human choroinic gonadotropin

Pass The N.E.T.™, Nursing Entrance Test Tutorials

Written by kimmel52 on January 8, 2015 – 9:48 am

The Study Guide that covers
ALL Nursing Entrance Tests with Emphasis on Math
and Reading Comprehension !

Pass The Nursing Entrance Test, The First Time

All the practice that you need to Pass the Nursing Entrance Test. Pass the NET, The First Time contains over 1000 questions on Biology, Math, Reading Comprehension, English Grammar, Anatomy and Physiology in a 450 pages Pdf easily downloaded directly to your computer. Accessible today, no waiting for shipping.

You can also get immediate, online access to FREE practice tests and answers to help you pass the N.E.T., the HESI and the TEAS at www.nurseslearningcenter.com

Downloadable Version
Only!$29.99  

(Available in PDF format, can be immediately downloaded upon purchase by clicking on a secure link sent by email.)

Printed Version + the Kimmel Guide and NET Tutorial Software
Buy Now $57.44  

You will be able to get the 2 bonus downloads immediately and the printed book will be shipped to you priority mail. GET YOUR COPY TODAY!

“Helps prepare students better than the actual study guides for the HESI, The N.E.T. and The TEAS, much more comprehensive. This is the book we will carry!   (Jack, Bookstore Manager at WCCC)Read more testimonials from students that are using the book! 

95% Pass Rate! Proven results.

Written by Professor Nancy Kimmel RN, Leading Michigan Lecturer and tutor on helping students pass the NET for over 6 years.

 

 

 

Now in College Book Stores such as Henry Ford Community College in Dearborn, MI and all 5 Wayne County Community College Campuses.

Pre-nursing students going for the RN or LPN/LDN degree now have a reliable tutorial Read more »


Tags: , , ,
Posted in HESI TEAS The NET ATT, NCLEX, Nursing Education, Nursing Entrance Test (NET), Pass The Nursing Entrance Test, TEAS and The NET, The NET Reading Comprehension Section, The NET Study Guide, The Nursing Entrance Test | 7 Comments »

Computerized Adaptive Testing For The N.E.T., The HESI and The T.E.A.S.

Written by kimmel52 on December 12, 2009 – 12:53 pm

Computerized Adaptive Testing For Nursing Education

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Those who are graduate nurses and those who are going into nursing school will soon be sitting for their national boards known as the NCLEX, or taking the N.E.T, the HESI or the TEAS. The state nursing board examinations are computerized and set up to test the candidate’s skill level. In order to pass the NCLEX. the candidate must demonstrate the level of skill required to practice the art of nursing safely in their state. In order to determine this level of skill, the NCLEX. is formatted to adapt to the testers knowledge base.

This type of computerized adaptation is termed, “computerized adaptive testing” or CAT. This type of testing is not new. It has been in use for many years. This is the method that the Graduate Entrance Exams (GRE.) have been using. To better understand how computerized adaptive testing works, think about taking a test where all of the questions are very easy. This type of test does not really test the ability of the tester that knows the material thoroughly. Therefore the tester’s true mastery of the subject is not assessed. Some of the nursing entrance tests are also test via computerized adaptive testing.

It is similar to being in class, where the teacher is asking questions. As the student answers the questions, the level of difficulty continues to increase, until the student reaches a point where they cannot answer a question, then the level of difficulty decreases, and the cycle begins again. This type of testing then does away with the redundancy of questions wherein the level of each is on a plateau, but rather poses questions that challenges the tester’s ability to the point that their true ability of their mastery of the subject matter can be assessed.

Therefore, those student’s, sitting for the NCLEX who are answering easier questions, may find themselves answering more questions than those students who are able to answer the harder questions and thereby have fewer questions. One could say that computerized adaptive testing is geared to each individuals own knowledge base. After each question the tester is scored. Each following question will be chosen to match their skill based on how they answered the previous question. There is a statistical program built into the main program that estimates the tester’s knowledge proficiency. There is a pre-set statistical data base that dictates the percentage of questions that are needed for a graduate nurse to pass or to fail.

“The CAT usually ends when the amount of measurement error around the ability estimate reaches an acceptable level. Low levels of measurement error are required for high-stakes certification tests and indicate that the test would likely produce a similar score if re-administered immediately afterwards. It is not known exactly when the test will shut off or how many questions have to be completed. The computerized adaptive testing usually presents a variable number of questions, and a minimum and maximum number is pre-set.”

