Nursing Process (nursing + process)

Distribution by Scientific Domains

Selected Abstracts

Clinical Reasoned Judgment and the Nursing Process

NURSING FORUM, Issue 2 2009
Loucine M. Huckabay RN
Every nursing school student is taught the nursing process as a systematic framework for processing patient information to make clinical decisions. This article provides a model for integrating a conceptual model of critical thinking into the nursing process, with the goal of enabling nurses to think critically, reason accurately, and make appropriate clinical decisions about their patients. Eight elements of critical thinking provide the universal structure of thought processes: clarity, accuracy, precision, relevance, depth, breadth, and logic. The model provides nurses with a practical approach for making effective clinical decisions. [source]

Overcrowding in medium-volume emergency departments: Effects of aged patients in emergency departments on wait times for non-emergent triage-level patients

Mary Knapman MN BHScN GCEd RN
Knapman M, Bonner A. International Journal of Nursing Practice 2010; 16: 310,317 Overcrowding in medium-volume emergency departments: Effects of aged patients in emergency departments on wait times for non-emergent triage-level patients This study aims to examine patient wait times from triaging to physician assessment in the emergency department (ED) for non-emergent patients, and to see whether patient flow and process (triage) are impacted by aged patients. A retrospective study method was used to analyse 185 patients in three age groups. Key data recorded were triage level, wait time to physician assessment and ED census. Multiple linear regression analysis was used to determine the strength of association with increased wait time. A longer average wait time for all patients occurred when there was an increase in the number of patients aged , 65 years in the ED. Further analysis showed 12.1% of the variation extending ED wait time associated with the triage process was explained by the number of patients aged , 65 years. In addition, extended wait time, overcrowding and numbers of those who left without being seen were strongly associated (P < 0.05) with the number of aged patients in the ED. The effects of aged patients on ED structure and process have significant implications for nursing. Nursing process and practice sets clear responsibilities for nursing to ensure patient safety. However, the impact of factors associated with aged patients in ED, nursing's role and ED process can negatively impact performance expectations and requires further investigation. [source]

The Use of Nursing Diagnoses in Perioperative Documentation

Kristiina Junttila PhD
Hoitotyön kirjaaminen; hoitotyön diagnoosit; perioperatiivinen hoitotyö; Perioperative Nursing Data Set PURPOSE., To clinically validate the nursing diagnoses of the first Finnish version of Perioperative Nursing Data Set (PNDS) by using them in perioperative documentation. METHODS., Nursing diagnoses were used in documentation in four operating departments with 250 patients. In analysis, nonparametric tests were applied. FINDINGS., While intraoperatively nursing diagnoses focused on physiological concerns, postoperatively the focus shifted to that of recovery. CONCLUSIONS., The findings revealed the importance of safety-related routines in perioperative care. Nursing diagnoses in the Finnish version of PNDS are sensitive in describing the rationales for perioperative care. IMPLICATIONS FOR NURSING PRACTICE., Nursing classifications illustrate the nursing process in a structured form. Nursing diagnosis is an early step in the decision-making process that aims to achieve expected outcomes in nursing care. TARKOITUS:, Validoida PNDS-luokituksen suomalaisen version diagnoositermit käyttämällä niitä perioperatiivisen hoitotyön kirjaamisessa. MENETELMÄT:, Hoitotyön diagnooseja käytettiin kirjaamisessa 250 potilaan kohdalla. Aineiston analyysissä käytettiin ei-parametrisiä testejä. TULOKSET:, Hoidon intraoperatiivisessa vaiheessa korostuvat potilaan fysiologiaan liittyvät ja postoperatiivisessa vaiheessa potilaan toipumiseen liittyvät hoitotyön diagnoosit. JOHTOPÄÄTÖKSET:, Perioperatiivisessa hoitotyössä painottuvat potilaan hoidon turvallisuuteen tähtäävät rutiinit. PNDS-luokituksen suomalaisen version diagnoositermejä voidaan käyttää kuvaamaan leikkauspotilaiden hoidon tarpeita. TULOSTEN HYÖDYNNETTÄVYYS:, Hoitotyön prosessia voidaan kuvata rakenteisesti hoitotyön luokituksilla. Hoitotyön diagnoosin määrittäminen on osa päätöksentekoprosessia tavoitteena tunnistaa ja saavuttaa toivotut tulokset potilaan hoidossa. [source]

