Monthly Archives: June 2011

Study Skills: Reading & Note-taking

For incoming freshman/first year students, talking about how to take notes may seem humdrum. “Write down what the teacher says!” is the mentality many high school students seem to have. That is the problem with a lot of incoming freshman – they have not developed that mindset of concepts & critical thinking, a skill that many professors expect you to have. To fill this gap, instructors & mentors have taken the initiative to teach these skills & provide the resources to help newly admitted students succeed, develop the mentality of a studious college student in hopes of achieving their main goal of attending college – to be well educated & graduate with a degree so you can go out into the workplace & pursue your endeavors. It all starts with basics.

There are 6 main points to remember when refining your skills in note-taking. Yes, you know how to read & write & that is fantastic, but what use is the knowledge when you can’t apply it in real life? As students you need to be able to take the information, jot it down for reference in an organized fashion, review it in a timely manner & be able to analyze that information for an exam or project. Here are the basics for effective note-taking:

I. Stay organized. It may seem obvious but your notes can only help if you can find them!

  • Keep your notes in once place
  • Date & number pages; keeping them in order helps make it easier to recall material
  • Before the semester begins, review the syllabus your professor provides for you. Organize a binder or folder according to the number of exams & additional assignments for that semester.
  • Assign a color to the content based on what exam they fall under. For example, you can assign an orange highlighter for exam I, blue highlighter for exam II, etc. Or you may assign a color based on the classification of material – pink for vocabulary, yellow for general facts, green for references to figures, etc

II. Scan the required text & review any material BEFORE class to get a general idea. Write down any questions you may have.

    • A highlighter is a great tool to point out important information in your textbook, but do not overdo it! If you are highlighting every other word in a paragraph, drop the highlight & back away.

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III. During class, set up a format to help organize the way you take notes. One great method is the Cornell Note-taking Method.

  • Divide your paper into 3 sections – 2 inches from the left; 6.5 inches on the right & 3 inches from the bottom like below. The main section will be where you will record your notes during lecture. The left column will be a section for main points, important information as determined by your teacher, any references to textbook material & potential test questions.

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  • Set up any main points as a header. You may choose to assign a symbol to denote that piece of information as a header (like a Roman numeral or letter). Assign another type of symbol for subtopics & indent a space below the main header. This way, you have a coherent flow of notes without any run-on ideas that may confuse you.
  • Remember to write the main points & embellish them with additional information from the book or associated material. Note any vocabulary words, formulas, facts, etc. Write down a page number or figure number next to key points to use as reference.

Here’s an example of well-constructed notes:

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  • An alternate method is the Concept Map Method. This format centers thoughts & concepts around a central main topic & visualizes links & relationships between the information.
    1) Write down your main point or topic
    2) Divide that main topic intro 3 or more concepts as they would relate to each other
    3) Specify important tidbits of information linking back to the concepts & main topic. Write down textbook pages or slides as references.

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IV. Studies has shown that students forget nearly 80% of lecture material within 24 hours. So it would be wise to review your notes within the next 24 hours post-lecture.

  • Ask questions! Clear up any doubtful material. Get into the habit of getting to know your professors. The more they see you are willing to learn, the more they may be able to help you. After reviewing, write down main points, potential test questions on the left hand column of your notes. At the bottom, summarize your notes & write down any questions/thoughts you may have.
  • Set up a schedule of review a week before the exam. DO NOT use this time to finally study the content. You need to be proactive & study the material as early as possible to save any burden later on. Try to overcome the habit of procrastination.

There are many other methods for note-taking: concept maps, mind maps, bullets, etc. Experiment which format works for you. Some formats may work well for some classes & some may not be practical for others.

Remember, these tidbits are not only reserved for freshman or first-year university students. Nursing students can most definitely benefit from adapting an effective reading and note taking strategy to help them progress through their courses.

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Care Plans

A care plan is an outline of the care that is expected to be provided to a patient based on their clinical picture. A well constructed care plan consists of the following:

  1. a holistic approach, taking into consideration psychosocial and socioeconomic concerns
  2. focuses on interventions to relieve or minimize a current health problem
  3. has mutually set goals and parameters that are SMART (Specific, Measurable, Action-oriented, Relevant, Time-bound)

NURSING DIAGNOSES
Nursing diagnoses are clinical judgments set based on a patient’s response to actual or potential health problems. The following is a typical set up of a nursing diagnosis:

(nursing diagnosis) related to (medical diagnosis or primary complaint) as evidence by (signs & symptoms)
Example: Acute pain R/T abdominal incision AEB grimacing, rating of pain 6/10.

The North American Nursing Diagnosis Association-International (NANDA-I) is the main organization for defining standard nursing diagnoses. It is important to note the different between a NURSING and a MEDICAL diagnosis.

A MEDICAL diagnosis focuses on the primary complaint, disease or illness.
A NURSING diagnosis focuses on the patient’s response to actual or potential health problems.

