Congratulations Doctor Nurses!

The degree journey has ended, but the DNP adventures are just beginning. As the responsibility for improving the future of healthcare was laid upon us, so was the realization that we all have the strength and knowledge to meet the challenges ahead. Here are some highlights from the convocation and graduation of the UTHSC DNP class of 2012!

Pre-Graduation festivities at a lovely Vietnam Restaurant with the largest, most diverse psych/mental health DNP class that was . . .  or ever will be.  

The faculty address by Melody N. Waller reminded us of the many dimensions of love and loss that come with the nursing profession. Hearing all of the great capstone projects my peers have been working on, especially with diabetes, vulnerable populations, and health promotion behaviors, was inspiring.

Hooded by Cheryl C Stegbauer, who gave me the best complement of my life during Philosophy of Science when she told me I was a thinker.

This Dr. Nurse was voted Class Troublemaker - expect great strides in mental health advocacy from this one! 

With two future Dr. Nurses who are destined for great advancements in integrative care!

After being handed my fake diploma  (actually a lovely picture of the campus),  Chancellor Steve J. Schwab shook my hand and said "Congratulations doctor. Well done."  He did this for the thousand-odd graduates after delivering an address exemplifying how our current knowledge will comprise just a fraction of our future knowledge in a career of life-long learning and innovation.

And so it is official!

The Big Day

For the sake of posterity . . . and in case I loose the instructions!

Graduation Instructions

College of Graduate Health Sciences

The Fed Ex Forum: May 25, 2012, 1:30 p.m.

1. The commencement program will be held in the FedEx Forum, located at 191 Beale Street.

2. Parking is available in the Forum parking garage or surrounding area lots.

3. Students, faculty and staff who are participating in the graduation program are requested to be at the Fed Ex Forum in the appropriate assembly area by 12:45 p.m.

4. The assembly areas are located on the lower concourse and are best reached through the main entrance. Once inside the lobby area, the elevators to the lower level are located to the right at the top of the steps. The areas will be marked with signs for easy identification. Only ceremony participants are allowed in the line-up area.

5. DON'T FORGET TO BRING YOUR CAP AND GOWN. Orders for academic regalia can be made in the UT Bookstore or by calling 901-448-5413. The regalia may be picked up in the Bookstore on the Wednesday and Thursday of graduation week.

The Line-Up and Procession

6. The class president is designated as the class marshal and is responsible for getting the class into the correct line-up. A faculty committee member is designated as the college marshal. The college marshal will have a name/number list indicating the beginning and ending person in each row. You should go to the class marshal for assistance in locating your line-up position. The correct line-up is critical to the issuing of diplomas and to the "hooding sequence." Please stay in position.

7. Tassels on the academic caps for all candidates should be worn on the right front quarter of the cap.

8. The procession is led by the Mace Bearer and leaves the assembly area promptly at 1:30 p.m. Each college will be led in the procession by the college marshal who will also assist in the seating procedure. Please remain in correct order.

The Seating

9. The correct seating order will be directed by the college marshals utilizing the name/number list. Seating is done two rows at a time. Fill up the entire row. The second person in line for the college must leave an empty seat for the banner carrier (the first person in line for the college).

10. Remain standing, the Chancellor will preside and ask for an invocation and the singing of the National Anthem. Following the National Anthem all persons should be seated.

The Charge

11. A “Charge to the Candidates” will be given.

The Conferring of Degrees

12. Each dean will present their candidates for the conferring of their degrees. Follow the instructions given by the Dean and the Chancellor.

13. Tassels will be moved from right to left at the direction of the Alumni Association President.

The Hooding and Diplomas

14. The dean of each college will call for the graduates in the college to rise and come forward to receive their diplomas and academic hoods.

15. Only the front row rises and proceeds to the stairs on the right-hand side of the stage. Follow the directions of the Ceremonies Committee members (in red tams). At the top of the stairs, stand in front of the "hooding box" facing the audience. After the hood is placed over your head, and on signal from the "hooder," step to the right and proceed to the center of the stage to receive your diploma from the Dean.

16. As you approach the Dean, receive your diploma with your left hand and shake hands with your right hand.

17.After receiving the diploma, continue across the stage and down the steps back to your row and seat.

