AS YOU CAN --

WE'RE GOING TO START
NURSING PROCESS.

AND I'M GOING TO START IT BY
REVIEWING WHAT WE'VE DONE.

SO, WHAT IS NURSING PROCESS?
WHAT ARE THE COMPONENTS?

- ASSESSMENT.

- ASSESSMENT, DIAGNOSIS
OR ANALYSIS.

THEY ACTUALLY GO TOGETHER

COS WE'VE GOT TO ANALYZE OUR
INFORMATION TO MAKE A DIAGNOSIS.

AND THAT'S THE STEP
WE'RE GOING TO BE ON TODAY.

AND THEN NEXT?
- PLANNING.

THAT'S GOING TO BE YOUR
SECOND HOUR. THEN?

- IMPLEMENTATION.
- IMPLEMENTATION AND?

- EVALUATION.

INTERESTINGLY, WE ALL BECAME
NURSES, PROBABLY, BECAUSE WE
LIKE THE IMPLEMENTATION PHASE.

WE WANT TO DO SOMETHING FOR
PEOPLE AND WE WANT TO KNOW
WHAT TO DO FOR PEOPLE.

BUT THE BEST WAY FOR US TO DO
RIGHT THINGS THAT ARE HELPFUL

IS TO HAVE A PLAN BASED
ON RIGHT INFORMATION.

SO, WE'VE GOT TO GET GOOD
ASSESSMENT TO GET GOING.

ALRIGHT, WHAT WE'RE GOING TO DO
IS DEVELOP A NURSING DIAGNOSIS.

OUR FIRST STEP AS WE'VE
TALKED ABOUT IS ASSESSMENT.

THEN WE'VE GOT TO ANALYZE OUR
INFORMATION AND FORMULATE A
NURSING DIAGNOSIS.

ALRIGHT, LET'S JUST REVIEW.

TO DO NURSING DIAGNOSIS,
WE'VE GOT TO ASSESS

AND OUR ASSESSMENT NEEDS
TO BE HOLISTIC AND DETAILED.

WHAT THAT MEANS IS THIS.

WHEN YOU ASSESS SOMEONE,
IT'S MORE THAN JUST THE
PHYSICAL ASSESSMENT.

IT'S MORE THAN JUST THAT DATA.

THERE'S TWO KINDS OF OF WAYS
OF DOING IT, WHICH IS
SUBJECTIVE AND OBJECTIVE.

SO, WE'VE GOT TO TALK
TO THE CLIENT
AND GET SOME INFORMATION.

AND ONE OF THE KEY PHRASES
THAT YOU'RE GOING TO SEE
A LOT IS THE CC.

YOU'RE GOING TO SEE THAT
ON FORMS AND IT MEANS,

WHAT'S THEIR CHIEF COMPLAINT?
WHAT CONCERNS THEM THE MOST?

THEY MAY HAVE A BIGGER
PHYSIOLOGICAL ISSUE
THAT WE'RE RECOGNIZING,

BUT THEY HAVE A COMPLAINT
AND THAT'S WHAT DREW THEM
TO GET MEDICAL ATTENTION.

WE'RE GOING TO GATHER PHYSICAL
DATA. WE'RE GOING TO GATHER
SUBJECTIVE, OBJECTIVE DATA.

AND IN OUR OBJECTIVE DATA,
WE'RE GOING TO TAKE IT
A STEP FURTHER.

I HAVE ANOTHER LIST
THAT'S COMING UP.

WE'RE GOING TO LOOK AT OTHER
THINGS BESIDES
JUST WHAT WE FOUND

WHEN WE DID OUR HEAD TO TOE.

WE'RE GOING TO LOOK AT LAB.

WE'RE GOING TO LOOK AT
HISTORY AND PHYSICAL.

WE'RE GOING TO LOOK
AT RESULTS OF X-RAYS

AND WHATEVER DIAGNOSTIC
TESTS WERE DONE.

WE MAY TALK TO
A FAMILY MEMBER.

WE MAY OBSERVE A
RELATIONSHIP INTERACTION

THAT GAVE US LOT MORE
INFORMATION THAN WHAT OUR
PHYSICAL ASSESSMENT DID.

WE'RE GOING TO TAKE IN AS MUCH
INFORMATION AS WE CAN TO
MAKE CORRECT A CARE PLAN.

THE MORE RIGHT INFORMATION
YOU HAVE, THE CLOSER
YOU'RE GOING TO GET

TO A CORRECT AND HELPFUL
CARE PLAN FOR THAT CLIENT.

WE NEED CARE PLANT THAT
SUPPORTS CRITICAL THINKING.

AND THIS IS WHAT SEE HAPPENING
A LOT IN THE CLINICAL AREA.

THEY'VE CREATED FORMS FOR US TO
HELP US NOT MISS THINGS.

AND PEOPLE SOMEHOW SWITCH
GEARS AND THEY LOOSE TRACK

OF WHAT THEY CAME
TO NURSING TO DO,

AND THAT WAS TO HELP PEOPLE.

AND SO THEY TAKE ON
THAT FORM AND THEY JUST
CHECK, CHECK, CHECK.

GOOD. FORM'S DONE.

AND THEN THEY JUST
DO DOCTOR'S ORDERS.
WE MISSED IT.

IF WE'RE NOT THINKING ABOUT
WHAT WE'RE SEEING
AS A WHOLE PICTURE,

AND HOW THE CLIENT'S
RESPONDING TO IT,

HOW CAN WE HELP THEM BEYOND
JUST DOING FEW DOCTOR'S ORDERS?

THERE IS MORE TO
DO FOR PEOPLE.

AND THAT'S GOING TO ENTAIL
CRITICAL THINKING
FOR THE CLIENT.

WE'RE THEIR ADVOCATE.

WE'RE LIKE THIS OBJECTIVE
THIRD PARTY THAT LOOKS AT
THE WHOLE PICTURE

AND GOES, "WELL, WHY ISN'T
ANYONE DOING ANYTHING
ABOUT THIS?"

IF THAT WAS MY MOTHER,
I'D WANT THEM TO DO THIS.

THIS ISN'T MAKING SENSE,
WHY DOES -

DO YOU SEE WHERE I'M GOING?
SOMEBODY'S GOT TO THINK
ABOUT THE WHOLE PICTURE.

I'M NOT SAYING DOCTORS DON'T.
I'M SAYING WE'RE THE PARTY
OUTSIDE OF IT

THAT'S SEES SOMETIMES THE MORE
PERSONABLE AND PRACTICAL
ASPECTS OF CARE.

WE NOT ONLY WANT TO LOOK
AT THEIR PROBLEMS

AND WHAT THEY'RE EXPLAINING
OR DEFINING AS THEIR
CHIEF COMPLAINT,

BUT WE WANT TO LOOK AT
WHAT ARE THEIR STRENGTHS.

PEOPLE HAVE THINGS TO OFFER
TO HELP THEMSELVES

AS WELL AS HAVING
DEFICIENCIES OR PROBLEMS.

SO, DON'T JUST GO,
"OH, I FOUND THIS PROBLEM."

WHAT ARE THEIR STRENGTHS
AS WELL.

AND APPRECIATE THAT THE WHOLE
PROCESS IS ONGOING.

BECAUSE WHAT WE MIGHT ASSESS
TODAY MAYBE TOTALLY DIFFERENT
AND CHANGED TOMORROW.

IN FACT, IT MAY BE DIFFERENT
FOR THE NEXT SHIFT.

