Clueless About Clinicals

81ke83 · Nov 4, 2006

At our school, we had to become a CNA, so we spent 6 months in a nursing home. We don't do complete head to toe assessments until the second semester. As far as the nursing home, we helped to get our clients up for breakfast. If they went to the dining room we made their bed and cleaned up their room. When they came back from breakfast we did their vital signs, showers, Pt, helped them get dressed.

When we go to the hospital, we go the night before and look in a binder and get our patients name. We go to the computer and write down all the information, history, why they were admitted, labs, medications. Then we go home and compile and organizational sheet on what care we are going to do on the our client. We do a med sheet (looking up every med, interactions, allergies, etc) We do a concept map of our disease so we understand what is going on with our client. All of this take about 6 hours. So we don't get to bed until midnight. We arrive at the hospital at 0600 look to see if there are any new orders, then take care of our patient. We didn't start passing meds until the middle of the first semester. In pre conference we discuss with the instructor what focused assessments we are going to do. It could be a head to toe. Depends on what their diagnosis is. Our care plans are about 10-12 pages and take a total of 18-25 hours to complete. They tell me when we get good, we will be able to do them in 5 or 6. Hope that helps.........Kay

Lori RN_09_2b · Nov 4, 2006

I had my first night of nursing home clinicals last night, and I was feeling pretty uptight about it beforehand too. Turns out there was nothing to worry about. The instructor assigned us patients to do vitals on, we learned how to do glucose testing, and passed out dinners. We spent a lot of time going over charts, just kind of learning what to look for. For the next clinical on Tuesday we have to do a simple care plan and research five meds that the patient is on. Our instructor is really great, says this should be low stress because we're just starting out. Anything we haven't done yet--like assessments--she'll do with us. By the time we left I felt kind of "nurse-like" because I'd finally touched a patient!

So don't worry too much. Not only do most people feel exactly the same way as you do before they start, but it will probably turn out to be a great experience!

EmerNurse, BSN, RN · Nov 4, 2006

If I recall correctly, our first couple clinicals were in a nursing home and were designed to get us comfy approaching a patient, and doing basic nursing tasks, such as baths, ambulation, and just simply talking to patients (STRANGERS!) about personal issues.

I remember my shock when I first saw a CNA bathe a patient by pulling the sheet off him and having him just lying naked on his bed while she bathed him. (ok I'm still a little appalled by this hehe). So much was NEW to me.

Use your first clinical or two, within the parameters given by your instructor, to familiarize yourself with how to approach and and talk to patients and offer them basic care. It might be as simple as brushing thier dentures for them before they start their day (which can be freaky if you've never done it before).

Go with confidence, the residents are often very happy to have a dedicated person assigned to them for a short period, are very forgiving of any social gaffes (or they forget them in 2 seconds anyway), and are willing to talk to you.

This is the start of a fantastic journey - take that first step with the confidence born of a desire to help and be kind, and the rest will follow.

Much luck!!

edit:for typo - did I miss any?

Daytonite, BSN, RN · Nov 4, 2006

this is what i suggest you accomplish when you are in your clinicals. at some point you will need to go over as much of the important information in the patient's chart as possible in order to put together a nursing care plan. that information includes the history and physical that was done by the physician and any consultations that were done by consulting doctors. in nursing homes, the doctor's orders have to be signed by the doctor's every month, so all the orders in the past month's computer run and any newly hand-written orders since are the ones you should write down in your notes. these will include all the medications and treatments the patient is receiving and save you from commandeering the medication and treatment sheets to get this information. in the chart, you should also find and note the dietary, physical therapy and activity notes. these will give you a lot of information about the patient as well. nutrition and fluid is one of the biggest things nursing homes address with patients. they watch their patient's weights very carefully and monitor them for dehydration. if you can find the patient's care plan it would be good to get a look at it as well. it will not only tell you a great deal about the patient, but it will give you a heads up as to what is going to be important for you to put on your care plan for this patient. sometimes the official care plan can be hard to find. in some places i worked they were kept in the mds nurse's office. so, if you can't find the care plan, ask where it is because it exists somewhere.

i'm including a link to a nice little article on how to do a head to toe assessment in 5 minutes that should help you get started with doing a physical patient assessment. in a nursing home you are also going to be wanting to assess the patient's ability to perform adls, so you should make yourself a copy of adls so you don't forget what they all are. basically, they are all the activities we do to carry on with our daily lives. you will find that most nursing home patients have some major deficits and need some assistive care in accomplishing their adls. this is one of the big-ticket items of nursing home care.