Therefore, if the graduate nurse answers incorrectly the easy questions, as well as the more difficult questions, they will be less likely to sit for the entire six hours and their test may shut off after the minimum of seventy five questions. It is the seventy five questions that many graduate nurses are fearful of receiving, because they think that they have failed the NCLEX. If the tester has a good solid knowledge base and has prepared for the test by practicing NCLEX questions, then the seventy five questions shut off is actually a good sign. The score is based upon the level of difficulty that is achieved. This is the methodology that the NCLEX uses to test the nursing school graduates.

The HESI, The N.E.T. and The T.E.A.S. will shut off at a specific length of time, which is usually a 3 hour test. So not all of the questions that one student has, will the other student have. The most important preparation is to begin studying soon and to begin with the right materials that will help you to pass. You can begin to study for your Nurse Entrance Test at the Nurses Learning Center, where you can get immediate access to over 1000 questions and answers, tests are available 24 hours, 7 seven days per week, and you only have to pay a one time fee. This material is set up just like the HESI, The N.E.T. and The TEAS.


Tags: , , ,
Posted in Computerized Adaptive Testing, Nursing Education | No Comments »

Reading Comprehension on the N.E.T., HESI and The TEAS, How To Study to Pass

Written by kimmel52 on October 23, 2009 – 10:25 am

Critical Thinking on the NET Reading Comprehension

First one must be comfortable with reading. It is unfortunate in today’s culture that so much information is portrayed in visual media. How many people go to the library any more to pick up a classic like Huck Finn or Moby Dick? Colleges are also at fault for being lax at not pushing student’s to their maximum potential. Hence, when pre nursing students get to the point that their pre requisites are completed they sit for the NET and fail. The skill that many are missing is that of critical thinking. Critical thinking cannot be learned over night. Which is why so many students fail the second and third time they take the NET. Obviously there must be a way to pass the reading comprehension section without taking more courses in English. There is to be sure. As in mathematics where there is a logical sequence to solving problems, there is likewise a logical path associated with the reading comprehension. There are several key operating words that play a part in the questions and passages. Knowing what those key words are and how to interpret them are crucial to achieving a passing score. The reading comprehension of the NET is much more than memorizing what happened in a passage. It is more correct to state why this has happened in a passage based only on what information is provided. So many times students search their memory trying to pull from prior knowledge to answer the questions. This is the biggest mistake that they can make. The questions are designed so that all content must come from the passages, even if it seems that the questions are far reaching. All questions are based purely on the passage. Even if a student can prove the author is in error, it makes no difference since all the answers are based on the passage.

To begin practicing now just go to the nurses learning center and you can get unlimited access for as long as you want.  Just log in and start practicing.


Tags: , , , ,
Posted in Nursing Education, Reading Comprehension, The Nursing Entrance Test | No Comments »

Phlebotomy Career Training

Written by kimmel52 on September 4, 2009 – 12:53 pm

phlebotomyA hands on phlebotomy workshop in Garden City, MI – click below for more info and payment information:
Phlebotomy Career Training

Classes are now forming for Thursday, March the 11th, 2010, we will possibly be running a  Saturday Class as well on March the 13th if ther are enough students.

Currently there are 5 openings for the day class from 8:00 AM until 2:30 PM, and 8 openings in the afternoon class which meets from 3:00 PM until 9:30 PM, every Thursday for 6 weeks.

Course fee is $700.00, half to be paid on the first day of class and the other half is due during the thrid week of class.

Students are required to wear navy blue scrubs to each class, bring a box of latex or non-latex gloves (see course catalog for latex allergy questionnaire and form) and to wear white tennis shoes.

Miscellaneous items needed include; pencil, pens, notebook, paper, stethoscope and blood pressure cuff.

Students may refer to the course catalog for other details.  Course catalog will be posted on the web site as well as the registration form and course syllabus.

The student may expect to posses the following skills upon completion of the course;

  • Perform venipuncture on adults, children and elderly.
  • Perform heel sticks on infants.
  • Perform finger sticks.
  • Glucometer testing.
  • Read ECG strip rhythms such as Bradycardia, Tachycardia and other immediately dangerous to life and health arrythmias.
  • 12 lead ECG placement, and 5 lead placement
  • Intravenous catheter insertion.
  • Pharmacology of various blood pressure, heart and diabetic medications.
  • Anatomy and physiology of the cardiovascular system, veins and arteries.
  • Therapeutic communication,
  • MAGNET Training for patient care excellence
  • Hazardous Materials Management.
  • Infection Control.
  • Skill at Patient assessment, and understanding the disease process as it relates to the patient and the type of care provided.
  • Knowledge of how to perform a history and physical.

