Archive for March, 2008

Nursing diagnosis

Posted in Nursing

A nursing diagnosis is a standardized statement about to the health of a client (individual, family, or community) for the purpose of providing nursing care. One organization for defining standard diagnoses is the North American Nursing Diagnosis Association now known as NANDA-International.

Structure of diagnoses

There are five types of nursing diagnoses in the NANDA system.

An actual diagnosis is a statement about a health problem that the client has, and could benefit from nursing care. An example of an actual nursing diagnosis is: Ineffective airway clearance related to decreased energy and manifested by an ineffective cough.

A risk diagnosis is a statement about a health problem that the client doesn’t have yet, but is at a higher than normal risk of developing in the near future. An example of a risk diagnosis is: Risk for injury related to altered mobility and disorientation.

A possible diagnosis is a statement about a health problem that the client might have now, but the nurse doesn’t yet have enough information to make an actual diagnosis. An example of a possible diagnosis is: Possible fluid volume deficit related to frequent vomiting for three days and manifested by increased pulse rate.

A syndrome diagnosis is used when a cluster of nursing diagnoses are often seen together. An example of a syndrome diagnosis is: Rape-trauma syndrome related to anxiety about potential health problems and as manifested by anger, genitourinary discomfort, and sleep pattern disturbance.

A wellness diagnosis is used to describe an aspect of the client which is at a high level of wellness. An example of a wellness diagnosis is: Potential for enhanced organized infant behaviour, related to prematurity and as manifested by response to visual and auditory stimuli.

Some NANDA Nursing Diagnosis related posts:
Nanda jokes
Crazy NANDA Diagnosis
List of Nanda Diagnoses Online

Become an LPN, the fast path to a nursing career

Posted in Nursing

Licensed Practical Nurses provide the most amount of direct patient care within the nursing category of healthcare. If you’re interested in a healthcare career dealing directly with patients, becoming an LPN is a rewarding opportunity.

LPN Job Description

LPNs provide a large portion of direct patient care. LPNs may be assisted by nurses’ aides ( CNAs ) and other assistants in some of their duties. LPNs are directed by doctors and nurses (RNs & nurse managers). Typically, a LPN’s work duties include:

Taking vital signs
Preparing and administering injections and enemas
Applying dressings and bandages
Watching catheters
Treating bedsores
Providing alcohol massages or rubs
Monitoring patients and reporting changes
Collecting samples for testing
Provide patient hygiene
Feeding patients
Monitoring food and liquid input/output
LPNs work in a variety of settings like hospitals, outpatient facilities, long term care facilities, clinics and home care. Tenured LPNs may supervise nursing aides and assistants.

Salary Ranges

While nursing jobs in general are in high demand nationwide, LPN positions in hospitals are declining. However, since this has been caused by an increase in outpatient services, LPN positions in long term care facilities and home health is in as much demand as other nursing categories.

The U.S. Department of Labor has published the median income for LPNs as $31,440 in 2002. The range was $22,860 to $44,040 based on geographic location and work experience. Contract LPNs made the most money, while doctor’s office nurses made the least on average at $28,710.

A nursing career offers other benefits including a flexible schedule, a short work week (three 12 hour shifts with four days off), tuition reimbursement and signing bonuses.

Education / Getting Started

Because of the high level of patient responsibility, nursing is highly regulated, requiring both education and a license. Graduates must complete a state approved practical nursing program and pass a licensing examination.

An LPN certificate can be completed in less than a year. Some RN students become LPNs after completing their first year of study. Course work in the LPN program includes anatomy, physiology, nutrition, biology, chemistry, obstetrics, pediatrics, first aid as well as nursing classes.

Becoming an LPN is the fastest path to a nursing career. Advancement can take many forms, but additional education is usually required.

If you possess the traits necessary to become a successful nurse and want to secure a well paying, important profession caring for others, getting an LPN degree in nursing is a great way to secure your professional future.

Is Nursing A Profession?

Posted in Nursing

The question “profession or not” has never been satisfactorily answered, not least because the definition of ‘profession’ is not exactly a fixed item.

However, some aspects of the definition might be considered ‘core items’.

A profession has a unique body of knowledge and values – and a perspective to go with it.
A profession has controlled entry to the group eg registration
A profession demonstrates a high degree of autonomous practice.
A profession has its own disciplinary system.
A profession enjoys the Recognition and Respect of the wider community.