IT'S SO INTERESTING SOMETIMES
YOU SEE A CLIENT

AND THE NURSES FROM THE
SHIFT BEFORE WILL SAY,

"OH, IT WAS JUST AWFUL. HE WAS
SO CONFUSED AND COMBATIVE.

AND HE HAD EIGHT
INCONTINENT STOOLS."

AND YOU'RE, LIKE, THINKING, "OH,
WOW. I'M GOING TO HAVE BUSY
DAY."

THE NEXT SHIFT, TOTALLY
ALERT AND ORIENTED. NO
INCONTINENCE WHATSOEVER.

AND YOU KNOW -- DO YOU SEE?

THINGS CHANGE AS WE BREATH.
AND SO WE CONTINUALLY ASSESS

TO BRING THAT LOCATION FOR
WHAT WE'RE GOING TO DO.

NURSING ASSESSMENT IS ALL OF
THESE THINGS THAT I MENTIONED.
AND HERE'S COUPLE MORE.

IT'S NOT ONLY THE
HEALTH HISTORY,

WHICH WE GET FROM BOTH,
NURSING AND THE PHYSICIAN.

BUT IT'S OUR PHYSICAL
ASSESSMENT, THINGS IN THE
MEDICAL RECORDS,

DIAGNOSTIC TEST, IT'S
HEALTH TEAM MEMBERS.

I HAVE TO TELL YOU MY
NURSES AIDES WHEN I'M
WORKING WITH THEM,

BECAUSE THEY IN THERE
DOING A LOT OF [BATHS],

AND WATCHING THE FAMILY --
ARE HUGE SOURCE OF INFORMATION.

PHYSICAL THERAPY WILL PICK UP
SOMETHING THAT I DIDN'T PICK UP

BECAUSE THEY'RE DOING AN
ACTIVITY I DIDN'T DO.

SO YOU REALLY NEED TO
BE TALKING TO EVERYBODY,
RESPIRATORY THERAPY,

BECAUSE YOU HAVE THIS
WEALTH OF INFORMATION

BY GETTING IN TOUCH WITH
ALL THE TEAM MEMBERS.

AND THEN ANYTHING ELSE
THAT JUST STICKS OUT TO YOU.

SO, EVERYTHING HELPS US
IN OUR ASSESSMENT.

WE HAVE TO DEVELOP
THE QUALITY OF ASKING
OPEN-ENDED QUESTIONS.

THINGS LIKE, DESCRIBE
WHAT YOU ARE FEELING?

HOW LONG HAVE YOU
HAD THESE SYMPTOMS?

HOW LONG HAVE YOU BEEN
FEELING THIS WAY?

HOW WOULD YOU LIKE TO FEEL?
HOW HAVE YOU FELT BEFORE?

SOMETIMES IT FEELS LIKE
THESE ARE CONTRIVED,
AWKWARD QUESTIONS.

LIKE, WHEN WAS THE LAST TIME YOU
SAID TO SOMEONE, "DESCRIBE TO ME
HOW YOU'RE FEELING?"

DOES THAT SOUND WEIRD?

WELL, GET OVER IT. BECAUSE HOW
ELSE ARE WE GOING TO KNOW.

SO, TRY OUT SOME OF THOSE
QUESTIONS EVEN THOUGH
THEY FEEL LITTLE --

OH, I DON'T KNOW, CONTRIVED,
IF YOU WILL.

HOW ELSE CAN WE GET
THE ARRANGEMENT? TRY HARDER.

ALRIGHT, WE'LL GET
MORE ON THAT.

WE'RE GOING TO DO A THOROUGH
PHYSICAL ASSESSMENT.

PHYSICAL ASSESSMENT CAN BE ONE
OR TWO THINGS.

IT CAN BE HEAD TO TOE, WHICH IS
WHAT WE'VE INTRODUCED TO YOU,

OR IT CAN BE BY BODY SYSTEM.

ONE OF THE THINGS WE'VE ALLUDED
TO,

AND I'VE HEARD THE INSTRUCTORS
TALK ABOUT -- FOR EXAMPLE,

IF HAVE A CLIENT THAT WAS
ADMITTED WITH AN APPENDECTOMY,

THEY'RE 21 YEARS OLD,
ALERT AND ORIENTED.

THEY WERE OUT PLAYING SOCCER
YESTERDAY AND HAVE AN
APPENDICES ATTACK TODAY.

I'M PROBABLY NOT GOING TO DO
NEURO ASSESSMENT.

BUT IF I HAVE SOMEONE
COMING WITH A STROKE,
BOY, I'M DOING IT ALL.

DO YOU SEE WHAT I MEAN?

SO WE WANT TO EITHER BE LOOKING
AT SYSTEMS IN PARTICULAR

OR COMPLETE HEAD TO TOE TO
GATHER OUR ASSESSMENTS.

YOU WANT TO CAREFULLY ASSESS
EACH AREA FOR NORMAL AND
ABNORMAL FINDINGS,

AND THEN BE SURE AND USE
AS MANY OF THE METHODS

OR MODES OF ASSESSMENT AS ARE
TYPICAL.

WE'RE LOOKING FOR NORMAL AND
ABNORMAL FINDINGS.

AND THEN WHAT YOU WANT TO DO IS
AFTER YOU GATHER YOUR DATA

YOU WANT TO ASK THE
CLIENT TO VALIDATE

OR CONFIRM WHAT
YOUR FINDINGS ARE.

IT'S NOT ALL ABOUT YOU. IT'S
ABOUT TALKING TO THE CLIENT.

SO, THIS IS WHAT I NOTICED.

AND THEY'LL GO, "OH I KNOW."

"DOES THIS DESCRIBE HOW YOU
FEEL?" "NO, NOT REALLY."

THIS IS WHAT I MEAN.

TALK TO THEM, REPLAY IT,
RESTATE IT BACK.

"TELL ME MORE.
WHAT CAN I DO TO HELP?"

THEY -- I HAVE AN
IDEA OF WHAT I THINK I NEED.

THAT WILL HELP YOU PLAN
EDUCATION, EXPERIENCES.

OR HOW YOU'LL BEST SERVICE
THAT CLIENT,

BY MEETING THEIR NEEDS AS WELL
AS WHAT OUR OBSERVATIONS WERE.

AND THOSE ARE CRITICAL
THINKING PERFORMANCES.

ONCE WE'VE GOTTEN OUR
INFORMATION, WE WANT TO REPORT

AND RECORD THE INFORMATION.

SO LET'S SAY THEY HAVE PAIN.
THEY'RE GOING TO REPORT,

THEY HAVE SHARP,
UNRELENTING PAIN.

THEY'RE VITAL SIGNS ARE GREATLY
DEVIATED FROM NORMAL AND THEN OF
COURSE, WE WOULD LIST THEM.

THERE'S A CHANGE IN THE LEVEL OF
CONSCIOUSNESS.

IF YOU ARE TO FIND ANY OF
THESE THINGS ON YOUR CLIENT

WHAT DOES IT MEAN BY REPORT?

FIRST YOU'RE GOING TO REPORT
TO YOUR INSTRUCTOR.

THEN YOU'RE GOING TO REPORT TO
THE NURSE OR VICE VERSA.

BECAUSE REMEMBER WHO'S CHARGE OF
YOUR CLIENT IN THE FLOORS?

THE NURSE IS. BOTTOM-LINE, THE
NURSE IS RESPONSIBLE.

SO THAT NURSE NEEDS
THAT INFORMATION
WITHIN A FEW MINUTES.

