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25
Nov

Treatment of Pressure Ulcers

Written by kimmel52
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Change in practice assignment
The purpose of this article is to address the problem of the development of pressure ulcers occurring in susceptible individuals during short terms stays in the hospital. Identifying those factors that put patients at risk and critically evaluate current nursing practices used on the floor, such as documentation, identification and current methods of prevention.
The Development of Pressure Ulcers during Short Term Stays
According to the National Guideline Clearing House, people of all ages are at risk of developing pressure sores based on the vulnerability of their current health status (“Target population,” 2011, para. 4). In the current work setting, almost all patients with limited mobility who cannot get out of bed by themselves and need to wear briefs or use the bedpan begin to develop a stage I pressure ulcer prior to discharge within 1 -2 days after hospitalization or short term emergency room stay. The hallmark of quality nursing care is excellent skin care (Wurster, 2007, p. 267). It is up to the nurse to lead the role in pressure ulcer prevention. The importance of this problem extends beyond the hospitalization stage. Those individuals who are discharged with stage 1 pressure ulcers do not always have properly trained family members to care for them thereby preventing the stage 1 from getting worse. For many of the elderly patients, pressure sores are a common health problem particularly among the physically limited or bedridden and without proper treatment can remain for the duration of the persons life (Jaul, 2010).
The incidence of pressure sores has increased by 63% between the years of 1993 to 2003 in hospitalized patients(Wurster, 2007). The nurse is responsible for targeting the care that these patients need to receive to prevent pressure ulcer development. Coordinating staff to work as a team is currently lagging in the work place. The charge nurse does not follow up on the staff nurse notes, nor does the staff nurse follow up on the nurse aide tasks of turning the patients and providing nutritional supplements provided by their dietary orders. The assessment and management of pressure ulcers require a comprehensive multidisciplinary approach (Jaul, 2010, p. 313). Read more »

08
Jan

isolation-room-photo

Evidenced based practice as a change agent
nancy kimmel
November 4, 2014

Evidenced based practice as a change agent
Researching as a Team
Change begins with acknowledging a common problem and having the curiosity to research that problem in hopes of finding documented solutions(Schmidt & Brown, 2012). The BSN nurse is trained to be the agent of change(Video Laureate Education, Inc., 2009). The change agent should encourage nursing staff to participate in research regarding the problem at hand. This helps with building the teamwork ethic among staff. Assessing the literature requires a keen eye for gaps. Gaps, are what is known about a problem or if that problem has not been thoroughly tested(Schmidt & Brown, 2012, p. 69). Gaps also occur when there is only one or two case studies regarding a problem, insufficient information or lack of proven results(Schmidt & Brown, 2012, p. 69). For instance, a single study that only incorporates 50 test subjects, regardless of the strength of the statistical results is not sufficient evidence for evidenced based practice to be implemented. On the other hand, 20 or more similar case studies with strong statistical evidence to support the research question, would allow one to generalize the findings to a wider population(Schmidt & Brown, 2012, p. 69).
Practical Transition
Finding a solution to a problem as a group is a euphoric experience. However, taking that solution and putting into practice is a different matter. There are many pitfalls to the implementation of any new ideas or practice theories. Suppose the change that will take place requires a special device. This device costs money. The question is, will the hospital provide the financing for such equipment or supplies? All new protocol must be documented on the floors policy and procedure manual which utilization review must first approve. Hence, the red tape.
The Iowa Model for EBP (Evidenced Based Practice) is a systematic method for organizational change(Schmidt & Brown, 2012, p. 390) The Iowa Model diagrams the necessary steps to incorporate EBP in promoting better health care(Schmidt & Brown, 2012). The model provides a series of logical steps that assist the change agent in the decision making process.
Common Errors and Pitfalls
Not everyone is on the same page. The change agent should be sensitive to the fact that some nurses have no desire to engage in research, nor implement new care skills(Schmidt & Brown, 2012). Complex statistical evaluation and knowledge diffusion poses barriers to most practical nurses(Schmidt & Brown, 2012, p. 396). Change is a process that creates an alteration in a person or the environment(Schmidt & Brown, 2012, p. 397). While there is no exact answer how to implement change, theorists have suggested that preparation should be the first step(Schmidt & Brown, 2012). Beginning a journal club helps to engage others and encourages participation(Schmidt & Brown, 2012). The disciplined clinical inquiry model is helpful in structuring the journal club, by empowering nurses in clinical practice to consider the patient, clinical setting and resources(Schmidt & Brown, 2012, p. 399). Kotter’s eight change phases model is simple in design and begins with establishing a sense of urgency(Schmidt & Brown, 2012, p. 407).
Summary
While there is no one model fits all, the change agent should be aware of the important role they play in advocating change. Finding solutions to promoting better health care and positive patient outcomes is a responsibility of every nurse. Some nurses find that this is too much of a burden to bear in the context of their daily routines. Therefore the change agent needs to help with facilitating the process through preparation, empowerment of their staff nurses, encouragement and communication. Identification in the gaps of patient care is a team effort and all teams need a leader.

