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Nursing process by raj kumar mehta

to encourage nursing professional to provide sound, effective and holistic nursing care to the client by using nursing process. Nursing process is the both heart and brain of the Nursing.

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Nursing process by raj kumar mehta

  1. 1. Nursing Process
  2. 2. Nursing Process  Nursing Process – Objectives  Benefits of Nursing Process  Steps of the Nursing process  Characteristics of the Nursing Process  Benefits of Using the Nursing process  What are your responsibilities  Nursing diagnosis  Medical Vs nursing diagnosis
  3. 3.  Characteristics of nursing diagnosis  Format of nursing diagnosis  Taxonomy of nursing diagnosis  Outcome identification  Establish client goals and outcome criteria  Types of nursing plan of care  Writing nursing plan of care Nursing Process…
  4. 4.  A Hospital may be soundly organized, beautifully situated and well equipped, but if the nursing care is not of high quality the hospital will fail in its’ responsibility. - Jean Barrett
  5. 5. Nursing process  Nursing  Unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health, or its recovery, (or to peaceful death) that he/she would have performed unaided if he/she had the necessary strength, will or knowledge and to do this in such a way as to help him/her gain independence as rapidly as possible -Henderson, 1966, p. 15
  6. 6.  ;g !(^^ df elh{lgo x]G8;{gn] g;{sf] ljlzi6 st{JonfO{ o; k|sf/ kl/eflift ug'{ ePsf] 5 –æg;{sf] ljlzi6 st{Jo :j:Yo jf c:j:Yo JolQmnfO{ :jf:Yo nfe -jf zflGtk"0f{ d[To' j/0f _ ug{sf nflu cfjZos lqmofsnfk h;nfO{ p :j:Yo, ;Ifd / hfgsf/ eO{ :j]R5fn] ug]{ lyof]–df ;xof]u k'of{P/ Definition of the Nursing…
  7. 7.  x]G8/;gsf nflu g;{sf] pk/f]Qm ljlzi6 st{Jo p;sf] ljlzi6 ljz]iftf x'g'sf ;fy} cGo ;xfos st{Jox?sf] pbud klg xf] . o;sf] ;+/If0f clgjfo{ 5 . :jf:Yo If]qdf sfo{/t ;d'xsf] cGo ;b:oaf6 o; k|sf/sf] ljlzi6 ;]jf sfo{sf] cf; /fVg' x'b}g lsg eg] c?af6 of] ljlzi6 ;]jf k|bfg ug{ ;Dej x'b}g Definition of the Nursing…
  8. 8. Unique function of Nurse…  In a passage so lovely that it is almost poetry, Henderson translates this unique function:  “The nurse is temporarily the consciousness of the unconscious,  the love of life for the suicidal,  the leg of the amputee,  the eyes of the newly blind,  a means of locomotion for the infant,  knowledge and confidence of the young mother, and  the voice for those too weak or withdrawn to speak”.
  9. 9.  Process:-  Process (Nursing) is not what the nurse does, but it is the methodby which the nurse practices. Nursing process…
  10. 10. Nursing process…  It is a systematic method by which nurses plan and provide care for clients.  This involves a problem solving approach that enables the nurse to identify client problems and needs and to plan, deliver, and evaluate nursing care in an orderly, scientific manner.
  11. 11.  The framework of the nursing process enables the nurse to focus on client needs and to apply the broad Base of nursing knowledge in an organized fashion. Nursing process…
  12. 12. Thus, 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
  13. 13. 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 and others.
  14. 14. 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
  15. 15. The Nursing Process Utilizes The Following  Assessment  Nursing Diagnosis  Planning  Implementation  Evaluation
  16. 16. 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
  17. 17. Benefits of using the nursing process  Continuity of care  Prevention of duplication  Individualized care  Standards of care  Increased client participation  Collaboration of care
  18. 18. Being Accountable – how ???  Using critical thinking before taking actions  Being responsible for your actions  Entering the professional role  Working at the level of your peers  By Using the nursing process
  19. 19. Something to think about:  Nurses are responsible for a unique dimension of healthcare – “ the diagnosis and treatment of human responses to actual or potential health problems”
  20. 20. MARTHA ROGERS, NURSE THEORIST  “When an apple is cut, others see seeds in the apple. We, as nurses, see applesin the seeds.”
  21. 21. What Are Your Responsibilities?  Recognize health problems.  Anticipate complications.  Initiate actions to ensure appropriate and timely treatment.  Begin to think CRITICALLY !!!!!!
  22. 22. Critical Thinking  MENTAL OPERATIONS –decision making & reasoning  KNOWLEDGE-having the facts & understanding the reason behind the knowledge  ATTITUDES- curious/open-minded/non- judgmental….
  23. 23. Critical Thinking…  Critical thinking in nursing is an essential component of professional accountability and quality nursing care.  Critical thinking is careful, deliberate, and goal directed.
  24. 24. Steps of the Nursing process 1. Assessment 1. Assessment Data collection History and physical examination Assessment
