The Nursing Process

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The Nursing Process

• A Critical Thinking Model for Nursing
• Prof. Chichi Echezona-Johnson

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Introduction to the Nursing Process

• Used to identify, diagnose, and treat human
  responses to health and illness.
• Five steps
• Assessment
• Nursing Diagnosis
• Planning
• Implementation
• Evaluation

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The Nursing Process

• The nursing process is an orderly, systematic
  manner of determining the clients health status,
  specifying problems defined as alterations in
  human need fulfillment, making plans to solve
  them, initiating and implementing the plan, and
  evaluating the extent to which the plan was
  effective in promoting optimum wellness and
  resolving the problems identified. (Yura
  Walsh, 1988)

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The Nursing Process

• The Nursing process is a method of problem
  identification and problem solving. The Nursing
  process is not applied in an objective,
  value-free way. Human values influence both
  problem identification and problem solving.
• (Gordon, 1994)

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The Nursing Process

• The nursing process and its five interrelated
  steps are designed to help you
• Organize and prioritize patient care
• Keep the focus on whats important the
  patients health status and quality of life
• Form thinking habits that help you gain
  confidence and skills you need to think
  critically in the clinical setting

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Planning
Nursing Diagnosis
Implementation
Evaluation
Assessment
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Assessment

• Observation
• Interview
• Physical Examination
• Health records and diagnostic data

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Diagnosis

• Thorough assessment data provides the foundation
  for nursing diagnoses.
• Diagnosis The clinical act of identifying
  problems.
• To diagnose is to analyze the assessment
  information and derive meaning from this analysis.

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Planning

• Client-centered goals and expected outcomes are
  established and nursing interventions selected
  that can resolve the clients problems and meet
  the goals/outcomes.
• Priorities are established to help the nurse
  anticipate and sequence nursing interventions in
  the presence of multiple problems and/or nursing
  diagnoses.

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Priority Setting

• High Priority Nursing Diagnoses
• Life threatening situations
• Something that needs immediate attention
• Something very important to the patient
• Intermediate Priority
• Problems that could result in unhealthy
  consequences.
• Not likely to threaten life

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Priority Setting

• Low Priority
• Problems that can be easily resolved
• Have little potential to cause significant
  dysfunction
• The Nurses priorities may differ from the
  clients priorities!
• PRIORITIES CONSTANTLY CHANGE AS THE CLIENTS
  SITUATION AND CONDITION CHANGE.

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Goals/Outcomes

• Factors to consider when determining
  goals/outcomes
• Clients current state of health
• Expected length of stay
• Age, values, culture
• Available resources (including financial)
• Is this goal realistic for this patient???

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Interventions and Care Planning

• A nursing intervention is any treatment, based on
  clinical judgment and knowledge, that a nurse
  performs to enhance client outcomes.
• An autonomous action, based on scientific
  rationale, performed by the nurse to benefit a
  patient. These are based on the nursing diagnosis
  and work to assist the client in achieving the
  desired outcome.

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Nurse-Initiated vs Physician-Initiated
Interventions

• Nurse-Initiated Interventions Actions within the
  nurses scope of practice, requiring no
  supervision or direction from other
  practitioners.
• Physician-Initiated interventions Require
  specific nursing and technical knowledge may not
  be initiated without prescription or order from a
  licensed practitioner (MD, PA, NP)

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Implementation

• Nursing actions and planned interventions are
  performed with the patient.
• A continuous process, during which the nurse is
  required to utilize all the steps in the nursing
  process.
• The nurse carries out the plan of care, assesses
  for any response to the intervention, documents
  actions, and re-evaluates for further
  interventions.

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Evaluation

• Measure the clients achievement of desired
  outcomes
• Identify factors that have contributed to success
  or failure to achieve outcomes
• Modify, change, or discontinue the plan of care
• Must be client centered evaluating the response
  elicited not the intervention or nurses
  performance/intentions!!

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How Do You Evaluate???

• Did the client meet the desired outcome?
• Behavior
• Time frame
• Fully met vs Partially met
• ASSESS AND RE-ASSESS!

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The Nursing Process Your Guide to Nursing Care

• The process is an unending cycle
• Constantly revising and rethinking the process
• Requires thought, attention, and
  individualization for each and every client and
  situation.
• When utilized effectively, assures the client
  continuity and consistency of care from all
  members of the health care team.

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Introduction to Concept Maps

• Concept mapping is a technique that allows
  students to understand the relationships between
  ideas by creating a visual map of the
  connections.
• Concept maps allows the student to
• (1) see the connections between ideas they
  already have,
• (2) connect new ideas to knowledge that they
  already have, and
• (3) organize ideas in a logical but not rigid
  structure that allows future information or
  viewpoints to be included

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Use of Concept Maps

• The concept map enables students to synthesize
  relevant data such as diagnoses, signs and
  symptoms, health needs, learning needs, nursing
  interventions, and assessments.
• Analysis of the data begins with the recognition
  of the interrelatedness of the concepts and a
  holistic view of the client's health status as
  well as those concepts that affect the individual
  such as culture, ethnicity, and psychosocial
  state.

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