Statistics class at Azusa-Pacific University

Just started the statistic class at Azusa-Pacific University with Dr. Carl Renold last week.  We are now starting to learn the SPSS statistic tool how to measure certain variables.

My goal is to be able to measure the level of confidence, competence and caring using the existing forms already being used.

Hopefully, this will be the foundation in screening the Modified Nursing Process(R) Practitioner in the future.

Developing…..

Welcome Batch 97!!!!

The Excel Vocational Center is glad to welcome our new group, Batch 97. They are a great group of people with diverse backgrounds. But each one has committed to learning with our Spatial Logic: Integrated Intelligence™ method. As a result, they started our image visualization process. This will help them to visualize the steps they ar learing for different caring situations.  They will be incorporating our computer program and they will be the first Batch to use our on-line image training as well. They will also be using our synergistic model which will have them  teaching each other with our truth graphs. We are proud to have Batch 97 ready to take on the challenges of our CNA program, and look forward to seeing each of them complete their training.

Former Excel Math Student Joins CNA Program

We have been fortunate to learn that one of Excel’s former Math students is joining our school to become a CNA! We expect great things from her. Her name is Rachel Lopez. Here is the very bright young lady speaking to her High School group.

Congratulations Batch 96!!!

August 30, 2009

To our BATCH 96 (July 16-August 30) Class

The Excel Vocational Center teaches clinical skills that are specific and deliberate actions with clear guidelines for students to follow. It is not done in a random manner nor is it a result of unintended consequences.  It is a plan called the Modified Nursing Process® that took more than 20 years to develop both in long-term care facilities, acute care settings and classroom settings. The training program followed certain guidelines that run parallel to the Cone of Experience espoused by Edgar Dale (1946).

However, to be fully successful, it requires your full participation.  The Excel Vocational Center provided the necessary tools; but you honed your critical-thinking and clinical skills by putting in the hard work: by the computer, lab practice and actual clinical practice at SunnySide Nursing Center. You interacted very well with the staff and the residents. Above all, nursing care is about caring.

When you receive your Certification of Completion and educational awards, you will know that you prepared yourself for an engaging study program that will forever change your approach to nursing care. The more you participated and completed the entire exercises, the greater the likelihood that you will master the techniques you were taught. Your ultimate reward is being employable:  Confident, Competent and Caring, the hallmark of a Modified Nursing Process ® Practitioner.

One of the concepts I have developed, and being applied at the Excel Vocational Center, is the Spatial Logic: Integrated Intelligence®.  It is best described when you say-to my enjoyment- “I got it. It is so easy.” It is the moment when you cry out “Aha!”

It has been a pleasure to see Batch 96 grow from insecurity, at the start of our class, to confidence as the program progressed. You have practiced and studied as a team, and have taught each other. You have followed the instructions fully and with great gusto.  As each technique has to work in conjunctions with others, you have taken time to practice each technique thus you have mastered the Spatial Logic: Integrated Intelligence ® critical-thinking skills protocols. You have achieved what other groups achieved and more.

I say, “Thumbs up.”  Congratulations!

Elijah D. Nacionales RN SMN

Director, Nursing Assistant Program

Founder, Modified Nursing Process® Practitioner

The POPPPSS® Pyramid

The cornerstone of all the work we do at the Excel Vocational Center is centered on the POPPPSS® Pyramid. It was developed on the reseach done in logic and cognitive studies by Elijah Nacionales RN MSN (Pictured above with the pyramid). Part of that has already been posted here. It represents the four areas of the human knowledge base. The process of integrating the four areas of human knowledge base is called Spatial Logic: Integrated Intelligence®. The mechanism of Spatial Logic:Integrated Intelligence® has been documented byEdgar Dale in his famous cone of experience; reseach which was done at the NTL Institute for Applied Behavioral Science.

Learning With Technology

With a lot of perseverance and teamwork, previous and current students have overcome many learning obstacles through the use of the computer. In the early 2000’s, the use of the computer was in its infancy in relation to the development of nursing notes. Though useful, the notes were uncoordinated, thus understanding the notes took more time.

But times have changed. Today the computer has become an integral part of our program and a favorite tool of our students. It makes it easier for students to cover notes. In addition, they have access to their grades and are able to monitor their progress, making feedback fast and only a click away.

All of this didn’t happen by accident. In fact, it was the result of strategic change after we got a lot of student feedback. In other words, it is a student-based outcome. They made an important contribution to how they would review work and be tested on the computer.

