What is Nursing?

Definition and Historical Context

Nursing is a science and art focused on the diagnosis and treatment of human responses to actual or potential health problems. The profession has evolved through history, shaped by influential figures and major reports.

• Key Figures: Florence Nightingale (pioneered modern nursing education and practice).

• Goldmark Report (1923): Advocated for university-based nursing education and standardized training.

• Modern Nursing: Emphasizes medical advancements, cost containment, and healthcare reform.

Definition (ANA): Nursing is the diagnosis and treatment of human responses to actual and potential health problems.

• Professional Roles: Direct care provider, communicator, patient/family educator, patient advocate, counselor, leader, manager, case manager, research consumer.

• Important Qualities: Critical thinking, judgment, compassion, ethical orientation, organizational skills, communication, patience, competence.

Nursing as a Profession: Combines science and art, is service-oriented, and requires a body of knowledge, autonomy, higher education, and responsibility.

• Nursing Organizations: ANA, NSNA, Sigma Theta Tau, NCF.

• Mission Themes: Caring, Christian context, Holism, Critical thinking, Cultural competence.

Critical Thinking & The Nursing Process

Critical Thinking in Nursing

Critical thinking is essential for effective nursing practice, involving reasoned thinking, open-mindedness, and reflection.

• Key Components: Reasoned thinking, openness, reflection, truth-seeking.

• Improvement: Motivation, prioritization, clinical judgment.

• Involves: Problem solving, decision making, diagnostic and clinical reasoning.

• Clinical Judgment: Noticing, interpreting, responding, reflecting.

The Nursing Process

The nursing process is a systematic, patient-centered approach to care, consisting of five phases.

• Phases: Assessment, Diagnosis, Planning Outcomes, Planning Interventions, Implementation, Evaluation.

• Assessment: Data collection (subjective and objective). Types: Initial, Comprehensive, Focused, Special needs.

• Diagnosis: Identifying patient problems and needs.

• Planning Outcomes: Setting measurable goals and expected outcomes.

• Planning Interventions: Selecting nursing actions to achieve outcomes.

• Implementation: Carrying out interventions.

• Evaluation: Assessing goal attainment and revising plan as needed.

Nursing Process Part 2: Organizing Data & Diagnosis

Data Organization and Diagnosis

Organizing patient data is crucial for accurate diagnosis and effective care planning.

• Gordon’s Functional Health Patterns: Health perception, nutrition, elimination, activity/exercise, cognition, sleep, self-perception, roles, sexuality, coping, values.

• Nursing Diagnosis: Nurses can treat independently or collaboratively; forms the foundation for interventions.

• Diagnostic Reasoning: Analyze data, cluster, draw inferences, identify strengths/problems, prioritize, record.

• Collaborative Problems: Physiologic complications requiring physician/nursing intervention.

• NANDA-I: Standardized nursing diagnoses, reviewed every 2 years.

• Components of Diagnosis: Diagnostic label, related factors, defining characteristics.

Nursing Process Part 3: Planning Outcomes

Planning and Goal Setting

Planning involves setting realistic, measurable goals and expected outcomes for patient care.

• Types of Planning: Formal (deliberative) vs. Informal (mental notes).

• Types of Plans: Initial (first contact), Ongoing (changes during care), Discharge (starts at admission).

• Priorities: Change with condition, consider client perception and self-care ability.

• Goals/Outcomes: Expected Outcomes (EO) linked to diagnosis, realistic, specific, measurable.

• Goals: Short-term (hours–days, before discharge), Long-term (weeks–months, prevents rehospitalization).

Nursing Care Plan

Components of a Nursing Care Plan

A nursing care plan is a structured approach to patient care, including diagnosis, goals, interventions, and evaluation.

• Nursing Diagnosis: Label, related factors, defining characteristics.

• Goal/Expected Outcomes: Short-term and long-term; measurable, realistic.

• Nursing Interventions: At least three; specify direct vs. indirect, with rationale.

• Evaluation: How to measure if goals were met.

Sample Nursing Care Plan (Case Study: Mr. Jameson)

• Nursing Diagnosis:

  • Ineffective airway clearance r/t increased secretions and fatigue AEB productive cough, shortness of breath, O2 sat 87%.

  • Imbalanced nutrition: less than body requirements r/t fatigue and decreased appetite AEB patient reporting not eating well.

• Goal/Expected Outcomes:

  • Short-term (24–48 hrs): Patient’s O2 saturation will improve to ≥ 92% on 2L nasal cannula.

  • Long-term (1–2 weeks): Patient will verbalize and demonstrate effective coughing and deep breathing techniques to maintain airway clearance.

  • Nutrition long-term: Patient will gain 2 lbs within 1 month.

• Nursing Interventions (with rationale):

  • Direct care: Position patient in high Fowler’s position to maximize lung expansion. Rationale: Improves ventilation and gas exchange.

  • Direct care: Encourage use of incentive spirometer every hour while awake. Rationale: Promotes lung expansion and mobilizes secretions.

  • Direct care: Provide high-protein, high-calorie meals with assistance as needed. Rationale: Supports recovery and improves energy for healing.

  • Indirect care: Collaborate with respiratory therapy for breathing treatments. Rationale: Enhances airway clearance through specialized interventions.

• Evaluation:

  • O2 saturation consistently ≥ 92%.

  • Patient demonstrates proper breathing/coughing techniques.

  • Patient verbalizes increased appetite and consumes >75% of meals.

  • Weight gain of at least 2 lbs at follow-up.

Medical vs Nursing Assessment

Comparison Table

The following table summarizes the differences between medical and nursing assessments:

NANDA-I Nursing Diagnosis Components

• Diagnostic label

• Related factors

• Defining characteristics

Obstacles to Critical Thinking

• Anxiety – manage through mindfulness/study planning.

• Bias/overcommitment to assumptions – challenge self with alternative perspectives.

Phases of the Nursing Process

1. Assessment

2. Diagnosis

3. Planning Outcomes

4. Planning Interventions

5. Implementation

6. Evaluation

Key Terms and Definitions

• Assessment: Systematic collection of patient data.

• Diagnosis: Identification of patient problems based on assessment data.

• Planning: Setting goals and expected outcomes.

• Intervention: Actions taken to achieve goals.

• Evaluation: Determining if goals were met and revising care as needed.

Formulas and Equations

• Goal Setting Equation:

Additional info:

• Some content inferred for completeness, such as definitions and rationale for interventions.

• Expanded explanations for critical thinking and care planning to ensure academic quality.