Nursing process PPT

1. Definition of Critical
Thinking
• Cognitive process during
which an individual
reviews data and
considers potential
explanations and
outcomes before forming
an opinion or making a
decision

2. • “Critical thinking in nursing
practice is a discipline specific,
reflective reasoning process
that guides the nurse in
generating, implementing, and
evaluating approaches for
dealing with client care and
professional concerns.” NLN
2000

3. Critical Thinking in Nursing
Nurses use critical thinking skills
in a variety of ways:
• Nurses use knowledge from
other subjects and fields
• Nurses deal with change in
stressful environments
• Nurses make important
decisions

4. Critical Thinking in Nursing
• Guided by professional
standards and ethic codes
• Requires strategies that
maximize potential and
compensate for problems
• Constantly reevaluating, self-
correcting, and striving to
improve

5. Nursing Process
• Organized framework to guide
practice
• Problem solving method -
client focused
• Systematic- sequential steps
• Goal oriented- outcome criteria
• Dynamic-always changing,
flexible
• Utilizes critical thinking
processes

6. Nursing Process
• Specific to the nursing
profession
• A framework for critical
thinking
• It’s purpose is to:
“Diagnose and treat human
responses to actual or
potential health problems”

7. Components of Nursing
Process

8. • Hall originated the term
nursing process in 1955
• 1967 Yura &Walsh proposed
four component
• ANA suggested five
components
• 1982 recommendations of
NANDA (North American Nursing
Diagnosis Association ) accepted

9. Advantages of Nursing
Process
• Provides
individualized care
• Client is an active
participant
• Promotes continuity
of care
• Provides more
effective
communication
among nurses and
healthcare
• Develops a clear
and efficient plan
of care
• Provides personal
satisfaction as you
see client achieve
goals
• Professional
growth as you
evaluate
effectiveness of
your interventions

10. 5 Steps in the Nursing
Process
• Assessment
• Nursing
Diagnosis
• Planning
• Implementing
• Evaluating

11. When using the Nursing
Process
• Identify health care
needs
• Determine Priorities
• Establish goals &
expected outcomes
• Provide appropriate
interventions
• Evaluate
effectiveness

12. Nursing Process
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

13. Characteristics of the
Nursing Process
• Data from each phase provide
input into the next phase.
• Dynamic
• Client centered
• It is an adaptation of problem
solving
• Decision making

14. • Interpersonal & collaborative
• It is a framework of nursing
care process
• Uses a variety of critical
thinking skill
• Open,Flexible
• Goal directed
• Individualized

15. ASSESSING
• Collect data
• Organize data
• Validate data
• Document data

16. DIAGNOSING
• Analyze data
• Identify health problems,
risks, and strengths
• Formulate diagnostic
statements

17. PLANNING
• Prioritize problems/diagnoses
• Formulate goals/desired
outcomes
• Select nursing interventions
• Write nursing intervention

18. IMPLEMENTING
• Reassess the client
• Determine the nurse’s need for
assistance
• Implement the nursing
interventions
• Supervise delegated care
• Document nursing activities

19. EVALUATING
• Collect data related to
outcomes
• Compare data with outcomes
• Relate nursing actions to client
goals/outcomes
• Draw conclusions about
problem status
• Continue, modify, or terminate
the client’s care plan

20. Types of Assessment
• Initial nursing assessment
• Problem focused assessment
• Emergency assessment
• Tme-lapsed reassessment

21. Initial Assessment
• Performed within specified
time after admission to a health
care agency
Purpose - To establish a complete
database for problem identification
reference,and future comparison
• Eg :Nursing admission
assessment

22. Problem-focused
assessment
• Ongoing process integrated
with nursing care
• To determine the status of a
specific problem identified in
an earlier assessment
• Eg -Hourly assessment of client’s
fluid intake and urinary output
in an ICU

23. Emergency assessment
During any physiological or
psychological crisis of the
Client
Purpose-To identify life-threatening
problems
•To identify new or overlooked
problems
Eg:Rapid assessment of a person’s
airway, breathing status, and
circulation during a cardiac arrest

24. Time lapsed
• Several months after initial
assessment
• To compare the client’s
current status to baseline
data previously obtained
• Eg:Reassessment of a client’s
functional health patterns in a
home care or outpatient setting
or, in a hospital, at shift change

25. Assessment
• First step of the Nursing Process
• Gather Information/Collect Data
– Primary Source - Client / Family
– Secondary Source - physical exam,
nursing history, team members, lab
reports, diagnostic tests…..
– Subjective -from the client (symptom)
• “I have a headache”
– Objective - observable data (sign)
• Blood Pressure 130/80

