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**Wow it's been a year since I logged in on this website. A lot has changed! This is a question about Tanner's Model of Clinical Judgement. For those who are unfamiliar with this model, it's basically an explanation of what clinical judgement means. It has four stages: noticing, interpreting, responding, and reflecting. I have most trouble understanding the difference between noticing and interpreting. Could anyone please provide me examples (patient care scenarios) that illustrate the main difference between noticing and interpreting? For example, you are assigned to a child who shows obvious signs of bruises and fractures. The "noticing" part would be that I can see the bruises and fractures. The "interpreting" means that this child is abused because I'm aware of the parents being violent and etc cetera. Am I doing this right? Any suggestions or advice would be greatly appreciated. Thank you!

Wow, such wise words from all of you! Thank you so much. You're right - nursing school is hard and the first we need to focus on is studies. I am lucky that I have one friend but sometimes I would feel lonely whenever I see someone in my nursing classes going up to a person to start a conversation easily. I can't do that. I cannot just go up to the person easily and start a conversation because I'm a huge introvert. I hope that when the right time comes, I'll have plenty of friends.

Oops, I forgot to mention one thing! Last year I had one speech language pathologist who assessed my speech and said to me, "I'm not concerned about your speech. There were some words I couldn't understand but overall your speech was very good." Perhaps you were all right - I'm jumping to conclusions way too fast.

Thank you for your comment. I like this comment. My speech is pretty understandable - I mean a lot of classmates could understand me (in fact some of them even told me that my speech was good but I find that hard to believe). One of my classes has a component in which you are assigned to a group and then you discuss what you learn in that class. I always raise my hand to participate (participation is mandatory) and I get surprised when someone or my instructor can understand me. I don't know what's going on, but now I can feel my speech is getting worse a bit, so that's why I said I'm getting speech therapy sessions soon.

Hi GrnTea, yes I am aware that I have made multiple threads but this thread is particularly about making friends or communicating with my other nursing classmates. As for the two threads you posted, the suggestions are very useful for me, but I felt I needed to post a new thread about socialization. I'm sorry if I keep bothering all of you with my multiple new threads. Missmollie, Yes! Sometimes people do come up to me and start a conversation, and in order to maintain it, I would ask them questions like, "how was your weekend? Did you like the new professor? blah blah..." Often, they would interrupt and say, "oh I have to go." This has happened MANY times. Even on Facebook, when it's easier for me to communicate because I don't have to miss anything out, people would not even respond at all! Luckily, there's one friend whom I can talk to and we can have conversations that would last hours, but she doesn't initiate a conversation neither. It has to be me.

Also, thank you for your support. I much appreciate it.

Yes, there are other hearing impaired students at my university but I haven't met them (they are not in nursing; in fact, a faculty member told me that I'm the only nursing student with a hearing disability). I have to admit that I can be reluctant to start a conversation sometimes. Based on my past experiences with how people get frustrated when communicating with me, I completely avoid socializing with people at all.

I know I shouldn't blame this on my hearing disability alone, but I believe it's the culprit. I'll explain why: when I attempt to make a conversation with someone, I would notify them about my hearing loss first so that they would talk slowly and clearly. This goes well. Two minutes into the conversation, I would miss something out and ask them to repeat what they said again. You could see a bit of frustration in their facial expression and they repeated what they have just said. I would say, "oh wow! That's great! blah blah". As I mentioned before, I have a bit of an accent so I can easily pinpoint (based on personal experiences) whether or not people are putting an effort to understand me or communicate with me with my limited hearing. This is a different topic but there's one girl whom I met in my nursing class and we added each other on FB. Then she asked me a question about some science course or whatever and kept asking me questions about gastrointestinal system, cardiovascular system, nervous system, EVERYTHING. It seems that she wanted me to teach her the whole course, so I didn't mind. Now she stopped asking me questions and whenever I see her in lectures, she wouldn't even bother starting a conversation with me. She would say, "hi how are you?" and that's it.

But how long am I going to wait till I get a job to find real friends? Because I am almost done my first year, all nursing students will have a clinical placement once a week and I don't live in the same city as the placement. I commute to save money and someone suggested that I sleep over at one of my friend's house before the clinical placement every week. What friend?

