Sabtu, November 01, 2008

The Nursing Process: A Common Thread Amongst All Nurses

The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care.


Assessment

An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain mediation.


Diagnosis

The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.


Outcomes/Planning

Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it.


Implementation

Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.


Evaluation

Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

Selasa, Oktober 28, 2008

NURSING PROCESS

From Wikipedia, the free encyclopedia

Contents

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The nursing process is a process by which nurses deliver care to patients, supported by nursing models or philosophies. The nursing process was originally an adapted form of problem-solving and is classified as a deductive theory.

Characteristics of the nursing process

The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the patient has, and for every element of patient care, rather than once for each patient. The nurse's evaluation of care will lead to changes in the implementation of the care and the patient's needs are likely to change during their stay in hospital as their health either improves or deteriorates. The nursing process not only focuses on ways to improve the patient's physical needs, but also on social and emotional needs as well.

  • Cyclic and dynamic
  • Goal directed and client centered
  • Interpersonal and collaborative
  • Universally applicable
  • Systematic[1]

The nursing process is not something foreign or unusually complex. On the contrary, we use the nursing process method on a daily basis without even realizing it. For example, a trip to the gas station to get fuel requires Assessing the various prices and the number of people waiting to get gas among other things. A subsequent decision, or Diagnosis, is made based on the former criteria. This may include pulling into the gas station to fuel up or going down the road for better prices and/or less of a crowd. The price is right and there's not much of a crowd, we're pulling in. Now the Planning can take place. This may include which pump to use, how much gas to put in the tank, whether or not to clean the windows along with other things. We're at the pump and ready to fuel up. We must now Implement what we planned prior to pulling up to the pump. We've pulled up on the passenger side because the gas tank resides on this side, part of our plan. We've also given ourselves enough room to exit without getting blocked in by another vehicle, part of our plan also. We now unscrew the gas cap and begin fueling or Implementing what we planned. Things went well. We are fueled up and have exited the gas station without complication. Our Evaluation of the trip to the gas station would be a good one. We may choose to use this method in the future. The Nursing process is that simple in theory. However, as a nurse, the nursing process tool will be used for more complex and difficult situations but is applied the same way as the gas station analogy.

Skills

The nursing process involves skills a nurse should possess when he or she has to initiate the initial phase of the process. Having these skills contributes to the greater improvement of the nurse's delivery of health care to the patient, including the patient's level of health, or health status.

  • Cognitive or Intellectual skills, such as analyzing the problem, problem solving, critical thinking and making judgements regarding the patient's needs. Included in these skills are the ability to indentify, differentiate actual and potential health problems through observation and decision making by synthesizing nursing knowledge previously acquired.
  • Interpersonal skills, which includes therapeutic communication, active listening, conveying knowledge and information, developing trust or rapport-building with the patient, and ethically obtaining needed and relevant information from the patient which is then to be utilized in health problem formulation and analysis.
  • Technical skills, which includes knowledge and skills needed to properly and safely manipulate and handle appropriate equipment needed by the patient in performing medical or diagnostic procedures, such as vital signs, and medication administrations.[2]

Phases of the nursing process

The following are the steps or phases of the nursing process.

  • Assessment (of patient's needs)
  • Diagnosis (of human response needs that nurses can deal with)
  • Planning (of patient's care)
  • Implementation (of care)
  • Evaluation (of the success of the implemented care)

Assessing Phase

The nurse should carry out a complete and holistic nursing assessment of every patient's needs, regardless of the reason for the encounter. Usually, an assessment framework, based on a nursing model or Waterlow scoring, is used. These problems are expressed as either actual or potential. For example, a patient who has been rendered immobile by a road traffic accident may be assessed as having the "potential for impaired skin integrity related to immobility".

Models for data collection

The following nursing models are used to gather the necessary and relevant information from the patient in order to effectively deliver quality nursing care. This will help the nurse determine the ranking of the problems encountered.

