Nursing Lecture Notes Unit 2.0

1967- First comprehensive book of Nursing was published.
1973- ANA Congress for Nursing Practice developed Standards of Practice.
1982- State board use nursing process as organizing concept.


The Nursing Process is an organizing framework for professional nursing practice, it's steps are very similar to the ones used in scientific reasoning and problem solving.

The Nursing Process is based on EBN, EBN is a systematic process that uses current evidence in making decisions about the care of clients including
- Evaluation of quality and applicability of existing research
- Client preferences
- Cost
- Clinical exper

The Nursing Process:
- Assessment: Collecting data, validating data, and communicating data about the client using physical assessment and interviewing techniques.
- Diagnosis: Analyzing client data using critical thinking skills to identify and validate

- Planning/Outcome ID: Writing measurable client outcomes and interventions to accomplish outcomes
- Implementation: Initiating the care plan and performing the interventions
- Evaluation: Evaluating if outcome(s) met and appropriateness of the interventi

When used well, the nursing process achieves for the patient:
- Scientifically based
- Holistic
- Individualized care
- The opportunity to work collaboratively with nurses
- Continuity of care.

Nurses who use the nursing process in a thoughtful and systematic way achieve:
- Clear
- Efficient
- Cost-effective plan of action by which the entire nursing team can achieve the best results for the patient.

The nursing process is a systematic method that directs the nurse and patient, as together the accomplish the following:

1. Assess the patient to determine the need for nursing care
2. Determine nursing diagnoses for actual and potential health problems
3. Identify expected outcomes and plan care
4. Implement care
5. Evaluate care

What are the five key descriptors of the characteristics of the Nursing Process?

- Systematic: Part of an ordered sequence of activities
- Dynamic: Great interaction and overlapping among the five steps
- Interpersonal: human being is always at the heart of nursing
- Outcome oriented
- Universaly applicable in nursing settings

There are several methods to problem solving in the nursing process, some include:
- Trial-and-error problem solving
- Scientific problem solving
- Intuative problem solving
- Critical thinking: Intuative, logical or both

- Intuition should not be thought of as a replacement for scientific or logical problem solving

This is a systematic, seven step, problem solving process that results in conclusion or revision of the problem or study?

Scientific problem solving
(Used most correctly in a controlled lab setting and closely related to the general problem solving processes used by healthcare professionals)

This form of problem solving uses a direct understanding of a situation based on a background of experience, knowledge, and skill that makes expert decision making possible?

Intuitive problem solving
(Begining nurses must use scientific problem solving and nursing knowledge as the basis of care they give, intuitive problem solving comes from years of experience)

Potential errors in decision making include:
- Bias
- Failure to consider the total situation
- Impatience

Short-term vs Long-term goals:
- Short-term goals are set to be accomplished during hospitalization
- Long-term goals are set to be accomplished once the patient is discharged

The steps of the nursing process were legitimized in 1973, when the ANA Congress for Nursing Practice developed Standards of Practice to guide nursing performance.

The Joint Commision requires that care be documented according to the nursing process.

The primary purpose of the nursing process is to help nurses manage each patient's case:
- Scientifically
- Holistically
- Creatively
To do this they need cognitive, technical, interpersonal, and ethical/legal blended skills.

- Cognitive and technical skills equip nurses to manage the clinical problems stemming from the patients changing health or illness state
- Interpersonal and technical skills are essential, however, for nurses concerned about the patients broader well-bei

Skills that are used in the Nursing Process:
- Cognitive
- Technical
- Interpersonal
- Ethical/Legal

Cognitively skilled nurses are critical thinkers, this is defined as a systematic way to inform and shape one's thinking. It functions puposefully and exactingly. It is thought that is disciplined, comprehensive, based on intellectual standards, and as a

Developing a method of critical thinking envolves 5 methodical steps, determine:
- Purpose of thinking
- Adequacy of knowledge
- Potential problems
- Helpful resources
- Critique of judgement/decision

When developing critical thinking, certain habitual dispositions are necessary such as:
- Thinking independently
- Being fair-minded
- Being intellectually humble
- Being intellectually corageous
- Demonstrating good faith and integrity
- Being curious an

Developing ethical/legal skills involve:
- Developing accountability: Nurses hold themselves accountable for the well-being of patients entrusted to their care.
- Reporting incompetence, unethical, or illegal practices: The ANA Code for Ethics obligates n

For nurses, incompetent practice is measured by nursing standards as defined in:
- State Nurse Practice Acts, and Regulations
- Scope of Practice
- Professional Standards of Nursing Practice
- Other practice guidelines and protocols.

