Whose fault is it? and what is wrong if you think little outside the box?

           Nowadays I do have lots of free time since I am in transition of looking for new job, hence most my time is in computer doing school work and facebooking. While going through the facebook, I found this article titled, " 15 Dumbest Patients that doctors have had to deal with. Faith in humanity lost."http://www.tickld.com/x/15-dumbest-patients-ever. I usually don't click on these kind of links but when you have nothing to do, you do everything that you did not used to do. Invested my time to read all those 15 points, while going through each and every it made me to think about our healthcare system and our generation. Our generation thinks that we know each and every aspect of life and if someone does not know anything that we know, we think they are dumb or crazy. There are lots of nurses and doctors out there who does not know where exactly is Nepal, some even does not know that Nepal is a country, and some even does not know that Nepal even exists. That does not mean that those nurses and doctors are dumb for not knowing geography, that's what exactly my point is. If you know all the medical stuff that does not mean you know everything about other stuffs. The patient/person you are referring as dumb may be a farmer who knows each and every thing about farming and he may be your source who is helping you to have a food in your dining table tonight.
        
Here are the some scenarios that I want to talk about:

1) " I once had a 20 year old female patient who didn't know that having sex would lead to pregnancy. She had no idea."

            After reading this point thousands of people might have laughed and shared the story to other coworkers. That 20 year old female may be from different culture or may follow different religion. She might have been not only in abstinence but also restricted from sex education. If someone does not tell you or if you are not allowed to learn about something, how are you going to learn about sex? For those girls, someone who knows about sex when they are 12 years old and gets pregnant when they are 13-14 are crazy and dumb. But in reality no one is dumb or crazy, it is just the reality of different culture, level of education, and their experience of life.

2) " After looking at the patient's chart and seeing she had diabetes
Me: Do you have any medical conditions?
Patient: No
Me: Are you sure, you've never been told you have any disease
Patient: Never
Me: What Medications do you take?
Patient: Insulin, for my diabetes

           What you all think about this conversation, your first reaction may be what?, really? seriously? lol? and so on...... but think from the other side, think as a patient perspective. That patient did not go to medical school or nursing school nor worked in a medical field. None of her family members have any experience about medical terminology. When patient was first diagnosed with diabetes, did any of the medical person sat down and educated the patient about his new diagnosis. Did anybody informed the person that diabetes is a medical condition, or a disease. May be those nurses or doctors were too busy saving lives, that is our excuse most of the time.  Whose fault is it now in this situation and who is dumb or crazy. Hence, before you laugh and say someone crazy/dumb please try to think out of the box and try to stand on their feet.

3) "A middle aged lady in the operating theater once told us at the last minute (as she was being wheeled in) that she's allergic to latex. Everyone freaks out cos so much of the stuff we use in theater has latex in it, so we take her to the latex free theater and do her surgery there. When she's in recovery and awake I enquire as to what reaction she has to latex. " I just don't really like the sound the latex gloves make, dear". I just turned around and walked out."

       If I was that nurse/medical personal who heard that little lady saying she is allergic to latex, I might have same reaction or I might have walked out. But, if we think and evaluate it it is nurse's or that medical personal fault, who asked if patient have any allergic reaction or but does what kind of reaction, or verify it with patient chart. If someone at least had asked what kind of reaction? then they would not have gone through extra hassle.

4) "20- something year old patient comes to ER, chief complaint on the board is "private." This should be good. Go in, he is visibly depressed and sad. Tells a story about how he slept with a women, didn't use protection, and after he noticed she had a "plastic box on her." When she told it was an insulin pump for diabetes he was mortified. Came in immediately to be tested for diabetes. "

      This is similar to the first point I discussed here. It is lack of education. That patient is not aware of disease process of diabetes. If you think as a normal person without any knowledge of medicine, if you get HIV through sexual transmission why not another disease like diabetes. What is our responsibility here? provide education. There is still stigma around HIV it gets transmitted through mosquito, by sharing room and personal items with patients etc. Shouldn't we provide more education. 

5) " Don't eat or drink anything after midnight" Before his 3 year old daughter's surgery the next morning (tonsils and adenoids). While intubating his daughter the next morning, she vomited scrambled eggs, causing her to aspirate them into her lungs. Her heart stopped, and I did chest compressions on her for 25 minutes. We got her back, aborted the surgery, and transferred her to pediatric ICU on a ventilator. Her father's response..." she said she was hungry. I thought you were being too hard on her. It must have been something you did to her."

