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Pass Nursing School Exams With an “A”

Written by kimmel52 on July 27, 2013 – 7:54 pm

 

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Ethics, Biases and Responsibilities of Nursing

Written by kimmel52 on January 8, 2013 – 9:59 pm

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Ethics, Biases and Responsibilities of Nursing
nancy kimmel
October 7, 2014

Ethics, Biases and Responsibilities of Nursing
On any given day, the nurse will be faced with ethical challenges. The consequences of the nurses action in doing the “right thing” creates a dislocation point within their peer and management group.(Huston, 2014, p. 256) From my personal experience I know of one ethical dilemma that I faced. It was the morning shift. I had just made rounds. As I sorted out the medications I was going to pass, I noticed that one of my patient’s medications consisted of Depakote®(“Valproic Acid and Pregnancy,” 2014), Zyprexa®(“What special precautions should I follow?,” 2014) and Tetracycline®(“What special precautions should I follow?,” 2014). This would not have been a problem except the nurses from the midnight shift stated that the patient was only three months pregnant and had stated she was going to have an abortion. I looked through the chart to see if there was a consent signed for a D &C. There was none. I also proceeded to check if the psychiatric medication consent form was signed. This form needed to be signed prior to administering any anti-psychotic medications. The Physician was responsible for explaining to the patient the side effects. Next, I noticed that the attending Physician wrote the order for the Tetracycline and that the Psychiatrist wrote the order for the anti-psychotic meds. After reading this, I went to the patient and explained to her that there could be very teterogenic side effects to her unborn fetus if she were to take these medications either together or individually. She stated that she didn’t care because she was planning to have an abortion. I graciously bowed out and went to my head nurse. I explained to my head nurse that without documentation of a procedure for a D & C or any signature from the patient indicating that they understood the side effects of the combined medications, I could not in good faith pass these meds. In fact, I added that she could change her mind in a few hours. My head nurse just looked at me and asked me if I was defying a Physicians order. I said, “Yes”. She then proceeded to call the nursing supervisor who also asked me if I was refusing to pass the meds. I told her that I would not pass the meds citing documentation via the Micro-Medex®(“Truven Health Analytics,” 2014) drug compatibility table and my nursing code of ethics, to do no harm.(“Code of Ethics for Nurses,” 2010) After a brief discussion with my head nurse, they relieved me of this patient and gave me someone else. The nurse who took over the care of my patient followed the Dr.’s orders and passed the meds. I was told to write an incident report.
Impact of Legal Responsibilities
My first and foremost responsibility is too my patient. That has and will always be how I practice nursing. However my stance, the actions that I took obviously affected the care of the patient and not for the better. Could I have done it differently? It is important that the nurse has a scope of practice. This is what guides us to know what we can and cannot do. As nurses we must be very careful what lines we cross. Physicians are notorious for asking us to perform skills not within the scope of our practice.
Strategies to Address Conflict
There is no easy answer but as a group voice we can be heard. Which is why being part of the legislative due process of lobbying, helps to have laws passed that protect the nurse and patient.(Mason, Leavitt, & Chaffee, 2014, p. 669) Joining a nursing association also helps bring a unique camaraderie for nurse in their field so specialty, where they can also find peer group support for their cause.

References
Code of Ethics for Nurses with interpretive statements. (2010). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Huston, C. J. (2014). Legal and Ethical Issues. In Professional Issues in Nursing Challenges & Opportunities (3rd Edition ed., pp. 256-262-262). Baltimore, MD: Lippincott Williams & Wilkins a Wolters Kluwer business.
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2014). Policy and Politics in the Community. In M. Iannuzzi (Ed.), Policy & Politics in Nursing and Health Care (6th ed., pp. 668-669-669). St. Louis, MO: Elsevier Saunders.
Micromedex Solutions. (2014). Retrieved from http://micromedex.com/
Olanzapine. (2014). Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601213.html
Tetracycline. (2014). Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682098.html
Valproic Acid and Pregnanacy. (2014). Retrieved from http://www.mothertobaby.org/files/Valproic_Acid.pdf


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Treatment of Pressure Ulcers

Written by kimmel52 on November 25, 2012 – 11:08 pm

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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 »


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Evidenced Based Practice as a Change Agent

