Innovations in Nursing - NurseMuse (With Dr. Catherine Prato-Lefkowitz)

Five-time UNLV alumna Catherine Prato-Lefkowitz discusses the program she developed called "NurseMuse", a software that can guide nurses, specifically students, to build effective care plans for patients and understand the purpose behind the treatments. She also talks about the limits of technology in nurse education.

Joe Gaccione 0:09
Hello, and welcome to vital views UNLV school nursing Podcast. I'm Joseph Gaccione, communications director for the School of Nursing. We created this podcast to help share tales from our hard working nurses out there, whether they're students, faculty, staff, alumni or donors. These stories focus on work on the frontlines in the classrooms, in the lab, wherever our nurses are making a difference. We don't just talk about nursing, we dive into broader healthcare topics to bring attention to bigger issues that impact everybody. We also talk about ways to keep you your family and your community healthier, both physically and mentally. It's no secret nursing school can get hectic to the point where you're writing down so many notes and care plans it can get pretty confusing for nursing students especially it can be challenging when you don't exactly know what a health care plan is and what to include in it. Enter nurse muse. This is a concept created by UNLV alumna Dr. Catherine Prato Lefkowitz, she is a nurse, educator and consultant who has more degrees than a Las Vegas thermometer. She earned her Bachelor's, Master's and PhD in nursing all from UNLV as well as her Executive MBA and bachelor's in psychology. She was previously the director of nursing education for the Nevada State Board of nurse nurse Muse is a software Catherine thought up to help nurses specifically students to stay organized to create care plans and take notes seamlessly all from a centralized program. Having launched the software earlier this year, she's ready to raise more awareness not just for this technology, but in general how to improve Nurse Education. Catherine joins us today. Thank you for stopping by. Thank you so much. Let's start with the basics. How did the idea for nurse Muse come to you?

Catherine 1:37
Well, as you mentioned, I did get my executive MBA through UNLV, which is a fabulous program. Fortunately, we were the COVID cohort. So instead of going on our international business trip, we were in our entrepreneurial class, and we had a fabulous instructor who said so I want you to start thinking of ideas of something that you could build or create that you go out and sell. And at the same time when we found out we weren't going on our trip, the program director said okay, instead of the trip, you guys get to do a thesis. And I started thinking what could I make for my passion and my passion is nursing students in nursing education. So I started thinking about all of the nurses who run around the hospital caring for their patients with their piece of paper, which we call a nursing brain board in the nursing world. And it has all of the patient's you know, vital signs and medications and allergies. And at the end of the day, you get home and you have like pockets full of notes. So I said I wonder if there's a an application I could create that could allow nurses on the floor to kind of stay more organized. But more specifically, as I started developing the idea, is there an application that I could create that could keep nursing students more on track. So nursing students, when you enter nursing school, a lot of people don't have healthcare experience. So you're in your fundamentals, you get told you're going to the hospital, you're gonna go in and talk to your first patient, you have to do a head to toe assessment, you have to document on that. And you also have to do a care plan. And a lot of these students are scared to death of touching a patient talking to a patient, sometimes we have to push them into the room for the first time. And then they're tasked with creating a care plan. And a lot of students don't really understand that idea of what that is. So I created nurse muse, where it's a, it's an online application for nursing students that guides them through creating their care plan. So in nursing, we use nursing diagnoses, we can't use medical diagnoses, because we're not practitioners. So for example, if our patient has hypertension, we have to come up with nursing diagnoses that relates to hypertension. And this is a lot of information to throw it new nursing students, even nursing students who are in their third or fourth year, they still struggle with I can't come up with appropriate nursing diagnoses and nursing diagnoses really guide your practice of how you keep your patient safe and provide effective care. So nurse muse, basically, I've linked all of the medical diagnoses to the nursing diagnoses to the interventions and the rationales. And it's really important for nursing students all around the world to understand the rationales for what they're doing. Many times your faculty member is going to come in and ask you why are you doing XYZ and you have to have an evidence based rationale, right? So I've linked all of that. So our newer nursing students kind of have an upfront overall global view of what a care plan is. So after my 10th patient with hypertension, I'm going to know these five things I have to make sure I do. That's based on evidence. So like I said, it's really challenging for nursing new nursing students to come in and kind of put those pieces together. So it kind of gives them a little stepping stone of you know, how to start thinking critically and thinking like a nurse.

