What do you see, nurses, what do you see? Are you thinking, when you look at me – A crabby old woman, not very wise, Uncertain of habit, with far-away eyes, Who dribbles her food and makes no reply, When you say in a loud voice — “I do wish you’d try.” Who seems not to notice the things that you do, And forever is losing a stocking or shoe, Who unresisting or not, lets you do as you will, With bathing and feeding, the long day to fill. Is that what you’re thinking, is that what you see? Then open your eyes, nurse, you’re looking at ME… I’ll tell you who I am, as I sit here so still; As I rise at your bidding, as I eat at your will. I’m a small child of ten with a father and mother, Brothers and sisters, who love one another, A young girl of sixteen with wings on her feet. Dreaming that soon now a lover she’ll meet; A bride soon at twenty — my heart gives a leap, Remembering the vows that I promised to keep; At twenty-five now I have young of my own, Who need me to build a secure, happy home; A woman of thirty, my young now grow fast, Bound to each other with ties that should last; At forty, my young sons have grown and are gone, But my man’s beside me to see I don’t mourn; At fifty once more babies play ’round my knee, Again we know children, my loved one and me. Dark days are upon me, my husband is dead, I look at the future, I shudder with dread, For my young are all rearing young of their own, And I think of the years and the love that I’ve known; I’m an old woman now and nature is cruel – ‘Tis her jest to make old age look like a fool. The body is crumbled, grace and vigor depart, There is now a stone where once I had a heart, But inside this old carcass a young girl still dwells, And now and again my battered heart swells. I remember the joys, I remember the pain, And I’m loving and living life over again, I think of the years, all too few — gone too fast, And accept the stark fact that nothing can last – So I open your eyes, nurses, open and see,

With this issue, we begin the third volume of Evidence-Based Nursing (EBN). In this editorial, we describe how the journal is produced, identify the journals from which we abstract the most studies and share the results of a recent subscriber survey. We then update you on new and future developments in the production of EBN. Steps in creating EBN EBN shares a similar production process to sibling abstract journals, Evidence-Based Medicine, Evidence-Based Mental Health, and ACP Journal Club . It begins with the meticulous scrutiny of every issue of approximately 140 clinical journals (a complete list appears in each issue of EBN) by research associates, who have extensive research training and experience in information science and clinical epidemiology and biostatistics. After identifying every primary study and systematic review related to prevention or treatment, assessment (screening or diagnosis), prognosis, causation, quality assurance, economics of healthcare programmes or interventions, clinical prediction guides, and qualitative studies, they apply appropriate methodological criteria outlined in the Purpose and Procedure section of each issue. In the next step, each article that “passes” the appraisal is reviewed by the 3 editors to identify those of most relevance to nursing practice. Because we do not have expertise in all areas of nursing, colleagues from around the world help us to determine the relevance of some of the articles. The third step involves the preparation of a structured abstract that summarises the question(s), design, setting, patients, results, and evidence-based conclusions for each of the articles that have been selected for inclusion. In step 4, the associate editors collaborate with the research associate in editing each abstract. We then invite a nurse with expertise in the topic area to write a commentary that discusses whether and how the study results might be implemented in nursing practice. In step 5, the associate editor, through exchanges with the commentator, fine tunes the abstract and commentary. Step 6 brings in the lead author of the paper who reviews the abstract and commentary for accuracy. Before submitting to the publishers, the abstract and commentary are reviewed once more by a research associate, who has not read the original paper, to assess their clarity. The material is then sent to the technical editor in the UK who works closely with the research associates through 3 cycles of typesetting and proofreading before the issue is published. This multistep process relies on the collaboration of numerous individuals from around the world and is crucial to maximise the accuracy and usefulness of the abstract and commentary.

