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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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Pass The N.E.T.™ v3 Nursing Entrance Test Tutorial Helps Students Pass The First Time

Written by kimmel52 on May 14, 2013 – 9:46 pm

PASS THE N.E.T. (Nursing Entrance Test) the First Time

Pre-nursing students going for the RN or LPN/LDN degree now have a reliable tutorial that streamlines the learning process. A proven 95% of students using the tutorials have passed the nursing entrance test on their first try.

Finally there is a tutorial that will prepare students to pass the nursing entrance test the first time. Though there are many study guides on the market, most students feel they are insufficient in adequately preparing them for this three hour exam. The Pass The N.E.T.™ tutorials stand out against the competition. Read more »


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Posted in HESI TEAS The NET ATT, How to Pass the HESI, Nursing Entrance Test Math Question of the Day, Nursing School Education, Pass The Nursing Entrance Test, The NET Reading Comprehension Section, The NET Study Guide, The Nursing Entrance Test | 4 Comments »

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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Change in Practice

Written by kimmel52 on January 8, 2013 – 9:51 pm

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Change in practice assignment
nancy kimmel
November 16, 2014

Change in practice assignment
The purpose of this assignment 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).
Practice Change
The proposed evidenced based practice change would begin by the identification of gaps in knowledge and practice of the treatment of pressure sores (Schmidt & Brown, 2012). This process would begin with a survey on current patients with pressure sores, identifying their dietary intake of protein, vitamin C and other nutritious intake such as flavored protein shakes and healthy snacks(Wurster, 2007). The survey would include verifying linen change frequency and adherence to turning schedules. Identification of vulnerable patients who have limited mobility, incontinence, dementia or are over the age of 65 (Jaul, 2010).
Staff RN’s current knowledge base on pressure sore prevention should be evaluated. This could be done by asking the RN’s to fill out a pressure sore prevention questionnaire. The nurse aides would also be asked to fill out a questionnaire on pressure sores, identifying patient’s comfort levels and the importance of a turning schedule. The questionnaires would also evaluate the level of communication between staff members and shift team members thus identifying communication gaps (Banning, 2005).
RN’s would be assigned to collect quantitative articles from credible databases such as CINAHL or the National Guideline Clearninghouse for best practices documentation literature review. A proposed meeting time and place would be agreed upon to review article research, wherein the credibility of the articles obtained would be determined. The articles requested would be those that meet the quantitative standards(Schmidt & Brown, 2012).
Articles that meet quantitative and or qualitative standards would be decided at journal club meetings. Best practices would include statistically significant data based upon population parameters, level of significance and positive outcomes. Identification of the RN’s role in delegation of duties to the nurse aide’s job of providing patient safety, comfort and importance of prioritizing the patient’s needs would be reviewed. Determining the importance of the lead RN and their responsibility to subsequent shift team leaders would be identified and discussed at team meetings.
Rewards, praise and recognition of the importance of team members plays a large role in facilitating change (Schmidt & Brown, 2012). The lead RN initiating the change in practice should be responsible for coordinating meetings and dissemination of data.
Evidence Supporting Proposed Change
Icek Ajzen’s theory of planned behavior states that behavior is influenced directly by intention to perform the behavior (Ajzen, 2011, p. 1113). The nurse in charge of the change process begins by creating a sense of urgency (Schmidt & Brown, 2012). Several studies done on nurses’ attitudes toward pressure ulcer prevention revealed that there were barriers and gap knowledge present within staff members.
The first study identified (Athlin, Idvall, Jernfalt, & Johansson, 2009) 30 RN’s as the sample. The setting included two hospitals and one community care facility. The instrument used to evaluate the RN’s attitude toward pressure ulcer prevention was a questionnaire. Variables that were identified included patient health status and vulnerability to the development of pressure sores, the health care structure variable that affect pressure ulcers and prevention. Findings of the research indicated that the knowledge of pressure ulcer prevention was present. However the ability to follow through with collaborative treatment was lacking. This knowledge gap was due to lack of staff, time and consistent prevention routines.
A descriptive cross-sectional study involving 77 RN’s and 77 Nurse Aides traversed six hospitals and six clinics (Kallman & Suserud, 2009, p. 336). The researchers used a 47 item questionnaire which included an 11 item attitude scale (Moore & Price, 2004). The research concluded that all RN’s and Nurse Aides had a positive attitude toward the prevention of pressure ulcers. Their inability to provide collaborative care stemmed from environmental factors such as lack of time and communication between staff members. Performance in the prevention of pressure ulcers was inadequate due to lack of teamwork, access to necessary preventative equipment and supplies and current work routines.
The necessity for increased knowledge regarding the prevention of pressure ulcers is evident across both studies as is the necessity for more staff, time and open lines of communication regarding the worsening status of the patients’ current condition.
Evaluating the Change
To identify whether or not a change is evident begins with the patient population and identification of a positive outcome. In this case it would be a decrease in the amount of stage 1 pressure sores not present at the time of discharge. In short term admissions the first step would be to do a thorough assessment of the patient and their risk for pressure ulcer development. Having collected relevant research data from articles and questionnaires, the lead RN would initiate the plan of action. Identifying team leader RN’s for each shift would ensure that the tasks for prevention of pressure ulcers are being followed through by the staff RN and the nurse aide. Having access to and providing the patient with adequate nutrition would be a priority for all staff (Jaul, 2010) Making sure that their over bed table is always within reach and that assistive feeding be followed through until the patient has finished eating. Frequent turning schedules are to be implemented on patients who are alert and oriented but do not ask for anything or turn on their call light (“Target population,” 2011) Nurse aides and nurses should always ask to reposition for comfort and explain why they are doing so for the patient’s own knowledge. Daily shift meeting should address those interventions taken on the patient’s that are vulnerable for pressure ulcers. Linen change each shift should be mandatory for patients at risk (“Target population,” 2011). Moisture frequency should be evaluated every hour for those who are incontinent of bladder or bowel. This can be done by assistive turning and inspection of the area per patient’s approval. Keeping patients’ involved in their own care is an important aspect of nursing. Self care helps the patient develop confidence and hope in their treatment.
Assuming that all criteria is evaluated with attention to where the knowledge gaps are evident and corrected and the RN’s and nurse aides are able to perform their required tasks, the outcome should be positive. Determining the where the problem with pressure ulcer prevention exists would in the responses from the RN’s and nurse aides. Once the problem is identified then the development of the plan of action would be developed as described above. Putting the plan of action into place requires that the change agent or the lead RN verify that everyone is staying on task. The lead RN can do this through a daily shift evaluation of the patients’ condition and through nurse charting notes. Communication between shifts is a common problem as is the continuum of care. Quality care is the key. Prevention of pressure sores is not that difficult when it becomes a common goal for all who are working on the floor. With the implementation of the described changes the resulting outcome should be positive.
Summary
Research has documented that there are knowledge gaps between staff members in the flow of care in the prevention of pressure ulcers. While pressure ulcers continue to be a problem in most healthcare institutions, there is hope in lessening their prevalence. This paper focused on the development of evidenced based practice to reduce the incidence of stage 1 pressure ulcers that develop with a few days after admission in short stay patients’. Evidence from research on the attitudes of nurses and nurse aides in regards to the prevention of pressure ulcers shed light on a common theme, that of a lack of communication and the consistency of care (Kallman & Suserud, 2009). Those interviewed stated that lack of knowledge, time and or access to necessary preventative equipment also exacerbated the patient’s condition. The proposed evidenced based change practice initiates a sense of urgency and provides a plan of action to help reduce the frequency of stage 1 pressure ulcers. The EBP change details how to begin the study and the methods to evaluate the study. Ensuring that the standard of care continues across all shifts requires communication between all shifts. A nurse leader can ensure that this takes place with proper team leadership on each shift. Rewarding and recognizing those who are following the plan of care and going above and beyond ensures that the plan will continue to have positive outcomes for the patient.

