Saturday, April 13, 2013

Ten Great General Tips

        As a senior Nursing student. I've spent plenty of time in nursing school, around nursing students, preceptors and faculty.As a result, I’ve collected some useful advice for students on getting through nursing school. Some of these may seem obvious, but they can be easy to forget when you’re in the flurry of the program!


1. Self-care is crucial. Get enough sleep, drink plenty of water, exercise and apply what you’re learning in nutrition class to yourself. You have to be able to take care of yourself before you can take care of someone else.

2. Work hard with a system that works for you. Different study systems work for different people, and even for different classes. For example, methods include making up songs using medical vocabulary and using flashcards and acronyms. Find study methods that work for you. Nursing programs are difficult, so ignore the scuffs from your pre-med friends and make sure you’re putting everything you have into your classes. Remember that what you learn will be used to protect and save lives later in your career, so don’t just study for the grades—study to learn.

3. Develop good study habits and be organized. I found it helpful to prepare for classes by reading assigned materials that we would be covering a day before lectures, and then reviewing them within a day after the materials were taught. There have been scientific studies that say this is helpful to retain information. Being organized is important for almost anything you do. Have a big calendar on your wall with all the exam dates and other important dates, and also a personal calendar (paper or digital) for the daily tasks you need to do.


4. Form a study group. Nursing programs are unique in that the group of people you know will most likely be with you throughout the program and take the same classes as you. So make friends! Even if you prefer studying by yourself, remember that nursing is a cooperative career where you have to work with others to give the best care to your patients. Your study group of nursing students can also become your support system, since they’ll know what you’re going through when you get frustrated or discouraged.

5. Ask your professors for help when you have questions. In clinical courses, ask your clinical instructor for help when you’re not familiar with the procedures. Also make sure to practice until you’re confident that you can do it right by yourself. Be sure to ask plenty of questions in your classes. In fact, be like the child who continually asks why something works the way it does. One question that I always asked my professors in my nonclinical courses was “How does this apply when we’re treating patients?”

6. Talk to senior nursing students for advice and tips. Most of the time, they can offer you lots of insight into a particular professor’s teaching style or tell you what to expect for certain classes you have to take. It’s valuable information that only a person in the program ahead of you would know.

7. Get some learning experience during the summer. If you’re not taking classes during the summer, consider an externship at a local hospital or community clinic, and review your textbooks for classes you’ve taken or will take. Whatever you do, definitely continue learning during the summer, even if you have a summer job. If you’re passionate about nursing, this won’t be hard to do, and you’ll be a lot more confident when the semester starts. Working in the clinical setting is invaluable experience that can make you more comfortable when the school year resumes.

8. Believe in yourself and don’t give up. When times get tough, remember the reason why you wanted to become a nurse in the first place, and call on your support system for help if you feel you’ve forgotten or you feel too overwhelmed. You’re not the only one going through this, so talk to your fellow nurses.

9. Remember to relax. Have a good sense of humor, don’t forget to laugh and breathe even when things get hectic.

10. Remember the Golden Rule. Be the kind of nurse you would want if you were a patient yourself. This is the nursing version of the “golden rule.”

References:

8 Nursing Student Clinical Survival Tips

          The question that is often asked by student, “How can I make the most of this year’s clinical rotations when I don’t like the specialties covered this semester?”. First of all, no one is expected to enjoy every aspect of the varied career options that comprise the field of nursing. The issue is not that you will enjoy every aspect but that you learn from the experience. Part of what you learn may be that you don’t want to work in pediatrics or psych.

Here are 8 tips to make sure you get the most out of the rotation, or ANY ROTATION!

Be willing to work: Come prepared to spend your time working. Despite the time you think you are spending, no nursing student gets enough time in a clinical setting before graduation. That means you must make the most of the time you have. Be prepared when you hit the floor. If offered the opportunity, look over your patient charts beforehand and plan your day.

Keep an open mind: A closed mind will be unable to learn anything. Work to remove your preconceived notions and focus on what is going to be positive about each rotation. Take 5 minutes and make a list of the pros if you have to.

