Mentor

My mentor is whoever works the day I come in at Brazos Urgent Care. They are teaching me to work with patients with various personalities and illnesses. I can't wait to continue to work alongside them taking notes and asking questions. They work with my schedule and work on weekends and understands school and home life.  I cant wait for the rest of this year!

Interview #2

                                                                           Aliesha Baker

                       What was your first encounter with a patient? What was it like? What type of care/ unit were you in?

I graduated from my respiratory therapy program in May of 2010. That same year, in November, I was hired to work at Texas Children's Hospital and I began training on the pulmonary floor in which I cared for a variety of patients with different lung conditions and diseases. Many of the patient encounters I had involved pediatrics sick with Respiratory Syncytial Virus (RSV), Cystic Fibrosis (CF), reactive airway disease/asthma, and neurological disorders that caused a weakened respiratory system. The first few months of working as a newly graduated respiratory therapist were very intimidating as it was an adjustment to learn the ins and outs of the hospital, the hospital's treatment protocols/equipment, time management when it came to caring for multiple patients during one shift, while maintaining my confidence with my patients. I will say, when caring for a pediatric patient, you are also caring for a "second patient" (their family). It can be very scary and stressful for a family when their child is ill and admitted into the hospital. Much care and communication involves showing compassion, empathy, and building trust when you are caring for someone's baby.

             How did you start your career?    

I originally began attending college not knowing exactly what it was that I wanted to pursue. I was trying to knock out my basics when I was blessed with a very enthusiastic and passionate biology teacher who made learning about science extremely interesting. I continued to take other science courses, including microbiology, when I decided to pursue healthcare and respiratory therapy.

             What is your certification?

I graduated with an Associate in Applied Science of Respiratory Therapy and am currently a Registered Respiratory Therapist with Neonatal and Pediatric Specialty (RRT-NPS)

             What was Respiratory school like?

Respiratory school was only two years, but very rigorous. It consisted of 2 fall semesters, 2 spring semesters, and a summer semester in between the 1st and 2nd year. It was a combination of hours of classroom time, lab time, as well as clinical rotations twice a week at various hospitals around the area and in the Houston Medical Center. Many hours were spent outside of school studying and learning all about cardiopulmonary anatomy and physiology, disease processes, treatments, medications, medical equipment, and procedures within an RT's scope of practice.

             what skills/techniques helped you more when studying?

Practicing and simulating hands-on skills, reading and taking notes, making flashcards, and having a study buddy/buddies

               What is the number one thing you believe is something a nurse should know and follow?

Always care for your patient and their family/friends as if they were your very own family member 

Autoimmune Heart Diseases

Autoimmune diseases are diseases that cause damage to the body's own tissues as a result of immune dysfunction, often involving multiple organs and systems. The heart is one of the common target organs of autoimmune diseases. The whole structure of the heart can be affected, causing microcirculatory disorders, arrhythmias, pericardial damage, myocarditis, myocardial fibrosis, and impaired valvular function. However, early clinical manifestations of autoimmune heart damage are often overlooked because they are insidious or have no typical features. The damage is often severe and irreversible when symptoms are apparent, even life-threatening. Therefore, early detection and treatment of heart damage in autoimmune diseases is particularly important. Herein, we review the clinical features and mechanisms of cardiac damage in common rheumatic diseases.

Myocarditis may be one of the most important manifestations for cardiovascular system involvement in PM/DM patients. The main effect of myocarditis including myocardial hypertrophy, myocardial ischemia, myocardial infarction, cardiac enlargement and left ventricular systolicand diastolic dysfunction. The abnormal immune system of DM/PM patients attacks their own skeletal muscle cells while also attacking cardiomyocytes, resulting in varying degrees of cardiomyocyte involvement. Myocardial biopsy in patients with DM shows CD4+ T lymphocyte infiltration in the surface layer of the muscle bundles and the epimysial region that surrounds small vessels. There is also tissue atrophy around muscle bundles. Similar changes can be found in the cardiac conduction system as well.

Arrhythmia and conduction abnormalities are most common in PM/DM myocardial damage. Electrocardiogram and Holter abnormalities observed in PM/DM included premature atrial or ventricular contractions, atrial tachycardia, ventricular tachycardia, atrial fibrillation, atrioventricular block, bundle branch block, abnormal Q waves, and nonspecific ST-T wave changes (49). Bundle branch block and atrioventricular block were predominant in conduction block, with left anterior fascicular block and right bundle branch block being the most common (48). The cardiac conduction system is affected by immune processes, such as myocarditis and myocardial fibrosis (involving the sinoatrial node and conduction system), accompanied by lymphocyte infiltration and contraction band necrosis. In addition, cardiac small vessel disease, such as luminal narrowing, smooth muscle hyperplasia and vascular intimal hyperplasia, can also cause arrhythmia, cardiac strangulation and other symptoms. The prognosis of PM/DM is related to the degree of cardiac involvement, so the detection and treatment of early cardiac dysfunction is critical and can prevent serious complications.

How to handle the trauma unit 

You already know it. Nursing can take an emotional toll. Being a nurse often means managing issues like high-stress environments, trauma exposure, psych/social needs of patients and their families, chronic exposure to illness, and ethical/emotional dilemmas—the mental and physical offshoot of all this can have a cumulative effect.

Managing how these traumatic experiences impact you is critical to safeguarding your emotional well-being and ensuring continuity and high-quality patient care. As a nurse, neglecting your trauma management can lead to burnout, decreased job satisfaction, and compromised patient care.