18. As the last person in the row proceeds to the stage, the next row rises in unison in order that the first person in the next row may be ready to proceed to the stage. The previous row will sit, when the last person of that row has returned to their original seat. Do not leave the arena floor.

The Benediction and Recessional

19. Rise and men remove caps at the benediction. Replace cap and remain standing.

20. Recessional: Faculty and administration are led by the Mace Bearer and are followed by the graduates.

21. The recessional moves from the Forum floor back to the assembly/ gowning area. Please do not break the line and congest the recessional.

22. Caps, gowns, hoods and honor stoles must be turned in immediately following the ceremony in the gowning area.

23. Diplomas, in graduation jackets, will be distributed in the same area immediately following the recessional.

24. A photographer will be photographing each graduate as you are hooded and as you receive your diploma. Proofs of the photos will posted on the web site listed in the commencement program within a few days after graduation so that you may purchase copies, if you so desire.

An Important Announcement

To Graduating MSN, DNP & PhD Students:
Congratulations on your upcoming graduation from the University of Tennessee Health Science Center College of Nursing! In conjunction with the UTHSC Commencement the afternoon of May 25th, the College of Nursing will host a Dean’s Convocation the morning of commencement honoring our graduates and their families. A reception will follow the ceremony. Attendance is required at both the Dean’s Convocation and Commencement unless excused by the Dean.

The convocation will be held at Lindenwood Christian Church, 2400 Union Avenue at 9:00am on Friday, May 25, 2012. Students and faculty will be in full academic regalia during the convocation and, of course, in appropriate dress afterwards. Lindenwood Church is located on Union Avenue immediately east of the intersection of Union Avenue and East Parkway, approximately 3 miles from the College of Nursing. Plan to arrive at the church at 8:30am. We anticipate the ceremony & reception will be completed no later than 11:00am. Invitations are being printed for the convocation ceremony and will be forwarded to you shortly for your use in inviting family and friends.

Congratulations again and we look forward to celebrating with you and your family on May 25th.

! Sent with high priority (no kidding!)

Finals Done and Final Thoughts

The last full week of on-campus learning has come and gone. I find myself both excited and wistful about graduation in May.  Perhaps I have overdosed on sappy Christmas movies and am feeling overly-sentimental, but I feel enormously lucky to have met the peers and mentors I have through the course of the program. But without further blubbering, here is the on-campus week in review:

Psych Seminar
This seminar was aimed at getting folks to narrow down their capstone and start drafting an abstract for APNA. In a move that labeled me teacher's pet, Dr. Cunningham shared the abstract I submitted for 2011 as an exemplar and talked about my prowess as a writer.  Apparently, writing 200 words a day is a prescription for improving writing skills - the blogging comes in handy in more ways than I thought! Since I cannot re-use my own work, I am investigating ideas for how to integrate Traditional Chinese Medicine modalities in to Psych Nursing practice. Based on the feedback I received on the APNA forum, it looks like a practice roundtable might be in order for 2012.

Health Care Economics
Never a dull moment, I did not have to attend this session for the 2.5 points, but I just love the debates that always crop up when Dr. Thomson and Dr. Carter are at the front of the room. While most of us agree that primary care should not be done by physicians and some sort of interdisciplinary comprehensive healthcare exam would be useful for parity purposes, I am in the camp that believes the American Board of Comprehensive Care (aka the third step of the USMLE) is NOT the appropriate answer. One of my pediatric NP classmates was quite persuasive on the matter of differing education and role between MDs and NPs that makes the ABCC test prejudicial in favor of physicians. As she pointed out, many pediatricians cannot pass the PNP board exam.  Moreover, NP education focuses on prevention and primary, community based care, whereas MD education focuses on tertiary, hospital-based acute-care.  It would be far more logical to embed a standards-of-care module into the respective exams for independent healthcare providers with a uniform minimum pass-rate. Whoever can design that will make a fortune.