How to collect data

  • Client Interview
  • Physical Examination
  • Observation

Diagnosing Phase

Nursing diagnoses are part of a movement in nursing to standardize terminology which includes standard descriptions of diagnoses, interventions, and outcomes. Those in support of standardized terminology believe that it will help nursing become more scientific and evidence based.The purpose of this stage is to identify the patient's nursing problems. See Nursing diagnosis

Maslow's hierarchy of needs is used when the nurse prioritizes identified nursing health problems from the patient.

Maslow's hierarchy of needs is used when the nurse prioritizes identified nursing health problems from the patient.

Types of Diagnosis

  • Actual Diagnosis-a judgment on clients response to a health problem that is present
  • High Risk-based on most likely to develop
  • A Possible Nursing Diagnosis-a health problem is unclear and causative factor is unknown
  • Wellness Diagnosis-indicating a well response of the patient

Components of a Nursing Diagnosis

  • Problem Statement(diagnostic label)-describes the clients health problem
  • Etiology(related factor)-the probable cause of the health problem
  • Defining Characteristic-a cluster of signs and symptoms

e.g. Ineffective airway clearance related to the presence of tracheo-bronchial secretion as manifested by thick tenacious sputum upon expectoration.

Problem (Ineffective airway clearance) + Etiology (related to) + Defining Characteristics (as manifested by)

Planning Phase

In agreement with the patient, the nurse addresses each of the problems identified in the planning phase. For each problem a measurable goal is set. For example, for the patient discussed above, the goal would be for the patient's skin to remain intact. The result is a nursing care plan.

Implementing Phase

The methods by which the goal will be achieved is also recorded at this stage. The methods of implementation must be recorded in an explicit and tangible format in a way that the patient can understand should he wish to read it. Clarity is essential as it will aid communication between those tasked with carrying out patient care.

Evaluating Phase

The purpose of this stage is to evaluate progress toward the goals identified in the previous stages. If progress towards the goal is slow, or if regression has occurred, the nurse must change the plan of care accordingly. Conversely, if the goal has been achieved then the care can cease. New problems may be identified at this stage, and thus the process will start all over again. It is due to this stage that measurable goals must be set - failure to set measurable goals will result in poor evaluations.

The entire process is recorded or documented in an agreed format in the patient's care plan in order to allow all members of the nursing team to perform the agreed care and make additions or changes where appropriate.

See also


Nursing portal

References

  1. ^ Assessing, Fundamentals of Nursing: Concepts, Process and Practice, Second Edition, Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, 2004, p.261
  2. ^ Critical Thinking and the Nursing Process, Fundamentals of Nursing: Concepts, Process and Practice, Second Edition, Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, 2004, p.245-253
  3. ^ Notes on Healthcare Process, 2004

NURSING PROCCES: defined

The nursing process is a problem-solving approach that enables the nurse to provide care in an organized scientific manner.

The goal of the nursing process is to alleviate , minimize, or prevent actual or potential health problems. The nursing process can be applied in any interaction that involves a nurse and a client.

The process can take place in a variety of settings, including a hospital, community setting, private home,or long term care facility.

The 5 steps/components of NURSING PROCESS are, assessment, nursing diagnosis, planning, implementation, and evaluation.

Initally the steps are followed in sequence. After the process has begun, it becomes a continuous cycle, as outlined on the homepage image.

GREEN NURSING CARE REFORM

The key points of the nursing care reform concept presented by the German government in June 2007 leaves one wondering why they took so much time working on it. The current catalogue of measures – both content-wise and financially – is little more than a drop in the bucket. The Green Party parliamentary group presented a complete nursing care reform package already back in September 2006 – long before Germany's ruling coalition of Christian and Social Democrats was ready to recognize the urgency of such reforms.

Nursing care policy goals

Our reform concept is based on two premises: patient-oriented care and stronger emphasis on outpatient care, including alternative care and living options. We believe structural reform is important because only when we know what sort of care we need, we will be able to say how much and what sort of financing it will require. That's why we've developed a concept in which various measures are interconnected and where the needs of those affected are given priority.