     We provide education in a way how we want to hear, but providing education means to provide education in the way how that person is going to take it. Do not eat or drink anything after midnight. That is not a education that is instruction or better an order that you are giving to the patient/ family members. You should provide an education when you verify with the patient/family members did they really understood what you are trying to teach. That medical doctor/nurse/ medical representative should have given extra 2 minutes to describe reasons for not eating before surgery. Also another questions arise, did anyone asked the father if patient have eaten anything that morning before surgery. May be not, because we think according to our way, if I said not to eat, patient might not have eaten, right?

6) "The best was the women who was feeding her 3 month old dog every few days for no other reason than she thought a dog should only eat that often. Came in for hypoglycemia(0f course). 
The nurse who spoke with her has no patient for this kind of jacked ignorance, and actually shouted at her "DO YOU EAT EVERY THREE DAYS!?""

      May be she has dementia like our grandmother or grand father have, may be that patient have some psychological problems that might have been ignored by the medical personals. And she might have genuinely thought that's how you feed dog.

 7) "Once had a patient who was prescribed an inhaler for his cat allergy. He came back a week later saying he was none the better. Turns out he was spraying the inhaler on his cat. 

--see below


8) " My favorite was when someone was prescribed estrogen patches and told a stick one patch on herself every other day. At the next follow-up she said she didn't like the patches because she had been running out of space." I didn't think to clarify to her that she should have been placing a new patch and removing the one from yesterday each day. Very amusing. She indeed was covered in sticky patches.

      During my last three of nursing career, I had a great group of co-workers, leaders and supervisors. I learned a lot from them, and still I have to learn more. One of the story that one of my supervisor shared was almost the same like above two. This gentleman came back to ER stating that he did not liked taking suppository for his constipation because it tasted bad. (By the way suppository should be inserted anally.) While she was saying the story she was not laughing and she was not pointing that patient as a dumb or crazy. She had a chance to learn something new during her initial nursing career and teach us about nursing education citing the story. In all the stories described above in points 7 and 8 and story of my supervisor's patient reflects that we are still lacking with good education in healthcare for our patient population. It's not even education. it's 10 second instruction. We still need to be more clear and concise with our patients. Put a patch every other day means putting a patch every other day, we also need to explain them that old patch needs to be taken out before patient applies the new patch. If that inhaler was the first prescription for that patient, we lacked to provide education how to use the inhaler, that's why patient came back to ER. That is not good for patients and also not good for the hospitals. We are using the resources that are always in shortage for some of the stuff that did not need us due to our own fault or negligence.

Out of those 15 examples, I talked about 8 of the above, that I thought there is lack of education for our patients, and lack of our common sense, since we do not think out of the box. Please start thinking something different than you think and please at least start to think what's going on the other end. It is just a feelings and thoughts that I shared here, no one have to think like me and no one have to agree with me too. I may not know how the plants of my favorite foods look like and I still enjoy it and I think a farmer does not expect me to know how those trees look like.

Thank you
Smita Sharma
Indiana.

Kaplan's Video about NCLEX RN test.....

I really got surprised when I saw these videos yesterday. You might be surprised with the fact that I passed my NCLEX more than two and half years ago, but I do constantly do researches for the NCLEX resources to assist new graduates and for those who is planning to give the test. These Kaplan videos by Barbara Irwin, MSN, RN will be really helpful for you all. First video is overall about the NCLEX test and will help to decline your stress and fear, and will answers lots of questions that are arising in your mind about NCLEX

How to Transfer your RN license to Indiana from other states

Recently I moved from Oklahoma to Indiana and had to transfer my Oklahoma RN license to Indiana. It was not that much of stressful but still it is taking some time. If you are planning to transfer your license to Indiana here is the "Step by Step" process that I did:

1) Indiana does not have a separate website for Board of Nursing it is under Indiana Professional Licensing Agency (PLA). And here is the link
http://www.in.gov/pla/nursing.htm

2) Transfer of license is called endorsement application. Here is the link below with instructions and it is pretty detailed in the website itself.
http://www.in.gov/pla/2506.htm

3) After you get into the link above application form is underlined as completed application which is on PDF file.

4) You need PDF installed in the computer if not you can get it from http://get.adobe.com/reader/

5) After you download the application form, application form will look like this:

you can type or print, if you decide to type you can save the data.

