Just Do It

I was recently interviewed by the Australian Teachers Magazine for one of their upcoming Student Guides. I was humbled and privileged to be a part of something that could potentially impact on the next generation. Part of the process was an interview in which a variety of questions were asked regarding my educational journey, my journey to becoming a nurse, and it culminated with the final question which was If you could give just one piece of advice to a student considering further study, what would you say to them, without hesitation I answered with Just do it!

This experience led me to reflect on the journey through Nursing to this point, the people along the way, the learning opportunities, the teaching opportunities, and the people impacted along the way. Before I even began studying my Diploma I had friends and family who were either currently studying the Bachelor or have been in the industry for a number of years offering advice on how I should go about my study, areas of Nursing to pursue, or even anecdotes of encounters with different patients. Even during this early stage I began to notice that nursing was more of a harmonious collective then a series of individuals. As I progressed further with my study this notion didn’t falter, of course there are the odd few that are the exception to the rule, but for the most part Nurses here in Australia are a fairly accomodating and encouraging bunch.
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During the Diploma itself, I was with some 40 odd other students who came from a variety of backgrounds, and had a diverse range of skills. We had everything from the School Leaver to the Re-skilling Mum to the 30 something Career shifter. All of these different people made for a unique learning experience. We were at the University for three days a week, every week during the semester. This gave us all a lot of time to spend with one another. Friendships were formed, clicks began to emerge, but on the whole we worked as a class to get through the learning, practice the skills, and become better nurses accordingly.

These ladies and gentlemen and I would hone our nursing skills by using each other as patients, this gave us the unique opportunity to see what the care we were providing was like from the patient’s perspective. We practiced everything from bed making to hoisting to basic observations to administering medications via a mixture of routes. Some students came forward as natural leaders and teachers and subsequently lended themselves to assist the class when they were having difficulty. I formed a close friendship with two of the ladies in the class, Sarah and Michelle; we studied together, learnt together, and unwound together. I am thoroughly thankful for every single person in the class, without them I would not have strived to be the nurse I am today, I would not have the skills or the knowledge I have now. Ladies and Gentlemen I thank you.

As I entered the workforce I found that the same camaraderie that I found during my study continued into the profession. The nurses I work with every day have no issue taking the time out of their busy day to help out, and conversely know that if they need assistance for whatever reason I will be all to willing to provide it. I am currently on one of my placements for the Bachelor, it is in a facility I have never worked in before, and the staff have been great. They have taken the time to show me around, answer all my silly questions that arise in a new facility, and help me to stop thinking like an Enrolled Nurse and start thinking like a Registered Nurse. What I didn’t expect was the opportunity I had to share my knowledge. I was on shift when one of the patients required their Negative Pressure Wound Therapy, or Vac dressing, changed. None of the RNs on shift that day had changed one before, or it had been so long that they had all but forgotten. Given I work in an area that sees frequent vac dressings, as well as having  spent a large amount of time with one personally, I was able provide the information required.

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So why share this story? Sure its a nice feel good, heart warming piece, but what’s the point? The point behind this post is to encourage those who are considering taking up a career in Nursing to jump in and Just Do It. For those who are thinking of taking up an apprenticeship or traineeship, Just Do It. For those who are wondering whether or not they should study at TAFE or University and are concerned they might be too old, Just Do It. For those who considered study but thought to yourself I am not smart enough or I am no good at school, put the doubt aside, and Just Do It. No simpler message could I possibly impart.

Maintain The Rage

Luke Sondergeld

Placement Rage

As regular readers will know I am coming to the end of my Diploma of Nursing studies, which culminates with a five week Acute Care placement, totally some 200 hours. As I did with my Aged Care placement and my Community Care placement, I will be documenting my thoughts, interactions and reflections on my experience. Unlike my last two placements, I will not be summarising after the fact, but in fact giving a daily summary of experiences, emotions and lessons learnt.

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Current Thoughts

I am looking forward to putting my accumulated knowledge to use, I am looking forward to the challenge that lies ahead. But, I would be lying if I didn’t say I was slightly apprehensive. I hope I never get to the day where I feel like I know enough, if you don’t think you know enough you will keep asking questions. I am not concerned with my clinical skills, and I am looking forward to learning and applying new ones.

