1. Care Planning The Who, What, Why, and How of Care Plans for Nurses © AusmedOnline PPPRES30v1.0July 2010 1

2. By the end of this presentation, you should be able to: Explain what a care plan is. Identify the steps of the nursing process. Describe why care plans are necessary. Understand the need for a universal nursing language for care planning and documentation requirements. Understand how to use care plans in your own practice. Objectives © AusmedOnline PPPRES30v1.0July 2010 2

3. What Is A Care Plan? The Nursing Process (ADPIE):  Background  Assessment  Diagnosis  Planning  Implementation  Evaluation Documentation Case Studies Resources To Help Create Care Plans References Contents July 2010 3 © AusmedOnline PPPRES30v1.0

4.  A care plan is a document that outlines the nursing care that is planned for a patient.  Care plans evolved as a way for nurses to monitor nursing care and to communicate between incoming and outgoing shifts (Arets and Morle, 1995).  Care plans ensure that nursing care is planned, measured, documented, and evidence-based, and that outcomes are examined regularly (Greenwood, 1996). What is a Care Plan? July 2010 4 © AusmedOnline PPPRES30v1.0

5. Care plan formats vary from facility to facility. Generally, a care plan has sections that correspond to each step of the nursing process (ADPIE). You will document your observations and choices in the spaces. Usually, there is a care plan for each nursing diagnosis. What Does a Care Plan Look Like? July 2010 5 © AusmedOnline PPPRES30v1.0

6. Sample Care Plan July 2010 6 © AusmedOnline PPPRES30v1.0

7. ‣ Care planning is an ongoing, dynamic process. It makes no sense to make a care plan, and then leave it to collect dust. As the patient’s situation changes, so should the care plan. ‣ Care plans are not static. They are modified, updated, corrected and extended according to the patient’s changing needs. Care Planning is Ongoing July 2010 7 © AusmedOnline PPPRES30v1.0

8. Your patient is 5 days post-op for total knee replacement. Her care plan, written 1 day post-op, states that she requires a one-person assist to ambulate. However, she has progressed to ambulating independently with a walker. Does it make any sense for the care plan to indicate that she requires a one-person assist? Of course not. This is why we reassess and update the care plan on a regular basis. Example July 2010 8 © AusmedOnline PPPRES30v1.0

9. Nurses develop individualized care plans for each patient with a series of defined steps called the nursing process. Therefore, to develop care plans, you have to know what the nursing process is. Where Do Care Plans Come From? July 2010 9 © AusmedOnline PPPRES30v1.0

10. The nursing process is: “a conceptual process that enables the student or the practicing nurse to think systematically and process pertinent information about the patient” -(Huckabay, 2009) What is the Nursing Process? July 2010 10 © AusmedOnline PPPRES30v1.0

11. “The purpose of the nursing process is to provide a systematic approach for processing patient care information for handling actual or potential patient care problems.” (Huckabay, 2009) The Nursing Process: Purpose July 2010 11 © AusmedOnline PPPRES30v1.0

12. The term “nursing process” was coined in the United States in the 1950s and gradually made its way into nursing curriculums around the world (Hughes, Lloyd & Clark, 2008). Use of a universal nursing process helps nurses achieve greater autonomy and professionalism (Henderson, 1982). The Nursing Process: Background July 2010 12 © AusmedOnline PPPRES30v1.0

13.  The nursing process addresses the need for nursing care to be:  Holistic  Individualized  Evidence-based  Documented The Nursing Process: Background July 2010 13 © AusmedOnline PPPRES30v1.0

14. ‣ When you learn the nursing process, you learn how to collect patient data systematically, how to analyze that data and how to plan patient care based on your analysis (Huckabay, 2009). ‣ Another way to describe this process is critical thinking, through constant analyzing and revisiting information (Castledine, 2010). The Nursing Process: Background July 2010 14 © AusmedOnline PPPRES30v1.0

