A year at U of R

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Friday, June 30, 2006

What's your ethnicity?

Imagine walking up to a stranger and asking "How do you identify yourself racially? What is your ethnicity?"

Nursing is that is direct, honest and too the point. I always thought of nurses as caring, compassionate, sympathetic. They are all of these, but directness and honesty are more important to gaining trust. If a client asks you "Am I dying?", you tell the truth. If you are making an assessment, and a client exhibits signs of depression, you ask them, "have you thought of hurting yourself?" and "have you had any suicidal thoughts?"

The trick to trust is not to make judgements. You are just gathering information. If you're interviewing a client, you might ask, "Do you use crack? How about ecstasy or heroine? How many times a week? Does it affect your job and family?" They may answer yes to all and clearly have a health risk, but you don't comment on it. You record the data and move on to questions about their diet or family background. The client won't be afraid to answer further questions if they know you won't make judgements.

When it came to questioning about ethnicity, it brought out more than a little tension to the surface in our class. What if you don't consider yourself part of any one defined group? Isn't this information private? How do you tactfully ask someone who looks Caucasian or African American what their "race" is? However, for nursing, these are relevant questions. You have to get past your own discomfort at asking these questions and realize that it's not about you and your discomfort. It's about the client.

We've become very accustomed to asking eachother in lab "How is your urination pattern?" and "Can you descibe your last bowel movement?" If you're going to ask about their bowels, why feel shy about asking anything else?

Fuld Fellowship

Yesterday, I started working on my project for the Fuld Fellowship. I applied for the Fuld when I was accepted to the U of R, and about 20 or 25 people received the fellowships. In return for them paying a large chunk of tuition, you assist in a research project, participate in a lecture series, and learn about nursing research.

I didn't even know that nurses conducted independent research before I came here. I had assumed that they just participated in or administered research projects where the chief investigators were doctors. All of the projects for the Fuld Fellowships are NURSING research.

The first thing we had to do was read a book and take a test to receive Human Subjects Protection numbers so that we could participate in research. It was interesting to learn some of the ethical issues surrounding human subjects. It is far more complex than I'd thought.

The project I'm working on is called "HIP Teens", or Health Interventions Project for Teens. It's an NIH funded project studying health intervention to prevent AIDS and STD's in teenage girls. They've currently recruited half of the 850 participants. The girls are assigned to one of two training groups, and meet for four group training sessions. They follow the girls for about a year and a half after the intervention, and look at how the training sessions have affected AIDS transmission and STD's.

Because this is research, and not an educational program, I won't actually work with the girls. Everything in the study is controlled, and all of the recruitment of subjects and educational sessions are highly formatted and monitored. I'll be working with data, helping around the office, observing a recruitment session, and maybe even redesigning a logo for them!

Tuesday, June 20, 2006

Case studies

One of the most interesting parts of the pathophysiology/pharmacology class is case studies. The instructor tells us a client's history, and she keeps us guessing the diagnosis as she goes.

The first client history was a 26 year old woman who was short of breath, fatigued, and had gained weight in the past couple of months. When they listened to her heart, they found that the heart sounds were located in her shoulder, not chest! She had edema, swelling, and all kinds of other symptoms. They sent her home with anti-arrythmia medication and a diuretic, suspecting a heart problem. Three days later, she delivered a baby.

The second client history we did was a man who had recently had a vasectomy, and had all kinds of weird cardiac symptoms symptoms, a normal ECG, capillaries bursting in his retina and earlobes, no hypertension, and a sore kidney. He turned out to have subacute bacterial endocarditis.

In another week, we have a major paper due in that class, where we have to write up a case study ourselves. Very exciting.

An average day

I thought I'd give you an update on an average day.

Classes began at 8am, with a 2 hour physical assessment lecture. We finished up assessing the cardiovascular system, and now we're learning the pulmonary system. We need to know how to percuss the chest with our hands, measure chest expansion, locate the position of the diaphragm during inspiration and expiration, and listen to a variety of chest sounds with a stethoscope. We also do a number of other tests where the client says different words, whispers, etc. Tomorrow in lab, we get to practice all of that. We're going to be drawing where the different lobes of our lungs are located right onto our partner's chests and backs.

Some people had lab after the lecture, but I had a couple of hours off. I studied for the next exam, and practice the cardiovascular assessment techniques on some classmates.

At 1pm, we took a standardized pharmacology test that we must pass in order to enter clinicals. It involved a lot of dosage calculations. Then we had a pathophysiology/pharmacology lecture until 4pm. It was fantastic. We did a case study, where the instructor reads a client's history and information to us, and we try to diagnose what is wrong using what we've learned about systems interactions.

Then, well, I went to the gym. I studied nonstop yesterday, so I needed a break. I cooked some dinner, and now it's 8pm, and I'm studying like crazy for the lab tomorrow, upcoming papers, exam on thursday, etc. It never ends.