Quality of Nursing Diagnoses: Evaluation of an Educational Intervention

Jan Florin RN
PURPOSE.,To investigate the effects on the quality of nursing diagnostic statements in patient records after education in the nursing process and implementation of new forms for recording. METHODS.,Quasi-experimental design. Randomly selected patient records reviewed before and after intervention from one experimental unit (n = 70) and three control units (n = 70). A scale with 14 characteristics pertaining to nursing diagnoses was developed and used together with the instrument (CAT-CH-ING) for record review. FINDINGS.,Quality of nursing diagnostic statements improved in the experimental unit, whereas no improvement was found in the control units. Serious flaws in the use of the etiology component were found. CONCLUSION.,Nurses must be more concerned with the accuracy and quality of the nursing diagnoses and the etiology component needs to be given special attention. PRACTICE IMPLICATIONS.,Education of RNs in nursing diagnostic statements and peer review using standardized evaluation instruments can be means to further enhance RNs' documentation practice. [source]

Use of NANDA, NIC, and NOC in a Baccalaureate Curriculum

Cynthia Finesilver
BACKGROUND For the last 8 years, NANDA, NIC, and NOC have been successfully introduced to students in fundamentals courses at Bellin College of Nursing. As students progress through the curriculum, the classifications are expanded and applied to various client populations in all settings. The faculty expect students to use NANDA, NIC, and NOC in a variety of ways: during preparation for care of clients, documentation of client care, discussion of clients in postconference; in formal nursing process papers; and in the college laboratory setting. MAIN CONTENT POINTS Through the use of standardized languages, which address all steps of the nursing process, students have been able to plan, implement, and evaluate nursing care in all settings, from primary care to specialty care areas. Application of the NANDA, NOC, and NIC frameworks into a baccalaureate curriculum is desirable because the classifications are research based, comprehensive, and based on current nursing practice. NOC and NIC include physiologic, psychosocial, illness prevention and treatment, health promotion, and alternative therapies. Because of the universal and clinically meaningful language, students are able to communicate and document nursing activities in diverse settings and better define the unique actions and value of nursing. Feedback from students and faculty has been positive. Faculty members are encouraged to refine and alter course expectations related to NANDA, NOC, and NIC as needed. Students in the fundamentals courses adapt easily to NANDA, NOC and NIC during small group work and during discussion of common client problems, such as constipation. CONCLUSIONS Although the frameworks are not used as part of the organizing framework, they are used to teach nursing process and increase students' critical thinking and problem-solving capabilities. [source]

A Computerized Nursing Process Support System in Brazil

Maria da Graça Oliveira Crossetti
BACKGROUND Hospital de Clinicas de Porto Alegre introduced the nursing process model as the basis for nursing practice at the hospital more than 20 years ago. A computerized nursing order system based on nursing diagnoses was introduced. The strategies used in the development of the system included establishment of Nursing Diagnosis Work Groups in 1998; systematic analysis of nursing processes based on the work of existing studies, the NANDA taxonomy in 1999; development and implementation of a data collection instrument to analyze the nursing diagnosis process; training of all nursing staff during 1999,2000; meetings between analysts and nursing staff to articulate the nursing process needs the system would be required to support; pilot implementation of the computerized nursing process system in the ICU in February 2000; and hospital-wide implementation in December 2000. The system supports nursing diagnoses and orders. It was developed in-house by the information systems group at the hospital and is implemented as an Oracle database accessed in client server mode over a Windows NT-based Ethernet network. The system is part of the hospital's larger clinical information management system. MAIN CONTENT POINTS The patient care module includes medical orders and nursing orders. On entering the nursing orders module, the user selects a patient and the system presents a list all current orders completed and pending. These orders can be examined, updated, and reprinted, and new daily nursing orders can also be input at this time. The "new order" screen provides the user with any previous orders to ensure consistency in nursing care. New nursing orders are prepared based on the patient history, physical exam, and daily evaluations. Required interventions are identified based on changes in the patient's "basic human needs." This process can be realized through two distinct paths through the nursing care module: one associated with diagnoses and the other with signs and symptoms. A nurse with more clinical experience and knowledge of diagnostic reasoning will opt to develop orders based on diagnoses. After the diagnosis and associated etiology is input, the system generates a list of possible interventions for selection. The duration and frequency of the intervention can then be specified and the order individualized to a patient's particular needs. Less experienced nurses and students will develop nursing orders based on a patient's signs and symptoms. The system generates a list of diagnoses, etiology, and associated basic human needs in response to the signs and symptoms input. The nurse selects the appropriate diagnoses and etiology and the system generates the list of nursing intervention options. Nurses following either path are required to confirm their orders. They then have the option of developing other orders for the same patient until all that patient's basic human needs have been addressed. The orders can be printed but also remain in the system for nursing staff to implement. CONCLUSIONS The application of systematic, evidence-based methods in nursing care results in improved quality of service that conforms to individual patients' basic human needs. [source]

