Nursing research is the term used to describe the evidence used to support nursing practice. Nursing, as an evidence based area of practice, has been developing since the time of Florence Nightingale to the present day, where many nurses now work as researchers based in universities as well as in the health care setting.
Nurse education places emphasis upon the use of evidence from research in order to rationalise nursing interventions. In England and Wales courts may determine whether or not a nurse acted reasonably based upon whether or not their intervention was supported by research.
Nursing research falls largely into two areas:
• Quantitative research, is based in the paradigm of logical positivism and is focused upon outcomes for clients that are measurable, generally using satistics. The dominant research method is the randomised controlled trial.
• Quantitative research, is based in the paradigm of phenomenology, grounded theory, ethnography and others, and examines the experience of those receiving or delivering the nursing care, focusing, in particular, on the meaning that it holds for the individual. The research methods most commonly used are interviews, case studies, focus groups, and ethnography
Recently in the UK, action research has become increasingly popular in nursing.
References
• Hamer S. & Collinson G. (1999). Achieving Evidence-Based Practice. Ballière Tindall. ISBN 0-7020-2349-3.
• Parahoo K. (1997). Nursing Research: Principles, Process and Issues. Macmillan. ISBN 0-333-69918-1.
Wednesday, July 30, 2008
The Nursing Outcomes Classification (NOC)
The Nursing Outcomes Classification (NOC) is a classification system which describes patient outcomes sensitive to nursing intervention. The NOC is a system to evaluate the effects of nursing care as a part of health care. The NOC containes 190 outcomes, and each with a label, a definition, and a set of indicators and measures to determine achievement of the nursing outcome.
References
* Donahue, M.P. & Brighton, V., Nursing outcome classification: Development and implementation, Journal of Nursing Care Quality, 1998, 12(5).
* S. Moorhead, M. Johnson, M. Maas, E. Swanson, Nursing Outcomes Classification (NOC), Elsevier, Fourth Edition, 936 pages, 2007, ISBN-10: 0-323-05408-0
References
* Donahue, M.P. & Brighton, V., Nursing outcome classification: Development and implementation, Journal of Nursing Care Quality, 1998, 12(5).
* S. Moorhead, M. Johnson, M. Maas, E. Swanson, Nursing Outcomes Classification (NOC), Elsevier, Fourth Edition, 936 pages, 2007, ISBN-10: 0-323-05408-0
The Nursing Interventions Classification (NIC)
The Nursing Interventions Classification (NIC) is a careclassification system which describes the treatments that nurses perform. The NIC consists of a standardized list which contains 433 different interventions. Each intervention is defined and the definition describes a set of activities a nurse preforms in order to perform one of the interventions. Each of the 433 interventions is coded into a three-level taxonomic structure consisting of 27 classes and 6 domains. The taxonomic struture allows for easy selection of an intervention and to classify them by means of a computer. The NIC also allows for the implementation of a Nursing Minimum Data Set (NMDS).
References
* Iowa Intervention Project (1996). Nursing Interventions Classification (NIC) (2nd ed.), St. Louis: Mosby-Year Book
* Henry SB, Warren JJ, Lange L, Button P., A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems, J Am Med Inform Assoc. 1998 Jul-Aug;5(4):321-8
* Henry SB, Mead CN., Nursing classification systems: necessary but not sufficient for representing "what nurses do" for inclusion in computer-based patient record systems, J Am Med Inform Assoc. 1997 May-Jun;4(3):222-32
References
* Iowa Intervention Project (1996). Nursing Interventions Classification (NIC) (2nd ed.), St. Louis: Mosby-Year Book
* Henry SB, Warren JJ, Lange L, Button P., A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems, J Am Med Inform Assoc. 1998 Jul-Aug;5(4):321-8
* Henry SB, Mead CN., Nursing classification systems: necessary but not sufficient for representing "what nurses do" for inclusion in computer-based patient record systems, J Am Med Inform Assoc. 1997 May-Jun;4(3):222-32
Nursing assessment
Nursing assessment is the gathering of information about a patient's physiological, psychological, sosciological and spiritual status.
Stage one of the nursing process
Assessment is the first stage of the nursing process in which the nurse should carry out a complete and holistic nursing assessment of every patient's needs, regardless of the reason for the encounter. Usually, an assessment framework, based on a Nursing theory nursing model is used.
The purpose of this stage is to identify the patient's nursing problems. These problems are expressed as either actual or potential. For example, a patient who has been rendered immobile by a road traffic accident may be assessed as having the "potential for impaired skin integrity related to immobility".
