Congratulations to me!

I completed my degree requirements for a Bachelor of Science in Nursing (BSN) at Southwest Baptist University, Mercy College of Nursing, this month.  As many in nursing will attest, having a BSN is becoming more necessary, especially if one wants flexibility in their nursing career.  More and more hospitals are requiring a BSN prior to employment.

Next on the table, I will take a short break from academics to relax, catch up on some much needed sleep, and then begin exploring my options for an advanced degree.  There are many options within nursing and determining my next step will take some time.  I am particularly drawn to leadership, administration, informatics, and nursing research.  Each incorporates my current skill set with skill sets from my previous career as a scientist.  Given my scientific past, I have a unique perspective upon which I would like to capitalize.  Oncology is a fertile ground for scientific exploration.  As cancer treatments move to more individualized regimens, understanding and synthesizing emerging data will be critical to the delivery of care.

Social Media Novices Who Happen to be Nurses

The internet is a system whereby computers are able to connect and communicate with one another.  Funded by the Department of Defense, the original intent was for universities and research institutions to be able to share information from one computer to another.  As with any verbal language, it was vital that a common language protocol be established in order for computers to understand each other.  Once established, the TCP/IP protocols made this possible.  The same can be said about social media; it is a way in which people can connect and communicate or share information with each other.  Social media, such as Facebook and Twitter, are tools which exploit the internet in order for users to connect in creative ways.  The basic principle is simple: Person A wants to tell Person B something.  However, now, with the accessibility of messages through social media platforms, Person A can tell an entire population of people something.  Person A gets to determine what that message is.  The message can be simple (i.e., “I have a dog named Rex.”) or complex (i.e., “I went to the Mission Viejo no-kill animal shelter and adopted my dog, Rex.”).  With the simple message, a few people may be interested.  But, with the complex message, not only are dog lovers potentially interested, but the message draws attention to the no-kill animal shelter in Mission Viejo.  Thus, the content of a message determines who the audience will be and, in some ways, how long the audience is willing to direct its attention to the messenger. 

Having been in the laboratory prior to and during the web explosion of the 1990s, I have seen many iterations of how people choose to connect using the web.  It was once revolutionary to send email messages across the country to friends and family who also had access to an email account.  And, while email is still a standard form of communication, social media sites have attracted users by their ease of use and the creativity users can bring to their message.  It’s a lot like scrapbooking.  We were once satisfied with putting our printed pictures in photo albums.  Then, scrapbooking became popular because it was a way in which we could share our pictures with a creative flair.  Being visual creatures, we are drawn to outlets which allow us to explore and share our creativity.  I’m not shocked by the popularity of social media.  But, much like being at a large dinner party, the number of conversations occurring at one time can give me a headache.  It is important to remember that social media is about communicating a message to an intended audience.  Understanding this, my view of social media has not changed since delving into Nursing Informatics.  What has changed, however, is my awareness of the number of platforms from which to choose.  Ultimately, I feel, many of the tools that are being marketed as ways to reach an audience are tired reenactments of existing tools.  It is important to be able to recognize what is truly revolutionary and what is not. 

When someone tells you they are a nurse, this tells you very little about what they actually do.  Sure, nurses care for patients, but nurses can work in clinics, in hospitals, within large insurance companies, as counsel to lawyers, in schools, at camps, and as teachers.  The list goes on.  Clearly, social media can be a creative way for nurses to communicate a message with their target audience.  The message can be extremely useful but, if nobody is listening, it doesn’t really matter much.  There’s a woman who appears to be homeless whom I can find a few blocks from my home on almost any day of the week.  She rattles and mumbles words at people incessantly.  I daresay very few people actually listen to her message.  She doesn’t command attention from walkers-by.  Her appearance is off-putting and, because she is constantly talking, her words have less value.  The same can be true with nurses (or any profession) trying to communicate a message.  We must present ourselves as authorities and we must present our message in a way that makes people want to listen to us.  In essence, we have to grab the attention of our audience or else we are just cluttering up the web.  Whether the message is delivered through Twitter, Facebook, a blog, or a vlog is irrelevant.  What matters is that the message be one that people want to receive and the method of delivery is flexible enough to evolve as social media evolves. 

