Implementing Your Patient Centered Care

We're excited to be sharing more of what makes nursing great! This week we are continuing to discuss the Nursing Process and how it impacts patient care. This week's focus: Implementation!

This is where the rubber glove meets the patient, so to speak. We are working with the healthcare team and the patient/client to help them meet the goals we have already laid out previously. During this time make sure you are always focusing on the patient. The goals and everything are great, but if you patient begins to show signs of decline or distress immediately discontinue the planning and meet the patient's immediate needs to maintain patient safety.

During Planning, we have already set reasonable time frames for this care. Just to reiterate: Implementing care can be over a shift; a period of months with home health; during a clinic visit; or, dare we say lengthy, hospital stay.

This is an observation of the patient for signs and symptoms of improvement or decline. Continue to gather data to be used later in the final phase of the Nursing Process. Always make sure you focus on a plan and implement it over an achievable time frame.

It is expected that a patient and his/her support system is educated on the plan of care in an effort to maintain compliance. The patient and family will most likely have questions about certain aspects of the plan and we have an obligation to meet those needs and make sure the patient understands why they are doing something. Some of the biggest reasons for failure of implementation are lack of knowledge from the family or patient. If someone does not understand the "Why" for doing something they won't do it. For example: You always get that old veteran who likes things his way (you know the patient; love him to pieces, but he sometimes drives you crazy). This fella will agree on the surface to do whatever you want, but as soon as he goes home, he won't do a thing. He will continue his care though if you let him know how his plan works and how he can directly affect his future health and care.

Next week we'll be talking about Evaluation. Follow this link here to read that post now!

The time frame will constantly be changing based on a patient's need and progress so be sure to continue to monitor...

Planning Your Patient Centered Care

We're talking about planning this week and what that means for your patient's care!

Welcome back ADPIE Nation!

This week we are covering PLANNING!

Some individuals plan everything, while others go with the flow... even in healthcare. That’s totally applicable! You’ll find one nurse planning their day by writing down each medication or checking off each task. Another nurse may feel that's unnecessary and would rather handle tasks as they come.

Whether you desire meticulous planning or not, a crucial component in patient care is the care plan. So what’s the point in having a care plan? Why do we [nursing] need to have care plans in our practice?

Care plans provide a sense of direction for patient centered care that is composed collaboratively by our patients, their support system, and the nursing staff. 🙂

Care plans, although a basic tool, are extremely important in the everyday interactions with your patients. Our instructors weren’t tough on us in school because they wanted to be; they wanted us to be proficient at care plans. These are nursing interventions that truly demonstrate your devotion and accountability to your patients and their care. It gives ownership in your nursing practice.

When planning a patient’s care, there are so many factors that we as healthcare professionals will have to take into consideration. Along with factors directly relating to the patient, a sometimes overlooked barrier is family dynamics. Understanding and planning for some of these less obvious factors can set a patient up for success. Ultimately, maintaining their compliance and hopefully helping them to meet their goals! Patients, and families, will need guidance, structure, and redirection at times.

Nurses aren't the only ones invested in patient planning. Multidisciplinary teams may collaborate in patient’s care along with Nursing!

*cue the music* We’re all in this together! 😆

In acute care, you may see social services working and collaborating with therapy on a stroke patient’s care. They may be discussing his/her need on an outpatient basis. These meetings are regularly scheduled to assure patients will receive the appropriate continued care!

We should ALWAYS work as a team! Every faction of healthcare is critical to patient care! If we all work together and always put our patients first each time, then our patients can receive the care they deserve!! Remember, that patient you’re caring for and creating that care plan for belongs to someone. Take care of them just as you’d like for someone to care for your loved one!

Next week we'll be talking about IMPLEMENTATION! Follow this link here to read it now.

Your care plan should always include your patient and their needs!

Nursing Diagnosis + Free Download

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Hello ADPIE Friends!

We're so thrilled to have you with us for another post. As promised, this week we are discussing Diagnosis.

After you have gathered your patient data, we begin to group it together and decide how we can improve this patient's situation. This could mean that we want to help them move better, meet their nutritional needs, improve communication, or improve their mental health. It is all driven by the patient's condition and their goals! You need to include your patient in the plan of care for it to be truly beneficial for them.

