Extremely New and Confused Nursing Student

Daytonite, BSN, RN · Sep 12, 2005

I've been a nursing manager and supervisor for years. I've never heard of the pqrst method. What is that?

jacqueli7445 · Sep 12, 2005

I've been a nursing manager and supervisor for years. I've never heard of the pqrst method. What is that?

its a 5 step method used to help you store the information you read in your long term memory. the P is to preview your text, look at headings, formulate headings and key information in chapters into questions etc. the Q is to question, ask yourself questions you may have about the chapter as you go along. the R is to read, actually read the text after you have in your mind the preview and the questions on hand. the S is to state what you have read about the material in your own words, and in this step is where the vital information is to be stored in your long term memory, and the T is to test yourself on what you have learned, answer all the questions at the end of the chapters, do the excercises in the chapter given so forth and so on, this is just a little bit about each step, i think it is pretty accurate but i may be off as far as which step stores the information, but anyway, I feel like i am overanalyzing the project at hand, and to make a long story short this particular method is to help me retain information and it is not working for me and this is frustrating me more. It is my fourth day of school and i feel like i am not retaining anything, i am not utilizing my time properly because it can take me 20 minutes to read one page, and i feel like i dont understand what i am reading and i am currently reading on how to learn and test taking techniques so forth and so on. Take care, if you have any tips for me let me know, i am up for anything. thanks

Daytonite, BSN, RN · Sep 13, 2005

OK, I see what you were getting at. I think previewing a chapter is important because it tells you how the chapter and the information in it is being organized. If I can put all the headings in an outline form it helps me to see how the information is being organized. It also helps me to see lists that may be grouped under a heading. Those lists are sometimes the most helpful things to know. The rest of the information under them then expands on them. I also think that when you are trying to assimilate nursing information it is very helpful to try to put the information with any past experiences you might have had. Much of nursing is grounded in common sense and can be applied to other things beside nursing. Leading and managing definitely is not unique to nursing. Your parents were leaders and managers of your development. Your teachers were leaders and managers of some of your learning experiences. If you are a parent yourself or ever babysat you were acting in the role of a leader and manager. I think that perhaps the reason you feel you are not retaining anything is that you are trying to memorize it. Try associating what you are reading with actual experiences you have had or you know others may have had including what you might have read or seen on TV. Then, apply the information from your text and ask yourself what a person did that was different from the textbook and what they did that was what the textbook said. Develop your questions about the material from that. I hope that helps you a little.

jacqueli7445 · Sep 14, 2005

OK, I see what you were getting at. I think previewing a chapter is important because it tells you how the chapter and the information in it is being organized. If I can put all the headings in an outline form it helps me to see how the information is being organized. It also helps me to see lists that may be grouped under a heading. Those lists are sometimes the most helpful things to know. The rest of the information under them then expands on them. I also think that when you are trying to assimilate nursing information it is very helpful to try to put the information with any past experiences you might have had. Much of nursing is grounded in common sense and can be applied to other things beside nursing. Leading and managing definitely is not unique to nursing. Your parents were leaders and managers of your development. Your teachers were leaders and managers of some of your learning experiences. If you are a parent yourself or ever babysat you were acting in the role of a leader and manager. I think that perhaps the reason you feel you are not retaining anything is that you are trying to memorize it. Try associating what you are reading with actual experiences you have had or you know others may have had including what you might have read or seen on TV. Then, apply the information from your text and ask yourself what a person did that was different from the textbook and what they did that was what the textbook said. Develop your questions about the material from that. I hope that helps you a little.

Thanks for your advice, and you are correct about trying to memorize everything, it isnt what i am trying to do though, but I feel since i cannot retain it just to keep reading it over and over until it makes since and it is taking up so much of my time, i have been doing homework and studying constantly and feel very discouraged because the things i am learning are common sense like you said, and i am trying to use association like you suggested, I feel i am over analyzing everything, but thanks for taking the time to get back to me. I have another project due tomorrow, this should be fun. keep and ear out i may need your help. it is about applying the nursing process to a scenario given about a 72 year old woman who has just had a stroke 5 days ago, she has right side weakness and goes daily to physical therapy and tires easily,she has very little control over her bladder and is prone to accidents, she states she hasnt had a bowel movement in 3 days(subjective info) and also states she usually goes after breakfast daily. from this i am to use the nursing process, Assess, Diagnose, Plan, Implement, Evaluate. I only have to make 1 assessment to go by meaning I can say from the information given that she is constipated, and go by that, but i feel there is too little information here to use the nursing process, originally the scenario given was to form a care plan and we are not up to that yet, we are just learning the nursing process so our teacher wants us to do this any pointers for me? Also would you be able to recommend any tutorials for a new student? :confused:

