2 Role of the Professional Nurse American Nurses Association (ANA)- according to the ANA nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacyFour broad goalsTo promote healthTo prevent illnessTo treat human responses to health or illnessTo advocate for individuals, families, communities, and populations
3 Role of the Professional Nurse—(cont.) Nursing: Scope and Standards of Practice (ANA, 2010b) and Code of Ethics for Nurses with Interpretive Statements (ANA, 2010a)Nursing activities to promote health and prevent illnessAppropriate nursing interventionsImplementing educational programsCoordinating community resourcesPatient/family teaching
4 Role of the Professional Nurse—(cont.) Care responsibilitiesIndependent interventionsPatient teachingTherapeutic communication; physical proceduresMember of a professionScholarship and research-to provide care based on current evidenceAdvocacy- nurses take responsibility to protect the legal and ethical rights of patients.Nursing values-beliefs or ideals to which a person is committed ie. Respect, Unity, Diversity Integrity, Excellence
5 Role of the Professional Nurse—(cont.) Registered nurse and advanced practice nurse rolesAPRN educationMSN; doctorate (2015)APRN rolesNurse Practitioner (NP)Certified Nurse Midwife (CNM)Certified Registered Nurse Anesthetist (CRNA)Clinical Nurse Specialist (CNS)
6 Purpose of Health Assessment Health assessment: “Gathering information about the health status of the patient, analyzing and synthesizing those data, making judgments about nursing interventions based on the findings and evaluating patient care outcomes” (AACN, 2011)A health assessment includesHealth history; physical assessmentAdditional necessary factors assessedPsychological; sociocultural; spiritual; economic; lifestyleNursing process begins with a complete, accurate health assessment.
7 Wellness and Health Promotion Wellness: “An integrated method of functioning, which is oriented toward maximizing the potential of which the individual is capable” (Dunn, as cited in Zimmer, 2010)Nurses collaborate to promote higher levels of wellness.Facilitate wellness via health promotion, teachingNational model for health promotion, risk reductionHealthy PeopleTen foci: goals; evaluation and revisionRisk assessment, health-related patient teaching
8 Wellness and Health Promotion—(cont.) Interventions promoting healthy changePrimary prevention: strategies aimed at preventing problemsSecondary prevention: early diagnoses, prompt treatmentTertiary prevention: preventing complications of existing disease, promoting highest health level possible
9 Primary, secondary or tertiary prevention ImmunizationsPap smearsDiet teaching for pt. with DMBP screeningInhaler teaching for pt with lung diseaseHealth teachingSafety precautionsVision screeningExercise programs for pt w/ MITB skin testNutrition counseling
10 Wellness and Health Promotion—(cont.) The three levels of prevention
11 Assessment in the Nursing Process Systematic problem-solving approach, identifying and treating human responses to actual or potential health difficulties (ANA, 2013)Nursing process components (nonlinear, interactive)AssessingDiagnosingPlanningImplementingEvaluating
12 Assessment in the Nursing Process—(cont.) Assess: complete, accurate health data compilationDiagnose: data clustering to determine patient’s conditionNorth American Nursing Diagnosis Association (NANDA-I)Plan goals, outcomes: formulation of measurable, realistic, patient-centered goalsPatient outcomes are more specific than goals.Plan care: determining resources; targeting nursing interventions; writing plan of care
13 Assessment in the Nursing Process—(cont.) Implement: any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient outcomes (Bulechek, et al., 2007)Monitoring health status; prevent, resolve, control a problemAssist with ADLs; promote optimal health and independenceEvaluate: judgment of nursing care efficacy in meeting patient goals and outcomes based on patient responses to nursing interventionsRequires knowledge of care standards, expected patient responses, conceptual models and theories
14 Critical ThinkingPurposeful, outcome-directed (result-oriented) thinkingDriven by patient, family, community needsBased on nursing process, evidence-based thinking, scientific methodRequires specific knowledge, skills, experienceGuided by professional standards and codes of ethicsContinually reevaluating, self-correcting, striving for improvement
15 Question Is the following statement true or false? A health assessment includes both a health history and a physical assessment.
