Best Clinical Day Yet

Today was a great clinical day. The best yet. I think it was because we basically got to map out our day with our patient without having to worry about waiting for our clinical instructor to observe us do our assessments/vitals. 

New skills today: giving suppository (!) and changing dressing on a toe/foot wound (related to diabetic neuropathy). I totally didn't flinch--neither did my patient...my patient could not feel it. Diabetics: PLEASE TAKE CARE OF YOUR FEET!

I've got so much studying to do tonight and tomorrow, that I can't write more. But since I'm in a celebratory mood...I wanted to share.  

Only THREE clinical days left this semester.

Cheers.

Second Fundamentals Test Coming Up!

Friday we have our second fundamentals lecture/theory exam. I have not yet started studying for it.

Thankfully, I did manage to complete my lab skills readings quiz for Thursday and my lecture readings for Friday (for after the test) this past weekend and completed the General Assessment write up today...all that remains is to watch a bunch of skills videos (for skills lab), write one care plan and finish up my Nurse-Client Interaction assignment. The NCI proved very challenging last week as my patient was on isolation precautions. So no paper was allowed to go in/out of the room. So I had have to depend largely on my brain to recall the 5 minute conversation and then to evaluate the conversation and non-verbals for therapeutic and non-therapeutic conversation. And I was very busy with my patient, so it was tough to find time to recall/write down the conversation. I understand we'll get to do this again next semester and then again in our psych clinical during our 2nd year.

Not yet overwhelmed or nervous about this test...but I REALLY want to do better than last time (88). I would LOVE to get an A in this class. And the tests are where that happens. We have a quiz average that is included, but I do not see how I will score lower than 95 average on that...but really hoping for a 100 (once they drop quizzes). I anticipate I'll try to study some hours tomorrow and Wed/Thursday evenings.

I'm going camping this Friday/Saturday to celebrate the 2nd test being over and hopefully relax a bit. I'm only going to spend one night (could go for two) b/c I need to get basic life stuff done, plus probably some studying too. We've got our next lab skills test a week from Thursday...on meds administration (oral, topical, injection, IV etc...) so I do need to plan for that!  Sadly, we won't actually get to do med administration until next semester.

Oh, already have idea of next semester's schedule:  Two classes:  Nursing Fundamentals 2 and Pharmacology.  Monday morning is our Fundamentals Lecture, Tuesday morning is Pharmacology lecture, Wednesday and Fridays are our clinical days with clinical prep on Tuesday afternoon/evening. So it looks like my weekends will be eaten up with lecture prep! ACK! I will have option to take Pharmacology either in classroom or online format. I'm leaning towards the online format...simply to cut out time it takes to travel to school and sit through lecture. I really wish they could tell us if performance/grades were higher in one version than the other. sigh.

Tomorrow afternoon I am interviewing for seasonal employment at the distribution center for a local electronic retailer. They need folks from end of November through the holidays. I'd need to have reduced hours for the first couple weeks after Thanksgiving b/c of school exams, but can work plenty of hours after that through Christmas. I really don't want to work EVERY DAY during the holidays, as I am looking forward to a break. Maybe I'll just rest in January if I'm not needed to work. But the money will be nice supplement to my bank account and being able to not stress over gift-giving this year. I also probably need to figure out if I plan to go to Ohio for Christmas. But that largely depends on what my other sisters plan to do and usually they don't make plans early. New Years is when we do the full family thing (all sisters, parents, nieces/nephews)...so it's a matter of figuring out where I'll be for C'mas Day.

I probably should post an update of my expenses here soon. I keep forgetting...plus not a lot of time. We'll it's time for me to head for bed...another full day tomorrow of school assignments/studying, job interview and getting ready for clinical on Wed.

Blah Blah Blah...

Tomorrow is another clinical day. I'll be turning in three physical assessments from last week: Urinary, Bowel and then we had one of our choice and I chose Skin/Tissue. We also had to complete 3 care plans--1 per assessment. Tomorrow we'll be doing another General Assessment and a Nurse-Client Interaction (NCI) assessment. I've been dreading the NCI ever since I learned we'd be doing this. Basically documenting verbal/non-verbals on both sides... recording the therapeutic communication techniques we used with our patients and the responses...along with non-therapeutic communication that undoubtedly will slip in there. Basically a blow by blow of 5 minutes of conversation. I'm not altogether sure how this will work and am fairly nervous/confused.

