UPDATE!!

Wow, sorry it's been so long since I blogged. It's just been the last thing on my mind since exams finished, LOL.

I got a few of my results back a while a go:

Acute Care:
Assignment # 1: 62%
Assignment # 2: 92%
Practical Exam (Venepuncture): 100%!!
Total grade for Acute Care: 75 (B)

Pretty happy with that.

Community Nursing:
Group Assignment: 90%
Team oral presentation: 95%
Online quiz: 85%
Assignment # 1: 55% (everyone I know got this mark or lower . . . WTF??)
Assignment # 2: don't know
Total grade for Community Nursing: 69 (C) . . . why couldn't I get just one more point??? Then it would be B instead of a C. Oh well.

I haven't completed my clinical placement or my assignment (based on the placement) yet so I don't know what my grade is for that subject is and I can't even find out what mark I got for the exam worth 50%.

I'm leaving for Canberra at the end of this week, staying there for one month to do my mental health placement. I've actually been reading up in the last week or so - drug abuse, schizophrenia, self-harm, bi-polar etc.

Also enrolled in next year's subjects. I'm already half way through my course and this time next year I'll be finished, I'll be ready to get out there and start my career as a registered nurse! How time flies. It's wonderful to set goals and slowly see yourself achieving them.

2011 THIRD YEAR NURSING SUBJECTS:

Semester 1:
Complex Care Nursing
Nursing Older People
Professional Transition in Nursing

Semester 2:
Interactions in Nursing
Clinical Practice Consolidation
Managing Chronic Conditions

That's all for now. Will definitely be blogging more often this month while I'm on my placement. No doubt I will have some very interesting stories from the psych ward!

I got venepuncture!

Yay! I think I did pretty well, I hope so because it is worth 25%. Now just have Acute Care multiple choice exam to go. Only 30 questions and worth 15%.

Acute Care Practical Exam prep

Mental Health was not too bad, I think I definitely got at least three quarters of the answers right and the rest I made an educated guess. The most annoying thing about the exam was that quite a few questions were repeated and there were loads of typo and grammatical errors which they interrupted us at least 5 or 6 times during the exam to correct them. I don't think the exam was proofread until after it had been printed.

Anyway, that's out of the way now. For today's Acute Care Practical Skills exam I have to be prepared to perform and talk about these three skills: venepuncture, wound packing, and oxygen therapy. I will only do one skill in the exam but won't know which one it is until I get there.

To prepare I have done the following:
Reading:
• Oxygen therapy via nasal cannula or various masks
• Complex wounds – packing a wound
• Venipuncture
• Aseptic dressing technique
• Assessment of breathing
• Positioning a breathless patient
• Administering humidified oxygen
• Measuring peak expiratory flow rate
• Measuring pulse oximetry (oxygen saturation)

Youtube Videos:
• Oxygen therapy skills demonstration (20 minutes)
• Performing Venipuncture - taking blood (7 minutes)
• Wound Irrigation, Packing and dressing (7 minutes)

I also invited my (new) boyfriend around to practice venepuncture and wound packing procedure on him (just pretend of course, but using the actual equipment to build up my psychomotor skills), and he even gave me some constructive feedback. I hope I get to do venepuncture in the exam because of the three I think it's the most straight forward, uncomplicated and I've had quite a bit of practice doing it both in the labs with the fake arm, and on clinical placements.

Mental Health Exam Prep ctd

Reviewed all mental health drugs in the following categories:
• Antianxiety agents (benzodiazepines) – eg. Alprazolam a.k.a “Xanax”, Diazepam a.k.a “Valium” and Oxazepam a.k.a “Serapax”.
• Antidepressants – Tricyclic (eg. Amitriptyline a.k.a “Endep”), Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (eg. Escitalopram a.k.a “Lexapro”, Fluoxetine a.k.a “Prozac” and Sertraline a.k.a “Zoloft”), serotonin and noradrenaline reuptake inhibitors (eg. duloxetine a.k.a “Cymbalta” and Venlafaxine a.k.a “Efexor”), and atypical antidepressants (eg. Mirtazapine a.k.a “Avanza/Sol Tab”).
• Antipsychotics/Neuroleptics – eg. Carbamazepine, Chlorpromazine a.k.a “Largactil”, Clozapine, Olanzapine a.k.a “Zyprexa”, and Quetiapine a.k.a “Seroquel”.
• Sedatives – eg. Temazepam a.k.a “Normison”, Zopliclone a.k.a “Imovane”, and Zolpidem a.k.a “Stilnox / Ambien”

The examples are ones that I consider to be the most well known . . . how many have you heard of?

Read Australian Clinical Practice Guideline Summaries for:
• adult deliberate self-harm
• Suicidal thoughts and behaviours
• Depression
• Bipolar disorder
• Anorexia nervosa
• Schizophrenia
• Panic disorder and phobias

Then I did the short answer section of a past exam that a classmate emailed to me. Although this exam is open answer instead of multiple choice it’s a good indication of the types of questions that might come up in the exam.
1. List the components considered to comprise a comprehensive psychiatric assessment.
2. Name the key components of a mental status examination.
3. Name five risk factors that indicate increased risk of suicide.
4. With regard to schizophrenia name:
a. Three types of hallucination
b. Two types of delusional thinking
5. List five key signs of clinical depression.
6. List five key signs of bi-polar disorder in the acute phase of illness.
7. List four common side effects of anti-psychotic medications.
8. Name the five criteria for involuntary treatment as prescribed in the Mental Health Act:
9. What are the key elements of seclusion as described by the Mental Health Act.
10. List the forms of non medical psychological treatment used in the treatment for a person with a mental illness.
11. Name the three major themes identified by VIC HEALTH for priority action in Mental Health Promotion.
12. Within communication skills, what are the two types of questions utilised to elicit information from clients.

Mental Health Exam Prep

My first exam is for Mental Health Nursing at 9am this Wednesday. It's going to be 100 multiple choice questions and worth 50% of the total grade for the subject, so basically I'm just reviewing everything they've thrown at us in the form of lectures and reading. This is what I've covered in the last few days:

Lectures:
• The Nursing Considerations of a Patient with Mental Illness in the General Ward.
• Therapeutic Relationships
• Psychopharmacology
• Mental Status Examination
• Mini mental examination
• Mental Health Assessment
Reading:
• Procedure for making a request and recommendation for involuntary treatment as an inpatient or in the community under the Mental Health Act.
• Mental Health Assessment and Care Planning`
• Applying the recovery model of intervention
• Recovering from Chronic Mental Illness Guidelines
• National Practice Standards for the Mental Health Workforce
• National Aboriginal and Torres Straight Islander Health Survey Summary of Findings
• Cultural Considerations and Communication Techniques Guidelines for Providing Mental Health First Aid to an Aboriginal or Torres Strait Islander Person
• Anthropology in the Clinic: The Problem with Cultural Competency
• Metabolic Syndrome

Reading – Drug Use in Australia: Preventing Harm

I started reading this book just before I had my clinical placement in the detox centre and have found it really interesting and well-written. These are the chapters that I've read through so far:
• Psychological theories of drug use and dependence
• The Social Context of Drug Use
• Alcohol and Aboriginal Society Heavy Drinking and Allied Responses
• Women and Drugs
• Adolescent Substance Abuse
• Addressing Drug Problems: the case for harm minimisation
• The problem with grand theories of drug use – this chapter was about how society tends to villainise and stereotype drug users as sinners, sick people and social victims. Furthermore, a drug user’s socioeconomic status and physical appearance will determine how society and the justice system view them. For example, users who come from poor families, are unemployed, need to commit crimes to pay for drugs, or have sores on their skin get labelled as “junkies”, whereas users who are well-heeled (think Matthew Newton, Kate Moss, Lindsey Lohan and Ben Cousins) are merely people who “have some issues with drugs/alcohol” or are “troubled” and “need some time off to get help and deal with their demons”. Because of their beautiful appearances, high profile jobs and bank balances they can avoid criminal convictions and harsh labels, and instead they go to rehab centres which are extremely expensive and inaccessible to the average person. Similarly, kids from the poor side of town who drink and take drugs in the park or at the train station get called “nuisances” and “delinquents” wasting their lives, whereas rich kids who drink and take drugs at parties in posh homes are “party animals” just having a good time and letting off steam at the weekend (after studying so hard during the week). The reality is that drug users come from all walks of life, and have different reasons for using drugs. Some are addicted or use excessively which seriously affects their lives and those around them in a negative way, while others are social users who do not have any problems. Some are physically addicted, while others are only psychologically addicted (ie. Their mind really wants it but they’re not getting the shakes or feeling sick if they don’t have it). Some use every day while others wait till the weekend then binge, and even those people are not necessarily addicts, just like people who go out drinking every weekend, or who have a glass of wine or two with dinner every night are not necessarily alcoholics. All in all, broad generalisations and being quick to judge is dangerous and counter-effective to fixing the problem.