I want to excel, which brings with it a certain level of apprehension as D-Day approaches, doubt creeps in and you begin to wonder if you are going to be good enough. If any of my class mates are reading this, they will be getting ready to echo back the same thing i have been saying to them for months, You will be fine, you know what you are doing, just breath, relax and dive in. And I have been reminding myself of these words, and the sense of irony certainly isn’t lost on me either.

The first day will set the tempo for the whole placement, Orientation Day. We are meeting up at a facility outside of the hospital to be inducted, trained and tested to ensure we are up to scratch before we hit the floor. With previous orientation sessions, the information was simple enough with the focus being on manual handling and general safety. This time however we will be conducting more complicated procedures, delivering medications and monitoring patients who are in a far less stable condition. But as my old Chief Bosun used to tell me, or rather yell at me, Pressure Makes Diamonds.

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Blogging Timetable

So the nitty gritty. I will be writing my daily reflection almost as soon as I get home. Therefore if I was to publish as soon as I wrote them, the posts would come out at all varying times, and no one would be able to keep up. So instead I will be releasing the posts the morning after my shift. That will mean the blog posts for the week will be published as;

  • Monday’s at 0600 (AEST) will be normal Maintain the Rage posts
  • Tuesday’s through Saturday’s at 0600 (AEST) will be Acute Care Reflections from the day previous
  • Sunday’s will remain the Sabbath and there will be no new posts

Placement Rage 3I thank everyone for their support of Maintain the Rage thus far, and I thank everyone for their words of encouragement going forward not only with my placement, but my Nursing Career in general.

Maintain The Rage

Luke Sondergeld

Studious Student

In all endeavours we should attempt to excel past expectations and achieve the best we can achieve; for some of us that come easy, for others not so much. There are many stresses put upon us by others, and many more that are put on by ourselves. As a student I know there are expectations to retain knowledge, pre-read textbooks, complete assignments, study for exams, pass said exams, eat healthily, maintain the rage, maintain a work life balance, hold down a job, pay my fees, and somewhere in all that actually sleep. I know that a lot of people out there are going to think that the life of a student is easy, that compared to the real world there are no pressures, that how hard could it be to simply rock up and pay attention, and until I returned to study, I would have shared similar thoughts. But I have since seen the struggle of being a full time student, full time parent, part time employee, full time friend, and full time human being. The juggle is difficult, but I thought I would share some of the simple things that have helped make me a Studious Student and the habits that can be adopted to ensure that you too can be the best that you can be.

Studious Students Study

Pay attention and Study

The temptation to skip class, study in the evening, study in front of the TV, read only the sections of the textbook that you need to for the assignment and coast through is strong. But at the end of the day, you are paying a large sum of money (my course is totalling somewhere near $18,000 which doesn’t include textbooks) to be in class, absorb knowledge and pass. For my course, the Diploma of Nursing at CQUniversity, we have to attend three full time days per week, 0830 till 1600. During those days we have classes that are a mix between lectures and tutorials, clinical skill development, and content discussions with the instructors. In those classes it is not unusual to cover large volumes of textbooks, broad subject material and a ton of detail. The expectation is that you take the information from class, add another 40 hours per week in reading and studying to fill the blanks, and keep up with what happens in the rest of the week. If that sounds intense, that’s because it is. I began the course thinking the 40 hour reading and study on top of classwork was over exaggerated. By the end of the second week, I realised it wasn’t enough. I spend, on average, 50-60 hours reading textbooks, journal articles, news articles, research papers, and anything remotely related to the subjects at hand. All of this study now brings up the total hours spent on Schooling to 75 to 85 hours a week.  But it pays dividends, for every hour I work during the semester is three hours I don’t have to madly cram for an exam at the end, it saves me countless hours in research for assignments, and gives me the confidence and ability to answer correctly when the instructors ask something of me. It also means when I am on placement, I am confident in my own abilities and know my own limitations. So I implore you, pay attention in classes, take notes, read the textbooks. As I like to say to my other budding nurses, You are studying to save a life not pass an exam.

