Mediocre Impressions

OB and Peds are okay. Upperclassmen always told me it was a "nice break", but I'm neither relieved nor inspired.

I'm a little frustrated; I study for OB and Peds equally but have an A in one and a C in the other. I partially blame the C on the ridiculous lecture format for that course. My instructor spends the first 45 minutes of each class talking about how to study and very little time actually talking about what it is we should be studying. More often than not diseases just... aren't discussed. It's frustrating; so Meredith, Cris, and I have started making up our own chapter outlines every week in an attempt to create USABLE notes. After classes on Thursday, we just park it in the library and don't leave until we finish reviewing everything.

I miss Instructor Incredible's class. At least I learned things in there, and never felt sleepy.

My clinical experiences have been somewhat disappointing as well. I spent several days in Labor and Delivery without seeing a single birth. Then, on my LAST day there I got to witness a C-section. It was horrifying to behold because the epidural... uh... well it wasn't working. That lady was kinda screaming and fighting them. They had to hold her down in order to push general anesthesia meds... but by the time they got her under, the surgeons were already cutting through the uterus. I observed all this while pressed up against the back wall with several other speechless students. Apparently this was a very unusual occurrence, but since it was the only live birth I've ever seen, my perceptions of the process will forever be skewed. This has only confirmed my extreme distaste for labor-type nursing.

Peds is disappointing mostly because I am being held on such a short leash. We aren't even giving meds! I understand the caution with which one must treat kids... but I feel like too much of my time is spent sitting idly by rather than providing care. Also, my patience with children is fairly thin, but my patience with parents is even less substantial.

In short, I'm not having the fabulous time I was used to having. That's probably more my fault than anyone else's. Therefore I'm going to have to work especially hard at observing Instructor Exhausted and Instructor Technology if I'm going to uncover the gems of wisdom I previously found so abundant. In the meantime, I look to my Nurse Tech job as a source of inspiration.

Procrastinating...

I should be studying for a nursing class test and a bio quiz and working on my nursing care plan, but instead I am reading email and forwarding funny jokes, so here is one of my favorites:

It doesn't hurt to take a hard look at yourself from time to time,
and this should help get you started
During a visit to the mental asylum, a visitor asked the Director
what the criterion was which defined whether or not a patient
should be institutionalized.

"Well," said the Director, "we fill up a bathtub, then we offer a
teaspoon, a teacup and a bucket to the patient and ask him or her
to empty the bathtub."

"Oh, I understand," said the visitor. "A normal person would use
the bucket because it's bigger than the spoon or the teacup."

"No." said the Director,
"A normal person would pull the plug. Do you want
a bed near the window?"

DID YOU PASS, OR DO YOU WANT THE BED NEXT TO MINE ?

Again?

And so it happened again. A shooter entered a school in Colorado and shot and killed a female student, then took his own life after holding 6 girls hostage for 4 hours.
There are no words left to say... sadness is what I feel.
When will this type of stupidity end?
http://news.yahoo.com/s/ap/20060928/ap_on_re_us/school_evacuation

Travel Nurse: Have Husband, Will Travel

You don't have to be single to be a traveling nurse.

While most travel nurses are single, my experience has been that there are also a large number of nurses that travel with their husbands. The majority of them that travel around do find some sort of work in the location the nurse is working in.

Some have "portable" jobs like an online or internet business, or a "work-from-home" type job. Others have been able to find short-term positions, that they arrange prior to relocating, that only last for the duration of the contract.

Your spouse could also explore working in the hospital you will be in. The demand for nurses is so great, that they may be willing to employ your spouse just to get you to their facility. Consider speaking to your travel nursing recruiter about negotiating this before you sign to work at any hospital. Many hospitals are glad to accomodate you and, depending on their needs, are happy to gain two new employees rather than one.
It is easy to find work in a majority of the areas you travel in, but if you are looking to relocate to be at travel nurse in a rural community, it may be difficult to find jobs for your spouse. In those types of isolated conditions there aren't usually many job availablilties, but if the pay is good enough to sustain both of you, then your husband could consider being a "house husband," which usually works out great, especially if he's a dad too.
If your husband finds it difficult to find a job that will allow only temporary employment, remember-you can always renew your assignment contract and stay for an extended period and if you end up liking the location, you can always take on a permanent position at the hospital there.

Cold Case...

