Nursing process definition. The nursing process consists of five main stages
Nursing process - a systematic, well-thought-out, targeted plan of action for the nurse, taking into account the needs of the patient. After implementing the plan, it is necessary to evaluate the results.
The standard nursing process model consists of five stages:
1) nursing examination of the patient, determining his state of health;
2) making a nursing diagnosis;
3) planning the actions of the nurse (nursing manipulations);
4) implementation (implementation) of the nursing plan;
5) assessing the quality and effectiveness of the nurse’s actions.
Benefits of the nursing process:
1) universality of the method;
2) ensuring systemic and individual approach to provide nursing care;
3) widespread use of professional standards;
4) provision High Quality provision of medical care, high professionalism of the nurse, safety and reliability of medical care;
5) in caring for the patient, in addition to medical workers, the patient himself and members of his family take part.
Patient examination
The purpose of this method is to collect information about the patient. It is obtained through subjective, objective and additional ways examinations.
A subjective examination consists of interviewing the patient, his relatives, familiarizing himself with his medical documentation(extracts, certificates, medical card outpatient).
For getting complete information When communicating with a patient, the nurse should adhere to the following principles:
1) questions should be prepared in advance, which facilitates communication between the nurse and the patient and allows important details not to be missed;
2) it is necessary to listen carefully to the patient and treat him kindly;
3) the patient should feel the nurse’s interest in his problems, complaints, and experiences;
4) short-term silent observation of the patient before the start of the interview is useful, which allows the patient to collect his thoughts and get used to the environment. At this time, the health worker can get a general idea of the patient’s condition;
During the interview, the nurse finds out the patient’s complaints, anamnesis of the disease (when it started, with what symptoms, how the patient’s condition changed as the disease developed, what medications taken), life history (past illnesses, lifestyle, nutrition, presence bad habits, allergic or chronic diseases).
During an objective examination, an assessment is made appearance patient (facial expression, position in bed or on a chair, etc.), examination of organs and systems, determine functional indicators (body temperature, arterial pressure(BP), heart rate (HR), frequency breathing movements(NPV), height, body weight, vital capacity (VC), etc.).
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Plan objective examination patient:
1) external inspection (describe general state the patient, appearance, facial expression, consciousness, position of the patient in bed (active, passive, forced), patient’s mobility, condition of the skin and mucous membranes (dryness, moisture, color), presence of edema (general, local));
2) measure the patient’s height and weight;
5) measure blood pressure in both arms;
6) in the presence of edema, determine daily diuresis and water balance;
7) record the main symptoms characterizing the condition:
a) organs respiratory system(cough, sputum production, hemoptysis);
b) organs of cardio-vascular system(pain in the heart area, changes in pulse and blood pressure);
c) organs gastrointestinal tract(state oral cavity, indigestion, examination of vomit, feces);
d) organs of the urinary system (presence renal colic, change in appearance and amount of urine excreted);
8) find out the condition of sites of possible parenteral administration medicines(elbow, buttocks);
9) determine the psychological state of the patient (adequacy, sociability, openness).
Additional examination methods include laboratory, instrumental, radiological, endoscopic methods and ultrasound. It is mandatory to carry out such additional research, How:
1) clinical analysis blood;
2) blood test for syphilis;
3) blood test for glucose;
4) clinical urine analysis;
5) fecal analysis for helminth eggs;
7) fluorography.
The final step of the first stage of the nursing process is to document the information received and obtain a database about the patient, which is recorded in the nursing medical history of the appropriate form. The medical history legally documents the independent professional activity of the nurse within her competence.
Making a nursing diagnosis
At this stage, physiological, psychological and social problems The patient's problems, both actual and potential, are prioritized and a nursing diagnosis is made.
Plan for studying patient problems:
1) identify the patient’s current (existing) and potential problems;
2) identify the factors that caused the occurrence current problems or that contribute to potential problems;
3) determine strengths patient, which will help solve current and prevent potential problems.
Since in the vast majority of cases, patients have several pressing health problems, in order to solve them and successfully help the patient, it is necessary to find out the priority of a particular problem. The priority of a problem can be primary, secondary or intermediate.
Primary priority is a problem that requires an emergency or priority solution. Intermediate priority is associated with the patient’s health condition, which is not life-threatening, and is not a priority. Secondary priority is given to problems that are not related to a specific disease and do not affect its prognosis.
The next task is to formulate a nursing diagnosis.
The purpose of nursing diagnostics is not to diagnose the disease, but to identify the patient’s body’s reactions to the disease (pain, weakness, cough, hyperthermia, etc.). A nursing diagnosis (as opposed to a medical diagnosis) is constantly changing depending on the patient’s body’s changing response to the disease. At the same time, the same nursing diagnosis can be made for different diseases for different patients.