Components of a nursing assessment
Nursing history
Taking a nursing history prior to the physical examination allows a nurse to establish a rapport with the patient and family. Elements of the history include:
• health status
• course of present illness including symptoms
• current management of illness
• past medical history including family's medical history
• social history
• perception of illness
Psychological and social examination
The psychological examination may include;
• Client’s perception (why they think they have been referred/are being assessed; what they hope to gain from the meeting)
• Emotional health (mental health state, coping styles etc)
• Social health (accommodation, finances, relationships, genogram, employment status, ethnic back ground, support networks etc)
• Physical health (general health, illnesses, previous history, appetite, weight, sleep pattern, diurinal variations, alcohol, tobacco, street drugs; list any prescribed medication with comments on effectiveness)
• Spiritual health (is religion important? If so, in what way? What/who provides a sense of purpose?)
• Intellectual health (cognitive functioning, hallucinations, delusions, concentration, interests, hobbies etc)
Physical examination
A nursing assessment includes a physical examination : the observation or measurement of signs, which can be observed or measured, or symptoms such as nausea or vertigo, which can be felt by the patient.
The techniques used may include Inspection, Palpation, Auscultation and Percussion in addition to the "vital signs" of temperature, blood pressure, pulse and respiratory rate, and further examination of the body systems such as the cardiovascular or musculosceletal systems.
Documentation of the assessment
The assessment is documented in the patient's medical or nursing records , which may be on paper or as part of the electronic medical record which can be accessed by all members of the healthcare team.
Assessment tools
A range of instruments has been developed to assist nurses in their assessment role. These include:
• the index of independence in activity daily living
• the Barthel index
• the Crighton Royal behaviour rating scale
• the Clifton assessment procedures for the elderly
• the general health questionnaire
• the geriatric mental health state schedule
Other assessment tools may focus on a specific aspect of the patient's care. For example waterlow score deals with a patient's risk of developing a bedsore (decubitus ulcer), the Glasgow Coma Scale ( GCS ) measures the conscious state of a person, and various pain scales exist to assess the "fifth vital sign".
Stage one of the nursing process
Assessment is the first stage of the nursing process in which the nurse should carry out a complete and holistic nursing assessment of every patient's needs, regardless of the reason for the encounter. Usually, an assessment framework, based on a Nursing theory nursing model is used.
The purpose of this stage is to identify the patient's nursing problems. These problems are expressed as either actual or potential. For example, a patient who has been rendered immobile by a road traffic accident may be assessed as having the "potential for impaired skin integrity related to immobility".
Components of a nursing assessment
Nursing history
Taking a nursing history prior to the physical examination allows a nurse to establish a rapport with the patient and family. Elements of the history include:
• health status
• course of present illness including symptoms
• current management of illness
• past medical history including family's medical history
• social history
• perception of illness
Psychological and social examination
The psychological examination may include;
• Client’s perception (why they think they have been referred/are being assessed; what they hope to gain from the meeting)
• Emotional health (mental health state, coping styles etc)
• Social health (accommodation, finances, relationships, genogram, employment status, ethnic back ground, support networks etc)
• Physical health (general health, illnesses, previous history, appetite, weight, sleep pattern, diurinal variations, alcohol, tobacco, street drugs; list any prescribed medication with comments on effectiveness)
• Spiritual health (is religion important? If so, in what way? What/who provides a sense of purpose?)
• Intellectual health (cognitive functioning, hallucinations, delusions, concentration, interests, hobbies etc)
Physical examination
A nursing assessment includes a physical examination : the observation or measurement of signs, which can be observed or measured, or symptoms such as nausea or vertigo, which can be felt by the patient.
The techniques used may include Inspection, Palpation, Auscultation and Percussion in addition to the "vital signs" of temperature, blood pressure, pulse and respiratory rate, and further examination of the body systems such as the cardiovascular or musculosceletal systems.
Documentation of the assessment
The assessment is documented in the patient's medical or nursing records , which may be on paper or as part of the electronic medical record which can be accessed by all members of the healthcare team.
Assessment tools
A range of instruments has been developed to assist nurses in their assessment role. These include:
• the index of independence in activity daily living
• the Barthel index
• the Crighton Royal behaviour rating scale
• the Clifton assessment procedures for the elderly
• the general health questionnaire
• the geriatric mental health state schedule
Other assessment tools may focus on a specific aspect of the patient's care. For example waterlow score deals with a patient's risk of developing a bedsore (decubitus ulcer), the Glasgow Coma Scale ( GCS ) measures the conscious state of a person, and various pain scales exist to assess the "fifth vital sign".
Nursing Care Plan
Definition
A nursing care plan outlines the nursing care to be provided to a
patient.It is a set of actions the nurse will implement to resolve
nursing problemsidentified by assessment. The creation of the plan
is an intermediate stageof the nursing process. It guides in the
ongoing provision of nursing careand assists in the evaluation of that care.