Daytonite, BSN, RN · Sep 14, 2005

From the information given, this patient has the following problems:

right sided weakness

urinary incontinence

she is at risk for falls and injury (that is the prone to accidents thing)

fatigue

constipation

The information you need to design this care plan comes partly from the condition the patient has which is a stroke. Review what your nursing textbook has to say about stokes and what kinds of problems stroke patients have. Stroke patients are often paralyzed or have weakness and paresthesias on one side of their body. They have a myriad of other problems not all of which this lady has. Since "she" states she hasn't had a BM in three days you will want to assess her for that (check nursing records for evidence of a BM, listen to bowel sounds, possibly do a digital check). Your nursing diagnoses will revolve around the problems I have listed. So, all you need to do is pick one of them and go with it. Each problem and plan for it should include all the functions a nurse performs. What are the roles of a nurse? (EX: performing patients ADLs, teaching, advocate, management of care) Take each of those roles and figure out how the role will be used to address the patient's problem. You include some evaluation as part of the plan. (Ex: evaluate patients ability to walk with a walker daily and document in chart.)

I'd rather focus on the right sided weakness. . .Diagnosis will be something like Impaired physical mobility related to decreased motor function due to stoke. You will have a plan listing things like teaching and demonstrating for the patient how to perform passive ROM on her affected limbs, instructing the patient to do the passive ROM four times a day (teaching role of the nurse), evaluating her ability of doing this by watching her do it at least once each shift and documenting it, making sure her weakened limbs are in good alignment however she is positioned, plan for progressive mobilization, and helping her to become more independent in specific activities. You would include making sure she gets to her physical therapy (and eventually occupational therapy) sessions (management role of the nurse), and placing items she uses on the unaffected side so she can get to them and reach them easily (call bell and telephone to be place at her unaffected side). Those would be basic nursing actions. I could include that her side rail be up at all times on her affected side (so she doesn't fall out of the bed). That is just a start. Care plans can be short, one page long, and to the point or very drawn out, 50 pages long and extended depending on what you are required to supply to your instructor.

You should get a care plan book to help you with these things and help you come up with lists of nursing actions to include in the nursing care plans you will be writing. Many of the basic nursing actions you will want will come from a basic nursing care textbook. You start to identify problems with a disease condition by looking at what the symptoms of the disease are. That comes from your nursing textbooks or a textbook from a course on disease processes. Making a care plan involves using several books for references. It is an exercise in thinking and putting together information. Instead of writing an essay you are putting your words into a column format.

jacqueli7445 · Sep 15, 2005

From the information given, this patient has the following problems:
right sided weakness
urinary incontinence
she is at risk for falls and injury (that is the prone to accidents thing)
fatigue
constipation
The information you need to design this care plan comes partly from the condition the patient has which is a stroke. Review what your nursing textbook has to say about stokes and what kinds of problems stroke patients have. Stroke patients are often paralyzed or have weakness and paresthesias on one side of their body. They have a myriad of other problems not all of which this lady has. Since "she" states she hasn't had a BM in three days you will want to assess her for that (check nursing records for evidence of a BM, listen to bowel sounds, possibly do a digital check). Your nursing diagnoses will revolve around the problems I have listed. So, all you need to do is pick one of them and go with it. Each problem and plan for it should include all the functions a nurse performs. What are the roles of a nurse? (EX: performing patients ADLs, teaching, advocate, management of care) Take each of those roles and figure out how the role will be used to address the patient's problem. You include some evaluation as part of the plan. (Ex: evaluate patients ability to walk with a walker daily and document in chart.)
I'd rather focus on the right sided weakness. . .Diagnosis will be something like Impaired physical mobility related to decreased motor function due to stoke. You will have a plan listing things like teaching and demonstrating for the patient how to perform passive ROM on her affected limbs, instructing the patient to do the passive ROM four times a day (teaching role of the nurse), evaluating her ability of doing this by watching her do it at least once each shift and documenting it, making sure her weakened limbs are in good alignment however she is positioned, plan for progressive mobilization, and helping her to become more independent in specific activities. You would include making sure she gets to her physical therapy (and eventually occupational therapy) sessions (management role of the nurse), and placing items she uses on the unaffected side so she can get to them and reach them easily (call bell and telephone to be place at her unaffected side). Those would be basic nursing actions. I could include that her side rail be up at all times on her affected side (so she doesn't fall out of the bed). That is just a start. Care plans can be short, one page long, and to the point or very drawn out, 50 pages long and extended depending on what you are required to supply to your instructor.
You should get a care plan book to help you with these things and help you come up with lists of nursing actions to include in the nursing care plans you will be writing. Many of the basic nursing actions you will want will come from a basic nursing care textbook. You start to identify problems with a disease condition by looking at what the symptoms of the disease are. That comes from your nursing textbooks or a textbook from a course on disease processes. Making a care plan involves using several books for references. It is an exercise in thinking and putting together information. Instead of writing an essay you are putting your words into a column format.

