full ppn review

What is the Nursing Process (NP)?

A systematic and rational method of planning and providing patient care organized around phases that facilitate evidence-informed and ethical nursing practice

Who developed the Nursing Process and why?

Ida Jean Orlando (1958); to help nurses formulate an effective nursing care plan that can be adapted to patient needs

What are the 5 steps of the Nursing Process?

1. Assessment

2. Diagnosis

3. Planning

4. Implementation

5. Evaluation

What is the rational for using the Nursing Process?

• Assists critical thinking

• Provides guideline for data collection and care planning

• Help organize work

• Assists with documentation of client needs and plan of care

What is the Nursing Process NOT?

• A conceptual framework

• A theory

• A model of care

• A standard for the profession

What is a Nursing Care Plan (NCP)?

Written plan (kardex, standardized, computerized) including:

• Nursing diagnosis

• Expected outcomes

• Nursing interventions

Purpose of a Nursing Care Plan

• Communication

• Continuity

• Coordination of care

• Information exchange

Difference between Nursing Process and Nursing Care Plan

• Nursing process is a process (thinking method)

• Nursing care plan is a written documentation of care

How are Nursing Process steps linked?

• Each step builds on the previous one

• Assessment → Diagnosis → Planning → Implementation → Evaluation

• Data and outcomes continuously influence next steps

How does critical thinking relate to the Nursing Process?

• Influences observations

• Helps prioritize high, intermediate, low needs

• Uses research, evidence, and experience

• Evaluates client responses with measurable indicators

How does Nursing Process support clinical judgement?

• Focuses on client needs

• Uses systemic thinking

• Supports decision-making and evaluation of outcomes

Difference between Nursing Process and Clinical Judgment Model

• Nursing process: systemic data collection

• Clinical judgment model: focuses on “what matters most” (relevance of data)

Steps of Clinical Judgement Model

1. Recognize cues

2. Analyze cues

3. Prioritize hypothesis

4. Generate solutions

5. Take action

6. Evaluate outcomes

Diagnostic reasoning

Process of using assessment data to logically explain a clinical judgement

Clinical inference

Drawing conclusions from related pieces of evidence

Principles of diagnostic reasoning

• Based on scientific method

• Uses cues and patterns

• Uses inferential reasoning

• Requires validation of data

Steps of diagnostic reasoning

1. Attend to cues

2. Formulate hypothesis

3. Gather data

4. Evaluate hypothesis → final diagnosis

Steps in nursing diagnostic process

• Data clustering

• Inferential reasoning

• Identify problems/needs

• Formulate diagnosis statement

Types of diagnostic errors

• Errors in data collection

• Errors in interpretation

• Errors in clustering

• Errors in diagnostic statements

Risks of diagnostic errors

• Incorrect nursing diagnosis

• Poor care planning

• Missed or delayed interventions

What is a Nursing Diagnosis (ND)?

Clinical judgement about responses to actual or potential health problems

What is a Medical Diagnosis?

Identification of a disease condition based on signs, symptoms, tests

What are Collaborative Problems?

• Physiological complications

• Nurses monitor and collaborate with healthcare team

Format of a Nursing Diagnostic statement

2-part format:

• Diagnostic label

• Related Factors (etiology)

Phrase used in diagnostic statements

“Related to” (NOT “because of”)

What is a 3-part statement?

• Problem (label)

• Etiology (related factors)

• Signs/symptoms (defining characteristics)

Actual Nursing Diagnosis

• Problems exist

• Has signs/symptoms (defining characteristics)

Risk (potential) Nursing Diagnosis

• Problem may develop

• Based on risk factors

Health Promotion Diagnosis

• Focuses on readiness to enhance health behaviours

• Not about illness

Wellness Diagnosis

• Focus on improving level of wellness

• Used when client wants higher level of health

Rules when writing a Nursing Diagnosis

• Identify client response, not medical diagnosis

• Use clear NANDA language

• Identify treatable etiology

• Focus on client problem

• Avoid judgemental statements

• One problem per statement

What is the goal of Assessment?

To “solve the puzzle” and form a clear picture of the client

Types of assessment data

• Subjective

• Objective

Sources of data

• Primary: client

• Secondary: family, healthcare team

• Tertiary: records, literature, nurse experience

Data validation

Double-checking data to ensure accuracy and avoid incorrect references

Assessment: Step 1 of Nursing Process

The nurse collects data pertaining to the client’s health status or situation.

Diagnosis: Step 2 of Nursing Process

The nurse analyzes data to determine key issues and make clinical judgement

in form of nursing diagnosis

Planning: Step 3 of Nursing Process

The nurse prioritizes proposed strategies and interventions and creates a client-centred care plan, identifying expected outcomes.

Implementation: Step 4 of Nursing Process

The nurse carries out the care plan and/or coordination of care

Evaluation: Step 5 of Nursing Process

The nurse looks at achievement of outcomes to determine whether or not the interventions have been effective.

Methods of data collection

• Interview

• Nursing history

• Physical Examination

Comprehensive Assessment

A detailed database that includes all spheres of human functioning (physical, psychological, spiritual, socio-cultural)

Data Clustering

Organizes data into meaningful clusters to help recognize significant cues/problems

What is setting priorities in nursing care?

Ranking of nursing diagnoses, client problems, and collaborative problems based on urgency

What factors influence priority setting?

• Urgency of diagnosis

• Client involvement (when applicable)

• High, intermediate, low priorities

• Client condition changes → priorities may change

• Requires ongoing assessment and critical thinking

Why must priorities be frequently reassessed?