Characteristics of the nursing care plan
1. It focuses on actions which are designed to solve or minimize the existing problem.
2. It is a product of a deliberate systematic process.
3. It relates to the future.
4. It is based upon identifiable health and nursing problems.
5. Its focus is holistic.
6. It focuses to meet all the needs of the service user.
Elements of the plan
In the USA, the nursing care plan may consist of a NANDA nursing
diagnosis with related factors and subjective and objective data that
support the diagnosis, nursing outcome classifications with specified
outcomes (or goals) to be achieved including deadlines, and nursing
intervention classifications with specified interventions.
The nursing process
Care plans are formed using the nursing diagnosis. First the nurse collects subjective data and objective data, then organizes the data into a systematic pattern, such as Marjory Gordon's, functional health patterns. This step helps identify the areas in which the client needs nursing care. Based on this, the nurse makes a nursing diagnosis. As mentioned above, the full nursing diagnosis also includes the relating factors and the evidence that supports the diagnosis. For example, a nurse may give the following diagnosis to a patient with pneumonia that has difficulty breathing: Ineffective Airway Clearance related to tracheobronchial infection (pneumonia) and excess thick secretions as evidenced by abnormal breath sounds; crackles, wheezes; change in rate and depth of respiration; and effective cough with sputum.
After determining the nursing diagnosis, the nurse must state the expected outcomes, or goals. A common method of formulating the expected outcomes is to reverse the nursing diagnosis, stating what evidence should be present in the absence of the problem. The expected outcomes must also contain a goal date. Following the example above, the expected outcome would be: Effective airway clearance as evidenced by normal breath sounds; no crackles or wheezes; respiration rate 14-18/min; and no cough by 01/01/01.
After the goal is set, the nursing interventions must be established. This is the plan of nursing care to be followed to assist the client in recovery. The interventions must be specific, noting how often it is to be performed, so that any nurse or appropriate faculty can read and understand the care plan easily and follow the directions exactly. An example for the patient above would be: Instruct and assist client to TCDB (turn, cough, deep breathe) to assist in loosening and expectoration of mucous every 2 hours.
The evaluation is made on the goal date set. It is stated whether or not the client has met the goal, the evidence of whether or not the goal was met, and if the care plan is to be continued, discontinued or modified. If the care plan is problem-based and the client has recovered, the plan would be discontinued. If the client has not recovered, or if the care plan was written for a chronic illness or ongoing problem, it may be continued. If certain interventions are not helping or other interventions are to be added, the care plan is modified and continued.
There are also care plans written for "at risk" problems, as well as "wellness" care plans. These follow a similar format, only designed to prevent problems from happening and continue or promote healthy behavior.
A nursing care plan outlines the nursing care to be provided to a
patient.It is a set of actions the nurse will implement to resolve
nursing problemsidentified by assessment. The creation of the plan
is an intermediate stageof the nursing process. It guides in the
ongoing provision of nursing careand assists in the evaluation of that care.
Characteristics of the nursing care plan
1. It focuses on actions which are designed to solve or minimize the existing problem.
2. It is a product of a deliberate systematic process.
3. It relates to the future.
4. It is based upon identifiable health and nursing problems.
5. Its focus is holistic.
6. It focuses to meet all the needs of the service user.
Elements of the plan
In the USA, the nursing care plan may consist of a NANDA nursing
diagnosis with related factors and subjective and objective data that
support the diagnosis, nursing outcome classifications with specified
outcomes (or goals) to be achieved including deadlines, and nursing
intervention classifications with specified interventions.
The nursing process
Care plans are formed using the nursing diagnosis. First the nurse collects subjective data and objective data, then organizes the data into a systematic pattern, such as Marjory Gordon's, functional health patterns. This step helps identify the areas in which the client needs nursing care. Based on this, the nurse makes a nursing diagnosis. As mentioned above, the full nursing diagnosis also includes the relating factors and the evidence that supports the diagnosis. For example, a nurse may give the following diagnosis to a patient with pneumonia that has difficulty breathing: Ineffective Airway Clearance related to tracheobronchial infection (pneumonia) and excess thick secretions as evidenced by abnormal breath sounds; crackles, wheezes; change in rate and depth of respiration; and effective cough with sputum.
After determining the nursing diagnosis, the nurse must state the expected outcomes, or goals. A common method of formulating the expected outcomes is to reverse the nursing diagnosis, stating what evidence should be present in the absence of the problem. The expected outcomes must also contain a goal date. Following the example above, the expected outcome would be: Effective airway clearance as evidenced by normal breath sounds; no crackles or wheezes; respiration rate 14-18/min; and no cough by 01/01/01.