Evaluation of Practice
A few bumps in the road on this course, which is expected given this is the first year of the re-design. I know from being at the front of the classroom that there are some brands of student that feel the first draft of the syllabus is a sacred tomb not to be altered for anything less than plague, pestilence, or flood. Me, I roll with the changes to make the changes work for me. I also do not  interpret that which is not graded as that which is necessary, and there were a number of ungraded assignments in this course. The end result found me reviewing my Improvement Science project with Dr. Mona Wicks, Associate Dean of Research, who not only provided enormous encouragement and essential edits to my project, but taught me a valuable lesson in professional reflection. I must remind myself I do NOT need a PhD no matter how tempting it sounds!

Clinical Management of Mental Health Disorders
Despite reviewing strategies on how to get out of doing our presentations, we all went backed-down and went through with it.  All of the consultation process were unique and well done. Here is ours for any future students in need of some ideas:

Sexual Abuse Prevention Consultation

View more presentations from Jaclyn Engelsher

"We Take Care of It"

It's that time of year again. Time for me to curse Delta, humidity, and numb-butt. On campus for our third semester means 10 months until graduation . . . 10 months + 1 day until student loans go back into repayment. It also means I get to explore a bit more of downtown and contemplate how exacly to formulate a group session on alcohol therapeutics.

Compared to last year, it is almost like we are barely on campus. Monday was for the newbie and the only thing on the official agenda for Tuesday was Evaluation of Practice. I proudly waltzed in an hour late along with several other slackers (all of which I believe were from the Psych option) and spent most of my time looking up old evidenced-based practice lectures from my MSN to refresh myself on what a PICO question was. I would love to report I have any idea what the class was about, but a revised syllabus, 2 detailed assignment lists, and a lesson in literature search later and all I know is everything must be submitted electronically and the professors are willing to fire our group partners for us if they are not pulling their weight. You fire our problem? I don't think so. In psych, if we have a problem, we take care of it. No need to resort to tattling (I think that is a king to rook four on the lateral violence chess board, but I need to look it up to be certain).  I think this class is going to be the Epidemiology of year two.

Did I mention 10 months until graduation?

Two for Tuesday

Morning Session


I woke up early this morning for a much needed workout and SVU reruns. The morning starts with a call to AAA, once again validating my 12-years of membership dues, and the discovery I can get $30 off my nightly hotel rate since I am at UT. Fabulous!

Our only class today was recapping and sharing some stories on our therapy experiences this semester. It solidified my love for the self-pay business model. No federal money means no federal rules . . . other than the usual ones we all have to abide by.

Afternoon Delights
Because I live by the notion that everywhere is Vegas if you have the right attitude, I have an amazing low back/hip massage, reflexology, and a facial at Rachel's Salon and Spa. As usual, I am given the royal treatment by both my therapist and the receptionist with promises to return on the next trip in August. I top the afternoon off with some awesome BBQ duck nachos and a drinkable Bulleit Bourbon Sidecar from Flight ("we don't have a cocktail menu, but we have a full bar" is my new sign to order Makers on the rocks).


Liquid Therapy
A group of us from class decide to end the semester in the traditional nursing fashion: drowning martinis, forking dessert, and discussing various clinical experiences involving genitalia.

We started out at Huey's - the hundreds of toothpicks shot in the ceiling via straw left me reasonably certain I was about to hear he "we have a full bar" line in answer to my cocktail menu questions. I was right. We decide to take a walk over to the sushi/Thai resturant after everyone fails in their attempt to spit hard enough to add to the decor.

Our new haunt, Bankock Ally, is appropriately named for the direction of the conversation. In the interest of professional courtesy and confidentiality, I will refrain from specifics. Sufficed to say, if you are a nurse you know what we talked about. If you are not a nurse, we discussed how awesome it is to work for cute doctors and be angels of mercy. And what serendipitous fortune! We are presented with the Two for Tuesday menu and toast to the fruits of our semester's labor. And to all a good night!

 

Fight, Flight, Freeze, or Caregive . . . . or Have a Cocktail: Kicking Back with Bowen's Family Systems

Got into Memphis at 8am courtesy of Delta (still the only direct flight to Memphis and a steal at $500 a ticket) and whisked off to the ever reliable Springhill Suites via Last Minute Transportation (superior service, as always).

Afternoon Funk

Nothing gets a trip started like a some sailors jammin' to "Ride Sally Ride" and a hot dog from a cart!

