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home & public health, med-surg, hospice
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Kelly_the_Great specializes in home & public health, med-surg, hospice.

Kelly_the_Great's Latest Activity

  1. Kelly_the_Great

    Students Cheating

    Guys this is something (unmotivated students, disruptive/pensive attitudes, cheating/just wanting the "answers" instead of valuing broad-based understanding, etc.) that I have REALLY struggled with in nursing education, both in the classroom and in the clinical setting. During this past year I was SO FORTUNATE to come across literature regarding civility in nursing education and how to foster it. I believe there are a multitude of reasons for this phenomenon: 1.) common courtesy and civility are not virtues that are held in high regard within our society in general (if it was Donald Trump wouldn't be held in such high esteem... lol), 2.) civics classes aren't being included within secondary schools' education curriculum anymore; it's not being addressed in a tangible way like with citizenship grades, etc., rather it's reactionary to disruptive to behavior, and 3.) many of the academic settings are fraught with educators who are uncivil towards each other, as well as the students. The students are under the impression that teachers are just reading PowerPoints, have "favorites" and are trying to "weed" them out. Honestly, y'all, is there not some truth to that? Do we have instructors who are merely reading PowerPoints? Do we have instructors who aren't putting forth the effort to competently (let alone expertly) understand the content and concepts that we are expecting them [the students] to understand? There are reasons for this that the students don't realize, they don't understand that we don't have all the answers and that when an instructor comes in and can explain difficult theories/concepts in an easy way to understand that we've spent HOURS familiarizing ourselves long before we presented it to them. They don't know what our course and workloads are like. They don't realize that very often there is an unfair distribution of work amongst the instructors. They don't understand that we have lives too! They honestly think we just have all the answers, that we're all just that smart and that we're just sitting on our asses during our office hours!! When we don't have all the answers and/or inadequately explain concepts they think we're intentionally holding back information and not "helping" them or don't respect or care about them enough to do our jobs that they're paying us to do. Additionally, it is hard for them to grasp the level of understanding that they need to posses to be safe nurses (application/analyses). So when they have teachers who don't explain things but, rather, teach to the test; they think those are the "nice" teachers. It's not unlike my perception of bedside nurses who are task-oriented. You think, look this nurse is just doing tasks and doesn't really care about the patients. Although the patients and families might think they're great because maybe they're in the room more talking/visiting (or managers think they're great because they're getting all their paperwork done and not complaining about the impossibilities of providing ADEQUATE care due to staffing and acuity levels) because they're not doing their assessments, discovering changes, monitoring labs/studies/trends and notifying the doctors of changes. As a side note, I've recently had a critically ill, close family member in the hospital setting and can attest to these as being widespread behaviors. Usually when this occurs, it's because they're short-staffed and the management only cares about numbers. Is this also not what happens to us? I hear y'all saying that again and again, Our administration is only interested in "numbers" of those that successfully get through our program and not rocking the boat- Then what happens is that you have groups of people who just go along with and act like it's all okay and they become management/administration's favorites. You have instructors who become burnt-out (just like bedside nurses), they don't teach the students and they just pass them along. In my program I work opposite clinical instructors who only have students on the floor for THREE HOURS (send them to the floor late, let them take 1-1.5 hr long lunches, talk about their personal lives at post conference and then send them home 2 hours early), we're supposed to be there 7.5 hours, talk about being set-up to look like the mean teacher! These instructors don't "rock the boat" though, so what do you do? What I have done, that may help you, is familiarize myself with the phenomenon, Incivility in Nursing Education, and sought literature regarding what it is, what are the causes for it and how do we address it. There's a good article on Medscape, which talks about it The Downward Spiral: Incivility in Nursing and there is also a pdf document Fostering Civility in Nursing Education and Practice that might be good starting points for you. If you have an account with NurseTim they have a lot of audio presentations on this, along with handouts, you can just listen to them while you're driving/working out. One of the best ones is Incivility Ten Strategies for Minimizing or Managing Student Misbehavior by Dr. Susan Luparell because it actually offers you with real suggestions to deal with it versus just complaining about it. Students become uncivil when they think we don't care and they don't see the relevancy in what we're teaching them. A few things that have helped me demonstrate care to my students is providing opportunities to learn concepts through introspective activities (narrative pedagogy), giving meaningful work that shows relevancy through rationales (mainly NCLEX style questions prior to lecture) and providing interactive opportunities like through polling and soliciting their input (what do they think) in class. Something else I do is share with them the Bloom's taxonomy model, they appreciate it because they want to learn and do well, they want to see the relevancy of doing what they're doing. It's an easy concept for them to understand because it's similar to Maslow's hierarchy with one thing building on top of another. Anyway, when we do questions together I have them determine what level of question it is; this helps them better understand their required level of understanding and it helps them "think about thinking," which inspires them to want to do it! Something I found interesting that you had said is that you were a nurse 1st and an educator 2nd. Every good nurse teaches. And it takes a good one to teach one (and I am quite certain YOU ARE or you wouldn't be feeling the spiritual distress that you are now experiencing). You haven't left the profession of nursing, you just have a different patient population (students) with different goals (reaching their optimal levels of learning and practice versus personal health management). They are deliverers of care versus receivers of it. You would be feeling the exact same conflicts at the "bedside" that you are feeling at the "podium", which is a lack of care and integrity from nurses (be they student nurses or licensed/registered nurses) in practice. If anyone would like to message me, I would be MORE THAN HAPPY to fellowship and share with you articles and resources that have helped me. My heart goes out to you and all of us who are struggling with this and truly care.
  2. Kelly_the_Great

