I hate to say this, but it's so neat to be out of that first semester and have those jitters gone (only to be replaced by NEW jitters, but you can't win, can you?)!! :>) Here's what I do, not just then, but now when I go to clinicals. First of all, take lots of deep breaths and picture stress and anxiety and fear as 'red steam' and calmness and wisdom and strength as 'blue steam'. Breathe out red, breathe in blue. I have been known to secure myself in the corner of the supply room to do some creative visualization in a pinch!!! Don't be embarrassed...you will be clear headed and focused, which will allow you to be the best nurse you can be. Secondly, realize that even the most experienced physicians and nurses started out just like you- scared to death not knowing what the hell they were doing. Lots of people just don't admit it- I'm one that does. I admit that I am a student. I have a limited amount of knowledge. I don't know everything. I hardly know anything. Tip of the iceburg, as far as nursing is concerned. What I do know is this: I am a great person. My heart is in the right place, and my mind will follow. If I am in doubt, I will hesitate and ask rather than risk harm to my patients, no matter how trivial or small it may seem. I forget things. I have used these IV pumps for two years now, and occasionally, I STILL forget how to program them. NO problem. I just ask. With a big smile and a wink. Humor helps. A LOT. So does charm. Lay it on thick. "I know I should probably know this, but you know us nursing students- totally worthless. *wink&smile* Would you mind showing me/reminding me/answering a question for me? I'd really appreciate it." "I feel comfortable asking you this, because you're so with-it and seem so knowledgeable..." Etc. Okay. Next step? When you go into a patient's room, or to their bed, remember ALWAYS that they are a person just like you. They are a son or daughter. They have a sister or brother or wife or kids. They may have a job, they may have experienced loss, they may be broke, they may have a heart of gold, they may be misled or confused...they're all people, just like we are. Exhale, smile, walk into the room, make eye contact. Connect with them. They are not a bunch of machines with a person thrown in there...they are a PERSON FIRST, with a bunch of machines and tubes to keep them company. ;>) Introduce yourself (again, even if you've met them before), ask them how they're feeling this morning. Any complaints? Did they get some sleep last night? I always make a little joke and smile my butt off to get them 'on my side', if you will. "So, did you manage to eek out an hour or two of sleep with all of these crazy people running in and out of your room all night?" I smile and laugh, maybe touch their arm if it's appropriate, all the while I'm connecting with this person. Pretend they're your favorite neighbor. Your best friend's dad. Whatever. Already, you're gathering important information here- if they don't respond, why not? Are they just lying there in a coma? Are they lying there with an irritated expression and purposely ignoring you? If so, what could be the reason for that? ARe they answering your questions and perhaps complaining about no sleep because of pain? Great! You just got pertinent info for your assessment. Patient is alert and oriented; c/o abdominal pain. Now, you want to be as specific as possible. (We always do an opening, head-to-toe narrative every morning.) They just said their stomach is hurting. Okay, how badly? Can they rate it? Can they describe it? Can they point to it? Take a look at the abdomen. Put on a pair of gloves, lift the gown, look at the abdomen. Wow, it looks okay to me...let's see... gently palpate (as appropriate- in some cases you won't do this, but you decide)...he moans as you barely touch his left upper quadrant. Okay, great! More pertinent info! Pt. c/o sharp, stabbing abd pain in LUQ rated 9 on a 1-10 scale. Tender upon light palpation. Or, you may see that their dressing is soaked through with blood...upon further inspection, you might find that their stiches have come apart and their abdomen is gaping open. Whatever- it will vary from patient to patient, but you get the idea. Chart it. I used to use looseleaf, then copy it over to the chart once it was approved by whoever (instructor, RN). The best thing to do is a head to toe. Start at the head. Go from top to bottom...look at the eyes...expression on their faces (smiling? Frowning? Facial drooping to one side?). Are they sweating? Anything unusual? Do the whole face. Great. Now move on to the neck...anything wrong there? Carotid pulses intact? Jugular vein distention? Nothing wrong? Look thoroughly, then move on down. Chest. Listen to the apical pulse. What does it sound like? Strong? Rhythmical? Skipping