Healthcare Experience Allowance: Be Rewarded for Your Prior Knowledge

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Legacy Healthcare Careers has come up with yet another creative way to help certain new students save some much-needed money on their tuition and fees while rewarding them for prior healthcare career training, work experience or schooling. In essence, a $50 allowance will be granted to newly enrolled students who possess workplace and/or scholastic experience in the medical field or healthcare sector.

The Healthcare Experience Allowance offers new enrollees with healthcare experience or previous training the opportunity to obtain a $50 allowance to be applied toward tuition at Legacy Healthcare Careers. This monetary allowance is really useful in the context that it can help offset some often-forgotten expenses associated with attendance such as gas, lunch money, school supplies, transportation and so forth.

To be eligible for the Healthcare Experience Allowance, newly enrolled students must have prior experience or training in the healthcare or medical fields. Attendees can have experience as a home health aide, emergency medical technician, medical assistant, nursing assistant (CNA), phlebotomy technician, dialysis technician direct care worker, transporter, patient care technician, 911 dispatcher or personal care attendant. 

Other persons who are eligible to receive the Healthcare Experience Allowance include students in nursing school, healthcare occupational programs, and other health science training programs. To download the $50 voucher, click here to visit Legacy Healthcare Career’s school website, then scroll until the Healthcare Experience Allowance section is found. As always, call (682)313-6404 for questions, concerns or more information.

Once the voucher is accessed, show it to a school official at Legacy Healthcare Careers during the enrollment process in person, either by printing it out or displaying it using a cell phone. The voucher is valid for $50 off the usual tuition and/or fees at the time of registration. Enrolled students cannot receive additional allowances or discounts off the previously agreed-upon tuition and fees after enrolling. Discounts cannot be combined.

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Reminder of the CNA School Open House + Open Registration Event Friday 4/5/2019

Generic Open House

This is yet another friendly reminder that Legacy Healthcare Careers, an approved vocational school with a small campus in the Mid Cities area of the Dallas /Fort Worth Metroplex region, will host an Open House and Open Registration Event on Friday April 5, 2019 from 2:00 p.m. to 5:00 p.m.

The address of Legacy Healthcare Careers’ Mid Cities campus location is 7100 Boulevard 26, Suite 205, Richland Hills, Texas 76180. Please feel free to telephone either (682)313-6404 or (682)626-5266 to RSVP and confirm your attendance. As always, snacks, light refreshments, coffee, bottled water and beverages will be served.

During the Open House, the nurse aide training program instructors plan to make themselves available to answer any questions that potential students may have regarding the school, nurse aide training, nursing careers and job outlook. As a gentle reminder, two nurse aide (CNA) training programs, one for the daytime and one at night, will begin on Monday April 8, 2019.

Both of the aforementioned nurse aide training programs are fast-track two-week CNA classes with planned graduation dates of April 22, 2019. On par with the course, these class schedules are hand-crafted to be as convenient as possible for adult learners who might be managing full time jobs, families and busy lifestyles outside the school setting.

Since this is also an Open Registration event, all new enrollees must present an acceptable form of picture ID. Acceptable forms of picture identification include a drivers license, state ID card, passport, or school picture ID. During registration, a social security card will be needed along with a diploma, GED, high school transcript, college transcript, an old report card or any proof of completion of the 8th (eighth) grade.

To register for any of the two-week CNA programs, new enrollees need to provide a $200 down payment in order to guarantee their seat in the next nurse aide training class that starts on April 8. Acceptable forms of payment include cash, credit card, debit card, money orders, and cashiers checks. Legacy Healthcare Careers helps students set up flexible payment plans with as low as $200 down to begin coursework.

www.LegacyHealthcareCareers.Com is the official school website for Legacy Healthcare Careers CNA School.

Open House & Open Registration Event for 2-Week CNA Program: Friday April 5th 2:00-5:00pm

April 5 Open House

It is that time of the month again! Legacy Healthcare Careers, a small trade school with a cozy campus located between the cities of Dallas and Fort Worth, is hosting an Open House and Open Registration Event on Friday April 5, 2019 from 2:00 p.m. to 5:00 p.m. Legacy Healthcare Careers is located at 7100 Boulevard 26, Suite 205, Richland Hills TX 76180. Call (682)313-6404 or (682)626-5266 to RSVP and confirm your attendance.