THEN, YOU RIGHT NOW AREN'T ABLE
TO TAKE DOCTOR'S ORDERS.

SO DON'T CALL THE DOCTOR BECAUSE
THEY'RE GOING TO WHIP OUT SOME
ORDERS TO YOU.

BUT FOLLOW THAT NURSE AND SAY,

"CAN I LISTEN TO YOU WHEN YOU
CALL THE DOCTOR?"

GET ON A EXTENSION AND HEAR WHAT
THE DOCTOR SAYS,

HEAR HOW THEY
DIALOGUE TOGETHER.

ONE OF THE MOST INTIMIDATING
THINGS YOU'LL DO OR FEEL MOST
INSECURE ABOUT

IS CALLING PHYSICIANS,
ESPECIALLY IF YOU FEEL LIKE

YOU DON'T REALLY KNOW WHAT
YOU'RE TALKING ABOUT

OR YOU DON'T KNOW WHAT THEY'RE
GOING TO SAY BACK.

SO PRACTICE IT WITH THE NURSES

SO THAT YOU GET USED TO THE
DIALOGUE AND WHAT
THEY ARE DOING,

BUT THAT'S GOING TO GET
REPORTED FOR THE DOCTOR.

WHENEVER IN DOUBT,
YOU'RE NOT EVEN SURE.

YOU'LL GO, "OH, I'M NOT EVEN
GOING TO TELL HIM.
HE'LL THINK I'M STUPID.

NO, YOU BETTER BE TELLING.
IT'S BETTER TO JUST

GET OUT THERE AND LET PEOPLE
KNOW WHAT YOU'RE IN DOUBT ABOUT.

ALL THE INFORMATION
HAS TO BE REPORTED

IN THE HEALTH HISTORY OR
PHYSICAL ASSESSMENT OR IN THEIR
COMPUTER,

OR HOWEVER YOUR INSTITUTION IS
DOCUMENTING INFORMATION
RIGHT NOW.

BE CAREFUL, IN REGARDS TO
CONFIDENTIALITY, THE INFORMATION
THAT YOU SHARE.

I KNOW THEY'VE TALKED
TO YOU ABOUT IT,
I JUST WANT TO EMPHASIZE

HIPAA IS SERIOUS.
CONFIDENTIALITY
IS A HUGE ISSUE.

YOU CAN'T BE TALKING IN THE
ELEVATOR TO YOUR INSTRUCTOR
ABOUT YOUR CLIENT

IF THERE'S SOMEBODY
ELSE IN THAT ELEVATOR.

BECAUSE YOU DON'T KNOW
WHAT THEY'RE HEARING.

YOU CAN'T GO UP IN THE CAFETERIA
AS STUDENTS AND GO,

"OH, MY GOSH! YOU SHOULD HAVE
SEEN THAT PATIENT. THAT WOUND
WAS SO GROSS. DID YOU SEE THAT?"

RIGHT THERE IS THEIR FAMILY,
TABLE NO.2. YOU DON'T KNOW.

SO YOU HAVE TO BE VERY,
VERY CAREFUL ABOUT
WHAT WE SHARE.

KEEP YOUR NOTES SAFE. DON'T
LEAVE ANY THING OUT OF SIGHT.

YOU HAVE TO KEEP YOUR
STUFF WITH YOU.

ONE OF THE THINGS I SEE
HAPPENING SOMETIMES

IS WE PUT OUR INFORMATION
ON A CLIPBOARD

AND MAYBE THEY'RE IN ISOLATION,

SO THERE'S A LITTLE CARD OUTSIDE
THE ROOM IN THE HALLWAY.

SO, WE DON'T WANT OUR STUFF
COMING IN FOR SURE.

WE LEAVE IT ON THE CARD OUTSIDE
THE HALLWAY,

GO IN AND DO OUR THING, COME
BACK AGAIN OUR PAPER SITTING

IN THE HALLWAY, WITH EVERYTHING
ON IT.

NO GOOD. GOT TO MAKE SURE YOU
STUFF IS PROTECTED SO THAT NO
ONE'S READING IT.

WE ARE STUDENTS
SO WHAT DO WE DO

AND HOW DO WE GET THAT
INFORMATION?

WELL, JUST MAKE SURE THAT ON
YOUR PAPER,

YOU'RE JUST PUTTING INITIALS
DOWN AND NO IDENTIFIERS

THAT PEOPLE CAN SAY, "OH THAT'S
MY NEIGHBOR."

BECAUSE THAT WOULD BREACH
CONFIDENTIALITY.

IS THAT EVERYTHING I JUST SAID?

ALRIGHT.

WHAT WE'RE GOING TO DO AFTER WE
GATHER ALL OUR INFORMATION

IS NOW WE'RE GOING TO PURPOSE AT
ANALYZING OUR INFORMATION

TO MAKE A NURSING DIAGNOSIS.

WE'RE GOING TO CREATE A
DIAGNOSIS THAT HAS
THREE PARTS TO IT.

THERE ARE TWO PART DIAGNOSIS
AND THREE PART.

WE WANT YOU TO DO A
THREE PART DIAGNOSIS

WHICH IS A DIAGNOSIS,
A RELATED TO FACTOR
AND DEFINING CHARACTERISTICS.

OR TRANSLATE IT, WE'RE GOING TO
TALK ABOUT MORE.

A NURSING DIAGNOSIS AS PER OUR
LIST OF -- OUR TAXONOMY LIST.

IT'S IN THE BACK OF THE BOOK
WE'LL LOOK AT IT IN A MINUTE.

RELATED TO FACTORS BEING THE
CAUSE OR THE IDEOLOGY,

THE THING THAT'S CONTRIBUTING TO
THAT DIAGNOSIS.

AND THEN WHAT ARE THE
DEFINING CHARACTERISTICS.

AFTER YOU DID YOUR READING
WHAT ARE THE DEFINING
CHARACTERISTICS?

IT'S YOUR ASSESSMENT.

IT IS THE SYMPTOMS,
IT IS THE COMPLAINTS,

IT IS WHAT YOU ASSESSED
THAT MADE YOU DECIDE

I HAVE AN ISSUE TO DEAL WITH.

SO DEFINING CHARACTERISTICS ARE
THE ASSESSMENT, THE SYMPTOMS.

THOSE ARE THE WORDS I HEAR MOST,
BUT IT'S YOUR ASSESSMENT

THAT RELATE TO THAT DIAGNOSIS.

ALRIGHT, LET'S START
FROM THE BEGINNING.

WHAT IS A NURSING DIAGNOSIS?
WHO ARE WE?

THIS IS SO CRITICAL TO
WHAT WE ARE AS NURSES

AND OUR SCOPE OF PRACTICE.

THIS IS YOUR DEFINITION, IT'S ON
WHATEVER PAGES ON YOUR BOOK.

IT'S THE FIRST PAGE
OF THE CHAPTER.

BROKEN DOWN A LITTLE BIT.
IT'S A CLINICAL JUDGMENT.

WHICH MEANS, THAT SOMETHING THAT
YOU OBSERVE IN YOUR --

IN YOUR ASSESSMENT GATHERING

IN THE CLINICAL SETTING.

IT HAS TO DO WITH EITHER AN
INDIVIDUAL, A FAMILY,
OR A COMMUNITY.

BECAUSE WHERE ELSE WOULD A
CLINICAL JUDGMENT TAKE PLACE?

WHAT IF YOU'RE A SCHOOL NURSE?

