Nursing Diagnosis: Anxiety
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Anxiety Control
* Coping
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Anxiety Reduction
* Presence
* Calming Technique
* Emotional Support
Definition: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat.
Anxiety is probably present at some level in every individual’s life, but the degree and the frequency with which it manifests differs broadly. Each individual’s response to anxiety is different. Some people are able to use the emotional edge that anxiety provokes to stimulate creativity or problem-solving abilities; others can become immobilized to a pathological degree. The feeling is generally categorized into four levels for treatment purposes: mild, moderate, severe, and panic. The nurse can encounter the anxious patient anywhere in the hospital or community. The presence of the nurse may lend support to the anxious patient and provide some strategies for traversing anxious moments or panic attacks.
* Defining Characteristics: Physiological:
o Increase in blood pressure, pulse, and respirations
o Dizziness, light-headedness
o Perspiration
o Frequent urination
o Flushing
o Dyspnea
o Palpitations
o Dry mouth
o Headaches
o Nausea and/or diarrhea
o Restlessness
o Pacing
o Pupil dilation
o Insomnia, nightmares
o Trembling
o Feelings of helplessness and discomfort
* Behavioral:
o Expressions of helplessness
o Feelings of inadequacy
o Crying
o Difficulty concentrating
o Rumination
o Inability to problem-solve
o Preoccupation
* Related Factors: Threat or perceived threat to physical and emotional integrity
* Changes in role function
* Intrusive diagnostic and surgical tests and procedures
* Changes in environment and routines
* Threat or perceived threat to self-concept
* Threat to (or change in) socioeconomic status
* Situational and maturational crises
* Interpersonal conflicts
* Expected Outcomes Patient is able to recognize signs of anxiety.
* Patient demonstrates positive coping mechanisms.
* Patient may describe a reduction in the level of anxiety experienced.
Ongoing Assessment
* Assess patient’s level of anxiety. Mild anxiety enhances the patient’s awareness and ability to identify and solve problems. Moderate anxiety limits awareness of environmental stimuli. Problem solving can occur but may be more difficult, and patient may need help. Severe anxiety decreases patient’s ability to integrate information and solve problems. With panic the patient is unable to follow directions. Hyperactivity, agitation, and immobilization may be observed.
* Determine how patient copes with anxiety. This can be done by interviewing the patient. This assessment helps determine the effectiveness of coping strategies currently used by patient.
* Suggest that the patient keep a log of episodes of anxiety. Instruct patient to describe what is experienced and the events leading up to and surrounding the event. Patient should note how the anxiety dissipates. Patient may use these notes to begin to identify trends that manifest anxiety. If the patient is comfortable with the idea, the log may be shared with the care provider who may be helpful in problem solving. Symptoms often provide the care provider with information regarding the degree of anxiety being experienced. Physiological symptoms and/or complaints intensify as the level of anxiety increases.
Therapeutic Interventions
* Acknowledge awareness of patient’s anxiety. Because a cause for anxiety cannot always be identified, the patient may feel as though the feelings being experienced are counterfeit. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings.
* Reassure patient that he or she is safe. Stay with patient if this appears necessary. The presence of a trusted person may be helpful during an anxiety attack.
* Maintain a calm manner while interacting with patient. The health care provider can transmit his or her own anxiety to the hypersensitive patient. The patient’s feeling of stability increases in a calm and nonthreatening atmosphere.
* Establish a working relationship with the patient through continuity of care. An ongoing relationship establishes a basis for comfort in communicating anxious feelings.
* Orient patient to the environment and new experiences or people as needed. Orientation and awareness of the surroundings promote comfort and may decrease anxiety.
* Use simple language and brief statements when instructing patient about self-care measures or about diagnostic and surgical procedures. When experiencing moderate to severe anxiety, patients may be unable to comprehend anything more than simple, clear, and brief instructions.
* Reduce sensory stimuli by maintaining a quiet environment; keep "threatening" equipment out of sight. Anxiety may escalate with excessive conversation, noise, and equipment around the patient. This may be evident in both hospital and home environments.
* Encourage patient to seek assistance from an understanding significant other or from the health care provider when anxious feelings become difficult. The presence of significant others reinforces feelings of security for the patient.
* Encourage patient to talk about anxious feelings and examine anxiety-provoking situations if able to identify them. Assist patient in assessing the situation realistically and recognizing factors leading to the anxious feelings. Avoid false reassurances.
* As patient’s anxiety subsides, encourage exploration of specific events preceding both the onset and reduction of the anxious feelings. Recognition and exploration of factors leading to or reducing anxious feelings are important steps in developing alternative responses. Patient may be unaware of the relationship between emotional concerns and anxiety.
* Assist the patient in developing anxiety-reducing skills (e.g., relaxation, deep breathing, positive visualization, and reassuring self-statements). Using anxiety-reduction strategies enhances patient’s sense of personal mastery and confidence.
* Assist patient in developing problem-solving abilities.
o Emphasize the logical strategies patient can use when experiencing anxious feelings.
Learning to identify a problem and evaluate alternatives to resolve it helps the patient to cope.
* Instruct the patient in the appropriate use of antianxiety medications.
Education/Continuity of Care
* Assist patient in recognizing symptoms of increasing anxiety; explore alternatives to use to prevent the anxiety from immobilizing her or him. The ability to recognize anxiety symptoms at lower-intensity levels enables the patient to intervene more quickly to manage his or her anxiety. Patient will be able to use problem-solving abilities more effectively when the level of anxiety is low.
* Remind patient that anxiety at a mild level can encourage growth and development and is important in mobilizing changes.
* Instruct patient in the proper use of medications and educate him or her to recognize adverse reactions. Medication may be used if patient’s anxiety continues to escalate and the anxiety becomes disabling.
* Refer the patient for psychiatric management of anxiety that becomes disabling for an extended period.
Minggu, 21 Februari 2010
ACTIVITY INTOLERANCE
Nursing Diagnosis: Activity Intolerance
Weakness; Deconditioned; Sedentary
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Activity Tolerance
* Energy Conservation
* Knowledge: Treatment Regimen
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Energy Management
* Teaching: Prescribed Activity/Exercise
Definition: Insufficient physiological or psychological energy to endure or complete required or desired daily activities
Most activity intolerance is related to generalized weakness and debilitation secondary to acute or chronic illness and disease. This is especially apparent in elderly patients with a history of orthopedic, cardiopulmonary, diabetic, or pulmonary- related problems. The aging process itself causes reduction in muscle strength and function, which can impair the ability to maintain activity. Activity intolerance may also be related to factors such as obesity, malnourishment, side effects of medications (e.g., Beta-blockers), or emotional states such as depression or lack of confidence to exert one's self. Nursing goals are to reduce the effects of inactivity, promote optimal physical activity, and assist the patient to maintain a satisfactory lifestyle.
* Defining Characteristics: Verbal report of fatigue or weakness
* Inability to begin or perform activity
* Abnormal heart rate or blood pressure (BP) response to activity
* Exertional discomfort or dyspnea
* Related Factors: Generalized weakness
* Deconditioned state
* Sedentary lifestyle
* Insufficient sleep or rest periods
* Depression or lack of motivation
* Prolonged bed rest
* Imposed activity restriction
* Imbalance between oxygen supply and demand
* Pain
* Side effects of medications
* Expected Outcomes Patient maintains activity level within capabilities, as evidenced by normal heart rate and blood pressure during activity, as well as absence of shortness of breath, weakness, and fatigue.
* Patient verbalizes and uses energy-conservation techniques.
Ongoing Assessment
* Determine patient's perception of causes of fatigue or activity intolerance. These may be temporary or permanent, physical or psychological. Assessment guides treatment.
* Assess patient's level of mobility. This aids in defining what patient is capable of, which is necessary before setting realistic goals.
* Assess nutritional status. Adequate energy reserves are required for activity.
* Assess potential for physical injury with activity. Injury may be related to falls or overexertion.
* Assess need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLs). Some aids may require more energy expenditure for patients who have reduced upper arm strength (e.g., walking with crutches). Adequate assessment of energy requirements is indicated.
* Assess patient's cardiopulmonary status before activity using the following measures:
o Heart rate Heart rate should not increase more than 20 to 30 beats/min above resting with routine activities. This number will change depending on the intensity of exercise the patient is attempting (e.g., climbing four flights of stairs versus shoveling snow).
o Orthostatic BP changes Elderly patients are more prone to drops in blood pressure with position changes.
o Need for oxygen with increased activity Portable pulse oximetry can be used to assess for oxygen desaturation. Supplemental oxygen may help compensate for the increased oxygen demands.
o How Valsalva maneuver affects heart rate when patient moves in bed Valsalva maneuver, which requires breath holding and bearing down, can cause bradycardia and related reduced cardiac output.
* Monitor patient's sleep pattern and amount of sleep achieved over past few days. Difficulties sleeping need to be addressed before activity progression can be achieved.
* Observe and document response to activity. Report any of the following:
o Rapid pulse (20 beats/min over resting rate or 120 beats/min)
o Palpitations
o Significant increase in systolic BP (20 mm Hg)
o Significant decrease in systolic BP (20 mm Hg)
o Dyspnea, labored breathing, wheezing
o Weakness, fatigue
o Lightheadedness, dizziness, pallor, diaphoresis
Close monitoring serves as a guide for optimal progression of activity.
* Assess emotional response to change in physical status. Depression over inability to perform required activities can further aggravate the activity intolerance.
Therapeutic Interventions
* Establish guidelines and goals of activity with the patient and caregiver. Motivation is enhanced if the patient participates in goal setting. Depending on the etiological factors of the activity intolerance, some patients may be able to live independently and work outside the home. Other patients with chronic debilitating disease may remain homebound.
* Encourage adequate rest periods, especially before meals, other ADLs, exercise sessions, and ambulation. Rest between activities provides time for energy conservation and recovery. Heart rate recovery following activity is greatest at the beginning of a rest period.
* Refrain from performing nonessential procedures. Patients with limited activity tolerance need to prioritize tasks.
* Anticipate patient's needs (e.g., keep telephone and tissues within reach).
* Assist with ADLs as indicated; however, avoid doing for patient what he or she can do for self. Assisting the patient with ADLs allows for conservation of energy. Caregivers need to balance providing assistance with facilitating progressive endurance that will ultimately enhance the patient's activity tolerance and self-esteem.
* Provide bedside commode as indicated. This reduces energy expenditure. NOTE: A bedpan requires more energy than a commode.
* Encourage physical activity consistent with patient's energy resources.
* Assist patient to plan activities for times when he or she has the most energy. Not all self-care and hygiene activities need to be completed in the morning. Likewise, not all housecleaning needs to be completed in 1 day.
* Encourage verbalization of feelings regarding limitations. Acknowledgment that living with activity intolerance is both physically and emotionally difficult aids coping.
* Progress activity gradually, as with the following:
o Active range-of-motion (ROM) exercises in bed, progressing to sitting and standing
o Dangling 10 to 15 minutes three times daily
o Deep breathing exercises three times daily
o Sitting up in chair 30 minutes three times daily
o Walking in room 1 to 2 minutes three times daily
o Walking in hall 25 feet or walking around the house, then slowly progressing, saving energy for return trip
This prevents overexerting the heart and promotes attainment of short-range goals.
* Encourage active ROM exercises three times daily. If further reconditioning is needed, confer with rehabilitation personnel. Exercises maintain muscle strength and joint ROM.
* Provide emotional support while increasing activity. Promote a positive attitude regarding abilities.
* Encourage patient to choose activities that gradually build endurance.
* Improvise in adapting ADL equipment or environment. Appropriate aids will enable the patient to achieve optimal independence for self-care.
Education/Continuity of Care
* Teach patient/caregivers to recognize signs of physical overactivity. This promotes awareness of when to reduce activity.
* Involve patient and caregivers in goal setting and care planning. Setting small, attainable goals can increase self-confidence and self-esteem.
* When hospitalized, encourage significant others to bring ambulation aid (e.g., walker or cane).
* Teach the importance of continued activity at home. This maintains strength, ROM, and endurance gain.
* Assist in assigning priority to activities to accommodate energy levels.
* Teach energy conservation techniques. Some examples include the following:
o Sitting to do tasks Standing requires more work.
o Changing positions often This distributes work to different muscles to avoid fatigue.
o Pushing rather than pulling
o Sliding rather than lifting
o Working at an even pace This allows enough time so not all work is completed in a short period.
o Storing frequently used items within easy reach This avoids bending and reaching.
o Resting for at least 1 hour after meals before starting a new activity Energy is needed to digest food.
o Using wheeled carts for laundry, shopping, and cleaning needs
o Organizing a work-rest-work schedule
These reduce oxygen consumption, allowing more prolonged activity.
* Teach appropriate use of environmental aids (e.g., bed rails, elevating head of bed while patient gets out of bed, chair in bathroom, hall rails). These conserve energy and prevent injury from fall.
* Teach ROM and strengthening exercises.
* Encourage patient to verbalize concerns about discharge and home environment. These reduce feelings of anxiety and fear.
* Refer to community resources as indicated.
Weakness; Deconditioned; Sedentary
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Activity Tolerance
* Energy Conservation
* Knowledge: Treatment Regimen
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Energy Management
* Teaching: Prescribed Activity/Exercise
Definition: Insufficient physiological or psychological energy to endure or complete required or desired daily activities
Most activity intolerance is related to generalized weakness and debilitation secondary to acute or chronic illness and disease. This is especially apparent in elderly patients with a history of orthopedic, cardiopulmonary, diabetic, or pulmonary- related problems. The aging process itself causes reduction in muscle strength and function, which can impair the ability to maintain activity. Activity intolerance may also be related to factors such as obesity, malnourishment, side effects of medications (e.g., Beta-blockers), or emotional states such as depression or lack of confidence to exert one's self. Nursing goals are to reduce the effects of inactivity, promote optimal physical activity, and assist the patient to maintain a satisfactory lifestyle.
* Defining Characteristics: Verbal report of fatigue or weakness
* Inability to begin or perform activity
* Abnormal heart rate or blood pressure (BP) response to activity
* Exertional discomfort or dyspnea
* Related Factors: Generalized weakness
* Deconditioned state
* Sedentary lifestyle
* Insufficient sleep or rest periods
* Depression or lack of motivation
* Prolonged bed rest
* Imposed activity restriction
* Imbalance between oxygen supply and demand
* Pain
* Side effects of medications
* Expected Outcomes Patient maintains activity level within capabilities, as evidenced by normal heart rate and blood pressure during activity, as well as absence of shortness of breath, weakness, and fatigue.
* Patient verbalizes and uses energy-conservation techniques.
Ongoing Assessment
* Determine patient's perception of causes of fatigue or activity intolerance. These may be temporary or permanent, physical or psychological. Assessment guides treatment.
* Assess patient's level of mobility. This aids in defining what patient is capable of, which is necessary before setting realistic goals.
* Assess nutritional status. Adequate energy reserves are required for activity.
* Assess potential for physical injury with activity. Injury may be related to falls or overexertion.
* Assess need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLs). Some aids may require more energy expenditure for patients who have reduced upper arm strength (e.g., walking with crutches). Adequate assessment of energy requirements is indicated.
* Assess patient's cardiopulmonary status before activity using the following measures:
o Heart rate Heart rate should not increase more than 20 to 30 beats/min above resting with routine activities. This number will change depending on the intensity of exercise the patient is attempting (e.g., climbing four flights of stairs versus shoveling snow).
o Orthostatic BP changes Elderly patients are more prone to drops in blood pressure with position changes.
o Need for oxygen with increased activity Portable pulse oximetry can be used to assess for oxygen desaturation. Supplemental oxygen may help compensate for the increased oxygen demands.
o How Valsalva maneuver affects heart rate when patient moves in bed Valsalva maneuver, which requires breath holding and bearing down, can cause bradycardia and related reduced cardiac output.
* Monitor patient's sleep pattern and amount of sleep achieved over past few days. Difficulties sleeping need to be addressed before activity progression can be achieved.