For more advice, take a gander at my podcast:

Before you swallow that supplement!

a webliography

by Karl Rusterholtz

10 February 2013

Complementary and alternative medicine (CAM) is a broad category of practices or therapies neither taught widely in U.S. medical schools nor generally available in U.S. hospitals.  Complementary modalities are those treatments that are used in conjunction with mainstream treatments and alternative modalities are those treatments that are used instead of mainstream medical treatments (National Center for Complementary and Alternative Medicine [NCCAM]).  Though manipulative and mind-body therapies, such as osteopathic manipulation, biofeedback, meditation, and yoga, are considered CAM, biologically-based and alternative medical systems are of particular concern to physicians of conventional medicine, particularly when these practices are sought by patients without the knowledge of their doctors.  Though CAM focuses on practices within the Unities States, alternative medicine is popular worldwide and is not always considered alternative. 

Herbal and dietary supplements are used widely in the United States, however, their efficacy and safety are not as controlled here as in Europe.  Again, this is of particular concern to physicians of conventional medicine.  CAM is often sought by those diagnosed with cancer.  However, biologically-based alternative therapies can significantly impact the health of patients and may interfere with bio- and chemotherapies in the oncology setting.  Therefore, the focus and goal of this webliography is to be a resource to healthcare professionals and their patients diagnosed with cancer.  It is important that oncology patients and their healthcare professionals speak openly and fluently about CAM practices and how these practices can impact conventional therapies. 

National Center for Complementary and Alternative Medicine
http://nccam.nih.gov/

The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government's lead agency for scientific research on complementary and alternative medicine (CAM).  It is 1 of 27 institutes and centers that make up the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services.

CAM Basics: http://nccam.nih.gov/health/whatiscam
This factsheet webpage provides an introduction to, definition of, and types of complementary and alternatives medicine.  Hypertext links to consumer information and frequently asked questions (FAQs) are also provided.

Resources for Healthcare Professionals:  http://nccam.nih.gov/health/whatiscam
This webpage provides evidence-based resources with the intent of preparing healthcare professionals to discuss CAM approaches with their patients.  Hypertext links within the webpage provide additional information, including evidence-based medicine and guidelines for oncology and rheumatology (whose patients are often treated with bio- and chemotherapies) professionals.


National Cancer Institute
http://www.cancer.gov/

The National Cancer Institute is an institute within the National Institutes of Health. NCI conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.  Tabs on the NCI homepage guide the user to general cancer topics, clinical trials information, cancer statistics, and research funding information.   

Dictionary of Cancer Terms:  http://www.cancer.gov/dictionary

This is an easy-to-use, searchable database of terms related to cancer and medicine.  Professionals and patients can search on types of cancers, individual chemotherapies, and chemotherapy regimens.  Links from this page lead the user to other databases specific to cancer genetics, cancer statistics, and specific drugs.  Within the drug specific database, some drug entries include a "patient information" button that links to a drug information summary page.

Education and Training: http://www.cancer.gov/cancertopics/cancerlibrary/health-professional-training-tools

This is a collection of cancer education and training tools and offerings from NCI and NIH for health professionals.  The education and training material formats include online and downloadable self-studies, CD/DVD resources, and webinars. 

Publications locator: https://pubs.cancer.gov/ncipl/detail.aspx?prodid=P042

In addition to providing a general link to NCI publications, this specific link leads the user to "Thinking About Complementary and Alternative Medicine: A Guide for People with Cancer" which describes how to make informed decisions about CAM.

Videos: http://www.youtube.com/user/NCIcancertopics?feature=watch

This Youtube channel provides audio-visual learners many useful videos, including much of the information that can be found in text on the main NCI website.  Many videos are also presented in Spanish.  

National Cancer Institute: Office of Cancer Complementary and Alternative Medicine

http://cam.cancer.gov/index.html

The Office of Cancer Complementary and Alternative Medicine (OCCAM) is an office of the National Cancer Institute (NCI) in the Division of Cancer Treatment and Diagnosis.  OCCAM is responsible for NCI's research agenda in complementary and alternative medicine (CAM) as it relates to cancer prevention, diagnosis, treatment, and symptom management. A brief (1:48) video by the OCCAM Director explains the meaning of CAM and some of the precautions patients should take.