Planning the nursing process
Planning medical events pursues certain goals, namely:
1) coordinates the work of the nursing team;
2) ensures the sequence of measures to care for the patient;
3) helps keep in touch with others medical services and specialists;
4) helps determine economic costs (as it indicates the materials and equipment needed to perform nursing care activities);
5) legally documents the quality of provision nursing care;
6) helps to subsequently evaluate the results of the activities carried out.
The goals of nursing activities are the prevention of relapses, complications of the disease, disease prevention, rehabilitation, social adaptation sick, etc.
This stage of the nursing process consists of four stages:
1) identifying priorities, determining the order of solving the patient’s problems;
2) development of expected results. The result is the effect that the nurse and the patient want to achieve in joint activities. The expected results are a consequence of the implementation of the following nursing care tasks:
a) solving the patient’s health-related problems;
b) reducing the severity of problems that cannot be eliminated;
c) preventing the development of potential problems;
d) optimizing the patient’s ability to self-help or get help from relatives and close people;
3) development of nursing activities. It specifically determines how the nurse will help the patient achieve the expected results. From all possible activities, those that will help achieve the goal are selected. If there are several types effective ways, the patient is asked to make his own choice. For each of them, the place, time and method of execution must be determined;
4) entering the plan into documentation and discussing it with other members of the nursing team. Each nursing action plan must have a date of preparation and be certified by the signature of the person who compiled the document.
An important component of nursing activities is the implementation of doctor's orders. It is important that nursing interventions be consistent with therapeutic decisions, be based on scientific principles, be individualized to the individual patient, utilize patient learning opportunities, and allow for active patient participation.
Based on Art. 39 Fundamentals of legislation on protecting the health of citizens medical workers must provide first medical care to everyone who needs it medical institutions and at home, on the street and in public places.
Execution of the nursing plan
Depending on the participation of the doctor, nursing activities are divided into:
1) independent activities - actions of the nurse on his own initiative without instructions from the doctor (teaching the patient self-examination skills, teaching family members how to care for the patient);
2) dependent activities performed on the basis of written orders from a doctor and under his supervision (injections, preparing the patient for various diagnostic examinations). According to modern ideas the nurse should not carry out the doctor’s prescriptions automatically, she should think through her actions, and if necessary (in case of disagreement with the doctor’s prescription) consult the doctor and draw his attention to the inappropriateness of the questionable prescription;
3) interdependent activities involving joint actions of a nurse, doctor and other specialists.
Help provided to the patient may include:
1) temporary, designed for a short time, which occurs when the patient is unable to self-care, self-care after yourself, for example after operations, injuries;
2) constant, necessary throughout the patient’s life (in case of severe injuries, paralysis, amputation of limbs);
3) rehabilitating. This combination physical therapy, therapeutic massage and breathing exercises.
The implementation of the nursing action plan is carried out in three stages, including:
1) preparation (revision) of nursing activities established during the planning stage; analysis of nursing knowledge, skills, and identification of possible complications that may arise during nursing procedures; provision of necessary resources; preparation of equipment – stage I;
2) implementation of activities - stage II;
3) filling out documentation (complete and accurate recording of completed actions in the appropriate form) – stage III.
Evaluation of results
The purpose of this stage is to assess the quality of assistance provided, its effectiveness, results obtained and summing up. The quality and effectiveness of nursing care is assessed by the patient, his relatives, the nurse herself who performed nursing activities, and management (senior and chief nurses). The result of this stage is the identification of positive and negative aspects in the professional activities of a nurse, revision and correction of the action plan.
Nursing history
All activities of the nurse in relation to the patient are recorded in the nursing medical history. Currently, this document is not yet used in all medical institutions, but as nursing is reformed in Russia, it is becoming increasingly used.
Nursing history includes the following:
1. Patient information:
1) date and time of hospitalization;
2) department, ward;
4) age, date of birth;
7) place of work;
8) profession;
9) marital status;
10) by whom it was sent;
11) therapeutic diagnosis;
12) presence of allergic reactions.
2. Nursing examination:
1) a more subjective examination:
a) complaints;
b) medical history;
c) life history;
2) objective examination;
3) data additional methods research.
The nursing process is a method of scientifically based and practically implemented actions of a nurse to provide care to patients.
The goal of this method is to ensure an acceptable quality of life in illness by providing the maximum possible physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values.
Currently, the nursing process is one of the basic concepts of modern models of nursing and includes five stages:
Stage 1 - Nursing examination
Stage 2 - Nursing diagnostics
Stage 3 - Planning
Stage 4 - Implementation of the care plan
Stage 5 - Assessment
The range of responsibilities of a nurse, which includes the implementation of interventions prescribed by a doctor and her independent actions, is clearly defined by law. All manipulations performed are reflected in the nursing documentation.
The essence of the nursing process is:
specifying the patient's problems,
determining and further implementing the nurse's action plan in connection with the identified problems and
evaluation of results nursing intervention.