Developing interpersonal skills involve:
- Promoting human dignity and respect
- Establishing caring relationships
- Enjoying the rewards of mutual interchange


These are evidence based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical settings?

Critical thinking indicators

This is an instructional strategy that requires learners to identify, graphically display, and link key concepts, it promotes critical thinking and self directed learning?

Concept maps
(Cognitive maps, min maps, meta cognitive tools for learning)

This is the systematic and continuous collection, validation, analysis, and communication of patient data, or information?


This, when effectively done, will help you identify the patients health status, health history, medical history, strengths, health problems, health risks, and need for nursing care?

Nursing history
(Information is also obtained by performing a physical assessment, taking vital signs, and noting diagnostic test results)

Medical vs Nursing Assessments:
- Medical assessments target data pointing to pathologic conditions
- Nursing assessment focus on the patient's responses to health problems

The purpose of the initial assessment, performed shortly after admission, is to establish a complete database for problem identification and care planning.

What are the four main types of nursing assessments?

- Initial assessment
- Focused assessment
- Time-Lapsed assessment
- Emergency assessment

This type of nursing assessment is where the nurse gathers data about a specific problem that has already been identified, it can also identify new or overlooked problems as well?

Focused assessment
(Symptoms? When did they start? What were you doing when they started? What makes them better/worse? Any remidies?)

This type of nursing assessment is scheduled to compare a patient's current status to baseline data obtained earlier?

Time-Lapsed assessment

Preparing for data collection:
- Establishing assessment priorities
- Stematically structure data collected
Two important considerations

Establishing Nursing Assessment Priorities:
- Health Orientation: Help pts ID health risks, habits, behaviors, beliefs, and attitudes
- Developmental Stage: Taylor assessment to the developmental needs of the pt.
- Culture: Taylor assessment according to

Structuring the Nursing Assessment:
- Some institutions have a minimum data set
- Many nursing assessment guides are based on holistic models rather than medical models

- Objective data (signs) are observable and measurable data that can be seen, heard, or felt by someone other than the person
- Subjective data (symptoms) are infromation perceived only by the affected person

Characteristics of Data Collected:
- Purposeful
- Complete
- Factual and Accurate
- Relevant

Sources of Data Collected:
- Patient
- Family and significant others
- Other healthcare professionals
- Nursing and other healthcare literature
- Patient record: (Medical hx, physical exams, progress notes, consultations, lab reports, diagnostic sutdies,

Methods of Collecting Data:
- Nursing History
- Nursing Physical Assessment

Nursing History:
- Captures and records the uniqueness of the patient so that care may be planned to meet the patient's individual needs
- Focuses on getting to know the patient
- The interview can be understood in terms of its four phases: Prepatory phas

Patient Interview Phases, Prepatory:
- Review current/past history
- Do not let sterotypes/prejudices affect nurse-pt relationship
- Chairs at right angles, 3-4 ft appart
- Time needed vaires

Patient Interview Phases, Introductory:
- Sets the tone for the interview
- Names, purpose, and roles are identified here
- Assess pt comfort and abilities

Patient Interview Phases, Termination:
- Helpful to recapitulate (summarize) the interview
- Both the nurse and pt should be satisfied
- Helpful to ask "Is there anything else you would like us to know that will help in your plan of care"?
- Alert pt as t


Nursing Physical Assessment:
- Examination of the pt. for objective data that may better define the pts. condition and help the nurse in planning care
- Four methods are used to collect data during a physical exam, inspection, palpation, percussion, and a

- Unlike the physical assessment performed by the physician to identify pathologic conditions and their causes, the Nursing physical assessment focuses primarily on the patient's "functional abilities

Data Validation
- Identify Data to be Validated: When there are discrepancies (s/s not correlating with what pt says), when there is lack of objectivity

Identifying Cues and Making Inferences
- Nurses now use the language of cues and inferences to describe the process of validation (Patient does not respond when I speak to him on his right side = cue the something is wrong, The pateints hearing may be imp

Models for Organizing/Clustering Data:
- Human Needs: Maslow
- Functional Health Patterns: Peoples normal health patterns vs abnormal patterns
- Human response Patters: How patients respond to various factors
- Body System Model: Clustering according to b

- Human Needs model, Functional Health model, and Human Response model are all holistically based
- Body System model is medical based and is most familiar to nurses

The purpose of diagnosing is to:
1. Identify how an individual, group or community responds to actual or potential health and life processes
2. Identify factors that contribute to or cause health problems (etiologies)
3. Identify resources or strengths th

Actual or potential health problems that can be prevented or resolved by independent nursing intervention are termed nursing diagnoses.

