WHAT EVER HAPPENED..."Favorite Quotes"

These are among my most favorite sayings.  I hope you like them too.

“Rescue dogs can make the most incredible pets.” Nat Geo Wild

“God's plan for our life is bigger than our own.” Joel Osteen

“There are two great days in a person's life – the day we are born and the day we discover why.” William Barclay, Scottish theologian [Go, Scots, go!]

“The whole purpose of having a life-saving operation is to go back and live life.” Dr. Oz

“Forgiveness is not an occasional act. It is a permanent attitude.” Martin Luther King, Jr.

“O, would some power the giftie gie us, / To see ourselves as others see us,” Robert Burns, Scottish poet [Telling us the value of seeing ourselves objectively.]

“The words you speak become the house you live in.” Hafiz

“No matter how difficult the past, you can always begin again today.” Jack Kornfield

“The only way you can change the world is by changing yourself.” Tommy Chong

“Life can only be understood backwards; but it must be lived forwards.” Soren Kierkegaard

“You must do the thing you think you cannot do.” Eleanor Roosevelt

“Women are like tea bags. We don't know our true strength until we are in hot water.” Eleanor Roosevelt

“I think teaching is the most honorable profession there is.” Oprah Winfrey

“…that if you become a teacher, by your pupils you’ll be taught.” Rogers and Hammerstein’s King and I.

“I forgive, I love, I learn, and I move on.” Marie Osmond [I pray I can do that someday.]

“One person can change things.” John Hall, musician, congressman, author

“It's important to keep reinventing yourself.” Marie Osmond

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” John F. Kennedy

“The sooner you accept it, the sooner you'll get over it.” Girl teenagers I overheard talking at my church. [So insightful – I told them they’d be in my book.]

“Our words have the power to build up or tear down.” Our Daily Bread

“Father, please curb my careless speech and put a guard on my tongue today and every day.” Our Daily Bread

“Don't believe everything you think.” Sound of Life, Hudson Valley, NY, radio station

“Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward.” C. S. Lewis

“The world can only change from within.” Eckhart Tolle

“Change your thoughts and you change your world.” Norman Vincent Peale

“The trick is to enjoy life. Don't wish away your days, waiting for better ones.” Marjorie Pay Hinckley

“Never be in a hurry; do everything quietly and in a calm spirit. Do not lose your inner peace for anything whatsoever, even if your whole world seems upset.” St. Francis de Sales

“Happiness is not a station you arrive at, but a manner of traveling.” Margaret Lee Runbeck

“Who you are is the sum of all the choices that you make in this life.” Signed, Sealed, Delivered: Truth Be Told [Hallmark movie]

“The way to get started is to quit talking and begin doing.” Walt Disney

“Less is more.” Robert Browning

“My brain has no off switch.” Cold Case [TV show]

“Understanding is a two-way street.” Eleanor Roosevelt

“Life is what we make it. Always has been. Always will be.” Grandma Moses

“I have never felt that anything really mattered but knowing that you stood for the things in which you believed and had done the very best you could.” Eleanor Roosevelt

 “A little rain can straighten a flower stem. A little love can change a life.” Max Lucado

“To strengthen the muscles of your heart, the best exercise is lifting someone else's spirit whenever you can.”  Dodinsky

“All great changes are preceded by chaos.” Deepak Chopra

“In the end these things matter most: How well did you love? How fully did you live? How deeply did you let go?” Buddha

“It is always wise, I think, if you feel something is wrong, to try to stand up for what you believe is right.” Eleanor Roosevelt

“Nothing has ever been achieved by the person who says, 'It can't be done.'” Eleanor Roosevelt [In my classroom, I told the kids not to use this four-letter word, “can't.”]

