Dr. Abdalkarim Radwan The Nursing Process
Jan 17, 2016
Dr. Abdalkarim Radwan
The Nursing Process
Dr. Abdalkarim Radwan
Resources
Andrea Ackermann, Mount St. Mary College, Critical-thinking-the-nursing-process 2001.
http://www.umanitoba.ca/nursing/courses/128,(2005)
Sara-jo Wiscombe, Nursing Process ,Wallace Community College ,May 22,2001.
Tucker C, MODULE A INTRODUCTION TO NURSING Process, August 21, 2002 .
Dr. Abdalkarim Radwan
Dr. Abdalkarim Radwan
The Nursing Process
An organizational framework for the practice of nursing
Orderly, systematicCentral to all nursing careEncompasses all steps taken by the
nurse in caring for a patient
Dr. Abdalkarim Radwan
Definition of the Nursing ProcessAn organized sequence of problem-
solving steps used to identify and to manage the health problems of clients
It is accepted for clinical practice established by the American Nurses Association
Dr. Abdalkarim Radwan
Benefits of Nursing Process
Provides an orderly & systematic method for planning & providing care
Enhances nursing efficiency by standardizing nursing practice
Facilitates documentation of care Provides a unity of language for the nursing
profession Is economical Stresses the independent function of nurses Increases care quality through the use of
deliberate actions
Dr. Abdalkarim Radwan
The Nursing Process Utilizes The Following
AssessmentNursing DiagnosisPlanningImplementationEvaluation
Dr. Abdalkarim Radwan
Characteristics of the Nursing ProcessWithin the legal scope of nursingBased on knowledge-requiring critical
thinkingPlanned-organized and systematicClient-centeredGoal-directedPrioritizedDynamic
Dr. Abdalkarim Radwan
Benefits of using the nursing process Continuity of care Prevention of
duplication Individualized
care Standards of care
Increased client participation
Collaboration of care
Dr. Abdalkarim Radwan
Being Accountable
Using critical thinking before taking actions
Being responsible for your actions Entering the professional role Working at the level of your peers Using the nursing process
Dr. Abdalkarim Radwan
Something to think about:
Nurses are responsible for a unique dimension of healthcare – “ the diagnosis and treatment of human responses to actual or potential health problems”
Dr. Abdalkarim Radwan
MARTHA ROGERS, NURSE THEORIST
“When an apple is cut, others see seeds in the apple. We, as nurses, see apples in the seeds.”
Dr. Abdalkarim Radwan
What Are Your Responsibilities?
Recognize health problems. Anticipate complications. Initiate actions to ensure appropriate
and timely treatment.
Begin to think CRITICALLY !!!!!!
Dr. Abdalkarim Radwan
Critical Thinking
MENTAL OPERATIONS –decision making & reasoning
KNOWLEDGE-having the facts & understanding the reason behind the knowledge
ATTITUDES- curious/open-minded/non-judgmental….
Dr. Abdalkarim Radwan
Critical Thinking Critical thinking in nursing is an essential component of professional
accountability and quality nursing care.
Critical thinking is careful, deliberate, and goal directed.
Dr. Abdalkarim Radwan
Assessment of Well-Being
According to the World Health Organization is well-being in these domains:EmotionalPhysicalSocialSpiritual
Dr. Abdalkarim Radwan
Lets Get Started :
Nurse collects background info from previous charts
Ensure environment is conducive Arrange seating Allow adequate time Nurse introduces self Identifies purpose of interview Ensure confidentiality of information Provide for patient needs before starting
Dr. Abdalkarim Radwan
TYPES OF INTERVIEWS
DIRECTED NON-DIRECTED
THINGS THAT IMPAIR COMMUNICATION: PRESENTING QUICK SOLUTIONS UNWARRANTED CHEERFULNESS FALSE REASSURANCE GIVING ADVICE CHANGING THE SUBJECT
Dr. Abdalkarim Radwan
ASSESSMENT
Observation Interview
Types of questionsEnvironment (physical and
emotional) Spiritual conciderations
Examination
Dr. Abdalkarim Radwan
Types of Data To Collect:Objective data-observable and
measurable facts (Signs)Subjective data-information that only
the client feels and can describe (Symptoms)
Dr. Abdalkarim Radwan
CULTURAL DIVERSITY
MUST PROVIDE CARE CONGRUENT WITH A CLIENT’S EXPECTATIONS
“This is not about you” ? Respect INDIVIDUAL’S DIFFERENCES,
What is the significance of the problem or illness to the client?
