NURS 04 FUNDAMENTALS OF NURSING PRACTICE

I. PROBLEM SOLVING PROCESS

Overview

Nursing students will be expected to have or develop strong problem-solving skills. Problem
solving is centered on your ability to identify critical issues and create or identify solutions. Well-
developed problem-solving skills is a characteristic of a successful student. Remember, problems
are a part of everyday life and your ability to resolve problems will have a positive influence on
your future.

➢ Problem solving is the process of defining a problem, identifying its root cause, prioritizing
and selecting potential solutions, and implementing the chosen solution. There's no one-
size-fits-all problem-solving process.
➢ Problem-solving in nursing management improves patient care by enabling swift
identification and resolution of issues affecting the patient's health. It promotes efficiency,
increases the quality of care, and aids in decision-making to increase the overall patient
satisfaction and safety.

• Example of problem-solving: when an individual gets a flat tire on their car in the morning
and decide to fix it. They take the old tire off, put a new one on, and then they go about
their day as normal.
Steps of Problem Solving

1. Identify and Define the Problem

➢ It is not difficult to overlook the true problem in a situation and focus your attention on
issues that are not relevant. This is why it is important that you look at the problem from
different perspectives. This provides a broad view of the situation that allows you to weed
out factors that are not important and identify the root cause of the problem.
2. Analyze the Problem
➢ Break down the problem to get an understanding of the problem. Determine how the
problem developed. Determine the impact of the problem.
3. Develop Solutions
➢ Brainstorm and list all possible solutions that focus on resolving the identified problem.
Do not eliminate any possible solutions at this stage.
4. Analyze and Select the Best Solution
➢ List the advantages and disadvantages of each solution before deciding on a course of
action. Review the advantages and disadvantages of each possible solution. Determine
how the solution will resolve the problem. What are the short-term and long-term
disadvantages of each solution? What are the possible short-term and long-term benefits
of each solution? Which solution will help you meet your goals?
5. Implement the Solution
➢ Create a plan of action. Decide how you will move forward with your decision by
determining the steps you must take to ensure that you move forward with your solution.
Now, execute your plan of action.
6. Evaluate the Solution
➢ Monitor your decision. Assess the results of your solution. Are you satisfied with the
results? Did your solution resolve the problem? Did it produce a new problem? Do you
have to modify your solution to achieve better results? Are you closer to achieving your
goal? What have you learned?
II. NURSING PROCESS

Introduction

The nursing process is a modified scientific method which is a fundamental part of nursing
practices in many countries around the world. Nursing practice was first described as a four-stage
nursing process by Ida Jean Orlando in 1958. It should not be confused with nursing theories or
health informatics.

▪ According to Phil. Nurses Association (PNA)

it is a scientific, orderly sequence of steps of giving nursing care. it is also a scientific,
problem solving process which focuses on the total health care needs of clients.
▪ It is a special way of thingking and acting.
▪ it is the systematic, problem solving appoach used to identify, prevent and treat actual or
potential health problems and promote wellness purpose: to provide a framework within which
nurse use their knowledge and skills to assists clients in meeting thier health

CHARACTERISTICS OF NURSING PROCESS

1. Dynamic and cyclic
2. Client centered
3. Goal directed
4. Flexible
5. Problem oriented
6. Ccognitive process
7. Action oriented

SKILLS IN APPLYING NURSING PROCESS

1. Interpersonal skills - communicating, listening, developing trust, obtaining data
2. Technical skills - using equipment and performing procedures
3. Intellectual skills - analyzing, problem solving, critical thinking, sound judgements

PHASES OF NURSING
PROCESS
1. Assessment
2. Nursing Diagnosis
3. Planning
4. Intervention/Intervention
5. Evaluation

1. Assessment- getting the

facts/ gathering relevant data
through observation, interview
and examination.
- needs -physical,
physiological,
phychological, emotional,
spiritual, social
- purpose - to establish a
database(all the information about the client: health, history, physical exam, results of laboratory
and diagnostic test.)
Types of Aassessment
Initial assessment to establish complete to establish complete
database for problem database for problem
Focus/ on going assesment on going process integrated to identify new or overlooked
with nursing care problems and to

determine status of identified

problems in earlier
Emergency assessment during any physiologic or to identify life threatenin
phychologic crisis problems
of the client

I. The Assessment Process:

1. Collection of data process of gathering info about clients health status
Types:
➢ subjective (symptoms) - can be describe only by the person experienceing it.
e.g pain, nervousness, vertigo, tinnitus
➢ objective (signs) -can be observe and measured
e.g pallor, diaphoresis, BP- 120/80, reddish urine
Sources:
► Primary -patient/ client
► Secondary - indirect, like significant others, patients record/ chart, health team members,
related leterature
2. Organizing Data - to obtain data systematically, the nurse uses an organized assessment
framework, often referred to as nursing history or nursung assessment
- there are many framework that can be used and maybe modified according to patients status
3. Validating Data - act of double checking or verifying data to confirm that they are accurate and
factual