“The problems of the world will never be settled unless our national leaders go to God in prayer.” Billy Graham

“The more you like yourself, the less you are like anyone else, which makes you unique.” Walt Disney

“Tomorrow can be a wonderful age.” Walt Disney

“When you believe a thing, believe it all the way.” Walt Disney

“No one’s invisible pain should go unnoticed.” Lady Gaga

“If too many things are planned, there’s too much to remember.” Harry Connick, Jr.

“Our past tells us that our future belongs to the Lord.” Randy Prentiss, Staff Chaplain, Taconic Retreat Center, Red Hook, NY.

“We can be freer if we let stuff go.” Randy Prentiss

“If everyone lends a helping hand to those in need, we would take a giant step towards a more peaceful world.” Harry Swimmer, CNN Hero

“It’s never too soon to be kind.” Our Daily Bread

 “Maybe if you zip [your mouth] up, your wall will come down.” Joel Osteen

“I’ve learned…that I can always pray for someone when I don’t have the strength to help him in any other way.” Andy Rooney

“I’ve learned…that sometimes all a person needs is a hand to hold and a heart to understand.” Andy Rooney

“I’ve learned…that love, not time, heals all wounds.” Andy Rooney

“Find the good. It’s all around you. Find it, showcase it, and you’ll start believing it.” Jesse Owens, Olympic gold medal track and field athlete

“We’re so over, we need a new word for ‘over.’” Carrie, to Mr. Big, in HBO’s Sex and the City. [Even though she told him it was over, she ended up marrying him. I never married Aiden, so it really is over for us.]

“…because it’s so easy for, I will say, a man to say you’re crazy….” [Taking no ownership of his behavior.] Amber Frey, Dateline NBC’s “The Laci Peterson Story.”

“If you find someone you love in life, you must hang onto it and look after it.” Princess Diana [I miss her SO much!]

     A whole different level of quotes comes from the Bible. Here they are:

“Get rid of all bitterness, rage and anger, brawling and slander, along with every form of malice. Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you.” Ephesians 4:31-32

“God will work out everything for our good.” Romans 8:28

“And the Lord's servant must not be quarrelsome but kindly to everyone, an apt teacher, forbearing, correcting his opponents with gentleness.” 2 Timothy 2:24-25 [Appropriately – this was printed on my calendar on my birthday – November 1st!]

“Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen.” Ephesians 4:29

I learn a lot from other people – some famous, some not.

 ###

I (Douglas Winslow Cooper) have been excerpting, weekly, material from this almost-final version of the fine book by Janet Johnson Schliff, M.S. Ed., which she wrote over a three-year period with some coaching and editing help from me, through my business, Write Your Book with Me.

Her memoir is now available in paperback and ebook formats from Outskirts Press  and amazon.com: 

What Ever Happened to My White Picket Fence? My Brain Injury from My Massive Brain Tumor

                                              ###

BOOK TALKS AND SIGNINGS

Janet is taking a much-needed respite from her book tour. More talks will be planned in the spring of 2019… she can be contacted at 845.336.7506 (home) or 845.399.1500 (cell).

Janet Johnson Schliff spoke at the Oblong Books Bookstore in Rhinebeck, NY, on Tuesday, February 6 at 6 p.m.

Janet was on WKNY Radio 1490 in Kingston, NY, on Thursday, March 1 at 9:10 a.m. 

Janet spoke at Barnes & Noble in Kingston, NY, on Saturday, March 3 at 1 p.m. 

Janet spoke at the Starr Library in Rhinebeck, NY, on March 6 at 7 p.m. 

Janet spoke at the Golden Notebook Bookstore in Woodstock, NY, on March 17 at 2 p.m.

Janet spoke at the Morton Library in Rhinecliff, NY, on March 28 at 6:30 p.m. 

Janet spoke at RCAL in Kingston, NY, on April 3 at 4 p.m. [They gave her an impromptu book-launch party.]

Janet spoke at the Parkinson's Support Group at the Starr Library in Rhinebeck, NY, on April 4 at 2:30 p.m.

Janet spoke at the Stone Ridge Library in Stone Ridge, NY, on April 27 at 5:30 p.m.