beats? Fast? Weak? Make a note of it. Listen to the breath sounds. Note them. While you're doing this, check out their skin. Scars? Wounds? Bruises? Anything wrong? Listen to the abdomen. Bowel sounds? Feel it. Tender? Soft and squishy? Does it look swollen? Is the skin tight and shiny? Check out the arms. Have them grip your fingers and pull with both arms at the same time. How is their grip strength? Weak? Nonexistant? Normal and strong? Can they lift their arms up? Move them around? Great. ROM is intact in upper extremities. Move to pubic area. Do they have a foley catheter? Is it unclamped? Draining? Kinked? Unkink it. Look at the collection chamber. Is there urine in it? Bloody urine? Clear yellow urine? Amber urine with clumps? Write it down. What about the pubic area? Is it clean? Blood present? Does the area around the foley look swollen or irritated or otherwhise abnormal? Note it. You get the idea. Simply move head to toe. Don't be afraid to use your flow sheet, if you have one. I have often used it to double check that I haven't forgotten anything. Don't worry if you have to go back and do something. I always say, "Alright, now, I appreciate you being patient becasue as you know, nursing students don't know a whit about nursing." winkwink. Of course, don't say this if you think they're going to freak out. Improvise, say what you think will be appropriate. I use a lot of Southern charm and thank them furiously for being patient with me, because when I started, I'm sure I took a reaaaaaaaaaaaaaally long time to do my assessments!!! :>) Do the head to toe. If you haven't done this by the time you're done, once you finish the head to toe, go back to the equipment. Does he have an IV? A heplock? Where is it? What does the site look like? Chart it. Hep-Lock to left anterior hand; dressing clean and dry, site shows no signs of erythema/infiltration/irritation. Is the heplock attached to tubing and an IV? Okay. follow the tubing up to the IV. Look at the bag, get the drug and dosage (10 grams, whatever). Then look at the pump, get the drip rate. Chart it. 0.9% NS IVF infusing at 120 cc/hr to left anterior hand. Is there more than one? Follow each tubing and chart it. One at a time. ONE AT A TIME!! Don't panic. Break it down into approachable bits. When you're done, ask if you can get anything for the patient. Ice? Water? Tell them when to expect breakfast, if they're allowed to eat. If not, tell them why they can't eat, and then tell them what you CAN do, ie, get them as much juice as they want, or get them as much ice and water, or only ice chips, or whatever. Let them in on the plan for the day. Okay, this is what I'm going to do...I am going to go write all of this good stuff down. I'll bring some apple juice and an extra blanket for you. We're going to get you out of bed for a bit and get you cleaned up, and you can brush your teeth like you asked me about before. While you're up, I'll change the sheets and all on your bed. After that, we'll see what else we can do for you this morning, okay? Then go do your thing. You get outside and you forgot something? No problem. Run back in and say, whoops, I forgot one thing...let me just check your eyes real quick...great, thanks Mr. Jones. I'll be back in just a bit and we'll get started. Big smile. Don't freak. ;>) YOu'll do great!!! I find that talking to them is really crucial...it puts us BOTH at ease. I talk to patients who don't even respond! I sing to patients in comas, I talk soothingly to patients who are disoriented, I talk to the walls if I have to!! ;>) I find that if they're alert and all, explaining what I'm doing helps also. Okay, now, I need you to flex your feet up like this for me...great...now what do you feel when you do that? Nothing? Any discomfort? Great. We do that because it helps us find out if you're developing any complications from being in bed so long...we want to keep you healthy so you get get out of here before the dawn of the next century!! You get the picture. You'll do wonderful. You will, I promise. You'll sweat, you'll freak, you may cry from panic, but you might not. Either way, you'll do a hell of a lot better than you think you will! Take stuff with you- lists of parameters, lists of drugs, calculation formulas, lists of vocabulary that you cant remember, whatever. Make a binder, and each semester, add charts and whatnot to it. It'll be your greatest resource. Copy coma scales and things on figuring caloric need and IBW and anything else you might need. A paper ruler to help figure out wound size. Things like that. Put a zipper pouch in there and throw things in that you can use. Paperclips, safety pins, a sharpie marker, small roll of tape, measuring tape, extra penlight, extra black and red pens, etc. Good luck, and email me if you need more help!!
A fellow student :>)