everything i've told you about so far is going to be good information you can use to help you write any nursing care plan that might be required of you. actual hands-on care of the patient involves making a little list for yourself of what has to be done for the patient. routine in most nursing homes is usually that patients are dressed in their street clothes and gotten to the dining room for breakfast. after breakfast bathing and showering is done. in most nursing homes patients are only showered twice a week and are almost always put on a regular schedule so you'll need to check to see if your day in clinical is a regular shower day for your patient. a shower day usually includes a complete linen change of the bed linens. some patients will be resistive to being showered on a day that is not their regular day. you'll have to ask the cnas how a patient's personal laundry is handled for that facility as well. you'll have to figure out when medications and treatments need to be worked in. in between all that the patient may need help with being toileted, attend physical therapy or some other activity. lunch is usually around noon and it is often their big meal of the day. after lunch many patient's are pooped out and are put down for naps

your instructor should also have some instructions on what you will be required to do, so follow those directions. you may be required to take vital signs on your patient so you may need to bring your stethoscope. there is usually a pre- and post-conference where all you students meet with your clinical instructor and discuss what is about to go on or what has gone on for that day. care plans usually take some time to compose and write and most often are not expected to be turned in until the next clinical day at the earliest, although each school handles this differently.

you and your fellow student's are all in the same boat. the first clinical or two is a little nerve racking because you are not quite sure what is going to happen. after a few times you'll figure out what you need to be getting accomplished at your clinical sites.

http://www.mededcenter.com/module_viewer.asp?module=+118#headtotoe - this is a great guide to physical assessment. it is called head to toe assessment in 5 minutes (well, maybe a little longer than that) that was originally posted on this thread https://allnurses.com/forums/f205/help-health-assessment-evals-139193.html by scmomof3.

Priddyeyez · Nov 5, 2006

Thank you for your responses, I will certainly be using your suggestions.

Daytonite- THANK YOU for that link! I feel SOOOO much better having a clearer idea about head to toe assessments.

locolorenzo22, BSN, RN · Nov 5, 2006

LET ME TELL YOU SOMETHING!! The first 2 clinicals were NERVE-wracking! I got a major talking to, failed part of the day for failing to give patient meds quickly enough and not making sure he'd had his breakfast before his meds..I thought policy was vice versa. How were we to know, as the instructor NEVER told us general flow of day, etc. etc. how to structure our time to do what we had to, etc. etc. I then got a progress report for failing clinical and had to write measurable goals/plans on how to improve!

Here's my tips:

1. Learn the routine of the home as QUICKLY as you can. Sometimes a resident has a favorite activity, church, exercise, etc. that you can take them to, and end up going to do research for 30 mins while they're there.

2. I JUST completed my head-to-toe assessment checkoff with instructor present, and went well. Do what you can with client in position they are already in, like sitting or lying down, then adjust from there. You most likely will NOT be able to do things in order, so you have to adjust.

3. Try to remember that a SMILE goes a long way in fostering trust. One lady keeps calling me daddy as I walk by, and I just smile, say "hi", and keep walking, she stays calm until she sees me again.

4. Take a deep breath and remember that you CAN get through this.

hocke5716 · Nov 5, 2006

Thanks alot ... new to nursing .... extremely helpful

WDWpixieRN, RN · Nov 5, 2006

I've got to think you'll get a lot more further instruction from your CI....they're responsible for your actions, as well as the school, so they're not going to just let you have at it!!

We learned assessments & vitals before clinicals so we were expected to do those as well as bathing and bed making. We are in a hospital environment however, not LTC.

One of the most important things I'll impart on you is to learn where things are (linens, bandages, tape, misc. supplies, dirty equipment closets, where/how dirty linens are disposed of, etc.), and to be friendly to the staff, even if they don't appear very friendly up front. You never know when you'll need an answer from someone that might include a facilities person, unit clerk, or the RN or MD.

Just pay attention to everything's that's been told to you so you'll be able to reference the information when the time comes! My RN needed gauze for a pt just started on heparin who started some pretty copious bleeding after she removed an IV.....she asked me to go grab some and I had to ask someone where it was...we had been shown during orientation several weeks before, but I forgot!! :eek:

NaomieRN · Nov 5, 2006

Going to clinical is nothing to be afraid of if you want to be a nurse. The first day, I was a little nerves because I did not know what to look for in the chart and how to document on the computer. As far as the patient, I was comfortable from the beginning. Once you look at the patient's chart and know what they are in the hospital for, then you can plan the care. The most important things to look at are: activity level, diet, I&O and DNR order. In the hospital, I usually check lab results. Just be yourself, take care of the patients as you would someone taking care of you, respect them and do your best for them. Good luck to you.