Night shift

End of week two . . .

This week I did two night shifts on Monday and Tuesday night. They're pretty long shifts, from 9pm till 7:30am so I needed Wednesday to recover. At this stage in the semester I only have to take one patient, but it will increase gradually up to a full load as the weeks go by. One patient on a night shift is very boring! Because there's not much to do between 10:30pm and 6:00am. However, I made good use of time and got heaps of reading for uni done and got a couple of tasks out of the way for my clinical learning portfolio which will be worth 55%.

This week I also finished my job applications for next year. I've already heard back from two of them for an interview in the next couple of weeks. I've applied to four different psychiatric grad nursing programs. It was so hard to narrow it down to just four places, and also choose whether I wanted to do general medical/surgical or psychiatric, or community. In the end I chose psychiatric because it's what I'm most interested in and enjoy doing, I can increase my qualifications during the program, and there are opportunities to work in acute inpatient care, community, teenagers, emergency, drug and alcohol . . . there's a lot of choice within psych so I don't feel as though I'm limiting myself by choosing that path.

Here's a summary of what I've been studying this week:

Lectures
• The impact of chronic conditions
• Promoting comfort_and managing symptoms

Reading
• The social construction of chronicity: a key to understanding chronic care transformations
• Healthcare providers’ perspectives : estimating the impact of chronicity
• Chronicity and complexity: is what’s good for the diseases always good for the patients?
• Clinical Practice Consolidation subject guide
• Ward Orientation
• Journal article case study: An 81 year old man with massive rectal bleeding – this was related to one the patients I had on the ward.
• Journal article: Nurofen Plus misuse, an emerging cause of perforated gastric ulcer – again this is related to a patient on the ward who had been abusing a packet a day of nurofen plus, which is ibuprofen plus codeine. They abuse it for the codeine and you don’t need a prescription to get it. The problem is because it has the ibuprofen it wears away the lining of the stomach over time.
• Assessment of Digestive and Gastrointestinal Function – anatomy of the gastrointestinal tract, chewing and swallowing, gastric function, small intestine function, colonic function, waste products digestion, age related changes in the gastrointestinal system, assessing pain, indigestion, intestinal gas, nausea and vomiting, changes in bowel habits and stool characteristics, physical assessment, foods and medications that alter stool colour, stool tests, breath tests, Australian guidelines for colorectal cancer screening, abdominal ultrasonography, genetics and gastrointestinal disorders.

This week I have two more nightshifts again so I'm going to get as much reading done as I can while I've got the chance.

Final Semester!

Long time, no blog post . . . well here I am, it's my final semester already. By the end of october I will be FINISHED! I am very busy right now, with getting stuck into the lectures, reading and assignments for my new subjects, as well as working 2 - 3 days a week, and applying for graduate nursing positions.

First let me wrap up last semester. It was a stressful one but I made it through. My results weren't as high as I've gotten in the past but they were okay:

Complex Care Nursing - 60
Professional Transitions in Nursing - 69
Nursing Older People - 70

I did bang out most of the assignments at the last minute and got between 65 - 75 for most of them. I seem to get the best scores in oral presentations. All in all, I'm not too disappointed because the academic transcript that went out with my job applications had only A's, B's and C's on it, no D's.

I had to make up 2 days of my Nursing Older People clinical placement before my holiday and I did that at an aged care nursing home which was good because I got to experience the nursing side of it, rather than just the caring side.

This semester my subjects are:

Consolidation of Clinical Practice - which includes 240 hours of acute care placement. I requested another ward and this semester I'm going to be on the gastrointestinal ward.

Managing Chronic Conditions - this subject is taught completely online, even the exam. There are several assignments including group assignments and online discussion groups.

Challenging Interactions in Nursing - this subject is about communication which I find really interesting.

