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Discussion

From a student - how much of what we learn is really done?

I'm a brand new nursing student, just starting week 6, and I'm in a bit of shock with the information we're learning . . . WAY different than what I expected. I had never heard of nursing diagnosis, for example. I have also never had or seen a nurse do a thorough assessment like they're teaching us to do, in my life that's what the doctors do.

My feeling (and please confirm or deny!) is that this is what I need to learn to pass the exams, and the real world nursing is not like this! Maybe I'm wrong, my only real experience with nursing is the nurses at the doctors offices, who basically take vital signs, weight, height etc. and maybe give injections, and a few times when my kids were in the hospital. But I don't get the whole nursing diagnosis thing . . . I mean, why diagnose someone as "impaired respiratory status" or something when you KNOW they have pnuemonia and just need antibiotics and maybe a nebulizer? I don't get it.

So am I right or am I wrong? Is my school teaching us the way things really are or not?

Thanks for any info!

Kelly

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Wow....when you start clinicals in a hospital setting you will see how much of nursing school you incorporate. A nursing diagnosis is a way of standardizing the nursing process in a written way. It insures continuity of care. Once you get your head around them they are useful. Assessments are a vital part of nursing and excellent assessment skills are absolutely necessary, you must become familiar with the full head to toe assessment and also the many focused assessments that nurses use every day in the hospital setting. Good luck to you.

You are in for a big shock if you believe all nurses do is take vital signs, give injections, etc. Most likely, these "nurses" in the doctor's office were not nurses at all, but probably medical assistants. Very few physicians hire nurses to do such tasks anymore because it is not cost effective.

Nurses do need to know how to perform complete assessments because one of the important aspects of nursing is monitoring patients for changes in status. You must know how to do an assessment in order to do this. However, it is unlikely that you will perform the entire assessment as you learn it in nursing school. Once you are practicing, you will learn how to perform a more focused assessment depending on what area of nursing in which you are practicing and what is wrong with the patient. For example, in the ED, assessments are very focused depending on what the chief complaint is. In the ICU, you would be expected to perform a much more complete assessment. My school taught us the full assessment skills from head to toe, but then also taught us a "real world", more practical assessment.

The NANDA nursing diagnosis is somewhat controversial. In my experience, they are not used a great deal in real practice. I do believe that they teach you how to think in terms of nursing outcomes though. Some facilities do use nursing care plans to guide nursing care, but it is usually computer generated.

I would suggest that you take some time to shadow a few nurses before you get much farther in your education. It sounds as though you may not know what nurses really do and you should be sure that it is something you will enjoy.

In my experience, they are not used a great deal in real practice. I do believe that they teach you how to think in terms of nursing outcomes though. Some facilities do use nursing care plans to guide nursing care, but it is usually computer generated.

I agree with this 100%. In nursing school, I initially thought they were a ridiculous waste of time ("We'll never use these"). But they really do hep you understand the nursing process and how to focus your care.

I absolutely use my assessment skills everyday! Pay attention in class and practice!

when you KNOW they have pnuemonia and just need antibiotics and maybe a nebulizer? I don't get it.

Say you are at work in the hospital, caring for your patient with pneumonia....What do you look for to tell you if that patient is improving? What do you look at to know if they need an aerosol treatment, or antibiotics?Are they going down hill? How do you know when to call the doctor.... or increase o2? Assessment skills! When the doc comes in and asks how the pts lungs are...it would be a good idea to know!

Wheezes, crackles... fluid building in the lungs? Getting tight? YOU will be the one taking care of the patient. Docs won't just be hanging out to assess the pt on an ongoing basis. That will be your job....and it is a fun and rewarding one!

  • Author

I would suggest that you take some time to shadow a few nurses before you get much farther in your education. It sounds as though you may not know what nurses really do and you should be sure that it is something you will enjoy.

Thank you for your response! I am starting clinicals next week so we will be working with RNs. I know I have a lot to learn and don't get me wrong, I'm happy if there is more to nursing than just taking vital signs :nuke:. I'd just never heard of a nursing diagnosis before, and as far as the assessments, I wondered if nurses had time in the real world to do such complete assessments. As another example, one of our instructors was critical of night nurses who don't turn on the lights, and do assessments. When my kids were in the hospital the nurses never turned on the overhead lights or did real assessments during the night . . . KWIM? They did check on the kids and maybe take vital signs, although I can't remember exactly, but I wouldn't say they did assessments.

Kelly

The nursing diagnosis is simply a way of standardizing the language. Which is more professional: "Pt's lungs sound like crap and he's having a hard time breathing because he's filled with snot" or "Impaired gas exchange secondary to airway congestion as evidenced by bilateral rhonchi that do not clear upon coughing and oxygen saturation of 85% on room air."

Now, don't get me wrong. Just today I said, "Hey, your patient's sat just dropped to 89 and his lungs sound like crap. You may want to go take a look." But I certainly wouldn't document it that way.

