Saturday, August 18, 2012

Writing a Script for Health Assessment Check-Offs

Depending on your learning style and the amount of time you have to invest in preparation for your weekly check-off (CO), you may find it useful to write out a script for your CO. Depending on the organization of the CO sheet, you may be able to order the steps in your script to match the order of assessment elements on your CO sheet.

When you’re writing your script, remember IPPA (inspection, palpation, percussion, auscultation) is always the order in which you perform your assessment, with the exception of assessment of the abdomen (Seidel, et al., 2011). As you proceed through your assessment, assess your patient from head-to-toe. This helps you stay organized and move in a methodical manner. For example, when you’re assessing the integument, start at the head, noting any blemishes such as macules, papules, or pustules (Seidel, et al., 2011). Tell your evaluator what you see: location, size, shape, color, texture, and distribution. Is it raised or flat? Is it the size of a pencil tip or pencil eraser?

When you’re writing your script, keep in mind that you will be performing your assessment as if the evaluator (either an upper classman nursing student or clinical instructor) is not in the room. Talk to your patient; they are the ones you are evaluating. At the same time, remember that your evaluator cannot read your mind. If you’re inspecting a patient’s skin, tell the patient, “Now I’m going to inspect your skin. I see that you have a small papule on your left cheek that is light brown, raised, well-circumscribed, and less than six millimeters (mm).” This point would be a good opportunity to explain the ABCDs of melanoma. Tell your patient, “A is for asymmetry; B is for border; C is for color, and D is for diameter. An ideal papule or macule is symmetrical, has a clearly defined border, is uniformly colored, and is less than six mm in diameter.” If a papule or macule is asymmetrical, has a border that is blurred, has two different colors, or is greater than 6 mm in diameter then you should advise your patient to see their physician because these might be signs of melanoma and they should have their papule or macule examined by someone trained in identifying melanoma. Even if your patient’s macule or papule does not show signs of melanoma, it’s important to remind them to watch any moles for changes in size and color, asymmetry, or indistinguishable borders (Seidel, et al., 2011).

You may find it helpful to include pictures in your script such as diagrams of the locations to place your stethoscope when listening to lung sounds, heart sounds (S1-S4), etc. You will not be able to refer to your script or CO sheet during your CO, so come to the Nursing Lab prepared to CO on your assessment for the week. The goal is for you to remember what you should be assessing in each system so that when you get to the hospital, you’re not carrying around a million papers containing the list of things you should be assessing on your patient. This is why I suggest you initially memorize what you need to assess in each system so that you can, first of all, pass your COs and, most importantly, know what you need to be paying attention to when you assess your real-life patients. 

When you perform your assessment, remember that for anything that you perform on one side, you must also perform on the other UNLESS you say, “I would do the same thing on the other side.” For example, if you percuss for diaphragmatic excursion on the left side, you must say that you would do the same thing on the right side otherwise you will either receive half credit or no credit at all because you professor can deem the skill incomplete. It’s a good idea to include the statement, “I would the same thing on the other side,” in your script so that you remember to say it when you CO.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby's guide to physical examination (7th ed.). St. Louis, MO: Mosby.

Tuesday, August 14, 2012

A Time-Saving APA Reference and Citation Tool in MS Word

The following tutorial provides step-by-step instructions for using Microsoft Word's APA sixth ed. reference and citation tool. Using this MS word tool saves time and energy; however, you must always remember to double check your information and in-text citation/reference list format against the most current version of the APA manual.

Sunday, August 12, 2012

Using Liberty University's Summon

  The tutorial below details the steps for performing a basic search in summon.

Liberty University Library Nursing Database Tutorial

The below tutorial gives step-by-step instructions for finding scholarly journal articles using the CINAHL (nursing) database.

Using Liberty University's Library Journal Finder

This tutorial guides Liberty University students step-by-step through the process of using Liberty University's Journal Finder.

Saturday, August 11, 2012

Serving: God’s Highest Calling

“But Jesus called them [His disciples] to Himself and said, ‘You know that the rulers of the Gentiles lord it over them, and their great men exercise authority over them. It is not this way among you, but whoever wishes to become great among you shall be your servant, and whoever wishes to be first among you shall be your slave; just as the Son of Man did not come to be served, but to serve, and to give His life a ransom for many’” (Matthew 20:25-28, NASB). As I was reading this passage in scripture this morning, I was struck by the similarity of Jesus’ description of a servant to what I’ve observed nurses and certified nurse aides (CNAs) do in the hospital. They feed patients, give them their medications, make them comfortable in bed, help them walk to the restroom, clean their wounds, and sundry other tasks. How privileged then should we feel to be studying to be nurses? The Lord has given us a high calling—the calling to be a servant of people whom He loves. Each person is special to God. Each person has a story, a life they’ve lived, and unique life circumstances. When we’re in the hospital, let’s all try to remember that our to-do list is important to God. We are being the hands and feet of Christ as we serve our patients. Remember that “’…whoever in the name of a disciple gives to one of these little ones even a cup of cold water to drink, truly I say to you, he shall not lose his reward’” (Matthew 10:42, NASB).

Wednesday, August 8, 2012

Nothing Is Impossible with God

Recently I was reflecting on the semester ahead—the obstacles we will all face and the highs and the lows in the adventure of nursing—and I realized that God would never ask us to do anything impossible unless He was planning provide us with the strength to press on to the end. Now don’t get me wrong, I’m not saying nursing is impossible. There are plenty of nurses out there who have successfully completed nursing school and now work as registered nurses. What I am saying is that it is difficult, yet I know firsthand that God is all-powerful, and countless times He has given me the strength to press on in spite of difficulties.

