There can’t possibly be a nurse in the world who hasn’t at some point laughed, cried, or complained about the concept of the nursing diagnosis. It is one of the uniting factors we as nurses, young and old, regardless of level of training, specialty, or experience have: the nursing care plan. These time consuming, monotonous, and sometimes even silly write-ups consumed much of my nurse schooling. They made up the dreaded preparation for clinical, the dreaded write-ups each week that determined whether your care had been satisfactory or not. Sure, these care plans serve a purpose. They are like training wheels: two extra conveniently located wheels that keep the bike upright before its rider has gotten the motion of it down to a science.
Let me explain what I am talking about to my non-nurse readers. Much of what nurses do is establish the plan of care for the patient. Because we are the one in and out of the room, and realistically at the bedside all day, it makes sense that we initiate a plan of what the patient will need in addition to the medications and procedures planned out by the physician. We prioritize the patient care, address current needs, and project the future anticipated issues with their necessary interventions. As a seasoned RN planning all of this becomes second nature. Give me a few details of a hypothetical patient and I can likely tell you their priorities and my subsequent plan of care. I can now ride this bike on two wheels.
In nursing school I wasn’t ready, I needed the training wheels, the ribbons on the handle bars, and a basket on front. So I spent hours surrounded by text books each week before clinical, flipping through the pages trying to find something, anything that my patient may need that I, as the nurse, could actually provide. These interventions are not to be confused with medical assessment, diagnosis, and treatment. The doctor can say pneumonia but the nurse gets dibs on ineffective gas echange or impaired airway clearance.
Each care plan required a certain number of diagnoses with interventions each week. Many varied drastically by patient but I learned early on that I could save buckets of time by having a few broad staples I could apply to anyone.
Caregiver Role Strain
As evidenced by tired, cranky, rude family member, secondary to chronically and acutely ill child.
I mean really, what patient in the hospital doesn’t fit the criteria for caregiver role strain? Every patient has an exhausted and strained wife, husband, child, friend, or parent. On the off chance that I encountered someone that didn’t fit here, I always kept “lack of social support” suited up on the bench, but I rarely needed to use it.
As a kid I experienced the extent of this caregiver strain. My father is a gentle giant. On paper the man is terrifying; former Special Forces in the Army, he hunts and shoots, has an important job. On days that he works, he has that professional appearance that intimidates. On days when he doesn’t he has that scary homeless man appearance that intimidates. But under that bearded trained killer shell is the sweetest man I have ever known. Yet, I watched first hand as “caregiver role strain” ate away at his soft exterior. I watched him go from the gentleman that always has a hug and a joke, the man that befriends the waitress or cashier every time, to the man that was short with nurses and lost his temper at doctors. The parent that makes the nurses duck the other way and whisper under their breath about “the crazy dad in room 7.”
I watched as my parents held strong on the outside, but behind the closed doors of their bedroom or outside of my hospital room crumbled under the pressure of a sick child.
As a nurse it is so easy to feel frustrated with family members. They are often in the way, focused on the wrong details, demanding, and unrealistic. Most days it seems like the job would be easier without them. I have been guilty on multiple occasions of snapping at a parent, rolling my eyes, or leaving the room to gripe with my coworkers. When a parent loses their cool I have written them off as crazy or inappropriate. In those moments, I forget watching my father do the same. I forget that instead of being frustrated with their lack of understanding of what I need to do, maybe I should instead be overwhelmingly aware of my inability to fully understand what they are going through.
I did this again this week when a parent questioned the way I had done something. I felt myself beginning to snap back at his ignorance of what I was doing, his lack of trust in my abilities. I felt frustrated, belittled, and annoyed. It wasn’t until I left to room to clarify what I had done with a fellow nurse that I realized this father has watched this done over and over, but without the understanding of why and how the plan may change. I should want nothing less from the parents of my patients than that attention to detail.
Parenting looks hard. Parenting a sick child looks nearly impossible.
Caregiver role strain doesn’t even begin to cover it.
Family friends of ours experienced this similar struggle through the slow and draining loss of their middle son to a rare and degenerative disease. They stood by, adjusted, and strained as their once vibrant and healthy son slowly lost his vision, his independence, and eventually his life. By the end of his life his parents and brothers felt broken and fragile, yet they were blessed to be surrounded by support. Support doesn’t fix the difficulty a caregiver experiences, but it can help. Out of their experience, they started a full time ministry, David’s Refuge, for families in these situations. Similarly strained caregivers in need of recuperation and respite.
They serve these parents by providing them a break. A time to be together and refill the tank, something I am learning is important for all of us. More than any of this though, they validate their guests and stand alongside them. They remind them that they aren’t alone.
Often as caregivers we focus so thoroughly on the patient that we forget the family. As a result, I think often the family forgets themselves as well.
So maybe I do still need my care plans and nursing diagnosis.
Over the last few weeks I have tried harder to remember this staple diagnosis in the care I provide and for my life in general. I plan to do it better in the future.
For more information on David’s Refuge visit here
Also, please consider following Warren’s blog here
According to Kateri 
Thanks Kateri for sharing our outreach to parents of children with special needs or those struggling with a life threatening disease. You are absolutely right when you say parents need to discover they are not alone. Once a parent begins to believe they are all alone despair sets it claws in deep and hard. I know because we were there as we watched Batten disease rob David of his life. The role you and all your fellow nurses play in reminding parents they are not alone can breath life into these weary caregivers. Keep up the great work!
Loved reading this Kateri. Parenting is definitely a challenge in itself (i have 4 now ages 6,5,3, and 6 months if that paints a picture) my oldest has a seizure disorder that no one can explain. As a parent of a child who has a medical condition i do everything i can to keep my cool as my son is being put through EEGs, MRIs, bloodwork, Autism screening(s) etc on top of seeing him struggle in school because he has difficulty with motor planning, reading, writing, speech, PT, etc…its not always easy but i also take a second to look at these nurses, dr’s, specialists, teachers and think about what they must have to go through in a single day dealing with multiple patients, students, etc. I often see people that are far stronger than i could ever imagine myself being. I am strong for my kids, in all situations. Its never easy. Its harder to do when in the rare occasion that my son’s father shows up for an appointment or procedure all he does is flip out on the professionals for doing nothing more than their jobs. I dont know how you do it. My mother in law is a nurse and the stories i have heard about disgruntled patients disgust me…it makes me wonder about people these days. How can a person treat another person that way? especially someone who dedicates their life, education and time to CARING for people?! I understand that a lot of people cant handle stressful situations and buckle under the pressure but at the same time i feel like if they take a deep breath and look at the people around them they might realize they are not JUST drowning in their own tragic situation and they HAVE the ability to ask a question about their loved one’s “plan” or simply and nicely ask you what it is you are doing and how it will help in the long run rather than flip their lid. In the past two years my son has had 3 unexplained seizures, my daughter has had her tonsils and adenoids removed on top of having tubes placed in her ears. Their father does nothing to support them, emotionally, physically, what have you. With ALL of that on my plate on top of therapists, school, extra curricular activities, specialists and doctors- i can STILL find it in my heart to treat people with respect and like people. Even when they do not treat me the same way. You are a caring person and your patients are lucky to have you as a nurse 🙂
This made me laugh and think deeply all at the same time! As a second year and primary caregiver for my elderly parents (one particularly adorable 95 year old Papa), I related to all of this!! You ought to consider teaching one day, your empathy and recollection of your nursing school days would make you a natural!!
Great insight on caregiving! Caregiver stress is something very near to my heart. I wanted to ask you a quick question, but can’t find your contact info. If you could, please email me when you see this. Thanks!