I also read two books that I found in my school library:
• The Truth about Heroin Addiction and Treatment
• Alcoholism and the Family

Detox Diary - Week 2

Day 6 - A client self-discharged after 3 days. We talked to her and tried to convince her to stay but she kept saying "I can't do it", and "I feel like I'm going crazy". Because she had already bonded with the other clients, we had a meeting with them after she left so they could talk about how they felt about her leaving.


Day 7 - A new client was admitted and he was clearly high on heroin but denied that he had just had some. It's not unusual for them to have one last hit before to ease their anxiety. Some tell you straight out that that's what they did, while others are ashamed or think they'll be judged negatively for doing that. Actually the reason the nursing staff need to know is because we need to monitor their withdrawal symptoms and planning their medication accordingly. He had no withdrawal symptoms, speech very slurred, very flat affect, about a 5 second delay when you ask him a question and pupils were not reacting to light (we shine a torch in their eyes). When someone has had narcotics, whether it's heroin, morphine or general anaesthesia, their pupils are very small and do not reacted to light. When we did his bag search (I get to live my border security fantasy or being a customs officer by doing bag searches when the clients come in), we found two used syringes in his backpack. It was a difficult and awkward admission, he seemed very negative and not sure about being in detox, and had no plans for when he got out.


Day 8 - slept through my alarm and was two hours late today . . . oops! luckily they said it was no problem. I offered to stay back to make up the hours but they said not to worry about it.


Day 9 - Led an afternoon discussion group on "mindfullness" - being mindful of your thoughts, words, behaviour and the effects they have on those around you, especially in this environment right now. The client who was admitted two days previously who was high on heroin when he came in, is now coming out of his shell, we are seeing more of his personality, sense of humour and other good qualities he has. He says he feels "straight" and really good, and that he is really enjoying being here . . what a turnaround! Actually it is very heartwarming to see that by the end of their stay, most clients don't want to leave because they are so happy with where they are at, in a safe, supportive, happy, healthy, drug free environment. However, they have to move on and start rebuilding their life. Most go to assited living/rehab facilities with a plan to stay for three months or more. The places they go to have activities to keep them busy, regular/daily AA and NA meetings, meditation, housework and other life skills they have to do, and counselling. They are allowed to leave, but they get random urine testing and if they have been drinking or using drugs they're out.


Day 10 - watched a documentary about recovering heroin addicts on the methadone program. After watching this I am totally for this program. Not everyone realises this but being on the methadone (or suboxone) program means these addicts have to go to the same pharmacy every day for their dose, and it does not make them feel 'high' or like they have had 'free heroin'. The drug does affect the same opiate receptors but it just makes them feel 'normal' or 'straight' and not craving heroin. Some addicts do use heroin on top of their methadone because psychologically they want the 'rush', however physically they do not need it. Being on methadone is expensive, about $150 per month, and it is not covered by PBS. However, it is a lot cheaper than having a daily heroin addiction which can cost up to $100 a day for long-term users, and most of them would have to commit crimes such as burglary or prostitution to find this kind of money.

Also took a couple of clients clothes shopping at the Salvation Army store. Some clients are homeless or come to detox with just the clothes they are wearing. If they have no money they can get a voucher.

The last thing that happened today is I am going to be a Salvation Army volunteer! I will be doing a one hour meditation and relaxation techniques instruction and discussion group every week in the next month's activities program. I will most probably doing it on a week night. How exciting! I am really happy about this.

Detox Diary continued . . .

Day 4 - admitted two new clients, a 24 year old girl, and a 29 year old guy. Asked them about their intake for the last two weeks and what their goals are after detox. For most clients it seems their goal is to work, because they've lost their jobs due to their drinking/drug use. The guy was really struggling with withdrawal and wasn't sure if spending a week in detox was really what he wanted. The next day I he was already gone, decided he couldn't handle it. I offered the group a meditation session before bed, seeing as they seemed to like it. I advertised it as "Hardcore Relaxation", hahaha. It was a heart chakra meditation about unconditional love, followed by a discussion.

Day 5 - Found out that the guy who was admitted yesterday self-discharged, couldn't handle it, wanted to drink. Spent about an hour comforting the girl who admitted yesterday who was upset about her domestic situation (family were being evicted) and desperately wanted to leave so she could help them and also so she could drink away the worries. We convinced her the best thing she could do for her situation is stay right where she is and thankfully she did. The clients requested another guided meditation before bed, so this time I did "Detoxifying Meditation".

Weekend - spent all weekend researching and writing my final assignment for this year. It's for my Community Nursing subject and is about Secondary School Nursing. I chose that topic because I felt it was something I can relate to and write about. The essay was 1200 and I wrote it in one day. I thought I would be able to submit it electronically, but I found out late last night that it had to be handed in hard copy at uni. So today after finishing at 3:30 I came home, proof read it one more time, printed it and drove to uni just in time to hand it in at 4:55pm (due 5pm). Phew!

Detox Diary

Day 1: Arrived at detox centre and met the Registered nurse on duty and the Drug and Alcohol support worker. Nursing handover then I had a tour of the facility. It's two levels, boys upstairs and girls downstairs, there's a living room with a TV and library, fitness room, kitchen, ping pong table and outdoor area mainly used for smoking. It's located just near Australia's largest brewery, but luckily the clients aren't allowed to leave by themselves.

Each day they have activities to participate in including daily trip to the local pool to swim, sit in the spa or have a sauna. In the afternoon there are meetings with social workers, AA or NA meetings and housework chores to do (there's a roster). The patients get everything for free - food, accommodation, medicine - but they have to stick to the rules, participate in the activities and be respectful, otherwise they're out.

The patients have to prepare the dinners for everyone. It's good food and staff can eat it too so I've been getting free meals too. Most of them are really malnourished and need a good feed. I've been getting to know about them as much as I can and most of them are friendly and talkative.

In the evening everyone watched a short DVD about the science of relapse (how the brain works when someone is an addict) followed by a discussion.

Day 2: I started taking on more of the role of the RN. I did all the daily OBS and gave out evening and night medications. I also gave my first intra-muscular injection (a Vitamin B injection in the bum cheek). Also started assessing the patient's withdrawal symptoms. Attended my first AA meeting.

There are only about 12 patients and most of them are withdrawing from alcohol. It can actually be really dangerous (as well as very difficult) if they try to do it on their own, they can have a seizure and die, so it needs to be done under medical supervision so they can use diazepam (Valium) to manage their symptoms and also get 24 hour emotional support and reassurance when they're feeling frustrated. I've seen a few very frustrated patients already.

There are also a few who are withdrawing from opioids such as heroin and painkillers. They take a different drug that helps ease their withdrawal symptoms and reduce psychological cravings.

Most of the patients have a bed in rehab to go to after detox, but some just go back home. The patients are a mix - aged about 25 - 50 on average, a few of them are aboriginal, some of them have been in and out of detox centres, rehabs, jail and boarding houses their whole lives, and others have had more 'normal' lives that have recently fallen apart due to their drinking/drug use. One (a middle aged woman) recently relapsed "because St Kilda lost the grand final".

Day 3: Today I did two new admissions. I had to read through all the rules and get them to agree and sign a contract. Then I did an assessment of their drug and alcohol use in the last two weeks, their medical, psychological and social situation, and what their goals are. Each new patient gets a bum injection of vitamin B for the first 3 days after they arrive. I also made some calls for a patient who has Hep C, who needs to find treatment and support services in his area. In the evening there was a relaxation/meditation session which I took part in. Everyone was really enthusiastic about it and thought it was "awesome". They obviously don't do enough of that.

So far I'm really enjoying this placement. I'm the only student and there are only two staff members so I already feel like part of the team and the patients all know me by name. I don't even have to wear my uniform, it's very casual.

Placement finished, two more to go

My hospital placement is over now. The last two days I looked after a patient who had a flesh eating bug that gave her massive sores on her legs that looked a lot like pressure wounds. I got to do the dressings each day for her which involved washing out the wound using sterile technique then packing it with gauze again and re-dressing it. It took about 45 minutes each time. The wounds looked a lot like this and each one was about twice the size of a tennis ball and quite deep. There was a lot of yucky yellow stuff in it as well.


Because the bug was resistant to all antibiotics and contagious she was in an isolated room and I had to wear a disposable gown every time I went in. The other patient I had had TB and anyone who went into his room had to wear a mask. He was also a drug addict and was very rude and abusive. He always asked for more morphine and said his pain was 10 out of 10 even though 5 minutes before he was walking around and going downstairs for a cigarette. He even wanted "lots of morphine to take home" when he was discharged. In those cases, I just got the doctor to speak to him about it because he was just bossing me around. It didn't bother me though. You can't take these things personally, and it's good preparation for my next placement - drug and alcohol detox.

