Z OYA M INASYAN RN-MSN-EDU Nursing Practice Today

ZOYA MINASYANRN-MSN-EDU

Nursing Practice Today

CURRENT NURSING PRACTICE

Domain of Nursing PracticeWide variety of roles and responsibilities to meet the health care needs of society.


Definitions of Nursing(ANA American Nursing Association)

Is a protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.


Nursing’s View of Humanity-An individual has

physiologic, psychologic (or emotional), sociocultural (or interpersonal), spiritual, and environmental

components.-No two individuals are exactly alike.


Scope of Nursing Practice entry level( work with other health providers), specialty(critical care, pain management,

pediatric, psychiatric, med-surg, dialysis), certifications(ongoing: oncology, DM

Delivery of Nursing Care Team nursing-team leader Primary nursing-one designated nurse was

responsible for planning the pt’s care Managed care-case management

Critical thinking Confidence, creativity, flexibility, open minded,

intelligent, information seeking, logical reasoning.

INFLUENCES ON FUTURE NURSING PRACTICE

Healthy people 2010 Physical activity Overweight and obesity Tobacco use, substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care



Evidence- based practice EBP It is a use of evidence based on research,

pt’s assessment, clinical experience, pt’s preferences and values in decision making.

JCAHO joint Commission on Accreditation of Health Organizations now requires that practice be based on evidence.


Five steps of the Evidence- based practice EBP

1. Ask question by using PICO formatP- patient interestI- InterventionC-Comparison of interestO- Outcome(s) of interest

2. Collect the evidence.3. Synthesize the evidence.4. Integrate all evidence in making a decision or

change.5. Evaluate the decision.

FIVE STEPS OF THE EVIDENCE- BASED PRACTICE(EBP)

STANDARDIZED NURSING TERMINOLOGY

NANDA-North American Nursing Diagnosis Associationwww.nanda.org; Appendix B in your textbook

NOC- Nursing Outcome Classificationwww.nursing.uiowa.edu/noc/Ex: The pt will maintain normal vital signs in

respond to activity in 2 days. NIC- Nursing Intervention Classification

www.nursing.uiowa.edu/nic/Ex: Monitor pt’s oxygen response(Vital signs)Encourage, assist, provide, monitor, collaborate

with PT and OT, teach, etc…

http://www.nanda.org/

http://www.nursing.uiowa.edu/noc/

http://www.nursing.uiowa.edu/nic/

NURSING INFORMATICS

Is a specialty nursing science, computer science and information science

in collecting, identifying, processing and

managing data an informationto

support nursing practice, administration, education, research, and the expansion of knowledge.

NURSING PROCESS IN NURSING PRACTICE

Independent-more autonomous, nurse initiated

Dependent-when carrying out med orders, diagnostic tests and orders

Collaborative-including nurse, physician, IV med’s, providing emotional support



AssessmentCollection of data

subjective –interviewing patient; whatever patient says

objective-observed and measured


Diagnosis Phase Data analysis and problem identification Nursing diagnoses

NANDA nursing


Diagnosis Phase

One part statement: Readiness for enhanced nutrition.

Two part statement:Imbalanced nutrition: less than body requirements r/t limited income for food purchase.Risk for aspiration r/t impaired swallowing.

Three part statement: problem-etiology-signs and symptoms(PES).

Pain r/t surgical incision, localized pressure, edema, as evidenced by verbalization of pain, isolation and withdrawal.


Planning Phase Priority setting Identifying outcomes

Nursing Outcomes Classification (NOC)Short outcome-The pt will maintain normal VS in

response to activity in 2 days.Long outcome- the pt will identify a realistic activity

level to achieve or maintain by D/C. Determining interventions

Nursing Interventions Classification (NIC)Choosing activities (managing, monitoring, teaching…)


Implementation Phase Delegation and assignment Nursing interventions that require independent

nursing knowledge, skills, or judgment, such as assessment, pt teaching, and evaluation of care, cannot be delegated.

(Using activates)



Evaluation PhaseAs a result of evaluation, the nurse

determines whether the plan should be maintained or discontinued.


Documentation Nursing care plans

Specific directions for carrying out the planned intervention, also used as a teaching /learning tools.

Concept maps Visual diagrams for pt problems and interventions

Clinical (critical) pathways includes care plan, documentation, interventions

THE NURSING PROCESS AND CRITICAL THINKING

Apply the attitudes

Mental habits and Skills

necessary for critical thinking when using the nursing process in client care.

Ex: NG tube insertion, etc…

SCENARIO ONE:

The nurse is caring for a client who was involved in a motor vehicle accident and sustained superficial skin trauma. The client’s epidermal layer of skin on the right knee, forearm, and hand is excoriated, reddened, and bleeding as the result of sliding across a cement pavement.

ANSWER

Impaired Skin Integrity R/T: mechanical factors, shearing forces AEB: disruption of skin surface, destruction of

skin, layers, traumatized skin excoriated, reddened, bleeding

SCENARIO TWO

The client you are caring for has been medically diagnosed with a right cerebral vascular accident (stroke). He experiences partial paralysis on the left side of his body. He is unable to turn over while in bed without assistance and has demonstrated decreased muscle strength and control in the left extremities.

ANSWER

Impaired Physical Mobility R/T: neuromuscular impairment AEB: inability to purposefully move within the

environment, decreased muscle strength, control, left-sided partial paralysis

RISK NURSING DIAGNOSES EXAMPLE

Cancer patient, Risk for Infection Risk for infection R/T inadequate secondary

defenses and immunosuppression.

Documents

Z OYA M INASYAN RN-MSN-EDU Nursing Practice Today