Join the Liberty Nursing Journal Club

As many of you know a few senior nursing students founded the first Liberty Nursing Journal Club for our Department last semester. As the Club's President, I would like to invite you all to join the Liberty Nursing Journal Club for an exciting time of learning from each other about the latest research in fields like Cardiology, Neurology, Trauma Nursing, and Critical Care. Participating in this student-led group will give you the opportunity to explore ground-breaking research in nursing and discuss how this information applies to you and your future practice with your peers.

The LU Nursing Journal Club meets once monthly for about one hour. Dates will be advertised in the Nursing Department Office on the Department's kiosk. You can also check out the Liberty Nursing Journal Club Facebook page. 

I Shall Fear No Evil

This morning I undertook the task of re-memorizing Psalm 23, a chapter I learned when I was 6. After reading it a few times, I decided to turn it into a prayer of thanksgiving to God. It was only after doing this that my heart was impacted by the magnitude of His love and grace toward me, His child.

The LORD, the Great I AM, the Lord of Angel Armies, is my Shepherd, and He takes care of my needs so that I do not lack anything (Psalm 23:1). He not only gives me the peace I need to rest (John 14:27), but He makes me take a break and lie down like sheep in green pastures (Psalm 23:2a). He leads His sheep, His Church, by still waters--waters I can drink from and not be swept away (Psalm 23:2b). He again is protecting me from danger as a Good Shepherd would. He restores my soul when my spirit is weak and exhausted (Psalm 23:3a); He imparts new joy. I am continually able to rejoice in His mercies, which are new every morning (Lamentations 3:22-24)! 

Even though I do not know the future or the path that my feet will take, I can trust that God will lead me in the path of righteousness in order to bring His name honor and glory (Psalm 23:3b). And even if the path I take brings me right into the valley of death, I shall fear no evil because my God--who created the valley--is with me and will lead me through to the other side in safety (Psalm 23:4). I know that God is my Salvation; I will trust Him (Isaiah 12:2) and not fear the enemy who stalks in darkness (Psalm 91:6). In fact, the Lord blesses me even when I am in the presence of my enemies (Psalm 23:5).

Truly, it is good to follow the Lord! He takes such great care of His people, the sheep of His pasture (Psalm 100:3). He causes us to experience His goodness and mercy every day of our lives (Psalm 23:6). And when our time on earth is fulfilled, we will dwell with Christ in the house He has prepared for us forever (John 14:3). Praise the Lord for His continual faithfulness and mercy!    

Never Give Up. Never Give Up. Never Give Up!

I dedicate this post to every student who is feeling overwhelmed about his or her approaching examinations. Never consider the potential for defeat, but always consider the potential—YOUR potential—for VICTORY, and then make it your aim and goal to achieve that victory.

Never give up when you are faced with a massive amount of work. I know many—if not most of us—will be studying our entire Thanksgiving Break. While I understand that this may be necessary in order to do well on your tests, I believe it is also good to give yourself a break, even for a day. So, consider planning your study so you get at least one day completely off; your mind and body will thank you.  

In a commencement speech at his alma mater in 1941, Winston Churchill spoke these words: “Never give in, never give in, never, never, never, never-in nothing, great or small, large or petty - never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.” The enemy you will face after break is not a real adversary, yet it (finals week) is still an imposing obstacle to many of us. I want to encourage you to not fear; rather, TRUST the LORD in EVERYTHING (Proverbs 3:5-6). Do your best to prepare, and then leave the rest up to Him (Psalm 37:4-5, 55:22). The best thing I ever do with my tests is surrender the outcomes to God because, when I do, He gives me peace (Philippians 4:4-7; Psalm 62:8; Proverbs 16:3; 1 Peter 5:7). 

Stand fast (1 Corinthians 15:58). Remember how far the Lord has taken you (Isaiah 63:7). If you're a junior nursing student, you've already taken three Med/Surg and three Pharmacology exams. You’ve made it! There’s just a little bit left for you to accomplish by God’s grace (2 Corinthians 12:9-10). You can do it!  Consider your last week of school your opportunity to SHINE (Matthew 5:16).

Where Is God in the Storms of Life?

Today, my pastor taught about Job and the great trials that bombarded him during his great trials. In the first few chapters of the book, Job loses his monetary possessions, numerous servants, and his seven sons and three daughters. In rapid succession, he received horrendous reports from the last surviving servant from each area telling him of the loss of his oxen, donkeys, sheep, camels, and dearly beloved children. In the twinkling of an eye, he was transformed from the wealthiest man in the East (Job 1:3) to a bereaved man stripped of his earthly possessions.

