Medical Training

Have you ever wondered what a patient’s story is prior to admission to a health care facility?  I’ll never forget that question that was asked many years ago by my nursing instructor.  Today I teach LVN students at Gurnick Academy of Medical Arts and encourage them to be curious and find out more than just their patients’ diagnosis and vital data.  Fortunately there is already a program, called My Story, which offers steps in finding out about who the patient really is beyond their room number.  In 2003, Michael Dann became the inspiration to his wife Doreen for starting this program.  After a motor vehicle accident, Michael became just another “John Doe” comatose patient in a trauma unit.

During those last 8 days of life, Doreen Dann, C.O.O. of St. Jude Medical Center in Fullerton, California, created a life-serving tool to bring connection between Michael and his caregivers. The My Story brochure includes questions about the patient’s support system and what they enjoy, such as their favorite pets, hobbies, movies, music, and food.  Depending upon each facility’s policy, these valuable brochures may be filled-out by nurses, volunteers, family, patients, and student nurses. After the brochure is filled-out it is then posted up in the patient’s room, which allows each caregiver, including LVN/LPN students to easily read about their patient prior to administering care.  A DVD is also provided for the caregivers to understand the purpose and story behind the My Story program.

In the DVD Doreen Dann shares her view about how there is healing power in the life story itself.  She explains that when we are able to connect to the life essence, then we can truly become a partner with each other.  With this healing intent, it is no surprise that this program has a history of not only being beneficial to the patient, but also to the caregivers.  For those who enroll in a LVN/LPN program they usually are filled with excitement about their new career.  To keep this spark of enthusiasm, it is important to utilize tools, such as My Story to continue their nursing education even after graduating from a LVN/LPN school.

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.

Parts of the LVN clinical training in Module 4 is that LPN licensed practical nursing students are scheduled to participate in various field trips throughout the Bay Area.  There are scheduled field trips to HeadStart, Martin Luther King, Jr. Preschool, Lynn Center, California Medical Facility in Vacaville, John Muir Medical Center and Sonoma Developmental Center.  These scheduled field trips during LVN courses are done to enhance the knowledge and experience of our students and thus better prepare them to be the best nurses they can be.  One of our field trips for Group 11 was to go to the Napa Coroner’s Office to observe an autopsy.

On July 16th Group 11 drove to the Napa Valley eager to have a life altering experience.  Students were anxious with cold, sweaty palms but also excited to experience the unknown.  We were welcomed by the Deputy Sheriff who gave us a nice tour of the facility and told us that there were two autopsies scheduled for that morning: a 25 year-old male and a 58 year-old female.  The Deputy Sheriff was explained that these two cases will be good experience for the students, as they will be able to see a variety of cases in one day.  We were briefed by the Deputy Sheriff as to what to expect and what was expected of us, but nothing could really prepare us for what we saw.

Our Clinical Coordinator, Nancye Maffei, handed out the Personal Protective Equipment (PPE) and instructed us to put it on.   As we put it on, we began to wonder why we needed this level of protection to observe an autopsy.  Nancye told us that during previous autopsies the pathologist allowed students to touch and hold human organs.  Experience from previous classes also taught us that there is the risk of exposure to clothing and skin.

We were told if we could not stand the smell or being that close to a dead body we could always stand behind the glass window in the other room.  As we were guided inside the coroner’s laboratory you could feel the cool breeze and the absolute absence of noise.  As the metal gurney was wheeled in with a closed body bag, reality started to kick in.  When the pathologist opened the zipper of the body bag we could feel the anxious, tense feelings of the students in the room.

The Pathologist (as well as all of the staff) was very accommodating to the Gurnick Academy of Medical Arts LVN students.  As he proceeded the pathologist told us exactly what he was doing.  The experience was very overwhelming to the students but it definitely taught them a lot about human anatomy and physiology.  For most LVN students it was the first time they had seen a human brain, heart, lungs, larynx, stomach, kidney, liver, thyroid, spleen and other organs.  It was an experience we will remember.

A major area in nursing is addressing wellness for both the physical and mental health of patients.  Unfortunately attending to one’s mental health can be very challenging not only the patient, but also for the LVN/LPN.  Fortunately nurses, patients, and their family have a resource called the National Alliance on Mental Illness (NAMI), which addresses mental health, and has expanded by promoting health for the whole person with mental illness.NAMI has a Wellness Center at their National Convention that promotes healthy living.

The Wellness Center offers activities, advice and information including topics such as: medications, nutrition, blood pressure, smoking cessation, and dental hygiene. According to the NAMI website at www.nami.org, many people with mental illness have challenges with their teeth. Other than dental health professionals, most medical courses, such as the objectives in a LPN program are not required to have extensive dental training.  Knowing the need for further dental health education, Lisa Knapp Stillman and her sister started the Dental Voice for Mental Health.

