I fired off an email to the department for the ACCN certificate, asking when I could theoretically begin some of the coursework.

Their reply: "You would need to be in your final Year (4th year) of your Degree program to take the ACCN courses. You would be able to take some of the theory course prior to graduating."

Okay, so I have a year to consider my options. This is good. I have an ICU theory term and clinical rotation in the coming year, so I can make a more informed decision at that point.

A lady at work yesterday saw me reading my latest textbook for my correspondence class. It's dry stuff, but at the same time interesting. The current chapter is examining paradigms and methods of scientific inquiry. It is making me wonder how on earth I'll ever get to the point that I can identify a knowledge deficit and choose to research something real and relevant. This is something I'm going to have to tackle in a Master's program. I guess that's why they want me to have a year's experience in my specialty before applying. But I digress...

She asked me how much longer I had to go in my program. "2 years!" I cheerfully replied, and then we were both a little surprised at how fast the previous 2 years have gone by. A lot of the ladies at my work are very old-school (I am one of the youngest people there, by like 20 years) and they seem to have a real reverence for my being a student nurse. It's a little unnerving. No matter how much I tell them that I actually don't know anything, they want me to shed light on various medical concerns they have - my office has a LOT of medical concerns. In fact I have been clamouring for them to get an AED there specifically because I work with a lot of overweight older adults.

However I was actually able to provide some good information to a co-worker whose dad was in end-stage cancer, receiving palliative care. He lived in another province. She was pretty distressed and didn't want him to die alone in a hospital bed. I told her to inquire about home care nurses in that area.  A few months later she told me that home care allowed him to die peacefully in his own home with his own family present, and she was very pleased with the supportive environment. I was glad that I had managed to pick up SOME little tidbits from Med-Surg, lol :)

Blech. I've written 3 care plans this year, one for each of my clinical rotations. They are essentially full-sized research papers worth a huge chunk of my final grade.

Care plans are fickle creatures. We never had a proper care-plan-class, which really irritates me. I mean, I had to take English (again) to ostensibly learn how to write papers, but I don't have to take a care plan class to learn how to write care plans? Especially when I have never seen a care plan in my life and said care plan has the same impact on my final grade as any research paper had?

So because the learning curve was kind of steep (last semester we were briefly introduced to the nebulous concept of writing a care plan, and all of a sudden this semester we were told to Write A GOOD One Because It's Worth 30%), I had a lot of self-learning to do. Something I do frequently, it seems...

As part of the framework required to write the care plan, my school assigned the following guidelines:

• Patient's age, gender, marital status, religion, allergies, admission date, diet, activity, code status
• Current medical diagnoses including pathophysiology
• Past medical hx and health problems
• Applicable surgical/other procedures and their most common complications
• The patient's context of health, including (my personal favorite... lol) ye olde Determinants of Health and the principles of Primary Health Care
• The patient's developmental and social hx, including family and their influences on the pt's health
• Ordered tests, treatments, and interventions, including agency protocols and policy
• Recent diagnostic tests and results
• The teaching/learning needs of the pt
• How other members of the interdisciplinary team are involved in pt care
• Strengths & capacities of the pt
• Ordered medications including rationale, classification, side effects, and nursing considerations specific to the patient
• And, finally, 3 primary patient needs to address in the care plan. Each must include:
• Nursing diagnosis (NANDA stem, etiology, and manifestations)
• NOC labels 'SMART' goals (specific, measurable, appropriate [person-centred], realistic, & time limited
• Nursing interventions (NIC labels)
• Rationale
• Evaluation

Physical environments. “The physical environment is an important determinant of health. At certain levels of exposure, contaminants in our air, water, food and soil can cause a variety of adverse health effects, including cancer, birth defects, respiratory illness and gastrointestinal ailments (Public Health Agency of Canada, 2003).” Jane has lived in Alberta for her entire life. The urban health regions have a much lower mortality rate for all causes of death for females from 2006 to 2008. Calgary has 419.43 deaths per 100,000 population and Edmonton has 427.59. The mean for Alberta is 443.65 (Alberta Health and Wellness, 2009). Jane’s physical location is positively impacting her health simply by virtue of health accessibility and active living opportunities.

I also got very detailed with my NANDA-specific nursing diagnoses (this was the first of 3):

Priority need. Ineffective coping related to loss of vision, personal vulnerability, perception of inadequate control, impaired adaptive behaviors, and problem solving skills, as evidenced by flat affect, social isolation, inability to meet role expectations, poor self-esteem, uncertainty about choices, and deference in decision-making. Jane’s history of dependent behavior is making it a challenge for her to adjust to life as a visually impaired person. It is easier for her to surrender decision-making responsibility to John and rely on him to perform the roles of partner, guide, and caregiver than to accept her blindness and find ways to manage with it and go on with her life. Jane instead copes by isolating herself and being the passive member of their relationship.

Apparently it paid off, because I scored 18.9/20 on it. I was floored. I NEVER expected that kind of mark on the last paper of the year. Yay, me!

If you struggle as much as I do with writing care plans, I STRONGLY recommend investing in a good care plan book. I really, really like Gulanick & Myers' Nursing Care Plans: Nursing Diagnosis and Intervention. The book was very well rated on Amazon and with good reason. It has the NANDA, NIC and NOC labels for all included care plans as well as oodles of online resources and plenty of interventions and rationales. I am very happy with it. So is everybody who keeps 'borrowing' it every time a care plan comes due. At $40 it has been way more valuable to me than the freakin APA guide I spent an embarrassing amount of money on in first year.

Also keep in mind that your campus library, hospital library, and often hospital unit have really good (and really specific, in the case of on-unit material) references available. That's how I found specifically psychiatric care plans such as the one I used for my 'Ineffective Coping' diagnosis.

Another really good free online source I found is the Care Plan Constructor which I have linked on my Resources list. It's not as detailed as a book would be, but it gives you some more interventions and rationales to cite. It's also faster to navigate than a book, IMO, so it can be really handy to peruse for diagnosis ideas.

If I think of any other good things to add, I will. If you need help with your care plan I'd be happy to try. If you have any questions, fire away!

You may remember all of the textbooks I bought for first year – I spent close to $1000 on books alone. Then I went hungry but not *quite* hungry enough to eat a textbook. Well, surprise! Some of those books I barely even cracked open. Here’s what I did for this year:

I didn’t buy a damn thing. Not one.

I know, I know, I can hear you WTFing from here! “But I’ll fall behind on my readings!” you say? I hear you. This is what I did, and I didn’t fall behind on my readings – all it took was a little ingenuity.

...Is this book. Yesterday I spent 6 hours around town at various quiet locations studying anatomy. I was mostly studying the bones of the pectoral girdle and the upper limb. My eyes started blurring around the coronoid fossa, but I whipped out my handy Analogy Guide To Anatomy, that then took what I was trying to learn by forced memorization and spelled it all out so nicely:

Today, I am feeling like a student nurse. Although this semester we are only covering theory (no clinicals), I got a glimpse of Pressure - with a capital P.

Today I went to the bookstore and picked up most of the books for this semester. 9 so far, and that doesn't include English or one of my classes (Foundations in Health)!