Nursing process

Last updated
BLW Nurse's Chatelaine or tool kit. BLW Nurse's Chatelaine.jpg
BLW Nurse's Chatelaine or tool kit.

[ needs context ]

The nursing process is a modified scientific method which is a fundamental part of nursing practices in many countries around the world. [1] [2] [3] Nursing practise was first described as a four-stage nursing process by Ida Jean Orlando in 1958. [4] It should not be confused with nursing theories or health informatics. The diagnosis phase was added later.

Contents

The nursing process uses clinical judgement to strike a balance of epistemology between personal interpretation and research evidence in which critical thinking may play a part to categorize the clients issue and course of action. Nursing offers diverse patterns of knowing. [5] Nursing knowledge has embraced pluralism since the 1970s. [6]

Some authors refer to a mind map or abductive reasoning as a potential alternative strategy for organizing care. [7] Intuition plays a part for experienced nurses. [8]

Phases

Diagram of the five-phase nursing process Nursing process (NANDA).svg
Diagram of the five-phase nursing process

The nursing process is goal-oriented method of caring that provides a framework to nursing care. It involves seven major steps:

Assess (what data is collected?)
Diagnose (what is the problem?)
Outcome Identification - (Was originally a part of the Planning phase, but has recently been added as a new step in the complete process).
Plan (how to manage the problem)
Implement (putting plan into action)
Rationale (Scientific reason of the implementations)
Evaluate (did the plan work?)

According to some theorists, this seven-steps description of the nursing process is outdated and misrepresents nursing as linear and atomic. [9]

Assessing phase

The nurse completes a holistic nursing assessment of the needs of the individual/family/community, regardless of the reason for the encounter. The nurse collects subjective data and objective data using a nursing framework, such as Marjory Gordon's functional health patterns.

Models for data collection

Nursing assessments provide the starting point for determining nursing diagnoses. It is vital that a recognized nursing assessment framework is used in practice to identify the patient's* problems, risks and outcomes for enhancing health. The use of an evidence-based nursing framework such as Gordon's Functional Health Pattern Assessment should guide assessments that support nurses in determination of NANDA-I nursing diagnoses. For accurate determination of nursing diagnoses, a useful, evidence-based assessment framework is best practice.

Methods
  • Client Interview
  • Physical Examination
  • Obtaining a health history (including dietary data)
  • Family history/report

Diagnosing phase

Nursing diagnoses represent the nurse's clinical judgment about actual or potential health problems/life process occurring with the individual, family, group or community. The accuracy of the nursing diagnosis is validated when a nurse is able to clearly identify and link to the defining characteristics, related factors and/or risk factors found within the patients assessment. Multiple nursing diagnoses may be made for one client.

Planning phase

In agreement with the client, the nurse addresses each of the problems identified in the diagnosing phase. When there are multiple nursing diagnoses to be addressed, the nurse prioritizes which diagnoses will receive the most attention first according to their severity and potential for causing more serious harm. The most common terminology for standardized nursing diagnosis is that of the evidence-based terminology developed and refined by NANDA International, the oldest and one of the most researched of all standardized nursing languages. [10] For each problem a measurable goal/outcome is set. For each goal/outcome, the nurse selects nursing interventions that will help achieve the goal/outcome, which are aimed at the related factors (etiologies) not merely at symptoms (defining characteristics). A common method of formulating the expected outcomes is to use the evidence-based Nursing Outcomes Classification to allow for the use of standardized language which improves consistency of terminology, definition and outcome measures. The interventions used in the Nursing Interventions Classification again allow for the use of standardized language which improves consistency of terminology, definition and ability to identify nursing activities, which can also be linked to nursing workload and staffing indices. The result of this phase is a nursing care plan.

Implementing phase

The nurse implements the nursing care plan, performing the determined interventions that were selected to help meet the goals/outcomes that were established. Delegated tasks and the monitoring of them is included here as well.

Activities

Evaluating phase

The nurse evaluates the progress toward the goals/outcomes identified in the previous phases. If progress towards the goal is slow, or if regression has occurred, the nurse must change the plan of care accordingly. Conversely, if the goal has been achieved then the care can cease. New problems may be identified at this stage, and thus the process will start all over again.

Characteristics

The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the individual/family/community has. The nursing process not only focuses on ways to improve physical needs, but also on social and emotional needs as well. [11]

The entire process is recorded or documented in order to inform all members of the health care team.

Variations and documentation

The PIE method is a system for documenting actions, especially in the field of nursing. The name comes from the acronym PIE, meaning Problem, Intervention, Evaluation. [12]

See also

Related Research Articles

Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's ability to fulfill their daily routines and roles. OTs have training in the physical, psychological, and social aspects of human functioning deriving from an education grounded in anatomical and physiological concepts, and psychological perspectives. They enable individuals across the lifespan by optimizing their abilities to perform activities that are meaningful to them ("occupations"). Human occupations include activities of daily living, work/vocation, play, education, leisure, rest and sleep, and social participation.