So far, I've mainly been listening to lectures and reading for Challenging Interactions in Nursing:

Lectures
• Awareness of Self & Others
• Conflict Resolution
• Managing aggression - De-escalation
• Managing aggression - Professional Boundaries
• Lecture notes: De-escalation strategies
• Strategies and skills for dealing with unprofessional workplace behaviour
• My Experience in Hospital: Interview with a patient who had a negative experience
• Ideal Situation for dealing with complaints

Reading
• Talking with patients
• Common communication issues
• Egan's Three Stage Helping Model: Problem clarification, setting goals, and facilitating action
• Heron's six-categories of counselling interventions – supportive, informative, cathartic, prescriptive, catalytic, and confronting
• Strategies for managing aggressive behaviour

In the workshops so far we have done some roleplaying of difficult communication situations in nursing, including asking probing questions when the patient is reluctant or unable to explain why they are noncompliant, and responding to inappropriate or threatening comments.

I'll write more about my job applications and other subjects in upcoming posts . . . stay tuned!

Exam

Just got home from the exam - it went okay. I answered all the questions and was confident about my answers for most of them except a couple of questions about ECGs (which coronary arteries each of leads corresponds to) and underwater chest drainage. But those questions were only worth 5 points out of 50. I just guessed the answers for those.

This is the preparation I did and most of it was actually very useful.

Listened to lectures (someone them I re-watched):
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting

Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient

Also, got some results back for my group's Falls Prevention presentation. We got 17.5 out of 20 (worth 20%), so that's very good.

3 weeks off uni now during which time I'll be working, doing my graduate nursing applications and spending one week in Bali. This weekend I'll be relaxing - catching up on non-uni related reading, watch a movie and go to yoga.

Exam prep

Listened to lectures (someone them I re-watched):
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting

Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient

Results
• 17.5/20 for group Falls Prevention presentation

Big update

Sorry for the lack of updates recently. I've been working a lot and doing assignments. I've now finished all my assignments for this semester which is a relief. In the last couple of weeks I handed in a 2000 word Clinical Case Management Review of one the patients I looked after in my geriatric nursing placement. That was worth 50% so I hope I did ok on that. Also did a 1500 word report about advances in the care of older people with depression, dementia, and end-of-life care, worth 30%. Before that I did a professional development reflective essay worth 40%. So basically one assignment a week for the last three weeks.

Other homework I've doing are a discussion board research posting about nursing care of Stroke patients, types of stroke and how they affect the patient, readings on Systematic review of treatments for depression in older people and End-of-life care and dementia.

Got some grades back for assignments I did earlier on in the semester - one worth 50% and another worth 40%. I can't remember the exact numbers but there were both in the 70s, which is "very good", so I was happy with those results.

Other than that I've also been doing a lot of research and thinking about where I want to work when I graduate. I've been attending a few career information nights with different organisations including the Royal District Nursing Service and Royal Melbourne Hospital. I need to apply for graduate positions by the end of July, and then interviews will take place in August followed by job offers in early October. So I will know before I finish my final semester where I will be working. Apparantly, most student end up getting their first preference so I have to think really carefully about my preferences and what I want. Also, I can only chose and apply to four places and I have to put those in order of preference. It's like applying to uni after year 12. So far I'm most interested in psych nursing programs at the major hospitals which have rotations in acute inpatient care, youth inpatient care and community care. There are three of these programs that I like the look of at Royal Melbourne, the Austin and the Alfred. At the Austin and the Alfred there are also programs that have two six month rotations - one in med/surg and one in psych, so you can consolidate your skills and experience both areas. However, they do not have the post graduate study included or an ongoing position. As well as all those programs, I'm also keen on community nursing with the Royal District Nursing Service which involves driving around Melbourne giving nursing care to people in their own homes for medication, wounds, dementia, diabetes and so on. I'm pretty sure I don't want to go straight to ward nursing on a busy med/surg ward. It just doesn't feel satisfying or interesting to me compared to psych or community nursing. So I have a lot to think about, and next week will start preparing my applications and making a decision about my preferences.

