Guide for Writing Nursing Care of Adults Concept Papers

*This guide for writing concept papers for Nursing Care of Adults was written by Bethany Babovec, a former Writing Center Consultant, in fulfillment of an assignment for Topics in Composition, the Writing Center staff development course.

The three hundred course Nursing Care of Adults is a writing intensive course. Each student must submit a writing portfolio by the end of the term. Each student is also required to do six concept papers. Bethany helped to provide information on how to produce a satisfactory concept paper. If the student gets a 90% or better on the first five concept papers, they are excused from the sixth, which is an incentive to write the paper to the student's best ability. The professor of this class is Anita Nicholson. Each Nursing Diagnoses write up requires an in-depth report about a real patient. Each student is assigned to visit a real patient at St. Luke's and then must complete the write up after their visit.

The organization of this type of paper is laid out for each student. The professor provides an outline of the paper. Exactly what needs to be included in each part is written out explicitly. The introduction needs to include a brief description of the patient. The patent's history and a brief description of the student's psycho-social information. The main portion of the paper is the nursing care plan. The first part of this section is the diagnosis. This is collected during the actual visit to the hospital. Detailed objective and subjective data needs to be collected and written out clearly. After that the preliminary diagnosis needs to be written up. What does the student think the problem with the patient is? After the student prediction is written up, the student then proceeds to use resources. The student researches the patient ailment and gives a research-based diagnosis. This needs to be backed up by multiple valid sources. An accurate description of the patient's symptoms and what are causing them need to be included. The student must also set goals for the care of the patient. These goals need to aid in improving the patient's symptoms or any other problems. Each student must set at least one long term and one short-term goal. Each goal needs to be rationalized according to research. The student then must write up how they plan to attain these goals. These are called interventions. These can vary from actual medical care to simply cheering up the patient. The student must also rationalize each intervention. How will this help the patient? The student needs to back up their intervention plan with text. The last section of the paper is to analyze whether the goals were achieved or not. The student must report why the goals were achieved or not and what interventions helped to achieve the goals. Each intervention most be analyzed in its effectiveness. The professor also expects a bibliography of the sources used.

The concept paper for Nursing Care of Adults need to be about 15 to 20 pages long. In order to write a successful paper it is vital that the student follows directions exactly. Organization is everything. Due to the length of the paper, it must be well organized in order to get the information across clearly. Bethany recommends that any student in this class prepare for their visit to the hospital. The student needs to know what information needs to be collected and what to look for. Bethany also advises that when the student goes to the hospital they need to collect an adequate amount of data. Write down everything, even if it seems trivial. The student should do their lab write up shortly after their visit to the hospital because they will remember more details about the patient and their symptoms. This is not a hard paper to write, just very detailed. Every claim the student makes needs to be backed up with information from their textbook or other valid sources. The more sources supporting a claim, the better.

Anita Nicholson provides a sheet on how she is going to grade the paper. Bethany reports that she follows these guidelines specifically. For a C on the paper 72% of her standard must be completed. These standards exactly follow her outline. If the student completes everything on the outline then they should have a successful paper. For an A most of the standards need to be completed in a coherent manner. Nicholson tents to be somewhat picky as far as clarity goes. Get to the point; she doesn't want any extra information.

For a successful Nursing Diagnoses write-up paper a student must follow the outline exactly. The student must relay the information in a clear concise format as possible. The most important factor in a successful paper is not procrastinating. The student should prepare ahead of time for their trip to the hospital. The student should also write their paper shortly after their visit. DON'T PROCRASTINATE.


Nursing Diagnoses Write-Up Guidelines

Introduction - Brief history of patient

  • Include patient's code name and age.
  • List Pertinent medical/surgical history.
  • Describe important medical/surgical information related to the patient's current hospitalization and priority problem.
  • Include brief psycho-social information (i.e. marital status, family support, education level).

Nursing Care Plan

I. Assessment

  1. Use a variety of resources to collect data.
  2. Include subjective and objective data (defining characteristics).
  3. Compare to normal parameters.
  4. Summarize extensive data and provide trends.
  5. Should follow standards when applied to a specific nursing diagnosis.

II. Nursing Diagnosis

  1. List priority nursing diagnosis and the pattern.
  2. List all priority nursing diagnoses in order of priority.
  3. At times high risk nursing diagnoses may have a higher priority than actual ones.
  4. Should follow standards listed on form: Standards for Critiquing Nursing Diagnoses Write-Ups.