AND THERE'S HEAD LICE?

IS THAT AN INDIVIDUAL PROBLEM, A
FAMILY PROBLEM OR A COMMUNITY
PROBLEM?

ALL THREE.
THE PERSON THAT'S GOT IT,

THE FAMILY'S THAT'S
GOING TO CATCH IT

AND THE COMMUNITY
THAT'S BEEN EXPOSED.

OKAY? SO, HOW ARE WE GOING TO
ADDRESS THOSE ISSUES?

AND THEN IT'S A RESPONSE

TO THIS ACTUAL PROBLEM OR
THIS POTENTIAL PROBLEM.

IN OTHER WORDS, A PATIENT
MIGHT HAVE COPD.

THAT'S WHAT WE'RE GOING TO WORK
WITH A LITTLE TODAY.

WE KNOW WHAT THAT IS, CHRONIC
OBSTRUCTIVE PULMONARY DISEASE.

BUT WE DON'T DEFINE IT,
WE DON'T DIAGNOSE MEDICALLY

THAT THEY HAVE COPD. WHAT IS
THEIR RESPONSE TO COPD?

WHAT'S A RESPONSE TO CHRONIC
OBSTRUCTIVE PULMONARY DISEASE?

RESTRICTED AIRWAY.
- EDEMA.

- EDEMA, SOMETIMES,
BUT NOT NECESSARILY.

IT'S MORE BREATHING.

- SHORTNESS OF BREATH.
- SHORTNESS OF BREATH.

- COUGHING,
- LACK OF OXYGEN.

THAT IS THE RESPONSE
TO THE DIAGNOSIS.

THAT HOW THEY'RE HANDLING IT.
WHAT'S A RESPONSE
TO APPENDICITIS?

- PAIN. VOMITING.

THAT IS A RESPONSE
TO A DIAGNOSIS.

WE'RE LOOKING AT HOW THE CLIENT
IS HANDLING WHAT THEY'VE GOT.

AND WE CAN DEAL WITH THAT AND
MAKE NURSING DIAGNOSIS.

IT'S BASED ON OUTCOMES AND
INTERVENTION --

OR IT'S THE BASIS FOR OUR
OUTCOMES AND INTERVENTIONS.

OUTCOMES ARE OUR GOALS WHAT WE
WANT TO DO TO HELP THAT CLIENT

AND WHAT WE'RE DOING
TO HELP THAT CLIENT.

AND THE NURSE IS TOTALLY
ACCOUNTABLE FOR THOSE ACTIONS.

IT'S OUR SCOPE OF PRACTICE.

OKAY. THAT'S WHAT WE ARE.
WHAT ARE WE NOT?

WE ARE NOT A MEDICAL DIAGNOSIS.
SO, WHAT IS A MEDICAL DIAGNOSIS?

IT'S BASED ON PHYSICAL SIGNS.
WE DO THAT TOO, IN SYMPTOMS,

IN MEDICAL HISTORY AND RESULTS
OF DIAGNOSTIC TESTING.

BUT A DOCTOR IS LICENSED TO
TREAT DISEASES AND PATHOLOGIES

DESCRIBED IN THEIR MEDICAL
DIAGNOSTIC STATEMENTS.

THEY HAVE THEIR OWN TAXONOMY.

THEY HAVE THEIR OWN LIST OF
MEDICAL DIAGNOSIS.

HAVE ANY OF YOU WORKED
IN A DOCTOR'S OFFICE

WHERE YOU DID BILLING?

AND YOU WERE --
WHAT'S THAT BOOK?

[AND DRAWING DRG'S.
IT'S THAT SALE.]

UH-HUH. IT'S ALL YOUR CODING.

BASED ON APPENDICITIS, COPD,

ECZEMA, JUST THINK OF ANYTHING
THAT'S A MEDICAL DIAGNOSIS

THAT YOU HAVE -- CANCER.

WE DON'T GET TO DIAGNOSE CANCER,
WE RESPOND TO IT.

HOW IS THE CLIENT RESPONDING TO
THEIR CANCER?

PHYSICALLY AND EMOTIONALLY?
THAT'S NURSING.

SO, WHAT WE'RE NOT IS A MEDICAL
DIAGNOSTIC STATEMENT.

ALRIGHT, ONCE WE'VE GATHERED ALL
OUR INFORMATION, WE'RE GOING TO
ANALYZE IT

AND THEN WE'RE GOING TO GROUP
ALL OUR INFORMATION.

WE CALL IT CLUSTERING
THE DATA.

AND WE'RE GOING TO PUT IT INTO
COMMON GROUPS OF INFORMATION.

PATIENTS MAY PRESENT WITH A
LOT OF DIFFERENT CONCERNS,
PROBLEMS, STRENGTHS.

AND WE'RE GOING TO GROUP THEM
INTO SYSTEMS OR COMMON
AREAS OF COMPLAINT.

FOR EXAMPLE, A CLIENT MAY
COMPLAIN THAT,
"I'M NOT SLEEPING WELL.

I WAKE UP IN THE
MIDDLE OF THE NIGHT

AND I'M HAVING TERRIBLE
PAIN IN MY STOMACH."

WELL, MAYBE THEY'RE HAVING
A SLEEP DISTURBANCE.

WE DON'T KNOW. WE GOT TO PURSUE
THAT. AND THEY'RE HAVING
A PAIN ISSUE.

BUT THEY MAY ALSO HAVE --
BECAUSE THE PAINS IS RELATED

TO A SURGICAL SITE,
A RISK FOR INFECTION.

SO, WE'RE GOING TO GROUP
ALL OUR INFORMATION

INTO THOSE KINDS OF CATEGORIES

TO SEE WHAT'S OUR PRIORITY
AND WHAT WE'RE GOING
TO DO ABOUT IT.

ONCE WE'VE, KIND OF, GATHERED
OUR INFORMATION,

WE'RE GOING TO TAKE WHAT
WE BELIEVE TO BE THEIR
PRIORITY RESPONSES

OR CONCERNS AND WE'RE GOING TO
THEN APPLY TO THE 172 DIAGNOSIS

THAT HAVE BEEN CREATED BY NANDA.

WHO IS NANDA?

NORTH AMERICAN NURSING
DIAGNOSIS ASSOCIATION.

ALRIGHT. WE'RE GOING TO TALK
ABOUT THEM IN JUST A SECOND.

BUT WE HAVE THESE, 172 DIAGNOSIS
THAT THEY'VE CREATED.

AND WE WANT TO BE THINKING
AS WE'RE LOOKING AT THOSE.

CAN A CHANGE OCCUR WITH
THE NURSING INTERVENTION?

IS THERE SOMETHING NURSING
CAN DO TO IMPACT
OR INFLUENCE THIS ISSUE?

DOES IT FIT THE
NANDA DEFINITION?

YOU'RE GOING, "WHAT THE HECK IS
THAT? I DON'T KNOW.
WILL YOU LOOK AT THAT!"

NOT ONLY DO THAT CREATE THESE
DIAGNOSIS, CATEGORIES,

BUT THEY GIVE A DEFINITION TO IT
SO WE UNDERSTAND WHAT THEY MEAN.

AND THEN, ARE THE DEFINING
CHARACTERISTICS IN THE
ASSESSMENT APPROPRIATE

FOR THE DIAGNOSIS?
WHAT ARE THE DEFINING
CHARACTERISTICS?

YOUR ASSESSMENT. OKAY?

DO THEY MATCH UP WITH WHAT YOU
THINK THIS IS THE PROBLEM?

