by Fidelindo Lim, M.A., R.N. Minority Nurse Writer
Nursing education is about immersion—jumping into the clinical environment head first, ready to get messy. Of course, it's interspersed with APA papers, seminars, evidence-based projects, and care plans. But students learn by watching, practicing, and emulating what they see senior nurses and faculty do in real life. Students don't learn by critical thinking alone, but by repeating skills at the bedside.
Today's nursing students are voracious learners, but sometimes their clinical exposure is limited. This gap in hands on experience may be due to poor program design or just an absence of clear, focused clinical opportunities. To combat some deficiencies in hands on training, I have come up with some straightforward, no-nonsense, and candid practice hints to guide student nurses. Students can try these tips independently or in collaboration with their peers. The aim is to improve skills and productivity while synchronizing what is learned in labs and lectures.
What the heel?
You'll have a pressure ulcer to contend with if you don't get your patient's heels off the mattress! Bed-bound patients frequently develop ulcers on the least assessed area of the body, the heels. Let the heels hang freely; use a pillow and other soft materials to prop them up.
Tie, stick, date, tape
You could save yourself, not to mention your patients, a lot of IV re-insertions if you anchor IV sites with a generous helping of tape—without compromising the skin. Labeling and dating IVs make changing the lines in a timely fashion much easier too.
According to a report reviewing the relationship between skin hygiene and infection, bacterial counts are at least as high or higher after bathing or showering with a regular soap than before.1 Imagine what happens when washing a patient with just one basin of water! Does this mean you should skip bed baths? No. But you should change the bath water and your gloves often. You can also prevent bacterial gestation by storing dry basins upside down and making sure there are no collections of water lying around the bedside .2
Saved by Vaseline
Nurses inevitably deal with incontinent patients, and with incontinence comes unfortunate messes. Luckily, you can protect sensitive areas, and keep bowel incontinence from sticking to patients' skin, with Vaseline or Vitamin A&D ointment. No prescription needed, and they're inexpensive.
In the appropriate context, humor can be the balm that soothes a patient's pain, in mind and maybe even body. I recall a time when a patient asked for meds for a headache, but he couldn't take acetaminophen due to liver issues, and ibuprofen upset his stomach. He was NPO and IV painkillers would be overkill. I said, "How about if I just put a cool washcloth on your forehead, hold your hand, and sing you a song?" He laughed—always a good sign.
One day I admitted a patient to a two-bed room. While wheeling her in, I asked with the self-assured demeanor of a senior flight attendant, "Would you like a window or an aisle seat?" She laughed and said, "I suppose no smoking in the lavatories?" A fine rapport was soon established between us.
What's a glove got to do with it?
Gloves, like shoes, work better when you are wearing the correct size. To prevent accidents, use only proper-fitting gloves. Get some boxes in your size and put them in your patients' rooms at the beginning of your shift. Keep in mind that some synthetic materials break easily, so change your gloves often when bathing patients, during general clean up, and doing other "high-tear" work.
Ask any veteran nurse how he or she gets through a seemingly insurmountable pile of work and most will credit the support of a helpful staff. Be generous with your time and talent. Help busy co-workers when you can, and be humble enough to accept assistance when you need it too.
Have you ever considered what goes to waste when nurses and other health care professionals hoard supplies at patients' bedsides? When patients leave, housekeepers discard many of the supplies left in their rooms, often still clean and re-usable. Try to take only what you need and return unused supplies. Plus, a de-cluttered room will facilitate healing. There's no searching through piles, and the room feels more open and clean.
Grey's Anatomy, ER, and Scrubs
If you want to improve your clinical knowledge, don't do it parked in front of your television! Hospital-themed shows may be entertaining, but they're generally a far cry from the real thing. But you do need to keep abreast of health science news; it's a crucial part of staying on top of your professional game.
Read peer-reviewed journals, both the general and those particular to your specialty, if you have one. The New York Times' Science Times on Tuesdays is also a good source of information you can use with patient or family teaching. Read, read, read. Attend conferences. And never stop learning.
Speed up, slow down
At the start of your nursing career, there will be times when you feel slow, disorganized, and perhaps lost. Try not to be flustered in these moments, and remember you are not alone. Eventually, you will develop your own system, the motions will become second nature, and one day you will look back and marvel at the nurse you have become. Learn from your preceptors and ask plenty of questions.
Separation from aspiration
I do this exercise with my students: slouch on a chair, put your head back, and try to swallow. Then, bring your chin to your chest and try to swallow again. In both positions, you will find it difficult to swallow. Feeding patients with their heads in such positions could potentially cause aspiration. Keep your patients upright (30 degrees) in bed during meals or tube feeding at all times, unless contraindicated. You'll avoid aspiration, pneumonia, and more importantly, choking.
Get out of bed
Unless contraindicated, move your patient from the bed to a chair for a sitting period; even small movements can be beneficial to otherwise immobile patients.
Make time for yourself
For your own health and well-being, remember there is more to life than work. Make the most of your days off, and try to get out of your house or apartment. Enjoy your free time, cultivate a hobby, and avoid talking about work when you are not at work.
To last in this life-saving enterprise called nursing, you need colleagues and nurse educators who are generous with their time, expertise, and practical advice. In turn, you need to be willing to ask for and accept their wisdom and guidance.
During my orientation, so many years ago, my preceptor told me to "put the patient on room air." I was too shy to ask what "room air" was. I just assumed it was stored somewhere, like a canister of helium. So I went to the supply room to search for it. It took 20 minutes for me to muster the courage to ask where I could find "room air." I was flushed with embarrassment, but it instantly created a running gag amongst my peers.
The experience taught me two things. First, there's a difference between critical thinking and over-thinking, and the latter is not only impractical, but can even be dangerous. Second, don't be afraid to ask questions; you will find they are the simplest way to learn.
Larson, E. (2001). “Hygiene of the skin: When is clean too clean?” Emerging Infectious Diseases, 7(2), 225-228.
Johnson D., Lineweaver, L. & Maze, L. (2009). “Patients’ bath basins as potential sources of infection: A multicenter sampling study.” American Journal of Critical Care, 18(1), 31-38.