The nursing process, including a brief introduction to the NCSBON Clinical Judgement Measurement Model.
Hey, and welcome to nursing with Dr. Hobbick. Today we're going to talk about the nursing process. I know this probably should have been the first episode. So to keep it brief, the nursing process is a variation on the scientific method that allows nurses to follow a systematic approach that will allow us to use critical thinking in order to make a clinical judgment about our patients. So there are a couple of variations on the nursing process, you may have heard of add pi, which is assessment, diagnose, plan, implement, and evaluate. There's one that has analysis instead of diagnosis. And then the National Council of State Boards of Nursing has recently released this clinical judgment measurement model, which will probably see take over the field. And this is recognized cues, analyze cues, prioritize hypothesis, generate solutions, take action, and evaluate outcomes. So you can see how that's even more in line with the scientific method. So it's really, it allows us to practice nursing in a systematic way, so that we can make inferences about the meaning of our patient's condition about the meaning of their response to their conditions, so that we can help them you know, we see a pattern that helps us take care of them or helps us to alleviate symptoms. So we want to make sure that we're thinking about the patient, this individual patient, we want to make sure that we are patient centered, the first step is going to be recognized cues or assessment. So the queues are the things that you see when you do your assessment. So this is going to be your physical assessment health history. Remember that we have two different sources of information primary source and secondary, the patient is your primary source unless they're a minor or unable to make their needs known, in which case, it will be a caregiver or a parent. Everything else is a secondary source. So the chart is a secondary source that physician, the nurse before you giving report, those are secondary sources. We have two types of data, we have objective data and subjective data. Objective data is something that I can objectively measure, I can see or touch. subjective data is something that patient has to tell me because I cannot experience it in any way. So for example, vital signs that we measure, those are objective data, the patient's pain or feelings. Those are subjective data. So we're going to collect all of our data. And we're also going to validate and verify the data. So the patient will tell us things and we use those cues to help us validate or verify, we'll also use the diagnostic testing laboratory data, those health history information to verify and make sure that we have a full database. So the next step, then is going to be patient problem, or diagnosis or analyze cues and prioritize hypotheses. So this step is where we really define the patient's problem with identify their need. And it allows us to then create a plan of care. So this could be the patient has abdominal pain, or they need teaching on a specific medication or something else. So that's going to be our next step. Then, from there, from defining it, we're going to generate solutions or plan. And this, the current National Council State Boards of Nursing clinical judgment measurement model really kind of combines prioritize hypothesis, because at this point, we need to prioritize what we're going to do, your patient will have a lot of problems or a couple anyway. So we're going to classify our priorities based on high intermediate and low, high priorities or emergent things. high priorities are things that are going to imminently threatened the patient life or limb. Intermediate is mostly what we deal with in nursing. These are problems that patient has right now. And then low problems, low priority problems, and those are going to affect the patient's future well being so a high priority problem is a patient who has sepsis, or a patient who is hypovolemic, a patient that doesn't have enough fluid in their body to help them perfuse their their tissues, intermediate problems, or would be impaired skin integrity, the patient has a wound, the patient has pain. Low priority will be things like the patient has a risk for infection or the risk for falls. Those are things that will affect their future health. Now, there's something that you've identified that is putting the patient at risk, whatever that thing is, that's your intermediate problem. So we would focus on that then to prevent those bad outcomes like infection or false. So now that we've prioritized we're going to choose you know, the highest priority item and we're going to make a plan we're going to make a goal so this is where we make a goal statement and then we decide on interventions that we can put in place. So we're still in that planning process, right. So when we set a goal, it needs to be specific, measurable, attainable, or Achievable, Relevant or realistic, and time bound students struggle the most with the time bound piece. But here's, here's what it is, without this very specific type of goal, this smart goal. It's like a recipe with no directions. So I can tell you throw some flour, some water, some yeast and some butter together, let it sit for a while after you mix it up, make it into a bowl shape, let it sit a little bit longer, throw it in the oven, take it out tonight, you have bread, except you probably have glue, because I didn't give you enough directions you didn't have any time frames, you didn't know specifically what temperatures or amounts of stuff you needed. So for all of us to be on the same page to be providing the same level of care and having the same goals. The goals need to be smart goals. So we want to make sure that we have effective goals that are smart. So the next thing that we're going to think about is our implementation or intervention. So we'll decide on interventions that will help us meet the goal. That's the whole idea. The goal is something that the patient will do. The goal is a change in patient condition or behavior. So the goal usually starts with the patient will, interventions or nursing interventions, and these are things that the nurse is going to do so the nurse will the interventions or things the nurse will do in order to help the patient meet the goal. So interventions come in a couple of different ways we have direct and indirect care. Direct Care is where I am physically interacting with the patient, I am washing the patient and providing medications I'm discussing things are providing education to the patient. Indirect care things that I either do to manage the patient's environment, turning down the temperature, leaving the door closed documentation or even something I've done on the patient's behalf for I am asking for a console of physical therapy. So direct versus indirect direct is where I'm in engaged with the patient, indirect is where I'm doing something on their behalf or managing their environment. Now we also have nurse initiated, provider initiated and other provider initiated interventions. So nurse initiated interventions are independent, these are things that you can do on your own, you don't need a doctor's order or providers order for these. This is raising the head of the bed, closing the door, providing education on a topic, those are all things that you can do on your own health care provider initiated, these are dependent interventions. And of course, they require an order from a healthcare professional, other provider initiated, these are interdependent. So these would be things like the nutritionist comes and decides on a diet for the patient, then we are the ones who are making sure the patient is following those directions. So we're going to do our interventions. And the most common interventions that we do are education, medication administration, and patient care. When you're thinking about education, something that's really important for you to assess is the patient's readiness to learn. You have to have good timing, you need to make sure the patient is invested and engaged. And you want to make sure that you eliminate any barriers. So a conducive environment that is quiet and comfortable. You need to manage the patient's pain, nobody can learn anything if they're in a lot of pain. So you want to make sure that you remove those barriers, if you need an interpreter, get one, don't let that be a barrier to your patients care. So we also want to make sure that we tailor the care to the patient. In other words, I'm not going to walk into a room of someone who only has a high school education and speak in medical ease, right, we need to make sure that we have broken it down for the patient. So you want to make sure that you have collaborated with the patient and if appropriate their family when you're making your plan of care and selecting your interventions, because again, they need to be part of the process. Because if they don't agree with what you're doing, obviously, nothing's going to happen. You also need to make sure that you are able to provide the care or intervention that you are outlining, so it's got to be something that you are competent with doing and if not, you need to be comfortable asking for help or seeking someone else to perform that procedure intervention for you. And finally, evaluation. And the thing I want everyone to know about evaluation is we don't wait until we have gone through this whole process to evaluate. You're evaluating constantly. It's an ongoing process. So if I walk in the room and the patient seems short of breath, and I raise the head of the bed, I'm not going to wait until I do a full assessment and define the problem and cut you know, prioritize what's going on and create interventions and then do them. Like I've done all that in this in just a moment and I'm evaluating me What's going on in the patient? So, once we have met our goals, our patient goals, then we can discontinue the plan of care. But remember that we probably have multiple things that we're helping the patient with. It's not just one thing. So when we, when we discontinue that plan of care, there's a maybe another plan of care that we're also working on simultaneously or we create a new plan of care for the patient based on their current condition. And this is where we full circle and we start again with a new assessment. So I hope you enjoyed this discussion about the nursing process and I look forward to having you listen to more. Have a great day.