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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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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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Reading Comprehension on the HESI A2

Written by kimmel52 on February 7, 2010 – 3:47 am

Dear Future Nursing Students;

Passing the Nursing Entrance Test the first time with high scores many be your only opportunity to get into nursing school. There is a tutorial that will help you pass the HESI A2, TEAS, and THE N.E.T. (Nursing Entrance Test). You can choose from individualized PDF subjects such as Math or Reading Comprehension, or the comprehensive Pass The N.E.T. book which contains over 450 pages of tests, tutorials and explanations on the following subjects; Anatomy and Physiology, Chemistry, English Grammar, Biology, Math, and Reading Comprehension.

Students who call me have very intense apprehension about taking the Nursing Entrance Test. I have spent many hours with students on the phone talking with them and helping to give them the confidence that they need to pass. Unfortunately they find my material after they have failed the NET the first or second time. This is a very important test. Let no one tell you different. Therefore the student needs the most up to date and comprehensive materials to help them PASS the First Time. As a professor, nurse, and author, I have spent many years developing The Nursing Entrance Tutorial material in an easy to understand fashion. I feel so bad for students who are given a small book to study that does not even prepare them for what is on the test. Students must be very careful what they choose to be their study guide. I have lectured on the steps to Pass The NET in Michigan and have tutored many nursing pre nursing students to success. I am in your corner. Please see some of the content regarding the PDF books below;

Reading Comprehension for the NET, HESI, HESI A2 and The TEAS, over 140 pages of topics, passages, tutorials, tests and detailed answers with explanations.
The Pass The NET Reading Comprehension Section in PDF; the Student will be able to…
1. Analyze the passage and determine the Authors point of view.
2. Recognize the key words whose meaning reflects the passages points.
3. Find the main concept or subject.
4. Identify proofs of concepts
5. Illustrate subjective points.
6. Integrate all information
7. Formulate the correct idea that the author is trying to convey.
8. Build reading comprehension skills
9. Develop their critical thinking skills (This is a must for Nursing School)
The Methods that the student will use to achieve the above goals are the following;
10. Practice answering questions on many scientifically based passages in such topics as Biology, Nursing, and Psychology.
11. Questions and tests at the end of each passage.
12. Complete explanations, not just answers.
13. Workbook spaces to answer questions posed after several sentences.


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Pass The N.E.T. First!

Written by kimmel52 on December 14, 2009 – 9:41 pm

By Nancy Kimmel R.N. Ph.D. mpj0185026000011

O.k., so you want to become a nurse. Good choice. Did you know that National surveys of registered nurses, physicians, and hospital executives document considerable concern about the U.S. nurse shortage?(1) Will you have job security? Absolutely! Now all you need to do is to become a nurse. As the population continues to grow, so does the need for educated nursing professionals. With such a strong need for nurses many would think it would be easy to get a nursing education. The fact is it may be harder than many people think. Today the United States also has a shortage of nursing educators and this makes many nursing programs hard to get into often with long waiting lists.
Getting onto these waiting lists is all dependent on how well the student performs on the NURSING ENTRANCE TEST This is a three hour exam that tests the students knowledge from reading comprehension to anatomy and physiology. Student aspirations of having a career in nursing can come true if they know how to study intelligently for the NURSING ENTRANCE TEST. This test can become a stumbling block for students who do not adequately prepare for the N.E.T. Comprehensive study materials can be found online at the Nurses Learning Center
Students have online access twenty four hours a day, seven days a week, as long as they need the program. Having access to a comprehensive battery of tutorial test that will help raise students score on the N.E.T is a must is the student plans to get into nursing school on the first try. Not pass the NURSING ENTRANCE TEST is a great set back for everyone trying to get into nursing school, and one that most people can’t afford to take.
Nursing forum – career planning and education advice for nursing careers

Even with all these hurtles in place, a nursing career is still a great choice as long as you select the correct career path. As with any career you choose, you want to create a plan and time line so you can advance into a senior position in the future.While in fact the program of nursing is a grueling one, the rewards of helping others outweighs all other factors considered. The five steps are outlined below.
Step 1. Have a great desire to help others. Becoming a nurse means caring about others as you would care for yourself, your children, your parents and other loved ones. Love of mankind is definitely a prerequisite. This is the most important step. Read 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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Unlimited, Online, Nursing Entrance Tests Available 24/7

