Certification Review The Nursing Process

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Certification ReviewThe Nursing Process

• Jan Brooks RN, BSN, CGRN
• HRSGNA

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Nursing Process

• Objectives Assessment
• 1. Identify steps of a nursing assessment as it
  applies to the GI Patient
• 2. Discuss the assessment of the patient
  receiving sedation and analgesia in the GI Setting

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Nursing Process

• Nursing Process is a systematic, interactive
  approach to Nursing care.
• Steps
• Assessment
• Nursing Diagnosis
• Planning
• Implementation
• Evaluation

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Nursing ProcessAssessment

• Medical Assessment is used to define the
  existence of medical problems and underlying
  pathology
• Nursing assessment is to identify the response
  to medical conditions, treatments and changes in
  activities of life

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Nursing ProcessAssessment

• Performed initially to gather data about a
  patient
• Focus assessment used to look further at a
  specific issue
• Requires updating and reassessment at regular
  intervals
• May also include an emergency assessment with a
  life threatening situation
• May require a collaborative effort with
  multidisciplinary team

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Nursing ProcessAssessment

• Steps of a Nursing Assessment
• We do these automatically and dont think about
  steps
• 1. Collecting Data
• Interview --subjective and objective
• Observation involves all senses
• Physical ExamInspection, Palpation, Percussion
  and Auscultation
• Review of Records and Diagnostic reports
• Collaboration with Colleagues

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Nursing ProcessAssessment

• 2.Identifying cues and making inferences
• Inferences are made after collecting
  subjective and objective data as related to the
  patient and his or her illness or situation
• 3. Validating Data
• Confirmation of data received or may require
  further explanation
• Example is pt who states NKA, yet is documented
  with an allergy

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Nursing ProcessAssessment

• 4. Clustering Data
• The organization of the data to assist with the
  Nursing Diagnosis
• Needs to also be organized to focus on priority
  of care
• Identifying patterns and Testing First
  Impressions
• Validation of information from initial
  assessment,
• What is relevant or irrelevant?
• Communication with other Team members

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Nursing ProcessAssessment

• Reporting and Recording Data
• All data must be communicated and/or recorded in
  a timely manner
• Critical information must be recognized and
  communicated immediately
• Data must be recorded legibly, in a timely
  manner
• Data should include descriptive, subjective and
  objective information supported by documented
  facts

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Nursing ProcessAssessment

• Assessment for the GI Patient
• Many patients are frequently sedated for
  procedures
• Assessment includes
• NPO status
• Medications currently prescribed
• Underlying medial problems
• Any diagnostic testing completed
• Respiratory status
• Other underlying or contributing factors
• Ride home

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Nursing Process

• Objectives Nursing Diagnosis
• 1. Define Nursing Diagnosis
• 2. Identify actual and potential nursing
  diagnoses applicable to GI patients

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Nursing ProcessNursing Diagnosis

• Term began being used in 1950s
• 1996 Dr. Lester King wrote an article that
  refuted the idea that Physicians were the only
  ones to diagnose.
• Defined as A statement of an actual or
  potential health problem that can be alleviated
  or prevented by independent Nursing intervention.

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Nursing ProcessNursing Diagnosis

• Provides a basis for selecting nursing
  interventions
• Provides useful and practical method for
  organizing nursing knowledge
• Based upon data obtained from nursing assessment
• Is a concise statement of interpretation of data
  collected

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Nursing ProcessNursing Diagnosis

• Types of Nursing Diagnoses
• ActualMade when condition is validated by
  presence of clinical characteristics
• RiskPatient/family or community are vulnerable
  to a potential problem
• Possibleproblem that is suspected, but requires
  further supportive data

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Nursing ProcessNursing Diagnosis

• Types of Nursing Diagnoses

Wellnesstaking an individual, group or family
from one level of wellness to a higher
level SyndromeFairly new concept Describes a
cluster of signs and symptoms ExampleDisuse
syndrome would incorporate risk for infection,
constipation, thrombosis, activity tolerance
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Nursing ProcessNursing Diagnosis

• Medical Diagnosis Focuses on identification of
  diseased based pathology and etiology
• Nursing Diagnosis Focuses on present health
  problems, strengths and limitations and methods
  of adapting to health problems
• Collaborative Diagnosis Utilizes other members
  of the health care team

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Nursing ProcessNursing Diagnosis

• Nursing diagnosis as related to the GI Patient
• Actual--Elimination processalteration of normal
  bowel patterns due to ulcerative colitis
• Actual or potentialKnowledge deficit related to
  procedure and sedation
• PotentialImpaired physical mobility due to
  sedation

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Nursing Process

• Objectives Planning
• 1. List three types of planning utilized in care
  planning
• 2. Compare nursing and medical plans of patient
  care

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Nursing ProcessPlanning

• Planning --Development of Nursing activities
  based on nursing diagnosis for the purpose of
  preventing, reducing or resolving health problems
  through Nursing intervention.
• Involves setting priorities for care
• Determining patient goals and expected outcomes

