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jjjoy LPN

Content by jjjoy

  1. First off, thanks for the interesting & civil dialogue! Lots of food for thought! Are you suggesting, though, that nurses would have been more likely to figure out the cause of the illness? Are you suggesting that "the nursing process" (and the DO process, presumably?) is more likely to yield an answer than "the medical diagnostic process"? If so, when those few holistic MDs incorporate a more holistic approach into their assessment & diagnostic process, are they then applying the nursing process (or DO process) ? I don't think so. I'd argue that the nursing process (in the broadest defintion) *is* a holistic health care assessment that drives a plan of care (APIE). Teachers also must do holistic assessments of their students, considering home conditions, psychological issues, etc in order to fully address their students' needs. Ideally physicians would do holistic assessments. The medical diagnostic process is simply the diagnostic process applied to health conditions. The diagnostic process is also utilized by mechanics attempting to determine why the engine "is making a funny noise." This is where ND fail. There is no diagnostic process in determining ND. To me, diagnosing is attempting to determine why something is different. Why is the pt experiencing chest pain? Maybe it's cardiac ischemia. Maybe it's indigestion. ND seems more like a translation of the subjective and objective *assessment* data. Assessment: pt can't dress self (dressing self is self care and the patient has a deficit) = self care deficit. How is that a "diagnosis"? Maybe just getting rid of the word "diagnosis" in ND would help matters - a formal *typology* of nursing considerations DOES make sense to me. To ensure nurses are covering all bases, they can make sure that they address all of the typologies relevant to their area of practice - self care, fluid/volume balance, nutrition, etc. Hmm... what to call it? Calling this categorization a nursing diagnosis, just seems to confuse things - at least for me - and apparently my instructors - and many other nurses!
  2. Many, many nurses work in settings where at least one known medical diagnosis is a primary reason for the patient's visit. Yet some instructors of ND would force linguistic contortions in attempts to avoid any direct reference to a documented medical condition because they feared a blurring of the lines between practicing nursing and medicine. One might argue that those instructors just didn't get ND, but if instructors get so easily confused about how to utilize NDs, doesn't that point to problem with the NDs themselves? That's great. But nurses are not the only health care professionals tasked with prevention. Many health care professionals do not live up to that expectation, including nurses. And even then, I'm not convinced that NDs are required. ADPIE works just find as APIE (no diagnosis) in many contexts. Assessment - pt unable to take care of ADLs, Plan - part-time in-home ADL assistance... why even bother with a diagnosis of "self care deficit"? Isn't it kinda like, well, "duh"? I can see that self care is a general category of nursing need to be assess and address. But I don't see that it's necessary step in identifying what the self care needs are or how to address them.
  3. hmm... knowledge deficit is a nursing diagnosis. by that logic, does it mean that only a nurse can formally address this issue? and it kind of sounds unnecessarily exclusionary as well. maybe that's how it is legally today, but maybe it shouldn't be. some physicians may argue that only physicians can legally diagnose a medical condition, but proponents of nurse practitioners would argue that nps have/should have that right as well. that makes sense. similarly, should an rn developed care plan automatically trump a social worker's care plan? wouldn't it depend upon the specifics of the case in question and the specific expertise of the care planner in question? is md life care planning medicine?
  4. I think you make some good points here. A nurse is informed that pt has PAD, they draw upon their knowledge of pathophys and then "diagnose" impaired tissue perfusion? That's how we were taught ND. That is not a useful exercise in my book. My experience in school was that ND of the NANDA variety wasn't taught as "just one way to conceptualize the issues which may or may not be helpful for you". I very much agree with this.
  5. thank you for sharing your experience and perspective. maybe you can clarify this for me... what you describe is indeed valuable and differentiated from medical diagnosis and treatment planning. however, if a nurse developing such a 'big-picture' care plan is "practicing nursing" then when a social worker develops a life care plan for someone with special needs, are they then practicing nursing without a license? or perhaps both nurses and social workers are qualified to practice "life care planning" in different scenarios - and when the nurse does it, it's nursing and when the social worker does it, it's social work? - i hope i don't come across as argumentative. i truly wonder about questions like this! if clinical nursing experience is required for certain life care plans, then that situation doesn't call for nursing care, it calls for life care planning from a reputable, credentialed person with relevant clinical nursing experience and with relevant life care planning experience as well. is that being too nitpicky with words? to me, this gets back to the very basic question of "what is nursing?" (which is a very different question than what do licensed nurses do)? a very large percentage of practicing nurses rarely utilize the broader 'nursing' assessments and plans of care. in both outpatient and inpatient settings, a nurse's primary function is to do *physiologic* assessments and provide *medical* care. thus, taking into consideration and working with the psychsocial aspects of the situation, reassuring and providing understandable explanations, is not 'nursing' in my perspective. good nurses do it, definitely! so do good doctors, good accountants, good lawyers, etc. if the crux of nursing care is the psychsocial and long-term qol aspects (as opposed addressing immediate medical needs), i could go so far as to argue that many of today's nursing jobs involve relatively little nursing. i just think that if we define "nursing" as anything that nurses (have been cross-trained or co-opted) to do or have done, it ends up being meaningless as it would encompass great swaths of psychotherapy, physical therapy, health education, public health, infection control, health informatics, and medicine itself, of course (nurse practitioners, anyone?) definitely a fav subject of discussion for me... and it really does relate back to nursing diagnoses somehow, really, it does!
  6. That makes sense to me. Things change over time... I don't see why ND (or however one labels the conclusions one draws based upon their assessment) can't change to be more clearly relevant and useful across the spectrum of nursing practice.
  7. I've made the comparison to an auto tech not being allowed to say "flat tire" because he's not a certified mechanic. Problem? Impaired mobility (of the vehicle) due to lack of pressure in rubber tubing (tire) on wheel rim related to puncture in rubber tubing as evidenced by rubber tubing in contact with ground conforming to shape of ground (flat). And what about the associated problem of the risk of damage to the wheel rim when there's a flat tire? Let's come up with another convoluted statement! I definitely see the benefit of nursing care plans and demonstrating understanding of the relationship bewteen physiologic/pathologic conditions and nursing needs, but the wording of traditional nursing diagnoses just confuses things. Have you looked up previous threads on this? You'll find lots of company!
  8. jjjoy