OKAY, YOU'RE GOING TO ORGANIZE
YOUR INFORMATION.

DO YOU SEE ANY PATTERNS?
I'M GOING TO HIGHLIGHT PATTERNS.

YOU'RE GOING TO LIST ALL THEIR
PROBLEMS, GROUP THEM TOGETHER.

MAKE SOME INFERENCES
OR IMPRESSIONS.

I THINK, THIS IS WHAT'S GOING ON
OR THIS SOUNDS LIKE THIS TO ME.

AND YOU'RE GOING TO MAKE
SOME APPLICATION.

AND THEN WE'RE GOING TO
PRIORITIZE THE PROBLEMS.

REMEMBER, I SAID THEY MAY
PRESENT YOU WITH
A LIST OF THINGS.

HOW DO YOU KNOW WHAT'S
THE HIGHEST PRIORITY

AND WHAT'S A LOWER
LEVEL PRIORITY.

WE'RE GOING TO APPLY
MASLOW'S HIERARCHY

TO SET UP OUR
PRIORITY LISTING.

WHAT DO WE KNOW ABOUT MASLOW?
WHAT'S THE FIRST PRIORITY?

PHYSIOLOGICAL. PHYSICAL ISSUES.

SO ARE THEY BREATHING?
ARE THEY BLEEDING?

WE'RE GOING TO ADDRESS
THOSE ISSUES FIRST.

THEN THERE ARE SOME
SAFETY ISSUES,

THEN THERE ARE
PYSCHO-SOCIAL ISSUES.

IT DOESN'T MEAN THAT WE'RE GOING
TO IGNORE PYSCHO-SOCIAL ISSUES,

IT JUST MEANS, THAT OUR
HIGHEST PRIORITY

IS TO MAKE SURE THAT THEY'RE
BREATHING AND MOVING

BEFORE WE TAKE CARE OF THEIR
SELF-ESTEEM ISSUES.

AND THEN WE'RE GOING TO REPORT
ALL OUR INFORMATION.

ALRIGHT, THERE YOU HAVE IT.
NURSING DIAGNOSIS. OKAY.

IT'S VERY CONFUSING AND THE ONLY
WAY TO DO IT IS TO DO IT.

SO, THIS IS WHAT WE'RE
GOING TO DO, DO IT.

EVERYONE SHOULD HAVE GOT A
WHITE PIECE OF PAPER.

OKAY, THIS ONE.
DID EVERYONE GET IT?

NO?

IF YOU DIDN'T GET IT, COME UP
HERE AND GET ALL FOUR.

WHAT WE'RE GOING TO DO IS JUST
APPLY THIS NURSING PROCESS.

WE'RE GOING TO COME UP
WITH OUR DIAGNOSIS.

WE'RE GOING TO COME UP
WITH OUR IDEOLOGY

AND WE'RE GOING TO APPLY
OUR ASSESSMENTS.

NOW, BEFORE WE DO THAT,

I HAVE A POST-IT NOTE,
SO I WOULDN'T FORGET.

AND THIS SAYS, 'BRING YOUR MED
BOOK NEXT WEDNESDAY.'

ALRIGHT, SO YOU GOT IT MED BOOK.
A LITTLE, FAT, WHITE THING.

BRING IT NEXT WEDNESDAY.

ALRIGHT, HOW ARE WE
EVER GOING TO FIND

OR DECIDE ON A NURSING --
THAT ONE. HOLD IT UP --
THE OTHER WAY.

OKAY, HOW DO WE PICK THE
NURSING DIAGNOSIS?

FIRST OFF, GO TO THE BACK OF
YOUR BOOK.

IN THE BACK OF YOUR
BOOK ARE THE --

I DIDN'T COUNT THEM,
THERE SHOULD BE 172.

IF THERE'S NOT,
THERE'S 167, I THINK.

THEY JUST ADDED A FEW
NEW ONES IN 2005 AND 6.

THIS IS WHAT A
NURSING DIAGNOSIS IS.

NURSING DIAGNOSIS IS A VERY
SUCCINCT PHRASE.

YOU PROBABLY PICKED UP IN YOUR
BOOK, IT SAID,

"THEY USED THE LEAST AMOUNT OF
WORDS TO DESCRIBE A PROBLEM."

AND MOST OF US WERE
SAYING,"WELL, YOU COULD
HAVE USED A FEW MORE.

THAT WOULD HAVE BEEN HELPFUL."
BUT IT'S A -- JUST A VERY
SUCCINCT PHRASE

TO DESCRIBE WHAT'S GOING
ON WITH THE CLIENT.

AFTER YOU'VE LOOKED
AT YOUR CLIENT

AND YOU COME UP WITH
A LIST OF PROBLEMS,

THIS BOOK IS GOING TO GIVE
YOU THE ANSWERS.

YOU DON'T HAVE TO KNOW IT ALL.
YOU DON'T HAVE TO KNOW WHAT TO
DO YET.

THAT'S WHY YOU HAVE A BOOK
TO GIVE YOU THE ANSWERS.

THERE'S TWO WAYS THAT WE CAN GO
ABOUT GATHERING OUR INFORMATION

OR GETTING OUR INFORMATION,

AND THAT IS AFTER WE LOOK AT
WHAT'S GOING ON WITH OUR CLIENT,

YOU CAN COME BACK TO
THE BACK OF THE BOOK

AND GO "WELL, DO I THINK IT'S
ANY OF THESE?"

AND JUST START LOOKING AT
EACH ONE AND GO,

"YOU KNOW WHAT? I THINK IT MAY
HAVE TO DO WITH THE INEFFECTIVE
AIRWAY CLEARANCE

OR ACTIVITY INTOLERANCE.

I'M GOING TO PURSUE
THOSE TWO THINGS."

BECAUSE YOU JUST LOOKED AT THE
LIST AND YOU JUST STARTED...

..LOOKING AND DECIDING.

SOMETIMES YOU GET A DIAGNOSIS
OR A PATIENT

AND YOU DON'T REALLY EVEN KNOW
WHERE TO LOOK.

ONE OF THE THINGS THIS BOOK
DID TO HELP US

WAS THEY TOOK MEDICAL
DIAGNOSIS CATEGORIES

AND PUT NURSING DIAGNOSIS IN
THAT CATEGORY

TO HELP US KNOW WHAT MIGHT APPLY
TO THEM.

SO, YOU CAN EITHER GO HERE AND
JUST LOOK 'NURSING DIAGNOSIS'

OR LET'S JUST LOOK AND SEE WHERE

CHRONIC OBSTRUCTIVE PULMONARY
DISEASE IS. FIND

THERE IT IS.
SO GO TO YOUR INDEX,

LOOK UP CHRONIC OBSTRUCTIVE
PULMONARY DISEASE.

SO, IS IT UNDER COPD OR
CHRONIC OBSTRUCTIVE?

CHRONIC OBSTRUCTIVE.
ALWAYS WISH IT WAS COPD,

BUT THERE IT SAYS IN LITTLE
PARENTHESIS, COPD.

WHAT PAGE DID YOU GUYS
COME UP WITH?

- 379.
- THANK YOU.

SO YOU GO TO PAGE 379

AND YOU SEE CHRONIC OBSTRUCTIVE
PULMONARY DISEASE.

AND YOU SEE THAT IT COULD BE
SOMEBODY THAT HAS
CHRONIC BRONCHITIS,

EMPHYSEMA, ASTHMA, CHRONIC
AIRWAY LIMITATIONS.

