Presentation on theme: "Standardized Nursing language"— Presentation transcript:
1Standardized Nursing language Applications in A Nursing Practicum CourseCopyrightKelly J. Smith RN, MSNUniversity of IowaCollege of Nursing
2Why introduce standardized language at the undergraduate level? Creates an awareness of Nursing LanguageSupports the learning of the nursing processProvides consistency between practicumDevelops critical thinking skillsImproves CommunicationResearch Based*This is the time when student are learning the nursing process and “planning and implementing nursing care are central components of any undergraduate nursing practicum course” (Schoenfelder, NOC, 2004,p.814) It also decrease the students confusion concerning the difference between an outcome and an intervention.**Standardized language improves consistency through out the undergraduate program, leading to less confusion for the student.*The use of standardized language should be implemented before the students learn other ways of developing plans of care. Therefore, “old ways” do not need to be un-taught.*Use of Standardized Language when developing plans of care can develop critical thinking skills (Van De Castle, 2003) Student swill need to prioritize their nursing Diagnosis’ and identify relevant nursing activities and outcome indicators. Students will also need to consider the needs of the patient and family when individualizing care.*The use of standardize language improves communication among nursing and other healthcare disciplines. It also assist faculty in understanding the students’ perception of the patient’s problem(s).*The use of NANDA, NIC & NOC frameworks are desirable because they are research based, therefore faculty will be utilizing evidence based practice.
3Components of Nursing Language NANDA: Nursing Diagnosis: Definitions and ClassificationNIC: Nursing Interventions ClassificationNOC: Nursing Outcomes Classification
4NANDA: Nursing Diagnosis A nursing diagnosis is defined as “ a clinical judgment about an individual, family or community responses to actual and potential health problems/life processes. Nursing diagnosis provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”(NANDA, 2009)A Nursing Diagnosis is critical component in the nursing process. This is the first step in identifying how we should plan nursing care for our patients’ to improve patient outcomes for which nurses are held accountable. It also helps us to identify what are the priorities in caring for this patient.
5 Variations of Nursing Diagnosis’: 1. Actual diagnosis: describes health conditions that exist and supported by defining characteristics2. Risk diagnosis: those which describe disease or other conditions that may develop and are supported by risk factors3. Wellness diagnosis: describe levels of wellness and potential for enhancement to a higher level of functioning(NANDA, 2009) and (Denehy & Poulton, 1999)
6Components of a Nursing Diagnosis 1. Label or Name and definition2. Related Factors OR Risk Factors3. Defining Characteristics1. A label or name and definition: the label is selected base upon a) matching the related factors or defining characteristics and the definition of the label validates your decision.2. Related factor(s) which describe conditions antecedent to or associated with the diagnosis ORRisk factor(s) which describe the environmental factors and physiologic ,genetic or chemical elements that increase the vulnerability of a (client) to an unhealthful event ( NANDA, 2009)3. Defining characteristics, which are observable signs and symptoms that are manifestations of the diagnosis (Denehy & Poulton. 1999)a definition does not need to be written in the care plan. It is there to help you decide if this Nursing Diagnosis is appropriate for this patient.Related factors are elements that have an effect on the person, family or community, either internal or external, that contribute to the problemDefining Characteristics are subjective or objective s&s indicating the presence of a condition“Risk for” Nursing Diagnosis’ do not need to include defining characteristics, because at this time there is no evidence that the condition exists. There is only a possibility the condition could exist.
7Case Study 4 year old boy with ALL Admitted one week after chemo with a fever of 102.5FWBC is 0.3,absolute neutrophil count is zeroNew central line placed 10 days agoC/O nausea & vomitingCries and hides behind mother when approach by nursing staffNursing diagnoses are chosen by using this subjective and objective data.
8Examples1. Risk for infection related to immunosuppression secondary to chemotherapy, inadequate primary defenses (central venous catheter),chronic disease (ALL)and developmental level.Definition of the label: At increase risk for being invaded by pathogenic organisms ( NANDA,2009)
9Was our choice correct?Definition of the label: At increased risk for being invaded by pathogenic organismsRisk Factors:Insufficient knowledge to avoid exposure to pathogens (developmental level)Inadequate secondary defenses (leukopenia)Inadequate primary defenses (broken skin from newly placed central line)Pharmaceutical Agents (immunosuppressant, i.e. chemotherapy)(NANDA,2009)There are no defining characteristics for this diagnosis since it is a “Risk for” Nursing Diagnosis. More on that later.