    Nursing scrubs are darn expensive

    Can't say since I'm not sure what your definition of expensive or good stuff is. Elaboration?
  9. As another noted, the first term can be really slow as it slogs through basics (spending 20 minutes on a 13 point step wash cloth folding technique) and then as NS goes on, they'll just toss out in a brief side comment on the importance of recognizing signs of shock.
  10. Here's my take on it... Conceptually, NS may not be difficult; however, student strategies for pre-req classes rarely apply well in NS, even if one was acing the pre-reqs with minimal effort, or even if one has aced the entire pre-med curriculum in addition to the pre-nursing courses. Those who found pre-req coursework hard, then, are even more likely to consider NS hard. Though there are some for whom NS is their groove. If one's successful strategy thus far in school has to been to review everything backwards and forward until every last tidbit is internalized and thoroughly understood, that probably won't work in nursing school. There just aren't enough hours in a day to finish all the day-to-day work such as careplans AND take a fine-toothed comb to the hundreds of pages of reading AND develop good test-taking strategies and skills for NCLEX style questions. 1) Quirky NCLEX-style test questions can negatively impact one's grade despite great retention and comprehension of material; lectures and book materials often do not offer any guidance on what to expect from test questions; reviewing NCLEX test questions can be a good test-prep strategy. Getting good grades on NS tests may mean one has a knack for NS test questions as opposed to having a better grasp of the covered material. 2) NS has massive amounts of assigned readings. Even if you are never tested on all of it, your instructors and future employers may expect you to know it. And you may want to know it. Though I do better conceptualizing many nursing texts more as reference books than instructional books. On the plus side, there is much overlap between many conditions and the nursing care; so some people may find that they can blow through some lenthy reading assignments. 3) you cover a little bit of just about every condition and specialty out there, set after set of summary overviews of pathophys, signs & symptoms, treatments, complications, psychosocial factors and repetitive of lists of nursing care. With so much to cover (geriatrics, labor and delivery, pediatrics, GI and GU conditions, mental health and more) in so little time, one rarely has time to fully process all the info being covered. 4) patient care plans can be lengthy and time consuming to pull together in very limited time frames, which can leave little time for other nursing school work.
  11. My mom's onc had confidently discussed with us how treatment would progress over the next several months. And then there'd be a scan to see how the treatment was working. If it wasn't working? Well, then we'd consider our options again then. Three weeks of draining radiation treatment later, my mom slipped into a coma. She passed away a week later. The onc's comment was something along the lines of "Well, it wasn't unexpected." Anyway, it's also your right, as a daughter, to talk to your mom about quality of life questions, even at the risk of upsetting her. After all, she also might be relieved if you bring it up. But it's your right to decide not to talk to her about those questions as well. If your mom resists addressing those questions, that's her right, too. May you have peace during this time of hardship.
  12. Given your background, PCT might be more useful as the more hands on experience you can get before having full RN responsibilities, the better. If you could be cross-trained, though, that would be even better! Unit secretaries get a perspective on what happens away from the bedside (order entry, physician call-backs) that can be hard to get exposure to as a PCT or student nurse.
  13. jjjoy

