A Entry Will Be Added Soon….

“Skill cannot take the place of sympathy and understanding, for science without heart is ugly and pitiless.”

—Dr. Katharine Berry Richardson

Last week, we had a little snow storm on Monday with very, very, very bad winds. It was basically white out conditions in the country. Because of that, clinical was cancelled last week on Monday, meaning that we had to do an hour and a half on Tuesday morning and another hour and a half on Tuesday afternoon (in place of class).

However, with clinical pretty much caught up, we are wrapping up what are our educational clinicals. This means that starting next week, we show up at the hospital.

It doesn’t happen all at once however. Tomorrow (Monday), we still meet in the clinical lab at school and go over a few more things. On Tuesday, we go to the clinical site and get orientated. We will not be touching patients at that time. Then, next Monday we are going to meet at the school again for competencies. Basically for that we’ll be demonstrating that we can properly place  a foley and properly administer a shot. Then that Tuesday, the ninth, we begin our real clinical rotation.

Right now, I’m rather excited. I’m excited because I love what I am doing. I’m excited because I’ve been wanting to get into the hospital for so long. I’m excite for a lot of reasons.

I’m also a little bit nervous. My vision can be a serious hinderance to me. We honestly don’t know whether I can or cannot do the skills in nursing. Also, I’m worried about making mistakes, about not finding things, about everything that could go wrong.

I also don’t have a ride yet to clinicals, which bothers me. I don’t even know for sure if the e-mail actually got sent, because we’ve been having a lot of problems with our school e-mail system. But no one has responded to anything I sent and that worries me because I need a ride there. I really don’t want to have to take the bus or taxi to the hospital every week, partly because of the cost (It would be about $60 for the semester.) and partly because I don’t like the bus.

But, besides that, I’m excited. I feel rather confidant in what I do know and I’m willing to learn. But more than that, I have to do this. I don’t know what it will be like, nor do I know what to expect, but I think it will be a wonderful experience.

Synagogue opens field hospital in Haiti
•Plans to adopt 500 orphans
By Jossy Idam
Sunday, January 31, 2010

To give medical attention and succour to the wounded and children turned orphans by the devastating earthquake in Port-au-Prince, capital of Haiti, the Synagogue church last Sunday flew in a plane -load of medical and food supplies.

T.B. Joshua

In partnership with some foreign charity organizations, the church with headquarters at Ikotun, a suburb in Lagos earlier dispatched an advance team last Saturday to the Caribbean Island. As reported by the church’s satellite television, Emmanuel tv, the advance team and the plane, a chattered cargo plane took off from Miami, Florida, U.S.A.

The cargo plane with registration number N587 and Emmanuel TV boldly emblazoned on it in blue letters also had on board a team of doctors, nurses and sundry humanitarian workers.

Reporting live for Emmanuel TV, Gary Tange showed viewers the warehouse where the medical and food supplies were stock piled before being loaded aboard the cargo plane.
The owner of the plane who also pilots it, Tito Menedez was full of praise for Synagogue and the General Overseer of the church, pastor T.B. Joshua. As televised live last Sunday afternoon before the plane took off, Tito said: “I’m happy to be part of this private effort. Prophet T.B Joshua and Emmanuel TV are great.”

During the church service on Sunday afternoon, prophet Joshua explained why Synagogue is in Haiti, saying: “Haiti has given me sleepless nights. If it means selling my clothes, I’ll do it. We are going to take care of the wounded, the sick, the hungry. We will also adopt at least 500 orphans and take care of them there.”

Speaking to Sunday Sun on the corridor of the church immediately after the service, prophet Joshua further said, “I’m looking at a convenient time to join our team in Haiti. We and our partners want to help.”
He put the cost of the project at $3 million.

Well, it is time to share some good internet information with all of my nursing friends out there. I had more than one thought this week so I am writing about a few issues…. Read on and Happy Almost February

Health Assessment Resources on the WWW

Key to the foundational knowledge of any nurse is the ability to perform an exemplary health assessment, whether beginner or returning to school for a graduate nursing degree. The internet has provided a new medium through which to reach students at any geographic location at virtually any time of day. This makes access, comprehension, and visual/audio opportunities unending for our students. The following websites offer great supplemental learning of the physical examination through interaction, video, and audio.