“I really love your computer program” says Iris Ortega, Batch 96 (July 16-August 30) student. “It really helps me learn fast. It is the best. We get high grades.” Since students are teamed up to work in groups during the computer’s use, it fosters bonding and improves the team dynamic.

One thing the students consider a big help is the free use of our program after school hours. It encourages the students to spend even more time studying and reviewing. In the end, by the virtue of their perseverance and teamwork, they become excellent students.

To learn more about our methods and school visit us at the  Excel Vocational Center

Modified Nursing Process® Charting guide Part 4

Sample Charts: Using The Modified Nursing Process® due to Change of Condition

This portion describes the resident, the 11pm-7am shift, and the events that happened on this shift. There was no change of resident’s condition (shortness of breath) until 6 am in the morning.

Background: Change of condition (shortness of breath) at 6am

Description of Resident:

• Mental Status: Disoriented to person, place and time; combative at times
• Diagnosis: CHF, Diabetes Mellitus, OBS, S/P CVA, Hypothyroidism
• Diet: 1800 cal Diabetic Diet
• Medication: Synthoid, Diabeta, Lasix, Haldol, Keflex due to URI. Oxygen at 2L/min via cannula for SOB.
• Treatment: stage IV decubitus to buttocks.
• Others: Has F/C; Intake and Output; Full Code.

Modified Nursing Process® Charting Guide Part 3

Our Modified Nursing Process(R) charting has been described in terms of real life situations. Here are some final guidelines to think about when it comes to:

Safety Measures

1. Time sequence MUST be clear. Be sure to put the date and time you charted. This will give the time frame of activities.
2. Descriptive charting must have nursing intervention. Descriptive charting describes the resident’s condition such as disorientation to people, place and time.
3. Must be factual. Avoid terms that merely give a general idea. For example, sever pain could invoke different meaning to the reader. Give exact words or describe the resident such as grimacing, hunching over with their hand on the stomach.
4. Must be legal. To be legal, be sure that your action is within the standard of nursing practice coupled with the physician order.
5. Errors are to be crossed out with a single line and initialed.
6. No charting gaps: late entry only.

Comfort Measures

1. Provide basis for measures that alleviate pain, discomfort or irritation.

Follow Up Measures

1. Notify DON if you are unsure of what to do.

ORDER OF SEQUENCE OF CHARTING

1. Follow the Safety Measures, Comfort Measures, and Follow-Up
2. Measures in sequence if indicated. IN OTHER WORDS, SAFETY MEASURES should come first before COMFORT
3. A good rule of thumb for charting a situation
   1. Situation with Safety Issues: use safety, comfort, and follow-up measures.
   2. Situation with Comfort Issues Only: Use comfort and follow-up measures.
   3. Situation with Follow-up Measures Only: chart follow up measures only.

Advantages of Modified Nursing Process® Charting

1. Easy to follow the condition of the resident. Because of the Re: which serves as the topic sentence, the reader knows the content of the chart.
2. Easy to follow the nursing interventions. Such nursing interventions are grouped together according to categories, no matter how many problems the resident has, the SAFETY, COMFORT, AND FOLLOW-UP measures are grouped together.
3. Easy to spot errors in charting. Since charting is sub-divided, the nurse can easily find out what transcribed days before by merely reading portions of the chart

Modified Nursing Process® Charting Guide-Part 2

The following sequence of events will help you see how you can apply this to your own situation

11:00 pm – rounds made by CNA. Resident is in bed with vest restraint.not combative; in no acute distress.

11:30 pm – rounds made by LVN. Resident is resting comfortably.Vital sign:  T=98.8 (R); P= 80; R= 20; B/P= 130/80

12:00 am – CNA changed the resident due to BM. Restraint was released. LVN gave the Keflex; no SOB noted.

2:00 am –   CNA made routine rounds; LVN made rounds; in no acute distress

4:00 am -   CNA made routine rounds; LVN made routine rounds: in no acute distress.

5:00 am –   LVN made rounds; noticed the resident to be lethargic with SOB. Vital signs: T= 102 (R); P= 90; R= 30; B/P= 150/90 Oxygen given per cannula; accucheck = 190 (usual 160)

6:10 am -   Doctor was notified; Ordered resident to be transferred to hospital. Family was notified at 6:10 am; ambulance was notified at 6:15 am

6:45 am -   Ambulance came; brought resident to hospital.

(Sample charting based on the above description)

Re: Problem:

Description of resident: safety measures, comfort measures, follow-up measures (relating to the problem, description of the resident).

