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MBar1 RN

Med/Surg
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MBar1 is a RN and specializes in Med/Surg.

MBar1's Latest Activity

  1. Communication: A Vital Utility Communication can be defined simply as the sharing of information. Even more broadly, communication can be distilled down to the act of a sender producing the content of a message in any of the many forms available to us, to then transfer this information from one entity to another at varying speeds.[5] A receiver intercepts the incoming message, then proceeds to decode the content into terms that are easy to comprehend, and that reduces the chances of error.[5] In healthcare, error is evaded at all costs as the consequences can be catastrophic, and in some instances, permanent. That is why so much effort is put forth to ensure that the means of communication is operating at peak effectiveness at all levels and why simply communicating with one another is not as straightforward as it may seem. How we communicate with one another in practice is largely based on the mode by which information is transferred from one provider to the next. Even more, the logistics of the message, that is, the organization of the content, word choice, and use of clinical terms is also seen as paramount to the productiveness of communication.[4] “Huddle” is one of the numerous communication strategies that is recommended by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) in response to a publication from 1999 titled, To Err is Human, which presented what seemed to be an inconceivable figure of annual mortality rates due to medical errors.[3] This figure presented an astonishing 98,000 deaths annually due to what is defined as failure to do what was intended or failure to implement the correct plan to accomplish a common goal.[3] Among the contributory factors, failure of communication, however defined, was implicated in this avoidable reality.[3] An entire curriculum had been created in response to these issues as existing team-based training programs lack sufficient evidence in regards to their effectiveness, and were not designed to retrofit or conceive new programs based on their existing architecture.[4] At some point between 2001 & 2003, AHRQ and DoD almost decided to base their program on the Federal Aviation Administration (FAA) circular for airworthiness for commercial and private aviation. However, this was scrapped and TeamSTEPPS was created.[3] TeamSTEPPS is an acronym that reads; Team Strategies and Tools to Enhance Performance and Patient Safety. It is a curriculum aimed at practice investigators and those at the institutional level to implement, to, well, strategize the team approach and to streamline the care process, while improving upon patient safety. This U.S based program is making its way to Canada in collaboration with the Canadian Patient Safety Institute.[2] So, whichever preconceived notions you had regarding the utility of a.m team huddle, as you can see, there is a reason for it, and more importantly, there are people who see a larger vision over the horizon- as you should too. Team huddle is just one of many interventions aimed at improving communication.[1] (See pocket guide). What Does “Huddle” Mean? Team huddle is an event that typically takes place at routinely scheduled times on a daily basis and involves relevant members of the care team. It is a meeting that tends to take place early on in the day and lasts for about 10-20 minutes.[8] The goal of team huddle is to communicate pertinent information regarding patient care as well as unit and hospital operation. It is a tool used to facilitate communication between team members face to face, in an open forum, usually at or near the nurses station.[8] Similar to a town hall event, participants are there to listen and share without fear of judgment or being penalized for holding a certain opinion or thought. Team huddle gives team members the opportunity to adapt their workflow for the day and prioritize patient and unit needs.[8] Members of the team are given the opportunity to communicate information that brings necessary parties to the forefront of an imminent problem or concern, and in turn, contribute to the formation of a timely solution. Typically those involved in huddle include front line providers, management, unit attendees, clerical staff, and any one of the many other important stakeholders involved in patient care.[8] However, this does vary on an institutional basis. Team huddle can be seen as a preventative strategy that allows the unit to run smoothly and efficiently. Time can then be spent focusing on quality patient care, instead of putting out fires that could have been prevented. Huddle should be held at the right time, at the right place, and with the right people.[8] Why Are Team Huddles Effective? Team huddles provide a forum in which open discussion can take place regarding patient care. Topics that are typically discussed include goals for the day, patients to be discharged or transferred, patient-specific care plans such as falls prevention, unit census, workload/assignments, etc.[6] Discussing patient care using prioritization hierarchies and anticipating patient needs allows front line staff to plan out their day right from the get-go. This allows the team to be efficient, flexible, and adaptive for when the high volumes, heavy workloads, and admission/discharges begin to consume the day. And of equal importance, huddle provides the opportunity to connect leaders with front line staff and to bring awareness to safety and quality control concerns from both ends.[7] “Plan to Prioritize and Prioritize with a Plan” Huddles are most engaging when they are structured, but brief, and perceived as valuable. This fosters engagement from members of the team, and hopefully over time, becomes a staple within the units practice culture. Having everyone on the same page in such a fast-paced and high acuity environment is paramount. This can only be accomplished through effective communication and joint effort among those involved. Going Forward … What may seem like a sacrifice of your time may actually be a time-saver in the long run. I guarantee that no one in healthcare has ever said “too much information is bad” or “less information is more”. I am certain that having the opportunity to mention that the confused 90yr old in room 424 (1) is known to bed exit and does not yet have a plan in place to prevent falls, will surely save you more time in the long run. Because post-fall orders, calling family, charting, speaking to the multidisciplinary team, and dealing with avoidable injury would suck more time out of your day than spending 10 minutes attending huddle. Bar none. And of course, the care we work so desperately hard to hold to the highest standard would be flagged as preventable if appropriate intervention had been taken. We certainly do not want that for our patients. Nor do we want to foster a culture in which we become complacent with being “reactive” as opposed to “proactive” towards our day to day efforts.
  2. MBar1