Studious Students Pay Attention

Read Broadly

The temptation as a student is to see a reading list that has been prescribed more as a set of guidelines, though the broader we read, and dare I say it, even outside of the prescribed reading, the better students and better graduates we become. I have purchased every book on my reading list (that was available), either Prescribed or Recommended, and I have collected over a dozen other books of use from book fairs, second hand stores and family. All of these books have been useful at one stage or another. I also read journal articles, health news, nursing news and magazines, blogs, Twitter feeds, converse with Nurses in the field, overseas and local professionals, I endeavour to gather as much information regarding our profession, how to conduct it and the latest and greatest procedures I can. This gives me a wide and varied base to draw from for exams and assignments. It means I am as up to date as I can be, and as a professional, ensures that I am maintaining my professional development habits which will serve me well in the future. My suggestion is read broadly and read often. Buses, trains, morning tea breaks, lunch, quiet times in the lounge room, relaxing in the bath, everywhere is a potential reading spot to absorb more knowledge.

Studious Students Concentrate

Don’t Cram

Anyone who is anyone has crammed at one stage or another, and if they say they haven’t, they lie. I have crammed for exams in the past and it serves to only have you pass in the short term but provides no long term information retention. During my time in the Navy we would be learning a new concept every week, with an exam on the Friday. It was expected that you pass the exam on the Friday so you could start a new subject on the Monday, if you failed however, you would resit the exam on the following Thursday, and still have the new exam on the Friday. Now you had two exams to study for. So cramming became a way of life, which was ok for passing exams and frying brains, but horrible for long term retention. The only way we retained the information was through constant drill and use. The information became so second nature, that I could almost step back onto the bridge of a Patrol Boat and not have too many dramas. However, in Nursing you are studying to use information one month, two months, three years or even a decade later. Cramming is no longer effective, and rigorous drill is ineffective as there is simply too much information to rote learn and reflex learn. So, slow, methodical learning through reading, writing, studying, revising, and reciting is the only viable way to retain the information long term. Now within all of this your individual learning style still applies. I am, for example, an aural learner with visual tendencies. Which basically means I learn best by listening, but can get away with reading. Some people are kinaesthetic, which means they learn through movement or by doing. The difficulty is going to be discovering what works best for you and going for it. I remember listening to a recording of a friend of mine, which ran for just over 45 minutes, with the rules for Navigation, droning on and on and on, and listened to it over a two day car trip incessantly in the interest of passing an exam on the other side. Which I did. So for me that worked.

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So there we have it, a quick look at some tips and pitfalls of study and being a Studious Student. I am in no way the perfect student, but I have learnt over time some habits that have helped me. So I now pass them on to you. If you have other hints, tips or lessons learnt from your study, add them in the comments below, or connect with me on the connect page. Don’t forget to subscribe so you can get regular updates on what is happening on the blog.

Maintain the Rage

Luke Sondergeld

Student Voice

For those of you who have read my previous blogs Maintaining My Rage and Controlled Chaos you will know already that I am passionate about leaving the World better than when I found it. I am also passionate about legacy and passing on knowledge to the next generation hence the reason why I am a Scout Leader. But I am also a strong advocate for students at CQUniversity, of both the TAFE and Higher Education persuasion. I believe that all students should have a voice in the way their school is run, what services it provides and ensuring the school (even the local high school) keeps its focus on its students and not the press. That’s why I volunteer my time on the Student Representative Council (SRC) and Student Participation and Retention Committee (SPARC). So to that end I believe that a students voice should be comprised of three things; Advocacy, Reformation and Honesty.

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Advocacy

Advocacy, in all of its forms, is the simple act of providing a voice, and subsequent defence, for someone who does not have one, or cannot be heard. I know this sounds like something from the Oxford Dictionary but it is true. As a nursing student we are taught from day one that we are the advocate for our patients, we are there to stand up for them to other medical staff and to defend them if we believe that a treatment plan for them is inappropriate or unwanted. My belief in advocacy is no different. On the SRC and SPARC my role is to ensure that issues of the student body in relation to campus life, retention, support, tutoring, mentoring, access to equipment, safety, or any other facet of student life is heard, and heard well. Thankfully both the SRC and SPARC either have the ear of members of staff who can effect change or are the body that makes up the majority of the committee. We have been empowered by the University to question, raise concern, hold to account and disagree with the decisions made by the University and propose better solutions for the students. This in turn brings around good change for the students, not just change for change sake, and that is why Advocacy is such an important part of the student voice.