6) After application is filled, along with your application you need to submit $50 application fee payable to "Indiana Professional Licensing Agency" , proof of license in another state ie (Scan or print copy of your license from your state) and a photograph as described by Indiana professional licensing agency as below:

Include a photograph, approximately 2 ½ x 3 ½ inches, head and shoulders view, black and white or color, of professional quality. Polaroid type or laminated photographs will not be accepted. Please tape, rather than staple, the photo to the application. Please place your signature on the front of your photograph
 Derived from http://www.in.gov/pla/2506.htm 

7) Mail to the address :

Professional Licensing Agency     
Attn: Indiana State Board of Nursing
402 W. Washington Street, Room W072
Indianapolis, Indiana 46204

8) Send your Transcript: from your college directly sent from college in a sealed envelope from the registrar's office.

9) Request license verification from your state, you have to fill out separate form for this step and form can be found in your board of nursing website.You can find the application form for Oklahoma
https://www.ok.gov/nursing/forms3.html it is all the way down in the list called written verification of Licensure and they will charge you $40 (Fee may change)

10) Wait for response from the staff that they got your application.

11) After you get the response your next step is background check you can call or register at http://www.identogo.com/

12) After all this done now just wait for the result.

Good luck and best of luck for your nursing career, I hope you love your nursing career as much as I do or more that I do (I don't think that is possible just kidding........)

Beauty of small hospital.

      Today at work, I was able to see almost every aspect of life.  I took care of an 8-months patient who is learning how to hold bottle for his survival, got opportunity to take care of 84-years old lady who has to call for a nurse even for a sip of water. I did hear a story of a veteran who served for the country. Today someone is serving for him and he feels embarrassed about the situation and really thankful for the nurses and staff for the great care. I took care of a pleasant gentleman who heard the news that he is free from cancer after part of his organ was removed. On top of all that I took care of a patient who got diagnosed with cancer which is not curable and there is nothing in this world that could make him happy today. 

       At the end of the day I questioned myself what kind of nurse I am. Today I had a surgical patient, medical patient, I had an ortho patient and surely I had a pediatric. I am a pediatric nurse but I get chance to take care of wide range of population which is the beauty of a small hospital. Although management and administration try to allocate specific area for the patients, sometimes it's not possible and floor nurse end up having fun with gathering lots of experience. At the end of the day, it does not matter where you work and whom you take care of, it matters how much you affected the life of that specific person with your good deed. 

      To all nurses anywhere in the world... love what you do, try to make a space on each and every person's heart and care like your family member, you never know when your grandmother might end up next door. 

I love being a Nurse....

I took care of 82 years old today, after working in surgical floor for a month two things I have learned is get SCDs and IS for a patient, since she had hard time using IS, I decided to ask her to do deep cough and breathing every time I enter the room, I realized, it went little extreme when my patient started coughing every time when she saw me even while I was walking down the hall. I admit sometime we do torture the patient unintentionally although it is good for them.......I love being a nurse......

Tips for NCLEX test

Here are some tips for NCLEX test for the process and for the exam itself

1) Decision Tree
Decision Tree

2) Test Taking Strategies for Nursing Students by Caralee Bromme'RN, MSN CCRN 
Test Taking Strategies for NCLEX 

3) Official website about NCLEX with detail information 
Make sure you go through every little bit of information you can find in this website especially tips for Before, During and After the examination 

4) National Council of State Board of Nursing 
If you want to learn more about NCLEX examination as a whole follow the link below 
 NCSBN  

Please Enjoy and I will keep posting, if you feel like I need to add something more let me know thank you.

NCLEX Decision Tree (Similar to Kaplan)

After a long wait and search, I am able to find the decision tree here in internet. This decision tree is almost similar to Kaplan Decision tree. It was very helpful for me. Mostly it is important to those who knows the content but unable to choose the right answer. Helps for critical thinking.

More NCLEX RN Practice questions: Free NCLEX RN Practice questions
Derived from: http://www.slideshare.net/rebeccabowman2/decision-tree-25818301?from_search=11

Top Patient Safety Strategies to implement now

Nowadays I am more interested in quality improvement in medical settings, which includes, nursing, medical, pharmaceutical and so on. Here is the great article that I found while going through Medscape.com. It is short and precise slideshow presented by Laura A. Stokowski, RN, MS. Please click the link below

Top Patient Safety Strategies to implement now

 References:
Picture: Derived from, http://www.medscape.com/features/slideshow/patient-safety, November 30, 2013, Stokowski, Laura A.

Made my day.....

At the end of the shift, 86 years old cute little lady asked me, " are you going to be here tomorrow, I have to leave hospital for whole afternoon tomorrow, if you are going to be here I can leave him alone,(pointing her 90 yrs old husband, who are married for good 64 years) I know you will take a good care of him, I trust you" made my day.......