Joe 4:57
And that's an interesting point you bring up about the rationale. You know, like, it's not just a task, it's not just a list of things they have to click on, and type in or even write in, they have to understand the why behind it.

Catherine 5:10
Correct. And that's nursing. And a lot of people who aren't in the medical field might not understand that. But, you know, working those 12 or 13 hour shifts, and people say, Oh, you only work three days a week, you're constantly thinking because you're giving medications, but you as a nurse need to understand what the underlying medical condition is, how that medication might affect that patient, and how to be on the lookout for any adverse effects. You need to look at labs and know when to contact the provider and when not to contact the provider. So you really need to understand that the baseline rationale for everything that you're doing,

Joe 5:44
for those out there who aren't necessarily familiar with nursing, or healthcare in general, what is a care plan? And why is technology like this so critical to simplify that process.

Catherine 5:57
So a care plan is the plan that you're going to do for your patient for that day. So if your patient has hypertension, you're going to do education, you're going to give them medications, you're going to be monitoring their blood pressure, you're going to be monitoring their weight, you're going to be doing a ton of interventions. Like I said earlier, we as nurses, we don't use the medical diagnoses to guide our practice, because we're not physicians or providers. But we have to be cognizant of, you know, if I give this medication, I need to look out for X, Y, and Z. And I know if you know, a is happening, it's it's a bad effect, something's not working. So a care plan is basically picking like your top three problems for your patient that you're going to focus on for that day. And then after you identify those problems, you come up with your interventions of how you're going to work through those problems. And then at the end of the day, you can evaluate if you've met your goals for that day for that patient, or if not, if not you, of course you talk to the provider, you talk to the oncoming nurse to say we might need to revisit our goals for this patient because he or she hasn't met it, or they've exceeded it. So now we can move on to problem number four or five, which is less critical.

Joe 7:09
How long did it take you to put this together?

Catherine 7:12
It's been about three and a half years now. So once I finished with that class, I had to start finding someone who could help me develop the program. So I found a really wonderful company that I've been working with, we've had weekly meetings. In the very beginning, I said, you know, I need to really get some input on this, because I'm making this for nursing students, I want to make it useful to them. And not just something else that they have to purchase or have to buy, I want them to really use it. So I have talked to many nursing students, I've gone to a few nursing schools in Las Vegas and showed them the program and asked her their input. At first, who was just going to be the nursing care plan part, you know, linking everything that I talked about before. But after talking to nursing students, they said, Oh, you know, we wouldn't really love like, references like, if I forget what a normal hemoglobin is like, I would love to be able to just click on that tab and see it. So it's really grown over the past three and a half years, it's expanded and it continues to expand. So with nurse muse, you're not only going to get the help with writing the care plans, but you're gonna get a lot of references. I have like the vital signs from a neonate to an elderly person, and I have the normal blood values. And there's just a ton of resources, everything is cited, everything is evidence based. And then the one request I had from a nursing student was, if you can make this printable, so we made it printable. So at the end of their clinical day, when they go home, they finished free typing all of their notes, then they can print it and turn it in for their care plan for that day.

Joe 8:50
What were some of the challenges putting this together? You mentioned COVID before.

Catherine 8:53
Yes, well, I hope we never go through another COVID pandemic or any pandemic. But I think that this would be a helpful tool if we ever did, because unfortunately, as we know, nursing students had to stop their clinicals during COVID. So a lot of schools were scrambling on how they're going to get their clinical hours without actually going into clinicals. Because all the clinical sites were closed. And challenges I think just chose starting with anything, you know, you if you you have to think of a broad concept. You have to pare it down, you have to narrow it down. So there's a lot of back and forth with nursing students and I've sat down with about 200 Working nurses and I've had them look at it and I get their input. And then just the challenge of working with my team and in actually building it. You know, it takes time. It takes money. It takes a lot of effort. And then so after I built it, and it's ready to go, it's you can go out and find it on line. But now it's just the marketing portion. So I'm actually working with two marketing companies just getting nurse Muse out there, to nursing programs and to nursing schools. You know, I have worked in administration, and I know that you get a lot of emails all the time with people trying to sell you stuff, you know, you can buy my product, I'm going to help your nursing students pass NCLEX. I'm not a testing company, I don't sell testing. It's just it's a tool. It's an evidence based tool that nursing students can really use to give the best care that they possibly can. And I still work in the clinical field, as a nurse, and also as a nurse faculty, and my students still come to me with the questions of, I don't know, the pathophysiology of COPD, while on nurse Muse with the it within that care plan, I have the pathophysiology of all those problems that patients can be seen with. So it's based off of real life experience. But it's just getting people's attention, right, you got to get people to sit down for five minutes and show them the program for them to actually see its benefits. And that's just what I'm trying to do right now is get the word out social media, and working with my marketing team.

