NURSING PROCESS

By Ms. Buruwaa Osei Duodu

 Learning Objectives

 Describe the use of nursing process

 Identify the components of the nursing process
 Identify steps and formulate nursing diagnosis
 Identify, plan and draw nursing interventions

relevant to specific nursing diagnosis.

 Describe how to evaluate achievement of

expected patient outcomes.

 Nursing Process

Components of the nursing process

 Assessing
 Diagnosing
 Planning
 Implementing
 Evaluating
 Introduction
 Nursing process has been part of nursing care
for decades.
 Is an integral part of all nursing training

programmes irrespective of level.

 Uses the scientific process and problem

solving approaches as theoretical basis.

 But implementation at the practice area is

faced with challenges.

 Definition of Nursing Process

 A systematic, client – centered method

for structuring the delivery of nursing
care.

 Systematic,rational method of planning

and providing nursing care.
 Origin of the Nursing Process

 Lydia Hall coined the term in 1955, Johnson in 1959,

Orlando in 1961 and Wiedenbach in 1963.

 In 1973, it gained additional legitimacy when it was

included in ANA standards of clinical practice.

 In Ghana, it was incorporated into the curriculum of

nursing programs in the 1980s.
 Purpose of the Nursing Process

 Toidentify the clients health status and

actual or potential health problems to
establish plans and deliver specific
nursing interventions to meet those
identified problems.
 Scope

The nursing process is holistic and addresses:

 Physical
 Emotional
 Psychosocial
 Developmental
 Spiritual being of all patients
 Focus is on the ‘Whole’ Patient
 The nursing process involves looking at the whole
patient at all times. It personalizes the patient, not
“the Diabetic in room 4B”.

 It also forces the health care team to observe and

interact with the patient, and not just the task they are
performing such as a dressing change, or a bed bath.

 The process provides a roadmap that ensures good

nursing care and improves patient outcomes.
COMPONENTS

Nursing Process
Characteristics of the Nursing Process

 Cyclical and dynamic in nature

 Interpersonal and collaborative in style
 Client – centered
 Problem solving and decision making
 Flexible
 Universally applicable
 Involves critical thinking
 Benefits of the Nursing Process
To the Nurse:
 Job satisfaction
 Acquisition of knowledge and skill
 Meets standards of care
 Promotes flexibility and independent thinking
 Avoids legal confrontations.
 Enhance professional accountability
 Maximizes the use of time and resources
 Enhance team work
 Speeds up diagnosing and problem solving.
 Benefits of the nursing process
To the Patient
 Improved quality of care
 High patient participation
 High patient satisfaction
 Responsibility for own health
 Cost effective health care.
 The Nursing Process

 ASSESSING
 ASSESSING
Purpose:
 To establish a database about the clients response to

health concerns / illness and the ability to manage

health care needs.
 Nursing assessment should include clients past

history, as well as current perceived needs, health

problems, related experiences, health practices,
values and lifestyle.
 To be most useful, data must be relevant to the

particular health problem.

 Assesing

 Students should be able to efficiently obtain

baseline data that is complete, accurate, factual
and relevant
 Systematic and continuous collection,

organization, validation and documentation of

information.
 Types of Assessment
Initial Assessment:
 Performed soon after admission, for problem

identification, reference and future comparisons.

Problem-Focused /Ongoing Assessment:
 Ongoing process integrated with nursing care to

determine status of specific problem and identify new /

overlooked problems
Emergency Assessment:
 Performed during physiological / psychological crisis

to identify life threatening problems.

 Types of Assessment Cont.

Time – Lapsed Assessment:

 Performed several months after initial

assessment to compare current status with

baseline data previously obtained.
 Steps of Assessing

 Collect data
 Organize data
 Validate data
 Document data
 Collecting Data

 Theprocess of gathering information

about clients health status.

