Tuesday, 24 March 2015 21:22

1982-1994 Computers to MacNursing

In 1982, computers disguised as game machines were just starting to become a consumer product. Atari was popular for it's games like Donkey Kong and Pac Man. The Commodore 64 was also becoming popular. I bought an Atari but was more interested in it's word processing capabilities than I was the games. The games didn't hold my interest very long at all. I have never understood why one would think it was an accomplishment to win a game when the same energy could be applied to some real accomplishment in life.

As I was going through nursing school, I was becoming more interested in the early computers. A new company named Apple, with it's founders Steve Jobs and Steve Wozniak had released their revolutionary computer called the Apple II and IBM soon came out with their personal computer which quickly became the standard of the time. By this time, I was following computer development in the news and news magazines related to their development and getting on line with the first on line service called Compuserve. I had grown tired of the Atari's limitations and was interested in something more powerful. I remember reading in a magazine about something new that was coming out from Apple, which they called Macintosh. first mac

The early IBM PC's were not really "user friendly" at all. Everything was done by typing in arcane commands on a command line in something called DOS which had been created by a young company called Microsoft and it's founder Bill Gates. This was fine for business users but not really much fun. The new Macintosh that was coming out was the first computer for consumers that would use a graphic user interface, (GUI), and something called a "mouse." Instead of typing in codes, one just clicked on little pictures called "icons." You could do everything on a Macintosh that you could do on a PC but in addition to the word processing and spreadsheets, you could also do something new called desktop publishing. The Macintosh had enormously more appeal for artists and other creative types as well. It was the computer for "the rest of us." It was released with the iconic George Orwellian 1984 Super Bowl commercial. Computing would never be the same. 

At about this same time, in my nursing program, we wanna-be nurses were learning how to write "care plans." A care plan is a document that describes a patients problems and the goals for those problems and the interventions to reach those goals. It is a kind of roadmap of patient care for the bedside nurse. While we were studying how to write care plans in my classes, we were having a hard time keeping the same kind of documents updated at my job on 4-East at Saint Francis Hospital. Patients would get admitted and the nurse would sometimes do all the paperwork involved in the admission except for the care plan or the care plan was written quickly and often incomplete. The Joint Commission on Accredidation of Hospitals were emphasizing care plans about that same time and so the managers at my job were nagging staff to write better care plans and keep them updated.

I got tired of hearing management nagging the staff to do care plans without coming up with any realistic plan or means for getting them done and I figured out a way to write some standardized care plan templates that one could just use a copy machine to copy onto our forms. Although this technique for doing care plans was a big time saver and staff and management loved the idea, the problem with that was that the care plans were not specific to the patient and could not be easily editable. This caught my imagination and in a staff meeting one day with our medical director, Dr. Anderson, I suggested that we could "computerize" care plans.

I explained that from what I had been reading about computers and something called databases, care plans would be a great project for computerization. Dr. Anderson seemed intrigued by the idea. I let him know that the Macintosh was supposed to be something that anyone could use. He encouraged me and actually got funding for a new Macintosh computer. There was a little confusion as to ownership initially as he had also told one of the Social Workers, who had their office elsewhere that she could use the Macintosh. Once the computer had been purchased, I felt like it was my responsibility to see that it warranted the outlay of funds which came to about three thousand dollars if I remember correctly and I saw to it that it stayed on the psychiatric unit where the entire nursing staff would have access to it rather than just one Social Worker.

When the Macintosh arrived, I was excited by the graphical user interface. The screen was only about nine inches and black and white but it used something new for computers, called icons, to navigate through commands. I read everything I could find in my spare time about using the machine and searched for software that would help me do care plans. Almost every day that I could, I would clock out after my shift and then stay on the unit to work on the Macintosh.

At first, I just tried putting the same standardized care plans I had written earlier into a word processing program. The problem was that we were using pre-printed forms and it was difficult to get the text to line-up on the pre-printed forms. The only solution in my mind was to actually put the pre-printed forms onto the computer. One of the programs I experimented with early on and which worked well initially was Filemaker. The forms could be put into the database and the nurse could select a standardized care plan but they were still not able to customize it completely. Eventually I read about a new relational database program called 4th Dimension made by a company called ACIUS. I could create separate databases that would relate to one another. I could creaate a database of nursing problems that could merge with a database of patient information. 