10Examples2. Nausea related to chemotherapy as evidenced by vomiting, patient c/o “tummy ache” and aversion toward food.Other pertinent Nursing Diagnosis’
11Examples3. Fear related to unfamiliarity with environmental experiences as evidenced by avoidance behaviors (hides behind mother) and crying.A pertinent Growth and Development NDNote defining characteristics.
12NOCThe nursing outcomes classification (NOC) is a classification of nurse sensitive outcomesNOC outcomes and indicators “allow for measurement of the patient, family, or community outcome at any point on a continuum from most negative to most positive and at different points in time.” ( Iowa Outcome Project, 2008)“The use of NOC outcomes provides a quantitative measure of the [patient's] progress that is easy for all health care providers to understand and use.“ (Denehy and Poulton)
13ComponentsA neutral label or name used to characterize the behavior or patient statusA list of indicators that describe client behavior or patient status.A five point scale to rate the patient‘s status for each of the indicatorsThe NOC outcome label indicates the behavior or status to be monitored.When using NOC Outcomes, You must use the label and definition as written, but the outcome can be individualized by selecting only the appropriate indicators or adding additional indicators if needed (Denehy and Poulton)
14NANDA/NOC LinkageEach nursing Diagnosis is followed by a list of suggested outcomes to measure whether the chosen interventions are helping the identified problemEach outcome can be individualized to the patient or family by choosing the appropriate indicators or adding additional indicators as necessary
15NOC examples: Linked with “Risk for Infection” Immune Status (0702)Infection Severity (0703)Knowledge: Infection Control (1807)Nutritional Status (1004)Tissue Integrity: Skin & Mucous membranes (1101)Wound Healing: Primary Intention (1102) Location of wound (#4, Front of Neck)
16Immune Status (0702)Definition: Natural and acquired appropriately targeted resistance to internal and external antigens.1=severely compromised thru 5= not compromisedAbsolute WBC values WNLDifferential WBC values WNLSkin integrityMucosa integrityBody temperature IERGastrointestinal functionThe scale applies to each outcome indicator in above exampleie. WBC count would be rated at a “1” since it is <1.0K and the differential cannot be measured
17Immune Status (Continued) 1= severe thru 5= NoneRecurrent InfectionsWeight LossTumors (Immature WBC’s)(NOC, 2004 p.322)Other NOC outcome labels that may apply are:Wound healing primary IntentionKnowledge: infection control
19NIC“The nursing interventions classification (NIC) is a comprehensive, standardized language describing treatments that nurses perform in all settings and in all specialties.” (Iowa Intervention Project, 2008)NIC was developed based on existing practice and research and was designed in an easy to use organizing structure, using language that is familiar and clinically useful.
20InterventionsDefinition: “any treatment based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes.” (Iowa Intervention Project, 2000,p.3)Note in the language the linkage to patient/client outcomes.
21Components Name or label A definition A set of activities the nurse does to carry out the intervention**Students should include the name/label of the intervention and all of the appropriate individualized activities.
22NANDA/NIC LinkageEach NANDA diagnosis is followed by a list of suggested interventions for resolving the identified problemInterventions and activities should be chosen to meet the individual clients needsActivities can be further individualized by adding client specific informationAdditional activities may be added if appropriate** Some interventions and activities are more general than others. Activities can be further individualized by adding pertinent information concerning that individual client. i.e # cc’s of fluid per day required for maintenance listed with “Encourage Fluids”** When using NIC interventions, you must use the NIC label and definition as written, but care can be individualized by selecting only those activities that are needed, adding more specific information to an activity or by creating additional activities as appropriate.**Interventions or activities may be direct or indirect. Both are to benefit the patient/ client outcome.
23NIC Examples: Linked with “Risk for Infection” 6550 infection protection1100 nutrition management3590 skin surveillance6650 surveillance3660 wound careExamples
24Infection Protection 6550Definition: Prevention and early detection of infection in a patient at riskActivities:Monitor for systemic and localized s & sx of infection (central line site check every 4 hours.)Monitor WBC, and differential results (qd or qod)Follow neutropenic precautionsProvide a private roomLimit number of visitorsA detailed example: The details, such as frequency of the activity are determined by institution-specific protocols or by age/weight specific information found in textbooks. Other specific details may be added by gathering input from the patient and/or family. The items in red/orange are those that were added to individualize the nursing activity for this particular patient.
