I have thoroughly enjoyed the experience that I have gained during this practicum!  My preceptor and all of the instructors that I have had the pleasure of working with have taught me so much.  I know that I have so much more to learn, but just having the opportunity of working with them has given me the inspiration to keep striving to become even better.

 This semester I wanted to be able to identify the different learning styles of the students and then teach to their style.  There were four students that I worked closely with and feel like a very strong relationship was developed.  Each of them was unique in their learning styles; from the overachiever, go getter, to the student who was flying under the radar, each helped me grow in the attention that needs to be given to each and every student.

 Effective time management was a huge challenge for me.  I felt prepared for clinicals, however, my problem came with raising a family, working up to 30 hrs a week and taking 13 hrs this semester.  I feel like I was there for Jennifer on the floor, but I would have liked to have been able to help her grade care plans and see how she conducts evaluations with the students.

 My third objective was to communicate in an effective manner and making the students comfortable.  I can say that I feel like I was able to meet this goal.  I was able to spend a lot of time with four of the students, as that two were able to come to my job and follow me throughout my day.  Then there was the one student that I worked closely with to build his confidence.  It was amazing to see how much he has grown over the semester.  Jennifer complimented me on how much she had seen him grow under my guidance.  As much as that meant to me, I have to admit that the best compliment was from that student himself.  He came to me and simply asked, “Are you planning at teaching at TWU after you graduate”?  I told him that I wasn’t sure and he responded with, “I hope that you can because there needs to be more instructors like you who understand what we are going through and who we feel safe coming too”.  It brought tears to my eyes and I could not have received a more flattering compliment!!

 Developing critical thinking skills are so important for nurses.  We need to be able to think on our feet and see all factors that can contribute to a patient’s status.  I love using open-ended questions and will continue to do so.  It is so fun to see the look of surprise when they realize that they actually understand the process and the end result!  Jennifer has spoken to me and confided that she felt that he has come a long way from the beginning of the semester.  This gave me a sense of gratitude to have my efforts acknowledged.

 I do need to be more cognizant of the nurse who is actually taking care of the patient.  As I see teaching opportunities, I tended to use them.  Unfortunately, I stepped on the toes of a nurse!  I think I went in with “guns a-blazing” and now realize that I should make the time to meet with each nurse and actually find out what they have in mind for the plan of the day.  I now realize that I should have taken the student outside to explain the different ways on pain management.

 Objective 5 was to assist Jennifer to the best of my ability.  During the semester, I think that I became more independent and confident in myself.  I truly feel like she trusted me and felt comfortable with me helping her on the floor.

 I completed two teaching projects for my 6^th objective.  The first was my powerpoint presentation on Nursing Burnout.  There was the problem with my ppt not formatting correctly, and this is where I was dinged the most on the evaluations.  I, too, would have given myself the same point scores.  This was truly a valuable topic for these nursing students and maybe even the instructors.   Nursing Burnout was the topic of my Pro Paper and I have to say that I learned even more while putting this ppt together.  My second project was a self-study guide on End-of-Life in the pediatric population.  While there were a few changes and additions made by the lead instructor, overall, I feel like it was a great (ok, I really liked it) work and I believe that it will replace the module that they currently use.  This was the project that I had planned to submit for my teaching project, but only had 7 people, 1 instructor and 6 students, return the evaluation form.

 Objective 7 was to discuss Nursing Burnout which I was able to do.  This closely goes along with objective 6 because it was one of my teaching projects.

 The goal for my 8^th objective was to facilitate a friendly learning environment for the students and myself.  I know this goal was achieved and the reason I say this is because of the lecture from H-E-double hockey sticks.  Anyway, some of the students could tell that I was not feeling confident and they were kind enough to go to Jennifer and tell her that I needed some help. I think that this shows the students were able to critically think of a way to help me and also to show the respect that I think that I had developed with them on the floor.  I have so much more to learn and so much more to give!  I need to work on my confidence and realize that not everyone knows everything.  Also, no matter if you are the student or instructor, learning occurs every day for everyone.

 Now that the semester is drawing towards an end, I wish that I had more time.  There are so many more things that I feel like I need to learn!  I wish that I could have been involved in the grading of projects, online discussions and care plans.  However, I was fortunate enough to be allowed to partake in the review of a test and discussion afterwards.  I so wish that I had this opportunity before taking my Measurement class!

 I asked Jennifer what her sub-roles of administrator were she wasn’t even sure.   I believe that some of the sub-roles of administrator entail evaluating and guiding the students, helping those who are struggling, giving guidance when there are issues and problems that arise, and advising those who are at risk.

 After experiencing both sides of teaching, online (rewriting the course) and teaching in a face-to-face environment, I have to say that I am gravitating towards the face-to-face experience.  I even think that the use of blogs is a valuable tool for all.

