Contents
1
Overview of Nursing Process 1
INTRODUCTION 1
WHAT IS NURSING? 1
Nursing Theory 3
Human Responses 4
Nursing,Medicine, and Multidisciplinary Practice 5
Nursing in Wellness and Illness 6
WHY IS THE NURSING PROCESS IMPORTANT? 7
WHAT IS NURSING PROCESS? 10
Relationship to Nursing and Caring 10
Background 10
Purpose and Characteristics 12
Organization: Phases of the Nursing Process 13
Relationship to Problem-Solving Process 18
QUALITIES NEEDED BY THE NURSE 20
Cognitive (Intellectual) Skills 20
Creativity and Curiosity 20
Interpersonal Skills 21
Cultural Competence 21
Psychomotor Skills 21
Technological Skills 22
NURSING PROCESS AND WELLNESS 22
NURSING PROCESS AND COMMUNITY HEALTH 23
ETHICAL AND CULTURAL CONSIDERATIONS 24
SUMMARY 26
Nursing Process Practice 27
Critical Thinking Practice: Self-Knowledge 29
Case Study: Applying Critical Thinking and Nursing Process 30
SELECTED REFERENCES 31
2
Critical Thinking 35
WHY DO NURSES NEED TO THINK CRITICALLY? 35
Nursing Is an Applied Discipline 36
Nursing Draws on Knowledge from Other Fields 37
Nurses Deal with Change in Stressful Environments 37
Nurses Make Frequent,Varied, and Important Decisions 38
WHAT IS CRITICAL THINKING? 38
Some Definitions of Critical Thinking 39
Characteristics of Critical Thinking 39
Types of Nursing Knowledge 41
CRITICAL THINKING ATTITUDES 43
Independent Thinking 44
Intellectual Humility 44
Intellectual Courage 45
Intellectual Empathy 45
Intellectual Integrity 46
Intellectual Perseverance 46
Intellectual Curiosity 46
Faith in Reason 47
Fair-mindedness 47
Interest in Exploring Thoughts and Feelings 47
CRITICAL THINKING SKILLS 48
Using Language 49
Perceiving 51
Believing and Knowing 52
Clarifying 53
Comparing 54
Judging and Evaluating 57
Reasoning 58
COMPLEX INTELLECTUAL ACTIVITIES 62
STANDARDS OF REASONING 66
CRITICAL THINKING AND NURSING PROCESS 66
CRITICAL THINKING AND NURSING ETHICS 69
DEVELOPING CRITICAL THINKING 70
SUMMARY 71
Nursing Process Practice 72
Critical Thinking Practice:Using Language 74
Case Study: Applying Critical Thinking and Nursing Process 76
SELECTED REFERENCES 77
3
Assessment
ASSESSMENT:THE FIRST PHASE OF THE NURSING PROCESS 79
Purpose of Nursing Assessment 80
Relationship to Other Phases of the Nursing Process 81
Critical Thinking in Assessment 81
COLLECTING DATA 83
Subjective and Objective Data 83
Primary and Secondary Data Sources 87
Initial Versus Ongoing Assessment 88
Comprehensive Versus Focus Assessment 89
Use of Computers in Assessment 94
Data Collection Methods 95
VALIDATING THE DATA 105
ORGANIZING DATA 105
Nursing Models 107
NONNURSING MODELS 109
RECORDING DATA 115
SPECIAL-PURPOSE ASSESSMENTS 116
Home Care and Functional Assessment 116
Cultural Assessment 117
Spiritual Assessment 121
Wellness Assessment 123
Family Assessment 123
Community Assessment 123
ETHICAL AND LEGAL CONSIDERATIONS 129
Honesty 132
Confidentiality 132
Malpractice Suits 132
SUMMARY 133
Nursing Process Practice 134
Critical Thinking Practice: Believing and Knowing 139
Case Study: Applying Critical Thinking and Nursing Process 147
SELECTED REFERENCES 147
4
Diagnostic Reasoning
INTRODUCTION 151
DIAGNOSIS: SECOND PHASE OF NURSING PROCESS 153
History of Nursing Diagnosis 154
Importance of Nursing Diagnosis 155
HUMAN RESPONSES 157
DIAGNOSING HEALTH STATUS 158
Patient Strengths 160
Wellness Diagnoses 160
Recognizing Nursing Diagnoses 160
