1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins MS 1 Program Group 3-30 Chapter 03: The Nursing Process

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Introduction –Provision of healthcare: Process of problem-solving –Purpose of nursing process: Provides a systematic method to plan and implement client care to achieve desired outcomes –Includes: Collecting information; identifying problems; developing an outcome-based plan; carrying out plan; evaluating results –Framework for nursing care

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The purpose of nursing process is intentional, contemplative, and outcome-directed thinking.

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False The purpose of nursing process is to provide a systematic method for nurses to plan and implement client care to achieve desired outcomes. Critical thinking is intentional, contemplative, and outcome-directed thinking.

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Introduction –Begins: Client enters healthcare system –Five steps Assessment Diagnosis (nursing) Planning Implementation Evaluation

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Introduction Figure 3-1 Five steps of the nursing Process, pg 18

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Assessment –Client’s health status: Careful observation; evaluation –Collect information: Determine abnormal function, risk factors, client strengths –Recurring nursing activity –Client database: Medical and nursing history; physical examination; diagnostic studies –Baseline data: Comparison for future signs and symptoms

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Nursing diagnoses are different from medical diagnoses.

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True In nursing diagnoses, the nurse reports or analyzes data to identify health problems that independent or physician-prescribed nursing actions can prevent or solve. Medical diagnoses identify medical conditions. It violates licensure for nurses to assign medical diagnoses.

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Assessment (cont’d) –Reference for determining improvement in client’s health –Initial and ongoing assessment: Provision of nursing care Nursing Diagnosis –Report or analyze data: Identify and define problems –LPNs report information: Actual or potential health problems

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Nursing Diagnosis –RNs examine and analyze client database: Formulate nursing diagnoses –Identify and define health problems nursing actions can prevent or solve –NANDA-approved nursing diagnoses (pg 19) –Nursing diagnostic statement Problem: Name; cause; signs and symptoms or data indicate the problem Phrases used: Cause “related to” or “secondary to” (figure 3-2)

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Nursing Diagnosis –Data link: “As manifested by” or “as evidenced by” –Actual diagnoses: Identify existing problems –Risk diagnoses: Identify potential problems; stem “risk for” –Possible diagnoses: Stem “possible” –Collaborative problems: Denote complications with physiologic origin; manage problems using physician- prescribed and nursing-prescribed interventions (potential complication – PC)

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Nursing Diagnosis –Wellness diagnoses: Stem “potential for enhanced” –Syndrome diagnoses: Identify diagnosis associated with a cluster of other diagnoses –Five syndrome diagnoses: NANDA Planning –Setting priorities; defining expected (desired) outcomes; determining specific nursing interventions; recording plan of care

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Planning (cont’d) –Respect client’s right to participate in healthcare; involve client and family –Establishing priorities Prioritize client’s multiple problems Framework used for prioritizing: Maslow’s hierarchy of human needs First-level needs: Baseline survival needs; highest priority Problem that poses threat to physiologic functioning: Rank first

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Planning –Establishing priorities (cont’d) Nursing diagnoses that affect First level, physiologic needs: Ineffective breathing pattern, deficient fluid volume Second level, safety and security: Anxiety, risk for injury Third level, love and belonging: Parental role conflict, social isolation Fourth level, esteem and self-esteem: Powerlessness, ineffective coping

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Planning –Establishing priorities Nursing diagnoses that affect (cont’d) Fifth level, self-actualization: Delayed growth and development, spiritual distress –Defining expected outcomes Client and family: Include in establishing outcomes Outcomes: Specific, realistic, measurable

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Planning –Determining specific interventions Plan of care: Identifies interventions or actions for achieving outcomes Relieving cause of problem: Directs interventions Identify specific interventions to decrease effects of the problem (Examples of expected outcomes – Table 3-3, pg 21)

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Planning –Recording the plan of care RN: Assigns interventions in written plan as nursing orders Nursing orders: Specific nursing directions; clear; appropriate; compatible with medical orders Preprinted or computer-generated care plans: Saves time Complete plan of care: Communication; basis for continuity of care REVIEW: Nursing Care plan, 3-1, pg 23

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Implementation –Carrying out written plan of care –Performing interventions; monitoring client’s status; assessing and reassessing client before, during, and after treatments –Involvement of client, family, community, and members of healthcare team –Documentation; discuss importance of accurate and thorough documentation in medical record –(Important element)

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Implementation (cont’d) –Functions: Communication; client status; legal document; validation for reimbursement; evaluation –Document permanent record: All nursing actions, observations, client responses –Record of nursing action: Mirror image of the written plan –Appropriate documentation: Maintains communication; ensures that client’s progress is monitored

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of the Nursing Process Evaluation –Assessment; review: Quality, suitability of care given, client’s responses –Actual outcomes compared with expected outcomes –Conclusions during evaluation: Outcome achieved, not met, or not achieved –Reasons for client’s lack of progress: Unrealistic expectations, incorrect diagnosis, additional problems, ineffective nursing measures, premature target date

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Three possible conclusions can be drawn during the evaluation phase of the nursing process.

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Three possible conclusions can be drawn during the evaluation phase of the nursing process: Outcome achieved, outcome not met, or outcome not achieved.

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process and Critical Thinking Critical Thinking –Intentional, contemplative, and outcome-directed thinking –Critical thinking is used in the nursing process –Nurse’s role when caring for clients: Continuous assessment of clients’ needs; dealing with situations that involve multiple interventions –Good critical thinking skills: Make nurses more efficient and effective

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process & Critical Thinking Critical thinking (cont’d) –Use of the nursing process: Combines critical thinking with problem-solving methods –Nursing process: Helps nurses acquire critical thinking and problem-solving skills; dynamic, continuous process –Identify specific cognitive and mental activities to use when thinking critically –Requirement for developing critical thinking skills: Knowledge, practice, experience.

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins NCLEX Questions & Question Time!!