Nursing diagnoses are written to describe patient problems that nurses can treat independently.

Four Components of a Diagnosis:
- Label identifies the particular diagnosis
- Definition tells you what qualifies as the particular diagnosis
- Defining characteristics characteristics indication reasons what type of situations would make this diagnosis a

Nursing Diagnosis VS Medical Diagnosis:
- Medical diagnoses identify diseases, whereas Nursing diagnoses focus on unhealthy responses to health and illness.
- Medical diagnoses describe problems for which the physician directs the primary treatment, where

- Medical diagnosis remains the same for as long as the disease is present, whereas the Nursing diagnosis may change from day to day as the patient's responses change.

These are defined as certain physiologic complications that nurses monitor to detect onset or changes in status, nurses manage these using physician-prescribed and nurse interventions to minimize the complications of the event?

Collaborative problems
(Unlike medical diagnoses, collaborative problems are the primary responsibility of the nurses)

Data Interpretation and Analysis involves:
- Recognizing Significant data
- Recognizing Patterns or Clusters
- Identifying Strengths and Problems
- Identifying Potential Complications
- Reaching Conclusions
- Patterning with the Patient

- Identifying Strengths: Determining patient's strengths, patient's problem areas, and problems the patient is likely to experience
- Reaching Conclusions: No Problem, Possible Problem, Actual or Potential Problem, Clinical Problem Other than Nursing Diag

This is a grouping of patient data or cues that points to the existence of a patient health problem and is used to indicate a nursing diagnosis?

Data Cluster

Models for Organizing/Clustering Data (Maslow):
- Physiologic Needs
- Safety & Security Needs
- Love and Belonging Needs
- Self-Esteem Needs
- Self-Actualization Needs

Models for Organizing/Clustering Data (Functional Health Patterns):
- Health Perception/Health Management
- Nutritional-Metababolic
- Elimination
- Activity/Exercise
- Cognitive-Perceptual
- Sleep/Rest
- Self-Perception/Self-Concept
- Role/Relationship

Models for Organizing/Clustering Data (Human Response Patters):
- Exchanging: Nutrition, elimination, circulation, etc...
- Communicating
- Relating
- Valuing
- Choosing
- Moving
- Perceiving
- Knowing
- Feeling

Models for Organizing/Clustering Data (Body Systems):
- Neurologic
- Cardiovascular
- Respiratory
- Gastrointestinal
- Musculoskeletal
- Genitourinary
- Psychosocial

During the nursing diagnosis is when the nurse determines that certain indicators are related (i.e. elevated temp, increased respirations, and increased blood pressure (A data cluster).


Terminology for Writing Nursing Diagnoses:
- When the nurse recognizes a "cluster of significant patient data" indicating a health problem that can be treated by independent nursing intevention, a nursing diagnosis should be written.

Nurses do not need to strictly adhere to the NANDA diagnoses, diagnoses can vary according to school, employer, or specialty organization.

NANDA describes five types of nursing diagnoses, what are they?

1. Actual Nursing Diagnoses
2. Risk Nursing Diagnoses
3. Possible Nursing Diagnoses
4. Wellness Nursing Diagnoses
5. Syndrome Nursing Diagnoses

This type of nursing diagnoses represent problem(s) that has been validated by the presence of major defining characteristics and is supported by defining characteristics and related factors?

Actual Nursing Diagnoses
(Four components: Label, Definition, Chracteristics, Related Factor)
Example: Imbalanced nutrition: more than body requirements r/t excessive intake in relation to metabolic needs aeb weight 20% over ideal for height and frame, co

This type of nursing diagnoses are clinical judgements that an individual, family, or community is more vulnerable to develop the problem than other in the same or similar situation (Defining characteristics and related factors are not available since the

Risk Nursing Diagnoses
Example: Risk for imbalanced nutrition: more than body requirements: concentrating food at the end of the day.

This type of nursing diagnoses are statements describing a suspected problem for which additional data are needed?

Possible Nursing Diagnoses
Example: Possible chronic low self esteem

This type of nursing diagnoses are clinical judgements about an individual, group, or community in transition from a specific level or wellness to a higher level of wellness?

Wellness Nursing Diagnoses
(Written as a one part statement that contains the label "Readiness for Enhanced" followed by the desired higher level of wellness)

Validating Nursing Diagnoses:
- Is my database sufficient?
- Does my synthesis of data identify a pattern?
- Does subjective & objective data determine the existence of a pattern?