Today in Russia the need to introduce the nursing process in healthcare institutions remains open. Therefore, the educational and methodological center for scientific research in nursing at the FVSO MMA named after. THEM. Sechenov, together with the St. Petersburg regional branch of the all-Russian public organization “Association of Nurses of Russia,” conducted a study to determine the attitude of medical workers to the nursing process and the possibility of its implementation in practical healthcare. The study was conducted using a survey method.
Of the 451 respondents, 208 (46.1%) are nurses, of which 176 (84.4%) respondents work in Moscow and the Moscow region, and 32 (15.6%) work in St. Petersburg. 57 (12.7%) respondents were nursing managers; 129 (28.6%) are doctors; 5 (1.1%) – teachers of higher and secondary medical educational institutions; 37 (8.2%) are students; 15 (3.3%) are other healthcare system specialists, 13 (86.7%) of whom work in Moscow and the Moscow region, and 2 (13.3%) work in St. Petersburg.
To the question “Do you have an idea of the nursing process?” the majority of all respondents (64.5%) responded that they had a complete understanding, and only 1.6% of survey participants responded that they had no idea about the nursing process.
Further analysis of the survey results showed that most of respondents (65.0%) believe that the nursing process organizes the activities of nurses, but it is needed, according to 72.7% of respondents, primarily to improve the quality of patient care.
According to 65.6% of respondents, the most important stage of the nursing process is the 4th stage - implementation of the plan.
When asked who should evaluate the nurse’s performance, more than half of all respondents (55.0%) named the head nurse. However, 41.7% of all respondents believe that a doctor should evaluate the performance of a nurse. This is exactly what the majority of the doctors surveyed (69.8%) think. More than half of the group of nurses (55.3%) and the majority of the group of nursing managers (70.2%), on the contrary, believe that the assessment of the performance of a nurse should be carried out by a senior nurse. Also, much attention in the group of nursing managers is paid to the assessment of the patient and the nurse herself (43.9% and 42.1%, respectively).
When asked about the degree of implementation of the nursing process in their institution, 37.5% of respondents indicated that the nursing process was partially implemented; 27.9% – sufficiently implemented; 30.6% of respondents noted that the nursing process has not been implemented in any form in their medical organization.
When determining the possibility and necessity of introducing a nursing process for the further development of nursing in Russia, it was revealed that 32.4% of respondents consider the implementation necessary, 30.8% - possible, 28.6% - mandatory. Some respondents (two nurses and one nursing manager) believe that the introduction of the nursing process is harmful to the development of nursing in the Russian Federation.
Thus, based on the preliminary results of the study, the following conclusions can be drawn:
the majority of respondents have an idea of the nursing process and participate in its implementation in their healthcare institutions;
the implementation of the nursing process is an integral element of the quality of nursing care;
the majority of respondents recognize the feasibility of introducing a nursing process.
The first stage of the nursing process is the nursing assessment.
At this stage, the nurse collects data on the patient’s health status and fills out nursing card inpatient patient.
The purpose of examining a patient is to collect, substantiate and interconnect the information received about the patient to create an information database about him and his condition at the time of seeking help.
Survey data can be subjective and objective.
Sources of subjective information are:
the patient himself, who sets out his own assumptions about his state of health;
close and relatives of the patient.
Sources of objective information:
physical examination of the patient by organs and systems;
acquaintance with the medical history of the disease.
For a general assessment of the patient’s condition, the nurse must determine the following indicators:
general condition of the patient;
position of the patient in bed;
the patient's state of consciousness;
anthropometric data.
The second stage of the nursing process is nursing diagnosis
The concept of a nursing diagnosis (nursing problem) was first officially recognized and legislated in 1973 in the USA. The list of nursing problems approved by the American Nurses Association currently includes 114 main items, including hyperthermia, pain, stress, social isolation, poor self-hygiene, anxiety, decreased physical activity and etc.
A nursing diagnosis is a patient's health condition determined as a result of a nursing examination and requiring intervention by the nurse. This is a symptomatic or syndromic diagnosis, in many cases based on patient complaints.
The main methods of nursing diagnosis are observation and conversation. The nursing problem determines the scope and nature of care for the patient and his environment. The nurse does not consider the disease, but the patient's external reaction to the disease. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing diagnosis is based on describing patients' reactions to health problems.
Nursing problems can be classified as physiological, psychological and spiritual, social.
In addition to this classification, all nursing problems are divided into:
existing - problems that bother the patient in currently(eg, pain, shortness of breath, swelling);
potential are problems that do not yet exist, but may appear over time (for example, the risk of bedsores in an immobile patient, the risk of dehydration due to vomiting and frequent loose stools).
Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, and also identifies the patient’s strengths that he can counteract the problems.
Since a patient always has several problems, the nurse must determine a system of priorities, classifying them as primary, secondary and intermediate. Priorities are a sequence of the patient's most important problems, identified to establish the order of nursing interventions; there should not be many of them - no more than 2-3.
Primary priorities include those patient problems that, if left untreated, could have a detrimental effect on the patient.
Intermediate priorities are the patient's non-extreme and non-life-threatening needs.