References
Huston, C. J. (2014). Collective Bargaining and the Professional Nurse. In Profesional issues in nursing challenges & opportunities (3rd ed., pp. 19-23. Baltimore, MD: Lippincott Williams & Wilkins, a Wolters Kluwer business.
Schmidt, N. A., & Brown, J. M. (2012). Evidence-based practice for Nurses appraisal and application of research (2nd ed.). Sudbury, MA: Jones & Bartlett Learning .
Video Laureate Education, Inc. (2009, ). Research and scholarship for evidence-based practice: Introduction to evidence-based practice and research [Video file]. Retrieved from

08
Jan

Critical Thinking in Nursing

Written by kimmel52

nurse pic

critical thinking in nursing
nancy kimmel
September 30, 2014

Critical Thinking in Nursing

As a new nurse, I remember how frightened I was that someone would die do my lack of experience or a poor judgment call. I will never forget my one instructor who said, “You will make a medication error at some point in your nursing career.” That statement shook me to the core. How could that happen? During my orientation on the medical/surgical step down unit, I witnessed nurses nonchalantly switching out I.V. bags of different solutions without first checking the drugs compatibility. What if one of those medications causes a precipitate to form in the line? Then what? Someone could die of an embolism!
Soon I was on my own shift with my own patient load. The fears that plagued me during nursing school did not magically disappear, but instead became magnified. I was a nervous wreck. How did these other nurses manage their patient load with such grace under pressure? When would this ominous fear of doing something wrong let up? For me, it never did. The delicate balance between life and death based on a decision or action is what kept me sharp. Eventually I was able to display a calm exterior while internally; I was ready to react at the slightest change in my patient’s condition. There were no cutting corners. I know that sounds crazy. Obviously, when there were no washcloths we had to use towels, or sometimes we had to make do with what supplies were on the floor. Did I ever deliberately cut a corner just to save time? The answer is no. Everything that I do is for my patient. Even the smallest action of making a toe pleat in the bed or mitering a corner was a action of respect for the patient in that bed.
Nursing school prepared me with critical thinking skills. As my experience as nurse progressed, I became better at assessing a patient’s condition. I would not say that I became an expert according to Benner’s Stages of Critical Competence.(Benner, 2011, para. 5)
Making a competent clinical decision is not based on just one lab result or a patient’s symptoms. The personality traits of going above and beyond, taking risks and deliberate practice seem to be the traits that make an expert nurse.(Kaminski, 2010, p. 967)
Benner’s Stages(Benner, 2011, table 1) verified that I have much to learn. I am looking forward to learning more about evidenced based practice and the critical thinking skills necessary in advanced practice nursing.
Advanced Practice Nurses have the responsibility of providing and documenting research on evidenced based practice for the nursing profession as a whole. Nursing continues to develop and progress into a clinical science. This development is due to the efforts of those nurses who understand the dynamics of change in the role of the nurse in today’s society.

References
Benner, P. (2011, December 20). “Staged” Models of Skills Acquisition. Society of Gastroenterology Nurses and Associates. Retrieved from http://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htm
Kaminski, J. (2010). Theory applied to Informatics- Novice to Expert. Retrieved from http://cjni.net/journal/?p=967

 

 

 

 

 

The N.E.T. Study Guide, LLC is pleased to announce that TEXAS Women’s University School

of Nursing has approved the book, “Pass The NET, The First Time” to be the official study

guide for pre nursing students seeking to pass the TEAS A5.
Many Thanks to Dr. Ann Stiles and all of the Nursing Professors,
Thank you,
Nancy Kimmel RN, PhD

Great News;
Pass The N.E.T. has just been released in its second edition. This book continues to help student pass the HESI, HESI A2, TEAS and the N.E.T. Not only does this book have more questions and tutorials, but it includes additional sections on medical/surgical nursing practice questions, medication calculations, scholarship information and much much more.

