Demonstrate Use of NursesDemonstrate Use of Nurses’’Pocket Guide inPocket Guide in

Independent Nursing PracticeIndependent Nursing Practice

Marilynn Doenges APRN, Retired

History42 y old female 4 years of therapy with a psychologistDSM III-R Generalized AnxietyReferred to address understanding of male sexuality

First Step—Assessment Use of Pocket Guide

Nursing Based History Tool

Ego Integrity—Subjective

Describe selfSelf-esteem ratingMoods

Stress factors Coping patterns used Significant losses/changes

Ego Integrity—Objective

Manner Verbal/nonverbal behaviorDefense mechanisms

Second Step—DiagnosisUse of Pocket Guide

Refer to Diagnostic DivisionsChoose NANDA labelCompare Related FactorsReview Defining Characteristics

Nursing Diagnosismoderate Anxiety

related to threat to self-concept and interaction patternsevidenced by

concerns about relationship with partnerrestless body movementspoor eye contactreport of angry outbursts

Third Step—PlanningUse of Pocket Guide

Develop outcome/goalChoose interventions

Plan of Care Outcomes/Goals

Recognize precursors of angry outburstsVerbalize reduction of anxiety by the 6th session

Plan of Care

InterventionsLink behavior and feelings Discuss ways to deal with feelings Journal feelings & events

Mental Health ReportSubmitted to

Insurance Provider/PayorPsychiatrist

CONCLUSIONSUse of the Nurses' Pocket Guide:

Facilitates use of nursing process to develop individualized plan of care Provides ready reference for submitting reports reflecting professional level of care