For Patients: http://cam.cancer.gov/health_patients.html

This webpage resource provides hypertext links to important considerations prior to using CAM and safety warnings from the Food and Drug Administration (FDA).  

Workbook: http://cam.cancer.gov/talking_about_cam.html?cid=EBcam_apple

This 15-page, downloadable workbook, "Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips", is a resource directed toward patients, but useful to healthcare providers as well.

U.S. Food and Drug Administration

http://www.fda.gov/

With the task of protecting consumer health and safety as relates to food and drugs in the United States, the FDA has oversight of prescription medications.  Supplements do not fall under this category as long as they do not make any specific health claims.  However, due to many of the (sometimes fraudulent) claims made by companies, the FDA has some oversight.

How to Spot Health Fraud:   http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm137284.htm

This webpage is a useful guide for consumers, particularly those who are desperate to find a cure for their cancer.


National Institutes of Health: Office of Dietary Supplements

http://ods.od.nih.gov/

The goal of the Office of Dietary Supplements, within the National Institutes of Health, is to provide information on dietary supplements to consumers, scientists, health professionals, or members of the dietary supplement industry.

Factsheets: http://ods.od.nih.gov/factsheets/list-all/
In addition to the hypertext links for individual dietary supplements, there are several useful, general supplement information factsheets provided.


National Institutes of Health: U.S. National Library of Medicine
http://www.ncbi.nlm.nih.gov/pubmed

The US. National Library of Medicine with the National Institutes of Health provides a searchable database of literature covering many topics related to health, medicine, and biotechnology.  Using the search function, the user can search on terms of interest for published literature on, for example, "alternative and complementary medicine".  Adding the term "evidence-based" will provide a list of articles from the journal Evidence-Based Complementary and Alternative Medicine.  From there, it is easy to search within the journal for research on CAM and chemotherapy.  

Oncology Nursing Society

http://www.ons.org/

The Oncology Nursing Society is a professional nursing organization of over 35,000 registered nurses and other healthcare providers dedicated to excellence in patient care, education, research, and administration in oncology nursing.

CAM Resources: http://www.ons.org/ClinicalResources/BreastCancer/CAM

Several links are provided, including a Power Point presentation on various types of CAM.  A hypertext link directs the user to a webpage that discusses several issues of which to be aware with regard to dietary supplements.  Much of the information is a reiteration of information that can be found on the websites noted above.  However, the website provides links to the society's PEP (Putting Evidence into Practice) series of factsheets for symptom management.  For example, the PEP for Chemotherapy-Induced Nausea and Vomiting (CNIV) indicates whether certain CAM practices are "recommended for practice", "likely to be effective" or "effectiveness not established".  

Finding a Needle in a Haystack

What do you think of when you think of healthcare informatics?  Those in the healthcare industry may have an idea what this means.  It seems like an easy enough concept: take two words, healthcare and informatics, and combine them to get one meaningful discipline.  What about those outside of healthcare?  I would imagine that for most, whether in the healthcare industry or not, the term healthcare informatics conjures up similar images: hospitals and computers.  This is a good place to start, but an image of hospitals and computers is very limited. 

Healthcare encompasses more than hospitals.  Hospitals, clinics, urgent care facilities, insurance companies, research institutions, pharmaceutical and biotechnology companies, and universities make up a bulk of what is happening in the healthcare environment.  Each generates a vast amount of information (data).  Incorporating the complementary and alternative medicine component adds another element to the data that is generated on a daily basis.  Enter informatics.  Once, data generated in each of these venues was, largely, trapped in paper form.  Not that the information was not available, but the amount of time it would take to retrieve the archived data was significant.  In the 1950s and 1960s, computers helped healthcare institutions with the financial aspects of the delivery of care (Sewell & Thede, 2013).  But, healthcare was slow to adopt technologies that would allow them to digitize and store information (Kudyba, 2010).  The rapid advancement of computing technologies in the 1990s, including those that made personal computers and information sharing more readily accessible to the masses, fueled advances in virtually every industry.  Yet, the healthcare industry remained reluctant to adopt emerging technologies that would allow it to let go of its strangle-hold on paper.  Particularly in the U.S., healthcare was using the most advanced diagnostic and delivery technologies in the world concurrently with the most primitive of information storage possible: paperwork stored in file boxes and microfiche films. 

