Medical Training

Everyone probably has heard of Q Tips cotton swabs and their versatile uses from applying and removing makeup, painting, and household cleaning.  The LVN/LPN uses an elongated version of this short household tool for cleaning around the infant’s umbilical cord, wound care, and if needed, come in sterile packages.  Today the acronym Q-TIP can serve the purpose of stress management by redirecting our attention away from stress-filled thoughts.  Every time a nurse uses a cotton-tipped applicator, they can be reminded of the meaning of Q-TIP, which stands for “Quit Taking It Personally.”

These four simple letters can buy the nurse or nursing student the time to make choices on how to respond before they are automatically in a state of reaction to perceived stress.  As the student nurse in a LVN/LPN program takes on more and more responsibility at their clinical sites, it isn’t easy to just let things go, especially when their patient’s condition worsened or their patient’s family vented their anger.  To maintain a caring attitude from the role of student to licensed nurse, it is important to have tools that can quickly get them back on track.  Jill Hare in her TheApple article Five Ways to Quit Taking it Personally” reminds us that “The bad moods of others are more about them than they are about you.” Even though Jill’s article is focused on how teachers can build their confidence without taking on the actions of their students, her tools are very appropriate to improving the nurse/patient relationship.

Hare points that in some careers, such as teachering, they tend to think too much about something and try to fill-in the blanks with words or tone that can magnify our stress-response.  Her solution to this over-active mind is to “Take things at face value. If you don’t understand the point someone is trying to make, ask for clarification. Don’t assume anything.” Kelly Bryson, MFT, Certified Nonviolent Communication Trainer states the following about how to apply Stan Dale’s Q-Tip acronym in his book Don’t Be Nice, Be Real,  “People are never angry or upset with us; they are distressed about an unfulfilled need of their won. I may be the detonator but I am never the dynamite.”  In other words, there is a difference between acknowledging that we can be a trigger to someone’s stress without being the cause.  Nursing students have plenty of opportunities in both the clinical site and the LVN/LPN school to follow the advice from these authors such as Jill Hare who states, “More likely than not, the behavior [of others] is not stemming from something you’ve done, so don’t blame yourself.”

Learning a skill, such as how to take vital signs including blood pressure, temperature, and heart rate, is just one part to the completion of a nursing task.  The other part of completing a nursing skill is to become competent in communication.  As a LVN instructor at Gurnick Academy of Medical Arts, my students are given the opportunity to practice on mannequins and their classmates prior to working with patients at their assigned clinical site.  When working with their classmate I have them both obtain vital signs from an agreeable classmate, and then attempt to complete the same skill with their classmate saying “no” to having their vital signs taken.  As you can probably guess, this classroom scenario quickly leads into a valuable lesson in communication.  Communication can be so simple until the patient replies with the dreaded, “No!”  Since some of our students have been or are parents, they are all too familiar with hearing the word “no” from their children.

As with parenting, a LVN/LPN has the choice to make a request sound like a request, instead of a demand.  The challenge in making requests usually lies in neglecting to connect with the patient to inquire if the patient is hearing the nurse’s requests as a demand.  Marshall Rosenberg, PhD, founder of Nonviolent Communication (NVC) and author of Nonviolent Communication: A Language of Compassion, says the following about hearing someone’s “no” word, “Because of our tendency to read rejection into someone else’s, “no” and “I don’t want to…,” these are important messages for us to be able to empathize with.  If we take them personally, we may feel hurt without understanding what’s actually going on within the other person.”

Rosenberg suggests an alternative to taking the patient’s negative words personally or getting stuck on their “don’t want to” phrases, is to instead hear and empathize with their unspoken, unmet needs.  Early on in the LVN/LPN program the student nurse learns about Abraham Maslow’s hierarchy of needs, which offers a foundation for advancing their communication skills.  In the clinical scenarios and setting, the student nurse is giving the opportunity to apply their theory knowledge by identifying the unmet needs of their patient.  Even though LVN/LPN schools allow for time to practice these skills, the student is responsible to continue practicing these communication skills at home, which will only improve their chances in becoming hired and more competent in a LVN/LPN job.

Eating out at a taco shop can seem mundane until you notice that someone sitting next to you begins to choke and turn blue.  For the lay person without medical training from a LVN/LPN program, the thought of someone choking can be frightening.  One of the many benefits about becoming a LVN/LPN is that all LVN/LPN students must be trained in Cardiopulmonary Resuscitation (CPR).  In addition, healthcare facilities usually require nurses to be recertified in CPR every 2 years to be updated on the latest resuscitation methods.  Just in the last 3 years the amount of chest compressions has increased in ratio to the breaths. Some LVN/LPN schools, such as Gurnick Academy of Medical arts offers CPR training onsite for their nursing students.  Not all CPR courses are the same.  When taking a CPR course find out which CPR guidelines are taught in their program.

