Question

List and describe the steps of the nursing process: subjective data collection; objective data collection; validation of data, documentation of data, and analysis of data.  . Describe the steps of the analysis phase of the nursing process.  Compare and contrast the four basic types of nursing assessment:
(a) initial comprehensive
(b) ongoing or partial
(c) focused/problem-oriented
(d) emergency
Explain how the nurse’s role in assessment has changed over the past century. Discuss what the nurse’s role might be 25 years from now.

Answer 1

Nursing process is a series of steps designed to assist nurse in planning ,organsing , and delivering individualized effective patient care . It includes :-

Assessment

Diagnosis

Planning

Implementation

Evaluation

• Assessment

is the systematic gathering of information related to the physical, mental, spiritual, socioeconomic, and cultural status of an individual, group, or community

• Collecting data

• Categorizing data

• Validating data

• Recording data

The purpose of assessment is to obtain data to allow you to help the patient. The nursing interview and the physical assessment findings become part of the patient database. You will use the facts, impressions, and contextual information obtained in your assessment to develop a plan of care.

• Diagnosis

is the second step of the nursing process. It is the phase in which you analyze the assessment data. Using critical thinking skills, identify patterns in the data and draw conclusions about the client's health status, including strengths, problems, and factors contributing to the problems.

provides the data necessary for identifying client problems and strengths

Using critical thinking skills to identify patterns in the data and draw conclusions about the patient's health status

• Planning

is the 3rd step of the nursing process, planning can be divided into two phases: planning (predicting) outcomes and planning interventions. The finished product of the planning phase is a holistic nursing care plan, individualized to reflect the clients problems and strengths.

planning outcomes

- ( data about the clients motivation, family, and available resources help you formulate reliable goals) this is where you work with the client to decide goals for your care - that is, the client outcomes you want to achieve through your choice of interventions. (outcomes are patient oriented)!!!

planning interventions

- (assessment data help you to choose the most effective interventions) phase you develop a list of possible interventions based on your nursing knowledge and then choose those most likely to help the client achieve the stated goals. The best interventions are one using evidence based practice (interventions are nurse oriented!!)

• Implementation

The action phase, during implementation, you will carry out or delegate the actions that you previously planned

• Evaluation

In the evaluation phase ,we evaluate the effectiveness of the planned care and make further improvements and modification if necessary .

Four basic types of nursing assessment :-

- Initial Assessment

The initial assessment, also known as triage, helps to determine the nature of the problem and prepares the way for the ensuing assessment stages. The initial assessment is going to be much more thorough than the other assessments used by nurses. Components may include obtaining a patient's medical history or putting him through a physical exam, or preparing a psychosocial assessment for a mental health patient. Other components may include obtaining a patient's vital signs and taking subjective statements from the patient, as well as double-checking the subjective symptoms with the objective signs of the condition.

- Focused Assessment

The focused assessment is the stage in which the problem is exposed and treated. Due to the importance of vital signs and their ever-changing nature, they are continuously monitored during all parts of the assessment. Depending on the malady, initial treatment for pain and long-term treatment for the root cause of the malady is administered and monitored. Part of the goal of the focused assessment is to diagnose and treat the patient in order to stabilize her condition. Focused assessments may also include X-rays or other types of tests.

- Time-Lapsed Assessment

Once treatment has been implemented, a time-lapsed assessment must be conducted to ensure that the patient is recovering from his malady and his condition has stabilized. Depending on the nature of the malady, the time-lapsed assessment may span the length of one or two hours or a couple of months. During the time-lapsed assessment, the current status of the patient is compared to the previous baseline during and prior to treatment. Similar to the focused assessment, the time-lapsed assessment may also include lab work, X-rays or other diagnostic medical testing.

- Emergency Assessment

During emergency procedures, a nurse is focused on rapidly identifying the root causes of concern for the patient and assessing the airway, breathing and circulation (ABCs) of the patient. Once the ABCs are stabilized, the emergency assessment may turn into an initial or focused assessment, depending on the situation. If the nurse is not in a health care setting, emergency assessments must also include an assessment for scene safety so that no other individuals, including the nurse himself, are hurt during the rescue and emergency response process.