* Observe and document response to activity. Report any of the following:
o Rapid pulse (20 beats/min over resting rate or 120 beats/min)
o Palpitations
o Significant increase in systolic BP (20 mm Hg)
o Significant decrease in systolic BP (20 mm Hg)
o Dyspnea, labored breathing, wheezing
o Weakness, fatigue
o Lightheadedness, dizziness, pallor, diaphoresis
Close monitoring serves as a guide for optimal progression of activity.
* Assess emotional response to change in physical status. Depression over inability to perform required activities can further aggravate the activity intolerance.
Therapeutic Interventions
* Establish guidelines and goals of activity with the patient and caregiver. Motivation is enhanced if the patient participates in goal setting. Depending on the etiological factors of the activity intolerance, some patients may be able to live independently and work outside the home. Other patients with chronic debilitating disease may remain homebound.
* Encourage adequate rest periods, especially before meals, other ADLs, exercise sessions, and ambulation. Rest between activities provides time for energy conservation and recovery. Heart rate recovery following activity is greatest at the beginning of a rest period.
* Refrain from performing nonessential procedures. Patients with limited activity tolerance need to prioritize tasks.
* Anticipate patient's needs (e.g., keep telephone and tissues within reach).
* Assist with ADLs as indicated; however, avoid doing for patient what he or she can do for self. Assisting the patient with ADLs allows for conservation of energy. Caregivers need to balance providing assistance with facilitating progressive endurance that will ultimately enhance the patient's activity tolerance and self-esteem.
* Provide bedside commode as indicated. This reduces energy expenditure. NOTE: A bedpan requires more energy than a commode.
* Encourage physical activity consistent with patient's energy resources.
* Assist patient to plan activities for times when he or she has the most energy. Not all self-care and hygiene activities need to be completed in the morning. Likewise, not all housecleaning needs to be completed in 1 day.
* Encourage verbalization of feelings regarding limitations. Acknowledgment that living with activity intolerance is both physically and emotionally difficult aids coping.
* Progress activity gradually, as with the following:
o Active range-of-motion (ROM) exercises in bed, progressing to sitting and standing
o Dangling 10 to 15 minutes three times daily
o Deep breathing exercises three times daily
o Sitting up in chair 30 minutes three times daily
o Walking in room 1 to 2 minutes three times daily
o Walking in hall 25 feet or walking around the house, then slowly progressing, saving energy for return trip
This prevents overexerting the heart and promotes attainment of short-range goals.
* Encourage active ROM exercises three times daily. If further reconditioning is needed, confer with rehabilitation personnel. Exercises maintain muscle strength and joint ROM.
* Provide emotional support while increasing activity. Promote a positive attitude regarding abilities.
* Encourage patient to choose activities that gradually build endurance.
* Improvise in adapting ADL equipment or environment. Appropriate aids will enable the patient to achieve optimal independence for self-care.
Education/Continuity of Care
* Teach patient/caregivers to recognize signs of physical overactivity. This promotes awareness of when to reduce activity.
* Involve patient and caregivers in goal setting and care planning. Setting small, attainable goals can increase self-confidence and self-esteem.
* When hospitalized, encourage significant others to bring ambulation aid (e.g., walker or cane).
* Teach the importance of continued activity at home. This maintains strength, ROM, and endurance gain.
* Assist in assigning priority to activities to accommodate energy levels.
* Teach energy conservation techniques. Some examples include the following:
o Sitting to do tasks Standing requires more work.
o Changing positions often This distributes work to different muscles to avoid fatigue.
o Pushing rather than pulling
o Sliding rather than lifting
o Working at an even pace This allows enough time so not all work is completed in a short period.
o Storing frequently used items within easy reach This avoids bending and reaching.
o Resting for at least 1 hour after meals before starting a new activity Energy is needed to digest food.
o Using wheeled carts for laundry, shopping, and cleaning needs
o Organizing a work-rest-work schedule
These reduce oxygen consumption, allowing more prolonged activity.
* Teach appropriate use of environmental aids (e.g., bed rails, elevating head of bed while patient gets out of bed, chair in bathroom, hall rails). These conserve energy and prevent injury from fall.
* Teach ROM and strengthening exercises.
* Encourage patient to verbalize concerns about discharge and home environment. These reduce feelings of anxiety and fear.
* Refer to community resources as indicated.
Sabtu, 20 Februari 2010
NURSING DIAGNOSIS
Nursing Diagnosis: Decreased Cardiac Output
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Cardiac Pump Effectiveness
* Circulation Status
* Knowledge: Disease Process
* Knowledge: Treatment Program
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Cardiac Care
* Hemodynamic Regulation
* Teaching: Disease Process
Definition: Inadequate blood pumped by the heart to meet the metabolic demands of the body
Common causes of reduced cardiac output include myocardial infarction, hypertension, valvular heart disease, congenital heart disease, cardiomyopathy, pulmonary disease, arrhythmias, drug effects, fluid overload, decreased fluid volume, and electrolyte imbalance. Geriatric patients are especially at risk because the aging process causes reduced compliance of the ventricles, which further reduces contractility and cardiac output. Patients may have acute, temporary problems or experience chronic, debilitating effects of decreased cardiac output. Patients may be managed in an acute, ambulatory care, or home care setting. This care plan focuses on the acute management.
* Defining Characteristics: Variations in hemodynamic parameters (blood pressure [BP], heart rate, central venous pressure [CVP], pulmonary artery pressures, venous oxygen saturation [SVO2], cardiac output)
* Arrhythmias, electrocardiogram (ECG) changes
* Rales, tachypnea, dyspnea, orthopnea, cough, abnormal arterial blood gases (ABGs), frothy sputum
* Weight gain, edema, decreased urine output
* Anxiety, restlessness
* Syncope, dizziness
* Weakness, fatigue
* Abnormal heart sounds
* Decreased peripheral pulses, cold clammy skin
* Confusion, change in mental status
* Angina
* Ejection fraction less than 40%
* Pulsus alternans
* Related Factors: Increased or decreased ventricular filling (preload)
* Alteration in afterload
* Impaired contractility
* Alteration in heart rate, rhythm, and conduction
* Decreased oxygenation
* Cardiac muscle disease
* Expected Outcomes Patient maintains BP within normal limits; warm, dry skin; regular cardiac rhythm; clear lung sounds; and strong bilateral, equal peripheral pulses.
Ongoing Assessment
* Assess mentation. Restlessness is noted in the early stages; severe anxiety and confusion are seen in later stages.
* Assess heart rate and blood pressure. Sinus tachycardia and increased arterial blood pressure are seen in the early stages; BP drops as the condition deteriorates. Elderly patients have reduced response to catecholamines, thus their response to reduced cardiac output may be blunted, with less rise in heart rate. Pulsus alternans (alternating strong-then-weak pulse) is often seen in heart failure patients.
* Assess skin color and temperature. Cold, clammy skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and desaturation.
* Assess peripheral pulses. Pulses are weak with reduced cardiac output.
* Assess fluid balance and weight gain. Compromised regulatory mechanisms may result in fluid and sodium retention. Body weight is a more sensitive indicator of fluid or sodium retention than intake and output.
* Assess heart sounds, noting gallops, S3, S4. S3 denotes reduced left ventricular ejection and is a classic sign of left ventricular failure. S4 occurs with reduced compliance of the left ventricle, which impairs diastolic filling.
* Assess lung sounds. Determine any occurrence of paroxysmal nocturnal dyspnea (PND) or orthopnea. Crackles reflect accumulation of fluid secondary to impaired left ventricular emptying. They are more evident in the dependent areas of the lung. Orthopnea is difficulty breathing when supine. PND is difficulty breathing that occurs at night.
* If hemodynamic monitoring is in place:
o Monitor central venous, right arterial pressure [RAP], pulmonary artery pressure (PAP) (systolic, diastolic, and mean), and pulmonary capillary wedge pressure (PCWP). Hemodynamic parameters provide information aiding in differentiation of decreased cardiac output secondary to fluid overload versus fluid deficit.
o Monitor SVO 2 continuously. Change in oxygen saturation of mixed venous blood is one of the earliest indicators of reduced cardiac output.
o Perform cardiac output determination. This provides objective number to guide therapy.
* Monitor continuous ECG as appropriate.
* Monitor ECG for rate; rhythm; ectopy; and change in PR, QRS, and QT intervals. Tachycardia, bradycardia, and ectopic beats can compromise cardiac output. Elderly patients are especially sensitive to the loss of atrial kick in atrial fibrillation.
* Assess response to increased activity. Physical activity increases the demands placed on the heart; fatigue and exertional dyspnea are common problems with low cardiac output states. Close monitoring of patient’s response serves as a guide for optimal progression of activity.
* Assess urine output. Determine how often the patient urinates. Oliguria can reflect decreased renal perfusion. Diuresis is expected with diuretic therapy.
* Assess for chest pain. This indicates an imbalance between oxygen supply and demand.
* Assess contributing factors so appropriate plan of care can be initiated.
Therapeutic Interventions
* Administer medication as prescribed, noting response and watching for side effects and toxicity. Clarify with physician parameters for withholding medications. Depending on etiological factors, common medications include digitalis therapy, diuretics, vasodilator therapy, antidysrhythmics, ACE inhibitors, and inotropic agents.
* Maintain optimal fluid balance. For patients with decreased preload, administer fluid challenge as prescribed, closely monitoring effects. Administration of fluid increases extracellular fluid volume to raise cardiac output.
* Maintain hemodynamic parameters at prescribed levels. For patients in the acute setting, close monitoring of these parameters guides titration of fluids and medications.
* For patients with increased preload, restrict fluids and sodium as ordered. This decreases extracellular fluid volume.
* Maintain adequate ventilation and perfusion, as in the following:
o Place patient in semi- to high-Fowler’s position. This reduces preload and ventricular filling.
o Place in supine position. This increases venous return, promotes diuresis.
o Administer humidified oxygen as ordered. The failing heart may not be able to respond to increased oxygen demands.
* Maintain physical and emotional rest, as in the following:
o Restrict activity. This reduces oxygen demands.
o Provide quiet, relaxed environment. Emotional stress increases cardiac demands.
o Organize nursing and medical care. This allows rest periods.
o Monitor progressive activity within limits of cardiac function.
* Administer stool softeners as needed. Straining for a bowel movement further impairs cardiac output.
* Monitor sleep patterns; administer sedative. Rest is important for conserving energy.
* If arrhythmia occurs, determine patient response, document, and report if significant or symptomatic.
o Have antiarrhythmic drugs readily available.
o Treat arrhythmias according to medical orders or protocol and evaluate response.
Both tachyarrhythmias and bradyarrhythmias can reduce cardiac output and myocardial tissue perfusion.
* If invasive adjunct therapies are indicated (e.g., intraaortic balloon pump, pacemaker), maintain within prescribed protocol.
Education/Continuity of Care
* Explain symptoms and interventions for decreased cardiac output related to etiological factors.
* Explain drug regimen, purpose, dose, and side effects.
* Explain progressive activity schedule and signs of overexertion.
* Explain diet restrictions (fluid, sodium).
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Cardiac Pump Effectiveness
* Circulation Status
* Knowledge: Disease Process
* Knowledge: Treatment Program
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Cardiac Care
* Hemodynamic Regulation
* Teaching: Disease Process
Definition: Inadequate blood pumped by the heart to meet the metabolic demands of the body
Common causes of reduced cardiac output include myocardial infarction, hypertension, valvular heart disease, congenital heart disease, cardiomyopathy, pulmonary disease, arrhythmias, drug effects, fluid overload, decreased fluid volume, and electrolyte imbalance. Geriatric patients are especially at risk because the aging process causes reduced compliance of the ventricles, which further reduces contractility and cardiac output. Patients may have acute, temporary problems or experience chronic, debilitating effects of decreased cardiac output. Patients may be managed in an acute, ambulatory care, or home care setting. This care plan focuses on the acute management.
* Defining Characteristics: Variations in hemodynamic parameters (blood pressure [BP], heart rate, central venous pressure [CVP], pulmonary artery pressures, venous oxygen saturation [SVO2], cardiac output)
* Arrhythmias, electrocardiogram (ECG) changes
* Rales, tachypnea, dyspnea, orthopnea, cough, abnormal arterial blood gases (ABGs), frothy sputum
* Weight gain, edema, decreased urine output
* Anxiety, restlessness
* Syncope, dizziness
* Weakness, fatigue
* Abnormal heart sounds
* Decreased peripheral pulses, cold clammy skin
* Confusion, change in mental status
* Angina
* Ejection fraction less than 40%
* Pulsus alternans
* Related Factors: Increased or decreased ventricular filling (preload)
* Alteration in afterload
* Impaired contractility
* Alteration in heart rate, rhythm, and conduction
* Decreased oxygenation
* Cardiac muscle disease
* Expected Outcomes Patient maintains BP within normal limits; warm, dry skin; regular cardiac rhythm; clear lung sounds; and strong bilateral, equal peripheral pulses.
Ongoing Assessment
* Assess mentation. Restlessness is noted in the early stages; severe anxiety and confusion are seen in later stages.
* Assess heart rate and blood pressure. Sinus tachycardia and increased arterial blood pressure are seen in the early stages; BP drops as the condition deteriorates. Elderly patients have reduced response to catecholamines, thus their response to reduced cardiac output may be blunted, with less rise in heart rate. Pulsus alternans (alternating strong-then-weak pulse) is often seen in heart failure patients.
* Assess skin color and temperature. Cold, clammy skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and desaturation.
* Assess peripheral pulses. Pulses are weak with reduced cardiac output.
* Assess fluid balance and weight gain. Compromised regulatory mechanisms may result in fluid and sodium retention. Body weight is a more sensitive indicator of fluid or sodium retention than intake and output.
* Assess heart sounds, noting gallops, S3, S4. S3 denotes reduced left ventricular ejection and is a classic sign of left ventricular failure. S4 occurs with reduced compliance of the left ventricle, which impairs diastolic filling.
* Assess lung sounds. Determine any occurrence of paroxysmal nocturnal dyspnea (PND) or orthopnea. Crackles reflect accumulation of fluid secondary to impaired left ventricular emptying. They are more evident in the dependent areas of the lung. Orthopnea is difficulty breathing when supine. PND is difficulty breathing that occurs at night.
* If hemodynamic monitoring is in place:
o Monitor central venous, right arterial pressure [RAP], pulmonary artery pressure (PAP) (systolic, diastolic, and mean), and pulmonary capillary wedge pressure (PCWP). Hemodynamic parameters provide information aiding in differentiation of decreased cardiac output secondary to fluid overload versus fluid deficit.
o Monitor SVO 2 continuously. Change in oxygen saturation of mixed venous blood is one of the earliest indicators of reduced cardiac output.
o Perform cardiac output determination. This provides objective number to guide therapy.
* Monitor continuous ECG as appropriate.
* Monitor ECG for rate; rhythm; ectopy; and change in PR, QRS, and QT intervals. Tachycardia, bradycardia, and ectopic beats can compromise cardiac output. Elderly patients are especially sensitive to the loss of atrial kick in atrial fibrillation.
* Assess response to increased activity. Physical activity increases the demands placed on the heart; fatigue and exertional dyspnea are common problems with low cardiac output states. Close monitoring of patient’s response serves as a guide for optimal progression of activity.
* Assess urine output. Determine how often the patient urinates. Oliguria can reflect decreased renal perfusion. Diuresis is expected with diuretic therapy.
* Assess for chest pain. This indicates an imbalance between oxygen supply and demand.
* Assess contributing factors so appropriate plan of care can be initiated.
Therapeutic Interventions
* Administer medication as prescribed, noting response and watching for side effects and toxicity. Clarify with physician parameters for withholding medications. Depending on etiological factors, common medications include digitalis therapy, diuretics, vasodilator therapy, antidysrhythmics, ACE inhibitors, and inotropic agents.
* Maintain optimal fluid balance. For patients with decreased preload, administer fluid challenge as prescribed, closely monitoring effects. Administration of fluid increases extracellular fluid volume to raise cardiac output.
* Maintain hemodynamic parameters at prescribed levels. For patients in the acute setting, close monitoring of these parameters guides titration of fluids and medications.
* For patients with increased preload, restrict fluids and sodium as ordered. This decreases extracellular fluid volume.
