I unfolded the article and read the date, 6 July 2010. I can only assume it sat on the shelf for over a month until there were enough things my father wanted to send me, when he also found that article and tossed it in. Now the article wasn't anything to special, just something he read that he thought I might like. Have you ever done this? Perhaps you aren't the type to cut articles, but have you ever had a friend send you an article or had someone recommend you look for an article they think you would like?

We like sharing things that we like, think are important, or might be useful for other people. Every time people hear the word social media they assume it is a new term, I've been trying to say it just happens in a new way.

Why do we need a new way? There are a ton of things that can go wrong with the old way, and there are many factors that slow the process down:

• Hardcopies can go easily missing ( the book is misplaced, paper is misfiled, etc)
• You forget to pass it along
• The clipping gets damaged
• You don't see the person for months
• It takes months to finish a book, and maybe years before you want to recommend it to an individual

Technology is simply creating more forms of media and new ways to share what you are taking in. From facebook apps to entire social networking sites that allow you to share what books you are reading. Every webpage can have buttons to share anything (journal articles, videos, technology products, etc) that allow you to pass them on to specific friends (by email) or recommend it to anyone one of your friends (facebook) or followers (twitter).

Nurses need to get used to this change in media, even though it may seem a bit overwhelming. If we don't start to understand how these tools can be used we can't understand how they make our work easier, faster and less demanding. Framing social media as to confusing, 'not for me' or too much work is short sighted and prevents progress. Not everyone could drive a car just because Henry Ford started making more of them. Each individual has to take responsibility for learning how new tools can be useful for them, either that or stop complaining when everyone goes speeding past their horse and buggy.

The reason that I say this is it has some fantastic features. The book has many of the features that you would expect from a print version of a drug pocket guide:

• Basic drug information (actions, availability, indications and dosage, contraindications, precautions, administration, adverse reactions, patient monitoring, and patient teaching)
• Information on safe drug administration (Injection sites, monitoring blood levels, drug prep/handling/admin, and preventing extravasation)
• Photographic gallery of common tablets and capsules
• Valuable clinical information

In addition to these features this application also takes your basic drug guide information and makes it searchable and light weight. The developers also included a more information and great images, as well as a fun function that give you a random drug of the day. If you look at the pictures below the app is quite simple, making it straight forward and easy to use.

Another feature I liked is that you can bookmark certain drugs. I know when I was working on a multi-organ transplant floor there were a ton of drugs that I would only come across infrequently. Having the list of drugs used on my floor makes it easier to access informations on certain drugs and check important information, such as drug compatibility.

When looking at the information given for each drug I found that I liked this application because it went beyond the medical information and provided the important information for nurses and patient education. This app would have been a huge benefit to me as a nursing student, and I definitely would recommend it to any floor nurse that is looking to stop carrying a textbook on the floor every shift.

My only criticism that I had to offer for this app is that it is pretty cut and dry. When I think about drug medication I often get flashbacks to learning to calculate drip rates, and trying to remember what the correct gtt. Adding something as simple as a drug calculator to this application would make this application even more useful and prevent me from having to exit the application in order to open another application with the capability.

I hope I am not speaking for myself when I as ABSOLUTELY NOT. There is no way we could work on a space that small, and at this point if anyone has a desk that size I'd suggest you start looking for another job. How could we possible accomplish what we need to with that little space?

So how is your digital desktop any different. Anyone who has tried to write a paper on their computer, or do any sort of multitasking knows you end up with a ton of windows open and you spend a lot of time flipping between them copying information or looking for something. Using a second monitor can be extremely useful for productivity. Consider for minute how much easier you can ignore email notifications if you could see all of you emails in your second monitor and assess if it is worthy of interrupting your current task. Reading, paraphrasing and transcribing information that you need for a report, memo or email also become a lot easier if you can have both documents open at the same time. Scheduling and time management can be improved by leaving it open in your second window.

Depending on your workflow there are a number of ways that having a second monitor can tremendously improve you workflow. It becomes up to each individual to test it and to find out hot to use it in order to become more effective. A study by microsoft found that a second monitor increases productivity on average 9-50%. Here is an example of a legal nurse that made the switch and won't consider going back: Legal Nurse.