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Reformation

Reformation isn’t just something that the Church went through in the 16th Century after a gentleman nailed his ideas to his bosses door, it is the idea that change, real change, can be made by those who are willing to stand for what is right and true. The idea that women can vote, that those of colour should be born and allowed to be free, that divorce is a thing, same sex couples are not evil, and that a New South Wales supporter doesn’t have two heads, are all reformative ideas. They all took, with the exception of NSW, someone to stand up and voice the concerns for the people, to say This isn’t right!  The student voice is no different, and I am glad that CQUniversity have given such a reformative voice to the SRC. One of my ideas that developed into a project, that is currently going through the costing and budgetary stage, was the idea of students supporting students to pass through the course, the idea of you have to collaborate to graduate. It sounds simple enough, it even sounds like an idea that already exists, but not an idea that is formally supported by Universities, and certainly not in the TAFE sphere. So I pitched it to the SRC. It was met with a wondrous curiosity, that led to many meetings and discussions with many of the staff regarding the who, what, where and how. After these discussions CQUniversity have finally decided on a model which works for them and are now, as previously mentioned, going through the costing and budgetary phase to conduct a two year trial program in the Diploma of Nursing. A student voice that effected reformation.

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Honesty

The student voice does have an obligation to be honest, this does mean that if a particular choice is the best for the student long term, even if not the popular choice, it should be the one chosen. The message to the student body then has to be equally honest. I have been engaging in discussions with a dear friend of mine over the seeming lacking financial support for over 30 year old students. It would appear that if you are under 25, live in a remote or regional area, are of Aboriginal or Tourist Straits descent, or are studying Engineering then the World is your oyster. As for anyone else, you are on your own. After doing some research into unemployment and education statistics it would seem that the support for the aforementioned is well placed and therefore not that unbalanced. Youth unemployment in Australia is at 12.8%, compared to the National Unemployment of 5.5%, and that number has been steadily increasing since its all time low of 7.8% in 2008. This coupled with the increased cost of living, on average 10.84% higher than that of the US not including rent, has meant that more and more support is needed for these groups. But what about the over 30s? According to Australian social research firm McCrindle the over 30s average Australian is 37 years old, employed and earning about $60,330 per year, exercising 3 times per week and sleeping 7 hours a night. So from a statistical point of view not someone who needs a lot of support. And this is where it becomes tricky for anyone who is a position to be heard. You want to support those who have asked for it, or who you perceive to need the assistance, but the reality is, the battles need to be picked or the voice will fall on deaf ears if there isn’t enough data, facts or truth behind the words. So though Honesty may not be the most glamorous or politically beneficial portion of the Student voice it is the most important.

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I hope this either helps people understand the Student Voice a little more and what I strive to do every time I enter a meeting, I also hope this spurs others to step up and use their collective voice for real change. If you have a voice, no matter how small you think it is, or want to share something that you feel needs to be heard, write it in the comments below, alternatively email me on the connect page and lets chat.

Maintain the Rage,

Luke Sondergeld

Five Community Care Reflections

To follow on from the Reflections of Aged Care and in the interest of continued Reflection so I can Maintain the Rage the following are lessons that I have learnt while on my Community Placement for my Diploma of Nursing. The lessons and revelations that I came to during my placement were; Community Care is not a lesser form of care, Discharge from Hospital doesn’t mean Healthy, Funding is a speed bump not a road block, D is for Danger, a little care goes a long way.

Community Care is not a lesser form of Care

After spending a week in the community setting I very quickly realised, it’s not a lesser form of care, less equiped or less skilled, if anything I found the opposite. The organisation I placed with had two Nurse Practitioners on staff, a myriad of Clinical Nurses and Registered nurses, and an Assistant in Nursing who ran the stores and supply chain. This was a well oiled machine of Healthcare. They were all completely professional, top of their game and the most caring people I think I have met on my journey so far. They work diligently to provide the best level of care they can, and if they can’t, they find someone who can. They didn’t know the meaning of the phrase ‘Too Hard’.  It completely changed my perception of what community care was, which I will admit, wasn’t a very positive one. I alway pictured nurses with a bag of observation equipment, some simple dressings and a box of drugs going from clients home to clients home dealing with  the Elderly and Disabled because they couldn’t make it to the General Practitioners. I could not have been more wrong. This particular organisation ran a clinic in the CBD, an after hours service, visits to the aged care facilities, at home palliation, home delivered clinical services and intra venous antibiotic therapy in the home. Nothing short of a real Hospital in the Home.