Light refreshments and beverages will be served, and the nurse aide training program instructors will be readily available to address questions potential students might have. Two nurse aide (CNA) training programs, one for mornings and one for evenings, start on Monday April 8, 2019. Both of these are two-week CNA training classes. As always, class schedules are created to fit into the lives of adult learners who have full time jobs.

This is an Open House event; in addition, this is an Open Registration event. In order to enroll, new students will need to provide a picture identification such as a drivers license, passport, school ID or state issued identification card. Also, a social security card will need to be presented along with a diploma, GED, high school transcript, college transcript, old report cards or any proof of completing the 8th (eighth) grade.

To register for the two-week CNA program, new students will need to have a $200 down payment to ensure their seat in class for the next nurse aide training class that starts on April 8. Acceptable forms of payment include cash, credit card, debit card, money orders, and cashiers checks. Moreover, Legacy Healthcare Careers will set up flexible payment plans with as low as $200 down to begin the next class.

Legacy Healthcare Careers is a legitimate career training school. All of the healthcare training programs offered at Legacy Healthcare Careers are wholly approved to operate by the Texas Workforce Commission. Programs also have full approval to operate from the state Department of Aging and Disability. Rest assured that new students are in competent, caring hands at Legacy Healthcare Careers CNA School!

Well, here is the million dollar question: why should potential students and adult learners pick Legacy Healthcare Careers over other local career training schools? First of all, we offer smaller class to promote learning. We provide hardcore job placement assistance before students even graduate. We offer after-care support services after students graduate such as resume preparation, skills practice, and career coaching.

Do any other compelling reasons exist to choose Legacy Healthcare Careers over some of the other nurse aide /CNA training programs in the Dallas /Fort Worth metroplex? The school’s convienient Mid Cities area campus is easily accessible for those who live in Dallas, Grand Prairie, Fort Worth, Denton, Arlington, Euless, Irving and surrounding cities. The tuition and fees are very affordable, and scholarships are available.

Every enrolled nurse aide student undergoes a 40 hour hands-on clinical practicum externship at a local skilled nursing facility or licensed healthcare center. During this comprehensive clinical externship, an abundance of chances to obtain practice with basic nursing care and personal care procedural skills on real patients, residents and clients are available.

Call (682)626-5266 or (682)313-6404 to jump-start your legacies at Legacy Healthcare Careers CNA School. We will see you in class soon.

Healthcare Workplace Spotlight: It’s All About How People Feel Around You

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Here is a harsh reality of workplace politics that some people have not quite grasped: regardless of how well we are able to perform the technical and procedural aspects of our job duties, most employees will never get too far at work if people do not feel comfortable around them. Yes, the way people feel around us is very important. Some further elaboration on this phenomenon is needed, so here we go…

Many workers are amazing at the hands-on, technical aspects of their jobs. For instance, a nurse named Selma has approximately 10 years of experience in various areas. She is highly intelligent and has a masters degree in nursing. Selma has worked in a variety of higher acuity nursing specialties including interventional radiology, critical care, post anesthesia recovery, same day surgery, inpatient dialysis, and the emergency room.

Selma is proficient in a large number of technical and procedural hands-on skills that many other nurses have not fully mastered. For example, she is an expert at operating ventilators. She is also an expert at starting intravenous lines, accessing ports, running bedside hemodialysis machines, managing multiple IV drips, applying wound vac appliances, and performing comprehensive head-to-toe assessments of patients.

However, something is not quite right with Selma. She has had 19 jobs in her 10 year career as a nurse. Patients and families complain that she is not expressive or warm and that her bedside manner is cold. Coworkers would say she is very smart, but brutally honest and hard to be around for expended periods of time. Selma believes she does her work well, so she does not understand why she never manages to keep a job for long.

On the other hand, another nurse named Mamie also has 10 years of experience in a number of different areas. Mamie is an RN with an associate degree from a trade school and experience in lower acuity nursing specialties such as long term care, hospice, post acute rehabilitation, home health, private duty, doctors offices and seasonal flu shot clinics. Mamie has been at her current job at a nursing home for the past seven years.

Mamie does not have most of the hands-on technical skills that Selma possesses. Mamie does not know how to operate ventilators or access ports, and she is not terribly good at starting intravenous lines or managing IV pumps. While Mamie can complete patient assessments, she has never touched a dialysis machine. While Mamie knows how to apply wound vac appliances, she surely would not call herself an expert at this skill.