Now for those of you who are still skeptical, I will assume it is the cost, lets think it through. If we assume that an employee gets a starting salary of $40,000 (thinking conservatively... hopefully). A few days of orientation add $350 in instructors/human resources time, possibly divided by the number of attendees so a minimum of $10 just to keep it conservative. Now this is just a ball park, but you have the cost of an office or cubicle plus heating, electricity and office supplies (desk, binders, tacs, etc) which adds up to thousands of dollars. You have to also higher a manager, human resources, and accountants in order to manage, develop and pay this employee another large investment. Then depending on the contract, there can be many more costs for vacation, education, travel, and cellphones, all in the thousands and possibly tens of thousands of dollars for the organization per year.

After all of those logical investments why not add the $199 dollar screen, which dollar per dollar will see the highest return in productivity for that employee? Think about it.

Now if you are a manager start to offer your employees that work all day on computers a second monitor. If you are an employee present the business case for your boss, and if all else fails use my fall back plan and bring your own. After I have started using a second monitor, there is no way I would let an organization waste my time by giving me a computer that slows me down.

Whether you are a student or a floor nurses I would highly encourage you take the time, time that you undoubtably get back ten-fold, to watch this lecture. I have watched it numerous time and continue to revisit it a few times a year.

Here is a link to his most famous lectures "the Last Lecture" and "Time Management"

Over the last decade in nursing, the discipline of informatics has seen and witnessed some exponential changes. The word ‘informatics’ had been used in practice and literature since the mid-1970s, and was picked up by nursing in the early 1980s. As nursing entered the late 1990s, the term ‘eHealth’ began to collect support as the catch-all term used to describe practically anything that crossed between health and technology. With the rise and plateau of the eHealth vernacular both in professional and lay audiences in the latter part of this decade, other neologisms have gained momentum within healthcare – namely, Web 2.0 and social media.

To both insiders and outsiders, this confusing mixture of verbage to describe the use of technology and innovation in healthcare has long confounded individuals attempting to describe ‘what they do’. In my discussions with colleagues of the Ontario Nursing Informatics Group , I have realized that I am not the only person out there who sometimes does not know how to describe this informatics/eHealth/social media mixing pot.

A few months ago I began to critically question why I chose to use certain words, in specific writings or situations. For instance, why would I choose to use the word informatics, as opposed to eHealth to describe a hospital information system? Or, why would I select eHealth as opposed to informatics to outline the use of PDAs in clinical care? I didn’t really have an answer until I started looking at the network of actors (both human and non-human) that formulated and inscribed my past and present thought processes.

So, as you can see through my concept listing, the blurring of the terms exists at many entangled socio-political-technological levels. The ability tease apart the differences are rather difficult at the best of times and sometimes a moot endeavor. Context is probably the best predictor of what term to use, but even that rule of thumb can be flawed. In my short time (respectively) within the profession, I’ve had the opportunity to see terminology come, go, evolve, die, and be replaced with an entirely new cross-section of lexicon. Sadly, I doubt the future will bring any clarity to this issue.

I guess my take away point is to examine how you use certain terminology when describing innovation in healthcare. Neologisms are time limited and sometimes do not gain traction in the literature or practice language. It is probably wise to not fully align one’s self with a term that might only have a useful half-life of 3-4 years. I encourage you to attempt the reflective exercise I’ve tried above and let me know if any of your conceptualizations differ from mine – I’m interested to see how others conceptualize this mashup of terminologies used in describing the informatics discipline.

In the last four years my inbox has changed from being something I would occasionally check and infrequently get messages from friends. Recently my inbox has become something I compulsively check and that can dominates my life. The worst part is that even though I often check my email, and find things I need to do, the emails will just sit there and pile up.