15. Historically, the nursing process has had several formats. The gold standard is ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation) (Pesut & Herman, 1999). The Nursing Process: ADPIE July 2010 15 © AusmedOnline PPPRES30v1.0

16. Remember the 5 steps of the nursing process with this acronym: ADPIE The Gold Standard July 2010 16 © AusmedOnline PPPRES30v1.0

17. A ssessment D iagnosis P lanning I mplementation E valuation What Does ADPIE Stand For? July 2010 17 © AusmedOnline PPPRES30v1.0

18. A ssessment This is what you find when you examine and talk to the patient. It is an ongoing process. (Wright, 2005). For example: “The patient has dry, cracked lips, dry mucous membranes and low urine output. The patient’s skin turgor is slow to return and the patient states that he is thirsty.” The Nursing Process (ADPIE): Assessment July 2010 18 © AusmedOnline PPPRES30v1.0

19. D iagnosis (defining problem) This is a description of what the nursing problem is. The language may be your own, or chosen from a list of over 200 standardized nursing diagnoses from the North American Nursing Diagnosis Association (NANDA) (Palese, et al., 2009). The Nursing Process (ADPIE): Diagnosis July 2010 19 © AusmedOnline PPPRES30v1.0

20. Your assessment findings are often included in the nursing diagnosis, using the phrase “as evidenced by”. The nursing diagnosis is what you determine to be an actual or potential reaction to the patient’s state of being. The diagnosis also helps guide you towards appropriate interventions. The Nursing Process (ADPIE): Diagnosis July 2010 20 © AusmedOnline PPPRES30v1.0

21. The nursing diagnosis is not a medical diagnosis, such as diagnosis of a disease or health condition. Rather, it is a description of the patient’s response to their current situation. That is, “multiple sclerosis” is a medical diagnosis, not a nursing diagnosis. “At risk for powerlessness due to disease process” is a nursing diagnosis (NANDA, 2010). The Nursing Process (ADPIE): Diagnosis July 2010 21 © AusmedOnline PPPRES30v1.0

22.  For the patient we assessed earlier, the NANDA nursing diagnosis would be: Deficient fluid volume You would individualize by adding “as evidenced by dry mucous membranes, low urine output, slow-to-return skin turgor and expressed feelings of thirst”. This is our nursing diagnosis! (Gulanick et al., 2006) The Nursing Process (ADPIE): Diagnosis July 2010 22 © AusmedOnline PPPRES30v1.0

23.  P lanning Describes what you expect will occur for the patient. It can be helpful to think of this step as Goals or Outcomes.  I mplementation Describes what you plan to do to meet the patient’s needs, guided in part by your NANDA diagnosis (Hughes, et al., 2008). Sometimes termed Interventions. The Nursing Process (ADPIE): Planning and Implementation July 2010 23 © AusmedOnline PPPRES30v1.0

24. Use the acronym SMART to guide your Planning and Implementation:  S pecific  M easureable  A chievable  R ealistic  T ime-specific (Wright, 2005) The Nursing Process (ADPIE): Planning and Implementation July 2010 24 © AusmedOnline PPPRES30v1.0

25.  Nursing Outcome Classifications (NOC) is standardized language available to describe Planning, similar to NANDA for Diagnosis.  For our patient example, appropriate NOC terminology for Planning (desired outcome) is: Fluid balance (Kautz et al., 2006) The Nursing Process (ADPIE): Planning July 2010 25 © AusmedOnline PPPRES30v1.0

26.  Nursing Interventions Classification (NIC) is standardized language available to describe Implementation, again similar to NANDA for diagnosis.  For our patient example, appropriate NIC terminology for Implementation is: Measure intake and output (Kautz et al., 2006) The Nursing Process (ADPIE): Implementation July 2010 26 © AusmedOnline PPPRES30v1.0