29
Jan

HESI & HESI A2 TEST SECRETS

Written by kimmel52

What do you do when you tried and tried but consistently failed the HESI and HESI A2?  You have to look for a study guide that will help you prepare for the exam.  One that has problems similar to the test.  A study guide that has been time proven and is up to date with the information that will assist in preparing the student for the exam.

Students should be comfortable with sitting for the HESI or HESI A2.  They should feel prepared, ready and confident, knowing that the material that they studied would help them achieve a high score.  Higher scoring students have the edge  to get into nursing school than those who score lower on the exam.  A good study guide should accurately reflect the type of tests that will be administered.  Pass The NET, The First Time, does just that.  NET stands for, “The Nursing Entrance Test”.  There are many nursing entrance tests being given across the U.S.  There is the N.E.T., the HESI, HESI A2 and the TEAS.

Students are confused much of the time if they have purchased the right study guide.  Unfortunately, even the study guides prepared by the companies that offer the tests do not adequately prepare the students to pass.  This is where the study guide, Pass The NET, the First Time, steps things up a notch.  Not only does this study guide prepare student’s to pass, it helps them pass with high scores.  Professor Kimmel has taken great care at writing a book that covers the subject matter which is covered on the HESI and HESI A2.   Professor Kimmel states; ” I have been tutoring students to success for many years and have seen many of the nursing entrance tests.  I know what the student needs to study, as well as how to present the material in an easy to understand format.”

Time to get the edge over the rest.  Get started today with the study guide,

Pass The NET, The First Time

09
Sep

Online practice for the HESI, the TEAS, and the N.E.T.

Practice Taking HESI Tests Online at the Nurses Learning Center
Attention all students. Now you can pass the HESI Nursing Entrance Test on the first try. The Nurses Learning Center now offers online HESI practice tests designed to help students pass the first time. Failure is no longer an option.

FOR IMMEDIATE RELEASE
PRLog (Press Release) – Sep 10, 2010 – HESI Online Practice Tests are now available at the Nurses Learning Center. Students can now take advantage of online tests and tutorials designed to help them pass the Nursing Entrance Test HESI Exam. The online tests are written by nurses and educators who have taken and administered the HESI Exam. The educational team involved in the development of the Nursing Entrance Test question and answer bank have dedicated years of their lives to helping students achieve their goals of becoming a nurse.
Students are searching for reliable study materials and guides to better prepare them for the HESI Test. Preparation is the key to getting scores high enough to get into nursing school. When students are not prepared, they lose their opportunity to enter nursing school that year. This is very disheartening, especially when they have already dedicated two or more years of studying nursing school prerequisites.
Nursing school enrollment is soaring across the nation. Unfortunately, many wonderful pre-nursing students are left behind due to poor HESI scores or not passing the HESI exam. The educators at Nurses Learning Center have decided that enough is enough. Since the actual guide does not help students pass the HESI Test, then there should be a guide that does help students pass. Hence, the Nurses Learning Center Developed the online test bank for students to practice for the HESI Exam.
The online test bank includes tests on Anatomy and Physiology, Biology, Mathematics, English Grammar, Reading Comprehension and Chemistry. There are over one thousand questions and answers for students to practice. The tests are designed around first year nursing school curriculum.
This is what separates the Nurses Learning Center site from the rest of the testing sites and guides. The fact is that the educators care about student’s performance on the HESI Exam, and truly want students to pass the first time. Online testing simulates the actual HESI Test and the manner in which it is administered. Many of the nursing entrance tests are now computerized. If students are not familiar with the format of testing on a computer, their chances of passing become poor opposed to those students already familiar with online testing.
Many students find the Nurses Learning Center after they have already failed the HESI Exam one or more times. The Nurses Learning is a small company but one that is committed to the success of students. Professor Nancy Kimmel has been a nurse and educator for over twenty years. Author of the book, Pass The NET, she has pioneered the online testing site with all of her knowledge and skill.
Students have been able higher scores than they could imagine, using the online Nurses Learning Center. Professor Kimmel states, “I have such wonderful letters from students who have passed their HESI Tests after using the Nurses Learning Center online test bank with tutorials. It is a great feeling knowing that you have had some small part to play in the goals of those who pass the HESI Test. These students are going to be nurses, and we helped to get them there! There is no better compensation than a student’s success. “
The Nurses Learning Center enables the students to surpass the level of difficulty required by the HESI Exam. This is the reason that 95% of all students who take the HESI Test after using the Nurses Learning Center pass the first time. The online Nurses Learning Center site can be accessed at http://www.nurseslearningcenter.com

