2.06.2008

Metrology Day

We begin each semester with a metrology test. Metrology is the knowledge of drug dosage calculations. This is a crucial understanding to achieve in Nursing, not because we decide what dosage to administer, but because we're the last line of defense ensuring that the substance is safe to administer to that particular patient at that particular time.

The actual math we're called upon to do in the general units is minimal. Most things are pre-packaged from the pharmacy and standardized in ways to reduce the amount of calculations required from the Nursing staff. The hardest calculations I've seen a Nurse do can be solved by simple dimensional analysis or simple analogy. X is to Y as Z is to W. Solve for one. Here are some examples from our practice questions:

*50 mg of nitroglycerin must be prepared. How many mL should be prepared using a 10 mL ampule labeled 5mg in 1 mL?

*0.25 mg of Rocephin must be prepared. Rocephin is available in mg. How many mg of Rocephin should be prepared? (that's not a typo, that's actually what appears in the list)

*How long will it take for an intravenous infusion of 1000ml of 5% Dextrose, set to run at 35 gtts per minute, when the drop factor is 20 gtts/ml?

*Epinephrine in D5W is to be titrated 0.1-1mcg/kg/min. The IV solution was prepared by adding 8mg of Epinephrine to D5W. The final solution contained a total volume of 500 mL. Your patient’s current weight is 91 lbs. You should infuse at a rate of ___ to ___ mL/hr.

*One half strength Osmolite must be prepared for a tube feeding. You have available full strength Osmolite. To prepare 90 mL of feeding, you dilute ___ mL of the full strength Osmolite with ___ mL of water.

That last one, believe it or not, was difficult for people who had successfully passed algebra. I had people coming up to me asking me how to solve that kind of question. Despite my acerbic tone here, I used to tutor math and I take it pretty seriously. I don't talk down to people or make them feel inferior when I'm demonstrating a problem (obviously, some people have a complex about this, so they'll always assume a neutral tone is threatening). I have a knack for breaking complex things down into simple steps and explaining things to people that they thought were beyond their ability to comprehend. This is fun to me, mainly because it results in there being more people for me to talk to. Also, I believe it's impossible to learn something from someone without becoming a little fond of them, and, well, that's an opportunity I tend to seize on. I can use all the friends I can get. I enjoy tutoring math for the same reason I enjoy Nursing. I seem to be good at it, it's fun, and people benefit from it and respect me for it. Most of the time.

The disparity in math skills is mystifying to me, though. Yes, I was an engineering student, yes, I took several advanced math classes, but the level of math we're being asked to do is several levels below what was required in the pre-requisite classes. We're being asked to divide, multiply, add and subtract numbers, and we even get to use calculators. I'll be the first to admit word problems can be tricky, they were the bane of my existence in pretty much every math class I took (although there's a great related-rate word problem involving the tip of a tightrope-walker's shadow that I always relate to get people interested in calculus), but when people are having trouble dividing a number in half and writing it down twice, there's an obvious break-down in reasoning skills that goes beyond inadequate training in maths. I think reading comprehension is a big part of it. Our educational systems (my favorite scapegoat) are training us to be marginally literate and incapable of abstract thought. Is it any wonder mental illness is on the rise?

I'm not saying any of this to denigrate my peers, they work hard and take what they do seriously (so seriously, in fact, that it sometimes gets in their way, but that's another topic for another day), but they've been failed egregiously by institutions that place social efficiency above personal growth and development. It does seem, by the way, that many people got into this biz because they thought they could get away with not knowing much math and science...and they're right. If current trends hold, more than half of us will stay at the lowest "Registered Nurse Technician" level anyway, maybe branching out into management or switching fields later on, so what does it matter?

What irritates me the most is how the tests have been modulated to ensure a higher success rate. This last metrology test of our ADN careers was a perfect example. Out of forty questions, at least 5 could be solved by taking the product of the only two numbers in the question, 3 or 4 only asked you to convert lbs to kg, two of the questions were duplicates, and all five or so of the feeding solution questions (that I posted an example of above) were half-strength feedings. Divide by two and type in twice. Not only that, even though we're told we are only given three chances to pass before we fail clinical, there have been multiple occasions where students have failed three times and then allowed to take it again after a week of supervised practice. I'm not saying that being flexible is a bad thing, but if you're going to lie about your standards, why have them in the first place? People are being given a free pass, to be sure, and some of them are going to be in for a rude awakening further down the line because of it.

It's clear that the people having trouble with this need one-on-one instruction to transmit the necessary skills and reduce anxiety, not only tests with grim warnings of failure. The false warning of failing clinical after three failed attempts can only be meant to "scare" the students into...what...performing better? A couple of semesters ago we had a 10-minute visit from someone from the math department who introduced basic elements of numerical problem solving with these goals in mind, but it was just one short, isolated encounter. There are tutoring resources available at school, maybe people are too busy or embarrassed or something. Who knows. I guess part of the learning process is figuring out what you need help with and getting it on your own, instead of waiting for someone to hold your hand through it. That's what they told us back in Theory, anyway.

After the mathamagical festivities, I learned that my classmate from the psych rotation got moved to a different unit because two of the patients were fixating on her. She was warned about this on the first day, one of the patients with an indecent exposure target-behavior exhibited some behavior that elicited a warning from his therapist.

What was to be my second day there, I stayed home. Car trouble. I'll have to make the day up, in the Maximum-security forensic unit instead of Medium. I'm lookin' forward to that. While I was gone, all this stuff happened. My partner for that unit will now be another one of the male students. Like in the field, males are an extreme minority in our class. I think it's somewhere around 7.5%, which is actually more than in the field (5% last I checked). In every clinical learning environment I've been in, at least half the other males in the class have been there with me, like we're being clumped together, despite being from far-flung reaches of the state.

The change in assignments (for them, I'm still in the same place) will turn out being a positive thing, though. My new psych-partner is someone I've worked with in the past, and he's one of the few people in my class that I actually look up to (and not just because he stands about three heads taller than me). Although he's knowledgeable and dependable, I enjoy having him around because he's friendly, and that's not as common as you might expect it to be.

The rest of the day was pretty empty. A student government meeting here, some personal stuff there (oh, how I wish I could write about that, but I don't even know where I would begin), and then off to the coffee shop to jam out on some experimental electronics, harmonica and uke' music.

Our actual "classes" seem to have become perfunctory. As much as I adore the instructors, I don't get much out of powerpoint slideshow presentations that take an hour to deliver information I can get in minutes by reading. I slept through the lecture this morning, not being able to sleep the night before made it necessary to spend that extra hour or three in bed. Since I missed lab last week, I dragged myself out of bed to make it for Lab (which counts as clinical time, even though it's just additional lecture time), which was canceled today...because of that useless metrology test, supposedly. It seems like the point of our academic psych content is just to get us used to the idea that mentally ill people exist, and that you aren't going to catch it from them like an infection. Valuable insight, I suppose, if you were lacking it. The psychopharmacology content is moderately interesting (since psychopharmacology got me interested in these matters initially), but also frustrating, since the methods of action of many of the agents is poorly understood. The side effects and adverse reactions of psych meds are obviously very important to know, though, and I'm glad it's included in our curriculum. Maybe I'm just bored because I learned about these meds back in the group-home.

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