NURS 201: Fundamentals of Nursing and the Caring Process Topic: Caring

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NURS 201 Fundamentals of Nursing and the Caring
ProcessTopic Caring
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Theories of Caring

• Benner and colleagues
• Caring is primary
• Leininger
• Transcultural perspective
• Watson
• Transpersonal caring

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Theories of Caring (contd)

• Swanson five processes of caring
• Knowing
• Being with
• Doing for
• Enabling
• Maintaining belief

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Caring Behaviors

• Providing presence
• Touch
• Listening
• Knowing the client
• Spiritual caring
• Family care

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Caring

• Lindsey is a senior nursing student assigned to
  care for Mrs. Lowe, a 62-year-old client being
  treated for lymphoma (cancer of the lymph nodes).
  Mrs. Lowe is to receive an injection for her
  pain. In what way can Lindsay show caring in the
  way she administers the injection to Mrs. Lowe?

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Caring

• Mr. Leonard is a 42-year-old man who is married
  and has two teenage daughters. He underwent
  surgery this morning for an angioplasty to
  correct obstruction of his coronary arteries. The
  recovery room nurse calls the nursing division
  and tells you that Mr. Leonard has arrived, is
  stable, and will likely be there for 2 to 3
  hours. His doctor will be up to the division
  shortly. What can you do to demonstrate caring
  for Mr. Leonard?

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Break time!!
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Introduction to Nursing the Caring Process

• Theoretical and Research Foundations of Nursing
  Practice

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So What is Nursing?
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KCU Definition of Nursing

• Nurses as role models must endeavor to pursue
  healthy lifestyles, promote wellness within the
  family, community, and global village and effect
  social change that promotes a healthy
  environment.
• Nurses must be able to make responsible moral and
  ethical decisions and think logically,
  analytically, and critically.
• Nurses must know how to seek, find, and use
  health information and commit to lifelong
  learning.

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KCU Definition of Nursing

• Nurses must be skilled contributors to their
  profession, committed to serving the needs of
  others, regardless of ethnic identity, race,
  gender, age, status, diagnosis, or ability to
  pay.
• Using Jesus Christ as a model of servant
  leadership, nursing is a ministry of
  compassionate, competent, and comprehensive
  physical, psycho social, and spiritual caring,
  even if the nurse's personal beliefs do not
  coincide with those of the individual, family, or
  community receiving her/his care.

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Characteristics of a Profession

• Specialized Education
• Body of Knowledge
• Deliver Unique Service
• Code of Ethics
• Autonomy
• Professional Behaviors

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Nursing Beliefs

• Holistic
• Person
• Health
• Environment
• Nursing

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Components of a Theory

• Set of concepts
• Definitions
• Relationships
• Assumptions or propositions

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Model of Nursing Beliefs
Environment
Environment
Nursing
Person
Health Continuum
Optimal Health
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Interdisciplinary Theories

• Systems theory
• Basic human needs
• Health-and-wellness model
• Stress and adaptation
• Developmental theories
• Psychosocial theories

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Selected Nursing Theories

• Nightingales theory
• Focus on the clients environment
• Peplaus theory
• Focus on interactive processes
• Hendersons theory
• Focus on 14 basic needs

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Selected Nursing Theories

• Abdellahs theory
• Focus on holistic client needs
• Johnsons theory
• Focus on clients ability to adapt
• Rogerss theory
• Focus on unitary being as an energy field
  continuously interacting within the universe

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Selected Nursing Theories

• Orems theory
• Focus on self-care
• Neumans theory
• Focus on systems approach and clients responses
  to stressors
• Leiningers theory
• Focus on cultural care

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Selected Nursing Theories

• Kings theory
• Focus on interaction of personal, interpersonal,
  and social systems
• Roys theory
• Focus on adaptation to changing needs
• Watsons theory
• Focus on transpersonal caring

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Watsons Philosophy Science of Caring

• Person
• Viewed as being-in-the-world
• Three spheres of being mind, body, soul
• Experiencing perceiving organism
• A persons existence is embodied in experience,
  in nature, and in the physical world, but a
  person can transcend the physical world nature
  by controlling it, subduing it, changing it, or
  living in harmony with it.