 Done systematically and continuously to

reflect clients changing health status.
 Types of Data

 Subjective / convert data / symptoms

 Objective / overt data / signs

 Sources of Data

 Primary / Direct : the client

 Secondary / Indirect: family members, other

support persons, other health professionals,
records and reports, laboratory and diagnostic
analysis and relevant literatures.
 Data Collection Methods

Observing:
 Conscious and deliberate effort at

collecting data using the five senses.

 Observation has two aspects:
 Noticing the data
 Selecting, organizing and interpreting the

data
 Interviewing

 May be directive /non directive

 Primarily with the client, and then

significant others as appropriate

 Each contact yields information, verifies

information or clarifies data.

10 Key Elements To Successful Interview
 A clear sense of underlying purpose
 Preliminary research prior to interview
 A formal request to the interview
 Sound interviewing strategy
 Effective use of icebreakers
 Smoothly addressing the business of the interview
 Good rapport between nurse and client
 Sensitivity to clients needs during interview
 Adequate time for recovery after discussing sensitive

issues
 Closure of interview
 Examining
 Involves systematic physical assessment to detect health
problems
 May be organized in a head – to – toe or systems approach
 Techniques incorporate the senses of sight, hearing, touch

and smell.
 Inspection
 Palpation
 Percussion
 Auscultation and measurements of vital signs, weight,

height, etc are taken.

 Characteristics of Data

 Complete

 Accurate

 Truthful

 Relevant
 Organizing Data
 Written
/ computerized format that organizes
assessment data systematically is used.

 Referred
to as nursing health history / nursing
assessment / Nursing database.

 The nursing health history i.e. format may

include available frameworks modified
according to clients physical status.
 Non Nursing Models

 Maslow'stheory of needs
 Developmental theories
 Nursing Conceptual Models

 Gordon’s typology of 11 functional health

patterns
 Orem’s eight universal self-care requisites of

humans
 Unitary person framework and wellness

models
 Basic Components of a Nursing Health
History
 Biographical information
 Chief complaint / reasons for visit
 History of present illness / health concern
 Past health history
 Family history of illness
 Lifestyle
 Social data
 Psychological data
 Patterns of health care
 Review of systems (ROS)
 Integumentary system
 Cont.

 Respiratory system
 Cardiovascular system
 Nervous system
 Musculoskeletal system
 Gastrointestinal system
 Genitourinary system
 Reproductive system
 Immune system
 Validating Data

 The act of double checking / verifying data /

comparing data with another source to confirm that
they are accurate and factual
 Ensures assessment data is complete
 Ensures objectives and related subjective data agree.
 Provides additional information that may have been

overlooked
 Helps differentiate between cues and references
 Cont.

 Prevents jumping to conclusion and focusing

in the wrong direction to identify problems
 Objective data do not require validation
 Literature review confirms that data is

consistent with medical diagnosis

 Assumptions regarding clients physical and

emotional behaviors must be validated

 Documenting Data

 Accurate documentation of all data about

the clients health status is essential
 Data is recorded in a realistic manner and

not interpreted by the nurse

 Subjective data are recorded in the clients

own words
 DIAGNOSING

 Students should be able to identify

patients health problems and formulate
appropriate diagnostic statements.
 Diagnosing

 Diagnosis is often used to describe both a

process and a product.
 It is a pivotal step that requires critical

thinking skills to interpret assessment

data and identify clients strengths and
problems
 Purpose of nursing Diagnosis

 To identify patient strengths and

problems that can be prevented / resolved
by independent and collaborative nursing
interventions

 Todevelop a list of nursing and

collaborative problems
 Nursing Diagnosis
 A nursing diagnosis provides the basis for selection
of nursing interventions to achieve outcomes for
which the nurse is accountable
 A clinical judgment about and individual, family, or

community responses to actual and potential health

problems / life processes. (NANDA INTERNATIONAL, 2005)
 A statement that describes the clients actual /

potential response to a health problem that the nurse

is licensed and competent to treat.
 Types of Nursing
Diagnosis
 Actual nursing diagnosis:
Problem is present, and based on the presence
of associated S & S e.g. ineffective breathing
pattern / anxiety
 High risk nursing diagnosis:

