Nursing process

Lecture for nursing student

1. Jasmin Akter Lecturer Prime College of Nursing, Dhaka Nursing Process

2. Definition Nursing process is a scientific process which is a foundation, the essential tool, and the enduring skill that has characterized nursing from the beginning of the profession. It is a plan of care for the patient which may look different from institution to institution but provides both systematic and effective course of intervention to patient.

3. Significance of Nursing process Provides individualized care Client is an active participant Promotes continuity of care Provides more effective communication among nurses and healthcare professionals Develops a clear and efficient plan of care Provides personal Professional growth as you evaluate effectiveness of interventions

4. Characteristics of Nursing process 1. Cyclic and Dynamic : – it is an ongoing continuous process throughout the stages of illness and treatment and ends with the cease of the illness. 2. Goal directed and Client oriented : The nursing process is intended to treat the patient and is in the best interest of the patient. 3. Interpersonal and Collaborative : This goes to explain the amount of interaction that might be necessary between nurses, patients of similar illnesses and the medical team. It might involve group therapy and / or family counseling.

5. 4. Universally applicable : This process is universally standard and no matter what the institution it may be, the process remains the same. It is like a common nursing language with common nursing terminology followed universally. 5. Scientific and Systematic : Every symptom or sign is a result of a scientific fact which leads to scientific methods of treatment and follow-ups.

6. Steps of Nursing Process IMPLEMENTATION PLANNING AND OUTCOME IDENTIFICATION NURSING DIAGNOSIS ASSESSMENT EVALUATION

7. 1. Assessment Definition: It is also called as data collection. Assessment is both the most basic and the most complex nursing skill which is at the same time both the initial step in the nursing process and an ongoing component in every other step in the process.

8. Assessment is composed of - Observation of patient Interview of patient, family and support systems Examination of the patient Review of medical records.

9. Purposes of Assessment To establish a database To identify health‐promoting behaviors To identify actual and/or potential health problems.

10. Type s o f nursin g assessments Comprehensive Ongoing Focused

11. Steps in Nursing Assessment STEPS 1.Collecting data 2.Validating data 3.Organizing data 4.Interpreting data 5.Documenting data

12. 2. Diagnosis A nursing diagnosis is a clinical judgment about the patient’s response to actual or potential health conditions or needs. It is the process of- Data analysis Problem identification Formulation of nursing diagnosis.

13. Types of Nursing diagnosis There are three types of nursing diagnosis with example: Actual nursing diagnosis: Impaired skin integrity r/t physical immobilization as manifested by disruption of the skin surface over the elbows and coccyx. Risk nursing diagnosis : Risk for impaired skin integrity r/t physical immobilization in total body cast, diaphoresis. Possible nursing diagnosis: Possible nutritional deficit.

14. Components in Nursing Diagnosis (PES Format) Problem statement or diagnostic label Etiology Defining characteristics Problem statement Etiology Defining characteristics Deficient fluid volume Diarrhea Dry skin ,dryness of the mouth.

15. Advantages of nursing diagnosis Communication Identification of Appropriate Goals Quality improvement Standard for Nursing Practice Acuity Information Assist in Discharge planning Common language

16. Comparison between nursing & Medical diagnosis Nursing Diagnosis Within the scope of nursing practice Identify responses to health and illness Can change from day to day Example: Ineffective Breathing Pattern Medical Diagnosis Within the scope of medical practice Focuses on curing pathology Stays the same as long as the disease is present Example: Chronic Obstructive Pulmonary Disease

17. 3. Planning Once a patient and nurse agree on the diagnoses, a plan of action can be developed. If multiple diagnoses need to be addressed, the head nurse will prioritize each assessment and devote attention to severe symptoms and high risk factors.

18. Ongoing Planning Initial Planning Discharge Planning Phases of Planning

19. PLANNING PROCESS 1‐ Setting priorities. 2‐ Establishing client goals/desired out comes. 3‐ Selecting nursing strategies. 4‐ Writing nursing orders.

20. Intermediate Low High Classification of priorites

21. Implementation This fourth step of the nursing process involves the execution of the nursing care plan derived during the Planning phase. Direct care Indirect care INTERVENTION

22. Implementation skills Cognitive Skills Interpersonal Skills Psychomotor skills

23. Implementation process Reassessing the client Reviewing and revising the existing nursing care plan Organizing resources and care delivery Anticipating and preventing complications Implementing nursing interventions.

24. Evaluation Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals; in this phase nurse compare the client behavioral responses with predetermined client goals and outcome criteria. {CRAVEN 1996}

25. Purposes Determine client’s behavioral response . Compare the client’s response with outcome criteria. Appraise the extent to which client’s goals . Assess the collaboration of client and health team 5.Identify the errors in the plan of care. 6. Monitor the quality of nursing care.

26. Methods of Evaluation of nursing care Evaluating nursing care Reflection Reflect on own experiences both socially with other friends.. Nursing handover Hand over information about the nursing care of clients to nurses Reviewing the plan Evaluates the care given against the set goals. Patient satisfaction Appreciation that is sometimes offered by clients

27. Example for Evaluation At the end of 8 hours , patient pain has reduced as evidenced by pain score 2/10 and improved activity