Wow, unreal. Tonights episode of Cold Case is about 2 teenagers into violent video games who open fire on other teens at the mall... CTV has the decency to post a warning BEFORE it started and after every comercial break about "due to recent events viewer discretion is advised..." I for one appreciate that warning.

And so we move on

On Friday, September 22, students and staff met at 11:00 a.m. at the de Maisonneuve entrance to remove the flowers together. They were placed on the West grounds and will be made into compost for a garden to be planted in the future. Thank you to all who participated.

Thank you Dawson for doing this. We need to move on and this was the perfect way of doing so.

WOW! I feel like a "real" nurse!

Hehe, we had our pics taken for ID cards at the hospital... now I feel official even if it is only for another 4 weeks! (only St-Mary's makes students get ID cards too). I had this done week one (2 weeks ago), but never got around to putting it up...

One Week Later

Last Wednesday we, Dawson College students, staff, faculty and friends, were frightened and lost. We went through a terrible ordeal, one young life lost and 20 others injured, 2 still remain in coma.
I thank all who support us still, friends, family, teachers/staff.
Todays blog is about that. I want to show others what the school has done for us, to help us get through this as a "family".
One pic is of the doors with messages taped onto them, one is of all the flowers that have been left,(and this is just a small sampling of what is around the school), one is one the "cafeteria" wall where it all hapened, it has big white boards that we were able to write messages, and one is a close up of my message "Let us unite and be strong, show others who we are"

Today we stood as one

Today was tough... real tough. The school did an amazing job at welcoming us back though. Staff/teachers/psychologists all were there to greet us outside and inside the school. They clapped and said welcome back, we are glad you came. Teachers who don't even know you would walk up to you and ask if you are ok.
I went to the nursing dept. and spoke to my teachers and hung out with friends. We cried and lauged, we ate (there was tons of food). We then went to the main cafeteria and signed the books they had set up, full of messages from us, the student body. We signed the "wall", large poster boards were hung with markers and we could write whatever we wanted.
So the first day back is over and I find myself still crying when I stop and think about all that has happened, but I know that I have friends and teachers who are there for me, no matter what.
Thank you to all who support Dawson College and all of it's students. Montrealers have shown us that they love us, they support us and feel the same sadness we felt on that day and the days since.

Normal?

Nothing will feel normal tomorrow.

Sure there won't be signs of the bloody violence that occured in my school, at least not any physical signs to the inside of the building... blood, bullets, all gone. But the memories are there, the feelings we have are there and the remaing fear is there too.

They say (psychologists and the like) that for 95% of us, this fear and sadness will decrease and disapear in the next 2 weeks. But what about the remaining 5% ? Those who SAW it ALL happen? Like my friend M who watched in horror as the gunman shot and killed one and shot 19 others.

I'm not sure when "normal" will return, or if it ever really will. Dawson is a great place with great people. The support that has been shown our "community" has been amazing. Our teachers have been and will be supportive and comforting. There are many activities set up for us tomorrow in many dept. as well as for the school in general.

Life goes on, it has to. For me it always has, no matter what the challenge... this is yet another one I have to face.

Jean Watson's theory selected as framework at St. Joseph Hospital, Orange, California

Saint Joseph Hospital in Orange, California has selected Jean Watson's Theory of Human Caring as the framework on which we base our nursing practice. Burlew Medical Library has prepared a selective bibliography of articles by or about Watson from 1996-. This list of articles is in part 1 (articles available to SJO/CHOC employees) and part 2 (articles which could be ordered for SJO/CHOC employees. SJO/CHOC employees need only contact Burlew Medical Library to request any of these articles. Individuals at other entities should contact their own medical libraries.

Additionally, we will be offering a special viewing of a moving and inspirational DVD on the "Theory of Human Caring" which was produced by SJH nurses.

One hour sessions are scheduled in the Zhoul auditorium on

Monday Sept 18 12:00 noon to 1:00 pm 2006
Tuesday Sept 19 7:30 am - 8:30 am
Tuesday Oct 3 7:30 - 8:30 am
Monday Oct 16 12:00 noon to 1:00 pm
Friday Nov 3 7:30 am - 8:30 am
Monday Nov 6 12:00 noon -1:00 pm

No registration is required and breakfast/lunch will be served to St. Joseph Hospital of Orange staff.

Along these same lines, there is a very cool Nursing Theory Link page out of Clayton State University Department of Nursing where you can read about many nursing theories.