Secondary priorities are the patient's needs that are not directly related to the disease or prognosis (for example, in a patient with a spinal cord injury, the primary problem is pain, the intermediate problem is limited mobility, the secondary problem is anxiety).
Priority selection criteria:
All medical emergencies, e.g. sharp pain in the heart, the risk of developing pulmonary hemorrhage.
The most painful problems for the patient at the moment, what worries him most is the most painful and most important thing for him now. For example, a patient with heart disease, suffering from attacks of chest pain, headaches, swelling, shortness of breath, can point to shortness of breath as his main suffering. In this case, “dyspnea” will be the priority nursing concern.
Problems that can lead to various complications and deterioration of the patient’s condition. For example, the risk of developing bedsores in an immobile patient.
Problems whose solution leads to the resolution of a number of other problems. For example, reducing fear of upcoming surgery improves the patient's sleep, appetite, and mood.
The next task of the second stage of the nursing process is the formulation of a nursing diagnosis - determining the patient's response to the disease and his condition.
Unlike a medical diagnosis, which is aimed at identifying a specific disease or the essence of a pathological process, a nursing diagnosis can change every day and even throughout the day as the body's reactions to the disease change.
The third stage of the nursing process is care planning.
After examining, establishing a diagnosis and identifying the patient’s primary problems, the nurse formulates the goals of care, expected results and timing, as well as methods, methods, techniques, i.e. nursing actions that are necessary to achieve the goals. It is necessary, through proper care, to eliminate all conditions complicating the disease so that it takes its natural course.
During planning, goals and a plan of care are formulated for each priority problem. There are two types of goals: short-term and long-term.
Short-term goals must be completed in a short time (usually 1-2 weeks).
Long-term goals are achieved over a longer period of time and are aimed at preventing relapses of diseases, complications, their prevention, rehabilitation and social adaptation, and acquiring medical knowledge.
Each goal includes 3 components:
action;
criteria: date, time, distance;
condition: with the help of someone/something.
After formulating the goals, the nurse draws up the actual patient care plan, which is a detailed listing of the nurse's specific actions necessary to achieve the nursing goals.
Requirements for setting goals:
Goals must be realistic.
It is necessary to set specific deadlines for achieving each goal.
The goals of nursing care should be within the competence of the nurse, not the physician.
Formulated in terms of the patient, not the nurse.
After formulating goals and drawing up a plan of care, the nurse must coordinate actions with the patient, obtain his support, approval and consent. By acting in this way, the nurse orients the patient towards success by proving the achievability of goals and jointly determining ways to achieve them.
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The goal of the nursing process is to prevent, alleviate, reduce or minimize the problems that the patient has.
The nursing process consists of 5 stages:
- 1. nursing examination (collection of information about the patient);
- 2. nursing diagnosis (identification of needs);
- 3. setting goals and planning care;
- 4. implementation of the care plan;
- 5. assessment and correction of care if necessary.
All stages in mandatory are registered in the documentation for the implementation of the nursing process.
Stage I - nursing examination. The nurse must clearly understand the uniqueness of each of her patients in order to implement such a requirement for professional care, as the individuality of the nursing care provided. Taking into account the realities of Russian practical healthcare, it is proposed to provide nursing care within the framework of 10 fundamental human needs. To do this, she questions the patient, performs a physical examination of his organs and systems, studies his lifestyle, identifies risk factors for this disease, gets acquainted with the medical history, talks with doctors and relatives, studies medical and special literature on disease prevention and patient care. Having carefully analyzed all the collected information, the nurse proceeds to stage II - nursing diagnosis.
Nursing diagnosis always reflects the patient's self-care deficit and is aimed at accommodating and overcoming it. Nursing diagnosis may change daily and even throughout the day as the body's responses to illness change. Nursing diagnoses may be physiological, psychological, spiritual, social, present or potential. At the end of the second stage, the nurse identifies priority problems, that is, those problems whose solution is most important at the moment.
At stage III, the nurse forms goals and draws up an individual plan for nursing interventions. When developing a plan of care, the nurse can be guided by the standards of nursing practice, which list the activities that provide quality nursing care for a given nursing problem. At the end of the third stage, the nurse must coordinate her actions with the patient and his family and record them in the nursing history.
Stage IV - implementation of nursing interventions. The nurse does not necessarily do everything herself; she entrusts some of the work to other persons - junior medical staff, relatives, and the patient himself. However, she takes responsibility for the quality of the activities performed. There are 3 types of nursing interventions: 1. Dependent intervention - performed under the supervision of a doctor and as prescribed by a doctor; 2. Independent intervention - the nurse’s action at her own discretion, that is, helping the patient with self-care, monitoring the patient, advice on organizing leisure time, etc. 3. Interdependent intervention - collaboration with doctors and other specialists.