We'll be getting our General Assessments back tomorrow from two weeks ago, so hopefully we'll learn from our previous mistakes so that we can write up a better Gen Assessment tomorrow. The patient that I did my first Gen. Assmt on was discharged after 3 hours. So hopefully that won't happen again--as that would possibly be problematic for completing my NCI.

I'm so glad that I will not be repeating last week's late bedtime (only 4 hours or so of sleep and HR over 100 when I went to bed!)

Last week the first care plans that we did were returned to us. I think for the most part I had a well-executed CP but instead of my nsg dx being "Impaired skin integrity..." I should have had "Risk for skin integrity..."  I can't remember now what my rationale was for choosing the full monty, but I remember I thought about it and thought about it. It was a confusing one. But since there weren't a lot of red markings, I felt pretty good about it. We'll be getting feedback about our first General Assessment tomorrow, but she already gave me feedback   from my CET (Clinical Evaluation Tool) that said I did really well with my Nsg Dx's...so gives me hope that I'm on the right track.

Hard to believe that after tomorrow, we'll only have 4 more clinical days left. For the following two clincal days (not including tomorrow) we'll be doing a General Assessment with 3 care plans. Those weeks will be heavy weeks, but then all that's left is to do is final evaluation of ourselves and then meet with our instructor for her evaluation.  I have mixed emotions about clinicals. They are anxiety producing (since this semester we don't know our patient assignment until 30 minutes before care starts) and a lot of school work. However, this is where we learn to be a nurses. Where the theoretical meets reality. I really wish I had pursued some shadowing experiences during this semester, but reality is that it's been challenging enough to get my school stuff done and still allow for some fun/balance in my life. I could probably manage to do 5-10 shadowing experiences in 5 weeks time--even with the holidays. So glad I'm not working...but I suppose that if a temp job was offered to me, I'd be foolish not to take it. Even better if the job was in healthcare field--but I don't want anything stressful!

This past week I started my "Christmas Break To Do" list. I love lists and this gives me something to look forward to--even if what I need to do/accomplish is not very fun.

Half-Way!

Hard to believe we're half-way through the semester! Yay!  And I've only got five more clinical days left! Instead of feeling panicked about what I will experience at clinical, now I'm a bit anxious about what I won't get to see/experience this semester. Funny how that is. I really would like the chance to insert a catheter, NG tube, administer an enema--uh, no, not all on the same patient-yikes!  It's really the luck of the draw what patient I am assigned to and what they are ordered on the day that I'm there.

Monday/Tuesday of next week are Fall Break, but for me, it's like any other week since my classes are Wed-Friday. So no break for me...I still have to prepare for my classes next week. We've got our 2nd lecture test coming up two weeks from today, so things will be getting K.E.R.A.Z.I.E. again. sigh. 

We'll have our last clinical day mid-November--the week before Thanksgiving,. After that all I have left is the 4th skills lab test and our 3rd lecture test...and then final on Dec. 10th.  My cousin's wedding is the weekend before Thanksgiving, so I'm very grateful for the chance to just chill out with my family that weekend and for the week of Thanksgiving and not have school stuff hanging over my head. I'll have plenty of time to study for my tests. School stuff will be finished by December and then five lovely weeks of break! Ahhhh!

All I can say is so-far so good. So far my feeling is that is the material isn't all that hard to understand. It's that we are rushing through it so fast. Kinda afraid it's gonna leak out of my brain before I have a chance to use it. I think by far the most challenging is just keeping up with all the readings and clinical assignments. 

I took the afternoon off to give my brain a break-- but I expect I'll be spending all day tomorrow working on care plans and if time, I'll start reading for classes next week. Sigh. No rest for the weary.

Care Plans, First of the First

Today I worked on my very first Care Plan (CP) which was skin-oriented based on the Skin Assessment we had to complete last week during clinical. It being our first CP we only had to do one Nursing Dx and three interventions/rationales. Subsequent ones will require us to do three priority Nursing Dx with expected outcomes, as well as appropriate interventions...(I'm still a bit unclear if there's a minimum number of interventions they expect).