By this time, I had gone into debt to buy my own Macintosh. I had gotten a copy of the database software, 4th Dimension, which came with several thick manuals and I would sit up all night at the computer, trying to get it to work. In the beginning, 4th Dimension itself was a little buggy and it made it difficult to know when it was me that was making programming errors or if problems were being caused by the initial bugs in 4D. As the bugs got worked out in 4D and I got better in my programming skills, what I would eventually call "MacNursing" started coming together.

The database was developed initially for the needs of Western Psychiatric Center at Saint Francis hospital and eventually almost all of the written forms for the admitting process were transitioned into the computer database. The nurse would enter the patient data and then select patient problems specific to the patient and then could edit those problems and truly customize the care plan to each individual patient. The forms were put into the official medical record and passed inspection by Joint Commission. Even the California State 5150 and 5250 forms were approved and printed from the MacNursing database.

When the Western Psychiatric Center budget got tight, a new position was created around my computer program and the admitting process as it became more efficient for a nurse with typing and computer skills to admit patients using my computer program. An admitting process that had been slow, cumbersome and ineffecient, now became much faster and thorough.JPEG 0358

Western Psychiatric Center would continue to use my program for admitting patients for the next ten years.  Although Saint Francis never compensated me for the hours of work I had done on my own time to develop the program up to that time, I was okay with that since there was never any question as to who owned the rights to the MacNursing. After I had resigned and left Saint Francis, they did hire me to come back and customize a new version of the program for them and I was compensated for that work. 

Meanwhile, one of the nurses and a social worker at Saint Lukes hospital across town heard about my program and contacted me and made arrangements to come and see what I had acomplished at Saint Francis. They got their own Macintosh computer and raised funds to pay me to customize a program for their use. The problem at Saint Lukes, I believe, was that they did not have a "MacNursing" evangelist there as Saint Francis had in me. In those days, nurses most often did not type and most felt intimidated by computers. There were very few hospitals that even used computers in those days and if they used them at all, they were primarily for billing purposes rather than nursing purposes. Once Saint Lukes had paid me for their own version of "MacNursing," I don't think that the staff were willing to adapt to the program. Change is always difficult and nurses that were used to writing everything out by hand found it easier to do things in the way they had always done them rather than learn a new way of doing things. The learning curve would take time and most nurses were not willing to put in that time and I don't think they were given any extra time to do so. 

By this time, I was getting visits from from others in the healthcare field that heard what I was doing at Saint Francis. I received visitors from Kaiser Permanente. I was more than willing to show anyone and everyone what I was doing as I truly was an evangelist for computers in nursing, especially Macintosh computers in nursing as I believed the Macintosh was actually user friendly and so it was nurse friendly. 

I rented at booth at the California Nurses Association, nursing Convention in Oakland sometime in the late eighties and showed my program there. I rented an extra Mac and an overhead projector so that people walking by could see the program on a big screen. There was some interest but it did not lead to any new consulting jobs or sales. CNAConventionMilton at C.N.A. Convention Boothcnaconvention2miltonCNAConvention3Me at my C.N.A. Convention Boothcnaconventionmilton2cnaconventionsylvancnaoaklandconventionJPEG 0461Bob Shoemaker at my C.N.A. Convention Booth

At one point in the 80's, Apple contacted me and invited me, to their offices at One Post Street in San Francisco for a meeting of developers that were using Macintosh computers in health care. There were probably 10 or 15 entrepreneurs at the meeting. The only company I remember, though, is A.D.A.M. which had developed an anatomy application that ran on the Mac. After this first meeting with Apple, I was invited to a small conference of Macintosh healthcare developers where we could show our work to business persons and venture capitalists that might be willing to invest. I had no business background and a terror of public speaking. I had not been informed that there was going to be an opportunity to show my product to a group and had not prepared for that. When an Apple representative came and asked if I was ready to do my "presentation," I answered that I had not prepared a presentation and did not want to try to improvise one. This is probably one of my greatest regrets in life- a missed opportunity. 

Apple continued to be supportive though. When Apple moved from black and white to color monitors, they loaned me a color Mac to rewrite my program to add color to it. Milton and I drove down to the Cupertino headquarters to pick up the loaner Mac and I was able to keep it long enough to re-write MacNursing.