Learn how to recognize and understand traumatic experiences in nursing, how to address and manage trauma with coping strategies, how to achieve work-life balance, and where to find support.

Traumatic Experiences You May Face During Your Nursing Career

You may face many types of high-stress or traumatic experiences throughout your career. Here are some common trauma causes and information to help you understand what makes each experience a potential threat.

• Sudden patient deaths: Witnessing a sudden and unexpected death of a patient due to cardiac arrest, traumatic injury, or unforeseen complications can be a deeply traumatic experience. Despite your best efforts as a nurse, you may not always be able to prevent death as the outcome.
• Violence and aggression: As a nurse, you are at risk of experiencing verbal and physical abuse at the hands of patients and their family members. Experiencing aggressive or violent behaviors can lead to physical and emotional trauma or injury.
• Medical errors: You may witness or be involved in medical errors that can seriously affect patients. These errors can result in psychological distress, self-doubt, and guilt for the nurses involved.
• Chemical hazards: Nurses are routinely exposed to chemicals used to sterilize and disinfect their work and patient environment. Some nurses may be exposed to other environmental hazards or radon, and that exposure can create health issues.
• Emergencies and disasters: Nurses are often managing work in high-stress environments. Responding to emergencies, mass casualties, accidents, natural disasters, and, most recently, a pandemic can be trauma-inducing.
• Critically injured or seriously ill children: Caring for critically injured or seriously ill children can be emotionally challenging for nurses. Strong emotions can arise when witnessing the suffering or passing of pediatric patients, resulting in traumatic experiences.
• Navigating codes: You may have used your knowledge of Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), or Pediatric Advanced Life Support (PALS) during a code. Regardless of the outcome, being involved with a code is stressful, anxiety-producing, and can have a lasting, traumatic impact on you.
• Physical injury: Nurses face occupational hazards that can cause harm with a higher-than-average risk of trips, slips, falls, upper body, and musculoskeletal disorders.
• Chronic exposure to disease and illness: Being chronically exposed to things like MRSA, TB, norovirus, influenza, COVID-19, and more is routine in nursing. Even the idea of this can be stressful and create anxiety.

Signs That a Traumatic Experience May Be Impacting a Nurse

Not every nurse will be traumatized by difficult situations, and not every nurse will exhibit the same symptoms. However, some of the most common symptoms of PTSD include the following:

• Re-experiencing the traumatic event: Nurses may experience nightmares, flashbacks, or intrusive thoughts.
• Adverse changes to cognition and mood: Low self-esteem, workplace dissatisfaction, or numbness to the work environment can occur.
• Dissociative and avoidant symptoms: Dissociative symptoms include withdrawing from people and places and avoiding thinking or talking about the event.
• Vigilance or hyperarousal: This symptom could include anxiety, difficulty falling or staying asleep, having trouble concentrating, and feeling a quick rush to anger.

Self-awareness is significant when it comes to trauma experience and response. Knowing yourself and the signs often seen when trauma impacts you could be essential to seeking help appropriately and promptly.

How Can Nurses Effectively Cope with Traumatic Experiences?

Self-care isn't selfish; it's pursuing an active role in protecting your well-being. Many types of self-care can address PTSD and help manage different levels of trauma responses. Asking for help is a form of self-care, and you will find that most people are supportive and grateful you're taking time to focus on yourself.

Here are some suggestions for self-care related to your physical, emotional, mental, and social health, as well as ideas for practicing mindfulness and meditation.

Physical self-care

• Eat healthy, nourishing meals.
• Drink plenty of water.
• Get adequate sleep.
• Move your body by going for a walk, hike, or bike ride.

Emotional self-care

• Do things that bring you joy.
• Enjoy nature.
• Listen to music.
• Read a book.
• Sit in the sunlight.

Mental self-care

• Find healthy ways to manage stress.
• Talk to a therapist.
• Try a mental health app.

Social self-care

• Don't take on too much when it comes to social commitments and responsibilities.
• Take time to do fun things with friends.
• Spend quality time with people who love and support you.
• Take a break from social media.
• Have a date night with your significant other, or plan a date with someone new if you're single.
• Take a vacation, staycation, or personal time off work.

Mindfulness and meditation techniques

• Participate in yoga or tai chi.
• Try a guided meditation app.
• Start a gratitude journal.
• Focus on breathing and learn some breathing techniques.

How Can a Nurse's Colleagues Help Provide Support after a Traumatic Event?

Peer support following a traumatic experience can be incredibly powerful. Feeling free to communicate openly about an experience can help you feel validated and supported. Peers and administration alike should encourage open conversations about trauma.

Create a safe and supportive work environment. Implement something like Code Lavender in support of all colleagues. Destigmatizing the effect of trauma on nurses within the healthcare setting would go a long way in fostering compassion toward nurses needing and seeking help.

Professional Resources Available for Nurses Dealing with Trauma

If you have witnessed one or many traumatic events and the impact is affecting your personal and professional life, it's time to seek help. Fortunately, there are many avenues available for getting that help.

• Check the Department of Public Health for your state by searching "[yourstate] .gov;" they offer many resources for healthcare providers. The US Department of Public Health also has a list of resources.
• Inquire within your facility. Talk to your HR department and have them direct you toward any support your workplace may offer.
• NurseJournal has a list of mental health resources for nNurses with dozens of links, hotlines, therapies, and options supporting nurses who have experienced trauma.
• Visit the Connecticut Women's Consortium to learn about trauma-informed care, and seek professional help when necessary.