  25. 25. 2. Diagnosis 2. Diagnosis -analysis of data (nursing perspective) - Formal statements of client’s (actual & potential health problems) Steps of the Nursing process…
  26. 26. 3. Planning 3. Planning 4. Implementat ion 4. Implementat ion 5. Evaluation 5. Evaluation Steps of the Nursing process…
  27. 27. Nursing diagnosis  A clinical judgment about individual, family, or community responses to actual or potential health/life processes.  Nursing diagnosis provide the basis for selection of nursing interventions to achieve outcome for which nurse is accountable.
  28. 28. Nursing Diagnosis  Terminology used by professional nurses that identifies actual, risk or wellness responses to a health state, problem or condition  Terminology used by professional nurses that identifies a person’s, family’s, or community’s motivation and desire to increase wellbeing and actualize human health potential
  29. 29. Comparisons  Medical Diagnoses  Chronic obstructive pulmonary disease  Cerebrovascular attack  Amputation  Nursing Diagnoses  Ineffective breathing pattern  Activity intolerance  Disturbed body image  Readiness for enhanced coping
  30. 30. Nursing Diagnosis: Definition  The NANDA definition of a nursing diagnosis was adapted from a national, Delphi study by Dr. Joyce Shoemaker (1984)  Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable (NANDA, 1997).
  31. 31. Suggested Revision to Definition of Nursing Diagnosis (2008)  A nursing diagnosis is a clinical judgment that nurses make about individual, family and community responses to conditions/life processes. Based on that judgment, the nurse is responsible for monitoring of client responses, decision-making culminating in a plan of care, and implementing interventions, including interdisciplinary collaboration and referral as needed. The nurse is wholly or partially accountable for the achievement of the desired outcomes.
  32. 32. Medical Vs. Nursing Diagnosis  Medical diagnosis describes a disease or pathology of specific organs or systems that treatment focuses on correcting or preventing.  Nursing diagnosis is actual, possible, or wellness of human response to a health problem that nurses are responsible for treating independently.
  33. 33.  Nursing diagnosis describes client’s response to disease process, developmental stage or life process and provide a way to communicate nursing interventions. Medical Vs. Nursing Diagnosis..
  34. 34. Nursing vs. Medical Dx
  35. 35. Medical Diagnosis  Terminology used by physicians and advanced practice nurses (nurse practitioners) for a clinical judgment that identifies or determines a specific disease, condition, or pathological state
  36. 36. Characteristics of Nursing Diagnosis  Nursing diagnosis provide a means for communicating nursing requirements for client care to other nurses, the health care team, and public.  Nursing diagnostic labels can serve as short hand for specific client problems.  Making accurate nursing diagnosis helps to ensure that individual get quality nursing care.
  37. 37.  Nursing diagnosis increases the specificity of nursing interventions for the receiver of care.  A cluster interpretation is synthesis of clue clusters.  Diagnostic validation occurs in two stages:  Comparing the cluster with norms  Evaluating the specific nursing diagnosis for its particular research base. Characteristics of Nursing Dx…
  38. 38.  Formulating the nursing diagnostic statements involves the  actual,  risk,  wellness, or  possible nursing diagnosis. Characteristics of Nursing Dx…
  39. 39. Format of Nursing Diagnosis Human response pattern (there are 9 patterns) Statement of diagnostic pattern (there are 4 patterns) Statement of nursing diagnosis RATIONALE Outcome identification and planning Implementation and evaluation
  40. 40. Taxonomy of nursing diagnosis  Exchanging  Communicating  Relating  Valuing  Choosing  Moving  Perceiving  Knowing  Feeling Human response pattern
  41. 41. Exchanging  Mutual giving / receiving ; physiologic in nature  Nutrition  Physical regulations  Elimination  Circulation  Oxygenation  Physical integrity e.g. break in the skin etc.
  42. 42. Communicating  Convey message verbally or nonverbally.  Impaired verbal communication  Alteration in non-verbal communication.
  43. 43. Relating  Establishing bond or to connect with another thing, person or place.  Socializing  Parenting  Sexuality
  44. 44. Valuing  Assigning of relative worth; to equate importance  Spiritual distress  Risk for spiritual distress  Potential for enhanced wellbeing
  45. 45. Choosing  Selection of alternatives; in accordance with inclinations (attitude)  Coping  noncompliance
  46. 46. Moving  Involves activity; ADLs, rest, recreation, feeding, growth and development etc.  Activity intolerance  Impaired physical mobility
  47. 47. Perceiving  Involves the reception of information; to comprehend what is not open.  Disturbance in body image, self esteem, personal identity.  Sensory perceptual alterations  Hopelessness  Powerlessness