Janet spoke at the Hurley Library in Hurley, NY, on May 4 at 6 p.m.

Janet spoke at the Kingston Library in Kingston, NY, on May 9 at 6 p.m.

Janet spoke at the Staatsburg Library in Staatsburg, NY, on May 14 at 7 p.m.

Janet spoke at the Clinton Community Library in Rhinebeck, NY, on May 31 at 6:30 p.m.

Janet spoke at the Mountain Top Library in Tannersville, NY, on June 9 at noon.

Janet spoke at the Gardiner Library in Gardiner, NY, on June 11 at 7 p.m.

Janet spoke at the Marbletown Community Center in Stone Ridge, NY, on June 20 at 6 p.m.

Janet was interviewed on radio station WTBQ-FM (93.5) on June 29 at 12 p.m.

Janet spoke at the Esopus Library in Port Ewen, NY, on July 13 at 7 p.m.

Janet spoke at the Pine Plains Library in Pine Plains, NY, on July 20 at 6 p.m.

Janet spoke at the Ulster Library in Kingston, NY, on July 23 at 5:30 p.m.

Janet spoke at the Northern Dutchess Bible Church in Red Hook, NY, on August 11 at 1 p.m.

Janet spoke at the Inquiring Minds Bookstore in New Paltz, NY, on September 6 at 7 p.m.

Janet spoke at the Adriance Library in Poughkeepsie, NY, on September 15 at 2:30 p.m.

Janet was interviewed on radio station WRIP-FM (97.9) on September 21 at 8 a.m.

Janet again spoke at the Mountain Top Library in Tannersville, NY, on September 22 at noon.

Janet spoke at the Enchanted Cafe in Red Hook, NY, on September 28 at 7 p.m.

Janet spoke at the Hyde Park Library in Hyde Park, NY, on October 4 at 7 p.m.

Janet participated in an Author Weekend at the Barnes & Noble in Poughkeepsie, NY, on October 14 from 11 a.m. to 3 p.m.

Janet spoke at the Tivoli Library in Tivoli, NY, on October 22 at 5:30 p.m.

Janet’s interview for the TV program Wake Up with Marci on the You Too America Channel aired on Monday, November 5, and Friday, November 9. It can now be found on the Internet.

Janet spoke at the Germantown Library in Germantown, NY, on November 7 at 6:00 p.m.

Janet participated in the Red Hook Middle School's College and Career Cafe in Red Hook, NY,  on December 19 at 10:30 a.m.

More signings will be coming up. A fine feature about Janet by John DeSantos [845 LIFE] appeared in the Middletown Times Herald-Record on Monday, March 12, as part of Brain Injury Awareness Month. An article about her book was just published in the May 2018 Living Rhinebeck Magazine. An article about her book appeared in the May 14 Daily Freeman of Kingston, NY. and another in the Family Life section of the Poughkeepsie Journal on June 8th. The Millerton News published an article on Thursday, August 2, about her talk at the Pine Plains Library. 

Publicity Secrets (Summary of Harrison Teleseminar)

“PUBLICITY SECRETS…” TELESEMINAR BY STEVE HARRISON

January 10, 2019

Using the acronym MEDIA, P.R. expert Steve Harrison presented the following information about getting publicity, as part of his video advertisement for his National Publicity Summit training via Bradley Communications Corporation. I [DWC] summarize it here.

We don’t realize how special our own information is. The media need guests! You can be a regular interviewee. The keys:

M - make a decision to become better known.

E – evaluate your “hooks.”

D – deliver  your proposal for a good story / show.

I – impact the audience.

A – amplify your publicity.

In general:

If you email, start with a subject line that makes them want to open the mail. Not merely worthwhile but one that will give their program better ratings. Promise the audience benefits. Why should they care? Tease a bit, don’t give away all the story. Make them want to learn more:  “Coming up….” The producers want “a show in a box.” Need a hook. “10 Foods You Should Never Eat.” Story, story, story. Prepare catchy email title and tell the story in a few paragraphs. They get hundreds of emails a day. If you have an idea, give them information and sometimes the access to a location.