A nursing diagnosis may be part of the nursing process and is a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. Nursing diagnoses foster the nurse's independent practice compared to dependent interventions driven by physician's orders. Nursing diagnoses are developed based on data obtained during the nursing assessment. A problem-based nursing diagnosis presents a problem response present at time of assessment. Risk diagnoses represent vulnerabilities to potential problems, and health promotion diagnoses identify areas which can be enhanced to improve health. Whereas a medical diagnosis identifies a disorder, a nursing diagnosis identifies the unique ways in which individuals respond to health or life processes or crises. The nursing diagnostic process is unique among others. A nursing diagnosis integrates patient involvement, when possible, throughout the process. NANDA International (NANDA-I) is body of professionals that develops, researches and refines an official taxonomy of nursing diagnosis.

Readiness for enhanced therapeutic regimen management is a NANDA approved nursing diagnosis which is defined as "A pattern of regulating and integrating into daily living a program(s) for treatment of illness and its sequelae that is sufficient for meeting health-related goals and can be strengthened." It was introduced at the 15th NANDA conference in 2002. Purpose: This book is devoted to a discussion of nursing diagnoses, outcomes, and interventions for older persons. As such, the diagnoses selected for the volume are not exhaustive, but represent a severely underdeveloped knowledge base. We have chosen diagnoses that are most prevalent, most difficult to treat, and/or most in need of further development to inform practicing nurses and nursing students and to improve the quality of life of older persons.

NANDA International is a professional organization of nurses interested in standardized nursing terminology, that was officially founded in 1982 and develops, researches, disseminates and refines the nomenclature, criteria, and taxonomy of nursing diagnoses. In 2002, NANDA became NANDA International in response to the broadening scope of its membership. NANDA International published Nursing Diagnosis quarterly, which became the International Journal of Nursing Terminologies and Classifications, and then later was reconceptualized as the International Journal of Nursing Knowledge, which remains in print today. The Membership Network Groups foster collaboration among NANDA-I members in countries and for languages: the German Language Group and the Dutch Language Group.

In 1976, Sister Callista Roy developed the Adaptation Model of Nursing, a prominent nursing theory. Nursing theories frame, explain or define the practice of nursing. Roy's model sees the individual as a set of interrelated systems. The individual strives to maintain a balance between these systems and the outside world, but there is no absolute level of balance. Individuals strive to live within a unique band in which he or she can cope adequately.

Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. Nursing assessment is the first step in the nursing process. A section of the nursing assessment may be delegated to certified nurses aides. Vitals and EKG's may be delegated to certified nurses aides or nursing techs. It differs from a medical diagnosis. In some instances, the nursing assessment is very broad in scope and in other cases it may focus on one body system or mental health. Nursing assessment is used to identify current and future patient care needs. It incorporates the recognition of normal versus abnormal body physiology. Prompt recognition of pertinent changes along with the skill of critical thinking allows the nurse to identify and prioritize appropriate interventions. An assessment format may already be in place to be used at specific facilities and in specific circumstances.

A nursing care plan provides direction on the type of nursing care the individual/family/community may need. The main focus of a nursing care plan is to facilitate standardised, evidence-based and holistic care. Nursing care plans have been used for quite a number of years for human purposes and are now also getting used in the veterinary profession. A care plan includes the following components: assessment, diagnosis, expected outcomes, interventions, rationale and evaluation.

Home health is a nursing specialty in which nurses provide multidimensional home care to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. Home health nurses create care plans to achieve goals based on the client's diagnosis. These plans can include preventive, therapeutic, and rehabilitative actions. Home health nurses also supervise certified nursing assistants. The professional nursing organization for home health nurses is the Home Healthcare Nurses Association (HHNA). Home health care is intended for clients that are well enough to be discharged home, but still require skilled nursing personnel to assess, initiate and oversee nursing interventions.

A clinical nurse specialist (CNS) is an advanced practice nurse who can provide advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice.

The Nursing Interventions Classification (NIC) is a care classification system which describes the activities that nurses perform as a part of the planning phase of the nursing process associated with the creation of a nursing care plan.

The Nursing Outcomes Classification (NOC) is a classification system which describes patient outcomes sensitive to nursing intervention. The NOC is a system to evaluate the effects of nursing care as a part of the nursing process. The NOC contains 330 outcomes, and each with a label, a definition, and a set of indicators and measures to determine achievement of the nursing outcome and are included The terminology is an American Nurses' Association-recognized terminology, is included in the UMLS, and is HL7 registered.

The Nursing Minimum Data Set (NMDS) is a classification system which allows for the standardized collection of essential nursing data. The collected data are meant to provide an accurate description of the nursing process used when providing nursing care. The NMDS allow for the analysis and comparison of nursing data across populations, settings, geographic areas, and time.

