Stressing out over first nursing assignment

Nursing Students Student Assist

Published

Hello, I'm new to the board and I stumbled upon it needing some help!

My assignement is a Concept Map on Health Promotion

I choose the topic personal hygiene. We have had to turn in bib cards for each of our articles and I focused basically on hand washing and soap types, because honestly that is all I could find in nursing journals.

I need to have 3 nursing diagnosises (which I have no idea what that would be for hand washing?)

I also need to have three assesments for each domain, I think if I get pointed in the right direction I can do better.

This is my first actual nursing class, and I'm very overwhelmed. Any assistance would be great! Thank you!

Specializes in med/surg, telemetry, IV therapy, mgmt.

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:

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:

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.

Up Vote Up Vote ×

Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig

The above book is the one I have - it's been priceless.

Also, word to the wise: Don't ever go back and tell your teachers that it was "impossible to get x number of dx". They hate that, and it's pretty much never true.

Asking you for three dx is really beginner's stuff. Later they will want 8-10, although you probably only have to spin out (with assessments, implementations, etc) three of them.

Daytonite has given you really complete material.

Hope this all has helped. Good luck!

Up Vote Up Vote ×

Now, I'm a little confused as to what you are actually supposed to pick as your patient's problem here.

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? .

I am also confused on what is supposed to be my patients problem. Originally my "problem" was personal hygiene and I was supposed to find 5 articles in nursing journals to help address my problem. I searched, and searched and had librarians help me numerous times. Finding that in NURSING JOURNALS only became tough...all we could find we like soap comparisions and hand washing techniques for the nurses. I spoke to my proffessor about this, and she claimed that was fine. Now I'm having trouble figuring out how to use this as a patient problem to apply it to health promotion.

And Daytonight....wow...thanks! That is a lot of information! Over all this whole website I think is going to be a life saver on this project! I think I should have chosen another topic, and I would be having an easier time....but this is just a challenge that once I overcome I will be proud of myself.

Thanks!

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

But I think you still have a dilemma here in that "personal hygiene" is not a problem. It is a very broad category. Handwashing is a nursing intervention for a problem that could be classified as a personal hygiene problem. You need to make up a problem that you have to apply this nursing intervention to. Now what kind of situation could a patient get themselves into where NOT washing their hands is going to get them into trouble? One thing I could see is where a wound would get infected because the patient failed to wash their hands before doing each dressing change. Dirty fingers in a wound. . . In that case, teaching handwashing before doing all dressing changes would be an absolute must. That's one thing that comes to mind. Then, in order to keep with the parameters of your assignment and stay within the domain of Health Promotion you might have a nursing diagnosis such as

  • Impaired Home Maintenance R/T knowledge deficit AEB unhygienic conditions in performing dressing changes to wound, wound infection due to use of unsterile materials in performing dressing changes, and storing dressing materials in a dirty environment.

If you have a nursing diagnosis book, look at the defining characteristics and related factors for the diagnosis of Impaired Home Maintenance and you will see how what I have listed above fit in with this diagnosis. Some of your nursing interventions would address the failure to wash the hands before doing the dressing changes and you would introduce the research articles as rationale to support that. Since you have articles that address types of soaps to use, you could use a defining characteristic (symptom) that might be "lack of financial resources to obtain bacteriostatic soap" or something similar. Since this is purely an exercise (and not a real patient) you can make up all kinds of things here. The idea that I think your instructor is trying to get you to understand is how the symptoms and interventions are related. If you look at how your concept map is going to be constructed, you are going to have these different things in their own boxes with arrows showing the connections between them.

Is that making sense to you? I'm trying to think of other things where not washing the hands can get people into trouble and you can utilize some of the other diagnoses on this list. Something else that comes to mind is in the food industry where salmonella can be transmitted to restaurant patrons when the hands are not washed after working with certain types of raw meats and foods. This might utilize the nursing diagnosis of Ineffective Community Therapeutic Regimen Management.