On the last day my buddy wanted to switch roles with me, so I played the role of the RN and he was my buddy. I had to make a plan for the whole shift for 4 patients, delegate tasks to my "buddy" and decide what to do when something unexpected happened. Nothing too exciting happened but it was a good exercise to gain confidence and I had the chance to liaise directly with the allied health staff (doctors/social workers etc) to plan patient care. We all had to bring something as a gift for the staff on our ward to say thankyou. I brought strawberries and a bag of lemons (from my garden) and they were a big hit. We got to leave a bit early and our whole group went out for dinner and drinks at one of the nearby pubs on Brunswick St.

Yesterday I went over to my nan's house again to watch the football grand final (again, because it was a draw last week). Collingwood won so a few drinks were had and I stayed for dinner. Today I've just been cleaning my house and doing my assignment which is due tomorrow and I've just finished. It was about patient care following a blood transfusion allergic reaction.

This week I have off but I have quite a bit planned: Monday - yoga, return library books, massage; Tuesday - hairdresser, take manny to vet for vaccinations; Wednesday - Le Bop dance class; Thursday - teaching; Friday - teaching.

Only 2 days left!

My clinical placement is just flying! It has been going really well, I'm enjoying it so much. All the nurses and doctors in the ward I am in are just so friendly and helpful. The patients have all been really different and I've been learning a lot about the pathophysiologies of their illnesses as well as getting the chance to practise new skills.

Goals that I've already achieved are: taking blood, giving showers/baths to patients with limited mobility (like stroke patients), taking out drainage tubes, performing an ECG, transfering a patient using a hoist, PEG tube feeding, urinary catheter removal, lots and lots of injections, nursing care planning and time management, and increasing my drug knowledge.

Every day after handover and before I give the 8:00am meds, I make a timeline plan for the whole day for the patients I am helping my buddy look after (usually 4). Then I look up all the drugs the patients are on (if I'm not familiar with the drug), and write it down in my notebook. So far I've familiarised myself with 58 new drugs!

The wide variety of patients this week have included: an Indonesian student - so got to use my language skills with him of course(actually about a quarter of the patients are international or have a low level of English), a Collingwood supporter, patient with bipolar disorder who can be really lovely one minute and abusive the next, patient with incontinance due to a stroke and who required full nursing care including spoon feeding, and young guy with dystonia. Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. He can't swallow so is fed through a PEG tub in his stomach, and he can't talk either. Unfortunately there is no cure but his symptoms are being treated with a special drug that had to be ordered from the US and costs over $1000.



Another interesting thing that I had never heard of before but have seen a lot of on this placement is the artereovenous fistula that renal dialysis patients have on their arm for a good strong, long term, access point to their blood (for the heamodyalis). One of the nurse's jobs is to feel it and listen to it with the stethescope to make sure it's working properly. They come in different shapes and sizes but look to me like a little mountain, or range of mountains, under the skin. When you feel it, the pulse is really strong. Actually you can even see it pulsating, and when you listen with the stethescope it makes a whooshing sound.



Today was my last early shift, so tomorrow I get a sleep in - YAY! and I can stay up late and watch TV - YAY AGAIN!

Fantastic first week!

My first week of placement has flown fast and been really good. I've had a different nurse buddy everyday and they have all been so nice and good teachers and gave excellent feedback about me to my clinical educator, so I passed the first week assessment with flying colours.

I've had a really interesting mix of patients including: 3 different kidney transplant patients at different stages, an HIV positive African refugee, alcohol and drug addicts who are going through withdrawal, suicide risk patients, and stroke patients.

Some of skills I've had a chance to practise are: lots of injections (including morphine), removing drainage tubes and urinary cathether (on a male), bed baths and showers, and sterile wound dressings.

Looking forward to next week but nice to have a break this weekend. Today I'm going over to my nan's house to watch the AFL grand final with her - GO PIES! Tomorrow I'll do yoga in the morning and then going to a baby shower for a friend from work in the afternoon.

Time to update my blog

I have been pretty absent from this blog for the past month, so apologies if you have been checking it for updates . . . but this week I started my clinical placement! so now I have things to write about. I am at the same hospital as last semester but this time I'm on a different ward and as far as I know I'll be on the same ward for the whole two weeks. It's the renal, neurology and stroke ward so very different patients from my last placement.

Yesterday we just had orientation and because I've been at this hospital before I knew most of the stuff already. Luckily in my group there are two other girls that I'm already friends with and our clinical educator is really really nice.

Today with my buddy nurse (who was also really really nice, so hopefully I will get to work with her again) I looked after 3 patients who have had strokes and one who has just had a kidney transplant after being on dialysis for three years. I think stroke patients are quite interesting because the stroke can affect people in different parts of their brain or body. For example, for some it is more their psychomotor skills that are reduced, while others could be affected in the language part of their brain which makes having a conversation with them confusing, for both parties.

Within the first hour, I gave one patient a shower and did an injection, as well as doing the standard morning vital signs obs, medications, blood sugar level testing and so on. Most of the patients have an indwelling urinary catheter and their fluid intake and output needs to be measured. For the kidney transplantee that needs to be done hourly. Also, looked up lots of medications that I didn't know (that the patients are on)

In the afternoon, there was an education session for graduate (first year) nurses about tracheostomy care and I went along to that which was very interesting. We haven't studied that at uni yet but it's a good opportunity to learn because the teaching is a lot better and easier to absorb in the clinical setting than at uni.

My big blunder today (well, not that big but stressful at the time) was that I failed to get up early. I was so organised, went to bed at 9:30 (after taking a sleeping tablet at 8:30), set two alarms for 5am with the plan of having a full shower (ie, including hair wash), making my lunch and being at the hospital by 6:45am for 7:00am start. But no, I completely slept through the alarm and woke up at 6:30!!! I literally put on my uniform, quickly fed manny, ran out the door and to the train station. I arrived 7:10 which is pretty fast but I didn't feel very 'fresh' when I arrived. Ended up spending $20 throughout the day on expensive coffee and food. Oh well. Hopefully will do better tomorrow.

2 assignments down, 2 to go

Finally finished the two assignments I have been working on this week. I had forgotten how long it can take to write an essay and how many times it needs to be re-checked and edited.

The first one was a 1000 word scenario for Acute Care about a patient having an adverse reaction to a blood transfusion. That one is due today and I just submitted it online. The second one is a 2000 word essay about community health needs assessment. I've managed to get it down to the right amount of words, and now I just need to read over it again a couple of times over the weekend to check for errors. It's worth 40% so I hope I do well on it. I'll hand that in next week on the due date.

Now I have just one more week "off" before my acute hospital placement. I've got two more assignments of 1000 words each that I haven't even looked at yet. Next week I'll try to get as much of those done as possible so I don't have to do them while I'm on placement. If I don't get them finished though there's no need to stress as they're not due for another month or so.

Quite bored

I haven't posted much on my blog lately because there hasn't been much going on. I've finished uni classes. I think my group presentations and assignments in the last week went really well but I haven't found out the results of those yet. I got 17/20 for the Community Nursing Test which was worth 20%, and now I'm just working on assignments and reading to prepare for my placements.

The two assignments I'm currently working on are a 2000 word essay about Community Health Needs Assessment and a 1000 word care plan about a blood transfusion (Acute Care). When I've done those I've got two more 1000 word assignments to do as well which I'd like to get done before my clinical placements start in two weeks from now.

I've also been adding to my reading some books about drug and alcohol (and other addictions, like gambling), to learn more before I go on my community placement.

So this is a summary of my learning for the last week or so:

Lectures:
• Nutritional Disorders
• Applying the Recovery Model of Intervention in Mental Health Care
• The Role of the Mental Health Nurse
• Analyse the impact of mental illness on the individual, their families and communities
• Mental Health Act 1986: relating specific mental health legislation to the provision of mental health care
• Mental Health Assessment and Treatment Planning
• Carer Perspective – this lecture was given by the mother of a paranoid schizophrenic and she talked about her experiences caring for her son throughout his life.
Reading
• Addictive and Risky Behaviours: Drugs, Alcohol, Inhalant Abuse, Smoking, Eating Disorders, Self Mutilation and Internet.
• The User: The truth about drugs and why people take them – this book is made up of factual stuff about drugs as well as interviews with recreational users, dependent users, parents, police officers and so on to get different perspectives on drug use.
• Drugs in Society: A History
• The Epidemiology of Australian Drug Use
• Ulcerative Colitis
• Peptic Ulcer Disease
• Crohn’s Disease

Tonight I'm going to a 30th birthday party of one of my primary school friends, looking forward to catching up with old Darwin friends, and according to the invitation "all alcohol will be provided", so should be a lot of fun, LOL.