However, Mamie is beloved at work due to her cheerful personality and ability to make people feel good about themselves in her presence. She always offers assistance and has great interpersonal skills. After five years of dedicated work as a floor nurse and weekend supervisor at the nursing home where she is employed, she was promoted into the nursing administration department to serve as the facility director of nurses.

What is the difference between Selma and Mamie? Even though Mamie may be far less skilled in the hands-on aspects of nursing, her social skills are impressive. In other words, Mamie has mastered the art of causing people to feel comfortable around her. Mamie is aware that people do not care what a person knows until they know that the same person cares about them. Meanwhile, Selma has not yet figured this out.

The moral of the story is this: our time, interactions, encounters and experiences at the workplace will be made more pleasant and easier if people feel a sense of positivity and optimism in our presence. The initial step to induce comfort in people and put them at ease is to behave in a gracious and kindly manner toward everyone, regardless of who they are. After all, the way people feel around us is very important. Remember that.

Healthcare Workplace Spotlight: the Importance of Personal Hygiene

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For starters, personal hygiene is defined as the various ways in which an individual provides care to his or her body. Personal hygiene is of the utmost importance for everyone in society, but this rings especially true for those who work in the medical field and healthcare industry. In fact, personal hygiene is so important in the healthcare field that it can mean the difference between life and death.

Why is personal hygiene so important? The human body can be an ideal place for many disease-causing microbes and germs to flourish and multiply. These microbes can result in illness for a person who does not practice good personal hygiene habits. In addition, the microbes can make the other people in the life of the unclean person extremely sick due to the fact that germs that cause disease are spread by way of direct contact.

What are some examples of poor personal hygiene habits for healthcare workers and others? Examples include wearing unwashed clothing and uniforms, not showering or bathing regularly, not brushing one’s own teeth twice per day, not routinely washing one’s hands, and failing to cover the mouth when coughing or sneezing. Unclean clothes, bodies, mouths and hands are all able to spread germs and make others ill.

For those who provide direct care to clients and patients, personal hygiene is so crucial that adherence to good cleanliness habits can mean the difference between life and death. For instance, unclean clothing contains dead skin cells and germs. A nurse aide who wears unclean scrubs to her workplace can spread germs to an elderly patient with a compromised immune system. The patient may develop an infection and die.

Certain types of patients and clients are more prone to contracting illness than others. These patients include the elderly, the very young, the unvaccinated, and those with reduced immunity due to acquired immunodeficiency virus (AIDS) or taking medications that suppress the body’s immune response. People with autoimmune diseases and those who have had organ transplantation often take drugs that lower the body’s immunity.

So, what are some examples of good personal hygiene habits that healthcare workers and others should practice? Some examples include taking daily showers or baths, brushing the teeth twice a day, washing the hands after using the toilet and before giving care or handling food items, wearing clothing that has been washed, ensuring one’s hair is clean, and covering the mouth when coughing or sneezing.

Good personal hygiene habits reduce microbial counts on a person’s skin and in the oral cavity, thereby minimizing chances of spreading germs that cause disease. Clean clothing does not harbor the germs that are found on unwashed clothes. Also, covering the mouth during a cough or sneeze keeps airborne and droplet germs from getting into the air, thereby preventing others in the immediate area from breathing them in.

Personal hygiene starts with at the individual level. It is up to the individual to do what he possibly can to protect himself, his family, the community, and the public as a whole. Good personal hygiene habits protect individuals, families, communities and the general public by reducing the number of disease-causing germs on peoples’ bodies. Personal hygiene is a health and safety issue. Remember that.

RESOURCES

Australian Government Department of Health. (November 2010). Good Personal Hygiene. Retrieved March 28, 2019, from http://www.health.gov.au/internet/publications/ publishing.nsf/Content/ohp-enhealth-manual-atsi-cnt-l~ohp-enhealth-manual-atsi-cnt-l-ch3~ohp-enhealth-manual-atsi-cnt-l-ch3.7

2-Week Day and Evening Nurse Aide (CNA) Training Classes Start Monday 4/8/2019

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The next daytime and evening certified nursing assistant (CNA) training programs at Legacy Healthcare Careers are scheduled to begin on Monday April 8, 2019. Both of these are fast track two-week nurse aide training classes that prepare students to sit for both the written and skills sections of the Texas CNA state examination. Call the school at (682)626-5266 or (682)313-6404 for additional information.