1. Nursing DOES have a unique body of knowledge and values, but all too often adopts the medical perspective over its own; most acadamic nurses these days don’t try very hard to inject new nurses with any values other than the medical model (Yes, there are exceptions!). In that sense, nursing can only ever be a ‘profession allied to medicine’, not a true profession in its own right.

2. Nursing does have controlled entry – most countries have a legally-enforced registration. This is beyond doubt, but of questionnable value, to some degree, it’s a cheat – “Nursing is a profession because the law says it is”.

3. Nursing has a variable degree of autonomy, but for the most part (Yes, there are exceptions!), has very little real freedom; indeed, nursing management, with it’s ‘cost saving’ mentality, does its utmost to strangle any independent thought or action, for fear of expensive litigation; there are ‘protocols’ for everything, these days, and woe betide the nurse who dares to use initiative (Yes, there are exceptions!).

Nurse practitioners (etc.) usually take orders from docs and are accountable to them, because their specialties are branches of medicine. But in many areas, nurses are responsible for *nursing* and in that sense are (still) independent of doctors.

It is a shame – but historically beyond doubt, that nurses tend to give away the areas they are most expert in; physiotherapy and occupational therapy both grew out of a nursing role, respiratory therapy is going the same way. Stoma therapy is an area that utilizes many core nursing skills; how long before it breaks off to become a profession in its own right?

Perversely, wound management was, until recently, a medical responsibility, though nurses applied almost 100% of dressings. Now, specialist nurses are teaching others the principles of wound care.

4. In many countries, Nursing does have its own disciplinary system – but in many of them, this is being eroded in favour of making nurses “accountable to the public” – understandable, but reflecting a view that nurses “cannot be trusted” to deal with there own problems – this is a diminution of professional resect and value.

5. Nurses are recognized as ‘nice’, ‘deserving better’ and ‘sexy’ – the jury is out on whether any of those assist in the definition of ‘professional’.

External recognition is vital, just as the legal side is ‘so what’ – few people would ever argue with doctor and lawyers as ‘true’ professionals; when the ‘Church was one, united, catholic church’, priests were similarly respected – I’m not so sure that’s generally true any more; individual clergymen are respected by individuals, and by their own community; as are individual nurses. But both fall shy of general respect to the level required, sadly. (Though both are streets ahead of journalists, real estate agents and heating engineers!).

To conclude, part of the problem is the poor self respect of nursing; just twenty years ago, the Process of Nursing, care plans and nursing diagnosis looked set to sweep in an era of nursing confidence and a bright, professional future.

Why did it fail? This is not the place to discuss that in detail, but factors include:

Overconfidence and a needless challenge to medicine – little illustrates the power of language better than the blinding stupidity of the term “nursing diagnosis”. Nursing assessment, as a serious, conscious, methodical activity was in its infancy, when ‘nursing diagnosis’ was invented. this simple act guaranteed a fear reaction and backlash from doctors, themselves under attack from the accountants and litigators. From being our allies, doctors become distanced at best, enemies at worst. All that could have been avoided by a few minutes invested in Roget’s thesaurus or a good dictionary .

A too rapid flight to academia – it is hard to argue against developments in Nurse education; God knows, a bit more has to be a ‘good thing’; but talk of a graduate profession form a tiny graduate base in less than twenty years meant that many mediocre people were sucked into senior postions; many good people were seduced away from clinical nursing, and many clinical idiots became academic idiots. Sad; and bad because instead of supporting and defending clinical nursing, academia began to control it, and did not defend it.

Failure to resist the suits – The inexorable rise of the accountant, who knows the price of everything, and the value of nothing, probably could not be stopped; but it was allowed to ride roughshod over nursing, destroying confidence and stopping development dead in its tracks.

Does Team Nursing work?

Posted in Featured, Nursing

The polite term for task allocation
On 11 August 2006, steven222, a Health Care Support Worker, submitted his view of team nursing:

Team nursing is the polite term for task allocation. It completely destroys all lines of accountability and responsibility as no individual nurse has both control of and responsibility for the care of any individual patient.

