I hate ADPIE's

  1. Ok..I am a first year ADN student. Tomorrow will be my 5th week of clinical. Here's my problem..the paper we are to turn in each week (the dreaded ADPIE) is giving me grief:angryfire. We were not really oriented with many of the things on them, and I am having a hell of a time with the Care Plan, Implementing and Evaluation...partly because as a new Nursing student, there are very few things that I can independently implement for my patient, and also, we do not stay at the hospital long enough for me to observe how the plan worked, i.e evaluating the outcome.
    I guess every school has these, I don't know what they call them everywhere else, but does anyone have any pointers on how to get through them without ripping my hair out?:uhoh21: :angryfire
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    About MLMRN1120

    Joined: Oct '07; Posts: 132; Likes: 85
    RN; from US
    Specialty: Med-Surg, Oncology, telemetry/stepdown


  3. by   nurturingkneads
    The clinical worksheets is what we call them. They take a lot of time and are frustrating in the beginning but you will get used to them and they will get you thinking like a nurse. Give it time. You will get there.
  4. by   StudentNurseAbby
    I don't think anyone likes them. lol
  5. by   Daytonite
    tina. . .i hate to burst your bubble here, but this is what you signed up for. adpie is the nursing process. . .is the problem solving method that nurses use. it is the ultimate thing you will be expected to have learned by the time you graduate. you will be doing it all through nursing school. it is the ultimate thing that your future employers will expect you to know. every day of your life on the job as a future rn you will use adpie to solve problems. your worth as a working rn will be your ability to solve problems. that is what rns do--solve problems.

    now, you already know this process and you've been doing it most of your life. you just haven't been labeling it adpie or calling it the nursing process. let me explain. you are listening to your portable radio and it suddenly stops working. what do you do? throw a fit? well, after that, what do you do? a - assess what might be wrong. you make a little examination of the radio trying to figure out what might be wrong. d - determine what the problem is. p - plan what you are going to do to fix the problem. i - put the plan into action (implement it). e - did it work? if so, you're good to go. if it didn't you go back to a and assess again and start the cycle all over. you have done this time and again in your life for all kinds of problems that came up from the electricity going out to problems with your car, screw ups with class schedules, people who didn't do what they promised for you, etc.

    you are in college. part of the collegiate experience is taking something like the nursing process and ripping it apart into its individual parts and scrutinizing them. every college and every college program of study does this--not just nursing. welcome to the world of higher education. it's even worse if you go on to get a bachelor's, master's or phd.

    you are only 5 weeks into a what?, 2-year program? why would anyone expect you to be an expert at this at 5 weeks? i write about adpie, the nursing process and nursing diagnosis all the time. i freely admit that i didn't "get" this stuff until well after i graduated and i'm no dummy. it's not necessarily true that there are very few things that you can independently implement for patients. you can find independent nursing interventions in your textbooks, care plan books and in this book: nursing interventions classification (nic), by joanne mccloskey mccloskey dochterman, gloria m. bulechek, and gloria m. bulechek. you will learn them from other nurses the longer you are in clinicals and a practicing nurse. and, it's true that you will not always stay at the hospital long enough to observe how a care plan worked out. that is going to be true of your entire career. being an rn means managing and directing care. an rn is a leader and supervisor of care and a care plan is one way we do that. after a while and seeing many patients with the same problems, care plans sometimes get pretty routine. you just haven't seen that happen yet because you are only 5 weeks into this.

    while you are a student one of the purposes of writing care plans is to help you learn not only the critical thinking but also learning about the medical condition and treatment that the patient you are adpie'ing is experiencing. please keep that in mind. if you have a patient with pneumonia, part of your care plan should be looking up as much as you can find about pneumonia, how the doctor diagnoses and treats it, the drugs commonly given for it and the nursing interventions for it--not just what your particular patient only needs. this is what will make you a great nurse.

    i have written about adpie (actually referred to it as the nursing process) on these two threads:
    please don't make it more difficult than nursing school has done with it. follow the steps in the order of adpie. the biggest problem i see students having are that they skip around and ultimately end up getting confused and lost in what they are doing. the major, major first step of the process is your assessment. it is the foundation of the process and every written care plan. everything rests upon the assessment because it results in determining the patient's signs and symptoms, or abnormal assessment data (nanda calls them defining characteristics). your goals/outcomes, nursing interventions and evaluation is based upon the signs and symptoms the patient displayed. adpie is nothing more than a problem solving process written down on paper in a specific format dictated by your instructors. an employer may dictate some other specific written format they want you to use, but the problem solving process you use will be the same. adpie is:

    the steps of the nursing process
    a problem solving process for nurses
    1. (a) assessment (collect data and list out the abnormal data)
    2. (d) nursing diagnosis (group your abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis to use)
    3. (p) planning (write measurable goals/outcomes and nursing interventions)
    4. (i) implementation (initiate the care plan)
    5. (e) evaluation (determine if goals/outcomes have been met)
  6. by   JeepDudeRN
    Hi Marlo,