Recognizing Collaborative Problems 163
Recognizing Medical Diagnoses 164
Computer-Assisted Diagnosis 167
Using Nursing Diagnoses With Critical Pathways 168
DIAGNOSTIC REASONING 171
Use of Nursing Models 171
Interpreting Data 171
Verifying Diagnoses 183
Labeling and Recording Diagnoses 184
Health Promotion: Diagnosing Wellness 184
CRITICAL THINKING AND DIAGNOSIS 185
Reflective Practice 185
Avoiding Diagnostic Errors 185
ETHICAL CONSIDERATIONS 190
SUMMARY 190
Nursing Process Practice 191
Critical Thinking Practice: Analysis and Synthesis 197
Case Study: Applying Nursing Process and Critical Thinking 202
SELECTED REFERENCES 203
5
Diagnostic Language
INTRODUCTION 205
STANDARDIZED NURSING LANGUAGES 206
Classification Systems 206
The Need for Uniform Nursing Language 207
Existing Nursing Taxonomies 208
NANDA INTERNATIONAL 208
The NANDA Taxonomy 210
NANDA Review Process 210
CHOOSING A PROBLEM LABEL 210
Components of a NANDA Diagnosis 211
How to Choose a Label 215
Learning to Recognize the NANDA Labels 218
FORMAT FOR WRITING DIAGNOSTIC STATEMENTS 219
Actual Nursing Diagnoses 220
Potential (Risk) Nursing Diagnoses 225
Possible Nursing Diagnoses 226
Wellness Diagnoses (Format) 226
Collaborative Problems 226
RELATIONSHIP OF NURSING DIAGNOSES TO
OUTCOMES AND NURSING ORDERS 227
THINKING CRITICALLY ABOUT THE CONTENT
OF DIAGNOSTIC STATEMENTS 228
WELLNESS DIAGNOSES 232
SPIRITUAL DIAGNOSES 234
FAMILY AND HOME HEALTH DIAGNOSES 235
COMMUNITY HEALTH DIAGNOSES 236
ISSUES ASSOCIATED WITH THE NANDA
CLASSIFICATIONS 237
Unrealistic Expectations 238
Effect on Holistic Perspective 238
Ethical Considerations 238
Cultural Considerations 240
RECORDING NURSING DIAGNOSES 240
PRIORITIZING DIAGNOSES 241
SUMMARY 243
Nursing Process Practice 244
Critical Thinking Practice: Clarifying, Comparing and Contrasting 251
Case Study: Applying Nursing Process and Critical Thinking 254
SELECTED REFERENCES 256
6
Planning: Overview and Outcomes
Learning Outcomes 259
INTRODUCTION 259
PLANNING:THIRD PHASE OF NURSING PROCESS 260
Initial Versus Ongoing Planning 262
Discharge Planning 263
PATIENT CARE PLANS 266
Computerized Care Plans 267
Comprehensive Nursing Care Plans 267
Multidisciplinary Care Plans (Critical Pathways) 271
PLANNING OUTCOMES 271
Purpose of the Outcome Statement 273
Writing Outcome Statements 273
The Nursing Outcomes Classification (NOC) 283
Family and Home Health Outcomes 285
Community Outcomes 286
Outcomes for Wellness Diagnoses 287
Patient Teaching Outcomes 289
CRITICAL THINKING: REFLECTING ON PLANNING 290
Guidelines for Judging the Quality of Outcome
Statements 291
Ethical Considerations in Planning 296
Legal Issues in Planning 297
Spiritual Planning and Outcomes 298
Cultural Considerations in Planning 299
SUMMARY 299
Nursing Process Practice 300
Critical Thinking Practice: Classifying 306
Case Study: Applying Nursing Process and Critical Thinking 310
SELECTED REFERENCES 312
7
Planning: Interventions
INTRODUCTION 315
NURSING INTERVENTIONS 316
Types of Interventions 316
Theory-Based Planning 319
Nursing Interventions and Problem Status 319
How to Generate and Select Nursing
Activities/Interventions 322
Computerized Planning 327
WRITING NURSING ORDERS 327
Purpose 328
Components of a Nursing Order 328
STANDARDIZED LANGUAGE FOR NURSING
INTERVENTIONS 329
The Nursing Interventions Classification (NIC) 330