Remember the golden rule: You are there to learn, but that doesn’t mean that you can’t be a helping hand to the unit. A little good will goes a long way. If you see someone who needs help with something, lend a hand! This shows a couple of things. First, you have demonstrated that you aren’t afraid of hard work. If you decide you like the working environment, you have put yourself in a position to be hired. Second, what goes around comes around. When you help someone, they will remember to help you. When a nurse has some interesting skill, procedure, or wound come up, they will be open to inviting you to come take a look. Help someone change some sheets and increase your opportunities to learn.

Divide and conquer: Team work with you fellow students is vital to success in nursing school. Working together in study groups, watching out for last minute scheduling changes, and sharing clinical experiences are all tried and true methods for nursing school success. In the clinical setting, you will need your classmates to proofread your nursing notes, patient care reports, and patient goals and interventions.

List your clinical needs: Knowing what you need to learn will help focus your efforts. Make a list of the clinical learning opportunities that you need, either for competencies or for you own satisfaction. If you need more practice placing a foley catheter, add it to your list. If you want to focus on wound care or replacing dressings, add it to the list. Review the list every week and make changes, marking off those items you’ve completed and adding others as they occur to you.

Use the Instructor: Share you successes and failures with your instructor. They are there to help you succeed. Tell them the areas in which you need improvement. They’ll watch the clinical opportunities for the class and be able to steer you towards the opportunities that will help you reach your goals. Also, ask the instructor to tell you where they think you need to improve. Sometimes, even though you have made a list, you miss something, a blind spot in your clinical education. Your instructor can help you identify these blind spots and help you move forward.

Have resources handy: Students need two things every clinical day. First they need a top quality drug guide. The second item needed is a clinical procedure review guide. You will probably already have one that is part of your textbook package. This gives you a resource to look over when you get a patient needing an intervention you haven’t performed before or haven’t performed often. With these two items, you will be ready for anything.

Know your staff: This goes hand in hand with the “golden rule” tip above. Get to know your staff. Not just the nurses but the techs, CNAs, pharmacists, and unit clerks. Nothing happens in a vacuum. A well run nursing unit is a team effort. Learn people’s names, say hi, and be respectful and friendly. This will pay off when you need something for your patient and can’t find the supplies, need an item from the computer, or just need an extra pair of hands to do something.

References:


The 4 C's of Communication in Nursing

        One of the most frequently asked questions by students from all levels of nursing is: “Why must I say things over and over and still not get my point across?”. Unfortunately, this failure to communicate dynamic is a pitfall that all students experience from time to time. Communication in nursing is a tricky two way street where you not only have to plan for what you are going to speak, write or otherwise convey, but you must also put yourself on the receiving side of your message and do your best to determine how you are going to be heard above all the “noise” that is ever present in your receivers world.


       Nursing communication is important to our careers, relationships, and of course, to our patients. It can be the tool that sets you apart from the good nurses and makes you an excellent nurse. It can be the vehicle that gets you mentioned in patient satisfaction surveys, requested shift after shift by a patient’s family, and if you are interested in the road to promotion, it is a key skill that will place you squarely on that path.  

Here are the Four C’s of clear, concise, and consequential communication:

Clear. If ever there is a place for embracing simplicity, it is in your communication. Simplicity is truly a beautiful thing. If your simple message is worth saying (or writing), it goes without saying that it will bear repeating. So know up front, you will have to repeat yourself, and then say it again. Yes, I know. I did repeat myself there. Keep your message simple, your purpose in mind, and communicate in the simplest manner that will get you your desired results. Here is a modified version of the old “KISS” method. K-eep I-t S-hort and S-imple. We live in a world of limited characters and attention spans. If you overwhelm your listener with too many words or too much text, they will tune you out.  Focus on Clear. Keep it short and simple.