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Discharge from Hospital doesn’t mean Healthy

I also learnt that just because someone is released from Hospital that doesn’t mean they are on the mend, they are simply stable and well enough to be at home. This is the sad state of affairs in most countries, where the need for hospital beds is pushing quicker and quicker turn around times. Hospital beds are also becoming cost prohibitive, with the average night stay in Australia costing over $1,800. This has spurred the community health sector into overdrive, the need for advanced clinical skills in the home and community environment is at an all time high. With more people being discharged early, or avoiding hospital and seeking alternative arrangements. That’s were services like the one I conducted my placement with really come to the forefront. We as citizens of our respective countries need to be aware of this, as fathers, mothers, brother, sisters, and children of someone who may be discharged from hospital one day, we need to be aware of what services are available, and what help can be sought. We also need to be aware that the instructions that are given to you on discharge are there to, hopefully, keep you out of hospital. So do yourselves a big favour, especially those who are heading into healthcare, and learn what community services are available and what they can do for your patients on discharge.

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Funding is a Speed Bump not a Road Block

John Kander wrote a song for for his 1966 production Cabaret  which said “Money makes the World go Round”, and unfortunately it does. Healthcare is driven by two things, firstly patients needs, secondly how much those needs cost. Community care in Australia is funded either by the Government or Private Enterprise, and the private enterprises are usually not for profit organisations who receive funding from the Government. These agencies receive a certain amount of money per patient depending on complexity, time needed and a swag of other criteria. These criteria then govern how much the organisation receives to run that service, and what boundaries the organisation has to stay in, so as not to step outside of their appointed jurisdiction. This however does not stop the services from providing the care to the patient. What tends to occur is the service will refer to another community care organisation that has the jurisdiction to cover what is required. As far as the patient is concerned they still receive the right treatment, and the healthcare system get a smiley face sticker for doing the right thing, its a win win.

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D is for Danger

As anyone who has completed their first aid certificate in the past can tell you there is the the pneumonic of  DRS ABCD, where the first D is for Danger, to both the casualty and yourself, community care is a lot like that. Before entering someones home for the first time a risk assessment is conducted, this covers everything from number of people in the house, to pets, to access to the inside, to lighting, everything. The community nurse also has the right to arrive at a patients home and not enter and simply drive away if they believe there is a real threat to their safety, like the 75 kg hungry Rottweiler thats sitting in the front yard. This is paramount for the community nurse, because if they enter the property and the Rottweiler decides they’re lunch, you now have two patients at the residence not one. This lesson can be carried into the acute setting as well, if you have a belligerent patient who won’t settle and is throwing bed pans, grab a mate and tackle the room (not the patient) together.

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A little care goes a Long way

The short amount of time you get with each patient in their home doesn’t leave much room for error, but by providing a little care to the patients in the time you do see them can lift their spirits and help with recovery. Human contact, social activity and conversation are all great ways of battling depression, anxiety and promote good health. The simple act of being kind and caring during your visit could be enough for a patient to see the light at the end of the tunnel and really focus on their recovery, not their condition. Even in community palliation, the difference between openly and compassionately communicating with the client, and always walking on egg shells, can be the difference between what is considered a good death and a bad one. So in all walks of your health care life, care a little, share a little and take the time to be with the patient, not the task.

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My community care placement has taught me a lot, I made a swag of new professional contacts, saw first hand what the services can do for patients, learnt a lot of clinical skills and developed the ones I already had. Do you have a lesson learnt from one of your placements? Do you, or have you had a friend or family member receive care from a community health organisation? If so comment below, if you would like to share your story head to our Connect page so we can share it with everyone. Don’t forget to subscribe to receive email updates of new articles.