Losing my mind with clinical paper expectations

Soupysoup · Nov 5, 2012

I have the same problems but related to APA guidelines. I will get marked off for having minor mistakes in formatting, yet other students do not even include a cover page, and receive no deductions. My papers are corrected by GTAs, there seems to be some inconsistencies between them. Maybe you're having the same problems. One way to help is to bring the draft paper to the instructor before the due date and ask them to do a once-over while bringing up issues you think they may have.

OB-nurse2013, BSN, RN · Nov 5, 2012

I just have to post your sclera comment made me laugh but on another note sometimes tehy want you to say...withoutredness or lacerations or something of that sort blah blah i dont know I dont have to do any real careplans this semester hahahhaha :) perks of term 4

Mattie2012 · Nov 5, 2012

I want to pull my hair out over clinical paper work too, but I can't because all I want to do is vomit because of the stress of it all. I received unsatisfactory after long hours as well I am at the end of my rope and just about to let it go

classicdame, MSN, EdD · Nov 5, 2012

I worked 9 years for ophthamologists who described a healthy sclera as "clear"

Sadala, ADN, RN · Nov 11, 2012

Light white with a hint of nutmeg?

Too funny!

I try to a) follow the directions in the liberal written criticism I receive and b) look in both the fundamentals and health assessment books for their examples of documentation/terminology for normal/abnormal anatomy and physiology. We're expected to go with color on sclera - white, usually.

hodgieRN · Nov 11, 2012

If you are referring to scholarly papers, I would like to give some advice...

Your grades can vary from one instructor to another. Some concentrate more on APA format while others concentrate on substance. You will find instructors who pride themselves on ripping essays apart. Some may tell the class "The highest grade you can get is 99% because no one writes a perfect paper." Others may forgive a few grammatical errors as long as you write the paper as instructed. Everyone teaches differently. You must also remember that a scholarly paper must meet the highest of exceptions. If you move on past your bachelors, your work will be peer-reviewed among the nursing community. Your instructors are prepping you for real world scrutiny that has zero tolerance for leniency.

Although some may disagree with me, I believe paper grading has a lot to do with interpretation. One teacher may hate it, while another will praise it (if the formatting is correct). You can grade a paper based on a number of different qualities. Even if you write the paper in perfect APA format, it can be marked down because it "doesn't flow right." It can be toss up when a paper is grade by an instructor or a grad student. Many times, the instructor is more harsh. But, you can always get the grad student who thinks of themselves as a perfectionist, so anything you write will never get their approval. While I was in college, I had an instructor that was conducting a study of how people interpreted essays (this was not nursing school). After you submitted your paper online, it was assigned to a group. Two students were assigned to your paper and they would grade it based on specific standards. This included college freshman right out of high school. Then, it was graded by 2 different grad students. Lastly, it was graded by the professor. Your final score was the mean of all five grades. Interesting enough, each score was different. The biggest difference I saw was between the two grad students. In the end, we submitted a questionnaire that rated the effectiveness. The point is, you will find different ranges on how instructors grade papers. However, there are things you can do to increase the likely hood of receiving high marks (other than writing papers in proper APA format).

Listen very closely to what instructors are looking for. If they say, "I am a stickler when it comes to APA format," take their word they are going to scrutinize every word. Make sure there are no grammatical errors, improper word placement, etc.

Write your papers based on what they want....not what you want. If an instructor likes substance, give them substance. If they like concise papers, don't go on and on, ranting about general things that don't support the essay. If an instructor wants specific factors, then that is what you give them. If you stray from that, the red marker comes out.

Find out their pet peeves. Many of them will say " It drives me crazy when students do this...." If you hear that, then never do it. There's always a student who never hears the instructor and the paper gets marked every time for the same thing.

Don't fill the paper with jargon or phrases so you can hit that word count. Say what you need to say in a very specific manner. If you are writing just to fill in another hundred words, they will pick up on it. Always write more than what you need and work backwards by deleting or paraphrasing your points.

Use your first paper as an assessment of how they grade, and then adapt to it. Some enjoy free thinkers who include greater lessons of life. Others hate grandiose generalizations and only want the details (most scholarly paper are this way. Free thinking is more for opinion essays or entry level english). So, your first paper will give you an idea of what type of scholar they have become. Fighting the grade will only cause friction, so adapt to their style and give them want they want.

After you are done writing your paper, edit it over and over, but don't change it so much that it becomes a different entity. When you think you are done, print it out and grab a red pen. You'd be surprised how many errors you find when you change from the monitor to paper.

Have someone in your family read the paper and ask them what they think. If they are confused with an area or question the flow of a paragraph, it probably won't flow with the instructor. Ask them to just read it...no grammatical checking. Value their opinion. They don't even need to know the terminology. They just need to say if it written well.