    Students Cheating

    Actually, you're right! It's not cheating if you were learning.
  3. Kelly_the_Great

    The *EXPERT* Beginner

    I should apologize for making generalizations. Mainly, I was just venting. I haven't posted in the forums in years and didn't realize it'd become a place whereby making observations/venting frustrations would cause one to be accused of reveling in bashing other nurses. To avoid generalizations and to be more specific, I work with a nurse who just got her RN license 6 weeks ago and on 3 different occasions I have seen her hold her name badge up to students and tell them, "Until you get one of these, you don't know nothing! " And I get tired of the arrogance. So now y'all tell me, am I just not appreciating everything she's bringing to the table or is this a nurse who just got their license and somehow thinks she is an expert of some sort? Like I said I apologize for making generalizations but some of y'all are making assumptions and being a little defensive too. Again, that's my fault for not being specific. However, I will say in response to a previous question, yes, compared to previous generations of new nurse grads I do think there's a greater sense of bravado amongst a lot of the new grads I see coming out now.
  4. Kelly_the_Great

    The *EXPERT* Beginner

    Is anybody else sick to death of new nurses acting like they are somehow experts all the sudden because they passed a state board exam? When I passed mine both times (LVN & RN), I felt like I knew enough to practice safely and now had a license to learn. The further I continue in my career, the more I feel I am learning. Yet, somehow these folks just got out of school and they are the experts on charting, assessment, etc. but don't know their meds or skills??
  5. Kelly_the_Great

    Nursing Classroom Education: The big bang of powerpoint slavery

    I stopped reading after page 3, please forgive me if I repeat what others have previously posted. Great topic & great idea about using the report method to engage. I think having an "engagement" activity is probably as important as having the goal, objectives, activities and evaluation methods determined when making a lesson. I myself try to use methods of engagement before and/or throughout lesson plans to emphasize the real-life importance of the material that's being covered. For instance, I showed a short video concerning a child's death due to a med error prior to teaching household to metric conversions using the dimensional analysis method to a class one time. They were able to connect the importance of accuracy to that of a life lost that was full of potential. Generally speaking, I think the majority of lecture should be for discussion and clarification. It should NOT be to memorize the information for the students. Sadly, that is what most of the students expect and we are left having to teach to the lowest standard for the most part. It's hard to branch out and engage (there's that word again) in higher learning activities when the students aren't equipping themselves with prerequisite knowledge (i.e. at least reading the chapter summaries) prior to class. There's a lot of material to cover in a short amount of time and, unfortunately, most students do not participate in any form of independent learning/discovery, thus, an INTERACTIVE lecture is very challenging because interactivity is precisely that: inter = between two things. When only one side of the equation has done any of the prior work leading to lecture, you're left with having to read to them and throw in scenarios, videos, activities when the time allows. Before you say, "I read prior to class," just know (and if you're honest with yourself, you already know this anyway) most of your fellow classmates do not. So, yeah, we could be having an intellectual discussion about the material and participate in more meaningful learning but the rest of your class would whine that the teaching is over their heads and half the class would probably fail.
  6. Kelly_the_Great

