Chapter Four The Use of the Nursing Process and Nursing Diagnosis in the Care of Older Adults

Introduction LPNs work in a variety of care settings Every practice area expects the nurse to be involved with the assessment, planning, implementation, and evaluation of older adults and the care they receive. What is the priority setting for this chapter? Pg.61

Environments of Care Home care Hospital care Long-term care facilities Work under supervision of RN Changing dressings, monitoring blood glucose levels, administering medications, assessing the status of chronic disease processes in the older adult’s home Hospital care May be paired w/RN to form a care team Assigned specific tasks: treatments, passing meds Long-term care facilities What is the difference in the level of care provided in skilled nursing facilities vs. assisted living facilities? Pg.61-62 What kind of responsibilities do nurses have in this type of setting? Pg.62

Nursing Process Problem-solving model that describes what nurses do Assessment Nursing Diagnosis Planning Implementation Evaluation Provides a structure for nurses to plan and give high-quality, individualized care Can the nursing process be utilized with the example listed in your book? Pg.62

Nursing Process (cont’d) Assessment Usually the assessment starts with the call/written summary from the agency/dept that is transferring the older adult What is some of the information you need before the patient is transferred? Pg.63 What did the enactment of the Omnibus Budget Reconciliation Act of 1987 and 1990 (OBRA 1987 & 1990) establish? Pg.63 In 2010 the Resident Assessment Instrument (RAI) was updated to 3.0 and includes the MDS 3.0; the RAPs has been replaced with Care Area Assessments (CAAs) The MDS is a very important part of the assessment What is the MDS & CAA? Pg. 64 Identify problem areas that must be assessed in the care plan

Nursing Process (cont’d) *The 1987 OBRA Act: the federal government determined that persons living in a long-term care facility are to be referred to as residents. They are residents of the facility.

Nursing Process (cont’d) Nursing diagnosis Developing nursing dx is a primary responsibility of the RN Involves diagnostic reasoning to reflect the older adult’s strengths, problems, and potential problems What does the RN consider when selecting specific nursing diagnosis? Pg.64 NANDA has helped establish the national standard for nursing diagnoses; why is this important? Pg.65 What are some common nursing diagnosis for older adults? Pg.65

Nursing Process (cont’d) Nursing Diagnosis and Medical Diagnosis What is the major problem with planning care based only on medical diagnoses? Pg.67 Planning: Setting Priorities What model can assist in setting priorities? Pg.67 Another consideration are the priorities of the resident, what example does the author give? Pg.67

Abraham Maslow’s Hierarchy of Needs *Removing the lodged food so that the resident could breathe would be a higher priority than putting on the resident’s shoes!

Nursing Process (cont’d) Planning: Goal Setting or Identifying Outcomes After identifying the priorities for the resident’s care, the nurse identifies goals or outcomes for each of the nursing diagnosis In order to direct care & describe outcomes, goals must be: Measurable Realistic Specific Timely Attainable In long-term care, how often will the goals be measured/reviewed? Pg.68 Let’s review the examples of goals listed on pg.68, what do you notice about them?

Nursing Process (cont’d) Planning: Designing & Documenting the Plan of Care After goals/outcomes are identified, the nurse along with other members of IDT begin to plan the activities to reach the goals What are some examples of interventions in an interdisciplinary care plan? Pg.69 Planned interventions must complement the interventions of other therapies Pt ambulated w/walker by physical therapist but encouraged to walk with a can by the nursing staff A coordinated approach enhances effectiveness of the care given Why is it important to develop nursing interventions with input from CNAs? Pg. 69

Nursing Process (cont’d) Implementation The part of the nursing process that nurses do best Bedside care is one of the most rewarding aspects of nursing Many of the interventions are assigned to who? Pg.70 *Note: RNs, LPNs/LVNs, & CNAs ALL perform nursing interventions Documentation is an important part of implementation The nurse is responsible for documenting that the intervention was done and what else? Pg.70 A simple model for documenting nursing interventions & resident responses: (pg.71) Assessment Action Plan

Nursing Process (cont’d) Final step in the nursing process Purpose: to decide if the identified goals were met, partially met or remain unmet; to assess the outcomes of nursing care The evaluation of goal achievement needs to be documented how often and where? Pg.71 Evaluation is ongoing & occurs daily, not just at mandatory reassessment intervals, example on pg.72 Making daily changes in the actual care given is common; translating the changes into the written plan of care is not Very important to update the care plan to reflect the actual care you want the patient to receive; this will ensure consistency among all staff

Conclusion Responsibilities: The management of care given by nursing assistants Working with the IDT Completing documents required by the federal government Delivering excellent care to the frail and vulnerable people in your care It is essential that you become highly skilled in the use of the nursing process in the care of older adults

Questions?