Submit you paper to a learning/tutor center. They can give great feedback. The people that proof your work are grad students and /or professors. It will give you an idea of your scholarly work. (But, be ready for your instructor to mark you down in areas that weren't addressed by the center. Your instructor may have different rules).

Don't assume that something you wrote before (that didn't get marked down) is hands off for being marked down now. I have said to myself, " I didn't get marked down for this last time, so it's messed up that I get marked now. That's not fair." However, it might have been missed, or maybe it was the 93rd graded paper that week and you got a pass. Sticking with guidelines and standards is the best way to stay consistent.

Ask your instructor for help or advice. That's why they are there. If you get an assignment that doesn't have specific instructions, then ask them for it. Ask what they want. Ask what they are looking for. Ask is there is anything to stay away from....like this guy who ends his sentences with prepositions.

When a new semester begins, remind yourself that this instructor may have different expectations than the last. You may need to slightly change your writing style from one class to another. Again, meet their specific expectations. It could mean the difference between a "B" and an "A."

Hope this helps :)

TheAmazingMrsA · Nov 11, 2012

hodgieRN, I appreciate the comment, but in my case it's not a scholarly paper. It's a clinical paper used to document our assigned residents. Which means, I cannot share it with anyone but the instructor and I'm not even allowed to talk about the contents with classmates due to HIPAA. It's about 12 pages, and it covers everything from functional assessment to bowel/bladder training. My "instructor" is actually a graduate student (since we have multiple clinical sites and not enough instructors to go around), and she's incredibly inconsistent in how she grades. I can't go talk to her about a paper because she's not on campus, ever, and she doesn't respond to e-mails in a timely manner. My clinical group is basically thrown in head first to paper writing and then given very little feedback on how to make our papers better.

I've passed all the papers so far, but just barely. Even when I take terminology right out of our text, she always sees something wrong with it. It just seems that her corrections are based solely on her judgment and opinion, and not any sort of guidelines (which there aren't any, by the way). It's infuriating.

hodgieRN · Nov 12, 2012

oh man....Well, the grading is hard to argue since there's so many variables, but if there is a concern with little feedback or poor/ late response to e-mails, I think it should be brought up the chain. With todays online classes and off-campus teachers, responding propmtly to emails is a necessity. Now, I am not a grad student, but I would think that giving proper feedback and responding promply to emails is apart of the requirements for those who wish to become professors. I've had instructors who do not have office hrs and they were on top of getting back to us with email. Professors should know any concerns regarding their grad students because they are responsible from them. I don't know both sides of the story, but I think the professor should know the status of their grad students, especially if the class is suffering from any lack of responsiblities. You said the grad student is never on campus...are they supposed to be? If they are not available (when they are supposed to be) then that is also something that should be brought up. You could take to your prof. and let them look at it and make a decision on whether or not the grad student is being fair. Don't get me wrong...most grad students are awesome and sympathic to being in school, but they are also learning. They also have requirements to meet.

Do they have office hrs?

nurseprnRN, BSN, RN · Nov 12, 2012

Nonsense. When you write it up on your computer, duplicate it, then do a search-change for all identifying things (like name, age, date, floor, etc.) Then have your colleagues read that. No identifying data, no HIPAA violation. These are identifying data according to the law. If your faculty objects, there's a link at the bottom to the website. Nursing is a collaborative profession and it's self-defeating to discourage it.

I used to let my students work together on care plans and other projects so long as each student turned one in AND included the names of everyone with whom they collaborated on it. It was easy to see who was copying and who had original material. People who were leeches and didn't contribute rarely got asked to help again and they were on their own. Others reaped the benefits of collaboration. Great learning tool. Tell your faculty.

