Explain the methods and steps in the nursing process

DEVELOPING EDUCATIONAL COURSE FOR NURSING STUDENTS

LEARNING OBJECTIVES

1. NURSING PROCESS AND CRITiCAL THINKING SKILLS

By the end of this course you should be able to:

Clearly define the nursing process

Explain the methods and steps in the nursing process

Describe and apply various nursing processes in dealing with issues today

Explain nursing process in terms of steps and components

Select and apply appropriate instructional media/ teaching aid

Evaluate students using relevant students’ performance assessment methods on their understanding of nursing process.

COURSE OUTLINE

The nursing process course assist nurses in helping patients with non-complex healthcare issues worldwide through applications of developed knowledge and skills as well proper management.

NURSING PROCESS

I. ASSESSMENT

· This is the first stage that involve nurses using systematic ways to collects and analyze data about the patient.

· During the process, the nurse will attempt to identify the problem and establish a database through conducting an interview of the individual or family members.

· Data can be collected in a subjective way, i.e. data which cannot be measured directly and may include verbal information such as asking questions, obtaining verbal feedback, interviewing other related individuals therefore gathering information on patient’s health history.

· Data can also be measured in objective way i.e. measurable, therefore measuring a patient’s weight, blood, pressure, heart rate and body temperature.

· In order to identify and come up with accurate data from this step, make sure the identified data is clear, concise, and consistent.

II. NURSING DIAGNOSIS

· In this process, the nurse’s clinical judgment about the patient’s response to actual or potential health conditions needs.

· It illustrates that the patient is in pain but the pain has caused the patient problems such as activity intolerance, Anxiety, Poor nutrition, hypothermia, sleep deficit.

· Once a diagnosis has been performed any potential risks that may cause complications or harm to the individual should be placed in order with the highest risk listed as the top priority and lower risk being addressed later in the list.

· With identification of problems and correction of new arising ones, continuous assessment of the individuals’ condition should be performed on a regular basis.

· After problem identification the next process is planning.

III. PLANNING

· This the process that nurses perform after assessment and diagnosis and involves development of a plan and establishment of SMART goals in order to achieve desired patients’ outcomes such as improving cardiovascular function and reducing pain.ordia improving cardiovascular function.

· Smart goals are specific, measurable, attainable, and realistic and time restricted. These goals are developed to provide a patient with a sure set of activities that are designed to improve their conditions.

· Goals can be long term or short term depending on the diagnosis and should focus on the patient outcome.

· A care plan and intervention strategies can as well be applied, developed and communicated to the team in order to maximize success of the plan.

· These includes the steps and strategies that need to be taken so as to achieve the desired goals.

· After the development and establishment of interventions, care plan and SMART goals, an implementation should be administered.

IV. IMPLEMENTATION

· The implementation of nursing care in relation to the care plan, so continuity of care for the client during hospitalization and the preparation for discharge needs to be assured.

· This phase may be performed using a combination of direct and indirect care.

· The direct care, is administered directly to the patient in a physical and verbal manner and may include: assisting patient with mobility, performing physical care and range of motion exercises with the patient as well as assisting with day to day living activities, counselling and providing feedback to the individual.

· The indirect one involves supervision of medical staff, delegating responsibilities and advocating for the individuals.

· The medical staff and individual receiving the care should reevaluate and question the steps and procedures that may appear to be inappropriate, non-actionable and questionable in order to ensure its safe and corresponds with the medical team and patients’ goals.

V. EVALUATION

· This is the last phase of the nursing process.

· In entails the assessment and evaluation of the success of the planning and implementation process by medical professionals to ensure progress of individuals towards achieving desired outcomes and goals.

· If the process is not working, it is reassessed and determined whether it needs to be modified or eliminated.

· Both patients’ status and effectiveness of the nursing care must be continuously evaluated and the care plan modified as needed.

· Evaluation should be performed throughout the nursing process on a regular basis, so as to make assessments and adjustments where necessary.

ADMINISTERING TOPICAL MEDICATIONS

Definition:

This is the application of lotions/creams on the skin.

Purpose:

· To promote comfort

· To treat local skin infections

Indication(s)

· Nappy rash

· Bacterial skin infections

· Inflammatory skin conditions

· Venipuncture

A. ASSESSMENT

Assess

1. The equipment required

2. Patient’s readiness for the procedure

3. The suitability of the site.

B. PLANNING

Self

Review own level of knowledge and skills of topical applications and requirements.