III. Knowledge past

  1. Define the human response (problem/nursing diagnosis). Restate the Nursing diagnosis, then use your Nursing Diagnosis book to help you further define the problem. State the causes/etiologies of the problem.
  2. Clearly state your patient's behaviors (defining characteristics) of the human response, and explain the pathophysiology (or psychological/sociological aspects) of each behavior. (i.e. the patient is experiencing an increased heart rate and blood pressure as a response to paint because it stimulates the stress response which causes the release of epinephrine and norepinephrine...)
  3. Explain how your patient's etiology contributes to the development of the human response and the resulting behavioral manifestations including compensatory medical diagnosis may be the antecedent condition to the etiology. Either way, the impact of the medical diagnosis should be explained. In some instances it may be necessary to explain some normal physiology in order to fully explain pathophysiological and compensatory manifesting behaviors.
  4. Synthesis from literature is expected. Avoid direct copying of the explanation from the literature source. Explanation should be individualized to the patient-ex.: what was his cause, his symptoms, etc.
  5. Include relevant specific to the patent's human response, behavior and etiology. Do not include a discussion of interventions in this section.
  6. Should conform to standards listed on form: Standards for Critiquing Nursing Diagnoses Write-Ups.

IV. Goals

  1. Long-term and short-term goal
  2. For each nursing diagnosis, identify the appropriate long-term and short-term goals. You may have more than one long-term goal for each nursing diagnosis. Long-term goals should reflect resolution of the initial unwanted or continuation of the positive human response in the problem aspect of the nursing diagnosis. Short-term goals reflect patient goals to be achieved in a short time frame, i.e., 8 hours.
  3. Appropriate short-term outcomes will be identified for each long-term and short-term goal.
    • List according to priority.
    • State as patient-centered.
    • Include a short-term outcome for each defining characteristic (sign and symptom) of the patient.
    • Short-term outcomes should be written in specific ad measurable terms.
  4. Should conform to standards listed on form: Standards for Critiquing Nursing Diagnoses Write-Ups.

V. Interventions.

  1. Identify the nursing intervention(s) appropriate for assisting the patient to achieve the identified outcomes.
  2. Include interventions to achieve comprehensive care (i.e., assessment, teaching, psychosocial and spiritual support). This would include meds, tests, procedures, etc.
  3. Describe interventions in specific terms (i.e., what, how, where, when, etc.)
    • Someone else should be able to use the plan and know exactly what to do for the patient.
    • Include medication name, dose, route, and frequency.
  4. Interventions should be individualized to your patient and reflect the uniqueness of your patient.
  5. You may also include interventions which you may not of actually implemented but which you found in the literature to be appropriate. Include scientific based interventions.
  6. Should conform to standards listed on form: Standards for Critiquing Nursing Diagnosis Write-Ups.

VI. Rationale

  1. State the rationale for each interventions. Rationale states the principle upon which the intervention is based-why you, as a nurse, performed the intervention and why it will assist in meeting the identified objectives and resolving the stated nursing diagnosis. It is a cause and effect statement.
  2. Each rationale is a shot statement of cause and effect (i.e., this intervention help because).
  3. The rationale should integrate pathophysiological explanations
  4. The rationale should be a synthesis of material from the literature rather than a direct quote.
  5. Should conform to standards listed on form: Standards for Critiquing Nursing Diagnosis Write-Ups.

VII. Evaluation of Patient Goals

  1. Statement reflecting achievement or nonachieving of long-term and short-term goals. (Did you patient's behaviors change and thus did he/she meet the criteria stated in the short-term goals?)
  2. Describe the clinical data that you evaluated to decide whether their long-term and short-term goals were met or not.
  3. Which nursing interventions were the most important in assisting the patient in meeting the identified outcomes? How did the other nursing interventions assist in the process?
  4. Discuss the resolution of initial problem. Does the identified actual/potential nursing diagnosis still exist? Has it changed? Does the care plan need to be continued, revised, etc.?
  5. Describe the appropriateness of the care plan. Include an analysis of variables affecting achievement/nonachievement of goals and outcomes. Analyze factors that positively or negatively affect the patient's outcome.
  6. Should conform to standards listed on form: Standards for Critiquing Nursing Diagnosis Write-Ups.

VIII. Bibliography

  1. Include at least one current journal article.
  2. Include textbooks: Pathophysiology, Med-Surg, Pharmacology, Laboratory, etc.

Standards for Critiquing Nursing Diagnoses Write-Ups

Evaluation Tool

Directions: In the space provided, check if the standard was met. There are 36 spaces. In order for the write-up to be satisfactory, 72% of these must be achieved or a total of 26.