What I did this week . . .

I'm really happy with how much I got done this week. I worked at my teaching job on Thursday and Friday and didn't do any study on those days so all of this was done on Monday, Tuesday, Wednesday and today - Saturday. I've now finished all the readings and lectures for Community Nursing, which I've been focusing on to prepare for the quiz. I've just done it and I'm pretty sure I will get a decent score. This coming week I have two oral presentations to do with my team (on Tuesday and Wednesday) and on Monday we have a 4 hour pre-clinical placement lab session. This week will be the last week of classes, and then it's just assignments, online lectures, clinical placements, and then exams. Once I've completed my assignments for Community Nursing and Acute Care (I have 4 to do), I will focus on the Mental Health content. I've hardly done anything for this subject so far because the assessment is 50% written exam (in November) and then 50% assignment based on my clinical placement which is not till January.

What I got done this week:

Online modules:
• Community Nursing Quiz (worth 20% of my final mark)
Reading
• Community Assessment for Health
• Wound Management
• Wound Care Products
• Wound Identification
• The Ottawa Charter for Health Promotion
• Screening, risk assessment, immunisation and surveillance
Lectures:
• Wound Healing Physiology – Acute Wounds
• Wound Healing Physiology – Chronic Wounds
• Wound Healing and Assessment
• Planning, Implementation and Evaluation in Health Promotion
• Health Education Promotion
• Community Nursing in Australia in this Era
Homework:
• Project Campaign Planning Sheet
• Team Education Session Plan and Evaluation Tool (worth 10%)
• Essay – Community Needs Health Assessment (worth 40%, 2000 words and about half done)
Videos:
• Wound Dressings – Topical Agents, Films, Foams, Hydrocolloids, Alginates, Cadexomer Iodine, Hydroactives, Hydrogels, Silver Dressings, Bandages.

End of week update

This is what I got done this weekend:

Online modules:
• Basic ECG Interpretation – I got 100% on this, although it was open book and the answers were pretty easy to find. This is actually a complicated skill that I don’t really understand that well yet.
Reading
• Spirometry in Primary Care
• Infection Control Standard Precautions
• Guidelines for the management of iron deficiency anaemia
• Assessing common endocrine abnormalities
• Preparing the Patient for Colostomy Care
• Assessment of Patient for Pressure Ulcer: Risk and Skin Asseessment
• Reviewing health promotion in nursing education
• Treating Pressure Ulcers
• Applying Dressing: Dry or Wet-to-Dry and Transparent
• Wound Vacuum assisted closure
Lectures:
• Effects of Immobility on the Medical Patient
• The Nursing Considerations of a Patient with Mental Illness in the General Ward
• Respiratory Disorders – Asthma and Pneumonia
Videos:
• Living with Asthma (Child)

This week I plan to work on assignments as much as I can. I have two individual essays due in the next few weeks and also two group oral presentations (both next week) to prepare for and a group assignment. I'm going to be working on Thursday and Friday so I probably won't have as much time get a lot of reading done like I have been doing on my days off, so I'm going to make the assignments my priority.

Wednesday

Lectures:
• Respiratory Conditions – COPD
• Community Health Needs Assessment
Reading
• Sleep and Sleep Disorders
• Patient Education
• Cor Pulmonale (Right-sided Heart Failure)
• Treatment of Rheumatoid Arthritis
• Spirometry
• Transfusion Basics: Prescribing Blood
• Chronic Obstructive Pulmonary Disorder
Videos:
• Living with COPD
• Teaching a Patient to use a Spirometer
Homework:
• General Patient Education Checklist
• Community Education Session Planning Sheet

Respiratory Disease

Monday - today's workshop and lab today was about Chronic Obstructive Pulmonary Disorder (COPD), causes, symptoms, how it is assessed and treated and so on. In the lab we practised using a spirometer (measures lung capacity for inhalation), peak flow meter for exhalation and pulse oximetry. We measured our own stats, I did very well on inhalation – got up to the max, and we also had a go at measuring our pulses and oxygen levels before and straight after exercise (running up and down the stairs.


I also met with my team for about an hour and we discussed what we are going to do for our group assignment for Community Nursing. We have decided to do an education project which is aimed at 12-15 year olds and can be presented in schools to raise their awareness and motivation regarding health behaviours, specifically to prevent obesity and the related morbidities like cardiovascular disease and diabetes. My section will focus on the importance of getting the right amount of sleep and stress management. Then we will also do an oral presentation (aimed at this audience) about diet.

Productive weekend

The Mornington trip was great, we were blessed with nice weather! We did lots of tasting of local produce - chocolate, cheese, beer etc. I forgot I was supposed to be practising my bahasa for my most of the day so on the drive home we made a strict rule of no English, LOL. Here are a couple of pics.



Other than that I got quite a bit done this weekend, catching up on reading and online lectures. Here's a summary:
Reading:
• Mental Health Medication Story (Education Tool for Indigenous Clients)
• Mental Health Nursing Subject Guide
• The Evolution of Ethics for Community Practice
• Context and Roles in Community Nursing Practice
• Nutrition and Nutritional Disorders
Lectures:
• Introduction to Mental Health Nursing
• Mental Health Nursing: Indigenous Context – Cultural Considerations
• Mental Health Nursing: Indigenous Context – Clinical Assessment
• Primary Health Care: Introduction
• Primary Health Care and Community Nursing
Videos:
• Managing your Colostomy
• Patient Arriving at Triage & Handover
• Emergency Nurse Patient Assessment on Arrival
• Patient’s Experiences with Scleroderma

Mid Week Update

This is what I covered today:

Online module:
• Stoma Care

Reading:
• Legal Principles in Nursing
• Stoma Patient Education, Care & Assessment , and Post-operative Care
• Specimen Collection: Wound swab, Urine specimen (Mid-stream Urethral Catheter), Urine specimen (Mid-stream male & female), Faecal specimen
• Obtaining Informed Consent for Blood & Blood Products
• Peristomal Skin Complications: Prevention and Management

Videos:
• Sterile Urine Specimen sample
• Nursing Management of Diverticulitis
• Finished watching BBC series The Human Body (on DVD) to expand and consolidate my anatomy and physiology knowledge. I quite enjoyed this series, except watching the last episode made me a bit teary because it was about the end of life and the man they showed dying was very sweet, I really liked him :-(.

On the weekend I need to go through quite a few of the online lectures. Tomorrow though, I am having a day off from studying and am going down to Mornington Peninsula with an Indonesian exchange student from my course, to do some sightseeing, food and wine tasting, hedge-maze exploring and so on. Hope the weather's good (for her), although it doesn't really matter for me if it's not. I'm just looking forward to going on a day trip and hanging out with my cool new Indonesian nursing friend so I can practise my Bahasa!

Clinical Placements

On Friday I found out my clinical placements for this semester. First I'll be doing my second Acute 2 week placement at the same hospital in Melbourne I did it at last semester. That's good news. Then I will have a week off, then my 2 week Community Nursing Placement which will be in St Kilda at an organisation which offers "a distinctive programme for the treatment of persons with alcohol, drug, and/or other dependencies, and believes in a holistic approach to recovery. A combination of individual, group and/or family counselling, spiritual awareness, life skills training, and staff role modelling are used to encourage the client to make significant life changing decisions." That should definitely be interesting too. My Mental Health 4 week placement won't be until January and I'll be doing it in Canberra.
So I have a lot more clinical experience coming up. For now though, I'm trying to absorb lots of new learning.


Monday Summary:

Online modules:
• Infection Control
Videos:
• Ostomy pouching systems
Lectures:
• Nexus between individuals & community health needs assessment
• Mental Health Nursing: Indigenous Context – Indigenous Health Overview
• Mental Health Nursing: Indigenous Context – Mental Health
Reading:
• The Healthcare Delivery System
• Community Nursing
Homework:
• Best practice for Treating a Hypoglycaemic Episode

First Week Learning Summary

Lectures:
• Orientation to Acute Care B
• Anaemia and Blood Transfusions
• Law and Ethics related to Blood Transfusions
• Endocrine System & Disorders (Diabetes)

Reading:
• Community-based Nursing Vs Community Health Nursing: What Does it all Mean?
• Reconciling the differences between health promotion in nursing and ‘general’ health promotion
• The concept of population health within the nursing profession
• Pressure Ulcers
• Health & Wellness
• Diabetes – signs, symptoms, causes, management
• Anaemia – signs, symptoms, causes, treatment

Homework:
• Care plan for pressure ulcer risk management

Online modules:
• Blood Safety Certificate
• Venepuncture (Taking a blood sample)

Back to school

I am pleased to announce my results for last semester which I found out this morning:

Acute Care 82 A
Clinical Assessment & Decisions 73 B
Medications 64 C

They are pretty much what I was expecting/hoping for. Actually the Medications one is higher than I thought it would be because not only did I find the theory exam difficult, and my skills assessment (nebuliser) was something I hadn't done, but also my team got a very low grade (a fail) for our assignment and I had to fight hard to get it re-marked. Then when they re-marked it it should have been a pass but they added it up wrong and it was still a fail, although a higher fail than before. Very stressful. Anyway I'm just glad I didn't get a D for that subject because a D just looks and feels Disappointing and Depressing. I also passed the drug calculations exam with 100% on my first attempt! Half of the students in the subject did not pass and will get two more chances at it. If they don't get 100% they will fail the subject, and Medications is a pre-requisite for all the subjects in second semester, so they would have to differ/extend their studies. I know those students are stressing big time right now, which is tough because it's just the start of a new semester and we're already getting a lot of new learning thrown at us.