I've got to say, the faculty are AMAZINGLY responsive. There was a huge outcry that students were feeling lost in lab. By that afternoon, the instructors sent out an email with five extra open lab sessions for us to go practice and answer questions.

Saturday, June 17, 2006

My First Patient

Here he is, my very first patient! This handsome, single, muscular, slightly syncopic guy is Sim-man. And for just $40,000, you could own one to. Heck, for $40,000, I'll lie there for a year and let people take my blood pressure.

Sim-man is worth every penny. He may not be very neat, he doesn't send birthday cards and he can't cook worth a damn, but you can palpate his radial, brachial, and femoral pulses, and take his blood pressure both arm and thigh. You can ausculate his breathing sounds and heart rythmn. What's more, the guy can be hooked up to a computer monitor, and you can give him any number of weird heart arrythmias, cardiac conditions, or lung problems. If his breathing noises get in the way of listening to the heart beat, you can just turn the breathing off. Can you hook your guy up to a computer monitor?

However, I was still horrified at the cost. I took figure sculpture, and I could certainly come up with a model for less than $40,000. So being really obsessive, I went ahead and made my own model for $7.39. It's not quite as dashing, but at least I can practice taking blood pressures without going broke.


It has been a busy, stressful week because of that monster we all hate, GRADES.

The first day, they told us not to expect A's, that it is just the nature of an accelerated program. I started the program determined to keep things in perspective, and not worry about a bad grade here or there. In fact, I don't want to worry about them at all. My resolve was tested this week.

They meant what they said the first day about not getting all A's. The tough part wasn't getting a "C" on my paper, it was dealing with the reactions of the class as a whole. When papers were handed back in my lab section, it was like vesuvius erupting; spectacular from a distance, but no fun if you're in the middle of it. There was cursing, tears, explosions and fireworks! Oh, the drama would have made some excellent reality T.V. (late-night only, due to language). The stress was palpable. I heard that one lab section had to have a counseling session.

It got to be a little too much. It was impossible to escape the stress. "Really, this is ridiculous," I told myself. But it was almost impossible to go home an not wonder if anyone, myself included, was going to make it past the first semester.

My advice to the instructors ... get these students on some sedatives, give them chocolate, try hypnosis, anything alter the senses before handing out grades!

Tuesday, June 13, 2006

Life in a 300 yard radius

I feel like my life has contracted down into a tiny little radius between the library, the nursing school and my studio. I'm not used to my life feeling so limited. I don't have much to tell my friends about except school, school and school. I think everyone feels the same way to some degree. The students with families have a tough time with multiple obligations, but they have the benefit of some forced diversion, which wouldn't be a bad thing.

That said, there has been some slacking activity going on. This weekend I went out for Tapas with some fellow students on Friday night, and on a fantastic hike for a couple of hours on Saturday. The tapas event felt a little like a sorority party - all girls! Other than that, the weekend was pretty much studying.

It's pretty incredible what the instructors do for you. They are online 24/7. I wonder if they ever sleep. At 6pm on Saturday night, I was taking an online quiz in genetics, when I got an email from the instructor about our written assignment. I emailed her back with some questions, and we ended up having an email conversation over the next half hour. This at 6pm on SATURDAY. The classes never end, but the instructors are right there with you.

Friday, June 09, 2006

Naked Lab

Today was the first naked lab-fest. Yup, we all paired up, stripped down, and donned attractive hospital gowns to evaluate eachother's skeleto-muscular systems. None of the instructors got naked.

Some of the guys in co-ed pairs were a little shy at first, but basically we spent the lab giving each other back-rubs (called "palpating the spinous processes") and hand-massages ("evaluating metacarpal-phalangeal joints"). Quite relaxing. I felt like I was at the beach, only minus the sand, ocean, and sunshine. Next lab, I'm bringing my purple sarong and beach towel. I don't think the instructors would mind some mai-tai's. Maybe a few daiquiris and they'll be naked too.

Why don't you become a doctor?

Why don't you go to medical school? Has anyone asked you this? I think most people, myself included, have only a vague idea what nurses do. Don't they just assist doctors? They take orders, do what the doctors say, and administer the drugs the doctors prescribe. Why wouldn't you want to be a doctor, then? Why a nurse?

Nursing at U of R seems to be treated 100% equally in its own right to medical school or dentistry.

I'm one of the Fuld fellow, a nursing research fellowship that is given each year. As part of the fellowship, I'll participate in a research project. I just had a look at the list of possible projects. They are all major studies doing primary research, funded by institutions like the NIH, conducted by NURSES (no, not M.D.'s)! I didn't even know that nurses were involved in conducting their own major funded research, published in peer-reviewed journals.

On a smaller scale, I expected Miner Medical library to cater primarily to medical students. I was amazed to find that the reference librarians at know all of the nursing instructors, the nursing curriculum and what each teacher covers. They teach us how to do primary research using all of the major online medical, clinical and pharmacological databases. Highlighted on the library homepage, right underneath OVID/MEDLINE, is the primary nursing research database of I think 6,500 different nursing journals.

