NURSING AS A SCIENCE 3

• Conceptual models/frameworks


  • Most schools and health care agencies developed their own structured assessment format based on selected nursing models/frameworks
  • Examples: Gordon's Functional Health Patterns, Orem's Self-care Model, Roy's Adaptation Model
• Wellness models


  • Nurses use to assist clients to identify health risks and to explore lifestyle, habits and health behaviors, beliefs, values, and attitudes that influence level of wellness
• Nonnursing models


  • Body system model
  • Maslow's hierarchy of needs
  • Developmental theories
• Diagnosing


  The second phase of the nursing process where nurses use critical thinking skills to interpret assessment data and identify client strength and problems
• Identification and development of nursing diagnoses began formally, when 2 faculty members of SLU, Kristine Gebbie and Mary Ann Lavin, perceived a need to identify nurse's roles in an ambulatory care setting


  1973
• The conference group accepted the name NORTH AMERICAN NURSING DIAGNOSIS ASSOCIATION (NANDA), recognizing the participation and contributions of nurses in the USA and Canada


  1982
• The organization changed its name to NANDA INTERNATIONAL to further reflect the worldwide interest in nursing diagnosis


  2002
• Purpose of NANDA International


  To define, refine and promote TAXONOMY of nursing diagnostic terminology of general use to professional nurses
• Taxonomy


  Classification system or set of categories arranged based on a single principle or set of principles
• Diagnosing


  Refers to the reasoning process
• Diagnosis


  A statement or conclusion regarding the nature of a phenomenon
• Diagnostic labels


  The standardized NANDA names for the diagnoses
• Etiology


  Causal relationship between a problem and its related or risk factors
• Nursing diagnosis


  The client's problem statement, consisting of the diagnostic label plus etiology
• NANDA definition of nursing diagnosis


  A clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community
• NANDA-1 THINK TANK, 2009 on nursing diagnosis


  A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability
• Status of nursing diagnoses


  • Actual
  • Health promotion
  • Risk
  • Syndrome
• Actual diagnosis


  A client problem that is present at the time of the nursing assessment
• Health promotion diagnosis


  Relates to client's preparedness to implement behaviors to improve their health condition
• Risk nursing diagnosis


  A clinical judgment that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene
• Syndrome diagnosis


  Assigned by a nurse's clinical judgment to describe a cluster of nursing diagnoses that have similar interventions
• Components of a NANDA nursing diagnosis


  • Problem (diagnostic label) and definition
  • Etiology (related factors and risk factors)
  • Defining characteristics
• Problem (diagnostic label) and definition


  Describes the client's health problem or response for which nursing therapy is given, in a specific and concise way
• Qualifiers


  Words added to some NANDA labels to give additional meaning to the diagnostic statement, e.g. deficient, impaired, decreased, ineffective, compromised
• Etiology


  Identifies one or more probable causes of the health problem, gives direction to the required nursing therapy, and enables the nurse to individualize the client's care
• Defining characteristics


  The cluster of signs and symptoms that indicate the presence of a particular diagnostic label
• Nursing diagnosis


  A statement of nursing judgment and refers to a condition that nurses, by virtue of their education, experience, and expertise, are licensed to treat, describing the human response
• Medical diagnosis


  Made by a physician and refers to a condition that only a physician can treat, referring to disease processes
• Independent functions


  The areas of health care that are unique to nursing and separate and distinct from medical management
• Dependent functions


  Nurses are obligated to carry out physician-prescribed therapies and treatment
• Collaborative problems


  Type of potential problem that nurses manage using both independent and physician-prescribed interventions
• The diagnostic process


  1. Analyzing data

  2. Identifying health problems, risks, and strengths

  3. Formulating diagnostic statements
• Analyzing data - Comparing data with standards


  Nurses draw knowledge and experience to compare client data to standards and norms and identify significant and relevant cues
• Analyzing data - Clustering the cues


  Data clustering is a process of determining the relatedness of facts and determining whether any patterns are present, whether the data represent isolated incidents, and whether the data are significant
• Analyzing data - Identifying gaps and inconsistencies


  Skillful assessment minimizes gaps and inconsistencies in data, but data analysis should include a final check
• Identifying health problems, risks, and strengths


  The nurse and client together identify strengths and problems, primarily a decision-making process
• Determining problems and risks


  The nurse and client together identify problems that support tentative actual, risk, and possible diagnoses, and determine whether the client's problem is a nursing diagnosis, medical diagnosis or collaborative problem
• Determining strengths

  The nurse and client establish the client's strengths, resources and abilities to cope, to develop a more well-rounded self-concept and self-image
• Formulating diagnostic statements


  Most nursing diagnoses are written as two-part or three-part statements, with the basic two-part statement having a problem and etiology, and the basic three-part statement having a problem, etiology, and signs and symptoms
• One-part statements


  Used for any health promotion diagnoses and syndrome nursing diagnoses, consisting of a NANDA label only