What does it mean in the family/community?
Dr. Abdalkarim Radwan
COMMON Challenges:Defense Mechanisms
COMPENSATION DENIAL DISPLACEMENT
RATIONALIZATION
PROJECTION REPRESSION SUPPRESSION REGRESSION
Dr. Abdalkarim Radwan
Continued
THE NURSING PROCESS HELPS NURSES UNDERSTAND THE STRATEGIES CLIENTS USE IN their attempt at coping:
This knowledge will help you FURTHER INDIVIDUALIZE THEIR CARE
Dr. Abdalkarim Radwan
Resources
Client Other individuals Previous records Consultations Diagnostics studies Relevant literature
Dr. Abdalkarim Radwan
Assessment
Data base assessment – comprehensive information you gather on initial contact with the person to assess all aspects of health status.
Focus assessment – the data you gather to determine the status of a specific condition.
Dr. Abdalkarim Radwan
Sources of DataPrimary source: ClientSecondary source: Client’s family,
reports, test results, information in current and past medical records, and discussions with other health care workers
Dr. Abdalkarim Radwan
Disease Prevention
Primary prevention – protection from a disease while still in a healthy state.
Secondary prevention – early detection and treatment of disease.
Tertiary prevention – prevent complications and to maintain health once the disease process has occurred.
Dr. Abdalkarim Radwan
Verifying Data
Essential in critical thinking!!!!! Measurable data Double check personal observations Double check equipment Check with experts and team members Recheck out-liers Compare objective and subjective data Clarify statements
Dr. Abdalkarim Radwan
Planning
Establish the goals, interventions and outcomes
Dr. Abdalkarim Radwan
General Guidelines for Setting Priorities
1. Take care of immediate life-threatening issues.
2. Safety issues.3. Patient-identified issues.4. Nurse-identified priorities based on
the overall picture, the patient as a whole person, and availability of time and resources.
Dr. Abdalkarim Radwan
Nurse Identified Priorities
Composite of all patient’s strengths and health concerns.
Moral and ethical issues. Time, resources, and setting. Hierarchy of needs. Interdisciplinary planning.
Dr. Abdalkarim Radwan
Identifying Client-centered Outcomes State what the patient will do
or experience at the completion of care.
Give direction to the patient’s overall care.
Patient behaviors not nurse behaviors!!
“The patient will…”
Dr. Abdalkarim Radwan
DIAGNOSIS Sort, cluster, analyze information Identify potential problems and
strengths Write statement of problem or
strength Risk of infection related to
compromised nutrition
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Nursing Diagnosis (cont.)
Potential for effective breastfeeding related to knowledge level and support system
Prioritize the problems Not a medical diagnosis
Dr. Abdalkarim Radwan
Steps for deriving outcomes from Nursing Diagnosis
Look at the first clause of the nursing dx and restate in a statement that describes improvement, control or absence of the problem.
Risk for infection r/t surgical procedure.
The client will demonstrate no signs or symptoms of infection.
Dr. Abdalkarim Radwan
Components of Outcomes
Subject: who is the person expected to achieve the outcome?
Verb: what actions must the person take to achieve the outcome?
Condition: under what circumstances is the person to perform the actions?
Performance criteria: how well is the person to perform the actions?
Target time: by when is the person expected to be able to perform the actions?
Dr. Abdalkarim Radwan
Nursing Interventions
Road maps directing the best ways to provide nursing care.
Evidence based nursing.
1. Monitor health status.
2. Minimize risks.
3. Resolve or control a problem.
4. Assist with ADLs.
5. Promote optimum health and independence.
Dr. Abdalkarim Radwan
Interventions
Direct interventions: actions performed through interaction with clients.
Indirect interventions: actions performed away from the client, on behalf of a client or group of clients.
Dr. Abdalkarim Radwan
Nursing DiagnosisHealth issue that can be prevented,
reduced, resolved, or enhanced through independent nursing measures
Dr. Abdalkarim Radwan
Documenting the Plan of Care To ensure continuity of care, the plan
must be written and shared with all health care personnel caring for the client.