Be persistent, not feisty. Watch their show. Have visuals, demo. Be confident, humble, polite. Seek to be unique. On radio, you are trying to be visual in an audio medium. Know your strengths but be willing to go outside your book’s boundaries a bit.

Here’s a M.E.D.I.A. check-list:

M - Make a decision to become better known. Decide you will get heard/interviewed regularly.

E – Evaluate your “hooks.” Make them clear and clever. “5 Tricks….” What’s in It for Me? Fast results. Use “you” in the title. Mention credentials: “scientist,” “Harvard.” How to…. Have props, demonstration where can.

D – Deliver a proposal for a great show. Try to meet them face-to-face. Else, call or email. Not just a book, but position self as an expert. Have material to back up your claim to expertise: Book. Video. Audio. List of appearances.

I – Impact their audience. Make them feel you gave them material of great value. Solutions, stories, followed by Call to Action. What should people do? Buy book? Visit website? Sign you to speak? Trash a myth, turn it around. Recall Rich Dad, Poor Dad: what the rich teach their kids: your house is not an investment, but an expense. If you want them to book you as a speaker, mention solutions and how you applied them. Mention your talks elsewhere. Have a readily remembered website title, best with a benefit. [e.g. MeetTheMedia.com.] Don’t be bashful. Do give value. Be on a mission. Get others to join you. Make a movement. 

E.g., Carole Brody Fleet, author of Widows Wear Stilettos; her husband died of ALS, but nothing written met her needs. Thus, others likely had unmet needs, too. Needs gave her a Table of Contents, effectively. Realized she needed publicity quick. By now, 750+ radio show appearances, topics around death. Message: you don’t have to suffer alone, in silence. Extended this to all manners of loss. Enjoys meeting people who have been affected. Does not measure her success in sales. Change lives, move them, ease their pain. Highly competitive media environment. Have a web site, with tapes, lists, books, mp3…. Media platform needed. “Here’s what I am; here’s what I do; let’s get together.”

Tell your story. Why you do what you do. Who you are.  

Print media. Looking for stories. Build a relationship with writers. Suggest stories. Must tell your story well. Like elevator pitch. Query letter, a 4-paragraph sales pitch on a story. Example title, “It’s the idea, stupid: 100 ideas per employee per year.” “The Unkindest Cut: What Steve Richardson’s Jigsaw Cutters…” Editors get hundreds of emails a day, and you must entice them to open yours. Title line should have headline and subhead. Story must touch people: tragedy, comedy, newsworthy…bar is higher for non-celebrity. If local, you have an advantage in local media. Story: beginning, middle, exit.

E.g., Ron Clancy was a natural. Resident of NJ and first article was in local mag. Orphan who grew up in Philly orphanages. Xmas eve they would go to Mass, and he always remembered the carols. Went on quest to produce CDs etc. of beautiful carols. Boxed sets. Lavish. His passion.

Another, Joan D. had a story, Super-size Cycle, company for large women. Flattened the tires of a bike first time. “I’ll make the bikes myself.” Health story for a web publication and another for a small business newsletter. NYT editor wanted case study: a choice with a dilemma. Joan had a choice: how far to expand…manufacture where?

A – Amplify your publicity. Connect with media. Then do more with it. Author got book talk on Good Morning America, later was asked, “what did you do with this? Tell your customers? Put on website?” No, she missed these opportunities. Let media know you have done media. Have a media page on your site. Hardest is first major coverage. Others then think you are a safe choice after that. Your first session can be a “discovery” outing. Dr. Lombardo did this, became a regular on the Today Show, as is Dr. Ish Major. Did good job on first interview. Show flexibility…beyond what is in your book. Become “Go-to Guest.” Don’t forget to look good. Get appearance advice.