So, I'm feeling pretty chuffed and today I rewarded myself with two new pairs of earrings and two scarves from Sportsgirl. I also did my tax return today and I'm getting a BIG return which will ease my financial stress significantly.

Also, more good news, because of the strong fight and protest by some of the students (including me) against the faculty choosing students for month long clinical placements interstate "at random" because not enough were volunteering, the faculty have changed their policy and now they have told us "no one will be forced to go interstate unless they specifically volunteer to go a certain place". I will find out where my placements are on Friday. There are 2 weeks for Acute Care B, 2 weeks for Community Nursing, and 4 weeks for Mental Health. The interstate/rural places I volunteered for were Canberra and Mornington Peninsula, because I have free accommodation with family in those two places and can take my cat with me, so I hope I get at least one of those. It will be like a little holiday, and change of scene.

This week in Acute Care we have been doing the following skills:
- Taking blood (we practised on a fake arm with fake blood which was really fun, I did it over and over until I was satisfied that I'd done it perfectly, you can do that when it's a fake arm, LOL)
- Doing a blood transfusion

The patient scenario is to do with anaemia, gastric ulcer and diabetes. I started reading up on those topics as well as the blood stuff while I was still on holiday because I didn't get back till Sunday and my first class was 9am on Monday.

What am I going to change about my learning methods this semester from last semester?

Firstly, I'm not going to rely so much on my tutors and the lectures to learn the content. I found that textbooks (from the library) explain how to perform skills a lot better than the teachers at uni. However, it's good to watch them do it but the actual explanation is better in books. Some teachers are a lot better than others and some are a lot worse than others. I can't choose which teachers I have so if I get a bad one, rather than be disappointed and complain, I just need to be more resourceful to learn what I need to know. I need to come to skills lab sessions having ALREADY read up on and watched online videos on how to perform the skills. I can't expect to learn it from scratch in the lab session. Skills labs are my ONLY opportunity to practise clinical skills with a registered nurse present before I go out on clinical placement. So this week I watched a couple of videos on how to take blood both from a real person and from the fake arm, and read up on all the steps, so I felt really prepared when I got there and already feel satisfied that I've got that skill down. Huge difference from last semester when I often felt I didn't know what I was doing.

As for prioritising when things get really busy and overwhelming, all lectures are online and can therefore be viewed and reviewed anytime during the semester. The most important thing for the next 5 weeks will be getting the most out of my lab sessions (skills practise) and making sure I'm on the right track with my assignments. Actually we only have labs in Acute Care and the other two subjects are theory/discussion - there are no new clinical skills.

For assignments I need to ask questions on the online discussion board which the subject co-ordinators will answer, and not rely so much on my own, my classmates' or my tutor's interpretation of how to do the assignment. I also need to use more academic resources (ie. journal articles) in my assignments and perfect my APA referencing style. I might have to go to a workshop or something. Actually I have one of the same tutors this term (one I like) and she offered to look over our first drafts. She said she is very anal about APA referencing so she will hopefully be a good person to help me with that.

This is a long blog post and that's pretty much all I have to say right now so I'll end it here. :-)

Favourite words

I mentioned in a previous post that I have a vocab book full of words I had to look up this semester related to my studies. Here are some of my favourites:

exudate - oozing fluid from a wound

tangentiality - a mild though disorder characterised by never getting to the point.

infarction - death of organ tissue that occurs when the artery carrying its blood supply is obstructed by a clot.

paralytic ileus - when the bowels aren't moving and there are no bowel sounds present.

diaphoresis - excessive sweating.

emboli - a clot that travels from one part of the body to another.

renal calculi - kidney stones.

oliguria - lack of urine.

diuresis - excessive urination.

enuresis - urinary incontinence, bedwetting.

dysuria - pain during urination.

hirsutism - excessively coarse and pigmented body and facial hair on a woman, caused by hyperandrogenism.

pruritis - itching.

striae - stretch marks.

ptosis - drooping of the upper eyelid due to a neurological disorder (Paris Hilton has this, LOL)

bruxism - habitual teeth grinding that often occurs while sleeping.

petechiae - bruising.

polydipsia - abnormal intense thirst which leads to drinking large amounts of fluid (a symptom of diabetes)

polyphagia - gluttonous excessive eating.

thrombocytopenia - reduction in the number of platelets in the blood, causing bleeding into the skin, spontaneous bruising and prolonged bleeding.

colostrum - breast milk.

expressive aphasia - unable to speak.

apnoeic - not breathing.

rhinorrhea - runny nose.

cebrospinal rhinorrhea - when cerebrospinal fluid (from the brain) leaks out of the nose.

I think one of the reasons there are so many latin words and acronyms in the health care industry is so the patients don't know what the doctors are talking about and they can feel superior, LOL. As nurses though, we need to know how to explain things to the patients in plain English.

2 exams to go!

Yesterday's Actue Care exam was much easier than I was expecting. It was only 30 multiple choice questions and I was pretty certain for about 70% of them. The rest I made an educated guess. Nearly everyone left half an hour early! Today's pharmacology exam was very hard. 100 multiple choice questions, all very wordy and complicated, a few of them asking about drugs I have never even heard of (and I reviewed every drug we learned about in our lectures and case studies). I was certain for at least half of my answers, others I used "deductive reasoning", and few I just had to guess at random.

Tomorrow's exam is Clinical Assessment. There are a lot of different body systems to study but I'm concentrating mostly on the heart because it's so complicated and confusing to me, interpreting the charts and knowing the difference between all the different heart problems. Here's an example:

Mr Smith is diagnosed with an inferior myocardial infarction (heart attack). Which cardiac artery is usually affected with this infarction site?

a. Circumflex artery
b. Left anterior artery
c. Right coronary artery
d. Right coronary artery or dominant distal left circumflex

Answer: D

What part of the heart is affected with an inferior myocardial infarction ?:

Answer: Base of the left ventricle.

What lab study is most specific for acute myocardial infarction?

a. elevated sedimentation rate
b. elevated blood sugar
c. elevated levels of creatine kinase - MB
d. elevated levels of creatine kinase - BB

Answer: C (it's an enzyme released by the cardiac muscle)

Exam marathon

Last week of exams. I have one everyday this week: Today - Acute Care, Tomorrow - Clinical Assessment, Wednesday - Pharmacology, Thursday - Drug Calculations. I have to get 100% on that one to pass the subject and there are up to three attempts. actually that's the one I'm least worried about because it's easy to access practice exams and the calculations are pretty easy. For the others there are no practice exams available (not fair!) and they just say study the lecture material. But there is so much! I've just been rereading it all hoping I absorb whatever I need to know. At least they're multiple choice. Ugh! Can't wait till Thursday when these exams will be over - O.V.A.H!!!

SLACKER!

Don't let the title of this post make you think I haven't been studying, I have. But I haven't updated my blog in a while. Here's what stage I'm at now:

Last Tuesday I had my drug administration exam. I got NEBULISER! The only one I haven't actually done before. Thank God I studied it and watched the youtube video on the morning of the exam. I didn't feel too confident going in and got a bit flustered during it because I got put off when the examiner asked me questions like "why are you doing that?". I couldn't tell by her tone if she was hinting that I was doing something wrong or if it was part of the exam and she just wanted me to explain the rationale of what I was doing. In hindsight, I think it was the latter. She said she could see that I was a bit panicky and I told her it was because I hadn't done nebuliser before. She said everyone who got nebuliser said the same thing and that some students didn't even know what it was or have any idea how to do it. She assured me that I did ok. I think that experience motivated me to study harder for my next exam (Clinical Assessment) which is tomorrow.

