Focus Charting

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    I am in my first year as a nurse in Puerto Rico. I am working in a cardiac unit where we document using narrative style. The hospital announces us that we are going to change to focus charting because they are planning in two to three years to change to computer charting so they need to us to know how to document in focus charting. No matter they are giving to us information and seminars we all in my unit are scared because is so hard to think in a focus to start the documentation and to split it in DAR way. May be some one can help me with a well developed list of focus that you are actually using. Thanks and excuse my english that is just my second language
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    I can't stand DAR. When I chart it usually comes out at DRA. D=what's going on, A=What did I do about it, and R= patient's response, traditionally.

    But for assessment notes, well, what's going on is that I'm writing down an assessment, duh. If my patient has no complaints then there's not much I'm doing except monitoring, so it sounds kinda dry to me. So I am weird and prefer the "will continue to monitor" statement to be at the end of my note, hence my DAR turns into a DRA.

    Now if there's a problem that I did something about, I have no problem putting that in the right order. D=Pt. found lying in bed, bleeding from ... somewhere. A= Held pressure on whatever spot that was, approx. 5 minutes. Cleaned patient up, changed bed. R= Patient eventually stopped bleeding, is asymptomatic, no complaints.

    What kills me is having to WRITE the D, A, and R as little notations in the body of my narrative. I thought it was supposed to be a tool to teach me to think and chart the note in a proper format, so I do and then have to go back later and stick little capital D's, A's, and R's in there. It's annoying. I suppose if there wasn't a format we're supposed to use, then people would just write any old thing, who knows?
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    I didn't realize there were that many hospitals that weren't doing computer charting. I've never even heard of DAR.
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    DAR may be silly to me, but it sure beats APIE which is what our ICU uses. Their notes wind up being almost incomprehensible.
    A=assessment
    P=plan
    I= intervention
    E= evaluation

    One letter short of ADPIE (from nursing school) is what that is. I considered applying for ICU here but I would have serious trouble thinking up nursing diagnoses in the middle of charting. They shouldn't have to format their notes so closely considering that the flow sheet has everything imaginable on it. Why write that "assessment as listed" when duh. It's right there. I shudder to have to read their notes, crammed into such a little tiny space, abbreviations that I never would have dreamed possible being used... I don't mind DAR so much when I think of what they have to write.
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    Thanks for your help Indy. Did somebody have a focus list that they are actually using
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    What do you mean by a focus list? Now I'm the one that's lost.
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    By focus list I mean a list where I can choose from any concern with the patient. I mean alist of words that I can use to do my charting esier. By know we have no computer to do the charting. Each time I have to report something I have to start looking in my mind for the word that I am going to use as a focus. Sometimes is easy : headache, blood pressure, fever, but somestimes I use time just to locate a word to use as a focus. Much better?
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    We use focus charting where I work. We have to use the list of authorized NANDA diagnoses. We use DAR (Date, Action, Response).

    Example: Focus is "Risk for Injury r/t (related to) weakness and altered mental status (whatever is putting pt at risk for injury)

    D) Pt awake and alert, orient x3.
    A) Oriented pt to nurse, callbell, and procedures. Encouraged pt to use callbell when needing assistance. Safety precautions observed, please refer to assessment for details (or you can list things such as armbands in place, siderails up, callbell within reach, etc).
    R) Pt voiced understanding without questions. Demonstrated use of callbell. 0 injuries noted.

    I hope this helps. We have to address every focus at least once and then each time if one arises. I love focus charting, but then again this is the only type of charting Ive done except narrative when Im pulled to ICU. I would much rather do the focus charting.
    Brand new RN likes this.
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    "focus" is the same as problems or concern that you need to focus on your DAR...Funny 2 months ago I was in your position because I did'nt know how to write my Nurse Progress notes using the DAR format. I'm still learning though...sometimes I catch myself stuck on what to write.
    Some of the FOCUS ideas are: MOBILITY/ACTIVITY, ELIMINATION, PAIN, TRANSFER, PROCEDURE, NUTRITION, SAFETY, the list goes on and on.....you just have to know what you are focusing on....or you can also use some of the Nursing diagnoses that relates to your assessment findings...I just don't use it very much coz it's too long to write (he-he-he-he)...Let me know too if you come up with any ideas as I too am still learning...
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    Quote from chenoaspirit
    We use focus charting where I work. We have to use the list of authorized NANDA diagnoses. We use DAR (Date, Action, Response).

    Example: Focus is "Risk for Injury r/t (related to) weakness and altered mental status (whatever is putting pt at risk for injury)

    D) Pt awake and alert, orient x3.
    A) Oriented pt to nurse, callbell, and procedures. Encouraged pt to use callbell when needing assistance. Safety precautions observed, please refer to assessment for details (or you can list things such as armbands in place, siderails up, callbell within reach, etc).
    R) Pt voiced understanding without questions. Demonstrated use of callbell. 0 injuries noted.

    I hope this helps. We have to address every focus at least once and then each time if one arises. I love focus charting, but then again this is the only type of charting Ive done except narrative when Im pulled to ICU. I would much rather do the focus charting.
    Thanks so much for the quick review. Tomorrow is my 1st day of clinical experience at a 2nd (different) hospital this semester. I'm in my 1st year of two yr RN program. We did narrative at the 1st hospital we were at but this hospital does focus, so focus it is. I guess if anything it helps to keep us on our toes and flexible!:typing


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