Pre-clinical prep and clinical paperwork

phuretrotr · Aug 25, 2014

The first 3.5 years of my BSN program, we were required to pre-lab the day before. Half of the 8th semester, we had a choice of whether to pre-lab the day before or the morning of clinical on our patients. Really it was what made you feel most comfortable. The last half, which was during our preceptorship, we obviously just did it the morning of as any nurse does.

I think it helped starting off going in the day before because you have no clue what most of the medications, diagnoses, lab values, etc. really mean or are. If I had to do it the morning of, I would not be very confident in much of my care. But getting prepared helped a lot with confidence and ability.

However, once I was use to many of the meds, dx, and labs, I had that knowledge to get the gist(sp?) of what was going on with my patients. I knew what most meds and dx where and why meds and labs were ordered/abnormal. The ones I didn't know didn't take long to look up.

Some clinicals of mine had concept mapping but for me, it was more confusing than helpful. Some of my classmates liked them and they were neither easier nor harder to complete than just writing up everything. I guess you could see the connections drawn out, but I like bullets.

I don't think nursing diagnoses are all they're cracked up to be, but I think it does help in seeing why a person is having x, y, and z. The actual patient information (meds, dx, labs) I think is what helped me the most and would not have done it differently.

A big thing for me was really focusing on the patho of dx and the action of medications. This helped me tremendously when I understood.

If I was organizing paperwork, I would have 1 or 2 complete care plans in each semester/rotation, depending on how many weeks they are in the hospital, which would include:

- nursing dx - NIC, NOC, NANDA (3 dx, 1 outcome each, 8 interventions for each outcome, and follow up on each outcome)

- pt. dx - definition, patho

- meds - MOA, reason, route, time, dose, SE, contraindications

- labs - normal, pt. value, reason abnormal

- any dx tests - definition, reason

- full assessment (normal and abnormal) + any changes throughout day/next day

- plan of care they expect to preform that day (depends on what skills they are able to preform)

The other weeks I would just have the students do:

- pt. dx - definition, patho

- meds - MOA, reason, route, time, dose, SE, contraindications

- labs - normal, pt. value, reason abnormal

- any dx tests - definition, reason

- full assessment (normal and abnormal) + any changes throughout day/next day

- plan of care they expect to preform that day (depends on what skills they are able to preform)

Basically just excluding the nursing dx because those take A LOT of time. Or you could opt to just having them list their top 3 nursing dx (no NIC, NOC, NANDA).

Just my 2 cents and what I liked about my program.

**NICU Guy, BSN, RN** · Aug 26, 2014

We had 2 concept maps due for the semester. The instructor picked the patients prior to the start of the clinical. He then let us choose which patient we wanted. His rationale was that when you are a nurse, you do not come in the night before your shift to research your patients. About 30 min. into clinical he would meet with each of us and we would give him a report about our patients. We needed to know the chief medical problem; other current medical issues; meds- what they are for, why are they on them, and side effects; and relevant labs for the patient and why they are high or low. Essentially, what a nurse would do at the start of their shift to get an overall picture of a new patient. During a clinical we would let him know if we were going to do a care plan on this week's patient. It would be due the next week. That allowed us to plan ahead so that we don't have a care plan due the same week as an exam.

sdmwd5987 · Aug 26, 2014

I wonder how first semester students in a med-surg course would do with not having any prep prior to going in? I know when I was in school- a long, long time ago- we did not go the day before. We were in the hospital for clinical 3 days a week, though. Gathering info on day 1- working through care plan ideas the first night after clinical, then implementing the next 2 days. Our students today have a clinical day a week in the first semester. For only 6 hours. By the time they gather all that data- the day is done and they may have barely seen the patient. Just something else to consider.

Whispera, MSN, RN · Aug 26, 2014

Another consideration is that sometimes patients are discharged pretty quickly after they're admitted, and the staff may not know someone is going to be discharged the next day, if students come in to gather information. If their patients are discharged, then all that work is down the tubes...

phuretrotr · Aug 26, 2014

Another consideration is that sometimes patients are discharged pretty quickly after they're admitted, and the staff may not know someone is going to be discharged the next day, if students come in to gather information. If their patients are discharged, then all that work is down the tubes...

I've had that happen... It sucks.

suni, BSN, RN · Aug 26, 2014

I have an evening clinical group and they come in late morning for their assignment and prep work. They have a concept map that is due by the end of clinical the second day. They also have to review labs, history and physical, meds, diagnosis etc. It is a fair amount of prep work but it helps them build some critical thinking skills.

ameliamaern · Apr 24, 2015

My clinical group has clinicals for 10.5 hours a week, over 2 days. They do come and do preplanning, because they are 1st semester. They haven't even had pharm yet. Occasionally I have dismissed the pre-planning, if there are a lot of discharges and I don't have enough patients for all students do preplan on their patient. As it gets further in the semester, and the students become more comfortable with where to find the information, I am not as worried on making sure they do the pre-planning the night before.