Presence of risk factors indicates that a

problem is likely to develop e.g. high risk of
infection.
 Cont.
Possible nursing diagnosis:
Evidence about a health problem is
incomplete / unclear e.g. Possible social
isolation related to unknown etiology.
Wellness diagnosis:
Indicates a healthy response, client desires a
higher level of wellness. E.g. reading for
enhanced copping
 Cont.
Syndrome diagnosis:
Associated with a cluster of other
diagnosis e.g. risk for disuse syndrome in
a long – term bedridden client, with
clusters of diagnosis like risk for
impaired tissue integrity, impaired
physical mobility and risk for infection,
etc.
 Components of a Nanda Nursing
Diagnosis
Problem / diagnostic label:
Describes the clients health problem / response
clearly and concisely in a few words.
 Directs formation of goals / expected

outcomes, and may suggest some nursing

interventions.
 Need to be specific, stating area of problem

e.g. knowledge deficit (medications).

 Cont.

 May require use of qualifiers to give

additional meaning e.g. deficient,
impaired, ineffective, compromised,
acute, chronic, altered ( for altered put the
specific in bracket) e.g. altered comfort
(dizziness)
Etiology (Related Factors / Risk Factors)

 Identifiesone or more probable causes of

the health problem.
 Gives direction to required nursing

therapy and individualizes care.

 Identifying the right cause of the problem

is important.
 Defining Characteristics

S & S that indicates the presence of a

particular diagnostic label / problem.
 Steps in Diagnosing

 Analyze data
 Identify health problems, risks and

strengths
 Formulate diagnostic statements
 Evaluate quality of nursing diagnosis
 Analyzing Data
Comparing data with standards:
 Based on knowledge and experience,

the nurse compares data with

standards and norms to identify
abnormal and relevant cues.
 Clustering Cues
 The beginning of synthesis
 Involves determining the relatedness of

facts and whether any patterns are present

 Involves making inferences about the

data.
 The nurse interprets the possible meaning

of the cues and labels the cue clusters

with tentative diagnostic hypothesis
 Identifying Gaps & Inconsistencies In
Data
Skillful assessment ensures complete data
 Possible sources of inconsistencies /

conflicting data includes measurement

error, expectations, inconsistent /
unreliable report
 All inconsistencies must be clarified
 Identifying Health Problems, Risks &
Strengths

 The nurse and clients identify strengths and problems

 Determining problems and risks:
 The client must acknowledge that the problem exists
 They indentify actual, risks and possible problems,

determine type of problem ( nursing, medical or

collaborative)
 Determine the need for help in dealing with each

problem
 Determining Etiologies

 The nurse examines the causal

relationships between problems and their
related risk factors – physiologic,
sociologic, psychological, spiritual or
environmental
 Determining Strengths

 They establish the clients strengths,

resources and abilities to cope
 Strengths can be aid to mobilizing health

and regenerative processes

 Can be obtained from nursing assessment

records, health examination and clients

records
Formulating Diagnostic Statements
Basic two-part statements:
 Problem (P) – statements of clients response +

etiology (E) – factors contributing to /

probable causes of the response
 The two parts are joined together by related to,

merely implying a relationship E.gs

 Ineffective breastfeeding related to breast

engorment
 Constipation related to prolong laxative use
 Basic Three-parts Statements
PES FORMAT
 Problem + etiology + signs & symptoms, where S &

S are the defining characteristics manifested by the

client ( for actual problems only)
 The parts are joined by related to and as manifested

by / as evidenced by E.g.
 Fluid volume deficit related to frequent watery stools

and in adequate fluid intake as manifested by dry skin

and mucus membranes, poor skin turgor, reduced
urinary output and sunken eyes
 One-part Statement
 Wellness and syndrome nursing diagnosis, consist of
NANDA labels only
 More specific so that nursing interventions can be derived

from the labels

 E.gs
 Health – seeking behaviors
 Effective breastfeeding
 Readiness for enhanced growth
 Post – trauma response
 Rape – trauma syndrome
 Defensive copping
 Variations Of Basic
Formats
1. Writing ‘unknown etiology’ e.g. noncompliance related to unknown
etiology