* Maintain adequate ventilation and perfusion, as in the following:
o Place patient in semi- to high-Fowler’s position. This reduces preload and ventricular filling.
o Place in supine position. This increases venous return, promotes diuresis.
o Administer humidified oxygen as ordered. The failing heart may not be able to respond to increased oxygen demands.
* Maintain physical and emotional rest, as in the following:
o Restrict activity. This reduces oxygen demands.
o Provide quiet, relaxed environment. Emotional stress increases cardiac demands.
o Organize nursing and medical care. This allows rest periods.
o Monitor progressive activity within limits of cardiac function.
* Administer stool softeners as needed. Straining for a bowel movement further impairs cardiac output.
* Monitor sleep patterns; administer sedative. Rest is important for conserving energy.
* If arrhythmia occurs, determine patient response, document, and report if significant or symptomatic.
o Have antiarrhythmic drugs readily available.
o Treat arrhythmias according to medical orders or protocol and evaluate response.
Both tachyarrhythmias and bradyarrhythmias can reduce cardiac output and myocardial tissue perfusion.
* If invasive adjunct therapies are indicated (e.g., intraaortic balloon pump, pacemaker), maintain within prescribed protocol.
Education/Continuity of Care
* Explain symptoms and interventions for decreased cardiac output related to etiological factors.
* Explain drug regimen, purpose, dose, and side effects.
* Explain progressive activity schedule and signs of overexertion.
* Explain diet restrictions (fluid, sodium).
STUDY TIP FROM STUDENT
"Sometimes, if I have a study guide, I'll tape it to the front of my Trapper Keeper, so if I have any extra time, I can glance at it."
"For girls, when you study, have a scent in the room, preferably a perfume or something. Then when you take the test, wear that perfume. It can help you remember what you study because you relate the scent to the information. Of course you have to use a scent that you wouldn't normally smell."
"Listen to soothing, but invigorating music. I usually listen to Beethoven while I do mindless homework like math, French, or science assignments. It gets your brain pumping and flowing, and keeps you alert and awake."
"While studying, keep peppermint in your mouth... it clears your nasal passage for fresh air. More fresh air means more oxygen to the brain. Trust me, this really helps with memorizing and studying for school."
"When having a test or quiz on your notes (which happens quite frequently), take your notebook to your computer, and type all of your notes pertaining to that chapter in that particular section of your notebook. By typing the notes you need to know for your test, a lot of the information is displayed from your short-term memory to your long-term memory. After typing your notes out, look them over and study in-depth... This always helps.
"Definitely listen in class, you won't have to study so hard if you actually know some of the information beforehand (from class)."
"Be careful about wearing too much perfume or sitting near someone who does. The chemicals in some perfumes may affect your power to concentrate and remember information.
"Depending on the type of class, taking notes on a PowerBook computer has helped me immensely.
•It makes my notes readable & printable.
•My notes are saved in a retrievable place for the class and to use as citations for papers in other classes-(make sure you date your notes for this purpose).
•Professors and other students think you are smarter and more attuned to learning, just because you have a PowerBook in front of you, and will pay more attention to your questions. Other students will want to share their notes because they can read yours.
•The process of recording lecture notes onto a word processing document makes you consciously categorize topics as you type. Example: putting terms in bold type, putting concepts in italic, putting key ideas in underlined form, and preceding subtopics with a bullet •. This process organizes the ideas in your mind as you are doing it. The PowerBook is not helpful in Math classes, nor is it helpful in classes involving a lot of discussion.
Read over the notes a couple of times and then summarize it in your own words. Writing it down might help store it into the long-term memory."
"I'm recently starting year 12, I'm trying to get organized, I found your Tips very helpful. Though there are many other useful techniques, one of the best is teaching others what you have learned. I found when I helped others with questions I would gain a better knowledge of what I learned. I have also learned from my experience from year 11, that just studying a couple days before is not really studying but cramming. Therefore to gain better marks you have to study months before. Using flow charts, making notes simples, that's what summaries are supposed to be. My friend also gave me a study hint, though yet to be proven, she said the color yellow helps you remember things better, she always uses yellow paper for studying
"I have a TIP for you. Students should try to study as much as they can during daytime hours. When I study, I usually try to study during daytime, From my personal experience, study during the day time is much better than study during night time. I remember things better during daytime and I tend to not to slack off as much during daytime. Sometimes, there are less distraction for me during the daytime and I found myself more awake, even if I feel sleepy, take a 20~30 minute nap to recharge your energy. You should only study everything at night only if it's absolutely necessary, (i.e., due to work, after school activities,...etc.) besides, study as much as possible would usually reduce yourself from getting stress out at night time. Best of all, it would prevent you from staying up all night!"
"I am currently half way through my year 12, but I have talked to many students who have finished year twelve as well as teachers for study hints. The things that I have already put into practice, and have gotten very good results from is to write out my own study guide from the syllabus (this makes you understand the concepts you are summarizing, as well as putting the information into your long-term memory.) I have also found doing as many past papers with a time restriction extremely helpful, as many exams have similar types of questions to previous years, and after doing the questions a few times, you get so used to them, that the hard questions seem basic, because you are used to the style of question."
I have found through personal experience that by separating all of my different classes from one another by using different notebooks for each (different colors works good for me), I am not only more organized but more likely not to wander away from that subject when studying. A friend told me it's my subconscious. That I associate the notebook with that class and it helps me to concentrate on it alone. No matter what the reason is, it helped me boost my grades tremendously and learn a whole lot more then I had been before."
"Keycards are great study aids. You summarize your notes for the subject by each topic then you summarize the summary so that you have the key ideas and points for each topic. These you write down on cards under each topic heading. Put them in a small ringbinder and carry them with you. Then you can flip through them while waiting in a queue or waiting at your desk for a class to start. These quick flip-throughs of all the major points keep facts alive in your memory ready for recall in the exam.
"This is especially for my geography class because there is a lot of writing involved!
I've found that writing notes in shorthand (e.g. people=ppl) and going home that night while it is still fresh in the memory and typing it out longhand on the computer helps to memorize or keep the info in the brain because for people that constantly look up at the screen are rereading what they have typed. I don't know if this is a good study method but it works for me!
A good study TIP that I have found works quite well is to read the material to be covered in a lecture beforehand, and as you are reading create an outline, leaving plenty of space. Take this outline to the lecture and add to it new information the teacher gives, highlight on it things that you already have listed that are things she stresses as important. I type my outlines and type in blank lines using the underscore key so that they are easier to add to and because it being typed makes it easier to tell the difference between the information that came from the textbook and the information that came from the teacher. I also list questions that I have at the bottom of my outline, with lines to write the answers on. If the teacher gives the answer during the lecture then I write it in the space I have provided, the questions that she does not answer I ask for answers to."
Don't play sport or tire yourself before doing anything that requires thinking, memory etc. such as a test, or study period. Make sure you are fully rested and relaxed. I made the mistake, and took me three exams to figure it out.
The HSC is very stressing as everyone keeps on reminding you. While you are in year 12 many people will be telling you what you should and should not be doing. The important thing is to get YOUR OWN priorities straight. We judge ourselves by what we feel capable of doing, while others judge us by what we have already done. Only you know what you are capable of, so make sure your goals are set accordingly, and not to what others believe."
"This isn't an effective way to study but a method that my dad taught me, and it may be of use to you. You may already know it. Anyway, on the first day, you study what you learned in class. Then you read and study about 2 pages of your text book ahead, but just briefly, so you have the preview of what it is about. The next day in class, the teacher will teach the method, and you already know the basis of it, so it all clicks and maybe you learn a little more. When you get home, you don't really need to study that much. I don't know if you can get it by the way I'm explaining it. You sort of learned it the night before, and study during the actual lesson, so you're always a step ahead. Do you get it? I hope you understand what I've written. Have a good day.
"When summarizing a chapter of a subject, I type the information out in question format (e.g. instead of simply typing "alveoli are thin in shape which results in fast diffusion of substances..." I type "Discuss the structure of alveoli. How does their structure aid them in their primary role?"), then I type in the answer and, when the chapter summary is completed, print a copy. A family member or friend then asks me the questions and I give the answer. That way I'm not just making a summary once, but completing the equivalent whenever I can nag anyone into helping me. It also prepares me for exams in which they generally expect to you use your knowledge and apply it to answer questions.
For my personal TIP, I would suggest that students like me would make our own notes for every class discussion. Because if we only rely on our book, there could be some points that are hard to understand. Moreover, if we only listen to our professors, there is always a tendency to forget, knowing that we have lots of things in our mind, and that we can't remember every single detail which could be very important. One more thing, if ever we borrow our classmates' notes, for example if we missed a class, we are not sure that their notes are complete or that their notes are all correct. It is possible for them to miss out important details or misunderstood some explanations. Hence, we should attend classes regularly because it's going to be our loss to miss a class and not others
take three simple steps in order to succeed in studying.
1. Play some relaxing music (whatever music you enjoy listening to) before studying to clear my mind of everything.
2. Concentrate on what I'm studying when I begin to study, and do that throughout the process of studying.
3. Review it over orally to see if I actually remember what I studied, to see if I'm ready for that particular test.
Also, if the test is on Wednesday morning, I would study the night before, a few hours before I sleep. Since it would be fresh in my mind. Then an hour before the test, I will study for a second time just to make sure I'm completely ready. I've been doing this type of studying all my life, and it hasn't failed me. If this helps you, more power to you. If not, well hey everyone has their own methods of studying. Whatever works for you.
"For girls, when you study, have a scent in the room, preferably a perfume or something. Then when you take the test, wear that perfume. It can help you remember what you study because you relate the scent to the information. Of course you have to use a scent that you wouldn't normally smell."
"Listen to soothing, but invigorating music. I usually listen to Beethoven while I do mindless homework like math, French, or science assignments. It gets your brain pumping and flowing, and keeps you alert and awake."
"While studying, keep peppermint in your mouth... it clears your nasal passage for fresh air. More fresh air means more oxygen to the brain. Trust me, this really helps with memorizing and studying for school."
"When having a test or quiz on your notes (which happens quite frequently), take your notebook to your computer, and type all of your notes pertaining to that chapter in that particular section of your notebook. By typing the notes you need to know for your test, a lot of the information is displayed from your short-term memory to your long-term memory. After typing your notes out, look them over and study in-depth... This always helps.
"Definitely listen in class, you won't have to study so hard if you actually know some of the information beforehand (from class)."
"Be careful about wearing too much perfume or sitting near someone who does. The chemicals in some perfumes may affect your power to concentrate and remember information.
"Depending on the type of class, taking notes on a PowerBook computer has helped me immensely.
•It makes my notes readable & printable.
•My notes are saved in a retrievable place for the class and to use as citations for papers in other classes-(make sure you date your notes for this purpose).
•Professors and other students think you are smarter and more attuned to learning, just because you have a PowerBook in front of you, and will pay more attention to your questions. Other students will want to share their notes because they can read yours.
•The process of recording lecture notes onto a word processing document makes you consciously categorize topics as you type. Example: putting terms in bold type, putting concepts in italic, putting key ideas in underlined form, and preceding subtopics with a bullet •. This process organizes the ideas in your mind as you are doing it. The PowerBook is not helpful in Math classes, nor is it helpful in classes involving a lot of discussion.
Read over the notes a couple of times and then summarize it in your own words. Writing it down might help store it into the long-term memory."
"I'm recently starting year 12, I'm trying to get organized, I found your Tips very helpful. Though there are many other useful techniques, one of the best is teaching others what you have learned. I found when I helped others with questions I would gain a better knowledge of what I learned. I have also learned from my experience from year 11, that just studying a couple days before is not really studying but cramming. Therefore to gain better marks you have to study months before. Using flow charts, making notes simples, that's what summaries are supposed to be. My friend also gave me a study hint, though yet to be proven, she said the color yellow helps you remember things better, she always uses yellow paper for studying
"I have a TIP for you. Students should try to study as much as they can during daytime hours. When I study, I usually try to study during daytime, From my personal experience, study during the day time is much better than study during night time. I remember things better during daytime and I tend to not to slack off as much during daytime. Sometimes, there are less distraction for me during the daytime and I found myself more awake, even if I feel sleepy, take a 20~30 minute nap to recharge your energy. You should only study everything at night only if it's absolutely necessary, (i.e., due to work, after school activities,...etc.) besides, study as much as possible would usually reduce yourself from getting stress out at night time. Best of all, it would prevent you from staying up all night!"
"I am currently half way through my year 12, but I have talked to many students who have finished year twelve as well as teachers for study hints. The things that I have already put into practice, and have gotten very good results from is to write out my own study guide from the syllabus (this makes you understand the concepts you are summarizing, as well as putting the information into your long-term memory.) I have also found doing as many past papers with a time restriction extremely helpful, as many exams have similar types of questions to previous years, and after doing the questions a few times, you get so used to them, that the hard questions seem basic, because you are used to the style of question."
I have found through personal experience that by separating all of my different classes from one another by using different notebooks for each (different colors works good for me), I am not only more organized but more likely not to wander away from that subject when studying. A friend told me it's my subconscious. That I associate the notebook with that class and it helps me to concentrate on it alone. No matter what the reason is, it helped me boost my grades tremendously and learn a whole lot more then I had been before."
"Keycards are great study aids. You summarize your notes for the subject by each topic then you summarize the summary so that you have the key ideas and points for each topic. These you write down on cards under each topic heading. Put them in a small ringbinder and carry them with you. Then you can flip through them while waiting in a queue or waiting at your desk for a class to start. These quick flip-throughs of all the major points keep facts alive in your memory ready for recall in the exam.
"This is especially for my geography class because there is a lot of writing involved!
I've found that writing notes in shorthand (e.g. people=ppl) and going home that night while it is still fresh in the memory and typing it out longhand on the computer helps to memorize or keep the info in the brain because for people that constantly look up at the screen are rereading what they have typed. I don't know if this is a good study method but it works for me!
A good study TIP that I have found works quite well is to read the material to be covered in a lecture beforehand, and as you are reading create an outline, leaving plenty of space. Take this outline to the lecture and add to it new information the teacher gives, highlight on it things that you already have listed that are things she stresses as important. I type my outlines and type in blank lines using the underscore key so that they are easier to add to and because it being typed makes it easier to tell the difference between the information that came from the textbook and the information that came from the teacher. I also list questions that I have at the bottom of my outline, with lines to write the answers on. If the teacher gives the answer during the lecture then I write it in the space I have provided, the questions that she does not answer I ask for answers to."
Don't play sport or tire yourself before doing anything that requires thinking, memory etc. such as a test, or study period. Make sure you are fully rested and relaxed. I made the mistake, and took me three exams to figure it out.
The HSC is very stressing as everyone keeps on reminding you. While you are in year 12 many people will be telling you what you should and should not be doing. The important thing is to get YOUR OWN priorities straight. We judge ourselves by what we feel capable of doing, while others judge us by what we have already done. Only you know what you are capable of, so make sure your goals are set accordingly, and not to what others believe."
"This isn't an effective way to study but a method that my dad taught me, and it may be of use to you. You may already know it. Anyway, on the first day, you study what you learned in class. Then you read and study about 2 pages of your text book ahead, but just briefly, so you have the preview of what it is about. The next day in class, the teacher will teach the method, and you already know the basis of it, so it all clicks and maybe you learn a little more. When you get home, you don't really need to study that much. I don't know if you can get it by the way I'm explaining it. You sort of learned it the night before, and study during the actual lesson, so you're always a step ahead. Do you get it? I hope you understand what I've written. Have a good day.
"When summarizing a chapter of a subject, I type the information out in question format (e.g. instead of simply typing "alveoli are thin in shape which results in fast diffusion of substances..." I type "Discuss the structure of alveoli. How does their structure aid them in their primary role?"), then I type in the answer and, when the chapter summary is completed, print a copy. A family member or friend then asks me the questions and I give the answer. That way I'm not just making a summary once, but completing the equivalent whenever I can nag anyone into helping me. It also prepares me for exams in which they generally expect to you use your knowledge and apply it to answer questions.