Individual Group and Family Therapy 2-6pm

Sylvia Landau gave an amazing presentation on Bowen's family systems theory. My new mantra: "I'm not being selfish, I'm fostering self-actualization." Seriously, I now have an explanation for why neither mom's Catholic or dad's Jewish guilt trips work on me and new rational for my relative lack of concern for doing what is expected. Of course, there is a fine line between ass and actualized, but it seems those who adopt a Machiavelli attitudes suffer fewer health issues and far more joy than those who take on the world's woes and feel compelled to do either everything for everybody or nothing for themselves. I must have had a self-care premonition since I already booked myself for a facial and reflexology at Rachel's for tomorrow afternoon! Some great points from the lecture:

• Who we are is defined by the family gossip
• You are just one bean in the soup
• Active listening gives the patient permission to do their own work and trust themselves
• Health is to become whole
• Saying nice words does not negate the impact of scary thoughts
• Get neutral, not guilty
• Psychosis can be an adaptive coping response
• Like matter, anxiety can neither be created or destroyed, rather it is projected and absorbed.
• Be a friend, not a blood sucker
• We run from reality as long as we can get away from it
• The system will try and change you back
• Cancers are cells in other systems' business 
• Present mindfulness helps extinguish automatic role patterns and tolerate the familiar
• Feel your emotions, but don't get too sentimental

To top it off, we received a copy of Caterpillars Chrysalis to Butterflies: Humans Change Through the Family Process which Dr. Landau was kind enough to sign for me. Interestingly, we share "All the Way" in common, although Fred and I prefer the James Darren version to Sinatra's.

Dinner at Grill 83

I am working my way through nearby fancy-town dining and had a lovely chat with the bartender about cocktails, sake, and bourbon. May I suggest the Memphis Passion Martini, Shrimp Spring Rolls, Beet Salad, Creme Brulee, and the Memphis French Martini should you care to visit?! 

Mid-Year One Week: Day Three

Leadership & Health Policy

I admit it - I am bitter that I have to take this course. Again. I already took a DNP level health policy course in the fall that would not transfer because it was not "exactly" like the one at UT. I should not be surprised because nearly every university does this so they don't loose out on one dime of that beautiful cash American, but if I have to go over the health care bill in detail yet again, I am going to require Xanax. Stupid boutique classes. I cannot even rip off my own papers!

Memphis Highlights

Springhill Suites is a winner and I will certainly stay again even if I do not rate customer of the day. Breakfasts are great, the decor is modern and relaxing, there is excellent free wi-fi and printer access, plus they have a lovely little soiree on Wednesday nights with beer, wine, and appetizers.

Last Minute Transportation was once again a great transportation service with that personal touch. Unknown to me, the trolley decided not to run down Madison and they came through in a pinch when I had 8 minutes to get to class.

Felicia Suzanne was having a private party in the bar area so we wound up checking out Flight for some apps and drinks. As the name indicates, they specialize in pairing wine and food flights. The concept was pretty cool, but the execution was nothing to rave over. The sidecar was weak to say the least, and my dining partner was not impressed with the pomegranate martini. In fairness, we only had one of the flight appetizers, so I will probably give it another roll on the next visit.

Mid-Year One Week: Day Two

Individual and Family Counseling

Bleary-eyed and without decent coffee, we headed to class at 7:30 in the morning to listen to a fantastic lecture on the relationship between temperament and attachment. This is one of the only classes I would prefer in lecture format just because it is so interesting and interactive. Even at dawn.

Concept and Theory

Reaffirming why I love on-line delivery of material! The teacher is great, I want to take her out for a drink. Unfortunately, this is one of those classes where all of the disciplines are put together and you see the "nurse" personalities come out in the (very unnecessary if you would actually read the material, will probably have to ask again later, and should be emailed because they only apply to you) questions. "One more thing" is one of the most evil promises when you don't really mean it.

The class ended with a video of the Hallelujah Chorus in a food court for the purposes of illustrating how quickly awareness develops. Fine. But the oral and subsequent apology for showing a Christian-based example was totally unnecessary. Anyone who would have been offended by it would have been looking to be offended. If it was "Rock of Ages" or the Mormon Tabernacle Choir or the Gayatri Manta, I would not have expected an apology because I am not Jewish or Mormon or Hindu. Ahhh, the oversensitive times in which we live.