Legacy Healthcare Careers is a small healthcare occupations vocational school that delivers extremely affordable nurse aide training classes in the middle of the Dallas /Fort Worth metropolitan area. All of the CNA training programs at Legacy Healthcare Careers have full programmatic approvals to operate by both the state Department on Aging and Disability Services (DADS) and the Texas Workforce Commission (TWC).

Tuition and registration fees for the certified nursing assistant training programs are $850; in addition, the school has flexible payment plans. The coursework is only two weeks from start to finish. Also, the planned graduation date for the upcoming April 8th CNA training class will be April 22, 2019. In other words, a motivated individual could potentially enjoy a new career in the exciting healthcare field in just a couple of weeks.

Legacy Healthcare Careers is also offering a fast track one-week (7-day) CNA training program that entails four very long days in the class and three really long clinical shifts. Additionally, a high school diploma or general education diploma (GED) is not required to enroll in nurse aide training program coursework as long as the prospective student can provide timely evidence of an eighth (8th) grade educational attainment.

Also, Legacy Healthcare Careers provides all enrolled nurse aide training students with a comprehensive clinical practicum externship that allows them to deliver hands-on basic nursing care and perform procedural skills on real patients and residents at a skilled healthcare center. Let us not forget that the one week and two week nursing assistant training programs can quickly open the doors to a dynamic career as a nurse aide.

Real job placement assistance is offered to all graduates of the healthcare occupational training programs offered at Legacy Healthcare Careers. A sizable network of hiring managers and healthcare workplaces with job openings is waiting to recruit the in-demand nurse aide graduates and hire them as soon as reasonably possible.

Again, feel free to place a telephone call to Legacy Healthcare Careers CNA School at (682)626-5266 for more information. Prospective students can also call the 24-hour enrollment hotline at (682)313-6404 for more information and/or questions regarding upcoming class schedules, clinical externship sites, and any other inquiries about CNA school that need to be clarified. Classes will be starting soon, so reserve a seat now.

Scholastic Spotlight: the Importance of Classmates

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Classmates, also referred to as schoolmates, are defined as students who attend at least one of the same classes together at a particular school or educational institution. Classmates are important and can serve as amazingly valuable resources to a person’s future career pathway in the healthcare industry, albeit for a number of good reasons that might not be completely apparent at the first glance.

Why are classmates so valuable? Firstly, classmates can enlarge a person’s professional and personal network. Second, classmates are a great source of knowledge and wisdom. Third, classmates can make the time at school pleasurable. Fourth, classmates can be the ones to provide character references for jobs or college applications. Finally, classmates can help each other to learn the mountains of material being taught in school.

The majority of adult learners opt to go back to school or enroll in career training classes so they can acquire job skills that will make themselves more marketable and salable in the employment marketplace. In other words, people go back to school to increase the odds of getting better jobs for higher pay. Classmates can be a helpful part of a personal network since they may know of potential workplaces that have job openings.

Furthermore, classmates can bestow a lot of free knowledge and pearls of wisdom upon each other by way of sharing their life’s experiences, backgrounds, personal stories and work histories. For instance, the 48-year-old student with 25 years of home health care-giving experience can provide useful info to her classmates on the benefits and pitfalls of giving direct care to clients in a homelike residential workplace setting.

Also, friendly relationships with classmates can enhance the social experience at school. Aristotle said that human beings are social animals and therefore naturally seek the company of others as part of their well being (Cohen, 2010). Students often take pleasure in joining one another for coffee breaks, lunch time and class sessions. These friendly bonds may extend outside school and can last for many years after graduation day.

Do not forget about professional and personal references that a job seeker needs when applying to places of employment, educational programs and so on. Hiring managers and school program directors often request character references from people who can vouch for the applicant’s habits and goodness. When a former student keeps in touch with his classmates, they will be more likely to offer character references for him.

Finally, classmates can help each other learn the material that is being covered in school. Groups of students who attend the same class may form study groups to learn and retain the information. Also, classmates can share the techniques they use to study for quizzes, exams, hands-on skills and reading assignments. Some classmates exchange phone numbers and may call or text each other when they need help or clarification.

