NR 505 Week 8 Reflection on Learning

I chose to reflect on the question, “What do you think your role in research will be I believe that research will be invaluable to practice as an NP. Not only is the medical

The field is constantly changing regarding treatments and advancements in technology, but it is an industry that deals with people who are inevitably creatures of change and adaptation. In order to continue to provide the best care for our patients, our practice must be rooted in evidence-based practice, and we must be able to think critically. Part of that includes being able to find and decipher new information, evaluate and adjust the found information, and find ways to utilize it in practice. We must be able to research the research we find to decide if it is valid and reliable. We must be willing to delve into our own research in the hopes of finding new and better ways to care for our patients. I believe research is one of those things that will always be relevant to the nursing profession and should be sought after to increase our knowledge base. My personal role will be to research things related to my intended field, psychiatric mental health nursing, and strive to incorporate the best I find or produce my own research if I am unable to find something satisfactory.

Week 2

The challenges I found in developing the PICOT question this week were being able to accurately get the idea in my head onto paper in a manner that made sense to those reading it and met the requirements. Defining the age of the population was something I found difficult for my area of interest, which was the care of psychiatric mental health patients in the ED setting. Since we have no age restrictions in the ED, this was an area of struggle. After reading the comments from the collaboration posts and discussing this information with my nurse manager in the ED, we (my manager and I) discovered that more than 75% of the patients we see in our locked psych unit in the ED were between 18-65, so that is the age range I chose to look at for my question.

Finding information on my chosen intervention did prove as difficult as I thought it might be. From my research, it seems that the use of Telepsychiatry for the treatment of mental health patients in emergency departments has gained popularity in the last few years, and I was able to find several good resources that showed the positive benefits of using these services. My ED currently does not use Telepsychiatry, however, in my asking around my department for this week’s assignment, I was able to get contact information for those in upper management who may be able to help in establishing this kind of service in my ED.

Week 3

How hard was it to find a quantitative article related to your area of interest?

I did find it slightly difficult to find a quantitative article for my area of interest. I did find plenty that were qualitative, and as I am dealing with a mental health issue, I can see how it would be easier to obtain qualitative data. There were quite a few articles that had quantitative data related to the mental health field. However, finding something that was specific to the boarding time of mental health patients in the emergency department did prove difficult.

Did you have any difficulty determining whether the articles you reviewed were quantitative?

I do not believe that determining if the article was quantitative or not was difficult, and the Johns Hopkins worksheet helped immensely. I believe that worksheets will prove useful throughout my career for assisting in examining articles and other research I come across.

Is the quantitative approach appropriate for your area of interest? Would you be able to replicate the study you found?

Yes, I think the approach from the article I chose is appropriate for my area of interest and could be easily replicated in my emergency department. The fact that the researchers used every patient who checked into the ED and required a mental health evaluation adds to the ease of replicating the study.

NR 505 Week 8 Reflection on Learning

Week 4

Overall, it was much easier to find qualitative information on my area of interest. It was slightly more difficult to find one that was directed at the telepsychiatry aspect being utilized to reduce mental health patient boarding time in the ED. There seem to be many opinion-type articles on the subject but fewer articles with actual research done. Determining if the article was qualitative was not as difficult as deciphering if the article was quantitative for week three. (Plus, the article stated it was a qualitative research study in the title, so that helped.) I believe that qualitative research would be useful regarding my area of interest, as finding out from personal opinions and experiences will always be beneficial in guiding how to reform a system that is currently not working. The study would not be difficult to replicate, and I believe this type of interview-based study on how providers perceive the use of Telepsychiatry in the ED may open the eyes of upper management to how broken the current system truly is and that it does, in fact,, need to be revamped. In terms of which kind of research would best suit my area of interest, I believe that a combination of all the methods would provide a well-rounded and comprehensive picture of the dire state of mental health care in emergency departments and provide needed information to begin enacting changes to how these patients are moved through the healthcare system.

Week 5

Was it difficult to find evidence related to your selected area of interest? It was slightly difficult to find articles that specifically touched on using Telepsychiatry in the emergency department to reduce boarding time. There were multiple articles related to the use of Telepsychiatry in the ED but no mention of boarding time, as well as studies on patient/insurance/provider characteristics that contributed to boarding time.

What types of evidence were easiest to find (quantitative, qualitative, reviews, practice guidelines)? Qualitative was the easiest to find, followed by quantitative. There were many reviews of other studies as well. I did not find any clinical practice guidelines that directly addressed my area of interest.

How did you find the overall quality of the available evidence? The overall quality of what I could find was good and well-researched. There is a significant lack of research on the topic of telepsychiatry use in the emergency department, whether it is being used to improve outcomes or reduce boarding time. It would appear that this is a topic that needs more research.

