1. Fereshteh Mazhari RN.,MSN
Nursing Process
Fereshteh Mazhari RN.,MSN

2. Back Ground
The nursing process is based on a nursing theory developed by Ida Jean Orlando. She developed this theory in the late 1950's as she observed nurses in action. She saw "good" nursing and "bad" nursing.
From her observations she learned that the patient must be the central character.
Nursing care needs to be directed at improving outcomes for the patient, and not about nursing goals.
The nursing process is an essential part of the nursing care plan.

3. تعریف فرآیند پرستاری
فرآیند پرستاری چارچوبی برای برنامه ریزی و اجرای مراقبت های پرستاری برای بیمار و خانواده اش است. فرآیند پرستاری روشی سیستماتیک برای تفکر پرستار است. چارچوبی از فعالیت های مرتبط به هم، پویا، مداوم، علمی و مشکل مدار است. راهی سازمان یافته برای تشخیص عکس العمل های بیماران نسبت به بیماری و کاهش سلامتی یا درمان است.

4. 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

5. 5 components of the Nursing Process:
Assessment
Diagnosis
Planning
Implementing
Evaluating

6. We will only focus on 4 components of the Nursing Process:
Assessment
Diagnosis
Planning
Implementing
Evaluating

7. Benefits of using the nursing process
Continuity of care
Prevention of duplication
Individualized care
Standards of care
Increased client participation
Collaboration of care

8. مراحل فرآیند پرستاری 1- ASSESSMENT
در این مرحله که می توان آن را به شکل رابطه زیر نشان داد
جمع آوری اطلاعات + تجزیه و تحلیل اطلاعات + تشخیص پرستاری
اینکه هر گونه اطلاعاتی را جمع آوری کنیم درست نیست، بلکه پرستار باید در جمع آوری اطلاعات مهارت داشته باشد و فقط اطلاعات مربوط را جمع آوری کند.

9. جمع آوری اطلاعات
بطور کلی از طریق دو فرم تاریخچه پرستاری و بررسی وضعیت سلامت انجام می شود.
انواع داده ها عینی : علایم و رفتارهایی که پرستار مشاهده و بر اساس آن قضاوت
می کند. objective data
ذهنی : اطلاعاتی که بیمار به پرستار می دهد. Subjecthve data
انواع روش های جمع آوری داده مشاهده : Observation
مصاحبه : Interview
معاینه : Examination
(اندازه گیری) (Measurement)

10. ASSESSMENT: Observation Interview Types of questions
Environment (physical and emotional) Spiritual conciderations
Examination

11. Types of Data To Collect:
Objective data-observable and measurable facts (Signs)
Subjective data-information that only the client feels and can describe (Symptoms

12. Resources Client Other individuals Previous records Consultations
Diagnostics studies
Relevant literature

13. جمع آوری اطلاعات
مهارت های لازم برای جمع آوری اطلاعات شامل : الف – مشاهده : تمرین و تکرار ب – مصاحبه گوش کنید و سئوال کنید. مشاهده کنید و تفسیر کنید. اطلاعات بدست آمده را با هم ترکیب کنید. اطلاعات را ثبت کنید. ج – بکار بردن قدرت تعقل (Wisdom )، قضاوت ( Judgment)، حضور ذهن ( Tact ) و استفاده از تجارب خود.

14. 1st Component of the Nursing Process- ASSESSMENT:
Data Collection
Assessment involves taking vital signs (TPR BP & Pain assessment.
Performing a head to toe assessment
Listening to the patient's comments and questions about his health status
Observing his reactions and interactions with others. It involves asking pertinent questions about his signs (observable) and symptoms (Non-observable), and listening carefully to the answers.