    A Shift in Perspective

    The practice of medicine lies on a continuum. An event that takes place within practice, and that changes an approach previously viewed as "best" means that the axiom by which previous thought and process was perceived has now ventured down a new path-one that is novel and continuously transfiguring based on the purpose it serves. So EBP is new, not relative to date of inception, but to the utility of the proposition that practice can be, and perhaps should be subjugated by the scientific method. So the sentiment goes: EBP is another stop along the voyage to an effective and well equipped profession that services the public and the health of the population. Think about it; maybe one day healthcare, either the entirety or a sub component of it (perhaps palliation & end of life) could be based upon Greek dogmatic ideology-that could perhaps help navigate the grey areas of palliative care in relation to suffering, reality of life, and purpose. Who knows? But until then, the novelty of practice will continue to be predicated on the most relevant school of thought, from which, preceding approaches once reigned supreme,and were inevitably outgrown by a necessity for CHANGE.
  3. MBar1

    A Shift in Perspective

    Have you ever tried to change the ingredients in your mother’s chicken pot pie recipe and lived to hear the repercussions of such a malevolent crime? The answer is probably yes. But following what appears to be an act of treason from the perspective of your mother, you simply take it to the chin and pray that you never have the audacity to change any of your mother’s cooking again. You will proceed to eat the same pot pie that you have been accustomed since the age of 7 and your life will go on relatively unchanged for better or for worse. This, however, can not be spoken of in the same context of your nursing practice, and especially so when it comes to the concept of change. Nursing Practice and Change To attempt to change your mother's special pot pie recipe and fail miserably is the equivalent to a slap on the wrist. But to take the same approach to your practice is not only a tragedy, but an act of negligence that has the potential to do more harm than good. You see, almost every action that you perform as a nurse, and every thought you have towards an inquiry along the continuum of your critical thinking has been answered or proven in some way. Whether it be the type of fluid solution, antiseptic, medication to treat blood pressure, or the type of dressing to use for a wound, somewhere, somehow, it has been proven to either be effective or ineffective, shown to perform a certain mechanism that was previously unknown, and/or claimed to be the “gold standard” with 95% certainty. There are only two certainties with respect to the ways of knowing in nursing and in science, that is, objective truth and subjective truth. We simply do not play “pin the tail on the donkey” when it comes to answering a research question. The scientific method is employed, a hypothesis is created, an experiment is performed, and results are tabulated. This idea of “method” can be traced back to the Platonic era, in which truth was established using geometry and deductive reasoning [4]. Florence Nightingale and Change Skipping ahead to the 19th century, we see the emergence of what is referred to today as “evidence-based medicine” and the beginning of a new era and approach to the practice of medicine and nursing. To speak about the concept of evidence-based medicine without first paying homage to the individual who began the conversation would be inappropriate [1]. Florence Nightingale, the face of nursing, and her contributions to the Crimean War in the mid-1800s, precipitated a change in perspective that we see today in the practice of nursing. If it wasn’t for Nightingale's astute eye, and perhaps outlook on her role in the grander scheme, it could be concluded that the number of casualties caused by the war would be far greater and topics such as asepsis and infection prevention would not be where they are today [1]. Fast forward to present day, and we literally have information at our fingertips. From RNAO Best Practice Guidelines to medical periodicals, peer-reviewed journals, etc. It would be ungrateful for us as a collective to do “what has always been done” and simply ignore a proven truth. While there are barriers that exist with respect to the implementation of evidence base(s) into practice, which include, but are not limited to nursing characteristics, organizational culture, and clinical context, there are ways to promote change [2]. Evidence-based practice is the new kid on the block. Underneath lies improved patient outcomes, a stepping stone for future research, improved cost savings, and equally as important, provides accountability and transparency within the decision making process [3]. Change is Constant And with that said, the only constant here is change. Change in the way things are done. Just because something is ALWAYS done a certain way, it does not mean that it’s the right way to go about it. Owe it to yourself, and most importantly, your patient, to be up to date on the happenings around you. You will be better for it and so will the practice of nursing. We owe it to Nightingale.
  4. MBar1

    "Nurses Eat Their Young"