27. For our patient with a nursing diagnosis of deficient fluid volume, our plan is to achieve fluid balance, and so far, our implementation is to measure input and output. What other interventions might be appropriate? The Nursing Process (ADPIE): Implementation Practice July 2010 27 © AusmedOnline PPPRES30v1.0

28. Additional interventions:  Daily weights  Vital signs  Encourage oral fluid intake  Administer IV fluids as ordered The Nursing Process (ADPIE): Implementation Practice July 2010 28 © AusmedOnline PPPRES30v1.0

29. Planning and Implementation must be evidence- based. You communicate the evidence base for your choices by giving a rationale. In nursing school, you need to provide the rationale and references to show your instructors that you are utilizing the nursing process. Most workplaces do not require a stated rationale or references on care plans. The Nursing Process (ADPIE): Planning and Implementation July 2010 29 © AusmedOnline PPPRES30v1.0

30. A rationale for measuring urinary output for the patient in our example is: Reduced urinary output can indicate dehydration. Normal urinary output is considered to be >30 mL per hour for an adult (Berman, et al., 2008). The Nursing Process (ADPIE): Planning and Implementation July 2010 30 © AusmedOnline PPPRES30v1.0

31. E valuation This is when you review your patient’s progress to see if your interventions were effective. Your evaluation may indicate you need to change your approach to achieve your planned goals (outcomes). (Wright, 2005) The Nursing Process (ADPIE): Evaluation July 2010 31 © AusmedOnline PPPRES30v1.0

32. Perform evaluations as often as necessary to keep track of your patient’s progress and changing needs. Usually, this translates to once a shift (or more often) in an acute, in-patient setting, and monthly or quarterly in a nursing home. The Nursing Process (ADPIE): Evaluation July 2010 32 © AusmedOnline PPPRES30v1.0

33. You use the nursing process to generate care plans. Care plans must be documented. Care plans are legal documents and should be treated accordingly. When you make additions or changes to a care plan, initial all entries to ensure you are recognized for your contribution, and you leave a record of your actions. Documentation July 2010 33 © AusmedOnline PPPRES30v1.0

34. DO: Sign (or initial) and date all changes or entries to the care plan so that it is clear who made the revisions or changes. DO: Review your care plan on a regular basis. The frequency of your review really depends on the setting, the situation and your employer’s policies. Documentation Do’s July 2010 34 © AusmedOnline PPPRES30v1.0

35. DON’T use white out on a paper care plan. Cross out an error with one line (so your error remains legible), write the word ‘error’ and add your initials. For electronic records, follow your facility’s policy. DON’T attempt to delete or remove unsuccessful interventions from a care plan. You will adapt your care according to your evaluations, and this should be reflected in your documentation. Documentation Don’t’s July 2010 35 © AusmedOnline PPPRES30v1.0

36. ‣ This is when one documents abnormal findings only. If there is no documentation, normal findings are assumed. ‣ This approach may reduce repetition, subjective observations, and documentation time. (Short, 1997; Cummins, 1999) Documentation by Exception July 2010 36 © AusmedOnline PPPRES30v1.0

37. Documentation by exception assumes: ‣ That each nurse’s definition of “normal” is consistent and universal. ‣ That you have proof of your assessment, even if you do not chart all of it. Documentation by Exception July 2010 37 © AusmedOnline PPPRES30v1.0

38. As nurses, we have a duty to produce accurate records of what we find and what we do. If it is not documented, it has not happened. Documentation by Exception: Caution July 2010 38 © AusmedOnline PPPRES30v1.0

39. ‣ You may want to document all of your findings, normal or otherwise, regardless of the facility’s policy. Your employer’s policy is important, but no one should fault you for doing more than the minimum requirement. ‣ Ensure that you cover yourself legally with your documentation. Ask yourself if you could accurately describe a situation years later in court, based only on your charted notes. Documentation by Exception: Caution July 2010 39 © AusmedOnline PPPRES30v1.0