Consists of:
1. Prioritized nursing diagnostic statements.
2. Outcomes.
3. Interventions.
Dr. Abdalkarim Radwan
Documentation
Clear and concise Appropriate terminology
Usually on a designated form Physical assessment
Usually by Review of Systems• Overview of symptoms• Diet• Each body system
Dr. Abdalkarim Radwan
Documentation
Use patient’s own words in subjective data – enclose in “ ___” (quotation marks)
Avoid generalizations – be specific Don’t make summative statements –
describe - e.g. patient is being ornery should be patient resists instruction or patient states “Don’t talk to me, I don’t care about that”
Dr. Abdalkarim Radwan
Evaluation
1. Determining outcome achievement
2. Identifying the variables affecting outcome achievement
3. Deciding whether to continue, modify, or terminate the plan
Dr. Abdalkarim Radwan
Determining Outcome Achievement Must be aware of outcomes set for the
client. Must be sure patient is ready for evaluation. Is patient able to meet outcome criteria? Is it: Completely met? Partially met? Not met at all? Record in progress in notes. Update care plan.
Dr. Abdalkarim Radwan
Identifying Variable Affecting Outcome Achievement Maintain individuality of care plan:
1. Is the plan realistic for the client?
2. Is the plan appropriate at the time for this particular client?
3. Were changes made in the plan when needed?
4. How does the client feel about the plan?
Dr. Abdalkarim Radwan
Predict, Prevent, and Manage
Focus on early intervention Based on research Predict and anticipate problems Look for risk factors
Dr. Abdalkarim Radwan
Diagnostic StatementsName of the health-related issue or
problem as identified in the NANDA listEtiology (its cause)Signs and SymptomsThe name of the nursing diagnosis is
linked to the etiology with the phrase “related to,” and the signs and symptoms are identified with the phrase “as manifested (or evidenced) by”
Dr. Abdalkarim Radwan
Collaborative Problems-Nurse’s Responsibility
Correlating medical diagnoses or medical treatment measures with the risk for unique complications
Documenting the complications for which clients are at risk
Making pertinent assessments to detect complications
Dr. Abdalkarim Radwan
Continued
Reporting trends that suggest development of complications
Managing the emerging problem with nurse- and physician-prescribed measures
Evaluating the outcomes
Dr. Abdalkarim Radwan
The Nursing Process
Nursing DiagnosisJudgment or conclusion about the risk for—
or actual—need/problem of the patientNANDA format
Dr. Abdalkarim Radwan
NANDA – North American Nursing Diagnosis Association
Identifies nursing functions Creates classification system Establishes diagnostic labels
Risk of infection related to compromised nutritional state
Potential complication of seizure disorder related to medication compliance
Dr. Abdalkarim Radwan
PlanningThe process of prioritizing nursing
diagnoses and collaborative problems, identifying measurable goals or outcomes, selecting appropriate interventions, and documenting the plan of care.
The nurse consults with the client while developing and revising the plan.
Dr. Abdalkarim Radwan
Setting PrioritiesDetermine problems that require
immediate actionMaslow’s Hierarchy of Human Needs
Dr. Abdalkarim Radwan
Short-Term GoalsOutcomes achievable in a few days or
1 week Developed form the problem portion of
the diagnostic statementClient-centeredMeasurableRealisticAccompanied by a target date
Dr. Abdalkarim Radwan
Long-Term GoalsDesirable outcomes that take weeks
or months to accomplish for client’s with chronic health problems
Dr. Abdalkarim Radwan
The Nursing Process
PlanningIdentification of goals and outcome criteriaPrioritizationTime frame
Dr. Abdalkarim Radwan
Selecting Nursing InterventionsPlanning the measures that the client
and nurse will use to accomplish identified goals involves critical thinking.
Nursing interventions are directed at eliminating the etiologies.
Dr. Abdalkarim Radwan
Selecting an intervention
The nurse selects strategies based on the knowledge that certain nursing actions produce desired effects.
Nursing interventions must be safe, within the legal scope of nursing practice, and compatible with medical orders.
Dr. Abdalkarim Radwan
Communicating The PlanThe nurse shares the plan of care with
nursing team members, the client, and client’s family.
The plan is a permanent part of the record.
Dr. Abdalkarim Radwan
EvaluationThe way nurses determine whether a
client has reached a goal. It is the analysis of the client’s
response, evaluation helps to determine the effectiveness of nursing care.
Dr. Abdalkarim Radwan
The Nursing Process
EvaluationOngoing part of the nursing processDetermining the status of the goals
and outcomes of care
Monitoring the patient’s response to drug therapy
Dr. Abdalkarim Radwan
Documentation
Clear and concise Appropriate terminology
Usually on a designated form Physical assessment
Usually by Review of Systems• Overview of symptoms• Diet• Each body system