After the goal is set, the nursing interventions must be established. This is the plan of nursing care to be followed to assist the client in recovery. The interventions must be specific, noting how often it is to be performed, so that any nurse or appropriate faculty can read and understand the care plan easily and follow the directions exactly. An example for the patient above would be: Instruct and assist client to TCDB (turn, cough, deep breathe) to assist in loosening and expectoration of mucous every 2 hours.
The evaluation is made on the goal date set. It is stated whether or not the client has met the goal, the evidence of whether or not the goal was met, and if the care plan is to be continued, discontinued or modified. If the care plan is problem-based and the client has recovered, the plan would be discontinued. If the client has not recovered, or if the care plan was written for a chronic illness or ongoing problem, it may be continued. If certain interventions are not helping or other interventions are to be added, the care plan is modified and continued.
There are also care plans written for "at risk" problems, as well as "wellness" care plans. These follow a similar format, only designed to prevent problems from happening and continue or promote healthy behavior.
The Nursing Care
Patient care is part of a nurse's role. Nurses use the nursing process to assess, plan, implement and evaluate patient care. Patient care is founded in critical thinking and caring in a holistic framework. Nursing care is increasingly framed in best practice, which is the application of evidence-based concepts to patient problems in a particular setting. Florence Nightingale is recognized as the first nurse researcher.
Infection control
Nurses must observe the principles of asepsis at all times to prevent the spread of infection. They wash their hands thoroughly with soap and warm water before and after caring for patients, after handling any waste, before and after eating and drinking, after smoking, coughing, touching clothes, and after wearing gloves. Alcohol gel has come into common use to sanitize the hands in place of washing hands that are not visably soiled. Infection control regulations states, hand washing must be done after the third instance of using hand sanitizer. Gloves are generally worn when patient care is given, especially when exposure to patient bodily fluids is likely.
Nurses also observe aseptic technique. This speciality is used for procedures such as wound cleaning and any insertion or removal of appliances into or out of the patient's body. Examples are insertion of an intravenous or urinary catheter, or feeding (nasogastric) tube.
Surgical scrub techniques are also taught to nurses. This speciality is used for operating room technique, where nurses are an important part of any procedure.
Records
Nurses keep accurate records of all care and observations for many purposes. The patient's record is how the different members of the health care team communicate with each other. The chart is a legal document that serves as evidence of care provided. Since the maintenance of records is a legal responsibility, the charts have to meet certain standards, e.g. records must be permanent, accurate, complete, and kept for years after the care was given.
Vital Signs
Nurses may take a person's vital signs several times a day. Vital signs include taking and recording a patient's temperature, blood pressure, respirations, pulse, and pain level. Other things recorded in vital signs may be weight (especially for renal patients), bowel movements, and blood pressure measurements which are taking in different positions (in heart patients, for example, it is common to do a lying then standing measurement to assess the cardiovascular system's ability to compensate).
Vital signs are usually done with an electronic machine (commonly called a Dynamap) in modern first world countries, however all nurses are usually trained to also use manual equipment. These include a sphygmomanometer for blood pressure and a thermometer for temperature. Nurses are also trained in use of a stethoscope to hear heart, lung and bowel sounds on patients of all ages.
Medication
Medications are typically dispensed during nursing care. In some countries a nurse is only responsible to administer medication as prescribed by a doctor. In other countries nurses are legally responsible to ensure that the medication is appropriate for the patient and have the authority to interpret the order. Administration of medication by nurses generally requires the nurse to apply advanced knowledge and critical thinking to determine the safety of the administered medication. Advanced practice nurses (Nurse Practitioners, Nurse Midwives, Clinical Nurse Specialists and Certified Registered Nurse Anesthetists) prescribe medications as regulated by the state boards of nursing. Advanced practice nursing requires additional education, generally at the master's level. Advanced practice nurses, depending on specialty and state regulations may assess, order and interpret diagnostic tests, diagnose and treat medical conditions and evaluate the results. Advance practice varies in the different states from supervised (by a physician) to completely independent practice. Multiple research studies indicate patients treated by advanced practice nurses have the same outcomes as patients treated by physicians. Patient satisfaction has been equal to treatment by physicians. Advanced practice nurses may be part of the solution to an overburdened and costly health care system. Advanced practice nurses retain the holistic and preventative framework of nursing, and are ideally suited to wellness care.