    "Nurses eat their young". I read this phrase in utter disappointment. I feel disappointment towards the destructive nature of this very sentiment. The idea that experienced nurses and their behavior towards students or novice nurses shape succeeding generations of front line nursing staff. We are, in this instance, the very people who hold the key to the fate of the profession. By "fate", I am not referring to its survival, but rather its vitality. Imagine going to work everyday with the expectation that the very last bit of self-confidence you had had would somehow, in someway be stripped away by a snarky comment or backhanded compliment. Now, dig a bit deeper and tack this onto the responsibilities of the job, the stresses that it brings, and the collaborative obligation you have to operate around others, who, according to your negative experiences, do not appear to want anything to do with you. Then, consider anyone in their right mind and the quality or quantity of motivation that they have to get up in the morning and do their job. Its a system waiting to fail. A bomb about to implode. Perhaps a nurse ready to give up and move on from the negativity. The origin of this phenomenon would be interesting to dissect in terms of its conception into the practice of nursing and how it was first perceived. But more importantly, the motivation that lies beneath this behavior is even more interesting. In my estimation the motivation can either be obligatory in nature or an unjust reality. Nurses can choose to behave less than optimally towards those with fewer miles under their belt purely due to the culture that has developed surrounding the "student" & "master" ideology. Perhaps the idea that "experience" trumps "knowledge" or weighs more heavily in favor of time spent in practice is what sparks the fire (so to speak) in response to an underlying fear of powerlessness by way of the knowledge that the novice brings. I suspect that its a bit of both. A little bit of influence from nursing culture and a hint of our own fear apparently makes for a poor or sub-optimal experience for those who will proceed the next generation of nurses. But I digress. What is more troubling to me is that in a very nonsensical way we are contributing to the degradation of the profession. In other words, we are being our own worst enemies. Allowing the unnecessary torment of the novice nurse will lead to burnout, resignation, poor mental health (confidence, self image, etc), and a level of vitality that continues to suffer one jaded nurse at a time.
  5. MBar1

    QOL vs Preservation of Life

    I read that. That's great for those with terminal dx's. If there wishes are to remain at home, and that seems to be the best approach/most appropriate to end of life care, than that's great. However, over 50% of deaths are still occurring in facilities and are dependent on the most relevant dx.
  6. MBar1

    QOL vs Preservation of Life

    @brownbook Of course my post is theoretical. Each concept or idea I mentioned has some sort of theoretical basis based upon the derivation of its knowledge. Whether it be through the scientific method or story telling. Whether it’s been applied into practice or not is the concern here. The “messiness” of the above topics is part of the reason why there is no clear-cut solution as for an approach or philosophy to guide practice.
  7. MBar1

    QOL vs Preservation of Life

    I am always curious to hear others thoughts and opinions related to a topic that is on everyone's minds, in private conversation with colleges, and sometimes inferred in conversation with patients and families, however, that is never really explored head on, for what it truly is. How do you reconcile preserving life if it is not one of quality? Is it that preserving life is easier to justify ethically because attempting to create parameters for a quality life & describe what that should entail is far more difficult? The answer is probably yes. But what do you think? Do we attempt to rationalize certain things in medicine that perhaps aren't rationale by themselves, at there core? Topics such as mortality, suffering, and self-determination? Who says these problems are based solely in medicine? I see philosophical, ethical, and sociological dilemmas here. Also, anthropological and theological implications. The human condition is so characteristically subjective. To each of there own, our experiences are simply different from one another. The way we think, learn, believe. On the contrary, medicine is predominately objective (with a few exceptions of course) in nature. How do we reconcile tackling both realities and spitting out a universal truth that is applicable to both. I believe the answer is, you don't. And this is where the messy grey areas begin to infest. A reality that most ignore, but should come to recognize as chief importance to the quality of individual and collective life. Comment below
  8. MBar1

    I've had enough.

    The days feel like centuries, and I do not know if I can continue. Being a student is all I have and my journey is coming to an end. What will I do after this? I have nothing. No relationships. No supports. Just a family that I neglect to share my feelings with and ultimately feeling like a stranger in my own home. I am tired all the time. I feel tired before I go to bed and when I wake up. Even after a full nights sleep on my days off (~10hrs). I still have motivation, but not for long. I feel alone, even when I am around people. I am introverted and do not allow people into my life. I feel as though they will let me down. As a result, I am alone. I feel like no one cares about me or my existence. I feel like the world is against me and I am constantly fighting a silent war. I do not know who is winning. All that I know is that I am not. I have a 10 point GPA (on a 12 point scale) and I feel like this is all I have. I thought that once I finished my education, I will be happy. But more recently, as I get closer to beginning my own life, thinking about financial goals, where I want to be in 5 years, relationships, etc, I have come to discover that I will never be happy as I will always be waiting for the next "thing"- at which point I will utter, "I will be happy when...". I am at a loss and do not know what to do. I have never been diagnosed with any form of mental health ailment, nor do I want to entertain the possibility of being diagnosed and therefore labelled. The "D" word brings a realness to things that I have no interest in entertaining. I would feel weak and defeated if I ever let someone tell me that I am sad and this is something that I will have to deal with the rest of my life.
  9. MBar1

    NCLEX Study Prep Tips.. PLS HELP!!

