NR 500 Week 8 MSN Foundations Closing Reflection Example

Closing Reflection: I Came Into Informatics to Fix Tools, and I Am Leaving With the Habit of Asking What a Claim Rests On

Student Name

College of Nursing, Chamberlain University

NR 500: Foundational Concepts and Applications

Instructor Name

Month Day, Year

Closing Reflection: I Came Into Informatics to Fix Tools, and I Am Leaving With the Habit of Asking What a Claim Rests On

What This Reflection Concludes

My conclusion is that the most important skill this course asked of me was not technical. I came into the informatics track thinking of the specialty as the work of fixing tools: better templates, fewer clicks, faster screens. I am leaving thinking of it first as the work of asking what a claim about a tool rests on, and of measuring the answer locally. The tools still matter, but the course showed me, on three specific occasions, that I had been ready to change a tool on the strength of a claim I had never examined.

That conclusion is specific to my specialty. In clinical informatics, the claims come from vendors, from colleagues, from intranet pages and from our own impressions, and they are rarely checked, because the tools arrive already installed.

Occasion One: The Sentence on the Intranet

In Week 4 I set out to evaluate the intranet's promise that our sepsis alert finds at-risk patients early. I expected to find a study behind it. There was none. The nearest independent evidence, an external validation of a widely used vendor sepsis model, reported that it missed 67% of patients who developed sepsis while alerting on 18% of all hospitalized patients (Wong et al., 2021). I had repeated the intranet's sentence myself to new nurses. The occasion changed what I say in orientation, and it is the reason my first professional goal includes measuring before changing.

Occasion Two: The Document I Had Not Read

In Week 3, writing the standards review, I reached the specialty's own scope and standards document and realized that I had never read it. I had cited it in an earlier discussion post as if I had. The honest entry in the review said that I had not read the full text and did not summarize it. That entry was uncomfortable to write, and it taught me more than any summary would have, because it made me notice how often in practice we pass on what we believe a document says. The request for a copy is still pending; when it arrives, I will read it before I cite it again.

Occasion Three: Twenty Shift Notes

In Week 5, I compared 20 shift notes with the flowsheet and found values that disagreed in 7. I had assumed the double entry of vital signs was a waste of time; I had not imagined it was also producing records that contradicted each other. The finding was small, and I said so in the brief, but it changed the problem from an efficiency complaint into a safety question. It also showed me why the published literature matters: Moy et al. (2021) found that documentation burden has no agreed measure, so my own small count, clearly defined, was a legitimate contribution rather than an amateur substitute for a standard tool.

Occasion Four: A Question From a Classmate

The fourth occasion came from outside my own work. In Week 1, a classmate in the nurse practitioner track replied to my post by asking whether informatics nurses ever see patients. My first answer was defensive: I listed the ways informatics work affects patients indirectly. Over the term I came to think her question deserved a better answer. The informatics nurse who redesigns a note template or evaluates an alert does not see the patient, but every decision in that work lands on a patient through a bedside nurse. The shift note disagreement I found in Week 5 is a patient-safety finding precisely because a nurse reading the wrong heart rate might act on it.

I wrote back to her in Week 7 with that answer, and with the example of the 20 notes. She replied that it was the first time the specialty had sounded to her like nursing. That exchange showed me that the case for informatics as a nursing specialty is made most convincingly with a concrete finding, not with a definition.

The Specialty, Restated With Backing

At the start of the course, I described nursing informatics as a clinical specialty rather than a technical job, citing the certification requirements. I still believe it, with more backing now. The Informatics Nursing credential requires an RN license, clinical practice as an RN and informatics practice or a supervised graduate practicum (American Nurses Credentialing Center [ANCC], n.d.). The three occasions above add something the requirements do not say: the specialty's clinical character shows most clearly in its questions, such as whether an alert helps a nurse find a sick patient, or whether a note tells the next nurse the truth. Those are nursing questions asked about technology.

Feeling, in Its Place

I felt embarrassed in Week 3 and uneasy in Week 4, when I realized how much I had passed on without checking. I record that because it is true, but the feeling is not the point. The point is the change in practice: I now keep a short list of claims I have heard about our record system and, next to each, what it rests on. Most entries on the list say "not known yet." That list is the most useful thing I made this term.

What I Still Do Not Know

I do not yet know how to turn a question into an evaluation that a busy hospital will fund, how to read the statistics in validation studies without relying on the authors' summaries, or how to raise a doubt about a popular tool without sounding as if I oppose it. Those are skills for the rest of the program, and I expect the practicum to teach more of them than any course. What this course gave me is the habit of asking the question in the first place.

What Changes Next Term

Next term I start the course on data management, and I intend to carry the habit forward in two concrete ways. Before accepting any figure in the readings about how much time nurses spend in the record, I will look for the study behind it and its date, since the most cited figures may come from before electronic records were common. And before proposing any change in my own hospital, I will write down, as I did for the sepsis alert, what the claim for the change rests on and what local measure would show whether it worked. The list of claims and what they rest on will go with me into the practicum, where I expect to add to it faster than I can check it.

References

American Nurses Credentialing Center. (n.d.). Informatics nursing certification (NI-BC). American Nurses Association. https://www.nursingworld.org/our-certifications/informatics-nurse/

Moy, A. J., Schwartz, J. M., Chen, R., Sadri, S., Lucas, E., Cato, K. D., & Rossetti, S. C. (2021). Measurement of clinical documentation burden among physicians and nurses using electronic health records: A scoping review. Journal of the American Medical Informatics Association, 28(5), 998-1008. https://doi.org/10.1093/jamia/ocaa325

Wong, A., Otles, E., Donnelly, J. P., Krumm, A., McCullough, J., DeTroyer-Cooley, O., Pestrue, J., Phillips, M., Konye, J., Penoza, C., Ghous, M., & Singh, K. (2021). External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Internal Medicine, 181(8), 1065-1070. https://doi.org/10.1001/jamainternmed.2021.2626