View
219
Download
1
Category
Tags:
Preview:
Citation preview
Nursing Process• Conceptual Description of What Nurses Do • Broadly Accepted Worldwide• Five Phases, Cyclical:
• Assessment• Diagnosis• Planning• Implementation• Evaluation
Nursing Assessment
Nursing Diagnosis
PlanningImplementation
Evaluation
Continuous Clinical JudgmentDefinition
“Interpretation or Conclusion About a Patient’s Needs, Concerns, or Health Problems, and/or the Decision to Take Action (or Not), Use or Modify Standard Approaches, or Improvise New Ones as Deemed Appropriate by the Patient’s Response” (Tanner, 2006, p.204)
Assessment Data are Interpreted• What Happens?
• Nurses Convert Data to Interpretations
• Why?• Nurses, as Other People, Have Limited Space in
Short-Term Memory, Cannot Remember All Data But Remember Interpretation
• How?• Connect Patient Data with Knowledge in Memory
1973: First Conference to Identify the Names for Data Interpretations• 80 Nursing Diagnoses First Identified
• Evolved to NANDA International (I)
• Purpose of NANDA-I: Approve Nurse-Developed Research-Based Names for Data Interpretations, Labels and Descriptions
Nurses are Diagnosticians• Nurses Use a Diagnostic Process in
Partnership with Patients
• Why? • Focus is Health• People Make Themselves Healthy
Diagnostic Competencies
• Intellectual
• Interpersonal
• Technical
• Personal Strengths:• Tolerance of Ambiguity• Use of Reflective Practice
Mental Processes: Cognitive Skills and Habits of the Mind
• Examples of Cognitive Skills:• Analyzing• Logical Reasoning• Applying Standards
• Studies Show That:• Adults Vary in Cognitive Abilities• Thinking Processes can be Improved
To Develop Thinking Abilities• Use Thinking
• Think About Nursing Concepts, e.g.:• Health Management• Sleep
• Seek Support
• Develop Confidence
Interpersonal Competencies• Trust Enables Patients to Share Valid and
Reliable Data with Nurses
• Communication Skills Enhance Trust
• Work in Partnership with Patients
• Listen
Technical Competencies• Nursing Assessment:
• Health History• Physical Examination
• Use a Framework That Yields Nursing Concepts,
e.g. Functional Health Patterns
Personal Strength: Tolerance of AmbiguityWhy?• Numerous Factors Influence Clinical
Situations
• Human Beings are Complex and
Unique
• Enables Consideration of Many Factors
Assessment and Nursing Diagnosis• Units of Analysis: Individual, Family or
Community
• Books That Appropriately Link Assessment to Nursing Diagnosis
Principles of Diagnostic Reasoning and Assessment• Work in Partnership with Individual, Family or
Community
• Think About Diagnostic Hypotheses; Collect Data to Support or Reject Hypotheses
• Complete Data Collection Before Deciding on Diagnoses
• Validate Diagnoses with Patients
Recognize Cues• Cues: Units of Data That Have Meaning in Relation
to Diagnoses, e.g. Rate of Breathing and Ineffective Breathing Pattern
• Recognition of a Cue and Its Meaning Depends on Knowledge in Memory
• For Meaning: Compare Cues to Knowledge and the Individual Patient
Mentally Generate Possible Diagnoses• Consider Context of Situation
• Compare Cues with Knowledge in Memory
• Consider Multiple Possible Explanations
• Avoid Deciding Too Soon (Premature Closure)
• Be Flexible in Thinking
Conduct Focused Data Collection• Collect Additional Data to Support Diagnostic
Hypotheses
• Collect Data to Rule Out Competing Hypotheses
• Summarize Data with a Possible Explanation or Diagnosis
Validate Diagnoses with Patients and Others• Collaborate with Patient and Family
• If Patient is Unable to Validate, Collaborate with Other Nurses or Providers
ReferencesBelenkey MF, Clinchy BM, Goldberger NR, Tarule JM. (1983) Women's Ways of Knowing: The Development of Self, Voice, and Mind. New York: Basic Books.
Benner PA. (1984) Novice to Expert: Promoting Excellence and Power in Professional Nursing Practice. Menlo Park, CA: Addison Wesley.
Bulechek GM, Butcher H, Dochterman JC. (2008) Nursing Interventions Classification (NIC), 5th edn. St Louis, MO: Mosby.
Doane GH, Varcoe C. (2005) Family Nursing as Relational Inquiry: Developing Health Promoting Behavior. Philadelphia: Lippincott.
Herdman TH. (ed). (2012) NANDA International Nursing Diagnoses: Definitions and Classification, 20122014. Oxford: Wiley-Blackwell.
Institute of Medicine. (2004) Keeping Patients Safe. Washington, DC: National Academy Press.
Kassirer JP. (1983) Teaching clinical medicine by iterative hypothesis testing. Let’s preach what we practice. New England Journal of Medicine 309: 921-923.
Levin RF, Lunney M, Krainovich-Miller B. (2004) Improving diagnostic accuracy using an evidenced-based nursing model. International Journal of Nursing Terminology Classification 15(4): 114-122.
Lunney M. (1992) Divergent productive thinking and accuracy of nursing diagnoses. Research in Nursing and Health 15: 303-311.
Lunney M. (2008) Critical need to address nursing diagnosis. Online Journal of Issues in Nursing. www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/AccuracyofNursesDiagnoses.aspx
Lunney M. (2009) Critical thinking to achieve positive health outcomes: nursing case studies and analyses. Ames, IA: Wiley-Blackwell.
Miller CA. (1956) The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychological Review 63: 81-97.
Moorhead S, Johnson M, Maas M, Swanson E. (2008) Nursing Outcomes Classification (NOC). 4th edn. St Louis, MO: Mosby.
Munhall PL. (1993) ‘Unknowing’: toward another pattern of knowing in nursing. Nursing Outlook 41: 125-128.
Rubenfeld MG, Scheffer BK. (2010) Critical Thinking Tactics in Nursing. Boston: Jones and Bartlett.
Scheffer BK, Rubenfeld MG. (2000) A consensus statement on critical thinking. Journal of Nursing Education 39: 352-359.
Tanner CA. (2006) Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education 45(6): 204-211.
Recommended