Douglas Winslow Cooper, Ph.D., LLC

WriteYourBookWithMe.com

WHAT EVER HAPPENED...? "The Bag Lady"

I dubbed myself this title because I carry bags to every place I go (including movies, doctor appointments, church functions, various organizations and support groups I attend, and on and on and on….). The bags contain things I need for each place. This is the way I remember things. Way too many people have either rudely commented and/or questioned me about my bags. They are not purses, but bags of all shapes, sizes, and many with great sayings on them. They now replace the huge L.L. Bean teacher bag I once had when I taught school.

What always cracks me up is when someone who’s been rude to me about my habit of lugging stuff forgets or loses something of their own. I want to say, “Well – if you had all your needed items in a bag like mine, you would have what you now have to do without.”

But – I just smile and bite my tongue. I’ve had to bite my tongue so many times. I truly don’t comprehend why my bags puzzle others to the point of rudeness.

At one of the many stores I buy decorated bags at (Cracker Barrel), I told the register lady how I have a bag for each doctor I see. That way, when it’s time for another appointment, I don’t have to look for what I need to share with that doctor. It’s all organized right there in that bag. Register Lady told me that was a great idea, and she was going to do it from now on.

Once, when I went to a jewelry party, and we played one of those silly games before looking through the catalog to purchase jewelry, we had to find certain weird things in our purses or bags. I had every single, strange item on the list, so I won lots of prizes!

I have to be careful, though. A few times, my bag has been in the way and someone else, or even myself, has tripped over it. That’s not too helpful, so I try to squish the bags out of the way, when I can.

Many bags I own have Mickey Mouse on them, but I also have tons without. Because these other bags are too good to gloss over here, I’ve included what many of them say. Enjoy! [My own comments are added for some.]

·       Teachers have homework too!! [The bag I used each Friday for three years when I went to meet with my editor.]

·       Book Nerd [Just like my T-shirt.]

·       Don’t pretend to understand my problems

·       Do more of what makes you happy

·       Funny – I don’t recall asking for your opinion

·       Take delight in the Lord

·       A good book has no ending

·       Live happy

·       Scotland! [I bring this one to my Dutchess County, NY, Scottish Society meetings.]

·       Bloom where you are planted

·       Where’s the beach?

·       Once upon a summertime

·       Give me some sugar

·       Little bag of awesome!

·       Every tree has character

·       Life is all about how you handle Plan B

·       Live. Love. Bark.

·       Give thanks to the Lord, for He is good

·       My best friend is my dog

·       This is the day that the Lord has made

·       Mahalo [Which I think means “thanks.” A great gift store in Catskill, NY, has this title, and I’ve bought great bags there. While writing this chapter, I even received a gift bag from them.]

·       There’s no place like the bookstore.

·       Practice Gratitude…. Give More…. Sparkle More…. It’s the Little Things…. More Road Trips…. Live Happy [All on one bag!]

·       Happy camper

·       Random Crap [On each of two bags, one large and one larger, from Stickle’s, my mother’s favorite store in Rhinebeck, NY.]

·       Great Big Bag of Stuff [Another bag, the largest, from Stickle’s.]

·       Live in the moment

·       Positive Mind. Positive Soul. Positive Life.

So, now you know why I love my bags, and I’m proud to be “The Bag Lady.” Sometimes what’s important is not so much what’s IN the bag, it’s what’s ON the bag….

                                               ###

I (Douglas Winslow Cooper) have been excerpting, weekly, material from this almost-final version of the fine book by Janet Johnson Schliff, M.S. Ed., which she wrote over a three-year period with some coaching and editing help from me, through my business, Write Your Book with Me.

Her memoir is now available in paperback and ebook formats from Outskirts Press  and amazon.com: 

What Ever Happened to My White Picket Fence? My Brain Injury from My Massive Brain Tumor

                                              ###

BOOK TALKS AND SIGNINGS

Janet is taking a much-needed respite from her book tour. More talks will be planned in the spring of 2019… she can be contacted at 845.336.7506 (home) or 845.399.1500 (cell).