The nursing profession is unquestionably one of the most challenging and rewarding careers in healthcare, and it can come at a cost as nurses often witness traumatic and emotionally taxing experiences. You've learned the importance of addressing and managing traumas, with an emphasis on healing the healers, as not only a personal responsibility but a collective one.

Remember that healing is a journey, and every nurse holds the capacity to emerge from traumatic experiences with a new sense of strength and resilience.

Author Bio

Patti Ashwell, BSN, RN, CCRN, has more than twenty years of clinical experience in the critical care setting. While the primary portion of her career has been in adult ICU, she has practiced in CCU, ER, and hospice.

She is also a freelance medical/healthcare writer committed to bringing timely and topical content to the general public and medical community. Patti lives in New England with her wife and their dog.

           Where can I get Educated to Become a Nurse

The School of Nursing at the University of the Western Cape (@uwcson) is located at the Bellville Campus and is part of the Community and Health Sciences Faculty. The School is the largest in the Faculty of Community and Health Sciences.

Also referred to as Baccalaureate degree. Offered at many California State Universities and some private colleges. Prepares you to provide registered nursing care in numerous settings and to move to administrative and leadership positions. 

Bachelor of Science in Nursing (BSN)
Prepares you to provide registered nursing care in numerous settings and to move to administrative and leadership positions.

What is the best major before nursing school?The most popular majors for these students are: Kinesiology, Public Health, Human Development, Nutrition (all in the College of Health), Psychology, Anthropology, or Spanish (in the College of Liberal Arts).

What is the hardest class for a nursing major?Anatomy and Physiology, often referred to as A&P, is widely regarded as one of the most challenging classes in nursing. In this course, students embark on a journey through the intricate world of human anatomy and physiology.

For those who are interested in more behind-the-scenes work, or who want to explore their options in healthcare, health science is a great alternative major to nursing. A health science degree can lead to many different careers, from a healthcare administrator to medical biller and coder

The Doctor of Nursing Practice (DNP) degree is designed to prepare nurses for the highest clinical practice level in nursing as a Family Nurse Practitioner (FNP).

Obstetrics/gynecology RNs have one of the broadest types of nursing careers in women's health to ensure good reproductive functioning in females from puberty through menopause.

Some of the more popular specialties for male nurses include: Certified Registered Nurse Anesthetist (CRNA): One of the highest-paying professions in the nursing field, Certified Registered Nurse Anesthetists provide anesthesia care for patients undergoing surgical procedures. 

by Jody Dugan, RN, BSNUpdated May 30, 2024 

                                     Types of Nursing 

There are four fields of nursing: adult nursing • children's nursing • learning disabilities nursing • mental health nursing.

Certified nursing assistants are the first level in the hierarchy of nursing. The role involves helping patients with the tasks associated with daily life, including eating, dressing, and bathing.

There are five levels of nursing Here they are lowest to highest level: Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN), Registered Nurse (RN), Advanced Practice Registered Nurse (APRN), and Doctor of Nursing Practice (DNP)

It's important to note that both PAs and NPs are mid-level medical professionals. They're basically at the same level. However, NPs can work independently in many states that PAs can't. So, it places nurse practitioners above physical assistants in terms of practice independence.

Payment Differences:

Highest-Paid Nursing Jobs:

1. Certified Registered Nurse Anesthetist - $212,650
2. Certified Nurse Midwife - $129,650
3. Neonatal Intensive Care Nurse - $128,211
4. General Nurse Practitioner - $126,260
5. Clinical Nurse Specialist - $124,374
6. Pain Management Nurse - $121,916
7. Psychiatric Nurse Practitioner - $119,801
8. Health Policy Nurse - $117,469
9. Nursing Administrator - $110,680
10. Registered Nurse First Assistant - $108,267
11. Gerontological Nurse Practitioner - $107,530
12. Family Nurse Practitioner - $103,803
13. Nurse Educator - $86,530
14. Intensive Care Unit Nurse - $85,205
15. Informatics Nurse - $84,574

 The median annual RN salary in the United States is $86,070, per U.S. Bureau of Labor Statistics (BLS) reports. But that figure spans all types of nurses, including the lowest and highest-paying nursing jobs, with some of the highest-paid nurses earning over $200K annually!

by: https://nurse.org/articles/15-highest-paying-nursing-careers/

What are the types of Schedules for a Nurse? 

Full-time would be five 8 hour shifts, four 10 hour shifts, or three 12 hour shifts per week. The common standard is 36-40 hours per week to be considered full-time. Part-time would include the same 8-hour, 10-hour, and 12-hour shifts, however, the part-time staff member would just work fewer days.

Nurses often work rotating schedules, including a schedule of 4 nights on and 4 nights off. This means that they work four consecutive night shifts, typically lasting 12 hours each, and then have four consecutive days off. After this period, they would again work 4 nights on and have another 4 days off.

Why do nurses only work 3 days a week?Instead of the workforce standard of two days off per week, you get four days off. Nurses on 12-hour shifts typically work three days a week, and many prefer to run these days consecutively. This four-day gap allows you to recharge and spend more quality time with family and friends. 

https://www.nursingworld.org/content-hub/resources/workplace/nurse-schedules-12-hour-shifts/#:~:text=Working%20a%2012%2Dhour%20shift,are%20they%20advantageous%20to%20nurses%3F

   My Mentor schedules

Monday: 2-3 hrs study

Tuesday: 2-3hrs study

Wednesday: 2-3hrs study

Thursday: 2-3hrs study

Friday: 2-3hrs study

Saturday: see mentor for 2-4hrs

Sunday: break day 

Every day if I have a project due I must work on it, it will also go on my hours.