Nursing Diagnosis and Nursing Theory: Exploration of Factors Inhibiting and Supporting Simultaneous Use

FAAN, Noreen C. Frisch PhD
PURPOSE. To explore the values and philosophies of nursing theories that inhibit the simultaneous use of nursing diagnosis and nursing theory. SOURCES.Published articles, books, book chapters. DATA SYNTHESIS. Four factors in the literature and reflected in practice may have had a negative influence on the use of nursing diagnoses: (a) commitment to the uniqueness of each person, (b) an abandonment of the nursing process, (c) a perspective that nursing care is an evolving interaction, and (d) a belief that theory-derived language is more articulate and precise than standard classifications. PRACTICE IMPLICATIONS.Strategies for combining theory and diagnoses include emphasizing the diagnostic terms as professional shorthand and permitting flexibility in modifying diagnoses as needed; widely disseminating the concept that classification can be used effectively with newer iterations of the nursing process reflecting circular, simultaneous, and intuitive processes; developing classification language based on concepts of hypothesis and perception; and including diagnostic categories associated with theoretical perspectives. Search terms:Nursing classifications, nursing diagnoses, nursing theory Diagnostics infirmiers et théories de soins: Exploration des facteurs qui freinent et soutiennent leur utilisation simultanée BUT.Explorer les valeurs et les conceptions à la base des théories de soins qui inhibent I'utilisation des diagnostics infirmiers avec les théories de soin. SOURCES.Articles, manuels, chapitres d'ouvrages. SYNTHÈSE DES DONNÉES.Les données de la littérature professionnelle et l'examen de la pratique ont permis d'identifier quatre facteurs qui ont pu avoir une influence négative sur l'utilisation des diagnostics infirmiers: (a) l'importance donnée au caractère unique de chaque personne; (b) l'abandon de la démarche de soins; (c) l'idée que le soin est fait d'interactions en évolution constante; (d) la croyance que le langage découlant de la théorie est plus précis et articulé que les classifications normalisées. IMPLICATIONS POUR LA PRATIQUE.Quelques stratégies pourraient faciliter la combinaison de la théorie et des diagnostics, notamment: souligner le fait que les termes des diagnostics constituent une sorte de sténographie professionnelle et permettre la flexibilité pour les modifier; disséminer le fait que les classifications peuvent être utiles dans une démarche de soin rénovée, reflétant les aspects circulaires, simultanés et intuitifs du raisonnement; développer un langage basé sur les concepts d'hypothéses et de perceptions et inclure des catégories diagnostiques associées à des courants théoriques. Mots-clés:Classifications de soins, diagnostics infirmiers, théories de soins Diagnóstico de enfermagem e teoria de enfermagem: Exploração dos fatores inibidores e estimuladores do seu uso simultâneo OBJETIVO.Explorar os valores e filosofias das teorias de enfermagem que inibem o uso simultâneo dos diagnósticos de enfermagem e das teorias de enfermagem. FONTES.Artigos publicados, livros, capítulos de livros. SÍNTESE DOS DADOS.Quatro fatores citados na literatura e refletidos na prática podem ter tido uma influência negativa no uso dos diagnóstics de enfermagem: (a) compromisso com a singularidade de cada pessoa, (b) um abandono do processo de enfermagem, (c) uma perspectiva de que o cuidado de enfermagem é uma interação que evolui e (d) uma crença de que uma linguagem derivada da teoria é mais articulada e precisa do que classificações padronizadas. IMPLICAÇÕES PARA A PRÁTICA.Estratégias para combinar teoria e diagnósticos incluem enfatizar os termos diagnóstics como uma taquigrafia profissional e permitir flexibilidade para modificar diagnósticos sempre que necessário, disseminando amplamente o conceito de que a classificação pode ser usada efetivamente com novas repetições do processo de enfermagem, refletindo processos circulares, simultâneos e intuitivos; desenvolver uma linguagem de classificação baseada em conceitos de hipótese e percepção; e incluir categorias diagnósticas associadas com perspectivas teóricas. Palavras para busca:Classificações de enfermagem, diagnóstico de enfermagem, teoria de enfermagem Diagnóstico enfermero y teoría enfermera: Exploración de factores que inhiben y apoyan una utilización simultánea PROPÓSITO.Explorar los valores y filosofías de teorías enfermeras, que inhiben la utilización simultánea de diagnósticos y teorías enfermeras. FUENTES.Artículos publicados, libros, capítulos de libros. SÍNTESIS DE LOS DATOS.Cuatro factores reflejados en la práctica y en la bibliografía, pueden haber tenido una influencia negativa en la utilizatión de los diagnósticos de enfermería: (a) compromiso a la singularidad de cada persona, (b) abandono del proceso de enfermería, (c) una perspectiva de que los cuidados de enfermería son una interacción que evoluciona y (d) una creencia de que el lenguaje derivado de la teoría, es más preciso y expresa mejor que las clasificaciones estándar. IMPLICACIONES PARA LA PRÁCTICA.Las estrategias para combinar la teoría y los diagnósticos enfermeros, incluyen: Dar énfasis a los términos diagnósticos como una abreviatura profesional, permitir ser flexible al modificar diagnósticos si es necesario, diseminar ampliamente el concepto de que la clasificación puede usarse eficazmente con nuevas iteraciones del proceso enfermero que reflejen procesos circulares, simultáneos e intuitivos, desarrollar lenguajes de clasificación basados en los conceptos de hipótesis y percepción, Incluir categorías diagnósticas asociadas con perspectivas teóricas. Términos de búsqueda:Diagnósticos enfermeros, clasificaciones enfermeras y teoría enfermera [source]