I went in on Friday and acted as the patient for my classmate's exam so I got a sneak peek of how the exam is and what questions they ask. Since then I've been reading and preparing all my cue cards for that exam. There are so many - these are the topics I could have to demonstrate:
• Cardiovascular assessment
• Abdominal assessment
• Musculoskeletal assessment
• Integumentary system assessment (hair, skin and nails)
• Mental status assessment
• Neurological assessment
• Perform an Electrocardiogram and explain its purpose
• Explain anatomy of the ear and do an ear examination using an otoscope
• Explain anatomy of the eye and do an eye examination using an opthalmascope
• Perform a blood sugar test and explain its purpose

I'll have to do two of these on the day but I won't know which until I get there, so I have to be prepared for anything, as I learned in my last exam.

Neck update: My osteopath appointment helped my neck a lot. I got an adjustment of both my neck and spine. I have a follow up appointment today.

Drug Administration Exam

Today this afternoon I have my drug administration exam which is worth 45%. I could be assessed on giving an injection (subcutaneous or intramuscular), nebuliser (eg. for asthma), topical (eg ointment or patch), ear/eye drops or oral drugs. I've been practising preparing injections, and I had lots of practise with oral drugs and drops on placement. The only one I'm nervous about getting is nebuliser because I haven't done it before. So this morning I watched some videos on Youtube that demonstrate it step by step. This exam includes reading time to look up the relevant drugs and check for type of drugs, actions, side effects, normal doses, nursing precautions and follow up care. In the real world you would also do this before administering any drug.

On the weekend I went to uni and met up with a classmate to practise focused health assessments: neurological, cardiovascular, respiratory, elimination, musculoskeletal, integumentary, and mental status. We also compared cue cards which we can use in the exam. Her exam is this Friday and I am her patient, and then next Tuesday I have my exam and she is my patient. We have to organise our own patient for the exam.

1 exam down, 6 to go

I think my exam this afternoon went really well. It only took 15 minutes and my examiner was one of the (nice) lab teachers I had this semester. The skill I had to demonstrate was IV Therapy. Luckily this is the one I've had the most practice at because I had to do it with patients nearly every day on clinical placement. The other two skills I had only practised in the lab. After the exam I looked over the checklist of things you have to do and I'm pretty sure I did everything.

After, I went to Safeway and Target to buy a few things and I'm going to spend the rest of the day relaxing. My next exam is Drug Administration Skills next Tuesday and I'm also going into uni for a few hours on Saturday to practise Clinical Assessment skills. I'll start preparing for those tomorrow.

My back and neck are feeling really sore at the moment. I have a massage booked for next week which should sort the back out but my neck feels like it's out of alignment because whenever I turn or flex my neck it hurts and I feel like I don't have my usual range of motion. This is particularly annoying when I'm driving and it's been bothering me for about a week already. So this morning I booked a short session with an osteopath (at the same place I get my massage) on Thursday morning. I may need a neck adjustment which I haven't had in about five years. Hopefully, it will get rid of the problem.

Assignment finished

Finally finished my assignment! I'm about to go to uni to hand it in. Overall I think what I've done is good but I won't be surprised if I get marked down on a few things. We were supposed to use at least 10 peer reviewed journal articles on whatever topic we chose (mine is arteriovenous malformation and tracheostomy care). However I only used about 6 and couldn't even find 10 journal articles. I think AVM is a bit of an obscure topic because it is very rare. It's also frustrating that some of the articles online cost money to access - like $45. I'm going to make it one of my goals next term to get some help with research skills because it's very different in health sciences than it is for arts or law. I'm also quite a bit over the word limit so I didn't write how many words I have on the cover page. Hopefully they won't notice. But it must be nearly impossible to include everything they ask for and stay within the word limit.

After I drop off the assignment I'm going to study for tomorrow's exam. It's Acute Care skills which means I will have to demonstrate and explain one of the following skills, but won't know which one until I get there:
• Setting up an IV line
• Nasogastric intubation
• Aseptic wound care technique and suture removal

Practise session

Today I was at uni from 10 till 3 practising clinical skills with a couple of classmates. We did: aseptic technique (took a couple of dressing packs to practise more at home too), nasogastric tube insertion, injections (just on the sponge, not on each other!), setting up and administering IV fluids, and removing stitches and staples. I feel pretty confident about this exam now, in terms of clinical psychomotor skills. Will practise aseptic technique dressing pack a couple more times before the exam on Tuesday and will also do some reading about all the theory behind everything so I can explain stuff in more detail in the exam while I'm doing it.

We also got two of our scores back for group assignments. We got 78.5% for the group assignment (which was worth 10%) and 93% for the oral presentation, which was worth 15%. I'm really happy with those scores, it's very encouraging, and I think my group worked really well together. Group work can be tough if the members disagree on how to do things, or if some don't put in enough time and effort and just rely on the others too much. I'm glad my group also trusted me and were enthusiastic about my crazy ideas for our oral presentation, like everyone had to play a character, learn the script that I wrote, wear a costume and bring in props (eg, nursing uniform, one guy even wore a wig that I bought) and I used my iPod for sound effects and music to suit each scene. It was very different from what the other groups did, but in the end it paid off and everyone was happy with it. It's not enough to just present the information by talking to the audience because it's too boring. Of course, the content is very important but you have to present it in an 'engaging' way too otherwise the audience might get bored. As a teacher I've sat through and assessed about a hundred oral presentations myself and I think I know what works and what doesn't!

This weekend I need to finish off my assignment and I'll be handing it in on Monday.

Lectures completed!

Today I worked again but I think I will have the rest of the week off to study (not booked in for any more teaching this week). Last week I went to uni to return library books and borrow more books for both exam studying and my assignment. I've had the same books out all semester and renewed them three times (the maximum) for a total of three months. It's saved me a lot of money on buying text books. The books that come in handy the most a small ones that I can take with me to labs but for big expensive textbooks I think it's best to borrow them from the library.

I've been catching up on a few lectures that I hadn't got round to doing before my clinical placement. These are the topics:
• Neurological Assessment (includes all the senses)
• Anti-depressants and mood-stabilizing drugs
• Anti-psychotic drugs
• Anxiolytic drugs
• Psychotropic and anti-cholinergic drugs

Now I've completed all the lectures, every single one including all the online ones and the ones recorded live at uni. Currently I'm working on my assignment, have done the outline and research, and I'm also working my way through all my vocabulary, which is a huge list of about 200 medical words that have come up in lectures that I don't know the meaning of. I'm using my medical dictionary that I bought recently and is probably the most useful of all my books. When I was going to classes I took it to uni every day and got a lot of use out of it.

Last week Manny had a big operation. He had teeth cleaning to remove a buildup of plaque and four teeth were extracted due to gingivitis. He had to go under general anaesthesia and have an IV drip! He had a bandage on his arm from the IV and as soon as he got home he took it off, LOL. For the last few days he's been on a soft food diet and as of tomorrow he'll be on a special diet to keep his teeth healthy. He also needs to lose 500g to get his BMI in the 'healthy' range. I can't believe he's 'overweight'. If Manny's overweight, the majority of cats in my neighbourhood must be OBESE! I think it's a case of 'average' not necessarily indicating 'normal' or 'healthy'. A lot of humans in western countries are overweight but they think they are 'normal/healthy' because in those countries the 'average' person is overweight!

Back into Study mode

For the last three days I have been working at my teaching job and today was the first day I got stuck into the studying again after my clinical placement.

This is what I got done today:
Reading
• Stockings for DVT prevention – how they work and how to use them
• Intravenous Therapy
• Guidelines for use of the National Inpatient Medication Chart

Pharmacology Online Tutorial
• Answered and submitted about 10 questions. This took quite a while because I had to research and provide references for the answers.

Online Ethical Discussion for Medications in Nursing
• I should have done this ages ago but kept putting it off. Had to contribute to two of the ethical issues on the subject's online discussion board. These were the questions I chose and the answers I wrote:

1. Your patient is confused and is refusing their prescribed medicatons which include an antihypertensive drug. Your patient's BP is 160/95 and the RN Div I asks you to crush the medications and mix them with the patient's breakfast. What do you do?

Medication should not be crushed and added to an adult patient's food without their knowledge. If you do not have the patient's consent to administer the drug, it is unethical and beyond scope of practice to do so. As a student, you can and should refuse to follow an order from an RN nurse if you know it is unethical, illegal or not best practice.

In the case of this patient, I would try to find out why the patient is confused, and why they are refusing their antihypertensive. It may be a good idea to come back an hour later when the confusion might have eased. If they are still refusing I would ask them to give their reason why. It might be necessary to re-educate them about what the drug is for.

I would educate them that the reason they have been prescribed the drug is that persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysms, and is the leading cause of chronic renal failure.

His blood pressure of 160/95 suggests he is on the borderline between Stage 1 and Stage 2 Hypertension. It is normal for blood pressure to be highest in the morning [www.merck.com/mmhe/sec03/ch022/ch022a] so on average he probably has Stage 1 hypertension and therefore taking the anti-hypertensive is very important in preventing him from getting to Stage 2.