SO YOU SAY TO YOUR SELF "YEAH,
THAT'S WHAT MY CLIENT HAD,
THAT'S GOOD."

WHAT IS COPD, ANYWAYS?

WHAT THIS BOOK DOES IS IT
GIVES YOU A LITTLE PATHOLOGY,

PATH STATEMENT RELATED
TO THIS DIAGNOSIS.

SO THAT YOU'RE NOW LEARNING
A LITTLE BIT ABOUT
THE DISEASE ITSELF.

THEN YOU GO OVER HERE AND
UNDER THAT BIG HEADING

THERE IS A WHOLE BUNCH OF
NURSING DIAGNOSIS.

THAT SAYS, MAYBE, 'INEFFECTIVE
AIRWAY CLEARANCE,' WOULD BE YOUR
CONCERN,

OR MAYBE 'IMPAIRED
GAS EXCHANGE,'

OR MAYBE YOU WANT TO CONSIDER
'IMBALANCED NUTRITION,

LESS THAN BODY REQUIREMENTS.'

I WONDER WHY THAT?

WE'RE GOING TO HAVE
TO DO BREATHING.

OR 'RISK FOR INFECTION'
MIGHT BE WHAT'S GOING ON
WITH YOUR CLIENT,

OR 'DEFICIENT KNOWLEDGE.'

SO IT GIVES YOU SOME IDEAS
ABOUT WHAT'S GOING ON
WITH YOUR CLIENT.

ALRIGHT, JUST A QUICK MINUTE.

WE'RE JUST PERUSING.
I HAVEN'T MADE A DECISION.

I JUST WANT YOU TO
UNDERSTAND THE BOOK.

WHEN THE NURSING GROUP GOT
TOGETHER, THEY CREATED THESE
DIAGNOSIS FOR US.

THEY KNEW IT WAS REALLY
SIGNIFICANT THAT WE UNDERSTAND

EVERYONE HAD THE SAME DEFINITION
OF WHAT THESE DIAGNOSIS WERE

AND THAT WE'RE WORKING
WITH IT APPROPRIATELY.

I WANT YOU TO LOOK ON
PAGE -- WELL, 386 IS FINE.

THE NURSING DIAGNOSIS IS
DEFICIENT KNOWLEDGE.

WHAT DOES THAT MEAN?

I BELIEVE THERE'S NO
DEFINITE ANSWER.

THIS IS WHAT YOU NEED TO
KNOW ABOUT THE BOOK.

NOW TO THE FRONT OF THE BOOK,

ON PAGE...ROLL OVER TO 13.

JUST LOOK AT THE CONTENTS
OF THE BOOK.

CHAPTER ONE EXPLAINS HOW TO DO
CARE PLANS.

SO YOU MIGHT REVISIT IT, BUT
IT'S REALLY PRETTY MUCH WHAT
YOU'RE GOING TO COVER.

IT'S ALWAYS GOOD TO SEE WHAT
SOMEONE ELSE HAS TO SAY.

NOW IF YOU LOOK UNDER...

..DEFICIENT KNOWLEDGE.
WELL -- CHAPTER TWO.

CHAPTER TWO IS WHERE YOU WOULD
GO IF YOU HAD LOOKED AT THE BACK
OF THE BOOK,

AND YOU'RE GOING TO GO DIRECTLY
TO A NURSING DIAGNOSIS
THAT YOU'VE CHOSEN.

YOU ALREADY KNOW THAT YOU THINK
HOPELESSNESS IS THE BEST CHOICE
FOR YOUR CLIENT.

SO YOU'RE GOING TO GO TO CARES
BASED ON HOPELESSNESS DIRECTLY.

YOU DON'T NEED TO GO TO A
MEDICAL DIAGNOSIS FOR HELP.

WELL, LET'S GO OVER TO WHAT WE
WERE TALKING ABOUT,
DEFICIENT KNOWLEDGE.

GO TO PAGE 103, KEEPING YOUR
FINGER IN PAGE 386.

GO OVER TO 103.

AND NOW WE HAVE DEFICIENT
KNOWLEDGE BETWEEN PATIENT,
TEACHING

OR HEALTH INFORMATION OF THE
PATIENT.

BUT NOW WE HAVE OUR
NANDA DEFINITION.

IN THIS BOOK, THE DEFINITIONS
FOR THE DIAGNOSIS ARE ONLY IN
THE CHAPTER TWO CARE PLANS.

I DON'T KNOW WHY THEY DIDN'T
SPRING FOR A DEFINITION.

REALLY ON ALL THESE OTHER ONES,
ONLY TWO LINES, BUT THEY DIDN'T.

SO IF YOU'RE TRYING TO MAKE THE
BEST DECISION AND YOU'RE DOING
IT BY MEDICAL DIAGNOSIS,

YOU'RE STILL GOING TO HAVE TO
FLIP OVER AND MAKE SURE THAT'S
THE DEFINITION THAT YOU WANT,

BECAUSE RIGHT NOW, YOU'RE NOT
REALLY SURE WHAT IS THE
DIFFERENCE BETWEEN

INEFFECTIVE AIRWAY CLEARANCE AND
INEFFECTIVE GAS EXCHANGE.

WHAT'S THE DIFFERENCE? YOU'VE
GOT TO LOOK AT THE DEFINITION.

ALRIGHT, I WANT YOU TO
APPRECIATE THAT. NANDA HAS FOUR
PARTS.

IT HAS A DIAGNOSIS.
IT HAS A DEFINITION.

IT HAS IDEOLOGIES AND
DEFINING CHARACTERISTICS.

SO WHEN WE'RE LOOKING AT THE
DIAGNOSIS ITSELF. WE WANT TO
LOOK AT ALL FOUR PARTS.

NOTICE HERE ON PAGE 103, YOU GOT
KNOWLEDGE DEFICIENT,

WE HAVE A NANDA DEFINITION,
WE'VE GOT A WONDERFUL
LIST OF DESCRIPTION

OF WHAT THAT IS,
HERE ON PATHOLOGY.

AND THEN IF YOU TURN THE PAGE,
YOU HAVE RELATED TO FACTORS,

IDEOLOGY AND YOU HAVE
DEFINING CHARACTERISTICS,

WHICH ARE SYMPTOMS.

ALRIGHT, THAT'S JUST A BASIC
OVERVIEW OF HOW WE'RE GOING TO
USE THE BOOK.

WE'LL DO THE REST RIGHT HERE.

ALRIGHT, LET'S GO OVER
OUR CASE STUDY.

WELL, LET ME JUST...

I NEED TO EXPLAIN TO YOU ONE
THING THAT YOU'RE GOING TO
NOTICE IN CLINICAL SETTING

AND I NEED YOU TO APPRECIATE IT.

YOU'RE IN SCHOOL
AND YOU'RE GOING TO LEARN
HOW TO DO THIS WELL,

EFFICIENTLY AND YOU'RE GOING TO
WORK REALLY HARD AT IT.

AND YOU'RE GOING TO
BE A LITTLE FRUSTRATED

BECAUSE YOU'RE GOING TO GO TO
THE CLINICAL SETTING

AND YOU'RE NOT GOING TO HEAR OF
NURSES ALWAYS USING A CHART.

THAT WE'VE BEEN EMPHASIZING.
LET ME EXPLAIN TO YOU WHY.

THIS IS REALLY A
VERY NEW PROCESS.

