Step 3 ： Analyze nursing diagnoses relationships

1. Step 3：Analyze nursing diagnoses relationships • Draw lines between nursing diagnoses to indicate relationships. • Prepared to verbally explain to your clinical faculty why you have made these links if it is not obvious. • Concept mapping is a holistic approach to patient care. • This step focuses on the relationships between diagnoses and the labeling of nursing diagnoses .

2. Step 4：Identifying goals, outcomes, and interventions • Write patient goals and outcomes and then list nursing interventions to attain the outcomes for each of the numbered diagnoses on your map. • The nursing interventions should include appropriate treatments and medications and patient teaching. • Prepared to verbally explain the goals and rationales for nursing interventions with your clinical faculty.

3. Step 5：Evaluate patient’s responses • This step is the written evaluation of the patient’s physical and psychosocial responses. • It also involves writing your clinical impressions and inferences regarding the patient’s progress toward expected outcomes and the effectiveness of your interventions to bring these outcomes about.

4. Documentation • Documentation involves correctly identifying patient assessment data to record about a problem, determining what to record about the interventions to correct the problem, and describing the patient’s responses to the interventions. • Concept map care plans as the basis of documentation --- detail in chapter 7

5. Medication Administration • Organizing the drugs to be administered • Relationship of the drug to the problem • Interacting effects of the drug related to the total clinical picture. • Example: Digitalis -- Decreased cardiac output 。what is the relationship between low levels of Potassium and digitalis? 。assessing the patient carefully for adverse reactions to the drug.

6. Nursing Standards of Care • Standards of the American Nurses Association  general standards of care • Standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  specific policies and procedures • Standardized nursing care plans  based on typical nursing diagnoses

7. Nursing Standards of Care--con’s • Patient education standards  appropriate for the patient’s individual needs and ability • Insurance agency & government care standards  clinical pathway / critical pathway • Utilization review standards  review charts. Judge the necessity and appropriateness of care and efficiency with which care is delivered.

8. Managed Care in Hospital Settings • There is a direct relationship between the care standards described above and the management of care. • Hospital-based nurse case managers assigned to monitor and coordinate their progress through the health-care system. • To make links for patients to home health services, transitional care units, long-term care facilities, and other agencies to provide quality care.