The Nursing Process as the Most Important of All Nursing Concepts - Essay Example

The Nursing Process The Nursing Process The Nursing process is the most important of all nursing concepts of care/ it is a concept that anybody who intends to get into the world of nursing must clearly understand and be able to use at all time and for all patients. The concepts significantly embody the application of knowledge and behavior to assist in transforming nursing experiences into more nurturing, efficient and intellectual. Nursing, as both a science and art, is wholly concerned with the physical, psychological, sociocultural, and spiritual aspects of care. This means that an organized formula of care and application of skills and abilities of a nurse while still maintaining professionalism and rationale must be sought. The nursing process is a problem-solving and decision-making model developed by nurses themselves to assess, plan and implement the best care for all the patients’ problems (Alfaro-LeFevre, 2012). Kowalak & Hughes et al, (2002) describes the nursing process as the method of care that applies critical thinking which is focused on addressing and solving patients actual and potential problems (Kowalak & Hughes et al, 2002). The process is a five-step systematic formula of offering care to patients in different situations and the environment. The nursing process has been described as “the essential core of practice for the registered nurse to deliver holistically, patient-centered care” (Alfaro-LeFevre, 2012). In basic terms, therefore, the nursing process is a tool for nurses to work and focus on retaining, maintaining and sustaining the highest state of well-being of the patient. Such objectives require a great deal of data collections to identify actual and potential problems, and to address them. The nursing process is, therefore, composed of five crucial steps: Assessment, Formulation of Nursing Diagnosis, Planning for care, Implementation of care, and evaluation. Assessment According to scholars, assessment refers to the judgment of clinical situations of circumstances (Alfaro-LeFevre, 2012). It is a step of the nursing process where information regarding the patient is collected leading to identification of their health needs. Assessment is done essentially to identify the basic risks and highlight problems affecting a patient with the motive of addressing the real health issues. In the assessment, information is collected concerning the patient (person), their environment, and their health status. This information helps identify real and potential problems affecting the patient and through critical thinking understand their causes, courses, and associated factors (Potter et al., 2004). Assessment data is obtained through verbal and non-verbal communication, written records and investigations. Nursing Diagnosis Once the patient’s data is collected, the next step involves the identification of the manifesting problems and those that through critical thinking the nurse feel are likely to occur. At this point, the nurse should make their own independent diagnosis. A nursing diagnosis has three parts. The first part identifies the problem, and the second part identifies the associated health, personal or environmental issue while the third part specifies the informational evidence from the collected data in the assessment (Alfaro-LeFevre, 2012). Planning for Care Once the problems affecting the patient have been formulated, the nurse should plan for the care of the patient. In this step, the nurse first arranges the diagnoses in terms of priority and for each, specify the objectives to be met and the expected outcome. The objectives must be achievable and time-bound. The nurse then identifies all the actions that will be taken to achieve the objectives under each diagnosis. Implementation or Intervention When the objectives have been set, and the patient problems prioritized, the nurse implements the actions identified. This step involves the application of the nursing knowledge and skills as well as collaborative management of issues and consultation. The main idea during this time is to address all the patients’ health problems optimally and put the patient in a better position to hand them with less assistance. There are two types of nursing interventions, direct and indirect. In direct interventions, the actions or treatment interventions are done through direct interaction between the patients, such interventions include wound dressing, administration of medication or psychotherapy. Indirect interventions, on the other hand, are those interventions that do not require direct interaction with the patient but are for the patient. Such interventions include case report or case conferences. Further, a nursing intervention can be nurse-initiated, independent or dependent. In the nurse initiated intervention, the nurse performs an action based on the nursing diagnosis. An example of such an intervention is the turning of bed-ridden patients to maintain skin integrity. Independent interventions, on the other hand, are those actions not necessarily on the nursing diagnosis but which the nurse performs independently of physician’s direction. An example of such is the manipulation of patients’ environment through changing of bed linens and assisting the family on feeding. Dependent interventions are those interventions which the nurse performs as accomplishing the directions of the physician. Such interventions include administering the prescribed medication and fluids for rehydration therapy (Cronin, 2011). Decision making is fundamental to the nursing practice. It is one thing to have the knowledge and skills to perform