right wording to type in the search bar. I guess that is where MeSH functions can help.

Barriers?
For a clinician who does not use the database regularly or who has not been trained in all of its advanced features and functions would find this very cumbersome. It is much easier to do a quick Google search. And yet, as Jeanne LeBar states in the tutorial Google Scholar lacks reliable search functions, might not be up to date and lacks controlled vocabulary.

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A Little Entertainment Never Hurts

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100% Successful

I became friends with four great women when I started nurse practitioner school. Over the course of our program, we studied together, traveled together, worked on group projects together

partied together, marched across the stage together at graduation























and NOW we ALL passed our boards!! It is a great feeling to 1) have passed and 2) to have ALL passed! Congratulations to each one of us. We are now officially board certified FNP's.

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Module I

Why do you as a graduate level nurse need to know about information management?

Graduate nurses are leaders. Leaders must be the driving force to embrace the future, which includes a maze full of complex information and technological advancements. We are cresting the top of a tall mountain where the impending ride up and down on the Information Technology rollercoaster is going at full speed. The use of technology will only grow. There is no turning back. Now that we cook with stoves, no one wants to go back to cooking over an open fire. Such is the way with technology. And smart leaders in healthcare are the ones who learn to use it, and make the technology work for them. Not the other way around.

I was surprised that both Imhoff and Curran painted broad strokes regarding the need to know informatics. She contends that informatics encompasses much more than learning to work the computer and make spread sheets. Curran (2003) even goes so far as to say that competency in informatics is necessary to master the information and knowledge required to be successful in the health care environment.

To reiterate: Curran claims competency in informatics equals competency in practice. Those are strong words, placing information management on equal footing with other well accepted competencies such as knowledge, clinical decision making, critical thinking, etc. Imhoff (2000) also infers a similar message and again uses a broad definition with informatics as the basis for learning, assimilating and distributing knowledge.

So in essence, we need to learn information technology because it, along with the patients, are at the very core of everything we do as practitioners / educators / managers, etc.

Describe what is happening related to IT in your clinical or practice setting.


I will speak to the great things that are happening in the world of teaching. I am impressed with the way the professors at the U are embracing technology to enhance the adult learner's experience. Effective teaching is learner centered. And effective learning happens through active (not passive) means. Use of webCT, discussion boards, Wimba, etc. all help students to be more actively engaged. And the use of the internet for asynchronous learning extends the ability of education to those in rural areas without having to relocate. This ability to educate has such a positive trickle down effect in many areas of nursing.

When I think about IT in the clinic settings where I worked for practicum, I echo what everyone has said regarding the use of computer charting. But I also think IT extends beyond record keeping and management. Think about the use of a digital camera to aid documentation. I worked with a plastic surgeon whose digital camera was more important to him than a stethescope. Simply having a photo in the patient's chart can save the provider a lot of time from having to accurately describe the lesion, rash, etc.

The use of Information Management can be used to reduce errors, enhance compliance, promote prevention, save time, improve communication, and lower costs. Some may argue that technology weakens the interpersonal component of healthcare. I actually disagree.

What structured documentation, standards, and/or coded terminologies do you see within your practice setting (if none--where might they be applicable)? 


Documentation at the places where I did my practicum was all computer generated. Templates were often used. There are pros and cons to using templates. But I must admit, they were a huge timesaver. Especially for a novice like myself who was slow at charting. Coding was done without the computer. I think if somehow coding could be done on the computer, it would be more accurate and consistent.

How are structured/coded clinical data useful in promoting quality patient care?


In order to evaluate quality outcomes, data must first be gathered and analyzed. Using structured / coded data makes the analysis process so much easier. Charts and graphs can be created which speak volumes at a simple glance. Spreadsheets are also great in managing large amounts of data and side by side comparisons. Klijakovic et al. (2004), points out that coded clinical data is not uniformly utilized and implemented between inpatient and outpatient settings, pointing out that there is still great room for improvement, and that many providers still need to grasp the concept that informatics is their friend.

References
Curran, C.R. (2003). Informatics competencies for nurse practitioners. American Academy of Clinical Nurses, 14 (3), pp 320-330.

Imhoff, M., Webb, A., Goldschmidt, A. (2000). Health informatics. Intensive Care Medicine, 27, pp 179-186.

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

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Commercial Break

We interrupt this program to bring you an unscheduled exciting announcement:

Jenni just passed her FNP boards!

Here is what my brother had to say: "Whenever I pass my boards, I like to wear gloves so I don't get slivers. Just a tip. Take or leave it."


Here I am with my celebration cupcakes from Twenty Five Main. Yum.

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Introduction to Ms. Fish

Hello. My name is Jenni. My husband calls me the Mighty Missus Fishy (for reasons I won't say!). I live in Hurricane, Ut with my hubby of 22 years, and four active delightful teen-agers (ages 19, 17, 15, 15).

I graduated in May 2009 in the Family Nurse Practitioner program from the home of the red Utes! I currently do not have a job as an FNP or a nurse. I am working as a TA for Gillian Tufts here at the college. So I am slightly disconnected from current life in the trenches. I have been an RN since 1986 and have worked in many areas of both inpatient and outpatient nursing. I like change and I like challenge.

I am semi excited about the DNP program (just because I'm fresh off the heels of school). But I am totally excited about the assignment to start a blog. I love blogging! I think the crazy world of blogging dissolves both physical and emotional space and connects people in meaningful ways.

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Fish Bytes

A new blog (I named it Bytes of Fish in honor the of the Informational Technology focus).
A clean slate.
Endless possibilities!

And one of the great things about this blog is that a generous artist, whose work I LOVE, was kind enough to let me use his artwork for the topper. Thanks to J. Vincent Scarpace. Check out his work here.

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