Students will be qualified to work in the following job classifications upon graduation.

  1. Hospital Emergency Room
  2. 24 hour Urgent care facilities
  3. Physicians Clinics
  4. Laboratory Sites
  5. other health care facilities

After the six week course, students will graduate upon successful completion of required evaluation process, and will then begin their 25 draws along with capillary draws. The school will allow students to come in to draw on Tuesdays from 10:00 AM until 2:00 PM and on Wednesday from 5:00PM until 8:00PM.  Once the student has completed their 25 draws  and 10 capillary draws they are then eligible to sit for the National Healthcareer Association Exam.  This exam will certify the student as a Phlebotomy Technician in all 50 states.  Once this certification has been achieved, the student can then go on to do their clinical rotation through Oakwood Hospital Out Patient Labs to complete their 100 draws.  The student will work one on one with another certified phlebotomist drawing blood samples from patients coming in as well as processing laboratory specimens using the centrifuge machine and preparing fresh frozen specimens.  The student will not get paid for their rotation.  This is a complimentary externship for the student to help better prepare them for employment. The students liability insurance is paid through the school.


Tags: , ,
Posted in Are You Ready?, Nursing Education | 26 Comments »

Caring, Part of Survival

Written by kimmel52 on November 12, 2008 – 12:19 am

Nursing is an art and a science. The nurse uses a scientific process to determine a client’s immediate and long range needs, in order to help the client achieve a higher level of psychological and physiological wellness. Norwood (1999) proposes that Maslow’s hierarchy can be used to describe the kinds of information that individual’s seek at different levels. For example, individuals at the lowest level seek coping information in order to meet their basic needs. Information that is not directly connected to helping a person meet his or her needs in a very short time span is simply left unattended. Individuals at the safety level need helping information. They seek to be assisted in seeing how they can be safe and secure.This process is also termed the nursing process. It consists of the following elements, Assessment, Diagnosis, Planning, Implementation, and Evaluation. It is within the application of the nursing process that the nurse incorporates attending to and ensuring that the client’s hierarchies of human needs are met.

These needs, according to Abraham Maslow (1954) consist of the following:

1) Physiological: hunger, thirst, bodily comforts, etc.
2) Safety/security: out of danger
3) Belonging and Love: affiliate with others, be accepted
4) Esteem: to achieve, be competent, gain approval and recognition.
Theory can be defined as “an internally consistent group of relational statements (concepts, definitions and propositions) that present a systematic view about a phenomenon and which is useful for description, explanation, prediction and control” (Bodie & Chitty, 1993).

Nursing theories are used to describe, develop, disseminate, and use present knowledge in nursing. Read more »


Tags: ,
Posted in Caring Is Essential For Survival, Nursing Education | No Comments »

Nursing Professionalism

Written by kimmel52 on November 12, 2008 – 12:09 am

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

All professions have as their cornerstone and creed a code of ethics and or professional performance standards. The nursing profession is no different. As the field of nursing grows and changes in defining the role of a nurse, the central theme will always be that of caring. It can be said that, all other duties and responsibilities of nurses have centered around, “caring”. Caring has been described by many nursing theorist as the innate nature of a human being to be able to give unconditional help in the form of doing for, therapeutic communication, therapeutic touch, compassion, a gentleness of spirit and humbleness of knowing ones self.
The nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.

· The nurse safeguards the client’s right to privacy by judiciously protecting information of a confidential nature.

· The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetent, unethical or illegal practice of any person.

· The nurse assumes responsibility and accountability for individual nursing judgements and actions.

· The nurse maintains competence in nursing.

· The nurse exercises informed judgement and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others.

· The nurse participates in activities that contribute to the ongoing development of the profession’s body of knowledge.

· The nurse participates in the profession’s efforts to implement and improve standards of nursing.

· The nurse participates in the profession’s effort to establish and maintain conditions of employment conducive to high quality nursing care.

· The nurse participates in the profession’s effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing.

