ZOYA MINASYANRN-MSN-EDUNursing Practice Today

CURRENT NURSING PRACTICE Domain of Nursing Practice

Wide variety of roles and responsibilities to meet the health care needs of society.

CURRENT NURSING PRACTICE 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.

CURRENT NURSING PRACTICE 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.

CURRENT NURSING PRACTICE 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 PRACTICEHealthy 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

INFLUENCES ON FUTURE NURSING PRACTICE

INFLUENCES ON FUTURE NURSING PRACTICE

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.

INFLUENCES ON FUTURE NURSING PRACTICE

Five steps of the Evidence- based practice EBP1. Ask question by using PICO format

P- 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…

NURSING INFORMATICSIs a specialty nursing science, computer

science and information science in

collecting, identifying, processing and managing data an information

tosupport 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

NURSING PROCESS IN NURSING PRACTICE

NURSING PROCESS IN NURSING PRACTICE Assessment

Collection of datasubjective –interviewing patient;

whatever patient saysobjective-observed and measured

NURSING PROCESS IN NURSING PRACTICE

Diagnosis Phase Data analysis and problem identification Nursing diagnoses

NANDA nursing

NURSING PROCESS IN NURSING PRACTICEDiagnosis 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.

NURSING PROCESS IN NURSING PRACTICE 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…)

NURSING PROCESS IN NURSING PRACTICE

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)

NURSING PROCESS IN NURSING PRACTICE

NURSING PROCESS IN NURSING PRACTICE

Evaluation PhaseAs a result of evaluation, the nurse

determines whether the plan should be maintained or discontinued.

NURSING PROCESS IN NURSING PRACTICE

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

Skillsnecessary 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.