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Nursing diagnoses and interventions with the acute stroke patient.

The multiple and complex needs of the stroke patient may best be managed by thorough nursing assessment, precise interpretation of clinical signs and symptoms, and identification of individualized nursing diagnoses, etiologic factors, desired outcomes, and nursing interventions. A strong knowledge base of neuroanatomy and cerebral blood flow, together with skillful use of the nursing process, will help the nurse meet the challenge of caring for these complex patients in the acute phase.

Acute Disease↗

An overview of the rationale, process, and nursing implications of peripheral blood stem cell transplantation.

Peripheral blood stem cell transplantation (PBSCT) is the process of removing circulating stem cells from the peripheral blood through apheresis and returning these cells to the patient after dose-intensive chemotherapy. Clinical trials using PBSCT and dose-intensive chemotherapy are underway at cancer centers across the country. Nurses caring for patients who are undergoing PBSCT need an understanding of all aspects of the process in order to competently manage the toxicities, as well as to educate patients, families, and other staff. Nurses need to consider issues for nursing research to improve the quality of life for these patients.

Antineoplastic Agents↗

Time to extend the 'process'?

During the past two decades, nurses and nursing students have been encouraged to organize care planning via the 'nursing process'. Although it is helpful to adopt a systematic approach to planning nursing care, it may be time to evaluate our use of the process; to consider whether strict adherence to it has shifted nursing's perspective from holism to an unduly mechanistic approach to care giving. Several research studies support the notion that intuitive processes are an important aspect of clinical judgement. In order to educate future generations of nurses for expertise in practice rather than mediocrity, these processes must be acknowledged and taken account of in curriculum planning; the nursing process should be recognized as merely a fraction of the equation for practice.

Clinical Competence↗

The management of quality assurance in nursing.

The results of a national survey of hospital patients as they relate to nursing are presented. A brief review of the literature locates the study in the context of developments in nursing quality assurance, examining, in particular, conceptual issues of how the nursing process may be measured, and the role of the nursing profession in quality assurance. Results of the study identify a number of problems with the process of nursing care, including pain management, discharge planning and physical care, with wide variation between hospitals on many issues. The implications of these results for managers of nursing are discussed.

Humans↗

The European Basic Core Curriculum for Nephrology Nursing, the process of writing, publishing and disseminating.

In August 2002 the European Basic Core Curriculum (BCC) for Nephrology Nursing was published on the EDTNA/ERCA homepage. At the EDTNA/ERCA annual conference in The Hague in September 2002, it was presented to the delegates as an oral presentation and a poster presentation. Publicity flyers were translated into seven languages and distributed to delegates. This paper will describe the aims of the BCC, the process of writing and publishing, the use of the BCC in nursing schools and the measures that have already been taken in implementation and dissemination.

Curriculum↗

Community health nursing practice and the Roy Adaptation Model.

In the current health care environment in the United States, the work performed by community health nurses is increasingly being recognized and valued by society at large. An increased societal emphasis on health promotion and disease prevention has generated many opportunities for community health nurses (CHNs) to stretch their practices from individually-oriented type practice models to more encompassing population-focused type practices. Addressing this trend, the Roy Adaptation Model of nursing has been reconceptualized and expanded to offer a framework for the systematic delivery of nursing care to aggregates in community settings. The purpose of this paper is to describe the current health promotion movement in the United States and discuss the impact of this movement on the practice of community health nursing. In recognition of the importance of theory-based nursing practice and the opportunities that CHNs will have in the health promotion movement, the use of the a specific conceptual model, the reconceptualized Roy Adaptation Model, will be presented as a theoretical framework for community health nursing practice. The nursing process according to Roy is applied to community health nursing and specific attention is paid to the performance of community assessments within the newly defined adaptive modes that relate to collectives: the physical, group identity, role function, and interdependence modes. To date, few references appear in the literature which link the Roy Adaptation Model to community health nursing.

Adaptation, Psychological↗

Application of King's Theory of Nursing to the care of the adult with diabetes.