So this summer I am vowing to change that, or at least to try something new. That something is Inbox Zero, and was thought of by Merlin Mann. After noticing that others struggle to do what he does, continually empty his inbox, Merlin decided to teach others the tricks. The simplified message is that ever email needs to be dealt with as soon as you open it by applying 1 of 5 options:

• Delete
• Delegate
• Respond
• Defer
• Do

Looking at the list it seems simple and obvious enough, but every nursing student and nurse I know is guilty of ignoring these rules. The compulsion is to open our email, check it and if it is important enough or we have time do something. If not the email will sit there and pile up.

Being a student I rarely have the option of delegating. However, I regularly need to do things, and yes it is true we don't always have time to do things immediately. That is why the To Do list was invented. Now a new problem, I have 3 scraps of papers, three napkins and a dozens of stickies with random lists of things I need to do. This requires further organization. Another smart individual is David Allen, who wrote Getting Things Done. His basic premise is as soon as we think of something to do it needs to go on a to do list. That way we can put all the stress and worry out of our mind and focus on tasks. So combining Merlin and David's advice, I downloaded Things. Now when ever I get an email, if I have to do something, even simply "respond to John Doe" it goes on my To Do list.

Although it doesn't seem like a big deal. This has taken a lot of effort, but has already started to pay off. I feel less stress when I open my inbox, because I know what to do with emails that bring more work because  I have a system to organize my work. Also, when I have time to work on things I don't open my inbox, and get flooded by more emails with things to do. Instead I go to my To Do list and start getting the satisfaction of ticking things off that list.

As a nursing student, adopting a great system for managing emails as well as To Do's is critical. There will be hundreds if not thousands of emails that nursing students will open about paying tuition, getting reference checks, course selections, clinical placements, and who knows maybe even grade appeals, none of which need to stay in your inbox. Find a way to file them, even if you just archive them. Just get them out of you inbox and dealt with.

Nurses could also benefit from reducing the amount of email they have in their inbox. Nurses are always dealing with a lot of information and an over flowing inbox is not something nurses need.

This means I need to say thank you. To the people that have supported and mentored me, to the people that have found this website and told others, and those of you who have been encouraging me the whole way. I truly appreciate it and I couldn't have done this without you.

iPad Apps for a Nursing Student

If you want to be a technology evangelist then you need to understand the technology. That and a hundred other half baked justifications (excuses), a bit more student debt, one expensive trip to the Apple store and this nurse has an iPad.

In all seriousness I want to test the iPad's usability and see if it has a felt (since I can't 'measure') impact on my workflow. The product is only weeks old (in Canada), and there are already some fantastic applications and more on the way.

For now I'm starting with:

Productivity iPad Apps

Good Reader: PDF/document viewer. I have been using it to sync research reports that I need to read. I sync 1-5 for fun, and then stacks (20+) when I'm writing about a particular topic so I can flip through them on the subway.

Evernote: I was not a big user of Evernote until the iPad. This application syncs notes, which can include photographs/screenshots, audio (20 minute intervals) and video attachments. I like this for tracking ideas (this blog post for example), random thoughts, project materials, and to file some of the random things I like yet don't have a place for.

Things: This is a expensive To Do list manager and a bit for project management, I'm sure you could get better free ones, but this one syncs with the paid for apps (iPhone/iPad/Desktop), which is mandatory for my lists.

Pulse: A fantastic visual viewer for RSS feeds

Kindle: Free app for eBooks, this is fantastic. I'm not sure about you, but I am definitely an optimistic packer- meaning whether on vacation or a trip to school I will bring extra books just incase I get time to read them. Now I have the books I want to eventually get through on more than my night stand.

Clinical Resources iPad Apps

Epocrates: Provides information on drugs and a range of options from FREE all the way to $199 a year.

Universal Doctor Speak: Don't be scared off by the name of this app, it is really a translator for basic in clinic conversations and has potential for nurses as well. It provides english to French, Spanish or Chinese, as well as some speech options. This allows you to point to an instruction so patients understand your questions/instructions.

Web MD: This app allows you to check out symptoms, drugs and basic first aid information. Useful for interest and to recommend for patients. Interesting to see what patients are able to learn and find out without health care providers.

