Objective 4: Apply the nursing process in the provision of direct and indirect care of individuals, families, and communities in a variety of settings and across diverse populations.

Care plans are the first thing that come to mind when I think about this objective. I failed this part of my Professional Foundations (1) final because I did not understand the “foreign” language spoken by the North American Nursing Diagnosis Association (NANDA) and the whole concept of the Nursing Process (assessment, diagnosis, planning, implementation, evaluation and back to the beginning to do it again). Over the course of clinicals and classroom work, I have written many care plans and now value them as a tool for providing individualized, holistic care for an individual, a family or a community.

I have found that providing culturally sensitive care is hard to accomplish. I have seen the toll that a language barrier takes on a hospitalized patient. Many times my best form of communication was a hug because we could not understand each other’s words. I know that food preferences often cause distress. I have felt the frustration and helplessness that comes from not having the time or tools to get beyond cultural barriers. Even as healthcare claims to be more sensitive to cultural differences, in actual practice the barriers are often insurmountable. Those that fair best are the ones who have bilingual family members who can be at the beside most of the time.

I have to admit however, at this point in my nursing career the Nursing Process is not a comfortable, integral part of my care for my patients. I have difficulty stepping back and looking at the big picture. Rather, I become bogged down in the steps that need to be accomplished to provide the basic level of care expected by the institution—assessment, pain management, medication administration, charting, etc. Sometimes I can’t even remember why the patient is in the hospital. When I feel in over my head, I take a deep breath, figure out what I need to know and do and try to prioritize to the best of my ability at that moment in time. As I continue to ask a million questions a day and talk to more experiences nurses I know that the Nursing Process will become a part of the way I do things even to the point of using it outside of Nursing.

R E L E V A N T   W O R K   S A M P L E S

1) Record of Clinical Practice: This chart is an incomplete list of clients I have cared for. It gives an idea of the variety of persons and settings I have cared for and worked in. Variety is the key word.

View a PDF of my client list [1.7 mb]

2) Peer Health History: This is my first use of the Assessment-Diagnosis portion of the nursing process. It was unbelievably time consuming. It took a long time for the nursing process to make sense to me. In our Leadership class, Dr. Schultz showed us how it is applicable in any field of study. I think it was at that point that it finally started to sink in.

View a PDF of my paper

3) Freidman Family Assessment: Family assessment form. The nursing process is the same structure but there are various ways of putting the information together. Here is an example of the Freidman Family Assessment short form.

View a PDF of my assessment

4) Fort Lewis Community Assessment: An example of the community as the client.

View the slideshow

5) Mental Health Care Plan: This is a care plan for a patient with depression and suicidal ideation.

View a PDF of my plan

6) Concept Map: Graphic representation of the nursing process for an individual. I like gathering the evidence and putting the puzzle together. It helps answer the question, “How can I help this patient move closer to well-being today?” The nursing process is the structure that guides the placement of the puzzle pieces.

View a PDF of the graphic

7) Mother/Baby Unit Care Plan: Included here to show the client is the family.

View a PDF of my care plan

8) Journals: When we were first assigned journaling about our clinical experiences I was not happy. I am not a person who likes to write very much and I saw it as a burden. Here at the end of Nursing School my journals are the one thing that I want to hang on to. Self-reflection is incredibly valuable for working out stress, working through tough times, reviewing decisions and choices made in the heat of the moment, celebrating and even bragging about a job well done. It also allows me a glimpse back in time to who I was at the beginning of this journey compared to who I am now. Emotional intelligence is an integral part of nursing and keeping a journal is a way to emotionally mature. Journaling has made me a better nurse. I hope I will continue when I enter practice.

View a PDF of my Community Health journal
View a PDF of my Med Surg 1 journal
View a PDF of my Med Surg 2 journal
View a PDF of my Mental Health journal
View a PDF of my Nurs 22 journal
View a PDF of my OB journal
View a PDF of my Pediatrics journal
View a PDF of my Preceptorship journal

9) Female Infibulation Poster: Talk about shocking. I had never heard of this practice and was appalled by the practice. I found it to be a great example of how intolerance can interfere with the nursing process. Something that is desired in one culture can be absolutely unthinkable to another and it made me really think about how I would react if ever faced with something like that. They need culturally sensitive nursing care.

View a PDF of the poster [3.4 mb]

10) MRSA Poster: Senior Seminar project that uses the nursing process to stop the spread of MRSA in hospital Med/Surg units. This is a care plan in poster form.

View a PDF of the poster