Assemble requirements.

Patient

· Explain the need , benefits, and risks of the procedure

· Provide detailed information regarding the patient’s role during and after the medication

· If a child, corporation can be enhanced if the child applies the medication under the nurse’s supervision

Requirements

A tray containing

· Cotton wool swabs in a galipot

· Wooden spatula in a container

· Local ointment/cream

· Receiver for used swabs

· Bandage if indicated

· Mackintosh and towel

· Shaving tray if required

· Gloves

C. IMPLEMENTATION

Steps

1. Take the equipment to the bedside, screen the bed and close nearby windows.

2. Wash, dry hands and put on gloves.

3. Request patient to position him/herself appropriately.

4. Expose only the part to be treated.

5. For creams and ointments, take the application and squeeze it into gauze swab held with gloved hands and apply to the affected area spreading it gently.

6. Bandage the site if indicated.

7. Take the tray and trolley to the treatment room.

8. Clear the equipment, clean them with soap and water, rinse, dry and store/dispose the disposable items.

D. EVALUATION

Evaluate

1. The comfort of the patient.

2. Whether the right medication was applied at the affected site.

E. DOCUMENTATION

Record

· Date, time, name, dosage, and route of administration.

· The condition of treatment area

· On any immediate effects of the medication

· Patient education on self-administration of the medication

CRITICAL THINKING

In nursing, critical thinking involves a discipline specific, reflective reasoning process that guides the nurse in generating, implementing and evaluating approaches foor dealing with patient care and professional concerns.

The purpose of critical thinking is to demonstrate the ability to identify a clinical situation that applies the use of critical thinking in the management care of a patient with uncomplicated health needs.

2. CRITICAL THINKING OBJECTIVES

By the end of this course you should be able to:

· Define critical thinking and how it is applied in the nursing field of study

· Explain the critical thinking and judgment correlation.

· Apply critical thinking in day to day life activities

· Select and apply various and relevant teaching aid in critical thinking

· Make decisions based on critical thinking

· Evaluate students with reference to performance assessment methods on their understanding of critical thinking.

CRITICAL THINKING AND NURSING JUDGEMENT

In separation of professional nurse from technical or ancillary staff, decision making skill is applied.

The process is acquired through hard work, commitment and an active curiosity towards learning.

Nurses must and should learn to look at alternatives, hence develop good problem solving skills.

Nurses can accomplish this by learning to be flexible in clinical decision making, reflect on past experiences and previous knowledge, listening to others points of view, and identify the nature of the problem and the best solution for improvement of patients’ health.

CRITICAL THNKING IN NURSING

1. Should be guided by professional standards and ethic codes.

2. Require strategies that maximize potential and compensate for problems

3. Should constantly involve reevaluation, self-correction and striving towards improvement.

4. Should be based on principles f nursing process and the scientific method.

5. Should be competent, skillful, specific nursing knowledge and experience with full skillful nursing practice.

CRITICAL THINKING COMPETINCIES

1. Scientific method

2. Problem solving

3. Decision making

4. Diagnostic reasoning and Inferences

5. Clinical Decision making

6. Nursing process

LEVELS OF CRITICAL THINKING

· BASIC

· COMPLEX

· COMMITMENT

ASPECTS

1. Reflection

2. Language

3. Intuition

APPLICATION

Nursing process being the systematic approach used by all nurses to gather information, criticaly examine and analyze data, take appropriate action and later evaluate effectiveness of the action. This involves use of critical thinking skills.

Common language to all nurses is to think through clinical problems.

Critical thinking and Assessment process; brings knowledge from physical, biological and social sciences as a basis for the nurse to ask relevant question, clinical experience contributes to assessment skills, application of standards of practice and personal attitudes.

Critical thinking also enables nurses to make flawless decisions before performing tasks and also helps in communication

ATTITUDES THAT FOSTER CRITICAL THINKING IN NURSING

· Fair-mindedness

· Independence

· Insight into ethnocentricity

· Intellectual humility

· Integrity

· Perseverance

· Intellectual courage to challenge status quo

· Curiosity

· Confidence

When using nursing process

· Identify healthcare needs

· Determine priorities

· Establish goals and expected outcomes

· Provide appropriate interventions

· Evaluate effectiveness

TEACHING STRATEGIES

OBJECTIVES

· Describe various teaching strategies and state their advantages and disadvantages

· Distinguish traditional from innovative/ mordern teaching methods

TRADITIONAL

1. PRACTICALS

A practical is where students perform tasks through illustratons and guide by the the teacher.

