انت هنا الان : شبكة جامعة بابل > موقع الكلية > نظام التعليم الالكتروني > مشاهدة المحاضرة

The Nursing Process

Share |
الكلية كلية التمريض     القسم قسم التمريض العام     المرحلة 4
أستاذ المادة سلمى كاظم جهاد الابراهيمي       13/11/2016 06:53:54

The Nursing Process:

Certain characteristics of that process are important for community health nurses to emphasize in their practices

1. Deliberative
The nursing process, like the research process in EBP (evidence-based practice), is deliberative purposefully, rationally, and carefully thought out. Community health nurses often practice in situations that demand the ability to think independently and make difficult decisions.
2. Adaptable
The nursing process is adaptable. Its dynamic nature enables the community health nurse to adjust appropriately
to each situation and to be flexible in applying the process to aggregate health needs, its flexible, applied specifically to the individual situation and group of people.

3. Cyclical :
The nursing process is in constant progression. Steps are repeated over and over in the nurse– aggregate client relationship.
The nurse engages in continual interaction, data collection, analysis, intervention, and evaluation. As interactions between nurse and client group continue, various steps in the process overlap with one another and are used simultaneously.

4. Client Focused
It is used for and with clients. Community health nurses use the nursing process for helping aggregate clients, directly or indirectly, to achieve and maintain health. Clients as total systems—whether groups, populations, or communities—are the targets of the PHN’s nursing process.

5. Interactive
Nurse and clients are engaged in a process of ongoing interpersonal communication. Giving and receiving accurate information is necessary to promote understanding between nurse and clients and to foster effective use of the nursing
process. community health nurses have increasingly joined forces to assume responsibility for promoting community
health.

6. Need Oriented
The nursing process is need oriented. nurse can use the nursing process to anticipate client needs and prevent problems. The nurse should think of nursing diagnoses as ranging from health problem identification to primary prevention and health promotion opportunities.


Interacting With the Community
All steps of the nursing process depend on interaction, reciprocal exchange and influence among people.
It is an essential first consideration for community health nursing
Listening to a group of elderly people, teaching a class of expectant mothers, working with parents to set up a dental screening program for children—all these involve relationships, and relationships require interaction. Mutual give and take between nurse and clients.

Types of Community Needs Assessment
Assessment is the key initial step of the nursing process. Assessment for nurses means collecting and evaluating information about a community’s health status to discover existing or potential needs and assets as a basis for planning future action. assessing a community’s ability to enhance its health, the nurse may collect data on community lifestyle behaviors and interpret previously collected data on morbidity and mortality.

Community needs assessment
Is the process of determining the real or perceived needs of a defined community.
community health nurses may need to perform a cursory examination or “windshield survey” to familiarize themselves with an entire community without going into any depth.

Familiarization or Windshield Survey
A familiarization assessment is a common starting place in evaluation of a community. Familiarization
assessment involves studying data already available on a community, then gathering a certain amount of firsthand
data in order to gain a working knowledge of the community. Such an approach may utilize a

windshield survey—an activity often used by nursing students in community health courses and by new staff members
in community health agencies. Nurses drive (or walk) around the community of interest; find health, social, and governmental services; obtain literature; introduce themselves and explain that they are working in the area; and generally become familiar with the community and its residents. This type of assessment is needed whenever the community health nurse works with families, groups, organizations, or populations. The windshield survey provides knowledge of the context in which these aggregates live and may enable the nurse to better connect clients with community resources.

Problem-Oriented Assessment
Begins with a single problem and assesses the community in terms of that problem.
The problem-oriented assessment is commonly used when familiarization is not sufficient and a comprehensive
assessment is too expensive.
This type of assessment is responsive to a particular need. The data collected will be useful in any kind of planning for a community response to the specific problem. Data should address the magnitude of the problem to be studied (e.g., prevalence, incidence), the precursors of the problem, information about population characteristics, along with the attitudes and behaviors of the population being studied.

Sources of Community Data
Data sources can be primary or secondary, Information gathered by talking to people provides primary data, because the data are obtained directly from the community. Secondary sources of data include people who know the community
well and the records such people create in the performance of their jobs. Specific examples are health team members, client records, community health (vital) statistics, census bureau data, reference books, research reports, and community health nurses.

Data Analysis And Diagnosis

The Analysis Process
First, the data must be validated: Validated data are then separated into categories such as physical, social, and environmental data. In many instances, data spreadsheets are used to provide a structure for data organization. Next, each category is examined to determine its significance. At this point, there may be a need to search for additional information to
clarify the meaning of the data.
Only then can inferences be made and a tentative conclusion about the meaning of the data be reached. Some computer programs are designed to analyze community assessment data. For large, complex, or ongoing community assessment plans, this may be the best method. For smaller, one-time assessments, the paper-and-pencil method may be sufficient and less unwieldy.

Community Diagnosis Formation

The diagnosis “describes a situation” and “implies a reason” or etiology focusing on a specific community . Various taxonomies and classification systems are used in nursing to describe specific nursing problems and each one has its limitations when dealing with community-level diagnoses.
The North American Nursing Diagnosis Association (NANDA) is much more oriented to nursing diagnoses of individuals and families than to community-level problems.

The statement of a [client’s] response which is actually or potentially unhealthful and which nursing intervention can help to change in the direction of health. It should also identify essential factors related to the unhealthful response.
The statement of a client’s [community’s] healthful response which nursing intervention can support or strengthen. It should also identify the essential factors related to the healthful response.

