Ministers of Healing

During Christ's ministry on earth, He faced much opposition from the Pharisees who sought to enforce their own interpretation of the Law of Moses. On one occasion there was a man with a withered hand in the synagogue. The Pharisees were watching intently to see if Jesus would heal this man, an act they assumed broke the Mosaic Law to do no work on the Sabbath. When Christ was asked if it was lawful to heal on the Sabbath, He responded this way: “. . .Which one of you who has a sheep, if it falls into a pit on the Sabbath, will not take hold of it and lift it out? Of how much more value is a man than a sheep! So it is lawful to do good on the Sabbath”  (Matthew 12:11-12).

The value of one human life in the eyes of God is beyond our comprehension. What a great privilege we have as nurses to share Christ's love daily, including the Lord's day! I believe this verse shows us that we need not worry about breaking the Sabbath when we are scheduled to work on Sundays because Christ Himself chose to heal on the Sabbath. We follow His example as ministers of healing when we take every opportunity to do good by using our nursing skills to bring healing and restoration to our patients' bodies and spirits.   

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. 

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).

Patience for Our Patients

Patience is fourth in the line of spiritual fruit listed by Paul in Galatians that is supposed to characterize believers in Christ (Galatians 5:22-23). How much more should we, who have this high calling to serve those who are sick and impoverished, continue to demonstrate patience to those in our care? 

Throughout my life I have noticed how my attitude affects my actions. When I have a good attitude, it is easy for me to be joyful, caring and compassionate. If, however, I allow myself to forget why I am here and what my purpose is (to serve others as unto the Lord), then I find that thoughts of impatience have an opportunity to creep into my mind. Although I aim to never show these emotions, they are sometimes very much there. The question is how to deal with them when they happen. 

The word of God again provides the answer. "We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ” (2 Corinthians 10:5). Our minds are truly a battlefield for the war between good and evil desires in our person (Romans 7:21-25; Romans 8:5-13). When I find myself thinking impatient thoughts, such as “Would this car get up the road already?!”, I have an opportunity to put in practice the virtue of patience.

Thankfully, we are not alone in our battle against evil (Romans 8:27; 2 Peter 1:3). We have many weapons of warfare at our disposal (Ephesians 6). We have the divine power of Christ in us (2 Corinthians 10:4-5), and we have the Word He has given us (Ephesians 6:17).

When I was younger, my mom taught me to pray a simple prayer whenever a wrong thought came into my head, and ever since then I have used it clear my mind of unwelcome thoughts. When I realize I am thinking about something that I shouldn’t, I pray “Lord, I ask that you would take captive this thought and make it obedient to You.” A wise person once said, you can’t help what birds fly over your head, but you can keep them from making a nest in your hair. In other words, you can’t always help what comes into your brain, but you can help what you meditate on (Philippians 4:8).

Let us commit to turning our negative thoughts into prayers. When we are beginning to feel impatient—with our patients, our coworkers, our friends, or even our family members—let’s take the opportunity to turn our frustration into prayer—for God’s grace for ourselves and His blessing for them.

Patience isn’t easy. And I have by no means mastered it. In fact, I am writing this out of a realization of how much I need to grow in this area. Since we are weak and imperfect creatures, let us remember God’s promise: “…My grace is sufficient for you, for my power is made perfect in weakness…” (2 Corinthians 12:9a).

"Why Me, God?"

Have you ever wondered why God allows bad things to happen? I know even I have struggled with this question. Parents get killed by drunk drivers. Children die in house fires. Still others live with terrible deficits from these freak accidents. Teenagers get paralyzed in motorcycle crashes. Others are left with scars from the battle wounds they receive in gang fights. 

As nurses, we are surrounded by a great deal of pain and suffering (cancer, pancreatitis, liver and kidney failure, MIs, suicide attempts--the list is endless). So how will we answer when someone (a patient, a family member, a fellow nurse) asks "How can a 'good' God let bad things happen?" 

The answer isn't easy. And I don't pretend to know 100% of why. But I do know that God's original intention was for a perfect world--a world with no sickness, no pain, and no heartache. Man sin is what brought all this evil into the world. It was never God's plan for man to suffer. 