The Health History: Of note, before I progress into this further, I want it to be known that I feel the most important part of any health assessment is not the physical exam, but the health history. A good, complete, and culturally competent health history will not only direct the examiner toward potential problems, but inform about areas of preventative needs and patient education, such as the need for adult immunizations, smoking cessation, or even grief counseling. Many of these things cannot be discerned by the physical exam alone. The physical exam is an unfortunate emphasis of many health assessment classes and basic RN programs. Unfortunately, the internet echos the same gap in emphasis with numerous physical examination resources and very few health history examples, forms, reasoning, etc….

The Physical Exam: I am not going to belabor the things we all know about a health history. Providing a warm room, privacy, equipment, good lighting, WASHING the HANDS in front of the patient, and actually meeting and talking with the patient, clothes on, before they don an ultra comfortable and stylish examination gown is basic groundwork for a good exam. There is truly an art to the physical exam and starting at the head and working your way down (head-to-toe) is best, helping to keep things organized. The following internet video/audio/interactive websites are excellent adjunct additions to any health assessment course, or simply as a refresher.

OPETA website from the University of Florida – http://opeta.medinfo.ufl.edu/

LEARN HOW TO EXAMINE website from Dr. Diane Davitt, PhD, RN – http://www.webster.edu/~davittdc/index.html

LEARNERS TV Video Examination Series – http://www.learnerstv.com/lectures.php?course=ltv032&cat=Medical&page=1

THE INTERACTIVE GUIDE TO THE EXAMINATION at OSU – http://medicine.osu.edu/exam/Pages/index.aspx

How to Make a Podcast for Your Course, to Send to Someone, or For Anything Else

Audio podcasts are a great way to ‘verbally’ connect with students and people, without the need for synchronicity in schedules. They also offer a great way for lectures, thoughts, etc. to be downloaded to iPods and played over and over. I am continually surprised at how many of my colleagues find this notion ’scary’ and therefore resort to the same methods of communication without trying new ones. It is one of the easiest things in the world to do, so here is a step by step to help you along….

For you PC users (yes that means WINDOWS)

1. Go to the little search box in your start menu and type in Sound Recorder.

2. You will then need a microphone of some sort, many laptops now come with this ‘built in’ so when you hit the red record button you are good to go, however…. many desktop computers do not. A great plug-in headset like this one from Logitech can be purchased cheaply. (I have a new noise canceling one that loads in my USB and it totally ROCKS)…. anyway….

3. Simply make sure your microphone and headset are working and hit record.(I recommend having a script ready and reading through it a few times or your lecture notes handy).

4. You have now made a recording. Save the file to where you like and give it a unique name. NOW…. there is more to do… you can’t just post this file, because it is not an MP3 file its a .wav.

5. Download a great free MP3 file converter like the Switch Audio Converter (be sure to scroll to the bottom to get the PC version).

For you Mac Users

1. To make easy MP3 recordings Mac is going to ask you to buy Quick Time Pro. If you already have this, then simply open it and record away and save as an MP3 file.

2. For those of you who don’t have Quick Time Pro, I recommend free recording software like Switch Record Pad.

3. Once you install it to your applications folder, simply open it, and go to ‘preferences’ to convert the output to an MP3 file. Also, make sure your headphones and microphone work (see above PC directions), practice your recording, and then record and save.

It is easy, quick and can be loaded to most LMS, even e-mails and webpages. How cool is that?!!

Other Thoughts…. One of my internet friends, Rob Frasier, asked me, in response to a blog post, a very important question that academic faculty and students need to ponder about the internet. He asked if copyright would be an issue when students post papers and assignments to the WWW. I have to say that the answer to this is both yes and no.

Yes, because if students post a paper to their blog without citations or references then there are some major copyright violations, however they should be learning proper formatting in school. ‘Yes’ also because if students turn the same paper in for more than one course (a NO-NO for you students) then plagiarism programs like TurnItIn should pick up on those and alert the instructor. Students should not post their papers until after turning them into the course instructor and should also alert the instructor that the assignment has been posted to the student’s blog as well. (note* This is good brownie points for you students and really gets some great miles out of the things you are turning in. I am a firm believer that the world needs to see what students are working on. I avoid this problem all the way around as I will discuss below.)

No…. I say ‘No’ because the student’s work belongs to them and if they are writing and publishing their own blog, then they can post their work their without copyright infringement or plagiarism. I always caution students to make issues they write about devoid of direct patient information and at first when they begin to post I have them use assignments that are not specific to patient encounters, until they get the hang of de-identifying writing. Further, I simply avoid the entire TurnItIn issue with their work by having them only turn things in through blog postings in one of my classes. Creating and maintaining blogs teaches a bit about social media, encourages good writing output from the outset, and offers a continuing forum for students to practice written communication.

