Nursing process

Nursing process are standards and guidelines which are used by nurse practitioner to
deliver quality care, healthcare that is patient centered. Nursing profession is a complex
profession which brings aspects of art and sciences together. Nursing profession is concerned in
protecting, promoting people’s overall wellbeing including physical, emotional and
psychological wellbeing. The concept of nursing process is eccentric to all nurses; the process
involves five steps; a) Nurse assessment; b) nursing diagnosis; c) nursing planning and
identification of outcome; d) nursing implementation; e) nursing evaluation (Lee, 2010).
The first step of nursing process is assessment. This entails collection of information and
data related to a certain matter or event. Nurse practitioners are required to conduct holistic care
on the patient including their cultural background, their religious and social norms. This is to
ensure that the interventions established are culturally and socially competent and to establish the
exact care demands of a person (Svavarsdottir et al., 2014). The information gathered during the
assessment phase are organized and documented, for use in the future. The second step is nursing
diagnosis. This entails reviewing the information collected during the assessment more critically.
This way, the actual issue of concern is identified, and prognosis is done in accordance to the
clinical manifestation of disease. This is also involves identification of risk factors that
motivates progression of the disease (Lu et al., 2015).
The next step is nursing planning which involves designing interventions by establishing
priorities, identifying objectives that will facilitate provision of expected outcome. The planning
process entails identification of interventions as established by evidence based research
(RodraA-guez-Martan et al/, 2015). An effective action plan is one which is guided by Maslow’s

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hierarchy of needs. This involves provision of care as guided by the ladder of needs, and until all
patient demands or needs are identified. Evaluation process is the last step of nursing process. It
involves measuring of interventions and expected outcome to check if they are congruent with
implementation plan. If the outcome is not positive, the interventions can be altered accordingly
(Vaillant-Roussel et al., 2014).
Nursing Interventions Classification (NIC), direct nursing interventions include activities
which directly interact with the service user. These include interventions such as administering
therapy to patient suffering from dementia or Parkinson disease (Svavarsdottir et al., 2014).
Indirect nursing interventions are nursing practices that aim at improving patient’s health, but the
patient is not directly involved. For instance, the healthcare facility can introduce an automated
system to curb medication errors. Additionally, nursing interventions can be grouped into three
categories (Lee, 2010). The first category is the interdependent interventions which include
activities implemented through partnership and effective communication among the healthcare
staff. These include actions such as recommendation of non invasive surgery for patients
suffering from renal diseases. These interventions are only carried out if all other alternative
therapy has failed, and it involves lots of consultation. The dependent interventions include all
nursing practices done only under instructions from the higher authority. This could be
termination of service user medication due to medication error or allergic reactions to
medications. Lastly, the independent intervention which entails nursing actions performed by
nurses without need for permission from the higher authority; and includes all nurse practices
under nurse practice (Vaillant-Roussel et al., 2014).

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The importance of nursing process is that it guides registered nurse when making
healthcare decisions. This is particularly important when making patient centered and culturally
competent decisions. This process ensures that the registered nurses can identify the nursing
issue, its etiology as well as analyze appropriate risk factors. From the information collected,
registered nurse is in a position to design a patient centered plan of action, in an organized and
structured process. In this framework, the expected outcomes are focused and oriented towards
providing quality care. In each step, the registered nurse must document the information for
effective communication and for future use. Evaluation process is important because it helps in
analyzing the effectiveness of an intervention. If the action plan goals are inadequately achieve,
then the healthcare providers should collaborate and work jointly to identify the underlying
barriers which need to be re-evaluated and addressed (Svavarsdottir et al., 2014).
Some of the variables associated with ineffective outcomes include inaccurate
assessment and data gathering processes; because some relevant information such as cultural
aspects is more likely to be overlooked. In other situation, the interventions and the expected
outcome could be unreasonable and somewhat unrealistic. In this case, the registered nurse is
required to address the interventions and the expected outcome to ensure that they are congruent.
This is done through modification of the assessment plan, diagnosis or even the implementation
process. If necessary, the registered nurse can include other healthcare staff to contribute on the
most effective ideologies which will bring forth successful interventions as outlined by evidence
based research. This also involves thorough and adequate research which will inform the
registered nurse adequately on ways and an appropriate strategy to identify the health issue,
effective action plan and approaches to obtain the best conclusions (Lu et al., 2015).