Joe 11:23
And that's another aspect to it too, is now you're not just a nurse, you're not just an educator or an administrator, you're also an entrepreneur. So now, there's that element of it to where you're not necessarily trying to be a salesman, like you've referred to before, but you still have to try and like you said market, you have to try and show them in a maybe in a non nursing way, like okay, combining or the nursing and the non nursing ways to say, This is why it would be valuable.

Catherine 11:51
Yeah, so being an entrepreneur, it's fun, I'm having a lot of fun. I find it very challenging it you know, I can go and I can talk to a bunch of nursing faculty. And if I were to give a lecture on whatever, any psychiatric illness, I'd be fine, but it's different. When you're going in, as you said, more of like a salesperson. So I know my strengths and I know my lead my weaknesses. And so that's why I have enlisted enlisted the help of my marketing team because they're having you know, it's coming from a different lens is not me coming in trying to teach your students I'm trying to give them a tool to help them Our ultimate goal is for them to pass the NCLEX. But a bigger goal is for them to stay in the profession, feel like they're competent, be competent, and be safe.

Joe 12:41
To play devil's advocate for a second. Is there such a thing as too much technology for nursing students? How do you balance reliance on that with sticking to evidence based practices?

Catherine 12:55
Yeah, I think that's really important. So one example I always give is when we teach fundamental nursing students how to take a blood pressure, we do it manually. And a lot of students say how can we have to do this manually when there are blood pressure machines all over the hospital or all over the clinic. And we always have to say, we can't always rely on technology, right? We need to be strong in our assessment skills to really understand what's going on. What if you call the provider and he or she wants a manual blood pressure on both arms. You can't say I don't know how to do that. As part of your scope of practice, you need to know how to do that. With nurse muse, it's a tool hoping to enhance the nursing students critical thinking abilities. So if there's a technical glitch, or if their computer isn't working, hopefully with them using nurse Muse over and over every week in their different clinical rotations and experiences, like I said, after that 10th patient that you have with hypertension, you're going to know the rationale for all of the interventions that you're doing. So it's going to become ingrained in your brain, which is our goal. So I think that of course, everyone relies on technology, especially with these new generations of nursing students. Many of them grew up on computers and typing their notes, which I would have never thought of doing. I still have to write out my notes. But you know, after you graduate and you become a nurse, all of your attorneys going to be on the computer. Unfortunately, when you're in a nursing program and nursing student, you can't chart in a computer on your patient that you're caring for because you're not a licensed nurse. So I think we're at a disadvantage with our nursing students if we don't give them the opportunity to have a tool such as nurse Muse where they actually are charting on the computer, and they're getting that experience of typing in their assessment findings and not writing it out by hand because once they graduate, they're not going to write it out by hand. So yes, technology is great. It's a great tool. But as a nurse, you have to have the fundamental knowledge and skill set to appropriately assess, and then diagnose with your nursing diagnoses. To figure out your plan of care

Joe 15:10
when it comes to on the line, same line of technology. Have you met resistance from maybe older nurses? Or are more experienced nurses, or faculty that are kind of hesitant towards this kind of technology? Like they prefer to do it the old fashioned way? Well, I