Evidence-based nursing (EBN) is an approach to making quality decisions and providing nursing care based upon personal clinical expertise in combination with the most current, relevant research available on the topic. This approach is using evidence-based practice (EBP) as a foundation. EBN implements the most up to date methods of providing care, which have been proven through appraisal of high quality studies and statistically significant research findings. The goal of EBN is to improve the health and safety of patients while also providing care in a cost-effective manner to improve the outcomes for both the patient and the healthcare system. EBN is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. The evidence used to change practice or make a clinical decision can be separated into seven levels of evidence that differ in type of study and level of quality. To properly implement EBN, the knowledge of the nurse, the patient's preferences, and multiple studies of evidence must all be collaborated and utilized in order to produce an appropriate solution to the task at hand. These skills are taught in modern nursing education and also as a part of professional training.

The Omaha System is a standardized health care terminology consisting of an assessment component, a care plan/services component, and an evaluation component. Approximately 22,000 health care practitioners, educators, and researchers use Omaha System to improve clinical practice, structure documentation, and analyze secondary data. Omaha System users from Canada, China, The Czech Republic, Estonia, Hong Kong, Japan, Mexico, New Zealand, The Netherlands, Turkey, the United States, and Wales, have presented at Omaha System International Conferences.

The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in 1974 by Lawrence W. Green that can help health program planners, policy makers and other evaluators, analyze situations and design health programs efficiently. It provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing and evaluating health promotion and other public health programs to meet those needs. One purpose and guiding principle of the PRECEDE–PROCEED model is to direct initial attention to outcomes, rather than inputs. It guides planners through a process that starts with desired outcomes and then works backwards in the causal chain to identify a mix of strategies for achieving those objectives. A fundamental assumption of the model is the active participation of its intended audience — that is, that the participants ("consumers") will take an active part in defining their own problems, establishing their goals and developing their solutions.

The Clinical Care Classification (CCC) System is a standardized, coded nursing terminology that identifies the discrete elements of nursing practice. The CCC provides a unique framework and coding structure. Used for documenting the plan of care; following the nursing process in all health care settings.

Genetics nursing is a nursing specialty that focuses on providing genetic healthcare to patients.

The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes." Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refer to the effects of healthcare on the health status of patients and populations. Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966. While there are other quality of care frameworks, including the World Health Organization (WHO)-Recommended Quality of Care Framework and the Bamako Initiative, the Donabedian Model continues to be the dominant paradigm for assessing the quality of health care.

ADIME, or Assessment, Diagnosis, Intervention, and Monitoring/Evaluation, is a process used to ensure high quality nutrition care to patients and clients from nutrition professionals, such as Registered Dietitians (RD) or Registered Dietitian Nutritionist (RDN). ADIME is used as a means of charting patient progress and to encourage a universal language amongst nutrition professionals.

Nursing documentation is the record of nursing care that is planned and delivered to individual clients by qualified nurses or other caregivers under the direction of a qualified nurse. It contains information in accordance with the steps of the nursing process. Nursing documentation is the principal clinical information source to meet legal and professional requirements, care nurses' knowledge of nursing documentation, and is one of the most significant components in nursing care. Quality nursing documentation plays a vital role in the delivery of quality nursing care services through supporting better communication between different care team members to facilitate continuity of care and safety of the clients.

References

  1. Funnell, R., Koutoukidis, G.& Lawrence, K. (2009)Tabbner's Nursing Care (5th Edition), p. 72, Elsevier Pub, Australia.
  2. Ackley, B. J., & Ladwig, G. B. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (10 ed.). St. Louis: Mosby/Elsevier
  3. Ann Marriner Tomey & Marthe Raile Alligood, ed. (2011). Sygeplejeteoretikere - bidrag og betydning i moderne sygepleje (in Danish). Translated by Stig W. Jørgensen. Munksgaard. pp. 381–406. ISBN   978-87-03-04480-4.
  4. Marriner-Tomey & Allgood (2006) Nursing Theorists and their work. p. 432
  5. Reed, P. (2009) Inspired knowing in nursing. p. 63 in Loscin & Purnell (Eds) (2009) Contemporary Nursing Process.Springer Pub
  6. Kim, H (2010) The Nature of Theoretical Thinking in Nursing. p. 6.
  7. Bradshaw, J & Lowenstein (2010) Innovative Teaching Strategies in Nursing and Related Health Professions.
  8. Funnell, R., Koutoukidis, G.& Lawrence, K. (2009) Tabbner's Nursing Care (5th Edition), p. 222, Elsevier Pub, Australia.
  9. "RogerianNursingScience - Chapter 7 Practice Methods". rogeriannursingscience.wikispaces.com. Retrieved 18 April 2018.
  10. Tastan, S., Linch, G. C., Keenan, G. M., Stifter, J., McKinney, D., Fahey, L., ... & Wilkie, D. J. (2014). "Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: A systematic review". International Journal of Nursing Studies. 51 (8): 1160–1170. doi:10.1016/j.ijnurstu.2013.12.004. PMC   4095868 . PMID   24412062.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. Kozier, Barbara, et al. (2004) Assessing, Fundamentals of Nursing: concepts, process and practice, 2nd ed., p. 261
  12. Barbara Kuhn Timby (2008-01-01), Fundamental Nursing Skills and Concepts, Lippincott Williams & Wilkins, p. 114, ISBN   978-0-7817-7909-8