Ethnographic Reflection
According to the world of oncology and being what is known as an Oncology Nurse Navigator, unfortunately, encounters with new patients seems to be more frequent than not. However, with the framework of Data, Information, Knowledge, Wisdom (DIKW) greeting cancer patients obtaining data and information can be an indicator of what could possibly be a barrier to their care. Considering patients that are told they have cancer can be overwhelming within itself, and giving them more information when I first meet them can offer a level of additional stress. At saying that, assessing the needs of newly diagnosed cancer patients can be somewhat of a challenge, but when the DIWK format is used it aides me in establishing a level of trust and that allows me to obtain the necessary information needed to help them in a time of such. After assessing the patients and gleaning the data and information needed to help them and identify the barriers to care my assessment is communicated to other members of the interdisciplinary team by way of using standardized terminology. This terminology is known as the North American Nursing Diagnosis Association-International (NANDA-I), the Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). The patient scenario that
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I chose will include the framework DIKW and the standardized terminologies (NANDA-I, NIC, and NOC) as I encounter patients during the course of my daily practice.
Data, Information, Knowledge, Wisdom By using the DIKW format as a framework to obtain data and interacting with my patients, employs me with wisdom and the opportunity to better serve them upon assessment. Therefore, "if the processing of data, information, and knowledge are used by practicing nurses" such as myself and passed on to other parties in the healthcare team wisdom should be obtained through their daily practice as well. Based on Matney, Brewster, Sward, Cloyes, & Staggers (2011), “data, information, knowledge, and wisdom are considered major concepts that support nursing informatics and the practice thereof” (p. 6-7). However Schwirian (2013) goes on to discuss the information and knowledge and the management of the information in how it is communicated can assist to promote the health of people, their families and the communities in which they live. Though these are two different perspectives of the DIKW framework, both are conveying the importance of its use. Whatever approach that is taken as a nurse interacts with a patient the commonality is that the concept of the DIKW format is necessary. Having met CB for the first time in her oncologist office, I was encountering a scared female that thought she had been given a death sentence. She was a 45 year old with a recent diagnosis of lymphoma without insurance. Various diagnostic tests and procedures had to be done by the request of her oncologist and she was afraid due to the diagnosis, but to compound her fears she had no insurance to start the battery of tests. Upon initially meeting CB the data I had before me was her pathology report with demographical information. In order for me to assist her, I needed to get a “meaningful picture” (Topaz, 2013, p. 3) to put with the data I had to obtain more information. CB worked part-time and was not able to afford insurance and lived in a low income apartment. Drawing from past experiences, I was able to glean from the data and information I had received from her to develop a plan from my knowledge to better assist CB. I began to gain trust with CB in informing her that I was able to help her during this time of crisis. With the reassurance, I gave her the confidence in knowing I was going to aide her in getting the procedures/tests done she needed and obtaining health insurance along with the other members on her healthcare team. At saying that, I gave her contact information to the oncology social worker and someone to assist with her financial needs, as I worked with each department to get diagnostic tests scheduled and once her insurance was approved it could retroactively cover charges ninety days. I was able to get all of her procedures/tests scheduled and done within 4 days and met with her the oncologist office and she felt was better able to hear what the physician was informing her about the disease and not let the lack of insurance and her financial state be a barrier to her care. CB was now able to understand what the plan of care (POC) was for the new diagnosis of cancer and remission was achievable. CB was able to somewhat inform me of the procedures/tests that were done, the results, and the POC designed for her.
With my knowledge and previous oncology experience, I was able to correct some of her points she made regarding her care and clarify some of the misconceptions she had and educate her where it was necessary. I was able to explain how and why the POC that was designed for her by the oncologist was determined using National Comprehensive Cancer Network (NCCN) guidelines. Based on my experience, I was using wisdom as to what to say to CB and the approach to take in for her to take an active role in her care and feel like I was there for her as support to achieve the best
care.
NANDA-I, NIC, NOC After having spoken with CB using the DIKW format, relaying this information to the other parties in the healthcare team that can further assist her is important. Documentation is vital in this encounter as I inform the social worker, and the financial assistant of CB’s immediate needs. Dontje & Coeoneen (2011) indicates that the American Nurses Association (ANA) views as minimum standards eight nursing terminologies, and a building block to sound clinical decisions is standardized nursing terminologies. By using the NANDA-I, which is an agreed set of nursing diagnosis (CCN, 2016) I would venture to say CB could have been diagnosed with the following: Fear of the Unknown, Health Management, and Coping Responses to name a few. Due to the fear I could see in her eyes when she was told she had cancer with no insurance. Communicating my report to the interdisciplinary team, I made CB’s needs known as I discussed the distress screening tool we use to obtain patients immediate needs both physical and psychological on a scale of 0-10. The NIC has interventions for educating the patient and I discussed with CB some of the side effects to expect from her treatment and questions to ask the doctor. Not only does the NIC aide in helping the patient, but in the education if her family and friends. The NOC addresses the concerns of CB in a psychosocial aspect therefore the distress screening tool will meet the outcomes classification. With the acquired wisdom I have from experience as an oncology nurse navigator, I have begun to make plans and adjustments according to the needs of CB. By using standardized terminologies with the other members of CB’s healthcare team, we are all aware through clear communication how to meet her needs.
