2. C URRENT N URSING P RACTICE Domain of Nursing Practice Wide variety of roles and responsibilities to meet the health care needs of society.

3. C URRENT N URSING P RACTICE Definitions of Nursing(ANA American Nursing Association) Is a 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 advocacy in the care of individuals, families, communities, and populations.

4. C URRENT N URSING P RACTICE Nursing’s View of Humanity -An individual has physiologic, psychologic (or emotional), sociocultural (or interpersonal), spiritual, and environmental components. -No two individuals are exactly alike.

5. C URRENT N URSING P RACTICE Scope of Nursing Practice entry level( work with other health providers), specialty(critical care, pain management, pediatric, psychiatric, med-surg, dialysis), certifications(ongoing: oncology, DM Delivery of Nursing Care Team nursing-team leader Primary nursing-one designated nurse was responsible for planning the pt’s care Managed care-case management Critical thinking Confidence, creativity, flexibility, open minded, intelligent, information seeking, logical reasoning.

6. I NFLUENCES ON FUTURE NURSING PRACTICE Healthy people 2010 Physical activity Overweight and obesity Tobacco use, substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care

7. I NFLUENCES ON FUTURE NURSING PRACTICE

8. Evidence- based practice EBP It is a use of evidence based on research, pt’s assessment, clinical experience, pt’s preferences and values in decision making. JCAHO joint Commission on Accreditation of Health Organizations now requires that practice be based on evidence.

9. I NFLUENCES ON FUTURE NURSING PRACTICE Five steps of the Evidence- based practice EBP 1. Ask question by using PICO format P- patient interest I- Intervention C -Comparison of interest O- Outcome(s) of interest 2. Collect the evidence. 3. Synthesize the evidence. 4. Integrate all evidence in making a decision or change. 5. Evaluate the decision.

10. F IVE STEPS OF THE E VIDENCE - BASED PRACTICE (EBP)

11. S TANDARDIZED N URSING T ERMINOLOGY NANDA-North American Nursing Diagnosis Association www.nanda.orgwww.nanda.org; Appendix B in your textbook NOC- Nursing Outcome Classification www.nursing.uiowa.edu/noc/ Ex: The pt will maintain normal vital signs in respond to activity in 2 days. NIC- Nursing Intervention Classification www.nursing.uiowa.edu/nic/ Ex: Monitor pt’s oxygen response(Vital signs) Encourage, assist, provide, monitor, collaborate with PT and OT, teach, etc…

12. N URSING INFORMATICS Is a specialty nursing science, computer science and information science in collecting, identifying, processing and managing data an information to support nursing practice, administration, education, research, and the expansion of knowledge.

14. N URSING P ROCESS IN N URSING P RACTICE Independent-more autonomous, nurse initiated Dependent-when carrying out med orders, diagnostic tests and orders Collaborative-including nurse, physician, IV med’s, providing emotional support

15. N URSING P ROCESS IN N URSING P RACTICE

16. Assessment Collection of data subjective –interviewing patient; whatever patient says objective-observed and measured

17. N URSING P ROCESS IN N URSING P RACTICE Diagnosis Phase Data analysis and problem identification Nursing diagnoses NANDA nursing

18. N URSING P ROCESS IN N URSING P RACTICE Diagnosis Phase One part statement: Readiness for enhanced nutrition. Two part statement: Imbalanced nutrition: less than body requirements r/t limited income for food purchase. Risk for aspiration r/t impaired swallowing. Three part statement: problem-etiology-signs and symptoms(PES). Pain r/t surgical incision, localized pressure, edema, as evidenced by verbalization of pain, isolation and withdrawal.

19. N URSING P ROCESS IN N URSING P RACTICE Planning Phase Priority setting Identifying outcomes Nursing Outcomes Classification (NOC) Short outcome-The pt will maintain normal VS in response to activity in 2 days. Long outcome- the pt will identify a realistic activity level to achieve or maintain by D/C. Determining interventions Nursing Interventions Classification (NIC) Choosing activities (managing, monitoring, teaching…)

20. N URSING P ROCESS IN N URSING P RACTICE Implementation Phase Delegation and assignment Nursing interventions that require independent nursing knowledge, skills, or judgment, such as assessment, pt teaching, and evaluation of care, cannot be delegated. (Using activates)

21. N URSING P ROCESS IN N URSING P RACTICE

22. Evaluation Phase As a result of evaluation, the nurse determines whether the plan should be maintained or discontinued.

23. N URSING P ROCESS IN N URSING P RACTICE Documentation Nursing care plans Specific directions for carrying out the planned intervention, also used as a teaching /learning tools. Concept maps Visual diagrams for pt problems and interventions Clinical (critical) pathways includes care plan, documentation, interventions