Nursing Process Approach.pptx

nursing process approach

1. NURSING PROCESS APPROACH Unit VII

2. NURSING PROCESS INTRODUCTION: Nursing process is a systematic problem-solving approach used to identify, prevent and treat actual or potential health problem and promote wellness. A systematic way to plan, implement and evaluate care for individuals, families, groups and communities.

3. Definition: Nursing process is a critical thinking process that professional nurses use to apply the best available evidence to caregiving and promoting human functions and responses to health and illness (American Nurses Association, 2010). Nursing process is a systematic method of providing care to clients. The nursing process is a systematic method of planning and providing individualized nursing care.

4. Nursing process primarily refers to the independent responsibility of the nurse in providing client care. It has been derived from the scientific method and adapted as an organized systematic method for identifying clients concern and problems, choosing expected client outcomes, determining interventions to resolve these problems and evaluating achievement of excepted outcomes following provision of nursing care.

5. PURPOSES OF NURSING PROCESS To identify a client’s health status and actual or potential health care problems or needs. To establish plans to meet the identified needs. To deliver specific nursing interventions to meet those needs.

6. COMPONENTS OF NURSING PROCESS It involves Assessment (data collection), N ursing diagnosis, P lanning , I mplementation , and E valuation .

7. CHARACTERISTICS OF NURSING PROCESS Cyclic Dynamic nature, Client centeredness Focus on problem solving and decision making Interpersonal and collaborative style Universal applicability Use of critical thinking and clinical reasoning.

8. FORMULATING NURSING CARE PLAN

9. FORMULATING NURSING CARE PLAN The nursing care plan is written guide that organizes information about a client’s care into a meaningful whole. It includes the actions nurses must take to address the client’s nursing diagnosis and meet the stated goals.

10. PURPOSES OF WRITTEN CARE PLAN Provide a direction for individualized patient care. Provide continuity of care for the patient with all hospital departments. Provide direction about what needs to be documented on the client’s progress notes. Serve as guide for assigning staff to care for the client. Provide documentation on patient and family needs. Provides for individual and family participation in the nursing care plan. Provide the source of information for quality improvement and research.

11. WRITING A NURSING PLAN OF CARE A nursing plan of care documents the problem solving process. The ability to create the nursing plan of care has become a standard expected of every nurse. The plan is a critical element in focusing nursing activity. To serve as evaluation criteria and meet the standards of health care. The plan must be developed by a registered nurse, it must be documented in the client’s health record and it must reflect the standards of care established by the institution and the profession.

12. CONCEPTS GUIDE A NURSING PLAN OF CARE The plan of care is nursing centered. The plan of care is a step by step process.

13. 1. The plan of care is nursing centered Keeping the plan of care nursing centered is essential to identify the scope and depth of nursing practice. By focusing on the treatment of human resources to actual or potential health problems, the nurse remains in the nursing practice domains.

14. 2. The plan of care is a step by step process . A step-by-step process is evidenced by the following:- Sufficient data are collected to substantiate nursing diagnoses. At least one goal must be stated for each nursing diagnosis. Outcome criteria must be identified for each goal. Nursing interventions must be specifically designed to meet the identified goal. Each intervention should be supported by a scientific rationale. Evaluation must address whether each goal was completely met, partially met, or completely met.

15. GUIDELINES FOR WRITING NURSING CARE PLANS Date and sign the plan . Use the category headings Nursing Diagnosis Goals / outcome criteria Nursing orders Evaluation and include a date for the evaluation of each goal.

16. Use standardized medical or English symbols and key words rather than complete sentences to communicate your ideas. Refer to procedure books or other sources of information rather than including all the steps on a written plan. Tailor the plan to the unique characteristics of the client by ensuring that the client‘s choices, such as preferences about the time of care and the methods used, are included. This reinforces the client‘s individuality and sense of control .

17. Ensure that the nursing plan incorporates preventive and health maintenance aspects as well as restorative. Ensure that the plan contains orders for ongoing assessment of the client. Include collaborative and coordination activities in the plan. Include plans for the client‘s discharge and home care needs.