Janet Johnson Schliff spoke at the Oblong Books Bookstore in Rhinebeck, NY, on Tuesday, February 6 at 6 p.m.

Janet was on WKNY Radio 1490 in Kingston, NY, on Thursday, March 1 at 9:10 a.m. 

Janet spoke at Barnes & Noble in Kingston, NY, on Saturday, March 3 at 1 p.m. 

Janet spoke at the Starr Library in Rhinebeck, NY, on March 6 at 7 p.m. 

Janet spoke at the Golden Notebook Bookstore in Woodstock, NY, on March 17 at 2 p.m.

Janet spoke at the Morton Library in Rhinecliff, NY, on March 28 at 6:30 p.m. 

Janet spoke at RCAL in Kingston, NY, on April 3 at 4 p.m. [They gave her an impromptu book-launch party.]

Janet spoke at the Parkinson's Support Group at the Starr Library in Rhinebeck, NY, on April 4 at 2:30 p.m.

Janet spoke at the Stone Ridge Library in Stone Ridge, NY, on April 27 at 5:30 p.m.

Janet spoke at the Hurley Library in Hurley, NY, on May 4 at 6 p.m.

Janet spoke at the Kingston Library in Kingston, NY, on May 9 at 6 p.m.

Janet spoke at the Staatsburg Library in Staatsburg, NY, on May 14 at 7 p.m.

Janet spoke at the Clinton Community Library in Rhinebeck, NY, on May 31 at 6:30 p.m.

Janet spoke at the Mountain Top Library in Tannersville, NY, on June 9 at noon.

Janet spoke at the Gardiner Library in Gardiner, NY, on June 11 at 7 p.m.

Janet spoke at the Marbletown Community Center in Stone Ridge, NY, on June 20 at 6 p.m.

Janet was interviewed on radio station WTBQ-FM (93.5) on June 29 at 12 p.m.

Janet spoke at the Esopus Library in Port Ewen, NY, on July 13 at 7 p.m.

Janet spoke at the Pine Plains Library in Pine Plains, NY, on July 20 at 6 p.m.

Janet spoke at the Ulster Library in Kingston, NY, on July 23 at 5:30 p.m.

Janet spoke at the Northern Dutchess Bible Church in Red Hook, NY, on August 11 at 1 p.m.

Janet spoke at the Inquiring Minds Bookstore in New Paltz, NY, on September 6 at 7 p.m.

Janet spoke at the Adriance Library in Poughkeepsie, NY, on September 15 at 2:30 p.m.

Janet was interviewed on radio station WRIP-FM (97.9) on September 21 at 8 a.m.

Janet again spoke at the Mountain Top Library in Tannersville, NY, on September 22 at noon.

Janet spoke at the Enchanted Cafe in Red Hook, NY, on September 28 at 7 p.m.

Janet spoke at the Hyde Park Library in Hyde Park, NY, on October 4 at 7 p.m.

Janet participated in an Author Weekend at the Barnes & Noble in Poughkeepsie, NY, on October 14 from 11 a.m. to 3 p.m.

Janet spoke at the Tivoli Library in Tivoli, NY, on October 22 at 5:30 p.m.

Janet’s interview for the TV program Wake Up with Marci on the You Too America Channel aired on Monday, November 5, and Friday, November 9. It can now be found on the Internet.

Janet spoke at the Germantown Library in Germantown, NY, on November 7 at 6:00 p.m.

Janet participated in the Red Hook Middle School's College and Career Cafe in Red Hook, NY,  on December 19 at 10:30 a.m.

