1. Step 3 ： Analyze nursing diagnoses relationships  Draw lines between nursing diagnoses to indicate relationships.  Prepared to verbally explain to your clinical faculty why you have made these links if it is not obvious.  Concept mapping is a holistic approach to patient care.  This step focuses on the relationships between diagnoses and the labeling of nursing diagnoses.

2. Step 4 ： Identifying goals, outcomes, and interventions  Write patient goals and outcomes and then list nursing interventions to attain the outcomes for each of the numbered diagnoses on your map.  The nursing interventions should include appropriate treatments and medications and patient teaching.  Prepared to verbally explain the goals and rationales for nursing interventions with your clinical faculty.

3. Step 5 ： Evaluate patient’s responses  This step is the written evaluation of the patient’s physical and psychosocial responses.  It also involves writing your clinical impressions and inferences regarding the patient’s progress toward expected outcomes and the effectiveness of your interventions to bring these outcomes about.

4. Documentation  Documentation involves correctly identifying patient assessment data to record about a problem, determining what to record about the interventions to correct the problem, and describing the patient’s responses to the interventions.  Concept map care plans as the basis of documentation --- detail in chapter 7

5. Medication Administration  Organizing the drugs to be administered  Relationship of the drug to the problem  Interacting effects of the drug related to the total clinical picture.  Example : Digitalis -- Decreased cardiac output 。 what is the relationship between low levels of Potassium and digitalis? 。 assessing the patient carefully for adverse reactions to the drug.

6. Nursing Standards of Care  Standards of the American Nurses Association  general standards of care  general standards of care  Standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  specific policies and procedures  specific policies and procedures  Standardized nursing care plans  based on typical nursing diagnoses  based on typical nursing diagnoses

7. Nursing Standards of Care-- con’s  Patient education standards  appropriate for the patient’s individual needs and ability  appropriate for the patient’s individual needs and ability  Insurance agency & government care standards  clinical pathway / critical pathway  clinical pathway / critical pathway  Utilization review standards  review charts. Judge the necessity and appropriateness of care and efficiency with which care is delivered.  review charts. Judge the necessity and appropriateness of care and efficiency with which care is delivered.

8. Managed Care in Hospital Settings  There is a direct relationship between the care standards described above and the management of care.  Hospital-based nurse case managers assigned to monitor and coordinate their progress through the health-care system.  To make links for patients to home health services, transitional care units, long-term care facilities, and other agencies to provide quality care.