First we need to be very clear that nurses cannot create medical diagnoses for patients! This is outside our scope of practice unless otherwise stated by your job title or advanced nursing degree. As we gain experience and increase our knowledge, the nurse can infer or discuss with the primary care provider what diagnosis might be appropriate for the patient. This knowledge is by no means an invitation to diagnose your patient in a formal manner. Always refer to your employer and appropriate laws. Nurses can only create nursing diagnoses. These can occasionally be driven by medical diagnoses, but you want to be a little more thorough; we'll explain further in a moment.

Diagnosis usually follows this formula:

Problem related to supporting data as evidenced by the root cause of your problem.

We used the example of anxiety before, so we'll explore it further here:

Anxiety as evidence by expressed concerns due to change in life, fidgeting, insomnia, and increased tension related to situational crisis

You have the problem: Anxiety
As evidenced by: expressed concerns due to change in life, fidgeting, insomnia, and increased tension
Related to: situational crisis

You problem will usually come out of a nursing diagnostic handbook. There are thousands of these to choose from and they help nurses speak in a common language to one another and other disciplines of medicine. Nursing is not a new profession, but we are one that is trying to create a legitimate image of ourselves. Towards this end, formal systems need to be in place to regulate our profession and create trust.

Your evidence is the data you have gathered to support your diagnosis. This is also listed in your diagnostic handbook and helps you narrow down the data that you are using. This is both subjective (data this is opinion or told to you) and objective (that which you can directly observe or measure) data. Objective data, is best for most things and that is true here. However, your patient stating their emotional state is subjective, but is very important to the nurse.

When you are trying to find what in the patient's life is relating back to the problem you are trying to do a root cause analysis of the patient and define why they are having this problem in the first place. Again, this portion of the nursing diagnosis is also found in your diagnostic handbook.

While we said that most if not all portions of the nursing diagnosis are found in your handbook that you get for school, you can always make one that is more appropriate for your patient that is not covered by the handbook.

As you gain experience, you won't even really think about these things. It is nice to refresh your basic knowledge and get back to what makes nursing great. ADPIE helps to set nursing apart from other disciplines of medicine. We should respect that and remember what we learned in school. Nursing diagnoses help guide the nurse and the patient in Planning the patient's care, which we will cover later! To read that post now, follow this link here.

For those of you who are on our mailing list, you have already received you free download! If you have not subscribed, add your email above to get yours in your mailbox. This worksheet includes some basic nursing diagnoses and helps you to formulate a complete nursing diagnosis for your patient. Feel free to post questions here or on our social media! In the mean time...please continue to monitor...

Assessment + Free Download

Welcome back! Last week we discussed what ADPIE is. During the coming weeks we will delve a little deeper into what each of those parts are. Lets get started!

ASSESSMENT is the basic act of gathering data about your patient. At this stage this has nothing to do with making a plan or even helping your patient in any meaningful way. Yet! Our goal here is to gather as much meaningful DATA as we can. The key here is "meaningful." We can gather a complete history on our patient, but we have to stay focused. Keep your eye on the prize! The prize being a complete history and physical in a timely manner. The patient will of course wander aimlessly in their description as to why they are in the hospital or clinic that day. You have to keep your patient focused. As the nurse, help the patient, and I mean this in the nicest way possible...get to the point.

You must get them to tell you why they came into the health care setting THAT DAY. This is especially true if you work in the ER or urgent care. If you are inpatient and the patient has been in the hospital for a while, THEN, you can gather more than what would normally be considered necessary.

Most healthcare settings will have a standard form for your facility or floor to gather information. Use that if you can. It has been specifically developed for your unit and will help you provide the most important information to the primary care professional. If you do not have something on your floor or facility, you are in luck! We have a tool to help you get the gist of gathering assessment data.

If you are subscribed, we have already sent you these documents with the weekly email. If you want your free download, hit that subscribe button and it will be in your inbox shortly.

You may not use all of the form. Our co-founder David, made it during his time in school and found it very helpful.

