Nursing process to a patient care

Using APA format, the information from this course, and your assigned readings write a
six (6) to ten (10) page paper (excludes cover and reference page) addressing the
application of the nursing process to a patient care scenario. Use these directions and the
scoring rubric as you develop the paper. Outlines and abstracts are NOT required with this
paper

Application of the nursing process to a patient care scenario

Part 1
Nursing process
The nursing processes are series of nursing steps designed to help the nurses provide quality
care. The nursing processes are five part system used to make decisions that pertains with the
identification of health complication and treatment process. These systems include diagnosis,
planning, implementation, as well as evaluation. These processes are scientific and are evidenced
based practice. The first step is the assessment step (Bruylands et al., 2014). This consist
collection of patient’s information relevant to diagnosis, carried out using various approaches
such as physical assessment, interviews, as well as observations. This involves the assessment of
patient’s psychological, sociological, spiritual, and physiological status. For instance, when a
patient visits a physician due to abnormal body functioning (Flemming, 2014). The registered
nurse checks the patient’s heart rate, blood pressure and the body temperature. The patient is
health assessment is done to identify the patient cultural and traditional values; nutritional
process and lifestyles are investigated. During this stage, the blood samples are taken to the
laboratory for further analysis of the patient health condition (Gratti, 2013).
The second phase in nursing process is the nursing diagnosis. This involves clinical judgment
about the patient, about the potential health complication that the patient could be suffering. This
is done using the health assessment, and is the basis that guides selection of nursing intervention.
In this phase, the nurses are expected to make ethical judgment regarding the potential health

Application of the nursing process to a patient care scenario
complication. In some cases, the nurse can make multiple diagnoses in one patient. The stage is
important because it helps the identification of the issue at concern, thus preventing risk of
further complication. The diagnosis is also done to assess patient readiness for treatment. For
instance, the registered nurse looks into the patient’s signs and symptoms. The nurse evaluates
the alteration of the patho-physiology and risks of developing associated diseases.
The next nursing process phase is the planning stage. This stage involves the establishment of the
care strategies and the outcome criteria for the patient care. The development of the plan action
involves the prioritization the care plans and more attention and efforts are devoted to high-risk
diseases and factors. Each healthcare problem is assigned a clear as well as measureable goal for
the expected beneficial outcome. In this phase, the nurses are required to apply the evidence
based nursing outcome classification (set of standards as well as measurements for tracking
disease wellness of the patient) (Fee and Bu, 2010). Nursing intervention classification can be
applied during the action phase. The Maslow’s hierarchy of needs is often used during the action
planning of care. For instance, the patient pharmacological and non-pharmacological therapeutic
processes are identified, the criteria of the administration is established as outlined by the
evidence-based practice.
Implementation phase is the fourth stage of nursing process. The stage involves demonstration of
activities that will be given to the patient, with the aim of improving their health. This includes
actions such as monitoring of patients to check for indicators of improvement, providing direct
care to the patient, medical tasks, education, and health management of the patient such as follow
up clinics. This could take days, weeks, and months (Mori 2014).
The last nursing process phase is the evaluation phase. This involves comparison of patient’s
current state of health in comparison with the expected outcomes. The findings indicate whether

Application of the nursing process to a patient care scenario
the patient care plan will be revised or not (Dailly, 2011). For instance, the patient can be asked
to answer a series of questions, have the symptoms been relieved, and have the patient condition
improved from the last time. If the care plan is successful, the patient is advised to continue with
care, as the registered nurse advices the patient on self-management strategies (Bernard, Hunter,
& Moore, 2012).
Direct patient care as described by the American Association of critical care nurse’s delegation
handbook includes activities that help the patient their immediate needs. On the other hand,
indirect care refers to the activities that that focus in the maintenance of the environment where
nursing care is delivered. Literature indicates that there is a thin line between the care providers,
but the registered nurse should not the differences (Kee et al., 2009). For instance, with direct
patient care, the healthcare provider will take the patient vital signs such as blood pressure,
temperature, and patient’s daily weights. Direct care also involves taking daily activities such as
brushing teeth and bathing. Changing patient beddings, feeding patients, and the calculation of
weight are among the direct care. Indirect patient care will involve activities of cleaning
equipments, taking patient specimens to the laboratories, phone calls, and communication, and
the scheduling of appointments. Additionally, patients supplies stock, utility, supplies and other
indirect care that is used to assist living homes (Olson-Sitki, Kirkbride, & Forbes, 2015).
Types of nursing interventions
Nursing interventions refers to the actual actions and treatments conducted to facilitate the
patient achieve the goals set for them. The registered nurses use their experience, critical
thinking skills and knowledge, which aids the registered nurse deliver quality care. There are
various types of nursing interventions classified in to three broad categories, dependent,
interdependent, and independent intervention (Kehrel, 2015). The interdependent intervention is