25Infection Protection (Cont.) Activities (Cont.)Screen all visitors for communicable diseaseMaintain asepsisInspect skin and mucous membranes for redness, extreme warmth or drainage (q4 hours)Inspect condition of surgical incision ( central line insertion site q 4 hours)Obtain cultures, as needed (Blood cultures prn T>38.3 C q 24 hours) Central line site)Promote Nutritional intake (1500 kcal per day, Pt. likes cereal)
26Infection Protection (cont.) Activities (cont.)Encourage fluid intake (1225 cc per day, Pt likes orange Gatorade)Encourage rest (naps every afternoon from 1-3 PM, bedtime at 2030)Monitor for change in energy level/malaiseInstruct patient to take anti-infective as prescribed(Bactrim BID, po, MTW and Nystatin 5cc,s & s, TID)Teach Family about s & sx of infection and when to report them to HCP(NIC, 2008)If there is something that the nurse feels needs to be added, then she should rely on her own clinical decision making skills and add additional activity(ies) as necessary.
27Sample Care Plan using Case Study NANDA Nursing DiagnosesNOC Outcomes and IndicatorsNIC Intervention Label and select nursing activitiesRisk for infection related to immunosuppression secondary to chemotherapy, inadequate primary defenses (central venous catheter), chronic disease (ALL) and developmental level.0702Immune StatusDefinition: Natural and acquired appropriately targeted resistance to internal and external antigens.1=severely compromised thru 5= not compromisedAbsolute WBC values WNL(within normal limits)Differential WBC values WNL(within normal limits)Skin integrityMucosa integrityBody temperature IER( in expected range)Gastrointestinal functionRespiratory FunctionGenitourinary Function1= severe thru 5= NoneRecurrent InfectionsWeight LossTumors (ImmatureWBC’s)(NOC, 2008 p.399)6550 infection protectionDefinition: Prevention and early detection of infection in a patient at riskActivities:Monitor for systemic and localized signs & symptoms of infection (central line site check every 4 hours.)Monitor WBC, and differential results (qod)Follow neutropenic precautionsProvide a private roomLimit number of visitorsScreen all visitors for communicable diseaseMaintain asepsisInspect skin and mucous membranes for redness, extreme warmth or drainage (q4 hours)Inspect condition of surgical incision(central line insertion site q 4 hours)Obtain cultures, as needed (Blood cultures prn T>38.3 C q 24 hours) Central line site)Promote Nutritional intake (1500 kcal per day, Pt likes cereal)Encourage fluid intake (1225 cc per day, Pt likes orange Gatorade)Encourage rest (naps daily 1-3 PM, bedtime t 8:30 PM)Monitor for change in energy level/malaiseInstruct patient to take anti-infective as prescribed(Bactrim po BID; Nystatin 5cc,swish & swallow, TID)Teach Family about s & symptoms of infection and when to report them to HCP-Teach patient and family how to avoid infections(NIC, 2008)
28Sample Blank CareplanNursing Diagnosis and Interventions: Choose the highest priority Nursing Diagnosis as indicated on the clinical reasoning web.Include problem statement (NANDA), related to or risk factors (etiology), and defining characteristics (as evidenced by or AEB) as appropriate.List all of the appropriate NOC Outcome labels and indicators and NIC intervention labels and nursing activities which will best help your client achieve those outcomes.List the rationale for each and determine where your client falls on the outcome indicator scale (1-5) at the specified time intervals.In the final column summarize why you gave your client the indicator scores that were given and any changes in your care plan that should be made.Briefly describe how the plan of care is helping the patient meet the desired outcomes and any changes that need to be made:Nanda Nursing DiagnosisNOC Outcome Label(s) and indicatorsRationale for NOC chosenand indictor scoreNIC Intervention label(s) and nursing activitiesRationale for NIC ChosenComplete NANDA Nursing Dx Statement including related or risk factors and defining characteristicsNOC label and appropriate indicators and rating on scale with date (s)Describe your rationale for choosing this NOC label and the indicator ratings that you chose for this patient.NIC label and appropriate activities with individualized information added.Describe your rationale for choosing this NIC label
29ReferencesDenehy,J. & Poulton,S. (1999) Journal of School Nursing, 15 (1),Iowa Intervention Project (2008). Nursing interventions and Classification (NIC). (4th ed.) St. Louis: Mosby, Inc.Iowa Outcomes Project (2008). Nursing outcomes classification (NOC). (3rd ed.) St. Louis: Mosby, Inc.NANDA Nursing Diagnosis: Definitions and Classifications (2009). Indianapolis, IN: Wiley-Blackwell.
30References (cont.)Pesut, D. & Herman, J. (1999) Clinical Reasoning: The Art & Science of Critical and Creative Thinking. Albany, NY: Delmar Publishers.Schoenfelder, Deborah (2004). Nursing outcomes classification (NOC). Appendix F. (2004) St. Louis: Mosby, Inc.Van De Castle, B. (2003) Comparisons of Nanda/NIC/NOC linkages between experts and nursing students. International Journal of Terminologies and Classifications 14(4)