Validating Nursing Diagnoses:
- Is my tentative nursing diagnosis based on scientific nursing knowledge and clinical ecpertise?
- Is my tenative nursing diagnosis able to be prevented, reduced, or resolved by independent nursing action?
- Is my degree of

Nursing Diagnosis Writing:
- One-part diagnoses are usually Wellness diagnoses (Defining characteristics and related factors are not available since there is not a problem yet).

- "Readiness for enhanced knowledge

Nursing Diagnosis Writing:
- Two-part diagnosis consist of nursing diagnosis and the "related to" statement.
- "Related factors are factors that appear to show some type of patterned realtionship with the nursing diagnosis" (also called etiology)

- Deficient knowledge r/t unfamiliarity with information about the nursing process and nursing diagnosis.

Nursing Diagnosis Writing:
- Three-part diagnosis consist of nursing diagnosis, the "related to" statement, and the defining characteristics, which are observable cues/inferences that cluster as manifestations of an actual or wellness nursing diagnosis (c

- Deficient knowledge r/t unfamiliarity with information about the nursing process and nursing diagnosis aeb verbalization of lack of understanding.

This type of nursing diagnoses comprise a cluster of actual or risk nursing diagnoses that are predicted to be present because of a certain event or situation (Has both defining characteristics and related factors)?

Syndrome Nursing Diagnoses
(Rape-Trauma Syndrome or Post-Trauma Syndrome)

Most nursing diagnoses are writen as two-part (Problem and Etiology/Cause) or three-part statements (Problem, Etiology/Cause, and Defining Characteristics).

- Problem: Defines health state or health problem of patient
- Etiology (related factors): Identifies physiologic, psychological, sociologic, spiritual, and environmental factors believed to be related to or causing the problem
- Defining Characteristics

Writing Nursing Diagnoses:
- Phrase as a patient problem or alteration in health, not a patient need
- Problem preceeds etiology and is linked by "related to"
- Defining Characteristics, when used, should follow etiology and be linked by "as manifested by

Writing Nursing Diagnoses:
- Use legally advisable terms
- Use nonjudgemental language
- Indicate what is unhealthy about the pt. or what the pt. wants to change
- Avoid medical dx or things that cannot be changed

- The primary benefit that a nursing diagnosis provides to the patient is individualized patient care
- The process of prioritizing nursing diagnoses is the first step in planning care

Multiple nursing diagnoses need to be prioritized according to the ABC's and Maslow's Hierarchy of Needs.

When the diagnosis process is used incorrectly, the patient might be misdiagnosed:
- Premature diagnoses based on an incomplete database (not enough patient information)
- Erroneous diagnoses resulting from an inaccurate database or a faulty data analysis

- Routine diagnoses resulting from the nurse's failure to tailor data collection and analysis to the unique needs of the patient (right diagnosis but pt noncompliant at home)
- Erros of omission (Failure to update or modify existing diagnosis, or create n

NANDA Approved Nursing Diagnoses Domains:
#1 Health Promotion: Awareness or normality of function
#2 Nutrition: Taking in, assimilating, and using nutrients
#3 Elimination/Exchange: Secretion and excretion of waste
#4 Activity/Rest: Production, conservati

#6 Self-perception: Awareness about self
#7 Role Relationships: +/- connections or associations with people or groups
#8 Sexuality: Sexual identity, function, and reproduction
#9 Coping/Stress Tolerance: Contending with life events/processes
#10 Life Prin

During Outcome Identification and Planning steps of the nursing process the nurse works "in partnership with the patient and family" to facilitate critical thinking and:
- Establish priorities
- Identify and write expected patient outcomes
- Select eviden

- "Expected Outcomes" is used to refer to the more specific, measurable criteria used to evaluate the extent to which a goal has been met.

When writing outcome statements, it can be helpful to use the acronym SMART:
- Specific
- Measureable
- Attainable
- Realistic
- Timed

Examples of proper outcome statements:
- During the next 24 hour period, the patient's fluid intake will total at least 2,000 ml.
- At the next visit, 12/23/12, the patient will correctly demonstrate relacation exercises.

A formal plan of care allows nurses to:
- Individualize care that maximizes outcome achievement
- Set priorities
- Facilitate communication among nursing personnel and their colleagues
- Promote continuity of high-quality, cost-effective care

A formal plan of care allows nurses to:
- Coordinate care
- Evaluate the patient's response to nursing care
- Create a record that can be used for evaluation, research, reimbursement, and legal purposes
- Promote the nurse's professional development

The primary purpose of the Outcome Identification and Planning step of the nursing process is to design a plan of care for and with the patient that, once impemented, results in the prevention, reduction, or resolution of patient health problems and the a

- Your states Nurse Practice Acts outlines the scope of nursing practice
- Your state board of nursing also outlines what you are and are not allowed to do

Comprehensive Planning:
- Initial Planning
- Ongoing Planning
- Discharge Planning


This type of planning, performed by the admitting nurse who does the history and physical, is a comprehensive plan addressing each problem listed in the prioritized nursing diagnoses and identifies apporopriate patient goals and the related nursing care?