Diet
Diet is important for people to stay healthy. Dietitian or physician may place the patient on a regular, light, soft, or liquid diet. A person on a regular diet can eat any type of food; on a light diet the patient may have such foods as ground meat, chicken, fish, potatoes, rice, strained vegetables, custards, and puddings. Raw fruit and vegetables, rich, spicy or fried foods are not allowed on this diet. A soft diet includes such foods as bread, cereal, eggs, potatoes, custards, and ice cream. A liquid diet may consist only of clear liquids, such as soup, tea, and juices. People with certain illnesses may have other diet restrictions for example people with diabetes or on dialysis.
Infection control
Nurses must observe the principles of asepsis at all times to prevent the spread of infection. They wash their hands thoroughly with soap and warm water before and after caring for patients, after handling any waste, before and after eating and drinking, after smoking, coughing, touching clothes, and after wearing gloves. Alcohol gel has come into common use to sanitize the hands in place of washing hands that are not visably soiled. Infection control regulations states, hand washing must be done after the third instance of using hand sanitizer. Gloves are generally worn when patient care is given, especially when exposure to patient bodily fluids is likely.
Nurses also observe aseptic technique. This speciality is used for procedures such as wound cleaning and any insertion or removal of appliances into or out of the patient's body. Examples are insertion of an intravenous or urinary catheter, or feeding (nasogastric) tube.
Surgical scrub techniques are also taught to nurses. This speciality is used for operating room technique, where nurses are an important part of any procedure.
Records
Nurses keep accurate records of all care and observations for many purposes. The patient's record is how the different members of the health care team communicate with each other. The chart is a legal document that serves as evidence of care provided. Since the maintenance of records is a legal responsibility, the charts have to meet certain standards, e.g. records must be permanent, accurate, complete, and kept for years after the care was given.
Vital Signs
Nurses may take a person's vital signs several times a day. Vital signs include taking and recording a patient's temperature, blood pressure, respirations, pulse, and pain level. Other things recorded in vital signs may be weight (especially for renal patients), bowel movements, and blood pressure measurements which are taking in different positions (in heart patients, for example, it is common to do a lying then standing measurement to assess the cardiovascular system's ability to compensate).
Vital signs are usually done with an electronic machine (commonly called a Dynamap) in modern first world countries, however all nurses are usually trained to also use manual equipment. These include a sphygmomanometer for blood pressure and a thermometer for temperature. Nurses are also trained in use of a stethoscope to hear heart, lung and bowel sounds on patients of all ages.
Medication
Medications are typically dispensed during nursing care. In some countries a nurse is only responsible to administer medication as prescribed by a doctor. In other countries nurses are legally responsible to ensure that the medication is appropriate for the patient and have the authority to interpret the order. Administration of medication by nurses generally requires the nurse to apply advanced knowledge and critical thinking to determine the safety of the administered medication. Advanced practice nurses (Nurse Practitioners, Nurse Midwives, Clinical Nurse Specialists and Certified Registered Nurse Anesthetists) prescribe medications as regulated by the state boards of nursing. Advanced practice nursing requires additional education, generally at the master's level. Advanced practice nurses, depending on specialty and state regulations may assess, order and interpret diagnostic tests, diagnose and treat medical conditions and evaluate the results. Advance practice varies in the different states from supervised (by a physician) to completely independent practice. Multiple research studies indicate patients treated by advanced practice nurses have the same outcomes as patients treated by physicians. Patient satisfaction has been equal to treatment by physicians. Advanced practice nurses may be part of the solution to an overburdened and costly health care system. Advanced practice nurses retain the holistic and preventative framework of nursing, and are ideally suited to wellness care.
Diet
Diet is important for people to stay healthy. Dietitian or physician may place the patient on a regular, light, soft, or liquid diet. A person on a regular diet can eat any type of food; on a light diet the patient may have such foods as ground meat, chicken, fish, potatoes, rice, strained vegetables, custards, and puddings. Raw fruit and vegetables, rich, spicy or fried foods are not allowed on this diet. A soft diet includes such foods as bread, cereal, eggs, potatoes, custards, and ice cream. A liquid diet may consist only of clear liquids, such as soup, tea, and juices. People with certain illnesses may have other diet restrictions for example people with diabetes or on dialysis.
The nursing process
The nursing process is a process by which nurses deliver care to patients, supported by nursing models or philosophies. The nursing process was originally an adapted form of problem solving and is classified as a deductive theory.
Characteristics of the nursing process
The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the patient has, and for every element of patient care, rather than once for each patient. The nurse's evaluation of care will lead to changes in the implementation of the care and the patient's needs are likely to change during their stay in hospital as their health either improves or deteriorates. The nursing process not only focuses on ways to improve the patient's physical needs, but also on social and emotional needs as well.