Evidence Based Library Science Conference

Evidence Based Library & Information Practice4th International Conference"Transforming the Profession"May 6-11, 2007, Chapel Hill-Durham, North Carolina, USA http://www.eblip4.unc.edu/ The Evidence Based Library and Information Practice Conference(EBLIP4) is an exciting international event that has emerged inresponse to the growing interest among all types of libraries in usingthe best available evidence to improve information practice. The conference on May 6-9, 2007 in Chapel Hill, North Carolina will be followed by two days of continuing education. The conference provides a forum for the presentation of high quality papers and posters aswell as examples of how EBLIP is being implemented in library and information settings around the globe. EBLIP4 invites submissions for contributed papers and posters including both original research and innovative applications of EBLIP in library and information management. Papers that deal with library support of evidence-based practice in other fields such as health, social work and public policy are also welcome.

Full instructions to authors may be found at http://www.eblip4.unc.edu/ Chapel Hill-Durham is located in the middle of the Eastern United States close to the Raleigh-Durham international airport. This central location in the Research Triangle area is only a short drive from scenic locations in North Carolina. The beaches are approximately two hours to the east and the mountains are two hours to the west. Washington DC is a 4.5 hour drive or 30 minutes by air. Important Dates

December 1, 2006 Submission deadline for abstracts for papers and posters
February 11, 2007 Final decisions for accepted papers
February 15, 2007 Final decisions for accepted posters
March 15, 2007 Submission deadline for full papers

Carol Perryman MSLISTRLN Doctoral FellowSchool of Information & Library ScienceUniversity of North Carolina at Chapel Hill

...Update

According to the news, the shooter killed himself with one of his handguns AND the police did shoot him in the arm. What came first I do not know.

2 people remain in comas, one sedated on purpose to be in a coma, the other not. Very sad. 4 are left in the ICU still, including these 2 in comas.

Shooting at MY school...?

I cannot believe this has happened. This afternoon as I was finishing lunch (12:42PM), a bunch of students came running down the hall in a panic. There was a shooting in my school cafeteria. At least 19 injured, 2 dead (the shooter and an 18 yr old girl.)
2 people are in critical condition on life support from what we've heard.

It was and is still, very frightening. I cannot believe this happened at MY school. You always hear about these things, but you never think it could be your school.
Again I wonder, What is this world coming to?

Advertise on this Blog

More than 200 nurses and prospective nurses visit this blog every day. If this is the market you would like to reach and you would like to advertise on my blog please contact me at nurseaim@hotmail.com for rates.

Thank you,

Amy Robbins

Back to School!

This semester is Peds and OB. I like my instructors sofar (though nobody will take the place of Instructor Fantastic in my heart).

I'm a little pissed off because I'm having to take a statistics class. It's not so bad by itself, but I already took Stat as a math class in Houston. But does the school want that credit? Noooo, they want Psychology Statistics. I've fought and pleaded. I've asked to take a test, but to no avail! Basically I'm paying them money to sit around and re-learn things I've already mastered. On top of that, I find that many nurses are none-to-bright about math, and the pace of study is agonizingly slow compared to the first go-round. Let's hope I don't go crazy. ^_^;;

I'm still working as a tech in the PCU. I'd never really considered PCU as a place to start a nursing career, but it's becoming more appealing all the time. First of all, the patient ratio is lower than Med-Surg, but the patients aren't quite as critical as in the ICU. Secondly, the hospital is interested in "cross-training" people in ICU and ER skills in order to provide more options for "floating" extra staff in times of low census. Thirdly, I like the floor I'm on, and wouldn't mind working with these people in a larger capacity.

I've always been far more interested in critical care than anything else, mostly because I'm not too fond of children or surgery or the like. And I want to be in a place that will challenge me and keep me on my toes. Still keeping my options open, but it looks like this hospital has accomplished it's own goals by recruiting me for this job: getting me comfortable with this facility and reeling me in for employment after graduation.

We'll see how things work out when I graduate. If I don't end up in Texas, I really hope I end up right where I am.

Tomorrow I'm going to spend clinicals in Labor and Delivery. I reaallly hope a baby is born in the time that I am there, because I feel like that would be much more exciting than just hanging out with a woman moaning in labor for 8 hours. o_O

Taken two tests sofar. I actually made an A on the second one! (I'd almost forgotten how it felt to make A's on big tests with this funky grading scale!) My extra preparation is paying off. I'm making time to read the chapters before lecture and staying at least 2 hours afterwards in the library for review. And that works. (Well... except when a question is vague or weird. But that's not my problem.)