I get the feeling that the medical, dental, and nursing schools all have fairly close ties. One day, the nursing school lecture hall was in use, so our class was in the lecture hall across the street at the medical school. For our genetics class, we'll have a doctor come over from the medical school to give a lecture in his specialty.

I could go on and on, I will at some point. For the moment, just know that I'm not becoming a doctor anytime soon.

Online Classes

If you're planning on becoming a nurse, get online, and get used to it!

When I graduated from college in 1992, most people had computers in their dorm rooms, but laptops didn't exist. I survived college with a Mac Classic. Color monitors were to expensive to dream of. Then there was a geeky new thing called email...

Here at U of R, everything, EVERYTHING is online. Two of my classes are almost entirely online. We are graded on our class participation in the online chatroom, we hand in assignments in the virtual classroom, and we printout the powerpoint lectures before class. There are computers everywhere; the computer lab, viewing room, next to the hospital beds in the assessment lab, in the library, in the lounge. Next year, I believe they will introduce PDA's for notetaking during physical assessments in lab. They also have an amazing tech support department exclusively for the nursing school, to keep everything running. There is wireless connectivity around the whole building, so you can bring your laptop to class or lab, and connect to the virtual classroom.

This means that the classes never end. Professors send group emails out on the weekends, and at midnight. Got a question? Email your instructor, day or night, and you'll get a response. All communication within the school is via email.

The online lectures are really something. Log onto the classroom, click on the lecture, and media player opens to a video of the instructor teaching, coordinated with slides that play along side it with the lecture, and links.

For one class, we were assigned to watch a movie. No problem. Click on the link, and watch it on you computer, anytime, anywhere. All of the labs have video demonstrations that go with them. You can access them anytime, from any computer.

The end result is whether I'm in class, in lab, in the library, or just in the lounge, I'm always online.

Monday, June 05, 2006

Monday, Monday

Today was "easier"... a two hour review session for tomorrow's exam, followed by 5 hours of lectures. I've been in a dark auditorium for seven hours today, and I'm feeling like I live in a bat cave. Get me outta here! I may be a nurse in a year, but I may also be blind and hanging upside-down from the ceiling.

I'm going outside to put in another couple of hours of studying for tomorrow's exam and lab. Wish me well...

Saturday, June 03, 2006

The lab experience

I really didn't know what labs were in nursing school before I came here. The labs aren't the typical science or bio labs with tables. Instead, the skills lab is a mock-up hospital ward. This semester, we are learning to do health assessments. Each lab we go through tests to assess a different body system. Then we practice the assessments on ... EACHOTHER!

First, we have to mark up all of the anatomical points of interest on eachother with magic markers. You see people all the time walking down the corridor with weird X's and arrows on their faces. "Ah, you just came from lab!"

Next, we practice assessments. I've had my blood pressure taken about 50 times in the past 2 weeks, and everyone gets very excited when a classmate has something abnormal. Thankfully, we haven't done any systems yet that you have to get naked to assess, but I'm told those will come. I'll be sure to post photos!

Here's a photo of the lab, and me with some interesting marks on my face, trying to assess if my brain is still there after 2 weeks of school.

What do nursing students eat?

Here's some food for thought. What do nursing students eat? The frightening truth is right here for public viewing. This is a photo of my freezer, with my dinners for the next 5 nights.

I can't believe how un-green I've become, buying over-packaged salt-packed frozen dinners. But when you spend 10 hours or more a day in class or studying, something's got to give. I was a naive optimist when I packed those cookbooks to bring with me.

The nursing school does have a great coffee cart with chocolate pastries, and they also have a lounge with a refrigerator & microwave. Right across the street, the Med Center has multiple cafeterias, some of which serve just employees and med students. I highly recommend their veggie burgers.

I have gone out with classmates several nights, and Rochester's got some surprisingly good restaurants. We tried a Mediterranean place last night, which was fantastic. There is also a good Thai place nearby, and excellent dim sum downtown. Now if only I had a salary...

Thursday, June 01, 2006

The First Exam

Yesterday was the first exam of the year. The build-up was incredible. Everyone was endlessly reviewing what was really pretty straight-forward material. As usual, the anticipation was worse than the event itself.

All of the exams are given in the same format as the NCLEX (national nurse licensure exam). This means that for each question, you have to circle any of the answers which apply. There could be one answer or four answers to a question.

I felt like I knew the material, and studying any more wouldn't have helped. However, the format of the test was what we should have been studying! Each question had one clear answer, and several that could be valid .... but then again. We'll see what the results are.

This has been another frantic week so far. Because of Memorial Day, it is a short week. The lab yesterday was on how to do a complete neurological exam, and was quite detailed. It involved about thirty or more tests of every cranial nerve and muscle function. We then have to write up and turn in our results. I'm feeling a little brain damaged right now!