Application of the nursing process to a patient care scenario
nurse action plan that are implemented through teamwork. This includes consultations between
healthcare providers during the decision making process. Dependent interventions are the
strategies which as directed by the healthcare providers with higher authorities than the
registered nurses. These include activities termination patients or referral process. Independent
interventions are all activities implemented by registered nurses, and do not require consents
from the physician or other practitioners (Nazarko et al., 2010).
Modification of care plan where outcomes have not been met
Continuous assessment should be conducted to ensure that the outcomes are met. This process is
known as evaluation and is the last stage of the nursing process. This is done to ensure that the
implementation plan of care, nursing diagnosis and assessment process meet the nursing care
goals. Evaluating care is an ongoing purposeful practice the healthcare professionals determine
the effectiveness of action plan (Doenges et al., 2013).This is done to evaluate the intervention
effectiveness. It is the only to evaluate the responsibility and accountability of the nurse’s
actions. The nursing process helps the nurses identify the main challenge in the patient’s body.
The process helps the identification of etiology and facilitates the identification of risk factors.
Through the nursing process, the outcomes are expected are often goal oriented and focuses in
the provision of care (Gracia et al., 2014).
Using nursing process by RN to deliver care
Through the process, it is important to document and communicate effectively. The interventions
should be evaluated to examine whether they meet the patient expected outcome. This includes
working together to ensure that the outcomes have been achieved. If the interventions are not
effective, then the registered nurses will brainstorm to identify the research gap and identify the
variables that could cause the intervention not work effectively (Blodgett, 2009).

Application of the nursing process to a patient care scenario
Some of the variables that could cause failure of the intervention include data collection,
assessment, diagnosis processes, and the healthcare medical devices. In other cases, etiology can
be poorly explored causing misdiagnosis. In other cases, the outcomes could be unmanageable,
or unrealistic (Lu, 2013). The outcomes should result with reduced infections risks, reduced
readmission rates, and improved quality of life. If the interventions is not effective, the nurses
should begin planning for care overall. The nurses should conduct evidenced based research will
help the nurses identify the appropriate strategy that will help address the relevant matter as
necessary (Fjetland and Søreide, 2010).
Part 2; Nursing care plan
Impaired tissue integrity is the NANDA-I nursing, which associated immobility is caused by
pressure causing ulcer on the ischium on the buttocks of the right side (Savage and Kub, 2009).
Rationale: The patient sits in one position for a long period in the wheelchair, in the home care
facility. This puts more pressure on the ischium, causing the poor perfusion of the patient skin at
that site, resulting to maceration of the skin, making the skin to break down (Nazarko et al.,
2010).
Assessment: Assess skin above the ischium on the right side of the buttocks. Patient weight and
height, patient temperature, pulse rates, respiration, pupils dilated, gastrointestinal system,
neurovascular system, muscular system and blood pressure will be assessed.
Nursing diagnosis: Patient education, ulcer management, and pain relieve strategies.
Outcome: Patient will verbalize no pain, and wound recovers within eight weeks of the treatment
Patient will learn to reposition by themselves or with the aid of staff every two hours to relief
pressure
The patient dressing will be changes as needed to promote healing and independent

