1. NS 3910 Fall 2011 Concept Maps Concept Maps

2. Definition  CONCEPT-means idea  An alternative non-linear approach to planning and organizing nursing care  It is a visual diagram of concepts relating to patient problems and interventions

3. Purpose of Concept Maps  Organize patient data  Analyze relationships in the data  Establish priorities  Build on previous knowledge  Identify what you do not understand  Enable you to take a holistic view of the patient’s situation

4. Steps In Concept Mapping  Use the nursing process as the foundation of the concept care map:  Concept Map  ASSESSMENT  DIAGNOSIS (NANDA)  Care Plan  PLANNING  IMPLEMENTING  EVALUATING

5. Preparation for Concept Mapping: Assessment Assessment:  Assessment is the stage where you collect clinical data (as you know!)  Review patient records to determine current health problems, medical diagnoses and histories, physical assessment data, medications, treatments, lab results  Collect subjective data from the patient  Collect your data in any systematic fashion (eg. Head-to- toe, Orem, Newman, etc.)

6. Step One: Develop a Basic Skeleton Diagram Reason for needing health care Medical dx/surgical procedure Key assessments I don’t know how this fits with the info Key problem #

7. Step Two: Analyze and Categorize Data  Organizing data helps you provide evidence to support the nursing diagnosis you have made  You need to identify and group the most important data related to the patient’s reason for seeking health care  Nursing diagnoses flow outward from the patient’s reason for seeking health care

8. Reason for needing health care Bowel obstruction Key assessments Pain Distention No bowel sounds 80 years and Fragile I don’t know how this fits with the info (uses walker, frail looking) Key problem # Supporting assessment data Key problem Imbalanced nutrition, less than body requirements related to ineffective GI tissue perfusion Supporting assessment data Abd. Distention, NPO, NG tube, IV, 155 cm/62 kg; weak, anemia (Hgb 100) Key problem # Supporting assessment data Key problem # Supporting assessment data

9. Step Three: Label and Analyze Nursing Diagnosis Relationships  Prioritize by numbering or colouring or some other method  Draw lines between the concepts that relate and use linking words to show association

10. Reason for needing health care Bowel obstruction Key assessments Pain Distention No bowel sounds 80 years and Fragile I don’t know how this data fits Key problem #3: Anxiety Supporting assessment data: voices fear of possible surgery Key problem # 1: Imbalanced nutrition, less than body requirements related to ineffective GI tissue perfusion Supporting assessment data Abd. Distention, NPO, NG tube, IV, 155 cm/62 kg; weak, anemia (Hgb 100) Key problem# 2: Pain Supporting assessment data Rates pain 8/10; facial grimacing, abd. Tender to touch Key problem #4 Supporting assessment data

11. Reason for needing health care Bowel obstruction Key assessments Pain Distention No bowel sounds 80 years and Fragile Key problem #3: Anxiety Supporting assessment data: voices fear of possible surgery; pulse 100; BP 145/96 Key problem # 1: Imbalanced nutrition, less than body requirements related to ineffective GI tissue perfusion Supporting assessment data Abd. Distention, NPO, NG tube, IV N/S @ 150cc/hr, 155 cm/62 kg; weak, anemia (Hgb 100) Key problem# 2 : Pain related to pressure from abdominal distention Supporting assessment data Rates pain 8/10; facial grimacing, abdomen tender to touch and distended Key problem #4 Activity intolerance, risk for falls Supporting assessment Data Uses walker to ambulate Unsteady on feet Pain in abdomen affecting ambulation On narcotic analgesics Morphine 5 mg sc q 3h prn Lorazepam 1 mg po q6h prn Pain can lead to negative emotions (anxiety) which can intensify pain perception (Lewis et al., 2010) Medical diagnosis Rationale Medications Nursing Diagnosis

12. Step Four: Identify Goals Outcomes and Interventions  Write the patient goals and outcomes and then list nursing interventions to attain the outcomes for each of the diagnoses on your map  For the purposes of this course, the goals, NOC, NIC, and evaluation/reassessment will be done on a separate care plan sheet

13. Problem #: 3 Anxiety Goal: Decreased anxiety  Predicted outcome: Pt. will verbalize concerns on the day of care Nursing InterventionsPatient responses Therapeutic communication, especially empathy distraction, active listening (Lewis et al., 2010) Verbalizes concerns about dying Guided imagery to distract patient from anxious feelings (Austin & Boyd, 2010) States it helps her relax Teach slow deep breathing to control level of anxiety (Lewis et al., 2010) Appeared more relaxed, less grimacing Expressive touch (O’Lynn & Krautscheid, 2011) Held my hand when talking

14. Step Five: Evaluation  Summarize patient progress toward outcome objectives  Goal met: Patient responded to anxiety interventions by verbalizing concerns  Goal partially met: Patient talked about concerns but remains moderately anxious about outcome of surgery. Reassessment – ask nurses on night shift to talk to him about concerns  Goal not met: Patient refused to talk about concerns of upcoming surgery. Reassessment – have wife talk to him about concerns and relay information to nurses. Have surgeon talk to him about surgery.

15. Put It All Together and hand in to us Developed by Liz Richard, MN, RN – August, 2011