The most important thing a Nurse or Doctor will ask you

There are many common questions a doctor will ask, and they do so to help pinpoint what will be the most effective treatment plan. Some of the most common questions are:

• What brings you in today?
• What are your symptoms?
• When did your symptoms start?
• Have your symptoms gotten better or worse?
• Do you have a family history of this?
• Have you had any procedures or major illnesses in the past 12 months?
• What prescription medications, over-the-counter medications, vitamins, and supplements do you take? Which ones have you been on in the past?v
• What allergies do you have?
• Have you served in the military?
• Are you sexually active?
• Do you use any kind of tobacco, illicit drugs or alcohol?
• by: https://www.horizonhealthcare.org/questions-your-doctor-will-ask-during-a-primary-care-visit/

.

How do Nurses deal with Hostile Patients?

1. Maintain a Calm Demeanor

Maintaining a calm demeanor and intervening early with less restrictive measures, such as verbal and non-verbal communication, reduced stimulation, active listening, diversionary techniques, and limited setting can help relax the patient and promote a culture of structure, calmness, negotiation, and collaboration, rather than control. If nurses remain calm and cooperative, the patient will likely mirror their behavior.

2. Practice Active Listening

While most nurses are often tempted to retaliate when dealing with an aggressive patient, active listening and watching for nonverbal cues may be helpful in the de-escalation process. Active listening is pivotal in pre-empting an angry outburst by looking for or listening to para verbal communication that is tone, inflection, and volume.

Since most patients who arrive at the hospital are fearful or anxious, it is not uncommon for some patients to utilize anger or aggression as a coping mechanism. Therefore, nurses should utilize active listening as a tool to help comfort and reassure patients that they are invested in their safety and recovery.

3. Provide Patients an Opportunity to Vent

After actively listening to the patient, nurses must be able to offer thoughtful comments that demonstrate an awareness of the patient's unique feelings and concerns. By offering patients an opportunity to vent, it allows the nurses and patients to work collaboratively and address underlying issues.

When a patient appears to be upset or is demonstrating early signs of anger, it is imperative for nurses to substantiate what they see or hear, so that the patient feels validated. Often times, nurses are accustomed to telling patients what to do, that they forget to provide patients an opportunity to sufficiently express themselves. Therefore, when nurses provide patients a chance to vent, it not only provides patients an opportunity to voice out their frustrations but also diminishes the likelihood of physical violence to ensue.

4. Display a Non-Defensive Posture

Another important technique that must be considered when de-escalating an aggressive and hostile patient is displaying a non-defensive posture. By keeping the hands in front of the body, open and relaxed, and maintaining appropriate eye contact, it illustrates authenticity and compassion towards the individual. While proper eye contact is subjective however, it is imperative not to stare.

Since a nurse's reaction can greatly influence the emotional reactivity of highly dysregulated patients, the nurse must maintain a neutral expression at all times. By remaining calm and sustaining a neutral appearance, patients are less likely to overreact allowing nurses to regain control of the situation.

5. Impart Empathy and Compassion

Lastly, nurses should also be able to properly express their concern by conveying empathy and compassion towards the patient. The art of empathy and compassion helps reassure patients that they are not alone. Paraphrasing can be an effective tool in de-escalating a patient because it not only communicates empathy but also demonstrates understanding. By using phrases such as "I understand how difficult this can be for you," nurses can connect with patients much more effectively which can help facilitate the healing process by re-establishing trust and rapport.

Resolution Stage

Once the patient is successfully de-escalated, the nurse is then responsible for settling any unresolved feelings or concerns the patient may hold. During the resolution stage, the nurse should identify how the patient would like their anger to be dealt with if and when a similar situation recurs. During this time, the nurse should work collaboratively with the patient to re-establish therapeutic rapport and ensure all feelings and concerns are individually validated.

In conclusion

Take a deep breath, and remember: You don't have to take it personally. Refrain from angry or defensive language with difficult patients or coworkers. Be mindful not only of the words you say but of the message your body language is sending. Stay calm, caring, and in control. 

by: https://www.themdu.com/guidance-and-advice/guides/guide-to-dealing-with-challenging-patients#:~:text=Remain%20calm%2C%20listen%20to%20what,help%20you%20find%20a%20solution.

             What questions should I ask a                      mentor/higher-level nurse/ doctor? 