• Cyclic and dynamic
• Goal directed and client centered
• Interpersonal and collaborative
• Universally applicable
• Systematic
The nursing process is not something foreign or unusually complex. On the contrary, we use the nursing process method on a daily basis without even realizing it. For example, a trip to the gas station to get fuel requires Assessing the various prices and the number of people waiting to get gas among other things. A subsequent decision, or Diagnosis, is made based on the former criteria. This may include pulling into the gas station to fuel up or going down the road for better prices and/or less of a crowd. The price is right and there's not much of a crowd, we're pulling in. Now the Planning can take place. This may include which pump to use, how much gas to put in the tank, whether or not to clean the windows along with other things. We're at the pump and ready to fuel up. We must now Implement what we planned prior to pulling up to the pump. We've pulled up on the passenger side because the gas tank resides on this side, part of our plan. We've also given ourselves enough room to exit without getting blocked in by another vehicle, part of our plan also. We now unscrew the gas cap and begin fueling or Implementing what we planned. Things went well. We are fueled up and have exited the gas station without complication. Our Evaluation of the trip to the gas station would be a good one. We may choose to use this method in the future. The Nursing process is that simple in theory. However, as a nurse, the nursing process tool will be used for more complex and difficult situations but is applied the same way as the gas station analogy.
Characteristics of the nursing process
The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the patient has, and for every element of patient care, rather than once for each patient. The nurse's evaluation of care will lead to changes in the implementation of the care and the patient's needs are likely to change during their stay in hospital as their health either improves or deteriorates. The nursing process not only focuses on ways to improve the patient's physical needs, but also on social and emotional needs as well.
• Cyclic and dynamic
• Goal directed and client centered
• Interpersonal and collaborative
• Universally applicable
• Systematic
The nursing process is not something foreign or unusually complex. On the contrary, we use the nursing process method on a daily basis without even realizing it. For example, a trip to the gas station to get fuel requires Assessing the various prices and the number of people waiting to get gas among other things. A subsequent decision, or Diagnosis, is made based on the former criteria. This may include pulling into the gas station to fuel up or going down the road for better prices and/or less of a crowd. The price is right and there's not much of a crowd, we're pulling in. Now the Planning can take place. This may include which pump to use, how much gas to put in the tank, whether or not to clean the windows along with other things. We're at the pump and ready to fuel up. We must now Implement what we planned prior to pulling up to the pump. We've pulled up on the passenger side because the gas tank resides on this side, part of our plan. We've also given ourselves enough room to exit without getting blocked in by another vehicle, part of our plan also. We now unscrew the gas cap and begin fueling or Implementing what we planned. Things went well. We are fueled up and have exited the gas station without complication. Our Evaluation of the trip to the gas station would be a good one. We may choose to use this method in the future. The Nursing process is that simple in theory. However, as a nurse, the nursing process tool will be used for more complex and difficult situations but is applied the same way as the gas station analogy.
Nursing practice
Nursing practice is the actual provision of nursing care. In providing care, nurses are implementing thenursing care plan which is based on the client's initial assessment. This is based around a specific nursing theory which will be selected as appropriate for the care setting. In providing nursing care the nurse uses both nursing theory and best practice derived from nursing research.
Nursing theory
Nursing theory
Nursing theory is the term given to the body of knowledge that is used to support nursing practice. In their professional education nurses will study a range of interconnected subjects which can be applied to the practice setting. This knowledge may be derived from experiential learning, from formal sources such as nursing research or from non-nursing sources. To speak of nursing theory is often difficult. Nursing is many things to many people. Most universally agreed upon is that Nursing is a science involving people, environment and process fueled by a vision of transcendence in the context of healthcare. It is interesting to note that 90% of all Nursing theories have been generated in the last 20 years. Many schools encourage students to formulate personal philosophies or mid-range theories of Nursing as part of their curriculum. Some might argue that this multiplicity of theory is detrimental to the practice and undermines common vision. Others would say that the nature of the young science is sufficiently far reaching to require such tactics in order to elicit true consensus.
Nursing models are conceptual models, constructed of theories and concepts. They are used to help nurses assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformity and seamless care.