The task of stage V is to determine the effectiveness of nursing intervention and correct it if necessary. The assessment is carried out by the nurse continuously, individually. If the problem is resolved, the nurse should provide reasonable assurance in the nursing record. If the goal was not achieved, the reasons for the failure should be determined and the necessary adjustments should be made to the nursing care plan. The nursing process is applicable in any area nursing activities, including in preventive work.
The fourth stage of the nursing process is to implement the nursing intervention plan.
Concept of following a care plan
Execution of the care plan, in theory, follows planning of nursing actions. However, in practice, implementation can begin immediately after the examination. It is necessary to resort to immediate implementation only in cases where there is a direct threat to the physiological or psychological state patient. Examples of such a condition include unbearable acute pain, emotional breakdown caused by unexpected death loved one, uncontrollable vomiting, sudden cardiac arrest, etc.
Performing is the behavior of nursing staff that is aimed at achieving the expected result of care until its completion. Execution includes:
- providing assistance, physical and psychological;
- management of self-care activities;
- education and counseling of the patient and his family;
- assessment of the work of the entire team;
- recording and exchange of information important for treatment. Implementation usually begins after the plan has already been developed in accordance with the goals and expected outcomes of care.
Performance- a continuous and interconnected stage with other stages of the nursing process. Execution itself is a process. During implementation, nursing staff meet with the patient multiple times, reassess the patient's condition, evaluate if necessary, modify the existing plan of care, and schedule and implement nursing interventions. With each patient encounter, the nursing process begins anew as the patient's problems are subject to change due to circumstances, treatment, and nursing interventions. To successfully implement the plan, nursing staff must have a good knowledge of all types of nursing interventions and master the technique of concrete actions care within the competence of nursing staff.
Nursing intervention is any action by nursing personnel that puts into effect a plan of care or any objective of that plan. This could be: support, treatment, care, training, etc.
As we know from the previous chapter, nursing personnel perform interventions that can be dependent, independent, or interdependent. In addition, there are interventions that should be based on nursing orders and standards of practice.
Rice. The fourth stage of the nursing process
The first official standard approved by the Ministry of Health for implementation in nursing practice was the OST “Protocol for the management of patients. Bedsores." In addition to standards, there are orders, for example related to ensuring the prevention of nosocomial infections, that must be followed. The actions of nursing personnel prescribed by these orders can be treated differently. On the one hand, they are dependent, on the other - independent: the nursing staff is not free to perform them and at the same time the doctor does not prescribe them. However, when providing care related to the prevention of bedsores and ensuring a sanitary regime, nursing staff must be guided by the norms provided for in the orders and standards of nursing practice.
Besides this, there is special rules that determine the behavior of nursing staff in extreme situations, for example, in intensive care units and treatment rooms instructions are provided aimed at providing assistance in removing the patient from anaphylactic shock. The presence of such standards and instructions provides a legal opportunity to intervene in the treatment process in the interests of the patient.
Nursing staff, when providing care, use all types of nursing actions. It is a mistaken belief that nurses are only responsible for what they do without a doctor’s orders. The responsibility of nursing staff is equally great when performing any type of intervention.
Key areas of nursing action
Nursing interventions may include:
- providing assistance in performing activities related to life needs;
- advice and instructions to the patient and his family members;
- caring for the patient to achieve therapeutic goals;
- creating conditions for the speedy achievement of treatment goals;
- observation and evaluation of the work of all care participants.
Foundations of Nursing Practice- cognitive, interpersonal and psychomotor skills.
When starting to perform a certain nursing action, you should clearly understand the purpose, reason for the intervention, possible complications and the patient's reactions, in order to adjust care if necessary.
One of the main channels of influence on people is communication. Just as an injection of an analgesic can reduce pain, interpersonal communication techniques can help relieve fear. Answering the survey question: “Which doctors do you trust?”, the majority of current and potential patients answered: “Those who know how to heal!” What and who is hidden under this definition? It turned out: a medical practitioner and a human physician. A friendly attitude towards people is the basis of therapeutic communication, the foundation of professional activity not only of nursing staff. To provide the patient with information, to relieve fear of the disease or upcoming treatment, to instill hope and faith in improvement - these are the goals of therapeutic communication. Simplicity and clarity of judgments, culture and literacy of speech, sensitivity to emotional reactions, patience and tolerance, the ability to reliably accurately perceive verbal and non-verbal information from patients - these are the foundations of interpersonal communication in the practice of a health worker.
Direct care activities, such as changing clothes and bedding, injections, suctioning mucus from a tracheotomy tube, insertion urethral catheter, require certain psychomotor skills from nursing staff. The nurse has professional responsibility for correct execution these actions.
Lack of experience and proper qualifications cannot be used as an excuse in the event of harm to a patient as a result of any nursing intervention.
Registering nursing actions
Recording nursing interventions in the nursing record (NIH) is also a specific type of nursing practice.