· The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.
Jean Watson, a Ph.D. in Educational Psychology and Counseling developed a theory of caring first published in 1979. She believed that caring was central to the profession of nursing as well as being the unifying principle of practice. The two major assumptions that she made are as follows:
1. Care and love constitute the primal and universal psychic energy.
2. Care and love are requisite for our survival and the nourishment of humanity.

Madeleine Leininger, a nurse and anthropologist proposed a theory of caring based on culture. She was able to see that how one society defines caring is not always the same as another society. For instance, in Asia, looking directly into another’s eyes is not a sign of respect but a sign of disrespect. Therefore a western nurse unaware of the Asian culture of caring would be seen as an uncaring and disrespectful person. Leininger termed this knowledge of cultural caring as, “transcultural nursing”. “Her beliefs are that culture is the broadest and the most holistic way to conceptualize, understand, and be effective with people.” With the emergence of the, “caring”, theorists also came the emergence of “Standards of Profession Performance”. The two terms are entwined in their definitions. There cannot be one without the other. The American Nursing Association set forth the following requisites for standards of professional performance. It is within these standards that can be seen the unifying theme of caring.

Standard 1. Quality of Care.
The nurse systematically evaluates and effectiveness of nursing practice. The nurse does this by participating in peer review committees and in consistently evaluating his/her own performance and how her performance has enhanced the clients health and emotional wellness.

Standard II. Performance Appraisal
The nurse evaluates his/her own nursing practice in relation to the national and state statues set forth defining the role of nurse.

Standard III. Education
The nurse acquires and maintains current knowledge in nursing practice. Many states now require continuing educational credits to be earned by a nurse. The number of credits vary from state to state. However, a nurse cannot renew their license without proof of these continuing educational credits. These credits help to keep the nurse current with new medica/nursingl advancements related to patient care.

Standard IV. Collegiality
The nurse interacts with and contributes to the nursing profession by meeting with other professionals in the medical field, such as Physicians, Physical Therapist, Respiratory Therapists, and Home Care Coordinators, to exchange ideas and gain a mutual respect while stimulating a leaning environment that all will benefit.

Standard V. Ethics
The nurse’s decisions and actions in helping and caring for individuals are based on principles of ethics and institutional guidelines.

Standard VI. Collaboration
The nurse collaborates with other medical professionals in creating an environment for the clients that facilitate an increasing continuum of mental and physical wellness.

Standard VII. Research
The nurse will not cease to expand his/her educational horizons, and continue to seek out and explore new areas of research and statistics.

Standard VIII. Resource Utilization
The nurse will participate in committees within the organization to evaluate and increase the effectiveness of safety, costs in planning and delivering patient care.

It can be seen that within the guidelines of professional performance the center theme is the caring for the client from every aspect. It is within these guidelines that the nurse can better define his/her role as a the one individual who has the ability to enhance the clients mental and physical wellness by coordinating, educating, and working with others to promote a caring and supportive environment.

Reference: Blais, Kathleen Koenig, Hayes, Janice S., Kozier, Barbara, Erb, Glenora, Professional Nursing Practice concepts and Perspectives, co. 2002, 4th ed. Prentice Hall, New Jersey


Tags: ,
Posted in Nursing Education, The Standards of Professional Performance For Nursing | No Comments »

Reality Shock For New Nurses

Written by kimmel52 on November 12, 2008 – 12:07 am

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

So now you are close to graduating from nursing school or you have graduated recently. Whichever the case, you will be in for a reality shock when you begin your career as a Registered Nurse. What do we mean by the term, “reality shock”? Well, like the term says, it is the reality that shocks us. For second-career nurses, the transition from nursing school to working with real patients can range from somewhat uncomfortable to highly shocking. These rookies often have given up secure, well-established careers, only to discover on-the-job demands never mentioned in the textbooks.