A year or two after I had been at the C.N.A. convention in Oakland, I signed up for a booth at the American Nurses Association's convention in Boston. That was My sister, Donna, took a train from Seattle and met me there to help with my booth that weekend. I had rented a couple of Macs and had a similar set up as in Oakland. This time, there was much more interest and I met Elaine Lloyd, MS, a nursing administrator for the spinal cord injury unit in Palo Alto. We made arrangements for a meeting after the convention. 

In nursing, it was never necessary to wear a suit. With my MacNursing business, I had to buy a couple of suits to feel like I was in "business." I loathed wearing a suit or tie buy I convinced myself that I had to wear the costume to fit the part. "Business" was very stressful for me. I always felt like I was playing a "role." I had to attend various meetings at the V.A. spinal cord injury unit and others seemed to think at the time that my program might even be used at other V.A.'s across the country but I think my lack of business experience was evident and this was another missed opportunity.

 


While consulting with the V.A. in Palo Alto, Elaine and Linda Toth, MS, RN another nurse manager wrote an article called "Development and Testing of Computer Software for Nursing Assessment and Care Planning at a Spinal Cord Injury Center" which was published in the SCI Nursing, a publication of The American Association of Spinal Cord Injury Nurses. The three of us went to Las Vegas for a convention of Spinal Cord Injury nurses and they presented the findings of the paper, published August 1994.

By the time my consulting at the V.A. ended,  they had a network of about 10 computers running my program and they had used my consulting services for about ten years. Eventually, it was mandated that the Palo Alto V.A. use a different program that was in use elsewhere. I was told by the charge nurses that the new program did not do anywhere near as much as my program did but that didn't matter to the bureaucrats at the time. 

Over the years after that, I would see some of my ideas from those early years integrated into the programs of others. I don't really know if that was because the developers had seen MacNursing or if they had come up with similar ideas on their own. 

SCINursing

Development and Testing of Computer Software for Nursing Assessment and Care Planning at a Spinal Cord Injury Center
E. Elaine Lloyd, MS, RN; Linda L.Toth, MS, RN; Sylvan Rogers, RN

ABSTRACT 
This paper describes a pilot project using a Macintosh personal computer and customized software to computertize nursing admission assessment and care planning data. The project setting is a 47-bed Spinal Cord Injury Center with two inpatient units and an outpatient department serving approximately 1,000 patients with spinal cord injury at a Department of Veterans Affairs Medical Center in northern Califronia.  The computer software development, implementaiona, and evaluation are described. This sofware was found to be a low cost, customized approach to computerizing spinal cord injury admission assessment data and care planning which reduces repetive writing and facilitates continuity of care.  Personal computers and this sotware have provied the mechanism for establishing a spinal cord injury patient database.

 

 

 

 

 

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Article

01. Introduction

03- Dads Family

03- Photos of my Father and his family

04- My Mother's Family

04- Photos of my Mom

04- Video of my Mom

04- Walling Family Reunions

04-Audio Files of My Mom

04. Billie

04. Ole

04.1. Forbidden Dreams of Love

04.2. Flames of Forbidden Love

04.3 Mom Writing Her Life Story

05- Jim Tarbert

05. Roger

1950's Grandview to Toppenish

1957-1958 1st Grade

1958-1959- Third Grade

1959- Palouse

1961- 4th Grade- Last time I wore a dress

1962- Abilene

1963- Escondido- Early 60's

1964- Darlene Marries Chuck

1964- My Beatle Haircut

1964-The Luv Please

1965 or 1966- Steve Castle

1965- In Foster Care

1966 Living with Darlene & Chuck in Seattle

1967- Juvenile Hall

1976- I Praise Thee (poem to Stanley)

1976- My Second Lover, Stanley Dunne

1976- Paul McCartney and Wings

1976-1330 Bush Street #9J

1977- 1667 Haight Street

1977- Trip to San Diego with Mary Jo

1977-1980- Tumultuous Relationship with John Perry

1978- 525 Haight Street

1979- September- Dad is Murdered

1980's- AIDS- Death and Dying

1980- Winter- First Trip to New York

1980- Word, Sound and Power

1981- Milton- Falling in Love

1982-1993 465 Waller Street

1982-1994 Computers to MacNursing

1984- 33rd Birthday

1985- Graduation from Nursing School

1985- Trip to Hawaii (Oahu)

1988- MIdnight Caller

1989- Earthquake!

