Laurie -
I hate to be a wet blanket, but BF care plans in the hospital probably won't
actually work as well as they should. I say this because I used to do them
myself on every single pt. on the OB unit, and I don't think it actually did
much good. The other nurses quickly learned to ignore them, and see them as
"just another piece of paper" - and you KNOW how people feel about that!
It was my understanding, though, that you needed to have them as part of a
pt's chart anyhow - maybe it's a state-by-state thing. It definitely became
a big CYA issue - and I found that this was a responsibility that fell
almost solely on me. Even when I was off for a few days and never saw the
pt., the other nurses would save the charts for me to "do" the BF care plan,
because BF was seen as being within my realm of responsibility. I was the
one who was in deep doo-doo (from the head nurse, and the admin., and the
JCAH inspectors, and the state.....)if they weren't on the charts, so I was
the one that cared to get them there, but it was an exercise in futility.
What did work better, though, was updating, re-writing, and in-servicing
about policy re: these issues, including in each policy the appropriate
measures for each issue. Lots more work, but staff could then be held
accountable for their actions, and we had a P&P to point to along
w/standardized care plans.
One of the first things I did in that job was to develop a "teaching
checklist", which the nurse & the parents had to sign prior to DC. It
covered the "standard" stuff about fdg (br. or form. or combo), newborn
care, & self-care, and had room to personalize it for any kind of problem or
special circumstance. When the nurse signed each item, she was taking
responsibility that it had been discussed w/the pt, and the pt's sig.
indicated that she had been given the information and understood it.
Cathy Bargar, RN, IBCLC Ithaca NY
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