NURSING CARE PROCESS ACCORDING TO PATRICIA W.

IYER

SUSTAIN YOURSELF: ELYDANIA VALDEZ RODRIGUEZ

SUBJECT: NURSING CARE PROCESS

 Introduction:

This document will talk about the compilation of information that I was
able to obtain about the nursing care process according to Patricia W. Iyer
in her book titled "Nursing Process and Nursing Diagnosis." Patricia Iyer's
approach to nursing care is comprehensive and methodical, focusing on
the individual needs of the patient. It begins with the assessment phase, in
which the patient's current health and medical history are assessed. This
is used to create a care plan, which is tailored to the individual's needs.
The care plan is then applied, with periodic monitoring and evaluation.
The nurse can adjust the care plan as necessary, based on the patient's
condition.
 Nursing care process according to Patricia W. Iyer

Patricia W. Iyer defines the nursing process as “the system of nursing

practice, in the sense that it provides the mechanism by which the nursing
professional uses his or her opinions, knowledge, and skills to diagnose and
treat the client's response to real problems. or health potentials.”

According to V. Iyer (1987): "The nursing care process is the method by

which theoretical foundations are applied to the practice of nursing." "The
purpose of the process is to provide a framework of references within which
the needs of the subject of care, the family and the community can be
addressed in a comprehensive manner."

To Patricia W. Iyer and Col (1995) the nursing process is the system of
practice in which the professional uses his or her knowledge, opinions,
and skills to diagnose and treat the user's response to real or potential
health problems. This same author mentions that Yura and Walsh 1988
visualized the nursing process as; the series of actions indicated, designed
to meet the objective of nursing, which is to maintain the optimal well-
being of the user, and, if this is not achieved, the necessary nursing
assistance will be provided so that the patient makes the most of his or
her resources (strengths) and achieves the highest quality of life possible.

Iyer says that the application of the PAE requires nurses to demonstrate
theoretical, practical and personal skills, which allow them to assess
particular situations, determine nursing diagnoses, plan relevant actions,
execute them and evaluate the results obtained with them.

Iyer PW and Taptich BJ, state that the Nursing Care Process consists of five
stages:
Assessment

It is the first phase of the nursing process, its activities focus on obtaining
information from the user, the user system/family or community, in order
to identify the needs, problems, concerns, or human responses of the user,
the data are They are systematically collected using the interview,
physical examination, laboratory results and other sources recorded in the
nursing history. (Patricia W. Iyer 1995).

Regarding nursing assessment, Iyer emphasizes the importance of a

complete and accurate assessment, which includes identification of all
patient needs and detailed documentation of findings.

Iyer also highlights the importance of effective communication with other

members of the healthcare team, including doctors, therapists, and
support staff. She believes that collaboration and teamwork are essential
to providing quality care and avoiding errors.

She says that the assessment has several purposes: “it establishes a
mechanical form of communication between members of the health team.
The complete annotation helps to eliminate the repetition of interrogations
and examinations carried out by health personnel and allows the nursing
professional to develop diagnoses, results and nursing interventions.

According to Patricia Iyer, nursing assessment consists of several

steps that are essential to providing quality patient care. Below are
some of the steps she highlights:

1. Obtaining information from the patient: The assessment begins by

collecting information from the patient, including their medical history,
 family history, and any other relevant information.
2. Perform a physical assessment: The nurse should perform a complete
physical assessment of the patient, including mental status, vital signs,
skin condition, breathing, pulse, etc.
3. Identify the patient's needs: The nurse must identify the patient's
needs, both physical and emotional, and document them in detail.
4. Establish goals and care plans: Once the patient's needs have been
identified, goals and care plans must be established to meet those
needs.
5. Effective Communication: The nurse must communicate effectively
with other members of the healthcare team, including physicians,
therapists, and support staff, to ensure quality care and avoid errors.
6. Update assessment: The patient's assessment should be updated
periodically to reflect any changes in their condition and to ensure that
their needs are being met.

Nursing diagnosis

It is the judgment or conclusion that is produced as a result of the nursing

assessment.