What struck me was his response to such grief and heartache. Instead of blaming God, he worships God in his grief.

“Then Job arose and tore his robe and shaved his head and fell on the ground and worshiped. And he said, ‘Naked I came from my mother’s womb, and naked shall I return. The Lord gave, and the Lord has taken away; blessed be the name of the Lord.’ In all this Job did not sin or charge God with wrong.” (Job 1:20-22)

These few verse challenged me today to consider, “How will I respond the next time I am faced with a trial, testing, or grief?” Will I praise God in my grief and in my trial or will I question the good and perfect character of the Lord? My desire is that I will have Job’s response. That I will not charge God with wrong but instead praise God in the storms of life because He is there in the midst of them (Mark 6:48).

Here is God’s promise to you:

“’. . .Fear not, for I have redeemed you; I have called you by name, you are mine. When you pass through the waters, I will be with you; and through the rivers, they shall not overwhelm you; when you walk through fire you shall not be burned, and the flame shall not consume you. For I am the Lord your God, the Holy One of Israel, your Savior. . .’” (Isaiah 43:1-3)

10 Suggestions for Writing a Solid Patho Paper

1.      Figure out the main problem/diagnosis. The main medical diagnosis is usually what brought them into the hospital or it could be the root cause of their visit. For example, a patient who had a heart attack two weeks ago may present to the hospital with dyspnea and new onset heart failure. While dyspnea is their main complaint, the main problem is heart failure since it is the root cause of their difficulty breathing.

2.      Clearly structure your paper. This stems from a good outline. Before I ever sit down to write the Pathophysiology portion of my profile, I figure out what the main diagnosis/problem my patient is facing. Once you know the top problem, write down the various other issues that your patient is dealing with and then arrange your patho in a way that organizes the information in a logical fashion. For example, if your patient’s primary diagnosis is heart failure (HF) secondary to a recent myocardial infarction (MI) complicated by renal failure (RF), I would outline the paper like this: Hx of present illness, patho of HF (from macro to micro level, i.e. down to the cellular level) and how the diagnosis of HF was made (echocardiogram, BNP, etc.), patho of MI in relation to the development of HF, patho of RF which was caused by insufficient perfusion secondary to the decreased cardiac output associated with HF, discuss the patient’s current status (edema from fluid overload secondary to HF and RF, dyspnea secondary to fluid overload leading to pulmonary edema, etc.), and conclude with a paragraph discussing patient education (e.g. call the doctor about significant weight gain in short period of time) and follow-up care (nutritional consults, congestive heart failure out-patient clinic).    

3.      Spend sufficient time discussing the pathophysiology of the primary diagnosis. Write as much as you need to sufficiently cover the topic, including the normal anatomy and function, the pathophysiology of the disease, and the manifestations of the illness and what causes each of them. When discussing acute kidney injury (AKI), for instance, discuss the normal anatomy and function of the kidneys (nephrons, tubules, glomeruli and how they are involved in filtering urine and regulating fluid status), the original insult to the kidneys (e.g. decreased perfusion from low cardiac output associated with HF), the stages of renal failure, and the stage the patient is currently in and how each manifestation (peripheral edema, hypertension, and decreased urinary output) relates to the diagnosis of AKI.

4.      Be sure to include procedures and studies related to your patient’s diagnoses. If your patient has HF, discuss how it was diagnosis such as by Transesophageal echocardiogram (TEE) and BNP values. Discuss how this procedure, TEE, is performed and the physician’s interpretation of the results (ejection fraction, hypertrophy of ventricles, etc.).   

5.      Write at least one paragraph or more on the other diagnoses related to your patient’s primary condition. For instance, if the patient has HF, RF, and past MI. Discuss how the MI led to his HF, the patho of MI, and how it is currently affecting the patient (this could easily be three paragraphs). Also, discuss the patho of RF and why it resulted from HF and how it manifests in the patient.

6.      Relate the information to your patient in each paragraph. At the very minimum, include your patient (e.g. their presentation, diagnosis, etc.) in the topic sentence (usually the first sentence in a paragraph), and in the last sentence of the paragraph.