The sheet “Registration of nursing actions” should record information about the intervention or procedure performed (for example, “A conversation was held ...”, “An injection was performed ...”, “An enema was given”) and the patient’s reaction to care. Recording the patient's response to nursing interventions may provide the basis for additional measures to care for the patient. For example, while caring for a patient to prevent bedsores, after another change in body position, 2 hours later, the nurse noticed pronounced redness of the skin in the sacral area. This reaction requires additional measures aimed at preventing further skin damage and rehabilitation treatment.
The nursing medical history often records the actions of nursing personnel that have a direct impact on the treatment process and prognosis of the disease. Nursing interventions in health care settings are more often transmitted verbally from one nurse to another or to other members of the health care team. Nurses communicate when transferring a shift or transferring a patient to another department or hospital. In any case, whether orally or in writing, information related to patient care must be conveyed using the criteria for effective verbal communication.
Examples of recording nursing actions to solve the problems of patient Korikova E.V. are given in the NIB at the end of the section.
Types of nursing activities
Nursing staff use a variety of nursing activities to implement the plan of care, the choice of which depends on the patient's condition. Thus, patients with forced limitation of mobility need, first of all, help related to the natural needs of life. If it is determined that the patient lacks knowledge or has inaccurate information, it is necessary to involve actions aimed at training. To solve a specific problem of the patient, a type of influence (strategy) is selected that is aimed at solving it. Among these impacts are the following::
1. Providing assistance with activities related to daily living needs. Such assistance consists of providing feeding to the patient, dressing, washing, brushing teeth, serving a bedpan, etc. The patient's need for assistance may be temporary, permanent, or rehabilitative. The degree of dependence on others determines the extent of nursing staff's participation in providing this type of care. For example, a patient with bilateral splints upper limbs requires assistance from staff and relatives until the cast is removed. The degree of limitation of self-care in this case is partial, therefore the care will be partially compensatory, since the patient is able to walk, sit, stand, and move in bed.
Patient in comatose needs fully compensatory care, the duration of which will depend on the prognosis of the disease.
Worry about the loss of a loved one, geriatric age of the patient, news of the presence incurable disease may cause “loss of taste for life”, development depressive state. Patients who have lost the incentive to take care of their appearance only need counseling.
2. Adviсe. Advice is emotional, intellectual and psychological support. Nursing staff need to master the techniques of professional communication, the basics of pedagogy and andragogy, so that advice is listened to. Only then does advice help to consider alternatives, get rid of stress, come to terms with the need to adapt to an unusual lifestyle, for example, quit smoking, lose weight, exercise a certain type sports In cases where the disease is life-threatening, advice can be used to reconcile the patient and his family with the possibility fatal outcome.
3. Education. Advice is very closely related to teaching. However, the person giving the advice hopes for changes in the relationship and emotional sphere, and after training expects changes in intellectual development, acquisition of new knowledge and psychomotor skills. Nursing staff, while providing care, are responsible for identifying educational needs and the quality and effectiveness of patient education.
The learning process is an interaction between a teacher (nursing staff) and a student (patient or relative), during which certain cognitive goals are achieved. The training process is very similar to the nursing process and consists of the same components: identifying training needs, setting goals and planning training, implementation and evaluation of results.
4. Care to achieve patient goals. Nursing staff identify problems and plan care with the active participation of the patient. The patient's main goal is to gain independence from others. The nurse provides physical support to the patient: helps him find a comfortable place in bed, moves with the help of special devices, crutches or a stick, a wheelchair, supports the patient when walking, etc.
As experience shows, nursing diagnosis is often based specifically on the psychological state of the patient, and therefore actions aimed at reducing psychological discomfort, anxiety, and restlessness are important in nursing practice. important place. To relieve the fear associated with possible infection during parenteral administration of drugs, nursing staff demonstrates to the patient how to clean their hands before injection, putting the drug into a disposable syringe, a sterile tray for transporting the syringe, etc. To help the patient urinate while lying down, the staff helps him take a comfortable position on the bedpan, fences him off with a screen, and asks his roommates to go out into the corridor.
5. Creating conditions for the speedy achievement of treatment goals. A favorable environment, the internal climate of the medical institution itself, and the environment influence the condition of patients, the course and prognosis of the disease.
Patients should feel that they are not “extra people,” see the nursing staff as an ally in the fight against the disease, and feel a certain freedom in their actions and interaction with the staff.
Upon admission to the hospital, it is necessary to introduce the patient to the specifics of the department, the medical staff, and introduce him to his roommates. A prerequisite for the patient's adaptation is to familiarize him with the daily routine, the dining room, sanitary rooms, and office premises. Conditions should be created for the patient’s privacy, which is necessary when conducting hygiene measures, talking with relatives, friends or staff.
If the patient is receiving care at home, it is necessary to take the time to communicate with him about the goals of patronage and possible results such home visits.
Thus, the plan of care should not place the patient in some strict regime, but should have a certain degree of flexibility, allowing the patient to choose “what is best.”