Patricia Iyer emphasizes the importance of the nursing diagnosis in the

assessment process. According to Iyer, nursing diagnosis is a key
component of the patient's care plan, as it allows the nurse to identify and
treat the patient's health problems effectively.

Iyer maintains that nursing diagnosis is a critical process that involves

identifying the patient's needs, interpreting the data collected, and
formulating an accurate diagnosis. She believes that nursing diagnoses
should be specific and based on objective data, and should reflect the
unique needs of each patient.

Additionally, Iyer notes that nursing diagnoses should be updated

periodically as the patient's condition changes and evolves. This ensures
that the patient's care plan is always relevant and effective.
The diagnoses are classified into:

• Actual nursing diagnosis: describes responses to vital processes/health

conditions that exist in the individual, family and community.

• Risk nursing diagnosis: it is a judgment in which an individual, a family

or a community is more vulnerable to a certain problem than other
people who are in the same or similar situation.

• Possible nursing diagnosis: The evidence that a health problem exists is

unclear or the causal factors are unknown. A possible diagnosis
requires more data to either validate it or eliminate it.

• Wellness or health nursing diagnosis: is a clinical judgment about an

individual, a family or a community in transition from a specific level of
well-being to a higher level. (Iyer. et. to the. 1997 )

The steps of nursing diagnosis according to Patricia Iyer include:

1. Data Identification: The first step is to collect and review the patient's
available information, including their medical history, family history,
current signs and symptoms, test and examination results, and any
other relevant information.
2. Data Analysis: The next step is to analyze the collected data to identify
patterns, relationships, and correlations. The nurse must look for
relationships between the data and determine their relevance to the
patient's situation.

3. Problem Identification: In this step, the nurse identifies the patient's

health problems that require nursing intervention. Health problems
can be real or potential.
4. Formulation of diagnoses: The nurse formulates precise and specific
 nursing diagnoses based on the identified problems. Nursing diagnoses
should be written in clear and specific terms, and should reflect the
unique needs of the patient.
5. Diagnosis Prioritization: In this step, the nurse prioritizes nursing
diagnoses based on the importance and urgency of each health
problem.
6. Diagnosis Validation: The nurse validates nursing diagnoses with the
patient and other members of the healthcare team to ensure they are
accurate, relevant, and useful.

Patricia W, Iyer says that when preparing the nursing diagnosis,

some rules must be taken into account :

1) Use technical terms

2) Avoid value judgments, assumptions or deductions

3) Write the diagnosis as a response or problem of the subject of

attention

4) The first part should only state problems of the subject of attention

5) Write in relation to or related to rather than because of.

6) The first and second part must be different.

7) Avoid inverting the two parts of the statement.

8) Do not use medical diagnosis.

9) The problem and etiology must express what must be modified. Before
recording a diagnosis, it is advisable to verify its accuracy with the subject
of care.
Iyer P. says that the nursing diagnosis allows nursing activities to be
categorized into :

1) Independent (those made by the nursing professional as a result of

their critical judgment based on science or knowledge of nursing; they are
derived from the global vision of the subject of care)

2) Dependents (those derived from medical diagnosis; these are medical

orders)

3) Interdependent (are those that depend on the interrelationship with

other members of the health team).

Planning

For Patricia Iyer, planning is a critical step in the nursing care process.
Planning involves establishing goals and plans of care that are specific,
measurable, achievable, relevant, and timely, and that are designed to
meet the patient's unique needs.

Iyer emphasizes the importance of involving the patient in the planning

process and adapting care plans as the patient's condition evolves.
Additionally, the nurse must provide care with other members of the
healthcare team, including physicians, therapists, and support staff, to
ensure quality and avoid errors.

Planning should also be documented in detail and reviewed periodically to

ensure that the patient's needs are being met and that established
objectives are being achieved.

In this she talks about how the PAE contemplates “the development of
specific strategies to prevent, minimize or correct the problems identified in
the diagnosis (some problems cannot be corrected, so nursing can intervene
to minimize their consequences).”

The planning phase consists of several phases:

• Establishment of priorities for the diagnoses found.

• Set results with the user to correct, minimize or avoid problems.

• Write the nursing actions that will lead to the achievement of the
proposed results.