    No school til 2012, now what?!

    Maybe you can find some part-time work in the medical field. Working as a nursing assistant in a hospital would be a great way to start becoming comfortable providing basic nursing care, interacting with patients & other providers and just becoming familiar with the inpatient hospital environment. Working as a nursing assistant in nursing home is often very physically heavy work, but you'd get darn good at giving quick baths, doing safe transfers, and dealing with frail elderly. Working as a home health aide could introduce you to the daily obstacles faced by those with debilitating health issues. Working as a unit clerk in a hospital would give you exposure to the workflow at the nurses' station and to common orders and medications if the unit clerk is responsible for order entry. Working as an EMT in medical transport would give you a glimpse to patient homes and health facilities as well as allow you become familiar with common patient issues (eg pts on dialysis, with COPD, etc). Some of those roles also require extra training, but sometimes local community colleges or vocational centers offer that type of training for a reasonable price. Hopefully, this time can be more than just waiting to start school, but it can help build a foundation for your future practice.
  14. We practiced IV starts on fake arms. We weren't allowed to do them in clinicals (maybe facility policy?). We didn't learn blood draws at all, and maybe 5 minutes total on what the different vials were for. We heard "Don't worry, you'll learn it on the job." 'Course half the nurses I meet look at me funny when I tell them we weren't allowed to do even one IV start as a student.
  15. jjjoy

    Time to call a duck a duck, part II

    And if physicians were administering the immunizations, would then they be "administering nursing care"? How about if it's trained health workers (non-nurse) administering the immunizations? (eg in a rural third world immunization campaign) Lawyers often help craft policies based upon their knowledge and experience with the law. That's a vital perspective that only an experienced lawyer can provide. A lawyer engaging in policy-crafting makes sense and is necessary in many circumstances. A nurse engaging in policy-crafting, in providing medical care, in infection control, in designing medical information systems, etc makes sense and is necessary in many circumstances. I'm just thinking that that still doesn't mean that those activities *are* nursing per se. Part of a nursing assessment is determining if the patient needs medical care (eg medical workup for chest pain). A nurse (or non-nurse) may determine that the patient needs social work services or a perhaps a psych referral. A nurse (or non-nurse) may determine that the patient needs nursing care - assistance with carrying out medical care (IV med administration), assistance with ADLs, close monitoring of unstable conditions. Something like that. Hmm... maybe I'll start a new thread on that, revisiting a favorite question of mine... what *is* nursing?
  16. I hear you OP. Some programs do not accomodate those of us who may need more clinical time to "get up to speed" than some others. And the reality is that many work places also expect newbies to "get up to speed" pretty darn quickly. I don't believe that just because a student or nurse may take a bit longer to comfortably learn to speed up routine care that that means that they just don't have what it takes and should do something else. But many programs and employers do not allow much time for a steep learning curve, so for the 'slower' student/nurse to succeed, they need to find ways to support their learning style - such as carefully choosing a nursing program and positions with strong clinical training and supervision (as opposed to programs and positions that more or less just give you the opportunity to sink or swim). Getting a lot of related experience can also help this type of learner so that they aren't trying to master everything all at once. Experience as a nursing assistant can help nail down basic care. Experience as a unit clerk can help to learn common orders and improve interdisciplinary communication. Experience as a EMT may offer opportunities to hone assessment skills and reinforce how to handle emergent issue (which felt incredibly glossed over in my nursing program). If you do end up needing to re-take this course, it could be a blessing if it allows you the opportunity to build your skills. Then the next time you go through clinicals, you'd be able to learn that much more because you'd have freed up a lot of your learning energies.
  17. jjjoy

