Frustrated with Nursing Home Clinicals

[AragornSkywalker]

Ive completed 2/3 nursing home clinicals, and I am so lost and frustrated. After using EPIC, I hate paper charts. Not only am I lost as to where to find certain information, I can't read most of the handwriting either. The labs are all old, and interpretting them feels like an exercise in futility. There are 4-5 "current" dx and 4-5 comorbidities, and I just found out most of them are on there for billing medicare. Had I known sooner, I wouldn't have spent my first 2 care plans addressing irrelevant or outdated pathos.

Then there are my nursing Dx. One of my patients has hemiparesis on the left side with contractures in the arms and legs. All he does is lay in bed before getting wheeled to in front of the TV. Self-care deficit and impaired mobility both leaps to mind, but then I consider what interventions I can realistically perform and I am just lost. I thought about having him attempt to perform more self-care with the right arm, but the PCA just shaves and hoses him off in 5 minutes because she has 9 other pt to attend to. He says he plans to leave, but I dont see how that is likely. I did the gero depression scale and the answers were all over the place. He seems depressed though.

I just don't know what to hope to accomplish besides keep him and safe and not getting worse. I have 3 weeks and my instructor says that is alot of time to get something done. But it took me 2 weeks just to get an understanding of this patient. I have 1 clinical left and I want to at least appear to be starting on the right path. Our goals and outcomes should be achievable during our clinical periods, so should they be micro-steps in the bigger process? Like if there is a self-care deficit, should I just focus on trying to get him to wash his face and chest with his right arm rather than try to tackle everything?

Plus these places are so depressing. The staff treats him like a bad 5 year old, and his roommates can be loud and combative.