 I believe that I have grown so much during this practicum and have learned not only from the situations that I was able to experience, but also from the great opportunities that you, my fellow classmates, have been able to experience.  I think that blogging has allowed me to learn and gain ideas on what I might like to try out and even implement into my own teaching style and for this I thank you!

 I hope that I have been able to make an impact on these students as they continue on through their journey.  I know that next semester will be their final one and I hope that some of the skills that I have taught them will enable them to become more efficient on the floor and to have confidence in themselves.  Nursing is hard enough, I hope that I have given them some strong pointers on how to make their life and careers easier to handle.

 I hope that I have taught these students effective nursing skills that they can not only use in the pediatric setting, but in other areas as well.  Even though I have spent my whole career in pediatrics and NICU, I believe that they can take some of what I taught them and incorporate this information into their own nursing styles.

 Even though I feel that I have grown during this practicum, I know that I can and will continue to grow in this new role.  I feel that the students trust me and hope that the instructors see promise in me.  I feel like I am at the beginning of a rewarding career!  I hope that all the instructors and my preceptor feel as I do, that I will be an effective instructor and a huge asset to the field nursing education and for preparing nurses for future generations!

 Kay

Another area was the presentation that I gave last week.  I commented that “I’m not sure if I know a lot of this stuff” and 3 of the students who know me went to Jennifer and said that I needed help.  Well, as I was lecturing most of it came back, but like I mentioned, Chris and I ended up tag-teaming.  I was told that even if I feel like I don’t know the material, never admit it to the students b/c they will lose faith in you.  Lesson well taken.

The last was a comment about my End-of-Life ppt.  The main professor had rearranged the slides and added a few slides that she wanted to be covered.  My preceptor felt that I had too much on my plate and didn’t want to add more to my workload.  While I appreciate her concern, I feel like I lost an opportunity to take some constructive criticism and make it (the ppt) better.  Oh well, too late now.

I also spent time writing up my opinion on 4 of the students that I worked very closely with over the semester.  She liked what I had to say and was going to put them into her own format.

I thoroughly enjoyed working with Jennifer this semester and feel like I learned a lot.  What I want to know is, do I come across as not being able to handle stress?  Or that I might break?  Yes, my life is very stressful and I put a lot on my plate, but I think that I’m doing a pretty good job keeping up with things.

Time with Jennifer:  1 hr

Time writing up evals:  1 hr

Kay

I am attempting to attach the ppt, the “brief” video that Dr A so gracious figured out how to upload to a user friendly website, the evaluation form, and the results from the evaluations.  Any and all feedback is greatly appreciated!

Kay

http://drop.io/q1wetim/asset/mvi-0112-avi

Nursing Burnout

Speaker Evaluation for Nsg Burnout

Nursing Burnout Evaluations

I am so excited!  Dr A, I think I’ve finally got this blog thing down!!

Kay

Chris, the other instructor, had told me that I could rewrite to ppt, but didn’t want to insult her.  After all the time I spent going over her notes and writing down additional notes, I should have just rewritten the ppt.  I think that I taught myself a valuable lesson today.  It is so much harder to teach off someone else’s ppt.  I really felt like I let her down.  She kept saying otherwise, so let’s just say that I’m disappointed in myself!

I do think that the students were learning.  They were asking questions and answers questions presented to them.  There was even some pretty indepth critical thinking skills going on.  I was impressed with some of the questions and answers that they came up with.  Well I think this is all I’m going to blog because I’ve beat myself up enough today.  I may not be able to open my eyes tomorrow. ;-(

Prep time:  10 hrs

Class time:  3 hrs

Kay

Prep time:  3 hrs

End of life ppt evaluation

End-of-life care in the pediatric population

Questions for End-of-Life care for test

LOOK WHAT I DID!  I FIGURED THIS OUT!!  YEAH ME!!

Ok, I’m calm now.  Enjoy the ppt, etc.  Please give me any suggestions and comments.  I need to learn.  Also, Dr A was going to try and upload my video, all 4 1/2 mins of it, on Nursing Burnout.  I ended up burning it onto a CD and sending it to him to see if he could upload it for me.

Kay

Kay

Class prep time:  3 hrs

The student didn’t arrive til 9 because that’s when my little man wakes up.  I discussed GT feeds and how to use the feeding pump.  Also explained care of the GT site and how it is a good habit to get into checking the amount of water in the balloon once a week.

Went over the MAR and we discussed the various meds that he is on.  Was able to show how to use a nebulizer, IPV machine, a coughalator, vent and perform CPT.  She was shocked to learn that I was responsible for RT meds and procedures.  I also explained that whenever I got a chance, I worked with him on his ST, PT, and OT.