But how do we deal with the problem of evil when it effects our own lives? There isn't always a clear cut answer to that question, but I do know that God's nature doesn't change. He is still the same good God that He was yesterday, and He will be the same tomorrow and the next day (Hebrews 13:8), and I know His plan is to work out all the bad things that happen to us for our good (Romans 8:28). 

Job is a prime example. God allowed Job to endure unspeakable injury and insult at the hands of Satan, but God used it to prove to the Devil that Job was a godly man, and the Lord rewarded Job by giving him double of all that he had before (Job 42:10).

Joseph also was cast into a pit and then sold into slavery by his older brothers. Later just when he was experiencing the blessings of God and rising through the ranks in Potiphar's house, Potiphar's wife tried to seduce him, and then when he wouldn't consent, his reward was two years in prison (Genesis 41:1). It was only after Joseph remained faithful to the Lord through 11 years serving as a slave in Potiphar's house and 2 years as a prisoner in a dungeon that Joseph became second in command over Egypt. Speaking to his brothers, Joseph said “As for you, you meant evil against me, but God meant it for good, to bring it about that many people should be kept alive, as they are today” (Genesis 50:20).

How will we respond when we face trials? Will we have faith that God can use them, just like He used Job’s and Joseph’s, for His glory?

“Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing. If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him” (James 1:2-5).

Clustering Our Care

I know we’ve all heard about “clustering our care” as nurses until we’re blue in the face, but I’m here to testify that it really is important. It both respects our patient’s time as well as saves us time. I have found that something as simple as stopping to think about what I need, such as bathing supplies, full set of linens, towels, wash cloths, and shampoo cap, to accomplish my goal (bathing my patient and changing their linens) before I enter my patient’s room helps cut down on the number of trips I make between my patient’s room and the stock room. Patients will also appreciate your forward thinking because numerous trips in and out of a patient’s room can be disruptive to family visits and patient sleep.   

Stopping to think and plan takes only a few moments and saves you and your patient minutes. 

Nurse Aide Daily Task Checklist

Recently as I've been working as a nurse extern, I've created a checklist that helps me stay organized and make sure I complete the numerous tasks I am responsible for throughout the day. This is a tool I wish I had used while I was a sophomore and junior nursing student. I hope that you will find it to be useful to you during your time serving patients in the hospital. Feel free to use it and edit it any way you wish to best serve your needs as nursing students. 

Nurse Aide Daily Tasks Checklist by Elisabeth Campbell

Filled in NA Daily Task Checklist by Elisabeth Campbell

Audience of One

One of the things I've been learning recently is that it doesn't matter whether or not anyone thanks you for doing a good job. A lot of times nurses, and even nursing students, can feel unappreciated, which is understandable since many of the things we do for our patients go unnoticed, but that doesn't mean we should be discouraged or ever stop giving our best.

This morning I was reading in Psalm 40 how the Lord does not delight in sacrifices or offerings but rather in a heart that delights to do His will (vv. 6-8). The offerings and sacrifices are, in reality, outward manifestations of a heart that loves to be obedient to the Lord. In other words, God is after a heart that loves Him. This love for God should be the motivation of the good things we do for our patients, not a desire to be noticed or recognized.

"Slaves, obey in everything those who are your earthly masters, not by way of eye-service, as people-pleasers, but with sincerity of heart, fearing the Lord. Whatever you do, work heartily, as for the Lord and not for men, knowing that from the Lord you will receive the inheritance as your reward. You are serving the Lord Christ" (Colossians 3:22-24). 

"Slaves, obey your earthly masters with fear and trembling, with a sincere heart, as you would Christ, not by the way of eye-service, as people-pleasers, but as servants of Christ, doing the will of God from the heart, rendering service with a good will as to the Lord and not to man, knowing that whatever good anyone does, this he will receive back from the Lord, whether he is a slave or free" (Ephesians 6:5-8).

