nursing process & LTC...impossible?

Specialties Geriatric

Published

Hello all! Looking for some suggestions here...:)

I recently was looking through all the threads and was looking through one where the OP was about becoming more efficient while in LTC. I started my position as a new graduate in long term care about a month ago and found that while I am becoming more and more efficient with giving medications and providing all the different treatments, but I am finding that I am spending less time being able to sit with patients, get to know them and tailor care appropriately. I was shadowing another nurse while orientating and during this time, I had more time to get to know residents and learn that "resident a" likes their medications with juice and "resident b" would like you to leave the bedside light on because they like to read before bed. I really valued hearing about their experiences and being able to spend that extra 2 minutes to hear about their family or what visitors they planned to have on the weekend.

Now, that I am flying solo on the unit :nurse: I find that I can't do these things at all. I feel like my day is rushing through medications and then treatments!! I mean, I can still say the "good morning," "how is your day?" and various greetings but, the conversation does not go beyond that :( I'm just wondering if any other LTC nurses who have been in this specific nursing specialty have the time to go through nursing process, specifically nursing intervention vs. medical intervention? How are you able to carry nursing process out? What can I do to ensure that some sort of nursing process is carried out? As a new grad, I'm wondering if this specific specialty is right for me at this point :S Any thoughts or comments are more then welcome! Thank you :redpinkhe

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Welcome to LTC nursing!

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Specializes in M/S, Travel Nursing, Pulmonary.

I read your thread title and thought:

"Nursing process & LTC & Acute Care & Homecare & OR care & Public Care & Rehab Care & Psych Care & OB Care & PEDs Care & Onocology Care & Ortho Care & ICU Care & ER Care................impossible?........................pretty much, why do you ask?"

lol

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Sorry but unfortunately its all in the routine and you will find you dont have time for niceties and the extra care you want.

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Im in LTC also....yep seems that there is no time to talk or try and make a resident feel like you care. I try and talk to one or two each night for a few extra minutes....rotate and hope you can at least make a few feel loved that day.

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It can be done. You already know that you assess a different way in LTC than you do in acute. You don't have the time nor reason to to a head to toe on everyone and most often just do a focussed assessment. While you are doing this you are evaluating and coming up with a plan in your head over what needs done. Have you ever raised or lowered a bed for comfort, repositioned a pillow, held someone's hand...those are the nursing interventions you do without even knowing it....have you given a pain pill for pain or offered MOM or passed the pills...those are the medical interventions...you are already doing that.

As a PP stated..take the few extra minutes to just talk to a different res each day..maybe you are doing your charting at the same time or organizing your chart or doing their treatment...

I think you are doing more than you are giving yourself credit for.

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I agree with what others have said. As you get comfortable with the tasks in your job, the nursing interventions will become second nature. It is difficult to see this when you are a new nurse because we tend be overwhelmed with everything that needs to be done. As you gain experience, you will complete your tasks more quickly and be able to have a few extra minutes to do the things you mentioned. I would encourage you to engage your residents in conversation when you are performing your tasks. Take every opportunity you can to show you care.

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Specializes in ICU.

I usually do a focused assessment. I use the nursing process w/ out really thinking about it. Case in point, resident A state she has belly pain, I assess and determine it is gas pain. I encourage the resident to lay on her side and rotate frequently to help expel the gas. Then I give her the light and tell to call if it gets worse. Then I follow up and evaluate her response to my intervention. If it is better great, if not I proceed with new interventions and again evaluate the effectiveness. Its not glamorous!!! but gas is terrible and my residents appreciate me taking the time to address their problems. This goes for skin integrity, gas exchange, pain management, ect. Once you get the hang of doing the day to day, you learn to function when you are needed.

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Specializes in LTC, Memory loss, PDN.

The only way I can survive LTC is by using the nursing process. It starts with report. Based on report I assess the situation prioritize, plan my shift, rounds, med pass etc. Invariably something will come up and I have to reevaluate and make changes and reassess. You do it for each individual patient as well, it's just not as obvious when you're dealing with a whole floor.

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Thanks for all the valuable input from everyone who posted! I really appreciate whatever advice anyone can shed. I realize that I probably won't likely be able to sit and talk to a client one on one for an extensive period of time but, it helps to know that it's not impossible to engage with atleast a few residences once in a while. KellyRPNinOntario you bring up a really good point in rotating between clients, that is something that I will try and incorporate into my care! :D I also don't really consider alleviating patient's nausea or pain to be that huge of an intervention but, I'm seeing more and more how this affects a resident's day immensely! Thanks everyone!

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Specializes in Gerontology, Med surg, Home Health.
Thanks for all the valuable input from everyone who posted! I really appreciate whatever advice anyone can shed. I realize that I probably won't likely be able to sit and talk to a client one on one for an extensive period of time but, it helps to know that it's not impossible to engage with atleast a few residences once in a while. KellyRPNinOntario you bring up a really good point in rotating between clients, that is something that I will try and incorporate into my care! :D I also don't really consider alleviating patient's nausea or pain to be that huge of an intervention but, I'm seeing more and more how this affects a resident's day immensely! Thanks everyone!

Having been on the other side of the bed pan more than once----having one's pain or nausea alleviated is a HUGE intervention. I was a patient...had an horrific headache from caffeine withdrawal and asked for a cup of coffee. All the 'real nurses' told me to push the button on the PCA and get some morphine. I know myself...I needed caffeine. A student nurse wandered into my room at 2 AM, saw that I was in pain, asked what she could do, and found me a cup of coffee. Headache was gone. It was a small thing for her, but a HUGE thing for me. I called the supervisor and her instructor and gave her as much praise as I could. You should never feel that alleviating pain is a little thing.

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