I showed her how to give a bath to a pt with a trach and no muscle tone.  Explained why it was so important to have sxn in the bathroom during the bath.  I don’t think she realized what all is involved in home health.  As a matter of fact, I don’t think a lot of people realize what is involved in home health.  I laughed when she asked “you clean and vacuum”?  Yes, I keep my pt’s room clean in the hospital too.  Just at the home I don’t have housekeeping to come behind me and mop the floor and wipe down all the surfaces.  It’s funny, clutter drives me more crazy at my pt’s home then at my own home.

I made the student hold my little man, he has MTM, very hypotonic and has a very large head.  I wanted her to see what all was involved and how to manage it, especially with a trach.

After the bath, I was able to demonstrate how to change trach ties.  Once again, I performed all the skills and gave all the meds b/c mom is doing us a favor and I don’t want to jeopardize that relationship that we have built.  She may have been totally capable of performing some of these skills, but I just wanted her to observe and she was ok with that.

Little man goes down for his nap after his 1400 breathing treatment.  I showed her how I papoose his legs and brace his hips for tummy time.  I was able to explain to her how he is a wiggle worm and works his way out of tummy time when not “secure”.  She was wondering why tummy time was so important, I was hoping that she would ask this question.  Was able to show her how from his dz process, his muscles are beginning to tighten up in his hips and thighs and that we are trying to prevent any further contracture and possible reverse what has been developing.

Overall we had a good day.  The mom was great and spent a lot of time with us.

Kay

Clinical time:  6 hrs

My friend had one student assigned to him, but I volunteered him for 2 so that I could help him learn how to prioritize and the concept of  time management.  It was hard!  Even after my little talk in post-conference, his jot looked like it had hit by a mac truck!

I made up a jot for myself and then let him copy it so that he could work off of it.  I love my jot, those are my brains!  I think that he had pretty much forgotten everything that I had said the week prior.  I looked at his jot after report and just simply said, “we’ll be going on this again”.  He just laughed (I did tease him about it so the laugh was appropriate).

Our first pt was back in with a second spontaneous pneumothorax.  I lovingly volunteered him for that pt.  The look was priceless, all the color drained out of his face.  (The horns hold up my halo and the tail pushes the halo back up when it starts to slip off my head)!  Lots of teaching was done with this young man.  He comes from a broken home, living with grandparents, mom deserted the family and dad is in prison.  He had previously smoked, but stated that he had stopped after the last pneumo.  He still had a chest tube and was able to do a lot of teaching on this.  I spent some time with him before we entered the room discussing what we were looking for and what we would do if….?  A WONDERFUL teaching opportunity was that there was no petroleum gauze at the bedside.  Took him a while to figure out why this was so important, but he worked his way through it.  I was very proud of him!

Our other pt was a little 6 yr old in with asthma.  As we were flushing his 1100 med, the IV started leaking.  Another great teaching opportunity.  I was able to show him how to break the IV down and see if the connection was loose or if the site was bad.  Unfortunately, the site was bad.  We went and found the NP and explained the situation.  Happy and sad to report that he was being transitioned over to PO meds and we could leave the IV out.  That would have been another great teaching opportunity, but I’d whether wait since I hate causing undue pain to a little one.

I forgot to mention, our pneumothorax pt was on PCA Morphine.  I love teaching!  I didn’t think that I would like teaching clinicals as much as I have.  I won’t bore you again with how much he learned.  I was able to reinforce how important it is to assess a pt’s comfort level and how to explain to the pt about not letting the pain get too high before hittng his button.

As I said earlier, I had a jot also, and kept track of what we should be doing.  He waited until the last week to gather information for his care plan.  As we were nearing the time of being late for a med, I asked if he had anything to do.  His comment was that he had a med to give, but needed the information for his care plan.  I told him that pt comes first, that he should have been getting information before the last day and there were 2 choices:  1. come back after post-conference, or 2. stay there during lunch.  He picked staying during lunch.  I have to admit that I was disappointed with his answer and lack of motivation in this situation.

We were also able to auscultate an irregular regular heart beat on our little asthmatic.  He didn’t hear it so I had to point it out.  Is it just me or do the students just put their stethescope on the pt’s chest and act like they are listening?  He isn’t the only one who I noticed do this before.  I’ll ask what they heard, something that I think is very obvious, and they will have totally missed it.

Even though most of my day was spent with my friend, I did get a chance to help some of the other students with their charting.

Sorry to have typed your eyes out. 

Kay

Also this weekend, I spent roughly 6 hrs working on my End-of-life ppt.  I will be adding more when I revise it with the new suggestions and writing the test questions.

I also will be working on the lecture that I will be giving on the 23rd covering skin and infections.  I am responsible for coming up with 10 test questions.