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Nursing ProcessPlanning

• Reasons for Developing a Plan of Care
• Assists to assign priorities of care
• Provides a means of communication
• Uses universal language
• Gives professional quality to the act of nursing
• Has an economic impact especially related to
  Medicare and diagnosis related groups

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Nursing ProcessPlanning

• Medical and Nursing Plans of Care
• Similar both derived from assessment
• Both describe monitoring signs and symptoms
• Both prescribe measures based on scientific
  knowledge
• Nursing diagnosis focus on patient responses to
  medical treatment.
• Nursing interventions can include actions that
  nurses can legally perform

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Nursing ProcessPlanning

• Clinical Pathways
• Set along specific time lines
• Multiple disciplinary
• Provide teaching tools to patients and families
• Demonstrate quality care

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Nursing ProcessPlanning

• Planning involves
• Initial Planning
• Ongoing Planning
• Discharge Planning
• Identifying NURSING actions
• IE Access breath sound immediately post
  procedure
• Explain signs and symptoms of bleeding and
  interventions to be taken if bleeding were to
  occur post procedure
• Document Plan of care

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Nursing ProcessImplementation

• Objectives
• 1. Define general guidelines for implementing
  care of the GI Patient
• 2. Discuss the nurses role when implementing
  care of the GI Patient

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Nursing ProcessImplementation

• Is the Blue Print that guides Nursing Care
• Based on Scientific Principles
• Reflects the rights and desires of the patient
  and significant others
• Actions are carried out safely, skillfully and
  efficiently

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Nursing ProcessImplementation

• Implementation is impacted by the Care Teams
• Cognitive Ability
• Interpersonal Skills
• Technical Skills

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Nursing ProcessImplementation

• Functions
• Independent Interventions
• Interdependent Interventions
• Dependent Interventions
• Based on Nurse Practice Acts

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Nursing ProcessImplementation

• Variables that Affect Care Implementation
• Patient Variables
• Nurse Variables
• Standards of Care
• Research Findings
• Resources
• Ethical and Legal Guides to Practice

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Nursing ProcessImplementation

• Importance of Documentation
• Formal method of communication
• Used in multiple ways
• Planning
• Process improvement audits
• Research
• Education
• Legal Evidence
• Historical Document

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Nursing ProcessImplementation

• Patient Teaching
• Integral part of the Implementation Process
• Still has same activities
• Assessing and diagnosing knowledge deficit
• Planning learning Activity
• Providing learning Activities
• Evaluating learning

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Nursing ProcessImplementation

• Counseling
• The Act of rendering guidance to a patient and
  /or significant other
• May be short term, long term, or motivational
• Advocacy
• --Informing patients and families
• --Supporting that decision

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Nursing ProcessImplementation

• Informed Consent
• Between the physician and the patient
• Exchange of information
• Interaction not a thing (legal document)
• Required Admission
• Before diagnostic procedure or surgery
• Before any experimentation is enacted

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Nursing ProcessImplementation

• Advocacy in Ethical Dilemmas
• Seen especially with feeding tubes
• Guidelines in ethical decision making
• Teach, clarify, reinforce medical information
• Remain as objective as possible
• Provide willing ear, cautious mouth
• Approach respectfully
• Accept and support patient and family decisions
• Observe and communicate
• Work through appropriate channels

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Nursing ProcessEvaluation

• Objectives
• 1. Explain the tasks involved in the evaluation
  process
• 2. Explain the role Standards of Care have in
  the Nursing Process

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Nursing ProcessEvaluation

• The Final phase in the Nursing Process
• Is the analytical portion
• Were the things implemented effective?
• Time of reassessment, modifications made
• Is the goal realistic?

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Nursing ProcessEvaluation

• Nursing Practice is based on a Scientific
  Framework including
• Critical Thinking
• Communication
• Adherence to a STANDARD of CARE
• Criteria are measurable qualities that apply
  to Standard of Care or Practice

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Nursing Practice

• Guidelines vs Standards
• Guidelines
• Suggested performance
• Current recommendations
• May deal with technical performance

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Nursing Process

• ? Standards
• Measurable criteria to evaluate practice
• Incorporate a stronger statement of expected
  performance
• ? Regulation
• Legal statement that defines Required
  Performance

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Nursing ProcessEvaluation

• Standards of Care or Practice
• 1. Quality of Care
• 2. Performance Appraisal
• 3. Education
• 4. Collegiality

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Nursing ProcessEvaluation

• Standards of Care (or Practice)
• 5. Ethics
• 6. Collaboration
• 7. Research
• 8. Resource Utilization
• 9. Leadership found in Practice

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Nursing ProcessReview Questions

• 1. A nursing assessment
• A. Is a systematic approach to nursing care
• B. Is always comprehensive
• C. Is a process of identifying a patient
  problem
• D. Should precede a nursing history
• Validation is the act of
• Clarification
• Verification
• Repeating a patients responses twice
• Checking to be sure a nursing history was taken

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Nursing ProcessReview Questions

• 1. A nursing assessment
• A. Is a systematic approach to nursing care
• B. Is always comprehensive
• C. Is a process of identifying a patient
  problem
• D. Should precede a nursing history
• Validation is the act of
• Clarification
• Verification
• Repeating a patients responses twice
• Checking to be sure a nursing history was taken