Application of the nursing process to a patient care scenario
Pain medication will be administered to the patient independent.
The wound will be inspected daily to monitor complications, signs of infections and if the
wound is healing
The patient will be educated optimum nutrition including lipids, calories, and adequate protein to
aid the tissue healing. The patient will be advised to adequate hydrate to ensure that replenish
cellular loss of water, and improve circulation.
Interventions:
a) Establish the reason behind the preferred usage of movement aid. This will help identify
strategies that will help the patient prefer mobility, yet avoid sitting so much on the
mobility aid.
b) Patient agility will be recorded to monitor the patient movement pattern to identify the
patients walking aids that will reduce pressure ulcer
c) Nurse will conduct research to identify evidence based practice to reduce disease
progression to relieve pressure ulcer
d) Patient will be educated on behavioral modification , such as movements every two
hours to ensure that the patient does not remain seated in one position
e) Assess barriers that will reduce effective medical diagnosis and medication errors.
Rationale and evaluation
a) Patient verbalizes pain reduction and that there is little discomfort. The pressure ulcer is
caused by sitting in one position.
b) Routine monitoring and strategies to reduce patient pressure ulcer. Patient was advised to
use roho cushion seats, rotation every two years and use of padded wear to reduce
pressure wound.

Application of the nursing process to a patient care scenario
c) To ensure that the teaching program is objective and very realistic. This will help the
patient become empowered.
Part 3: patient education
Patient teaching is a core function of registered nurses as indicated by the nursing professional
bodies. In some states, teaching is one of the legal requirements by the nursing standards. The
patient should trust the nurse to be empowered through training (Baillie et al., 2014). The nurses
should understand the patient ability to learn. The relationship is enhanced through
communication that is reciprocal and continuous. The main objective is teaching the patient is to
ensure that the patient is empowered. The nurse should instruct the patient, describe the disease
physiology, and importance of medication (Olson-Sitki, Kirkbride, & Forbes, 2015).The nursed
should use the relevant sources information, review patients medical history, physical
examination, and documentation of nursing assessment, diagnosis, and intervention. The
caregiver and patient support is very important. It is also important to evaluate the patient health
literacy, skills, and attitudes to facilitate the learning process (Gotelli et al., 2008).
Learning process can be categorized into affective, cognitive, and psychomotor. The patient
emotional as well as experiential readiness to learn. The teaching approach chosen must be used
must be developmental. The nurse should assess patient’s intellectual development, psychosocial
development, motor development as well as the emotional maturity. It is important to identify the
patient’s strengths and weaknesses including reasoning ability, memory, and comprehension
(Vaillant-Roussel et al., 2014). The nurse should use anticipatory guidance that will facilitate
psychologically preparation of the person for the unfamiliar or unexpected events. The teaching
plan should be created; there are standardized plans for major topics of the health teaching which
can be used. The match content should be used appropriately. The teaching plan should allow

Application of the nursing process to a patient care scenario
active practice and should be scheduled based on time constraints. The teaching plans have
shorter to enable to digest the healthcare information and ensure that the objectives are met
(Svavarsdottir et al., 2014).

Application of the nursing process to a patient care scenario
References
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Usability and impact of a computerized clinical decision support intervention designed to
reduce urinary catheter utilization and catheter-associated urinary tract infections. Infection
Control & Hospital Epidemiology, 35(9), 1147-1155. doi:10.1086/677630.

Bernard, M., S., Hunter, K., F., & Moore, K., N. (2012). A review of strategies to decrease the
duration of indwelling urethral catheters and potentially reduce the incidence of catheter-
associated urinary tract infections. Urologic Nursing, 32(1), 29-37.

Blodgett, T. J. (2009). Reminder systems to reduce the duration of indwelling urinary catheters:
A narrative review. Urologic Nursing, 29(5), 369-379. Retrieved from

Bruylands, M., Paans, W., Hediger, H., & Müller-Staub, M. (2013). Effects on the Quality of
the Nursing Care Process Through an Educational Program and the Use of Electronic
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Doenges, ME. Et al. (2013). Nurse’s pocket guide (13ed): Diagnoses, prioritized interventions
and rationales. John Wiley7 sons. New York

Dailly, S. (2011). Prevention of indwelling catheter-associated urinary tract infections. Nursing
Older People, 23(2), 14-19. Retrieved from

Fleming, J. (2014). A Future for Adult Educators in Patient Education. Adult Learning, 25(4),
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everyday work?. Scandinavian Journal of Caring Sciences, 24(1), pp.75-83.
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Gratti, M. (2014). EB73 Infection precaution: Implementation of a nurse-driven protocol for
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Gracia, C. Et al. (2014). Population based public health nursing clinical manual: the Henry
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