Is your instructor wanting you to pick 3 of the Health Promotion diagnoses and do this kind of work with them? As I was looking at the NANDA taxonomy I realized that Health Promotion is the first domain in the taxonomy, so it sounds like your instructors are introducing you to the taxonomy and how it is organized. In addition it seems like they are trying to help you understand how the nursing process fits in with the development of a concept map.

Up Vote Up Vote ×

Is that making sense to you? I'm trying to think of other things where not washing the hands can get people into trouble and you can utilize some of the other diagnoses on this list. Something else that comes to mind is in the food industry where salmonella can be transmitted to restaurant patrons when the hands are not washed after working with certain types of raw meats and foods. This might utilize the nursing diagnosis of Ineffective Community Therapeutic Regimen Management.

Is your instructor wanting you to pick 3 of the Health Promotion diagnoses and do this kind of work with them? As I was looking at the NANDA taxonomy I realized that Health Promotion is the first domain in the taxonomy, so it sounds like your instructors are introducing you to the taxonomy and how it is organized. In addition it seems like they are trying to help you understand how the nursing process fits in with the development of a concept map.

Thank you again! You used the two examples ( the wound dressing and the salmonella) How would I tie both of these together with the same patient?

Some of the diagnosis's that I thought I may be able to use were these:

impaired communication (if my patient is from another country)

potential impaird skin integratiy

potential for infection

self-care deficit

alertations in health maintence

knowledge deficit

those were from one of the sites that Angie posted, I hope I'm ateast on the right track here, I think from all the help the three of you have provided I can better formulate questions for my professor for clarity.

You also asked questions on the specific assignment, so I am going to quote the information sheet she passed out, and maybe you can get a cleared idea on what it is she wants.

" Gudelines:

Develop a concept map that displays relationships of key concepts/factors related to health promotion for the selected need/problem. Some concepts to include are nursing diagnosis, assessment of the problem using the six domains essential for health promotion (biological, psychological,sociocultural, spiritual/religious, environmental and technological). Also include health promotion interventions related to the six domains, research highlights and a list of community resources.

Lust at least 3 nursing diagnoses and at least 3 assessments for each domain.

List 3 health promotion interventions for each domain.

Search the Columbus Community for material and people resources available for those with the selected problem or need. Include at least 5 different resources.

Present concept map on poster board."

I want everyone to know, I have been looking at all of the sites linked and bookmarking and taking notes! Everyone one of you have helped me so much, not only for this project I'm sure but in my future classes, thank you all so much!

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

yes, i think you need to get together with your instructor. your instructor is using terminology in a different way than i am. i'm using "health promotion" as one of the major domains in the nanda taxonomy. it doesn't sound like that is what your instructor is doing at all. your instructor is telling you that there are 6 domains: biological, psychological, sociocultural, spiritual/religious, environmental and technological, that all or most of the nursing diagnoses are classified into. were you given a list of the nursing diagnoses that were included under each of these domains? it would be very helpful to have that information. many people divide the nursing diagnoses up in many different ways. i know the nanda way, but it sounds like your instructor is using something different, so i'm at a loss to help you with choosing nursing diagnoses for some of these domains.

it sounds to me as if you need to choose 3 nursing diagnoses from the nursing diagnoses that are included under each of these 6 domains (biological, psychological,sociocultural, spiritual/religious, environmental and technological) and develop them as i did in the example i did for you in my last post. it seems that you would only need one abnormal assessment item (symptom) for each nursing diagnosis, and one nursing intervention for each of these abnormal assessment items (symptom) that is a health promotion intervention. at least that is what i am reading from what you have posted.