I really really want to do well this semester so I can increase those decimals after the 3 in my nursing gpa. I want to be inducted into Sigma Theta Tau! They only take the upper percent of the class, so I don't know what my chances are. If I keep making As though, maybe they'll improve. ^_^

Study: Nurses Lack IT training

A new study in eWeek finds that most nurses receive minimal or no IT training. Information literacy is integral to an understanding of how to approach Evidence Based Nursing.

Please post your comments below if you have any great ideas/suggestions on this topic.

Resources for teaching EBM

David Rothman from Syracuse, NY, just posted on his blog a very comprehensive list of resources for teaching EBM/Evidence Based Medicine. Most of the resources were compiled by puting a call out to the MEDLIB-L for assistance.

Travel Nurse: Earn Money While Visiting With Family

When my husband and I got married we decided we wanted to live near extended family so we (and our children) could remain close to them. The only problem was that my parents lived in Georgia, and his lived in Utah… so we had to pick. We chose Georgia.

After our son turned one, we decided we wanted to spend some time “out west” to let him get to know his grandparents, aunts, uncles, and cousins that live out there better, and to enjoy the sites. We didn’t have a whole lot of money with my husband in school so we knew that one of us would have to work if we wanted to stay for the whole summer.

That is where travel nursing helped out. My husband was not going to be in school for the summer, so we planned for him to stay home with our son while I worked. Most of the hospitals there wanted me to work three twelve hour shifts per week (which is what I preferred anyways). I had the choice of working either an 8 or 12 week assignment. We chose the 8 week one so we could have one month off to vacation. There were so many things to do out there that we enjoy (i.e. hiking, camping, rafting, and biking). All our travel (relocation) expenses were reimbursed (tax-free). We received a monthly housing stipend which was just an added bonus since we stayed with family. We ended-up making $12,080 in two months! Now try and beat that for a career! Now that my son is almost five, we often reflect back on that summer in Utah. What a great time we had, and how grateful I am that I chose nursing as a career.

Pressure Ulcers among Eldery Patients Early in Hospital Stay: Abstract with commentary by Dana Rutledge, RN, PhD

Abstract: Pressure Ulcers among Elderly Patients Early in Hospital Stay

Background. Pressure ulcers among elderly hospital patients diminish quality of life and increase the cost of hospital care. Evidence suggests that pressure ulcers can arise after only a few hours of immobility. The goals of this study were to estimate the incidence of hospital-acquired pressure ulcers in the first 2 days of the hospital stay and to identify patient characteristics associated with higher incidence.
Methods. A prospective cohort study was performed between 1998 and 2001. A total of 3233 patients 65 years old or older admitted through the Emergency Department to the inpatient Medical Services at two study hospitals were examined by a research nurse on the third day of hospitalization. Pressure ulcers were ascertained using standard criteria and were classified a either preexisting, possibly hospital-acquired, or definitely hospital-acquired.
Results. There were 201 patients with one or more possibly or definitely hospital-acquired pressure ulcers for a cumulative incidence of 6.25 (95% confidence interval, 5.4% - 7.1%). Most of the pressure ulcers were stage 2, and the majority were in the sacral area or on the heels. In multivariable analysis, pressure ulcer incidence was significantly associated with increasing age, male gender, dry skin, urinary and fecal incontinence, difficulty turning in bed, nursing home residence prior to admission, recent hospitalization, and poor nutritional status.
Conclusions. A small but significant proportion of elderly emergently admitted hospital patients acquire pressure ulcers soon after their admission. New models of care may be required to ensure that preventive interventions are provided very early in the elderly person’s hospital stay.
Baumgarten, M. et al. (2006). Pressure ulcers among elderly patients early in hospital stay. Journal of Gerontology: MEDICAL SCIENCES, 61A, 749-754.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