New Parkland, CA 91010 To Leslie Scanlon Manager, HR Orchard Manor Assisted Living 205 Pine Street I am writing to inform you that I will be resigning from my Certified Nurse's Aide position due to personal reasons. My last day of employment will be October 3, 2014 so please consider this letter to be my official two weeks' notice of resignation. I regret any inconvenience this may cause, but the situation is unavoidable at this time. I will work over the next two weeks to assist the residents in my care to prepare for my departure. I will make sure all of my paperwork is completed, and I am happy to help train someone to fill my role. Should you require further information, you can always reach me at (555)555-5555 or email me at jennifer@johnson.com. I will get back to you in a timely manner. I have thoroughly enjoyed my time of employment here at Orchard Manner and will my colleagues, as well as the residents. It has been a tremendous pleasure to serve them and a learning experience I will never forget. I wish everyone well, and I thank you for your attention to this matter. Sincerely, Jennifer Johnson CNA There are plenty of opportunities to land a CNA Resignation Letter position, but it won't just be handed to you. Crafting a CNA Resignation Letter that catches the attention of hiring managers is paramount to getting the job, and LiveCareer is here to help you stand out from the competition.

All nurses should practice the "6 rights" of medication administration. There have been many safeguard established to ensure the rights are followed. One is the process of scanning the patient and the medication at the bedside. Many institutions have adopted this system of scanning medications. 1. log into the hospitals software 2. find you patient's profile in the EMAR 3. scan your patient's armband 4. scan the barcode on the medication If there are any problems the software will alert you to a "right that is about to be violated". It will also assist you with double checking your dosage, time and route of administration. All nurses should practice the "6 rights" of medication administration. There have been many safeguard established to ensure the rights are followed. One is the process of scanning the patient and the medication at the bedside. Many institutions have adopted this system of scanning medications. 1. log into the hospitals software 2. find you patient's profile in the EMAR 3. scan your patient's armband 4. scan the barcode on the medication If there are any problems the software will alert you to a "right that is about to be violated". It will also assist you with double checking your dosage, time and route of administration. MEDICATION ADMINISTRATION RIGHT PATIENT 1. Verify patient by checking his or her identification bracelet/armband. 2. Ask the patient his or her name. Do not call the patient by name. Some clients will answer to any name. Ask for his or her date of birth (not always required). 3. Check the name on the patient's medication label or profile in the EMAR. 1. Verify patient by checking his or her identification bracelet/armband. 2. Ask the patient his or her name. Do not call the patient by name. Some clients will answer to any name. Ask for his or her date of birth (not always required). 3. Check the name on the patient's medication label or profile in the EMAR. RIGHT PATIENT RIGHT DRUG 1. Check the drug label three times: a) at the first contact the the medication bottle. b) before pouring the medication . c) after pouring the medication 2. Check that the drug order is complete and legible. If it the order is incomplete or not legible, contact the physician or charge nurse. 3. Know the medication action. 4. Check the expiration date. All outdated drugs should be thrown away or sent back to the pharmacy, whichever is the policy of the facility. 5. PATIENT QUESTIONS...If the patient questions the drug, recheck and check again the medication and the doseage. If you are in doubt see assistance from another health care provider. 1. Check the drug label three times: a) at the first contact the the medication bottle. b) before pouring the medication . c) after pouring the medication 2. Check that the drug order is complete and legible. If it the order is incomplete or not legible, contact the physician or charge nurse. 3. Know the medication action. 4. Check the expiration date. All outdated drugs should be thrown away or sent back to the pharmacy, whichever is the policy of the facility. 5. PATIENT QUESTIONS...If the patient questions the drug, recheck and check again the medication and the doseage. If you are in doubt see assistance from another health care provider. RIGHT DRUG RIGHT DOSE 1. Be able to calculate the medication doses using the ration and proportion, basic formula fractional equation. 2. Know how to calculate drug dose by body weght (kg) or by body surface area. 3. Know the recommended dosage range for the drug. If the nurse believes the dose is incorrect or not within the therapeutic range, a supervisor, pharmacist or the ordering physician should be contacted and all communication should be documented. 4. Recalculate drug dose and have a colleague recheck the dose. 5. Some facilities require the following drugs to be checked by a colleague: 1. Be able to calculate the medication doses using the ration and proportion, basic formula fractional equation. 2. Know how to calculate drug dose by body weght (kg) or by body surface area. 3. Know the recommended dosage range for the drug. If the nurse believes the dose is incorrect or not within the therapeutic range, a supervisor, pharmacist or the ordering physician should be contacted and all communication should be documented. 4. Recalculate drug dose and have a colleague recheck the dose. 5. Some facilities require the following drugs to be checked by a colleague: RIGHT DOSE RIGHT TIME Medications should be given at a specified time to maintain a therapeutic drug serum level. A dose given too soon can cause toxicity and missed doses can nullify the drug action and its effect. 1. Administer the drug at the correct time(s). Medications can be given 1/2 hour before or after the time prescribed. 2. There are specific cirecumstances that may cause a delay or ommission of a medication such as: labortory or diagnostic tests. 3. Administer drugs that are affected by foods either 1 hours before or 2 hours after meals. 4. Know the medications half-life. 5. Anitbiotics should be administered at regular intervals.