18. TYPES OF NURSING CARE PLANS As you care people in various health care facilities, you will discover a variety of nursing care plan formats. The documentation of the plan of care is also changing as federal, state, and accrediting agencies examine and modify their standards. It can be written in various ways.

19. The most common formats for care plans include: Student nursing care plan, I ndividually developed nursing care plan, P ractice guidelines, C ritical path or case management plans, and C omputerized nursing care plans.

20. 1. Student Nursing Care Plans: Each school of nursing has a care plan format adopted or developed by the faculty for student use. Because student plans are used as learning tools, they are usually more comprehensive and detailed than the care plans utilized by graduate staff nurses. Student care plans focus heavily on documenting signs and symptoms and proving the rationale for specific nursing interventions. This information is no less important to the graduate nurse. However , the experienced nurse is capable of high level assessment and synthesis of data, which are still step-by-step for the student. The components usually include Nursing diagnoses, client goals, outcome criteria, nursing interventions, scientific rationale, and evaluation.

21. 2. Individually Developed Nursing Care Plans : The Individually developed nursing care plan is the most traditional and oldest method of documenting the plan of care. It typically consists of three columns, which are labeled, according to the setting, as nursing diagnoses or problems, outcomes or goals, and nursing interventions or orders . Additional columns may be added to the format to include a spot for the date and initials of the nurse who developed the plan, the date for the outcome achievement, and the date the nursing diagnosis was resolved .

22. Advantages: The advantages of individually developed nursing care plans include their specificity to a particular person. They contain only the pertinent nursing diagnoses, outcomes and interventions. Disadvantages : The primary disadvantage of this is the time-consuming aspect of the development process. Also, as is true with other formats for care plans, the individually developed nursing care plan may not accurately reflect the person‘s current problems if it has not been updated.

23. 3. Standardized Nursing Care Plans: Printed care plans, known as standardized care plans, are developed commercially or by an individual health care facility. They direct nursing care for people with specific medical diagnoses (e.g. myocardial infarction) with certain nursing diagnoses such as pain or anxiety, or who are undergoing special procedures such as cardiac catheterization. These care plans are typed, preprinted, duplicated, and made available to the appropriate units in the health care facility.

24. Advantages: Reduced amount of writing needed to record routine nursing interventions and help to the staff by highlighting necessary interventions. These are usually developed by a group of nurses who use their collective expertise and experience to produce a well researched tool. Particularly helpful to nurses who may be asked to work in an unfamiliar area. Disadvantages : Nurses may use these care plans without individualizing them for a particular person. Many of the nursing diagnoses, outcomes, and interventions may not be applicable. These may tend to be long

25. 4. Teaching Plans: Teaching plans are a specialized form of nursing care plans. Individually developed teaching plans may be hand written or computer generated for individuals with complex teaching needs. An agency may have a variety of standardized teaching plans prepared for people with commonly seen teaching needs. The nurse modifies the standard teaching plan as needed and uses the form to document the outcome of the teaching.

26. Advantages: They clearly specify well-researched and agreed-upon management of certain problems. Once the initial work of developing the practice guideline is completed, their use saves much time by quickly transmitting information that does not need to be documented for each person for whom it is applicable. Practice guidelines are not considered standards. Disadvantages: The temptation to follow uncritically the interventions without individualizing them for a particular person. No prepared plan of care, no matter what its format, replaces the judgment and critical thinking of the nurse.

27. 5. Case Management Care Plans: Case management is a method of delivering care that has evolved from the emphasis on decreasing the length of stay in hospitals and the focus on achieving timely client outcomes. Case management is designed to organize care to achieve certain specific outcomes with in a time frame permitted by the reimbursement system . The Case management plan is a standardized care plan that consists of nursing diagnoses, outcomes, deadlines, nursing interventions, and physician interventions.