40. Documentation: Examples Poor Charting Skin normal Heart sounds normal Pulse good, 65 BPM No documentation of pain Skin pink, warm, dry and no visible injuries S1, S2 heard with no adventitious sounds Left radial pulse strong and regular, 65 BPM Patient denies any pain at present July 2010 40 © AusmedOnline PPPRES30v1.0 Accurate Charting

41. Care plans: ‣ Define how we look at patients and approach their care. ‣ Force us to really think about what we are doing with patients, and why we are doing it. ‣ Provide a structure for constant reassessment of the plan for patient care (Wright, 2005). ‣ Are a valuable communication tool among nurses and other health professionals (Greenwood, 1996). ‣ Help maintain consistency of care. What Are Care Plans REALLY For? July 2010 41 © AusmedOnline PPPRES30v1.0

42. ‣ Some facilities have electronic care planning resources. ‣ Some believe that the electronic care plan will revolutionize care planning, and enhance the care planning process. ‣ Some feel that nursing care plans are unnecessary. (Greenwood, 1996; Kennedy, et al., 2009; Lieber, 2010) Modern Care Planning July 2010 42 © AusmedOnline PPPRES30v1.0

43. ‣ Most experts, including nursing licensing bodies and regulators, believe that care plans are essential (Greenwood, 1996). ‣ Imagine working in an unfamiliar area, or starting an orientation period on a new floor. An existing care plan allows you to plan your care. It also helps other, experienced nurses know how to help you. Modern Care Planning July 2010 43 © AusmedOnline PPPRES30v1.0

44. The following case studies should help you understand the process behind creating a care plan. They are not meant to be comprehensive. They are only a small part of the bigger picture. Let’s Practice: Case Studies July 2010 44 © AusmedOnline PPPRES30v1.0

45. Remember, your Planning and Implementation should be:  S pecific  M easureable  A chievable  R ealistic  T ime-specific (Wright, 2005) Remember to be SMART July 2010 45 © AusmedOnline PPPRES30v1.0

46. Assessment: Two days ago, your patient had a open reduction internal fixation of a fractured right humerus. The patient is right-handed, and gets regularly scheduled and prn pain medication as ordered. Diagnosis: Acute pain related to surgical intervention and bone fracture as evidenced by: complaints of pain, patient exhibits facial expressions of pain, and patient reluctant to move right arm (which is casted). (Doenges et al., 2004) Case Study #1: Post-surgical Patient July 2010 46 © AusmedOnline PPPRES30v1.0

47. Case Study #1: Post-surgical Patient July 2010 47 © AusmedOnline PPPRES30v1.0

48. Planning: Relevant NOC outcomes include comfort level, medication response, and pain level. Sample outcome: Patient will report adequate pain relief and comfort throughout the shift. (http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/) Case Study #1: Post-surgical Patient July 2010 48 © AusmedOnline PPPRES30v1.0

49. Case Study #1: Post-surgical Patient July 2010 49 © AusmedOnline PPPRES30v1.0

50. Implementation: Relevant NIC interventions include analgesic administration and pain management. Sample interventions: Assess pain by asking patient to rate pain on scale of 1 to 10 every 3 hours or as indicated. Administer pain medication as ordered to maximize comfort. Rationale: Pain is subjective, so the patient is the best source of information regarding pain. Regular pain medication can prevent pain from escalating and may result in less overall use of pain medication (Gulanick, et al., 2006). (http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/) Case Study #1: Post-surgical Patient July 2010 50 © AusmedOnline PPPRES30v1.0

51. Case Study #1: Post-surgical Patient July 2010 51 © AusmedOnline PPPRES30v1.0

52. Evaluation: The patient reported pain levels that reached a maximum of 6/10, and prn pain medication was given twice during your shift. The patient was able to communicate to staff when the pain was not tolerable. Was this intervention successful? Case Study #1: Post-surgical Patient July 2010 52 © AusmedOnline PPPRES30v1.0