2. Using the phrase ‘complex factors’ when there are too many
etiologic factors
 E.g. chronic low self esteem related to complex factors

3. Using the word ‘possible’ to describe the problem / etiology when

more data is required
 E.g. Possible low self esteem related to loss of job and rejection by

family
 Altered thought processes possibly related to unfamiliar

surroundings.
 Cont.
4. Using “secondary to” to advice the etiology in
two making the statement more descriptive and
useful (e.g. wound)
 E.g. impaired skin integrity related to decreased

peripheral circulation secondary to diabetes.

5. Adding a second part to the diagnostic label to
make it more precise.
 E.g. impaired physical mobility; inability to

walk related to knee joint stiffness

 Cont.
6. Four-part statement are combinations of basic two-part
statements + variations 4 and 5
 E.g. impaired skin integrity: pressure sores related to
immobility secondary to presence of casts and traction
 Three-part statements can also be used to formulate four-
part statements.
 For collaborative problems, the diagnostic label begins
with “potential complications of ….” e.g. pneumonia
tends to exist when a particular disease / treatment is
present. Includes the possible complications being
monitored and the disease / treatment that is producing it.
 Guidelines in Writing Diagnostic
Statements
 State in terms of a problem not a need. E.g. fluid volume
deficit, not fluid replacement
 State so that it is legally advisable e.g. impaired skin

integrity related to immobility, not related to improper

positioning.
 Use non-judgmental statements. E.g. spiritual distress

related to inability to attend church services, not related

to strict church rules necessitating church attendance.
 Statements must be specific and precise. E.g. acute pain

(abdomen) related to inflamed peritoneum, not related to

disease process.
 Cont.
 Ensure that both parts of the statement do not say the
same thing
 Ensure that the clients response / problem precedes the

contributing factor or cause.

 Use statements that provide guidance for planning

independent interventions.
 Do not start a diagnosis with a nursing intervention.
 Use nursing rather than medical terms to describe both

clients problem and probable cause.

 Cont.

 Avoidusing a symptom such as nausea as the

problem.

 Useterms generally understood by other

professionals, not jargons

 Ensure that cause and effect are correctly

stated.
 Evaluating The Quality Of Diagnostic
Statement

 Consider the content of the diagnostic

statement by ensuring that it is;
 Accurate
 Concise
 Descriptive
 Specific
 Minimizing Diagnostic Errors
 Verify from patient and relatives.

 Build a good knowledge base from different areas

and acquire clinical experience.

 Having a working knowledge of what is normal

 Consult resources when in doubt

 Base diagnosis on patterns.

 PLANNING
 Objective:

 Students should be able to develop a plan of care

tailored towards the unique problems of the client.
 PLANNING

 Deliberative systematic step, involves decision making

and problem solving.

 Responsibility of the nurse, with inputs from patient

and support persons

 The nurse develops a plan of care that prescribes

interventions to achieve expected outcomes.
 Purpose
 To develop an individualized care plan that specifies
patient objectives / outcomes criteria, and related
nursing interventions
The Plan:
 Is individualized to patients needs
 Is developed with client, significant others and other

health care providers

 Reflects current nursing practice
 Is documented
 Provides for continuity of care
 Types of Planning
 Planning begins with the first patient contact and
continues until the nurse-patient relationship ends. i.e.
upon discharge.
Initial Planning:
 Follows the admission procedure and with available

data. Preliminary plan that is refined later.

Ongoing Planning:
 By all nurses working with the patient as new data are

obtained and upon client evaluation

 Done at beginning of shifts and daily to;
 Cont.
 Determine change in patients health status
 Set priorities for client care

 Decide which problem to focus on

 Coordinate nurses activities so that more than one problem

are addressed at each patient contact.