I also say ‘No’ because I think that we nursing faculty have a big hang up with the importance of the assignments we create. We cause our students much strife by creating varying writing assignments in courses with different topic sets, thus not allowing our students, even at a basic education level, to develop a body of knowledge that they can command. For example, BSN completion students often work in specific clinical areas where they have some expertise. Generic BSN students and even MSN students, although gaining basic nursing science foundational knowledge, often have subject areas they are interested in or want to know more about. We, nursing faculty, need to facilitate this curiosity from their first writing assignments so that they can continually build this body of knowledge and interest throughout their program of study. Say a student is interested in lung cancer, then in their cultural class let them write about cultural issues in some aspect of nursing patients with lung cancer, in community health let them write about lung cancer prevention, in leadership let them implement a change project concerning lung cancer, and in theories and research let them write a literature review or concept analysis on some aspect of lung cancer.

If we begin to use technology to enhance nursing learning and begin to think ‘outside the box’ in ways that our students can synthesize and express knowledge, the whole of health care will be much better served. Go NURSING!

This week we were focused on Neuro, personally I think that Neuro is almost as difficult as endocrine. There is just so many things to remember and also there are so many things that can go wrong!

Because of my cold/bronchitis that I was struggling with this week, and also because of the pregnancy fatigue I had a really hard time staying focused. Sometimes I just dont feel like I able to give it as much as I did before I was pregnant. I just cant pull the all nighters or study for hours on end anymore. Does anyone have any study suggestions for me?

Dont get me wrong, Im still studying my butt off. Its just that instead of sitting and reading for 5-6 hours straight, not its like an hour of studying and then get up walk around and try to eat something. Honestly I spend a whole lotta time trying to eat.

So back to Neuro…really.

You’re smart — why don’t you just become a doctor?

First of all, a little word to the wise: if you ask this question of a practicing nurse, don’t be surprised if his or her jaw drops to the floor and s/he walks out of the room, not to be heard from again for a few weeks. You have just lost some serious friend-points and will  need to regain the nurse’s love over time, maybe a long time.

You’re more likely to get a good answer out of a nursing student — we bright-eyed, bushy-tailed newbies are happy to tell you why we choose nursing over other professions, because the choice was pretty recent.  And we haven’t heard this question a hundred times before.  Yet.

So here’s my answer.

First, a little background.  In fact, I am becoming a doctor: a Doctor of Nursing Practice (DNP).  After I complete the NCLEX this summer, I start my DNP in pediatrics program in the fall.  (Now don’t get your panties all in a twist over the use of the title “doctor” by doctorally-prepared advanced practice nurses, if you’re one of those types.  Acceptable forms of address in the clinical setting are all in flux right now, and will work themselves out.  Besides, that’s a whole ‘nother post.)  So anyway, this tends to confuse people even more – if you’re going through all the trouble of getting a doctorate, why not get a doctorate in medicine?  You know, like a “real” doctor?

First of all, one underlying assumption here is that one reason people become nurses is because it’s “easy.”  HO, no, no, NO.  Nursing at any level is an incredibly challenging profession that requires a huge skill set, subtle interpersonal abilities, hawk-eyed observational skills, an open mind, critical thinking, extensive knowledge of illnesses, drugs, and procedures, and an ability to both plan ahead and make quick, on-the-spot decisions when necessary — and all this is often performed while on your feet for 12 hours at a time.  It isn’t easy.  You gotta love it.

The second big assumption here is that MDs are the first-choice professionals in all health care settings and scenarios, whether it’s your family care provider, the hospitalists at the local medical center, a specialty clinic, or what-have-you.  They have the most training, so they must be the best, right?  In some situations, yes (for example, no nurse practitioners do major surgery — you gotta have a specially trained MD for that), but in other situations, NPs provide a level of care that is equal to that of their MD colleagues, and has the added bonus (in my opinion) of being grounded in a unique nursing philosophy.  From day one, advanced practice nurses are trained to provide individualized, holistic, and patient-centered care that works with patients  within the context of their families, communities, and individual lives.  There is a strong focus on working with the patient in a partnership, not an authority-based relationship, and the nurse emphasizes patient education, empowerment, and prevention throughout the relationship.  Are there MDs out there who do these things?  Sure!  Are there NPs out there who try their best to do these things but miss the mark sometimes?  I’m sure there are.  But overall, I find that this nursing philosophy comes through in NPs’ approach to care, and that is why I choose NPs as my personal providers, and it’s also the kind of care I want to provide as a professional.