53. Case Study #1: Post-surgical Patient July 2010 53 © AusmedOnline PPPRES30v1.0

54. Assessment: Your 67-year-old patient has chronic COPD exacerbated by pneumonia. He is receiving oxygen by nasal prongs at 4 L per minute. He has a productive cough with yellow/green sputum. Diagnosis: Impaired gas exchange (ventilation or perfusion imbalance) related to disease process (pneumonia) (Gulanick et al., 2006). Case Study #2: Respiratory Patient July 2010 54 © AusmedOnline PPPRES30v1.0

55. Case Study #2: Respiratory Patient July 2010 55 © AusmedOnline PPPRES30v1.0

56. Planning: Relevant NOC outcomes include respiratory status and gas exchange Sample outcome: The patient will maintain oxygen saturation levels above 90% at all times. (Gulanick et al., 2006; http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor) Case Study #2: Respiratory Patient July 2010 56 © AusmedOnline PPPRES30v1.0

57. Case Study #2: Respiratory Patient July 2010 57 © AusmedOnline PPPRES30v1.0

58. Implementation: Potential NIC interventions include respiratory monitoring, oxygen therapy, and airway management Sample implementation: Monitor oxygen saturation continuously with a finger probe. Assess chest sounds and vital signs every shift and if patients shows signs of respiratory distress. Encourage patient to cough and deep breathe at least every hour. Continue oxygen as ordered. (http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor) Case Study #2: Respiratory Patient July 2010 58 © AusmedOnline PPPRES30v1.0

59. Rationale: Vital signs are affected by hypoxia. Respiratory rate can affect gas exchange and indicate compensation for low oxygen levels. Adventitious chest sounds can indicate atelectasis. Pulse oximetry levels under 90% in a patient with COPD may indicate a need to increase oxygenation. Retained sputum can contribute to poor gas exchange. (Berman, et al., 2008) Case Study #2: Respiratory Patient July 2010 59 © AusmedOnline PPPRES30v1.0

60. Case Study #2: Respiratory Patient July 2010 60 © AusmedOnline PPPRES30v1.0

61. Evaluation: The patient maintained oxygen saturation above 90% throughout the shift and was able to clear numerous secretions by coughing. There were no adventitious lung sounds. Oxygen administration remains at 4 L per minute by nasal prongs. Were the interventions successful? Case Study #2: Respiratory Patient July 2010 61 © AusmedOnline PPPRES30v1.0

62. Case Study #2: Respiratory Patient July 2010 62 © AusmedOnline PPPRES30v1.0

63. Assessment: Your 82-year-old patient scores 20/30 on a mini-mental exam. The family tells you that he often forgets what day it is, and easily gets lost in unfamiliar places. Diagnosis: Chronic confusion as evidenced by impaired short-term memory, disorientation to time, person, place or events (Townsend, 2004), and personality changes (Doenges et al., 2004). Case Study #3: Geriatric Patient July 2010 63 © AusmedOnline PPPRES30v1.0

64. Case Study #3: Geriatric Patient July 2010 64 © AusmedOnline PPPRES30v1.0

65. Planning: Relevant NOC outcomes include cognitive orientation, decision making, and safety behaviour: home physical environment. Sample outcome: The patient’s degree of mental impairment will be monitored regularly and adequate support will be provided if his functioning declines. (http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor) Case Study #3: Geriatric Patient July 2010 65 © AusmedOnline PPPRES30v1.0

66. Case Study #3: Geriatric Patient July 2010 66 © AusmedOnline PPPRES30v1.0

67. Implementation: Relevant NIC interventions include dementia management, environmental management: safety, and family involvement protection. (http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor) Case Study #3: Geriatric Patient July 2010 67 © AusmedOnline PPPRES30v1.0