I'm a nursing student but again posted this topic in this section because you are all very experienced and intelligent. So here it goes: I attend a university for nursing, and I absolutely love the program. The faculty members are phenomenal and they also have tremendous support for me to succeed in this program because I have a hearing disability. I'm beyond grateful to have their support. I was born deaf in both ears and got a Cochlear Implant so I can hear everything now. But in the school, it's almost over (two more weeks until exams) and I still have not made any friends. Not even a single friend. Let me elaborate. I've added the new friends I've made on my Facebook and whenever they are online, I would initiate a conversation to, you know, make new friends. That works but the problem is that they NEVER initiate a conversation with me. Never. Not even once. Sometimes people would come up to me and say, "hi" and that's it. They would walk away and sit in a different seat. Because of my hearing disability, my speech sounds a bit different (it's now worse but I will have speech therapy soon to rectify the problem) and I've noticed that when I'm in school and I go up to people to chat, they are like, "what?" As in they don't understand me a bit and they seem to be a bit lazy. For example, I asked a girl beside me in a lecture, "is that our professor?" and she said, "yea....wait what? What did you say?" People don't seem to be putting in an effort in making a conversation with me with my hearing loss. Also, every time I go to lectures, I've noticed that when my nursing classmates are with their circle of friends. Always. I have seen a few nursing students who come in alone but they will end up sitting with their friends in the lecture. I've always sat alone. There's one girl who I like and we are kinda "friends" but whenever she sees me sitting alone, she would say "hey how are you? blah blah blah" and then sit next to me. I would be so happy until HER friends come in and then she moves to a different seat to be with them. This happens to me every single time. Everywhere I go, I see nursing students with their circle of friends and I have no one literally. I'm a HUGE introvert but nonetheless I always make an effort to make new friends or talk to people. I think it's because of my hearing disability.

Thank you so much for sharing this valuable piece of advise. As a nursing student, I will definitely keep this in mind.

No, it can be ANY kind of pain. Not just phantom limb pain.

In my school two days ago, I overhead a conversation between three nursing students and one of them was having symptoms for some medical condition that her doctors cannot identify for some unknown reason and her friend said, "well, that's because the pain is all in your head." The third student said, "no that's ********. It cannot be in your head. C'mon, you are having PHYSICAL symptoms and the doctors cannot brush you off like that." Do you believe the pain is really in our head? Why or why not?

Whatever, when I told my friends that I've decided to be a nurse, they were like, "ohhh....but in the end, you will be a doctor right?" Well, I have deep respect for nurses and I don't consider nursing as a "stepping stone" towards medicine. I agree with CodeteamB - the public DOES highly regard us.

LOL this is completely off-track, but I didn't know what constipation was when I was in high school. So when I had constipation, I told my mother about my bowel movement and she confirmed that it was constipation. Not knowing the "stigma" surrounding the act of talking about BM's, my friend asked me what happened and I told her, "I had constipation." Her face was like, It was really awkward now that I know what constipation is.

My fellow nursing peers do act sometimes rude. They are idiots - they are like "what what what what what what" when they are really lazy to put in effort to understand my speech. Sometimes I would say one word like "Hello!" and they would be like . I mean, c'mon? Yes, I have unfortunately experienced adults who were very judgmental towards me because of my speech. Unfortunately I live in Canada and we do have health insurance, but it does not cover speech therapy once we turn 18.

It sounds like I'm very sensitive to how people react to me when I open my mouth to say a single word. When I see people get frustrated, I become sensitive, primarily because I haven't come to terms with my speech. So...I guess I need to start speech therapy soon.