This semester they have us creating CP's after caring for our patient (rather than before). Next semester we'll be going in the day before clinical to get data on our patient and then will write a CP before caring for that patient. But for this first clinical experience, they just want us to learn how to create them and get feedback so we can get solid on our CP'ing skills before next semester.

I think I completed it as they expected. It's always hard to know for the FIRST OF ANYTHING if you've completed it to their expectations. Plus what my clinical instructor wants may be different than what another clinical instructor is expecting. I'm the one who reads the instructions and checks/rechecks to make sure that I've done what they've asked. But there still might be something I missed. I'll have to wait until next week to get feedback on this CP. Thankfully we'll have gotten feedback from this CP before we are expected to do another one. The good thing is that I know my clinical instructor really is taking her role seriously. She's tough in a good way. I like it. The bar is set high, but she's supportive and encouraging, but won't let us get away with anything. It's awesome. I've heard stories from previous years clinical instructors who were more or less absent and didn't give helpful feedback on clinical assessments, assignments. That would frustrate me to no end not knowing if I was doing it right or not. The worst thing is to get half-way through the 2 year program and then have a really tough clinical instructor rake you over because of your work--when it passed the approval of previous instructors.

Since my clinical section had to miss our first clinical, we've been given an opportunity to do a make-up clinical this Friday at a local highschool for about 5 hours. We'll be assisting with the hearing/vision screenings. I'm looking forward to it. Should be interesting!

- -  break - -

Ack!  Earlier about 8pm, I realized that I had forgotten to wash my lab coat, so managed to get a load in/out by 9 pm and just finished ironing it.  So just a few minutes ago I went to look for my scrubs to lay them out. Heaven help me, but they were STILL in the dirty clothes! Argh. All week I thought they were ready to go since I saw my scrub pants in the closet. But turns out that was my second pair of scrub pants --without a top! So now I've got to stay up until they are washed/dried. Can't leave them in the dryer b/c they'll be all wrinkly in the morning. Ack. Well, thank goodness that I lay everything out the night before.

It seems everyone in the house will be getting up during the 4 am hour tomorrow morning. The Homeowners are  in town and tomorrow morning Mr. Homeowner has to fly back to Colorado for a funeral and will be flying out at 5 am something...so now I don't feel so bad about getting up and showering at 4:30!  And not so great is the Mrs. Homeowner is coming down with a cold :-(  Hmm? need to go find some immune boosters! I do NOT want to be sick again so soon!

Room to Improve

Our first test grades were posted today. If I calculate right, I missed 6 questions...so I got a B (88). I had hoped for better, but I knew there were some that I likely got wrong.  I wish there had been more questions so that each question wasn't worth so much. That fact I didn't earn an A doesn't have me shook up. Live and learn, what's done is done. Fact is that I'm not sure if I could have studied any harder or any better and improved my results any. I DO think that if I'd had 15-20 more minutes to take it, that I would have been able to review my exam and fix dumb errors (from rushing). We only had one hour for 50 questions. I am curious to find out which questions I missed (and if these were ones the majority missed as well) and am ready to learn from my mistakes. Unfortunately, it's very possible that I made stupid errors that I will later kick myself on. But hey, like I said before, while I could get preoccupied, anxious about my grade, I really just want to learn. And sometimes we can learn best from our mistakes. Tests are all about finding out what we know/don't know (and whether we can follow instructions and understand the questions). I still have 3 more tests/exams for this class. The hard part of getting B first time around is that you have less of a cushion--in case a future test is worse. But I'm not going there...just gonna focus on the present and making my reading/studying time count.

No time to sit around though. We have our next theory test at the end of October and we've got five units worth of material to cover in 3.5 weeks. Giddy-up! Obviously, my current study methods/efforts for my weekly readings will be tweaked a bit. Not sure exactly how until I see my exam and what my trouble spots were.