Community diagnoses refer to nursing diagnoses about a community’s ineffective coping ability and potential for enhanced coping. The statements about the community should include the strengths of the community and possible sources for community solutions, as well as the community’s weaknesses or problem areas.

Using the standard nursing diagnosis format, community-level diagnoses can be developed.
These diagnoses are used as tools as the community begins to plan, intervene, and evaluate outcomes. Diagnostic categories for individuals (e.g., knowledge deficit of senior services, high risk for injury or falls) can often be applied at the community level. Nursing diagnoses change over time because they reflect changes in the health status of the community; therefore, diagnoses need to be periodically reevaluated and redefined.
The changing diagnosis can be a useful means of moving a community toward improved health because it gives community members a clear standard against which to measure progress.

Planning to Meet the Health Needs of the Community

Planning is the logical decision-making process used to design an orderly, detailed series of actions for accomplishing
specific goals and objectives.

Planning for community health is based on assessment of the community and the nursing diagnoses formulated, but assessment and diagnosis alone do not prescribe the specific actions necessary to meet clients’ needs .
Knowing that a group of mothers at the well-child clinic need emotional support does not tell the nurse what further action is indicated. The nurse must systematically develop an appropriate plan as thee Levels of Prevention Pyramid). ( Student requirement )

The use of standardized tools enhances the planning process and promotes effectiveness of services, as well as professional standards of practice. In addition to using tools, a systematic approach to planning guides the community health nurse to list needs in order of priority, establish goals and objectives, and record the plan. As they do in the rest of the nursing process, community health nurses collaborate with clients and other appropriate professionals throughout
each of these planning activities.

Establishing Goals and Objectives
Goals and objectives are crucial to planning and should be feasible and specific. The diagnosis that identifies needs
must be translated into goals to give focus and meaning to the nursing plan. Goals are broad statements of desired outcomes.

Objectives are specific statements of desired outcomes, phrased in behavioral terms that can be measured. Target dates for expected completion of each objective are also stated. Objectives are the stepping-stones to help one reach the end results of the larger goal. For the elderly group concerned about crime in the neighborhood, the need, the goal, and the objectives were defined as follows:
?? Need: The group of elderly people has altered coping ability related to their fear of crime.
?? Goal: Within 6 months, this group of elderly people will feel comfortable to walk the streets of their neighborhood without experiencing any incidents of criminal assault.
Objectives:
1. By the end of the first month, a safety committee (composed of senior citizens, nurses, police, and other appropriate community members) will be established to study the crime patterns in the neighborhood.
2. The safety committee will develop strategies for crime reduction and elder protection, which will be presented to the city council for approval by the end of the third month.

Development of objectives depends on a careful analysis of all the ways in which one could accomplish the larger goal. One should first select the course of action that is best suited to meet the goal and then build objectives.

Planning means thinking ahead. The nurse looks ahead toward the desired end and then decides what intermediate actions are necessary to meet that goal.
Sometimes, an objective itself describes the intermediate actions. At other times, an objective may be further broken down into several activities.
Making decisions is an important part of planning. Decisions must be made during the process of establishing priorities.

Decisions are necessary for selecting goals and for choosing the best course of action from many possible courses. Further decision making is involved in selecting objectives and taking action to accomplish the objectives.
To facilitate planning and decision making, the community health nurse involves other people.

Clients must be included at every step because they are the ones for whom the planning is being done. Without their
insight and cooperation, the plan may not succeed. Additionally, the involvement of other nurses may be important. Team meetings, nurse–supervisor conferences, and nurse–expert consultant sessions are all useful resources for planning. In addition, with members of other health and professional disciplines (e.g., teachers, social workers, mental health professionals, city planners). Interdisciplinary team conferences are valuable for gaining a broader perspective and enlisting wider support for the evolving plan.

Implementing Plans For Promoting The Health Of The Community
Implementation is putting the plan into action. The nurse, other professionals, or clients carry out the activities
of the plan. Implementation is often referred to as the action phase of the nursing process. In community health nursing, implementation includes not just nursing action or nursing intervention, but collaboration with clients and perhaps other professionals. When bringing about change in a community organization, implementation involves the greatest commitment of time and planning. This often includes an implementation timetable, as well as funding or organizing physical/ informational/staff/management resources, collaboration with outside agencies, training staff and working with community volunteers as needed for program implementation, as well as actually putting into action those interventions created during the planning phase.
The actual course of implementation, outlined in the plan, should be fairly easy to follow if goals, expected outcomes, and planned actions have been designed carefully. Professionals and clients should have a clear idea of who, what, why, when, where, and how. Who will be involved in carrying out the plan? What are each person’s responsibilities? Do all understand why and how to do their parts? Do they know when and where activities will occur?

Evaluating Implemented Community Health Plan
Evaluation is usually seen as the final step, but since the nursing process is cyclic in nature, the nurse is constantly evaluating throughout the entire process. For instance, in the assessment phase, the nurse must evaluate whether
the collected data are sufficient and appropriate to beginning planning. Evaluation methods must be addressed during the planning phase as goals and objectives, as well as interventions are identified
Evaluation refers to measuring and judging the effectiveness of goal or outcome attainment. Too often, emphasis is placed primarily on assessing client needs and on planning and implementing service.
The nursing process is really not complete until evaluation takes place.


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
download lecture file topic