If he is still refusing, I would page his doctor to come up and have a chat with him.

2. Is it okay to provide a placebo medication if it is in the patient's best interest?

Firstly, the placebo response is when the mere taking of a medicine has a psychological effect that produces a beneficial physical response. This response is often an important contribution to the overall effectiveness of a chemically active drug. It is most commonly seen in analgesics, antidepressants, and anti-anxiety drugs. There are also certain types of people, known as "placebo responders" who are more likely to experience the effect than others. (Royal Australian College of Practitioners New Guide to Medicines and Drugs, 2008)

In my opinion, as an ethical rule, doctors should not prescribe placebos because it is dishonest. Transparency and informed consent are very important aspects of medical treatment, and it would not be fair on the patient to provide a placebo but make them believe they are taking a real drug.

However in some situations it can be okay to provide a placebo, such as:
- in drug trials, to find out the differences between placebo responses and chemical responses, and the effectiveness of the drug. However, whether providing a placebo in this case is 'in the patient's best interest' or not is questionable. If it is part of their informed consent that they understand some participants will be provided with a placebo, then I think it is ok.

- in children when they bump their head or have a tiny scratch on their leg but are crying really uncontrollably, you could rub a little bit of lipbalm into the skin and tell them 'this is special ointment that will make it better'. In this case it is definitely in their best interest because it will help calm them down.

These are the only two ethical examples I can think of where it would be ok to provide a placebo.

Last Day of Clinical!

Today is the last day of my first clinical placement. This week has been really good compared to last week. I haven't been stressed at all. Yesterday I got a chance to watch a surgery - plastic surgery on a hand. I had the opportunity to stay with and look after the patient - a Vietnamese butcher who cut his hand with a knife - from when he was brought up to the ward from emergency until he had his surgery and went home. Unfortunately for him that took more than 2 days but for some people it takes longer because what they need isn't high on the priority list. It was interesting to see the whole process of putting the patient under general anaesthesia and watching them wake up. He was very talkative when he woke up and wanted to know how the surgery went so it was good for him that I was there, otherwise he wouldn't have had anyone to talk to. He said 'you look apter me bery bery goo. my English no goo but you alway understan me'.

Another great thing yesterday was that I had my final assessment with my clinical teacher and I have passed this clinical placement satisfactorily. We don't get any grade, just satisfactory or unsatisfactory. I also gave two injections yesterday - woohoo! Everyone else had an opportunity already and I was waiting and waiting, hoping I would get a patient who needed one. Now I feel complete, LOL. My patients didn't wince or cry, they both said 'you did it good'.

Day 7 Clinical Placement

Just finished day 2 of my second week of placement. This week I am on the ENT (ear, nose, throat) and Plastics ward, and I'm also doing evenings instead of mornings. I'm finding the shift goes quicker even though I feel less busy, and I also don't get as hungry as I did on the morning shift. I like saying 'good night' and seeing the patients go to sleep at the end of the shift.

I'm enjoying the mix of patients, all ages, and learning about and caring for their conditions which are all very different. I have been looking after a room of boys (last week I was looking after a women's room). Two of them are very low maintenance (only have to do something for them twice in a shift, usually towards the end of the shift) and the others have been more high maintenance with lots of things to do and lots of checking up.

Today I had my first post-op patient which was good because that's one of the things we've been learning in this subject. We brought him up from recovery and then had to do half hourly observations of vital signs and pain level and the circulation to his fingers and check that the wound (on his hand) wasn't bleeding.

The other high maintenance patient has a tracheostomy (breathing through a hole in his throat) and needs continuous oxygen therapy. He also has a naso-gastric tube. He can only communicate through body language or a notepad because he can't talk due to the trachy. I haven't learned tracheostomy care yet so for that I've just been observing my nurse buddy but I've been able to do everything else. We also took him for a chest x-ray after the naso-gastric tube got dislodged.



I've had more opportunities to give drugs via different routes - several by IV port injection, crushed up pills via naso-gastric tube, mouth drops, and eye drops.

I've also chosen the patient I am going to use for my assignment which is a 2000 word nursing care plan due 2 weeks after this placement and it's worth 50% of my grade. The challenge was finding something not too complicated and not too simple and something that I find interesting. The patient I've chosen is a 20 year old male with a condition call arteriovenous malformation (AVM) which is a bleeding disorder for which he has needed major facial reconstructive surgery and has lost vision in one eye and also has only one ear. I looked after him on Monday and tomorrow I've arranged to do an interview with him. Since I haven't been too busy I've had the chance to read through his entire file and look at all the history and treatment he's had, and also do a bit of research on the internet about it.

Thank God It's Friday

Today was my last day in the oncology and haematology ward and it was a very emotional day for me. I had a new nurse buddy (fifth one in five days) and she was really really nice - a very good teacher and challenged me to do things as independently as possible and explain the rationale behind all my procedures and clinical decisions, but she wasn't mean when I didn't know something or if I wasn't confident and asked for her assistance or checking. She also encouraged me a lot and told me I was doing really well and we shared the same philosophy about nursing that I talked about in my previous post. She was also a grad nurse. Each nurse I have worked alongside is so different in their bedside manner, the way they do procedures, the way they teach, the way they write notes in the file. It can be confusing and frustrating. But I was grateful to have her with me today and my clinical teacher was very supportive in making sure I was not buddied up with yesterday's nurse. I got the same room with the same patients though.

The difficult parts of today were firstly one of my patients I've been looking after deteriorated a lot overnight. She has end stage cancer of the colon, liver and kidneys. Although she's only in her sixties she looks very very old, is bald, very skinny but with a very very inflated abdomen, like someone who is about to have a baby. When she lies in bed with no movement she says she's comfortable but as soon as she has to move for anything it's very painful and difficult. It's the first time I've seen someone in that condition in real life. Although I was able to have a nice conversation with her a couple of days ago, this morning it was hard to wake her up. When I took her to the toilet I asked her if she wanted to have a shower or a wash (she was in a commode which is a kind of toilet chair on wheels) and she said 'I'd prefer to have one in the morning'. I told her it is morning now and she suddenly looked really confused and upset. I said 'just relax, you're a little confused that's all, I'm just going to ask you some questions'.I began asking her questions such as 'do you know what day it is? do you know what the date is? the month?' she wasn't sure and seemed upset with herself that didn't know. then i asked questions such as 'do you know where you are?' 'who is the prime minister of australia?' she was able to answer those questions correctly. later that day it began to appear that was losing the ability to control her hands and legs. when she had the cup in her hand she could bring it to her mouth but then couldn't bring it back down it would just drop out of her hand. and she couldn't balance when we tried to get her to sit on the side of the bed. her hands were so cold and we had to tuck her in with lots of blankets like a cocoon. i felt so sorry for her and really wanted to help her and comfort her. I began to feel a bit emotional.

After that my teacher came and got me to go through my first formal assessment of how I've gone so far on this clinical placement. There are some skills that I'm not competent in yet, in the sense that I am not confident doing them independently without any guidance or checking, and I need to be in order to pass this clinical placement. I couldn't help myself, I cried, but he assured me I'm not going to fail and he is going to support me 100% to make sure I succeed. I couldn't stop crying for about half an hour. He said I am a very caring and sensitive person and because of that I'm going to be affected in this career more than some people, but I will get stronger as time goes on. I hope so. I don't want to become insensitive but I need to be strong in the sense that I keep my emotions under control. All the students in my group (all girls) have cried at some stage this week. Between the four of us, four patients have died, and we've seen some really sick people who have little hope of getting any better, so we've all been supporting each other a lot. I'm lucky to have such a nice teacher and nice group but it's still stressful. I haven't been this stressed in a long time.

Day 4 Acute Placement - Frustrated Rant!

Just one more day of placement this week and then i'll have the whole weekend to relax and I cannot wait because I am so exhausted. Each day I've been waking up between 4:30 and 5:00am and walking to the station in freezing cold rainy darkness. Today I missed the express by 30 seconds and ended up being 10 minutes late which isn't good.

I've been learning a lot and am gaining confidence in the basic skills of communicating with the patient, taking observations (blood pressure, pulse, pain assessment and so on), giving out and researching the actions of lots and lots of oral drugs as per the orders and under supervision of my buddy nurses or my clinical teacher, doing wound dressings, writing progress notes in the patient files, and administering IV fluids and drugs through the port of the cannula which is already in place in the patient's vein.