    Question about DKA

    Check it out the attached documents; am happy to share. Easy to understand format. Diabetic ketoacidosi_teaching.doc dka pretest.doc DKA Test.doc
  7. Kelly_the_Great

    I *do* recognize the need for nursing theory

    Your post reminds me of that bar scene in Good Will Hunting when the college student is spouting off his beliefs on the evolution of market economies in the southern colonies...lol I mean we could all quote some passage from one of our books that included nursing theory or was solely dedicated towards its study. What I continue to wonder is, should it take precedence over practice? How much weight should be granted in our instruction towards it? Are we putting too much emphasis on it, to the point of excluding "scientific" knowledge? Look at your sentences here: Are the theories helping our profession progress? Are they bringing us any unity? Are they helping us define nursing so we can control it, teach it, advance it and BILL for it? Or are they splintering us? Do they cause befuddlement amongst the students, at which point they just disengage from even considering advancing the profession, opting instead to just jump through the hoops and then become strictly task-oriented nurses? Do the students who do kind of buy into the indoctrination (upon whichever theory their particular program/instructor happens to espouse) then become overwhelmingly disillusioned when they enter the real world and discover that not only do the majority of their colleagues not know anything at all about theory but could care less? Furthermore, how many of these theories are demonstrably valid? How many of them can you measure with any validity whatsoever? Are they grounded in any "evidence" whatsoever? I propose its study does nothing at all to advance an autonomous profession and is a colossal waste of time! What other "profession" besides theology spends sooooooooooo much time studying its "theories" . Gosh, at least religions can pick one and set forth a doctrine stating who they are and what they stand for.
  8. Kelly_the_Great

    Anyone teach High School CNA/Health Careers classes?

    Hey, Cowgirl, sorry it's taken so long to get back with you, just got off an 8-day stretch @ work (pant, pant). Okay, here's a site that the administrator provided to me that's got a lot of good info: http://www.texashste.com/ Also, here's another good site: http://www.ctat.org/index.html They even have a conference this summer for new health science technology teachers: http://www.ctat.org/events/tcec09-index.html This is all Texas stuff, perhaps Illinois has a similar association? I'm thinking one of the best things for your health occupations would be: network, network, network!!! Do you have friends in other fields; PT, radiology, OT, lab???? Hey, I bet your school district has OT & ST on staff, huh? That's a start... Sure wish someone who's in this fields would join the conversation. What were/are their struggles, what's worked well for them. In particular, I'd like to know about interactive techniques, etc.
  9. Kelly_the_Great

    Anyone teach High School CNA/Health Careers classes?

    Hey CowgirlBSN, My local school district is considering offering a healthcare technology program & I'll be speaking with them about it next week. I'm sooooo excited! Not only for myself but also for the kids, you know? What a great service to offer to the kids - a career (or the introduction thereof) in the field of healthcare during these rough economic times. My principal is wanting to model it after a specific program and will be e-mailing me the info. tomorrow. If you'd like I could PM & share it with you. Are you guys modeling yours after any particular model? I'm excited about this (depending upon the content that is) because developing the teaching material can be the most arduous aspect of teaching in my opinion. I've only ever worked in education with & for fellow nurses, so I'm not sure what it'll be like working with the young adults. Apparently though, there'll be a screening process with admission to the program, i.e. high scores in sciences, an essay, etc. so only the motivated kids will be there. This program is going to be a sequenced program, whereby they take med. terminology one semester, then basic skills the next, etc. Do you live in a rural community? I do, so partnerships with practicing facilities will be limited. However, because it is so small, everybody knows everybody and it's a little easier to network? Do you have any relationships with folks at higher learning institutions nearby? Are you familiar with HOSA (health occupations student association) http://www.hosa.org/index.html Well, holler back when you get the chance. I'm so glad to hear of someone else who's going into this. Maybe we'll get some responses from folks who've been doing it for a while.
  10. Kelly_the_Great