15. During Assessment, the care provider:
Establishes A Data Base
Continuously Updates The Data Base
Validates Data
D. Communicates Data

16. Sources of Data Primary source: Client
Secondary source: Client’s family, reports, test results, information in current and past medical records, and discussions with other health care workers

17. تجزیه و تحلیل اطلاعات
این مرحله به منظور سازمان دادن به اطلاعات، پیدا کردن تناقض ها و درک اطلاعات از طریق رابطه زیر انجام می شود : مروری بر اطلاعات + تفسیر اطلاعات شناخت مشکل

18. Nursing diagnosis
“A clinical judgment about individual, family or community responses to actual or potential heal problems / life processes.
A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable

19. تشخیص پرستاری NURSING DIAGNPSIS
تشخیص پرستاری مشکل بالفعل و یا بالقوه بیمار است و برای حل، کاهش یا سازش بیمار ضرورت دارد.
بالفعل (موجود) : Present N.D
انواع تشخیص های پرستاری بالقوه (احتمالی) : Potential N.D
ممکن : N.D Tentative or Possible

20. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Identifies conditions the MD is licensed & qualified to treat
Identifies situations the nurse is licensed & qualified to treat

21. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Identifies conditions the MD is licensed & qualified to treat
Identifies situations the nurse is licensed & qualified to treat
Focuses on illness, injury or disease processes
Focuses on the clients responses to actual or potential health / life problems

22. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Remains constant until a cure is effected
Changes as the clients response and/or the health problem changes

23. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Remains constant until a cure is effected
Changes as the clients response and/or the health problem changes
i.e. Breast cancer
i.e. Knowledge deficit
Powerlessness
Grieving, anticipatory
Body image disturbance
Individual coping, ineffective

24. Diangosis Nursing diagnosis Medical diagnosis
Breathing patterns, ineffective
Chronic obstructive pulmonary disease
Activity intolerance
Cerebro vascular accident
Pain
Appendectomy
Body image disturbance
Amputation
Body temperature, risk for altered
Strep throat

25. NURSING DIAGNPSIS Present N.D Potential N.D Tentative or PossibleN.D
Risk of infection related to compromised nutrition
Tentative or PossibleN.D
Potential for effective breastfeeding related to knowledge level and support system
Problem + Etiology + Sign & Symptom

26. Problem + Etiology + Sign & Symptom
تشخیص پرستاری
نحوه نگارش انواع تشخیص های پرستاری :
Problem + Etiology + Sign & Symptom
باید دقت نمود که تشخیص ذکر شده مختصر، اختصاصی، مربوط به یک مشکل و با توجه به اطلاعات به دست آمده باشد.
مثال:
یبوست در رابطه با کاهش فعالیت که مشخص شده با کاهش دفعات مدفوع

27. تشخیص موجود:
مثال :
تخلیه غیر موثر راه هوایی در رابطه با ضعف شدید که مشخص شده است با سرفه غیر موثر.
تشخیص احتمالی:
خطر آسیب در رابطه با تغییر در حرکت و حالت گیجی
در این تشخیص قسمت سوم (علائم) وجود ندارد.
تشخیص ممکن:
احتمال کاهش حجم مایعات در رابطه با استفراغ مکرر برای سه روز که مشخص شده با افزایش ضربان قلب

28. مراحل فرآیند پرستاری (برنامه ریزی)
2- PLANING
از طریق رابطه زیر نشان داده می شود :
تعیین اولویت ها + تعیین اهداف + برنامه تدابیر پرستاری

29. تعیین اولویت ها
منظور این نیست که یک مشکل به طور کامل حل شود بدون اینکه مشکلات دیگر در نظر گرفته نشوند. نیازهای حیاتی مشکلاتی که بیمار اظهار می کند نکات ضروری مشکلات بالقوه منابع قابل دسترس، پرسنل و زمان مورد نیاز

30. Prioritizing the nursing diagnosis
Maslow’s hierarchy of needs

31. Maslow’s Hierarchy of Needs

32. تعیین اهداف
در واقع منظور از هدف، نتایج مراقبت پرستاری یا تغییر در وضعیت سلامت بیمار یا عملکرد اوست. کوتاه مدت ( مراقبت های ویژه، اورژانس و ریکاوری) انواع هدف بلند مدت (پیشگویی برای مددجو) معیار : رفتار بیمار + معیار انجام دادن کار + زمان + موقعیت

33. Planning & Outcome identification
Identifying outcomes
Goals
An aim, intent or end.
Short term goals
Hours to days (less than a week)
Long term goals
Weeks to months

34. General Guidelines for Setting Priorities
Take care of immediate life-threatening issues.
Safety issues.
Patient-identified issues.
Nurse-identified priorities based on the overall picture, the patient as a whole person, and availability of time and resources.