the nursing duties and quite another to know when to intervene and apply these concepts. The nursing process effectively gives a platform for decision making. Through the initial collection of patients’ information and its analysis through the formulation of nursing diagnoses, a registered nurse understands the patients actual and potential problems related to health. It is this knowledge that is the basis for decision making by nurses and hence lead to safer and more problem-directed and patient-centered care. Evaluation The last step in the nursing process involves the evaluation of the implemented actions. The evaluation is based on the already outlined objectives and expected outcomes. In the evaluation, further assessment of the situation is done, and more recommendations done to continue the process into another cycle of activities. Evaluation of the nursing process should be performed at the time specified in the expected outcome section for each diagnosis and also after the whole process which should be about 24 hours. For those objectives not met in one cycle re-assessment and re-planning is done to meet them. There are three most common variables that affect achievement of the objectives of care. These include the workload in terms of patient-nurse ratio and patients’ acuity (Potter et al., 2004). Other variables include the ability to plan for care and improve the situation and the nursing care model used in the workplace. This affects the handing over of tasks and duties and may adversely influence the ability to achieve the desired outcomes. Case Scenario The Nursing diagnoses The actual nursing diagnoses for the patient is; impaired skin integrity in the sacral region related to reduced mobility leading to pressure shear and friction as evidenced by pressure ulcer over the ischium on the right buttocks. Rationale: the patient may be having a number of other problems and health issues such as reduced movement, old age, lack of family support and disease associated with old age. However, the patient seems to understand all these and execute a desirable level of self-care especially in relation to nutrition, hygiene, medication and movement on the wheelchair. What goes unattended is the importance of moving out of the wheelchair to preserve skin integrity by relieving the ischial part of the pressure. This is also the main problem that brings the patient to the hospital. Assessment data The risk of development of decubitus ulcers increases with an increase in age as the skin integrity progressively become poor. With the aged, most parts of the skin are dry and hence any little friction is likely to cause skin breakage. In the case of this patient, the condition is worsened by the fact that he cannot move and, therefore, spends most of the time in the wheelchair. To manage the patient, the assessment must be conducted, and enough data collected. I will assess the patients preferred sitting and sleeping position and how this affects the skin integrity. Secondly, I will perform a physical assessment on the patient to rule out other positions of pressure ulcers and cases of poor hygiene. The mobility of the patient will also be assessed to verify the lack of or inadequacy of it as the factor associated with the breakage of skin and loss of integrity. I will also assess the part that the assisted-living facility plays in ensuring that their clients have skin integrity issues taken into consideration. The expected outcome Through proper intervention the patients skin integrity be restored remains intact by the time the patient is discharged, as evidenced by healed ulcers, no redness over bony prominences and capillary refill less than four seconds over areas of redness. This outcome is a physiological one. This is because the outcome targets the pathophysiology of decubitus ulcers and hence it’s healing. Further, the evidence of an achieved target is more of a physiological manifestation. The suggested timeframe is realistic. The healing of the pressure ulcers cannot be expected to heal within a short time. This is especially true when it comes to the elderly whose mobility is limited. Therefore, to achieve a healed ulcer may take an undefined number of days (Cox & Cwocn, 2011). Pressure area care must be undertaken to ensure that healing takes place progressively, and the patient advised to ensure turning and avoid too much time on the wheelchair. Nursing Interventions To reach the already planned expected outcome, several interventions must be done. These interventions will include nurse-initiated, physicians initiated and collaborative interventions. The proposed interventions include; Performing wound care and pressure areas attention to help maintain skin integrity. This will ensure that the debrided wound is free from infection and heal within the shortest time possible. Pressure areas care will include massaging the areas with pressure to maintain integrity. Patients who are at risk of developing decubitus ulcers often have skin inflammation presenting as redness patches. These are areas that will benefit from massage to prevent pressure damage. However, care must be taken as the extreme friction could be exacerbating any existing damage. Administer prescribed antibiotics. The patient is already septic, and the infection must have spread systemically. The antibiotics will help to clear out the infection and hence augment other interventions. Broad spectrum antibiotics or organism-specific antibacterial may be prescribed and hence are to be administered as advised. Methicillin-resistant Staphylococcus aureus (MRSA) is a microbe that are impervious to numerous antimicrobials. Most skin infections result from these