For my personal TIP, I would suggest that students like me would make our own notes for every class discussion. Because if we only rely on our book, there could be some points that are hard to understand. Moreover, if we only listen to our professors, there is always a tendency to forget, knowing that we have lots of things in our mind, and that we can't remember every single detail which could be very important. One more thing, if ever we borrow our classmates' notes, for example if we missed a class, we are not sure that their notes are complete or that their notes are all correct. It is possible for them to miss out important details or misunderstood some explanations. Hence, we should attend classes regularly because it's going to be our loss to miss a class and not others
take three simple steps in order to succeed in studying.
1. Play some relaxing music (whatever music you enjoy listening to) before studying to clear my mind of everything.
2. Concentrate on what I'm studying when I begin to study, and do that throughout the process of studying.
3. Review it over orally to see if I actually remember what I studied, to see if I'm ready for that particular test.
Also, if the test is on Wednesday morning, I would study the night before, a few hours before I sleep. Since it would be fresh in my mind. Then an hour before the test, I will study for a second time just to make sure I'm completely ready. I've been doing this type of studying all my life, and it hasn't failed me. If this helps you, more power to you. If not, well hey everyone has their own methods of studying. Whatever works for you.
classroom management
Classroom Management, Management of Student Conduct, Effective Praise Guidelines, and a Few Things to Know About ESOL Thrown in for Good Measure
One of the best and most highly recommended books on classroom management is available from Amazon.com. Click HERE to read about it and order it.
Surveys of graduates of education schools and colleges indicate that the #1 area of concern of new teachers is their feelings of inadequacy in managing classrooms. Despite clinical experiences, student teaching, and other observations in classroom settings, this problem has persisted for decades. There is no magic elixir that will confer skill in this area of professional responsibility. We only wish there were.
Classroom management and management of student conduct are skills that teachers acquire and hone over time. These skills almost never "jell" until after a minimum of few years of teaching experience. To be sure, effective teaching requires considerable skill in managing the myriad of tasks and situations that occur in the classroom each day. Skills such as effective classroom management are central to teaching and require "common sense," consistency, a sense of fairness, and courage. These skills also require that teachers understand in more than one way the psychological and developmental levels of their students. The skills associated with effective classroom management are only acquired with practice, feedback, and a willingness to learn from mistakes. Sadly, this is often easier said than done. Certainly, a part of this problem is that there is no practical way for education students to "practice" their nascent skills outside of actually going into a classroom setting. The learning curve is steep, indeed.
As previously mentioned, personal experience and research indicate that many beginning teachers have difficulty effectively managing their classrooms. While there is no one best solution for every problem or classroom setting, the following principles, drawn from a number of sources, might help. Classroom teachers with many years of experience have contributed to an understanding of what works and what doesn't work in managing classrooms and the behavior of students. The following information represents some of the things that good classroom teachers do to maintain an atmosphere that enhances learning. It is written in straightforward, non-preachy language, and will not drive you to distraction with its length. I think most students appreciate that. With that in mind, I truly hope this information is useful to you.
One of the best and most highly recommended books on classroom management is available from Amazon.com. Click HERE to read about it and order it.
Surveys of graduates of education schools and colleges indicate that the #1 area of concern of new teachers is their feelings of inadequacy in managing classrooms. Despite clinical experiences, student teaching, and other observations in classroom settings, this problem has persisted for decades. There is no magic elixir that will confer skill in this area of professional responsibility. We only wish there were.
Classroom management and management of student conduct are skills that teachers acquire and hone over time. These skills almost never "jell" until after a minimum of few years of teaching experience. To be sure, effective teaching requires considerable skill in managing the myriad of tasks and situations that occur in the classroom each day. Skills such as effective classroom management are central to teaching and require "common sense," consistency, a sense of fairness, and courage. These skills also require that teachers understand in more than one way the psychological and developmental levels of their students. The skills associated with effective classroom management are only acquired with practice, feedback, and a willingness to learn from mistakes. Sadly, this is often easier said than done. Certainly, a part of this problem is that there is no practical way for education students to "practice" their nascent skills outside of actually going into a classroom setting. The learning curve is steep, indeed.
As previously mentioned, personal experience and research indicate that many beginning teachers have difficulty effectively managing their classrooms. While there is no one best solution for every problem or classroom setting, the following principles, drawn from a number of sources, might help. Classroom teachers with many years of experience have contributed to an understanding of what works and what doesn't work in managing classrooms and the behavior of students. The following information represents some of the things that good classroom teachers do to maintain an atmosphere that enhances learning. It is written in straightforward, non-preachy language, and will not drive you to distraction with its length. I think most students appreciate that. With that in mind, I truly hope this information is useful to you.
becoming a teacher
Tips on Becoming a Teacher
It is absolutely true that some people, from the time they are in first grade, know they want to be teachers. For others, the idea to become a teacher can be a sudden insight, or a feeling that ferments for years in some remote corner of their consciousness. Regardless of where the idea comes from, for many, the images associated with becoming a teacher are compelling. However, as is often the case in life, the differences between images and reality can be stark, unsettling, and disappointing. Current uncertainties in the American, as well as world economies only serve to exacerbate the differences. This reality is the reason for this page.
We all know that as the "Baby Boomers" retire and leave teaching in large numbers over the next ten years, probably more than a million new teachers will be needed to replace them, let alone hundreds of thousands needed to keep pace with the anticipated growth of student populations, the current world-wide recession notwithstanding. Perhaps you will be one of these new teachers Perhaps not.
The current world-wide recession as of February 2010 has had some impact on public school systems hiring new teachers. In some areas there are hiring freezes, increased class sizes and cuts in courses offered, all of which affect hiring. This situation likely won't last more than a few years, and teachers will be hired, but probably at a much slower pace, affected possibly by the decisions of older teachers to stay longer in teaching than they originally planned. My advice is to hang in there, and be patient.
Please read on.
For lack of a better way to say it, this page is about some basic teacher-things. For sure, not every person who wants to be a teacher should be a teacher. There is a vast gulf between the ideal of teaching and the reality of the classroom. Teaching probably won't make you rich, and, to be sure, no one should make any career decision without gathering as much information as possible. Tips on becoming a teacher is a start.
Make no mistake; teaching is like no other profession. As a teacher, you will wear many hats. You will, to name but of a few of the roles teachers assume in carrying out their duties, be a communicator, a disciplinarian, a conveyor of information, an evaluator, a classroom manager, a counselor, a member of many teams and groups, a decision-maker, a role-model, and a surrogate parent. Each of these roles requires practice and skills that are often not taught in teacher preparation programs. Not all who want to be teachers should invest the time and resources in teacher training or teacher preparation programs if they do not have the appropriate temperament, skills, and personality. Teaching has a very high attrition rate. Depending on whose statistics you trust, around forty percent of new teachers leave teaching within the first five years. It is obviously not what they thought it would be. One thing for sure, it's about more than loving kids.
Make no mistake; as a teacher, your day doesn't necessarily end when the school bell rings. If you're conscientious, you will be involved in after school meetings, committees, assisting students, grading homework, assignments, projects, and calling parents. All these demand some sacrifice of your personal time. If you're committed to excellence as a teacher, it's a sacrifice you can live with. If not, you will be uncomfortable at best.
Teacher training and teacher preparation programs exist in every state, as well as in various forms of on-line courses and degree programs, and the requirements vary. You will have many options from which to choose. Choose wisely. My own advice is to select a program that offers a rich and solid foundation of courses, regardless of whether you intend to teach at the elementary, middle school, or high school level. I believe that no teacher education program, including the one in which I teach, can actually teach you how to teach. Rather, what we do is get you ready to learn how to teach, and that takes place on the job. My advice is to choose a program that offers a rich balance of subject matter content courses and pedagogy, including clinical experience in all its forms. You are learning both skills and understandings in any teacher education program. Practice those skills as perfectly as possible, and strive each day to deepen your understandings of the concepts, theories and generalizations that you encounter. By doing so, you will build a solid foundation for learning how to teach once you become employed, and, you will be a better teacher.
From my own teaching experience and from discussions and teaching many hundreds of teachers and thousands of teacher education students, there emerge common threads of understanding and skill that good teachers weave into an effective personal style of teaching. Assess your own knowledge and values in terms of your thoughts about the following:
Good teachers:
are good at explaining things. Do you like to explain how something works, or how something happened? Being comfortable with explaining content to students is an essential skill for teachers, regardless of the subject or grade level.
keep their cool. There will be times when you will be tempted to scream or yell at your students, other teachers, parents, administrators, and so on. Good teachers are able to successfully resist this urge.
have a sense of humor. Research has consistently shown that good teachers have a sense of humor, and that they are able to use humor as part of their teaching methods. Humor, used properly, can be a powerful addition to any lesson.
like people, especially students in the age range in which they intend to teach. Most teachers choose an area of specialization such as elementary education, special education, secondary education, or higher education because they have a temperament for students in those age ranges. If you are not comfortable working with young children, don't major in elementary education!
are inherently fair-minded. They are able to assess students on the basis of performance, not on the students' personal qualities.
have "common sense." It may sound a bit corny, but good teachers are practical. They can size up a situation quickly and make an appropriate decision. Whether managing a classroom, leading students on a field trip, seamlessly shifting from one instructional procedure to another, assigning detentions, supervising an intern, or dealing with policy and curriculum issues in the school, there is no substitute for common sense.
have a command of the content they teach. For elementary school teachers, that means having knowledge of a broad range of content in sufficient depth to convey the information in meaningful ways to the students. For secondary school teachers, it usually means having an in-depth command of one or two specific content areas such as mathematics or biology.
set high expectations for their students and hold the students to those expectations. If you are thinking about becoming a teacher, you should set high expectations for yourself, and demand excellence not only of yourself, but your students as well.
are detail oriented. If you are a disorganized person in your private life, you will find that teaching will probably be uncomfortable for you. At the very least, teachers must be organized in their professional and teaching duties. If you're not organized and are not detail oriented, teaching may not be the best choice of a profession for you.
are good managers of time. Time is one of the most precious resources a teacher has. Good teachers have learned to use this resource wisely.
can lead or follow, as the situation demands. Sometimes, teachers must be members of committees, groups, councils, and task forces. Having the temperament to function in these capacities is extremely important. At other times, teachers assume leadership roles. Be sure you are comfortable being a leader or a follower, because sooner or later, you will be called on to function in those roles.
don't take things for granted. This applies to everything, from selecting a college or school of education to filing papers for certification. Good follow-through habits should be cultivated throughout life, but they are never more important than during your teacher education program. Read the catalog, know the rules, be aware of prerequisites and meet deadlines. In one sense, you don't learn to teach by getting a degree and becoming certified. You learn to teach in much the same way you learned to drive -- by driving. You learn to teach by teaching, by making mistakes, learning from them and improving. The purpose of a teacher education program is to get you as ready as possible to learn how to teach by subjecting you to a variety of methods and experiences that have a basis in tradition and research.
have some "hard bark" on them. Take it from me as a teacher in both public schools and at the university level, that you need some hard bark in order to survive let alone thrive. to illustrate the point, here is an excerpt from an ADPRIMA page that discusses the subject in more detail:
John Russell, the name of the character played by Paul Newman in the 1967 movie "Hombre," was told, in the latter part of the film by a man he had just shot in order to protect a group of innocent, yet cowardly people, "Mister, you've got some hard bark on you." Indeed he did, because he was both physically tough and tough minded. He was also realistic, honest, fair, and understood that sometimes doing the right thing involves risk. There is a lesson in all of this for education students.
Without a doubt, young men and women entering the teaching profession today need to have some "hard bark" on them. If they don't, the small wounds inflicted by dealing with the everyday problems of teaching, disciplining, planning, counseling, dealing with administrators, colleagues, parents, and so on, mount up. If they're easily wounded by disappointment, rudeness, and even unfairness, they won't last because these things happen, and nothing will change that.
All of these qualities define some of the characteristics of good teachers. If it is not your goal to become a good teacher at the very least, perhaps thinking about the above will help you see other career alternatives. A good idea, when first making such a decision, is to talk to teachers. Find out what they do, and what led them into teaching. Do a personal inventory of your own values, personality, preferences and goals. But, whatever you do, don't go into teaching simply because you love kids!
It is absolutely true that some people, from the time they are in first grade, know they want to be teachers. For others, the idea to become a teacher can be a sudden insight, or a feeling that ferments for years in some remote corner of their consciousness. Regardless of where the idea comes from, for many, the images associated with becoming a teacher are compelling. However, as is often the case in life, the differences between images and reality can be stark, unsettling, and disappointing. Current uncertainties in the American, as well as world economies only serve to exacerbate the differences. This reality is the reason for this page.
We all know that as the "Baby Boomers" retire and leave teaching in large numbers over the next ten years, probably more than a million new teachers will be needed to replace them, let alone hundreds of thousands needed to keep pace with the anticipated growth of student populations, the current world-wide recession notwithstanding. Perhaps you will be one of these new teachers Perhaps not.
The current world-wide recession as of February 2010 has had some impact on public school systems hiring new teachers. In some areas there are hiring freezes, increased class sizes and cuts in courses offered, all of which affect hiring. This situation likely won't last more than a few years, and teachers will be hired, but probably at a much slower pace, affected possibly by the decisions of older teachers to stay longer in teaching than they originally planned. My advice is to hang in there, and be patient.
Please read on.
For lack of a better way to say it, this page is about some basic teacher-things. For sure, not every person who wants to be a teacher should be a teacher. There is a vast gulf between the ideal of teaching and the reality of the classroom. Teaching probably won't make you rich, and, to be sure, no one should make any career decision without gathering as much information as possible. Tips on becoming a teacher is a start.
Make no mistake; teaching is like no other profession. As a teacher, you will wear many hats. You will, to name but of a few of the roles teachers assume in carrying out their duties, be a communicator, a disciplinarian, a conveyor of information, an evaluator, a classroom manager, a counselor, a member of many teams and groups, a decision-maker, a role-model, and a surrogate parent. Each of these roles requires practice and skills that are often not taught in teacher preparation programs. Not all who want to be teachers should invest the time and resources in teacher training or teacher preparation programs if they do not have the appropriate temperament, skills, and personality. Teaching has a very high attrition rate. Depending on whose statistics you trust, around forty percent of new teachers leave teaching within the first five years. It is obviously not what they thought it would be. One thing for sure, it's about more than loving kids.
Make no mistake; as a teacher, your day doesn't necessarily end when the school bell rings. If you're conscientious, you will be involved in after school meetings, committees, assisting students, grading homework, assignments, projects, and calling parents. All these demand some sacrifice of your personal time. If you're committed to excellence as a teacher, it's a sacrifice you can live with. If not, you will be uncomfortable at best.
Teacher training and teacher preparation programs exist in every state, as well as in various forms of on-line courses and degree programs, and the requirements vary. You will have many options from which to choose. Choose wisely. My own advice is to select a program that offers a rich and solid foundation of courses, regardless of whether you intend to teach at the elementary, middle school, or high school level. I believe that no teacher education program, including the one in which I teach, can actually teach you how to teach. Rather, what we do is get you ready to learn how to teach, and that takes place on the job. My advice is to choose a program that offers a rich balance of subject matter content courses and pedagogy, including clinical experience in all its forms. You are learning both skills and understandings in any teacher education program. Practice those skills as perfectly as possible, and strive each day to deepen your understandings of the concepts, theories and generalizations that you encounter. By doing so, you will build a solid foundation for learning how to teach once you become employed, and, you will be a better teacher.
