Planning Nursing Care, Study notes of Nursing

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AMERICAN NURSING HISTORY

Planning Nursing Care

Nursing Process

Davida Michaels 3/20/

Contents

• Planning Nursing Care
  • Nursing Process
  • Background and History
  • Closer Look at Steps of the Nursing Process
    • Assessment
    • Diagnosis.................................................................................................................................
    • Organization - Classification Systems
    • Planning
    • Planning – Goal Setting
    • Implementation
    • Evaluation
  • References

known for the development the Behavior System Model of Nursing which stressed the importance of research-based knowledge about the effect of nursing care on patients. When she first proposed the theory in 1968, she explained that it was to foster “the efficient and effective behavioral functioning in the patient to prevent illness.” The nursing process of the Behavior System Model of Nursing begins with an assessment and diagnosis of the patient. Once a diagnosis is made, the nurse and other healthcare professionals develop a nursing care plan of interventions and setting them in motion. The process ends with an evaluation, which is based on the balance of the subsystems.iii

In 1961 Ida Jean Orlando-Pelletieriv^ introduced d the “Deliberative Nursing Process Theory- which included five stages: assessment, diagnosis, planning, implementation, and evaluation. (ADPIE ).Orlando’s nursing theory stressed the reciprocal relationship between patient and nurse; what the nurse and the patient say and do affects them both. The result was an effective nursing care plan that could be easily adapted when and if any complications arise with the patient,. v

Listen to an oral history by Ida Jean Orlando - https://www.youtube.com/watch?v=w3Gn3Ph-00Q ]

In 1963, Lois Knowles at the University of Florida used a five step nursing process called the ‘ five Ds’: discover, delve, decide, do and discriminate”. The discover and delve steps are relates to assessment phase, decide is the planning stage, do is the implementation stage; discriminate is the evaluation phase of client responses to nursing interventions

In 1967—Helen Yura and Mary B.Walsh. published The Nursing Process , which identified 4 strategic nursing care steps – also referred to as APIE:- Assessment, Planning, Implement and Evaluation.

Closer Look at Steps of the Nursing Process

Assessment In Notes on Nursing , Florence Nightingale cautions: "But if you cannot get the habit of observation one way or other, you had better give up the [idea of] being a nurse, for it is not your calling, however kind and anxious you may be." vi

Assessment establishes a data base by interviewing the individual and/or family members, observing their behavior and physical examination to identify problem(s). Assessment requires listening, critical thinking skills and data collection- subjective and objective. Subjective data involves verbal statements from the patient or caregiver. Objective data is measurable, tangible data such as vital signs, intake and output, and height and weight. Data may come from the patient directly or from primary caregivers who may or may not be direct relation family members. The data is recorded objectively and accurately – data is then organized and analyzed, to formulate a nursing diagnosis, goals and desired outcomes.

Diagnosis In 1953, Virginia Fry and R. Louise McManus introduced the discipline-specific term “nursing diagnosis” to describe a step necessary in developing a nursing care plan. The nursing diagnosis was used to standardize and define the concept of nursing care. Their hope this would help to nurses earn professional status.vii

In 1972, the New York State Nurse Practice Act identified diagnosing as part of the legal domain of professional nursing. The Act was the first legislative recognition of nursing’s independent role and diagnostic function. viii

Shoemaker defines a nursing diagnosis as:

 In 1982, the conference group accepted the name “North American Nursing Diagnosis Association (NANDA)” to recognize the participation and contribution of nurses in the United States and Canada.

 In 1984, NANDA renamed “patterns of unitary man” as “human response patterns” based on the work of Marjorie Gordon. Currently, the taxonomy is now called Taxonomy II.

 In 1990 during the 9th conference of NANDA, the group approved an official definition of nursing diagnosis: “Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

An actual nursing diagnosis is written as the problem/diagnosis related to (r/t) x factor/cause as evidenced by data/observations .A risk nursing diagnosis is written as problem/diagnosis related to (r/t) x factor/cause. A syndrome nursing diagnosis is written as problem/diagnosis related to (r/t) x factor/cause. A wellness nursing diagnosis is written as readiness to/for action.

Planning Planning nursing care is a formal process that includes correctly identifying existing needs, as well as recognizing potential needs or risks. Communication of care plans among nurses, and other healthcare providers is vital in the achievement of health care outcomes. Without the nursing care planning process,quality and consistency in patient care would be lost.