To be safe look for CPR certification agencies that follow the recommendations of the American Red Cross and American Heart Association for both CPR and AED techniques.  Just imagine what would happen if in a hospital everyone involved in a “code” received different CPR guidelines; not only that but what if they did not stay current on the latest techniques. Becoming an effective LVN/LPN and working safely in a LVN/LPN job requires receiving the most current information.  This leads us to the next question,“Where does one attend a reputable CPR recertification classes?” It may be tempting to take an online course or a one-hour quick course, but how much will you learn and retain without actually having sufficient practice time doing CPR on mannequins?

Another consideration is to find out if you will be able to practice the Heimlich maneuver, use an automatic external defibrillator (AED), as well as practice CPR on different size mannequins to resemble the adult, child and infant. You might receive training in adult CPR and mistakenly think you are proficient in CPR until you come to the aid of an infant choking or drowning, which requires a different technique.  The BLS Healthcare Provider Course, which is designed to provide the LVN/LPN student and a wide variety of healthcare professionals the ability to provide CPR, use an AED, and relieve choking in a safe, timely and effective manner. Even if you are not yet a nurse, this course can also be taken by nonlicensed healthcare professionals, and can prepare you for a variety of life-threatening emergencies.

As my LVN students study and fill their mind with new facts and data, they are also being taught how to become more sensitive to their patient during the physical tasks of lifting & transferring patients from a bed to wheelchair and stretcher, as well as pushing wheelchairs and stretchers.  Inside the LVN/LPN schools skill lab the students practice these skills and more while using their classmate and mannequins to substitute as a patient. One of the skills to master is “breaking the patient’s fall.”  The word “break” may sound as if they are breaking their own back to protect the patient, but rest assure that this is a safe technique that the students learn to allow their patient to slide down the student nurse’s leg to the floor, instead of a fatal fall to the floor.

The LVN Nursing students have both clinical instructor and their illustrated textbook with detailed steps to guide them down the safe path.  Along with practicing these steps, they themselves get to experience being a patient who is dependent upon someone else for transferring from one place to another.  Instead of choosing when and having the ability to jump out of bed, sit on a toilet, and freely ambulate down the hallway, the students sit in wheelchair waiting for another student nurse to push them through the handicapped-bathroom doorway and then transfer them onto the toilet.  Don’t worry, even though we want our nursing students to experience being a hospital patient the students keep their clothes on.

Soon after a student nurse experienced being a patient in a wheelchair she stated, “It’s the little things that matter.” She was referring to her classmate’s attentiveness to her as he pushed her in a wheelchair outside and avoided the hot sun, kept an even pace, and not once jeopardized injury to her limbs.  This was her positive experience after she had pushed him around in the wheelchair.  Another example of how valuable being the patient is to learning a skill is when students take turns being lifted/transferred from one hospital bed to another.  I can always tell who has never experienced being the patient before, as their eyes get big and sometimes even let out a scream as they are temporarily air-born during their transfer from one bed to another.  These valuable lessons that heighten one’s awareness require first-hand experience as they cannot be fully taught by a textbook or lecture alone.  Hopefully memories of being the “patient” will carry over to their LVN/LPN job to remind them of the importance of being sensitive to their patient.

Years ago when I became a LVN, I was pleasantly surprised to know that nutrition was one of the required courses to become a LVN/LPN.  Fortunately nutrition is still being taught in LVN/LPN schools with a minimum requirement of 32 theory hours in California.  The significance of good nutrition and health was even conveyed back in the days of Hippocrates (460-370 BC) who was the father of medicine known to say, “Let thy food be thy medicine, and thy medicine be thy food.” Today LVN/LPN students learn about the basic principles of nutrition to create a foundation for learning about the functions of protein, carbohydrates, fats and water.

With this knowledge the LVN/LPN may be the first one to notice that their patient is not eating adequate amounts of protein, which is essential for their patient’s wounds to heal and tissue to grow.  In addition, carbohydrates, such as glucose is essential for the brain to function, as this is the brain’s fuel.  Patients are sometimes not permitted to eat food prior to diagnostic tests and surgery.   This time of fasting can be very dangerous when the lack of food disrupts the blood sugar level and nutrients.  A patient may become disoriented and confused by having their diet withheld too long.  Fortunately for the patient, the nurse acts as a detective by keeping an eye out for all contributing factors that can be managed to prevent further problems with their patient.  Nutritional needs not only vary with different diagnosis, but also throughout the lifespan.

If you have ever been a patient in a hospital, you might have asked where are the male nurses?  You also may be surprised to know that the career for paid nurses started not with female, but with male nurses, and the first nursing school, which opened in India during 250 BC, only accepted male nursing students.  During the era of Hippocrates (460-370 BC), who was the father medicine, nursing care was delivered by men.  In the December 2009 article 10 Most Famous Male Nurses in History posted on Nursetini, Walt Whitman (1819-1892) is listed as one of the 10 most famous male nurses.  Whitman is famous for being a writer and poet, but it turns out that after his brother was wounded in the American Civil War, Whitman devoted both time as a volunteer nurse and writings about the need for nursing care for the soldiers.

