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Friday, January 25, 2008

My New Blog

Finally I am able to come up with a new blog about my life and experiences as a nursing student. I want to share the pain and suffering, the joy and laughter, and all of the things that my chosen profession has in store for me. I could firmly say that the nursing life is monotonous. The everyday experiences as a student nurse is always new, exciting, and quite interesting. The requirements, duty in the ward, 8-hour-straight brain-melting lectures and exams, and the likes are just right to add zest to our lives.

So why "My Nurse's Notes" you ask? Well nurse's notes is a way that nurses in the ward or in any department in the hospital for that matter document patient responses, nursing interventions, patient health assessment, and etc. The nurses notes is a medico-legal document that narrates the interventions or actions of the nurse for the patient and what the condition of the patient was during his/her stay at the hospital.

So in short, I'm sharing to you my life as a student nurse. I hope that you would continue to accompany me in my new learnings and new adventures in nursing. ^_^

Please don't wonder why there are posts that dates back to the year 2007 and so on. I copied some posts from my personal life blog: that were nursing related to here.

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Tuesday, January 22, 2008

Reading in the Operating Room: Is It Acceptable, Just Because We Can?

Reading in the Operating Room: Is It Acceptable, Just Because We Can?

by Terri G. Monk, MD, and Adolph H. Giesecke, MD

Like the stock market, which waxes and wanes in irregular, dysrhythmic undulations, the interest that residents and practitioners have in reading in the operating room (OR) follows a similar course. Recently, we have observed that reading in the OR has gradually crept back into our practice; it is in a waxing phase. We understand why anesthesiologists are tempted to read in the OR (“Watching surgery is like watching paint dry,” and “I have no time to read at home so I need to make up for lost time in the OR”). This subject became the focus of serious discussion in a panel on patient safety presented at the recent annual meeting of the Association of University Anesthesiologists in Sacramento, CA. We feel that reading in the OR seriously compromises patient safety and are opposed to it for the following 4 reasons:
First, reading diverts one’s attention from the patient. If, because one’s attention is diverted, 1 or 2 minutes of warning signals are missed, then the remaining time may not be adequate to evaluate the problem, make a diagnosis, and take corrective action. The consequence may be a severely injured patient. However, with improved monitoring techniques (pulse oximetry, capnography), it can be argued that this scenario is less likely.
Second, the patient is paying for our undivided attention, and most well-informed patients want to know if we plan to turn over a portion of their anesthesia care to a nurse or resident. If we are obliged to honestly answer that concern, then, should we also be obliged to inform the patient that we plan to read during a portion of the anesthetic? If patients knew, they would probably request a reduction in our fee for service or choose another anesthesiologist. On a personal level, we would not want the anesthesiologist caring for us or our family to read during surgery. Is it fair to provide less vigilance to our patients than we would expect during our own anesthetic?
Third, it is medico-legally dangerous. Any plaintiff’s attorney would love to have a case in which the circulating nurse would testify, “Dr. Giesecke was reading when the cardiac arrest occurred. Yep, he was reading the Wall Street Journal. You know he has a lot of valuable stocks that he must keep track of.” It is possible that if anesthesiologists informed their malpractice carriers that they routinely read during cases, the companies might raise premiums or cancel malpractice coverage.
Fourth, the practice of reading in the OR projects a negative public image. In this case, the nurses, technicians, aides, and surgeons represent the public. The officers of the ASA must occasionally serve as spokespersons for our profession at press conferences. Usually this follows a highly publicized disaster. It would be very difficult for them to defend the practice of reading in the OR. The public perception of our manner of practice is critical to the future integrity of the practice of anesthesiology. Let us strive to project an appropriate image. Reading in the OR should NOT be part of the image.
Despite our strong objections to reading in the OR, many of our colleagues feel differently. In 1995, Dr. Weinger wrote an article for the APSF Newsletter discussing the practice of reading in the OR and pointed out that there were no scientific data on the impact of reading on anesthesia provider vigilance.1 He concluded, “In the absence of controlled studies on the effect of reading in the operating room on vigilance and task performance, no definitive or generalizable recommendations can be made,” and the decision to read or not should be “a personal one based on recognition of one’s capabilities and limitations.”1 This commentary generated a flurry of letters to the editor from anesthesiologists supporting both sides of the issue. Advocates of reading said it was no different than “any conversation with another person in the operating room about topics unrelated to patient care” or “listening to music” during the procedure, while opponents called the practice “appalling” and “totally unacceptable.”
In an attempt to resolve the controversy, the APSF awarded a patient-safety grant to Dr. Weinger in 1997 for his project entitled “Scientific Evaluation of Anesthesiologist Performance: Further Validation and Study of the Effects of Sleep Deprivation and of Intraoperative Reading.” In a recent abstract, Weinger reported that anesthesia providers read in 35% of cases, but found no evidence that vigilance was different between reading and non-reading periods.2 He concluded that intraoperative reading by anesthesiologists “may have limited effects on vigilance and therefore may not a priori put patients’ safety at risk.”
While there appears to be no conclusive evidence that reading in the OR affects vigilance on the part of the anesthesiologist, we still object to this practice. Former President Bill Clinton was highly criticized for his affair with an intern, despite a lack of evidence indicating that this indiscretion affected his performance as president or adversely affected the country. When asked in a recent CBS television interview why he had an affair with Monica Lewinsky, Mr. Clinton responded, “For the worst possible reason: just because I could. I think that’s just the most morally indefensible reason that anybody could have for doing anything.” As anesthesiologists, we know that we can read in the OR and recognize that there is no scientific evidence that reading in the OR adversely affects a patient’s outcome. Would we, however, want to defend this practice in a television interview?
Dr. Monk is a Professor in the Department of Anesthesiology at Duke University Medical Center, Durham, NC, and Dr. Giesecke is a Professor of Anesthesiology and Pain Management and Former Jenkins Professor and Chairman at the University of Texas Southwestern Medical Center, Dallas TX.