Discharge Planning:
 Necessary due to recent short stay in hospital

 Involves comprehensive ongoing assessment of physical

care needs and availability of family friend caregivers,

home environment, client and family resources and
community resources.
 Steps in Planning

 Prioritize problems / nursing diagnosis

 Formulate objectives / outcome criteria

 Select nursing interventions

 Draw a nursing care plan.

 Setting Priorities
 Establish a preferential order for nursing strategies by
deciding which nursing diagnosis requires attention
first, second and so on with the help of a framework.
E.g. Maslow's hierarchy of needs.
High Priority:
 Life threatening problems such as loss of respiratory /

cardiac functioning
 Ineffective airway clearance
 Fluid volume deficit
 Ineffective breathing pattern
 Medium Priority
 Health threatening problems such as acute illness /
reduced coping
 Anxiety
 Altered comfort

Low Priority:
 Problems that arise from normal developmental needs /

that require only minimal nursing support

 Altered nutrition
 Self care deficit
 Altered sleep pattern
 Cont.
 Priorities change as patients responses, problems and
therapies change.
 Consider the following factors when assigning

priorities;
 Patients health values and beliefs
 Patients priorities
 Resources available to the nurse and patient
 Urgency of the problem
 Medial treatment plan.
 Formulating Objectives / Outcome
Criteria

 Set for each stated N.D. and written in order of priority

 Derived from the first clause (problem) of the N.D.

 Purposes

 Provide direction for intervention

 Provide time span for activities

 Serve as criteria for evaluation of progress

 Provide sense of achievement in patient and nurse.

 Components Of Objectives / Outcome
Criteria
 1. subject : the patient / any part of the patient . An attribute of the
patient.

 2. verb : an action the patient is to perform. Must be observable

behaviors such as walk, show, perform, state, identify and administer.

 3. condition / modifier : explains circumstances under which

behavior is to be performed. Explains what, where, when and how.

 4. criterion of desired performance :indicates standards/level of

performance of the specified behavior. May specify time/speed,
accuracy, distance and quality.
 Objectives
 Sometimes referred to as goals

 Broad statements of desired outcomes / change in patient

behavior

 Describe what the nurse with the patient wants to achieve in

terms of observable patient responses rather than nursing
activities.

 Begin with “patient”

 Provide realistic time span for planned activities

 Cont.
 Derived from problem clause of the nursing diagnosis. E.g.
potential for fluid volume deficit related to diarrhea and inadequate
fluid intake
 Stated as the opposite of the problem ( the unhealthy response) e.g.
patients fluid volume will be maintained
 Each objective should be derived from only one nursing diagnosis.
 Avoid statements that begin with verbs like enable, allow facilitate,
let permit, etc. followed by the word “patient”
 Objective must be considered important and valued by patient and
family
 Must be compatible with the work and therapies of other health
professionals.
Outcome Criteria / Expected Outcomes
 More specific / appraisable / measurable criteria used to
evaluate whether the objective have been met. E.g. output in
balance with fluid intake, normal skin turgor, moist mucous
membranes.

 If achieved, the outcome criteria would be evidence that the

problem has been resolved / prevented. E.g. fluid volume
deficit has been prevented, and the objective has been
achieved.

 Outcomes must be realistic for patients capabilities,

limitations and designated time span.
 Cont.
 Use observable, measurable terms, avoid words that are
vague and require interpretation / judgment. E.g.
patient answering questions correctly / increase in body
weight.

 State at least 2 outcome criteria.

 Nursing diagnosis with subjective problem clause will

require a subjective outcome criteria.
 Cont.
 Join the two parts with “as evidenced by”

 E.g.
 Patients fluid volume will be restored within 24hours

as evidenced by

 1. good skin turgor and

 2. output in balance with intake
 Or simplified as

 Restored fluid volume within 24hours as evidenced by

good skin turgor and output in balance with intake.