According to the Winter 2009 AHNA Beginnings article, “Why Aren’t There More Men in Nursing?” editor Lynne Nemeth states that the Reformation era (1550-1850), which was referred to by some as the dark ages of nursing, more women were becoming hospital nurses and medical care deteriorated allowing prisoners work as nurses “…in lieu of prison terms.”  With the Industrial Revolution, which took place in mid 17th and 18th centuries, men took advantage of higher paid jobs, which excluded low-paid nursing positions.  Nemeth refers to how “Ironically it is Florence Nightingale, considered to be the founder of modern nursing, who is credited with the demise of men in nursing.”

In 1867 Nightingale wrote about how she wanted the female head nurse to have the power over nursing and not the male nurse. Despite all the positive contributions to nursing, it wasn’t until 1955 when Edward L.T. Lyon became the first male nurse in the military. According to a 2005 Men in Nursing Study by Bernard Hodes Group, men only make up between 5-6 percent of registered nurses.  Fortunately there are both men and women working together to support and educate men into the career of nursing.  If you are presently in a LVN or LPN program and want to join a nursing organization that supports male nurses, the American Holistic Nurses Association (AHNA) has a history of supporting and honoring both male and female nurses.  In 2008, the AHNA named Richard Cowling, III, RN, PHD, APRN-BC, AHN-BC the Holistic Nurse of the Year. Unlike the AHNA, the American Nurses Association (ANA) did not allow men to become members until 1940.

Whether you are thinking about becoming a male LVN, LPN, or registered nurse, read about the many resources such as the free online Male Nurse Magazine at www.malenursemagazine.com. Today there are several LVN & LPN schools, such as Gurnick Academy of Medical Arts that encourage the presence of men in nursing, and have male faculty role models.

In June 2010 the American Holistic Nurses Association was blessed with having Jean Watson, PhD, RN, AHN-BC, FAAN as keynote speaker.  Mrs. Watson’s extensive biography includes her published theory of nursing “The philosophy and science of caring.”  Nursing theories are important for the student LVN or LPN to guide the way in development as a licensed nurse.  In the Spring 2010 AHNA Beginnings publication, Watson lists examples of how to implement the Caring Theory in her article Caring Science and the Next Decade of Holistic Healing: Transforming Self and System from the inside Out.  She states, “When systems begin to authentically embrace Caring Theory and its role in healing, and thus creating biogenic practices, the foundation for professional nursing shifts.

Within this article, she acknowledges the participants of International Caritas Consortium (ICC, www.cartiasconstortiu.org) for their efforts toward this nursing shift.  One of the simple examples that can be practiced not only by the ICC participants, but also in LPN schools and hospitals is hand washing.  Hand washing is not just used for cleaning our hands, but according to Watson this ritual can somehow “…energetically cleanse oneself…” which allows for “…pausing to set intention before entering a patient’s room.”

Another one of Watson’s simple, yet profound suggestions is to have magnets with positive affirmations and messages on patients’ doors.  This affirmative idea can be easily initiated by student nurses in any nursing program, including the LVN or LPN program.  One of the most intimate of Watson’s practices is to be “seeking” as we nurses look and connect to the “spirit-filled” person that might be hiding behind their diagnosis.   For more information about Jean Watson caring philosophy visit www.watsoncaringscience.org

The “dummy” is not so dumb when it is a high-fidelity simulator equipped with computer simulations and can respond as if it were a real patient.  As technology advances, so do clinical opportunities for students at Gurnick Academy of Medical Arts VN Program.  High-fidelity simulators include life-like and life-size mannequins that can be programmed to be both interactive and responsive to the student nurse’s care.  Simulated clinical scenarios provide not only a safe setting to teach students in  LVN / LPN schools how to perform different nursing tasks, but, surprisingly, are stimulating much more than critical thinking skills. Leighsa Sahroff, EdD, RN, NPP is the Coordinator of Simulation at Hunter College School of Nursing, City University of New York.  During a presentation entitled High Fidelity Simulators and Holistic Nursing Communication: 21st Century Technology meets Holistic Nursing Concepts, Sahroff offered examples of the unexpected lessons that student nurses are gleaning from the high-fidelity simulation process.

Instead of student nurses witnessing their first death experience in the hospital, they are afforded the opportunity to process their emotions within the simulation lab.  At times, there is so much happening at a real clinical site that the student misses certain cues, especially communication cues that are vital in both preventative care and in developing the nurse/patient caring-relationship.  The advantage of learning from simulated scenarios in an LPN program is that they can be repeated, video-taped, and slowed down to foster processing and awareness.

The learning possibilities are vast, especially in areas that stimulate student emotions around labor/delivery, fetal demise, pediatric illness, heart attack, seizure, anaphylactic shock, and psychiatric illness. By allowing students the freedom to make mistakes within the four walls of their school, where the simulated patient can recover from anything by the flip of a switch,  students can learn how do deal with real-life situations and, at the same time, explore their own strengths and weaknesses without any harm to a real patient.n