Health Related iPad Apps

Sleep Cycle: Fascinating app that lets you track the quality and length of yourself. Sleep is very important for nurses and nursing students, this app allows you to measure you average sleep and set an alarm that tries to wake you up when you are coming out of a deep sleep cycle. I also wonder what it would be like to have this type of functionality for out patients, it would be extremely useful to know how much rest they are actually getting. Think about how much we wake up our patients, if we knew they were in a REM cycle perhaps we could wait the extra half our before getting them up for a bath or round of medications.

Lose It: Another important health measure is out daily calorie and nutritional intake, and again this app could make a great addition to our electronic health records. Image your patient handed you a detailed report of their daily, weekly, and monthly calorie intake and weights. Much better than the traditional pen and paper 24 hour system we often use. I also know a lot of nurses that use this app on the iphone once they book their flights to warmer climates.

For those of you that have an website Editz.com is something worth considering. There are two reasons that you might want to use it, because writing is not your favourite thing to do (or your best talent, like me) or you want others to help you find your typo's  and grammar errors (lets face it they bother us).

Editz is a simple application for your website, that allows anyone to quickly and easily provide you with writing critiques and corrections. Instead of having readers that a writhing in pain, from your misuse of simple punctuation and spelling, they can simply point it out and you can easily fix it. This is what most people like to call a win-win situation. The best part is there is a third winner, the next reader to come by your site also has an easier time digesting what you have to say and won't get distracted by a mistake the last visitor already pointed out.

If you have a blog or your own personal website, take a look and see if it is right for you.

The word "unconference" gets a mixed reaction from many, in healthcare it is usually more confusion then skepticism. For those of you that don't know, the unconference was born out of the technology industry. They are about 4-5 years old depending who you ask, and they focus on participation by attendees. The wikipedia article on unconferences says they are

a facilitated, participant-driven conference centered on a theme or purpose.

Anyway, on Friday, May 28th 2010 I took part in organizing my second unconference called Mental Health Camp Toronto. This conference was a result of Anne attending Health Camp Toronto, and wanting to have one for her Mental Health. A few collaborators later (Madalyn, John, Carlos, and I) and we were on our way.

Although the unconference was born out of the technology industry, it provides an interesting model for participation, collaboration and knowledge transfer (if you want to be technical) for healthcare. I remember going to ChangeCamp, an event and community movement started by Mark Kuznicki to cultivate citizen participation and openness in government. Below is a short video of Mark explaining what an unconference is and how it might be useful in healthcare.

The crazy part is that, it takes the normal model of a committee of 10-30 people that make decisions (speakers, panels, etc) for hundreds of attendees and flips it on its head. With 5 people, we raised thousands of dollars and simply provide a space and food for participants to come together to talk about mental health, social media and anything that attendees wanted to discuss.

Needless to say, after many meetings at the Duke of York, Massey College, and the Centre for Addiction and Mental Health, the skype calls and a few hundred... maybe a thousand emails somehow it all came together. The event went incredible well and we were so happy to see our 'baby' born in 8 months.

Dr Nancy Walton - @researchEthics

Ryerson University

Associate Professor - Daphne Cockwell School of Nursing
Chair - Research Ethics Board

As many nurses begin to learn about patient care and research the topic of ethics comes up, or at least it should. In this interview I sit down with Nancy Walton, a nurse that found her love for ethics while pursuing her graduate education. She was the Associate Director at Ryerson University in 2009 and is the chair of their Research Ethics board. As an ethicist and a nurse Nancy understand difficulties that both sides encounter when they met. That said she is passionate about helping nurses to understand and use ethical reason to solve situations that arise in patient care and to plan their research. Although her career track to tenure has the traditional list of publications and academic work she is also using more accessible methods of writing through her website Research Ethics. In this interview we talk about her work, the importance of ethics for nursing, how nurses can get more involved and learn more about ethics.

Resources

• Joint Centre for Bioethics
• Research Ethics Blog
• Nursing Ethics - Codes of Ethics
• College of Nurses - Practice Standard Ethics
• Nursing Ethics (wikipedia)
• Institutional Review Board (IRB) Blog

Questions

Dr Nancy Walton RN: What do you feel would help you to further engage with ethics? How can educators and ethicists make it more accessible?

