have difficulty with "coordination" type skills? I don't have any problem with the "book stuff", but for me to learn a "skill" (to nursing standards for checkoff purposes) is very difficult. Frankly, I am almost "learning disabled" in this area. If I was having trouble in A&P or Microbiology, I would have MANY ideas for improving my odds (such as hiring a tutor, buying various software, study guides, web sites ect). However, with the actual "checkoff" skills I don't really have too many ideas. I have taken a CNA course, and plan on viewing some skills tapes over the Summer. I am also "pre-reading" my text books so that I can focus more time on the skills than the academics next Fall. Few people I've spoken to about this can relate at all to my situation since MOST people find the "competencies and skills" easy in comparison to the academics. Does anyone else have anything else that they have read about working for other people "slow" in this area?
Apr 7, '04
I am also a "book smart" person who is more challenged with the skills. I do not learn a skill until I have done it physically a few times. So, this is what I have done:
1) When learning to make beds, I put "Pillow Man" into my bed, and made the bed 3 times with "Pillow Man" occupying it. (he was very quiet and cooperative!)
2) My lab instructor gave me an extra primary and secondary tubing kit and saline to practice setting up piggyback IVs at home.
3) I practiced health assessment on my daughter's American Girls doll.
Okay, sounds weird, but for some of us, we can't just look at a tape and know how to do it. We have to go through the motions.
Hope this helps!
Apr 7, '04
Practice,practice,practice. Go through all the motions at home when you practice. Just like the other poster said take home supplies if you can. Practice opening sterile items even if they aren't really sterile anymore. Use dolls, use people anything you have available. If you don't have a foley tray for instance set up a pretend one at home and go through all the motions. Use your lab at shool if you have one. Ask other students to practice with you. Hope this makes sense I just got off night shift.
Apr 7, '04
I suggest a part-time job as a tech. This will give you practice with hands on skills and allay some of your anxiety.
My problem is performing tasks in front of instructors who I know are critical. This was a huge problem for me in my senior practicum because I got so nervous in front of my preceptor... that I messed up when I really knew the procedure. I completely agree with those who say practice. Repetition is the key with these skills.
Apr 7, '04
You are married to another nursing student if I remember right. Practice on her. Practice practice practice. Psycho-motor skills become fluent with practice after reading the procedure and thinking about it. Visualize it in your head, prioritize the scenario in your mind, then do it. If you mess up, visualize again, perform again. Each time you physically do it, the motions will become smoother and as they become smoother they become more normal. Practice and don't over analyze what you are reading. It will make cognitive sense to you as the physical sense becomes fluid, the more you practice the smoother you become.
Apr 7, '04
My perspective is that of someone who has been a student, a preceptor, and an instructor ...
I, too, have always been book smart -- but need extra practice to get the physical manipulation skills down. As everyone else has said ... practice, practice, practice.
Watching someone else do a skill helps me a lot, too -- even if that person is just another student. So, practicing with a partner might help. You could critique each other, offer suggestions, etc.
Also, I always get nervous when someone watches me do a skill. That always made any sort of "check off" testing procedure more stressful and difficult for me. For those types of situations, I think it helps to state that you are nervous because of the "testing situation" up front and out loud. It may also be helpful to state the key points of the procedure out loud before you begin (and throughout the procedure if possible). Stating the key points out loud will serve as a reminder to you to be sure to get that part of the procedure correct and help you focus on those key points. In addition, it lets the evaluator know that you know what to do -- and that your awkwardness is due to nervousness, not a lack of knowledge. A nice instructor will take that into consideration. While it may be against the rules to talk directly with the evaluator during the check off procedure, it may be possible to talk to yourself during it -- and saying the steps out loud to yourself can help you focus by having the book knowledge in your mind be leading the way through the procedure.
Apr 7, '04
It's hard to practice with my wife because I literally drive her insane with my awkward, nature we are virtual opposites in terms of our natures and personalities (however, that doesn't mean we won't or don't practice just that we often end up in arguments or her solemn pronunciations that I am doomed, a hopeless case, and should just save the tuition and find another field!). Does anyone know of a precedent of hiring a TUTOR to help with the practical skills? Do schools generally require such people to be upperclassmen in order to "enter" the skills lab? Maybe, I will get lucky and be paired up with someone equally motivated to succeed who will want to practice ALOT. Also, I am going to watch the skills vidieos over the Summer until I literally DREAM of them at night (they are expensive to buy, but they are available in the educational resources part of the school library). If in the end despite my best efforts I fail, then at least I will TRUELY have given my best effort.