ACTUALLY, IF YOU'VE READ
THE HISTORY,

IT'S A BEAUTIFUL LITTLE HISTORY.
I THOUGHT, THIS IS SO TRUE.

I WENT TO SCHOOL BACK
IN THE '70S.

WE HEARD THIS RUMOR THAT NURSING
DIAGNOSES WERE COMING

AND WE'RE LIKE, "WHATEVER."

BUT THEY DIDN'T KNOW WHAT THEY
WERE TALKING ABOUT.

THEY DIDN'T EVEN TEACH IT AT
SCHOOLS BECAUSE IT WAS NEW.

I GRADUATED IN '79.
AND OF COURSE,

WE WORKED JUST TOTALLY AND
SOLELY WITH MEDICAL DIAGNOSIS.

AND WE DID DOCTOR'S ORDERS AND
WE HAD OUR NURSING SKILLS AND
THAT'S WHAT WE DID.

AND THEN THEY TOLD US,
ABOUT 1985,

THESE DIAGNOSES CAME OUT IN
1982, BUT NOBODY KNEW
WHAT TO DO WITH IT.

WHEN YOU'RE OUT OF SCHOOL, YOU
DON'T SEE IT THAT FIRST YEAR.

PARTICULARLY IF THEY WERE SAYING
YOU GUYS HAVE TO DO
NURSING DIAGNOSIS.

SO THEY APPEARED AND NONE OF US
KNEW WHAT TO DO WITH THEM

BECAUSE THEY JUST APPEARED.

SO JOINT COMMISSION SAID,

EVERYBODY'S GOT TO HAVE A
NURSING CARE PLAN
WITH A NURSING DIAGNOSIS.

BUT NOBODY KNEW WHAT TO DO
WITH THEM.

IF SOMEONE'S THROWING UP
COFFEE GROUNDS,

AND THEY'RE HAVING BLACK,
TARRY STOOLS, WHAT DO YOU KNOW
ABOUT THEM?

THEY'RE A GI BLEED.
WHICH IS WHAT?

A MEDICAL DIAGNOSIS.

SO WE WERE STUBBORN ABOUT IT AND
WE SAID, "WHY DO WE HAVE TO
WRITE DOWN THAT THEY HAVE --"

WHATEVER DIAGNOSIS IT IS.
INSUFFICIENT CIRCULATION OR
POTENTIAL HEMORRHAGE,

WHAT DID WE ALREADY LEARN ABOUT
GI BLEED? SO THERE IS SOME VALUE
IN THE RANKS.

ABOUT TRYING TO DO
THIS NURSING THING.

SO WHAT DID TO ACCOMPLISH WHAT
JOINT COMMISSION
SAID WE HAD TO DO,

WAS THEY NEED THESE FORMS
THAT WERE ALREADY
PRE-PRINTED CARE PLANS.

SO THE GI BLEED CAME IN AND WE
WOULD GO TO THE GI BLEED FOLDER,

GRAB A NURSING CARE PLAN, STICK
IT IN THE CHART
AND CALLED IT DONE.

THEY DIDN'T THINK THAT WAS GOOD.
THEY SAID, "YOU GUYS HAVE TO
INDIVIDUALIZE THESE CARE PLANS.

NOT EVERY ONE'S THE SAME, JUST
BECAUSE THEY HAVE GI BLEEDS."

WE SAID, "OKAY, FINE." SO WE PUT
A FEW BLANKS IN,

AND FILLED IN SOME DATES AND
SOME TIME FRAMES AND SAID," THAT
WILL DO."

AND WE JUST FILLED THEM OUT,
STUCK THEM IN AND DIDN'T DO
ANYTHING WITH THEM.

BY NOW ABOUT 1992 TO ABOUT 1995,

AND WE'RE STARTING TO GET AWAY
WITH THE LANGUAGE,

BUT NOW WE'VE GOT NURSING
STUDENTS COMING OUT OF SCHOOL

WHO'VE WORKED WITH
AND LEARNED THEM
WHO ARE TEACHERS NOW.

AND I WAS LIKE, "OH, OKAY. WHAT
IN THE WORLD."

JOINT COMMISSION STAYED
PERSISTENT ABOUT IT AND THEY
SAID,

"WE ARE SERIOUS. YOU GUYS HAVE
TO WRITE CARE PLANS
FOR EVERY CLIENT.

AND YOU HAVE TO INDIVIDUALIZE
THEM USING NURSING DIAGNOSIS.
YOU'RE NURSES."

SO THE COMMUNITY SAYS, "FINE.
YOU BETTER TEACH OUR NURSES HOW
TO DO IT."

THEY CREATED A KIND OF SKELETON
OF CARE PLAN FOR US

THAT WE FILL IN THAT'S
VERY INDIVIDUALIZED.

HOWEVER, YOU'LL SEE IT FILLED
OUT ON ADMISSION DAY,

IT'S STUCK IN THE BACK
OF THE CHART.

HERE'S THE DEAL. NURSES HAVE
ALREADY LEARNED WHAT TO DO FOR A
PATIENT.

THAT'S WHAT THE NURSES PRACTICE.
SO THEY SET UP THE CARE PLAN AND
THEN THEY DO THE CARE.

AND THEY EVALUATE THEIR CLIENTS,
BUT IT DOESN'T ALWAYS GET
FOLLOWED THROUGH

AND IT'S A SYSTEMATIC WAY AS
WHAT WE'RE GOING TO PUSH TO DO.

SO YOU MAY GET A LITTLE
FRUSTRATED IF YOU'RE
NOT SEEING IT

AND DON'T KNOW WHAT YOU'RE
DOING HERE.

BUT REMEMBER IT'S
A TWO-FOLD PROCESS.

WE HAVE TO TEACH YOU WHAT TO DO
AS NURSES BECAUSE
YOU DON'T KNOW YET.

AND YOUR EXPERIENCE AND WORK
WITH THE BOOK IS GOING TO BE

WHAT HELPS YOU COMMUNICATE WITH
THE NURSES IN THE CLINICAL AREA.

IT'S STILL A VERY YOUNG PROCESS,
WE'RE REALLY GETTING
MUCH BETTER AT IT.

YOU'RE ON THE BETTER END
LEARNING IT, BECAUSE THAT
WILL HELP YOU?

BECAUSE YOU'RE GOING TO GET A
LITTLE FRUSTRATED WHEN
YOU GO TO CLINICAL AREAS.

WHEN YOU GO TO THE
CLINICAL AREAS,

I REALLY, REALLY ENCOURAGE YOU
TO LOOK INTO THE CHART AND FIND
WHERE'S THE NURSING CARE PLAN.

IT SOUNDS LIKE UMC IS USING IT
AS KIND OF A COMMUNICATION
TOOL

ON THE BASIS TO REPORT.

AND THAT'S SO FORWARD THINKING
OF THEM BECAUSE WE HAVE TO FIND
A WAY

TO PUT OUR INFORMATION, OUR
LANGUAGE AND OUR PRACTICE

OUT IN THE FOREFRONT NO MORE
THAN WHAT IT ALWAYS HAS BEEN.

THAT'LL HELP YOU UNDERSTAND
WHAT'S GOING ON.

ALRIGHT, CASE STUDY.

WE HAVE A 73-YEAR-OLD MALE
THAT'S BEEN ADMITTED TO THE UNIT

WITH AN ADMITTING MEDICAL
DIAGNOSIS OF COPD.

HE STATES THAT HE HAS DIFFICULTY
BREATHING

WHEN WALKING SHORT DISTANCES.