In looking at the available evidence, did you see any gaps in the evidence? What additional research on the topic would you like to see conducted? I did not identify any major gaps in the evidence. For the most part, the research substantiates each other, and they seem to agree that Telepsychiatry is useful, feasible, and well-received by both provider and patient. I believe that mental health as a whole requires more research and is typically overlooked as a vital component of holistic health.

Based on what you found, does the literature support a practice change? Yes, I believe the literature supports a practice change. It appears that providers are satisfied with the use of Telepsychiatry when they are not proficient in the area of mental health. While there were some negatives reported by patients using telemental health services, the majority of reported information was positive, and the patients felt they received adequate care. Based on the information, using Telepsychiatry in the emergency department (with the end goal of reducing boarding time) would appear to be a satisfactory solution to the long wait for mental health patients and their final disposition as well as assisting in reducing the overcrowding emergency departments are facing.

Week 6

In completing your CITI modules, was there anything that surprised you? I am not sure surprised would be a good way to describe it, but I was impressed at all of the guidelines that are required for a research study to be approved. The biomedical research community has made tremendous strides in improving how they conduct research with the aim of protecting the patient/participant. After learning about the history of biomedical studies, this is something that was direly needed, especially when it comes to vulnerable populations.

What similarities did you see between the CITI modules and the ANA Code of Ethics?

There are definitely similarities between the CITI modules and the ANA Code of Ethics, specifically with the focus being on the patient, ensuring the patient’s rights are upheld, and providing appropriate and beneficial care/treatments. A human life should never be considered expendable, no matter what the research is for or who it would benefit.

Do you see applications for this week’s content to your nursing practice? Absolutely. As we further our education and make the transition from caregiver to provider, we will have more opportunities to be involved in research. Knowing the history of biomedical research and understanding the why’s and how’s of conducting research will ensure that we are protecting and advocating for the patients. As current caregivers, this knowledge allows us insight into the process and will make us better advocates for any patients in our care who may be involved in biomedical research.

NR 505 Week 8 Reflection on Learning

Week 7

In looking at the possible types of dissemination, which appeals to you most? Why? The two types of dissemination that appeal to me the most are the poster and the podium. I feel that the poster is a good way to provide information in both a written and visual (graphics such as charts or images) form, which appeals to most people. Not everyone is a good reader or enjoys reading “technical” stuff; however, when the key points are presented as a poster with graphics to emphasize the written information, I feel it appeals to more people and therefore will allow the information to reach a greater number. The reasons the podium type appeals to me are along the same lines. When someone is speaking, presenting images and written words on a projector (PowerPoint), and there is the ability to print the presentation for observers to physically touch and take notes, you appeal to all the learning types and are more likely to have people engaging and absorbing the information being presented.

What steps could you take to share the results of your week seven project in a professional setting? I may have already spoken with my ED nursing director, who has been working on getting the “right” people together for me to speak with about the possibility of attempting a telepsychiatry program in our ED. I have also emailed the head IT person to inquire about the cost and resources needed to add an icon for Telepsychiatry to our desktops. The dayshift AOD has spoken with the chief financial officer on my behalf, and she is working up a projected cost analysis for me on implementing a telepsychiatry program. I am blessed to work for a hospital system that values employee ideas.

Week 8

What is your personal plan to promote lifelong personal and professional growth in the use of evidence-based practice? My personal plan is to read everything I can about my profession and chosen specialty and never stop learning. The nursing profession as a Whole is dynamic, and there is always new information to be gathered and examined. Part of ensuring I am providing the best, evidence-based care to my patients is to stay on top of the newest ideas and practices and to use my critical thinking skills to determine if this new information is a good fit for my unit and my practice.

Do you have any plans to disseminate the information you found to support your project in this course? I believe I have already done this, in a way. I have discussed my area of interest with my nursing director for the ED, and she has helped me to contact certain people within the hospital system who may be able to provide information or assist me in my attempt to get a proposal together so that we may try implementing Telepsychiatry in our ED. If I do get the chance to discuss my idea with the “higher-ups”, I plan to utilize the PowerPoint I made in this class.

Conclusion

I have learned quite a bit in this class and shall carry this new knowledge with me as I move forward in my education and my career.

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Question

Document includes reflections from all weeks 1-8: To complete the assignment, students will need to copy the reflections they entered into the weekly reflection threads from weeks 1-8 into one double-spaced Word document and submit the document to the dropbox.

Formatting: The document should be in APA format

Includes a title page in APA format

Document is double-spaced

Each week’s reflection is labeled with a level 1 heading listing the week’s number

.Only include a reference page if references were cited in the body of the reflections. If a reference page is included, it is in APA format.

What is your personal plan to promote lifelong personal and professional growth