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Topics in Clinical Nursing

Written by kimmel52 on January 23, 2015 – 12:31 am

Pass the HeSI,TEAS, TEAS a5

 

Topics in Clinical Nursing
Patient safety incorporates many core measures as put forth by the Joint Commission. As Dr. Shaunghnessy stated, the population in America will contain more aging adults than any other time in history (Laureate Education, 2009). This will put a burden on monies spent in health-care. Additionally, health-care professionals will be held to higher standards in order to lessen this burden, by performing their duties with a high degree of responsibility and accountability. The Joint Commission and the Centers for Medicare and Medicaid strive to improve the quality of health-care by developing core standards of protocol to be followed. The National Database of Nursing Quality Indicators assists nursing professionals at the unit level in making informed decisions to improve patient outcomes (“NDNQI,” n.d.).


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How to Pass the Math on the TEAS A5

Written by kimmel52 on March 12, 2014 – 6:09 pm

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So you just want to pass the Math section on the TEAS or the TEAS A5. How do you do that, if your math background isn’t that substantial. Well there is a way. Practice Practice and more practice. But where and what do you begin to study? At the Nurses Learning Center there are many tests that you can take online. You can choose from many different levels of math practice tests. All tests are online and you can choose to purchase one or more. Learn the steps to answer all of the math questions on the TEAS. Raise your scores so that you can get into the nursing school of your choice. Most nursing schools require a score of 80% on the TEAS or the TEAS A5. The math section is the one part of the exam that most students fail or score poorly. At the Nurses Learning Center students can feel confident that they are getting the correct study materials to pass the TEAS. What really helps students is that each questions has an explanation that goes through the entire problem, so that there is no question at how to arrive at the answer. Since students are not allowed to use a calculator on the test and they only have a short period of time to complete the math section, it is imperative that students can use their critical thinking skills.
The Nurses Learning Center helps students develop their math critical thinking skills by presenting the answer to each question step by step. Even students in school do not get as much help in their math classes. The Math 1 exam covers basic math skills such as adding, subtracting, decimals, long hand division and long hand multiplication. These skills are no longer taught in middle school and in high school. Yet those students seeking entrance into nursing school must do all the problems without calculators using long hand multiplication and division. Quite scary if you do not feel comfortable with these skills. Once you are a nurse you must use these skills to calculate medication dosages. Here a the Mynursingedu.com you can also purchase a hard copy book of the “Pass The NET”. It is the same as the online tests offered at nurseslearningcenter.com. Testing the TEAS can be very challenging. Students feel very intimidated by math. Some students will not go near a math test. Understanding math questions and knowing how to answer them will help students pass their math section. Knowledge is the key. Students should take their time studying for the TEAS. They should set aside time where it is quiet and they have the ability to concentrate. It is suggested that students take up to three months to prepare for the TEAS.
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Best Wishes to All,
Kindly,
Nancy Kimmel RN PhD


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Clinical Practice Guidelines for Chronic Pain