Nursing care plan formats are can be organized into four columns (1) nursing diagnoses, (2) desired outcomes and goals, (3) nursing interventions, and (4) evaluation. A three column format can also be used with goals and interventions combined in one column. As a general rule the care plans were usually written in pencil so they could be updated and stuck in the Kardex. These care plans usually became quite messy and were not saved as part f the individual’s record. With the advent of computerized records, documentation regarding problems, goals and outcomes

Home Health Care plans were a exception as private insurance, Medicare and Medicaid reimbursement required information regarding problems, goals, interventions and outcomes and

were reviewed periodically by state surveyors and representatives of the patient’s payer source for both reimbursement and standards of care.

Discussing Nursing Care Plans, Sharon LaDuke wrote in 2008 xvii^ “in the 1930s the nursing care plan developed as a way for nursing team leaders to guide the care provided by less-educated members of the team. These individualized, handwritten plans were worthwhile: hospital stays were long enough, and the pace slow enough, to actually implement them.”

Nursing education found the written care plan a useful tool to aide learning. As a nursing student in the late 1960’s I can recall spending time in the library writing care plans…one patient in particular with chronic renal failure – with multiple diagnostic and lab tests stands out. While I don’t recall the exact number of pages it took hours! As a student this was a good learning experience; as a graduate RN I found that the traditional nursing care plan was not practicable. First, times had changed, acuity soared, and hospital stays shortened; second, many patients were admitted with multiple conditions. Considering that the nursing process and planning care is dynamic and goal directed- as conditions change and the patient’s progress – or lack of it – toward achievement of goals changes, so does the plan of care. Considering we live in the age of the computer and electronic health records which aids interdisciplinary communication, separate, nursing specific care plans are not necessary. As LaDuke concludes “Despite its rightful place of honor at the center of student nurse education, the nursing care plan—as we’ve known it— belongs to yesterday”xviii

Planning – Goal Setting Planning is the process of developing a plan and establishing SMART goals in order to achieve a desired outcome such as reducing pain or improving cardiovascular function.

SMART criteria are commonly attributed to Peter Drucker’s management by objectives concept. The first-known use of the term occurs in the November 1981 issue of Management Review by George T. Doran. “There’s a S.M.A.R.T. way to write management’s goals and objectives.”

A pair of university psychologists, Edwin Locke and Gary Latham, helped develop the SMART criteria through field experiments. Goal-setting theory was developed within organizational psychology over a 25-year period, based on some 400 laboratory and field studies.xix

References

i (^) Ejeh, Sandra N. ADVANCES IN NURSING PROCESS: NANDA-I, NIC,NOC, PowerPoint presentation

downloaded 3/15/

ii (^) Ibid (op.cit canestar).

iii (^) https://nurseslabs.com/dorothy-e-johnsons-behavioral-system-model/

iv (^) Ibid v (^) https://nurseslabs.com/ida-jean-orlandos-deliberative-nursing-process-theory/ vi (^) Nightingale, Florence. 1969/1860. Notes on Nursing: What it is and what it is not.. Dover Publications, Inc. New York. vii Matt Vera, BSN, R.N. Nursing Diagnosis List: Complete Guide and Examples , Everything you need to know about nursing diagnosis .https://nurseslabs.com/nursing-diagnosis/

viii ix (^) Shoemaker, Joyce 1985 Characteristics of a Nursing Diagnosis. Occupational Health Nursing, August 1985. p. x (^) Note NANDA is now global and known as NANDA International xi (^) https://kb.nanda.org/article/AA-00266/0/What-is-the-difference-between-a-medical-diagnosis-and-a-nursing- diagnosis-.html xii Ibid xiii (^) Roseman University ABSN(Accelerated Bachelor Science Nursing) | What is a three-part nursing diagnosis? Published online July 9, 2014 Downloaded 3/17/ xiv (^) Citation: Gordon, M. (Sept. 30, 1998): Nursing Nomenclature and Classification System Development Online Journal of Issues in Nursing. Vol. 3, No. 2, Manuscript 1. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol31998/ No2Sept1998/NomenclatureandClassification.aspx’ xv (^) Ibid and xvi (^) https://nurseslabs.com/nursing-diagnosis/ xvii (^) SharonLaDuke, Viewpoint. AJN t June 2008 t Vol. 108, No. 6 xviii (^) Ibid xix (^) Hunt, Joe Beyond SMART Goals: How to Build Better Results http://www.houseofhunt.com/executive-edge/executive-edge-june-2016-smart-goals/