1.Weinger MB. In my opinion: lack of outcome data makes reading a personal decision, states OR investigator. APSF Newsletter 1995;10:3-5.
2.Weinger MB. Assessing the impact of reading on anesthesia provider’s vigilance, clinical workload, and task distribution. Available on the web at: Accessed on August 9, 2004.

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Saturday, January 19, 2008

After Midterms What’s Next?

At last, midterms have long passed and gone. This midterm week wasn’t that stressful at all and the exams were quite easy. They seem easy for me but I’m not sure if I fared that well. But it’s a good thing that I got a good score in my NCM 102 – RLE (medical-surgical nursing) because my prelim exams, both in RLE and lecture, were bloody (lots of wrong answers and red X-marks)! But as expected, with the good comes the bad. My lecture exam is missing! I thought that my clinical instructor was joking but oh my God, the world came twirling around and I fainted! Well, I didn’t really faint. But for a person who lost his exam and who is uncertain if he passed or failed, I seem quite relaxed actually. Thank God for my come-what-may attitude because if I keep on obsessing about my grade I might actually become a patient at Davao Medical Center – Psychiatric Department.

Right now I am in relaxed mode but ready to face the challenge that my chosen profession may throw at me. Char. I have learned so much from this week. I have learned that I am actually a morning person than a night person; I learn more and retain more when I study in the morning than at night. Also, to pass medical-surgical nursing I need to borrow the great war plan: divide-and-conquer! I need to study and read ahead before the semi-finals if I really want to pass.

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Goodbye Xavier, Liceo Here I Come

“Goodbye Xavier, Liceo here I come,” a normal phrase from nursing students of Xavier University – Ateneo de Cagayan who have a sense of impending doom. It has been a tradition in the College of Nursing to have a lot (half of the population) of third year students fail in NCM 102 (Medical-Surgical Nursing). And if they do fail, they have two options to choose from. One, they become “off-sem” or they don’t go to school until NCM 102 is offered again to students. Second is the very difficult and heart-wrenching decision to transfer to another school.