Clean. If you break this word down, it literally says “c” “lean”. That is your goal in written and verbal communication. You want your receiver to see, or hear, lean. Based on what we learned in the first C, you already know your message needs to be simple and easy to understand. It also needs appeal to your listener or reader. The key to 'clean' is for your listener or reader to be able to immediately repeat to you what they are to take away from your message. This “take away” should be something they know to DO after or that they understand as a result of receiving your communication. A good way to practice your c-lean message is to get a practice partner you trust, craft your message, deliver it to that partner, and then ask that person to tell you what they are going to do or what they understand as a result of your communication. If they are close, great! You just have a little tweaking to do. Are they out in left field? Then go back and clear it up and lean it down.

Consequential. Of course, when you take the time to communicate, you want that communication to be consequential, manifesting in the results or behaviors you are after. Remember, conversation can be off the cuff, but communication is consequential. To achieve the desired consequence, you must apply strategic communication. It is not enough to know what you want to say, you must craft your message with the end in mind. 

Commitment. If you have employed the first three C’s, and practiced them, you are well on your way to committing an effective nursing communication. Be aware that you will have to commit to the practice distilling the message for your listeners. Here is a reminder that you can repeat to yourself that will help you remember the four C’s. You will have to practice lean, practice clear, chart your course, and persevere.

     The payoffs in all facets of your professional and personal life will be well worth your investment of time these techniques.

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Ten Ways to Effectively Manage Your Time on the Unit

      You probably didn’t think that time management skills would come in handy working on the floor, but they will. In fact, learning how to effectively manage your time will probably allow you to deliver better quality care, get more done and feel less stressed in the process. So how can you best manage your time?

Get into the habit of arriving early. This will give you the chance to read through your reports and handover sheets, settle your mind and organise your tasks before the hustle and bustle of the shift ahead.

Make a note. If it is just for your personal use only, it could be in any form you fancy, whether it’s a tick box on your handover notes, a to-do list in your notebook or a grid of patient names with associated tasks, writing down your activities for the day will allow you to clearly see what jobs you need to accomplish.

Estimate how long it will take. Add time estimates next to each task so that you can see how much time you’re likely to spend on each. This will prevent you from spending too much time on one task and neglecting another.

Prioritise. Now that you have your list of tasks for the day, it’s a good idea to prioritise them. What needs to be done first? Which tasks are urgent? Which tasks need to be undertaken before you can carry out others? What would happen if a task wasn’t carried out immediately? Give each task on your list a number according to how urgent it is, 1 being the most urgent and 10 being the least.



Avoid tasks that aren’t on your list. If they’re not on your list, then they’re probably not the best use of your time. Avoiding activities such as watching television, taking long chats, sending emails or getting involved in long conversations with your colleagues will mean that you’ll fit more things into your shift and feel less stressed too.

Learn to say “No”. You can’t be everywhere at the same time, so some things will have to wait. Check in with a patient, saying something like ‘I’m sorry I have to deal with this right now but I will be back to help you in a few minutes.’

Listen to your patient. Your patient’s priorities may be different to yours, so try not to assume what they would like first, ask.

Take a deep a breath. You’re bound to get more done when you’re feeling in control. The stress of the day may make it feel like you can’t take a break, but using a few minutes to collect your thoughts can help you relax and focus on what needs to be done.

Be flexible. Working on the unit can be unpredictable and your priorities can change very quickly, so learn to be flexible and respond to what’s going on around you. It may be useful to regularly reassess and refresh your to-do list as your shift continues.

Don’t be too hard on yourself. With practice, you will get better at time management. Berating yourself for things that you didn’t manage to do during your shift isn’t helpful. There will always be something that you wanted to get done but didn’t have time. Experiment with different styles of time management.

General Guidelines For Health History and Physical Assessment

Introduction

Performing an accurate physical assessment and being able to differentiate normal from abnormal findings is one of the most important roles for today’s health care practitioner. If an accurate physical assessment cannot be performed, whether for baseline data or when the patient’s condition changes, then the patient is not receiving the level of competent care that should be given.You will work through the physical assessment on the basis of body systems and also include a psychosocial assessment.