References
Ajzen, I. (2011). The theory of planned behaviour: Reactions and reflections [Magazine]. Psychology and Health, 26, 1113-1127. http://dx.doi.org/110.1080/08870446.2011.613995
Athlin, E., Idvall, E., Jernfalt, M., & Johansson, I. (2009). Factors of importance to the development of pressure ulcers in the care trajectory: Prectptions of hospital and communcity care nurses [Magazine]. Jouranl of Clinical Nursing, 19, 2252-2258. http://dx.doi.org/10.1111/j.1365-2702.2009.02886.x
Banning, M. (2005, April). Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse precribers’ views. [Magazine]. Journal of Clinical Nursing, 14(4), 411-417. http://dx.doi.org/10.1111./j.1365-2702.2004.01086.x
Jaul, E. (2010). Assessment and mnagement of Pressure ulcers in the elderly [Supplemental material]. Drugs & Aging, 27(4), 311-325. Retrieved from http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=19&sid=fcecb593-84bd-4598-81db-b92f5a4f8e60%40sessionmgr198&hid=102
Kallman, U., & Suserud, B. (2009). Knowledge, attitudes and practice among nursing staff concering pressure ulcer prevention and treatment-A survey in a Swedish healthcare setting [Magazine]. Scandinavian Journal of Caring Sciences, 23, 334-341. http://dx.doi.org/10.1111/j.1471-6712.2008.00627.x
Moore, Z., & Price, P. (2004). Nurses’ attitudes, behaviours and preceived barriers towards pressure ulcer prevetnion [Magazine]. Journal of Clinical Nursing, 13, 942-951. http://dx.doi.org/10.1111/j.1365-2702.2004.00972.x
Pressure ulcer prevention and treatment guidelines. (2011). Retrieved from http://www.guideline.gov/content.aspx?id=25139&search=pressure+ulcers+during+short+term+stay+and+pressure+sores
Schmidt, N. A., & Brown, J. M. (2012). Evidence-based practice for Nurses appraisal and application of research (2nd ed.). Sudbury, MA: Jones & Bartlett Learning .
Wurster, J. (2007, September 1). What role can nurse leaders play in reducing the incidence of pressure sores? [Magazine]. Nursing Economic$, 25(5), 267. Retrieved from http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?sid=fcecb593-84bd-4598-81db-b92f5a4f8e60%40sessionmgr198&vid=11&hid=102


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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

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


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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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New 2nd Edition of Pass The N.E.T. is HERE!

Written by kimmel52 on June 3, 2011 – 11:32 pm

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.


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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.


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