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A virtual COMMUNITY of caregivers.

Online access to caregiving information

They are strangers, adopting aliases, tapping on keyboards, silently exchanging messages, gleaning information. Is it a spy thriller? No, we're talking listservs.

Topical e-mail conversations between far-flung strangers (who often become very good friends without even knowing each other's real names), are called listservs, or discussion groups. They are simply a group of people who have subscribed to an electronically synchronized e-mail list. Their messages back and forth, moderated or unmoderated, sometimes sent to the entire list, sometimes "closed" with personal replies only, constitute a forum for e-mail "conversation," creating an instant virtual community of like-minded professionals. These are not chat rooms, where you talk online with anyone who happens to be online at the same time. Once you've subscribed to a listserv, you receive all communication by e-mail.

For caregivers in skilled nursing facilities, discussion groups open a window to a vast pool of information and experience. "You can be sitting there doing an assessment, not knowing what to do, and type in a question," explains Nathan Lake, resident assessment product manager for Care Computer Systems (recently purchased by Keane Inc.). "We process e-mail every 10 minutes, so you could get an answer very quickly as long as someone out there reads his or her e-mail at the time." Even if no one picks up the message right away, rest assured you'll get an answer within a day.

Lake keeps track of all messages sent and received on two discussion groups, the MDS 2.0 and PPS Discussion Group, and the Administrators and DON Discussion Group. For registration, go to Care Insider at [less than][greater than].

More than 700 people belong to the MDS group, representing about 500 to 600 facilities, plus consultants, Health Care Financing Administration professionals, and state agency employees. "I would say there are 50 to 60 e-mails a day with various questions being asked and answered," says Lake. "In the two years we've been running, it's gone from me answering questions, because nobody else knew the answers, to subscribers responding among themselves. I don't participate much anymore because there are enough educated people out there who know what they are talking about," Messages are archived in digest form for reference.

Lake says that about 200 subscribers talk to each other on the Administration and DON list. Traffic there is lighter, but discussions are no less intense.

Talk is easy

Discussion groups like these are not hard to find. Click on your favorite health care association, nursing, long term care, or consulting company Web site. Most likely you'll find a button for discussion groups or e-mail lists. Membership might be in the hundreds, or amount to only a handful. Joining a list is easy. (See "Rules of the e-list road," page 26, and "Clicking for Care," page 28.) Click on the discussion group button, type in your e-mail address, get the list e-mail address to send messages to, and presto, you're a member. Unsubscribing is as easy as sending an e-mail to the server. You won't have to log onto the Web to get and send messages. E-mail messages will begin to flow into your mailbox. It might go something like this exchange from the MDS group hosted by Care:

Message 1: "Do you know who is required to fill out the recreational therapist section of the MDS? The director does it now, but can others who are not licensed? What are everyone's thoughts? Thanks in advance. Note--I can't find any regs that say licensed personnel are the only ones to fill it out."

Message 2: "As with anything MDS, any 'designated' person can fill out any section as long as he is willing to sign the dreaded attestation statement. We have a CRT do ours--you must have a CRT or CRT assistant do the tx anyway (manual page 3-168 under section T), so why not let the specialists handle sect T, too?

One of the benefits of belonging to a discussion group is the sense of community it fosters. You can participate constantly; you can be part of a conversation with people with similar interests and concerns. Participants usually find that there is a lot of support and a lot of technical how-do-I-do-this information available.

Find your niche on the Net

Sites with a narrow focus can be time-savers--you don't have to sort through a lot of messages to find your area of interest. For example, nurse assessment coordinators will find a targeted discussion at the site run by the American Association of Nurse Assessment Coordinators (AANAC). To register for the Skilled Nursing Facility MDS/PPS/ Case Mix Discussion Group, go to the AANAC Web page, [less than][greater than], click on "About AANAC" at the top; you'll see a dropdown menu that lists discussion groups.

"The reason I started AANAC was the power of the discussion group," says Diane Carter, executive director. "I'd never seen anything like it. Anybody, anytime, in any country can share information on anything. It was the first time I'd seen so many nurses talking about everything from certification for physician orders to case management and care planning evaluations."

The AANAC discussion group averages 30 to 40 messages per day with a membership of between 500 and 600 people. This is an unmoderated list, with all messages going to all members. "The exchange of information has raised the level of caregiving," says Carter. "Every time you see a question or an answer, it leads people to think about it. You ask yourself, am I doing that; should I? From what I see of questions and answers, people really desperately need information."

The American Nursing Association (ANA) runs a "closed" form of listserv. While it's not devoted exclusively to long-term care, nurses can have clinical questions answered by experts. Register on the ANA Web site, [less than][greater than]. The "closed" format means that nurses don't talk among themselves on the list, but rather they e-mail questions to George West, director of online services, who forwards them to the appropriate person within the ANA. He then sends the answer back to the questioner.

"We have probably 50,000 to 75,000 members on the list," says West. "Then a lot of people have their own trees--they might forward the messages on to their own little network of 10 to 20 people. It's a pretty powerful vehicle. It gets the message out."

The advantage of the closed list is that you know exactly who is answering your question. "We have a staff of more than 200 people, so I get a response from the appropriate person and send it back to the inquirer," says West. "It's a personalization mechanism. Plus, list members are getting an answer directly from experts at the ANA, so they know the credibility is a lot higher."

And credibility is an issue. It's important to realize that listservs are only as good as the people on them. Hang out on the list and see who responds. If you like the company, stay; if not, find another. After all, you don't know who members are beyond their e-mail name and address. "Blue Eyes" could be an RN with years of experience, an administrator with little clinical expertise, or an LPN on her first day at the job.