However, the right attitude can help you weather your first few months on the nursing unit. For those who overcome the challenges of transitioning to nursing, the rewards outweigh the costs of starting over. Education of nurses is thought to lack reality orientation, which is reflected in the difficulty graduate nurses experience in their transition from an educational to a work situation. The phenomenon of “reality shock” is defined by Kramer (1974) as this lack of reality orientation. On graduation, “neophyte” nurses are confronted with conflicting roles of professional (from education) and bureaucratic (from work environment). Adopting a particular role is part of the socialisation process graduates undergo. Methods of adjusting and improving the experience of “reality shock” have been suggested by Kramer (1974) and developed using a theoretical model, by Neuman (1982). The quality of care provided by graduate nurses needs to be examined as this is the ultimate role of the nurse. (1)The question you may ask is, “so there is a difference in the reality of being a student or graduate nurse”? The answer is an emphatic, YES! First of all, as a student nurse you were given assignments that were not beyond the scope of your practice or ability. In addition to that, you were working under your instructor’s license and whether or not you were aware, they kept a very close watch on you. Therefore, there was a safety net that always hovered beneath you in case you were to fall.

This is not the case as you take on the title, Registered Nurse. There is no safety net. You are out there by yourself, free to make decisions and make mistakes. With those decisions and mistakes you are also, FULLY ACCOUNTABLE. Now imagine yourself with eight or more patients. You may be asking yourself, “What do you mean eight or MORE patients?” Most student nurses never have more than six or seven patients and that is only at the very end of the program. Even then, the student nurses can delegate tasks to assistive personnel thereby lessening their work load. However, there will be time that you will be on a floor, without any assistive personnel, with more than eight patients and no one to rely on except yourself. To compound this scenario, there may be patients that have very critical care pathways that you must follow, incoming calls from patient’s families, doctor’s, operating room staff, and other collaborative care departments requesting information. Now, let’s stop this scenario in its tracks. You probably feel the stress building by just reading the previous passage. If so, don’t worry, it is a perfectly normal reaction. So, relax, and know that there are ways to ease this inevitable right of passage. Let’s take a look at some of the ways to help ease and deal with reality shock.

1. First of all, it is important to understand that, “reality shock” does indeed exist and you will come face to face with it. Knowing what you will face is most of the battle. The task at hand then becomes, knowing what steps to take and resources to use, and how to use them.

2. Learn as much as you can during your in-service training program, which usually lasts up to eight weeks or more. This means familiarizing yourself with every inch of your floor. Know where everything is located, from safety pins to I.V. tubing. You may never know when you may need it, NOW, and the worst thing that can happen is that you spend precious time looking for something as small as a safety pin.

3. Know, who the assisted personnel are, and know them by name and face. Find out who will be the ones that you will be working with during your shift. What usually happens during in-service training is that graduate nurses train on the main shift, which is most frequently days, before transferring to the shift that they have been hired to work. Therefore it is very important to know who you will be working with during your shift. Try also to develop a working relationship with the assistive personnel. Remember, it is not a popularity game, you are not out to make best friends. Your goal is quality patient care, and the patient comes first. Let your intentions be known that your number one goal is to give the best patient care that you have respect for the care team assistive personnel and are a willing and helpful body to them as well. In doing this, you will have disabled the invisible wall that exists between nurses and assistive personnel. That wall is the one entitled, I am a NURSE and you are ONLY an aide. One thing that you must strive for is to use an even tone of voice, and fairness when delegating. You must also remember the rights of delegation, which are as follows, a. the right task, b. the right person, c. the right communication, (must be clear and concise), d. the right feedback, (the person who is delegated the task must comprehend what it is that is asked of them and let the nurse know that they comprehend). By doing this you are ensuring that patient care will not suffer do to a personality glitch, which could have been avoided.

4. Know, know and KNOW where the Policy and Procedure manual is located on the floor. Part of your hospital in-service will include the introduction of the Policy and Procedure Manual. This is the manual that you will have to refer to many times for protocol from everything from changing out a Foley Catheter to transporting a patient to another floor. The final analysis will be in any investigation, “did the nurse use and follow the Policy and Procedure Manual?” You want to always be sure that you follow the rules and protocols contained in your institutions manual. Therefore, you should know where it is located and be familiar with how to look up various procedures and policies, particularly

5. The policy regarding medication errors. Most everyone makes them and it is crucial that you know what paperwork is required to be filled out. It will come in handy. You cannot just, “wing it”, when making a decision, you have to follow protocol.