The following questions are more general and help the interviewer better understand your personality and qualifications for the nursing leadership position you are interviewing for:

• What is your greatest weakness professionally?
• What is your greatest strength professionally?
• Why are you leaving your current job?
• Why are you interested in this particular nursing leadership position?
• Why should we hire you for this position?
• Why did you choose this nursing specialty?
• Do you work better as part of a team or independently?
• Where do you want to be career-wise in five years?
• What is your favorite part of being a nurse?
• How do you manage stress at work?
• What is the most challenging part of a career as a nurse in a leadership position?
• Are you self-motivated?
• What do you enjoy most about nursing leadership?
• What do you enjoy least about a nursing leadership career?
• How do you manage your leadership responsibilities with your nursing duties?
• How do you motivate your team of nurses to do their best each day?
• Describe an instance in which you had to make a quick decision regarding a patient.
• What is the greatest challenge that nurses face today, in your opinion?
• What is your method of task delegation?
• How has your training and education prepared you for this nursing leadership position?
• How would you handle a conflict between two nurses on your staff?
• Describe a time when you disagreed with a colleague about a patient's care and how you resolved it.
• What personality traits do you feel a good nurse needs?
• What qualifications do you feel are necessary for a nurse to have?
• How would you handle a distressed family member of a patient?
• How would you handle a patient who is unsatisfied with the care received while in the medical facility?
• Describe your experience with leadership development.
• Describe your leadership style.
• How have you contributed to the improvement of inpatient care in your previous positions?
• What are your most significant accomplishments in your nursing career thus far?
• Describe your experience in nursing management.
• Describe a time when you were required to discipline or terminate an employee and how you handled the situation.
• By: https://www.indeed.com/career-advice/interviewing/questions-to-ask-in-a-nursing-interview

Amazing Clinical Questions to ask 

Background questions ask for general knowledge about an illness, disease, condition, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc.

For example

• How overweight is a woman to be considered slightly obese?
• What are the clinical manifestations of menopause?
• What causes migraines?

Foreground questions ask for specific knowledge to inform clinical decisions. These questions typically concern a specific patient or particular population. Foreground questions tend to be more specific and complex compared to background questions. Quite often, foreground questions investigate comparisons, such as two drugs, two treatments, two diagnostic tests, etc. Foreground questions may be further categorized into one of 4 major types: treatment/therapy, diagnosis, prognosis, or etiology/harm.

For example

• Is Crixivan effective when compared with placebo in slowing the rate of functional impairment in a 45 year old male patient with Lou Gehrig's Disease?
• In pediatric patients with Allergic Rhinitis, are Intranasal steroids more effective than antihistamines in the management of Allergic Rhinitis symptoms?

Formulating a Well Built Clinical Question

According to the Centre for Evidence Based Medicine (CEBM), "one of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients' problems and phrased in ways that direct your search to relevant and precise answers."

A well-built clinical foreground question should have all four components. The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable query. Dividing into the PICO elements helps identify search terms/concepts to use in your search of the literature.

P = Patient, Problem, Population (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?)

I = Intervention, Prognostic Factor, Exposure (What main intervention are you considering? What do you want to do with this patient?)

C = Comparison (What are you hoping to compare with the intervention: another treatment, drug, placebo, a different diagnostic test, etc.? It's important to include this element and to be as specific as possible.)

O = Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)

Type of Clinical Question and Study Design

Two additional important elements of the well-built clinical question to consider are the type of foreground question and the type of study (methodology). This information can be helpful in focusing the question and determining the most appropriate type of evidence.

Foreground questions can be further divided into questions that relate to therapy, diagnosis, prognosis, etiology/harm

• Therapy: Questions of treatment in order to achieve some outcome. May include drugs, surgical intervention, change in diet, counseling, etc.
• Diagnosis: Questions of identification of a disorder in a patient presenting with specific symptoms.
• Prognosis: Questions of progression of a disease or likelihood of a disease occurring.
• Etiology/Harm: Questions of negative impact from an intervention or other exposure.

Knowing the type of foreground question can help you select the best study design to answer your question. You always want to look for the study design that will yield the highest level of evidence. Consult the pyramid (click the image to enlarge it) and the definitions below.To see more info on the relationship between study design and question type, check out Chapter Four "What is the Question? from the Users' Guide to the Medical Literature (see the link aboveDefinitions of Study Types
(From BMJ's Clinical Evidence Glossary)

Meta-analysis: A statistical technique that summarizes the results of several studies in a single weighted estimate, in which more weight is given to results of studies with more events and sometimes to studies of higher quality.

Systematic Review: a review in which specified and appropriate methods have been used to identify, appraise, and summarize studies addressing a defined question. (It can, but need not, involve meta-analysis). In Clinical Evidence, the term systematic review refers to a systematic review of RCTs unless specified otherwise.

Randomized Controlled Trial: a trial in which participants are randomly assigned to two or more groups: at least one (the experimental group) receiving an intervention that is being tested and another (the comparison or control group) receiving an alternative treatment or placebo. This design allows assessment of the relative effects of interventions.

Controlled Clinical Trial: a trial in which participants are assigned to two or more different treatment groups. In Clinical Evidence, we use the term to refer to controlled trials in which treatment is assigned by a method other than random allocation. When the method of allocation is by random selection, the study is referred to as a randomized controlled trial (RCT). Non-randomized controlled trials are more likely to suffer from bias than RCTs.

Cohort Study: a non-experimental study design that follows a group of people (a cohort), and then looks at how events differ among people within the group. A study that examines a cohort, which differs in respect to exposure to some suspected risk factor (e.g. smoking), is useful for trying to ascertain whether exposure is likely to cause specified events (e.g. lung cancer). Prospective cohort studies (which track participants forward in time) are more reliable than retrospective cohort studies.

Case control study: a study design that examines a group of people who have experienced an event (usually an adverse event) and a group of people who have not experienced the same event, and looks at how exposure to suspect (usually noxious) agents differed between the two groups. This type of study design is most useful for trying to ascertain the cause of rare events, such as rare cancers.

Case Series: analysis of series of people with the disease (there is no comparison group in case series).