7.      Integrate your patient’s labs into your paper. This is one of the best ways to relate your topic to your patient (#3). Whenever you give your patient’s labs don’t just list their lab values, include the normal ranges (specific to age and gender) and the correct interpretation of the labs (low/high/normal). Then apply this information to the patient and their diagnosis and prognosis. For example, your patient has low hemoglobin, hematocrit, and red blood cell count; you know this because these values are lower than the normal levels for an adult male, indicating that he is anemic. After explaining this, address the reason for his anemia. For example, he could be anemic as a result of insufficient production of erythropoietin secondary to his renal failure.

8.      Integrate your patient’s medications into your patho. This shows your understanding of your patient’s condition as well as the indication for the medications which they are prescribed. For example, your patient is on a statin, ACE-inhibitor, aspirin, and beta-blocker; these are all standard medications prescribed to a patient post MI. Don’t just list the medications; instead, talk about the specific medication your patient is prescribed, its drug category, mechanism of action, and indication for your patient. For example, your patient is prescribed metoprolol (Lopressor), a cardioselective beta-blocker, which decreases heart rate and blood pressure by blocking the beta-1 adrenergic receptors in the heart. This medication is given to treat hypertension by lowering this patient’s blood pressure.

9.      Read before your write. It is so much easier to write a patho if you’ve read about the diagnosis and the related issues in your Med Surg and patho textbooks and journal articles before you start writing. By doing this, you can avoid the risk of plagiarism that arises from writing as you read. You also are able to demonstrate your understanding by writing the information in your own words.  

10.  Read your patho before submitting it. The flurry of patho writing it is easy to miss grammatical mistakes and spelling errors that you will be able to catch on your final pass over your paper. I usually like to read a paper out loud before submitting; this keeps me from just skimming the content. Remember to use spell check and Google the spelling of words you are not sure how to spell. Finally, the undergraduate writing center at Liberty University is another great resource. They usually take a few days to review your paper, so start working on your patho and send it to them early if you want to be able to update your paper based on their comments before the deadline. 

Merciful God

Recently I was challenged by an elder at my church to keep a record of the lessons that the Lord teaches me so that I can share it with my children someday. Since it's so easy to forget the little things in life the Lord does and teaches us, I have resolved to make a habit of writing down some of the lessons the Lord teaches me. Here's a little excerpt from my journal entry this afternoon.

Today, I was reading Lamentations, a book filled with the mourning of a prophet over the plight of Judah. When I came across the most famous passage in Lamentations (3:21-26), I was struck by the dramatic context of this verse. Lamentations primarily focuses on the consequences of Judah's sin--the Judgment of the Lord. After highlighting the humiliation of God's people, the writer of Lamentations breaks the rather depressing description of Judah's desolation by calling to mind their one hope--the lovingindness and mercy of their God.

When everything looks hopeless, still there is reason to rejoice for God is still on the throne (Lamentations 5:19). The Lord will never give up on us just as He never gave up on Israel. Paul and Timothy were so certain of this that they wrote the church in Philippi saying, "And I am sure of this, that he who began a good work in you will bring it to completion at the day of Jesus Christ" (Philippians 1:6).  

"Remembering mine affliction and my misery, the wormwood and the gall. My soul hath them still in remembrance, and is humbled in me. This I recall to my mind, therefore have I hope. It is of the LORD'S mercies that we are not consumed, because his compassions fail not. They are new every morning: great is thy faithfulness. The LORD is my portion, saith my soul; therefore will I hope in him. The LORD is good unto them that wait for him, to the soul that seeketh him. It is good that a man should both hope and quietly wait for the salvation of the LORD" (Lamentations 3:19-26).

Let us remember to wait quietly for the Lord's salvation and take comfort in His mercy and compassion. 

Difference Maker

Have you ever wondered what kind of a difference you make as a Christian working in the hospital? I know I have. Unfortunately, most times we have no clue whether or not we made any impact on the lives of our patients. Then there those times when God decides to bless us with special reminders of why we do what we do—to love people like Jesus loves them and loves us. 

Within the past year, I have received notes from a family member as well as a former patient thanking me for simply caring. Many times we don’t realize how showing the love of Christ and praying with patients and their families can encourage people, especially when it’s in the darkest times of their lives.

So on the days that we feel like we’re just going through the motions, let’s remember that what we do does really make a difference. You—I—each one of us makes a difference on the world around us.

“And let us not grow weary of doing good, for in due season we will reap, if we do not give up” (Galatians 6:9).

