Nursing Dx

The scientific method of problem-solving introduced in the previous section is used almost instinctively by most people, without conscious awareness.

FOR EXAMPLE   While studying for your semester finals, you snack on pepperoni pizza. After going to bed, you are awakened by a burning sensation in the center of your chest.You are young and in good health and note no other symptoms (assessment).You decide that your pain is the result of the spicy food you have eaten (diagnosis).You then determine that before you can return to sleep, you first need to relieve the discomfort with an over-the-counter preparation (planning).You take a liquid antacid for your discomfort(implementation).Within a few minutes, you note the burning sensation is relieved, and you return to bedwithout further concern (evaluation).

As you see, this is a process you routinely use to solve problems in your life that can be readily applied to client-care situations. You need only to learn the new terms describing the nursing process, rather than having to think about each step (assessment, diagnosis/need identification, planning, implementation, and evaluation) in an entirely new way.

To effectively use the nursing process, the nurse needs to possess and apply some basic abilities. Particularly important is a thorough knowledge of science and theory, not only as applied in nursing but also in other related disciplines such as medicine and psychology. Creativity is needed in the application of nursing knowledge as well as adaptability in handling change and the many unexpected happenings that occur. As a nurse, you must make a commitment to practice your profession in the best possible way, trusting in yourself and your ability to do your job well and displaying the necessary leadership to organize and supervise as your
position requires. In addition, intelligence, well-developed interpersonal skills, and competent technical skills are essential.

FOR EXAMPLE   A diabetic client’s irritable behavior could be the result of low serum glucose or the effects of excessive caffeine intake. However, it could also arise from a sense of helplessness regarding life events. A single behavior may have varied causes. It is important that your nursing assessment skills identify the underlying etiology to provide appropriate care.

The practice responsibilities presented in the definitions of nursing and the nursing process are explained in detail in the publication Nursing: Scope & Standards of Practice. The standards provide workable guidelines to ensure that the practice of nursing can be carried out by each nurse. Table 1–1 presents an abbreviated description of the standards of clinical practice. With the ultimate goal of quality healthcare, the effective use of the nursing process will result in a viable nursing-care system that is recognized and accepted as nursing’s body of knowledge and that can be shared with other healthcare professionals.

TABLE 1–1

ANA STANDARDS OF NURSING PRACTICE
Standards of Practice
Describes a competent level of nursing care as demonstrated by the nursing process that encompasses all significant actions taken by the nurse in providing care and forms the foundation of clinical decision making.
1. Assessment:The registered nurse collects comprehensive data pertinent to the patient’s health or situation.
2. Diagnosis:The registered nurse analyzes the assessment data to determine the diagnoses or issues.
3. Outcome Identification:The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation.
4. Planning:The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.
5. Implementation:The registered nurse implements the identified plan.
    a. Coordination of Care:The registered nurse coordinates care delivery.
    b. Health Teaching and Health Promotion:The registered nurse employs strategies to promote health and a  safe environment.
   c. Consultation:The advanced practice registered nurse and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others, and effect change.
   d. Prescriptive Authority and Treatment:The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.
6. Evaluation:The registered nurse evaluates progress toward attainment of outcomes. 

Standards of Professional Performance 

Describes roles expected of all professional nurses appropriate to their education, position, and practice setting.
7. Quality of Practice:The registered nurse systematically enhances the quality and effectiveness of nursing practice.
8. Education:The registered nurse attains knowledge and competency that reflects current nursing practice.
9. Professional Practice Evaluation:The registered nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.
10. Collegiality:The registered nurse interacts with and contributes to the professional development of peers and colleagues.
11. Collaboration:The registered nurse collaborates with patient, family, and others in the conduct of nursing practice.
12. Ethics:The registered nurse integrates ethical provisions in all areas of practice.
13. Research:The registered nurse integrates research findings into practice.
14. Resource Utilization:The registered nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.
15. Leadership:The registered nurse provides leadership in the professional practice setting and the profession.
Source: American Nurses Association. (2004). Nursing: Scope & Standards of Practice. Silver Spring, MD: Nursesbooks.org.