From my own teaching experience and from discussions and teaching many hundreds of teachers and thousands of teacher education students, there emerge common threads of understanding and skill that good teachers weave into an effective personal style of teaching. Assess your own knowledge and values in terms of your thoughts about the following:
Good teachers:
are good at explaining things. Do you like to explain how something works, or how something happened? Being comfortable with explaining content to students is an essential skill for teachers, regardless of the subject or grade level.
keep their cool. There will be times when you will be tempted to scream or yell at your students, other teachers, parents, administrators, and so on. Good teachers are able to successfully resist this urge.
have a sense of humor. Research has consistently shown that good teachers have a sense of humor, and that they are able to use humor as part of their teaching methods. Humor, used properly, can be a powerful addition to any lesson.
like people, especially students in the age range in which they intend to teach. Most teachers choose an area of specialization such as elementary education, special education, secondary education, or higher education because they have a temperament for students in those age ranges. If you are not comfortable working with young children, don't major in elementary education!
are inherently fair-minded. They are able to assess students on the basis of performance, not on the students' personal qualities.
have "common sense." It may sound a bit corny, but good teachers are practical. They can size up a situation quickly and make an appropriate decision. Whether managing a classroom, leading students on a field trip, seamlessly shifting from one instructional procedure to another, assigning detentions, supervising an intern, or dealing with policy and curriculum issues in the school, there is no substitute for common sense.
have a command of the content they teach. For elementary school teachers, that means having knowledge of a broad range of content in sufficient depth to convey the information in meaningful ways to the students. For secondary school teachers, it usually means having an in-depth command of one or two specific content areas such as mathematics or biology.
set high expectations for their students and hold the students to those expectations. If you are thinking about becoming a teacher, you should set high expectations for yourself, and demand excellence not only of yourself, but your students as well.
are detail oriented. If you are a disorganized person in your private life, you will find that teaching will probably be uncomfortable for you. At the very least, teachers must be organized in their professional and teaching duties. If you're not organized and are not detail oriented, teaching may not be the best choice of a profession for you.
are good managers of time. Time is one of the most precious resources a teacher has. Good teachers have learned to use this resource wisely.
can lead or follow, as the situation demands. Sometimes, teachers must be members of committees, groups, councils, and task forces. Having the temperament to function in these capacities is extremely important. At other times, teachers assume leadership roles. Be sure you are comfortable being a leader or a follower, because sooner or later, you will be called on to function in those roles.
don't take things for granted. This applies to everything, from selecting a college or school of education to filing papers for certification. Good follow-through habits should be cultivated throughout life, but they are never more important than during your teacher education program. Read the catalog, know the rules, be aware of prerequisites and meet deadlines. In one sense, you don't learn to teach by getting a degree and becoming certified. You learn to teach in much the same way you learned to drive -- by driving. You learn to teach by teaching, by making mistakes, learning from them and improving. The purpose of a teacher education program is to get you as ready as possible to learn how to teach by subjecting you to a variety of methods and experiences that have a basis in tradition and research.
have some "hard bark" on them. Take it from me as a teacher in both public schools and at the university level, that you need some hard bark in order to survive let alone thrive. to illustrate the point, here is an excerpt from an ADPRIMA page that discusses the subject in more detail:
John Russell, the name of the character played by Paul Newman in the 1967 movie "Hombre," was told, in the latter part of the film by a man he had just shot in order to protect a group of innocent, yet cowardly people, "Mister, you've got some hard bark on you." Indeed he did, because he was both physically tough and tough minded. He was also realistic, honest, fair, and understood that sometimes doing the right thing involves risk. There is a lesson in all of this for education students.
Without a doubt, young men and women entering the teaching profession today need to have some "hard bark" on them. If they don't, the small wounds inflicted by dealing with the everyday problems of teaching, disciplining, planning, counseling, dealing with administrators, colleagues, parents, and so on, mount up. If they're easily wounded by disappointment, rudeness, and even unfairness, they won't last because these things happen, and nothing will change that.
All of these qualities define some of the characteristics of good teachers. If it is not your goal to become a good teacher at the very least, perhaps thinking about the above will help you see other career alternatives. A good idea, when first making such a decision, is to talk to teachers. Find out what they do, and what led them into teaching. Do a personal inventory of your own values, personality, preferences and goals. But, whatever you do, don't go into teaching simply because you love kids!
Kamis, 18 Februari 2010
care planing
Care Plan Constructor
This tool enables you to create customized plans of care by selecting items from many of the Nursing Diagnoses found in the 5th edition, as well as adding your own.
We are always striving to improve our online offerings. Please contact us with any suggestions or problems you experience with the Care Plan Constructor for Gulanick: Nursing Care Plans.
Start New Plan
1. Select a Diagnosis
2. Add Your Own Diagnosis
3. View Current Care Plan
4. Start New Care Plan
Instructions
1. To include Risk Factors, Outcomes, Interventions and Rationales from the book: Select a nursing diagnosis from the list of Care Plans.
2. This part of the Care Plan Constructor works much like an online shopping cart. Check the items on the Nursing Diagnosis page to include in your Plan of Care--you will have the opportunity to edit these later. Unchecking selected items on this page removes them from your Care Plan. If you want to clear all selections, select Start New Care Plan.
3. Return to the Constructor Home page to select other diagnoses.
4. Once you have completed all your selections, select Create the Care Plan or View Current Care Plan.
1. To create/add your own Risk Factors, Outcomes, Interventions and Rationales: Select Add Your Own Diagnosis and begin editing.
1. Editing your Care Plan: If you selected items made available from the book, you will see them at the top of the Care Plan Editing page. At the bottom of the page you may add your own nursing diagnosis.
2. Unless you select Start New Care Plan, your selections will remain selected for eight hours so you can edit them repeatedly.
3. Important: Any additions or edits you make to this page are sent forward to the next page by the Update and Create Printable Plan of Care buttons, but they are not retained for later retrieval. If you want to add more selections from the book, do so before using the Care Plan Editing page.
4. Add your client's name in the box provided at the top of the page.
5. The drop down box allows you to select either Independent (disc) or Collaborative (Triangle) for each Intervention you create.
6. Use the box provided and Update buttons to add more Outcomes and Interventions.
7. Each section may be included or excluded from the Printable Plan of Care by using the "Included on printed Care Plan" checkbox.
8. After you have made all your additions and edits, select Create Printable Plan of Care. The next page may be printed for your use.
Help us improve the Care Plan Constructor by alerting us to printing problems.
9. Hint: If you know HTML, you can alter the appearance of some items by including HTML tags in the editable content boxes.
1. Printing Care Plans You may print a completed care plan directly from your browser.
Netscape Printing Help | Microsoft Internet Explorer Printing Help
2. When you create a printable care plan, the plan will launch in a new window. To print from this window, press the Ctrl-P while that window is active.
1. Saving Care Plans Saving (works best in Netscape 4) — be sure to name your file carefully and save it somewhere you'll find it later.
1. Netscape 4: File-Save As from your browser. In the File Name box, give the page a name and the extension ".txt" — for example, if you call the page mytestcareplan, add the extension ".txt", so the full file name will be mytestcareplan.txt. You will now have an ASCII text version of the Care Plan that may be edited using your text editor or word processing software (eg, Word, WordPerfect).
2. Netscape 6+: File-Save Page As from your browser. You will now have an HTML version of the Care Plan that may be edited using an HTML editor (eg, Composer, HoTMetaL, FrontPage).
3. Internet Explorer 4: File-Save As from your browser and select Save as type: Text File. You will now have an ASCII text version of the Care Plan that may be edited using your text editor or word processing software (eg, Word, WordPerfect). If you Save as type: HTML File you will instead create an HTML version of the Care Plan that may be edited using an HTML editor (eg, Composer, HoTMetaL, FrontPage).
4. Internet Explorer 5+: File-Save As from your browser and select Save as type: Text File. You will now have an ASCII text version of the Care Plan that may be edited using your text editor or word processing software (eg, Word, WordPerfect). If you Save as type: Web Page, HTML Only (do not use Web Page, Complete) you will instead create an HTML version of the Care Plan that may be edited using an HTML editor (eg, Composer, HoTMetaL, FrontPage).
This tool enables you to create customized plans of care by selecting items from many of the Nursing Diagnoses found in the 5th edition, as well as adding your own.
We are always striving to improve our online offerings. Please contact us with any suggestions or problems you experience with the Care Plan Constructor for Gulanick: Nursing Care Plans.
Start New Plan
1. Select a Diagnosis
2. Add Your Own Diagnosis
3. View Current Care Plan
4. Start New Care Plan
Instructions
1. To include Risk Factors, Outcomes, Interventions and Rationales from the book: Select a nursing diagnosis from the list of Care Plans.
2. This part of the Care Plan Constructor works much like an online shopping cart. Check the items on the Nursing Diagnosis page to include in your Plan of Care--you will have the opportunity to edit these later. Unchecking selected items on this page removes them from your Care Plan. If you want to clear all selections, select Start New Care Plan.
3. Return to the Constructor Home page to select other diagnoses.
4. Once you have completed all your selections, select Create the Care Plan or View Current Care Plan.
1. To create/add your own Risk Factors, Outcomes, Interventions and Rationales: Select Add Your Own Diagnosis and begin editing.
1. Editing your Care Plan: If you selected items made available from the book, you will see them at the top of the Care Plan Editing page. At the bottom of the page you may add your own nursing diagnosis.
2. Unless you select Start New Care Plan, your selections will remain selected for eight hours so you can edit them repeatedly.
3. Important: Any additions or edits you make to this page are sent forward to the next page by the Update and Create Printable Plan of Care buttons, but they are not retained for later retrieval. If you want to add more selections from the book, do so before using the Care Plan Editing page.
4. Add your client's name in the box provided at the top of the page.
5. The drop down box allows you to select either Independent (disc) or Collaborative (Triangle) for each Intervention you create.
6. Use the box provided and Update buttons to add more Outcomes and Interventions.
7. Each section may be included or excluded from the Printable Plan of Care by using the "Included on printed Care Plan" checkbox.
8. After you have made all your additions and edits, select Create Printable Plan of Care. The next page may be printed for your use.
Help us improve the Care Plan Constructor by alerting us to printing problems.
9. Hint: If you know HTML, you can alter the appearance of some items by including HTML tags in the editable content boxes.
1. Printing Care Plans You may print a completed care plan directly from your browser.
Netscape Printing Help | Microsoft Internet Explorer Printing Help
2. When you create a printable care plan, the plan will launch in a new window. To print from this window, press the Ctrl-P while that window is active.
1. Saving Care Plans Saving (works best in Netscape 4) — be sure to name your file carefully and save it somewhere you'll find it later.
1. Netscape 4: File-Save As from your browser. In the File Name box, give the page a name and the extension ".txt" — for example, if you call the page mytestcareplan, add the extension ".txt", so the full file name will be mytestcareplan.txt. You will now have an ASCII text version of the Care Plan that may be edited using your text editor or word processing software (eg, Word, WordPerfect).
2. Netscape 6+: File-Save Page As from your browser. You will now have an HTML version of the Care Plan that may be edited using an HTML editor (eg, Composer, HoTMetaL, FrontPage).
3. Internet Explorer 4: File-Save As from your browser and select Save as type: Text File. You will now have an ASCII text version of the Care Plan that may be edited using your text editor or word processing software (eg, Word, WordPerfect). If you Save as type: HTML File you will instead create an HTML version of the Care Plan that may be edited using an HTML editor (eg, Composer, HoTMetaL, FrontPage).
4. Internet Explorer 5+: File-Save As from your browser and select Save as type: Text File. You will now have an ASCII text version of the Care Plan that may be edited using your text editor or word processing software (eg, Word, WordPerfect). If you Save as type: Web Page, HTML Only (do not use Web Page, Complete) you will instead create an HTML version of the Care Plan that may be edited using an HTML editor (eg, Composer, HoTMetaL, FrontPage).
nursing care planing
Nursing care plan
A nursing care plan outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment. The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.
Characteristics of the nursing care plan
1. It focuses on actions which are designed to solve or minimize the existing problem.
2. It is a product of a deliberate systematic process.
3. It relates to the future.
4. It is based upon identifiable health and nursing problems.
5. Its focus is holistic.
6. It focuses to meet all the needs of the service user.
Elements of the plan
In the USA, the nursing care plan may consist of a NANDA nursing diagnosis with related factors and subjective and objective data that support the diagnosis, nursing outcome classifications with specified outcomes (or goals) to be achieved including deadlines, and nursing intervention classifications with specified interventions.
The nursing process
Care plans are formed using the nursing process. First the nurse collects subjective data and objective data, then organizes the data into a systematic pattern, such as Marjory Gordon's Gordon's functional health patterns. This step helps identify the areas in which the client needs nursing care. Based on this, the nurse makes a nursing diagnosis. As mentioned above, the full nursing diagnosis also includes the relating factors and the evidence that supports the diagnosis. For example, a nurse may give the following diagnosis to a patient with pneumonia that has difficulty breathing: Ineffective Airway Clearance related to tracheobronchial infection (pneumonia) and excess thick secretions as evidenced by abnormal breath sounds; crackles, wheezes; change in rate and depth of respiration; and effective cough with sputum.(This Nursing Diagnosis is taken from the list of NANDA's functional health patterns,Disturbed pattern is "Activity and Exercise pattern")
After determining the nursing diagnosis, using the PES (Problem, Etiology, Signs and Symptoms) system, the nurse must state the expected outcomes, or goals. A common method of formulating the expected outcomes is to reverse the nursing diagnosis, stating what evidence should be present in the absence of the problem. The expected outcomes must also contain a goal date. Following the example above, the expected outcome would be: Effective airway clearance as evidenced by normal breath sounds; no crackles or wheezes; respiration rate 14-18/min; and no cough by 01/01/01.
After the goal is set, the nursing interventions must be established. This is the plan of nursing care to be followed to assist the client in recovery. The interventions must be specific, noting how often it is to be performed, so that any nurse or appropriate faculty can read and understand the care plan easily and follow the directions exactly. An example for the patient above would be: Instruct and assist client to TCDB (turn, cough, deep breathe) to assist in loosening and expectoration of mucous every 2 hours.
The evaluation is made on the goal date set. It is stated whether or not the client has met the goal, the evidence of whether or not the goal was met, and if the care plan is to be continued, discontinued or modified. If the care plan is problem-based and the client has recovered, the plan would be discontinued. If the client has not recovered, or if the care plan was written for a chronic illness or ongoing problem, it may be continued. If certain interventions are not helping or other interventions are to be added, the care plan is modified and continued.
Since its inception, the nursing process has been developed and honed by different authors. Additional detail has been added for each stage of the process, and new or adapted stages have also been suggested. The most recent 'repackaging' of the nursing process comes in the form of the ASPIRE approach to planning and delivering care[1]. This approach - developed within Hull University (UK) as a teaching and learning tool - takes the 5-stage approach outlined above and enhances it. 'Diagnosis' is retitled 'Systematic Nursing Diagnosis' to reflect the process of diagnosis in addition to the final product. An additional stage - 'Recheck' - is placed between Implementation and Evaluation, and reflects the information-gathering activities carried out by nurses, necessary to make an informed judgement about the effectiveness of patient care.
There are also care plans written for "at risk" problems, as well as "wellness" care plans. These follow a similar format, only designed to prevent problems from happening and continue or promote healthy behavior.
A- Assessment D- Diagnosis P- Planning I- Intervention E- Evaluation
A nursing care plan outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment. The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.
Characteristics of the nursing care plan
1. It focuses on actions which are designed to solve or minimize the existing problem.
2. It is a product of a deliberate systematic process.
3. It relates to the future.
4. It is based upon identifiable health and nursing problems.
5. Its focus is holistic.
6. It focuses to meet all the needs of the service user.
Elements of the plan
In the USA, the nursing care plan may consist of a NANDA nursing diagnosis with related factors and subjective and objective data that support the diagnosis, nursing outcome classifications with specified outcomes (or goals) to be achieved including deadlines, and nursing intervention classifications with specified interventions.
The nursing process
Care plans are formed using the nursing process. First the nurse collects subjective data and objective data, then organizes the data into a systematic pattern, such as Marjory Gordon's Gordon's functional health patterns. This step helps identify the areas in which the client needs nursing care. Based on this, the nurse makes a nursing diagnosis. As mentioned above, the full nursing diagnosis also includes the relating factors and the evidence that supports the diagnosis. For example, a nurse may give the following diagnosis to a patient with pneumonia that has difficulty breathing: Ineffective Airway Clearance related to tracheobronchial infection (pneumonia) and excess thick secretions as evidenced by abnormal breath sounds; crackles, wheezes; change in rate and depth of respiration; and effective cough with sputum.(This Nursing Diagnosis is taken from the list of NANDA's functional health patterns,Disturbed pattern is "Activity and Exercise pattern")
After determining the nursing diagnosis, using the PES (Problem, Etiology, Signs and Symptoms) system, the nurse must state the expected outcomes, or goals. A common method of formulating the expected outcomes is to reverse the nursing diagnosis, stating what evidence should be present in the absence of the problem. The expected outcomes must also contain a goal date. Following the example above, the expected outcome would be: Effective airway clearance as evidenced by normal breath sounds; no crackles or wheezes; respiration rate 14-18/min; and no cough by 01/01/01.