ADVANTAGES

· Provides a better understanding of the lecture content.

· It leads to creativity on the part of the student.

· It is effective for stimulating independent thought and changing attitudes.

· It gives immediate feedback on the performance of the teacher,

· It provides individual student to be helped by the teacher.

· It provides opportunity for development.

DISADVANTAGES

· It is costly, hence uneconomical way of using manpower and resources.

· It is time consuming, takes time carrying out practical work

· It needs special accommodation foe student closer to the practical area.

· It needs administrative staff for preparation and maintenance of materials.

2. LECTURE METHOD

This is a lesson given orally by a teacher

ADVANTAGES

· It is economical in the use of time.

· Appropriate for larger groups

· Use of single lecture theatre.

· Delivery of content by expert.

DISADVANTAGES

· Some students may be left behind

· Poor student nvolvement

· Impersonal

· No respect for individual space

3. FIELD VISIT

This is where learners are taken to actual area where activities take place such as hopitals and relate to what they have learnt.

ADVANTAGES

· It provides actual experience

· Students can observe and participate in the use of theory

· Provides creative and independent thought on part of the student

· Provides time for questions and discussions

· Information comes from multiple sources.

DISADVANTAGES

· It is uneconomical way of using manpower and resources

· It creates administrative problems in arranging programs

· It may confuse students because there is usually a wide gap between theory and practice

· If not well supervised, learning potential may be lost and it may turn into a social event.

4. DEMONSTRATIONS

Here the teacher performs a learning task while students observe and learn and in return learners are given opportunity to demonstrate to ensure well understanding

ADVANTAGES

· It provides an economical way of using manpower and materials.

· It provides audio-visual observation of the subject

· Students understand better

· Provides wide range of knowledge in a given time

· It is a good means of teaching where resources are readily available

DISADVANTAGES

· Students are just passive observers

· It has little regard for students’ individual differences

· There is no immediate feedback from the instructor

· It may not provide for activity for part time students.

5. SEMINARS

This is a session headed by a teacher, where an assigned subject is discussed.

ADVANTAGES

· It promotes interpersonal relationships between students

· Students can learn a lot from each other

· It allows teamwork

· It encourages full participation by students

· Provides immediate feedback

DISADVANTAGES

· It is uneconomical way of manpower

· It is too slow to cover more than limited amount of subject matter

· It may suffer interruptions

· It cannot provide repetition for individual needs

6. TUTORIAL

Is a discussion session between a teacher and a small number of students

ADVANTAGES

· Communication of knowledge is a two way between teacher and students

· It provides personal contact between teacher and students

· Teachers give full attention

· Encourages creativity of the learner

· Provides more understanding of the lecture

DISADVANTAGES

· It is uneconomical way of using manpower

· It moves too slowly to cover only limited subject matter

· It is liable to interruptions

· Cannot provide repletion necessary depending on the individual.

7. PROJECTS

This is an assignment given to students to carry out research on a particular topic.

ADVANTAGES

· Provides activity and calls for creativity on students part

· Encourages initiative in the student

· Encourages learners to be independent

· Learners can work at their own pace

DISADVANTAGES

· It takes time to carry out a project

· Projects may add to too much workload

· It creates administrative problems in arranging programs

8. SIMULATION

This is an instruction method that enable learners to develop skills in dealing with real life situations and problems in a classroom setting.

Two methods

Simulation game- take a written case history

Present a recording of chest sounds for the learner to listen to.

Simulators- operational models such as obstetrical phantom or model for first aid teaching

ADVANTAGES

· Can make link between the training situation and real-life situation

· Provides responsive environment

· Cheap method

· Can telescope time

· Important in risk management

DISADVANTAGES

· Cannot simulate all dimensions of a real life situation

· Time for planning and development may prove to be costly.

MORDERN OR INNOVATIVE TEACHING STRATEGIES

· Problem Based Learning (PBL)

· Self-Direct Learning (SDL)

· Small Group Tutorial (SGT)

· Community Based Education and Service (COBES)

· Computer Aided Education (CAE)

· Student-centered, Problem-Based, Integrated, Community-Oriented, Elective and Systematics (SPICE)