35. برنامه تدابیر پرستاری
این مرحله با توجه به اولویت های تعیین شده و اهداف در نظر گرفته شده طراحی می شود . در واقع در نظر گرفته می شود چه فعالیتی، چه وقت، چه مدت و چگونه باید انجام شود. همچنین تاریخ و زمان انجام فعالیت ها هم باید قید گردد.

36. Planning & Outcome identification
Developing specific nursing interventions
Independent nursing interventions
No order needed
Elevate edematous legs
Interdependent nursing interventions
In conjunction with an interdisciplinary team member
Assist client with physical therapy exercises
Dependent nursing interventions
Require an order
Administering of medications

37. The provider carries out the plan of care
Implementing:
The provider carries out the plan of care

38. Nursing Interventions
Road maps directing the best ways to provide nursing care.
Evidence based nursing.
Monitor health status.
Minimize risks.
Resolve or control a problem.
Assist with ADLs.
Promote optimum health and independence.

39. 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.

40. During Implementing, the care provider:
Carries Out The Plan Of Nursing Care or Setting your plans in motion and delegating responsibilities for each step.
Continues Data Collection And Modifies The Plan Of Care As Needed
Documents Care

41. 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:
Prioritized nursing diagnostic statements.
Outcomes.
Interventions.

42. مراحل فرآیند پرستاری (ارزشیابی)
4- EVALUATION
تعیین واکنش بیمار نسبت به تدابیر پرستاری
از طریق رابطه زیر نشان داده می شود
ارزشیابی دستیابی به هدف + مروری بر فرآیند پرستاری
چه مراقبت هایی انجام شده .
اطلاع از کیفیت مراقبت (مروری بر گزارشات بیمار و مقایسه با استانداردها راهی برای
بررسی کیفیت مراقبت های انجام شده است).
منبعی برای تحقیق.
مورد استفاده دیگران بودن.

43. Evaluating:
The measuring of the extent to which client goals have been met
Evaluation involves not only analyzing the success of the goals and interventions, but examining the need for adjustments and changes as well.
The evaluation incorporates all input from the entire health care team, including the patient.

44. During Evaluating, the care provider:
Measures The Clients Achievement Of Desired Goals/Outcomes
Identifies Factors That Contribute To The Client’s Success Or Failure
Modifies The Plan Of Care, If Indicated

45. Evaluation
5th step
Determining whether the clients goals have been met, partially met or not met.

47. Purpose of the nursing process:
To Achieve Scientifically- Based, Holistic, Individualized Care For The Client
To Achieve The Opportunity To Work Collaboratively With Clients, Others
To Achieve Continuity Of Care

48. Characteristics: a. Systematic b. Dynamic d. Goal-directed
The nursing process has an ordered sequence of activities and each activity depends on the accuracy of the activity that precedes it and influences the activity following it.
b. Dynamic
The nursing process has great interaction and overlapping among the activities and each activity is fluid and flows into the next activity
c. Interpersonal
The nursing process ensures that nurses are client-centered rather than task-centered and encourages them to work to enhance client’s strengths and meet human needs
d. Goal-directed
The nursing process is a means for nurses and clients to work together to identify specific goals (wellness promotion, disease and illness prevention, health restoration, coping and altered functioning) that are most important to the client, and to match them with the appropriate nursing actions
e. Universally applicable
The nursing process allows nurses to practice nursing with well or ill people, young or old, in any type of practice setting

49. مزیت فرآیند پرستاری
اطمینان و اعتماد رضایت شغلی برای پرستاران رشد و پیشرفت حرفه پرستاری تعیین استانداردهایی برای پرستاری بالینی شرکت بیمار در مراقبت از خود برای بیماران تداوم مراقبت ها افزایش کیفیت مراقبت های انجام شده

50. The Whole Patient
The nursing process involves looking at the whole patient at all times. It personalizes the patient.
It also forces the health care team to observe and interact with the patient, and not just the task they are performing such as a dressing change, or a bed bath. The process provides a roadmap that ensures good nursing care and improves patient outcomes.