Philosophy of Science Wrap-Up Presentation

40 people. 4 hours. Not surprisingly, most of the majors fit their stereotypes. I do not want to bad-mouth any specialty, least of all my own, but lets just say the folks you would expect to like the black and white philosophies did a great job when they took the logical positivist views and the folks who you figure would like the amorphous topics did a better job supporting the process philosophy viewpoints. We were a group of talkers and while interesting, we also took 1 hour longer than the other half of the class.

Bad News/Good News

Elizabeth Edwards, who I found out just before my plane took off was stopping chemotherapy, lost her battle with cancer. On the flip side, the SpaceX Dragon went up and splashed down - time for the stars!

Mid-Year One Week: Day One

Arrival

Gloryosky - I made it to Memphis without getting bumped off my flight. I called Last Minute Transport, as usual and they got me to Springhill Suites in no time. When I walked in the door, Jency the receptionist greets me with a "you are our customer of the day!" This entitled me to a room upgrade to the tower and free goodies from the market store. A room with 2 beds was immediately available which was lucky in light o the minus-6 hours of sleep on board. A great beginning to the trip. Unfortunately, MATA stopped trolley service down Madison so I had to spend $12 on a 5 minute ride to campus.

Interviewing and Counseling Wrap-Up

Reality check time! The final we took a couple of weeks ago consisted of several clinical scenarios that we had to make a therapeutic response to. Several examples from different students were anonymously presented - some were amazing and others were hilariously untherapeutic. A few of the good ones sounded familiar, but I was so emotionally spaced out when I took it, that I had a panic moment in November and asked the instructor to re-open the exam because I forgot I had taken it!

The same mental-health consumer who was present during orientation week came back and discussed communication issues among different types of health care providers. Not surprisingly, psychiatrists rated low on the list because of the short time spent in relation to decisions to start major brain-chemistry-altering medications. Family pratice rated high because of their holistic approach (yeah!).

Assessment Strategies

We started with a Medatrax tutorial. In my FNP program we used a similar tracking system for clinical logs and these things pretty much all work the same. There will be a Droid app or this soon, thankfully! We talked a bit about expectations, for the upcoming class, but the class does not start until January so the bulk of the information will come through Blackboard.

Psychopharm Wrap-up

I am so glad to know I am not the only person who feels both smarter and dumber after taking this course! The same mental-health consumer from I&C came to class and we broke down her medications, past and present, as well as cases from some of the practices of other classmates. Great ending, and I am looking forward to getting to the "meat of practice" with the assessment course.

WTF Moment

Word is PTSD and Narcissistic Personality D/O may be out of the DSM-V when it comes out in 2013? 2015? THe reason for PTSD is easy. If you get rid of a disorder, there is nothing to pay for. "Shell shock" will probably come back into the vernacular, but I imagine they will shuffle many of the PTSD cases into TBI if you can demonstrate any sort of head trauma. Narcissistic PDO is a little more disturbing only because the reason it may be out it because narcissism is so pervasive in our society, it is considered normal. Wow.

Best Line of the Day

"Inhale? He still owes money!" (former limo driver John James on Governor Bill Clinton in his heyday)

Memphis, Memphis Hear I Come!!!

Finals are taken, papers are turned in! All I have left is a 5 minute presentation on whether logical positivism or process philosophy is the better approach to studying sanity and the final edits to that paper and this semester is history.

And then on to the next semester the will start, oddly, concurrent to the conclusion of the current semester. So here is a sneak peak at what on-campus week looks like:

Tuesday:

8am direct flight on Delta which I cannot get a seat assignment for because the light is oversold. This is not a good omen.

8:30am I will make the flight, I will have a seat, I will get there in time to grab a ride over to the hotel in time to have a light lunch and trolley it over to the university.

1-3: Interviewing and counseling (final class)

4-5:30: Assessment strategies in mental health (first class)

5:30-8: Biological treatment of psychiatric disorders (final class)

8-?: I am getting a sidecar from the place down the street I went to last time. Yum.

Wednesday

7:30-9: Individual group and family therapy (first class)

9-12: Concept and theory analysis (first class)

1-5: PRESENTATION Philosophy of science (last class)

6-???: Party at the deans house!