Were you surprised at any of the predictors of pressure ulcers in this hospitalized elderly patients? You probably were not. Studies using the Braden Pressure Ulcer Risk Assessment Scale confirm that problems with moisture, mobility/activity, and nutrition are all predictors of pressure ulcer development. What is new about the Baumgarten et al. study is that in 6.2% of the patients, pressure ulcers developed within 3 days of hospital admission!! Earlier studies have not specifically looked at this time interval.
What were the strengths and limitations of the study. Strengths include the large sample size, use of 2 hospitals (one in Pennsylvania, one in Oregon), the large sample of African Americans, and use of trained research nurses to evaluate the study measures. Limitations are that the study involved only a brief one-time observation of the patients and that hospital-acquired and preexisting pressure ulcers may have been somewhat misclassified.
Taking these into account, what is the take home message for the practicing nurse? Elderly patients admitted to medical units may be prone to develop pressure ulcers within 3 days of admission. Thus, given recent trends towards shorter hospital stays, the potential for breakdown is high. Nurses MUST put preventive measures into place early!!

toe update

Now the only toe that ISN'T blue is the big toe... go figure! I have no idea WHY the 4 toes bruised, but they did. GROSS!

OUCH!

I broke my right baby toe...

Trip database-- free access

Trip Database :Turning Research into Practice

For the last 4 years, the Trip database has been a subscription service, but as of Sept 2006, it is once again a free resource. TRIP describes itself as " the Internet's leading resource for Evidence-Based Medicine allowing users to easily and rapidly identify the highest quality evidence from a wide range of sources." This site has recently been evaluated by a team from the Centre for Evidence-Based Medicine. Although not nursing focused, this free resource is a great one-stop source for answering clinical questions. The site supports Boolean searching and returns results that you can then filter by such entities as : evidence based synopses, clinical questions, systematic reviews, guidelines, e-textbooks, clinical calculators and even by medical speciality. You can also sign up for the Trip Blog on their web site.

Evidence Based Nursing Blog "Down Under"

I have come across a blog devoted to "Evidence-Based Nursing & Midwifery" which is being published by Stephen Barnett Darwin from Northern Territory, Australia. This site does primarily emphasize evidence based nursing from a OB/midwifery perspective.

A Nursing Evidence Based Practice Tutorial

We previously blogged about "The Evidence Based Knowledge Portal which was developed by the Eskind Biomedical Library at Vanderbilt with grant funding and includes tutorials addressing facets of statistical analysis and critiquing the medical literature as well as virtual practice cases that allow users to explore principles of EBM. This is an amazing tutorial but its orientation is toward medicine rather than nursing. Dana Rutledge recently told me about a great Evidence Based Practice Tutorial from Penn State University Libraries that is very comprehensive and oriented towards nursing. This tutorial also offers audio and some video and details the four overall steps in Evidence Based Practice. Two clinical scenarios are offered and the user also has available to them a listing of appraisal tools and an extensive list of EBP terminology.

Our blog discussed in Evidence Soup blog

Evidence Soup : show me the evidence : looking at uses and absues of evidence in everyday life is a very interesting blog put together by Tracy Allison Altman. This blog is not devoted exclusively to healthcare, but does concentrate on medical/nursing issues. It's interesting that both our blogs have subtitles along the lines of "show me the evidence"!!. On August 11, Evidence Soup gave our blog a nice plug. Thanks.

Julie's August picks from the literature

Some of these recent articles really intrigued me. Employees at St. Joseph Hospital, Orange or Children's Hospital of Orange County can access these online or request them through Burlew Medical Library. Others should consult medical libraries with whom they have privileges.

Accession Number 2009223633 NLM Unique Identifier: 16816597.Author Coopey M. Nix MP. Clancy CM.Title Translating research into evidence-based nursing practice and evaluating effectiveness.Source Journal of Nursing Care Quality. 2006 Jul; 21(3): 195-202. (9 ref)

Accession Number 2009232462 NLM Unique Identifier: 16767023.Author Giuliano KK.Title Continuous physiologic monitoring and the identification of sepsis: what is the evidence supporting current clinical practice?Source AACN Advanced Critical Care. 2006 Apr-Jun; 17(2): 215-23. (36 ref)

Accession Number 2009232451 NLM Unique Identifier: 16767019.Author Albert NM.Title Evidence-based nursing care for patients with heart failure.Source AACN Advanced Critical Care. 2006 Apr-Jun; 17(2): 170-85. (41 ref)

Accession Number 2009211028 NLM Unique Identifier: 16766627.Author Munro CL. Grap MJ. Jablonski R. Boyle A.Title Oral health measurement in nursing research: state of the science.Source Biological Research for Nursing. 2006 Jul; 8(1): 35-42. (47 ref)