Saturday, September 3, 2016

Assess, Plan, Implement, and Evaluate




As my nursing education continued we studied medical-surgical nursing, surgery, psychiatry, obstetrics and pediatric nursing.

They broke us up into groups and each group did a different session. This way we weren't a huge group in one area of the hospital. Our hospital is a 200-bed facility and there wouldn't have been enough patients for everyone at a given time. Some students went to hospitals in other towns. I was fortunate not to have to do any traveling and all of my clinical rotations were in our local hospital. Since I had two young boys at home this was important to me.

We got to wear white uniforms. I was beyond excited. I loved the white uniform. Most of us wore pants. Some of the ladies wore dresses. We all had to wear white hose and white, leather shoes. We could wear our caps if we wanted. They had to have a little triangle patch on it to show we were a student. But since none of the 'real' nurses wore caps, wearing one would have shown you were a student!! I did not wear mine. I am tall. The TV's at the hospital are mounted on the wall, at the foot of the bed. Not much room to walk. And my hat would have been knocked off a hundred times a day. Also, by this time, it wasn't in fashion to wear a nurses cap. We had a name badge that was huge. That was enough of a giveaway that we were students. A lot of the students didn't like to be identified as a student. I wanted to scream to anyone that was close "JUST A STUDENT" here. I was terrified of making a wrong decision.

Twice each week we were assigned A patient. Only one. And we were to report to the hospital the evening before our clinical to read the patient's chart. Write down all the drugs there were on. Make a drug card for each medication. And write a plan of care. Then bright and early the next morning we arrived at the hospital to "take report" in a small room with a tape recorder, the 'real nurses' and us. We listened to a taped report of what had happened to each person on the floor (usually 23 beds) the previous 8 hours. In this case, during the night. Most all of our clinical took place on day shift. We reported to duty at 6:30 a.m. and stayed until just after lunch was served. And then we headed to a conference room for a debriefing on what happened with each student's patient. 

I can remember many late nights. Not only because I was also working at the inventory service by this time, but doing the homework required to go to clinical the next morning. Some of those patients took a lot of drugs. And we needed to have at the very least a brief understanding of what the drug was for, what it's side effects were, and why our patient was taking it. We might be quizzed by the instructors. And we needed to have our care plans ready to share. 

What does a nursing care plan consist of, you might be asking! It is developed using 4 factors. Assess, Plan, Implement, Evaluate. Every hospital that accepts Medicaid or Medicare payments must include a written plan of care in every patient's chart. So we didn't just have to do these to please our instructors. It was mandated by law. And we had to continue doing them after we became registered nurses. We were told that if an instructor came up to us at any time after graduation for years to come they expected us to be able to rattle off the answer to their question: "What are the steps to the nursing process?" And we would say back, "Assess, plan, Implement, Evaluate." 

I am going to share a really basic nursing care plan and how I would write it. Say, for instance, a patient has activity intolerance because he becomes very short of breath. My nursing diagnosis would be "Activity intolerance secondary to SOB" (a funny kind of nurse-speak, SOB is shortness of breath not son-of-a...well you get the idea!)
I would then need to assess the patient for SOB. I would need to plan a routine for him to get through his ADL's (activities of daily living) in the easiest way possible. I would implement the plan : ie. plan for rest periods. And then I would evaluate for how this worked out for him. Get it? Fun! And we did this for each problem we identified that each patient had. This is how we went about learning the nursing process.

Also during these clinical times, we were learning to make a bed, give a bed bath, brush dentures and give oral care, walk patients, feed them, talk with them. Basic nursing care. Later we learned to insert catheters, nasal-gastric tubes, intravenous lines, and other fun things. We first practiced everything in the nursing lab at the college, demonstrated our proficiency to our instructor and then practiced on real live patients. And we learned how to write it all in the chart so everyone could see what we were doing. 

I have some funny stories (maybe one or two) about learning how to do some procedures but I will share those later. Enough nursing education for one day. Don't you agree??

21 comments:

  1. I found this SO interesting, Paula! One of my favorite photos of my mother was her graduation from nursing school. Even in her final days she spoke longingly of her graduation ... how, at the close of the evening's ceremony, they marched single-file, each holding a candle.

    Reading your 'take report' and care plan sounds a bit overwhelming. Impossible, when I stop and think how many patients a RN is responsible for on a 'normal' shift!
    Having Tom in and out of hospitals for much of 2013, I spent lots of time observing his care-givers and (sorry!!!) mentally judging them. Of course, most weren't RN's but I think you get the idea.
    I appreciate you affording us a glimpse of the 'other' side!

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    1. Thank you Myra. I don't think I knew that your mom was a nurse. RN? LPN? We didn't have a candlelight cermony (or even a pinning ceremony) when I graduated. They were stressing the "degree" at this time. The next couple years after I graduated they went back to the old pinning ceremonies. I always felt cheated. I had a new way at looking at nurses when Richard was sick. Also when my step-dad was in a hospital that wasn't mine and those nurses didn't know I was a nurse. There are a lot of sloppy nursing being done out there. But, like good cops, I feel the majority of nurses are good at their jobs.

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    2. Yes Paula, my mother was an RN, but quit working when I came along. I think she harbored great hopes I'd follow in her footsteps, but I'd no interest. (Good thing, since my worst grades came from science and math!)

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    3. I haven't harbored any great hopes for any of my granddaughters to become nurses but I have two of them interested. The oldest, Katie, is struggling because of the math and science. Harley is taking classes this year in high school to get her ready. I've told them both it is hard work, terrible hours, but very gratifying!

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  2. I think I said it before but nurses are the backbone of the hospital. They keep it running. Sounds so fascinating with how you were taught all you needed to know. I am enjoying these as you share them.

    Betty

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    1. That is exactly right Betty! It IS the nurses who make a hospital!

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  3. Looking forward to reading your funny stories learning procedures.

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  4. My mother has a picture of herself in that cap and dress. But I never saw her wear it. By the time I was old enough to understand, she always worked in scrubs.

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    1. I wore a uniform for all but the last 6 years of my career. And then I switched to scrubs.

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  5. When I was very young, all the nurses I met wore dresses and their caps. I'm guessing the scrubs are more practical and comfy. I never had a nurse I didn't care for and I've been in the hospital a lot over the years. Thanks for the work you did!

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    1. Scrubs are comfy. I don't like them and I had a hard time making the swith over. I felt they just made the nurses look like everyone else in the hospital because everyone else wore scrubs!

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  6. That was interesting! I often wish I went into some kind of patient care career instead of administrative assistant, but oh well!

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    1. I wish I had gone to nursing school directly from high school. Instead I thought I wanted to be in a business office!!

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  7. I love learning about your nursing career. You are very clear and concise. I can see that you were an excellent student.

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  8. Thanks for the look into your Nursing Education! :)

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  9. It sounds such a basic set of steps but what an important one. Care plans are vital to ensure a patient gets exactly what they need and would be pointless without the evaluation part. Great recollection Paula.

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    1. They are basic steps that will take us all the way to end of the hospitalization.

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  10. I am enjoying these as you share them.

    gclub

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