Application of the Nursing Process Paper
M6A3: Application of the Nursing Process Paper
Using APA format, the information from this course, and your assigned readings write a six (6) to ten (10) page paper (excludes cover and reference page) addressing the application of the nursing process to a patient care scenario. Use these directions and the scoring rubric as you develop the paper. Outlines and abstracts are NOT required with this paper. Do not include the scenario in the paper
A minimum of three (3) current professional references must be provided excluding a nursing diagnosis book. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used. Do not use abbreviations…write out everything.
The paper consists of three (3) parts:
1. The meaning and use of the nursing process in making good nursing judgments that effect patient care
2. The development of a plan of care using the nursing process for a specific patient situation
3. The preparation stage for a teaching plan to prevent a recurrence of a similar situation
The following sheet will assist you when composing the plan of care for the paper: Overview of the Nursing Process.
Part 1 (3-4 pages)
Review the required readings about the nursing process. In your own words, define each step of the process and provide an example for each step.
In the implementation step, what is meant by direct and indirect care as described by the Nursing Intervention Classification (NIC) project?
Discuss the three (3) types of nursing interventions (nurse-initiated, dependent, and interdependent) that applies to the patient care situation. Provide an example of each (refer to your textbook).
Explain how the nursing process provides the basis for the registered nurse to make a nursing judgment that results in safe patient care with good outcomes.
Discuss how the registered nurse evaluates the overall use of the nursing process. Identify three (3) variables that may influence the ability to achieve the desired outcomes for the patient.
How is the plan of care modified when the outcomes are not met?
How does the RN use the nursing process to make decisions about the priority of care?
Part 2 (3 pages)
Patient scenario
A 78-year-old man is living in an assisted living facility. He is able to walk very short distances and uses a wheelchair to transport himself to the communal dining room. He administers his own medications independently and bathes himself. Over the last year he prefers to remain in the wheelchair even when in his room. He has a history of CHF, hypertension, hyperlipidemia and lower extremity weakness. He is able to state his current medications include metoprolol (Lopressor) 50 mg once daily by mouth, furosemide (Lasix) 20 mg once daily by mouth, Quinapril (Acupril) 20 mg once daily by mouth, atorvastatin (Lipitor) 20 mg once daily by mouth. During a routine examination, his physician noted a pressure ulcer over the ischium on the right buttocks. The wound is oval about 10mm x 8 mm, with red and yellow areas in the middle and black areas on some surrounding tissue. It has a foul odor. The patient had been padding the area so “it doesn’t get my pants wet”. The physician arranged for him to be admitted to the hospital in order for intravenous antibiotic therapy and wound care to be initiated. After being admitted to the hospital his medications are: metoprolol (Lopressor )50 mg orally every 12 hours, furosemide (Lasix ) 40mg once daily by mouth, quinapril HCl (Accupril) 40 mg once daily by mouth, cefazolin (Ancef)1.5 Grams in 50 mL 0.9 % Normal Saline intravenously three times a day. The result of the wound culture identified Methicilin-resistant staphylococcus aureus. After a surgical debridement of the black tissue a SilvaSorb® (antimicrobial gel) dressing was ordered daily.
Develop a Plan of Nursing Care for this patient that includes all steps of the nursing process:
• One (1) actual NANDA-I nursing diagnosis statement addressing the priority problem the patient is experiencing. You need to provide the entire nursing diagnosis statement. For example: Acute pain, related to tissue trauma, as evidenced by patient rating pain at 7 on the 0-10 verbal pain scale. Provide a rationale, with evidence, why this nursing diagnosis is the priority for this patient.
• What is the assessment data that supports the use of this nursing diagnosis? These are the assessments you will collect to determine if the patient has this nursing diagnosis. For example: Will assess the patient's pain using the 0-10 verbal pain scale.
• One (1) expected outcome (realistic, measureable and contains a time frame). that addresses the diagnosis and meets the criteria for an expected patient outcome. Discuss whether the outcome is a cognitive, psychomotor, affective or physiologic outcome. Discuss why the time frame selected for the evaluative criteria was selected. Use evidence as the basis for the time frame and criteria. You need to be specific to this particular patient. For example: Patient will rate pain at 3 on the 0-10 verbal pain scale. Of course, you would also need to answer the rest of the items in this section.
• Four (4) nursing interventions that includes at least one (1) nurse-initiated, one (1) dependent, one (1) interdependent intervention. Label your interventions as above. Provide a rationale for each intervention that is evidence-based. Lastly, your interventions must be able to move the patient toward the achievement of the outcome. Select interventions, you as the RN can perform, that could reduce the pain and provide the rationale as to why; be sure they are evidence-based. For example: Teach patient guided imagery to distract attention and reduce tension.
Part 3 (1-2 pages)
To assist the patient in preventing a recurrence of a similar incident once he returns to the assisted living environment, the RN needs to develop a teaching plan. Use the nursing process to consider the information the RN would need prior to development of the plan. Respond to the following and be able to support your answers. You will not be developing a teaching-learning plan but demonstrating using the teaching-learning process to prepare for an individualized plan.