Site for NCLEX 3500 is working now

Site for NCLEX 3500 was down for a while, it is working now. Here is the link
NCLEX 3500
best of luck
More NCLEX RN practice questions: Free NCLEX RN practice questions

Pearsonvue Trick for NCLEX

Just done with your NCLEX test ? Worried about the results?, I will not pay extra money to know the result, here the trick that it is almost accurate.

Try to re-register at Pearson-vue website, if you get the message 'our records indicate that you have recently scheduled this exam. please contact your member board for further assistance. another registration cannot be made at this time. That means you passed. if you do not get message and go straight to the credit card information page, that means you did not pass.

I tried it when I tested for NCLEX and it worked, it's working for almost everyone who is giving test this year.

Good luck and have a great carrier in Nursing.

For free NCLEX practice questions follow the link you can find thounds of practice questions for free including HURST and Kaplan resources. Enjoy
Free NCLEX practice questions

Rookie Co-worker of the year.... way to go

Achievement in Nursing carrer

Picture speaks itself....

ACLS is Down

It's a relief after ACLS class, it's down and Smita Sharma is ACLS certified now, another step for nursing career. Still waiting for new classes and new challenge. From now I can run a code isn't it interesting and scary. Let's hope I can do it with confident in real world.

This is what a Nurse can do

All my complaints and tiresome day turned into a great day after one of my patient thanked me for all my care and patience with his tears on his eyes, I made a man cry with my good deed.... this is what a Nurse can do............

I am PALS certified

Another step for nursing carrer, I am PALS certified from American Heart Association. 

PALS: Pediatric Advanced Life Support, it is an advanced course for responding emergency situations among infant and pediatric population. Total hours of class including test was 8 hours, but it was worth worthy. During course hours you will get detailed information about CPR and AED. CPR administration by 1 rescuer and 2 rescuer, and also you will get chance to go through respiratory distress, respiratory failure, various kind of shock, and cardiac dis-rhythmia. Also teaches you detailed information about assessment, intervention and evaluation during the crisis. You will also get information how to lead a crisis or a code.
I found it as a helpful course. For more information go to American Heart Association.

Failure is not End of the World.

It had been while that I had not updated my Facebook status. Just to know how active I was in Facebook, I login my profile and went through my recent activity from last 3 months. I had updated my status for four times and quite few comments to my friend. I was not active in facebook and along with that I was out of contact with most of my friends. That means I was technically hibernating. I was trying to be out of reach with my friends, I don't remember I had called any of my friends in last three months just to talk with them and said any of my story. Some of those days I did realized that there was something wrong but was not able to realize what was that. I was into myself, I was just thinking about myself. I didn't passed my RN test for the first time, and turned my family and my love down. I was ashamed and not even able to trust myself for few of those days. But, all those unconditional love that my parents,my family, my husband and my co-workers gave to me encouraged me to think forward. I was able to think positive,I was able to focus on my study again. I learned the lesson that failure is not the end of world, it is an opportunity for you to learn something new, it is an lesson that teaches you how to handle your stress and how to prepare for the worst. Thank you so much all for continuous love and support. You all deserved for this day. Hence here is the day, day have came. I trusted on myself for the second time too, hence I was prepared for the second time, I was prepared for the best and worst. Today my parents can proudly say that their daughter is an RN, my husband can proudly say that his wife is RN. After all those childhood memories and stories, all those lonely days in school dorm, all those nursing classes, up and downs during school years, stressful moments in front of books and computer,had been fruitful today. Hence, just want to say all those who have failed for any time, please don't loose your trust, don't ever give up we all can do it, it does not matter how you did it, it only matter you can do it. So trust on yourself and trust on GOD, God will never let you down and so does your friends and family.

Kaplan vs Hurst NCLEX review course

Two most popular review course for NCLEX here in United States are Kaplan Review course and Hurst Review course. Most of the nursing graduates are confused to decide which course to take. I passed my NCLEX in the second attempt. I took my first course from Hurst and second from Kaplan (Both online). I found both of the courses different in their own way. Here are the differences that I found between Kaplan and Hurst.

1) The video lectures of the Hurst review are very detailed and the instructor is very energetic. It is very easy to follow the lecture. However, if you are confident enough that you know the materials, K will be the great source for revision since their course teach you how to read the questions and how to answer.