12/13/94   Re: ATB for URI/Routine rounds:

11:00 pm         Routine: Disoriented to person, place, and time; not

combative. On Foley cath: SM: vital sign: T= 98.8 (R); P = 80; R = 20; B/P =130/80 CM: turn off overhead, lights in the room; FM: vest restraint- in place no SOB noted; routine rounds by CNA- Zeny Blast LVN.

4: 00 am          Re: Routine rounds:  Keflex given at 12pm; Routine rounds done at 2 am and 4 am in no acute distress. – Zeny Blast LVN.

7:00 am           Re: Change of condition at 6 am: SOB. Routine \: made rounds and noticed resident to have SOB and lethargy. SM: Oxygen given at 2L/min; no rales or bronchi noted in both lungs; v/s = T = 102 (R); P= 90; R= 30; B/P= 150/90; Cm: CNA stayed in the room to observe resident; FM: Physician notified and ordered resident to be transferred to SPPH for evaluation; family notified; ambulance notified at 6:15am; ambulance came at6:45am. Discharges to SPPH at 7am. In no acute distress. – Zenny Blast LVN.

EXPLANATION:

1. Re: ATB for URI/Routine rounds. Routine- THIS GIVES FOR YOUR BACKGROUND CHARTING (ATB, FOR URI, ROUTINE ROUNDS) – make detailed charting.

Re: Routine rounds – minimal charting.

Re: Change of condition at 6am: SOB- make a detailed chart.

1. The time 11pm, 4am and 7am are the actual time for charting with description of activities in between.
2. At 4 am: no need for Safety, Comfort, and Follow-up measures= routine round.

CONDITIONS THAT REQUIRE SAFETY, COMFORT, AND FOLOW-UP CHARTING

1. Respiratory – rales, rhonchi, SOB, rusty sputum, reddish sputum
2. Digestive – vomiting, diarrhea, stomach pain, loss of appetite, refusal to eat
3. Metabolism – fever, hypoglycemia, hyperglycemia
4. Neuro –sudden lethargy, sudden confusion
5. Vascular –high B/P low B/P
6. Urinary – reddish urine, sediment, pain, during urination
7. Skin – new decub, skin tear
8. Fluid/electrolyte – dehydrated/ edema
9. Nutrition – losing weight, refusal of food for 3 days

10.  Others – complaint, incident, room transfer, infection charting

AVOID QUESTIONABLE DESCRIPTIONS (SUBJECTIVE) SUCH AS “BLOOD-TINGED, BLOODY” URINE, GOLD RING, DIAMOND RING, SEVERE RESPIRATORY PROBLEM

Modified Nursing Process® Charting Guide-Part 1

The Modified Nursing Process® has many unique ways of doing things. Here is an example of our charting guide, developed for our “P” Method of Management.  Charting, a mandatory activity for nursing, is very important in the nursing process. Without it, the specific care of a resident is not recorded for others to know and follow-up. When a nurse charts, it must be focused on the resident alone and on what interventions they did. The interventions which are divided into several parts.

1. Re: Health Focus

It should serve as the topic sentence and must point out problems that need addressing.

2. Routine Measures: Health Description

This part describes the resident and the problem. This serves as a guide for all nursing    intervention

3. Safety Measures: Health Protection

Here we try to minimize the negative. Here deal with the nursing interventions that apply  to direct nursing care, and in correcting and preventing complications; ex: harming of self, and others etc…

Primary Interventions

• -Fluid/Electrolyte Status
• -Oxygen
• -Infection Control
• -Nutrition
• -Vital Signs
• -Medications
• -Treatment
• Prevention of Complications
• -Head up (SOB)
• -Suctioning
• -Turing of resident (during seizures)
• -PERRLA (incident)
• -ROM (incident)

4. Comfort Measures: Health Promotion

This is where we maximize the positive. The nursing interventions here deal with environmental concerns; ex: relief of pain, anxiety, and inter-personal interactions.

Secondary interventions such as:

• -Environmental Concerns
• -Promotion of comfort:
  • -dimming off of lights
  • -offering of fluids
  • -massage

5. Follow-up Measures: Health Maintenance

This part emphasizes the continuity of care. The nursing interventions here deal with tertiary concerns such as:

• -Notification of physician, family, staff members etc…
• -Monitoring of staff members
• -Ordering and follow-up of labs, E-ray
• -Consults

Our charting method deals with all aspects of a patient’s health from the most vital to the tertiary. Next we will give an example of how to apply this to your own situation.