Evaluating nursing documentation , research designs and methods: systematic review

Kaija Saranto
Abstract Title., Evaluating nursing documentation , research designs and methods: systematic review. Aim., This paper is a report of a review conducted to assess the research methods applied in the evaluation of nursing documentation. Data sources., The material was drawn from three databases: CINAHL, PubMed and Cochrane using the keywords nursing documentation, nursing care plan, nursing record system, evaluation and assessment. The search was confined to relevant electronically-retrievable studies published in the English language from 2000 to 2007. This yielded 41 studies, including two reviews. Methods., Content analysis produced a classification into three themes: nursing documentation, patient-centred documentation and standardized documentation. Each study was assessed according to its research design, methodology, sample size and focus of data collection. In addition, the studies categorized under the heading of standardized documentation were assessed in terms of their outcomes. Results., Most of the studies (n = 19) focused on patient-centred documentation. Most (n = 20) were retrospective studies and used data collected from patient records (n = 35). An audit instrument was used to assess nursing documentation in almost all the studies. Studies classified under the heading of standardized documentation showed more positive than negative effects with respect to quality, the nursing process and terminology use, knowledge level and acceptance of computer use in documentation. Conclusion., The use of structured nursing terminology in electronic patient record systems will extend the scope of documentation research from assessing the quality of documentation to measuring patient outcomes. More data should also be collected from patients and family members when evaluating nursing documentation. [source]

