Stressing out over first nursing assignment

hi, blur411, and welcome to allnurses! :welcome:

first of all, you are writing a care plan that is going to be in the form of a concept map, or what is also called a care map. we have a sticky thread on the student forums that has information and weblinks to help you with care maps which you should check out:

• https://allnurses.com/forums/f205/care-maps-225330.html - care maps (in nursing student assistance forum)
  

please understand that a concept map is nothing more than a different physical way of presenting a care plan on paper. another way is the more traditional chart type presentation. another type is called a clinical pathway. in an essay form they are called case studies. they all, however, have the same concept behind them. they are the documentation of your problem solving process of what you have determined is wrong or needed by the patient.

now, i'm a little confused as to what you are actually supposed to pick as your patient's problem here. are you writing a care plan (concept map) or just supposed to be working on some specific nursing diagnoses? the nursing diagnoses that nanda lists under the domain for health promotion are as follows, and they all have to do with health management (page 271, nanda-i nursing diagnoses: definitions & classification 2007-2008):

• effective therapeutic regimen management
  
• ineffective therapeutic regimen management
  
• ineffective family therapeutic regimen management
  
• ineffective community therapeutic regimen management
  
• health-seeking behaviors (specify)
  
• ineffective health maintenance
  
• impaired home maintenance
  
• readiness for enhanced therapeutic regimen management
  
• readiness for enhanced nutrition
  
• readiness for enhanced immunization status

is it possible that your instructors want you to be using at least one, if not 3, of these diagnoses in a care plan (concept map)? you will definitely need a nursing diagnosis reference to use these in order to have the correct signs and symptoms (defining characteristics) if you use any one of them. you cannot develop any nursing interventions without knowing what symptoms you are dealing with.

to write a care plan, the patient must have a problem or need that you are addressing. and, it seems that your instructor(s) want you to focus your nursing interventions on health promotion. do i have that correct? now, from what i understand, you want to focus on handwashing. to me, handwashing would be an intervention--something that would be part of step #3 of the nursing process. so, the reason i think you are stuck here is because you've skipped steps #1 and #2 of the care planning process. you have no foundation to build this care plan and concept map upon. so, you need to back up here and start again. to get to step #2, the choice of a nursing diagnosis, you have to have done as assessment that nets you some symptoms.

the steps of the nursing process/care planning process are:

1. assessment (collect data from medical record and by doing a physical assessment of the patient)
   
2. nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis 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)

you must follow these steps in sequence in writing your care plan/concept map. but, to begin, you need to give your imaginary patient a problem that is going to end up giving you 3 nursing diagnoses for which you will write at least 3 nursing interventions of which 3 will be health promoting. it sounds to me as if you have carte blanche to pick a medical problem to deal with here. you are also required to have 3 assessments for each domain. i'm assuming that means 3 signs and symptoms that you would get from assessing the patient to support each nursing diagnosis. every nursing diagnosis is based upon the patient having distinct signs and symptoms that fit the criteria for that particular diagnosis. for that reason, when you are first learning to work with nursing diagnoses you really need to have some sort of nursing diagnosis reference. these references will have listings of the current nanda nursing diagnoses (there are currently 188), the definition of each one, the signs and symptoms for each (nanda calls them defining characteristics), and the etiologies or underlying causes/pathophysiology leading to the symptoms and that particular diagnosis (nanda calls them related factors). these three items will be combined to create your 3-part nursing diagnostic statements for your care plans (concept map).

there are four types of nursing interventions or actions that you can take. they are:

1. assess/monitor/evaluate/observe (to evaluate the patient's condition)
   
2. care/perform/provide/assist (performing actual patient care)
   
3. teach/educate/instruct/supervise (educating patient or caregiver)
   
4. manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
   

for each symptom, you should be able to develop at least one, if not all four types of interventions. that means that if you have 3 symptoms for a particular diagnosis, you should be able to come up with no less than 3 and as many as 12 nursing interventions. your health promoting interventions are going to be of the teaching type.

there are two sticky threads on the student forums to help with care plans. one of them has links to online nursing diagnosis pages and i have listed the post number where you can find them:

• https://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html - desperately need help with careplans (in nursing student assistance forum) - post #109 has the list of ackley/ladwig links to nursing diagnosis pages
  
• https://allnurses.com/forums/f50/careplans-help-please-r-t-aeb-121128-7.html - careplans help please! (with the r\t and aeb) (in general nursing student discussion forum)
  

the two references that i use in answering care plan questions for students here on the forums are:

• nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international
  
• nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig

however, any care plan book that also contains the nursing diagnosis information will be helpful as well. the difference between a nursing diagnosis book and a care plan book is that the care plan books will contain goals and nursing interventions. nursing diagnosis books, in general, may not, although the ackley/ladwig book does.

i hope this helps you. if i have misunderstood your posts i am sorry, but i found it difficult to understand what your assignment is. in any case, a care plan must follow the steps of the nursing process no matter what. and, care mapping is designed to kind of force you into following that sequence of steps.