Initial Planning

This type of planning is to keep the nursing plan up to date to facilitate the resolution of health problems, manage risk factors, and promote function?

Ongoing Planning

This type of planning is best carried out by the nurse who has worked most closely with the patient and family and actually begins once the patient is admitted?

Discharge Planning

Establishing Priorities:
- In general, it makes more sense to deal with medical (or suspected medical) problems first, if these can be resolved, many human response problems are gone.

Three helpful guides to facilitate critical thinking when prioritizing patient problems include:
1. Maslow's hierarchy of human needs
2. Patient preference
3. Anticipation of future problems

Identifying and Writting Outcomes:
- Derive Outcomes from Nursing Diagnoses
- Establish Long-term vs Short-term goals
- Determine Patient-Centered Outcome
- Ensure Quality Outcomes
- Use Cognitive, Psychomotor, and Affective Outcomes

- Involve Patient and Family in Outcome Development
- Identify Culturally Appropriate Outcomes
- Identify Outcomes Supportive of the Total Treatment Plan
- Write Patient-Centered Measurable Outcomes

Deriving Outcomes from Nursing Diagnoses:
- Outcomes are derived from the problem statement of the nursing diagnosis. For each nursing diagnosis in the plan of care, at least one outcome should be written that, if achieved, demonstrates a direct resolutio

Patient outcomes may be catagorized according to the type of change they describe for the patient such as:
- Cognitive: Desrcibes increases in pt knowledge or intellectual behaviors
- Psychomotor: Describes pt achievements of new skills
- Affective: Descr

This was developed by the Iowa Outcomes Project and was the first comprehensive standardized language used to describe the patient outcomes that are responsive to nursing intervention?

Nursing Outcomes Classification (NOC)

Writing Patient-Centered "Measurable" Outcomes:
- Subject: Patient or part of patient
- Verb: Indicates action the pt will perform
- Condition: Specifies the particular circumstances in or by which the outcome is to be achieved
- Performance Criteria: Des

Examples of proper outcome statements:
- During the next 24 hour period, the patient's fluid intake will total at least 2,000 ml.
- At the next visit, 12/23/12, the patient will correctly demonstrate relacation exercises.

Avoid common errors when writing patient outcomes:
- Expressing the patient outcome as a nursing intervention (What the pt will do vs what you will do)
- Using verbs that are not observable or measurable (What pt will do vs what pt will demonstrate)

Avoid common errors when writing patient outcomes:
- Include more than one pt behavior/manifestation of pt outcomes in short-term outcomes
- Writing outcomes that are so vague that other nurses are unsure of the goal of nursing care

This is any treatment, based on clinical judgement and knowledge, that a nurse performs to enhance patient outcomes?

Nursing Intervention
- Designed to:
1. Monitor health status
2. Reduce risks
3. Resolve, prevent, or manage a problem
4. Facilitate independence or assist ADL
5. Promote optimal sense of physical, psychological, and spiritual well-being

After writing pt outcomes, the nurse identifies various nursing interventions to help the pt achieve outcomes. what resource would the nurse use to identify various nursing interventions?

Nursing Intervention Classification (NIC)
(Comprehensive, validated list of nursing interventioons applicable to all settings)

Writing Nurse Initiated Interventions in the Plan of Care:
- Date
- Verb: Action to be performed
- Subject: Who is to do it
- Descriptive phrase: How, when, where, how often, how long or how much

- Offer patient 60mL water or juice (prefers orange or grape) every 2 hours while awake for a total minimum PO intake of 500 mL.
- Teach patient the necessity of carefully monitoring fluid intake and output; remind patient each shift to mark off

Interventions can be Nurse-Initated Interventions (follow guidelines set by local state nurse practice acts), Physician-Initiated Interventions, or Collaborative Interventions.

A physician-initiated intervention is an intervention initiated by a physician in response to a medical diagnosis but carried out by a nurse in response to a doctor's order.

Interventions carried out by the nurse that are initiated by other providers such as pharmacists, respiratoy therapists, or PA's are called?

Collaborative Interventions

This structured care methodology is useful in the management of high-risk subgroups within a cohort, contains binary decision trees, and very specific?


This structured care methodology represents a sequential, interdisciplinary, minimal practice standard for a specific population, has flexibility to meet pt needs, broad perspective, is phase or episode driven, and can measure cause and effect relationshi

Critical Pathway

This structured care methodology is a broad, research-based recommendations for practice, and has no mechanism for ensuring practice implementation?