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Part 2: Nurse Care Plan
Assessment
Patient A resides in a residential care. The patient is 78 years old and has been
experiencing mobility complications. For this reason, the patient movement is restricted and opts
to use mobility supportive device i.e. wheel chair for movement. The patient is able to carry out
the daily living activities such as bathing, dressing and feeding. The patient seems distressed and
is often in isolation. The patient medical history is that he has suffered from Congestive Heart
Failure (CHF); and has been diagnosed with associated pathologies such as hypertension,
weakness in the lower extremities and hyperlipidemia. Previously, the patient was prescribed the
following medication such as Atorvastatin 20mg, Lopressor 50mg, Quinapril 20mg and
Furosemide 20mg.
The patient current medication includes double dosage of Quinapril and Furosemide at
40mg, Metoprolol 50mg which are administered orally, and 1.5g in 0.9% normal saline (50Ml)
given three times a day. Recent regular check up, the registered nurse reported a pressure ulcer
on the patient’s right side of the buttock. The ulcer coloration is red with yellow spots, and is
estimated to be 10mm by 8mm; and also produces foul smell. Result from culture analysis
indicates that the wound is infected by Methicillin resistant Staphylococcus aureus. The
physician ordered for debridement of the black tissue, and daily dressing using antimicrobial gel
(SilvaSorb).
NANDA-1 nursing diagnosis
Acute pain due to trauma on the tissue is reported; scored at 6 on 0-10 pain scale.

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Risk for pressure ulcer due to tissue trauma associated with minimal movement to reduce
the pressure.
Assessment data
Vital Signs: Temperature 36.70C; RR 23/Min; HRT 89 BPM; Bp 120/80.
Skin; Dry and Pale, Pupils dilated, experiences muscle cramp; Joint Movement,
gastrointestinal system, urogenital systems and neurovascular system are intact.
Expected outcome
The expected outcome are Cognitive outcome- verbalize relieve pain to 2 in a 0-10
verbal pain scale and discomfort while sitting or sleeping; physiologic and affective outcome-
the patient is educated on ways to prevent progression of pressure ulcer and minimize
occurrence of such incidences in the future. The skin integument healing system could take a
longer time frame due to the patient attributes i.e. age and chronic infection which reacts
negatively to the patient immune system. In this context, the pan relief is expected to be achieved
within 48hours, and healing of the wound within 5 days.
Nursing intervention
Nurse initiated: Identify the main risk factor for pressure ulcer. This includes recording of
agility to monitor patient pattern of movement; and evaluate other mobility supportive devices
available other than use of wheel chair. Use of alginate dressings to reduce exudates as well as
lengthening the wound wears time.

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Rationale: This is to establish the most effective strategy to minimize progression of
pressure ulcers, and improvise ways to ensure that patient moves frequently or avoid sitting for a
long period of time. This is to ensure that the patient does not remain in one position for a long
time.
Interdependent intervention: protect the ulcer with silicone dressings to relieve pain,
effective transition of patient to the residential facility including exchange or effective
communication with the residential facility nurse to ensure that the identified nutritional and
exercise strategies are adhered to.
Rationale: This is to ensure that the patient feels comfortable during the healing process.
This also ensure that evidence based practice is followed; with the aim of rapid healing process
and reduce the progression of disease through interdisciplinary efforts.
Dependent intervention: administration of antibiotics as reported evidence based
practice. Rationale: this will help the patient self manage the ulcer pressure, as well as reduce the
progression of disease. Use of hydrogel with the aim of soothing painful pressure ulcers; use of
antimicrobial dressings so as to control the odor and bioburden. Clean of the peri-ulcer tissue to
devitalize the dead tissue and to control the known microbial infection well known for
colonization.
The patient will be educated on ways to modify behavior such as mild physical exercises
and nutritional modification which will facilitate faster healing rate. For instance, the patient can
be taught on approached to redistribute pressure. This includes periodic intervals turn as guided
by the patient’s wish or tolerance and the type of support surface. Evidence research practice