  48. 48. Knowing  Involves meaning associated with information  Knowledge deficit information  Confusion  Impaired memory  Altered thought process
  49. 49. Feeling  Involves subjective awareness of information; fact, event or state, mental/physical distress.  Pain  Grieving  Post trauma syndrome  Anxiety  fear
  50. 50. Types of nursing dxtic statements  Actual nursing diagnosis  Three part statement  Risk nursing diagnosis  Two part statement  Possible nursing diagnosis  Two part statement  Wellness nursing diagnosis  One part statement
  51. 51. Nursing dx : Statement-1  Actual nursing dx:  Diagnostic label  Related factors  Defining characteristics (s/s)  Stress incontinence related to weak pelvic muscles, obesity, and gravid uterus as evidenced by urine dribbling when coughing.  Pain related to surgical trauma and inflammation as evidenced by grimacing and verbal reports of pain.
  52. 52.  Risk nursing dx:  Diagnostic label  Risk factors  Risk for infection related to surgery and immuno suppression.  Risk for activity intolerance related to prolonged bed rest. Nursing dx : Statement-2
  53. 53.  Possible nursing dx:  Diagnostic label  Related factors (may be unknown)  Possible self esteem disturbance related to unknown etiology.  Possible impaired adjustment related to unknown etiology Nursing dx : Statement-3
  54. 54.  Wellness nursing dx:  Diagnostic label  Potential for enhanced parenting  Potential for effective breast feeding  Family coping potential for growth Nursing dx : Statement-4
  55. 55. Nursing diagnosis : Key points  Collection of data provides basis for identifying nursing dx.  Only registered nurse (RN) will make nursing diagnosis  It is a clinical judgment about individual, family, or community responses to actual or potential health/life processes. Accountable
  56. 56.  Activities include pattern identification, diagnostic evaluation, and formulation of nursing dx  Nursing diagnosis are organized as per the human response pattern Nursing diagnosis : Key points…
  57. 57.  Nursing diagnosis must be within scope of education of nurse and the nurse must be able to intervene legally and independent of physician prescribed actions.  Nurse is accountable to identify and treat collaborative problems. Nursing diagnosis : Key points…
  58. 58.  Nursing dx consists of diagnostic label definition, defining characteristics, risk factors, related factors and qualifiers.  A clue is a piece of information (objective/subjective) collected during information system  A cluster interpretation is synthesis of clue clusters. Nursing diagnosis : Key points…
  59. 59.  Diagnostic validation occurs in 2 – stages;  1-comparing the cluster with norms,  2-evaluating the specific nursing dx for its particular research base.  Formulating the nsg dxtic statements involves the actual, risk, wellness or possible nsg dx. Nursing diagnosis : Key points…
  60. 60. Outcome identification  Purposes:-  Provide individualized care  Promote client participation  Plan care that is realistic and measurable  Allow for involvement of support people
  61. 61.  Activities:-  Establish priorities  Establish client goals & outcome criteria Outcome identification…
  62. 62.  Establish priorities:-  High priority – transportation to O.T., inform surgeon / O.T.  Medium priority – quick history  Low priority – blood E.g. ER case –placenta previa pt. (wheels within wheel) Outcome identification…
  63. 63.  High priority:-  Life threatening situations  Difficulty in breathing  Consent before test  Something that needs immediate attention  Preparation for a test  Impending discharge  Something that is very important to the client  Anxiety  Pain (e.g., I want to see my child – you should arrange it – Higher priority) Outcome identification…
  64. 64.  Medium priority:-  Problem that could result in unhealthy consequences  Physical / emotional impairment but not likely to threaten life  Fatigue  Stress incontinence  Dysfunctional grieving  Priority to be assigned as per the significance from assessment data Outcome identification…
  65. 65.  Low priority:-  Problems that could be resolved easily with minimal interventions  Have little potential to cause significant dysfunction for the client  High likely hood for being resolved  Post-operative pain, client refusing to ambulate  Ambulation is priority for nurse, where as pain is priority for client.  Therefore, care to be given after discussion with client. Outcome identification…
  66. 66. Establish Client Goals & Outcome Criteria  Client goals:-  Goal is a educated guess (on the basis of some facts) of what the clients state will be after the nursing intervention is carried out.  It is directly addresses the problem stated in nursing diagnosis.  Goal has action verb and the qualifier (level of performance)
  67. 67.  Qualifier:-  Within 5 min……….↓  If not achieved set other objective & immediately act.  Goal : client demonstrates correct skin care procedure. Establish Client Goals & Outcome Criteria…