Written by kimmel52 on January 8, 2013 – 9:55 pm

Relax, there is a study guide to help you

Relax, there is a study guide to help you

Clinical practice guidelines for chronic Pain
nancy kimmel
October 18, 2014

Clinical practice guidelines for chronic Pain
The purpose of this paper is to identify the current clinical nursing guidelines regarding the treatment of chronic pain and its financial impact on the healthcare system, community, patients and their families. Additionally, this paper will explore the expectations of the BSN in the implementation and documentation of evidenced based practice.
Nursing management of chronic pain
Pain is a symptom that frequently goes unreported and unrecognized in patient care settings. Pain also has negative effects on the patient and their families.(Stenner, Carey, & Courtenay, 2012, p. 3335) “It’s disheartening for frontline nurses and other providers to feel they are not meeting their patients’ needs,” LaFevers said. “Not everyone can go to a pain specialist.”(“Better management needed,” 2014, para. 37)
Chronic pain and its significance in nursing practice
Chronic pain is an individual experience. Nurses face many challenges in helping those who suffer from chronic pain.(Dysvik & Furnes, 2012, p. 187) Pain is the main reason that patients seek healthcare.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) Research shows that over 50% of these patients have suffered pain within 24 hours of seeking medical help.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) An individual nurse may be able to help relieve the patient’s pain during their shift, whereas the next nurse on duty may not be able to provide the needed relief. Nurses working collectively as a team can better manage the effects of chronic pain in patients than a nurse acting alone. The management of pain as a group effort requires nurses’ to have a thorough knowledge of pain theory and the use of the behavioral and cognitive approach.(Dysvik & Furnes, 2012, p. 187)
The expectation of the BSN in chronic pain management
Belonging to a supportive team with clear roles helps in the complex management of chronic pain.(Dysvik & Furnes, 2012, p. 189) The BSN nurse typically assumes the leadership role.(Video Laureate Education, Inc., 2009) The group leader in the management of chronic pain is multifaceted.(Dysvik & Furnes, 2012, p. 189) The BSN must utilize the current research on the management of chronic pain and present this to the group. It is the moral and ethical duty of the BSN to utilize evidenced based practice.(Video Laureate Education, Inc., 2009) They are also the catalyst of change for their group.
Clinical practice guidelines in the management of chronic pain
According to the National Guideline Clearing House, chronic pain management should begin with assessment of the pain, the duration, intensity, description in the patient’s own words, location, onset, quality and duration.(Institute for clinical systems improvement [], 2013) The nurse should also take into consideration the psycho-social factors the chronic pain may influence, such as depression and drug abuse.(ICSI, 2013) The treatment of chronic pain is a mulifactorial group approach led by the physician and nurse leader.(ICSI, 2013) Treatment should be addressed in levels with medications not being the sole focus.(ICSI, 2013) Comprehensive patient assessment algorithms for chronic pain begin with addressing the psycho-social factors. These factors include the patient’s reaction to their pain, their scioeconic status, their support or lack of support system, family history of pain therapies and their cultural and ethnic beliefs on the management of pain. The nurses understanding of the biopsychosocial model helps with the implementation of a pain treatment protocol that will benefit the patient’s long term goals.(ICSI, 2013)
The impact of chronic pain on the patient and the community
The under treatment of pain is a global problem.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) Unresolved treatment of pain can have negative impact on the quality of life, economic productivity and healthcare utilization.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) In 2011 at least 100 million American adults have common chronic pain conditions.(“Relieving pain in America,” 2014, para. 12) Pain is a significant public health problem that costs society at least $560- $635 billion annually,( an amount equal to about $2000 dollars for everyone living in the U.S.).(“Relieving pain in America,” 2014, para. 12)
The cost of pain to the healthcare system
In 2008 the cost of pain to the federal and state government for medical expenditures was $99 billion dollars.(“Relieving pain in America,” 2014, para. 13) Analysis from the CDC showed that nearly half a million emergency department visits in 2009 were from people abusing or misusing prescription pain killers.(“Relieving pain in America,” 2014, para. 13)

References
Dysvik, E., & Furnes, B. (2012). Nursing leadership in a chronic pain management group approach [Chronic pain management group approach]. Journal of nursing management, 187-195. http://dx.doi.org/http://dx.doi.org.ezp.waldenulibrary.org/10.1111/j.1365-2834.2011.01377.x
Facts on pain. (2014). Retrieved from http://www.painmed.org/PatientCenter/Facts_on_Pain.aspx#highlights
Gretarsdottir, S., & Gunnarsdottir, E. (2011). Systematic review aimed at nurses to improve pain management [Magazine]. Nordic journal of nursing research and clinical studies, 31(4), 16-21. Retrieved from http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/resultsadvanced?sid=fe778475-dd1f-42b0-9f12-420e94669cc5%40sessionmgr113&vid=9&hid=125&bquery=nurses+to+improve+pain+management&bdata=JmRiPXJ6aCZ0eXBlPTEmc2NvcGU9c2l0ZQ%3d%3d
Institute for clinical systems improvement. (2013). Assessment and management of chronic pain. Retrieved from http://www.guideline.gov/content.aspx?id=47646&search=chronic+pain
Stenner, K., Carey, N., & Courtenay, M. ( 2012, February 9th). Prescribing for pain – how do nurses contribute? A national questionnaire survey [Prescribing for pain]. Journal of Clinical Nursing, 21(23/24), 3335-3345. http://dx.doi.org/doi:10.1111/j.1365-2702.2012.04136.x
The state of pain-better management needed. (2014). Retrieved from http://www.theamericannurse.org/index.php/2014/01/02/the-state-of-pain/
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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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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Critical Thinking in Nursing

Written by kimmel52 on January 8, 2012 – 9:57 pm

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


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Texas Women’s University Approves “Pass The NET” as their Official Study Guide

Written by kimmel52 on September 21, 2011 – 11:25 am

 

 

 

 

 

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


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