Hey, the way you sum it up makes it sound so easy, I hope that after i complete this course I will be able to sound as professional as you, I appreciate your taking the time to respond to me, I noticed your credentials and where you are in your career and i am sure you noticed i am only in my 5th day of school, I am feeling very discouraged because like i said previously i am finding it hard to comprehend and this is only the beginning, its 9pm my baby just went to sleep i have a final tomorrow, i am starting microbiology, finishing communications, i still have to do my project, I am not complaining even though it sounds as if i am, 5 people already withdrew from this course, i was smart in high school, but i smoked alot of marijuana, and i regret this now because when i was doing it i didnt think it would affect my memory as an adult :uhoh3:

but i am absolutely determined to succeed, I quit my job over the weekend because they wanted me to work all weekend which i thought would be ideal, but it just is not possible. I am going to start my report now, thanks so much for your guidance, can you tell me a little more detail about your career and how you started, and do you know anything about becoming a specialty or registered nurse once passing the boards for a LPN? Talk to you soon Jackie :nurse:

Daytonite, BSN, RN · Sep 15, 2005

I don't think that smoking pot has anything to do with your difficulty comprehending your studies. I get the feeling that you are carrying some guilt over this. That was when you were in high school. Stop worrying about it and move on with your life. You are older and you have a baby now. That makes a big difference in your life. We also learn differently when we are older. It is not as easy for us to memorize facts when we are older. Nursing is very common sense oriented. You can often relate nursing procedures with a lot of homecare you do for kids or a sick husband. Nursing also is a new subject to you and you have nothing in the past to base it on except your life experiences, like taking care of a child. Don't despair. All nursing students go through this "shock".

I finished RN school at a junior college in 1975. It took me another 9 years to get my BSN. I've worked all kinds of med/surg units and done a lot of work in nursing homes as well. I've been a nursing supervisor in a couple of different places and a head nurse (or, nurse manager) at a large city hospital. I worked as an IV therapist for a total of 6 years. My mother was an LPN. My mother wanted to work in Intensive Care and, by God, when she graduated from her LPN program she went to the hospital where her class had done their clinicals and got a job in their Intensive Care Unit. She was around 50 years old at the time. I'm very sensitive to the problems LPNs have because I heard my mother talk about them at home all the time. Believe me, nothing has changed that much between LPNs and RNs in the last 30 years!

Let me impart a little advice that may help you get that first job as an LPN in the specialty area you want. Have a positive attitude, especially around your instructors. You'll read a lot of negativity in the posts by some people on these forums. You don't want your instructors to hear that kind of negative thinking because they then form a negative impression about you. You are going to need them to give a glowing report of your nursing abilities when you apply for your first LPN job. You will need one or two recommendations from nursing instructors to get your first nursing job. You want your instructors to report positive things about you that are going to be attractive to a prospective employer. Nurse recruiters are very sharp at their jobs and they know how to read between the lines as well. They know when instructors holding back and not telling them things about people as well. Volunteer to get you return demonstrations of nursing procedures done first. Volunteer to give the first IM injection to a patient in the hospital. Ask to have a critical care patient so you can get the experience. Ask questions and show an interest in learning and in learning how to find answers on your own. Follow the rules you are given. If you are supposed to call and check with an instructor before giving any medication or moving any patient out of a bed, do it. No matter how asinine a rule might seem, just do what you are told. Otherwise, you will be at their mercy when it comes to grading and getting a reference. Nursing school is only a few months out of your whole life and the disagreements students get into with nursing instructors isn't worth the price of a good recommendation from them.

As far as specialties go, if there is some particular area of nursing you want to work in you just have to get out there and look for a job in that area. If you want a hospital job your best prospects are to apply for a job in the hospitals where you've done your clinical work for school. Apply two months before you reach the end of your LPN program. I don't know if you are aware of this, but a lot of LPNs work in long term care (nursing homes) as charge nurses or in doctor's offices. These are both a lot different from hospital-based nursing. If your final goal is to be an RN you should really consider going directly into an RN program if you can afford the wait. Otherwise, chose an RN school that is going to give you some credit for what you've learned in your LPN program.