There are four types of nursing diagnoses as defined by NANDA-I:

  • Actual diagnosis – an existing health problem
  • Potential diagnosis – a “risk for” problem
  • Health promotion/Wellness diagnosis – readiness to enhance well-being and self health
  • Syndrome diagnosis – a cluster of nursing diagnoses that are better addressed together

In nursing school, take the time to construct these efficiently. These care plans are meant to train you to think like a nurse. What is the patient’s background? What is your plan of action? What are several nursing diagnoses you can associate with this patient? What is your priority intervention? All of these questions need to be answered once you begin your shift as an RN in the real world.

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Get organized!

Before you dive into the sea of information you will encounter your first semester, it may be helpful to organize yourself.

By that I mean seting up a binder with dividers for each of the courses you will be taking this semester. Every course should come with a syllabus & in that syllabus should be a general timeline of the content throughout the semester.

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Look for exam dates, clinical assignments & other important information.

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Label your dividers based on the number of exams you will have. For example, if you will be having 3 exams, label “Exam I”, “Exam II”, “Exam III”, etc. As you go progress through the semester, any notes you print out or write down will then go under the exam covering it.

Set aside other dividers/tabs for clinical assignments. You will be turning in a lot of them, more specifically Care Plans, Critical Thinking Journals, Evaluations & Teaching Projects. Print out the templates for the CTJs & Care Plans to serve as a reference.

It may also help to assign a particular highlighter color to content under a certain exam. For example, I like to use a blue highlighter for material under exam 1, green for exam 2 and so forth. This way, I’ll be able to retrieve whatever information I need from past exams for a comprehensive final or other purpose.

Set yourself up for success! Maintaining an organized layout of notes & assignments may help to prevent any additional stress later in the semester. With exams & clinicals, finding where your notes should not be an additional problem!

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Useful Apps. Should I spend $200?

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You may have heard word about the $200 smartphone app that was considered a requirement for the nursing program. It’s called Skyscape. I have that app & I actually do like it, using it for care plans & during clinicals to look up medications & interventions. It comes with several categories: IV medications, Med-Surg Nursing, Mosby’s Dx & Lab Test Reference, Mosby’s Nursing Drug Reference, Mosby’s Pocket Dictionary, MosbyLab, Nursing Dx Handbook, Outlines in Clinical Medicine & RxDrugs. However, there are other apps that were recommended to me that I found to be pretty helpful.

I. Medscape – Medscape offers a variety of functions including: drug referencing, drug interaction checker, diseases & conditions, procedures reference, tables/protocols, daily medical news, hospital directories & continuing medical education activites. This is my favorite of the free apps. It’s very comprehensive & I would say it is almost just as good as the Skyscape app. You are required to make an account to sign into the app.

II. WebMD – This goes along with the same network as Medscape. It provides tools such as Symptom Checker, Drugs, First Aid Essentials & Local Health Listings.

III. NCLEX – This is a great NCLEX-RN quiz card game to use during your free time. It comes with rationales & covers a variety of nursing topics from Basic Care to Management. This app is designed to help you pass the NCLEX. I would suggest getting this as a review once your first semester is over.

IV. VitalSource Bookshelf – This app is simply for storing your nursing textbook & read them on the go.

V. Micromedex Drug Information – I haven’t used this one much, I just downloaded it for the fun of it. It’s simply another drug reference. It covers generic vs trade names, dosages throughout the lifespan, contra/indications, ADEs, pregnancy categories, pharmacokinetics, etc.

VI. 3M Littmann SoundBuilder – This is a very fun, interactive app. I find it very useful for Assessment. It’s designed to help you refine your auscultation skills for key heart sounds. It covers normal vs abnormal heart sounds & goes into detail under each type of heart sounds.

VII. iPharmacy – This is another drug reference, but it includes actual pictures of the pills & packages of about 12,000 drugs. This is helpful for the visual type of person.

The best part about these? They’re free! Consider playing around with these before buying the Skycape app. I personally like it & have found it very useful, but for those trying to save on money, I feel these will be just as sufficient.

FYI: If you do buy the skyscape app, there will be some text/books from the package in there already: Mosby’s Dictionary, Nursing Diagnosis Handbook, 2011 Drug Reference & (later on) Lab & Dx Test Reference for J1/S1. So I would advise if you consider buying the app, do some research to purchase the other textbooks at lower costs (you’ll still need to buy the Evolve codes & Assessment lab manual). If you choose to buy the package, then forget the app & download the above free ones.