 Or

 Patient having good skin turgor and output in balance

with intake within 24hours.
 Selecting Nursing Interventions
 Nursing activities relating to a specific N.D. that the nurse and
the patient will carry out to achieve objective.

 Correct identification of the cause (2nd clause) of the N.D.

provides framework for choosing successful nursing
interventions.

 Nurse and patient establish a number of alternative strategies /

interventions.

 Consider consequences of each strategy based on knowledge an

experience.
 Cont.

 Should focus on eliminating the cause in actual or

reducing risk factors in high risk / potential nursing
diagnosis.

 Must include observation / assessment

 Usually 3 -5, maximum 6 carefully chosen by nurse

and client from alternatives are satisfactory
 Selected strategies must
be:
 Safe and appropriate for patients age, health and so on.


 Achievable with resources available

 Congruent with patients values and beliefs

 Congruent with other therapies

 Based on nursing knowledge and experience

 Within established standards of care.

 Types Of Nursing Interventions

 Independent interventions

 Dependent interventions

 Collaborative interventions
 Writing Nursing Orders

 Selected nursing strategies / interventions are converted

into orders / instructions
 Components Of Nursing Orders
 Date: orders are then reviewed regularly

 Action verb: starts the order and must be precise e.g. explain, apply,
measure, etc.

 Content area: the where and what of the order. E.g. leg, wound, skin,
bandage, lotion, sterile towel, etc.

 Time element: answers when, how long, how often the nursing action
should occur. E.g. daily, morning and evening, 4hourly.

 Signature: shows accountability and has legal significance. Depending

on type of patient problem, the nurse writes the following orders.
 Types Of Orders
 observation orders. E.g. record I & O hourly.

 Prevention orders. E.g. turn patient 2hourly.

 Treatment orders. E.g. dress wound daily

 Health promotion orders. E.g. discuss importance of

daily exercise. (education)
 Drawing Nursing Care
Plan
 A nursing care plan is a written guide that organizes
information about patients care into a meaningful
whole.

 Includes actions nurses must take to address patients

N.D. and meet stated goals

 Drawn as soon as patient is admitted and constantly

updated.
 Types Of Nursing Care
Plans
 Standardized Care Plan: preprinted plan for predictable
situations (the protocols we have on the wards)

 Specifies nursing care for groups of patients with

common needs. E.g. myocardial infraction

Approaches include;
 1. protocols/care pathways: indicates actions commonly

required for a particular group of patients. E.g.

 Cont.
 Admitting into ICU
 Administering magnesium sulphate to a pre-eclampsia

patient.

 2. Policies / procedures: govern the handling of

frequently occurring situations. E.g. specifying number
of visitors a patient may have at a time, what to do in
case of cardiac arrest
 Part of institutional records.
 Cont.
Individualized Care Plan:
 Hand written, tailored to meet the unique needs of a specific patient
 Provides holistic care
 Begins on admission

 Purposes include; to
 Provide direction for individualized care
 Provide continuity of care
 Provide direction about what needs to be documented on patients
progress notes.
 Guide for assigning staff to provide care
 Guide for reimbursement from medical insurance companies.
 Format For Care
Plans
 Organized into (5) columns;

 Nursing diagnosis

 Objective / outcome criteria

 Nursing orders

 Nursing interventions

 Evaluation
Guideliness For Writing A Nursing Care
Plan
 Date and sign the plan
 Use the category headings
 Use standardized medical / English symbols and key words
 Refer to procedure books / other sources of information
 Tailor plan to the unique characteristics of the patient
 Ensure that the plan incorporates restorative, preventive and
health maintenance aspects
 Ensure plan contains ongoing assessment orders
 Include collaborative and coordinative activities
 Include plans for patients discharge and home care needs.
 IMPLEMENTING

 Objective:

 participants will be able to select and implement

appropriate interventions to solve patient identified
problems.
 IMPLEMENTING

 The nurse puts the nursing care plan into action

 Consists of doing, delegating and recording.