Additional hours:

classroom:  16 hrs

Kay

Monday – October 26th – Taught renal lecture

Taught renal disorder lecture the the Senior 1 class.  I think it went really well.  The students asked appropriate questions and seemed really interested.  My preceptor was very positive afterwards.

2 hrs prep, 1 hr lecture

Thursday – October 29th – Clinicals

Was asked by my preceptor to work closely with one of the students who tends to be flying under the radar.  He is very hesitant in peds and we were just concerned about his progress.  I spent most of my day with him and volunteered him to do several projects for the other nurses.  I also didn’t want him to feel like I had put on him so I did help all the other students at one time or another through out the day.  The nurse he was shadowing gave him 2 pts with pneumonia.  I was bad, I asked for the r/o endocarditis and the newborn with sepsis.  I turned out to be a good switch!

With this student, we were able to hear a fantastic heart murmur!!  I was so excited!  The child had been born with aortic stenosis and had a Ross procedure at 9 days of life.  That procedure failed and he had total replacement at 3 yrs of age, he is now 6 yrs old and in 1st grade.  I asked the mom if she wouldn’t mind if  the other students came in and listened to him.  Even Jennifer came in and was excited as I was!!  This was the 2nd time this child had been admitted, first was with the flu and now with FUO.  I was able to show him how it is important to address the parents as well as the child.  Make them feel comfortable and let them know that their child is well cared for and it can make all the difference in the world!  This little man’s IV became occluded and so I also volunteered us to remove the heplock.

Our 2nd pt was an 18 day old with fever.  I was able to go through the whole newborn assessment while the baby was asleep.  The student wanted to jump right in a take a bld pressure and I was able to show him all the things that he could get done before making the baby made with such a noxous stimuli.  I was also able to show the fontanels and it really turned out to be a good teaching/learning experience.  I also explained how if the baby was really upset with the BP to leave the cuff on and come back about an hr later and retake it.  This baby was also due for his 2nd PKU.  I ended up teaching both the student and the lab tech a new trick.  Loved it!  I showed him how difficult it was to fill out the PKU slip when they are readmitted, it took about 30 mins.  I showed him how to fill the first circle and then let him do the last 4.  He was very anxious about bending the baby’s foot and was a little clumsy so I ended up bending it while he filled the circles.

I gave meds with several of the other students and tried to show them the importance of time management and prioritizing.  In post-conference, I showed them how to make a jot, or as I like to call them, my brains.  I told them that they should be looking and gathering information and then incorporating what they like into developing their own jot.  They all seemed really open to the idea.

time:  8.5 hrs

Monday – November 2 – proctored test and sat in on test review

I was able to proctor a test this morning for the Senior 1s.  Very interesting.  More involved then you would think.  I really enjoyed working with the lead instructor for this particular course.  She let me go with her while she ran the scantrons through the grader and then explained how test items were decided.  (This would have been so helpful to be able to actually proctor a test and sit in during a test review while we were actually taking our evaluation course).  I then was able to sit in while each item that had student concerns were discussed, how they decided if a test item should be left in or not, and if the numbers were skewed, how to decide whether or not to keep that question.  I learned more in that 1 hr time frame then I think I did in most of the class online.

classroom time:  3 hrs

Monday – November 2nd afternoon

In the afternoon, I went to help my preceptor with her Monday afternoon clinicals.  What a difference in performance!!  I told her that I would probably be more concerned about some of these students then the one that I was asked to follow last Thursday!  It took two of them almost an hr to get through their orders on the chart.  Very little motivation and eagerness.  I went to every student to find out what their pt had and then worked from there.  We were able to work through meds, finding them on the order, why they were taking a particular medication, I had to explain that you just don’t say what the first indication for the med is, you need to look at what is going on with that pt and why they might be on it.  Able to explain the use of EMLA, feeding pump, rationale behind 1/2 strength formula after a baby had been throwing up most of the day, syringe pumps, watch an Echo being performed, see an actual IV inserted into the stomach!!  Neither Jennifer or I had ever seen this before, this little girl has VATER syndrome and that was the only place that the ICU doctor could find after 8 sticks.  Poor thing had pulled her PICC line out.    I was also able to help them chart and explain what was important to include and what wasn’t.

It was amazing, the difference between the two groups.  I don’t know if it was because of the shift or not.  The lack of motivation was just craziness.  We only had 4 students on the floor, but I felt like I ran twice as hard to get them to perform skills then with 6 on the floor during the day shift.

time:  4 hrs

Sorry this was so long!  If you made it all the way through the blod, I promise not to wait this long to blog again.  I’m blaming it all on my daddy, plus all the new gray hairs that I have acquired!!!

Kay