6. Proactive Care. Nursing staff must clearly understand the potential problems of patients associated with the disease or stay in a health care facility. For example, for patients with impaired mobility such a problem is bedsores, for patients with uncontrollable vomiting - aspiration and dehydration. Adverse reactions may occur in response to nursing interventions. It is necessary to anticipate the development of complications and adjust your actions in time or interrupt the manipulation. So, in the case of pronounced allergic reaction, the nurse has the right to stop the drip infusion before the doctor arrives. Nursing staff must know the list of drugs that reduce or eliminate adverse reactions and complications.
You should know the specifics of conducting various diagnostic procedures, their possible consequences. For example, side effect barium enema during irrigoscopy is stool retention. It is necessary to monitor the patient after such a study, give him recommendations regarding drinking regime, after talking with the doctor, if necessary, give a laxative, find out and note when the stool was.
7. Preventive actions
. Prevention is a set of measures aimed at maintaining and strengthening health and preventing diseases. Preventive measures are much broader and more varied than simply performing certain care actions. They are aimed at promoting a healthy lifestyle and people’s responsible attitude towards their health; identification and elimination of risk factors for various diseases; early diagnosis And timely treatment; prevention of complications, including iatrogenic nature; strengthening the rehabilitation capabilities of patients and providing assistance to people with disabilities.
Prevention is one of the main directions in the activities of nursing staff, and therefore, at every meeting with a patient, we must try to change his attitude towards his state of health, to make him an active participant in the nursing process aimed at treating the present disease, preventing exacerbations and preventing the emergence of new health problems. Examples of such actions: sister's participation in preventive examinations, immunization of the population, education of patients suffering arterial hypertension, measure blood pressure and keep an observation diary, and patients suffering from diabetes mellitus, independently determine your sugar level.
8. Performing care procedures and manipulations. Nursing staff must be fluent in the technique of conducting nursing procedures. Despite the standard approach to performing the procedure, in each individual case it is carried out taking into account the characteristics of the patient and personal experience personnel.
During the working day, medical personnel have to perform many procedures: changing the bed and shifting the patient, artificial feeding, parenteral administration of drugs, insertion of a urethral catheter, administration of an enema, etc. When performing manipulations, you must remember the oldest commandment medical ethics: “Do no harm!”, it is good to know the goals, time, stages, expected results of each action, possible reactions of patients. Nursing practice must be “thoughtful.” Only in this case can the quality and safety of care be guaranteed.
9. Carrying out emergency measures first aid
. This is an essential component of secondary practice medical personnel, one of his professional tasks. Here dependent, independent and interdependent actions are provided, which is determined, first of all, by the place of provision of first aid: prehospital stage or hospital. To provide such assistance, one must be able to recognize emergency, be fluent in resuscitation techniques, know the medications that are used in extreme situations, ways of introducing them, working clearly and harmoniously with team members.
10. Observation and evaluation of the actions of all team members involved in care. The entire range of care activities is usually carried out by several people. These are nurses (guard, procedural, dressing), dietician, exercise therapy instructor, junior nurse, relatives, etc. When distributing care, you need to be sure that it will be performed in accordance with necessary requirements or standards of nursing practice.
When caring for a patient, nursing staff must guarantee the quality and safety of the activities carried out and strive for perfection of the technique.
conclusions
- The fourth stage of the nursing process usually begins after the care plan has already been developed. It is necessary to resort to immediate implementation (ignoring the preparation of a plan) only in cases where there is a direct threat to the physiological or psychological state of the patient.
- For successful implementation, nursing staff must have a good knowledge of all types of nursing interventions and master the technique of carrying out specific nursing actions that are within their competence.
- Nursing intervention is any action by nursing personnel that puts into effect a plan of care or any task of that plan. This could be: support, treatment, care, training.
- Nursing staff perform specialty nursing interventions that can be dependent, independent, or interdependent. In addition, there are nursing interventions that should be based on orders and standards of nursing practice.
- Cognitive, interpersonal and psychomotor skills are the basis of nursing practice. Lack of experience and proper qualifications cannot be used as an excuse in the event of harm to a patient as a result of any nursing intervention.
- On the map nursing supervision The patient's actions are more often recorded by the nurse, which have a direct impact on the treatment process and the prognosis of the disease.
Fundamentals of nursing: textbook. - M.: GEOTAR-Media, 2008. Ostrovskaya I.V., Shirokova N.V.
Scientific, systematic, individual.
Background
The concept of the nursing process was born in the USA in the mid-50s and has now been widely developed in modern American, and since the 80s, in Western European models of nursing. Nursing models are based on nursing philosophy and reflect knowledge and practical changes not only in nursing, but also in other disciplines (ethics, medicine, psychology, philosophy, sociology, etc.).
All conceptual models of agriculture (Orem, Roy, Henderson, etc.) include four aspects of agriculture:
1. patient;
2. nursing;
3. environment;
4. health.
Professional care requirements:
Currently, the s/process is the core of s/education and creates the theoretical scientific basis for s/assistance in Russia.
Nursing process - It is a scientific method of practice, a systematic way of identifying the patient and nurse situation and the problems that arise in that situation, in order to implement a plan of care that is acceptable to both parties.