Deanna Gray-Micelli, PhD, GNP-BC, FAANP, Patricia A. Quigley, PhD, MPH, APRN, CRRN, FAAN, FAANP Reprinted with permission from Springer Publishing Company. Evidence-Based Geriatric Nursing Protocols for Best Practice, 4th Edition, © Springer Publishing Company, LLC. The text is available here. Goals A. Prevent falls and serious injury outcomes in hospitalized older adults. B. Recognize multifactorial risks and causes of falls in older adults. C. Institute recommendations for falls prevention and management consistent with clinical practice guidelines and standards of care. Overview Falls among older adults are not a normal consequence of aging; rather, they are considered a geriatric syndrome most often due to discrete multifactorial and interacting, predisposing (intrinsic and extrinsic risks), and precipitating (dizziness, syncope) causes., Fall epidemiology varies according to clinical setting. In acute care, fall incidence ranges from 2.3 to 7 falls per 1, 000 patient days depending on the unit. Nearly one-third of older adults living in the community fall each year in their home. The highest fall incidence occurs in the institutional long-term-care setting (i.e., nursing home), where 50% to 75% of the 1.63 million nursing-home residents experience a fall yearly. Falls rank as the eighth leading cause of unintentional injury for older Americans and were responsible for more than 16, 000 deaths in 2006. (Ref 3) Background and Statement of the Problem A. Definition 1. Fall: A fall is an unexpected event in which the participant comes to rest on the ground, floor, or lower level. (Ref 4) B. Fall Etiology 1. Fall risk factors include intrinsic risks of cognitive, vision, gait or balance impairment, high-risk/contraindicated medications, and/or the extrinsic risks of assistive devices, inappropriate footwear, restraint, use of nonsturdy furniture or equipment, poor lighting, uneven or slippery surfaces. (Ref 5) 2. Fall causes include, among others, orthostatic hypotension, arrhythmia, infection, generalized or focal muscular weakness, syncope, seizure, hypoglycemia, neuropathy, and medication. Parameters of Assessment A. Assess and document all older adult patients for intrinsic risk factors to fall: 1. Advancing age, especially if older than 75 2. History of a recent fall 3. Specific co-morbidities: dementia, hip fracture, Type II diabetes, Parkinson's disease, arthritis, and depression

Take the undershirt and cut it in half. Cut off the straps and cut the back in half so it opens up. Hem the bottom. To hem all you need to do fold the bottom up a half inch and then fold it again. Press with an iron to help keep folds straight and pin it. Use a simple strait stitch to sew the hem. Because of the material of my undershirt I did a second layer of stitching to ensure a good hold. Tada! The under layer is done! Now to attach it to the top shirt. First, turn the top shirt inside out with the front of the shirt facing towards you. Lay your undershirt right side down on top of your top shirt. Pin the shirts together along the armpit seam. Since my undershirt was smaller than my top shirt the seams do not line up perfect, but that is okay. Place a pin facing along the top shirt's side seam so you know where to stop sewing. Pin the left and the right sides this way. With thread that is an "exact, to close" match to your top shirt, sew the two shirts together along the armpit seam. Try to sew along or as close the top shirt's hem line as you can. When your two shirts are attached along the armpit seams, place a pin sideways at your side seams to mark the bottom of your undershirt. Your side pins will hold the undershirt in place. Flip the shirt outside right, and sew along the side seam, directly on top of the seam. It is SUPER important that your thread matches your shirt! Stop at your sideways pin. If you stayed along the seam you won't be able to see the stitches! :D Repeat on the other side, then flip the shirt inside out again. You will see your seam on the inside. Trim along the seam on both sides. You now have an under layer! Flip your shirt outside right again and enjoy! In roughly 25 minutes you made yourself and up-cycled, discreet, nursing top! If you want to add an extra touch (and your shirts are the same size) You can take the bottom of the undershirt and add it to the bottom of your top shirt for extra length and a layered look.