Apr 7, '04
I, too, have found the psychomotor ends of skills surprisingly challenging. First semester, not only could I not hear (anything) through my steth, I could not juggle my glasses, the steth, and the BP cuff all at once. I failed 30-sec sterile gloving the first time around. Instructors mocked my shaky hands while I did dressings on the lab dummies. I felt like all of the three stooges.
Seriously, I just practiced, practiced, practiced! I have two teenagers; not a single friend of theirs got in or out of this house without having vitals taken and letting me auscultate their heart and lungs. I did a head-to-toe assessment on my 10-yo every day. I donned and re-donned sterile gloves at the kitchen table ad nauseum. I also bought a much better steth (I was using a mid-price range Littmann, switched to an upper range DRG) so that now I feel like I have stereo speakers in my ears and auscultation is much clearer and easier.
In med/surg clinical, a lot of the things I stressed over in lab (and was hassled over by faculty) have gone amazingly well. While I'm confident in my vitals/assessment skills now--the reality is most floors have machines where all you do is put on the cuff and the sat finger monitor--and the machine takes all the vitals--I haven't done a manual BP since first semester, but I do know how if I need to. Heart and lung sounds seem pretty routine to me now. My first sterile dressing change I was talked through by a really considerate PA. He had begun it, looked at me across the pt, and said "Hey, you wanna do it?" (Giant abdominal wound with exposed bowel); then he was really supportive and kept telling em what a great job I was doing. That particular pt was a wound festival (the adb wound was her least serious one!)--so now dressing changes seem pretty routine.
So anyway, practice as much as you can. When you get to clinical, ask for "messy" and complex patients, but make it clear to the clinical instructor you need support the first time you do new skills on a real human.
Things that intimidate you one semester will eventually be much easier. The exposure/experience makes all the difference.
(I still dread the first time I have to cath someone--so far have only done it on the lab dummies)
Best of luck!
Apr 7, '04
Hahhahahahaha, sorry Roland, but the part about your wife cracks me up. Ah the crosses we must all bear. I wish I was more book smart, I feel comfortable with my skills but ask me the detailed rationale behind them and I freeze up and sound like a blubbering idiot.(Lots of hemming and hawing)
Good luck to ya!
Apr 7, '04
I try to think of creative ways I can practice skills at home, as there is limited time and space in open lab. Like you, just watching videos or reading instructions in the book isn't enough for me. Remember to go slowly and think through each step during check offs.
Buy Playdo! I know it sounds silly, but it comes in handy. You can use it to make an open wound when practicing wet to dry dressing. You can create your own "anatomically correct" male or female urethra to practice inserting Foley's.
Measure the size of the overbed tables in your lab. Cut a piece of cardboard the same size and use it to practice opening your supplies without contaminating your sterile field.
Physically act out and verbalize each step of a skill. You may sound silly talking to the dog/doll/pillow, but it helps you remember and you can work out any difficulties before check off.
Apr 7, '04
These are some really good suggestions. I am starting to feel that if I do everything possible there may be SOME hope for me passing. At the end of the day pass or fail I want to be able to say that I did everything that was humanly possible to succeed.
Apr 7, '04
I'm also better with the book stuff than the checkoffs. I actually failed my first checkoff, and it never happened again. All you can do is practice. Make sure you practice on the models, I didn't do this and it really hurt me on my first checkoff. Show confidence, and act like you know what you are doing. You still need to study the book for certain things, just make sure you're able to verbalize everything. Know the rationale for everything. Really, all you can do is practice practice practice...on the models, in the lab.
I used my kitchen counters/tables to practice for the cath check off, at night. And when I could I went in during the day and practiced on the dummies. I also watch the videos at home, no one else really does this, but it helps me.
I've also learned that my teacher is willing to spend 5 minutes to help me. I asked her, after I was very prepared, to come watch me do the cath..and it helped me having her watch, and she gave me some pointers. Practice w/other students, have them question and critique you. And you must be prepared!
I still have trouble with being nervous. I'm actually more nervous in checkoff than I am with the patient. The instructor doesn't want to fail you, she just wants you to know what you're doing, be quick, don't hesitate, and be prepared.
Apr 8, '04
I loved your post, Judith L! I, too, could not hear from my steth. It turns out that it works much better when you a) have the earpieces turned the right way, and b) have the side you are listening to "turned on"! I remember getting NO SOUNDS AT ALL, but my stethoscope was turned to the bell, and I was listening from the diaphragm. D'oh!
I now have a Littman Master Cardiology, and it works great. Cost $130, but WAY better than the other one. I feel like I can actually hear things now.
That's pretty funny about taking vitals on your teenagers' friends. My teenager doesn't stay still long enough. I was barely able to get him to stop so I could take pedal pulses!
Have a great day!
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