Free Drug Guide

Recently one of my friends introduced me to a great Drug Guide available on the ATI (Assessment Technologies Institute) website. The tool is great for finding the information you need to make medication sheets for patient profiles. I have found this tool to be very helpful, especially when I cannot find a medication in my drug book. The website provides all of the information you need to fill out the various components of the medication chart you use in clinicals, including mechanism of action (MOA), category, side effects, contraindications/precautions, and indication/use.

To access the Drug Guide, all you have to do it log on to the ATI website. You should already have a username and password from when you took ATI quizzes in your NURS 200 (Nursing Process Application) class. The "Drug  Guide Term Search" box is located on the right-hand side of the webpage. To search for a specific drug, enter in the generic name of the medication into the search box. This will bring you into a new window where you will be able to scroll through and find the information you need for your profile medication sheets.

Thoughts from My Experience in the Richmond Program

So far my experience in Richmond has been phenomenal. I have had the opportunity to observe several surgeries as well as work on three different units. By the end of my Richmond Experience I will have served on between five or six units, depending on what opportunities open up for us at St. Mary's. These units include Ortho-Joint, Ortho-Spinal, Peds, Ambulatory Operating Room (OR), Oncology, Peds Emergency Department (possibly), and/or Pediatric Intensive Care Unit/PICU (possibly). I have absolutely loved working in Richmond. Even though the weekends are intense with minimal sleep and long clinicals, taking care of my patients and learning in a new hospital setting has all been worth it.

For those of you who are worried that the Richmond Program would be too physically taxing for you, let me encourage you that God has provided me with the strength and stamina to complete my paperwork and be fully alert during my clinicals. He provides strength when I am weak (2 Corinthians 12:9).  

This experience has actually helped me to depend more on the Lord for strength than I would if I were completing weekly clinicals in Lynchburg. Because it requires more of me than I feel I can do on my own, I realize that God is the One who is providing my every need. This morning during my devotions I felt like God was leading me to read one of my favorite chapters in the Bible, Philippians 4. In this chapter, verse 13 leaped off the page and captivated my attention because it was applicable to the profound fatigue I felt this morning. Philippians 4:13 says, "I can do all things through Christ who strengthens me." This proves that when I don't feel like I can take another step or have the energy to complete another clinical, God will strengthen me. In verse 19, Paul continues by saying, "And my God shall supply all your need according to His riches in glory by Christ Jesus." This morning I needed supernatural energy just to get out of  bed, but God is always faithful to His promises and provided me with the strength I needed. Not only that, but He also gave me a great day in the unit I was on and allowed me to be a witness to the goodness of the Lord. 

Elsevier Resources

Some of you may already know about the resources available on the Elsevier website; however, I am one of the students who did not realize online practice questions, chapter summaries (called Key Points), and sample nursing diagnoses were available online through Elsevier's website until I was a junior in the nursing program.

Resources I have found particularly helpful to me have been the online practice questions and Key Points for Pharmacology and Medical Surgical Nursing as well as the care plan tools for the Nursing Diagnosis Handbook (Care Plan Constructor). I have recently started using the Care Plan Constructor to guide me in selecting the top three nursing diagnoses for my patient care plans. This tool allows you to match a particular nursing diagnosis to various symptoms, diagnoses, and procedures.

In order to use these resources, you will need to start an account with Elsevier, an opportunity which is completely free of charge. Once you've created an account you can add textbooks to your My Evolve by visiting the Evolve Catalog. Next click on Evolve Resources, enter the name of the book or author of the book you wish to register for (e.g. Fundamentals/Potter and Perry), and click on the book cover you wish to select. Click Register For This Now. The subtotal should be $0.00, so click REDEEM/CHECKOUT. Next click the box to accept the agreement, and hit submit. Resources should then appear for the textbook you selected in the My Evolve section of the website.

Tools for Clinical Success: Notebook and Clipboard

I would like to take the time here to provide recommendations to the sophomore class in regards to what you should bring with you when you begin your clinicals this semester.

The first item is a small notebook. One that fits in your pocket is perfect for taking quick notes, especially when your patient, nurse, or CNA asks you to do several things. I have also found using a small notebook as a great way to keep track of the vitals I take for several patients.

