Charting...what to say? - page 2

Correct me if I am wrong but in charting you're not supposed to say "I," right? We have a new nurse who charts, for example, "I spoke with the patient about X." I learned to write "writer... Read More

  1. Visit  Benedina profile page
    1
    I can give you a bad reason for avoiding the first-person voice: to avoid personal responsibility. This is generally gussied up as "sounding objective." It's a popular practice among lesser academics, healthcare workers, and IT support desks which is one reason why all the texts produced in such venues are barely readable.

    It's unnecessary even in those circles. Even the APA, one of the most godaawful style guides inflicted on a weary world, doesn't require it:

    http://owl.english.purdue.edu/owl/resource/560/15/

    Nonetheless my school and job require third-person constructions, so "this grad student/skilled nurse/case manager" uses both. And bides her time.

    Dina
    Spidey's mom likes this.
  2. Visit  dudette10 profile page
    4
    Esme, thanks for the excerpt. I love OWL too, although I didn't go to Purdue.

    The reason given was to "help maintain an impersonal tone." Hrmm. While the message of objectivity is good, I think that it can be done without using third person. I totally disagree with OWL's "improvement" from "I change the dressing daily" to "Nursing changes the dressing daily." WHO did the dressing change, when was it done? If taken to court, there is so much wrong with "Nursing changes the dressing daily," I don't know where to begin!
    prinsessa, macawake, anotherone, and 1 other like this.
  3. Visit  Esme12 profile page
    3
    That was not the best example....I just write....since I am doing the writing.

    Drsg changed...(then) what I observed, how I changed it (sterile etc), how I cleaned it/packed it/dressed it, what it looked like.

    For a patient being verbally assaultive.

    Patient shouting obscenities, "&*)^&%^$%*$(^&(&&*(" , loudly disturbing other patients in department. Patient states....."&**(&&%^%*(&)*^)*&_()*". Patient shouting verbal threats of physical violence to this nurse and other staff members by shouting....
    "()&_*&&*)^&^$%#!@!$&^&*_&_"

    while assisting patient with IV patient spit in this nurses face stating...."&*&^%^& ^&%^&%$^"

    Which Sounds better than...."the patient was calling me names and spit in my face."

    One sounds professional one sounds like a petulant child
    Last edit by Esme12 on Apr 27, '13
  4. Visit  MunoRN profile page
    9
    Quote from Esme12
    Patient shouting obscenities, "&*)^&%^$%*$(^&(&&*(" , loudly disturbing other patients in department. Patient states....."&**(&&%^%*(&)*^)*&_()*". Patient shouting verbal threats of physical violence to this nurse and other staff members by shouting....
    "()&_*&&*)^&^$%#!@!$&^&*_&_"

    while assisting patient with IV patient spit in this nurses face stating...."&*&^%^& ^&%^&%$^"

    Which Sounds better than...."the patient was calling me names and spit in my face."

    One sounds professional one sounds like a petulant child
    I get where you're trying to go with this but I'm not sure this is the best example, you changed far more than just the term "I" in this example. An objective way of charting this would be "patient expectorated in the direction of staff". Who was spit on is irrelevant from an objective standpoint, so whether you use "I" or "this Nurse" really doesn't matter, they are equally less objective ways of saying this.

    The term "this Nurse" is just a euphemism for "I", they're interchangable in terms of meaning, it just makes it sound clunky and is arguably poor grammar. The purpose of charting is to be precise, "I" means "I", "This Nurse" can mean "I" but it can also have other meanings, making it a less accurate, but no more objective, way of saying "I".

    When it comes to objective, boilerplate charting, H&P's are near the top of the scale, yet the term "I" is frequently used.

    I think the main problem is we've succumbed to the myth that speaking in third person adds objectivity and accuracy even though it doesn't. If I said "I don't like spinach" is that any less objective of a statement than "this person doesn't like spinach"? Same level of objectivity, just bad grammar.
    workingharder, Amnesty, Benedina, and 6 others like this.
  5. Visit  NurseDirtyBird profile page
    3
    I'd like to expand on Esme's post a bit and add that I always write the exact curse words yelled at me, in quotes of course, in the chart. Mostly to provide a complete and accurate account of events (the pt. did not say "asterisk asterisk asterisk", the pt. said "[insert expletive]), and partially out of the glee arising from putting curse words in an official document.