Written by kimmel52 on January 8, 2012 – 10:03 pm

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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


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Nursing Entrance Test to Nursing

Written by kimmel52 on January 11, 2009 – 2:59 pm

Time to seriously think about getting started toward a nursing career

Time to seriously think about getting started toward a nursing career

The new career for many people today is nursing. The driving force for such a large interest in nursing has to do with the job security that this field offers not only job security but financial gain from higher salaries. However, although job security and benefits are very wonderful to have, the prospective student must realize that they have to pass the Nursing Entrance Test first, before even getting into nursing school. For many displaced workers a career in nursing is the first choice. However, with any life changing decision that has been determined requires the next step of having some type of road map to achieve ones goal. Finding and preparing that road map can be difficult and frustrating if the person does not have knowledge of reliable resources. Time is also an issue. For many, time is of the essence. Time seems to be an important factor in beginning a second career. First of all the age factor seems to scare a lot of people from attempting to achieve their dreams. Age shouldn’t be the factor that keeps people from acquiring or trying to achieve their goal. Age should be looked at in a positive light. The numbers are staggering at those entering the nursing field in their thirties, forties and fifties. Even with people in their fifties, they can look forward to twenty years of work if they so choose. Money is another factor that causes concern for people choosing a second career.   Read more »


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Nursing Scholarships, Grants and Loans

Written by kimmel52 on December 10, 2008 – 1:36 am

You will find an immense amount of information in my book entitled, Kimmel Guide. Here are just some of the venues for funding your education. You can also purchase the entire guide to scholarships, grants and loans in my book entitled, “Get into Nursing School Fast”. For further information refer to, “My Product” page.

Financial Aid
This book would not be complete without a chapter dedicated to various types of financial aid available to aspiring graduates. Now that you have read about all the programs offering degrees through correspondence, you can start seriously thinking about what type of financial aid package might benefit you most. Read more »


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The Right Nursing School Scholarship for You

Written by kimmel52 on November 12, 2008 – 2:37 am

Are you considering a career in nursing, then before you begin you need to check out all of the wonderful scholarships available. You may not consider yourself eligible, but you will be surprised to find that there are nursing scholarships out there that are just for you. NELRP is a competitive program that repays 60 percent of the qualifying nursing educational loan balance of Registered Nurses (RNs) selected for funding in exchange for 2 years of service at a critical shortage facility. Participants may be eligible to work a third year and receive an additional 25 percent of the qualifying nursing educational loan balance.

The NELRP is authorized by Section 846(a) of the Public Health Service Act, as amended. The purpose of the NELRP is to assist in the recruitment and retention of professional RNs dedicated to providing health care in facilities with a crucial shortage of nurses and to provide an opportunity for RNs to consider a career in such facilities. The program offers RNs substantial economic assistance to repay a portion of their qualifying nursing educational loans in exchange for full-time service at a health care facility with a critical shortage of nurses. When considering a career in nursing, most of seek out financial aid only to find the resulting funds are usually never sufficient. Many scholarship and grant opportunities are available to nursing students to encourage people to enter the nursing field and help alleviate the increasing nursing shortages. With a little research, you can learn how to obtain this free money for your nursing school education.

Uncovering these funding sources can help free you from financial worries, and instead let you dedicate your efforts toward your schooling. The following five tips can help start your nursing scholarship and grant search and guide you in the application process. Read more »


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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 »


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The NCLEX Test Preparation

Written by kimmel52 on November 12, 2008 – 12:18 am

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

This is the day that you will sit for your nursing boards, and take the NCLEX.. Be sure that you have you ATT, (Authorization To Test) form with you. You will not be able to test without this form. You will also need to present picture identification. Of course now is not the time to ask yourself if you have studied enough, but hopefully you have. Many people who sit for the NCLEX have fears that they have not studied enough. Read more »


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Did You Pass The Nursing Boards?

Written by kimmel52 on November 12, 2008 – 12:16 am

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

Congratulations! So you finally passed your boards, and now you are a real Registered Nurse. How does it feel, to have passed the final test of all tests? Great? Absolutely! Now what? Well, to begin, you need to celebrate. There are many loved ones that are also looking forward to taking part in the celebration. Read more »


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