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Nursing ProcessReview Questions

• 3. The correct order of physical assessment is
• A. Inspection, palpation, percussion,
  auscultation
• B. Palpation, percussion, inspection,
  auscultation
• C. Auscultation, percussion, inspection,
  palpation
• D. Inspection, percussion, palpation,
  auscultation
• 4. Formulating a nursing diagnosis provides
• A. Important assessment data
• B. An interpretation of data collected
• C. Interdependent nursing interventions
• D. Outcome criteria for evaluation

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Nursing ProcessReview Questions

• 3. The correct order of physical assessment is
• A. Inspection, palpation, percussion,
  auscultation
• B. Palpation, percussion, inspection,
  auscultation
• C. Auscultation, percussion, inspection,
  palpation
• D. Inspection, percussion, palpation,
  auscultation
• 4. Formulating a nursing diagnosis provides
• A. Important assessment data
• B. An interpretation of data collected
• C. Interdependent nursing interventions
• D. Outcome criteria for evaluation

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Nursing ProcessReview Questions

• Cholecystitis with cholelithioasis is an
  example of a
• A. Collaborative diagnosis
• B. Nursing Diagnosis
• C. Medical Diagnosis
• D. Medical History

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Nursing ProcessReview Questions

• Cholecystitis with cholelithioasis is an
  example of a
• A. Collaborative diagnosis
• B. Nursing Diagnosis
• C. Medical Diagnosis
• D. Medical History

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Nursing ProcessReview Questions

• 6. The Nursing Care Plan
• A. Is based on scientific principles and
  incorporates
• findings of nursing research
• B. Advances nursings four aims and is tailored
  to the
• individual patient.
• C. Is designed to meet developmental,
  psychological,
• sociological and physiological needs
  of patients.
• D. All of the above.

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Nursing ProcessReview Questions

• 6. The Nursing Care Plan
• A. Is based on scientific principles and
  incorporates
• findings of nursing research
• B. Advances nursings four aims and is tailored
  to the
• individual patient.
• C. Is designed to meet developmental,
  psychological,
• sociological and physiological needs
  of patients.
• D. All of the above.

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Nursing ProcessReview Questions

• A GI nurse might vary the way he or she comforts
  an anxious 10 year old boy based on
• The developmental task of children aged 7-11
• His willingness to participate in counseling
• Recent findings concerning the impact of certain
  words
• in calming or provoking anxiety
• D. All of the above

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Nursing ProcessReview Questions

• A GI nurse might vary the way he or she comforts
  an anxious 10 year old boy based on
• The developmental task of children aged 7-11
• His willingness to participate in counseling
• Recent findings concerning the impact of certain
  words
• in calming or provoking anxiety
• D. All of the above

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Nursing ProcessReview Questions

• 8. Administering Medication is
• A. An independent nursing activity
• B. An interdependent task
• C. A dependent nursing obligation
• D. A non-nursing chore

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Nursing ProcessReview Questions

• 8. Administering Medication is
• A. An independent nursing activity
• B. An interdependent task
• C. A dependent nursing obligation
• D. A non-nursing chore

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Nursing ProcessReview Questions

• Nurses accomplish patient teaching in four
  phases, including planning the learning
  activity, providing learning opportunities,
  evaluating learning, and
• A. Correcting mistakes
• B. Diagnosing a patients knowledge deficit
• C. Explaining the patients privacy needs to
  s/o
• D. Helping patients make informed decisions

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Nursing ProcessReview Questions

• Nurses accomplish patient teaching in four
  phases, including planning the learning
  activity, providing learning opportunities,
  evaluating learning, and
• A. Correcting mistakes
• B. Diagnosing a patients knowledge deficit
• C. Explaining the patients privacy needs to
  s/o
• D. Helping patients make informed decisions

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Nursing ProcessReview Questions

• 10. Criteria are
• A. Nationally recognized standards
• B. Facts
• C. Interventions
• D. Measurable

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Nursing ProcessReview Questions

• 10. Criteria are
• A. Nationally recognized standards
• B. Facts
• C. Interventions
• D. Measurable

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Nursing ProcessReview Questions

• 11. The reason the nursing professionals
  evaluate the quality of care include all of the
  following except
• A. Nursing professionals aim to promote
  excellence in
• nursing care.
• B. Nurses must be accountable to society for
  the quality
• of the care they provide.
• C. Nurses want to improve professional
  performance.
• D. Nurses recognize that quality in health
  care is elusive
• and complex.

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Nursing ProcessReview Questions

• 11. The reason the nursing professionals
  evaluate the quality of care include all of the
  following except
• A. Nursing professionals aim to promote
  excellence in
• nursing care.
• B. Nurses must be accountable to society for
  the quality
• of the care they provide.
• C. Nurses want to improve professional
  performance.
• D. Nurses recognize that quality in health
  care is elusive
• and complex.

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Nursing Process

• Thank you
• Thank you to all SGNA Board
• Lisa, Mary, Lynn, Brenda and Debra
• As well as Rita, Candice, Laura, Randy and others
  behind the sceens.