Classmates function in all sorts of useful ways. They boost the size of a student’s personal network and can help in the job hunt. They are full of free knowledge and pearls of wisdom, and can enhance the schooling experience. They may serve as much-needed character references and can help each other learn the material. Since classmates are so very useful, they are of the utmost importance during a student’s time in school.

REFERENCES

Cohen, E. (2010, September 21). You Are a Social Animal. Psychology Today. Retrieved March 24, 2019, from https://www.psychologytoday.com/us/blog/what-would-aristotle-do/201009/you-are-social-animal

Healthcare Workplace Spotlight: Personal Care Group Homes

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Entry-level healthcare workers can secure employment at a variety of facilities that offer direct care services, including group homes. A personal care group home, also referred to as a residential care group home, is a private house within a residential community that is staffed with direct care personnel who provide around-the-clock assistance with activities of daily living to small groups of four or more adult clients who live there.

Personal care group homes are generally set up to replicate homelike atmospheres that appeal to clients and families who prefer cozier environments and more personalized services than those offered by large corporate-owned nursing homes and franchise chain assisted living facilities. Instead of living with 120 other nursing home residents, a client at a personal care group home would have anywhere from three to nine housemates.

Most personal care group homes provide services such as meal preparation, laundry, transportation, housekeeping, medication administration, housecleaning and custodial care services. Custodial care is defined as non-medical direct assistance with activities of daily living such as showering, dressing, eating, grooming, toileting and mobility. Entry-level direct care workers who staff these group homes provide help with custodial care.

It is normal for personal care group homes cater to specific subgroups of clients. For instance, some group homes are only occupied by clients who are adults with intellectual and developmental disabilities, whereas other homes have indigent clients who receive Medicaid. Still, some personal care group homes only accept financially secure elderly clients who are privately paying for their private or semi-private rooms with cash.

Most of the individuals who provide the direct custodial care to clients at personal care group homes are referred to as direct care workers. To become a direct care worker, a prospective candidate should have a high school diploma or GED, as well as valid state certification as a certified nursing assistant (CNA) or home health aide (HHA).

Even though it is possible to obtain a job as a direct care worker without a high school education or CNA certification, the rate of pay for this position will almost always be substantially lower without the aforementioned credentials. Therefore, it is advisable that entry-level healthcare workers obtain certification as a CNA prior to applying for positions as direct care members of staff at personal care group homes.

Call (682)626-5266 to enroll in two-week nurse aide (CNA) training classes at Legacy Healthcare Careers, a small vocational school in the Fort Worth area suburb of Richland Hills, Texas.

Nursing Care Spotlight: Preventing Skin Tears

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First of all, a skin tear is defined as a wound or laceration caused by trauma, friction and/or shearing forces. Skin tears rip through the upper layer of the sufferer’s skin, but not the lower layer that contains the various glands and nerve endings. Skin tears happen to be the most frequently occurring type of wound in older persons due to a number of reasons related to the aging process.

The likelihood of getting a skin tear increases dramatically as the elder’s skin becomes more weakened, drier, thinner and with less elasticity due to reduced subcutaneous fat, collagen, lessened elastin fiber deposition and sebacious (oil) gland production that occurs with advanced age (Aitken, 2018). In other words, skin tears are much more common as people age due to the fact that elderly skin undergoes predictable changes.

There are two distinct types of skin tears. A partial thickness wound happens when the epidermis, also known as the top layer of skin, becomes separated from the dermis (bottom skin layer). Meanwhile, a full thickness wound is a skin tear in which both the epidermis and the dermis layers become separated from the underlying skin (Ratliff and Fletcher, 2007).

Prevention of skin tears must be a priority for a number of compelling reasons. Firstly, the majority of people who seek care from the healthcare system are 65 years of age or older, so these patients are at increased risk of developing skin tears. Secondly, skin tears do have the potential to become infected. Third, skin tears can result in pain and suffering for the afflicted person. Finally, skin tears cost money to treat and heal.

The following is a list that merely scratches the surface regarding the various ways to prevent skin tears. Keep in mind that it is far more optimal to prevent a skin tear from happening in the first place since treating and healing this type of wound can turn into a time-consuming, somewhat expensive process.