Thursday

9-12 Leadership and Health policy (first class . . . again. I already took this stupid course at Bellarmine but they would not let me get out of it because "they did not teach it exactly like we do." PHFTTTTTTTTT)

1-4 Written scholarly activities workshop

And then I leave for Italy!

Orientation Week: Day Five

Another lovely 7am Interview and Concealing class - I am so happy we ran out of time for the planned exercises because I slept less than 3 hours that night. The big assignment coming up is recording a conversation using empathy and additive empathy. I really want to do this with a non-patient stranger rather than with someone I know.

The next class is another one that should have been optional. I knew I should not have walked in the door when I saw the powerpoint involved dressing for success, but like a chump, I rush to the front of the room thinking, surely this is not the full presentation. It was. Despite the fact everyone had to speak and dress well to make it through the interview, I guess they felt we all needed a brush up. Here are some highlights from the "rules" we went over:

- Wear a suit with a jacket that buttons

- No jewels after five

- Bread plate on the left, drink on the right

- Wear nail polish

- Do not eat until everyone sits at the table

- Shake with your right

- Get your hair done

- Wear your name tag on the right

- Wear make-up

I am not kidding.

The presenter was jovial, and we actually have the introvert personality in common. The most illuminating tidbit was the guidance on 15 second sound-bites if interviewed and having a collection of them that are clear, concise, and well practiced in the mirror. There! One lesson learned! One thing I love about attending a school in the real south, is that no one grumbled. They just smiled and left class.

And so orientation ends and I am off to home!

Orientation Week: Day Four

The morning started with a speech from our Distinguished Visiting Professor, Diana J Mason from Hunter College. We used her book during our Health Policy class in the MSN program at Bellarmine, so it was great to hear the author's voice. The bulk of the presentation concerned the role of the nurse in reforming health care. I feel I have been beaten over the head with health care reform enough. While it is true nurses play an important role in the restructuring of our healthcare system, this reform bill discourages nurse entrepreneurship through increasing regulation and taxation on small businesses (even those that are not healthcare-based!).

Here is a mix of things that ran through my head during the presentation (this is not inclusive, I wrote several pages of thoughts on this):

Primary Care Physicians assume they have the skills to be primary care providers – they specialize in diagnosis and treatment of disease, but not health promotion and disease prevention as part of care coordination. They also assume they have the qualifications to supervise DNPs! WE ARE NOT THE SAME PROFESSION!

Contrary to the contention that DNP's are not qualified to stand side by side with primary care MDs because we do not have a residency, we do have to proper education and clinical training that matches our scope of practice. Rather than front loading our programs with didactic work and coming out of medical school with little true patient time and responsbility, nurses have an integrated residency model that combines didatic and clinical work starteing the sophmore year at the BSN level. In fact, for many years one could graduate with their MD and do NO residency as long as they stuck to primary care and not a specialization. And guess what - those folks are grandfathered in to the states who finally decided to make residency a requirement for medical practice. It is worth reiterating ADVANCE PRATICE NURSES ARE NOT PRETENDING TO BE DOCTORS NOR ARE WE PHYSICIAN EXTENDERS! We are not "nurses with a little extra training" and we can do more than put a bandage on a wound and prescribe a Z-pack. We are our own profession with our own role in primary care that works with, not against physicians.

Why don't advanced practice practitioners train together in some type of integrated clinical experience? Good communication and collaboration can only benefit the patient and the various professions.

Another student gave a speech that I have said many times. MDs did not have a problem when Dentists, Podiatrists, Psychologists, Physical Therapists, Naturopaths, and Chiropractors encroached on the "Doctor" title that MDs commandeered as their own (despite the fact all of these are practice, not research doctorates). Why pick on the DNP?

“Communication is how we change things” I used to think just because you change the name of something doesn’t mean you change the perception. Changing nursing home to health home, patient to client (and probably coming soon, customer), noncompliant to noncoalescent does not change the facts that the home is under-funded and depressing, the person is seeking healthcare, and the person is not doing what you prescribed. On the other hand, I also believe “language is how we view the world” and that view can be altered if we change what we call it, though I do not believe the actual fact can. I hope.