6. Use assertive communication when interacting with doctors’. Assertive communication indicates that you are aware of yourself and your limitations as well as your liability to the patients that you care for. Using this form of communication with over assertive medical personnel will help you function to your maximum capability and earn respect as an independent care professional. {For more information on the uses and strategies concerning assertive communication, please refer to the text entitled, Nursing Today, Transition and Trends, by JoAnn Zerwekh, Jo Carol Claborn, 5th edition, Co. 2006, Saunders, Philadelphia.}

7. Ask questions. You will have time during your in-service training to ask questions and get answers. It is your right to do so. Remember, not knowing is not an excuse, and you do not want to be in a situation where there will be no-one to ask. This is not to say that you will know everything, but a least you are giving yourself a head start and a good solid foundation by knowing what you can. So don’t be afraid to ask. Also, know who your resources are, for questions that you may have on the shift that you will be working.

8. Find a mentor with whom you can relate. Try to find someone not only on the shift during training, but also on the shift that you will be working. It is nice to find someone who has the experience and understanding as well as someone that you can get along. There might be a time that you will want to call them in the middle of the night and vent your concerns, or just to have them give you positive input in your performance. Mentors are essential to the growth of a new nurse.

9. Lastly, Know, Know and Know, what your State Nurse Practice Act states. This Act, is your guideline for most all that you do as a Registered Nurse. Know it well.

Hopefully these tips will help to ease the reality shock that you will face during your transition from student nurse to full time graduate nurse. Remember, you can’t do it all. You are a welcome asset to your employer, but first and foremost an embodiment of all that Florence Nightingale stood for. Best wishes on your journey.
References:
Mirella Pancia


Tags: ,
Posted in Nursing Education, Reality Shock For Graduate Nurses | No Comments »

Critical Thinking as a Nurse

Written by kimmel52 on November 11, 2008 – 11:53 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

In the nursing profession, more now than ever, the ability to think critically is essential. The responsibilities of a Registered Nurse have increased over the years. In correlation with this increase in responsibility comes the additional increase in educational prerequisites and core requisites required to achieve a degree in Nursing. The ANA (American Nursing Association) Standards has set forth the framework necessary for critical thinking in the application of the “nursing process”.

Critical thinking is taught at the beginning of nursing school.  Many students feel that the nursing school tests are too difficult mainly because of their lack of training in the use of critical thinking and analysis.

The nursing process is the tool by which all nurses can equally become proficient at critical thinking. The nursing process contains the following criteria:

1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

It is in the application of each of these processes that the nurse may become proficient at critical thinking. It is important to look at the components that describe critical thinking in nursing, The table below lists components that define the critical thinking process. There is much more that goes into critical thinking than what is listed in the table. The table is a rough draft of the process.

CRITICAL THINKING COMPONENTS

Entails purposeful, informed, outcome focused thinking, that requires careful identification of specific problems and other physiological and psychological factors that affect the clients position on the health and wellness continuum. The process is driven by the client, the client’s family and other health team members who are also collaborating in ensuring essential client care.

Specific educational knowledge base and level of experience in applying that knowledge in client care. (Nursing School to graduate nurse to experienced nurse) As the level of experience of the nurse increases so will the scientific knowledge base that the nurse applies.

Proficiency in the application of the institutions standards, policies and procedures.

Application of the humanistic standards of caring in conjunction with the nursing process, to holistically treat the clients response to an actual or perceived illness.

Constant evaluation and re-evaluation of the nursing process to determine the clients level of wellness.

Nurses learn critical thinking via application with experience. Experience is the best teacher. But it is equally important to know that the process is being applied correctly. Many institutions will ensure that this pathway is followed by enlisting new nurses in a eight to ten week orientation program. During this time the new nurse will learn about the polices and procedures of that institution and what type of documentation is used for charting purposes. Also, the new nurse will have an experienced mentor who they will follow and who will evaluate their performance as well.

Documentation is an essential part of the critical thinking process for the nurse. Every institution places emphasis on documentation. It is said, “that if it is not documented, then it was not done”. Since the nursing process is a scientific process. In scientific research, all things are documented. In this documentation, researches can look back to see if the results were due to interventions and whether or not the interventions were successful or have to be altered.

The documentation process helps the nurse accomplish the same goals. Many times procedures are used that have unproven efficacy. In it is this framework of critical thinking and documentation that such procedures can be either continued or eliminated, depending on the efficacy of the research. In other words, does the procedure actually improve, help or otherwise jeopardize the client’s health. An example of the critical thinking process and scientific reasoning is in the efficacy of taking a rectal temperature of new born infants. Currently, this procedure is still widely accepted. However the scientific approach is to ask the following, is the procedure safe, is it necessary, and can an axillary temp be used in place of the rectal temp? In answering these questions, the nurse can better evaluate whether the efficacy of taking a rectal temp on a infant should be continued. This is just one example of how the critical thinking process is used within the nursing profession.

