| Continued from Page
1
Get the right look
| Important clinical updates |
Listed below are some of the more significant changes that have occurred in bedside practice in the past 10 to 20 years.
Two forms of patient identification are used for medication administration or other procedures. This is usually the patient's name and birth date.
Hand hygiene is practiced with traditional hand washing or new alcohol-based hand rubs.
There are now six rights to medication administration. The previous five, right drug, right patient, right time, right dose, and right route, have been supplemented by a sixth - right documentation of the medication and the patient's reaction.
The use of restraints is limited - restraints are used only after other nonrestraint methods are exhausted.
Skin breakdown is treated with protective and occlusive moist dressings. Heat lamps are no longer used. >>>
Lemon and glycerin swabs are no longer used for mouth care.
The terminology for classifying seizures has changed. >>>
Many abbreviations are now considered unsafe and are discouraged. Some examples include
Use the word "daily" instead of "q.d.," which can be misread as q.i.d. (four times a day).
Use the word "units" instead of "u," which can be misread as a zero, causing overdose.
For doses of medications that use decimal points and are less than one, use a leading zero (e.g., 0.25 mg, instead of .25 mg) so the period is not misread.
Trailing zeros should not be used. For example, 2.0 could be misread as 20 if the period is over looked. Instead, use just the number 2.
It is now common for the patient's temperature to be recorded in centigrade and for weight to be recorded in kilograms.
Pain assessment is considered "the fifth vital sign."
Mercury thermometers are no longer used.
Tighter blood sugar controls are sought in treating diabetes mellitus.
Nearly all IVs are administered on pumps.
Many more medications come in sustained release form and should not be crushed for administration.
Normal saline is used to flush most central lines and capped peripheral IVs, instead of heparin.
The use of the term "protime" for blood monitoring during coumadin therapy has been replaced with a new term, "INR," or international normalizing ratio.
The ventrogluteal injection site is preferred over dorsogluteal. When choosing landmarks for dorsogluteal injections, the use of the intersecting horizontal and vertical lines to identify the upper outer quadrant is no longer encouraged because of the risk of sciatic nerve damage. Instead, an imaginary line is used between the greater trocanter of the femur and the iliac crest.
Floor stock multidose vials are discouraged for heparin and potassium because of the risk of misreading the bottles when normal saline is needed.. |
Your preceptor probably can provide information about what to wear. If you will be doing clinicals in multiple facilities, consider white. Today, most facilities are more accommodating than in the past and allow a variety of uniform choices. Most nurses wear walking shoes or tennis shoes and not every facility requires white. But get a pair that can be wiped clean — nurses still encounter plenty of spills.
You also should ask about discounts for students at uniform shops. You may receive a lower price if you are doing clinical at a facility where the employees receive discounts.
Explore other learning opportunities
Many hospitals, nursing homes, and home health agencies have ongoing education inservices, and these are sometimes open to nonemployees. Ask to be put on mailing lists for continuing education. These courses are often available at student rates, so take them while you are registered for the refresher course.
You’ll also want to take a CPR class. Some refresher courses will require this as a prerequisite.
Most refresher courses are based on adult learning principles. Many times the students can learn from each other. If you have the opportunity to teach a part of the class, choose a topic based on an area of high interest. Another option is to teach something with which you have had personal experience. Several of my classmates used this approach. One, the recipient of a liver transplant, taught us the latest nursing care for his condition. Another had cataract surgery during our semester and talked about the importance of patient teaching.
Keep a journal and develop a calendar
- Record your thoughts, feelings, hopes, and fears, and bring them up in class. You will be pleasantly surprised how many other classmates have the same concerns .
- Keep track of things about which you want to get more information. Write down some of your experiences and the key points learned.
- Keep the class syllabus and course outline. It will come in handy for future job interviews. Incorporate it into your continuing education profile.
- For your calendar, you should include classes, tests, reading assignments, and clinical days. Integrate this with your personal calendar for work and home.
Celebrate the small victories
- Sometimes the little things make a big difference. Organize with other students for bringing snacks for class. These classes can last as long as four hours, and the snacks help keep you going.
- Applaud when other students give presentations. A little support can go a long way, so ask for each other’s references and get each other’s e-mail addresses and phone numbers.
- Arrange for a class reunion sometime in the six months after the class is complete. Make sure you pick a date and location, such as a local restaurant, before the course is over. If you don’t, you may never get together because of the difficulty of contacting everyone.
Going back to the bedside after a prolonged absence isn’t easy, but the greatest triumphs come from defeating adversity. If you’re ready to return, the bedside nursing is waiting for you. The timing couldn’t be any better.
Michael Bratton, RN, MA, has more than 25 years of nursing experience in clinical and leadership roles. He has practiced in acute care, critical care, home care, and rehabilitation, and has experience as a staff nurse, nursing manager, nursing director, and most recently as vice president, patient care services, and chief nursing officer at BryanLGH Medical Center East in Lincoln, Neb. Bratton recently went through orientation to work as an ICUstaff nurse at BryanLGH. |
Reply to Article