how to use standardized nursing diagnosis, interventions

How to Use Standardized Nursing Diagnosis, Interventionsand Outcomes – Using Cases

(Interaktiv Workshop)

DOKUMENTATIONSKONFERENCE 2020

Dansk Sygepleje Selskabs Dokumentationsråd

Tirsdag den 3. og onsdag den 4. november 2020

Scandic Sluseholmen

Molestien 11 • 2450 København SV

Howard K. Butcher, PhD; RN

Professor

Director of the PhD in Nursing Program

Christine E. Lynn College of Nursing

Florida Atlantic University

Boca Raton, Florida

Editor, Nursing Intervention Classification (NIC)

Deep Nursing is Accomplished by Practicing Nursing as Caring

Grounding Nursing in Caring as Nursing Theory (Waston, Roach, Boykin & Schoenhofer

Embracing Narrative (Capturing the Person’s Story)

Integrating Reflective Practice: Revolution in Clinical Decision-Making Models (OPT)

EHR use of Natural language processing capturing (NLP)

Outcome-Present State-Test Model for Reflective Practice

Outcome-Present State-Test Model for Reflective Practice

Cue

Logic

Reflection

Outcome

State

Present

State

Decision Making

Judgment

Client

-in-

Context

Story

Exit

Framing

Testing

Revolution in Clinical Decision-Making Models (OPT)

Non-linear

Emphasis is on outcomes

Incorporates “story”

Includes ”reflective practice”

Includes framing within a disciplinary lens (Nursing Theory)

Incorporates NANDA-NIC-NOC

Includes a Clinical Reasoning Web

Outcome-Present State-Test Model for Reflective Practice

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Outcome-Present State-Test Model for Reflective Practice

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Framing: Nursing as Caring

Care is the essence of nursing (Leininger)

Caring is a human mode of being (Roach)

All persons are caring (Boykin & Schoenhofer)

Caring is Nursing’s moral imperative (Watson)

The focus of nursing is nurturing of persons living caring and growing in caring

Caring is an intentional process in response to a call for care

Caring occurs with presence in a nursing situation

In the Nursing Situation, the nurse draws on personal, empirical, and ethical knowing to bring to life the artistry of nursing.

Relationships are transformed through caring

Each person grows in caring through interconnectedness with other

Personhood is a process of living grounded in caring

Outcome-Present State-Test Model for Reflective Practice

Cue

Logic

Reflection

Outcome

State

Present

State

Decision Making

Judgment

Client

-in-

Context

Story

Exit

Framing

Testing

Patient’s Story-in-Context

• Who is the patient

• What is the patient’s story

• How do you describe the patient and his or her story

• How do I think about the patient’s situation

• What contextual factors need to be considered

• What institutional policies and assessment forms are you using that influence your thinking and reasoning about the patient’s story

What is in the Patient’s Story

• Created to understand and interpret that patient’s trajectory

• It is the “Big Picture”

• Cognitive awareness and understanding

• Relevant history

• Data patterns that emerged during care activities

• Problems identified

• Holistic Care plan

• Synthesis of patient information

Source of Story Information

• All inclusive Information (Everything Counts)

• Objective-Subjective

• Conversations

• Patient’s History/Futurey

• Interview

• Health Appraisal

• Family Members

• Lab results/Diagnostic Tests

• Progress Reports

• Rounding

Case Application: Family Caregiving

Patient’s Story

Miss Davis, 26, caring for her 53-year old mother who has stage IV ovarian cancer.

She is experiencing depression, anxiety, fear of the unknown, grief, loss of personal freedom. Experiencing physical, emotional, and social burdens caring for her moher and younger siblings. Sleep disturbance.

Cue Logic

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Cue Logic

• The deliberate structuring of the patient-in-context data to discern meaning for nursing care

• Inductive, deductive or dialectic

• Useful in making sense of the information

• Framing is a process of attributing meaning to making connection

• Reflecting while listening to cues in the story

• Identifying the calls for nursing as caring = Nursing Diagnosis

Present State

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Present State

• Is the description of the patient-in-context calls for nursing as caring

• Describes the Nursing Situation

• NANDA-I (Nursing Diagnosis)

Nursing Diagnoses Classification: NANDA-I

• Caregiver role strain=Difficulty in performing caregiver role

• Caregiver Role Strain related to 24-hour care responsibilities evidenced by anger, frustration, and feeling depressed

OUTCOME STATE

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

540 Outcomes

Structure

• Label name

• Definition

• Measurement scale(s)

• List of Indicators

• References

How to Find a NOC

How to find a NOC

Alphabetically

Taxonomy

Linkages

Core Outcomes

Testing

Cue

Logic

Reflection

Outcome

State

Present

State

Decision Making

Judgment

Client

-in-

Context

Story

Exit

Framing

Testing

Testing

Testing is juxtaposing the Present State and the Outcome State and evaluating the gap between the two states to determine how the gap will be filled by considering and choose which evidence-based theory guided interventions can be implemented so patients can move toward desired outcomes.