    Time to call a duck a duck, part II

    I'd agree that those functions can be part of a professional nurse's practice. However, I'm still not convinced that that means that that particular function is *nursing care* per se. In this case, I'd say preventing the spread of disease through education and immunization is more of a public health function that can be (and often is) carried out by nurses, physicians, and/or properly trained community public health workers. Nurses, after all, do provide *medical care* as part of the their nursing practice, do they not? And, again, a non-nurse can provide nursing care (parents of medically fragile children, for example). So a nurse most certainly can provide public health services as part of their nursing practice. If a public health nurse is *only* providing education and immunizations, is it fair to say that that nurse is still "practicing nursing"? When I say *only* here, I am not diminishing the value of the activity, I simply mean to emphasize if the person wasn't providing any other services in that role. Just because nurses have often been behind many public health efforts 9and they most certainly have!), does that necessarily make it "nursing", as opposed to public health efforts that may be carried out by nurses or physicians... or if the demand is great enough, perhaps a specialized public health role with its own training and certification? I guess maybe I'm conceptualing the concept of the provision of nursing care as akin to the concept of teaching. If a principal hasn't been in front of a classroom in 10 years, would you consider it accurate to say that they've been teaching for the last 10 years? They most certainly have been involved in education! And ideally have been facilitating quality teaching through supportive policies and management. I'm thinking some 'expanded' nursing roles are kind of like that. They most certainly are involved in the provision of qualify health care, perhaps directly providing medical care (administering injections, prescribing treatments) or perhaps directly responsibility for the provision of nursing care (DON). But I'm not sure I agree with then labelling all that they may be doing as "nursing".
  18. jjjoy

    Time to call a duck a duck, part II

    First off, Erik, that conversation of yours had me laughing out loud! Seriously, what was up?! Too funny! Serious question here, why must we have a broader vision of the nursing profession? Probably the most narrow of nursing definitions would be something like providing for the physical needs of the ill, injured, old and very young. The best nursing care includes emotional support, in depth medical knowledge, health education and more. However, many a good, compentent nurse isn't a great educator, only has a basic understanding of pathophys (compared to some), or is gruff to patients. They can find jobs that fit their strengths and weaknesses. However, if a nurse doesn't provide hydration (via sips or IV) or cleanliness (via bed baths and/or complex dressing changes), then they aren't doing their job at all. Is a nurse who administers immunizations practicing nursing? It might be part of their overall practice, but in and of itself, I wouldn't call that function providing nursing care. On the other hand, when a non-nurse helps to bathe an ill person, I'd think that that person *is* providing nursing care, even though they may have no formal training in nursing care. I wouldn't say they are providing *professional* nursing care, but nursing care nonetheless.
  19. jjjoy

    Time to call a duck a duck, part II

    I think you put that well! Some nurses do do this. Too many, perhaps. And I suspect you've had your fill of them lately given the angle you're taking right now. But I think you're detracting from your own point by making assumptions and accusations about any specific individual's motives. Again, there may be too many examples out there of the type of leader you're referring to, but let's talk about what nursing leadership could be and should be as opposed to just deeming a whole group as "not one of us". I think some very valid issues are raised here and hope they can be addressed without finger-pointing and the like. Happy Friday, everyone!!!
  20. jjjoy

    Time to call a duck a duck, part II

    I totally agree. Let's not insult anyone providing health care by saying "any trained monkey could do that". Doesn't that imply that some health care roles don't require more than carrying out certain manual tasks without any further thought? Are there *any* hands on health care roles that involve blindly carrying out manual tasks? A medical office assistant who does nothing more than take height and weight still needs to do more than a monkey! Okay, maybe there are some monkeys out there who could run circles around certain lazy office assistants. But there are probably a few monkeys out there who could run circles around some lazy RNs we may have run across before. My point is that 'critical thinking' should be practiced by ALL personnel at ALL levels to the extent of that person's knowledge and experience; it's not something that only starts above a certain level of training and responsibility. On the other hand, I don't agree with lumping everything a nurse might happen to do in any one particular line of work as specifically "nursing".
  21. jjjoy