Catherine 15:28
personally, like I said, I teach in nursing programs. And it's interesting to me that students are still handwriting their care plans. And I don't know if that's just because that's the way it's always been done. I don't know if it's the faculty who don't really feel comfortable with the with the computers. I mean, we do have tons of, you know, age ranges in nursing these days. But I can tell you, as a faculty member, when I get an uploaded care plan, hand written, I can't read it half the time. And it's all, you know, chicken scratch, and they're trying to fit nursing diagnoses in small boxes, and it's very challenging. So it's like anything, I think it's change. Actually, I wasn't really aware that so many programs still have their students do their care plans by writing. And like I said, I think we have to be cognizant of our new generation of nursing students who are used to typing, I think that their brain works that way. And so for them to sit and write is maybe not helping them connect the dots. And if they're going to have to chart on a computer, when they graduate, we should help them by starting them charting, you know, in their first semester of nursing school to kind of get on board with how is all going to flow once you're a nurse, because I can tell you, when I took the NCLEX, many, many years ago, my NCLEX was I think it was like when the when the NCLEX first came out on the computer, and I had never taken a computer test in my life. Everything was written, everything was handwritten. And it was a shock me, first of all, it was a high stakes test, because I had to get my license. But second of all, it's a new platform. So you know, you have to switch your brain to think like that. So I think if that if the nurse if technology is only increasing, we're gonna get more technology, everything's gonna be more, you know, on the computer, we need to give our students that advantage from from the get go. Did

Joe 17:28
creating nurse Muse open up your floodgates for other ideas that you're toying with?

Catherine 17:34
Yes. So I like I said, I'm having a fun time. I think that there's, there's a need and a market for a nurse muse for maybe CNA students. Now, CNAs might not document as much as they do on the computer as nurses. But I think, again, having those concepts brought together lay in the big picture in the beginning really helps. A lot of our CNA programs are only six to eight weeks, we have a ton to teach them in those six, eight weeks. And they really need to be the partner with the nurse and the provider. Because they are the they are the eyes and the ears of the patient. They're in the room, you know, two or three times an hour. So I'm thinking I'm thinking that there could be a market, a marketplace for a nurse muse for CNAs. And then also maybe for nurse practitioners, when I went through school as a nurse practitioner. So huge shift from being a nurse to nurse practitioner because now you are the one diagnosing you are the one using the medical diagnosis, you have to come up with your differential diagnoses. So I think that there's a market that I'm going to start looking into for nurse practitioner students, for sure.

Joe 18:49
And you could theoretically open this up, you could expand it to practicing registered nurses. Correct.

Catherine 18:55
Correct. So as I was talking to you, the other day, I feel like I went through nursing school again when I created this, just because I had to, you know type out everything for every single problem that I can think of that a patient could have. But for practicing nurses, like a lot of people graduate nursing school, and they might start out on a med surg unit. While in nursing school, you learn about psychiatric nursing, OB, med surg, cardiac, all these different specialties. After you get out there and you get your foundational skills solidified, then you can change specialties. So if you've been a med surg nurse for a year or two and you want to go into OB, there's a lot of stuff that you probably forgot that you haven't used in two years that you need to understand for OB. So I think that that's a great tool for practicing nurses to just kind of go back and, you know, oh, yes, all the stages of labor and you know, what your spend the fetal strips and what you're supposed to monitor and all the testing that that your pregnant patient has to go through. So I like I said I feel like I went through nursing school again when I did this, but it was a great refresher, it was a fabulous refresher. So I highly suggest it for any practicing nurse.

Joe 20:09
With so much potential for nurse muse, what does it mean to you to be able to introduce something that can make nursing and education easier?

Catherine 20:20
I'm just excited. You know, I see, I see students struggle, I don't like to see students struggle. I mean, if they're putting in that the time and the effort, and they're just not linking those concepts, I think that we need, we have an obligation to our students to give them the tools to be successful. And you know, when I was in nursing school, from day one, my professors would say at the end, it's all going to come together, it's all going to come together. And I still hear people saying that. And I think our nursing students are sitting there with their eyes, bugged out of their heads saying I don't know what is supposed to come together. So I think showing them this big picture in the beginning, we'll help them kind of take it and then they can say, okay, now I can kind of break it down, I kind of see you know what it's supposed to be. And from there, I can kind of break it down and make it understandable for myself. So, you know, I'm all about nursing students, nursing students success, of course, I want everyone to go out and be safe practitioners. But I think we have to do we have it's our obligation to create safe practitioners and we need to give them tools to learn how to be safe and learn how to critically think and learn how to go out and find information. It's not horrible. If you're a nursing you don't have the answer, but you need to know where to go find the answer.

Joe 21:34
Catherine, thank you very much for joining us today. If you would like to learn more about this program, you can visit the website www dot nurse That's nurse Thank you for joining us today. Have a great day everybody.

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Innovations in Nursing - NurseMuse (With Dr. Catherine Prato-Lefkowitz)
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