2) Decision tree provided by Kaplan is most important part of Kaplan review, I loved it and used decision tree for answering each and every questions while practicing questions and also while taking examination for board.

3)Kaplan has detailed and too much information while Hurst has specific and concise information sometimes feels limited.

4) Kaplan teaches about critical thinking while I did not find in Hurst review, keep in mind that although critical thinking is necessary for test it is more important in real world.

5) Price: I can understand most of you are thinking about cost. Kaplan is little expensive than Hurst, my suggestion is choose the one that fits for you, price is worth it in both cases.

Since I passed my NCLEX after taking Kaplan review course I will give 100% for Kaplan and 95% for Hurst. I felt Hurst review needs to include more information about critical thinking. To decide the right one it's your own call but be confident and give your test you will do great. Make the plans before hand, I would say at least 2 months. And ya NCLEX is very very very, did I emphasize enough, different than exit exam.

Most important tip I can give is don't be over-confident, trust in yourself and get enough rest before test day. Here are the links for the both courses site.

Hurst Review
Kaplan Review

Free NCLEX RN Practice Questions

Hello,
Friends here are some great websites for NCLEX questions Practice.

Kaplan's original video about the exam
Before going through the list below you might want to go through the video in the following link. This site is not the question bank site but it is a great video that I found yesterday.  This Kaplan video by Barbara Irwin, MSN, RN will be really helpful for you all. First video is overall about the NCLEX test and will help to decline your stress and fear, and will answers lots of questions that are arising in your mind about NCLEX exam itself.
Kaplan's Video about NCLEX test itself

Free NCLEX questions, total of 3 test 75 questions each cover all the topics.
Free NCLEX questions

Kaplan Style 45 question, enjoy short but very helpful question
4Tests

NCLEX 3500 (You can try 3500 NCLEX questions at once... or can make your own exam from 3500 questions bank)
NCLEX 3500 

PRACTICE QUIZ 
Practice Quiz (165 total questions) 
It is available in study mode and quiz mode learn how you want to learn.

NCLEX Trainer Questions 
 
Trainer 1
Trainer 2
Trainer 3
Trainer 4
Trainer 5
Trainer 6
Trainer 7 


(Above resources referred from nclex-reviewer.blogspot.com)

Decision Tree (Similar to Kaplan)
one of the most important resource that I had during my NCLEX preparation is decision tree, this is really helpful for those who knows the content but does not know how to answer the questions. Hope it will help you. 
 Decision tree


150 Free NCLEX questions with some rationale from ProProfs Web school. 
 ProProfs 150 free NCLEX questions with Rationales

 Test ( Kaplan's more test questions)
 4 test
 
Some more Questions 
This site have total of 18 practice exam  
 RN- Pedia 

Most Popular Courses for NCLEX preparation with Guaranteed positive results are
 Hurst Review
 Kaplan Review


NCLEX Masters
I found a new link for more practice questions, just follow the link and download the PDF file it has 150 free NCLEX questions with answers and strategy. I tried it before I posted and it works.
NCLEX- Masters

NCLEX RN notes:
Great book with detailed information total of 281 pages, but it has great information, no questions though
NCLEX RN notes

NCLEX practice questions from nurselab.com
Please follow the below link for multiple practice questions, you will find great questions with various practice tests. Enjoy
Nurse-lab, free NCLEX practice questions

Kaplan's Free RN Prep Seminars and Classes.
NCLEX RN Prep

Good luck

Why they have curtain in between the patients in hospital......

Privacy, is one of the best reason behind the curtain between the patients in hospital. Although two patients are in the same room during their hospital stay they could never see each other. While I was in duty yesterday I was thinking why don't they open the curtain between the patients when they are not doing any procedures. Although, people do not have same life, same history they could be a great friends even when they are in hospital. Talking with each other can help patient to express their feelings, their anxiety and help to relief their pain and have quality of time without thinking their recent health problems.

I cured for two patients in hospital today, both were old age female, admitted to hospital one day apart and for sure they will be together in the room for a while, unless they get critically ill.Both of them were admitted to unit due their fall. I was thinking they could be a good friends at least when they are in hospital. But, I never saw that curtain opened for them and for sure that will not open. Both of them will wonder and think about each other when they are there.

Why we do this, I think we are applying more precautions than we are supposed to be, not only the psych patients need support group, activities and relation building every patient in hospital need it. Although they are sick they want to live their normal life. they need someone to talk with although they are in hospital. I can dream the day when there will not be curtain hanging on between two patients unless there is privacy involved.

thank you