68. Some potential interventions for each office visit: ‣ Assess degree of impairment with mini-mental status exam. ‣ Assess level of anxiety. ‣ Note changes in personal hygiene or behavior. ‣ Talk with family members regarding changes in behaviors. ‣ Identify areas of physical care in which the patient needs assistance. (http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor) Case Study #3: Geriatric Patient July 2010 68 © AusmedOnline PPPRES30v1.0

69. Case Study #3: Geriatric Patient July 2010 69 © AusmedOnline PPPRES30v1.0

70. Rationale: Can you supply rationales for these interventions? Evaluation: Will occur at future office visits. You will reassess the patient’s condition and adjust the care plan accordingly. Case Study #3: Geriatric Patient July 2010 70 © AusmedOnline PPPRES30v1.0

71. Case Study #3: Geriatric Patient July 2010 71 © AusmedOnline PPPRES30v1.0

72. ‣ Not every workplace enforces the use of care plans. You can still use them, regardless of policy. ‣ Care plans will improve the quality of your patient care, even if you have to manually add brief care plans to your progress notes. Day-to-Day Use of Care Plans July 2010 72 © AusmedOnline PPPRES30v1.0

73. ‣ NANDA, NOC and NIC provide a universal language for care plans, which improves consistency and understanding among caregivers. ‣ You may find the same interventions are recommended in different care plans for the same patient. Try to not repeat yourself when preparing care plans. (Adams-Wending, et al., 2008) Day-to-Day Use of Care Plans July 2010 73 © AusmedOnline PPPRES30v1.0

74. Books: Crofton, Christine, & Witney, Gaye, ‘Nursing Documentation in Aged Care’, Ausmed Publications, 2004. Richmond, Jennifer,. ‘Nursing Documentation – writing what we do’, Ausmed Publications 1997. Free access to information about NOC and NIC: http://www.nursing.uiowa.edu/excellence/nursing_knowledge/clinical_effecti veness/noc.htm NANDA web site: http://www.nanda.org/ Contains the NANDA diagnoses and classifications for 2009-2011: http://www.amazon.ca/gp/product/1405187182/ref=pd_lpo_k2_dp_sr_3?pf_rd_p =485327511&pf_rd_s=lpo-top- stripe&pf_rd_t=201&pf_rd_i=0323039545&pf_rd_m=A3DWYIK6Y9EEQB&pf_rd _r=1H2K1EM4DGHSEYBFC6DE Care Plan Resources July 2010 74 © AusmedOnline PPPRES30v1.0

75. Free download of a searchable NANDA diagnosis program for PDAs: http://www.pdacortex.com/Nursing_Diagnosis_Download.htm Care planning reference book: http://www.amazon.com/exec/obidos/ASIN/0323016278/medismartcom Free online care plan generator – uses NANDA, NOC, and NIC: http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/ Free online care plan generator – uses NANDA, NOC, and NIC: http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/H- O.html Care Plan Resources July 2010 75 © AusmedOnline PPPRES30v1.0

76. Care planning reference book: http://www.amazon.ca/Nursing-Care-Plans- Diagnosis-Intervention/dp/0323039545 An interactive CD-ROM from Mosby to assist you in producing over 90 different care plans: http://www.amazon.com/exec/obidos/ASIN/0323024025/medismartcom A paid membership site: http://www.careplans.com/ Care Plan Resources July 2010 76 © AusmedOnline PPPRES30v1.0

77. Free sample care plans: http://www.medi-smart.com/carepl10.htm Subscription site for nursing home [residential] care planning: http://www.cncplan.com/ Care planning specifically for MS patients: http://www.cnsonline.org/www/archive/ms/ms-07.html Free tips and comments on nursing care plans: http://www.virtualnurse.com/blog/category/nursing-care-plans/ Care Plan Resources July 2010 77 © AusmedOnline PPPRES30v1.0