The scientific approach using critical thinking helps the nurse develop evidence based practice. It is through “evidence based practice” that the Joint Commission on Accreditation of Health Care Organizations (JCAHO) rates the performance of hospitals. Further research is still continuing in delineating the intricacies of the nursing process and the integration of critical thinking. All health care professionals are encouraged to pursue this type of research in their practice to ensure the quality of client care and enhance the validity of their profession.

REFERENCES

Zerwekh, J.,Claborn, J.(2006).Nursing Today Transition and Trends. (5th ed). St. Louis: Saunders
Alfaro-LeFevre, R. (2006). Applying Nursing Process, A Tool For Critical Thinking. (6th ed). Philadelphia: Lippincott Williams & Wilkins


Tags: ,
Posted in Nursing Education, The Importance of Critical Thinking | No Comments »

Thinking About Your Goals as a Nurse

Written by kimmel52 on November 11, 2008 – 11:40 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

As the student nurse approaches graduation, thoughts of beginning a career in nursing come to mind. A new nurse should think very seriously about their career goals. These include long term as well as short term goals. As with any path of life that an individual takes, it is not random. Each person that seeks an education does so with a set of plans and directionality for their immediate goals and long term. The idea of graduating from a nursing program once again dictates to the graduate that plans once again must be laid for the road ahead. Nothing worthwhile doing is done haphazardly. All things require preparation. Even as one contemplated going into the nursing field, certain pre-requisites had to be completed before hand. Graduating from a nursing program is another transition phase that must be approached with the same dedication and planning as was first applied. The short synopsis below is a sample of a career goal paper. Everyone will have their own unique career goal paper. Now is a good time to start thinking about career goals.

INTRODUCTION:

The field of nursing attracted me for several reasons. The first reason being, that a nurse is the front line person in caring for others and saving lives. The nurse will in many cases such as in the hospital or homecare environment discover the patient who needs emergency attention before the physician. It will be up to the nurse to respond accordingly within the scope of their practice and hospital procedures. Why does this facet of nursing attract me? Well, it is because that this type of responsibility is not too far off from the type of responsibility that a physician has, which is what I had hoped to become many years ago. Nurses did not have that crucial level of responsibility initially. Because of this, many patients died. For instance, a nurse from the past may not have known the therapeutic values of electrolytes and blood gases thereby putting the patient’s health in jeopardy. Now, in present times, the nurse must know all of the pertinent lab values and act upon any change immediately, either by calling the physician or implementing standing orders.

The other aspect of nursing that is also attractive to me in becoming a nurse, is that the nurse uses therapeutic communication and treats the patient’s response to real or perceived illness. This is the corner stone of which nursing is based on. The holistic approach is so successful in helping patients to heal. I am a firm believer that for an individual to be able to heal from without, they must first heal from within. Therefore the nurse can help clients to adapt and grow in a positive way rather than negative. Since all of nursing is now based on evidenced practice, it is exciting to be able to put the scientific method to use. There are now logical and provable reasons that a nurse should take a particular course of action.

These are just some of the reasons which have attracted me to the profession of nursing.

SHORT-TERM CAREER GOALS:

My short-term career goals consist of successfully passing Nursing 255, then passing the national board exam. Once this is accomplished, I hope to be work on a medical-surgical floor and hone my skills as a graduate nurse. I have chosen medical-surgical nursing as a starting point because this particular field will help me to develop my clinical skills.

LONG-TERM CAREER GOALS:

I hope to be an active member in the profession of nursing, joining the American Nurses Association, attending seminars and lobbying for the advancement of nurses to prescribe medication independently. Hopefully within the next five years or so I will have a degree as an advanced practice nurse in the field of family healthcare and be working in an emergency room.

PERSONAL GOALS

My personal goals are humble. Money has never been a goal, rather doing that which enriches the soul. I am thankful to my Lord that I have been given the opportunity to have made it thus far. I take care of my mother and help my family as best I can. I am happiest when I am helping others, and owe a large debt of gratitude to my instructors, who have given of themselves their wealth of knowledge and experience to help produce competent nurses. I hope to make them proud.