Community Nursing Interventions 332
Family and Home Health Interventions 335
FORMAL TEACHING PLANS 336
WELLNESS INTERVENTIONS 338
Standardized Wellness Interventions 338
SPIRITUAL INTERVENTIONS 339
THINKING CRITICALLY ABOUT PLANNING 341
Reflecting on Interventions 341
Reflecting on Ethical Factors 342
Reflecting on Cultural Factors 343
SUMMARY 344
Nursing Process Practice 346
Critical Thinking Practice: Recognizing Relevant Information 350
Case Study: Applying Nursing Process and Critical Thinking 353
SELECTED REFERENCES 353
8
Implementation
LEARNING OUTCOMES 357
INTRODUCTION 357
Relationship of Implementation to Other
Nursing Process Phases 360
Healthcare Delivery Systems 360
PREPARING TO ACT 361
Preparing the Nurse 363
Preparing the Patient 363
Preparing Supplies and Equipment 364
ACTION:DOING OR DELEGATING 365
Teaching for Self-Care 366
Delegation and Supervision 367
THINKING CRITICALLY ABOUT IMPLEMENTATION 370
RECORDING 370
Functions of Client Records 372
Documenting Nursing Process 373
Documentation Methods 378
Computerized Documentation 381
Documenting with Standardized Language 386
Guidelines for Charting 386
Home Healthcare Documentation 388
Long-Term Care Documentation 390
ORAL REPORTS 391
ETHICAL ISSUES IN IMPLEMENTATION 392
Respect for Dignity 393
Privacy and Confidentiality 393
LEGAL CONSIDERATIONS 394
Falls 394
Restraints 395
Questioning Medical Orders 395
Patient Behaviors That May Contribute to an Injury 395
CULTURAL AND SPIRITUAL CONSIDERATIONS 396
Cultural Care 397
Spiritual Care 397
SUMMARY
Nursing Process Practice
Critical Thinking Practice: Reasoning
Case Study: Applying Nursing Process and Critical ThinkingSELECTED REFERENCES
9
Evaluation
LEARNING OUTCOMES 411
INTRODUCTION 411
GENERAL CHARACTERISTICS OF EVALUATION 412
Standards and Criteria 413
EVALUATION IN NURSING PROCESS 414
Relationship to Other Phases 415
Evaluating Patient Progress 416
Evaluating/Revising the Plan of Care 421
REFLECTING CRITICALLY ABOUT EVALUATION 428
Evaluation Errors 428
Ethical Considerations 429
Cultural and Spiritual Considerations 430
QUALITY ASSURANCE/IMPROVEMENT 431
Computerized Records and Standardized Language 431
Types of Quality-Assurance Evaluation 432
A Procedure for Quality-Assurance Evaluation 434
SUMMARY
Nursing Process Practice
Critical Thinking Practice: Judging and Evaluating
Case Study: Applying Nursing Process and Critical Thinking
SELECTED REFERENCES
10
Creating a Care Plan
LEARNING OUTCOMES 449
INTRODUCTION 449
COMPREHENSIVE CARE PLANS 450
Components of a Comprehensive Care Plan 451
Standardized Approaches to Care Planning 455
COMPUTERIZED CARE PLANS AND
STANDARDIZED LANGUAGE 465
CARE-PLANNING GUIDE 465
CREATING A COMPREHENSIVE CARE PLAN 466
Case Study: Luisa Sanchez 468
Assessment 470
Diagnosis 470
Planning 473
Implementation 480
Evaluation 480
HOW TO MIND-MAP A CARE PLAN 182
WELLNESS IN THE ACUTE-CARE SETTING 483
ETHICAL CONSIDERATIONS 485
SUMMARY
Nursing Process Practice
Instructions for Preparing the Nursing Plan of Care
Critical Thinking Practice: Similarities and Differences
Appendix A: ANA Code of Ethics for Nurses with
Interpretive Statements 494
Appendix B: Multidisciplinary (Collaborative) Problems
Associated with Diseases and other Physiological Disorders 495
Appendix C: Multidisciplinary (Collaborative) Problems
Associated with Surgical Treatments 504
Answer Keys 508
Index 533