Download to read offline
More Related Content
Nursing process
- 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 thinkingin 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 inNursing 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 inNursing • 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 • Organizedframework 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 • Specificto 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.
- 8. • Hall originatedthe 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 inthe Nursing Process • Assessment • Nursing Diagnosis • Planning • Implementing • Evaluating
- 11. When using theNursing 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 NursingProcess • 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 theclient • Determine the nurse’s need for assistance • Implement the nursing interventions • Supervise delegated care • Document nursing activities
- 19. EVALUATING • Collect datarelated 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 • Performedwithin 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 processintegrated 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 anyphysiological 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 • Severalmonths 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 stepof 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 • NursingInterview (history) • Health Assessment -Review of Systems • Physical Exam – Inspection – Palpation – Percussion – Auscultation
- 27. Assessment- collecting data • Makesure 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 AssessmentProcess • 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 • SubjectiveData • 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 • Statementthat 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 NursingCare • 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 Goalsand 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 • Interventionsare 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 Plansvs 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: • Reassessingthe client • Reviewing and revising the existing care plan • Organizing resources and care delivery (equipment, personnel, environment)
- 52. Evaluation • Step ofthe 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