This structured care methodology are preprinted orders used to expedite the order proess after a practice standard has been validated, compliments standards of practice, and can be used to represent the algorithm or protocol in order format?

Order set

This structured care methodology prescribes specific theraputic interventions for clinical problems unique to subgroups within a cohort, is multifaceted, minimal provider flexibility with treatment options, and is broader than an algorithm?


Developing Evaluative Strategies:
- Evaluative statements include a statement about achievement of the desired outcomes (Met, Partially Met, Not Met) and list actual patient behavior as evidence supporting the statement.

- Goal partially met; patient refused to ambulate in the morning but did walk to the bathroom once in the afternoon with the assistance of one nurse.

This is a written guide that directs the efforts of the nursing team as nurses work with patients to meet their health goals. It specifies nursing diagnoses, outcomes, and associated nursing interventions?

Plan of Nursing Care
(Common to all formats is a minimum of three columns for documenting nursing diagnoses, patient outcomes, and nursing interventions)

The Joint Commision requires healthcare institutions and agencies to formulate, maintain, and support a patient-specific plan for care, treatment, and rehabilitation.

Regardless of their format, plans of care communicate directions for three different types of nursing care:
- Nursing care related to basic human needs
- Nursing care related to nursing diagnoses
- Nursing care related to the medical and interdisciplinary

Types of Nursing Care:
- Nursing Care Related to Basic Human Needs: Communicates data about the pts usual health habits and patterns
- Nursing Care Related to Nursing Diagnoses: Contains outcomes and interventions for every nursing diagnosis and is the he

Types of Nursing Care:
- Medical Care Related to the Medical and Interdisciplinary Plan of Care: Contains current medical orders for diagnostic studies and tretament and specified related nusing care.

Formats for Plans of Care:
- Kardex Plans of Care
- Computerized Plans of Care
- Case Management Plans of Care
- Concept Map Plans of Care

Clinical Pathways (critical pathways, CareMaps) are tools used in case management to communicate the standardized, interdisciplinary plan of care for patients.

For each diagnosis, a clear and concise problem statement is followed by an etiology statement that identifies specific contribution factors.

- It is imperative that interventions and outcomes be valued by the patient, if they are not then the outcome needs to be re-evaluated.

These are prepared plans of care that identify nursing diagnoses, outcomes, and related nursing interventions common to a specific populations or health problem?

Standardized Care Plan

During the implementation step of the nursing process, nursing actions planned in the previous step are carried out.


The Nursing Interventions Taxonomy Structure: Each of the interventions listed in the NIC has a label, a definition, a set of activities that a nurse performs to carry out the intervention, and a short list of background readings.

The NIC taxonomy structure is designed to help clinicains locate and select interventions most helpful for patients.

The NOC is a classification of patient outcomes for nursing interventions, they aim to:
- Identify, label, validate, and classify nursing-sensitive patient outcomes and indicators
- Evaluate the validity and usefulness of the classification in clinical fi

One nursing's major contributions to the healthcare team is the role of coordinator., this helps to eliminate or control fragmentation of care.

Actual nursing diagnoses, interventions seek to:
- Reduce or eliminate contributing factors of the diagnosis
- Promote higher-level wellness
- Monitor and evaluate status

Risk nursing diagnoses, interventions seek to:
- Reduce or eliminate risk factors
- Prevent problems
- Monitor and evaluate statys

Possible nursing diagnoses, interventions seek to:
- Collect data to rule out or confirm the diagnosis

Collaborative problems, interventions seek to:
- Monitor for changes in status
- Manage changes in status with nurse-prescribed and physician-prescribed interventions
- Evaluate response

These involve carrying out nurse-prescribed interventions resulting from their assessment of patient needs written on the "nursing plan of care" and does not need a doctors order?

Nurse-Initiated Interventions (also called Independent Nursing Actions)
- Protocols
- Standing Orders

These are written plans that detail the nursing activities to be executed in spcific situations?


These empower the nurse to initiate actions that ordinarily require the order or supervision of a physician?