Team nursing consists of dividing the nursing workforce into two groups and then treating one group (staff nurses ) as too important ever to do any manual labour whilst treating the other group (HCSWs) as too gormless ever to do anything else. Then we go around looking puzzled at the fact that we don’t get on! It does however make for a good ideology to justify ignoring the patients call bell if you are a staff nurse.

Team nursing reminds me of the joke about the office where four people called Everybody, Nobody, Somebody and Anybody worked – Everybody thought that Somebody would do it ; Anybody could have done it but in the end Nobody did it. Each job and patient needs one nurse who IS responsible for them not four who might be.

Team nursing also means all HCSWs are permanently confined to basic tasks regardless of their level of knowledge and experience which will ensure that the good ones quit and only the timeservers remain. Team nursing does my head in. We need a national database of all wards which practise patient allocation and which practise bloody team nursing so we know which places to go and work and which to avoid like the plague!

Not a quick fix for understaffed wards
Andrew Heenan wrote this in 2004

There really is no quick and easy answer; there are so many variables; you could just as well argue “nothing works”.

A better question would be “How does it work”, followed by “(How) can I apply it my area.

Team nursing will not, by itself, improve morale or reduce staff turnover; but it can (applied appropriately in suitable environment) improve nursing care, which can then contribute to staff job satisfaction, then morale, then staff turnover.

If, for example, the nursing home is on two levels, then there is a good case for considering having a team for each level; staff would know where they’d be working each day, thus reducing instantly a major anxiety for some people. If one area is seen as ‘harder work’ then you could arrange to periodically rotate staff, or adjust staff numbers in each area. Such increased stability would lead to better staff understanding of the need for flexibility in the case of sickness, for example, rather than (for them) a random allocation with no continuity for them or the residents.

‘Geographical’ division is just one perspective; are there any other ways the resident group naturally divides?

There are other issues, such as skill mix and leadership – could it be practical to have two teams, but one leader (it would need to be a good leader!)

That’s just one scenario; it all depends on your local situation.

To me, primary nursing is the ideal, as I believe it offers the patient the best continuity and least potential confusion; team nursing – in practice – has almost always been about stretching resources, not really about improving anything.

In recent years, team nursing has increasingly involved RNs leading a team of untrained staff, whose ‘care’ the RN is accountable for. This means (of course) that the one person with nursing skills cannot actually use them, because of admin and safety responsibilities. The end of Real Nursing as we know it.

But primary nursing (in my view) cannot work in an under resourced unit, as the primary nurse and the relationship stand to ‘take the blame’ for the failings of the organization.

Personally, I prefer a ‘group nursing’ system; smallish teams, with primary nursing within the group – each member being associate nurse for the other nurses’ patients. This can reduce the number of individuals involved in each patient’s care, and can allow for mentorship and teambuilding within the group.

In fact, I don’t know of any system that is safe when nursing is under resourced – but while nursing models have had their reputation blackened by a plethora of time wasting jargon-ridden twaddle based on poorly researched undergraduate course work, promoting independence and involving significant others remains a “least worst” option.

When planning a system of nursing, there is never – ever – a ‘quick fix’.

Team Nursing CAN Work:
Ari Haytin, Student Nurse, UCSF, Submitted this 7th April 2007:

I would like to respond to the article that took the perspective that team nursing was more detrimental than beneficial. First the author believed that team nursing “destroys all lines of accountability and responsibility.” This can be the case if the unit is not a well-organized team. There are teams that people are enthusiastic and committed to being a part of and others where the morale is low and the members are not satisfied to be there.

The author’s experience of team nursing has been one of hierarchy and division, which is one way of organization, but it is important to be aware that there are other ways to organize teams. I am currently a nursing student that came from a counseling position in a community oriented public health clinic and never planned on working in a hospital partly due to the organization of many hospital units that lack a true team environment.

When I say true team environment I mean one that values all of the players on the team, that gives them all a voice and opportunities to grow and expand in their position. I have had the opportunity to observe many different units and truthfully to my surprise found that there are some units in the hospital that have amazingly well-organized teams. My first day observing at the Emergency Department the MD’s introduced themselves to me and welcomed me. The staff gave each other a lot of respect, trust and were there to assist one another when they needed it. I think this organization especially common in ICU and ED departments that have a high rate of success with their patients’ outcomes. I hope that some of the teams with low morale would look for ways of reorganizing their team instead of giving up on the team.