GUIDELINES FOR COMPLETING THE CLINICAL PREPARATION FORM
Purpose:
To assist the student in preparing for a selected client
Guideline: Prior to the start of each clinical day all student, except N150*, are to complete
sections A through D. The completed form is to be submitted to your clinical instructor at the
beginning of each clinical day.
*N150 students should complete sections A, B1, B6, C and D prior to going into clinical. Submit
form to instructor prior to start of clinical day. May use a medical dictionary to obtain the
information.
Section A:
Stage of Development- This section should include the name of the
developmental theorist you are using. It should also contain behaviors that
indicate achievement of the developmental task(s). You will later compare them
with where your client is developmentally.
Section B:
Textbook Description- You are to obtain the information in parts 1 through 6 from
you nursing medication surgical textbook. Do not use the client’s chart or Kardex.
This section is to assist you in your assessment and care of the client.
Etiology- the cause(s) of a disease
Pathology-how normal physiological processes are altered by disease
Assessment-The student will identify at least two (a) actual or at risk/high risk
SCDs that are appropriate for the client. Next the student should list five (5)
observations for each SCD selection that will need to be confirmed with the client
while providing nursing care. The student should bear in mind the Therapeutic
Self-Care Demands (TSCDs) appropriate to each client when developing
questions for SCDs.
Section C:
Section D:
Standards for Care- The student has several options for this section of the
preparation form.
1.
The student can construct a plan of care using the form provided; or
2.
The student can obtain the standards of care from a nursing text or care
plan book; PHOTOCOPY the plan from the book; and activate the use of a
yellow highlighter and individualize by rewriting nursing diagnosis, goals,
objectives, and implementation that are inappropriate or non-specific.
Staple to the clinical preparation form; or
3.
if available prior to clinical, pull the appropriate standardized care plan from
the assigned nursing unit files. Individualize through the use of a yellow
highlighter, and hand written additives as needed. Rewrite the nursing
diagnosis, goal, objectives, and implementations that are inappropriate or
nonspecific. Staple to the clinical preparation form. For each goal provide
at least four (4) objectives and five (5) things you can do to implement the
plan. Remember expected outcomes are not written the same way you
would write the evaluation on your plan of care. The evaluation is written
after you have provided the care to the client. You have provided the care
to the client. You would address whether the goal was met or not.
NORFOLK STATE UNIVERSITY
DEPARTMENT OF NURSING
NURSING CARE PLAN
Student
Date
Clients initials
Nursing System
Instructor
Facility
Age
DIRECTIONS: Complete sections A-D prior to the start of the clinical day. Submit completed
form to a clinical instructor prior to beginning of shift;
A. Stage of Development (include theorist and behaviors indicative of achievement of
developmental task. Address Piaget and Erikson for pediatrics).
B. Textbook Description: (Refer to a nursing text to obtain 1-6; NOT THE CLIENT’S KARDEX.
Use the university or hospital library when your text is insufficient).
1.
Medical Diagnosis (Name primary and secondary)
2.
Etiology
3.
Pathophysiology
4.
Signs and Symptoms (Include expected changes in lab values).
5.
Medical and/or Surgical Management
6.
Nursing Management
C. Assessments:
1. Select 2 SCDs, Self-Care Deficits, (potential/at risk/high risk”) that may be exhibited by the
client and name below:
a.
b.
2. List 5 observations that you will be expecting for each SCD selected (10 Observations total)
a.
b.
(1)
(1)
(2)
(2)
(3)
(3)
(4)
(4)
(5)
(5)
List 5 questions for each SCD selected that will need to be confirmed with the client during your
nursing care (10 questions total).
a.
b.
(1)
(1)
(2)
(2)
(3)
(3)
(4)
(4)
(5)
(5)
D. Standards of Care: (this is due on the clinical day after client care is performed)
Nursing DX
1.
2.
Goal (1) &
Objectives (4)
Implementation (5)
Evaluation