Calling All Sophomores Nursing Students

Tell me how I can help you. I would like to know what you want to know before you have your second clinical in the hospital.

Feel free to post any question as a comment to this post, and I will do my best to address it. 

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 Word to the OVER-ACHIEVERS

Rest… Such a simple word, but for some of us who try to do and be the best we can be at everything, it may seem hard to do at times. In nursing school it seems like lack of sleep, lack of energy, and lack of motivation are symptoms of a pervasive disease that has left no one unaffected.  But if I may, I’d like to share an amazing discovery. Having FUN—doing something other than studying—can prove to have abundant rewards.

I have found that taking time out of my busy schedule to do something that’s fun and involves physical activity helps me be more productive when I study. Taking even two or three hours to go and participate in recreational activities has helped me be so much more motivated when I come back to my dorm and study. Physical exercise is also beneficial because it makes me feel more energetic afterwards and helps me fall asleep quicker and feel well-rested when I get up in the morning.

Key point: Have FUN! Take time out this week to go hang out with friends. Do something that you enjoy. Don’t think about nursing while you’re doing it. Focus on what you’re doing right then. If you try to think about what you’re going to do when you get back, you’re missing the point. Mental breaks are the much needed medicine to cure the burn-out disease. 

Health Assessment Patient Education Project

Your patient education project is a great opportunity for you to practice taking information you learn in class and in your textbook and translate it for your patients in a way that can be easily understood. By completing this project you will also learn how to present information in way that is appropriate for the patient population you are targeting.

Read your Health Assessment syllabus for the details of the assignment. Your topic must be on a disease process or health promotion topic in one of the following systems: Breast & Female Genitalia or Prostate, Rectum & Male Genitalia.

Remember that you CANNOT use websites as a source. Your references must include your textbook and a minimum of three scholarly journal articles. Liberty University has an excellent Library site that provides students with access to numerous healthcare databases tailored to meet the needs of nursing students. (See previous posts for tips on using the Liberty Library databases).  

Choose a topic that interests you. Also, verify that your instructor approves your topic before you start researching and writing.

Be creative with your presentation. You can present your information in a pamphlet, cardboard trifold, scrapbook, booklet, poster, or other creative design. Make your project colorful. If possible, include pictures that will bring your information to life. (The cardboard trifold pictured above was purchased last year at Walmart).

Make sure to write your project at an age-appropriate reading level for your patient population. Don’t use medical jargon that will overwhelm or confuse your patient. If you need to use words that are not commonly understood by non-medical professionals, be sure to define them.

Make sure your work is neat and that you use proper American Psychological Association (APA) citation. There are several APA manuals in Liberty’s Library. Purdue Online Writing Lab (OWL) is also helpful site you can use as a quick reference.

Health Assessment Clinical Final

Here’s my advice to all the Type-A, driven, perfectionist nursing students like me: BREATHE. IN… OUT… There much better. Just relax. Alright, now we’re ready to talk.

Practice is essential to doing well on your clinical final. Practicing well will actually help relieve your stress the day of the test because practice brings confidence and confidence dissipates fears of failing. The day of my test I was able to remain calm because I had spent countless hours practicing on the person who I was going to assess.

Just like a regular check-off, I recommend writing out a full script of what you will say as you perform your full physical assessment. When I wrote my script, I relied heavily on my physical assessment pocket book as well as used my physical assessment textbook.

The day of the test I recommend not practicing at all. You need to go into the nursing lab with a clear mind. I made the mistake of practicing right before I tested with my instructor. This caused me to be confused about what I did when. For this reason, I almost forgot to palpate the lymph nodes and test all twelve cranial nerves.

Once you think that you are done with your assessment, I recommend going back through the major systems to make sure you did not miss anything. For example, palpate all the lymph nodes, palpate all the pulses, and verbally go through what you did to test all the cranial nerves.

After your final, go celebrate! YOU DID IT! When you finish, you will be one step closer to doing what you came here for—taking care of patients. 

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.

References

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.

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