NR 640B Week 6 Activity Narrative Example

Supervised Activity Narrative: What Was Done Under Each Practicum Objective, What Existed Afterward and the Objective Changed at Midterm

Student Name

College of Nursing, Chamberlain University

NR 640B: Informatics Nurse Specialist Practicum I

Instructor Name

Month Day, Year

Supervised Activity Narrative: What Was Done Under Each Practicum Objective, What Existed Afterward and the Objective Changed at Midterm

How This Narrative Is Organized

By the five objectives set in week 2, not by date. Under each are the activities that served it, what the student did, what came of it and what exists now. Weeks 2 to 6 are covered.

Objective 1: Follow One Nursing Request From Arrival to Closure

The request followed was the fall-risk carry-forward request from a medical-surgical unit, first seen in week one. I joined the specialist's call with the unit manager on 10 September, where the manager chose display of the previous answers rather than carrying them forward, after the specialist explained that carried-forward answers can be accepted without reassessing. I sat in on the clinical analyst's sizing on 14 September (five build hours, small). I watched the item ranked at the October optimization meeting, where it was approved for build after the upgrade freeze.

What existed afterward: an annotated timeline of seven dated steps, from submission on 21 July to approval on 1 October, with the reason for each wait. It shows the request spent 10 of its 10.5 weeks waiting, mostly for the monthly meeting. The request has not closed, so this objective is partly met; it will close after the freeze.

Objective 2: Attend Optimization and Change Advisory Meetings

I attended the September and October optimization meetings and two change advisory board meetings. At each I recorded the items discussed, the decision and the reason given. I did not speak, as agreed with the chair.

What came of it: the decision log shows that of 14 nursing items discussed in the two optimization meetings, 9 were approved, 3 deferred and 2 declined. Both declined items would have added mandatory fields. The "home medications reviewed" checkbox from week one was deferred again, because the data on how often it was ticked without a pharmacy history had not been produced.

What existed afterward: four sets of notes and a log of decisions, which the preceptor checked on 8 October and who corrected one item that I had recorded as approved when it was approved on condition.

Objective 3: Write and Run a Test Script

I wrote a test script for the revised Braden flowsheet row seen in week one, with 12 test cases covering each subscale, the total, a change back to a previous value and display in the shift summary. I ran it in the test environment on 29 and 30 September with the clinical analyst watching.

What came of it: 10 cases passed. Two failed: the total did not recalculate when a subscale was returned to its previous value, which the specialist had seen in week one, and the shift summary showed the old total for one refresh cycle. Both were logged as defects. The analyst fixed the first; the second was traced to a display setting and fixed on 6 October. I reran both cases and they passed.

What existed afterward: the completed test script with results and two closed defects. The analyst kept the script as a template for the next flowsheet test, which was the most practical sign that it was useful.

Objective 4: Data Extraction, Adjusted

This objective changed at midterm. See below.

Objective 5: Draft a Tip Sheet

Started in week 6, later than the others because a tip sheet has to follow a decided change, and the Braden row was only confirmed for November release after the defects were fixed. The trainer asked for a tip sheet on the revised Braden row, since it goes live in November. A first draft was sent on 9 October.

Working Relationships

The objectives depended on five people agreeing to have a student nearby. The clinical analyst let me watch sizing and testing and explained each step. The trainer took my draft tip sheet seriously enough to send it back with corrections. The meeting chair allowed observation. These relationships are part of the practicum's learning: much of informatics practice depends on goodwill between departments, as the specialist said in the interview, and workflow research describes the same dependence on how people coordinate around systems (Unertl et al., 2010).

The Midterm Assessment

The preceptor's assessment on 8 October marked objectives 2 and 3 on track, objective 1 on track but unlikely to close by week 8 because of the freeze, objective 5 started and objective 4 changed. The preceptor's comments: notes were accurate and useful to the team; testing was thorough; the student should practice asking clarifying questions of requesters, which I had been leaving to the specialist. I agreed to lead the questions on the next request the specialist reviews.

One Objective Adjusted

The original fourth objective was an hour learning how the analytics team pulls admission history completion times. The reporting manager declined on 25 September because the analytics team was preparing upgrade reports and had no hours until February. As planned in week 2, the objective changed to reading the existing report specification for nursing admission history and writing a field list from it.

I did that on 2 October. The field list covers the 41 fields in three sections of the adult admission history: allergies, home medications and advance directives. Beside each field I marked whether a field with the same meaning is documented elsewhere in the first 24 hours, by pharmacy or the admitting provider. Thirteen of the 41 fields have such a counterpart. The preceptor described this list as a useful start for the admission history review named in the annual plan, and asked that it be saved on the shared drive with its method so that it would not depend on the student.

What Produced Only Understanding

Not every activity left something behind, and the narrative does not pretend otherwise. Two afternoons of at-the-elbow support on a medical-surgical unit produced no artifact. They showed me how nurses move through the admission history: most use the navigator top to bottom and skip sections they believe pharmacy has done, which the checkbox debate assumed they did not. That observation matters for the week 7 idea, though it is one student's view of two afternoons, and the preceptor cautioned against generalizing from it until more units have been watched.

Fit With the Literature

The field list is a small step toward the kind of documentation measurement the literature describes as needed and inconsistent (Moy et al., 2021). Testing a change against a script before release is one way to catch the unintended consequences reported after clinical system changes (Ash et al., 2004).

References

Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112. https://doi.org/10.1197/jamia.M1471

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

Unertl, K. M., Novak, L. L., Johnson, K. B., & Lorenzi, N. M. (2010). Traversing the many paths of workflow research: Developing a conceptual framework of workflow terminology through a systematic literature review. Journal of the American Medical Informatics Association, 17(3), 265-273. https://doi.org/10.1136/jamia.2010.004333