78. Application for iPod Touch or iPhone to help formulate care plans: http://itunes.apple.com/ca/app/handbook-nursing- diagnosis/id311016899?mt=8 Nursing diagnosis handbook: http://www.amazon.ca/gp/product/0323048269/ref=pd_lpo_k2_dp_sr_1?pf_ rd_p=485327511&pf_rd_s=lpo-top- stripe&pf_rd_t=201&pf_rd_i=0323039545&pf_rd_m=A3DWYIK6Y9EEQB&p f_rd_r=1H2K1EM4DGHSEYBFC6DE Care Plan Resources July 2010 78 © AusmedOnline PPPRES30v1.0

79. Adams-Wendling, L., Paimjariyakul, U., Bott, M., & Taunton, R. L. (2008). Strategies for translating the resident care plan into daily practice. Journal of Gerontological Nursing, 34 (8), 50-56. Arets, J. & Morle, K. (1995). The nursing process: an introduction. In: Basford, L., Slevin, O., Arets, J., et al. eds. Theory and Practice of Nursing. Edinburgh, Scotland: Campion Press. pp. 304-317. Berman, A., Kozier, B., Erb, G., & Snyder, S.J. (2008). Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice (8th ed.). Upper Saddle River, New Jersey, U.S.A.: Pearson Education, Inc. Accessed at www.statref.com on 17 June 2010. Castledine, G. (2010). Critical thinking is crucial. British Journal of Nursing, 19 (4), 271. Doenges, M. E., Moorhouse, M. F., & Geissler-Murr, A. C. (2004). Nurse’s pocket guide: Diagnoses, interventions and rationales (9 th ed.). Philadelphia, Pennsylvania, U.S.A.: F.A. Davis Company. References July 2010 79 © AusmedOnline PPPRES30v1.0

80. Greenwood, D. (1997). Nursing care plans: Issues and solutions. Nursing Management, 27 (3), 33-40. Gulanick, M., Myers, J. L., & Galanes, S. (2006). Nursing care plans: Nursing diagnosis and interventions, 6 th ed. Toronto, Ontario, Canada: Mosby. Henderson, V. (1982). The nursing process: is the title right? Journal of Advanced Nursing, 7 (2), 103-109. Huckabay, L. M. (2009). Clinical reasoned judgment and the nursing process. Nursing Forum, 44 (2), 72-78. Hughes, R., Lloyd, D., & Clark, J. (2008). A conceptual model for nursing information. International Journal of Nursing Terminologies and Classifications, 19 (2), 48-56. Kautz, D. D., Kuiper, R., Pesut, D. J., & Williams, R. L. (2006). Using NANDA, NIC, and NOC (NNN) language for clinical reasoning with the outcome-present state-test (OPT) model. International Journal of Nursing Terminologies and Classifications, 17 (30), 129-138. References July 2010 80 © AusmedOnline PPPRES30v1.0

81. Kennedy, D., Pallikkathayil, L., & Warren, J. J. (2009). Using a modified electronic health record to develop nursing process skills. Journal of Nursing Education, 48 (20), 96-100. Lieber, H. S. (2010). Balancing act: Technology must be part of an overall patient- care plan. Modern Healthcare, 40 (9), 18. North American Nursing Diagnosis Association (2010). Nursing diagnosis frequently- asked questions. Retrieved from http://www.nanda.org/NursingDiagnosisFAQ.aspx.http://www.nanda.org/NursingDiagnosisFAQ.aspx Palese, A., De Silvestre, D., Valoppi, G., & Tomietto, M. (2009). A 10-year retrospective study of teaching nursing diagnosis to baccalaureate students in Italy. International Journal of Nursing Terminologies and Classifications, 20 (2), 64-75. Pesut, D. J., & Herman, J. (1999). Clinical reasoning: The art and science of critical and creative thinking. New York, New York, U.S.A.: Delmar Cengage Learning. Wright, K. (2005). Care planning: An easy guide for nurses. Nursing and residential care, 7 (2), 71-73. References July 2010 81 © AusmedOnline PPPRES30v1.0