I have been looking after the same room each day which has four patients in it. Three of them have been there all week, two older ladies and one 21 year old girl with leukemia, and have enjoyed getting to know them. I feel like I've developed a good rapport and they have all been really supportive and told me I am doing a great job. My philosophy is to be very warm and friendly, when they are in pain I offer my hand for them to squeeze and stroke their arm/leg/back and I try to be sympathetic. Whenever I walk past them I smile and ask 'do you need anything?' or 'how are you feeling?' I haven't been taught these approaches at uni or by the other nurses, I just do this according to the motto 'do unto others as you would want them to do unto you'. Also, I draw from my own experiences as a patient in various settings throughout my life and try to remember and imitate how the nice nurses/doctors I had were. At this stage I absolutely refuse to be one of those nurses that is really business like and cold, shows no affection and talks to the patient as if they have a low IQ. I've even seen fellow students doing that with the dummies at uni, as if that is how a nurse should act and I can't stand it. Receiving TLC, understanding and respect is a huge part of feeling better when you are in pain or feeling like crap.

Although I've been looking after the same patients, each day I have had a different nurse buddy. As I mentioned in my previous post on my first day my buddy was so nice. She was nice to me and nice to the patients. She gave one of them a hug when they were discharged. The second day I had what I call a 'mean nurse'. She was mean to me, very critical, no encouragement and had a cold bedside manner with the patients. She expressed her disapproval of the fact that I hadn't done first year and said I shouldn't have got any credit for my other degrees and life experience because they have got nothing to do with nursing. She also wasn't interested in finding out anything about me. On the third day my nurse buddy was a 'nice nurse'. She was in her grad year (first year out of uni) and was really understanding that this was my first placement and was really encouraging, saying things like 'I'm still learning new things everyday' and 'you're doing so well for someone on their first placement' and 'your background will really come in handy in your nursing career because you're used to communicating with people from different cultures and you have so much teaching experience' and so on. She gave me the chance to do the things I was confident doing independently and talked me through anything I wasn't totally confident in, even if I'm 'supposed to know it'.

Today unfortunately I had a 'mean nurse' buddy and this one really got to me. She was also a grad year nurse on her first rotation so only been a nurse for about 6 months, 22 years old, but she was so full of herself, acted and talked like a 50 year old matron, and criticised everything I did, even things the other nurses had shown me how to do, she said 'I don't do it that way' or 'that's not necessary'. Like my Tuesday buddy she also said it wasn't good that I had missed out on first year and when I told her what my background is she said in a patronising tone 'you obviously get bored very easily' and said 'teaching isn't a hard job at all'. I asked her 'have you been a teacher?' and she just snapped 'no but I know it's an easy job'. As the day went on she frustrated me more and more. I didn't like her bedside manner with the patients, she talked to them like they were children and shouted even though none of the patients are hard of hearing. I speak to them softly and have never had to repeat myself. When I was putting fresh sheets on a patient's bed because the sheets had gotten wet she said I hadn't done the hospital corners correctly, so I asked her to show me because that's one of the things I missed out on from first year. She did show me the correct way but while she was doing it she said 'this is the most basic skill of nursing that you should be able to do perfectly. you should be practising at home every day.' I told her that the reason I don't practise this at home is because I just have a doona, and she said: 'Well go out and buy a sheet. I've been doing hospital corners on my bed since I was FIVE YEARS OLD!' This was nearly the end of the day so I just said 'Good for you!' and walked out of the room and left her to finish making the bed by herself. I went and found my clinical teacher and told him that her attitude was really bothering me and I would like him to observe for the next half hour or so. When he was there helping she wasn't as much of a b*tch. I've only mentioned a couple of things here but she pretty much rubbed me the wrong way all day and by the end of the day I was feeling really upset. I'm sure being tired is a factor but it doesn't help being spoken to and treated like that, especially when I'm there to learn and practise, and she being such a junior herself. If she was a more senior nurse in age and experience maybe it wouldn't have bothered me as much. My clinical teacher was understanding but said it's something that I will have to learn to deal with because it is going to happen a lot throughout my uni placements and in my nursing career. Nevertheless I have requested not to be 'buddied up' with that nurse again. I hope I can work in the same room again tomorrow though as I really like the patients and I know they like me. Time to relax now, I'm going to watch Napoleon Dynamite (one of my favourite comedies) to cheer myself up and take my mind of things.

First Day of Clinical Placement

Today was my first day of my first clinical placement - how exciting and nerveracking! This week I am on the Oncology and Haematology ward - cancer and blood borne diseases. My hours this week are 7am - 3:30pm with just a half hour break for lunch. Very tiring but it goes really quickly. I have to wake up at 5am!!! Last night I took a sleeping pill because there is no way I would have been able to get to sleep, I would have been way too anxious that I would miss my alarm and be late. Actually most of the other people in my group said they couldn't sleep last night. Not me, I slept like a log, LOL.

There are four students including me on the same ward as me and four more on the floor below which is the Ear, Nose, Throat and Plastics (Facial Reconstructive Surgery) ward. Next week we'll be swapping - awesome!!! We're all so grateful to be placed on these two wards because they are so interesting. Next week we'll also be changing our schedule to afternoons, so it'll be 1:00 - 9:30pm.

Today we had a bit of orientation with our clinical educator who oversees our placement and assesses us. Then we went up to our respective wards and were assigned a 'buddy' who is one of the registered nurses. Mine was so nice and taught me so much. She just explained everything in lots of detail without me having to ask too many questions and feel stupid - everything from what all the medications are for, what diseases the patients have and how they are treated, how all the machines work, all the procedures, how to write notes in the patient's files, everything. I just followed her around all day and by that I mean I RAN! Omg, nurses are constantly on the move and work really quickly.

I didn't practice that many nursing skills today because I just wanted to get orientated and see how it all happened. Actually right after we arrived on the ward there was an emergency situation and one of the patients died. What a reality check. Later that day I saw the family come in who were naturally very upset and sat beside the body for a while. Most of the patients are being treated for cancer and are having chemotherapy. One of them is a prisoner and there were two prison guards sitting outside the room at all times. They just sit there doing nothing all day which looks pretty boring, not even reading.

The only skills I did were some urine dipstick analyses (for the chemotherapy patients because their pH needs to be a certain level before they are given the drugs), and a wound dressing for a small ulcer. I was hoping to do some basic OBS (blood pressure, temperature, pulse etc) but the patient had gone walkabout and then when they came back the equipment had been taken by another nurse. I'm sure I'll get plenty of opportunities later in the week.

We were all so exhausted at the end of the day, but I feel it was more because of the early start than working hard. I'm looking forward to tomorrow. Unfortunately I won't have the same lovely buddy nurse again because she is not working for the next couple of days.

Tonight I am just going to pop down to Woolies for a quick grocery shop, make lunch for tomorrow, eat dinner and watch Wife Swap, do a bit of reading about Chemotherapy and then in bed by 9pm.

World's Oldest Yoga Teacher

I saw this video about a beautiful woman who teaches yoga and competes in dance competitions at the age of 92! What an inspiration! I would like to be living life like her when I am an 'old lady'. Check it out!

http://www.yogabodynaturals.com/oldest-yoga-teacher-in-the-world

Week before placement

Yesterday I went to uni for a pre-clinical workshop and I turned up on the wrong day - oops! Luckily I didn't miss out, it was actually today. Today's workshop was only two hours but Friday's will be eight hours. We didn't really cover that much today. In the last couple of days I have been reading up on acute care skills. This is what I've covered and summarised in my notebook. I might put some of the more interesting summaries on my blog later on.

Preparing the Patient for Surgery:
• Deep Vein Thrombosis Prevention
• Preoperative Assessment
• Preoperative Teaching
• Physical Preparation for Surgery
Caring for the Postoperative Patient
• Immediate Post-anaesthesia phase
• Post Op orders
• Drainage
• Steps before discharge
Surgical Wound Care
• Cleansing a drain site
• Monitoring and emptying drainage devices
• Types of drainage devices
• Removing drains
• Removing staples, sutures and applying steri-strips

After I got home today I went grocery shopping and then did a huge load of laundry sorting and ironing. I watched The Duchess while I did that - great movie. Keira Knightley is so elegant and was very good in the role.

Last night I watched Anatomy for Beginners on SBS. This show is like a horror movie! Each week they disect a dead human body. The one this week had only died very recently so the body was still quite fresh with blood in it. One by one the organs in the abdominal and thorasic cavities were located and taken out. The most disturbing thing I thought about this show is that the anatomist, Professor von Hagens was wearing a wide brimmed black felt hat, had a strong German accent and seemed quite gleeful during the whole process. I don't understand why he needed to use a knife that was about a metre long (looked like a sword to me) to cut the heart in half. It's all a bit serial killerish. Nevertheless I will most probably watch the next two episodes in this series anyway. These shows really help to consolidate my anatomy knowledge because I think I learn and remember a lot more when I see something audiovisually, rather than just reading.