This paper demonstrates how King's theory of goal attainment can be applied to the care of the adult with diabetes mellitus. Salient components of King's theory are presented followed by application of the theory using the nursing process as a framework. An example of a nurse-patient interaction is used to more clearly present the application. The advantages of King's theory in relation to the care of the diabetic adult are also discussed.

Adult↗

[A successful implementation of a work tool].

The purpose of this year-long study, conducted in a medical ward at Edmundston Regional Hospital of New Brunswick, was to lay the groundwork for data collection as the first step of the nursing process. By adhering to the Collerette and Delisle planned change methodology, the author was able to overcome many of the usual barriers, such as lack of training and staff shortages, and build solid support for her pilot project. The results surpassed all expectations and the change process has instilled a new sense of pride among nurses at the hospital and sparked the development of training sessions for other nurses in the region.

Attitude of Health Personnel↗

The impact of nursing diagnoses in a long-term care setting.

Nursing diagnosis as a critical component of the nursing process provides a common taxonomy to describe problems that nurses can treat and is a convenient, logical way to reference nursing standards. Theory is translated into practice with the use of population-specific prototype care guides and a written orders system. Nurses in leadership are responsible for providing the necessary resources to promote professional growth and facilitate desired change. Recommendations to assist with the implementation of nursing diagnosis are identified in Table 1. The system is dependent on staff nurses' professional commitment to learning and willingness to actively participate in change. Involvement of staff nurses continues to be a critical factor in the improvement of nursing practice.

Hospital Bed Capacity, 500 and over↗

Integrative care planning in acute psychiatry.

Psychiatric nurses in Britain are increasingly utilizing the problem-solving techniques embodied in the nursing process in order to formulate programmes of care. The paper disputes the validity of an approach which suggests that one discipline (nursing) possesses the broad-based assembly of skills necessary to promulgate coping strategies in the client and his family or sustainer-group. The efficacy of such an approach is particularly questionable when we consider that much of our work as nurses is practised in a hospital environment, where the client is abstracted from his familiar surroundings and support networks. Suggestions are made for improving the appropriateness and quality of psychiatric nursing interventions within a multi-disciplinary care framework, and the argument is put forward that dogmatic adherence to the nursing process, with the emphasis upon finding answers to problems, may dually impede inter-disciplinary teamwork and also lead us away from analysis of the skills which are important in establishing an effective interaction with the client and his family.

Family↗

How Japanese nurses provide care: a practice based on continuously knowing the patient.

AIM: Criticisms of the nursing process as a problem-solving approach have emerged recently. This study aimed to identify and describe a way of nursing based on the clinical practice of selected nurses in Japan. METHODS: Data were collected using semi-structured interviews and observations at one 300-bed Japanese hospital in 1999. The purposive sample consisted of 24 female nurses. Data analysis occurred simultaneously with data collection, and questioning and constant comparison were used for data analysis. Codes were clustered into categories and relationships among these were identified. In the final stage of the analysis, two group interviews with participants were carried out to enhance credibility. FINDINGS: This study identified a Japanese way of nursing intended to help patients explore and realize meanings and values of their experiences with illness. When nurses first contacted a patient, they quickly formed a patient image, but altered it each time they obtained new patient information. A patient image consisted of the patient's subjective world (the patient's perspective) and the holistic patient (nurses' perspectives of the patient). The nurses sometimes pursued strategies to know the patient's subjective world. The target, direction, conditions and ways of nursing care were decided based on continuously knowing the patient. The nurses related their knowledge and thoughts to the patient, and by talking with the patient promoted the patient's consideration and participation, and empowered the patient. Nurses continued attending to patients even when they could not provide specific nursing interventions. CONCLUSIONS: Knowing the patient was found to be especially important in determining nursing care. The model described in this study does not contradict the nursing process as a systematic approach to problem-solving. Rather, it has some alternatives that might be useful in providing individual care in Japan.

Adult↗