  68. 68. Outcome criteria  Are specific measurable, realistic statements of goal attainment.  Subject:- Who will achieve the goal?  Verb:- What actions will be taken to achieve the goal?  Condition:- Under what circumstances the action will be performed.  Criteria:- How well the action will be performed?  Specific time:- When the action is to be performed?
  69. 69. Outcome criteria… The client (who) verbalizes (What action) three dietary modifications of a low salt diet to his wife (under what circumstances)accurately (how well) after the teaching session (When)
  70. 70. Types of Nursing Plan of Care  Instructional nursing plan of care  Giving instruction to other  Other have to give care e.g., position to be changed instead change of position  Clinical nursing plan of care  Individualized plan of care  Standardized plan of care  Generic plan of care  Computerized plan of care  Collaborative care plan: critical pathways
  71. 71. Implementation of nursing plan of care  Implementation skills  Intellectual skills  Interpersonal skills  Technical skills  Implementation activities  Reassess  Set priority  Perform nursing intervention
  72. 72. Implementation Activities  Not a easy job  Cognitive intervention  Educational (thinking process)  Supervisory  Interpersonal Intervention  Coordinating  Supportive  Psychosocial  Technical Intervention (Dealing with machinery)  Surveillance  Maintenance
  73. 73. Evaluation  Evaluation skills:-  Knowledge of standards of care  Knowledge of normal client response  Knowledge of conceptual models & theories  Ability to monitor effectiveness of nursing interventions  Awareness of clinical research (match your practice at present )
  74. 74. Types of evaluation  Structure evaluation – facilities  Process evaluation – injection given but unsterile  Outcome evaluation – activities done but pts behaviour not changed
  75. 75. Writing Nursing Plan of Care  Planning Nursing Intervention  Writing Nursing Plan of Care
  76. 76. Planning Nursing Interventions  Any treatment based upon clinical judgment and knowledge, that a nurse performs to enhance client outcomes.
  77. 77.  Purposes:-  Direct client care activities  Promote continuity of care  Focus charting requirements  Allow for delegation of specific activities Planning Nursing Interventions…
  78. 78. Taxonomy of Nursing Interventions  Six domains:  Physiologic : Basic – hygiene, comfort, positioning  Physiologic : Complex – O2  Behavioural  Safety  Family  Health systems
  79. 79. Types of Nursing Interventions  Psychomotor  Positioning, inserting, applying  Psychosocial  Supporting, exploring, encouraging  Educational  Demonstrating, teaching, observing, return demonstration
  80. 80.  Maintenance  Skin care, hygiene  Surveillance  Detecting changes  Supervisory  Other health care providers  Socio-cultural  Spending time, incorporating cultural differences in care regimens. Types of Nursing Interventions…
  81. 81. Writing Nursing Plan of Care…  Plan of care is nursing centered  Plan of care is step by step process  Sufficient data are collected to substantiate nursing diagnosis  At least one goal must be stated for each nursing diagnosis  Outcome criteria must be identified for each goal
  82. 82.  Each intervention must be specially deigned to meet the identified goal.  Each intervention must be supported by scientific rationale.  Evaluation must address whether each goal was completely/partially met or unmet or not at all. Writing Nursing Plan of Care…
  83. 83. Types of Plans  Narrative  SOAP : Subjective data – Objective data Assessment – Plan  SOAPIE : Subjective/Objective/Assessment/Nursing Diagnosis/Plan/Goals/Intervention/Rationales/Evalu ation  PIE : Problem – Intervention – Evaluation  FOCUS : Data – Action – Response  CBE : Charting By Exception
  84. 84. CBE—What is it?  Charting by exception (CBE) is a shorthand method of documenting normal findings, based on clearly defined normals, standards of practice, and predetermined criteria for assessments and interventions. Significant findings or exceptions to the predefined norms are documented in detail.  Murphy and Burke, 1990
  85. 85. Benefits of CBE  Standards allow for consistent quality of care and documentation within organization  Abnormal findings are highlighted  Repetitive documentation of routine care is eliminated through use of standards   documentation time
  86. 86. What are your views on Nursing/ Nursing Process ? Is it an art ? science?or
  87. 87. (1950)(1950)
  88. 88. The Future Face of Nursing Education & Practice
  • MariamAbbas5

    Jun. 16, 2020
  • ShubhraPaul2

    May. 14, 2020
  • SaranyasaraSaranyasara

    Dec. 24, 2017
  • drchandan

    Jan. 29, 2015

to encourage nursing professional to provide sound, effective and holistic nursing care to the client by using nursing process. Nursing process is the both heart and brain of the Nursing.

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