28. The plan is developed collaboratively by nurses, physicians and other health care professionals and is reviewed and individualized for a particular person. The comprehensive case management plan is often summarized in the form of a critical path or patient outcome timeline. Critical paths can improve quality of care by:- Allowing health care professionals to share knowledge with each other. Educating clients by thoroughly explaining the treatment plan. Permitting comparison of outcomes or results of various treatment methods. Identifying and reinforcing steps critical to the desired outcome.

29. Advantages : Easy to identify appropriate steps in achieving the outcomes. The person is actively involved in reviewing the plan of care. Nurses are given more authority to make changes in the system to facilitate the achievement of outcomes. Disadvantages : A great deal of planning needed to implement this method of delivering care. It may be difficult in some instances to gain the cooperation of physicians in defining how to manage certain types of clients and to collaborate with nurses on a professional level. Certain people will have preexisting conditions or complications that will prevent the achievement of outcomes at specified time periods.

30. 6 . Computerized Nursing Care Plans: Many software vendors have developed computerized nursing care plans and critical paths. Computerized plans of care are generated from assessment data entered into a computer about a specific client. The plan is written by experts in the area and the content is similar to that of standardized plan of care. Once the plan is on the computer screen, the nurse has opportunity to customize it for the client.

31. Advantages: Legibility . Reduction in the amount of time needed to develop and update the plan. Access to plans developed by expert clinicians. Ability to collect information about groups of patients for research. Disadvantages : It requires a critical analysis of a preexisting plan to ensure that it is appropriate and current. It is critical that all pertinent information be collected and entered into the system.

32. IMPLEMENTATION Introduction: The nursing process is a deliberative, problem- solving approach to meeting the health care and nursing needs of patients. It involves assessment, diagnosis, outcome identific ation , planning, implementation and evaluation, with subsequent modifications used as feedback mechanisms that promote the resolution of the nursing diagnoses. The process as whole is cyclical, the steps being interrelated, interdependent, and recurrent .

33. The nursing process is action oriented, client centered, and goal directed. After developing a plan of care based on the assessing and diagnosing phases, the nurse puts the plan into effect and evaluates the results. Based on this evaluation, the plan of care is continued, modified, or terminated. As in all phases of the nursing process, clients and support persons are encouraged to participate as much as possible. The degree of participation depends on the client‘s health status.

34. After the nurse and client identify problems and strengths, they plan together methods of helping the client maintain or return to healthy function. Out-come criteria are set for goals, and a plan of care is developed. Now they are ready for the implementation phase of the nursing process, the activity that provides planned care, and the evaluation phase, in which the client‘s status is measured in response to the nursing care provided.

35. DEFINITION Implementation refers to the action phase of the nursing process in which nursing care is provided. It is the actual initiation of the plan and recording of nursing actions. Its purpose is to provide technical and therapeutic nursing care required to help the client achieve an optimal level of health. Bulechek define nursing implementation as ―any direct care treatment that a nurse performs on behalf of a client. These treatments include nurse- initiated treatments resulting from medical diagnoses and performance of the daily essential functions for the client who that cannot do these.

36. IMPLEMENTATION SKILL The implementation phase of the nursing process draws heavily on the intellectual, interpersonal, and technical skills of the nurse. Decision-making , observation, and communication are significant skills, enhancing the success of action. These skills are utilized with the client, the nurse, nursing team members, and health team members. Competence in intellectual, interpersonal and technical skills is required to carry out the implementation phase.

37. INTELLECTUAL/ COGNITIVE SKILLS The intellectual skills used in implementation include problem solving, decision making, critical thinking and teaching. To solve problems, nurses ask clients pertinent questions, discuss alternatives, and are open new ideas. To enrich the decision making abilities of clients, nurses give them opportunities to choose which treatments are performed, when and in what sequence. Teaching requires knowledge about teaching-learning principles and information to convey.