All my life as a nursing student, I have been constantly challenged to put my gameface on and do my best to excel because I have to live to the expectations of being an Atenean, a student nurse from Xavier University. We are invigorated whenever a clinical instructor (CI) reminds us and says, “This is Xavier University, if you can’t live up to its standards, then you better transfer to another school.” This may sound harsh but it only shows that our CI’s care for us and they don’t want us to fail. I have a lot of CI’s who I really look up too because they are the ones who I want to be someday. Like my CI’s I want to be a graduate of Xavier University and be a pure blooded Atenean nurse who is committed, competent, compassionate, and a good conscience.

I remember my clinical instructor, whom I idolize, telling the class that we shouldn’t cheat because we are only degrading our intelligence, because every one of us has the capacity to excel because we are all intelligent, if we wouldn’t be then we wouldn’t have been accepted at Xavier. And this is quite true because out of 1000 plus applicants from around the Philippines, only a few are chosen, around 400. The XU College of Nursing does not accept transferees from other schools and second coursers. This may be because having a small number of students would provide an environment conducive for learning and so that the famed 100% passing rate in the board exams tradition won’t be discontinued. One of the greatest fears of nursing students from Xavier is that they will be the one to break the record of having a 100% passing rate because ever since the College of Nursing opened, all of its batches have graduated with a 100% passing rate. As my clinical instructor would say, “The problem is not passing the board, but topping it.” It's no wonder why Xavier is recognized as a Center of Exellence in Nursing.

I am proud to say that I am a student nurse from Xavier University – Ateneo de Cagayan. But sadly I would be transferring to another school next semester. Fortunately I’m not transferring to any other school in Cagayan de Oro, thank God! I’m not transferring because I failed, I got kicked out, or I can’t afford to go to school anymore. I’m transferring because I’m moving away somewhere this coming April or May and I don’t want to say where for now. But even if I transfer to another school, I would always be an Atenean at heart. I have been studying at Xavier University since high school and it’s very unfortunate that I can’t graduate as an Atenean nurse. But I will continue to practice what I believe in and all that I have learned during my formation as an Atenean.

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Saturday, January 12, 2008

My First Surgical Case

I am quite lucky to have been able to have my first surgical case at Xavier University Community Health Care Center. I was able to scrub in an excision or removal of a fibroadenoma at the left breast. A fibroadenoma is actually a sort of cyst or mass in the breast. It's actually benign so there was nothing to worry about. I was fortunate to have worked with such an intelligent, skillful, and understanding surgeon. The surgeon has showed me great surgical techniques that I thought I would only see on TV. It was amazing that I actually helped him do those procedures. Actually he could have done it himself. I wasn't really that helpful. Like it was my first time to scrub-in and it really took some time for me to think of what to do next. Dr. Perez was very understanding and he really helped in guiding me what to do. He must have empathized with me since he was also a nurse. He is actually still very young for a talented surgeon. I really had a difficulty in addressing him because I keep on calling him sir instead of doctor. Always remember to call doctors doctor because it is a bit degrading to be called sir because sir is only for male nurses and patients. Its a complex world of medical professionals. Anyway it was quite embarassing when I broke my sterility (that's the absence of microorganisms) but I won't say how because people might use it against me in the court of law. Hehehe. But my mistake wasn't that bad and the operating room nurse was kind enough to let me of the hook that time. The operating room is very amazing. Kind of like a magical place. Imagine in the morning I had to work in the ward and them in the operating room in the afternoon. I was so tired and I wanted to go home but once I entered the operating room adrenaline rush swept all over my body as an operation was actually already begun. It was a shame that I wasn't able to take pictures of the operation but we actually didn't think of taking pictures that time. We had several minor operations and each operation was like a new experience. If I were given a choice to choose where I would specialize, I would definitely say the operating room.

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Wednesday, January 2, 2008


Presenting the "IVF Fan: A quick reference for students and busy nurses plus a way to cool off in the ward!"

This is a project that I made. Our clinical instructor (CI) told us to use Intravenous Fluid (IVF) bottles and be creative in making a quick reference thingy. It was really fun racing each other to complete collecting 6 types of IVF. We really got down and dirty and searched every IVF bucket we could find. It was a great experience but I wouldn't want to do it again cause it's very draining. ^_^

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