Health Assessment: The Basic Study Skills

Assessment is one of those universal, important skills that every nurse needs to be able to do. This course is very interactive to cover the variety of skills performed in a head-toe-assessment. In studying for this course:

  • link the signs & symptoms of certain disease processes with the overall diagnosis of a patient,
  • differentiate between NORMAL & ABNORMAL
  • know how certain S&S manifest throughout the lifespan, more specifically infancy-childhood, adolescence, pregnancy & aging adult
  • familiarize yourself with the different tests used during an assessment
  • successfully perform an Objective Subjective Clinical Evaluation (OSCE)

Effective studying for this class entails reading the chapter(s) before class and adding any additional information to the notes provided for you. Making your own blueprints (assuming they are not provided for you) are fantastic in setting up an organized set of notes, focusing what you need to know for the exams. However, studying them alone may not be sufficient enough for you to make a high grade on the exam. You need to follow along with the textbook & write down any additional notes (like abnormals, values, etc) that can classify as potential test material. Here’s an example of a section of an exam blueprint covering a list of abnormals:

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Simply knowing that these conditions are abnormal is not enough. You need to know the signs & symptoms associated with these conditions, the definitions of these conditions, how/why is it abnormal, treatment & any other defining characteristics. Here’s an example of the same section, but now with additional thorough notes:

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Exam questions are typically not cut-and-dry, neither is real life nursing. They are probably not going to be: “I am a condition with small period-sized bleeding under the skin. I start with a P & rhyme with crème brûlée. What am I?” Instead they could be worded as:

“A patient presents to the clinic with tiny, pinpoint, non-blanching hemorrhages measuring around 2mm around her oral mucosa. Based on the following signs & symptoms, a nurse can conclude that this condition is known as __________ and is often caused by _________.”
A.) Purpura, scurvy
B.) Petechiae, septicemias
C.) Strawberry Mark, blood disorder
D.) Port Wine Stain, congenital condition

B is the answer. See how a bit more in detail the question is? Information regarding the definition & cause of these skin conditions (assuming you did not know what petechiae was) may have helped lead you to correct answer.

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Nursing Foundations: The Basic Study Skills

Foundations covers the basic knowledge and skills required to be a competent nurse. You have one semester to cover a variety of topics ranging from therapeutic communication and documentation to medication administration and end-of-life care. It may be overwhelming considering the amount of reading involved. My goal here is to show a more abbreviated way of studying while trying to get as much information possible out of the content, which is then applied in both exam questions and real life. It is all dependent on the student & his/her way of studying.
It is important to try to get a general grasp of this course because it is basically the “foundation” of nursing practice. A lot of the material here concerns nursing care and interventions, which is revisited throughout the upcoming semesters. Here’s some tips to get you up & running:

I. Pay attention to the objectives. They are a general overview of what you should learn after studying that particular chapter. Try to answer them as you go through the chapter.

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II. Don’t skip the information boxes. You’ll come across boxes with headlines such as “Focus on Older Adults”, “Concept Map”, Tables, Figures, “Cultural Aspects of Care”, “Client Teaching”, “Procedural Guidelines”, etc. They contain valuable information that is fair game for test questions. Review the “Nursing Care Plan” that comes with each chapter. They are great for putting all the information together in one coherent format as you would apply in real life.

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III. Do your EVOLVE modules early! You’ll find out how tedious doing these modules can be, but they are very helpful in supplementing the textbook material. They come with a variety of activities, diagrams, quizzes & photos as resource material.

IV. Do the Critical Thinking Exercises & NCLEX question at the end of the chapters. These help to reinforce the information you just learned & identifies any material that may need review.

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V. Utilize the resources provided for you to help you succeed in nursing school. The Learning Resource Center (LRC) has a software called NCLEX 4000. NCLEX 4000 breaks down question into certain topics (for this semester, concentrate on Nursing Fundamentals) & randomizes them to cover a variety of topics covered in your theory classes. You set up your own personalized exam to automatically give you rationales after answering a question. Another resource is the Student Success Center where you talk with instructors for any concerns you may have concerning your courses. There are also many supplemental books that are beneficial for use alongside your textbook. Examples include Reviews and Rationales, Saunders Comprehensive Review for the NCLEX and the Illustrated Guide to the NCLEX. The more you expose yourself to the material, the more it may become familiar to you. Evolve has multiple choice questions for each chapter. Although they are not completely reflective of an actual exam question, they are for knowledge-based practice.

VI. Attend the brown-bag sessions during the early part of the semester. They will be covering Test-taking Skills & Math for calculating medications. Being competent in math is one of the more important skills you’ll need this semester, not only because you’ll be required to take an exam in which you have to score 90%+ or else you’ll fail, but also you will be dealing with medications.

VII. Stay organized. As I mentioned earlier, you will be turning in many assignments throughout the course of the semester. Keeping them all in one place, like a binder, & make sure to turn them in one time. You’ll find that some assignments are only worth 1%-3% of you grade. Do not brush them off as unimportant. 1% could mean the difference between a letter grade. You’re a nursing student now, take your academics seriously.

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Content derived from Fundamentals of Nursing, 7th Edition.