Written by kimmel52 on December 9, 2009 – 9:34 pm

nurse pic

Now there are available online, all the tests and practice tests that students need to be able to pass such tests as the HESI, The TEAS, HESI A2, and the NET.  These tests simulate the actual computerized tests and help prepare the student to pass with high scores.  Just go to the Nurses Learning Center and read more about the wonderful options that await those struggling to find reliable testing material that will help them to not only prepare for the Nursing Entrance Test, but pass the first time with high scores.
Students need some extra help in studying for the various tests that are currently out there. Unfortunately there is not enough reliable resources on the internet to help students sufficiently prepare for the nursing entrance tests. Even the companies that produce them, such as ATI, (ERI World), and others do not give students the necessary information. The only online practice tests that they give are such that the student has only a few hours or days to practice, then the service is turned off. The fee is sizable for their service. Here at the Nurses Learning Center, students can access tests that include Anatomy and Physiology, Biology, Chemistry, English Grammar, Reading Comprehension, and Mathematics. Over one thousand questions and answers are available to the students. They can track their test scores and determine their weak points. There is no limit, and the service does not terminate. The student can simply access the internet then  begin their practice testing anytime throughout the day or night.

The best way to study is the right way to study.  The online tutorial testing is user friendly.   Students can log in at www.nurseslearningcenter.com/testing
All the student has to do is to choose a user name and password when they purchase the online product. This will be their password each time that they log in, no matter where they are.  Start studying today.


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Nursing Entrance Test, Reading Comprehension Passage

Written by kimmel52 on December 9, 2009 – 8:12 pm


The following is an example of a reading comprehension passage that you would find on THE NURSING ENTRANCE TEST OR THE N.E.T.. The student who is sitting for the NURSING ENTRANCE TEST needs to remember that they must not bring any previous knowledge into answering the questions. The passage will be on a computer screen and the student must scroll through out the passage until finally arriving at the questions. Time yourself on the passage below.

Childhood behavioral disorders such as ADD and ADHD have been are on the rise. It is important for parents to realize that children are not fully developed with respect to their bone growth and metabolism as adults. Just as an expectant mother’s deficiency in folic acid can lead to defects in the newborns neural tube, so can metal ions and complex organic compounds cause damage to a child’s bones, liver, kidneys and neurotransmitters. Why should we as parents, educators and doctors treat the symptoms of the above mentioned disorders with more chemicals in the form of pills? It is interesting to look at what are some of the chemicals that go into foods that we consume regularly. Below is a list of some of the food additives taken from Casarett and Doull’s Toxicology, The Basic Science of Poisons, 4th Ed.,McGraw Hill copyright, 1991. Page 823. Read more »


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Nursing Entrance Test Math Section

Written by kimmel52 on December 7, 2009 – 7:37 pm

How hard is the NURSING ENTRANCE TEST MATH SECTION?
Does the NURSING ENTRANCE TEST, OR N.E.T. contain any medication calculations?
The answer is yes! This may intimidate many students who are getting ready to take the N.E.T. There is hope. At the Nurses Learning Center students can study online tests and tutorials with unlimited access without worrying that they will lose their access. There are indeed some questions requiring knowledge of medication dosing calculations. These questions however can be broken down into simple ratios and proportions. The student will be using these formulas quite a bit during nursing school, where they can expect frequent medication calculation tests. The N.E.T. Study Guide author, Nancy Kimmel has broke down exactly how to solve for these ratio and proportion problems at the Nurses Learning Center. Whether the student is studying the drip factor of an IV or exactly how much medication to dispense, the student will find the information that they need to pass the NURSING ENTRANCE TEST MATH SECTION.

It is important for the student to prepare for the N.E.T. by getting a thorough understanding of how to use ratio and proportions prior to nursing school. One of the reasons that so many people do not do well on the MATH SECTION OF THE NURSING ENTRANCE TEST, is due to their lack of study in such subject matter.

MEDICATION SAFETY

While medications do a lot of good, most of them can cause a patient physical harm or death if too high a dose is administered. Because of this nurses typically double-check  and triple check their calculations when they are giving a new or potentially deadly medication, or have another nurse check their calculations.  As a nursing student you will check every doctor’s order with your instructor before the two of you act on the order. For a student to give a medication or change an IV rate without consultation with a professional is not permitted by this School or the clinical agencies. Medication safety is crucial. Below you will find some examples of ratio and proportion problems.

IV FLUIDS

The amount of fluids administered intravenously each hour should never be more than you would want to drink in an hour. Most often doctors order only about 4 ounces of IV fluid per hour for their clients. The Metric System is usually used by doctors to order the infusion rate for an IV. There are 30ml in an ounce of fluid. “Infuse 125 ml/ hour” is a common IV order. If the client has a heart or kidney problem, IV fluids might be restricted to 50 – 80ml/ hour. More than that could cause their lungs to fill with fluid, drowning them from the inside causing congestive heart failure.  In the following exercises if you get an answer wildly different from these numbers, your logic should tell you that your answer is probably wrong.