Decision Making = NIC

Cue

Logic

Outcome

State

Present

State

Decision Making

Judgment

Client

-in-

Context

Story

Exit

Framing

Testing

The Classification

NIC 7e comprises of 565 nursing interventions organized into 7 domains and 30 classes representing all nursing practice specialties and setting

NIC Taxonomy of Nursing Interventions: Domains & Classes

Physiological:

Complex

Physiological:

Basic

Behavioral Safety Family Health System Community

Activity & Exercise

Management

Elimination

Management

Immobility

Management

Nutrition

Support

Behavior

Therapy

Cognitive

Therapy

Communication

Enhancement

Coping

Assistance

Electrolyte & Acid-

Base Management

Neurologic

Management

Perioperative

Care

Drug

Management

Respiratory

ManagementPhysical Comfort

Promotion

Self-Care

Facilitation

Skin/Wound

ManagementPsychological

Comfort Promotion

Patient

Education

Crisis

Management

Risk

Management

Childbearing

Care

Childrearing

Care

Health System

Mediation

Health System

Management

Information

Management

Community

Health Promotion

Community Risk

Management

Lifespan Care

Thermoregulation

Tissue Perfusion

Management

How to Find a NIC

Alphabetically – If you know the name

NIC Taxonomy – Will see related NICs

Linkages with NANDA- will see NICs suggested

Core Specialty- Will see a list of NICs used in specialty practice

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Reflection-in-ActionCore Question: What information do a need to nurse (or use this skill/ procedure)?

Cue Questions:

• Who is this person?

• What health event brings the person to the hospital?

• How is this person feeling?

• How is this event affected their usual life pattern and roles?

• How does this person make me feel?

• How can I help this person?

• What is important for this person to make their experience of this procedure comfortable?

• What support does this person have in life?

• How does this person view the future for themselves and others?

Outcome-Present State-Test Model for Reflective Practice

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Judgment

•Drawing conclusions based on the effect of an intervention on a specific outcome

•Measure changes in NOC indicator levels

Case Application: COVID-19

Brazilian Nursing Process Research Network contributions for assistance in the COVID pandemic

Barros, A.L.B.L., Silva, V.M., Santana, R.F., Cavalcante, A.M.R.Z., Vitor, A.F., Lucena, A.F., Napoleão, A.A., Lopes, C.T., Primo, C.C., Carmona, E.V., Duran, E.C.M., Butcher, H.K., Lopes, J.L., Díaz, L.J.R., Cubas, M.R., Brandão, M.A.G., Lopes, M.V.O., Nóbrega, M.M.L., Almeida, M.A., Souza, P.A., Butcher, R.C.G.S., Jensen, R., Silva, R.S., Morais, S.C.R.V., & Santos, V.B. (2020). Brazilian Nursing Process Research Network contributions for assistance in the COVID pandemic. Revista Brasileira de Enfermagem, 73(Suppl 2): e20200798. doi: http://dx.doi.org/10.1590/0034-7167-2020-0798

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Case: COVID-19: Patients Suspected or With Mild and Moderate COVID-19

Patient’s Story-in-Context

Cue Logic

In the light and moderate spectra, the manifestation of a variability of clinical signs associated with the respiratory, gastrointestinal, cardiovascular, hematological and neurological systems is common. Among the signs and symptoms, pain, cough, sputum, anorexia, hyposmia, hypogeusia, nasal obstruction, rhinorrhea, diarrhea and fatigue stand out.

Moderate and severe cases still have dyspnea, fever and hypoxemia. Although limited the evidence has pointed out that the presence of signs that reflect respiratory function, such as dyspnea and hypoxemia, have been related to the clinical deterioration of patients, especially in those with advanced age and comorbidities.

Clinical Reasoning Web: Present StateNANDA-I

When considering the available evidence on patients’ clinical profile with mild and moderate COVID-19:

Risk of Infection (0004);

Ineffective Breathing Pattern (00032)

*Impaired Gas Exchange (00030)

Ineffective Airway Clearance (00031)

Impaired Spontaneous Ventilation (00033)

Activity Intolerance (00092)

Hyperthermia (00007)

Diarrhea (00013)

Impaired Comfort (00214)

Humanistic Dimensions

NANDA-I

Death Anxiety (00147);

Fatigue (00093)

Fear (00148)

Hopelessness (00124)

Disturbed Sleep Pattern (00198)

NOC

Anxiety Level (1211);

NICs

Emotional Support (5270);

Anxiety Reduction (5820);

Hope Inspiration (5310)

Self-Care Assistance (1800)

Additional NANDA-I to Consider

Risk Control: Infectious Process (1924)

Thermoregulation (0800)

Electrolyte Balance (0606)

Hydration (0602)

Comfort Status (2008)

Pain Level (2102)

Outcome State: NOC

Priority NOC

Respiratory Status: Ventilation (0403)

*Respiratory Status: Gas Exchange (0402)

Respiratory Status: Airway Patency (0410)

Additional NOCRisk Control: Infectious

Process (1924);

Thermoregulation (0800);

Electrolyte Balance(0606)

Hydration (0602)

Comfort Status (2008)

Pain Level (2102)

Decision Making- NIC

Priority NICs

Respiratory Monitoring (3350).

Airway Management (3140)

*Oxygen Therapy (3320)

Acid-Base Management (1910)

Additional NICs

Infection Protection (6550);

Temperature Regulation (3902);

Medication Administration (2300);

Fluid Management (4120);

Electrolyte Control: Hypermagnesemia (2003);

Pain Management (1400)

Sedation Management (2260)

Cue

Logic

Reflection

NOC NANDA-I

NIC Interventions & Activities

NOC

Indicators

Client

-in-

Context

Story

Exit

Caring as Nursing

Testing

Howard Butcher PhD, RNProfessorEditor, Nursing Interventions Classifications (NIC)Christine E. Lynn College of NursingFlorida Atlantic UniversityBoca Raton, Florida, USAEmail: hbutcher@health.fau.edu

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