Because the client condition changes, so priorities must adapt

What is a goal?

A specific client behaviour or response achieved through nursing diagnosis or collaborative problem resolution

(e.g, improved pain control)

What is an expected outcome?

Measurable criteria used to evaluate goal achievement (e.g., client turns without discomfort)

Goal vs expected outcome

• Goal: broad client response

• Expected outcome: specific, measurable indicator

2 purposes of goals and expected outcomes

• Guide selection of nursing interventions

• Provide focus for evaluation of effectiveness

Characteristics of well-written goals/outcomes

• Client-centered

• Singular

• Observable

• Time-limited (short/long term)

• Mutual (with client)

• Realistic

Why involve client in goal setting?

• Ensures goals are mutual and realistic

• Increases acceptability and participation

Implementation

Step where the nurse initiate or completes planned interventions

Independent nursing interventions

• Do not require orders

• Based on nurse’s judgement and evidence

• Example: elevating extremities

Dependent nursing interventions

• Require physician/NP order

• Treat medical diagnosis

• Example: administering medication

Collaborative nursing intervention

• Require multiple healthcare professionals

• Combined knowledge and expertise

Factors to consider when selecting interventions

• Nursing diagnosis

• Goals and expected outcomes

• Evidence base

• Feasibility

• Acceptability to client

• Nurses capability

How does critical thinking relate to implementation?

• Ensures interventions are appropriate and evidence-informed

• Requires adapting care based on client response

How does critical thinking relate to evaluation?

• Interprets whether outcomes were met

• Guides decisions to continue, modify, or terminate care

5 elements of evaluation

1. Identify criteria and standards

2. Collect data

3. Interpret and summarize findings

4. Document findings and clinical judgements

5. Decide to terminate, continue, or modify care plan

Example goal for Mrs. Brady (pain/mobility)

Client will achieve improved pain control

Example expected outcome (pain)

Client will turn in bed with minimal discomfort within X days

Example goal (nutrition)

Client will improve nutritional intake

Example expected outcome (nutrition)

Client will consume more than 75% of meals and increase protein intake

Example goal (hydration)

Client will improve fluid intake

Example expected outcome (hydration)

Client will increase fluid intake to adequate levels daily

Independent interventions for Mrs. Brady

• Reposition regularly

• Encourage oral intake

• Provide comfort measures

• Educate on importance of mobility

Dependent interventions for Mrs.Brady

• Administer prescribed pain medication

• Follow dietary orders

Collaborative Interventions for Mrs.Brady

• Work with dietitian (nutrition)

• Work with physiotherapy (mobility)

• Consult healthcare team

Why must interventions align with outcomes?

Because interventions are selected to achieve the expected outcomes and goals

How do diagnosis, goals, interventions, and evaluations connect?

• Diagnosis → identifies problem

• Goals/outcomes → define success

• Interventions → actions taken

• Evaluation → determines effectiveness

ageism

discrimination against people because of their age

personhood

the quality or condition of being an individual person deserving dignity

role transition

moving between social roles (role exit + role entry); some are welcomes (becoming a grandparent) and some are not (loss of mobility)

citizenship for older adults

the right to belong to a community, live independently, and have opinions heard and respected

why do nurses study care of older adults

• population is aging rapidly

• older adults live ~ 21 years longer

• increasing cultural diversity requires culturally safe care

Erikson’s ego developmental model (aging stage)?

older adults reflect on life and seek acceptance of their life cycle

Miller’s functional consequences theory

quality of life is linked to functional ability and ability to meet personal needs

what does functional consequences theory help nurses do?

assess function across:

• self-care

• mobility

• relationships

• cognition

• life engagement

maslow’s model in older adults?

prioritize:

1. physiological needs

2. safety and security

ethical dilemma

conflict between two “good” values that cannot be fully met

key ethical values from CNO code of conduct?

• safe, compassionate care

• informed decision making

• dignity and privacy

• justice

• accountability

example ethical dilemma in older care?

supporting client choice vs preventing harm (ex; swallowing risk but client refuses pureed diet)

how do nurses respect client choice?

• obtain informed consent

• respect beliefs and preferences

• provide culturally safe care

• communicate clearly

delirium

acute, sudden, reversible confusion with physiological/environmental cause

key delirium features

• sudden onset

• fluctuating symptoms

• reversible

• requires urgent assessment

types of delirium

• hypoactive: quiet, withdrawn, lethargic, slow responses

• hyperactive: agitated, hallucinations, loud, aggresive

• mixed

dementia

gradual, progressive, irreversible decline in cognition and memory

dementia affects what?

• memory

• language

• judgment

• reasoning

depression in older adults

reduces happiness and well-being that can be reversible

how older adults describe depression

“blue” or “down in the dumps”

difference between delirium, dementia, and depression

• delirium: sudden, reversible

• dementia: gradual, irreversible

• depression: mood disorder, may be reversible

reality orientation

use clocks, calendars, photos to connect client to environment

validation therapy

focus on emotional meaning instead of correcting facts

defusing catastrophic reactions

focus on cause of behaviour, not behaviour itself

sundowning

evening confusion/anxiety → keep clients active during day

responsive behaviours

use verbal cues to help short-term memory

elder abuse

mistreatment of vulnerable older adults, often by caregivers

why is elder abuse hard to detect?

• shame or embarrassment

• desire to protect family

• cognitive impairment

nurse responsibility if abuse is suspected?

must report to social/legal protective services