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Our educational products assist students in preparing for the Nursing Entrance Tests across the U.S., including the TEAS, The HESI and the NET. Students can choose from a variety of study materials, such as study guides, pdf downloads and online practice

26
May

Pass the NET

Written by kimmel52

The nursing entrance test is used to evaluate pre nursing students academic abilities. Students gain acceptance into nursing schools based on their scores. The tests that are used for evaluation incorporate subjects such as math, English, English grammar, biology, chemistry and anatomy and physiology. Several of the most widely used tests, are the HESI, the HESI A2 and the TEAS. There are many study guides available for the students that help them prepare for these tests. Unfortunately, even the actual study guides from the authors of the tests fall short of preparing the students to pass successfully. Students are faced with the dilemma as to what type of study guide will help them to best prepare. The frustration is critical, especially when their futures hang in the balance. Waiting lists for nursing school have exceeded to the point that people are told that they have to wait three to five years. If the student only gets three chances to pass the entrance test, then they have to choose another school or they feel forced to choose another career. This is unfair to the student who wishes to go into the nursing field to help people. Taking into consideration the nursing shortage that the U.S. is facing, one would think that getting into nursing school should not be so difficult. Instead, the stakes are continually raised. Not only now does the student have to pass the nursing entrance tests, but that is not enough, now they have to pass with a score that is higher than the rest. The question that has to be asked, is, if there is not a study tool that the actual authors of the tests produce that will give students this edge, then how can they pass with exceptional scores. The answer is, they can’t. It is no wonder that students are becoming disheartened at realizing their dreams of becoming a nurse. The good news is that there is hope. The book, Pass the NET, is the secret weapon that students now have to help the not only pass the nursing entrance tests, but pass with exceptional scores. So true is this that one nursing dean in the metro Detroit area stated, “It is probably better that we don’t tell students about this book, since it will give them an edge. This book is like a secrete weapon.” But the good thing is that this book is available to all, and it has been helping students across the U.S..

03
Apr

Student Testimonial

Written by kimmel52

4-1-10

Dr.Kimmel,
Thank you soooo much for writing such a fine study guide for the HESI 2.  When I layed eyes on this book, it felt like prepared knowledge for a open mind.
As instructed, I’m requesting the link to download the free software.  I remember you sending me a link which I did review for a couple of hours.  Dr. Kimmel, I don’t remember
downloading the program.  And when I went back to download from my email, the link had expired.  At your leisure, will you please send me the free software so I can download to my computer.
Again, I thank God for imparting His knowledge and wisdom into you to share with the body of potential nurses.
Sincerely,

Hurline McGee

Professor Kimmel, RN, PhD now has her book for sale on Amazon.  The book, entitled, Pass The NET™, The First Time has helped students pass many of the nursing entrance tests that are offered through various nursing schools across the United States.  Nursing entrance tests such as the HESI, TEAS, HESI A2 and THE N.E.T. are the main nursing entrance tests that students are required to take prior to admission into nursing school.  Dr. Kimmel’s book has helped many aspiring nursing students get into nursing school.  Students who have used Dr. Kimmel’s book have increased their scores to competitive levels and have helped those taking the nursing entrance test pass the first time.  Now Dr. Kimmel’s book is for sale on Amazon.  This will help students find her book more readily so that they can  have access to the wealth of information contained in the book, such as practice exams on Chemistry, Anatomy and Physiology, Biology, English Grammar, Math and Reading Comprehension.  Dr. Kimmel is also offering those who purchase the book from Amazon a free subscription to the Nurses Learning Center, where students can practice tests online that are similar in content to the HESI, HESI A2, TEAS and the N.E.T.  Nurse educators in Toronto are also using Dr. Kimmel’s study guides as practice tools for nursing students.