 The nurse carries out independent, dependent and

collaborative functions.
 PURPOSE

 To assist the patient meet desired objectives /

outcomes; promote wellness, prevent illness and
disease, restore health and facilitate coping with altered
functioning.
 Cont.

 Successful implementation depends on the part of the

quality of assessing, diagnosis and planning.

 Ongoing assessment occurs simultaneously with

implementation

 Varying degrees of patient participation are encouraged

depending on health status.
 Cont.
 The nurse need to have the following skills;

 1. cognitive: problem solving, decision making,

critical thinking and creativity. Crucial for safe and
intelligent care.

 2. interpersonal: verbal and non-verbal ways of

interacting enhances effectiveness of care.

 3. technical: “hands on” / psychomotor skills.

 STEPS IN IMPLEMENTING
 Reassess the patient

 Determine nurses need for assistance

 Implement the nursing intervention

 Supervise delegated care

 Document nursing activities

 REASSESSING THE CLIENT

 The nurse finds out whether the intervention is still

needed.

 New data may indicate a need to change priorities of

care or the nursing activities.
DETERMINING THE NURSE’S NEED
FOR ASSISTANCE

 The nurse may need assistance for any of these reasons;

 Inability to implement a nursing activity safely alone

 To reduce stress on the patient

 Lack of knowledge or skills to implement a particular

nursing activity.
 IMPLEMENTING NURSING
INTERVENTIONS
 Involves caring, communication, helping, teaching,
counseling, leading and managing.

 Important to explain interventions, sensations to

expect, patients role expected outcome.

 Important to ensure patients privacy.

 The nurse coordinates patient care.

 GUIDELINES FRO IMPLEMENTING
NURSING STRATEGIES
 Base nursing interventions on scientific knowledge, nursing research and
professional standards of care.
 Clearly understand interventions to be implemented
 Adapt activities to the individual client and be holistic
 [

 Implement safe care.

 Provide teaching, support and comfort.

 Respect the dignity of the patient and enhance self esteem

 Encourage patient to participate actively in implementing nursing

interventions
 SUPERVISING DELEGATED
CARE

 Nursing care are assigned and delegated to other nurses

where necessary

 The nurse responsible for the patients overall are

ensures that activities are implemented according to the
care plan.
 DOCUMENTING NURSING
ACTIVITIES

 Interventions and patients responses are recorded in the

nursing progress notes and verbally as well.

 Recording should be done after and not before the

activity is carried out.

 Routine activities may be recorded immediately after

carrying them out or at the end of shift.
 EVALUATING

 Objective:

 By the end of the presentation, participants will be able

to make decisions about clients health status and
determine the extent to which the nursing care plan was
effective.
 EVALUATING

 Planned ongoing, purposeful activity to determine

clients progress towards goal achievement, and
effectiveness of the nursing care plan.

 Continues until the client/patient achieves health care

objectives and is discharged from nursing care.
 PURPOSE
 To determine whether to continue, modify or terminate
the plan of care.

 Through evaluation, nurses;

 1. demonstrate responsibility and accountability for

their actions
 Indicate interest in the results of their activities
 Demonstrate a desire to adopt effective actions
 Effectiveness depends on preceding steps.
 TYPES OF EVALUATION

 Ongoing;

 Done while or immediate after implementing a nursing

intervention

 Helps the nurse to make on-the-spot modifications in

an intervention.
 Cont.
 Intermittent

 Performed at specific intervals

 Shows extent of progress toward achievement of

objective

 Enables the nurse to correct deficiencies and modify

care plan.
 Cont.

 Terminal :

 Performed at discharge

 Determines status of goal achievements

 Determines clients self care abilities.

 STEPS IN EVALUATION
 Collect data related to outcomes

 Compare data with outcomes

 Relate nursing actions to client outcomes

 Draw conclusions about problem status

 Continue, modify or terminate nursing care plan.