On Friday this week I have my one and only exam for Complex Care Nursing which is worth 40%. I've been told there are no exams next semester so this could be my last exam for quite a while. It's an open answer exam, not multiple choice like all the others in second year so could be difficult. Over the next four days I'm going to review about 10 of the lectures, the assignment, and all aspects of the two patient scenarios we studied in workshops for this subject. Hopefully that will get me through.

For the last two weeks I've been on my Nursing Older People Clinical placement. It was at a smaller suburban hospital in a geriatric rehab ward and I really enjoyed it. The nurses and patients were very nice and it was general medical and rehab nursing care, so the focus is on systems and functioning - renal, gastrointestinal, mobility and so on. Lots of tests like blood tests, urine tests, faecal specimens, xrays, CT scans and ultrasounds. I got to go with a patient for her CT brain scan and bladder/kidney ultrasound which was interesting. Unfortunately there was an outbreak of the Noro virus (a gastro bug) which I caught and had to stay home for two days. I had diarrhea and severe vomiting for about 18 hours but I wasn't allowed to come back until 48 hours after my last symptom. So I'll have to make up two days later on. Luckily I was better in time for my team's presentation on the last day which was worth 20% of our assessment. This weekend I'm trying to get an assignment done that's due on Monday, and then I've got another one due on Friday, and another one on the following Friday. Then it'll be time to study for the final exam and start doing grad year job applications.

Assessments:
• Team Presentation on preventing falls in acute care facilities
• Discussion board research postings (about 1000 words)- Clopidogrel (an antiplatelet drug) and Percutaneous Aortic Valve Replacement Post-procedure nursing care

Reading:
• Palliative Care Therapeutic Guidelines
• Advances in palliative care relevant to the wider delivery of healthcare
• Heart Disease – Health gums and a health heart: the perio-cardio connection

Lectures:(online)
• The Role of a Clinical Nurse Manager in ICU (Operations)
• The Role of a Clinical Nurse Manager in ICU (Quality & Risk)
• Mental Health: the state of the nation part 1
• National Legislation for Registration & Professional Development
• Preventing falls and functional decline

Update

Sorry about the lack of updates over the past few weeks. I haven't actually had classes or placement for the last five weeks, and I've been working in aged care, doing assignments and spending time with family. Next week I'm starting my final placement for the semester, a two-week geriatric acute care placement. I think the paid work I've been doing recently is really good experience and preparation for my next placement. Today I did a shift in a secure high level dementia wing. They basically need everything done for them and are very confused. It's really sad. I also have classes during those two weeks and have two assignments to do! So I'm going to be very busy.

Here's a summary of what I've done study-wise in the last few weeks:

Assignments
• Professional Transitions in Nursing Developing a Professional Development Portfolio – I got 70% for this assignment
• Professional Transitions in Nursing Group Oral Presentation (worth 20%) – my group’s topic was the nursing implications of patient aggression, such as clinical risk management, chemical and mechanical restraint, isolation, and law. We started it off with a role play which always gets a few brownie points and reaction from the audience. Our overall score was 75%. Well done.
• Complex Nursing Care – 2500 word assignment on pulmonary oedema and non-invasive ventilation, worth 40% - still waiting for the mark on this one.

Lectures
• Introduction to the subject
• The physiology of ageing – lecture and quiz
• Geropharmacology – lecture and quiz
• Strategic planning for an ageing population
• Delerium, dementia and depression
• Nursing: Taking Care of Our Future – a lecture about managing human resources in nursing. Brought up and interesting point about the ethics of recruiting nurses from overseas to make up the numbers needed here, because it is contributing to worsening healthcare systems in developing countries where there are not nearly enough nurses either.

For the rest of this week I'm going to try to get as much of my second PTN assignment (about professional development) done as I can, and I have to do about 1200 words worth of research and discussion for the online discussion board for complex care nursing (at least 3 posts).