When you have time, you need to do thorough assessments on your patients; however, focused assessments are most often the best way to go. This quick assessment style will hit all the major highlights of your patient's conditions and you won't miss anything. This usually looks like:

Neuro
Cardiac
Respiratory
Genito/Urinary
Gastrointestinal
Skin
Musculoskeletal
Psych-social
Other

We will go deeper into all of these in the coming weeks, but you need to hit those major systems in order to make sure you have done an effective assessment on your patient.

We would like to note that if your patient is not able to speak for themselves (English as a second language, altered mental status, comatose, minors, et cetera) you must work with them as best a possible. Your facility should have a standard way of addressing language barriers with some kind of interpretation service. Defer to the parents for your minor populations. Family is usually a good source as well for any of these patients. It really is case-by-case, but your nursing program or health care facility should help you differentiate them.

Next week we will be covering DIAGNOSIS, which takes the information we gathered and turns it into something we as nurses can use to better care for our patient. Follow this link here, to read it!

Until then, follow us on our social media for daily articles, inspiration, or a good laugh. Please, continue to monitor...

What is ADPIE and why does it matter?

What is ADPIE?
We are two nurses who love nursing and all that it is and can be. We started this blog kind of on a whim since it has been Sara's dream to be a blogger for a while and David just can't seem to not be busy with something. So, let's get started on what ADPIE actually is:

ADPIE stands for assessment, diagnosis, planning, implementation, and evaluation. If you are a student, you will come across this in your nursing theory class. First presented by Ida Jean Orlando in the 1950's, it has remained relatively intact even with all the advancements in medicine. This begs the question as to whether it is truly an effective tool or something that nurses have settled on. We believe that it is effective to give new nurses the groundwork that you need to function as a real nurse; after you graduate from a nurse-ling following your clinical instructor and trying not to be seen. It's going to happen, you just have to get past this part!

Once you are out of school though, this theory gets shoved WAY in the back of priorities. We're all guilty of just trying to get through the day and forget that nursing is an involved, active science. This is a cyclic process of looking at the patient and making them better in an intentional fashion rather than just waiting for a doctor's order. Used properly though, you can go a long way with making things easier for your patient and you didn't even have to ask the physician!

For example, we'll cover this process using anxiety! Something nurses and nursing students are intimately familiar with. Side note, this delves into writing a nursing diagnosis and we'll cover that later.

So, you have a patient with anxiety and the doctor won't give you an order to calm them the "eff" down, so you are left with your own devices. At first glance, you think you are screwed because you have a distinct lack of drugs. Fear not! You have more than you think!

Assessment & Diagnosis
Your patient is anxious as evidence by expressed concerns due to change in life, fidgeting, insomnia, and increased tension related to situational crisis (i.e. nursing school). This portion of the nursing diagnosis process covers the A and D. We'll go on to P!

Read our post on Assessment here and Diagnosis here.

Planning
This step involves basically coming up with what you are going to have the patient do and within what time it will be completed. In this case: The patient will identify, verbalize, and demonstrate techniques to control anxiety; demonstrate improved concentration and accuracy of thoughts; and demonstrate increased external focus. But, how will they reach these goals? This is also found in the Planning stage. We want to involve the patient in our care as much as possible; if they don't want to participate that is an entirely different topic.

Read our post about Planning here.

Implementation
Once these goals are identified, we graduate to I: Implementation! Here is where you actually do the work within the time you have decided. Throughout this process you are identifying further needs, observing that the patient is actually implementing the goals set forward. This falls under the last portion of the Nursing Process: Evaluation.

To read about Implementation, go here.

Evaluation
Evaluation never stops. You evaluate your patient, how your patient is doing, your co-workers, your life. It doesn't ever go away.

Even when you aren't in school anymore, you need to remember the basics to do some of your best work and caring for your patient that you have been assigned to make better. Task oriented minds won’t be able to think critically, so stop, take a deep breath, and start from the beginning of the nursing process. It may seem silly or time consuming, but when you apply it to your practice, it will become second nature and improve patient outcome!

Follow this link to read the post on Evaluation.
Students, please let us know if we can help you! What topics do you want to see? What are you covering in class? Have you taken the VARK? (More on this later, stay tuned!)

Remember:
No matter where you are in your career, ADPIE is evidence based; as nurses that is what ensures that our practice is in fact the safest.  Therefore, we owe it to our patients, our practice, and ourselves to:  ADPIE and continue to monitor…