After the goal is set, the nursing interventions must be established. This is the plan of nursing care to be followed to assist the client in recovery. The interventions must be specific, noting how often it is to be performed, so that any nurse or appropriate faculty can read and understand the care plan easily and follow the directions exactly. An example for the patient above would be: Instruct and assist client to TCDB (turn, cough, deep breathe) to assist in loosening and expectoration of mucous every 2 hours.
The evaluation is made on the goal date set. It is stated whether or not the client has met the goal, the evidence of whether or not the goal was met, and if the care plan is to be continued, discontinued or modified. If the care plan is problem-based and the client has recovered, the plan would be discontinued. If the client has not recovered, or if the care plan was written for a chronic illness or ongoing problem, it may be continued. If certain interventions are not helping or other interventions are to be added, the care plan is modified and continued.
Since its inception, the nursing process has been developed and honed by different authors. Additional detail has been added for each stage of the process, and new or adapted stages have also been suggested. The most recent 'repackaging' of the nursing process comes in the form of the ASPIRE approach to planning and delivering care[1]. This approach - developed within Hull University (UK) as a teaching and learning tool - takes the 5-stage approach outlined above and enhances it. 'Diagnosis' is retitled 'Systematic Nursing Diagnosis' to reflect the process of diagnosis in addition to the final product. An additional stage - 'Recheck' - is placed between Implementation and Evaluation, and reflects the information-gathering activities carried out by nurses, necessary to make an informed judgement about the effectiveness of patient care.
There are also care plans written for "at risk" problems, as well as "wellness" care plans. These follow a similar format, only designed to prevent problems from happening and continue or promote healthy behavior.
A- Assessment D- Diagnosis P- Planning I- Intervention E- Evaluation
ABOUT NURSING,,WD NURHAENY EMBA SAPUTRI
About Nursing: What You Should Know About Professional Nursing!
You need COMPASSION to be a good nurse.
You need TECHNICAL SKILLS to be a good nurse.
You need an in-depth SCIENTIFIC and LIBERAL EDUCATION to be a good nurse.
You need a lot of HEART to be a GREAT nurse!
The POWER to CHANGE lives!
Nurses are the largest single group of healthcare providers in the United States. Over the Years, professional nurses have shed their handmaiden role to become caregivers on the frontlines of health care. Purdue's four-year baccalaureate nursing program prepares you to work with any group of people, in any setting, at any time.
From surgery rooms to neonatal intensive care units to community health clinics, exciting and unlimited career opportunities are available for nurses:
* You can work in the emergency room of a large metropolitan hospital.
* You can help people in underdeveloped countries as a nurse in the Armed Forces or Peace Corps.
* You can deliver home health care to elderly or lower income families as a community health nurse.
* You can work in hospitals all over the world as a nurse employed by one of many traveling nurse agencies.
In the Midwest, $45,000 is the average starting salary for a new graduate with a bachelor's degree in nursing.� Experienced RNs can earn over $60,000 per year.
What Can You Do to Jump-start Your Professional Nursing Career?
Volunteering and community service will increase your self-esteem and teach you to appreciate the simple joys of life. It also gives you hands-on experience with the nursing profession and the healthcare industry.
Hospital Volunteer
Most hospitals have volunteer programs that enable participants to experience various areas of the hospital - from emergency room to intensive care to pediatrics to physical therapy.
Home Health Care
During the last decade, more sick people have been cared for in their own homes. Often, these "patients" need a visiting nurse or home health care service to provide for their advanced medical needs. Volunteers help with small tasks, like reading to a patient. This is a great way to experience the special relationships that form between patients and caregivers.
Extended Care Facility (ECF)
Formerly known as nursing homes, ECFs fulfill residents' basic needs and medical requirements. Since residents also need contact with the outside world, most ECFs provide a variety of extracurricular activities. From chair aerobics to singing to adopt-a-pet programs, volunteers are always needed.
What else can you do?
Look around your community. Do you see people who need help? Don't be afraid to get involved. Community service is an important part of your future success, no matter what career you choose.
Talk to as many nurses and health care professional as possible. Interview them for a school report or ask if you can observe them on-the-job for a day. There may even be mentoring programs already set up through your school.
Learn about the history of nursing and the various facets of nursing.
You need COMPASSION to be a good nurse.
You need TECHNICAL SKILLS to be a good nurse.
You need an in-depth SCIENTIFIC and LIBERAL EDUCATION to be a good nurse.
You need a lot of HEART to be a GREAT nurse!
The POWER to CHANGE lives!
Nurses are the largest single group of healthcare providers in the United States. Over the Years, professional nurses have shed their handmaiden role to become caregivers on the frontlines of health care. Purdue's four-year baccalaureate nursing program prepares you to work with any group of people, in any setting, at any time.
From surgery rooms to neonatal intensive care units to community health clinics, exciting and unlimited career opportunities are available for nurses:
* You can work in the emergency room of a large metropolitan hospital.
* You can help people in underdeveloped countries as a nurse in the Armed Forces or Peace Corps.
* You can deliver home health care to elderly or lower income families as a community health nurse.
* You can work in hospitals all over the world as a nurse employed by one of many traveling nurse agencies.
In the Midwest, $45,000 is the average starting salary for a new graduate with a bachelor's degree in nursing.� Experienced RNs can earn over $60,000 per year.
What Can You Do to Jump-start Your Professional Nursing Career?
Volunteering and community service will increase your self-esteem and teach you to appreciate the simple joys of life. It also gives you hands-on experience with the nursing profession and the healthcare industry.
Hospital Volunteer
Most hospitals have volunteer programs that enable participants to experience various areas of the hospital - from emergency room to intensive care to pediatrics to physical therapy.
Home Health Care
During the last decade, more sick people have been cared for in their own homes. Often, these "patients" need a visiting nurse or home health care service to provide for their advanced medical needs. Volunteers help with small tasks, like reading to a patient. This is a great way to experience the special relationships that form between patients and caregivers.
Extended Care Facility (ECF)
Formerly known as nursing homes, ECFs fulfill residents' basic needs and medical requirements. Since residents also need contact with the outside world, most ECFs provide a variety of extracurricular activities. From chair aerobics to singing to adopt-a-pet programs, volunteers are always needed.
What else can you do?
Look around your community. Do you see people who need help? Don't be afraid to get involved. Community service is an important part of your future success, no matter what career you choose.
Talk to as many nurses and health care professional as possible. Interview them for a school report or ask if you can observe them on-the-job for a day. There may even be mentoring programs already set up through your school.
Learn about the history of nursing and the various facets of nursing.
QUALITIES OF A GOOD NURSE
Qualities of a Good Nurse
Whenever you visit a hospital, you often see a cheerful, active person that is known as a nurse. A nurse is among the most responsible individuals in the hospital. If you want to make a career in this devoted profession, then you should know about the qualities of a good nurse.
Qualities of a Good Nurse
These days, nursing is one of the most in-demand careers. A nurse is an integral part of the health care profession. There are a number of institutes all over the world, which offer different courses in nursing. Nursing profession is just not a great way of making money. It is considered as a holy profession, serving the human being. This profession demands skill, hard work and devotion. To become a good nurse, a person should have the qualities such as passion, interpersonal skill, presence of mind and commitment. Let’s know more about the qualities of a good nurse.
Qualities of a Good Nurse
It’s not that easy to make a career in nursing profession. For that, you should be prepared for extreme hard work and dedication. Here are some qualities that a good nurse should have:
* A good nurse should be highly qualified and trained. She/he should have a sound knowledge of the nursing profession, obtained from a reputed institute. He/she should always be ready to learn more. Good professional skills are a must for the nurse.
* As a nurse is more frequently in contact with the patients, he/she should have excellent communication skills. These include speaking as well as listening skills. The nurse should be able to openly talk with the patients and their family members in order to understand their needs and expectations. He/she should be able to explain the treatment given to the patient.
* Watchfulness is an important quality of a good nurse. He/she should be alert every moment about the condition of a patient. He/she should be able to notice a minor change in the patient’s health status.
* A good nurse should have an emotional stability. Nursing is a very stressful job. Everyday the nurses witness severe traumatic situations, surgeries and deaths. The nurse should be mentally strong and should not get disturbed by such incidences.
* Good presence of mind is crucial in the nursing profession. In any critical condition or medical emergency, if the doctor is not there, then the nurse should not get confused. He/she should be confident enough to take the correct decisions.
* Kindness and empathy are the qualities that every nurse should possess. The nurse should be calm and kind to the patients, even if they are aggressive. The nurse should understand the pains and suffering of patients. He/she should provide comfort and sympathy to the patients, instead of getting angry with them.
* A good nurse should be flexible about his/her working hours and responsibilities. Nursing is a time demanding profession. It’s not like that to work for specific hours. Medical emergencies can occur at any time. Nurses often have to extend their duty hours, work in overnight shifts, or work on weekends too. They should not complain about that.
* A good nurse should have a strong physical endurance. He/she should be able to perform a number of taxing maneuvers, stand up for a long period of time or lift heavy objects/people on a daily basis.
* A nurse should have a respect for people and rules. He/she should be devoted to the profession. He/she should be aware of different cultures and traditions and confidentiality requirements of the patients. He/she should respect the wishes of the patients.
* A nurse should be active and cheerful. Her/his presence should make the patient relaxed and comfortable. The nurse’s pleasant appearance can reduce the patient’s stress and pains. His/her voice should be soft and gentle.
A nurse having these qualities is like an angel for the patients. They can rely on such committed, prompt and skilled nurse for their well-being.
Whenever you visit a hospital, you often see a cheerful, active person that is known as a nurse. A nurse is among the most responsible individuals in the hospital. If you want to make a career in this devoted profession, then you should know about the qualities of a good nurse.
Qualities of a Good Nurse
These days, nursing is one of the most in-demand careers. A nurse is an integral part of the health care profession. There are a number of institutes all over the world, which offer different courses in nursing. Nursing profession is just not a great way of making money. It is considered as a holy profession, serving the human being. This profession demands skill, hard work and devotion. To become a good nurse, a person should have the qualities such as passion, interpersonal skill, presence of mind and commitment. Let’s know more about the qualities of a good nurse.
Qualities of a Good Nurse
It’s not that easy to make a career in nursing profession. For that, you should be prepared for extreme hard work and dedication. Here are some qualities that a good nurse should have:
* A good nurse should be highly qualified and trained. She/he should have a sound knowledge of the nursing profession, obtained from a reputed institute. He/she should always be ready to learn more. Good professional skills are a must for the nurse.
* As a nurse is more frequently in contact with the patients, he/she should have excellent communication skills. These include speaking as well as listening skills. The nurse should be able to openly talk with the patients and their family members in order to understand their needs and expectations. He/she should be able to explain the treatment given to the patient.
* Watchfulness is an important quality of a good nurse. He/she should be alert every moment about the condition of a patient. He/she should be able to notice a minor change in the patient’s health status.
* A good nurse should have an emotional stability. Nursing is a very stressful job. Everyday the nurses witness severe traumatic situations, surgeries and deaths. The nurse should be mentally strong and should not get disturbed by such incidences.
* Good presence of mind is crucial in the nursing profession. In any critical condition or medical emergency, if the doctor is not there, then the nurse should not get confused. He/she should be confident enough to take the correct decisions.
* Kindness and empathy are the qualities that every nurse should possess. The nurse should be calm and kind to the patients, even if they are aggressive. The nurse should understand the pains and suffering of patients. He/she should provide comfort and sympathy to the patients, instead of getting angry with them.
* A good nurse should be flexible about his/her working hours and responsibilities. Nursing is a time demanding profession. It’s not like that to work for specific hours. Medical emergencies can occur at any time. Nurses often have to extend their duty hours, work in overnight shifts, or work on weekends too. They should not complain about that.
* A good nurse should have a strong physical endurance. He/she should be able to perform a number of taxing maneuvers, stand up for a long period of time or lift heavy objects/people on a daily basis.
* A nurse should have a respect for people and rules. He/she should be devoted to the profession. He/she should be aware of different cultures and traditions and confidentiality requirements of the patients. He/she should respect the wishes of the patients.
* A nurse should be active and cheerful. Her/his presence should make the patient relaxed and comfortable. The nurse’s pleasant appearance can reduce the patient’s stress and pains. His/her voice should be soft and gentle.
A nurse having these qualities is like an angel for the patients. They can rely on such committed, prompt and skilled nurse for their well-being.
A GOOD NURSE
A Good Nurse
This is an excerpt from the paper...
A good nurse must be compassionate, conscientious, and competent. Some people might think that that idea is an obvious one because the image of nurses portrayed in the mass media is almost uniformly sympathetic. Lurid stories of hospital nurses who become criminals and harm patients (Tresniowski, Grisby, and Klise 151) emphasize the stereotype of the nurse as a caring professional. Unfortunately, that concept is superficial because it does not capture the complexities that go into the practice of a helping profession. Nurses as much as or more than doctors have a significant impact on the quality and quantity of many people's lives. They are the main point of contact between patient and physician on one hand and between patient and health-care system on the other. The moral responsibility implied in such a position is great indeed, and that is why compassion, conscientiousness, and competence are so important.
Responsibility is, ironically, at the heart of why so many nurses experience burnout great enough to motivate them to leave the profession. Yet the need for nurses' special qualifications persists no matter how many nurses become disenchanted. This research will return to that point, but the qualifications themselves are also important.
Compassion can be considered a fundamental prerequisite for anyone who enters a helping profession, but especially in the case of nurses, whose interaction with patients is literally a matter of life
. . .
Some common words found in the essay are:
Grisby Klise, Skill Acquisition, Benner Ideally, Blanchfield Biordi, Novice Expert, Dreyfus Model, Substance Shadow, Journal Nursing, Administration Quarterly, Nurseweek February, american journal, american journal nursing, journal nursing 96, nursing 96, journal nursing, benner xix, competence nurses, nursing practice, compassionate conscientious, novice expert, nurses nurses, dreyfus model,
Approximate Word count = 1003
Approximate Pages = 4 (250 words per page)
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This is an excerpt from the paper...
A good nurse must be compassionate, conscientious, and competent. Some people might think that that idea is an obvious one because the image of nurses portrayed in the mass media is almost uniformly sympathetic. Lurid stories of hospital nurses who become criminals and harm patients (Tresniowski, Grisby, and Klise 151) emphasize the stereotype of the nurse as a caring professional. Unfortunately, that concept is superficial because it does not capture the complexities that go into the practice of a helping profession. Nurses as much as or more than doctors have a significant impact on the quality and quantity of many people's lives. They are the main point of contact between patient and physician on one hand and between patient and health-care system on the other. The moral responsibility implied in such a position is great indeed, and that is why compassion, conscientiousness, and competence are so important.
Responsibility is, ironically, at the heart of why so many nurses experience burnout great enough to motivate them to leave the profession. Yet the need for nurses' special qualifications persists no matter how many nurses become disenchanted. This research will return to that point, but the qualifications themselves are also important.
Compassion can be considered a fundamental prerequisite for anyone who enters a helping profession, but especially in the case of nurses, whose interaction with patients is literally a matter of life
. . .
Some common words found in the essay are:
Grisby Klise, Skill Acquisition, Benner Ideally, Blanchfield Biordi, Novice Expert, Dreyfus Model, Substance Shadow, Journal Nursing, Administration Quarterly, Nurseweek February, american journal, american journal nursing, journal nursing 96, nursing 96, journal nursing, benner xix, competence nurses, nursing practice, compassionate conscientious, novice expert, nurses nurses, dreyfus model,
Approximate Word count = 1003
Approximate Pages = 4 (250 words per page)
More Essays on A Good Nurse
Rehabilitation Nursing 1276 words
Role of Nursing Research 786 words
Nurse Training and Competency 2927 words
NURSE COMPETENCY AND TRAINING 2935 words
Nursing Tenets 1256 words
Issues in a Nurse/Patient Case 1115 words
Analysis of an Ethical Dilemma 1516 words
Cast Study of a Quadriplegic 2008 words
Salem Witch Trials 2197 words
Preterm Labor vs. Prenatal Harm Through advance 2729 words
Minggu, 14 Februari 2010
WHAT IS TRUE LOVE AND HOW DO YOU KNOW WHEN YOU HAVE FOUND IT
Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. Love never fails.