After the conference, I realized I needed to get my butt in gear and join the APNA, especially since their conference is in Louisville this year and I have a clinical group on Friday that could benefit from viewing the poster sessions.

We had yet another training in the afternoon. I have been using Blackboard for nearly 10 years now, and while I am not perfect, I did not learn anything new. All of these sessions really seemed targeted at learning the basics of the software and I wish that had made these sessions voluntary. In the meantime, I did set up my NAMI walk page, so it was not a total waste of time! Check out the Stigma Stampers team by clicking HERE.

The day ended with a gathering of all of us in the psych track and going over the timeline of clinical and requirements for the next 2 years. am so excited that I will have an opportunity to work with some of my mentors and that I am not strictly limited to MD and ARNP preceptors. This program really fosters learning, not just jumping through many of the usual arbitrary nursing hoops and red tape "because that's the way it is done, dear."

***If anyone is interested in a copy of Dr. Mason's lecture notes, let me know and I can forward a copy***

Orientation Week: Day Three

Having a 7am class on the schedule felt like hazing, however it was Interview and Counseling so at least I enjoyed it. We discussed reflective practice and methods to look back on interactions and improve them. It is interesting how vividly I remember the times I screwed up, especially when I first started as a nurse. Assumptions about how the patient perceives you can lead to postures, humor, or subjects that the patient finds offensive resulting in unforeseen escalations.

Biostatistics was up next, and what an amazing relief. From the syllabus, it looked like this was a rehash of the social stats class I took last year which is both good and bad. Apparently the teacher before him was a beast, but this guy is hilarious. He wants to take the scary out of statistics, but primarily, "the most important thing is by the end of the course, you love me." I am going to adapt a lot of his material if I get to teach a class at Bellarmine this year. When I found out he used to be an actor, it made sense that his style seemed similar to the way I instruct.

Last class of the day was Philosophy of Science. I admit that I have serious math envy and had already read a good chunk of Hawking before class. I would have loved to have been a philosopher if there was anyway to pay the mortgage by sitting around and thinking all day! I started working on the first essay assignment discussing space-time and defining several terms; if I actually submit what I think I am going to submit, my instructor is going to think I am either a real thinker, an idiot, or a wack-job.

Orientation Week: Day Two

We had a lot of tech-style orientation this morning – reviewing Office 2007 products (guess it is time to purchase the update!) and getting our laptops connected to the UTHSC system. I had a lovely afternoon break and hit the hotel gym. Unfortunately, the afternoon shower does nothing to stop me from pouring sweat on trolley back to school. The Memphis humidity is sneaky – unlike Louisville where you immediately can’t breath and feel ten ponds heavier when you walk outside, here you actually think it is bearable for a few minutes.

Next up, Epidemiology. This will undoubtedly be my challenge class because I want to “yes, but” nearly everything.

Take pertussis. The number of cases has risen by the thousands in the past several years and they are now recommending booster shots for pre-teens. If it is true the immunity wanes over the course of a few years, it has been doing so for decades. The rise in cases is recent and more likely do to lack of initial vaccination, not lack of a booster. I keep thinking about a lecture I hears a few years ago by an epidemiologist who is studying the link between the rise of auto-immune disease and preventative care measures like vaccines and anti-bacterial everything. Her arguments were compelling and I am putting it on the list of topics to re-research during the program.

After listening to the lecture, I have every confidence that the end results of epidemiologic study will lead to the following recommendations:

Balanced nutritional packets tailored to the individual as the dole means of nourishment (think the Matrix: “everything the body needs”)

Procreation via Petri-dish based on genetic optimization (See Heinlein’s “Beyond this Horizon”)

Mandatory vaccination, 6-month-breastfeeding, and exercise programs (funny that a lot of folks who are passionate about breastfeeding are wary of childhood vaccines)

Strict lights-out and wake-up-call policy by time zone (“ealy to bed, early to rise, makes men healthy, happy, and wise)

Motion-detection automatic UV-light sanitation systems installed in every home

Uniforms and job assignments by aptitude

Or, as explained in Escape from LA:

Snake Plissken: Got a smoke?