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indicates that the patient should be repositioned after every two hours. The support surface can
be modified using repositioning mattresses e.g. visco-elastic foam, pillows, chair cushion.
The patient should be educated on ways to maintain the skin hydrated and the nutritional
supplements compatible with the patient healthcare. This includes a lot of protein supplements
to facilitate faster healing rate. Additionally, the patient should be advised on ways to take care
of the skin. This includes applying of emollients as indicated by the manufacturer.
Rationale: this includes nutritional modification and mild physical activeness to cure,
reduce progression and prevent further formation of pressure ulcer.
Part 3: Patient teaching plan
Research indicates that the best healthcare services involve partnership between the
service user and the service provider. This is because it establishes a strong bond of trust; thereby
strengthening their relationship which improves quality of care. The core factor for a successful
partnership is communication. Appropriate communication ensures that the patient’s demands
are identified by the service provider, and they are adequately addressed. The best approach of
communication is through patient education program (Vaillant-Roussel et al., 2014). This
program empowers patients such that they can self manage the health complication with ease.
This improves their self esteem and self image. In this context, the registered nurse is mandated
to design a teaching plan that would educate the patient with ease. During the designing process,
several variables must be put into consideration including the patient age, gender, ethnic
background due to language barrier, education and socio economic background. This is
important because the nurse can identify with the patient, and can design education material

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which is custom made for that particular patient. These variables also help the registered nurse in
choosing the format of teaching i.e. verbal, written or audio-visual format (Jackson, 2008).
The registered nurses assess the patient specific demands from the patient medical
history. Based on the findings from the assessment report, the registered nurse can apply at least
three approaches namely cognitive, affective and psychomotor. The psychomotor approach is
applied to patients whose educational background is low as it entails physical teaching of the
interventions e.g. how to use mobility devices. The affective teaching is the most widely used
approach because it is more patient centered. This approach integrates the social cultural beliefs
into the clinical interventions (Kehrel, 2015).
The cognitive approach is uses cognitive functions and is mainly used to assess the
memory and adaptability of a patient. This approach is commonly used in youths and individuals
whose cognitive function is in good condition. Secondly, the registered nurse is required to set
both short term and long term goals. People who are closely related to the patient such as care
givers should be incorporated in the teaching process. Evaluation process is important because it
checks if patients’ understands the concepts taught. This also facilitates to assess the patients
strengths as well as weaknesses (Vaillant-Roussel et al., 2014). There are various tools for
assessment including interviews, observations or use of questionnaires. These tools record data
that will enhance the teaching plan of a patient. In cases where the patient fails to remember or
understand the concepts, the registered nurse should revise the teaching design, and if necessary
seek more information from literature and peers on the evidence based research and strategies to
solve the issue, and to ensure that the patient can effectively manage their healthcare
complication (Fleming, 2014).

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References
Fleming, J. (2014). A Future for Adult Educators in Patient Education. Adult Learning, 25(4),
166-168. doi:10.1177/1045159514546217
Kehrel, U. (2015). The acceptance of process innovations in drug supply – An empirical
analysis of patient-individualized blister packaging in stationary nursing facilities.
International Journal Of Healthcare Management, 8(1), 58-63.
doi:10.1179/2047971914y.0000000085
Jackson, M. (2008). Fundamentals of Nursing: Concepts, Process and PracticeFundamentals of
Nursing: Concepts, Process and Practice. Nursing Standard, 22(32), 30-30.
doi:10.7748/ns2008.04.22.32.30.b744
Lee, N. (2010). The Research Process in Nursing – Sixth editionThe Research Process in
Nursing – Sixth edition. Nursing Standard, 24(46), 31-31.
doi:10.7748/ns2010.07.24.46.31.b1086
Lu, C., Tang, S., Lei, Y., Zhang, M., Lin, W., Ding, S., & Wang, P. (2015). Community-based
interventions in hypertensive patients: a comparison of three health education strategies.
BMC Public Health, 15(1). doi:10.1186/s12889-015-1401-6
Rodríguez-Martín, B., Stolt, M., Katajisto, J., & Suhonen, R. (2015). Nurses’ characteristics
and organisational factors associated with their assessments of individualised care in care
institutions for older people. Scandinavian Journal Of Caring Sciences, n/a-n/a.
doi:10.1111/scs.12235
Svavarsdottir, E., Sigurdardottir, A., Konradsdottir, E., Stefansdottir, A., Sveinbjarnardottir, E.,
& Ketilsdottir, A. et al. (2014). The Process of Translating Family Nursing Knowledge Into
Clinical Practice. Journal Of Nursing Scholarship, 47(1), 5-15. doi:10.1111/jnu.12108
Vaillant-Roussel, H., Laporte, C., Pereira, B., Tanguy, G., Cassagnes, J., & Ruivard, M. et al.
(2014). Patient education in chronic heart failure in primary care (ETIC) and its impact on
patient quality of life: design of a cluster randomised trial. BMC Family Practice, 15(1).

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