Standing Orders

There are two sorts of collaborative orders:
- Physician-initiated interventions (Dependent nursing actions): involve carrying out physician-prescribed orders. State Nurse Practice Acts specify from whom nurses can receive orders. Nurses accountable for d

There are two sorts of collaborative orders:
- Collaborative interventions--Performed jointly by nurses and other members of the healthcare team. Because nurses are increasingly respected as professional colleagues with unique patient knowledge, they are

When carrying out the plan of care, nurse use specialized abilities to:
- Reassess the patient and reviewing the care plan
- Organize resources
- Anticipate unexpected outcomes
- Promote self-care: Teaching, Avocacy, and Counseling
- Assisting patients to

Variables that Influence Outcome Achievement:
- Patient variables: Developmental Stage, Psychosocial background
- Nurse variables: Expertise, creativity, time
- Resources: Staff, equipment, supplies
- Current standards of care: Staying within standard of

Common reasons for noncompliance with the plan of care:
- Lack of family support
- Lack of understanding about the benefits of compliance
- Low value attached to outcomes or related interventions
- Adverse physical or emotional effects of treatment
- Inab


- There appears to be certain areas of medicine that lends to patient non-compliance. Probably the most common area of non-compliance involves prescription medication
- Often relates to communication

- Lack of family support
- Lack of understanding about the benefits
- Low value attached to outcomes
- Adverse physical or emotional effects of treatment
- Inability to afford treatment

The five classic elements of the evaluation step in the nursing process are:
1. Identifying evaluative criteria and standards (what you're looking for)
2. Collecting data to determine if criteria has been met
3. Interpreting and summarizing findings
4. Do

The nurse collects Evaluative Data to determine whether or not the patient has met the desired outcomes.

These are measurable qualities, attributes, or characteristics that specify skills, knowledge, or health states. They describe acceptable levels of performance by stating the expected behaviors of the nurse or the patient?


These are levels of performance accepted and expected by the nursing staff or other health team member, they are established by authority, custom, or consent?


The type of data collected to support the evaluation of outcome achievement is determined by the nature of the outcome

Four types of outcomes:
- Cognitive: Increase in pt knowledge
- Psychomotor: Pts achievement of new skills
- Affective: Changes int he pts values, beliefs, and attitudes and are more complex to evaluate
- Physiologic: Physical changes in the patient

Documenting Your Judgement
- The two-part evaluative statement includes a decision about:
1. How well the outcome was met
2. Patient data or behaviors that support this decision

1/21/12- Outcome met. Patient reports 1 week of no tobacco use
1/21/12- Outcome not met. Patient reports no change in tobacco use. Revision: Reexplore patient's commitment to try tobacco-use control strategies and adequacy of personal support sy

When the nurse identifies the factors contributing to the outcomes not being achieved, the evaluative statement can be used to suggest the necessary revision in the plan of care:

1. Delete or modify the nursing diagnosis
2. Make the outcome statement more realistic
3. Increase the complexity of the outcome statement
4. Adjust time criteria in outcome statement
5. Change the nursing intervention

the Insitute of Medicine's Commitie of Quality of Health Care in America suggests 10 new rules to redesign and improve care:
1. Care based on continous healing relationships
2. Customization based on pt needs and values
3. The pt as the source of control

4. Shared knowledge and the free flow of information
5. Evidence-based decision making
6. Safety as a system property
7. Need for transparency
8. Anticipation of needs
9. Countinuous decrease in waste
10. Cooperation among clinicians

The following four steps are crucial in improving performance:
1. Discover a problem
2. Plan a strategy using indicators
3. Implement change
4. Assess the change; if outcome not met, plan new strategy

Establishing and Sustaining Healthy Work Environments:
- The prevalent culture of poor communication and collaboration among health professionals relates significantly to continued medical errors and staff turnover. Additionally, a lack of adequate suppor

Evaluative Programs:
Regulatory agencies, such as state boards of nursing. the Joint Commision, the Professional Standards Review Organization, and the National Health Planning and Resources Development Act, require nurses to document that nursing standar


There are two different approaches to ensuring quality:
- Quality by Inspection: Focuses on finding deficient workers and removing them.
- Quality as Opportunity: Focuses on finding opportunities for improvement and fosters and environment that thrives on

The ANA Model Quality Assurance Program directs attention to three essential components of quality care:
1. Structure
2. Process
3. Outcome

This type of evaluation or audit focuses on the environment in which care is provided?

Structure Evaluation

This type of evaluation or audit focuses on the nature and sequence of activities carried out by nurses implementing the nursing process?

Process Evaluation

This type of evaluation or audit focuses on meaurable changes in the health status of the patient or the end resutls of nursing care?

Outcome Evaluation

Concern about the spiraling costs of healthcare, coupled with the success of industrial models for quality improvement, led to a strong commitment to QI in the 1990's.

Quality Improvement is the commitment and approach used to continuously improve every process in every part of an organization with the intent of meeting and exceeding customer expectations and outcomes.