By: https://nursing.vanderbilt.edu/phd/clinicalfaq.php#:~:text=Examples%20of%20broad%20clinical%20research%20questions%20include%3A&text=What%20maternal%20factors%20are%20associated,men's%20experience%20of%20physical%20assault%3F

The Greatest Unanswered Questions of Medical Science

             What to do for patients who speak another                                                 language?

While there are numerous translation apps available, here are some common ones that could be helpful in health care settings:

• Google Translate: This app supports the translation of words or phrases in over 100 languages. Users are able to speak, type, or take a photo and receive instant speech translation. It's available to download on both iTunes and Google Play.
• SayHi: The SayHi app allows users to record their voice, and the app translates the word or phrase into a selected language. Users may also type their messages in the app rather than speak. It's available on iTunes and Google Play.
• Microsoft Translator: This app translates text, voice, and photos into over 70 languages. A split-screen mode allows two people to have a bilingual conversation. It's available on both iTunes and Google Play.

• While there are numerous translation apps available, here are some common ones that could be helpful in health care settings:

• Avoid asking family members to translate

  Some patients with limited English proficiency may bring family members or friends to medical appointments to act as their translators. Nurses should avoid asking family members to translate for the patient whenever possible. The family member or friend may be unfamiliar with medical terminology, which might lead to inaccurate translations. They may also be uncomfortable sharing the patient's personal information and refrain from speaking openly. In these situations, it's helpful for the nurse to use another method of communication, such as asking a medical interpreter to translate.

  Learn another language

  Learning another language could help nurses address disparities for patients who speak other languages. When nurses are fluent in a different language prevalent in their geographic region, it may help them communicate effectively with many of the patients they're treating. Bilingual nurses are able to speak openly with patients in their preferred language to encourage them to share information, resulting in more effective medical treatments.

  Complete training

  It's helpful for bilingual nurses at medical facilities to receive training on how to communicate with patients who speak other languages. A health care facility may offer classes or programs to teach nurses about cultural differences or nonverbal cues that may affect communication. Some facilities may even offer opportunities for bilingual nurses to pursue careers as certified medical interpreters to improve the level and quality of bilingual communication with patients.

  Use medical interpreters

  Medical interpreters are professionals who offer translation services for health care providers. These interpreters typically have fluency in two or more languages. They also have knowledge of medical terminology and standard health care practices, such as confidentiality regulations. The use of professional interpreters could be helpful when a health care facility has a large number of patients with limited English proficiency. These interpreters may translate for nurses who regularly care for patients who speak other languages.

  Use remote translation

  
  There are also remote translation services that nurses might use. Some medical interpreters offer services over the phone or through video conferencing to help nurses and patients communicate more easily. This type of translation service may be especially helpful in emergency care, such as hospital settings, where nurses and other health care professionals make quick decisions to treat patients. With video conferencing, remote interpreters are still able to make visual assessments and use non-verbal cues to provide effective translations so that nurses are able to deliver a higher quality of care for their patients.

  Related: Being Bilingual in Health Care
  

  Train to start your nursing career at Concorde

  Are you ready to start training for a career in nursing and have the opportunity to learn how to help patients receive quality care and treatment? At Concorde, you could complete training and prepare for a nursing career in months, not years, depending on the nursing program you're interested in. A practical or vocational nursing program allows you to work toward a diploma in as little as 13 months, while an online RN to Bachelor of Science in Nursing program may take as few as 15 months, depending on your course load. Contact us for more information, schedule a tour, or apply online today.

  By: https://www.goodrx.com/hcp-articles/providers/communicating-non-english-speaking-patients

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Honesty 

"Nurses are dedicated to being truthful. Patients are then able to trust the nurse in a therapeutic relationship throughout their care. This helps put the patient at ease and helps them to move toward optimal wellness."

When physicians communicate with patients, being honest is an important way to foster trust and show respect for the patient. Patients place a great deal of trust in their physician, and may feel that trust is misplaced if they discover or perceive lack of honesty and candor by the physician.

Why is honesty good for your health?When you're honest with the people in your life, you build trust and respect. This can lead to stronger and more meaningful relationships, which are essential for good mental health. Honest communication can also help you resolve conflicts with others more effectively, which can reduce stress and anxiety.

• Closer friendships. Honesty and integrity pave the way for greater intimacy. ...
• Higher quality friends. ...
• Trust. ...
• Confidence. ...
• Wellness – Honesty has been linked to less colds, less fatigue, less depression, and less anxiety.
• Less stress – Dishonesty needs to be maintained.

It builds trust and respect, fuels professional success, promotes moral responsibility, sets inspiring examples, and enhances self-respect. By embracing and living out our integrity, we not only enrich our own lives but also positively impact the lives of those around us.

Honesty is not just about telling the truth. It's about being real with yourself and others about who you are, what you want and what you need to live your most authentic life. Honesty promotes openness, empowers us and enables us to develop consistency in how we present the facts 

by: https://www.sju.edu/centers/icb/blog/truth-telling-in-medicine#:~:text=When%20physicians%20communicate%20with%20patients,and%20candor%20by%20the%20physician.

What is the most important trait to have while in nursing?

What is the most important characteristic of a nurse? Empathy is one of the most important traits of a good nurse. Empathy means showing compassion and understanding to others. It is such a vital skill for working with patients

• Extroversion. This factor reflects the degree to which people interact with others and their levels of comfort and assertiveness in these situations. ...
• Agreeableness. ...
• Openness. ...
• Conscientiousness. ...
• Neuroticism. ...
• Engaging Coping Strategies. ...
• Disengagement Coping Strategies.

