Saturday, April 23, 2011

Starting Nursing School Advice: Know ADPIE aka The Nursing Process

There is a lot of advice on the Internet about starting nursing school.  But one of the primary things that will be emphasized throughout nursing school (besides ALWAYS check the apical heart rate before administering digoxin) is the nursing process.  In fact, if you do not understand and apply the nursing process, you will most likely fail school, if not school, boards.  Pretty serious, right? I actually like the nursing process and try to consciously use it when I am on the job and to solve other problems.

ADPIE is the acronym for the nursing process:

A:  Assess
D:  Diagnose
P:  Plan                                                           
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I:  Implement
E: Evaluate

We can imagine the following scenario:  You are checking on patients and walk into 75 year old Mr. Doe's room and notice his respirations seem faster than they were at the beginning of the shift.  You begin to assess by counting the respirations, they were 18-20, now they are 28!  You further assess by checking his level of consciousness (aka as LOC).  At the beginning of the shift he was able to respond to simple commands and at times would respond verbally with simple words.  Now he is not responsive, you also obtain his vitals and notice his O2 sat is dropping below 90.

Now it is time to diagnose, a nursing diagnoses is not a medical diagnoses.  Your patient may have a medical diagnoses of Pneumonia.  But as a nurse you use a nursing diagnoses like Risk for Impaired Gas Exchange.  Using the above scenario your not going to run to a reference book and look up an approved nursing diagnoses.  Yet you just spent two years in school putting together care plan after care plan.  So you will automatically know that the issue is most likely related to the respiratory system and diagnose the problem accordingly.

Then you will plan, unlike school where you spent hours reviewing charts and putting a plan together with your neat care plan book.  You will most likely plan quickly, you know your client is at risk for respiratory failure.  Plan, oxygen on, HOB up (head of bed), call charge nurse, possibly call a Rapid Response (team of specialist who respond to situations before they become a code), call doctor to inform and get further orders. Continue to monitor vitals and O2 saturation.

Time to Implement the plan.  You take all the above steps, most will happen very quickly and hopefully with support from others on your floor.  O2 is put on, HOB raised, charge nurse jumps in and calls rapid response team, primary doctor is called.  Patient's O2 saturation raises to above 90, but still appears to be in distress.  Doctor and team transfer patient to ICU.

Time to evaluate what just happen. Could the situation have been prevented? Did the support you needed arrive in a timely fashion?  Did your plan work?  What could have made things work better?  When (not if) you find yourself in a similar situation, what could make things work better?  What did you do right (never forget to recognize what you did correct, keep your evaluations balanced)?  What was the end result for your patient?

As mentioned, in school you will use care plans and learn over time, but do not do what other students may do, and complain about your care plans.  In a possible real life scenario, you will not have the luxury of time, the above scenario can all happen in a few minutes.  Yet you will use all the steps to deal with the situation at hand because of all that time putting together those wonderful care plans.

Furthermore, when you take nursing test, you can use the nursing process to answer the questions.  Since most questions have more than one correct answer, you have to pick the BEST answer.  Knowing if your Assessing, Diagnosing, Planning, Implementing or Evaluating will help you with the question.  Most questions seem to focus on Assessing or Implementing.

You can also apply the nursing process to life.  Having relationship problems?  Try using ADPIE!  Money problems?  Try using ADPIE!   The nursing process is not an answer to all lifes problems but it does provide a method to help solve a lot of problems.

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