So, you nurses and nursing students our there, how or why did you choose your profession?  What do you love about it?  What do you want to tell the world about it?  Please post in the comments section!

P.S.  It’s worth noting that if you ask an older female nurse why she didn’t “just become a doctor,” it might well be she in fact DID want to be a doctor, but didn’t want to be the ONLY female in her class, or didn’t want to face the unending gender discrimination she knew she would face in schooling and in the profession.  Of course, by now, many of those women have gone back to school to become NPs and are very happy!

According to the already gushing reviews, the iPad is a “game changer” and “the device health care has waited for.”

Not really.

I do believe that there will be areas in health care where it could be very useful and could make a difference.  One example that comes to mind is the typical office visit.  My primary care doc uses the computer in the exam room while in the midst of our visit.  He can look up past visits, lab values, meds and all the ephemera of a medical visit.  Instead of staring at a computer through the visit, he can look at me and be more engaged with the patient, instead of being engaged with the computer.  Another w0uld be for rounding on the wards.  How useful could it be to have everything at your fingertips when you’re at the bedside conducting rounds?

But for the average nurse at the bedside it is a horrible idea.  First, it does not appear to be very durable, able to deal with the crap a bedside nurse could unleash upon it.  Us nurses are hard on equipment, especially things we use near continuously in our work.  It is more a repetitive stress type brutality than “give a shit” mentality.  I don’t think Jobs’ fancy, purty piece of engineering could stand up to a typical 12-hour floor shift.  Then there is the issue of exposure to bodily fluids, urine, blood, mucus, poop.  Bedside nurses deal with all of that on a daily basis and while we wold probably be careful with it, shit happens.  No one starts a shift wanting to get pooped on, but it happens y’know?  Then there is the infection control issue.  We have enough issues with nosocomical infections like MRSA and VRE in health care and a portable tablet could be a very effective fomite.  Not only would we then be reminded to wash our hands, but to sterilize our iPads.

Second, it’s lacking in important features.  Bar code scanner?  Nope.  With our new EMR, all meds will be bar-coded, lab slips will be the same, even the patients will be bar-coded, so not having that is fairly significant.  If you’re going to have a device to help with the  tasks and functions of a bedside nurse, we better not have to carry multiple devices, like the pad and a bar code scanner. Swappable batteries?  Uh-uh.  We work 12-hour shifts and according to the press, battery life is around 10-hours.  I don’t have the time on shift to stop, plug in my device for an hour to get more juice so I can finish my work.  Device integration to monitoring equipment?  Not yet and probably not without a very expensive software patch.  In our new EMR, our monitors and vital signs machines are supposedly going to be integrated so that instead of entering values, we click and the values populate.  Now I’ll believe it when I see it, but having used that before, it is cool beyond a doubt.  But is Apple going to open things up to support multiple standards?  Not without a hefty price tag, if at all.  And these were only the first three I came up with.

Third, and probably most important is price.  Even if we get the barebones version, with academic pricing, it’s still going to be expensive.  And if each nurse, on each shift needs one…that could get costly.  If my floor is full, we have 7 nurses, 2 aides, a unit secretary and a tele tech on days, at night, it’s 7 nurses, 1 aide and a tele tech.  To cover the needs we would need to have 14 tablets – at least, probably with one or two for back-up.  That’s one unit.  My manager handles 3 units of varying size, so you do the math.  And that’s just one group of units.  So what?  Do you issue them to nurses on hire?  Are we now responsible for the upkeep and cost should it be damaged?  Hard questions.  What about the “walking away” of the devices?   Some people will steal anything that isn’t bolted to the floor (and some will try to steal that as well) so a tablet you can slip into your coat could disappear quickly.

Would I love to see imaging results live at the bedside?  Sure.  Would it be great to have the last set of vitals, labs and meds at my fingertips when assessing the patient?  Yes, but we already have that thanks to in-room computers.  Would it be awesome to have a cool Apple toy to play with every day I work?  Yeah, it would be cool.  But cool doesn’t always make sense.