Communication skills are one of the most important requirements of a nurse's job—both following directions and communicating with patients and families. Patients who are sick or suffering often are not in a position of strength to speak up for themselves.

1. Empathy. Empathy is an incredibly important value in nursing as it helps you build trust with your patients and enables you to focus on their point of view. ...
2. Professionalism. ...
3. Autonomy. ...
4. Altruism. ...
5. Accountability. ...
6. Curiosity.

By: https://www.usa.edu/blog/nurse-qualities/#:~:text=Empathy%20is%20one%20of%20the,skill%20for%20working%20with%20patients. 

What is the work place like (Emergency Room)?

Nurses who work in hospitals and nursing care facilities usually work in shifts to provide round-the-clock coverage. They may work nights, weekends, and holidays. They may be on call, which means that they are on duty and must be available to work on short notice.

Emergency departments (ERs) are chaotic environments where nurses must balance helping multiple patients at once while juggling other responsibilities. To be successful in this role, you'll need a combination of clinical and people skills, as well as the ability to think on your feet.

• Pro: Highly rewarding. All nurses help people, but an emergency room nurse helps people who are in urgent need. ...
• Pro: Provides great variety. In the emergency room, no two shifts are ever the same. ...
• Pro: Numerous opportunities for learning. ...
• Con: Stress. ...
• Con: Physically draining.

The following includes common ER nurse specialties and special credentials: Trauma ER nurse: treats severe trauma cases. Triage ER nurse: determines priorities based on urgency. Flight ER nurse: treats patients during emergency air transport (certified flight registered nurse credential required)

An Emergency Department Nurse (ED), or Emergency Room Nurse (ER), is responsible for assessing, triaging, and treating patients that come through the hospital doors every day; this could entail treating injury, trauma, or acute-onset symptoms.

An ER nurse's primary responsibility is to identify medical issues, determine severity, and provide immediate support to minimize negative long-term effects and, if necessary, even sustain life. An ER nurse is one of the first responders when a patient is admitted to the emergency room.

Before you decide to become an ER nurse, there are a few things that you should know. First, you need to realize that this is a very demanding job. You will be working long hours and you will be expected to be available for overtime. You must also be prepared to deal with extremely stressful situations.

Whether it's a car accident victim requiring immediate intervention or a child with a high fever in need of prompt medical attention, as an ER nurse, you will utilize your expertise to stabilize patients quickly, take in important information, and alleviate their discomfort.

First, you need to realize that this is a very demanding job. You will be working long hours and you will be expected to be available for overtime. You must also be prepared to deal with extremely stressful situations 

By: https://www.bls.gov/ooh/healthcare/registered-nurses.htm#:~:text=Work%20Environment,in%20outpatient%20clinics%20and%20schools.

Psychiatry and when to know it's not physical but mental

If you are having a mental health screening, you'll answer a set of questions about your symptoms. The questions will be about your feelings, mood, sleep, appetite, and other parts of your life. A provider may ask you the questions or you may fill out a questionnaire and discuss your answers afterwards.

how do psychologists determine if a mental illness is presentA physical examination, lab tests, and psychological questionnaires may be included, often to rule out other illnesses. As all of this information is obtained and integrated, the professional will begin to determine if the person's symptoms match up with one or more official diagnoses.

What tests do the doctors run to determine whether a person has the mental disorder?The psychiatrist might use any one of a number of common tests. One example is the Mini Mental State Examination (MMSE), which is a short questionnaire used to measure cognitive impairment.

How would you compare a mental disorder to a physical illness?Mental illnesses are brain-based conditions that affect thinking, emotions, and behaviors. Since we all have brains – having a mental health problem at some point during your life is common. Unlike other general physical illnesses, mental illnesses are related to problems that start in the brain. The brain is an organ.

 By: https://www.onepeloton.com/blog/mentally-exhausted/

OPQRST

Each letter stands for an important line of questioning for the patient assessment. The parts of the mnemonic are: Onset , Provocation/palliation, Quality, Region/Radiation, Severity, and Time. (If you have not done so already) Add a new incident, or open an existing incident, as described in Add or edit an incident.

The OPQRST mnemonic can help clinicians take a thorough medical history of individuals who are in pain. Each letter in the mnemonic represents an aspect of symptom assessment: onset (i.e., acute, gradual); provocation/palliation (i.e., factors making pain worse or better, respectively); quality (e.g., sharp, dull, crushing, or burning); region/radiation (i.e., the body areas involved and whether the pain moves); severity (i.e., level of pain); andtime (i.e., duration and changes over time).

What does the "O" in OPQRST mean?

The "O" in OPQRST refers to the onset of pain, which refers to how pain begins or develops over time. Pain that begins suddenly without warning is referred to as sudden onset pain. This type of pain is often associated with traumatic injuries, such as fractures, cuts, or burns, and acute medical conditions, like kidney stones, a heart attack, or appendicitis. On the other hand, gradual pain develops slowly over time and it can result from chronic health conditions (e.g., arthritis), or as a result of repetitive strain injuries or overuse, such as in carpal tunnel syndrome or tendinitis.

What does the "P" in OPQRST mean?

