Ah, Cranial Nerves. Beyond amusing mnemonics, I have trouble remembering which does what, and I found this link while clicking around AN today.

This was probably the most helpful way to remember them that I've run across so far. I wish I had seen this picture while I was still in my assessment class... so I shall post it here for you :)

Full article is here, from americannursetoday.com



Or a shorthand version, probably more useful in the clinical setting:

While at work over the last few days, I have spent a few hours browsing iTunes U for various Nursing vodcasts. It's really, really fascinating to see how other schools teach their students. For those who don't know, iTunes U provides a medium for educational institutions to post video or audio feeds of their lectures, and they are free to view for anyone who has iTunes (also free). There are lectures on every subject you can think of. I love to just browse different topics and learn. The other day I watched a vodcast about Relativity. For no real reason, just because I could. [Photo Credit]

My school, new as it is, was built as a 'smart' institution with microphone hookups and live feed capabilities in pretty well every classroom. It doesn't currently participate in iTunes U, however. I think my school is concerned over privacy issues and intellectual property. I have this dream that instead of burying their heads in the sand and choosing not to address the promise of global education, our nursing faculty would embrace the accessibility of information and begin to publish some of our classes. (Check out the iTunes U how-to guide!)

I find it very exciting to think of how this technology could be utilized by the nursing community at large. For curious students (or would-be students!) like me, it is an easily accessible look at various aspects of nursing and it can introduce us to all kinds of specialties that we may not have known about. How awesome would it be to browse to a central organization website like the CNA, and be able to find and view lecture classes for specialties that you might be interested in? I am thinking specifically of the CCU certification I am interested in, or other advanced Post-RN coursework available at my university like Advanced Wound Care. You could utilize other schools' lectures to supplement your own - maybe to get a different point of view on difficult concepts, or to expand on something that you found interesting. You could even see how other student nurses in the world are learning.

On a larger scale, this could be utilized as refresher courses for distance learning or a video log of the entire class you took. I, for one, would LOVE a v-library of my lectures. I would pay extra to have a permanent record of the classes I take. I feel like I only ever take away about 30% of the information from any given lecture, because really, there's just way too much information assaulting my neurons at once. And how great would a v-library be for studying??

Imagine being an outpost nurse who is planning a community-scale intervention in diabetes management. Sure, you can spend hours and hours digging up relevant research (and you probably will), but imagine if you could visit the site for The Diabetes Nursing Interest Group and find podcasts for the most up-to-date EBP based on current research.

In short, you could find out how other nurses are nursing, straight from the specialty's organization. They could put out quarterly updates with new information or the latest in EBP.

How is this different from the newsletters or PDF publications that are already sent out, you ask?

The big differences would be accessibility - anyone could view this information, not just the organization and not just nurses (!) - and method of delivery.

Reading through a 37-page PDF is a lot more tedious and abstract than viewing a 10-minute video showing the latest in nursing interventions. How much easier is it to learn when you can actually watch a video of a nurse interacting with a patient, instead of just reading about it? Things that are best shown visually with an accompanying explanation, like new methods for IM injections or crisis interventions.

The possibilities are massive. This could theoretically be on a huge scale, with global involvement. Ideally, having this kind of information available from such reputable sources (CNA, PHAC, and NIH, to name a few) in such an incredibly accessible format - over 200 million iPods sold, worldwide! - could even be utilized to educate and influence public health. Inexpensively... AND "upstream" in that nebulous idea of primary health care.

I believe people are becoming increasingly open to being involved in their own preventive health maintenance (anyone notice how popular the Doctors have become? I laugh every time I see them in their pristine TV scrubs). I think that good, reliable information is hard to come by. Google any medical question and you're going to get 2,000 results from Yahoo! Answers or wrongdiagnosis.com. The world is ripe for reliable information at our fingertips. This kind of health information is mostly an untapped market, IMO. I find this all very very exciting.

I guess what I'm trying to say is that post secondary education and research isn't off in some ivory tower (or imposing brick-and-ivy academia) anymore. You don't have to get periodicals from the library to keep up with the current knowledge base. Any layperson can experience the post-secondary environment for free via one of the most accessible mediums to have ever been invented, short of the Internet itself. The information found there is (presumably) based on the most up-to-date resources available.