Oh, and we use SOAP notes, and the assessment is always a nursing diagnosis.

  • Experts
i had never heard of nursing diagnosis, for example. i have also never had or seen a nurse do a thorough assessment like they're teaching us to do, in my life that's what the doctors do. . .my feeling (and please confirm or deny!) is that this is what i need to learn to pass the exams, and the real world nursing is not like this!. . . i mean, why diagnose someone as "impaired respiratory status" or something when you know they have pnuemonia and just need antibiotics and maybe a nebulizer? i don't get it.

let me put this in a way that you might "get". what you are ultimately being trained to do is solve problems--all kinds of problems that patients will have. how do you solve a problem? give this some thought. you're sitting a home. it's nighttime and your lights suddenly go out. you have just been presented with a problem. how do you solve this problem? there is a process that you go through. the first thing you do (after getting upset) is try to figure out what has happened by doing a little bit of investigation. this is nothing more than assessment (also the first step of the nursing process and the first step in writing a care plan). but, how do you know what to assess if this has never happened before? you're not a trained electrician. you might flick a light switch off and on a few times and find it doesn't work (symptom). finally, your smartass boyfriend says, "check the breakers." what are those? you find a flashlight and go to the box where the breaker switches are and find one of them is clicked in the "off" position (another symptom). now, your boyfriend assures you that it's a pretty good bet that this is what the underlying problem is. (this is also the second step of the nursing process and the second step in writing a care plan--determining the problem.) so you're thinking that the thing to do is to get the electricity back on (goal) by flipping the breaker (intervention). (this is also the third step of the nursing process and the third step in writing a care plan--develop a plan). and, that is exactly what you do--implement the plan. (and, that is also step four of the nursing process and step four of writing a care plan.) next, you go back into the house to see if the lights have come back on--evaluation. (that's also step five of the nursing process and step five of writing a care plan.)

these steps, while they apply to something in your common life are still the steps of problem solving. a diagnosis is nothing more than a word that means "the resulting decision or opinion made after the process of examination or investigation of the facts". many people diagnosis, or problem solve, in the course of their jobs. nursing and medicine make it a big deal and have a whole set of nursing diagnoses and medical diseases to prove it! and, even more, they name the problem solving process that goes along with them: the nursing process and the medical decision making process. synonyms for the word "diagnosis" include analysis, conclusion, interpretation, and finding. they mean the same thing. the nursing process, writing a care plan--they are all nothing more than nursing's own process of solving a problem. in the process of solving the problem you must make some kind of examination of the facts and make some kind of opinion as to what the problem might be in order to apply interventions. now, here's the rub. . .the more accurate and better the information you have to work with, the better your decision making will be.

so you ask if nursing diagnosis and thorough assessments of patients is real world nursing? you bet. they are part of the problem solving process that you will use every single day of your work as a nurse. you may not formally use nursing diagnoses, which are basically labels assigned to patient problems. the use of nursing diagnoses is usually a decision made by the facility in which you will work. however, they were developed and are used extensively by entrepreneurial nurses in the billing process and many facilities have just taken a liking to them because they can be easily computerized. and what you probably aren't aware of is that a written care plan is required to be present in the permanent chart of every patient of any facility that accepts medicare or medicaid reimbursement from the u.s. federal government--that's just about every acute hospital and nursing home in this country. so, nursing schools are obligated to teach you, at a minimum, how to write some kind of a care plan. outside of that, however, is that you will be assessing patient for problems all the time. we don't just fluff pillows and hand out pills. if's that all you want to do then be a cna or a medication aide. problem solving is the one primary skill that is being drummed into you from the day you walked into your nursing classes. it is so important that it is constantly being emphasized again and again and again. the fact that you are hearing about it again and again and again should be a clue to its importance.

Daytonite, that was the best explanation I have ever heard. WOW!! That was too brilliant. Thank You for that.

  • Experts

Puts it in a much better perspective when it's said that way, doesn't it? Only nursing school could take something of such common sense and turn it FUBAR. Take heart, guys! It's just school. They have to give you something scholarly to do to prove that you are getting an education! We all had to go through it too.

Have you ever thought of teaching? Your explanation and analogy were great! I really enjoyed reading every word of it. Go you!

The real world is indeed different. Assessments are done on every patient, but usually focused on the problem they are having rather than complete head to toe, for example if I have a patient in with a fractured femur, I'm not going to test his cranial nerves if he's alert and oriented.

To me ND's are a way of teaching and expressing what we are doing. I wasn't a fan of them when I was in school. It helps us to look at the patient holistically from a nursing perspective and what we can do about it.

In the real world we do actually assess the patient, decide what's going on with them and what we can do about it. We don't think in ND terms, but we're doing it.

Daytonite, WOW!! Awesome explanation-what a brilliant mind!

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