As the new century advances, the delivery of healthcare has been mandated to adopt sharable electronic health records (EHRs) with the goal of providing a higher level of care in a more cost-efficient manner (Sewell & Thede, 2013).  Digitizing data makes this possible.  Managing the immense amount of digitized data that is generated is in the realm of information technology.  Data is not useful unless it can be linked in useful ways - rapidly.  Linking data requires a standardized language utilized by input sources, the ways and means to store data, search functions to retrieve the data, and an ability to perform analytics based upon the type of information one hopes to generate.  The ability to link data provides us the ability to ask important questions such as, “How many ERCPs were performed in-house this month?”, “What is the average age of clients diagnosed with lung cancer?”, and “How much does it cost to perform a cholecystectomomy?” 

As a scientist and oncology nurse, I am particularly interested in advances made in chemotherapies, biotherapies, and cancer genomics.  There is a vast amount of information generated in cancer research and the delivery of healthcare to those impacted by cancer.  In order to make significant advances, however, it is necessary to make higher-level connections between disease states and non-disease states.  In other words, what is different?  What changes do we see? What causes uncontrolled proliferation in one cell and not the other?  How can we exploit this information to provide better health outcomes?  In order to make these significant advances, we must be able to mine the data we generate.  Healthcare informatics is the goose that laid the golden egg. 

I was once part of a start-up biotechnology company in San Diego (watch the video if you want to get a better understanding of what I did and where the company is today).  In brief, we collected nucleic acids (genetic material) from environmental sources around the world.  Once purified, we would clone the genetic information into expression hosts, like E. coli, and look for gene products of biotechnological significance.  The myriad of sample sources, whether a hot spring in Costa Rica or a deep sea vent at the bottom of the ocean, combined with thousands of genes, and gene products discovered from those sample sources, created a mountain of data that would remain useless unless it could be stored and retrieved to facilitate research and development.  As one of the bioprospectors responsible for the collection, generation, and storage of genetic information, I was given the opportunity to work on an intracompany database.  Essentially, we needed to create a platform that would allow us to mine the reams of data we were generating.  Data and the scientific advances we made were the life-forces of our company.  If we discovered a commercially viable gene product (i.e, an enzyme that could be used in laundry detergents to break down fat stains on clothes or an anti-tumor compound) we needed to be able to go back to the original source of that material in order to conduct further studies.  Knowing where we collected that sample, how it was purified, the genetics of the expression host, and where it was stored was critical.  Developing the database, coming up with a standardized language, and providing a user-friendly platform gave us this ability.  Without this ability, our company could not stay in business.  Advances in cancer research and the delivery of healthcare are also dependent upon this ability.  We must be able to mine the data we generate in cancer research in order to provide the highest level of care that leads to better health outcomes for clients. 

Certainly, healthcare informatics is meant to provide a system whereby critical client information is stored and retrievable in a useable format to provide the best care available to clients.  But, it is not limited to the delivery of care directly to the client.  It starts long before a client enters the hospital, the urgent care clinic, or the physician’s office.  It starts when we start asking “How can we provide better health outcomes?”

 

References

Kudyba, S. (2010, April 19).  What is healthcare informatics? Retrieved from http://youtu.be/pzS--PaGC9o

Sewell, J. & Thede, L. (2013).  Informatics and nursing: Opportunities and challenges (4^th ed.).  Philadelphia, PA: Wolters Kluwer Health / Lippencott Williams & Wilkins

 

Charge Nurse University?

According to Heather Malcolm (2013), due to the shortage of nurses projected for 2020, there also will be a dearth of nurse leaders.  To stem the tide, West Virginia University Healthcare has created a leadership development program called Charge Nurse University (CNU).  The goal is to train skilled nurses to be nurse leaders.

I’ve now been a charge nurse at two hospitals.  The responsibilities at each location have been significantly different, but one characteristic of the charge nurse that appears to be consistent at both locations is an ability to be a leader.  The staff on the floor must have confidence in the charge nurse.  In many cases, nurse leaders are appointed based on their clinical nursing ability or willingness to serve – not their abilities to manage or lead (Malcolm, 2013). 