More signings will be coming up. A fine feature about Janet by John DeSantos [845 LIFE] appeared in the Middletown Times Herald-Record on Monday, March 12, as part of Brain Injury Awareness Month. An article about her book was just published in the May 2018 Living Rhinebeck Magazine. An article about her book appeared in the May 14 Daily Freeman of Kingston, NY. and another in the Family Life section of the Poughkeepsie Journal on June 8th. The Millerton News published an article on Thursday, August 2, about her talk at the Pine Plains Library. 

MANAGE NURSING CARE AT HOME, "Nursing Care Plans"

Nursing care is much more than administering physician-ordered medications and completing assessment sheets.  A professional registered nurse also develops care plans for patients.  These are guides that identify a patient’s medical or emotional condition and difficulty and details scientifically based nursing actions to improve the condition.  Knowing the basis of nursing plans may help in understanding the clinical reasoning, logic, and information that follows in our chapters concerning patient illnesses, treatments, and care considerations for your patient

If you have skilled nursing services providing care for your family member, you may come across Nursing Care Plans.  While you will not be responsible for formulating plans, implementing the protocols, or generally being involved with them, you should have a basic understanding of what they are and how they are used in nursing.

A nursing care plan begins with a diagnosis.  A nursing diagnosis differs from a medical diagnosis.  A medical diagnosis is formulated using scientific and clinical data to determine a disease process, illness, or injury.  A physician uses this diagnosis to plan courses of treatment to minimize or eliminate the medical disorder, such as by prescribing medications and ordering tests.

In nursing, the diagnosis is also determined using assessment and clinical data, and quite similar in the end-product, which is to benefit the patient’s health.  However, the results of what the patient is experiencing is diagnosed, not the medical ailment.  For example, a medical diagnosis could be “mesothelioma, lung cancer, and surgical removal of a lung lobe.”  A nursing diagnosis, which depicts the condition or problem the patients exhibits, could be “impaired gas exchange,” which is related to the removal of pulmonary tissue and decreased functioning of lung tissue due to the disease process.  These directly relate to the patient’s inability to oxygenate blood, yet don’t specifically relate to the lack of lung tissue or specify a disease.  All nursing diagnoses directly correspond to the patient needs and/or conditions.  Nursing diagnoses begin the care plan after assessment of the patient and diagnosis from those approved by the North American Nursing Diagnosis Association (NANDA).

The nursing diagnosis is determined by defining characteristics which validate the diagnosis.  They may be both subjective and objective.  Subjective characteristics, again using the example noted above, would be difficulty breathing (dyspnea) as in “I can’t catch my breath;” chest pain, because the lungs aren’t sufficiently expanding; or describing periods of lightheadedness.  These are reportable by the patient or family members.  Objective characteristics are measurable or perceptible by the nurse, such as: abnormal breath sounds heard with or without a stethoscope, thick and tenacious sputum, decreased blood oxygen saturation of less than 92% with supplemental oxygen, heart rate above normal, and confusion and restlessness due to decreased oxygenation of the brain.

Outcomes can then be proposed.  Outcomes are the positive, measurable benefits and goals expected to be achieved in a specified amount of time by implementing the nursing care plan.  Positive outcomes are evidenced by presenting data and are measurable.  For example, the patient is to have “increased gas exchange within 4 days as evidenced by decreased dyspnea at rest or exertion, increased sputum production to relieve congestion, increased of level of consciousness, decreased respiratory and heart rate, decreased adventitious breath sounds.”

Once the nursing diagnosis is determined and supported by defining characteristics (the first part) and the outcome is hypothesized (the result), the actions to get there are proposed and eventually tested by the evidence that the goal was or was not achieved.  The path to achieve those goals, stated as outcomes, is then detailed by listing interventions and rationales.  Interventions, very simply stated, are actions: “What I am going to do for the patient.”  Rationales are the reasons why the interventions will benefit the patient: “This will help because….” 