  • Utilize draw sheets when moving immobile patients in bed to reduce the chances of developing skin tears from shearing and friction forces.
  • Apply barrier creams and lotions to patients’ extremities (arms, legs, hands and feet). Dry skin is a risk factor for skin tear development, so direct care members of staff should keep the skin moisturized often.
  • Educate nurses, nursing assistants, patient care technicians, transporters, and other healthcare personnel who regularly come into contact with patients about proper transfer methods, shearing, friction, risk factors, and preventive measures.
  • If possible, remove equipment with sharp edges that might cause injury to patients’ skin. If the removal of equipment is not possible, sharp edges should be covered with padding to minimize the chances of skin tears to peoples’ skin.
  • Implement a plan to identify all inpatient populations in hospitals, extended care facilities, personal care group homes, and other healthcare centers who are at increased risk of skin tear development.

REFERENCES

Aitken, C. (2018). Skin Tears in the Elderly. Western Alliance. Retrieved March 17, 2019, from https://www.westernalliance.org.au/2018/08/skin-tears-in-the-elderly

Ratliff, C., and Fletcher, K. (2007). Skin tears: a review of the evidence to support prevention and treatment. Ostomy Wound Management, 53(3), pp. 33-42.

Scholastic Spotlight: the Art of Taking Notes

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We know. It is a widely known fact that not all pupils enjoy the tasks of writing or taking notes. To some students, writing and note-taking are tedious activities they would simply prefer to not do at all. On the other hand, note-taking is one of the most crucial actions students can take to promote their own active learning. This rings especially true for those enrolled in healthcare training programs and health science coursework.

Alas, a multitude of convincing reasons exist for the sheer importance of taking notes in school. Thus, for the sake of time, only the most significant rationale will be pointed out here: taking good quality notes tends to help students remember and recall important material that they would have otherwise forgotten. Recall and remembrance of crucial material is very essential when studying for quizzes, tests and the state exam.

To reiterate that point, taking notes is a really important task. This fact has already been established. However, taking notes correctly and efficiently is not always as simple a task as it appears to be on the surface. Good, effective note-taking does not just call upon students to write down every word the instructor or professor says in a haphazard way. In fact, effectual note-taking entails capturing main ideas in the student’s own words.

One recurrent theme most good students share is the fact that they adhere to a specific way of taking notes in class. A specific note-taking style assists students to focus and organize prior to class; in addition, it helps them effectively review and recall crucial concepts long after class has ended. Adhering to one note-taking style and sticking with it will help students pay attention during class while capturing important information.

Sticking to one specific style of taking notes has an array of other study-related benefits, too. For some students, it bestows more than enough motivation upon them to stay attuned to class discussions, pay close attention and participate in an active manner. It helps students reword their notes effectively so they do not lose focus of the main concepts and ideas once they start studying for final exams.

The following list provides an overview of the different styles of taking notes in school settings. It is advised to pick one method and try to stick with it unless another style of note-taking seems more suitable for the topic of study. Of course, now that this information is out here, students may take it and utilize it as they wish. Students are also totally free to avoid using any of this information at their own peril).

  • Flow-Based Note Taking Style: a way of taking notes in which the pupil writes down the main concepts instead of verbatim paragraphs and sentences. The student connects the written notes and concepts by drawing arrows, boxes and diagrams to link them together as interrelated ideas.
  • The Cornell Note Taking Style: a method of taking notes that organizes class topics of discussion into easily memorable summaries. This style works since the main concepts and summaries are all written in one place. In the Cornell Method, the note paper is divided into 3 sections: a 2.5” margin to the left, a 2” summary section on the bottom, and a main 6” in-class note section.
  • The Bullet Point Style: this is a method of taking notes that involves simply jotting down each noteworthy detail as a bullet point sentence. This style of note-taking works particularly wonderful for capturing important points in class discussions that are moving along quickly, as wells as fast-paced lectures that are filled with a great deal of information.
  • The Outline Style: this method is, in all likelihood, the most popular way to take notes in schools. This style of note-taking involves an outline to organize the noted material in a structured, logical manner that forms somewhat of a skeleton of the textbook chapter or lecture subject and serves as a wondrous study guide when preparing for tests (Missouri State University, n.d.).

REFERENCES

Missouri State University. (n.d.). Outlining Method for Note Taking. Retrieved March 16, 2019, from https://www.missouristate.edu/assets/busadv/p.24.pdf