 COLLECTING DATA RELATED TO
OUTCOMES
 The nurse uses clearly stated, precise and measurable
outcomes as guide.

 Both subjective and objective data are collected in

order to make conclusions about objective
achievement.

 Subjective data requiring interpretation could be

validated with patients statements/objective indicators
 Cont.

 Objective data requiring interpretations could be

substantiated by seeking the views of colleagues

 Data must be recorded concisely and accurately

 COMPARING DATA WITH
OUTCOMES
 Make judgment about objective achievements

 write an evaluative statement. i.e. conclusion +

supporting data.

 Possible conclusion includes

 1. objective fully met / partially met / not met.

 2. supporting data are the list of patient responses that

support the conclusion.
RELATING NURSING ACTIVITIES TO
CLIENT OUTCOMES

 Determine whether nursing activities had any relation

to the outcomes

 It should never be assumed that a nursing activity was

the cause of / the only factor in meeting, partially
meeting or not meeting an objective.
 DRAWING CONCLUSIONS ABOUT
PROBLEM STATUS
 The nurse uses judgment about client outcomes to
decide whether the care plan was effective in resolving,
reducing or preventing client problems.

 When objective is met, conclusion may be;

 1. actual problem has been resolved / potential problem

has been prevented, objective has been met and care is
discontinued
 Cont.

 2. the potential problem is being prevented but risk

factors are still present. The problem is kept on the care
plan.

 3. the actual problem exists although some objectives

are being met. Nursing interventions are therefore
continued.
 Cont.
 When objectives are partially met or not met, the
conclusion may be;

 1. the care plan may need to be revised in the assessing,

diagnosing, or planning steps, as well as implementing.

 2. the care plan does not need revision, the patient only
needs more time to achieve previously stated
objectives.
CONTINUING, MODIFYING OR TERMINATING
THE NURSING CARE PLAN
 After drawing conclusions about problem status, the
nurse modifies the care plan as indicated.

 Depending on the agency, a hi-liter is used to

mark/draw a line through portions of care plan, or
discontinued, objective met or problem resolved is
written and dated.

 Before modifying, the nurse determines if the plan as a

whole was not completely effective.
 Cont.
 A review of the entire care plan and a critical look at
each step of the nursing process is done.

 Assessing

 Diagnosing

 Planning

 Implementing
 SUMMARY ; SCENARIO

 Thomas Evans, 25years and a 2nd year university

student is admitted to the male surgical ward after
Laparotomy had been performed O/A of peritonitis 2°
to typhoid perforation. On the morning of first day
post-operation, you met him with a temperature of
39.9°C, nasogastric drainage of 740mls/24hrs sunken
eyes, dry skin, with poor turgor, and he complains of
pain at the wound site. He appears anxious.
 Cont.
 Patients problems include;

 1. Patient has a surgical wound

 2. Patient has high body temperature (39.9°C)
 3. Patient complains of abdominal pain
 4. Patient is dehydrated
 5. Patient is anxious
 6. Patient has excessive gastric drainage

(740mls/24hrs)
 REFERENCES
 Berman .A., Synder, S., Kozier, G., Erb, G. (2008)
 Kozier and Erbs fundamentals of Nursing: concepts,

process & practice (8th ed.) New Jersey: Pearson

Prenstice Hall.

 Doenges, M.E. & Moorhouse M. F. (2008).

 Application of Nursing Process & Nursing Diagnosis:

An interactive text for siagnostic Reasoning (5th ed.)

Philadelphia: FA Davis Co.
 REFERENCES
 Kozier, G., Erb, G., Breman, A., Snyder, S., Lake, R. &
Harvey, S. (2008) Fundamentals of Nursing: concepts,
Process & Practice (8th ed.). England, Toronto, New
York, Paris: Pearson Educating Nursing & Health.
THANK YOU

 QUESTIONS

 CONTRIBUTIONS