Since 2008 Lisa and her sister represent their project with a booth at the NAMI convention’s Wellness Center. Lisa, who is both a dental hygienist and a mother of a son with severe mental illness, knows first hand how the medications that treat mental illness can deteriorate teeth.  In The Dental Voice for Mental Health in the summer 2010 issue of NAMI Voice, Stillman states that there are over 700 medications that can cause the side effect, xerostomia (dry-mouth).

At the first meeting on the clinical site the instructor will review with you what to expect during clinical time.  I happen to know the Antioch staff is wonderful.  You will get a lot of great experience during this rotation.   The staff there has many strengths and is always helpful.  They show compassion, integrity, and teamwork.  We will be doing hands on patient care.  I love clinical nursing.  To me, being at the bedside and working with the patients is the most rewarding.  To be a good LVN clinical nurse (or LPN Licensed Practical Nurse) you have to be multi-talented.  You have you learn the best approach for each of your patients as they all have different personalities and needs.  You’ll learn about different cultures, values, and beliefs, which can be very exciting.  For example, you’re likely to encounter different languages, lifestyles, and social roles.  You will be doing patient assessments daily.  We will be reviewing clinical LVN skills (and LPN nursing) in the lab at Gurnick.  The students usually love this.  This is a great time to ask me any questions you may have.  Yes, you are to be dressed in scrubs with your hair up and ready to take notes.

Have you heard about first lady Michelle Obama’s campaign Let’s Move to solve the epidemic of childhood obesity within a generation?  The Let’s Move website states, “…only a third of high school students get the recommended levels of physical activity.” According to the Centers for Disease and Prevention, “Aerobic activity should make up most of your child’s 60 or more minutes of physical activity each day. This can include either moderate-intensity aerobic activity, such as brisk walking, or vigorous-intensity activity, such as running [at least 3 times per week].”  One of the ways to make exercise a part of your life at any age is to sign up for the Active Lifestyle Program.

This program site is located at www.presidentschallenge.org and is a part of the President’s Council on Fitness, Sports and Nutrition (PCFSN). The PCFSN’s mission is to engage, educate and empower all Americans across the lifespan to adopt a healthy lifestyle that includes both regular physical activity and good nutrition.  The Active Lifestyle Program can be a helpful tool for nurses, especially since the LVN / LPN already assists with setting realistic goals and encouraging fitness in their patient’s lifestyle plan.

Nursing students learn about the importance of movement at any age, including the curriculum taught in LPN programs.  Nursing schools, such as a LPN school addresses the concerns for physical movement with their patients to facilitate the body to heal and prevent further complications, such as blood clots and respiratory infections.  Check out www.letsmove.gov for more information about the importance of exercise and how to promote exercise toward a healthier life.

Surely you have read ads from people wanting to find the best caretaker for their loved one, but have you ever seen an ad requesting a caretaker for a nurse?  During a recent bout of food poisoning I found myself asking, “Who would I call if I needed a caretaker?”  Fortunately my husband was there to assist me until he realized that maybe it was time to call 911.  In my delirium I pleaded to “tough it out” at home.  Looking back I realize that just because I have the title of a nurse doesn’t mean I can always take care of myself or make wise decisions about my illness.

As the students in a LVN and LPN school train to become a LPN or LVN the focus is on the care of others more than self.  The LVN or LPN job requires that they be prepared for the ultimate “code.” When it comes to you as the nurse, prospective or attending nursing student, who would you call to make decisions about your care?  To prepare in advance, you can fill out a type of Advanced Directive, known as a Living Will or Health Care Directive.  For ease you can fill one out online at legacywriter.com, and make sure you check the current laws about these directives in the state you live in.

These directives pertain more to whether you want artificial life support and some other treatments when you are unable to make those decisions.  I recommend making your own “care plan of action” in advance that lists the people, who you both trust and have medical knowledge when you can not get a hold of your own healthcare provider.  These people might just be in your own neighborhood to assist you before you are on your death-bed.  For myself, I was able to remember my former neighbor’s name, who used to have her own medical practice.  She was able to give us much needed advice, which contributed to my fast recovery and a happy ending.

Nursing jobs relate to patient care in many ways, including care for people who are disabled, convalescent, sick or injured.LPN’s, like all nurses, work with patients who may be anxious, so an effective nurse usually has an empathetic , caring attitude.  According to the Bureau of Labor Statistics, an LPN needs to have an even temperament so that he or she can stay calm in stressful situations.  In addition, LPN’s must be observant and have strong communication and decision making skills.If you are considering a career in nursing, but you wish you could be working right now?  Training to be a licensed practical nurse is the closest you can get and still be a nurse.  Most LPN training programs take 1 to 2 years to complete.   After that, you take a national licensing exam and get a license in your state.  You are then ready to get a job as a real nurse.

LPN’s are the most hands on nurses.  They work closely with patients, implementing plans the doctors and registered nurses have made.  LPN’s carry out orders, but will also watch their patients closely, and write down and report everything about their patients condition.  It is the is the licensed practical nurse who bathes the patient, changes their surgical dressings, help thme to the bathroom, and help feed them if needed, as well as making sure oxygen therapy is working and intravenous lines are running.  They have been called “angels in confortable shoes.”