Patient-oriented care

For us, the crucial aspect of a sustainable nursing care plan is to reconsider what defines someone as needing care. This should be changed from the current concept of someone with psychological, physical and social problems to include criteria such as special needs and the resources available. Prevention and rehabilitation before and during the period of nursing care should be strengthened. We are pushing for the expansion of independent consultants dedicated to nursing care and living arrangements, as well as for the creation of independent case-managers. These should support those needing care and their relatives in finding tailor-made and sensible nursing care.

We are calling for the medium-term introduction of a nursing budget in order to better help patients. The funds will enable patients to buy support services beyond the current services catalogue, which is inflexible. We are also calling for legally mandated time off for those organizing nursing and terminal care, complete with wage compensation and job protection, allowing people to better combine care and their careers.

Our reform concept stands for the consistent backing and strengthening of outpatient nursing care, such as alternative living and care options. We are calling for equal financial support for in- and out-patient care in order to transition from an emphasis on the former to the latter. We are also calling for ambulatory care that orientates itself on a person's biography and domestic living situation.

Care financed with solidarity

We want to include all Germans in a All Citizen´s Nursing Care Insurance and are pushing for an end to the separation between public and private nursing care insurance. German citizens should pay in what they can, although payment rates will also be adjusted to income levels. If there aren't enough funds for improved nursing care, then we won't rule out an increase in care cost contributions.

In the spirit of generational equality, we are calling for so-called "Demographic reserves" that will be financed within the system through an additional solidarity contribution. Such reserves are indispensable for coming generations, who will be protected should they need nursing care. The need for such care is a risk that can affect all of us, sooner or later.

Senin, Oktober 27, 2008

Nurses get bionic "power suit"

  • From New Scientist Print Edition. Subscribe and get 4 free issues.
  • Peter Hadfield and Paul Marks

A robotic exoskeleton has been created by Japanese researchers to allow nurses to lift patients effortlessly - and without damaging their backs.

"Back injuries are a huge problem for us," says a spokeswoman for the Royal College of Nursing in London. Every year, 3600 nurses from Britain's National Health Service have to take time off work because of back problems.

To address this global problem, Keijiro Yamamoto and his team at the Kanagawa Institute of Technology in Japan have designed and built a prototype "power suit" with a jointed metal framework that straps on to the wearer's limbs.

While the prototype is distinctly unlovely - it trails an unwieldy thicket of cables and compressed-air lines - Yamamoto says he's begun refining his design.

Concerted effort

So how does it work? Sensor pads taped to the major muscle groups calculate how much force you need to pick up a patient. As you lift, the sensors send data to a microcomputer that triggers the business end of the system: a bunch of concertina-like limb and body actuators powered by compressed air.

These move slowly and create low mechanical stress - giving someone as much or as little help as they need, says Yamamoto.

The suit has five actuators: one for each elbow, one for the waist (not shown in graphic for clarity) and one for each knee. The elbow actuators push on the frame that lets your forearms lift the patient, while the waist actuator helps straighten your back and the knee actuators help you straighten your legs.

The computer simply works out when the nurse's limbs and joints have enough artificial support, allowing them to continue working, but effortlessly.

Power lift

The main role of the Power Assist Suit will be helping nurses and physiotherapists lift patients on and off beds. In tests, a nurse weighing 64 kilograms was able to pick up and carry a patient weighing 70 kilograms.

"And since the mechanics of the suit are hidden behind the wearer, the nurse can be in direct contact with the patient," says Yamamoto. "That's very reassuring for the patient."

The prototype suit weighs 18 kilograms, but Yamamoto believes he will be able to cut the weight in half for a commercial version.

Although developing the prototype cost around £15,000, Yamamoto says health authorities will be able to buy a commercial version of the suit for around £1200 within two years.