how to use standardized nursing diagnosis, interventions
TRANSCRIPT
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: [email protected]
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