    Thank you all for taking the time to respond. It is greatly appreciated!
  10. Hi, I am currently in my final semester of nursing school. I am beginning to prepare an outline of my NCLEX study plan. I am looking for recommendations for resources (ie. online programs & texts) to prepare for the NCLEX. I have been reading mixed things online and am confused as to where I should start. I currently have Saunders Comprehensive Review (7th edition). I used this for nursing school. I feel this is much more content focused. I scratched off the code in the front cover and am planning on doing the included 2500 questions. I also have Lipincott Q&A. I am confused as to whether this is just purely a content text or actually mimics the questions on the NCLEX. Can someone clarify please? I have been doing ~ 20 q's per day and have been reading over each rationale (right or wrong). Will ramp this up to 100 q's per day following Christmas break. So my plan as of now is: Lipincott Q&A --> Complete practice q's (~100 per day) & review all rationales. I plan on completing these daily during my final semester in hopes of completing all 6000 practice q's. Then, 4 weeks prior to writing my exam (most likely mid May or June) I will complete the 2500 Saunders online practice questions. I am just seeking insights into the NCLEX prep process. Obviously this is new to me as I am just completing nursing school. Tips & some advice to my current setup would be greatly appreciated! Thanks,
  11. MBar1

    Anxiety

    Thank you all for your wonderful insight. I really appreciate it!
  12. MBar1

    Anxiety

    Hello, I just wanted some opinions of what others thought on the subject. I am a third year nursing student. I am constantly overwhelmed by the depth of pathophysiology we must learn as nurses for a variety of disease processes. I find myself constantly going back and looking at information and terminology. My problem is with terminology. For example, having to remember cancer names (ie. fibroma, lipoma, etc) does not suit me well. I hate memorizing. Same goes with medications and lab ranges. However, I UNDERSTAND pathophysiological disease processes and how they affect organ systems, presenting symptoms, expected lab values, etc. I find myself having to always look back at medications names, memorizing their indications, side effects, and special considerations and it is very discouraging. I have an 80% avg (~) and pride myself in not spending hours upon hours trying to memorize information. Rather, I plan to study well in advance, utilizing different study techniques (ie. highlighting important information, making charts, venn diagrams, concept maps, and watch Youtube videos to solidify what I know). I constantly focus on the negative (ie. things that I do not know) and waste my life focusing on how I need to achieve this unrealistic state of "perfection". I get anxious and isolate myself from others as I feel unworthy. Failing at something would kill me. Not knowing something makes me feel lesser or inferior to others. I stay awake at night thinking of patient scenarios. Think about how I would react. What I would say. More importantly, what I would do. I would like to know if anyone feels the same way. Perhaps share some tips to get over or treat this anxiety. I just need to know that I am not alone in this. Thanks
  13. MBar1

    How to Memorize Drugs

    Hello, I am a third year nursing student. I was wondering if someone had a formula for the best way to memorize/understand medications. I understand what majority of the drug classes do in terms of mechanism of action, however, simply knowing what a medication does simply by looking at the name continues to screw me up. I have been reviewing common -suffix categories, however a lot of drugs overlap. Any advice would be greatly appreciated. Thanks.
  14. Learning is a process. The time it takes for one to learn, or master a concept or subject matter, will differ from person to person. In my opinion, studying consists of two parts: 1) Learn how to learn the content (ie. Does this subject require constant quizzing, use of mind maps, repetition... This process takes the longest 2) Applying the groundwork for learning the content (ie. I will complete 3 practice quizzes q night)... This step takes the least time. The more emphasis you place on worrying about how you will remember the content or apply it in daily life, the more time you are taking away from actually understanding it. Tips: -Do not sweat memorizing; understanding, most times, will trump memorization. Often times understanding of one subject will intercept with the understanding of another. -Study in chunks. -Organize the material in a way that best suits you (I call this the data mining stage) -Studying can be fun. -Develop such an in depth understanding of something to the point where you can have a 2 hour conversation with someone simply taking about, for example, hip fractures.
  15. MBar1

    Professionalism Award at nursing school

    Why is giving an award so much power and meaning even a thing? If you know, in your "hearts of hearts" that you have done your best, why is being recognized a sign of validation? Be the best you can be, work hard, and show constant interest and growth. Rewards, whether they be intrinsic or extrinsic, will come.
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