HE ALSO STATES THAT HIS HEART
FEELS LIKE IT'S RACING AT THE
SAME TIME.

HE STATES THAT HE'S TIRED ALL
THE TIME.

AND WHILE TALKING TO YOU, HE'S
CONTINUING WRINGING HIS HANDS
AND LOOKING OUT THE WINDOW.

ALRIGHT, IS THAT A
COMPLETE ASSESSMENT?

NO. WE WANT TO GET MORE.

BUT FOR OUR PURPOSES OF JUST
TRYING TO COME UP WITH
A DIAGNOSIS AND SO FORTH,

THIS IS WHAT WE'RE
GOING TO WORK WITH.

I CERTAINLY WANT TO GET HIS
VITALS AFTER WALKING.

I WANT TO SEE HOW HE TOLERATES
IT. I WANT TO GATHER SOME MORE
INFORMATION BECAUSE I'M CURIOUS

WHAT HE'S GOING TO DO,
BUT I WOULD NEED SOME
MORE OBJECTIVE DATA.

WE'RE GOING TO WORK
WITH THIS HOWEVER.

AND THIS IS WHAT WE NEED TO DO.

ALRIGHT, WITH YOUR PAPER
BUT WITH A PEN

I WANT YOU TO CIRCLE AREAS THAT
YOU THINK ARE PROBLEMS
IN THE ASSESSMENT.

SO JUST LOOK AT THIS, CIRCLE UP
WHAT YOU BELIEVE TO BE PROBLEMS.

THIS IS ALL THE DATA
YOU HAVE RIGHT NOW.

OKAY?

THAT'S WHAT YOU SHOULD
HAVE CIRCLED UP.

YOUR PATIENT HAS COPD.
THAT IS A PROBLEM.

IT'S NOT NURSING, IT'S MEDICAL.
BUT NEVERTHELESS,

IT'S THE PLACE THAT WE'RE
STARTING FROM, SUBJECTIVE DATA.

WE HAVE A LOT OF
SUBJECTIVE DATA.

DIFFICULTY BREATHING
AND HEART RACING,

TIRED ALL THE TIME.

AND THEN WHAT WE HAVE IS
OBJECTIVE DATA IN HERE.

HE'S WRINGING HIS HANDS AND
LOOKING OUT THE WINDOW.

ALRIGHT, MAKE A LIST OF
THE PROBLEMS THAT HAVE
BEEN HIGHLIGHTED.

TAKE A MINUTE AND JUST WRITE
THEM DOWN UNDERNEATH

SO THAT WE KNOW EXACTLY WHAT
WE'RE WORKING WITH.

PENCILS DOWN.

YOU SHOULD HAVE
COME UP WITH THIS.

YOUR LIST WAS COPD,
DIFFICULTY BREATHING,
HEART FEELS LIKE IT'S RACING,

TIRED ALL THE TIME AND THEY'RE
WRINGING THEIR HANDS.

CLUSTER THAT. YOU WANT TO
JUST CIRCLE IT,

BUT CLUSTER SIMILAR PROBLEMS.

YOU SHOULD HAVE TWO GROUPS OF
PROBLEMS, I'LL GIVE YOU THAT
LITTLE INFORMATION.

BUT CLUSTER IT INTO
SIMILAR GROUPS.

OKAY. YOU SHOULD HAVE COME UP
WITH THESE TWO.

COPD, DIFFICULTY BREATHING,
HEART RACING,
TIRED ALL THE TIME

AND WRINGING HANDS,
LOOKING OUT THE WINDOW.

YOUR PSYCHO-SOCIALS, OKAY?

LOOKING AT THIS GROUP,
ARE YOU ABLE TO PRIORITIZE

WHICH ONE IS MORE SIGNIFICANT
BASED ON MASLOW'S HIERARCHY.

- NUMBER ONE?

- PROBABLY THE TOP ONE. WHY?

IT HAS TO DO WITH
BREATHING ISSUES.

AND BREATHING IS A NUMBER
ONE PRIORITY IN OUR
PHYSIOLOGICAL ASSESSMENT.

SO WE'RE GOING TO TAKE HIS
BREATHING COMPLAINTS OVER WHAT
SEEMS LIKE ANXIETY.

WE'RE NOT SURE.
I NEED SOME MORE INFORMATION.

I'M NOT SURE IF HIS ANXIETY
IS RELATED TO LOW OXYGEN.

I NEED SOME MORE INFORMATION OR
IF HE HAS SOME PERSONAL ISSUES.

I DON'T KNOW. MAYBE HIS
WIFE'S LATE. I DON'T KNOW.

THAT'S NOT IN HERE, BUT IT
APPEARS TO BE PSYCHO-SOCIAL.

I'VE GOT TO PURSUE
IT A LITTLE MORE.

BUT I KNOW FOR SURE THESE
ARE COMPLAINTS RELATED
TO SHORTNESS OF BREATH.

BREATHING. THEY'RE GOING
TO BE MY PRIORITY.

OKAY, KNOWING THIS -- LET ME SEE
WHAT I'VE GOT.

ALRIGHT, WE'RE GOING TO GO TO
OUR NANDA LIST.

WE'RE GOING TO GO TO THE BACK OF
THE BOOK. WE'RE JUST GOING TO
START HERE AS ALTERNATIVE.

AND LOOK AT THIS LIST AND SEE
WHICH THINGS YOU THINK
MIGHT APPLY.

WITHOUT TALKING
OR YELLING THEM OUT,

BECAUSE I WANT EVERYONE TO HAVE
AN OPPORTUNITY TO SEARCH THE
LIST OVER.

I WANT YOU TO PICK TWO OR THREE
POSSIBLE DIAGNOSIS

THAT MIGHT HELP YOU --

THAT YOU THINK MIGHT APPLY. IF
YOU'RE NOT SURE JUST
LOOK AT DEFINITIONS.

BUT PICK TWO OR THREE
RELATED TO --

I'LL FLIP IT BACK SO YOU CAN
SEE. THOSE PROBLEMS.

ALRIGHT, I'M SEEING MANY --
COUPLE OF PEOPLE WITH NO BOOKS.

WHO DOESN'T HAVE A BOOK?
YOU DON'T HAVE A BOOK?

YOU BACK THERE?

ANYONE ELSE DON'T HAVE A BOOK?

OKAY, EVERYONE COME UP
WITH ONE OR TWO

THINGS THAT YOU CAN LOOK AT.

OKAY. COUPLE OF THINGS THAT YOU
MIGHT WANT TO CONSIDER

AS YOU'RE LOOKING AT THE LIST.

YOU'LL RECALL IN YOUR READING
THAT WE HAD SOME --

THEY REFERRED TO THEM SOMETIMES
AS AXES OR PROBLEMS,

BUT IS THE PROBLEM ACUTE?
WHAT DOES THAT MEAN?

- SHORT TERM.
- SHORT TERM.

USUALLY, FOUR TO SIX WEEKS.

OR IS THIS CHRONIC? WHICH IS?

- LONG TERM.
- LONG TERM.

WHICH CAN BE ANYWHERE FROM SIX
WEEKS TO THREE MONTHS AND ON.

INTERMITTENT --

- VERSUS CONTINUOUS. OKAY,
THAT'S WHAT WE'RE CONSIDERING.

IS THIS AN INDIVIDUAL PROBLEM,
FAMILY, GROUP OR COMMUNITY
PROBLEM?

WHAT DO WE HAVE GOING ON NOW?

LET'S GO BACK TO THE BEGINNING.