The "P" in OPQRST meansprovocation and palliation, referring to the factors that worsen or alleviate the pain, respectively. For example, chest pain that gets worse with exertion and is relieved with rest might indicate angina, especially if it occurs in an individual with cardiovascular risk factors (e.g., hypertension, dyslipidemia). On the other hand, a young person complaining of chest pain that becomes worse with palpation, and is relieved with analgesics like NSAIDs might suggest a muscular or inflammatory origin, instead of a heart problem.

What does the "Q" in OPQRST mean?

The "Q" in OPQRST refers to the quality of pain. Some descriptors to describe the quality of the pain include sharp, dull, crushing, burning, and tearing. The pain pattern, such as intermittent, constant, or throbbing, is also important.

Pain can be divided into nociceptive and neuropathic pain based on the quality of the pain. Nociceptive pain is caused by the activation of sensory nerve fibers called nociceptors, which are found throughout the body, including the skin, muscles, joints, and internal organs. This type of pain generally responds well to analgesic medications like acetaminophen or NSAIDs, like ibuprofen. On the other hand, neuropathic pain is a type of chronic pain caused by damage or dysfunction of the nervous system. Neuropathic pain can lead to various unpleasant sensations, including a burning or tingling sensation; a sharp, electric-like pain; or allodynia, which is described as pain that arises in response to non-painful stimuli, like light pressure or temperature changes. Neuropathic pain requires different pain management strategies than nociceptive pain, which often includes antidepressants like amitriptyline and duloxetine; and neuromodulators, such as pregabalin or gabapentin.

What does the "R" in OPQRST mean?

The "R" in OPQRST refers to region and radiation, which refers to where the pain is located on the body and whether it radiates, or moves to another area. Assessing radiation can suggest conditions such as a heart attack, where chest pain can radiate to the jaw and arms. Radiation can also occur with conditions like a herniated disc, where the nerve roots of the spine may become damaged or irritated, causing a tingling or burning pain that travels down the legs.

What does the "S" in OPQRST mean?

The "S" in OPQRST refers to the severity of pain. Pain intensity can be assessed through different pain rating scales. One of the most commonly used is the visual analog scale (VAS), where the individual sets the level of pain on a 10 centimeter line that goes from 0 (no pain) to 10 (worst imaginable pain).

The Wong-Baker FACES pain scale is a tool used for children to help them communicate their pain without words. It consists of six faces with facial expressions that represent different levels of pain so that children can choose the one that best represents what they are experiencing.

Finally, there is the PAINAD scale, which focuses on assessing objective items to determine the level of pain in people with dementia. These items include breathing, vocalizations (e.g., moaning, groaning, calling out), facial expressions, body language, and consolability.

What does the "T" in OPQRST mean?

The "T" in OPQRST refers to time. Based on its duration, pain can be divided into acute, subacute, or chronic pain. Acute pain is of short duration (usually less than 1 month), it typically arises suddenly and generally resolves when the body heals itself. It often serves as a warning signal, alerting the individual and prompting them to take action to protect themselves (i.e., pulling the fingers away from a hot pan). Subacute pain is acute pain that does not resolve within a month but persists for less than 3 months.

Chronic pain, on the other hand, is often more gradual in onset and typically lasts longer than 3 to 6 months. It can occur as a result of a previous injury or be a symptom of underlying medical conditions, like osteoarthritis, fibromyalgia, endometriosis, or irritable bowel syndrome, to name a few. 

By: https://www.ems1.com/ems-products/education/articles/how-to-use-opqrst-as-an-effective-patient-assessment-tool-yd2KWgJIBdtd7D5T/

Time

As a nurse, you know time is critical when caring for emergency patient situations. Strong time management skills in nursing are also essential to your overall health and well-being, including combating stress.

Nurses should establish clear boundaries between work and personal life, ensuring that they have dedicated time for themselves and their loved ones. This may involve setting specific hours for work-related tasks, avoiding work-related communication outside of those hours, and prioritizing personal commitments.

When you have more time with each patient, you can provide better care. You can take the time to listen to their concerns, answer their questions, and develop a personalized treatment plan. You can also be more proactive in identifying and addressing potential health problems. 

The common standard is 36-40 hours per week to be considered full-time. Part-time would include the same 8-hour, 10-hour, and 12-hour shifts, however, the part-time staff member would just work fewer days. The day's work may vary based on the facility. Many facilities also offer per diem nursing positions.

Part-time nurses have the same job duties as full-time nurses; the primary difference is that part-time nurses work less than thirty hours a week instead of forty or more hours. 

By: https://www.angelesinstitute.edu/nightingale/choosing-between-8-or-12-hour-shifts-for-nurses#:~:text=Some%20Nurses%20Prefer%2012%2DHour%20Nursing%20Shifts&text=This%20allows%20them%20to%20maintain,less%20money%20spent%20on%20gas.

The difference between an Emergency room and an Urgent care

Emergency rooms are the best option in cases where conditions are life-threatening and may require advanced treatment, such as having chest pain. Because life-threatening conditions are the number one priority in the emergency room, less severe cases will take longer to be treated.

Urgent care centers are not a substitute for emergency care as they don't have the same equipment or trained staff that emergency departments have, but they can be a solid option for minor injuries or illnesses or if your doctor's office is closed. Urgent care centers do not have a federal mandate to treat patients.

An Emergency Department treats life- or limb-threatening health conditions in people of all ages. It is the best option when you require immediate medical attention. Urgent Care is the middle ground between your primary care provider and the Emergency Department. 

By: https://www.scripps.org/news_items/4231-should-you-go-to-the-emergency-room-or-urgent-care