Application of a model of social information processing to nursing theory: how nurses respond to patients

Lisa Kennedy Sheldon
Abstract Title.,Application of a model of social information processing to nursing theory: how nurses respond to patients. Aim., This paper is a report of a study to assess the applicability of a theoretical model of social information processing in expanding a nursing theory addressing how nurses respond to patients. Background., Nursing communication affects patient outcomes such as anxiety, adherence to treatments and satisfaction with care. Orlando's theory of nursing process describes nurses' reactions to patients' behaviour as generating a perception, thought and feeling in the nurse and then action by the nurse. A model of social information processing describes the sequential steps in the cognitive processes used to respond to social cues and may be useful in describing the nursing process. Methods., Cognitive interviews were conducted in 2006 with a convenience sample of 5 nurses in the United States of America. The data were interpreted using the Crick and Dodge model of social information processing. Findings., Themes arising from cognitive interviews validated concepts of the nursing theory and the constructs of the model of social information processing. The interviews revealed that the support of peers was an additional construct involved in the development of communication skills, creation of a database and enhancement of self-efficacy. Conclusion., Models of social information processing enhance understanding of the process of how nurses respond to patients and further develop nursing theories further. In combination, the theories are useful in developing research into nurse,patient communication. Future research based on the expansion of nursing theory may identify effective and culturally appropriate nurse response patterns to specific patient interactions with implications for nursing care and patient outcomes. [source]

Problem-solving competency of nursing graduates

Leana R. Uys DSocSc
Aim., This paper reports a study describing and evaluating the outcomes of problem-based learning (PBL) programmes in nursing schools in South Africa in terms of the competence of graduates to solve problem in actual clinical settings, and comparing this competence with that of graduates from non-PBL programmes. Background., The nursing literature tends to equate problem-solving with patient-centred problems or the nursing process. However, it is also a skill used in managing the work role, working in a team and managing a health care unit. Problem-solving refers to the process of selectively attending to information in a patient care setting. The investigation of problem-solving in nursing is complicated by the complex relationships between different cognitive processes. Methods., A qualitative evaluation study, descriptive and comparative in nature, was carried out. In-depth interviews were held with graduates and their supervisors, asking them to identify problem-solving incidents in which they had been involved. Template analysis style and Benner's interpretive approach were used to analyse the data. Findings., The majority of the incidents described by the graduates (84%) were graded at the advanced beginner level or above. The majority of incidents at the novice level came from the non-PBL group. ,Using people skills' and ,being assertive' were the two problem-solving strategies most often used. The PBL group fared better than the non-problem-based group in the level of their problem-solving ability. Conclusion., The findings of this study suggest that further research is warranted into the problem-solving abilities of PBL graduates, their personal development over time and at different stages of practice. In addition, it would be interesting to follow the development of their problem-solving abilities over time. [source]

Resident-oriented care in nursing homes: effects on nurses

Afke J.M.B. Berkhout PhD
Background., In a resident-oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand-control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers' psychological and behavioural outcomes. Aims., This paper reports a study to investigate the extent to which the various features of resident-oriented care were implemented and its effects nurses' on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes. Methods., In a quasi-experimental design, experimental and control groups were followed over 22 months, using a pretest and two post-tests with questionnaires, interviews and qualitative observations. Results., The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho-geriatric experimental group, on resident-oriented tasks. The qualitative data showed that a partly task-oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy. Conclusions., The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings. [source]

Clinical Reasoned Judgment and the Nursing Process

NURSING FORUM, Issue 2 2009
Loucine M. Huckabay RN
Every nursing school student is taught the nursing process as a systematic framework for processing patient information to make clinical decisions. This article provides a model for integrating a conceptual model of critical thinking into the nursing process, with the goal of enabling nurses to think critically, reason accurately, and make appropriate clinical decisions about their patients. Eight elements of critical thinking provide the universal structure of thought processes: clarity, accuracy, precision, relevance, depth, breadth, and logic. The model provides nurses with a practical approach for making effective clinical decisions. [source]