38. INTERPERSONAL/ AFFECTIVE SKILLS The ability to work with others to accomplish goals is critical to nursing. Nurses use communication skills to carry out planned nursing interventions. Verbal and non-verbal communication skills are utilized when you interact with the health care team. These skills are often crucial in the successful implementation of nursing care. People often judge nurses not by their technical skills alone but by whether they are kind, concerned and caring. The ability to use effective interpersonal skills when communicating with physicians, social workers, and other personnel will also affect the success of the implementation phase. It is essential that the nurses be able to use cognitive skills to solve problems and make decisions and use interpersonal skills to implement those decisions.

39. TECHNICAL / CONATIVE SKILLS Psychomotor or technical skills are the third major category of skills used during implementation of nursing care. These skills are used to carry out treatments and procedures. Nurses learn the specific skills through clinical practice. Technical competence means being able to use equipment machines and supplies in particular specialty. For example , nurses working in delivery rooms must be familiar with fetal monitoring, positioning on delivery- room table, and neonatal resuscitation devices. On the other hand, nurses working on medical units may need technical competence in using hypothermia blankets, therapeutic beds or feeding pumps. Nurses often find that when technical skills are unfamiliar, it is difficult to incorporate the cognitive and interpersonal components.

40. IMPLEMENTATION ACTIVITIES: The activities of implementation include the following:- Reassessing. Setting priorities. Performing nursing intervention. Recording nursing actions.

41. REASSESS Assessing is carried out throughout the nursing process, whenever the nurse has contact with the client. Just before implementing, the nurse must reassess whether the intervention is still needed because a client‘s condition can change quickly and dramatically. For example, the client who experiencing pain may become quite and withdraw from external stimuli. Recognizing such a change, nurses can intervene, validate, and assist the client to become more comfortable. As they initiate the nursing plan of care, nurses must ensure that the planned interventions are still relevant.

42. SET PRIORITIES Because a person‘s condition changes, priorities also may change. Priorities are based on information collected during reassessment. When setting priorities, nurses rank nursing problems in order of importance based on several factor. The client‘s condition. New information from reassessment. Time and resources available for nursing interventions. Feedback from the client, family and health staff. The nurse‘s experience in assessing situations and setting priorities. Priorities can be set every few minutes, hourly, daily, weekly or for longer periods. For example, in the critical care unit, priorities may need to be set every few minutes for an unstable client with multiple traumas.

43. PERFORM NURSING INTERVENTIONS Nurse carry out the nursing interventions listed on the nursing plan of care. If a nurse is caring for several clients, he or she develops a schedule so that all clients are cared for in a timely fashion. INTERVENTION FOR COLLABORATIVE PROBLEMS : Nurses manage collaborative problems using both nurse and physician prescribed interventions to reduce risk of complications. Both types of interventions involve nursing judgment, because both require legal mandates.

44. RECORD ACTIONS After carrying out nursing interventions, nurses record them in the client‘s health record. Each institution determines the specific requirements for documentation and should prepare written guidelines for the use of all forms.

45. RESPONSIBILITIES IN IMPLEMENTATION OF NURSING CARE It is the professional responsibility to carry out the nursing care as the primary nurse, delegate certain interventions to appropriate nursing or allied health professionals and carry out physician orders, thereby integrating medical therapy into overall care plan. Nursing care is implemented to assist people in achieving the outcomes established in the plan of care, to prevent disease and illness by promoting wellness, to restore functioning and to facilitate coping with illness.

46. THE MAJOR RESPONSIBILITIES IN IMPLEMENTING NURSING CARE INCLUDE Reviewing the planned interventions for appropriateness. Scheduling and organizing the interventions. Collaborating with other team members. Supervising and delegating nursing care by other members of nursing team. Achievement of the organizational and client care goals. Providing direct nursing care. Providing counseling. Involving the client in health care. Teaching the client and family. Making referrals to other health care professionals. Documenting nursing care provided.

47. SUMMARY The ultimate intent of the implementation phase is the use of strategies to help the person achieve the outcomes. By providing focused and planned care, you use your cognitive, interpersonal and technical skills to assist the person. The major responsibilities of nursing care involve reviewing the planned interventions, scheduling, organizing, collaborating, supervising, providing direct care, counseling, teaching, referring and documenting.