• How does the RN decide the format of the teaching plan, i.e., written, verbal, or other?
• How does the RN know which information needs to be included?
• When does the RN determine how and when to evaluate the teaching-learning process?
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format.
Application of the Nursing Process Paper
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[1] The nursing process
The nursing process utilizes an organized framework to guide nursing practice while also providing holistic patient care. The first step in nursing process is assessment, which takes into account collection and analysis of data to provide nursing care. This mainly includes physiological, but also psychological, spiritual, socio-economic as well as lifestyle factors. This is followed by diagnosis, which is clinical judgment on a client’s response to potential health needs and conditions. The diagnosis is the starting point in nursing care plan, and planning is the next step that is based on outcomes. Planning is also related to setting goals on what is to be accomplished by identifying the diagnoses. The nurse then utilize the first three phases to help in implementing nursing care, resulting in undertaking nursing interventions and the plan. The last nursing step is the evaluation phase, where nurses establish whether the set goals have been met to ensure patient wellness.
Direct and indirect care
The Nursing Interventions Classification (NIC) describes and categorizes the interventions undertaken by practicing nurses into direct and indirect care. Direct care relates to the treatments that are undertaken when there are interactions with patients. Direct patient care includes taking the patients’ vital signs and providing emergency aid On the other hand, indirect care is the services and treatments in patient care that do not require interaction between the nurse and the patient. This could include sanitizing the home environment as well as the medical equipment as well as clerical tasks.
Nursing interventions
Nursing interventions may or may not require physician interventions and includes the dependent, independent and interdependent interventions. The intervention is the nurse initiated action initiated without supervision. Monitoring the vital signs is a nurse- initiated intervention to improve the patient’s health outcome in light of his medical history of CHF and hypertension The dependent intervention is any nursing action that is initiated after instructions from a physician or other health care providers. The dependent interventions will include administering medications, as well as obtaining laboratory tests. The collaborative/ interdependent intervention relates to the actions undertaken through the collaborative effort of a health care team.
Nursing process and nursing judgment
Nurses address health problem, and the nursing process is a problem-solving approach that focuses on assessment, diagnosis, planning, implementation and evaluation of individualized care. Hence the use of critical thinking skills as well as technical skills is vital to decision making in the nursing process. In each stage of the nursing process, there is a need to use judgment when making decisions especially when relying on critical thinking skills. The nursing process encourages development of clinical judgment skills, and this complements the nursing process (Standing, 2010). In any case, problem solving focuses on evaluating outcomes after there are interventions, since it is goal oriented.
Variables influencing desired patient outcome
The evaluation phase helps to determine whether the desired outcome has been achieved after the intervention. Core drug knowledge is one of the factors that affect the success of intervention. The extent to which patient education helps the patients to understand the effect of drugs as well as maintain safety and monitoring is taken into account. This allows the patient to report on the intended effect and where possible the adverse effects. The patient also gets to report on any special concerns, and this depends on core drug knowledge. Ideally, there ought to be good nursing-patient relationship.
The environment is another consideration that affects patient outcome, especially when there is need for patient education. The environment may affect patient compliance, meaning that more information is needed to understand whether the nurse care plan would be modified. If the patient does not adhere to drug therapy, then it would be necessary to look into the factors in the environment that affect their choices. The environment may increase the risk of adverse effects, making it likely that the desired outcomes would likely not be achieved.
Another factor that may affect patient outcome is the influence of lifestyle, diet and habits on health status. The patient suffering from hypertension needs to have a healthier lifestyle, since even planning the patient education takes into account lifestyle modification. The intervention might not be effective if the patient shares a different view about patient education. Hence, a patient’s current health status needs to be considered, given that it may affect their ability to remember some of the information. In any case, monitoring the patients’ progress ensures that there is no further health deterioration from adverse side effect.
Nurse’s action if the outcome is not met
Evaluation is a continuous process, meaning that when the expected outcome is not met, then there is a need to reevaluate the preceding steps. The rationale for this is that it is possible to identify factors that may have resulted in failure to meeting the desired outcome. This could also necessitate one to look for more data, and this would provide more information about the diagnostics.
The nursing process and decision-making
The registered nurses use the nurse process to make decisions that improve patient outcome, while taking into account the patient needs and those of the family. Additionally, the nursing process allows one to evaluate and redirect the implementation phase to ensure that there is improvement (White, Duncan & Wendy, 2010). Hence, the nurses grow more confident to use their reasoning skills while in line with the objective of improving patient outcomes. The nurses prioritize on the nurse process by utilizing the best available evidence to support nursing action. This makes it likely that the nurse will identify what needs to be improved after addressing patient outcomes. Overall, the goal measurement focuses on the short-term and the long-term goals as the outcome criteria to prioritize on patient care.
[2] Development care plan
Nursing diagnosis
The patient’s first diagnosis shows that the patient has a history of CHF, hypertension, hyperlipidemi...