My hearing is good, I can always adjust my hearing so that I am able to hear all the sounds. In fact, I can get a modified stethoscope so that the sounds from the bowel sounds, breathing, BPs, et cetera are amplified. It works great - the sounds are crisp which is perfect. I have no problem with understanding what patients are saying, although they will need to speak slowly and clearly. I know I will have problems with seniors who might not yell at the top of their lungs so I can hear them or they might mumble, or a patient may have a tracheotomy (sp?) that s/he may mumble. I know I will face challenges but I believe if I remain alert and listen to the patients carefully, I can overcome these obstacles. The problem is my own speech. GrnTea, what you said perfectly describes my feelings. I may be going crazy with my own speech. I can still speak to my mother or best friend and they can understand me perfectly fine but this is because they have exposure to my speech. I had one session with a speech language pathologist a few months ago and she noticed that I need to work on certain letters like these: /p/, /b/, /f/, /th/ and /r/. It's a lot but that session was the only first and last encounter I had with any speech therapist. Therefore she recommended that I get private speech therapy BUT what's ironic is that she even told me that she's not too concerned about my speech. In fact, when I talk to other speech therapists - of course they have a lot of experience with working with people who have speech problems - and they told me that my speech is very understandable although I need to work on some certain sounds. Last year I had a job in a local hospital and this required talking to patents (by no means in a professional/medical way) and I was able to have a conversation with many of them without any problem. But now that I'm in university and lonely, I am starting to feel that my speech is getting worse. Now I have to check if this is true or not by talking to another speech therapist and hear her/his input, but I haven't met one. So this could be in my head. I don't know. When I speak to my professors or TA's, they had no problems with me. But with other students, yes most of them do not get me. I don't know the reason behind this pattern. I'm seriously going crazy. This insanity that is slowly creeping into my head is now giving me doubts as to stay in nursing or not. I believe that if I have speech therapy (even though it's expensive) throughout the nursing school, my speech should be better in the future than it is now.

I know I sound like an extremely indecisive nursing student but my story behind becoming a nurse is really long, so I will not go into details. But I am having another doubt about becoming a nurse because of my disability. I'm hearing impaired (was born deaf and now have a cochlear implant) and as a result, my speech sounds...strange. I underwent speech therapy for 6 years but now I'm seeing much deterioration in my speech so I'm thinking of going back to speech therapy. The only obstacle that prevents me from getting speech therapy services is money. I'm broke as hell and I'm trying to save money so that I can get some sessions in the summer. But what's bothering me is that nursing requires patient interaction and I would love to talk with patients (this is one of the reasons why I went into nursing). I love the feeling that you have made a difference in your patient's life but with personal interaction. To elaborate, However, now in school, when I'm talking to my fellow peers, they don't seem to understand me and I'm noticing that more and more people are becoming judgemental towards me (e.g. making remarks about me or not being very patient with me). At this very moment, I just started having doubts and am now turning to you for advice. As I mentioned above, the story as to why I went into nursing is really long, but let's say if I have to explain, it would be financial hardship. I don't want to be poor like my family so that's why I'm determined to go into nursing even though the economy is really bad. But with my disability, I really don't know if I can last long in nursing. A few of you may have seen my previous post that I LOVE science and if I had a choice, I would major in Astronomy (my biggest passion). I really don't want to switch out of nursing for fear I will fall into the same hardship my family is suffering. I don't want to regret the decision that I may make for leaving nursing. In fact, I'm terrified of leaving nursing as my feeling of being a nurse soon is "secure", if you know what I'm talking about. I have wonderful support from my nursing school and my academic advisor - God bless her, she was the first person who helped me transition smoothly into nursing school after high school. Should I go talk to her (she's also an RN) and get her advice? But first, I need your advice because you have more experience than I do. Thank you so much.

I'm only a student but have decided to post in this section since you have more experiences with night shifts than I do. It's challenging for me to keep up with the workload and commuting (15 miles away), and luckily I have two days off, so I can catch up on some sleep and homework. But last term, I did really mess up my sleep pattern so I ended up sleeping at 3 a.m and wake up at 6:30 a.m. to catch the bus everyday. That has finally gotten back to me this term, and now I go to bed at 4 a.m. after finishing homework and wake up at 3:00 p.m. on weekends and 9:30 a.m. on weekdays (my classes start at 1:30 p.m.). Any tips on restoring my sleep pattern to normal?

Thank you so much!

I want one clarification about heart sounds...I cannot find anything on the Internet, so I thought it might be best to ask here. Is Erb's Point referred to the sound of the closure of both aortic and pulmonary valves? Also is it same as LLSB (Lower Left Sternal Border) because that's what my professor said, however the picture showed that LLSB is not at the same spot as Erb's point. Any help is much appreciated!

My mother, my calendar (literally!), and finally my cat Jks. My mother, my calendar/planner, and the amazing support from my school.

Yes that's exactly what happened. I'm still waiting. I am too an impatient person but when I felt the symptoms getting seriously worse (e.g. the stabbing pain underneath my ribs), I went back to my GP and asked for the referral to be rendered "urgent", still no call. I'm going to try to call the office again.

I could try visiting a naturopath but I am having gynaecological symptoms that I think may have been caused by these urinary tracts so that's why I'm clinging to visiting medical doctors. The problem is, they never listen to you!