Tags: ,
Posted in Nursing Education, Thinking About Your Goals as a Nurse | No Comments »

Nursing Interventions In The Diagnosis Of Bipolar Disorder

Written by kimmel52 on November 11, 2008 – 11:29 pm

Diagnosis Bipolar Disorder: Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal. (Lehne, 2004, p. 321)

The following is a short synopsis according to the DSM-IV-TR, Criteria for Bipolar Disorder includes a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least:
– 4 days for hypomania
– week for mania

During the period of mood disturbance, at least three or more of the following symptoms have persisted and have been present to a significant degree:
– Inflated self-esteem or grandiosity
– Decreased need for sleep
– More talkative than usual or pressure to keep talking
– Excessive involvement in pleasurable activities that have a high potential for painful consequences. (American Psychiatric Association [APA], 2000).

Psychodynamics of the Disease The onset of the disease usually occurs during late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. The mood swings that accompany this disorder are of several types. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,

Impairment in normal social functioning usually requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of normal functioning that would require hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last episode associated with Bipolar disorders is the Mixed Episode in which, patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts them at significant risk of suicide. (Lehne, 2004, p. 321)

Case Presentation
A Caucasian woman in her mid twenties presented signs and symptoms of self mutilation with a straight edge razor inflicted gash across her lower abdomen approximately six inches below the umbilicus. The depth of the gash just stopped at the abdominal fascia. The patient was sent from the emergency room to the psychiatric floor. Upon meeting the patient one day after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. She was holding her abdomen with one hand and appeared in some discomfort. Her black hair was short and disheveled. When the patient arrived at her room she sat down on her bed. She acknowledged with blunted affect that she cannot stop self mutilation, and described how she cut herself through the muscles in her abdomen almost down to the fascia. Her voice was tremulous and fast paced. This could be due to the fact that she had just been given her first dose of Clozaril. She stated that her mouth was dry and that she needed to drink some water. She then went on to say that she was getting very sleepy. The client felt comfortable with the interview.

She shared personal information in regards to being sexually abused by her bother beginning at the age of seven until the age of fifteen. Her brother was two years older than her and died in an automobile accident at the age of eighteen. She went on to say that her mother never knew or acknowledged the sexual abuse and that she could not tell her because the mother idolized the son. The client was receptive to cognitive reframing; however she was very critical of herself and stated that she felt worthless and ashamed. She appeared very tired and stated that she wanted to sleep.

Table 1
Textbook characteristics of Bipolar disorder versus client characteristics observed

Textbook Characteristics:
Pure Manic Episode
Hypomanic Episode
Major Depressive Episode-
Affective Flattening
Alogia
Avolition-apathy
Anhedonia
Mixed Episode
Rapid-Cycling Bipolar Disorder- Patients experience four or Client

Characteristics Observed:
No current symptoms
Rapid breathing, rapid speech, however due to medication a client was concurrently exhibiting lethargy
Client acknowledged sadness/ worthlessness
Facial expression flat
Thoughts of dying, hard to focus
Hair/clothes unkempt
Expressed no interest in children or own

Client’s Symptoms
1. Hypomania
2. Depression
a.) Affective Flattening
b.) Alogia
c.) Avolition & Apathy
d.) Anhedonia
3. Mixed Episode
4. Rapid Cycling
(Varcarolis, 2004, p. 485)

Nursing Interventions
1. Observe the client every 15 minutes while suicidal, remove all dangerous, sharp objects from room.
2. Reinforce that she is worth while,
a.) Assist the client in evaluating the positive as well as the negative aspects of her life
b.) Encourage the appropriate expression of angry feelings.
c.) Schedule regular periods of time throughout the day for recreational/occupational therapy, encourage client to groom self, offer praise for completing grooming.
d.) Ensure client’s participation in taking mood stabilizing medications. Watch client swallow medication.
3. Engage client in interpersonal therapies, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and journal episodes.

Table 2
Medical Interventions, Bipolar Disorder
Drug therapy using
Mood stabilizer
Antidepressants
Antipsychotics
Education and Psychotherapy
ECT
(Varcarolis, 2002, p. 483)

Clients Medical Interventions
Drug therapy includes
Lithium 300mg every h.s.
Not taking any Clozaril
Client is receiving psychotherapy, family counseling, group therapy while in hospital, and cognitive restructuring.
None

References
Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders
Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. Pennsylvania: Saunders


Tags: , ,
Posted in Bipolar Disorder, Nursing Education | No Comments »