    Anyone teach High School CNA/Health Careers classes?

    sorry, duplicate post
  11. to get ready for this requirement? Have you formed study groups? When are you meeting? Is your facility offering paid prepratory programs? Inservices? What resources are you using???
  12. Kelly_the_Great

    New Conditions of Coverage

    ((HUGS)) Lacie, sounds like you're in an impossible situation! Is there anyway you can get into acutes?
  13. Kelly_the_Great

    New Conditions of Coverage

    No doubt, traumaRUs! It's kind of frustrating that in this day of paradigm shifts towards patient empowerment, there is absolutely no patient accountability within the realm of the ESRD network, in relation to the standards by which we are being judged. I dunno, I wouldn't want to be a nazi when it came to patient compliace, like I hear it is in some countries - for instance, if they have an unexcused "absence" they are no longer allowed to dialyze & someone else takes their slot. However, there should be some patient accountability, you know? Have any of y'alls facilities made adjustments towards treatment man hours? As far as I know, ours hasn't (however, what I don't know is IMMENSE...lol). I've only just started in September. It seems accommodations will have to be made in order to ensure staff compliance with all these regulations. All I keep hearing is that it's a "business." Are any of you members of ANNA or other professional renal organizations? I'll be joing in hopes of advocating for the safety of patient care (primarily through adequate staffing). It's my understanding that in Texas the ratio used to be 3:1, it's now 4:1.
  14. Kelly_the_Great

    New Conditions of Coverage

    Wow, Renal Ruth, I'm surprised no one has replied, for my unit these changes have really been a challenge! We put out a little flyer that we gave the patients, explaining that the chairs & machines have a 10 min. dry time between patients & that the tape has to be prepared in a separate area, thus, increasing transition times. Otherwise, we're getting our information from administration. The POC (plan of care) & IDA (interdisciplinary assmt) have turned out to be a real nightmare.
  15. Kelly_the_Great

    Pulling Cannulation Needles and Labs

    In regards to pulling needles, I've not seen a policy that addresses this issue and I'm wondering what you guys do/see in practice..??? We have a few patients who prefer to have a bandaid placed over their insertion site when the needle is d/c'd. Then the gauze placed over, secured with tape and the pressure applied. In practice, this has been very difficult for me to accomplish. What they have you do is partially withdraw the needle then place the bandaid over the insertion site while it's still in, then put the pressure gauze over the site, fully d/c the needle, then apply pressure. This just seems so risky to me. I mean, sometimes, particularly if a patient has a problem w/bleeding, they bleed around the site, then also, I'm afraid the needle will become dislodged before the pressure gauze is ready or that a portion will become attached the bandaid and cause damage to the access because it doesn't pull out smoothly. The theory that one of the patients has espoused is that the bandaid is sterile and thus a better option than the nonsterile gauze. However, I feel like since it's not being opened in a sterile field, and because our gloves are not sterile then it's not really any better than gauze.
  16. Kelly_the_Great

    Newbie 2 chronic Dialysis n 2 weeks...

    wish I'd read some of the threads on All Nurses renal care prior to accepting the position! Was really attracted to the job due to what I thought would be a greater chance of providing holistic care (getting to see the patients frequently/case management), close proximity to home in rural area with little opportunity, working hours, etc. But, gosh, after reading many of the posts here...all the dissention between PCTs and nurses, high ratios, sounds like a crazy pace @ change out...plus I'll be charging in 6 mos... And from what I'm reading, that it takes at least a year to feel "competent."??? Plus some of the practices don't sound like best practices or even safe. I'm having to wear many hats at current job (infection control/employee health/staff education/sometimes am out on floor when they're short), working 60-70 hrs/wk but on 40 hr/wk salary. Now I'm thinkin' maybe I'm jumping out of the frying pan and into the fire..??? Any words of encouragement out there???