Validating data helps nurse to:

1. ensure that the assessment is complete
2. ensure that objective and related subjective data agree
3. obtain additional data that may have been overlooked
4. differentiate between cues and inferences
5. avoid jumping to conclusions and focusing in the wrong direction to identify problem

➢ to collect data accurately, nurse need to be aware of their own biases, values and beliefs and
to seperate fact from inference, interpretationand assumption
4. Recording Data- accurate documentation of all the data collected about the patients health status
➢ factual not interpreted by the nurse (must be obj. or pt.'s own word if it is subj.)
II. Nursing Diagnosis
➢ the nurse analysis the data gathered during assessment and identifies problem areas for the
patient
➢ according to NANDA, "is a clinical judgement about individual, family or community responses
to actual and potential health problems/ life processes
➢ provide the basis for selection of nursing intervations to achieve outcomes for which the nurse
is accountable
➢ the nurse analysis the data gathered during assessment and identifies problem areas for the
patient
 ➢ according to NANDA, "is a clinical judgement about individual, family or community responses
to actual and potential health problems/ life processes
➢ provide the basis for selection of nursing intervations to achieve outcomes for which the nurse
is accountable

Types of Nursing Diagnosis:

1. Actual - problem that actually present at the time of nursing assessment
2. High risk nursing diagnosis - one that likely to develop if the nurse does not intervene.
➢ in clinical judgement that the patient is more vulnerable to develop the problem than others in
same situation.
▪ e.g. Apatient with diabetes mellitus or a compromised immune system is at higher risk
than other patient.
nursing diagnosis: High risk for infection
3. Possible nursing diagnosis - which evidence about a health problem is unclear or the
causative factors are unknown.

FORMULATING DIAGNOSTIC STATEMENT

1. P.E Format (problem + (related to) etiology)
example: problem r/t etiology
impaired skin problem r/t physical examination
parental role conflict r/t divorce
2. P.E.S Format (problem+etiology+ signs and symptoms)
example: problem r/t etiology as manifested by sings & symptoms
impaired skin problem r/t immobization as manifested by distruption of the
skin surface over elbows and coccyx
impaired verbal communicaton r/t cultural differences a.m.b inability to speak English
3. SECONDARY to format (problem+ etiology+secondary to)= disease process
example: problem r/t etiology secondary to
impaired skin integrity; pressure sores r/t immobility secondary to leg cast

III. Outcomes / Planning

Based on the assessment and diagnosis,
• the nurse sets measurable and achievable short- and long-range goals for this patient that
might include moving from bed to chair at least three times per day; maintaining adequate
nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or
managing pain through adequate medication. Assessment data, diagnosis, and goals are
written in the patient’s care plan so that nurses as well as other health professionals caring
for the patient have access to it.
• The “Outcomes Identification” Standard of Practice is defined as, “The registered nurse
identifies expected outcomes for a plan individualized to the health care consumer or the
situation.”[15] The nurse sets measurable and achievable short- and long-term goals and
specific outcomes in collaboration with the patient based on their assessment data and
nursing diagnoses.
• “The registered nurse develops a collaborative plan encompassing strategies to achieve
expected outcomes.” Assessment data, diagnoses, and goals are used to select evidence-
based nursing interventions customized to each patient’s needs and concerns. Goals,
expected outcomes, and nursing interventions are documented in the patient’s nursing
care plan so that nurses, as well as other health professionals, have access to it for
continuity of care.
IV. Implementing phase
• The nurse implements the nursing care plan, performing the determined interventions
that were selected to help meet the goals/outcomes that were established. Delegated
tasks and the monitoring of them is included here as well.
Activities
• pre-assessment of the client-done before just carrying out implementation to
determine if it is relevant
• determine need for assistance
• implementation of nursing orders
• delegating and supervising-determines who to carry out what action
V. Evaluation
• The nurse evaluates the progress toward the goals/outcomes identified in the previous
phases. If progress towards the goal is slow, or if regression has occurred, the nurse
must change the plan of care accordingly. Conversely, if the goal has been achieved
then the care can cease. New problems may be identified at this stage, and thus the
process will start all over again.
• The nurse applies all that is known about a client and the client's condition, as well as
experience with previous clients, to evaluate whether nursing care was effective.
The nurse conducts evaluation measures to determine if expected outcomes are
met or not the nursing interventions.