Maternal Child Critical Care Program:Perspective of a Graduate

Warning: to all readers, if you are reading this I assume that you understand that you are about to enter the nerd-dom of Maternal Child Critical Care Certificate Program (MC-CCCP) NOT the original of adults in CCCP. This is the world of patients the size of teacup poodle puppies. This is NOT the world of ER re-runs and those ever-popular shots of scrub-bedecked heroes running down endless halls and pumping with all their might on the chests of unresponsive patients. This is the world of two-finger compressions, micro-changes in IV calculations, tiny bodies that require exquisitely careful care and much peace and quiet, inexpressible joy, broken hearts and messed-up homes. Welcome to MC-CCCP.

As noted, this is not adult CCCP. When I took it last year, we did not operate or run codes like the CCCP students. We spent more time in lecture and with guest speakers and less time running mock codes than our “adult” neighbors last year. Most of our practice was self-taught, with us designing and running our own scenarios. Considering the feedback we got from instructors after we all passed NRP and PALS, we were a pretty demanding set of self-teachers! All that to say, if you take MC-CCCP, you need to be motivated to learn. Like all of the nursing program, you get results in proportion to the effort you make.

If you do persevere and learn, it is a program you will never forget. I had the incredible privilege of working in a NICU. It was a small one and by weekend #2, my instructors were turning me loose to do basics on my own (with them only a few feet away in the tiny department). By the last weekend I was essentially put in charge of the patients assigned to my instructor and myself. I had the joy of watching the light bulb come on in a tiny child’s mind as he finally understood the idea of nursing from a special preemie bottle and took a giant step toward going home. I got to share that joy when his mom came to see him. My heart broke as I cared for and loved on babies only to meet their families, people unprepared for this responsibility. One had not even wanted the babies in the first place and could not make it into the department without crying. Then there was the one father who could win a smile from his tiny daughter and make her calm down and go to sleep against his chest, staying as long as he could just to be with her. Above all was the wonder and joy of working with some of the most beautiful creations God ever designed and sent to give us a taste of what unconditional love is and demands.

        

Fun epilogue: I do not currently work with any of the patient populations we covered in MC-CCCP. God has placed me for a time in long-term care and rehab. However, the skills of MC-CCCP have shown up here too! I was trained to face the worst, which makes it easier to prioritize and keep a levelheaded approach to a constant deluge of problems of all sizes. There are also basic concepts that apply to everyone: everyone must breathe, their hearts must pump and blood must circulate. And everyone is hungry for unconditional love. 

The above post was written by Elizabeth Houser, RN and graduate of the MC-CCCP

Critical Care Certificate Program

Over the past year I have received numerous questions regarding the Critical Care Certificate Program (CCCP) from nursing students at Liberty University. Most often these questions revolve around what the program is and how it benefits students interested in critical care nursing.

The Critical Care Certificate Program gives students the advantage of taking three American Heart Association tests that nurses normally will not take until they have already graduated. These three tests are Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Neonatal Resuscitation Program (NRP). Taking these tests before graduation allows Liberty Nursing students to achieve more qualifications for a nursing job than most new nursing grads, in effect, giving students an extra advantage. This is particularly helpful for positions, such as those in an intensive care unit (ICU) or emergency department (ED), that require these certifications be acquired soon after being hired.

Another advantage of the CCCP is the numerous hours that are spent in simulation, running code blues, interpreting EKGs, selecting and administering the appropriate drugs to the simulation patients, performing CPR, delivering breaths with an Ambu bag, and practicing recording drugs and interventions given during a response to cardiopulmonary arrest. This provides the opportunity to learn in a low-stress environment by working through real-life scenarios that allow you and your peers to learn from your and others' mistakes as well as successes.

I am currently in the Adult CCCP and loving it! We start each NURS 465 class with two hours of lecture, break for lunch, then come back and run mock codes for three hours. An added benefit is NURS 465 (for the Adult CCCP) counts for the nursing elective required to graduate from Liberty's Nursing Program.

Another advantage of being a part of the CCCP (both Maternal/Child and Adult) is you will be given preference during selection for Leadership. This means that your requests for Leadership clinicals will be looked at first before your peers who are not in the program. The reason for this is that you will need to complete 140 hours of Leadership (NURS 490) clinicals in a critical care setting, such as an ICU or ED, which is greater than the 90 hours of Leadership required of your peers. If you get into the Adult CCCP, you will also have the opportunity to shadow in a critical care setting of interest to you such as the CVOR, flight nursing, EMS/fire department, etc. These are great observational opportunities that you may never have again after graduation.  

Relationships in Nursing School

I often am asked by other nursing students my opinion on relationships in nursing school and whether it’s possible to have a boyfriend while in enrolled in such a rigorous program such as Liberty’s. My response in the past was to smile and remind the nursing student who asked the question that God is in control of everything, including her love story. While I used to point out that I knew several nursing students who had boyfriends, were engaged or even married, now I can testify from personal experience that it is possible to have a boyfriend and still be a successful nursing student, which was the real issue my nursing friends were getting at with their questions.

Desire for companionship and love is a natural longing deep-seated within the heart of a woman; nevertheless, it is dangerous to want a boyfriend just for the sake of having one. One of my friends told me recently that her goal for the year was to “get a boyfriend”. The problem with this thinking is that if you seek to make something happen—like getting a boyfriend—you may miss out on a better plan that God has for you. Solomon shares some insight into this in Ecclesiastes; “For everything there is a season, and a time for every matter under heaven: . . . a time to embrace, and a time to refrain from embracing;

a time to seek, and a time to lose; . . . a time to love, and a time to hate” (3:1, 5b, 6a, & 8a). The Song of  Solomon also speaks about waiting on God’s timing in your life; “I adjure you, O daughters of Jerusalem, by the gazelles or the does of the field, that you not stir up or awaken love until it pleases” (3:5).

To all the single nursing students, guys and girls, this is just a reminder to let God write your love story. Seek the Lord in prayer before entering any romantic relationship—just like I hope you do with every other decision you make. If there is no one in your life right now, do not be discouraged. Jesus is your Bridegroom King (Isaiah 54:5, 10), and He loves you with a love no other human being on this planet could ever match (Jeremiah 31:3). Rejoice in His love for you, and be content in waiting (Phil 4:4, 12).

When that special person does come into your life, be sure to have good time management. I used to joke before I was courting that I was dating my textbooks—not really an exaggeration for how much time I spent with them. Since I still study a lot, I have to be intentional about taking time to just be with my boyfriend and talk or do something fun. (Yes, having fun is important for single nursing students too! You should try it sometime). When the time comes, remember you can—and I often do—spend time with your significant other while studying. You both have to be able to stay focused, but it is possible to get a lot done and still be in the same room.

On a final note, I want to remind you all not to fall for the nasty Liberty rumor that you have to meet your spouse at Liberty University or you will never find anybody. One of my friends graduated from the nursing program single and unattached over a year ago...she's getting married this Saturday to the man of her dreams, who she met after graduation! So, if you graduate with no one in the romantic sphere of your life, trust the Lord. He may have a surprise waiting on the other side of graduation.

   

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.   

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.