Malloy: The United States is a non-smoking nation! No smoking, no drugs, no alcohol, no women - unless you're married - no foul language, no red meat!

Snake Plissken: [sarcastic] Land of the free.

Our professor is enthusiastic about her field and passionate about the wellbeing of the population. I am defiantly a individual and small-group focused practitioner, so my brain is going to get a good stretch in this class.

Last up of the day was my meat and potatoes class (or 30/30/40 if anyone is designing my nutritional regimen supplement) – Biological Treatment for Psychiatric Disorders. This was the smallest class and the first time we were able to have more personal introductions. We are a diverse bunch with varied backgrounds within the psych specialty. Some are in the second year of the 3-year post BSN-DNP, some are like me who have an NP degree and are working on their Psych Mental Health Certification with the DNP, and others are post MSN or CNL/CNS. Interests range from incorporating psych into their current adult/child/acute/family practice to further specialization in psych as a clinician.

Our first lecture discussed trauma as an origin for many of the over or misdiagnosed mental illnesses in childhood and a review of CNS responses to stress. I have so many new exciting things to share with my students this fall after just one lecture!

I also had that woo-woo feeling of “I am exactly where I need to be and doing what I am supposed to do.” I had that feeling over 10 years ago while driving back from the mountains in Santa Fe after the first week of my graduate program in Chinese Medicine. I love it when I get "signs" that don’t bonk me in the head!

Orientation Week: Day One

I flew into Memphis and cabbed it over to school just in time to sit through your usual school orientation - welcome, student assistance, health services, code of conduct, equality and diversity, honor code, campus safety, academic support, student panel - most of it was useful but much of it geared to the on-campus student. We got a free lunch (TNSTAAFL) and I snuck out to check into my hotel.

Since I hate driving, I decided to rely on public transport and take the trolly everywhere. I had initially intended on walking since my hotel is only a mile away, however the terrain is not conducive to a walk in triple digit temperatures. That, and when I asked some of the staff about walking there, bot said "this is Memphis, you know." Point taken.

The afternoon session began our first class, Interviewing and Counseling. This is the stuff I came for! We start with a "what would you say to this patient" exercise and I think years of teaching nurse-client interaction has made me a reflection junkie. We partnered up and recorded ourselves interview the other person and practicing empathy skills. I did not cringe at the sound of my own voice on playback and overall I did pretty well while identifying some areas I need to improve on. The class ended with a fabulous partitioner-patient communication demo by our instructor.

After preaching all last semester to my Nurse-Client Interaction students that there is not a script for perfect communication, it was nice to get validation from an instructor outside of Bellarmine. While I have been over lot of this material before, this was more of an advanced version. For example, I always thought the technique of echoing was a little creepy:

Patient: I feel sad.

Practitioner: You feel sad?

Sounds like you are just talking to talk or to prove you are listening. The "advanced" version is rephrasing with inference and a boatload of new emotional descriptions:

Practitioner: What I am hearing you say is you are discouraged and unappreciated because you have been working to have your family eat dinner together but no one wants to participate. That makes you want to stop trying and makes you feel like a failure.

Somehow therapeutic, somehow spooky in a fortune-teller sort of way! It is great to see that for as much as I know (or think I know), I have a good foundation on witch to refine and grow as a communicator.

The most interesting tidbit of the day came from the "Feeling Word Vocabulary" handout that classifies emotions into 5 categories with 3 levels of intensity. These link up nicely with the 5-Element emotions in TCM:

Happy - Heart

Scared - Kidney

Confusion - Spleen

Sad - Lungs

Angry - Liver

I keep thinking about a concept I learned in bioethics - language shapes the way we view the world. By and large I believe this to be true. Total number of words versus common and colloquial word usage between different languages is fascinating, especially when you come across those "it really isn't translatable in English" hurdles. In looking at this list, which is by no means comprehensive, there are dozens of ways to describe "happy" in English and I wonder if there is any correlation between knowledge/use of emotional descriptors and emotional contentment (i.e.. if you can specifically describe your feelings, does it aid your ability to set goals, feel secure, or pull out of unwanted emotions as opposed to someone who is vaguely or generally happy, sad, or angry?).

Bottom line - I am excited about this program and the upcoming changes in myself as both a clinician and a person.