OBJECTIVE: To provide data needed to design an intervention trial to prevent or treat skin disorders in a high risk, incontinent nursing home population. DESIGN: The incidence and prevalence of nine common skin disorders were measured prospectively over a 60-day period using trained observers. Urinary and fecal incontinence frequency were measured over 24 hours, and mobility was measured with subjects both in and out of bed. Direct measures of skin moisture were taken with an impedance device in the presence and absence of urinary incontinence. Multiple regression analyses were used to relate the incontinence and mobility variables to the presence and development of skin disorders. SETTING: Four nursing homes. PARTICIPANTS: One hundred incontinent nursing home residents. MAIN OUTCOME MEASURES: Prospective measures of nine common skin disorders and skin moisture in four perineal regions under continent and incontinent conditions. RESULTS: All subjects had at least one skin condition identified during the 60-day data collection period. The most commonly observed skin condition was blanchable erythema, which occurred in 94% of the subjects, predominantly in the front and back regions that were closest to the urethra and rectum. Twenty-one percent of residents developed either a Stage 1 (nonblanchable erythema) or 2 pressure ulcer. All skin conditions were transient when measured every 3 weeks with the exception of blanchable erythema, which showed stability. Stage 3 or greater pressure ulcers and edema were not observed, and interrater reliability for the measure of papules was poor. Measures of urinary and fecal incontinence severity were correlated with blanchable erythema severity, and blanchable erythema and low bed mobility were predictive of pressure ulcer severity. Blanchable erythema severity was also predictive of Stage 1 and 2 pressure ulcers. Skin moisture levels in the back perineal farthest from the rectum (peripheral) were affected most by urinary incontinence. CONCLUSION: A trial to detect a 50% preventive effect on Stage 1 and 2 pressure ulcers would require that 167 subjects be monitored for 60 days. The transient nature of the skin effects require that skin be monitored at least once a week. Because blanchable erythema is so prevalent and appears to be associated with more severe skin conditions, it would make an excellent marker for beginning to assess the potential preventive effects of various interventions on the incidence of pressure ulcers and other related skin disorders in incontinent patients. It is likely that the back area peripheral to the urethra and rectum would experience the greatest benefit from an intervention trial to reduce moisture caused by incontinence.

Jump from the bottom step Jump a distance of about 8 inches Jump on a trampoline with 2 hands held Begin to stand on one foot Begin to ride a tricycle Catch a large ball At 3 years old, most toddlers can complete the following gross motor skills: Run forward well Jump in place with two feet together Stand on one foot (with some support) Walk on tiptoe Kick a ball forward Walk on tiptoes and stand on one foot for up to 5 seconds Avoid obstacles in path Catch an 8 inch ball Climb and walk up stairs alternating feet You can help with early child development. Suggested gross motor activities for toddlers between two and three years old are as follows: Visit playgrounds often. When children see the slides and climbing structures, they naturally want to run, swing, and climb everything in sight. If you can’t make it to the playground, chasing each other in the backyard or taking a walk can help your child’s little muscles grow strong. Imitate each other. Stick your arms out wide and pretend to fly around the room. Tell your child it’s his/her turn to be the bird. Then, let your child be the leader and you copy whatever he/she does. Become a horse. If you cross your legs and place your child on your knee, it’s easy to take it for a horse ride. A variation would be to hold your child’s hands while it straddles your foot. Then bounce, bounce, and bounce some more. Play catch. Show your child how to hold out its hands and throw a ball directly, and gently, into them. Start out standing close together. As your child gets better, move farther away. It’s soccer time! Turn a large box on it’s side to become your goal. Then take turns trying to kick the ball into the goal, cheering when your little athlete makes a goal. Let’s be kangaroos. Make a chalk line on the sidewalk or place a washcloth on the floor. Show your child how to jump with both feet together and see how far each kangaroo can jump. Have fun with balloons. Here’s a fun game for a rainy day. Kick a balloon from one side of the room to another. Put a laundry basket on its side and your child can kick it into the basket. Act like animals. Can your child stand like a flamingo, squat like a duck, run on all fours like a lion? It’s fun to try. Don’t forget to make the appropriate animal sounds! Make a river. Put a folded towel on the grass. Tell your child the towel is really a river and ask if he/she can jump over the river without getting his/her feet wet. As your child gets better, unfold the towel for more of a challenge.