General Guidelines For Health History and Physical Assessment:

Review Available Data: Quickly review the chart prior to performing your assessment. Note the patient’s name, age, address, race, occupation, and religion. This will provide you with an idea of the patient’s lifestyle and will avoid asking repetitive questions.

Establish Rapport: Always greet the patient in a friendly, non-threatening manner. Use “Mr.”, “Mrs.”, or similar titles unless the patient is a child or adolescent. Explain your relationship to the patient’s care. During introductions many patients are often trying to figure out what they believe the examiner thinks of them. If the impression is good, the patient is more likely to be satisfied and cooperate with the examination. An example of an introductory statement in relation to health assessment performance is, “I will be taking a health history and performing a physical assessment to help meet your health care needs. The assessment will also provide a baseline picture of your health status so that we can notice any changes in your condition.”

Control Environment: If in a semi-private room, ensure maximum privacy by drawing the divider curtain. This is a time to excuse the family, if possible, so the patient can provide candid responses to sensitive issues of which the family may not be aware. Hostile or intoxicated people or persons who have been abusing chemical substances may feel trapped in a small room. For this reason, and also for the examiner’s safety, leave the door open. Also, this type of patient may feel more relaxed if coffee or juice can be offered.
Position Patient: The patient should be wearing comfortable, loose fitting pajamas or a gown. During the rapport establishing phase of the relationship, the examiner should stay at least three feet away from the patient to avoid invading personal space. As the assessment progresses there will be a need to move closer than three feet, but the personal space should still be maintained when just conversing with the patient.
Follow a Systematic Assessment Flow: Although the patient’s condition often dictates what area is covered first in the assessment, one should still observe some type of systematic progression to avoid excluding important assessment areas.
Techniques Of Physical Assessment:
Inspection

A method of systematic observation. Inspection should begin with general observation of the patient progressing to specific body areas. Inspection is a physical assessment technique that is often used but seldom thought about.

Palpation:
Process of examining patients by application of the hands. Used to determine:

  • The consistency of tissue directly or indirectly with the palms of the hands or finger pads.
  • Alignment and intactness of structures (such as the nasal septum or extremities).
  • Presence of thrills. Thrills are fine vibrations and can sometimes be felt over aneurysms or Grade IV or stronger heart murmurs.
  • Symmetry of body parts and movement.
  • Transmission of sound through vibration (known as tactile fremitus).
  • Areas of warmth and tenderness.
For light palpation, press the skin gently with the tips of two or three fingers held close together. Note tenderness or warmth (although the backs of the examiner’s hands are most sensitive to skin temperature) as well as the size and position of structures and the existence of masses. For deep palpation, place one hand on top of the other and press down with the fingertips of both hands. For example, deep palpation of the right upper quadrant lets you estimate the size of the liver.

Percussion:
Tapping of the body lightly but sharply to determine consistency of tissues and/or organs through vibration and areas of tenderness. Sounds that will be heard include:
  • Resonance – Loud, long low-pitched sound heard over hollow structures such as the lungs and abdomen.
  • Hyperresonance – Loud, very long sound, lower pitched than resonance, heard over areas such as overaerated lung tissue found in COPD. Hyperresonance sound lies between tympani and resonance.
  • Tympany – High-pitched, loud sound of medium duration heard over the stomach or gastric bubble.
  • Dullness – Medium-pitched, slightly louder than a flat sound heard over solid organs such as the heart, liver, or a distended bladder.
  • Flatness – Soft, high-pitched, short sound heard over bone and muscle.
The technique of percussion involves putting the middle finger of the nondominant hand on the patient’s body and tapping it briskly with the middle finger of the dominant hand. If the examiner’s hands are small, the technique may not make a sound loud enough to be heard. In this case, try striking the finger with the side of the thumb instead.


Auscultation:
Process of listening for sounds over body cavities to determine presence and quality of heart, lung, and bowel sounds. High-pitched tones are best heard with the diaphragm of the stethoscope while low-pitched tones are best heard with the stethoscope’s bell (“bell-low” is an easy way to remember). Hold the diaphragm firmly against the skin to block out extraneous noise. The bell should be place more lightly on the skin.

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