The Steps of an Assessment & Nursing Diagnosis Phases of the Nursing Process

4 major steps

1) Collection of subjective data

Done during the client interview

Sensations/symptoms (pain, hunger), feelings (happiness, sadness), perceptions, desires, preferences, beliefs, ideas, values, & personal info. that can be elicited & verified only by the client

- biographical info (name, age, religion, occupation)

- history of present health concern: physical symptoms related to each body part or system

- personal health history

- family history

- health & lifestyle practices (health practices that put the client at risk, nutrition, activity, relationships, cultural beliefs or practices, family structure + function, community environment)

2) Collection of objective data

The examiner directly observes this data by using 4 physical exam techniques: inspection, palpation, percussion, & auscultation

Another source of objective data is the client's medical/health record (what other health care professional observed about the client); objective data may also be observations noted by the family or significant others

- physical characteristics (skin color, posture)

- body functions (heart rate, respiratory rate)

- appearance (dress + hygiene)

- behavior (mood, affect)

- measurements (bp, temp, height, weight)

- results of lab testing (platelet count, x-ray findings)

3) Validation of data

Serves to ensure that the assessment process isn't ended before all relevant data has been collected, & helps to prevent documentation of inaccurate data

What types of assessment data should be validated, the diff. ways to validate data, & identifying areas where data are missing are all parts of the process

4) Documentation of data

Forms the database for the entire nursing process & provides data for all other members of the healthcare team

#. Nurse's Role in Assessment has Changed over the past century :-

LATE 1800s-EARLY 1900s

• Nurses relied on their natural senses; the client's face and body would be observed for "changes in color, temperature, muscle strength, use of limbs, body output, and degrees of nutrition, and hydration"

• Palpation was used to measure pulse rate and quality and to locate the fundus of the puerperal woman

• Examples of independent nursing practice using inspection, palpation, and auscultation have been recorded in nursing journals since 1901; some examples reported in the American Journal of Nursing (1901-1938) include gastrointestinal palpation, testing eighth cranial nerve function, and examination of children in school systems

1930-1949s

• The American Journal of Public Health documents routine client and home inspection by public health nurses in the 1930s

• This role of case finding, prevention of communicable diseases, and routine use of assessment skills in poor inner-city areas was performed through the Frontier Nursing Service and the Red Cross

1950-1969s

• Nurses were hired to conduct pre-employment health stories and physical examinations for major companies, such as New York Telephone, from 1953 through 1960

1970-1989s

• The early 1970s prompted nurses to develop an active role in the provision of primary health services and expanded the professional nurse role in conducting health histories and physical and psychological assessments

• Joint statements of the American Nurses Association and the American Academy of Pediatrics agreed that in-depth client assessments and on-the-spot diagnostic judgments would enhance the productivity of nurses and the health care of clients

• Acute care nurses in the 1980s employed the "primary care" method of delivery of care. Each nurse was autonomous in making comprehensive initial assessments from which individualized plans of care were established

1990-PRESENT

• Over the last 20 years, the movement of health care from the acute care setting to the community and the proliferation of baccalaureate and graduate education solidified the nurses' role in holistic assessment

• Downsizing, budget cuts, and restructuring were the priorities of the 1990s; in turn, there was a demand for documentation of client assessments by all health care providers to justify health care services

• In the 1990s, critical pathways or care maps guided the client's progression, with each stage based on specific protocols that the nurse was responsible for assessing and validating

• Advanced practice nurses have been increasingly used in the hospital as clinical nurse specialists and in the community as nurse practitioners

• While state legislators and the American Medical Association struggled with issues of reimbursement and prescriptive services by nurses, government and societal recognition of the need for greater cost accountability in the health care industry launched the advent of diagnosis-related groups (DRGs) and promotion of health care coverage plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs)