Scientific Process for Diagnosis by Staff Nurses

Scientific process of diagnosis for nurses

1. Scientific Method &
Nursing Process
Dr. Kalim Ullah
Post RN
Semester-I
Scientific Process
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2. Scientific Method
It is a systematic, rational method of
planning and providing nursing care. Its
goal is to identify a client’s health care
status and actual or potential health
problems, to establish plans to meet the
identified needs, and to deliver specific
nursing interventions to address those needs.

3. NURSING PROCESS - INTRODUCTION
The term NURSING PROCESS originated in
1955 by Haul.
Johnson (1959), Orlando (1961), and Wiedenbach
(1963) were the first users of the term nursing
process.
The Nursing Process enables the nurse to organize
and deliver nursing care.

4. Nursing Process
The nursing process is cyclical, that is, its
components follow a logical sequence, but
more than one component may be involved
at one time. At the end of the first cycle,
care may be terminated if goals are
achieved, or cycle may continue with
reassessment or plan of care may be
modified.

5. Nursing Process
Specific to the nursing profession
A framework for critical thinking
It’s purpose is to:
“Diagnose and treat human responses to
actual or potential health problems”
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6. Nursing Process
Organized framework to guide practice
Problem solving method - client focused
Systematic- sequential steps
Goal oriented- outcome criteria
Dynamic-always changing, flexible
Utilizes critical thinking processes
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7. CHARACTERISTICS:
a. Systematic:
The nursing process has an ordered sequence of activities
and each activity depends on the accuracy of the activity
that precedes it and influences the activity following it.

8. b.Dynamic:
The nursing process has great interaction and
overlapping among the activities and each activity is
fluid and flows into the next activity

9. c. Interpersonal: The nursing process ensures that nurses
are client-centered rather than task-centered and
encourages them to work to enhance client’s strengths
and meet human needs.

10. d. Goal-directed: The nursing process is a means for
nurses and clients to work together to identify specific
goals (wellness promotion, disease and illness prevention,
health restoration, coping and altered functioning) that
are most important to the client, and to match them with
the appropriate nursing actions

11. e. Universally applicable:
The nursing process allows nurses to practice nursing with
well or ill people, young or old, in any type of practice
setting

12. Scientific Method of problem solving
Investigate problem
Collect data
Form hypothesis
Plan of action
Hypothesis testing
Interpret results
Evaluate findings
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13. Advantages 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
satisfaction as you see
client achieve goals
Professional growth as
you evaluate
effectiveness of your
interventions
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14. 5 Steps in the Nursing Process
Assessment
Nursing
Diagnosis
Planning
Implementing
Evaluating
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15. Assessment
First step of 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 (symptoms)
•“I have a headache”

Objective - observable data (sign)
•Blood Pressure 130/80
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16. Assessment-collecting data
Nursing Interview (history)
Health Assessment -Review of Systems
Physical Exam

Inspection

Palpation

Auscultation
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17. Assessment-collecting data
Make sure information is complete &
accurate
Validate problem
Interpret and analyze data
Compare to “standard norms”
Organize and cluster data
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18. Closed question Open ended
question
Neutral questionsLeading question
1. Used in direct
interview,
2.Are restrictive
3.Generally requires
yes of No or short
factual answers
4.Often begin with
when, where, who,
what, do, did or
does, or is, are, was.
Eg.
a.Are you having pain
now?
b.What medication
did you take?
1.Associated with
nondirective
interview
2.Invite clients to
discover & explore,
elaborate, clarify or
illustrate their
thoughts or feelings.
3.It specifies only the
broad topic to be
discussed & invites
longer that one or
two words.
4.An open ended
question begins with
what or how?
Eg.
a.What brought you to
hospital?
b.How did you feel in
that?
1.Is a question the
client can answer
without direction or
pressure from the
nurse.
2.Used in non directive
that question.
Eg.
a.How do you feel
about that?
b.Why do you think
you had the
operation?
1.Used in directive
interview &
2.Thus directs client
answer.
Eg.
a.You’re stressed about
surgery tomorrow,
aren’t you?
b.You’ll take medicine
won’t you?

19. 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 don’t get it”
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20. Nursing Diagnosis
Second step of the Nursing Process
Interpret & analyze clustered data
Identify client’s problems and strengths
Formulate Nursing Diagnosis (NANDA : North
American Nursing Diagnosis Association)-
Statement of how the client is RESPONDING
to an actual or potential problem that requires
nursing intervention 20

21. Nsg Dx vs MD Dx
Within the scope of
nursing practice
Identify responses
to health and illness
Can change from
day to day
Within the scope of
medical practice
Focuses on curing
pathology
Stays the same as
long as the disease
is present
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22. Formulating a Nursing Diagnosis
Composed of 3 parts:
Problem statement- the client’s response
to a problem
Etiology- what’s causing/contributing to
the client’s problem
Defining Characteristics- what’s the
evidence of the problem
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23. Nursing Diagnosis
Problem( Diagnostic Label)-based on your
assessment of client…(gathered
information)
Etiology- determine what the problem is
caused by or related to (R/T)...
Defining characteristics- then state as
evidenced by (AEB) the specific facts the
problem is based on...
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24. Example of Nursing Dx
Ineffective therapeutic regimen
management
R/T difficulty maintaining lifestyle changes
and lack of knowledge
AEB B/P= 160/90, dietary sodium
restrictions not being observed, and client
statements of “ I don’t watch my salt” “It’s
hard to do and I just don’t get it”.
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25. Eg. Of subjective & objective data.
Sl.
No.
Subjective Data Objective Data
1 I have fever Body tem – 100
0
F
Tachycardia – 100 bt/mt
Dull & tired
Dried lips
2 I feel sick to my
stomach
Vomited 100ml of green tinged fluid
Abdomen firm
Slightly distended
Active bowel sounds in all 4 quadrants
3 I am short of breathRR – 28br/mt
Tachypnoea
Lung sound diminished in ® lower lobe.

26. Types of Nursing Diagnoses
Actual
Imbalanced nutrition; less than body requirements
RT chronic diarrhea, nausea, and pain AEB height
5’5” weight 105 lbs.
Risk
Risk for falls RT altered gait and generalized
weakness
Wellness
Family coping: potential for growth RT
unexpected birth of twins.
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27. Collaborative Problems
Require both nursing interventions and medical
interventions
EXAMPLE: Client admitted with medical dx of
pneumonia
Collaborative problem = respiratory insufficiency
Nsg interventions: Raise HOB, Encourage
MD interventions: Antibiotics IV, O2 therapy
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28. Planning
Third step of the Nursing Process
This is when the nurse organizes a nursing care
plan based on the nursing diagnoses.
Nurse and client formulate goals to help the
client with their problems
Expected outcomes are identified
Interventions (nursing orders) are selected to aid
the client reach these goals.
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29. Planning – Begin by
prioritizing client problems
Prioritize list of
client’s nursing
diagnoses using
Maslow
Rank as high,
intermediate or low
Client specific
Priorities can change
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30. 30

31. 31

32. 32

33. Nursing Care Plans vs Concept
Maps
NCP Concept/Mind Map
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34. 3. Benefits of Nursing Process
1.Provides an orderly & systematic method for planning &
providing care
2.Enhances nursing efficiency by standardizing nursing
practice
3.Facilitates documentation of care
4.Provides a unity of language for the nursing profession
5.Is economical
6.Stresses the independent function of nurses
7.Increases care quality through the use of deliberate actions

35. 3. Benefits of Nursing Process
1.Continuity of care
2.Prevention of duplication
3.Individualized care
4.Standards of care
5.Increased client participation
6.Collaboration of care

36. Planning- Types of goals
Short term goals
Long term goals
Cognitive goals
Psychomotor goals
Affective goals
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37. Goals are patient-centered and
SMART
Specific
Measurable
Attainable
Relevant
Time Bound
Pt will walk 50 ft.
Pt will eat 75% of meal
Pt will be OOB 2-4hrs
Pt will maintain HR<100
Pt will state pain level is acceptable 6 (0-10)
OOB=out of bed
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38. Planning-select interventions
Interventions are selected and written.
The nurse uses clinical judgment and
professional knowledge to select
appropriate interventions that will aid the
client in reaching their goal.
Interventions should be examined for
feasibility and acceptability to the client
Interventions should be written clearly and
specifically.
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39. Interventions – 3 types
Independent ( Nurse initiated )- any
action the nurse can initiate without direct
supervision
Dependent ( Physician initiated )-nursing
actions requiring MD orders
Collaborative- nursing actions performed
jointly with other health care team members
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40. Implemention
The fourth step in the Nursing Process
This is the “Doing” step
Carrying out nursing interventions (orders)
selected during the planning step
This includes monitoring, teaching, further
assessing, reviewing NCP, incorporating
physicians orders and monitoring cost
effectiveness of interventions
Utilize NIC as standard
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41. Implementing- “Doing”
Monitor VS q4h
Maintain prescribed diet
(2 Gm Na)
Teach client amount of
sodium restriction, foods
high in sodium, use of
nutrition labels, food
preparation and sodium
substitutes
Teach potential
complications of
hypertension to instill
importance of
maintaining Na
restrictions
Assess for cultural
factors affecting
dietary regime
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42. Implementing – “Doing”
Teach the client-
hypertension can’t be
cured but it can be
controlled.
Remind the client to
continue medication
even though no S/S
are present.
Teach client importance
of life style changes:
(weight reduction,
smoking cessation,
increasing activity)
Stress the importance of
ongoing follow-up care
even though the patient
feels well.
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43. Evaluation- To determine
effectiveness of NCP
Final step of the Nursing Process but
also done concurrently throughout client care
A comparison of client behavior and/or response
to the established outcome criteria
Continuous review of the nursing care plan
Examines if nursing interventions are working
Determines changes needed to help client reach
stated goals.
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44. Evaluation
Outcome criteria met? Problem resolved!
Outcome criteria not fully met? Continue
plan of care- ongoing.
Outcome criteria unobtainable- review each
previous step of NCP and determine if
modification of the NCP is needed.
Were the nsg interventions
appropriate/effective?
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45. Evaluation
Factors that impede goal attainment:
Incomplete database
Unrealistic client outcomes
Nonspecific nsg interventions
Inadequate time for clients to achieve
outcomes.
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46. Thanks
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