The other item is a clipboard. Last year I purchased a clear plastic clipboard from Walmart that works perfectly. I am able to wipe it down easily with a Cavi-Wipe if it gets dirty as well as hold several documents such as patient profile, assessment sheet, check-off sheet, and notes from my instructor simultaneously. Staying organized is important and is a mark of clinical excellence.

Richmond Experience

I would like to draw the attention of all my sophomore readers to the wonderful opportunity provided by the Richmond Program also known as the Richmond Experience. This program provides Junior Nursing Students at Liberty University with the privilege of completing Pediatric (Peds) and Medical Surgical (Med Surg) clinicals at Bon Secours' St. Mary's Hospital in Richmond, VA. Students who are accepted into the program complete all of their Med Surg and Peds clinicals in five weekends during either the fall or spring semester. These weekends start on Thursday when students collect their patient information. Clinicals occur on Friday, Saturday, and Sunday. Each weekend students work one 8-hour and two 12-hour shifts. This makes for a long weekend, but students only have clinicals half of the weekends and are off the other half.

At this point you might be wondering, why would I want to drive two hours to go to Richmond for clinicals? The benefit of participating in the Richmond Program is that you are able to gain more inpatient pediatric experience. St. Mary's pediatrics department provides care to a greater number of  high acuity Peds patients. This means there are more opportunities for hands-on learning experiences. Participating in the Richmond Experience also gives students the opportunity to work in another medical facility and work with another charting system. These are just some of the benefits of the Richmond Program. Stay tuned for future posts about what I love about St. Mary's Hospital as I will begin my clinicals there soon.

If you are a sophomore and are interested in the Richmond Experience, here's what you need to know. Applications for the Richmond Program are due no later than March 15, 2013. To apply to the Richmond Experience you need to follow the instructions provided on the Liberty University webpage.  Make sure to give your instructors the evaluation form as soon as possible since they may take some time before they are able to complete the form for you. Keep in mind this is a highly competitive program; it is to your advantage to apply early.

Praying with Patients

As nursing students at Liberty University, we have all heard our professors talk to us about providing spiritual care to our patients. One of the aspects of spiritual care that our instructors have emphasized is praying with our patients. I know some of us find the idea of praying with patients to be highly intimidating. But I would like to share from my own experience that praying with patients is not scary at all.

Ever since I started clinicals last year, I have made it a habit to pray with my patients at least once during my shift. I ordinarily wait until the end of my shift to ask my patient if I can pray with them because, at that point, I have developed a trusting relationship with them. I usually tell my patient that I make it a habit to pray with all my patients before I leave; I ask if they would like me to pray with them, and they are almost always happy that someone cares about them enough to take time out of their busy schedule in order to pray with them.

Now you might be wondering, what if the patient says they don’t want any prayer. In that case, you should respect the patient’s wishes and drop the subject. Even though there is always the possibility that your patient will say no, I have found that the response from patients has been overwhelmingly positive.

All things considered, I encourage you to make a habit of praying with your patients. It is just one more way we can be the hands and feet of Christ as we serve our patients in the clinical setting. 

Clinical Tips

Smile. A cheerful heart is good medicine (Prov. 17:22). There are so many long faces among patients and hospital staff. As a nursing student, you have the opportunity to be a bright sunny spot in the lives of numerous people, especially your patients and their nurses.

Be confident in yourself. Confidence communicates to your patients that you know what you’re doing, and they can trust you.   

Don’t be afraid to go into your patient’s room. At this point in your clinical experience, you may still feel like you’re bothering your patients if you go into their rooms, but your job is to take care of your patients, and you can’t do that from the hallway.

Don’t be afraid of criticism. Most patients are very understanding and encouraging, but even if they do criticize you, take it as an opportunity to learn from your mistakes and become a better nurse. You can learn a lot from your patients as they share with you their experiences, desires, and frustrations.  

Remember that you’re not alone. The Lord is with you wherever you go (Matt. 28:20). If God has called you to nursing, then He will give you the strength and grace you need to be a nurse (Phil. 1:6).

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.

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.

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).