"The key to the whole thing is to know who is answering your questions or making comments," says Rena Shephard, an independent health care consultant and president of AANAC. "If you go into it feeling that you don't know a whole lot, and you want to learn from the listserv, you have to recognize that a whole lot of people on the list are doing the same thing."

Shephard says she and her experienced colleagues make it a point to identify themselves clearly with a signature--their name, title, licensure, and credentials-so people know this is someone they can trust. "I've noticed that more and more people are doing that," says Shephard. "You get to know who has opinions and who has the answers. When someone asks a question regarding policy or regulations, I make it a point to actually quote the source document-to cut and paste and give the Web address, so people don't have to take my word for it."

You've got mail

There is a downside to all this conversation. Once you've joined a listserv, depending upon its size, you will receive email. Possibly lots of e-mail. Possibly an overwhelming amount of e-mail. "For people who aren't used to e-mail, the volume of incoming e-mail drives them absolutely out of their minds," says Lake. One option is to receive the list in digest form once a day. You'll get one e-mail message and you can scan subject lines for those that interest you. Otherwise, you get used to scanning subject lines of incoming e-mails for a topic of interest and you simply chuck the rest.

In addition to forums and listservs, Web sites offer all sorts of resources and support for caregivers. The National Guideline Clearinghouse ([less than][greater than]), for example, is a trove of evidence-based clinical practice guidelines. The site is jointly sponsored by the Agency for Health care Research and Quality, the American Medical Association, and the American Association of Health Plans. Browse the site to find guidelines on interventions and treatments such as feeding methods, catheterization, patient isolation, and respiratory therapy. An electronic discussion list is also available.

Directors of nursing can access an archive of caregiving articles at the Web site for the National Association of Directors of Nursing Administration in Long Term Care (NADONA). At [less than][greater than], articles from NADONA's journal, The Director, go back to 1997, and can be searched by topic. On the Web-page display for The Director, click on Distribution, then Past Articles. According to Associate Director Gary Warden, the association has plans in the works to post chat discussion topics for specific dates and times. Tune in for talk.

CNAs, those often neglected caregivers, have Web resources also. A discussion group at [less than][greater than] has about 125 members, including some doctors and nurses. Webmaster Patti Green says conversations usually revolve around career issues, but she sometimes posts survey results from several facilities, so CNAs can read and discuss why a facility failed a survey.

Nursing assistants and others who deal with dementia patients will find information and support at ALZwell, [less than][greater than], which bills itself as "Information, Escapes, and Outlets." Although this site is for families as well as other caregivers of dementia patients, professional caregivers will find valuable care tips, resource links, and an emotional outlet for the frustration and anger often associated with dealing with difficult patients. Write on the Anger Wall, or enter one of four chat rooms to share caregiving experiences. All this online caregiving can only be accessed if caregivers have computers, "I'm still disappointed that more facilities don't have e-mail and Internet access for their employees," says Lake. He's right. Opportunities for gathering information are growing every day. The Web and e-mail discussion groups are fast becoming important professional tools that can lead to better care. The people who use them are hooked. It's just possible that these online discussion groups are habit forming.

K. T. Anders is a regular contributor to CLTC.


Here's some netiquette of which you'!! want to be aware.

* Listen before you speak. Get the feel of the list for a few days before you barge in-then match your tone to the membership.

* Introduce yourself briefly.

* Do not type in caps-it's the equivalent of screaming and is considered very rude.

* Add your credentials and title to give your message credibility.

* Cite the actual regulation if you're interpreting government rules.

* When replying to a post, use a snip from the original query to give a context to your reply. But do not paste the entire original post into your reply-long, repeated messages are a breach of etiquette.

* No advertising. Ever. Period.

* Spell out acronyms the first time, unless they are very common, such as MDS or PPS.

* Do not send chain letters.

* Do not use profanity.

* Do not badmouth individuals or companies.

* Be courteous and supportive to your fellow professionals and generous with your knowledge.


Here's a sampling of online sources for caregiving. Remember to bookmark the sites you like. Always look to see if there's a date showing when the site was last updated.

[less than][greater than], Alzheimer's caregiving information here is for both professionals and families.

[less than][greater than]. Care Computer systems offers two discussion groups: MDS/PPs, and Administrators and DONs.

[less than][greater than]. The National Guideline Clearinghouse provides clinical articles and an electronic discussion list.

[less than][greater than]. CNAs will find support and information here.

[less than][greater than]. Joanne Wilson's Gerontological Nurse Ventures sponsors this monthly e-zine for post-acute nurses.

[less than][greater than]. Dale Mueller has compiled a list of lists on his Skilled Nursing Resource Site. Evaluations include sponsorship, accuracy, usage, and subscription information.

[less than][greater than]. Clinical Geriatrics online journal, featuring clinical articles archived for the past three years.

[less than][greater than]. Clinical caregiving articles from the journal The Director are archived and searchable by topic.

[less than][greater than]. Nurse To Nurse is an RN discussion group. A real-time chat room is also available.

[less than][greater than]. The forum discussions are for nurses in all venues.

[less than][greater than]. Register here for the American Nursing Association's "closed" listserv, where nurses can have clinical questions answered by experts.

[less than][greater than]. The American Association of Nurse Assessment Coordinators features a large, targeted discussion group.

[less than][greater than]. CNAs will find free courses with caregiving tips.

[less than][greater than]. Various nursing specialties have home pages and discussion groups.
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Article Details
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Author:ANDERS, K.T.
Publication:Contemporary Long Term Care
Date:Jul 1, 2001
Previous Article:Effective design.
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