Rob Fraser RN: Have you ever taken ethics training? How was ethics taught to you?

If you cringe at the thought of your organization blogging or even raise an eye brow consider this, a blog is simple a chronologically organized content. A blog does not have to involve personal feelings, pointless rambling, or any other misconceptions you might have. In fact there are many reasons that a blog might be the PERFECT fit for your organization. If you want to develop web traffic, keep stakeholders informed of projects, share vision and values, or describe 'things to come' so that people are aware of what you working on then a blog is a great fit.

After a recent search of Canadian nursing organizations' websites I realized very few, if any, had a blog, news or updates section. I have two suspicions why this is, first no one wants to be in charge of the project and second no one wants to great more work for themselves or others. To counter this I would say 99% will not have to do (much) more work. Why? Because every organization is already generating the content that is almost perfect for this.

Walking through hospitals I constantly see newsletters, every few months I get numerous bulletins and magazines, I open my computer I get dozens of updates from organizations, and attending annual general meetings I sit for hours hearing about the things the organization has been working on. Every single one of these things is taking time to share what your organization is doing, and for some reason very few healthcare organizations are taking time to do this online line.

This is costing the organizations in different serious ways. First, for every hour that it might take to develop anyone of the previously listed things it might take a 10 minutes to make an internet posting out of it. Organizations are simply losing out on the chance to get significantly higher return by a small increase of effort into something they are already heavily invested in. The second thing the organization is losing is web traffic. This costs the organization the chance to tell their members and the public what they are doing. Increased content on an organization's website increases the search traffic for the entire website too. So although not ever article will being thousands of readers slowly increasing content helps more people find out about the work they are doing and services they offer.

If healthcare organizations are serious about getting on the web and engaging their members as well as the public they need to increase their online presence. Creating a blog is a simple and easy way to do this. Before beginning to walk you need to crawl, similarly before taking on highly complicated forms of social media healthcare organizations need to start with the basics.

May 31, 2010 Toronto's St Michael's Hospital showcased the Research Advancing Practice's (RAP) [2009 PDF] latest cohort. The program involves a group of frontline nurses that enroll in a program that gives them to time to learn and conduct research. Behind the program is Dr. Lianne Jeffs (see Lianne Jeff's Nursing Ideas interview here) and takes in nurses like Martha Schroder (her interview here). The program is fantastic on so many levels, it promotes a culture of learning, allows nurses to improve the workplace, job satisfaction is enhanced and most importantly the research focuses on improving patient care!

When I heard the date for these presentations was announced I marked off my calendar I knew I wanted to go, but when I got there there was something different. This year the nursing RAP (what a great name!) had a new abbreviation, the RAPpers (as they are called) took part in RAP-CD (career development). During the opening remarks it was explained that Janice Waddell had been working on integrating the Donner-Wheeler career visioning into the program. Although at first glance it might not appear a large addition. Career development is not a new topic, but to nursing the incorporation of CD into a program that is already doing incredible things this addition is very significant. Nurses that participate expresses a number of positive outcomes, and one of those is an interest in further education. When nurses are given the opportunity to learn, conduct research, and improve patient care it really improves they way they view their role in the hospital, including the CD ensures that nurses not only consider further education but also their future career.

Watching the nurses talk about their experiences, research, and what they hope to do in the future was inspiring. Rarely on walking into a hospital is it possible to walk into a room of energized nurses talking about how excited they are, how the organization is supporting them, and creating future dreams about what they would like to do. Below are some pictures from the day, I highly encourage you to take a look, consider if your organization might be able to do something similar, and finally to remember that nurses are the frontline of healthcare delivery, which gives us the best perspective to come up with great research questions.

The RAP-CD initiative is a fantastic idea. I truly encourage every nurse and nursing organization to consider if this is a possibility. Creating dynamic programs like RAP-CD create amazing opportunities to support employees and improve patient care!