The Hospital Consumer Assessment of Healthcare Providers and Systems provides consumers with information about a hospital's performance in key areas of communication, pain control, timeliness of care, discharge instructions, cleanliness and treatment with


The Hospital Consumer Assessment of Healthcare Providers and Systems provides:
First, the survey is designed to produce data about patients' perspective of care that allow abojective and meaningful comparisons of hospital on topics that are important to c

The Hospital Consumer Assessment of Healthcare Providers and Systems provides:
Second, public reporting of the survey results creates new incentives for hospitals to improve quality of care.
Third, public reproting serves to enhance public accountablity i

This is a method of evaluating nursing care that involves reviewing patient records to assess the outcomes of nursing care or the process by which these outcomes were achieved?

Nursing Audit

This type of evaluation is conducted by using direct observation of nursing care, paitent interviews, and chart review to detemine wherther the specified evaluative criteria are met?

Concurrent Evaluation
(vs Retrospective Evaluations)

Quality control departments have been the main change agents in health care facilities, bringing in new methods of improving care.

EB" is used when interventions have scientific rationale for research that has been obtained from disciplines other than nursing.

These two processes use nursing interventions to improve the quality of care for large numbers (vs individuals with the nursing process) of clients to help them achieve positive outcomes?

1. Evidence-Based Nursing
2. Quality Initiatives

Who enforces safety work in hospitals through guidelines?

The Joint Commision

Evidence-Based Nursing, Quality Control, and Safety initiatives work together in a synergistic manner to support each other and lead to excellence in nursing care.

In practicing EBP, nurses ask questions about clinical areas of interest or an intervention, the most common method of asking questions is PICO:
P- Patient, population, or problem of interest
I- Intervention of interest
C- Comparison of interest
O- Outcom

The ANA develops indicators and assessment tools that evaluate the quality of nursing care in accute care settings such as nosocomial infection rates, and patient satisfaction with nursing care, pain management, educationsal information, and care druing h

The Joint Commision of Accredition of Healthcare Organizations is responsible for private regulatory accrediation

The National Commitie for Quality Assurance is the accrediting body for managed care

Centers for Medicine and Medicaid Services collect clinical, financial, and administrative data in home health agencies

- Nurse-Initiated Interventions are derived from the nursing diagnosis (Patient goals).
- Outcomes are derived from the problem statement of the nursing diagnosis (Etiology, the cause of the problem).


This is the collecting of data about the client using physical assessment and interviewing techniques?

- Identify assessment priorities determined determined by the purpose of the assessment and pts condition
- Organize and cluster data
- Establish database: database, physical exam, review record and nursing literature
- Continuously update datab

This is using client data (data clustering) and critical thinking skills to identify and validate an appropriate nursing diagnosis?

- Interpret/analyze pt data
- ID pt strengths and health problems
- Formulate/validate nursing diagnosis
- Develop a prioritized list of diagnoses
- Detect/refer s/s that may indicate problems beyond nurse's abilities

This is writing measurable client outcomes and interventions to accomplish outcomes?

- Establish prioities
- ID expected pt outcomes
- Select EBN intervention
- Communicate plan of care

This is initiating the care plan and performing the interventions?

- Carry out plan
- Continue data collection and modify plan as needed
- Document care

This is determining if outcome(s) were met and appropriateness of the interventions to meet client needs?

- Measure how well pt has achieved outcomes
- ID factors contributing to pts success or failure
- Modify plan of care if indicated

Comparison: Nursing Diagnosis, Collaborative Problem, Medical Diagnosis:
- Nursing Diagnosis: Clinical judgement about individual, family, or community responses to actual or potential health problems or life processes.

Comparison: Nursing Diagnosis, Collaborative Problem, Medical Diagnosis:
- Collaborative Problem: Certain physiologic complication that nurses monitor to detect onset of changes in status (Cannot manage independently).
- Medical Diagnosis: Traumatic or di

Nursing Concerns /Responsibilities (Alfaro, 2004):
- Monitoring for changes in health status
- Promoting safety and preventing harm
- Identifying and meeting learning needs

Nursing Concerns /Responsibilities (Alfaro, 2004):
- Promoting comfort and managing pain
- Promoting health and well-being
- Addressing problems that limit independence
- Determining human responses

Problems Related to Outcome Identification and Planning:
- Failure to involve patient
- Insufficient data
- Nursing diagnoses developed from inaccurate or insufficient data
- Outcomes stated too broadly
- Outcomes derived from poorly developed nursing dia

Advantages of Nursing Interventions Classifications:
- Standardizing nomenclature
- Expanding nursing knowledge
- Developing information systems
- Teaching decision making
- Ensuring appropriate reimbursement
- Allocating nursing resources
- Communicatin