BASIC INFORMATION YOU NEED TO KNOW ABOUT AN IV

  1. Usually IVs come in clear plastic bags with lines on the side showing how much fluid is left in the bag so a nurse can see how much of the IV has infused.
  2. The most common size is about a quart which is equal to 1000 ml. 1000 ml is one liter. The total amount is printed on the bag.
  3. There are many different solutions in these bags, but they all look the same. The name of the solution is printed on the bag. Even though they may be all piled in a heap on a shelf, it is critical that the correct solution be hung for each patient. The wrong solution could kill.
  4. The tubing that connects the bag to the client comes in different diameters. The wider the tubing, the faster fluid gets into the client. When you look at the box the tubing came in it could give a “Drop Factor” of 10 drops/ ml or 12 or 15 or 20 drops/ ml. When the Drop Factor is between 10 – 20 it is called “macrodrip tubing”. A drip rate can’t be figured out unless you know the Drop Factor for the tubing being used.
  5. Some tubing has a needle built in that limits the size of the drop that can enter the tubing from the IV bag. Pediatric nurses use this kind of tubing because their little patients can only tolerate tiny amounts of IV fluid. It takes 60 of these little drops to equal one ml. When the Drop Factor is 60 the tubing is called “microdrip tubing”
  6. All IV tubing has a chamber at the end near the IV bag where nurses can see the fluid dripping out of the bag before the fluid enters the tubing. This is where they count the rate of the falling drops using the second hand on their watches. So you can check your answers for logic be aware that if the tubing delivers one ml every 10 drops, a drip rate of 21 will give the patient 125 ml in an hour. If the tubing delivers one ml every 15 drops, a drip rate of 31 will give the patient 125 ml in an hour.
  7. If the drip rate is less than 10 drops each minute the client’s vein may clot off the IV, meaning s/he might have to get stuck again to start a new IV.
  8. Just because the IV is no longer in the IV bag a nurse can not assume that it infused into the client. It could have disconnected and be in a puddle on the floor. Nurses always check the client’s infusion site to make sure everything is connected and the client’s arm looks okay.

FORMULAE AND PRACTICE

The goal for these exercises is for you to be able to quickly formulate and calculate IV problems.

This is a useful formula to compute the drip rate of an IV. Memorize it. You will need to prove that you can use it in every clinical course before you will be allowed into the clinical area.

= drops/minute

Another way of saying the same thing is:

Example #1

Dr. A. orders your client to receive 125 ml of D5W an hour for the next 8 hours. The nursing unit used tubing with a drop factor of 10. What is the drip rate?

Fill in the formula putting an X for the drip rate because that is what you want to know.

Notice that the fact that the information about 8 hours was not needed to figure out the drip rate.

Example #2

Dr. B. orders a liter of D5W to run this 8-hour shift. The drop factor is 15. Put this information in the formula with the X in the spot for the drip rate.

Example #3

Dr. C. wants your client to have 50 ml of a pre-mixed antibiotic. The Pharmacy writes, “infuse in 30 minutes”. The tubing box says drop factor = 15.

Many Thanks to the wonderful faculty at Fairleigh Dickinson College of Nursing

http://www.fdu.edu/
If you would like to begin to prepare to study for the N.E.T today, you will be making a decision that will help your chances at being placed on the nursing school waiting list before the other testers.


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TEAS-ATT A&P Review

Written by kimmel52 on December 7, 2009 – 12:10 pm

Anatomy and physiology review for the NURSING ENTRANCE TEST, THE TEAS-ATT, OR THE HESI, require that the student apply the nursing process. However, no one tells that student that those are the type of questions that they will see on the NURSING ENTRANCE TEST. The best preparation is for the student to read about how the nursing process applies to real world nursing, and thus see how their knowledge of anatomy and physiology is used in the health care field.

Nursing care for allergies include some of the following; identifying the level of health care deficit, providing comfort care, encouraging self care, promoting comfort, assuring that the patients airway is patent and free of any obstruction, and that is no further injury to skin integrity caused by scratching. Nursing diagnoses that are applicable to those suffering from allergies can include but are not limited to; impaired skin integrity related to persistent scratching secondary to an allergic reaction, knowledge deficit related to treatment of allergy symptoms and insufficient air exchange related to congestion secondary to an allergic reaction. Notice that nursing care and nursing diagnoses are not medical diagnoses, such as the diagnoses of an allergy or an allergic response. Nurses who specialize in care for patients with allergies and asthma are able to assist with diagnosis, establishing nursing care objectives and providing treatment. Nurses help determine the cause and treatment of allergic reactions, administer medication and monitor the patients progress throughout the treatment program. Allergy nurses must have knowledge of signs and symptoms allergic reactions and are trained to provide emergency treatments such as, resuscitation, emergency intubation and administration of proper medications when necessary. Allergy nurses help patients understand their conditions, medications and self-care skills.
To learn more about how to better study for the A&P section on the HESI, TEAS TEST, or THE NURSING ENTRANCE TEST, just go to the Nurses Learning Center.


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