Examples of interventions and rationales for the patient included elevating the head of the bed (the intervention) because it provides increased oxygenation and decreases pressure on the diaphragm, thereby promoting ease of breathing (the rationale).  Auscultating (listening to) lung sounds and assessment of breathing and respiratory values include noting rate and quality of the respirations every 2 hours; these checks provide positive or negative changes in the patient’s condition.  Signs of further decrease in function would be shallow respirations, nasal flaring, increases in heart rate, and decreases in level of consciousness.   These are all further evidence of lack of oxygen due to decreased gas exchange and would indicate further decline.  Giving the patient more fluids (an intervention) would help to loosen tenacious secretions and noting input amounts provides indication whether enough quantities are being consumed. 

Teaching and assisting the patient with frequent deep breathing exercises and use of incentive spirometer maximizes expansion of lung tissue including smaller airways.  Teaching and assisting patients with splinting their chest and effective coughing when sitting up aids to relieve chest discomfort and maximizes production.   These are all examples of nursing interventions based upon a diagnosis of impaired gas exchange.  They are intended to treat the condition of the patient – not the disease the patient has. 

The nursing process and nursing care plans are adjustable.  They change and are amended as the patient’s condition improves or worsens.    Additionally, nursing care plans do not solely involve the nursing profession.  They are collaborative and involve all aspects of the patient’s care-giving team, such as respiratory therapists, physical therapists, physicians, and numerous other professionals involved in the patient’s path to well-being.

         A detailed example of such a nursing care plan is given in Appendix 5.

        In the following chapters we turn our attention to managing the nursing care at home for some conditions with which we lack first-hand at-home experience, thus having to rely on the medical literature, our training and our experience in other venues.

While not all medical conditions, situations, or disease processes can be addressed in depth in this book, the authors felt it was important not to ignore other events and illnesses that your patient may be experiencing.  There are so many illnesses that can occur, that we needed to take a different approach from an illness-specific one.  To do so, we decided to use the classification system often used in medical settings for assessments. Within the eleven principal categories will be highlighted some of the more common illnesses. In some cases, as with cancer, several categories are involved. In addition, this section will also speak to the method of assessment and the systemic approach which typically dictates medical practice.  As much as possible, this section will follow that system-based approach. Familiarity with these assessment categories will assist in the understanding and management of nursing care.

The Nursing Assessment form used in our home situation is separated according to various systems.  This is a standard approach to all nursing documentation.  Assessments are not haphazard comments about the patient.  Rather, assessments are a standard method of examining the patient and recording data in a precise manner based upon the function of a system. 

Some overlap of findings may occur between systems.  This should not be considered unusual. The body uses individual systems that interact with each other to maintain the body as a unit. 

When one system is failing, or having difficulty, the body reacts to try to achieve a functioning that is as normal and balanced as possible (homeostasis).  Perhaps the best way to illustrate this is by a simple analogy:  When the mother has the flu, the father steps in and cooks dinner for the family.  He doesn’t cook as well as mom, usually, but the kids are fed, mom can rest, and he isn’t overworked, so he can go to his job in the morning and perform well. 

When the body has a dysfunctional system, the other systems step in and help.  They might not do as well as the ailing system, but, at least temporarily, positive functioning continues.  For example: when respiratory function is decreased, the heart rate and therefore the cardiac output (blood flow) increases to deliver oxygenated blood to tissues. 

This cannot continue indefinitely. The other systems help, but eventually cannot maintain homeostasis.  As in the example above, the increased heart rate tires the heart; it may increase in size, eventually causing cardiac dysfunction, be less able to pump, and/or eventually cease working altogether.

Monitoring individual systems provides an insight to the operation of the whole body.  Adverse changes to more than one system can then alert to multiple system problems and indicate the need for intervention.

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Contact information:

Diane R. Beggin, RN

40 Sycamore Drive

Montgomery, NY 12549

DianeBegginRN@gmail.com

http://ManageNursingCareAtHome.com

Our book is available from amazon.com, bn.com, and OutskirtsPress.com: How to Manage Nursing Care at Home