this seems to be a rather large project because by my count, you need to end up with a total of 18 nursing diagnoses that each have one symptom and one health promotion nursing intervention that addresses that symptom. question for your instructor: would that nursing intervention need to be the handwashing for all the nursing diagnoses? check with your instructor, but i still think this is an exercise in learning how to put together all the parts of a nursing diagnosis through the understanding of the steps of the nursing process. i believe that you have to use one medical condition as the underlying basis for the nursing diagnoses you choose. that would fit in the central box of your concept map. the main issue is that you are able to show the relationship between the problem (nursing diagnosis), symptom (defining characteristic) and your health promoting nursing intervention(s). this is where you visually show that on a concept map with all the arrows, etc. i think if you start to put some of this information onto a concept map form it will start to make more sense to you.

i leave you to your thoughts on how to put this together. i like the idea of using an infected surgical wound because you should be able to come up with potential nursing diagnoses from each of your 6 domains in relation to this particular problem. the biological domain is easy because all you need to do is think of all the symptoms of an infection and there are plenty of nursing diagnoses to cover them. psychological deals with emotional response, self-perceptions, and coping. your sociocultural has to do with access to healthcare services and cultural beliefs (and people can have some goofy ones that impede their treatments). and i'm hoping you have a listing of nursing diagnoses for the other domains because i am at a loss for them.

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

it occurred to me that rather than a medical diagnosis in the central box of this concept map, you should put "bacterial invasion/contamination through direct contact". that will give you more latitude in choosing symptoms and nursing diagnoses.

then, for each domain, you will need to come up with abnormal assessment data that fit with that domain category. use them to match with defining characteristics of the nursing diagnoses that are classified within that domain. you should use a nursing diagnosis reference to make sure you are doing this correctly. if you know the nursing diagnoses in each domain category, just look them up and read the defining characteristics (symptoms) for each to see if any are going to fit in with your central idea. then, use it. you will probably want your nursing intervention for each defining characteristic to lead you to handwashing in most instances.

Up Vote Up Vote ×

I'm still awaiting a response from my professor. I e-mailed her on saturday. She wanted us to work on this over break, but isnt available to answer e-mails. I'm getting frustrated! Thanks to all that replied, I'm just waiting on clarification from her on some of the basic things so I can put all of your great information to use!

Up Vote Up Vote ×
Specializes in oncology, hospice.

We were required to get Ackley's Nursing Diagnosis Handbook (NURSING DIAGNOSIS HANDBOOK ACKLEY edition 8, ELSEVIER SCIENCE

ISBN: 978-0-323-04826-2) and it has all the NANDA (North American Nursing Diagnosis Association) approved diagnoses in it. It is VERY helpful for writing care plans and for patient care as well (helps me focus on WHAT the problem is so I can figure out HOW best to attack it). Hope this helps!

Up Vote Up Vote ×

Update:

I talked with my professor finally today. She said this is not a care plan, but instead just a concept map (that was her answer) She clarified what I was to do though (its actually two professors) They both seemed to have different understandings of what they were expecting but seemed to come to an agreement. I actually onlt need three assesments for three domains of my choice, totaling in 9 assesments. From there, I need interventions for those assesments. I needed a total of three nursing diagnosis's which they also helped me come up with, with are "Potential for impaired skin integrity", "Self-care deficit" and "Knowledge deficit".

In the middle of my map I'm going to have Infection Control, handwashing in the middle and from there use my diagnosis's and then add my assements ( choose biological- signes and symptoms, what organisms are infecting, how are the organisms spread. sociocultural-Language barriers, hygiene methods currently in place, and I need one more. Technological-Do they have soap available, do they have antibacterial soap available, and I need one more for that). Then, for interventions I was going to do biological- education, handwashing techniques, need one more

sociocultural-education, handwashing techniques, hygiene techniques, and one more.

technological-information on importance of using soap, education on importance of type of soap, and need one more.

Thank you for all of your help, and if I can get feedback on what I have now that would be great! I know all the information I got here is going to help me throughout nursing school, and I have printed it out and stored it for future use as well. Thanks again!

Up Vote Up Vote ×
+ Add a Comment