Nursing Program Outcome: Provide advocacy and individualized care for diverse populations.
Student Learning Outcome: Utilize the nursing process when providing basic care to culturally diverse adults with an emphasis on older adult patients.
Safety
Nursing Program Outcome: Provide safe, quality care while minimizing risk of harm to patients and providers.
Student Learning Outcome: Adheres to established safety protocols and plans for selected clinical skills and procedures.
Nursing Process (ADPIE)
The Nursing Process:
Assessing
Diagnosing
Planning
Implementing
Evaluating
Clinical Judgement Model
Recognize cues (Assessment)
Analyze cues (Analysis)
Prioritize Hypotheses (Analysis cont.)
Generate Solutions (Planning)
Take Action (Implementation)
Evaluate Outcomes (Evaluation)
Factors to Consider
Environmental Setting, Situation, and Environment
Client observation
Resources
Health Record
Time Pressure
Cultural Considerations
Task Complexity
Risk Assessment
Individual Nurse Factors
Nurse Characteristics
Cognitive Load
Recognize Cues (Assessment)
Highlights: Assessment!
Objective and Subjective Data
Relevant data
Monitor trends and changes!
Gathering information from different sources (S/Sx, assessment data, health Hx, environment etc…)
Subjective vs. Objective Data
Subjective Data (Symptoms)
Information Perceived Only By The Affected Person
What The Person Says
Objective Data (Signs)
Observable And Measurable Data
Can Be Seen, Heard, Or Felt By Someone Other Than The Person Experiencing The S/Sx
When to Validate Data
Subjective/Objective Data Do Not Agree Or Make Sense
Client’s Statements Differ At Different Times In The Interview
Data Are Far Outside Normal Range
Factors Are Present That Interfere With Accurate Measurement
Analyze Cues (Analyze)
Highlights: EVIDENCE BASED
Pathophysiology
Clinical Presentation
Link gathered cues to identify a probable patient issue
Prioritize Hypotheses (Analyze)
How to prioritize:
ABCs!
Maslow’s Hierarchy of Needs
Least Restrictive and Invasive
Acute vs Chronic
Establish priority interventions based on the patient’s health problems
Maslow’s Hierarchy of Needs
Generate Solutions (Planning)
Considerations:
Collaboration!
Realistic, patient-centered outcomes!
Evidence Based actions
Independent vs. Dependent Nursing Interventions
Identify expected outcomes and nursing interventions to meet the patient needs
Goals of Planning Phase (generating solutions)
Identify Expected Patient Outcomes/Goals
Select Evidence‐Based Nursing Interventions
Communicate Plan Of Care
Outcomes Must Be:
Specific
Measureable
Attainable
Realistic
Time Limited
Client-Centered Outcomes
State what the patient will do or experience at the completion of care
Give direction to the patient’s overall care
Patient behaviors…not nurse behaviors!
Ex: “The patient will demonstrate…”
Goals Statement Examples
Short Term vs. Long Term
The patient will ambulate a full lap around the nurse’s station, with a front wheeled walker, three times by the end of shift today. (Short Term)
The patient will verbalize what blood glucose level indicates a hypoglycemic event by the end of shift today. (Short Term)
The patient will verbalize adequate pain management (2/10 on the pain scale) by discharge. (Long Term)
The patient will demonstrate a safe subcutaneous insulin injection on themselves by discharge. (Long Term)
What Are Nursing Interventions?
Purpose: To Achieve Client Outcomes
AKA Nursing Actions
Based On Clinical Judgment And Nursing Knowledge
Reflect Direct And Indirect Care
Selecting Nursing Interventions
Nursing interventions must be:
Safe
Within the legal scope of nursing practice
Compatible with medical orders
Like outcomes/goals, they should be specific and realistic
Process for Generating and Selecting Intervention
Review The Cues & Desired/Expected Outcomes
Identify Several Interventions/Actions
Choose The Best Interventions For This Patient
Individualize The Standardized Interventions
Take Action (Implementation)
Considerations:
Collaboration
Documentation
Educate
Monitor patient responses
DO!
Implement the appropriate interventions to promote the patient’s optimal level of health
Implementing the Plan
PROMOTE CLIENT PARTICIPATION
COORDINATE CARE
DELEGATE WHEN APPROPRIATE
Documentation
The final step of implementation
Records the nursing activities and the client’s response
Important means of communication between other shifts & other disciplines
Imperative for continuity of care
Evaluate Outcomes (Evaluation)
Considerations:
Re-assess the patient!
Were the interventions effective?
If outcomes not met: revise!
Evaluate the patient’s response to the interventions; use nursing judgement to evaluate the extent the patient met the outcomes
Evaluation
Client’s Progress Toward Goals
Effectiveness Of Nursing Care Plan
Quality Of Care In The Health‐Care Setting
How Do I Evaluate Client Progress?
Record: Record The Evaluative Statement
Judge: Judge Goal Achievement
Collect: Collect Reassessment Data
Review: Review Outcomes
*Evaluative Statements
Decide how well outcome was met
Met
Partially met
Not met
List patient data or behaviors that support this decision
Evaluating Goals
The patient ambulated around the nurse’s station, with a front wheeled walker, three times today. Met
The patient ambulated around the nurse’s station, with a front wheeled walker, two times today. Partially Met
The patient stated they were in too much pain to ambulate at all today. Not Met
Revisions to the Plan of Care
Delete Or Modify The Nursing Diagnosis
Make Outcome Statement More Realistic
Adjust time criteria in outcome statement
Change nursing interventions
Nursing Care Plans
The comprehensive nursing care plan is the central source of information needed to:
Guide holistic, goal-oriented care
Address each client’s unique needs
Ensures care is complete
Provides continuity of care
Promotes efficient use of nursing efforts
Provides a guide for assessing & charting
Preprinted, Standardized Plans
Unit standards of care: General guides; describe the care that nurses are expected to provide for all clients in defined situations
Standardized nursing care plans: Detailed nursing care for a particular nursing diagnosis; for all nursing diagnoses that commonly occur with a certain medical condition
Critical pathways: Outcome-based, interdisciplinary plans that sequence client care based on case type
Computerized Care Plan
Enter diagnosis or desired outcome.
Computer generates list of suggested interventions.
Choose appropriate interventions.
Individualize by typing in own interventions as needed.
Process for Writing Individualized Nursing Care Plan
Individualize: Individualize the standardized plan as needed.
Decide: Decide which problems can be managed with standardized care plans or critical pathways.
Make: Make a working problem list.
Think Like a Nurse
Scenario: Patient, Jeanette Wu, has become incontinent of bowel and bladder and has impaired skin integrity (pressure ulcer on sacrum). The healthcare provider orders an indwelling urinary catheter.
Urinary catheterization is a sterile technique.
Questions:
As a student, what should you do?
If you were an RN, what are some things you could do to assure that both you and the patient are prepared for the procedure?