The VA Learning Opportunities Residency (VALOR) Program gives outstanding registered nursing students who have completed their junior year in an accredited clinical program the opportunity to develop competencies in clinical nursing while at a VA-approved health care facility. Learning opportunities include didactic or classroom experiences, competency-based clinical practice with a qualified RN preceptor, and participation in nursing-focused clinical conferences. VALOR participants who take a position with VA upon graduation are usually hired one-to-three steps above the entry-level salary rate established for new graduates. This is because VALOR participants are already oriented to VA and its practice requirements. VALOR students may be appointed on a full- or part-time basis during the summer months, and may continue during their senior academic year on a part-time basis. Contact the nursing education department at your local medical center for more information about the VALOR Program and how to apply. Every facility in our health care system provides a structured nursing orientation program for new graduates. The program includes the assignment of preceptors and mentors who provide experiences tailored to each individual new hire's requirements. In addition to orientation, VA provides a work environment that supports the transition from new graduate to experienced nurse, including abundant opportunities for continuing education programs, as well as clinical learning experiences. Working as a nurse at VA comes with a number of work/life benefits designed to help you achieve your best, personally and professionally. Our nursing benefits include: Nationwide job transfer opportunities Tuition reimbursement and scholarship programs (subject to funding availability) Competitive salaries and pay differential rates Generous vacation, personal, and sick leave, as well as 10 Federal holidays Stable retirement and health care plans BCLS and ACLS classes provided at no cost to employees

A nursing student at Misericordia University has filed suit against the university, claiming that the school broke federal law by denying her the ability to talk to her professor during an exam. Jennifer Burbella is suing the university, several members of the administration and staff, as well the professor after she failed a required course two times. Burbella said that she suffered from a host of mental health problems, including anxiety, depression and poor concentration, and that the university failed to make reasonable accommodations to her testing environment to account for her disability. Specifically, Burbella claims that the university did not allow her to take the test in the same building as her professor and that when she was unable to reach the professor by phone during the final exam, she broke down crying “on several occasions” during the exam. The suit raises some tricky questions about what accommodations are “reasonable” under federal disability law and whether Burbella can attribute failing her exam twice to her inability to speak with her professor during the test. “Because she was denied her statutory right to accommodations, we’re looking primarily to have her take the test or take the course over with the accommodations she needs, ” Harry McGrath, Burbella’s attorney, told The Washington Post. “And if she passes the test. fine. And if she doesn’t pass the test, fine, then she has to live with that.” According to the lawsuit, even before Burbella matriculated in 2010, she knew that she “had an existing predisposition which caused her to suffer from anxiety and depression.” At Misericordia, she began seeing a school psychologist for her anxiety, depression and poor concentration in 2011. But in spring 2014, Burbella failed a core curriculum class in her nursing program that required a minimum grade of 78 percent. She agreed to retake the class in the summer, and the school officially agreed to make accommodations during the test because of her disability: extended time on the exam and a distraction-free environment. When the time came for her to take the final exam again, the professor, Christina Tomkins, verbally offered to be available to answer questions that Burbella might have during the exam, according to the suit. The only problem with that offer was that Burbella had already been scheduled to take the exam in a building different from the one used by the rest of her peers, so that she could have a distraction-free environment. Her professor was scheduled to proctor the exam in the other building. Burbella claims that Tompkins denied her request to be moved to the same building as her classmates and instead gave Burbella a cellphone number on which she could be reached. “The unfortunate reality of the situation on the day of the exam was that Professor Tompkins did not answer her cell phone despite [Burbella’s] repeated attempts to contact her throughout the final examination, ” the suit said. “Professor Tompkins’ failure to be available to the Plaintiff on numerous occasions during the examination created an even more stressful environment for the student.”