• Record of nursing diagnoses, results and nursing actions in an

organized manner in the care plan. (Patricia Iyer, 1995).
The steps in planning nursing care according to Patricia Iyer are as
follows:

1. Goal Setting: The first step is to establish specific, measurable,

attainable, relevant and timely goals that are designed to meet the
patient's needs. Goals should be realistic and patient-centered.
2. Development of care plans: In this step, care plans are developed that
are specific to the patient and that are designed to achieve the
established objectives. Care plans must include nursing intervention
and the specific ones must be adapted to the unique needs of the
patient.
3. Collaboration with other members of the healthcare team: The nurse
must collaborate with other members of the healthcare team, including
physicians, therapists, and support staff, to ensure quality care and
avoid errors.
4. Patient involvement: The patient must be involved in the planning
process and must be educated about their condition and how care
plans can help improve it. The nurse must work with the patient to set
realistic expectations and ensure that care plans are acceptable to the
patient.
5. Detailed documentation: Care plans must be documented in detail,
including objectives, interventions and evaluations, to ensure
continued quality care.

6. Review and update: Care plans will be reviewed and updated

periodically as the patient's condition changes and established goals
are achieved.

In addition to specific steps for planning nursing care, Patricia Iyer also
emphasized the importance of flexibility in the planning process. She
believes that care plans should be flexible to adapt to the evolution of the
patient's condition and should be reviewed periodically to ensure that
they are effective in meeting the patient's needs.

According to Patricia Iyer, the purposes of planning in nursing care

are the following:

1. Establish goals and plans of care: Planning allows the nurse to establish
specific, measurable goals and plans of care, designed to meet the
unique needs of the patient.
2. Provide a guide for nursing care: Care plans provided a clear and
detailed guide for nursing care, including specific strategies for
achieving established objectives.
3. Communicate and coordinate care: Care plans allow the nurse to
communicate and coordinate care with other members of the
healthcare team, including physicians, therapists, and support staff.

4. Involve the patient in care: Planning involves the patient in the care
process, allowing them to set realistic expectations and participate in
their own care.
5. Evaluate the effectiveness of care: Care plans allow the nurse to
evaluate the effectiveness of care and make adjustments as necessary
to ensure that the patient's needs are being met.

The goals or purposes of planning can encompass multiple aspects of the

Human response (such as the physical appearance and functions of the
body), symptoms, knowledge, psychomotor skills, and feelings or
emotional states.
Nursing interventions are intended to help the subject of care achieve care
goals. They focus on the etiological part of the problem or second part of
the nursing diagnosis. Therefore, they are aimed at eliminating the factors
that contribute to the problem. The goal is achieved by the subject of care
and the intervention is carried out by the nursing professional with the
subject of care and the health team. Nursing interventions receive various
names, actions, strategies, treatment plans and nursing orders.

Execution

For Patricia Iyer, the execution phase in nursing care is the moment in
which the care plans designed during the planning phase are put into
practice. In this phase, the nurse implements specific nursing
interventions, monitors the patient's condition, and thoroughly
documents the patient's progress.

Iyer emphasizes the importance of effective communication with the

patient, other members of the healthcare team, and the patient's family
during the implementation phase. The nurse must work collaboratively
with other members of the healthcare team to ensure quality care and
avoid errors.

Furthermore, Iyer highlights the importance of adaptability in the

execution phase. The nurse must be able to adapt to the patient's changing
needs and adjust care plans as necessary.

Patricia Iyer suggests that the execution of the implemented actions

requires communicating the care plan to all the people involved: example:
with authorization from the pediatrician on duty, with the help of Flor, a
nursing assistant. One by one, all the theoretical postulates applied in the
professional practice of this nurse are revealed.

Regarding the usefulness of the care plan, she says that currently, different
types of care plans are used. The most commonly used ones are
individualized, standardized with modifications and computerized. The
first are printed and divided into columns intended for the nursing
diagnosis, expected results and nursing actions. In standardized plans
with modifications, which allow for individualization, nursing diagnoses,
expected outcomes, and actions are specified using fill-in-the-blank
spaces. Computerized care plans can be prepared at the terminal in the
patient's room or at a central control. Once the information has been
validated and entered, it is printed daily in each shift or when needed.
Computerized plans allow you to develop individualized and standardized
plans with modifications.

