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My Beloved Nursing Students

Student Assist Article   (14,851 Views 41 Replies 1,389 Words)
by Esme12 Esme12, ASN, BSN, RN (Moderator) Nurse

Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

5 Followers; 4 Articles; 146,141 Visitors; 20,896 Posts

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As a long time nurse and educator I want to be sure that the touch is handed over to the next generation with the same wish it was handed to me. I was graced with loving mentors who never failed to help me become the best nurse I could be...so to my beloved students. Here is what I share.

My Beloved Nursing Students

To my beloved nursing students

There are many of us here who love helping you. We ask that you show us your work. Show us that you have your critical thinking caps on and are trying to grasp this new way of thinking.

Tell us what you think and we will go out of our way to help you. Saying that we will not do your homework is not being mean. Our job is to help you become the best nurse that you can be. We want you to have the AhHa moment where it suddenly clicks and makes sense.

Care plans really aren't that hard with the right resources and assessment about what your patient needs. Many nursing students over this this process and become over whelmed. Think about your care plan as a recipe card for how to care for the patient step by step.

So, when you ask about a care plan...tell us about your patient. What did you see? What did they say? What does your brain tell you that they need.

Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first.

You need to

  • Know the pathophysiology of your disease process
  • Assess your patient
  • Collect data
  • Find a diagnosis
  • Let the patient data drive that diagnosis

So......back to square one.....What is your assessment? What are the vital signs? What is your patient saying?. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future. TELL ME ABOUT YOUR PATIENT...:)

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics.

From a very wise AN contributor Daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

Quote
  1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADL'S, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
  3. Planning (write measurable goals/outcomes and nursing interventions)
  4. Implementation (initiate the care plan)
  5. Evaluation (determine if goals/outcomes have been met)

Care plan reality

The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing

The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at).

The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list.

This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality

What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Give us a little and we will give you whatever you need.

35 years experience, my specialty is critical care/ED/Trauma Flight and being Mom to 2 teenage children and one spoiled Weimaraner.

5 Followers; 4 Articles; 146,141 Visitors; 20,896 Posts

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beckyboo1 has 30 years experience.

11,261 Visitors; 369 Posts

Thank you Esme! I've been an LPN since 87 but am back in RN school and can always use care plan advice. Thanks also for the info from Daytonite--hadn't thought of her in ages, may she RIP.

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SHGR is a MSN, RN, CNS and specializes in nursing education.

2 Articles; 30,982 Visitors; 1,405 Posts

LOVE this. Thanks for your sage and patient advice. I've learned a lot from your approach.

Funny story- my advanced physical assessment prof (CNS and NP students in the class) told us the first night of class how we would be coming up with diagnoses. I raised my hand. "You mean nursing diagnoses, right?" She kind of smirked (was otherwise a wonderful teacher) and said, "no, medical."

I was actually disappointed.

Believe it or not, the longer I've been a nurse, the more I appreciate the depth and wisdom of the nursing diagnoses. Kind of disappointed that it's missing from a lot of the APRN curriculum. The CNS-specific class has more of the nursing approach, which is one reason I was drawn to it.

Long story short, thanks for what you do and I hope you keep doing it for a long, long time, Esme12.

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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

5 Followers; 4 Articles; 146,141 Visitors; 20,896 Posts

Thank you....

Technically the ANP does make a medical diagnosis. Their scope is completely different as a mid level provider. However, I do believe that the continued use of a nursing diagnosis helps the APRN be a better provider and provides a more holistic care focus of the patient. It's what makes nurses different....we care for the whole patient.

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SHGR is a MSN, RN, CNS and specializes in nursing education.

2 Articles; 30,982 Visitors; 1,405 Posts

Thank you....

Technically the ANP does make a medical diagnosis. Their scope is completely different as a mid level provider. However, I do believe that the continued use of a nursing diagnosis helps the APRN be a better provider and provides a more holistic care focus of the patient. It's what makes nurses different....we care for the whole patient.

I know, of course, that APRNs make medical diagnoses, but I was coming at it thinking nursing + medical; her philosophy was medical only. Like the nursing got replaced rather than added to.

But that's a whole different thread :)

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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

5 Followers; 4 Articles; 146,141 Visitors; 20,896 Posts

I know, of course, that APRNs make medical diagnoses, but I was coming at it thinking nursing + medical; her philosophy was medical only. Like the nursing got replaced rather than added to.

But that's a whole different thread :)

Agreed....I think they are trying to find their path....time will tell how this plays out.

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16,376 Visitors; 1,026 Posts

Thanks for this very nice post. I enjoy assessing clients. I always make sure that I get all the relevant information when I assess them. I am not yet good at this but I hope I am getting better. Thanks again.

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cinlou has 37 years experience as a BSN, MSN, RN and specializes in Emergency and Critical Care.

1 Article; 6,330 Visitors; 208 Posts

I would like to add, that so often students come in to a program thinking they have to forget everything they have known and do, and start from scratch. I ask them if they have children, what do you do when your child is ill? You feel their forehead, you ask them what is going on, you assess them, you choose what to do for them based on that information, you may go to the store and get an OTC medicine. How do you know what to give? You read the label or you may consult the pharmacist. Remember you have many resources available to you.

We instructors can not teach you everything you need to know but if we can teach you how to find that information on your own and evaluate the quality of that information; we have taught you the ability to be critical thinkers (trouble shooters).

I was taught 35+ years ago in nursing school that I could gain 70% of my assessment of my patient by walking into the room looking around introducing myself to the patient touch their hand, ask them their name. I have assessed their surroundings, I have touched them and know their skin texture, hydration state, and warmth, I have a partial neuro assessment based on their speech and ability to respond to me: Did they move their hand, did they re-position themselves; did they smile or were they sad, angry. So much we can gain by being patient centered and looking and listening and touching our patients.

Edited by NRSKarenRN
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2,744 Visitors; 75 Posts

This is such a helpful post. I am in the middle of my semester, 1st clinical, and I have hardly worked with patients. I only had the opportunity of helping a patient to the bathroom. Starting this Saturday, I should, and hopefully will be working with patients for the whole day. This information has helped a lot for carrying my assessment etc. Thank you guys for such a great post.

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Call me sparky specializes in hoping for the ER/ED.

1,826 Visitors; 16 Posts

Esme12 do you by chance have any links to different style "brain" sheets? I haven't found one I REALLY like and would love to see different styles so that maybe I can make one that works for me. Thank you for being who you are as well. I have enjoyed reading HOW you explain things and HOW you make things come together. I will graduate soon (41 weeks but who is counting) and I want to be the best newbie I can be. Thanks again!

Edited by Call me sparky
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