According to the American Organization of Nurse Executives (AONE), core competencies common to nurses in executive practice include: communication and relationship building; knowledge of the health care environment; professionalism; business skills and leadership.  I imagine each of us can think of nurse leaders who demonstrate these competencies better than others.  On the flip-side, each of us has varying innate abilities to lead.  How do I stack up?  How do you stack up?  A self-assessment of strengths and weakness may or may not reflect the opinions others have of us.  According to Seth Godin, the changing marketplace requires each of us to consider ourselves as leaders (2008).  With that in mind, what lengths are we willing to go to become leaders? 

Image is powerful

Ask yourself these simple questions.  What role does image play in your life?  How much of your image is under your control? How do you perceive yourself?  How do others perceive you?  Does your image matter to you?

I argue that, like it or not, image matters to each of us.  Certainly, some worry about image more than others.  But, each of us feels social pressure to present ourselves in a particular way.  For me, I value education, intelligence, social responsibility, and hard work.  I place less importance on fashion, material possessions, and power.

Now consider those factors that are out of your control, such as gender, race, height, beauty, cognitive abilities, etc.  What role do these factors play in your perceived successes and your perceived failures?  Not only am I intrigued with the notion that I am the master of my own destiny, but I am also fascinated by those factors that are out of my control.  For example, as a white male in American society, I have been afforded access to opportunities that female minorities have not.  It is not that a black woman cannot achieve great successes in this country.  Just look at Condoleezza Rice, former U.S. Secretary of State.  However, one cannot argue that her obstacles were far different than mine.

Perhaps I am having difficulty illustrating my point or you are having difficulty believing the notion that factors beyond our control can play a significant role in our achievements.  So, I turned to TED Talks and found a video of a presentation by Cameron Russell.    This former Victoria’s Secret runway model clearly articulates that: 1) image is powerful, 2) image is superficial, and 3) she won a genetic lottery.

http://embed.ted.com/talks/cameron_russell_looks_aren_t_everything_believe_me_i_m_a_model.html"

I believe Ms. Russell succinctly illustrates how factors beyond our control play a vital role in our social trajectory.  So, why am I posing these questions about image?  I am doing so because I believe it relates to a greater social issue: health disparities in this country.  I ask you to contemplate those factors that are out of your control and how they have helped or hindered you on your path to achieving your goals.  Next, I hope you will consider these factors when you are at the bedside of each of your patients.  What roles do the inequities of life play in how your patient arrived at their current health situation? The disparity in health outcomes in the United States is a complex issue and reaches far beyond image.    But, clearly, taking into consideration the riches that have been afforded to each of us (for no other reason than our genetics) is a good place to start when considering ways to address the problem of health disparities in this country.  As Ms. Russell posited, what 'free stuff' do you receive?

A beginning

While this blog is a requirement for a BSN  Nursing Informatics course I am taking at Southwest Baptist University, it is one I have been mulling over for quite some time.  Sure, there is probably an overabundance of blogs.  Presumably, those of us who start blogs have a voice we believe needs to be heard - even if among a limited circle of friends.  Mine is not a grandiose aspiration (yes, I shamelessly used the word "grandiose", Mr. Hester, former AP English instructor at Craigmont High School).  Rather, I hope to reach an audience who is intrigued by science, who has some facility with health information, and who is interested in how I can make this entertaining.

More recently, I have become inspired by Seth Godin and his book, Tribes: We Need You to Lead Us.  The basic premise is that we should each consider ourselves leaders.  Leaders attract a tribe of followers who seek our lead - whether it is a small knitting circle of friends we form to amuse ourselves or a cutting edge personal electronics company attracting gadget aficionados a la Steve Jobs.  Thus, I have titled my blog "Leads in the Weeds".  This alludes to the fact that I am most certainly not in a placid, peaceful clearing.  Instead, I have juxtaposed myself, purposely, in the weeds.  In the weeds, I find myself entwined in information, seeking clarity and understanding.  Science seems like a good starting point.  Nursing - well, that's a natural springboard, too.  Can I make you laugh while doing so?  I certainly hope so, but I make no promises.

Namaste,

Karl