1991- Aug 10th- Mom Passes Away

1991- Black Males in Oils

1991- Crack of My Life

1993- Move to Vallejo & Our First Home

1995-1. Road Trip to Washington

1995-2. Surprise Trip to Vegas

1995-3. Grandmother Rogers & Aunts Visit Darlene's

1995-4. Amber

1998- Camping at Russian River

2000 -Thoughts about Progressive Christians

2000- Resignation from John George

2001- April- Trip to Cancun

2001- Peace and Justice

2001- September 11th

2002- April-Puerto Vallarta & Blue Bay Getaway

2002- Nov 12th- My Stepfather, George McHenry Passes Away

2003- Trip to D.C. and N.Y.

2004- Feb- Road Trip to Baha Mexico

2004- Walling Family Reunion in Spokane

2005- Christmas Poem

2005- Darlene Visit for Pride Celebration

2005- Trip to Orlando

2005-1. Europe- London

2005-2. Europe- Paris

2005-3. Europe- Venice

2005-4. Europe- Florence

2005-5. Europe- Rome

2005-6. Europe- Athens

2005-7. Knee Surgery & Tongue Biopsy

2006 Christmas Poem

2006- February 23- Times Herald

2006- Palm Springs White Party

2006- Trip to Seattle

2006-July 8th Solano Peace and Justice Coalition BBQ

2007- Feb- Carnival Destiny- Our First Cruise

2007- Tre and Casey Visit

2008- Aug 15-18 Spokane Visit

2008- Psycho Song

2009- Honored by Vallejo Gay Network

2009- Women in Oils

2010 Christmas Poem

2010- Feb. R.C. Mariner of the Seas Mexican Riviera Cruise

2010- June 24- Badlands

2010- Trip to Seattle

2010-1. Europe- Amsterdam

2010-2. Europe- Paris

2010-3. Europe- Barcelona & Sitges

2010-4. Europe- Madrid

2011-1. Feb. My Fabulous 60th Birthday Weekend

2011-2. April- L.A., Palm Springs & "The White Party"

2011-3. Poem- Girl From Medical Lake

2011-4. Old Man Dancing

2011-5. May- Misty and Alex Visit

2011-6. August- Darlene and Sean's Visit

2011-7. Alex 16-18 & Pics

2012- March- Carnival Splendor Mexican Riviera with Family

2013- Wedding

2014- Christmas Poem

2014- First Gay Cruise

2014- September Road Trip to San Diego

2015- Seasonal Affective Blues

2015- Second Gay Cruise

2015- War on Christmas poem

2015-"Badlands" and Gay Bar Etiquette

2015-September 8. Political History

2016 Do Not Speak for Gay Males

2016- April- Palm Springs RV Adventure

4/4/2016- Not Going Along to Get Along

9/4/15- Liberals vs Conservatives

Women in Oils- Click for story
Where I was born- Click for story.
1973- Psych Tech Program- Click for story.
Palouse- Click for story
1974- First Trip to Europe- Click to read story.
2015- 2nd Gay Cruise- Click for story.
Me in first grade- Click for story.
1957-1958 1st Grade- Click to read story.
1967- Summer of Love- Click to read story.
Forbidden Dreams of Love- Click for story.
Grandview- Click for story
5th Grade in Abilene Tx- Click for story
Cockettes & Angels of Light- Click for story
Amber- Click to read story.
Me in 3rd grade- Click for story.
1974- On Larkin Street- Click for story.
Gay Disco 70's- Click for story
My Dad's Family- Click for story.
1973 "You have to be hurt..." Click to read the story.
1964- Luv Please- Click for story.
Beatle haircut- Click for story.
1982-1993 Waller Street- Click to read story.
Escondido 1960's- Click for story
Photos of Dad & His Family- Click for story.
2005- Darlene Visits for Gay Pride- Click to read story.
Me in my 20's in 1970's- Click for story.
1970's Promiscuity- Click for story.
2001 Trip to Cancun- Click to read story.
2005 Darlene Visit for Gay Pride- Click for story.
2014- Road trip to San Diego- Click for story.
Second Gay Cruise- Click for story.
Darlene Marries Chuck- Click for story.
The Psychedelic Experience- Click to read story.
1958-1959- 3rd Grade- Click to read story.
Earthquake! Click to read story.
2015- 2nd Gay Cruise- Click to read story.
Summer of Love- Click to read story.
Click to read "Introduction."
4th Grade- Click for story.
2001 Trip to Cancun- Click to read story.
Black Men in Oils- Click to read story
My Mother- Click for more photos.