Throughout the execution, the nursing professional continues collecting

data. This information can be used as evidence to evaluate the achieved
objective and to establish changes in care according to the evolution of the
subject of care.

According to Patricia Iyer, the interventions that can be included in

the fourth step of the nursing process, implementation, can vary
depending on the patient's needs and the care plan designed in the
previous step:

Phase 4 of the nursing care process, according to Patricia Iyer, is the

implementation stage, where the care plan designed in the previous phase
is carried out. In this phase, the nurse applies the necessary interventions
to help the patient achieve his or her goals of care. Interventions may
include medication management, therapies and procedures, patient and
family education, and health promotion and disease prevention. It is
important for the nurse to continually evaluate the effectiveness of
interventions and make adjustments as necessary.

Patricia Iyer has not provided an explicit definition of each intervention in

the nursing process. However, here are some general definitions about the
interventions you mentioned:

1. Medicine administration: It refers to the delivery of

medications prescribed by a doctor to treat an illness or health
condition. This may include the administration of
oral, injectable, topical or intravenous medications.
2. Therapies and Procedures: Refers to a wide range of medical
treatments and procedures that can help treat or prevent diseases or
improve overall health. This may include physical therapies,
occupational therapies, respiratory therapies, and other types of
treatments.
3. Patient and family education: refers to teaching the skills and
knowledge necessary to adequately care for the patient's health and
prevent diseases. This may include teaching patients and their families
about proper diet, exercise, personal hygiene, and other aspects of
healthy living.
4. Health promotion and disease prevention: refers to the promotion of
healthy habits and the prevention of diseases. This may include
providing information on disease prevention, promoting physical
activity, proper nutrition, and other aspects of healthy living.
Assessment

Evaluation, according to Patricia Iyer, is the fifth and final stage of the
nursing process, which involves reviewing and evaluating the results of
interventions and adapting the care plan if necessary. Assessment is
essential to determine the effectiveness of care and to identify any
additional needs or complications. The assessment also helps ensure that
quality, effective patient care is provided.

Patricia Iyer has noted that assessment is crucial to determine the

effectiveness of care provided and to identify any problems or needs for
additional care. The evaluation can also provide important information for
planning future care and preventing complications.

In the evaluation of the nursing care plan, the extent to which the
interventions carried out were effective is determined, progress is
assessed, and the plan is reviewed to establish corrective measures if
necessary.
 Biograph
Patricia Iyer y

Patricia Iyer is a registered nurse and legal nursing consultant

who has worked in the nursing field for
over 40 years. She is the founder and CEO
of several businesses related to nursing
education, including Med League and the
Education Resource Center.

In addition to her work as a legal

consultant, Iyer has published several
books on nursing, including "The Nursing Process and Malpractice" and
"Medical Legal Aspects of Medical Records." She has also written articles
and spoken at conferences on topics related to nursing and healthcare.

Iyer has received numerous awards and recognitions for her work in
nursing, including the National Nurses Association Nursing Excellence
Award and the American Association of Nurse Educators Excellence in
Education Award. .

In summary, Patricia Iyer is a leader in the field of nursing, with a long

career in the field and extensive experience in legal consulting and
education. Her work has had a significant impact on the nursing
profession and healthcare in general.
Review of the book "Nursing Process and Nursing
Diagnosis" by Patricia Iyer:

The book "Nursing Process and Nursing Diagnosis" by Patricia Iyer is an

essential work for all professionals. It presents a
Nursing. The author
systematic and practical approach to the nursing
process, consisting of five key steps: assessment,
diagnosis, planning, implementation and
evaluation . Iyer emphasizes the importance of
collaboration and communication among
members of the healthcare team to ensure
optimal patient care.
The book also addresses the challenges and
ethical responsibilities that nursing professionals
face in their daily practice. Iyer offers practical
advice and useful strategies for approaching
difficult situations and making informed decisions.

In summary, "Nursing Process and Nursing Diagnosis" is a

comprehensive and practical guide to the nursing process, offering
unique and valuable insight into nursing practice in modern healthcare.