An interesting side note...while I've always been the curious one with accidents, natural disasters etc... I'm finding now that I'm in nursing school, I have a new way to think about these things. A man from my church was BADLY injured in an accident---life threatening injuries. His arm was partially amputated several days after the accident because of infection that set in to open wounds. And there's still more infection and they are going to have to go in and do more surgery to try to clean out the rest of arm (debridement of the dead skin/tissue remaining) otherwise they might have to amputate more.  So now as a student nurse this has me thinking on a whole new level. Nursing Dx's, Interventions, etc... it's overwhelming to contemplate. The medical field has come a LONG way since Florence Nightingale and Doc Baker on Little House on the Prairie (one of my favorite TV shows as kid). In those days, this man would have died-from loss of blood, brain swelling/bleeding, lack of oxygen, infection, failing kidneys. He's still not out of the woods yet--they are likely working hard to prevent systemic infection. The great news is that it appears his pain response is still intact and he is able to respond to commands. It will be a LONG recovery road for him. Have mercy, Lord.

Update: Rumor has it there was only one A (or only one grade in the 90s--not sure??) for our first test. One of my friends in the program who I spent a fair amount of time with/talking to got that A...and the other woman we hang out with...also got a solid B too. So I am pleased that the three of us did really well--am grateful to have connected with other smart women!  So while I would've loved to have gotten an A...I'm still very happy with my B, as rumor is that many did not pass it. :(

My Official Clinical Theme Song | Fall 2010

Last Tuesday I decided I needed a theme song for clinicals. A song that I could play on my drive in that would be meaningful, encouraging, hopeful and give me courage. It could've been something as provoking as the Rocky theme song or some other well known tune OR just have really great lyrics.

So here's my official theme song for this semester's clinicals:

Bebo Norman  |  "Here Goes"



My sister offered the one below, which I like too (it's kinda vague):

Frou Frou  |  "Let Go"



"Here Goes" seems to meet most of my criteria. It's got a good intro, which I think Frou Frou's is kinda left wanting. I need something to ramp me up and bolster me. Clinicals can induce plenty of anxiety--especially since we know nothing about our client/patient before we walk in the door (true only for this semester).

I hope you enjoy them...

First Fundamentals Test

It's been a crazy week and it was a huge relief to be handed our exam and told "you've got one hour". There were certainly some questions on the test to make me think. A handful of questions that I was left picking between two possible answers...making the best guess and hoping I was right.

Yesterday I camped out in the library after my lab skills class (4ish) until library closed at 9:30. I had spent so much time focused on Fluids/Electrolytes this past week (and getting all the other reading and assignments done) that yesterday afternoon was my first thorough review of all the previous chapters and lab skills theory content. But when I got in to my notes and objectives to review, it was like "hey, I know this stuff!"  Which is a pretty good feeling. So for those 5 hours I went over every Study Guide's objectives and did the NCLEX questions at the end of each chapter...then reviewed lab skills readings/notes. I spent a little time on Fluids/Electrolytes before leaving the library, and knew I needed to spend some more time on it when I got home. But leaving the library and walking through the parking lot at 9:30 at night, my optimism grew and the stress just rolled away. It was such a wonderful feeling...confidence mixed with relief. 

I had the same feeling after taking the test this morning. Confidence and relief. Confidence that I did alright and while I know there are some possible wrong answers and I may not score an A... I felt like I did well. I studied hard and feel like I have a good grasp of the material. It's not all about the grade--there is something to be said for learning from mistakes!  Sure there's a scholarship on the line for me...and always the risk of not passing the class (and being dropped from the program), but I don't feel that's an issue right now...so the stress is gone (for now). There were certainly folks who were even more stressed after taking the test. Reality is that I can't do anything about it, what's done is done and I will have to wait like everyone else for the results next week. And it is possible that they may end up dropping a question or two--if they find majority missed it and it was poorly written question...

So things will calm down (only a tiny bit) for a week or so...before lab skills test. But now that we've experienced a lab skills test and now a lecture test...the mystery is gone and that takes some of the stress off. 

The big challenge for me, I think, is MAINTAINING the knowledge about Fluid and Electrolytes and connected chemical processes. We'll be tested on it again at the end of semester for the final comprehensive exam...and then again throughout the rest of my nursing school career. So I need a strategy for reviewing it and letting it sink further and further into my brain for long-term retention. It's like I need to be tested on it EVERY WEEK to keep me on my toes.

This is also challenging my brain about the A&P I learned over a year ago. How easily we forget...BUT how easily it comes back with a little effort. :D

Well, off to enjoy my weekend.