I. Standards for Assessment Data

  1. ___ Does S and O data (defining characteristic) accurately support the human response (problem aspect) of the nursing diagnosis?
  2. ___ Are the Defining Characteristics written in specific and measurable terms?
  3. ___ Does S and O data support the etiology (the cause of the human response of the nursing diagnosis?)
  4. ___ Is only data included that is directly relevant to the human response and/or the etiology? (A point will be deducted for defining characteristics that do not relate to the nursing diagnosis.)
  5. ___ Is the list of S and O data comprehensive (all important data are included)? (A point will be deducted for defining characteristics that are not appropriately labeled.)

II. Standards for Nursing Diagnosis Statement

  1. ___ Is the diagnosis written in terms of the client's specific human response? (positive or negative)
  2. ___ Is the etiology ("related" to phrase) written in terms that can be changed?
  3. ___ Is the nursing diagnosis written in accurate terms of the [actual, risk for or potential for enhanced (wellness)] human response when the response is being manifested?
  4. ___ Is the diagnosis stated accurately and concisely?
  5. ___ Are the diagnoses listed in terms of priority?
  6. ___ Is there a comprehensive list of Nursing Diagnoses? (All important Nursing Diagnoses included.)

III. Standards for the knowledge base related to the specific nursing diagnosis (Does the knowledge base conform to the following progression or to an equally logical progression?

  1. ___ Is the human response (problem/nursing diagnosis) defined?
  2. ___ Are the behaviors (defining characteristics) of the human response as seen in the client stated?
  3. ___ Is the pathophysiology (or psychological/sociological aspects) of each behavior as seen in the client explained?
  4. ___ Is the etiology as present in the client explained in terms of how it contributes to the development of the human response identified in the stated nursing diagnosis?
  5. ___ Does the knowledge base only include relevant data specific to the client's human response and etiology? (A point will be deducted for irrelevant data, i.e. etiology that is not applicable, discussion of interventions, etc.)

IV. Standards for writing long and short term client goals

  1. ___ Does the Long-term goal reflect what you want to see happen to the human response aspect of the nursing diagnosis? (prevented, promoted, maintained, resolved)
  2. ___ Is there more than one long-term goal when appropriate?
  3. ___ Are the long-term and short-term goals realistic and within the client's acceptable level of performance (i.e., realistic, within his/her functional capacity, developmental level, financial capabilities, etc.; to meet the STO?)
  4. ___ Is each short-term goal time limited?
  5. ___ Are the short-term goals and outcomes written in specific and measurable terms and do they show how the behaviors of the human response will change if the goal is to resolve the human response; prevent the human response; promote the human response?
  6. ___ Is there an outcome for each defining characteristic that supports the human response in the problem aspect of the nursing diagnosis, and are all important outcome data included?
  7. ___ Does each outcome measure progress towards meeting the long-term goal and short-term goals?

V. Standards for writing nursing interventions

  1. ___ Is there at least one interventions for each short-term goal?
  2. ___ Do interventions cover a variety of actions and address both the human response and the etiology (i.e., assessment, interventions, physical care, psych/social/emotional care, teaching, counseling, referrals, etc.)?
  3. ___ Are interventions prioritized (i.e., assess client's learning needs before initiating teachings or assess client prior to initial etiological care)?
  4. ___ Is there a comprehensive list of interventions (all important interventions are included)?
  5. ___ Is each intervention individualized and specific to the human response and client's current situation, i.e., type of dressing; amount of solution and how often to perform; medication name, dose, route, and frequency? (Interventions should answer the questions who, what , when, where, and how.)

VI. Standards for writing rationale

  1. ___ Is there a rationale (R) for each intervention?
  2. ___ Is each R a short statement of cause and effect and not just a factual statement? (i.e., the intervention is done because it helps ___________. Include pathophysiological explanations when appropriate.)
  3. ___ Does each R explain why this nursing intervention is appropriate for dealing with the human response in the identified nursing diagnosis for which the intervention is being used? (Explain why this intervention is appropriate for improving the nursing diagnosis.)

VII. Standards for evaluating client goals

  1. ___ Were the long-term and short-term goals met or not met?
  2. ___ What clinical data did you evaluate to decide whether the long-term and short-term goals were met or not met (i.e., what clinical data supports the resolution of the displayed human response such as pain being reduced or eliminated)?
  3. ___ Is there a discussion of the interventions that were most helpful in dealing with the human response?
  4. ___ Is there a discussion of what changes (in the future), if any, should be made in the nursing diagnosis, client outcomes, interventions?
  5. ___ Is there an analysis of factors affecting the positive or negative outcome of the human response? (Is the plan, as a whole, appropriate? Why or Why not?)

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