    As far as third-person narratives go, they sound more formal and professional. I am not a high school student writing a note, I am a health care professional documenting objective observations and care provided. "I-statements" are not objective statements.
    Janey496, nrsang97, and Esme12 like this.
  6. Visit  NurseDirtyBird profile page
    4
    I just discussed this with my husband - he's a police officer, and his narrative reports end up in courtrooms far more often than ours - and he uses "I" in all of his narratives. He was trained to do so. So I guess I'm on the fence. The legal system doesn't seem to have a problem with using "I." Perhaps we shouldn't either.
    kylee_adns, workingharder, macawake, and 1 other like this.
  7. Visit  HazelLPN profile page
    1
    Even though I graduated from nursing school when we used leeches and herbs, I was always taught to write in the third person and referred to myself as "This LPN" because it was to be as objective vs subjective as possible.

    Ex: Received report from M. Ratched, RN, reviewed assessment, changes made per this LPN.

    What really happened? I had to follow Nurse Ratched who's shift assessment was simply done by clicking the "no changes" button and I don't think she even looked at this kid in the past few hours. I had to clean up her mess and fix everything before anymore harm was done to MY patient.
    Esme12 likes this.
  8. Visit  dudette10 profile page
    2
    Quote from MunoRN
    I think the main problem is we've succumbed to the myth that speaking in third person adds objectivity and accuracy even though it doesn't.
    Well said.
    MatrixRn and Pangea Reunited like this.
  9. Visit  MunoRN profile page
    3
    What makes a statement less objective is clarifying something was done to you rather than someone, such as saying the patient spit in "this Nurses" face rather than just saying the patient spit in the direction of staff. Whether you use "my" or "this Nurse's" face makes absolutely no difference in terms of the objectivity of the statement.
  10. Visit  Esme12 profile page
    4
    Quote from NurseDirtyBird
    I'd like to expand on Esme's post a bit and add that I always write the exact curse words yelled at me, in quotes of course, in the chart. Mostly to provide a complete and accurate account of events (the pt. did not say "asterisk asterisk asterisk", the pt. said "[insert expletive]), and partially out of the glee arising from putting curse words in an official document.

    As far as third-person narratives go, they sound more formal and professional. I am not a high school student writing a note, I am a health care professional documenting objective observations and care provided. "I-statements" are not objective statements.
    Agreed.....
    I always quote the patient as well...verbatim. I too get some back handed third grade giggle factor at charting swear words. However, profanity is against the TOS.......and a mix of letters and symbols is also against the TOS....I used all symbols in quotes intending to mean....the quoted expletives.

    I will chart "SPIT" for to me that is intentional meanness, malfeasance, intent to harm........where expectorate is providing a specimen or clearing phlegm in the proper container or tissue and implies cooperation and manners. Like apples and oranges...they are both fruit but are completely different flavors.

    I realize that police officers use first place in their reports as I have spent plenty of time in court, as an ED nurse an mandated reporter of ETOH in my home/original state, as well as a sexual assault/SANE nurse.

    I was taught by medical legal experts and in my original program and additional legal/nursing type that referring to yourself in the first person isn't professional and negates you objectivity (for nurses). It has served my well for 34 years.....I guess you can't teach an old dog new tricks.

    Each nurse decides whether or not to follow their schooling or practices (usual and customary) and what another reasonable and prudent nurse would do/say/document.

    For me? This nurse will follow the recommended guidelines.

    Are there laws that say you can't chart in the first person? No. Whether or not you "should" is up to the individual or facility policy.
    Last edit by Esme12 on Apr 27, '13
    NurseDirtyBird, joanna73, MatrixRn, and 1 other like this.
  11. Visit  CapeCodMermaid profile page
    3
    I use I if I am the one who spoke to/saw/medicated/educated the patient. I think writing "this writer" is absurd.
    prinsessa, KelRN215, and macawake like this.
  12. Visit  RCBR profile page
    4
    Don't get too hung up on the "I" thing. There are much worse charting sins you can commit. Take your cue from physician notes; they use "I" all the time, as pointed by another poster here. The issue of objectivity is non-sense. Using the passive voice (dressing was changed) instead of the active voice (I changed the dressing) changes nothing substantively, only stylistically. You can only chart what you did, not someone else's work, so saying "dressing was changed" means exactly "I changed the dressing". The greatest sin in narrative charting is double charting, repeating what is already recorded in the flowsheets, such as A&Ox4, SR 70s, 4L O2 NC, VSS, etc. You should also avoid the "will continue to monitor" at the end. Of course you will continue to monitor, that is the core of your job! Writing a shift summary note does not mean you are abandoning your patient.
    macawake, RNperdiem, joanna73, and 1 other like this.
  13. Visit  TerpGal02 profile page
    0
    I use "this writer" also. I have found most social work people use it too. When I worked in the community all the staff shortened this writer to TW. I now work inpt psych and we still do paper nurses notes and its taken some getting used to to write out this writer rather than TW.


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