https://allnurses.com/hipaa-nursing-challenges/answer-hipaa-violation-693686.html
The following identifiers of the individual or of relatives, employers, or household members of the individual the asterisk * indicates permitted in a limited data set 164.514(e)(2)):
(A) Names (unless specifically released by written permission)
(B)* All geographic subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code
if
, according to the current publicly available data from the Bureau of the Census:
(1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and
(2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
[Limited dataset must exclude postal address information other than town or city, state and zip code]
©* All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
(D) Telephone numbers
(E) Fax numbers
(F) Electronic mail addresses
(G) Social security numbers
(H) Medical record numbers
(I) Health plan beneficiary numbers
(J) Account numbers
(K) Certificate/license numbers
(L) Vehicle identifiers and serial numbers, including license plate numbers
(M) Device identifiers and serial numbers
(N) Web Universal Resource Locators (URLs)
(O) Internet Protocol (IP) address numbers
(P) Biometric identifiers, including finger and voice prints
(Q) Full face photographic images and any comparable images (unless written permission obtained)
®* Any other unique identifying number, characteristic, or code, except as permitted by paragraph © of this section; If the algorithm for creating a "code" is disclosed to the recipient of the information, then the code is considered a unique identifier. The code is also considered a unique identifier if it is generated from any of the identifiers, or pieces of the identifiers, listed above.
Safeguarding PHI
The Privacy Rule requires you to "safeguard" PHI at your training site. Use the following practices to ensure Privacy Rule compliance.
If you see a medical record in public view where patients or others can see it, cover the file, turn it over, or find another way to protect it.
When you talk about patients as part of your training, try to prevent others from overhearing the conversation. Whenever possible, hold conversations about patients in private areas. Do not discuss patients while you are in elevators or other public areas.
When medical records are not in use, store them in offices, shelves or filing cabinets.
Remove patient documents from faxes and copiers as soon as you can.
When you throw away documents containing PHI, follow the facility procedures for disposal of documents with PHI.
Never remove the patient's official medical record from the training site.
Avoid removing copies of PHI from the training site; if you must remove copies of PHI from the training site, e.g., to complete homework, take appropriate steps to safeguard the PHI outside of the training site and properly dispose of the PHI when you are done with it. You should not leave PHI out where your family members or others may see it. All copies of PHI should be shredded or otherwise destroyed when they are no longer needed for your training purposes.
The U.S. Department of Health and Human Services has issued another set of HIPAA rules (the Security Rules) regarding safety and security of electronic data files and computer equipment, about electronic safeguards and how the HIPAA Security Rules may affect you at clinical training sites.
Use Only the Minimum Necessary Information
When you use PHI, you must follow the Privacy Rule's minimum necessary requirement by asking yourself the following question: "Am I using or accessing more PHI than I need to?" If you are unsure of the PHI you may use or access while providing health care for a patient at your training site, please contact your preceptor, supervisor or the HIPAA Privacy Officer at your training site
Disclosing PHI to a Patient's Family Members
Before you may discuss a patient's condition, treatment or other PHI with his or her family member, it must be determined if the patient would object to such a disclosure. You should confirm with your supervisor that the patient has agreed to allow or in some other way has expressed no objection to such disclosures before you may discuss a patient's condition, treatment, or other PHI with his/her family members.
This does not mean that you cannot receive information from these persons, only that you cannot give them any PHI without permission. You could be exposed to suit if you refused to listen to and record information that was later found to be important, and the patient was harmed by this omission.
Patients' Rights Under the Privacy Rule
Each training site covered by the HIPAA Privacy Rule will have policies and procedures for implementing the following patient rights under the Privacy Rule:
The right to request alternative communications.
Under the Privacy Rule, patients can ask to be contacted in a certain way. For example, a patient may ask a nurse if she/he can leave a message on the patient's home voicemail instead of contacting the patient at work. If a patient's request is reasonable, as is the previous example, the health care provider or facility must follow it.

The right to look at (and obtain copies of) records.
Patients can ask to read their medical and billing records, and have copies made.

The right to ask for changes to medical and billing records.
Each facility must review and consider all requests for changes to medical and billing records.

The right to receive a list of certain disclosures.
Your training site must make and keep a list of certain disclosures of PHI (excluding disclosures for treatment, payment, and health care operations) that are made without patient authorization. Patients have the right to see and receive a copy of this list.

The right to request restrictions on how PHI is used and disclosed.
Patients can ask health care providers and facilities to limit the ways they make use of and disclose the patient's PHI for treatment, payment, and health care operations. Providers and facilities are not required to agree to such requests. You, as a trainee, must never agree to such restrictions on behalf of the training site.

The right to receive a "Notice of Privacy Practices."
Each health care facility that provides direct patient care must give every patient/client a copy of their Notice of Privacy Practices. The notice describes their privacy practices and the Privacy Rule. The facility must make reasonable efforts to have each patient sign a form acknowledging he or she received the notice. We recommend that you obtain a copy of the Notice of Privacy Practices from your training site and become familiar with it.
An indispensable source for answers is found here:
HIPAA - Frequently Asked Questions

Stephalump · Nov 13, 2012

I don't have any advice, but I can definitely relate! I don't deal well with ambiguity - if you don't tell me to do something and I don't want to/think I need to do it then why would I? There are only 4 weeks left in the semester and I just discovered I'm sitting at a B+ in clinical because my responses in my clinical log aren't long enough. Why the heck wasn't that mentioned on the 7 write-ups I've already done before it was probably too late for me to raise my grade?

Sometimes I'll write something one way and there won't be any corrections. Then I'll write it the same way the next week and it's marked wrong. I'm going to lose all my hair by the end of this year!