Universal features of nursing models
Unlike most sciences, Nursing theories seem primarily concerned with what "Nursing" is or should do, rather than a phenomenon wt Nursing". All nursing models involve some method of assessing a patient's individual needs and implementing appropriate patient care. An essental portion of each nursing model is meaurable goals in order that the process can be evaluated in order to provide bet is used to dtermine a patient's treatment by nurses, doctors nd other halthcare professionals and auxiliary workes. These documentsare consideed o be living documents — they are changed and evaluated on a daily basis as the patientscondition an abilities cange. Theories of Nursingfall intoeories. “Neuman’s model focuses on the person a a compete system, the subparts of which are interrelated physiological, psychological, scicultural, spiritual, and developmental factors.” Polit & Henderson p. 103
History of nursing models
The original role of the nurse was primarily to care for the patient as prescribed by a physician. This evolved into thebiomedical model of nursing care which still strongly influences nursing practice today. The biomedical model focuses heavily upon pathophysiology and altered homeostatis but fails to identify individual differences and whilst it works well for traditional medical and physical care, it focuses solely on the treatment of disease, making little account of psychological, sociocultural, or politicoeconomic differences between individuals. The Biomedical Model essentially views all patients with the same disease as the same problem regardless of their religion, culture, or ethnicity. This is in contrast to the social model of healthcare that places emphasis on changes that can be made in society and in people's own lifestyles to make the population healthier.
The first theorist to clearly articulate a role of nurses distinct from the medical profession was Florence Nightingale. Her theories were developed during the Crimean War and published in Notes on Nursing:What It Is, and What It Is Not in 1859. Nightingale's model is based on the idea that the nurse manipulates the environment to promote the patient's well-being.
Nurses quickly realised that treating patients based upon their disease rather than making a holistic assessment was not a satisfactory way of attending patient care.
Presently, some of today contributing theorist include Roy (Kansas), Newman (Harvard), Waga (Rutgers), and Johnson (Yale)
Further information may be found in ANA (American Nursing Association).
Major nursing theorists
• Helen Erickson
• Virginia Henderson
• Imogene King
• Madeleine Leininger
• Betty Neuman
• Dorothea Orem
• Ida Jean Orlando (Pelletier)
• Hildegard Peplau
• Rosemarie Rizzo-Parse
• Isabel Hampton Robb
• Martha E. Rogers
• Callista Roy
• Katherine Kolcaba
• Katie Eriksson
Purposely left off this list is that most famous of all nurses, Florence Nightingale. Nightingale never actually formulated a theory of nursing science but was posthumously accredited with same by others who categorized her personal journaling and communications into a theoretical framework.
Also left off are the many nurses who improved on these theorists' ideas without developing their own theoretical vision.
Examples of nursing models
The models used vary greatly between institutions and countries. However, different branches of nursing have different "preferred" nursing models. These are summarized below:
Psychiatric nursing
• Roy's model of nursing
• Tidal Model
Children's nursing
• Casey's model of nursing
Perinatal nursing
• Ramona T Mercer maternal role attainment
Adult nursing
• Nightingale's model of nursing
• Roper, Logan and Tierney
• Orem's Model of Nursing
Community and rehabilitation nursing
• Orem's Model of Nursing
Critical care nursing
• Synergy model of nursing
Holistic nursing
• Rogers: Science of Unitary Human Beings
• McGill Model of Nursing
• Parse: Human Becoming
• Erickson, Tomlin & Swain: Modeling and Role-Modeling
• Newman: Health as Expanding Consciousness
Future of nursing models
Nursing models have been criticised for failing to provide holistic care, and preventing nurses from thinking "outside of the box". This has been compounded by many hospitals who have developed "pre-printed" care plans that have been misused by nurses who have failed to customise these generic care plans to the patient. An example of this would be using a standard care plan for appendectomy for an elderly patient with multiple pathology (for instance diabetes, angina pectoris and a history of myocardial infarction). Evidently, the patient's care needs would be very different from a fit-and-healthy 20 year old male with no previous medical history who neither smokes nor drinks. It is up to the professional to tailor the care plan to suit the individual patient.
Models of nursing have always been accused of being "out of touch" with the harsh reality of patient care, and creating yet more unnecessary paperwork for nurses to complete.
Technological advances may produce client specific nursing models.
Nursing theory is the term given to the body of knowledge that is used to support nursing practice. In their professional education nurses will study a range of interconnected subjects which can be applied to the practice setting. This knowledge may be derived from experiential learning, from formal sources such as nursing research or from non-nursing sources. To speak of nursing theory is often difficult. Nursing is many things to many people. Most universally agreed upon is that Nursing is a science involving people, environment and process fueled by a vision of transcendence in the context of healthcare. It is interesting to note that 90% of all Nursing theories have been generated in the last 20 years. Many schools encourage students to formulate personal philosophies or mid-range theories of Nursing as part of their curriculum. Some might argue that this multiplicity of theory is detrimental to the practice and undermines common vision. Others would say that the nature of the young science is sufficiently far reaching to require such tactics in order to elicit true consensus.
Nursing models are conceptual models, constructed of theories and concepts. They are used to help nurses assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformity and seamless care.
