each nurse is responsible for his/own nursing practice. neither my license nor regulations about my scope of practice mention a professional responsibility of or for the "care of surveys", "care of surveyors", or "comprehensive attention to needs of the boss."
if we keep writing care plans
to "cover", or for every rap "triggered", or caa "triggered", or new medication, or to acknowledge a preference, or refusing a flu shot, or to wear blue shoelaces on wednesday, we will never have time to think.
for a new patient/client who is staying only a short time, a workable care plan should already be in place by the time the comprehensive mds is done.
- this is the time to talk with our peers and with the resident, to figure out there is any underlying problem (or strength) to work on (or with) to assure that the short term approaches work and the goals for discharge are accomplished.
- the specific rehab plan with modalities and short-term goals, just like the medical orders, are part of the total plan of care--repeating them makes no sense.
- what does make sense is to find out if the patient feels (or the team believes) that this illness or surgery may cause any short or long term problems/concerns, above and beyond his/her normal state of health. the facility staff can help the patient sort out fears from realities or understand that "needing help" is not the same as "helpless".
for the long term resident who now has 54 problems, 100 pages of care plans, and the same approaches on 50 of 54 plans, the comprehensive mds/raps is an opportunity to sort through the "rubble."
- are the inability to perform adl's, incontinence, potential for dehydration, skin breakdown, "behavior" issues and lack of participation in activities really only "symptoms" of one underlying problem??
- is the "root" problem a progressive decline in cognitive functioning?
- a clear definition of the "root" cause makes care planning easier--it can eliminate the need to try approaches that research has shown will never work, and encourage the consistent use of the client's current or present "strengths", likes, or dislikes, in each approach.
this is not to say that we should not add a new problem and associated care plan if the resident experiences an acute medical or surgical problem. during this illness, our approaches to care may change dramatically and should be incorporated into the acute care plan. but once resolved, the basic plan is still intact--to be evaluated and updated when/if there is a change in the "root" cause.
capecodmermaid is 100% right--you and the "team" should focus on what it's really about--the patient/resident and his/her real problems--and planning/providing/evaluating care and outcomes.
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