Pray About the Little Things

Never underestimate the power of prayer. The Bible testifies that the “…fervent prayer of a righteous man availeth much” (James 5:16b, KJV). I believe we often forget to come before the Lord with the little things—the keys we’ve lost, the test we’re about to take, the patient load we find overwhelming, and the lack of sleep from studying all the time.

Recently, the Lord has been challenging me to come to Him with the little things because He cares about His children (1 Peter 5:7; Psalm 55:22). We can come before the Throne of God boldly as God’s children, confident that we will be received with open arms by our Father in Heaven.

“Let us therefore come boldly unto the throne of grace, that we may obtain mercy, and find grace to help in time of need” (Hebrews 4:16).

God promises to hear the prayers of righteous men (Proverbs 15:29; 1 Peter 3:12).

“The eyes of the Lord are on the righteous, and His ears are open to their cry” (Psalm 34:15, NKJV).

I can personally testify that the Lord really does care, and He does answer. Yesterday, I was going to log into the hospital charting system for the first time in almost a year. Because I had participated in the Richmond Program, I hadn’t logged onto a computer at this hospital in a while. Beforehand I was anxious because I wasn’t sure if I remembered my password or not, but before I attempted to log on for the first time, I bowed my head right there in the nurse’s station and asked the Lord to help me remember the right password. Then I typed in what I thought was the right one…and…it worked! I had no troubles and didn’t have to call technical support. God answered my prayer!

Earlier in the week too, I was anxious about a test I was about to take. Before the test, I prayed and told the Lord that I needed His help. I could not do this without Him. I surrendered the test AND the OUTCOME to Him. I chose to trust Him with whatever happened. Whenever I came to a question I struggled with, I prayed and asked the Lord to help me choose the right answer. Then today, I discovered yet again the faithfulness of the Lord because He gave me favor, and I received a phenomenal score on my exam. Praise the Lord! Because I depended on Him, He gets all the glory.

Tonight I want to challenge you to remember the God we serve. He knows everything. He knows what you need even before you ask (Matthew 6:8, 32). But He wants you to ask (James 4:2). Admit your dependence on Him (1 Peter 5:6). He is your Lord, Your Provider Who meets all your needs (Philippians 4:9). Remember to bring the little things to Him in prayerful surrender today.  

God Is So GOOD!

Isn't it good to know that we serve a loving God, who knows our needs even before we do? The other day I was feeling overwhelmed with all the things that were on my plate. I was feeling physically and emotionally drained from a long day. But before I even knew that I would be feeling this way, God knew it, and He orchestrated people and schedules so that one of my precious friends would be in the exact place where I was at the exact time when I needed some encouragement.

This friend of mine was bright and full of energy and love for the Lord. Her compassionate presence encouraged me that the Lord cared, and He was with me to bring me through and give me the strength I needed for the tasks at hand. My friend prayed for me when I needed it most.

Isn't it good to know that the Lord cares about us and can anticipate our needs better than any nurse does for her patients?

"And when you pray, do not heap up empty phrases as the Gentiles do, for they think that they will be heard for their many words. Do not be like them, for your Father knows what you need before you ask him" (Matthew 6:7-8, emphasis mine). 

Providence: The Best Daily Planner

In Ephesians 2:10 Paul unveils part of our destiny in Christ, saying "For we are his workmanship, created in Christ Jesus for good works, which God prepared beforehand, that we should walk in them." Isn’t it crazy to think that God, even before we were conceived, knew what He planned for us and has certain tasks with our name on them?

Recently I've been asking the Lord to give me divine appointments, and He's been faithful to answer my prayer. Even though I asked the Lord to send me these opportunities from Him, I somehow always seem to be surprised when they come. The scenario is always different, but God is teaching me (granted I am still a work in progress) how to better respond when He brings people into my life that need encouragement. 

Sometimes it’s just following the little promptings from the Holy Spirit to do simple things like give a friend some chocolate and let her know I care (because who doesn’t love chocolate right?!). Other times, it’s just meeting a friend in need and just being there even if it means sitting quietly until she’s ready to talk.

The real challenge is being willing to drop everything and do what God is calling me to do. It’s so easy to want to do something for God and another thing all together to obey when He’s telling you to do something that’s inconvenient. 

My prayer is that we would have the heart of Christ to seek our Father in Heaven’s will in everything, that we would trust Him to guide our steps, and that our lives would be orientated around living in a way that pleases the Lord.