This verse describes the characteristics of true love. These qualities can certainly be found in the person of Jesus Christ, and they can be found in all truly loving relationships. The problem with trying to “find” love in our dating lives, is that too often we don't look for these characteristics. Rather we look at physical appearance, popularity, or wealth. These are not the qualities that God looks at and neither should we.
But the LORD said to Samuel, “…The LORD does not look at the things man looks at. Man looks at the outward appearance, but the LORD looks at the heart.”
Love is best seen as devotion and action, not an emotion. Love is not exclusively based on how we feel. Certainly our emotions are involved, but they cannot be our only criteria for love. True devotion will always lead to action—true love.
Dear children, let us not love with words or tongue but with ACTIONS and in truth.
IDENTIFYING TRUE LOVE
We can only identify true love and know when we have found it, based on the Word of God. When we match our relationships up to what the Bible says that love is—and we are honestly prepared to make a life-long commitment to that person—then we can say that we are truly “in love.” The three keys to that statement are:
We have to…
1. look at the Word of God
2. be completely honest with ourselves
3. understand the level of commitment that comes with true love
true meaning of friendship..for u my best friend,,,wnes
Have you ever wondered what the real essence of the saying "A Friend in Need is a Friend Indeed" is? People talk about the true value of friendship actually without knowing what it stands for. True friendship is the one, in which the individuals do not have to maintain formalities with each other. Sharing true friendship is the situation, when the person you are talking about is counted as one among your family members, when the relation you share with him/her reaches a stage that even if you don't correspond for sometime, your friendship remains unscathed. Best friends need not meet up often to make sure that the friendship remains constant.
The trust between best friends is such that if one friend falls in trouble, the other will not think twice to help. If the bond between two friends is strong, true friends can endure even long distances. For them, geographical separation is just a part of life. It would not affect their friendship. They make it a point to stay in touch, even in the verge of being exhausted due to the drudgery of everyday life. True friendship never fades away. In fact, it grows better with time. True friendship thrives on trust, inspiration and comfort. Best friends come to know, when the other person is in trouble, merely by listening to their "Hello" over the phone. They can even understand each other's silence.
True friends don't desert each other when one is facing trouble. They would face it together and support each other, even if it is against the interests of the other person. Best friends don't analyze each other; they don't have to do so. They accept each other with their positive and negative qualities. Nothing is hidden between true friends. They know each other's strengths as well as weaknesses. One would not overpower the other. They would respect each other's individuality. In fact, they would understand the similarities and respect the differences. Best friends don't stand any outsider commenting or criticizing their friendship and they can put up a very firm resistance, if anyone does so.
True friends are not opportunists. They don't help, because they have something to gain out of it. True friendship is marked by selflessness. Best friends support even each other, even if the whole world opposes them. It is not easy getting true friends for the lifetime. If you have even one true friend, consider yourself blessed. Remember, all best friends are friends, but not all friends can be best friends. In this world of cynics and back stabbers, there are still some people who are worth being friends with. They have to be recognized and respected for being best friends, for the lifetime.
Jumat, 12 Februari 2010
funny story
I Know This Lawyers
A small town prosecuting attorney called his first witness to the stand in a trial-a grandmotherly, elderly woman. He approached her and asked, "Mrs. Jones, do you know me?"
She responded, "Yes, I do know you Mr. Williams. I've known you since you were a young boy. And frankly, you've been a big disappointment to me. You lie, you cheat on your wife, you manipulate people and talk about them behind their backs. You think you're a rising big shot when you haven't the brains to realize you never will amount to anything more than a two-bit paper pusher. Yes, I know you."
The lawyer was stunned. Not knowing what else to do he pointed across the room and asked, "Mrs. Williams, do you know the defense attorney?"
She again replied, "Why, yes I do. I've known Mr. Bradley since he was a youngster, too. I used to baby-sit him for his parents. And he, too, has been a real disappointment to me. He's lazy, bigoted, he has a drinking problem. The man can't build a normal relationship with anyone and his law practice is one of the shoddiest in the entire state. Yes, I know him."
At this point, the judge rapped the courtroom to silence and called both counselors to the bench. In a very quiet voice, he said with menace, "If either of you asks her if she knows me, you'll be in jail within 3 minutes!"
A small town prosecuting attorney called his first witness to the stand in a trial-a grandmotherly, elderly woman. He approached her and asked, "Mrs. Jones, do you know me?"
She responded, "Yes, I do know you Mr. Williams. I've known you since you were a young boy. And frankly, you've been a big disappointment to me. You lie, you cheat on your wife, you manipulate people and talk about them behind their backs. You think you're a rising big shot when you haven't the brains to realize you never will amount to anything more than a two-bit paper pusher. Yes, I know you."
The lawyer was stunned. Not knowing what else to do he pointed across the room and asked, "Mrs. Williams, do you know the defense attorney?"
She again replied, "Why, yes I do. I've known Mr. Bradley since he was a youngster, too. I used to baby-sit him for his parents. And he, too, has been a real disappointment to me. He's lazy, bigoted, he has a drinking problem. The man can't build a normal relationship with anyone and his law practice is one of the shoddiest in the entire state. Yes, I know him."
At this point, the judge rapped the courtroom to silence and called both counselors to the bench. In a very quiet voice, he said with menace, "If either of you asks her if she knows me, you'll be in jail within 3 minutes!"
Kamis, 11 Februari 2010
DAILY DUTIES A DIRECTOR OF NURSING,,,wd.nurhaeny emba saputri
Daily Duties of a Director of Nursing
Article Rating: (1 Ratings)
A director of nursing, also known as a nursing director, is a member of the nursing executive team who oversees several nurse managers and reports to the chief nursing officer of the organization.
Responsibilities
1. According to the National Student Nurses' Association, a director of nursing plans, develops, implements and evaluates strategic operations. She will meet formally and informally with physicians, other department heads and staff throughout the day to carry out that responsibility.
Functions
2. A director of nursing coordinates new programs and ensures strategies are in place to improve current services. On a day-to-day basis, she will conduct market research, network with colleagues at other organizations, and meet with quality improvement specialists to ensure the best possible patient care.
Features
3. A great director of nursing actively seeks input from nursing staff to improve nursing practice, and visits clinical areas regularly to monitor the satisfaction of both staff and patients.
Significance
4. According to the Robert Wood Johnson Foundation, nursing directors are key players in health care reform. A nursing director plans regular interactions with influential clinicians and hospital leaders to play her part in furthering the organization's mission and values.
Salary
5. The director of nursing salary varies depending on her education and experience. According to Salary.com, the median salary for a nursing director in the United States is $108,679 a year, according to 2009 data.
Article Rating: (1 Ratings)
A director of nursing, also known as a nursing director, is a member of the nursing executive team who oversees several nurse managers and reports to the chief nursing officer of the organization.
Responsibilities
1. According to the National Student Nurses' Association, a director of nursing plans, develops, implements and evaluates strategic operations. She will meet formally and informally with physicians, other department heads and staff throughout the day to carry out that responsibility.
Functions
2. A director of nursing coordinates new programs and ensures strategies are in place to improve current services. On a day-to-day basis, she will conduct market research, network with colleagues at other organizations, and meet with quality improvement specialists to ensure the best possible patient care.
Features
3. A great director of nursing actively seeks input from nursing staff to improve nursing practice, and visits clinical areas regularly to monitor the satisfaction of both staff and patients.
Significance
4. According to the Robert Wood Johnson Foundation, nursing directors are key players in health care reform. A nursing director plans regular interactions with influential clinicians and hospital leaders to play her part in furthering the organization's mission and values.
Salary
5. The director of nursing salary varies depending on her education and experience. According to Salary.com, the median salary for a nursing director in the United States is $108,679 a year, according to 2009 data.
HOW TO BE A DIRECTOR OF NURSING,,wd.nurhaeny emba saputri
How to Be a Director of Nursing
Article Rating: (1 Ratings)
According to the National Student Nurses' Association (NSNA), the director of nursing (DON) role is the entry-level position into executive leadership within a hospital or other health-care organization. The DON is typically responsible for several nursing units or service lines, overseeing unit-based nurse managers who have 24/7 accountability for specific clinical areas. The director of nursing generally reports to the chief nursing officer, who is the highest ranking administrative nurse within the organization. According to the Bureau of Labor Statistics, jobs for health services managers such as directors of nursing will grow 16 percent between 2006 and 2016.
Instructions
Things You'll Need:
* RN license
1.
Step 1
Earn your RN license. You can start your educational journey in a bachelor's of science degree in nursing (BSN) program at an accredited college or university. Upon successful completion of your BSN, you'll need to pass a standardized national exam known as the NCLEX to earn state-specific licensure as an RN.
2.
Step 2
Get some experience under your belt. According to NSNA, nursing directors generally need five to seven years of practice. You can start as a staff nurse, delivering care to patients to get a solid foundation of clinical knowledge and technical skills. While you're at it, take some continuing education courses with a leadership focus.
3.
Step 3
Move up through the ranks. The assistant nurse manager role is a good starting point. When you're ready and the time is right, move up to a nurse manager role. Take advantage of any educational programs and mentoring your employer offers.
4.
Step 4
Align yourself with the organization's mission. Every health-care organization has missions, values and strategic goals. When you're selected for a DON role, you'll be expected to implement effective strategies for the clinical areas you oversee. Focus on how your clinical areas contribute to the overall organization, and collaborate with colleagues to ensure your strategies are successful.
5.
Step 5
Go to graduate school. A director of nursing needs extensive knowledge of an increasingly complex health-care environment. According to NSNA, a master of science in nursing (MSN), master of health science (MHS) or graduate degree in a business-related field (such as an MBA) will give you the education you need for your DON role.
6.
Step 6
Network with colleagues. There's no need to reinvent the wheel everytime you face a new challenge. Keep up to date with health-care journals focused on management, play an active role in local organizations for nurse leaders, and attend professional conferences regularly.
Article Rating: (1 Ratings)
According to the National Student Nurses' Association (NSNA), the director of nursing (DON) role is the entry-level position into executive leadership within a hospital or other health-care organization. The DON is typically responsible for several nursing units or service lines, overseeing unit-based nurse managers who have 24/7 accountability for specific clinical areas. The director of nursing generally reports to the chief nursing officer, who is the highest ranking administrative nurse within the organization. According to the Bureau of Labor Statistics, jobs for health services managers such as directors of nursing will grow 16 percent between 2006 and 2016.
Instructions
Things You'll Need:
* RN license
1.
Step 1
Earn your RN license. You can start your educational journey in a bachelor's of science degree in nursing (BSN) program at an accredited college or university. Upon successful completion of your BSN, you'll need to pass a standardized national exam known as the NCLEX to earn state-specific licensure as an RN.
2.
Step 2
Get some experience under your belt. According to NSNA, nursing directors generally need five to seven years of practice. You can start as a staff nurse, delivering care to patients to get a solid foundation of clinical knowledge and technical skills. While you're at it, take some continuing education courses with a leadership focus.
3.
Step 3
Move up through the ranks. The assistant nurse manager role is a good starting point. When you're ready and the time is right, move up to a nurse manager role. Take advantage of any educational programs and mentoring your employer offers.
4.
Step 4
Align yourself with the organization's mission. Every health-care organization has missions, values and strategic goals. When you're selected for a DON role, you'll be expected to implement effective strategies for the clinical areas you oversee. Focus on how your clinical areas contribute to the overall organization, and collaborate with colleagues to ensure your strategies are successful.
5.
Step 5
Go to graduate school. A director of nursing needs extensive knowledge of an increasingly complex health-care environment. According to NSNA, a master of science in nursing (MSN), master of health science (MHS) or graduate degree in a business-related field (such as an MBA) will give you the education you need for your DON role.
6.
Step 6
Network with colleagues. There's no need to reinvent the wheel everytime you face a new challenge. Keep up to date with health-care journals focused on management, play an active role in local organizations for nurse leaders, and attend professional conferences regularly.
HOW TO BE A NURSE MANAGER,,wd.nurhaeny emba saputri
How to Be a Nurse Manager
Article Rating: (1 Ratings)
A nurse manager is a nursing supervisor who works with other nurses. Nurse managers make sure that nurses are able to function effectively and delivery good patient care to others. Becoming a nurse manager will allow you to earn money and use your skills at the same time.
Instructions
1.
Step 1
nurse
nurse
Graduate from nursing school. In order to become a nurse manager you must first become a nurse. In order to become a nurse you must first earn your RN or LPN license. You must complete all undergraduate coursework and spent at least one term working with patients in a hospital setting.
2.
Step 2
stethescope
stethescope
Gain experience. Spend at least two years working full time in a hospital or other health care setting. During this time pay close attention to the hospital's procedures and practices as well as how other nurse managers interac with staff members.
3.
Step 3
patient hands
patient hands
Get additional education. In order to become a nurse manager you should ideally graduate with a BSN or bachelor's of science in nursing degree. Once you have graduated from a college you should seek out additional educational credits such as a master's degree in the field of nursing as well as credits in business in order to understand how to work well with others.
4.
Step 4
Learn all aspects of the nursing business. As part of your nursing training you should learn as much as possible about nursing care including how to take care of patients and how to work with other nurses and doctors to make sure that patients receive the best possible health care.
5.
Step 5
Look for a mentor. Seek out a mentor. A nursing manager should have a role model they can follow and emulate. A good mentor will work with you to help you achieve your career goals. A good nursing mentor will understand all aspects of patient care and work with you to become better at your job.
Article Rating: (1 Ratings)
A nurse manager is a nursing supervisor who works with other nurses. Nurse managers make sure that nurses are able to function effectively and delivery good patient care to others. Becoming a nurse manager will allow you to earn money and use your skills at the same time.
Instructions
1.
Step 1
nurse
nurse
Graduate from nursing school. In order to become a nurse manager you must first become a nurse. In order to become a nurse you must first earn your RN or LPN license. You must complete all undergraduate coursework and spent at least one term working with patients in a hospital setting.
2.
Step 2
stethescope
stethescope
Gain experience. Spend at least two years working full time in a hospital or other health care setting. During this time pay close attention to the hospital's procedures and practices as well as how other nurse managers interac with staff members.
3.
Step 3
patient hands
patient hands
Get additional education. In order to become a nurse manager you should ideally graduate with a BSN or bachelor's of science in nursing degree. Once you have graduated from a college you should seek out additional educational credits such as a master's degree in the field of nursing as well as credits in business in order to understand how to work well with others.
4.
Step 4
Learn all aspects of the nursing business. As part of your nursing training you should learn as much as possible about nursing care including how to take care of patients and how to work with other nurses and doctors to make sure that patients receive the best possible health care.
5.
Step 5
Look for a mentor. Seek out a mentor. A nursing manager should have a role model they can follow and emulate. A good mentor will work with you to help you achieve your career goals. A good nursing mentor will understand all aspects of patient care and work with you to become better at your job.
HOW TO BE A GOOD NURSE,, Wd.nurhaeny emba saputri
How to Be a Good Nurse
Article Rating: (11 Ratings)
Like every job in the medical field, nursing takes a special person who is willing to be selfless and patient. Here are some tips on how to be a good nurse.
Instructions
1.
Step 1
Listening Skills: One of the most important traits a nurse can have is good listening skills. This can be either on the patient, or it can be on the doctor end. When you have good listening skills, the patients are better off in your care because you can tell the doctor what they are feeling and they feel like you actually care about their needs.
2.
Step 2
Double Check Instructions: Good nurses always double or sometimes triple check their instructions. This can be from the test the doctor ordered on the chart or the shot they are ready to give a patient.
3.
Step 3
That Special Touch: In order to be a good nurse, you need that "special touch." You know just how to make the patients bed, or give them a sponge bath in their bed. You know how to make them feel like you are their grandmother, someone who really cares about their wellbeing.
4.