The agricultural process is one of the basic and integral concepts of modern agricultural business models.
The C/process brings a new understanding of the role of the nurse in practical healthcare, requiring from her not only technical training, but also the ability to creatively relate to patient care, the ability to work with the patient as an individual, and not as a nosological unit, an object of “manipulation technique” ", the ability to individualize and systematize care. Constant presence and contact with the patient makes the nurse the main link between the patient and outside world. The biggest winner in this process is the patient. The outcome of the disease often depends on the relationship that is established between the medical professional and the patient, and on their mutual understanding.
Specifically, the nursing process involves the use of scientific methods to determine the health needs of the patient, family or society, and on this basis the selection of those that can be most effectively met through nursing.
S/process is a dynamic, cyclical process. Information obtained from assessing the results of care should form the basis for the necessary changes, subsequent interventions, and actions of the nurse.
Nursing -part of the healthcare system, specific, professional activity, science and art aimed at solving existing and potential health problems in the face of environmental change.
Nursing Process:
1. method of organization and practical implementation by the nurse of her duties in caring for the patient;
2. sequence of steps and actions aimed at achieving goals;
3. it is what shapes the nurse's thinking, what makes her think and act as a professional.
Nursing diagnosis:
1. a statement that describes a current or potential patient problem that the nurse is authorized and competent to address;
2. it is the nurse's clinical judgment that describes the nature of the patient's existing or potential response to illness. This reaction can be physiological, psychological, social.
Patient -this is a person (individual) who needs and receives care.
Nurse -specialist with vocational education, sharing the philosophy of farming and admitted to farming practice.
Environment -a set of natural, social, psychological and spiritual factors and indicators (conditions) where human life takes place.
Health -dynamic harmony of the individual with the environment, achieved through adaptation.
Medicine -diagnosis and treatment of diseases and painful conditions.
Disease -a change in the physiological, psychosocial and spiritual state of a person that leads to a decrease in his capabilities and life expectancy.
Painful condition -personal feeling of ill health, illness, state of deviation from the normal functioning of the body as a whole. A painful state can occur both in the presence of disease and in its absence.
Human -a holistic, dynamic self-regulating biological system, a set of physiological, psychosocial and spiritual needs, the satisfaction of which determines growth, development, and fusion with the environment.
Personality –social essence of man.
Purpose of the nursing process.
Stages of the nursing process,
their relationship and summary each stage.
The nursing process is an organizational structure for teaching nursing practice.
Three main characteristics of the s/process:
· target
· organization
· creation
I. Purpose of the process –ensuring an acceptable quality of life in illness, that is, ensuring the maximum possible physical, psychosocial and spiritual comfort for the patient in his condition. The same idea can be expressed in another way:
The purpose of the process is maintaining and restoring the patient's independence in meeting the patient's 14 basic needs or a peaceful death.
“The unique task of the nurse is to assist a person, sick or healthy, to carry out actions pertaining to his health, peaceful death or recovery, which he would undertake himself if he had the necessary strength, knowledge or will. And this is done in such a way that he regains independence as quickly as possible. M/s are the legs of the legless, the eyes of the blind, support for a child, a source of knowledge and confidence for a young mother, the mouth of those who are too weak or self-absorbed to speak (theory of V. Henderson).
Achieving the goal of the process is carried out by solving the following tasks:
· creation of a patient information database;
· determining the patient's health care needs;
· designation of priorities in s/services, their priority;
· drawing up a care plan, mobilizing the necessary resources and implementing the plan, i.e. providing assistance directly and indirectly;
· assessing the effectiveness of the patient care process and achieving the goals of care.
II. Organization –sequence of measures necessary to achieve the goal.
Organizational structure The s/process consists of 5 main stages:
1) Examination –collecting information about the patient's health status. The nurse collects her information about the patient from various sources. The information is necessary to determine the patient's problem.
2) Nursing diagnosis -identification and designation of existing and potential patient problems.
3) Planning –defining a program of action. The care plan is individualized and based on the patient's background and diagnosis. Planning includes the expected outcome, goals and action plan.
4) Intervention (execution, implementation) –these are direct actions that ensure the implementation of the plan; This medical service patient (what is done by hand).
5) Evaluation –study of patient reactions to nurse intervention. M/s notes progress in improving the patient’s health condition or a sharp deterioration.
Each of the 5 steps is an essential stage in solving the patient’s main problem. The stages are closely interrelated. Each subsequent stage follows and depends on the previous one. This sequence is a logical chain. During the examination, the m/s collects information that is important for identifying the problem. To the extent that the problem is correctly identified, assistance will be planned and provided correctly and professionally. Naturally, the assessment will also depend on the correctness of the previous 4 stages.
III. Creation -Creative skills are most often influenced by teachers. Deepening and continuing education expands the nurse's creative abilities. An experienced m/s can apply her knowledge and skills in solving problems of varying difficulty.