The Nursing Process:

The Nursing Process:

? An organizational framework for the practice of nursing
? Orderly, systematic
? Central to all nursing care
? Encompasses all steps taken by the nurse in caring for a patient

Definition of the Nursing Process:

? An organized sequence of problem-solving steps used to identify and to manage the health problems of clients
? It is accepted for clinical practice established by the American Nurses Association

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

The Nursing Process Utilizes The Following:

? Assessment
? Nursing Diagnosis
? Planning
? Implementation
? Evaluation

Characteristics of the Nursing Process:

? Within the legal scope of nursing
? Based on knowledge-requiring critical thinking
? Planned-organized and systematic
? Client-centered
? Goal-directed
? Prioritized
? Dynamic

Assessment of Well-Being:

? According to the World Health Organization is well-being in these domains:
? Emotional
? Physical
? Social
? Spiritual

Tools of assessment:

? Observation
? Interview
? Types of questions
? Environment (physical and emotional) Spiritual considerations
? Examination

Types of Data To Collect:

? Objective data-observable and measurable facts (Signs)
? Subjective data-information that only the client feels and can describe (Symptoms)

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

Disease Prevention:

? Primary prevention – protection from a disease while still in a healthy state.
? Secondary prevention – early detection and treatment of disease.
? Tertiary prevention – prevent complications and to maintain health once the disease process has occurred.
Planning:

? Establish the goals, interventions and outcomes

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

Nurse Identified Priorities:
? Composite of all patient’s strengths and health concerns.
? Moral and ethical issues.
? Time, resources, and setting.
? Hierarchy of needs.
? Interdisciplinary planning.

DIAGNOSIS:
? Sort, cluster, analyze information
? Identify potential problems and strengths
? Write statement of problem or strength
? Risk of infection related to compromised nutrition

Components of Outcomes:

? Subject: who is the person expected to achieve the outcome?
? Verb: what actions must the person take to achieve the outcome?
? Condition: under what circumstances is the person to perform the actions?
? Performance criteria: how well is the person to perform the actions?
? Target time: by when is the person expected to be able to perform the actions?

Nursing Interventions:

? Road maps directing the best ways to provide nursing care.
? Evidence based nursing.
1. Monitor health status.
2. Minimize risks.
3. Resolve or control a problem.
4. Assist with ADLs.
5. Promote optimum health and independence.

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.
Documentation:

? Clear and concise
? Appropriate terminology
? Usually on a designated form
? Physical assessment
? Usually by Review of Systems
• Overview of symptoms
• Diet
• Each body system

Evaluation:

1. Determining outcome achievement
2. Identifying the variables affecting outcome achievement
3. Deciding whether to continue, modify, or terminate the plan

NANDA – North American Nursing Diagnosis Association

? Identifies nursing functions
? Creates classification system
? Establishes diagnostic labels
? Risk of infection related to compromised nutritional state
? Potential complication of seizure disorder related to medication compliance

Community as Client:
• A community-wide group of people as the focus of nursing service
– The community directly influences the health of individuals, families, groups, subpopulations, and populations who are a part of it.
– Provision of most health services occurs at the community level.
Dimensions of Community as Client:
• One perspective:
– Status: morbidity & mortality data identifying physical, emotional, and social determinants of health
– Structure: services and resources
– Process: ability to function effectively
• Another perspective:
– Location (community boundaries, location of health services, geographic features, climate, flora, fauna, human-made environment)
– Population (size, density, composition, rate of growth or decline, cultural characteristics, social class and educational level, mobility)
– Social system (variables, health care delivery system)

Nursing Process Characteristics & Community:
• Problem-solving process; management process; process for implementing change
• Characteristics:
– Deliberative; adaptable; cyclic
– Client-focused; need-oriented
– Interaction with community (communication, reciprocal interaction, paving way for helping relationship, aggregate application)
– Forming of partnerships and building of coalitions

Community Needs Assessment:

• Process of determining real or perceived needs of a defined community
• Types
– Windshield survey (familiarization assessment)
– Problem-oriented assessment
– Community subsystem assessment
– Comprehensive assessment (key informants)
– Community assets assessment

Community Assessment Methods:
• Surveys
• Descriptive epidemiologic studies
• Community forums/town hall meetings
• Focus groups

Sources of Community Data:

• Primary: gathered by talking to the people
• Secondary: records produced by people who know the community well
• International
• National
• State
• Local
Community Diagnoses:

• Portray a community focus
• Include community response and related factors that have potential for change via CHN; logically consistent; response and factors logically linked
• Include statements narrow enough to guide interventions
• Use a community response instead of a risk, goal, or need statement
• Include factors within the domain of community health nursing intervention
• Deficit and wellness diagnoses (include maintenance or potential change responses due to growth and development) when no deficit is present

Planning to Meet Community Health Needs; Implementing Plans:
• Planning
– Tools for assistance: operational definitions of objectives and activities, conceptual frameworks and models; systematic approach
– Health planning process
• Implementing
– Preparation
– Activities or actions
Evaluating Implemented Community Health Plan:
• Measuring or judging effectiveness of goal or outcome attainment
• Types of evaluation
– Formative: focus on process during actual interventions; development of performance standards
– Summative: focus on the outcomes of interventions; effect; impact