Step 4
Be Observant: There are many people and things around you. Being observant to the doctors, the patients, and the personnel is a good way to prevent mistakes or situations where someone could get hurt. Good example: there is a patient in room 261 who has a problem breathing which you can hear when you walk by their room. You can either A: ignore them, B: go ask the nurse who has them to check on them, or C: actually go in the room and check on the patient. If you had chosen C, you might have noticed that their oxygen level had dropped considerably and they needed immediate attention. Being observant to your environment is a great trait for nurses.
5.
Step 5
Attitude: Have you ever noticed that when you have a bad day and express it, people around you start to have a bad day? That is why nurses need to have a positive attitude when they are in their work environment. Now if you had just lost your only son to cancer, then yes your countenance will be sorrowful. Yet you need to lay aside your personal life (your argument with your husband, the messy room of your son) and make your patients' day as bright as possible.
Article Rating: (11 Ratings)
Like every job in the medical field, nursing takes a special person who is willing to be selfless and patient. Here are some tips on how to be a good nurse.
Instructions
1.
Step 1
Listening Skills: One of the most important traits a nurse can have is good listening skills. This can be either on the patient, or it can be on the doctor end. When you have good listening skills, the patients are better off in your care because you can tell the doctor what they are feeling and they feel like you actually care about their needs.
2.
Step 2
Double Check Instructions: Good nurses always double or sometimes triple check their instructions. This can be from the test the doctor ordered on the chart or the shot they are ready to give a patient.
3.
Step 3
That Special Touch: In order to be a good nurse, you need that "special touch." You know just how to make the patients bed, or give them a sponge bath in their bed. You know how to make them feel like you are their grandmother, someone who really cares about their wellbeing.
4.
Step 4
Be Observant: There are many people and things around you. Being observant to the doctors, the patients, and the personnel is a good way to prevent mistakes or situations where someone could get hurt. Good example: there is a patient in room 261 who has a problem breathing which you can hear when you walk by their room. You can either A: ignore them, B: go ask the nurse who has them to check on them, or C: actually go in the room and check on the patient. If you had chosen C, you might have noticed that their oxygen level had dropped considerably and they needed immediate attention. Being observant to your environment is a great trait for nurses.
5.
Step 5
Attitude: Have you ever noticed that when you have a bad day and express it, people around you start to have a bad day? That is why nurses need to have a positive attitude when they are in their work environment. Now if you had just lost your only son to cancer, then yes your countenance will be sorrowful. Yet you need to lay aside your personal life (your argument with your husband, the messy room of your son) and make your patients' day as bright as possible.
HOW TO BECOME A LAWYER OR ATTORNEY,,,WNES
How to Become a Lawyer or Attorney
Article Rating: (1 Ratings)
How to turn yourself into a Lawyer or Attorney. So you want to be a lawyer or attorney? This is a long and tedious process that requires years of dedication and studying. Here are the steps:
Instructions
1.
Step 1
First, you should get into the best college you can go to for a four year degree, you'll need either a B.A. or B.S. or the like. Major in a course of study that focuses on reading, writing, logic, problem solving and strategy. To go to law school you do not need to have a pre-law degree, however, a major in biology will not do much to help you with the skills needed to succeed in this course of study. Criminal justice degrees and the like are also not generally smiled upon as they don't prepare students with the writing and reading skills needed for law school or to be a lawyer. You'll learn lots of law in law school and as an attorney, there's no need to learn it now when you should be honing your writing and reading skills in college. Good majors to choose are business, pre-law, engineering if you want to be a patent attorney (but of course make sure to take writing and reading classes), english, economics, accounting or finance.
2.
Step 2
Second, while you are finishing up your degree, you'll need to register and take the Law School Admission Test (LSAT), see my article on studying for this exam. This is generally taken during your senior year of college or right before your senior year of college.
3.
Step 3
Third, you'll have to register with the Law School Admission Counsel (LSAC) online. This is where you'll be submitting your transcripts, recommendation letters and admission essays (please see my other articles on all of these for more information!). You'll use the LSAC to apply to any law schools you wish to attend.
4.
Step 4
Fourth, once you've been accepted, most reputable law schools only matriculate in the fall of each year, so you'll have to wait until then. During the summer before law school, get a legal or at least an office job to start building your resume.
5.
Step 5
Fifth, once you've started school, you'll want to read my article on "How to Do Well in Law School". You'll be in law school for a minimum of three years and a maximum of five years. You are not allowed to stretch out your law degree for longer than five years, even if attending part-time.
6.
Step 6
Sixth, after graduating, if you wish to practice law, you'll have to take a bar examination (see my article on taking the MBE). During your last year of law school, you should apply to take the bar examination at least 6-8 months in advance. They will do a screen on your character and fitness to practice law and be an attorney. You will be required to collect documentation and fill out lengthy forms along with pay hefty fees to sit for a bar exam. You should enroll in a bar preparation course of your choosing (See my article on Studying for the Bar Examination). Take your bar exam, pass, and be sworn in as an attorney and you're on your way!
7.
Step 7
Law school is a costly and time consuming venture, before you decide to take the plunge, make sure to research all alternatives and be realistic with your goals. Starting attorneys do not make heaps of money like the movies want you to believe and many people fail out of law school with huge student loan debt they will need to pay back even if they didn't graduate with a degree or pass a bar exam. Good luck!
Article Rating: (1 Ratings)
How to turn yourself into a Lawyer or Attorney. So you want to be a lawyer or attorney? This is a long and tedious process that requires years of dedication and studying. Here are the steps:
Instructions
1.
Step 1
First, you should get into the best college you can go to for a four year degree, you'll need either a B.A. or B.S. or the like. Major in a course of study that focuses on reading, writing, logic, problem solving and strategy. To go to law school you do not need to have a pre-law degree, however, a major in biology will not do much to help you with the skills needed to succeed in this course of study. Criminal justice degrees and the like are also not generally smiled upon as they don't prepare students with the writing and reading skills needed for law school or to be a lawyer. You'll learn lots of law in law school and as an attorney, there's no need to learn it now when you should be honing your writing and reading skills in college. Good majors to choose are business, pre-law, engineering if you want to be a patent attorney (but of course make sure to take writing and reading classes), english, economics, accounting or finance.
2.
Step 2
Second, while you are finishing up your degree, you'll need to register and take the Law School Admission Test (LSAT), see my article on studying for this exam. This is generally taken during your senior year of college or right before your senior year of college.
3.
Step 3
Third, you'll have to register with the Law School Admission Counsel (LSAC) online. This is where you'll be submitting your transcripts, recommendation letters and admission essays (please see my other articles on all of these for more information!). You'll use the LSAC to apply to any law schools you wish to attend.
4.
Step 4
Fourth, once you've been accepted, most reputable law schools only matriculate in the fall of each year, so you'll have to wait until then. During the summer before law school, get a legal or at least an office job to start building your resume.
5.
Step 5
Fifth, once you've started school, you'll want to read my article on "How to Do Well in Law School". You'll be in law school for a minimum of three years and a maximum of five years. You are not allowed to stretch out your law degree for longer than five years, even if attending part-time.
6.
Step 6
Sixth, after graduating, if you wish to practice law, you'll have to take a bar examination (see my article on taking the MBE). During your last year of law school, you should apply to take the bar examination at least 6-8 months in advance. They will do a screen on your character and fitness to practice law and be an attorney. You will be required to collect documentation and fill out lengthy forms along with pay hefty fees to sit for a bar exam. You should enroll in a bar preparation course of your choosing (See my article on Studying for the Bar Examination). Take your bar exam, pass, and be sworn in as an attorney and you're on your way!
7.
Step 7
Law school is a costly and time consuming venture, before you decide to take the plunge, make sure to research all alternatives and be realistic with your goals. Starting attorneys do not make heaps of money like the movies want you to believe and many people fail out of law school with huge student loan debt they will need to pay back even if they didn't graduate with a degree or pass a bar exam. Good luck!
HOW BECOME A SMART LAWYER,,,WNES
How to Become a Smart Lawyer
Article Rating: (1 Ratings)
Good lawyers are common, but great lawyers are hard to find. What separates the men from the boys in the legal profession has a lot to do with a complex set of skills. But behind these skills lies the same attitude that separates mediocrity and greatness in any profession. Great lawyers love what they do, and this passion is what drives them to master every aspect of their profession. There are no classes you can take. What counts is changing the way you think.
Instructions
1.
Step 1
Know the law thoroughly. The substantive law of the case is obviously important--case law as it applies to slip and fall accidents, for example. You cannot memorize an entire law library, so you're going to have to study for every case. Evidence law is also critical, so that you can get your client's evidence in and keep your opponent's evidence out. Most important, however, is a split-second command of civil procedure--if you're one second too late to raise an objection, you have already missed the chance.
2.
Step 2
Know the facts of your case inside and out, detail by torturous detail. This is not so much a matter of reading the case file a hundred times as it is a matter of developing the ability to concentrate like a yoga master. Every case is a complex interaction between the law and its application to the specific facts of your case, and the law applies differently to every case.
3.
Step 3
Develop objectivity. This is the most difficult of all skills to achieve. Take the time to pretend you are your opponent's lawyer and plan a strategy to defeat your own case. Then pretend you are the judge and make a judgment. You don't need to sit at your desk with a laptop all day--great lawyers ponder their cases even while brushing their teeth. Objectivity is something you can practice in every area of your life, from discussions with your spouse to consultations with your garage mechanic.
4.
Step 4
Believe in your client and in your side of the case. Either refuse cases you don't believe in, or learn to brainwash yourself. The old saying, "If you don't believe, you don't belong," is nowhere more true than in the courtroom. The lawyers who make the most money are the ones who aren't practicing law primarily for money.
5.
Step 5
Know your own weaknesses. This will take both objectivity and humility. It is better to work around your weaknesses than to vainly attempt to be someone you're not. If you find the courage to admit to yourself that you will never develop the verbal fluency to give great summations, you can spend your time learning to cross-examine so skillfully that the witness will grudgingly advocate your cause more eloquently than you can. If you are not a great organizer, hire talented staff to organize for you.
6.
Step 6
Pay attention to detail, or hire someone who can do it for you. Great lawyers can imagine a trial so clearly that they will avoid small mistakes that cost other lawyers. Trials are part show business, and a good lawyer pays as much attention to choreography as a good director does.
7.
Step 7
Develop sound professional judgment. Apart from experience, the most important factor in good judgment is the ability to control your emotions. Tame your emotions and you will gain a great advantage while you coldly plot how to push the emotional buttons of opposing counsel to rattle them into making stupid mistakes.The ability to see beyond your own ego and emotions is extremely rare, and it is this quality more than any other that makes a great lawyer.
8.
Step 8
Learn how to handle clients. The client is the boss, but clients are typically more emotionally involved than their lawyers are, and they often insist upon bad decisions that will tie the hands of their lawyers. You will need to learn how to subtly guide your client into making the decisions you want them to make, and let them think it was all their idea. One-on-one persuasiveness is very different from being eloquent before a jury. Great lawyers are master psychologists.
9.
Step 9
Learn to think on your feet. You should be constantly anticipating possible scenarios and rehearsing your options in reactions to them, just like a good driver instinctively anticipates what his options would be if, say, another drive ran a red light. If you do this constantly, it will become second nature.
10.
Step 10
Keep your finger on the pulse of the people. Don't just associate with other lawyers. You will be dealing with juries made up of ordinary people, so it make a point to befriend people from all walks of life--the janitor, the mailman, the hairdresser, the taxi driver. Ask their opinions, listen to their viewpoints and understand how they think.
11.
Step 11
Learn how to teach people accurately, clearly and quickly--courts and juries need to be educated on the details of various cases (imagine a software piracy case, for example). If you have no experience teaching, then take a part-time job teaching ESL to immigrants--anything it takes to help you develop the ability to condense and simplify information and present it to people of average intelligence in easily digestible form.
12.
Step 12
Assemble a great staff. Learn to recognize talent, and take the time to think about how to who to trust, how much to trust them, and what to trust them for. You only have 24 hours a day, and a lot of what will make you smart is the legwork that other people have done under your supervision.
Article Rating: (1 Ratings)
Good lawyers are common, but great lawyers are hard to find. What separates the men from the boys in the legal profession has a lot to do with a complex set of skills. But behind these skills lies the same attitude that separates mediocrity and greatness in any profession. Great lawyers love what they do, and this passion is what drives them to master every aspect of their profession. There are no classes you can take. What counts is changing the way you think.
Instructions
1.
Step 1
Know the law thoroughly. The substantive law of the case is obviously important--case law as it applies to slip and fall accidents, for example. You cannot memorize an entire law library, so you're going to have to study for every case. Evidence law is also critical, so that you can get your client's evidence in and keep your opponent's evidence out. Most important, however, is a split-second command of civil procedure--if you're one second too late to raise an objection, you have already missed the chance.
2.
Step 2
Know the facts of your case inside and out, detail by torturous detail. This is not so much a matter of reading the case file a hundred times as it is a matter of developing the ability to concentrate like a yoga master. Every case is a complex interaction between the law and its application to the specific facts of your case, and the law applies differently to every case.
3.
Step 3
Develop objectivity. This is the most difficult of all skills to achieve. Take the time to pretend you are your opponent's lawyer and plan a strategy to defeat your own case. Then pretend you are the judge and make a judgment. You don't need to sit at your desk with a laptop all day--great lawyers ponder their cases even while brushing their teeth. Objectivity is something you can practice in every area of your life, from discussions with your spouse to consultations with your garage mechanic.
4.
Step 4
Believe in your client and in your side of the case. Either refuse cases you don't believe in, or learn to brainwash yourself. The old saying, "If you don't believe, you don't belong," is nowhere more true than in the courtroom. The lawyers who make the most money are the ones who aren't practicing law primarily for money.
5.
Step 5
Know your own weaknesses. This will take both objectivity and humility. It is better to work around your weaknesses than to vainly attempt to be someone you're not. If you find the courage to admit to yourself that you will never develop the verbal fluency to give great summations, you can spend your time learning to cross-examine so skillfully that the witness will grudgingly advocate your cause more eloquently than you can. If you are not a great organizer, hire talented staff to organize for you.
6.
Step 6
Pay attention to detail, or hire someone who can do it for you. Great lawyers can imagine a trial so clearly that they will avoid small mistakes that cost other lawyers. Trials are part show business, and a good lawyer pays as much attention to choreography as a good director does.
7.
Step 7
Develop sound professional judgment. Apart from experience, the most important factor in good judgment is the ability to control your emotions. Tame your emotions and you will gain a great advantage while you coldly plot how to push the emotional buttons of opposing counsel to rattle them into making stupid mistakes.The ability to see beyond your own ego and emotions is extremely rare, and it is this quality more than any other that makes a great lawyer.
8.
Step 8
Learn how to handle clients. The client is the boss, but clients are typically more emotionally involved than their lawyers are, and they often insist upon bad decisions that will tie the hands of their lawyers. You will need to learn how to subtly guide your client into making the decisions you want them to make, and let them think it was all their idea. One-on-one persuasiveness is very different from being eloquent before a jury. Great lawyers are master psychologists.
9.
Step 9
Learn to think on your feet. You should be constantly anticipating possible scenarios and rehearsing your options in reactions to them, just like a good driver instinctively anticipates what his options would be if, say, another drive ran a red light. If you do this constantly, it will become second nature.
10.
Step 10
Keep your finger on the pulse of the people. Don't just associate with other lawyers. You will be dealing with juries made up of ordinary people, so it make a point to befriend people from all walks of life--the janitor, the mailman, the hairdresser, the taxi driver. Ask their opinions, listen to their viewpoints and understand how they think.
11.
Step 11
Learn how to teach people accurately, clearly and quickly--courts and juries need to be educated on the details of various cases (imagine a software piracy case, for example). If you have no experience teaching, then take a part-time job teaching ESL to immigrants--anything it takes to help you develop the ability to condense and simplify information and present it to people of average intelligence in easily digestible form.
12.
Step 12
Assemble a great staff. Learn to recognize talent, and take the time to think about how to who to trust, how much to trust them, and what to trust them for. You only have 24 hours a day, and a lot of what will make you smart is the legwork that other people have done under your supervision.
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