So what would I find useful as a bedside nurse when it comes to a tablet-type device?  Here’s a short list:

• Small form factor – bigger than the iPhone, not quite so big as the iPad.  Big enough to view screens without scrolling too much, but possibly be able to slip into my scrub pocket.
• Durability/ease of cleaning.  It’s going to get dropped, exposed to fluids and bugs.  It needs to be able to stand up to that.
• Bar-code scanner.  It’s the wave of the future in EMRs, so any device coming into the arena will need that.
• Good battery life.  At least 12-hours worth, or with hot-swap capability.
• Easy transfer of notes.  I can think of how this would revolutionize the report-process.  You gather the info needed and send it to the next caregiver’s pad, report becomes easier.
• Solitaire.  We need a moment of brainless fun every now and then!
• Device integration.  I want to see the current telemetry on my patient and be able to review past alarms.  When I take vitals, I want it to populate the fields with one click.  I want to see what pumps I have going, volume left in an infusion and even order new meds if necessary from another patient’s room if I need to.
• Multi-tasking.  We’re doing it all the time, why can’t the device?  I want to be able to look up a drug in the database while calculating the dose, as one example.

These are just few things I came up with off the top of my head.  Sure some of this may sound like it based off of laziness (see infusion pumps and ordering), but I believe in working smarter, rather than harder, so if I can see what’s going on in another room without having to go there,I’m all for it.  I do think that at some point we’ll have tablet-type stuff at the bedside.  But right now, I think devices like the iPad are more suited to physicians and non-bedside nursing than to the bedside nurse.  Time will tell.

An honest effort was made on day one. A hopeful recovery attempted on day two. On day three the trial was completely forsaken.

In “Oh Canada: Part 1″, I looked at the number of food group servings recommended for breastfeeding women (by the Canada Food Guide). I decided to follow the guide for one day, assess its practicality, and report my findings. So what did I find? I found a challenge! As a busy new mom, it was surprisingly difficult to adhere to the guide for even one day.

Day one started out well. Oatmeal with walnuts and apple slices for breakfast. Of course. Grain – check. Meat alternative – check. Fruit -half check. An hour later I rushed out the house tardy for a scheduled appointment. What’s new. I intended to travel with a snack but didn’t get my act together.

The next meal wasn’t until  2pm. I could have scarfed down anything at that point but actually managed to prepare a quick, healthy meal – one baked salmon fillet and a veggie wrap. And so the day ensued. By the end,  I had satisfied the recommended intake of meat, dairy and oils. I fell slightly short on produce and well short on grains.

I thought, to be fair, I should give this another go. I decided to record my meals for two more days.

Day two started like day one but fell apart much sooner. My workout was a priority. Caring for Naomi was of course a priority. I was also preparing for evening guests. Cleaning, feeding, changing and cooking was quite the juggling act. Everything else fell off my radar.

I don’t think I ate a proper meal, never mind measuring and recording the servings.  I snacked on brie and apple appetizers as I made them. That’s gotta count for something. What about the tomato sauce on the pizza we ordered? Or the grapes that made that lovely merlot? How many fruit servings is that?

Day three. Experiment? What experiment?

Despite abandoning the effort, I did figure some stuff out . The biggest success was being more conscious of what I ate overall. Though I didn’t keep up with tallying my daily servings, I definitely gave more thought to my food choices. As a result, I ate more “real” foods and less processed foods for sure. Some other stuff I figured out:

• Wraps are a really easy option for a balanced meal or snack. Just throw a bunch of veggies, cheese and/or meat into a whole wheat tortilla. You can even eat it with one hand and baby in tow.

• Having a well-stocked fridge is key. I’m talking quality not quantity. If all you’ve got is lettuce, avocado and turkey slices, that’s what you’ll eat.

• It’s cool to measure things once in awhile just to be reminded of what a “serving” really is.

And to answer the questions set out in part one:

• No, I certainly didn’t find time to prepare each meal and snack. It was especially hard to do around daily outings and activities.

• If I was hungry it was due to poor eating schedule, rather than the Food Guide serving suggestions.

• I think healthy eating in general is sustainable but only SuperMom could fit in and track all those servings. The Canada Food Guide is exactly that – a guide.

• No noticeable change in milk supply or Naomi’s liking thereof. Mama still gave her some sugar

So, after agonizing about it for a couple of months now, the results of the November Nursing Board Exam are available online in this website. According to Inquirer, a total of 37, 527 out of 94,462 nursing graduates passed the November, 2009 licensure examination which roughly translates to 39% of the examinees.

To those who did not pass, brush yourself off and try again (if you’re really into nursing); if not, don’t be depressed and just try to do some things that you really want to do. Remember that wise saying by Rob Schneider in the Waterboy…

To those who passed the November boards, especially my friends and my girlfriend (YAY!), congratulations and welcome to the world of the underemployed!