16 AnswerTrueRationale: A health assessment is made up of the following two parts: a health history and a physical assessment.
17 Diagnostic ReasoningGathering and clustering data to draw inference and propose diagnosesBased on nurse’s critical thinkingSeven-step process used within context of health assessmentIdentify abnormal data, strengthsCluster dataDraw inferencesPropose nursing diagnoses
18 Diagnostic Reasoning—(cont.) Seven-step process used within context of health assessment—(cont.)Check for presence of defining characteristicsConfirm or rule out nursing diagnosisDocument conclusionsCollaborative problems
19 Types of Assessments Three common types of nursing assessments Emergency: life-threatening or unstable situationComprehensive: complete health history and physical assessment performed:Annually for outpatientsUpon hospital/long-term care admissionEvery 8 hours in critical careFocused: occurs in all settings, smaller in scope but increased depth for specific issue(s)
20 Priority SettingPrioritize assessments and care upon the patient’s health care situationIn determining priorities, useClinical experienceKnowledge; expertise; judgmentLife-threatening situation is top priority.Patient issue of top import should be considered high priority.
21 Frequency of Assessment Varies due toPatient needs; data collection purposeNurse’s role; health care settingHealth care settingLong-term careIntensive careFocused assessments posttreatmentOutpatient setting
22 Frequency of Assessment—(cont.) Well visit assessmentsMost common screening, prevention servicesBirth to 10 yearsMonitor growth, development11 to 24 years25 to 64 years65 years and olderTreatment of acute, chronic illness
23 Lifespan Issues Comprehensive assessment Cognitive development Emotional developmentPhysical growthIdentifyExpected growth, development patternsExpected variations, aberrations, deviations
24 Question When are focused assessments conducted? A. At different ages across the lifespanB. After specific treatments are givenC. When a patient is in the acute care settingD. Only in the outpatient setting
25 Answer B. After specific treatments are given Rationale: Patients also have focused assessments following treatments to monitor their effectiveness.
26 Cultural Considerations Cultural competence: complex combination of knowledge, attitudes, and skills health care providers use to deliver care that considers the total context of the patient’s situation across cultural boundaries (Purcell, 2009)Knowledge of cultural diversity is essential for competent nursing practiceSubculturesAssess import of spirituality and religion on patient’s health
27 Components of the Health Assessment Observe patient’s verbal and nonverbal communication.Maintain patient confidentiality.Purpose: Collect family and personal histories of risk factors and past issues.Subjective data: Patient is primary source.Therapeutic dialogueObjective data: measurable informationVital signs; auscultation; visual appearance
28 Documentation and Communication Documentation is essential.LegalCommunication with other providersCollaborative careShift or departmental transfer reportVarious forms, formatsSOAPConfidentiality is essential.
29 Frameworks for Health Assessment Three major health assessment frameworksFunctional assessmentFocuses on functional patterns all humans shareHead-to-toe assessmentMost organizedBody systems approachOrganizational for documentation, communicationPromotes critical thinking
30 Evidence-Based Practice Relies on research findings, high-grade scientific supportMinimizes intuition, personal experienceSolve common problems using four stepsClearly identify issue or difficulties based upon accurate analysis of current nursing knowledge and practice.Search literature for relevant research.Evaluate research evidence using established criteria regarding scientific merit.Choose interventions, justifying selection with most valid evidence.
31 QuestionWhich physical assessment framework promotes critical thinking?A. FunctionalB. Head-to-toeC. ComprehensiveD. Body systems
32 AnswerD. Body systemsRationale: A body systems approach is a logical tool for organizing data when documenting and communicating findings. This method promotes critical thinking and allows nurses to analyze findings as they cluster similar data.