26. Assessment-
collecting data
• Nursing Interview (history)
• Health Assessment -Review of
Systems
• Physical Exam
– Inspection
– Palpation
– Percussion
– Auscultation

27. Assessment-
collecting data
• Make sure information is
complete & accurate
• Validate prn
• Interpret and analyze data
Compare to “standard
norms”
• Organize and cluster data

28. Example of Assessment
• Obtain info from nursing
assessment, history and physical
(H&P) etc…...
• Client diagnosed with hypertension
• B/P 160/90
• 2 Gm Na diet and antihypertensive
medications were prescribed
• Client statement “ I really don’t watch
my salt” “ It’s hard to do and I just

29. Assessment
• Systemically collects, verifies,
analyzes and communicates
data
• Two step process- Collection
and Verification of data &
Analysis of data
• Establishes a data base about
client needs, health problems,
responses, related
experiences, health practices,
values. lifestyle, &
expectations

30. Critical Thinking and
Assessment Process
• Brings knowledge from
biological, physical, & social
sciences as basis for the nurse
to ask relevant questions. Need
knowledge of communication
skills
• Prior clinical experience
contributes to assessment skills
• Apply Standards of Practice
• Personal Attitudes

31. Assessment Data
• Subjective Data
• Objective Data
• Sources of Data
• Methods of Data Collection-
Interview
• Interview initiates nurse-client
relationship
• Use open-ended questions
• Nursing health history

35. Nursing Diagnosis
• Statement that describes the
client’s actual or potential
response to a health problem
• Focuses on client-centered
problems
• First introduced in the 1950’s
• NANDA established in 1982
• Step of the nursing process
that allows nurse to
individualize care

38. Planning for Nursing Care
• Client-centered goals and
expected outcomes are
established
• Priorities are set relating to
unmet needs
• Maslow’s Hierarchy of Needs is
a useful method for setting
priorities
• Priorities are classifies as high,
intermediate, or low

41. Purpose of Goals and
Outcomes
• Provides direction for
individualized nursing
interventions
• Sets standards of determining
the effectiveness of
interventions
• Indicates anticipated client
behavior or response to
nursing care
• End point of nursing care

42. Goals of Care
• Goal: Guideposts to the
selection of nursing
interventions and criteria in the
evaluation of interventions
• What you want to achieve with
your patient and in what time
frame
• Short term vs. Long term
• Outcome Of Care: What was
actually achieved, was goal
met or not met

43. Nursing Interventions
• Interventions are selected after
goals and outcomes are determined
• Actions designed to assist client in
moving from the present level of
health to that which is described in
the goal and measured with
outcome criteria
• Utilizes critical thinking by applying
attitudes and standards and
synthesizing data

44. Types of Interventions
• Nurse-Initiated
• Physician-
Initiated
• Collaborative
Interventions

45. Selection Of Intervention
• Using clinical decision making
skills, the nurse deliberates 6
factors:
• Diagnosis, expected outcomes,
research base, feasibility,
acceptability to client,
competency of nurse

46. Nursing Care Plans
• Written guidelines for client
care
• Organized so nurse can
quickly identify nursing actions
to be delivered
• Coordinates resources for care
• Enhances the continuity of
care
• Organizes information for
change of shift report

47. Nursing Care Plans vs Concept
Maps
NCP Concept/Mind Map

48. Implementation of Nursing
Interventions
• Describes a category of
nursing behaviors in which the
actions necessary for
achieving the goals and
outcomes are initiated and
completed
• Action taken by nurse

49. Types of Nursing
Interventions
• Standing Orders: Document
containing orders for the use of
routine therapies, monitoring
guidelines, and/or diagnostic
procedure for specific condition
• Protocols: Written plan specifying
the procedures to be followed
during care of a client with a select
clinical condition or situation
(Pneumonia, MI, CVA)

51. Implementation Process
involves:
• Reassessing the client
• Reviewing and revising the
existing care plan
• Organizing resources and care
delivery (equipment,
personnel, environment)

52. Evaluation
• Step of the nursing process that
measures the client’s response to
nursing actions and the client’s
progress toward achieving goals
• Data collected on an on-going basis
• Supports the basis of the
usefulness and effectiveness of
nursing practice
• Involves measurement of Quality of
Care

53. Evaluation of Goal
Achievement
• Measures and Sources:
Assessment skills and
techniques
• As goals are evaluated,
adjustments of the care plan are
made
• If the goal was met, that part of
the care plan is discontinued
• Redefines priorities