I teach in the last semester (Med-Surg) of an ADN program. I have complete faith in the faculty in earlier semesters. I know they are teaching the nursing process, and they are as frustrated as am I. I know it's very well covered in the texts we use. But the "seniors" can't reason their way out of a wet paper bag. How bad is it? Let me count the ways.
I ask my students to give me a focused assessment on their patient's principle problem. Here's how it typically goes....
" She is a 49 year old female who has a 18 g. IV in her left AC and has had vicodin 7.5 three times today, her leg is elevated and she is eating well. She uses the bedpan. She's very eager to go home because she doesn't like the food. Her blood sugars were all below 150 so she didn't get insulin today and her husband has been in the room all day."
There you go.
The real story is that the woman is a diabetic who had an rapidly evolving outrageous infection that went from a small lesion to involve almost the entire leg - ankle to thigh, came to ER where they did an ultrasound... on the wrong leg... and found a big DVT, in addition to the extensive cellulitis on the other. So the lady is on a weight-based heparin protocol and some significant IV antibiotics.
After listing a lot of random facts, including some vital signs, a student might tell me that the patient's problem is hypertension. Questioned about it, the student will say the patient's problem is hypertension because his blood pressure is elevated. Rather like saying, "my dog is a quadraped because he has four feet." Clearly, they don't use/understand nursing diagnosis and fall back on medical diagnoses but I KNOW they know better. Sometimes they make a show of using NANDA, but only in as much as they can run their fingers down a list and find something that sounds applicable to their patient. Usually they get it pretty close to the organ system involved.
Their goals are usually things like... "I will get him up three times today and walk him in the hall." The plan/nursing action for meeting the goal is "I will get him up three times today and walk him in the hall." Again... tautologies.
Obviously, then, since they can't identify related and relevant data, can't articulate (in any syntax) the patient's problems, and don't know what appropriate goals might be, the rest of their plan-of-care is silly and superficial.
This is the 4th cohort I've taught, and it hasn't been this bad before. However, (sad to say) it's also not a fluke, because I'm seeing the same thing in lower classmen coming my way. Trying to do this heavy lifting in their final semester of nursing school
is not the answer. How do you bring your students along in their understanding and application of the nursing process. I know that is a huge question, but any ideas would be appreciated.
I would be so grateful to hear from any of you.