microbes, and intravenous infusion of strong and sensitive antibiotics will be necessary (Smith et al., 2010). Teach the patient and the caregivers on the etiology, progression and prevention of pressure ulcers. This will help in ensuring that the problems do not recur and that there is continuity of care. Health education will ensure that care is continued in the facility ad also on the community to help also reduce the hospital admissions related to avoidable issues. Encourage the implementation and use of pressure relieving devices to commensurate with the risk and the actual ulcer. This will be done in collaboration with the physiotherapists and the physicians. Airbags and rings can be used to reduce pressure on the wheelchair. The wheelchair seat should also be improved to provide more padding and shock absorption. Teaching Plan Health education will effectively be a great input in the efforts to reach out and prevent recurrence of the problem. The education should go beyond the confines of the hospital to include the facility and other facilities in a collaborative intervention. The information to be included in the teaching plan will include the risk factors for pressure ulcers and how individuals, families and institutions can collaborate in preventing the problem and its recurrence. The nurse as the leader in care must establish the best format for the teaching plan. The nurse will first establish the need for education and then strategically list the education or teaching topics or fields. Further, it will be necessary to visit the facility for which the teaching plan is intended and assess the available facilities and also the audience. The topic of teaching, the available facilities and teaching aides as well as the audience dictate the format to use. The audio format will be considered where there is enough time to record and/ or present lectures to the patients and the caregivers (Glanz, Rimer, & Viswanath, 2008). Further, the availability of speakers and audio appliances will also determine the application. Similarly, the visual format will require time and facilities. The nurse, therefore, has to be keen on ensuring that the teaching is effective and efficiently use time and resources. In most cases, a combination of several formats in the teaching is effective as it helps fulfil the expectations of most audiences and communicate the intended topic targeting various kinds of audiences. When the format is selected, the teaching information to be put to consideration should be addressed. The type of information must first be relevant to the topic and efficient enough to bridge the knowledge gap. Further, the information must be well aligned to the selected format. All this means. Therefore, that the nurse must first establish the need for teaching in the facility and effectively identify the knowledge gap. This implies that the nurse must have known what the patients and the caregivers already know about the topic and how much more is required for them to meet the objectives. It also means that the teaching plan must have smart objectives to be met and these to determine the information to be included. In addition, the timeframe set aside for the teaching and the learners’ qualities such as age, level of education, physical abilities, and health status must also be considered. The evaluation of the teaching plan and its application depends on the content. The nurse must ensure that teaching is going on. The frequency of evaluation will depend on how simple or difficult the topic and the information is. For simple information that can be leant within a day, evaluation can be done after the whole process is complete. However, for progressive topics such as those involving behavioral change will take more time. Despite this, periodic monitoring must be put in place to ensure that the process runs according to the plans. As earlier indicated, the teaching plan must have objectives (Nutbeam, 2000). The objectives must be specific and time-bound, and this gives a direct indication of how and when evaluation mill be done. In this case, the evaluation will involve the comparison between the actual outcome of the objective and the planned outcome. This will be easily done when the objective was planned for accomplishment. References Alfaro-LeFevre, R. (2012). Nursing Process and Clinical Reasoning. Nursing Education Perspectives. doi:10.5480/1536-5026-33.1.7 Cox, J., & Cwocn, A. (2011). Predictors of pressure ulcers in adult critical care patients. American Journal of Critical Care, 20, 364–375. doi:10.4037/ajcc2011934 Cronin, P. (2011). Fundamentals of Nursing, Concepts, Process and Practice. Nurse Education in Practice. doi:10.1016/j.nepr.2011.03.001 Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health Behaviour and Health Education. Health Education (Vol. 63, pp. 97–121). doi:10.1016/S0033-3506(49)81524-1 Kowalak Kowalak J & Hughes A et al (2002). Best practices Best practices a guide to excellence in nursing care a guide to excellence in nursing care Lippincott Lippincott Williams & Williams & Wlikins Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15, 259–267. doi:10.1093/heapro/15.3.259 Potter, P., Boxerman, S., Wolf, L., Marshall, J., Grayson, D., Sledge, J., & Evanoff, B. (2004). Mapping the nursing process: a new approach for understanding the work of nursing. The Journal of Nursing Administration, 34, 101–109. doi:10.1097/00005110-200402000-00009 Smith, D. M., Snow, D. E., Rees, E., Zischkau, A. M., Hanson, J. D., Wolcott, R. D., … Dowd, S. E. (2010). Evaluation of the bacterial diversity of pressure ulcers using bTEFAP pyrosequencing. BMC Medical Genomics, 3, 41. doi:10.1186/1755-8794-3-41 Read More