Elisabeth Elliot, a courageous missionary woman who lost her first husband while serving the Lord in Ecuador, once wrote, “What God calls us to do is always impossible. Impossible, that is, without His help. It is always too big for us, too demanding. The price is too high. Yet He calls us to count not our lives dear to ourselves” (1988, pp. 154-55). I don’t know about you, but I am convinced that nursing is my calling. Yet I also know that without God’s help and divine direction, I wouldn’t have made it this far. What I need to remember is how small I am and how BIG God is. With that in mind, each day I want to remember to humble myself before Him, admit I can do nothing apart from Him, and ask Him for His help and grace (James 4:10).


Elliot, E. (1988). Loneliness. Nashville: Oliver Nelson.

Thursday, August 2, 2012

General Guidelines for Lab Portion of Health Assessment

Understand what is expected of you
The way NURS 210 (Health Assessment) works is the first hour or so of lab one of the professors will lecture on the material for that week; then you practice that skill for about 30-45 minutes depending on the skill, and then you will be tested on the skill you learned the previous week. What happens during the skill test (called a “check-off” or “CO”) is you go into one of the back rooms in the lab with your clinical instructor and demonstrate the skill to them on your lab partner, another nursing student from your clinical group. I suggest choosing someone you can practice/study with during the week.

Come practiced and well-prepared to your check-off
I strongly recommend writing up a script for yourself to practice before you go to your check-off. Your professor will post a “check-off” sheet on Black Board that lists the specific things you must assess in each system. For example, in the cardiovascular system they’ll ask you to assess heart rate, pulses, S1-S4 heart sounds, presence of murmurs, thrills, heaves, etc. In order to remember to get everything on the list, I found it helpful to practice with another sophomore nursing student and establish a routine or order for assessing a specific body system. Two helpful phrases for organizing your assessment in almost every system are IPPA (Inspection, Palpation, Percussion, Auscultation) and assess from “head-to-toe”. If you learn how to use these, you’ll be in great shape.

You will be responsible to check-off with a Jr. or Sr. nursing student in the lab during the week before you check-off with your clinical instructor. There will be a sign-up sheet located on the bulletin board outside the nursing lab where you will sign-up for a time slot to check-off. The time slots are usually posted Sunday afternoon, so if you have a tight schedule, be sure to sign up on Sunday if you can.

Come prepared for lab
You never know when there will be a pop quiz on the material you should have already read about for that day. Remember these are people’s lives we’re dealing with here. Be responsible. Do your part to be ready to give that cup of cold water to the patient who needs it and know when you can’t give it because their chart shows that they’re NPO.

Wednesday, August 1, 2012

Getting Ready for Your First Week of Sophomore Year

Make sure to buy you Physical Assessment textbook AND workbook early
If this year’s syllabus is the same as last year, before your first day of class you will need to read chapters 1-3, 5, 7, & 15 (only pages 474-478) of Mosby’s Guide to Physical Examination and complete the worksheets 1 & 2 in your student workbook to accompany Mosby’s Guide to Physical Examination (please double check your syllabus).

The first day of lecture you will have a quiz due on Black Board. This means that you should have completed it, at the very latest, the day before lecture in order to avoid testing in the “Red Zone” (see your syllabus for details). My syllabus from last year shows that quizzes should be available one week before the due date, so, if you can, complete them before you arrive on campus.

The first day of class you will hand in your two worksheets stapled and in a folder marked with your name, your nursing mail box number, and your NURS 210 section number. If you order your books through the bookstore, be sure to double check that they give you both the textbook and the workbook. The workbook somehow wasn’t included in my order last year, making for a very stressful first day of class.
Another suggestion I have is buy Mosby's Physical Examination Handbook, 7e [Paperback]. I found it very useful to keep it in my lab coat pocket and refer to it during class or during the week when I studied for my “check-offs.” I also used it when I was studying for and writing my script for my clinical final.

Get a Planner
This is probably a very obvious suggestion, but it is, nevertheless, necessary for me to point out. Before you even come to class I strongly encourage you to read your syllabus and write down ALL of the due dates in your planner so that you have a quick reference for all of your classes. Invest in a planner with enough space for you to write down the details. (I found a cute and inexpensive planner at Wal-Mart last year that held up well and helped me stay organized). The key to success often involves organization. Nobody wants to be cared for by a nurse who haphazardly organizes her patients’ care. Learn organizational skills now, and do yourself and your patients a favor. 

To the Future Life-savers of America: A Special Note to the Liberty University Nursing Sophomore Class

Welcome to your first year in the Liberty University School of Nursing! Many of you have been waiting for this moment all your lives. All your dreams of putting on those scrubs and saving people’s lives will soon begin to be achieved in this your first year in the program. Books ordered, uniforms fitted, equipment purchased—everything’s ready for your big debut. Some of you are overcome with excited anticipation as the weeks of summer slowly run out and the fall semester approaches. Others of you feel a sinking feeling in the pit of your stomach and are beginning to wonder if you can make it through the year… I’m here to tell you that you can. As a Junior I can say with confidence that you can do it. You’ve gotten this far. The Nursing Department believes in you; they would have never accepted you if they didn’t. You can do all things through Christ who gives you strength (Phil. 4:13). Nursing can be challenging, but it is also rewarding.

I have created this blog to offer support to the sophomore nursing class. I want to help you achieve your maximum potential as a nursing student so that later you will be super prepared to fulfill you calling, step into the shoes of an RN, and change the world for Christ’s glory. So get ready…the best is yet to come.