Certification Review The Nursing Process

1. Certification ReviewThe Nursing Process Jan Brooks RN, BSN, CGRN HRSGNA

2. 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

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

4. 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

5. 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

6. Nursing ProcessAssessment • Steps of a Nursing Assessment: • We do these automatically and don’t think about steps 1. Collecting Data • Interview --subjective and objective • Observation –involves all senses • Physical Exam—Inspection, Palpation, Percussion and Auscultation • Review of Records and Diagnostic reports • Collaboration with Colleagues

7. 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

8. 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

9. 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

10. 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

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

12. Nursing ProcessNursing Diagnosis • Term began being used in 1950’s • 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.

13. 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

14. Nursing ProcessNursing Diagnosis • Types of Nursing Diagnoses: • Actual—Made when condition is validated by presence of clinical characteristics • Risk—Patient/family or community are vulnerable to a potential problem • Possible—problem that is suspected, but requires further supportive data

15. Nursing ProcessNursing Diagnosis • Types of Nursing Diagnoses • Wellness—taking an individual, group or family from one level of wellness to a higher level • Syndrome—Fairly new concept • Describes a cluster of signs and symptoms • Example—Disuse syndrome would incorporate risk for infection, constipation, thrombosis, activity tolerance

16. 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

17. Nursing ProcessNursing Diagnosis • Nursing diagnosis as related to the GI Patient Actual--Elimination process—alteration of normal bowel patterns due to ulcerative colitis Actual or potential—Knowledge deficit related to procedure and sedation Potential—Impaired physical mobility due to sedation

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

19. 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

20. 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

21. 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

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

23. 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

24. Nursing ProcessImplementation • Objectives: • 1. Define general guidelines for implementing care of the GI Patient • 2. Discuss the nurse’s role when implementing care of the GI Patient

25. 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

26. Nursing ProcessImplementation • Implementation is impacted by the Care Team’s: • Cognitive Ability • Interpersonal Skills • Technical Skills

27. Nursing ProcessImplementation • Functions: • Independent Interventions • Interdependent Interventions • Dependent Interventions • Based on Nurse Practice Acts

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

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

30. 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

31. 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

32. 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

33. 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

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

35. 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?

36. 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

37. Nursing Practice • Guidelines vs Standards • Guidelines • Suggested performance • Current recommendations • May deal with technical performance

38. Nursing Process Standards • Measurable criteria to evaluate practice • Incorporate a stronger statement of expected performance Regulation Legal statement that defines Required Performance

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

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

41. 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 patient’s responses twice • Checking to be sure a nursing history was taken

42. 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 patient’s responses twice • Checking to be sure a nursing history was taken

43. 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

44. 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

45. Nursing ProcessReview Questions • “Cholecystitis with cholelithioasis” is an example of a: A. Collaborative diagnosis B. Nursing Diagnosis C. Medical Diagnosis D. Medical History

46. Nursing ProcessReview Questions • “Cholecystitis with cholelithioasis” is an example of a: A. Collaborative diagnosis B. Nursing Diagnosis C. Medical Diagnosis D. Medical History

47. Nursing ProcessReview Questions 6. The Nursing Care Plan: A. Is based on scientific principles and incorporates findings of nursing research B. Advances nursing’s 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.

48. Nursing ProcessReview Questions 6. The Nursing Care Plan: A. Is based on scientific principles and incorporates findings of nursing research B. Advances nursing’s 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.

49. 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

50. 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