Universal features of nursing models
Unlike most sciences, Nursing theories seem primarily concerned with what "Nursing" is or should do, rather than a phenomenon wt Nursing". All nursing models involve some method of assessing a patient's individual needs and implementing appropriate patient care. An essental portion of each nursing model is meaurable goals in order that the process can be evaluated in order to provide bet is used to dtermine a patient's treatment by nurses, doctors nd other halthcare professionals and auxiliary workes. These documentsare consideed o be living documents — they are changed and evaluated on a daily basis as the patientscondition an abilities cange. Theories of Nursingfall intoeories. “Neuman’s model focuses on the person a a compete system, the subparts of which are interrelated physiological, psychological, scicultural, spiritual, and developmental factors.” Polit & Henderson p. 103
History of nursing models
The original role of the nurse was primarily to care for the patient as prescribed by a physician. This evolved into thebiomedical model of nursing care which still strongly influences nursing practice today. The biomedical model focuses heavily upon pathophysiology and altered homeostatis but fails to identify individual differences and whilst it works well for traditional medical and physical care, it focuses solely on the treatment of disease, making little account of psychological, sociocultural, or politicoeconomic differences between individuals. The Biomedical Model essentially views all patients with the same disease as the same problem regardless of their religion, culture, or ethnicity. This is in contrast to the social model of healthcare that places emphasis on changes that can be made in society and in people's own lifestyles to make the population healthier.
The first theorist to clearly articulate a role of nurses distinct from the medical profession was Florence Nightingale. Her theories were developed during the Crimean War and published in Notes on Nursing:What It Is, and What It Is Not in 1859. Nightingale's model is based on the idea that the nurse manipulates the environment to promote the patient's well-being.
Nurses quickly realised that treating patients based upon their disease rather than making a holistic assessment was not a satisfactory way of attending patient care.
Presently, some of today contributing theorist include Roy (Kansas), Newman (Harvard), Waga (Rutgers), and Johnson (Yale)
Further information may be found in ANA (American Nursing Association).
Major nursing theorists
• Helen Erickson
• Virginia Henderson
• Imogene King
• Madeleine Leininger
• Betty Neuman
• Dorothea Orem
• Ida Jean Orlando (Pelletier)
• Hildegard Peplau
• Rosemarie Rizzo-Parse
• Isabel Hampton Robb
• Martha E. Rogers
• Callista Roy
• Katherine Kolcaba
• Katie Eriksson
Purposely left off this list is that most famous of all nurses, Florence Nightingale. Nightingale never actually formulated a theory of nursing science but was posthumously accredited with same by others who categorized her personal journaling and communications into a theoretical framework.
Also left off are the many nurses who improved on these theorists' ideas without developing their own theoretical vision.
Examples of nursing models
The models used vary greatly between institutions and countries. However, different branches of nursing have different "preferred" nursing models. These are summarized below:
Psychiatric nursing
• Roy's model of nursing
• Tidal Model
Children's nursing
• Casey's model of nursing
Perinatal nursing
• Ramona T Mercer maternal role attainment
Adult nursing
• Nightingale's model of nursing
• Roper, Logan and Tierney
• Orem's Model of Nursing
Community and rehabilitation nursing
• Orem's Model of Nursing
Critical care nursing
• Synergy model of nursing
Holistic nursing
• Rogers: Science of Unitary Human Beings
• McGill Model of Nursing
• Parse: Human Becoming
• Erickson, Tomlin & Swain: Modeling and Role-Modeling
• Newman: Health as Expanding Consciousness
Future of nursing models
Nursing models have been criticised for failing to provide holistic care, and preventing nurses from thinking "outside of the box". This has been compounded by many hospitals who have developed "pre-printed" care plans that have been misused by nurses who have failed to customise these generic care plans to the patient. An example of this would be using a standard care plan for appendectomy for an elderly patient with multiple pathology (for instance diabetes, angina pectoris and a history of myocardial infarction). Evidently, the patient's care needs would be very different from a fit-and-healthy 20 year old male with no previous medical history who neither smokes nor drinks. It is up to the professional to tailor the care plan to suit the individual patient.
Models of nursing have always been accused of being "out of touch" with the harsh reality of patient care, and creating yet more unnecessary paperwork for nurses to complete.
Technological advances may produce client specific nursing models.
What is a Nurse ?
A nurse is responsible along with other health care professionals for the treatment, safety, and recovery of acutely or chronically ill or injured people, health maintenance of the healthy, and treatment of life-threatening emergencies in a wide range of health care settings. Nurses may also be involved in medical and nursing research and perform a wide range of non-clinical functions necessary to the delivery of health care. Nurses also provide care at birth and death.
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