While I am waiting for the world to catch up to my ramblings, here are a few nursing-related lecture podcasts on iTunes U that I have subscribed to. I haven't watched them all, yet, but they're pretty much everything that I could find that was published from a School of Nursing. Please leave links to your favorite nursing podcasts in the comments and I'll update them here! Happy watching/listening :)

Acute Adult Nursing
Adult Health III
Clinical Skills for Student Child Health Nurses
College of Nursing Lectures - Video
Diabetes Care
NURS 083A: Pediatric Nursing
Nursing Informatics Program
Nursing Skills: Techniques for Sub Cutaneous and Intra Muscular Injections
Penn Nursing: Care to Change the World
Pharmacology for Future Nurses
Nursing-Psychology 342
The School of Nursing - Art of Bedside Care
The School of Nursing - NCLEX Review
Surgery ICU Rounds Podcast
Yale Health & Medicine

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!

Once I'm done this set, I should be done with midterms until September. Good riddance! I actually prefer finals to midterms because even though there's more ground to cover, they usually aren't as gruesomely detailed as midterms are. And you don't have to fit studying around class time. This weekend I've got the table pulled up to the couch again, basking in my Koi scrub pants because they are just so freekin' comfy, spread end to end with Micro and Physiology.

In Potter and Perry, it was mentioned that students can find touch stressful, but they learn to cope with intimate contact by changing their perceptions. As we were getting Mrs. E into bed, she was so tense that she was lifting her head and shoulders right off the bed. As I started the bed bath for her, it was initially very task-oriented for me: now I dip the washcloth in the basin, now I wring it out, is it too wet, oh, now is it too cold? Now I make the mitt – how does that go again? Now I touch the skin, not too firmly, not too gently. As I started getting the hang of it I realized I had run out of limbs to clean and it was time to do her abdomen. Mrs. E didn’t bat an eye when I undid her gown and she had her most private self exposed to me, but I saw a body that at one time had probably been reserved only for her parents or husband to see. And now, just about anyone wearing a uniform and an ID tag could see it.

I knew then that my perception had changed. She was much, much more than the unlucky recipient of my first bed bath. She was a person all her own and I had the privilege of helping her with her most intimate necessities. After that moment I began cleansing her abdomen knowing I was washing a unique human being. The task of washing became more of an act of caring. No longer did I concentrate so hard on the procedure. My focus was on helping Mrs. E take care of her needs. From there, I was more comfortable handling her body and the washcloth. As I relaxed, so did she! By the end of the bath she was lying flat out, completely relaxed. I could see that my touch had probably helped provide both relief from feeling unclean and, when I relaxed, my touch eased her into finding a position of comfort.

This might be TMI (warning, very graphic photos of a cervix). I found it amazing to see the changes in the cervix throughout a woman's cycle. Who knew!

I am a 25 year old woman who has never given birth.

My intention with this project was to better understand my cycle and the changes in my cervix throughout the month. As a doula and student midwife, I used this project to help me see how a cervix might look different throughout the cycle in the absence of vaginal infections and to understand speculum exams. You may notice on the right side of some photos, some jagged looking skin, which is the remnants of my hy me nal r ing. [UgRN in: I've broken up this phrase to hopefully help slow/stop the amount of creepy traffic I get from it]   My os (opening to the cervix) is round because I have never given birth; the os becomes more of a slit after childbirth.

Each photo was taken at approx 10:00 pm every day starting the first day of my menstrual cycle. I re-used a plastic speculum and macro function of normal digital camera (and a very talented boyfriend with a headlamp). For the duration of this project, we used condoms as our birth control method so as not to introduce semenal fluid into the photoshoot. I did not use tampons or mooncups during my bleeding time either.

There are several blogs I subscribe to that haven't been updated in a l-o-o-ong time. So I am moving their links into this post and removing them from my sidebar. I'll link this post in the sidebar so they won't get lost. Just because they're old, doesn't mean they aren't worth reading! A Clinic RN and a Single Mom blogging through the depths of sanity. My life as I know it started with coffee and conversation in a smoky room. This is where I'm at now.

I will never, ever, forget how fast to do chest compressions again:

The Bee Gees' disco anthem "Stayin' Alive" from 1977 has 103 beats a
minute, close to the number of chest compressions needed for cardiopulmonary
resuscitation to work, according to a study at the University of Illinois
College of Medicine at Peoria.

Video here

Yesterday we had an interesting workshop on researching information and how to find what you want. Since I've been a student for a few years now, I've already attended similar workshops and I thought it would be boring to go again. My prof, however, told us: Even if you've already been to an information literacy workshop, I highly suggest you attend this one.

Here's a fun site to check out:

http://discovernursing.com/

Lots of American information, but plenty interesting for us Canuck wannabe-nurses too! I've added it to the side nav bar.