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Watsons Philosophy Science of Caring

• Health
• Unity harmony within the mind, body, and soul.
• Goal of the person is self-actualization.
• Illness
• Not necessarily disease subjective turmoil or
  disharmony within the soul
• Troubled inner soul can lead to illness, and
  illness can produce disease.

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Watsons Philosophy Science of Caring

• Environment
• Phenomenal field totality of human experience
  influences how a person perceives and responds in
  a given situation
• Two persons (nurse and other) together with their
  unique life histories and phenomenal field in a
  human care transaction an actual caring
  occasion involves action choice.

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Watsons Philosophy Science of Caring

• Nursing
• Dynamic changing
• Nurse as a person nurse as responses and
  behaviors
• Knowledge, thought, values, philosophy,
  commitment, action, passion.
• Human care and caring is viewed as the moral
  ideal of nursing.
• Transpersonal human care giving-receiving
  behaviors responses between two people.

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KCC SoN Philosophy

• Individual
• A physically, psychosocially, and spiritually
  integrated being endowed with dignity and worth
  who is created in Gods image and has the
  capacity to live in a loving relationship with
  God, self, others, and the environment.
• Possesses self-direction and can be a responsible
  steward of Gods gifts of health and the
  environment.
• Composed of larger groups family, community,
  global village.

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KCC SoN Philosophy

• Health
• A gift from God.
• Being able to optimally function as God
  originally created man.
• Never complete on this earth but can only be
  realized in eternity.
• Individual perception of and satisfaction with
  ones ability to optimally function.
• Connections with family, community, global
  village can facilitate health.

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KCC SoN Philosophy

• Environment
• A gift from God.
• All factors that affect an individuals behavior
  but that are external to the individual
  includes both spiritual and physical realities.

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KCC SoN Philosophy

• Nursing
• Ministry of compassionate, competent,
  comprehensive physical, psychosocial, and
  spiritual caring, even if the nurses personal
  beliefs do not coincide with those of the
  individual, family, or community receiving care.
• Servant leaders.
• Promote wellness and effect social change that
  promotes a healthy environment.
• Skilled contributors to the profession.

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The Role of Nurses in Research
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Knowledge Acquisition

• Tradition
• Information seeking
• Experience
• Problem solving
• Critical thinking

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Classification of Sources

• Primary
• Secondary

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Role of Nurses in Research

• Associate degree nurse
• Participate in research activities
• Baccalaureate degree nurse
• Read research critically and determine use of
  findings in practice
• Masters degree nurse
• Active member of the research team
• Doctoral education
• Design studies and conduct research independently
  and collaboratively

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Nursing Process

• Assessment
• Planning
• Implementation
• Evaluation

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Chapter 15

• Nursing Assessment

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Nursing Process

• Steps
• Assessment
• Nursing diagnosis
• Planning
• Implementation
• Evaluation

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The Nursing Process
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Nursing Process (cont'd)

• Assessment
• Critical thinking approach

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Critical Thinking and the Nursing Process
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Assessment - Steps

• Collection and verification of data
• Analysis of data

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Assessment - Approaches

• Use of a structured database format
• Problem oriented

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Assessment Data Collection

• Types of data
• Objective
• Subjective
• Sources of data
• Primary
• Secondary

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Assessment Methods of Data Collection

• Interview
• Orientation phase
• Working phase
• Termination phase
• Nursing health history
• Components
• Physical examination
• Diagnostic and laboratory results

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Assessment Process

• Nursing judgments
• Data validation and interpretation
• Data clustering
• Documentation

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Chapter 16

• Nursing Diagnosis

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Nursing Diagnosis

• Definition
• Evolution
• NANDA
• Critical thinking approach

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NANDA Diagnoses

• North American Nursing Diagnosis Association
• Purpose to develop, refine, and promote a
  taxonomy of nursing diagnostic terminology of
  general use for professional nurses (p.301)
• pp. 301 302

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Diagnostic Process

• Analysis and interpretation of data
• Identification of client needs

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Steps of Data Analysis

• Recognize a pattern or trend
• Compare with standards for normal
• Make a reasoned conclusion