    What specifically are you having a hard time with? You would really be surprised what you can do independantly with your patient, even if you are in your first ever clinical. Your expected outcome should be measurable during the time you are there, unless you are doing a long term goal. Ex: patient will ambulate in hall 3 times this shift, or patient will verbalize decrease in pain, this shift, etc. Those are just barebone examples of course. I would not think you would have to do a long term goal until further on. I love care plans, and did really well on mine last semester, so if I can help you, send me a pm.
    Good luck,
  7. by   atmananda
    Hi there!
    I can see this is an older thread but I want to post anyway. I agree with Daytonite so much about the Nursing Process. (big fan, Daytonite!) I also understand the frustration and confusion that comes with the first weeks of nursing school. I think that some of us,in the beginning, forget how to think because we set nursing apart as something separate from other things--probably because we worked so hard to get there, you know, you hear angels singing and stuff because you're SO full on excited--and then these first few experiences in a clinical setting or with writing care plans are rarely what you imagined. I remember thinking that it was all really confusing until someone explained to me what Daytonite said very well. Don't forget how to think! It is the same...it just feels different because you're finally [I]there[I] and you really want to do it right. At least I did!
    There is always something you can do for your patient, even if it is learning more about a medication they are taking or reading a chart to see how things fit together. Sometimes the patient you're helping when you do these things is actually one you meet later on, because you know just what to do! The sun rises pretty slowly over these particular mountains but eventually it becomes day and you are enlightened as you realize you've are walked a well worn path.

    ps. and then there are the other days......
  8. by   Jonathank
    As Daytonite said so well, ADPIE is simply the decision-making process quantified. As for not having time to evaluate: simply write "ongoing" in that column.
  9. by   NurseLoveJoy88
    this thread is from 2007... lol
  10. by   ImThatGuy
    ADPIE is a label for natural thought progession. Find a problem (assessment), label it (diagnosis), figure out what you're going to do about it (planning), do something (implementation), and then checking to see if it worked (evaluation). I'd think it was common sense, but apparently it wasn't or no one would have started harping on it.

    I agree. Care plans are annoying. I can't stand the psychosocial ones. I'm a science guy interested in disease and treatment, but it's all part of the game. I do like psych stuff, but ineffective coping, deficient knowledge....yawn.

    Anyhow, if you don't know what implementations to use then get a care plan book. That'll lay it out. The Lippincott manual has some stuff in there you can use, plus it'll explain the condition also. That'll help since it's all new to you.
  11. by   Brauwin
    This is a reply to an old post but I figured Martina's frustrations are shared with a lot of new nursing student. I'm getting ready to graduate so let me share some tips:

    Don't fight ADPIE and ask "when the heck am I going to use this?" You use it everyday whether or not you conciously go over the steps in your head. They teach you this annoying accronym because it's the best way to explain to student how you need to approach every patient.

    ASSESS - You do this as you walk in the door, before you listen to heart and lungs sounds. LOOK at you patient.
    You can see how they breath, move and assess skin without even touching them. You assess level of
    conciousness as you talk to them. How many times have you looked at someone and thought
    "Wow he sounds like crap, I can hear him wheezing from here" you just assessed breathing effort!

    DIAGNOSIS - Ok so you are not a Doc and you can't make a medical diagonisis. But how many times have you \
    looked at a patient and said "Wow he's breathing really bad" you've just made a nursing diagnosis.
    Or how about when you are ambulating a patient and think to yourself "Yikes this guy is going to fall
    if someone doesn't help him to the toilet" you've just diagnosed "At Risk for Falls". Not so hard right?

    PLAN - People in our care are not functioning at the best level possible. As nurses our job is to 'help them get
    better" so we set goals. Remember they must be measurable and REALISTIC. That guy that looks like he
    going to fall every time he stands up, a realistic goal would not be to have him running a marathon in a
    week right? But we could say that ambulating 10 feet safely without assistance in one week is perfectly
    realistic. Also don't feel like every goal MUST be reached in the time frame you put down. Every patient is
    different in the recovery period. It isn't a failure if that goal isn't reached.

    IMPLEMENT - OK I know as student it's very hard to feel like you are making a difference when you see a patient
    for a few days, maybe not even that. But you CAN make a difference here. Say you notice that a
    patients hydration status is awful, and all day you offer them a drink when you can remember and
    at the end of the day before leaving you remind them to "drink lots". You just implemented!
    You "encouraged fluids" and probably did a world of good for your patient. Remember KISS here,
    sometimes the little things are the most important.

    EVALUATION - I know we don't always get to follow up with our patients, but we do evaluate at the end of the
    day. That patient you were encouraging fluids on, how much did they drink that day?
    What was their output, what did their urine look like? Did it change during the day?
    Did you reach your goal? If yes, awesome, if no why not? What stood in the way?

    And now we go right back to the assess, don't think of ADPIE as steps, think of it like a cycle.

    I don't know if this is just rambling or if it was helpful...I hope it was!