    Time to call a duck a duck, part II

    In developing a plan of care, though, I still could see the argument that one is drawing upon and applying their nursing knowledge and experience as opposed to *practicing nursing* when developing that plan of care. To be able to be an credible authority in developing that plan of care, the nurse should have already *practiced* nursing as relates to the plan of care that they are helping develop. Similarly, when a teacher helps develops a subject or grade level curriculum for a district, they, too are ideally drawing upon relevant teaching experience. However, I'm not sure I would say that developing a curriculum is, in fact, teaching. I would agree, though, that the best curriculum developers have substantial experience teaching in that subject or grade level. Why are nurse specialists so great? Isn't it usually *because* these nurses bring with them years of direct patient care experience? How much credence do you give to a nurse specialist / nurse administrator / nurse fill-in-the-blank if they DON'T have that direct patient care experience outside of nursing school clinicals? What is this highly valued experience? It's *nursing* experience. I'm just thinking nurses can work in the field of nursing without actively practicing nursing, just as teachers can work in the field of education without actively teaching (eg principal), an airplane pilot may continue working in aviation, drawing upon their flight experience, without ever piloting an aircraft again, etc. I'm thinking that any role where after years of doing only *that* role, the person can't quickly step back in and *provide direct patient care* *stand in front of a classroom and teach* *get in a cockpit and fly a plan* then they are not, in THAT role, practicing nursing, teaching, 'piloting' etc. (So then that does allow for specialists who CAN jump in and at least practice their particular specialty - L&D nursing, teaching third grade, flying lightweight aircraft.)
  22. jjjoy

    Time to call a duck a duck, part II

    Thanks everyone for sharing! I must admit I still tend to want limit the concept of the *practice* of professional nursing to direct patient care. A nurse engaging in case management or infection control may draw upon nursing knowledge and apply nursing principles, but does that necessarily mean that they are *praticing* nursing in that role? A case manager is also going to draw upon medical knowledge and apply medical principles in determining pt needs and plans; they are not professionally *practicing* medicine are they? Similarly, a practicing nurse constantly draws upon medical knowledge and applies medical principles, but is not practicing medicine, right? I'm also thinking that a physician in a public health or lab research is not *practicing* medicine *in that role* even if the reason that have that role is because they *do* have experience practicing medicine. Does that make sense? I agree that its a nurse's professional obligation to provide education. I also think it is physicians' professional obligation as well. And lawyers and accountants. All professionals should ensure that their clients understand what's going on. Do all do that well? No. Not all nurses are great educators, either. Heck, not all professional educators are great educators! My point is that a nurse who is educating is not *practicing* nursing when educating, though they most certainly are still professional and still a nurse! At that point, they are nurses who are educating as part of their professional obligation; same as when a lawyer explains things to their client, they are not *practicing* law in that moment. What about patients who need extensive education in regard to their health condition, such as a new diabetic? A non-nurse diabetes educator with 10 years experience will probably be a much better resource that any 'just-off-the-street' nurse without any specialized diabetes experience. One more example, let's say the diabetes educator role at a facility specifically involves professional clinical assessment that necessitates a licensed provider to fill the role. Couldn't a physician theoretically take such a role as well? Certainly, many wouldn't be well-suited to such a role, but there are also nurses out there who wouldn't be well-suited to the role of diabetes educator. So in the *same* role, would a diabetes nurse educator be practicing nursing while the diabetes physician educator is practicing medicine?
  23. Maybe someone at clinic had just called him and bawled *him* out for one of 'his' students cancelling at the last minute. If it was just set up yesterday for today, though, that doesn't seem such a problem. If you'd set up the interview a couple of weeks before and then cancelled the morning of the interview, that would be more problematic.
  24. jjjoy

    Use student loans to pay off debt??

    At the uni I went to, on-campus housing was *much* more expensive than sharing an off-campus apartment and the food plan was not a good deal either. So one can't generalize that on-campus is always cheaper. To add insult to injury, the 'on-campus' dorms weren't anywhere near the libraries and lecture halls; some off-campus housing was actually closer to where you needed to be as a student.
  25. jjjoy

    Nursing Shortage? Maybe not so much . . .

    LOL! Will they take the graduates from last year and this year as well who still haven't found work? Is this guy willing to sign a contract with future nursing grads guaranteeing to "take them all" by a certain date if they haven't found anything else? Can you imagine the backpedaling he'd have to do in a few years if someone trotted that quote out on him? Afterall, if a facility were *that* understaffed, the last thing they'd want to do is hire a bunch of newbies with no real prior nursing experience as that many newbies at once could more of a hindrance than a help. It rarely is explained that "nursing shortage" means shortage of nurses willing and able to fill certain roles at given wages. A bunch of inexperienced new grad nurses cannot just be plugged right in to any open nursing role - which is often the impression given in soundbites.

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