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Types of Diagnoses

• Actual
• Risk
• Wellness

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Components

• Diagnostic label
• Related factorsetiology
• Definition
• Risk factors
• Support of the statement

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Sources of Errors

• Data collection
• Interpretation and analysis of data
• Clustering
• Diagnostic statement

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Critical Thinking and Diagnosis
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Avoiding and Correcting Errors

• Identify the clients response
• Identify a NANDA statement
• Identify a treatable etiology
• Identify the problem caused by a treatment or
  diagnostic study
• Identify the client response to equipment

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Avoiding and Correcting Errors (contd)

• Identify the clients rather than the nurses
  problems or interventions
• Identify the clients problem rather than the
  goal
• Make a professional judgment
• Avoid legally inadvisable statements

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Avoiding and Correcting Errors (contd)

• Identify the problem and etiology
• Identify only one problem in the diagnostic
  statement

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Chapter 17

• Planning Nursing Care

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Planning

• Establishing priorities
• Determining client-centered goals and outcomes
• Selecting nursing interventions

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Planning (cont'd)

• Priorities
• High
• Intermediate
• Low

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Planning (cont'd)

• Goals
• Guidelines
• Time limited
• Short term
• Long term

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Critical Thinking and Planning
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Outcomes

• Progressive steps
• Linked to goals and nursing diagnoses
• Guidelines

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Goals and Outcomes

• Guidelines
• Client centered
• Singular
• Observable
• Measurable
• Time limited
• Mutual
• Realistic

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Nursing Interventions

• Types
• Nurse initiated
• Physician initiated
• Collaborative

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Nursing vs. Medical Dx
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Nursing Interventions (cont'd)

• Selection criteria
• Characteristics of nursing diagnosis
• Expected outcomes
• Research base
• Feasibility
• Acceptability to the client
• Nurse competencies

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Care Plans

• Student (see KCU example)
• Institution
• Community-based settings
• Critical pathways
• Concept maps

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Chapter 18

• Implementing
• Nursing Care

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Implementation

• Types of nursing interventions
• Direct and indirect
• Protocols and standing orders

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Nursing Interventions

• Critical thinking and selection of nursing
  interventions
• Nursing diagnosis
• Expected outcomes
• Evidence based
• Feasibility
• Acceptability
• Nurse competencies

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Critical Thinking and Implementation
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Implementation Process

• Reassessing the client
• Reviewing and revising the existing care plan

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Implementation Process (cont'd)

• Organizing resources and care delivery
• Equipment
• Personnel
• Environment
• Client
• Anticipating and preventing complications
• Identifying areas of assistance

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Implementation Process D/C
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Implementation Skills

• Cognitive skills
• Interpersonal skills
• Psychomotor skills

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Direct Care Measures

• Activities of daily living (ADLs)
• Instrumental activities of daily living
• Physical care techniques
• Counseling
• Teaching
• Controlling for adverse reactions
• Preventive measures

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Indirect Care Measures

• Communicating nursing interventions
• Delegating, supervising, and evaluating the work
  of other staff members

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Chapter 19

• Evaluation

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Process

• Identifying evaluative criteria and standards
• Collecting data to determine if criteria or
  standards are met
• Interpreting and summarizing findings
• Documenting findings
• Terminating, continuing, or revising the care plan

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Critical Thinking and Evaluation
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Success of Goals

• Examine the goal statement
• Assess the client
• Compare the outcome with client behavior or
  response
• Judge the degree of agreement between outcome and
  client response
• Determine reasons for no agreement or partial
  agreement

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Care Plan Revisions

• Discontinuing
• Modifying
• Reassessment
• Nursing diagnosis
• Client goals and outcomes
• Nursing interventions

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Quality Improvement

• Approachpurpose
• Outcome management
• Professional outcomes
• Client outcomes

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Example of a Goal, Outcome, and Evaluative Measure

• Goal clients pressure ulcer will heal within 7
  days
• Outcome erythema will be reduced in 2 days
• Evaluative measure inspect color, condition, and
  location of pressure ulcer

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Practice Time!!

• Select scenario
• What assessment would you perform?
• What would you consider in planning?
• How would you implement your plan?
• How would you evaluate if you were successful in
  your care?