Conclusion
In my conclusion it is imperative as a nurse navigator to identify the possible barriers to care for CB and take the proper steps to address them. If the DIKW framework had been omitted, figuring out how to address the needs of CB may not have transpired and could have hindered her in achieving a plan of care to achieving optimal care. CB could have decided to refuse or even delay treatment due to the lack of insurance. Therefore, it was important with the application of my knowledge base and wisdom gained through my experiences and evidence-based practice, helping CB achieve the greatest possible outcome with the use of DIKW framework and standardized terminologies.
I chose will include the framework DIKW and the standardized terminologies (NANDA-I, NIC, and NOC) as I encounter patients during the course of my daily practice.
Data, Information, Knowledge, Wisdom By using the DIKW format as a framework to obtain data and interacting with my patients, employs me with wisdom and the opportunity to better serve them upon assessment. Therefore, "if the processing of data, information, and knowledge are used by practicing nurses" such as myself and passed on to other parties in the healthcare team wisdom should be obtained through their daily practice as well. Based on Matney, Brewster, Sward, Cloyes, & Staggers (2011), “data, information, knowledge, and wisdom are considered major concepts that support nursing informatics and the practice thereof” (p. 6-7). However Schwirian (2013) goes on to discuss the information and knowledge and the management of the information in how it is communicated can assist to promote the health of people, their families and the communities in which they live. Though these are two different perspectives of the DIKW framework, both are conveying the importance of its use. Whatever approach that is taken as a nurse interacts with a patient the commonality is that the concept of the DIKW format is necessary. Having met CB for the first time in her oncologist office, I was encountering a scared female that thought she had been given a death sentence. She was a 45 year old with a recent diagnosis of lymphoma without insurance. Various diagnostic tests and procedures had to be done by the request of her oncologist and she was afraid due to the diagnosis, but to compound her fears she had no insurance to start the battery of tests. Upon initially meeting CB the data I had before me was her pathology report with demographical information. In order for me to assist her, I needed to get a “meaningful picture” (Topaz, 2013, p. 3) to put with the data I had to obtain more information. CB worked part-time and was not able to afford insurance and lived in a low income apartment. Drawing from past experiences, I was able to glean from the data and information I had received from her to develop a plan from my knowledge to better assist CB. I began to gain trust with CB in informing her that I was able to help her during this time of crisis. With the reassurance, I gave her the confidence in knowing I was going to aide her in getting the procedures/tests done she needed and obtaining health insurance along with the other members on her healthcare team. At saying that, I gave her contact information to the oncology social worker and someone to assist with her financial needs, as I worked with each department to get diagnostic tests scheduled and once her insurance was approved it could retroactively cover charges ninety days. I was able to get all of her procedures/tests scheduled and done within 4 days and met with her the oncologist office and she felt was better able to hear what the physician was informing her about the disease and not let the lack of insurance and her financial state be a barrier to her care. CB was now able to understand what the plan of care (POC) was for the new diagnosis of cancer and remission was achievable. CB was able to somewhat inform me of the procedures/tests that were done, the results, and the POC designed for her.
With my knowledge and previous oncology experience, I was able to correct some of her points she made regarding her care and clarify some of the misconceptions she had and educate her where it was necessary. I was able to explain how and why the POC that was designed for her by the oncologist was determined using National Comprehensive Cancer Network (NCCN) guidelines. Based on my experience, I was using wisdom as to what to say to CB and the approach to take in for her to take an active role in her care and feel like I was there for her as support to achieve the best
care.
NANDA-I, NIC, NOC After having spoken with CB using the DIKW format, relaying this information to the other parties in the healthcare team that can further assist her is important. Documentation is vital in this encounter as I inform the social worker, and the financial assistant of CB’s immediate needs. Dontje & Coeoneen (2011) indicates that the American Nurses Association (ANA) views as minimum standards eight nursing terminologies, and a building block to sound clinical decisions is standardized nursing terminologies. By using the NANDA-I, which is an agreed set of nursing diagnosis (CCN, 2016) I would venture to say CB could have been diagnosed with the following: Fear of the Unknown, Health Management, and Coping Responses to name a few. Due to the fear I could see in her eyes when she was told she had cancer with no insurance. Communicating my report to the interdisciplinary team, I made CB’s needs known as I discussed the distress screening tool we use to obtain patients immediate needs both physical and psychological on a scale of 0-10. The NIC has interventions for educating the patient and I discussed with CB some of the side effects to expect from her treatment and questions to ask the doctor. Not only does the NIC aide in helping the patient, but in the education if her family and friends. The NOC addresses the concerns of CB in a psychosocial aspect therefore the distress screening tool will meet the outcomes classification. With the acquired wisdom I have from experience as an oncology nurse navigator, I have begun to make plans and adjustments according to the needs of CB. By using standardized terminologies with the other members of CB’s healthcare team, we are all aware through clear communication how to meet her needs.
Conclusion
In my conclusion it is imperative as a nurse navigator to identify the possible barriers to care for CB and take the proper steps to address them. If the DIKW framework had been omitted, figuring out how to address the needs of CB may not have transpired and could have hindered her in achieving a plan of care to achieving optimal care. CB could have decided to refuse or even delay treatment due to the lack of insurance. Therefore, it was important with the application of my knowledge base and wisdom gained through my experiences and evidence-based practice, helping CB achieve the greatest possible outcome with the use of DIKW framework and standardized terminologies.