N320: Foundations

Intercollegiate Center for Nursing Education

of Eastern Washington University, Gonzaga University, and Whitworth College, and College of Nursing, Washington State University

Nursing Process Information Part 1

By Carol B. Allen MSN, RN

Comparison of Problem Solving Processes:

Nursing process is a problem solving process. The chart below compares the nursing process with other problem solving processes with which you maybe familiar.

Consider: What are the similarities? What are the differences? Why do you think that nursing uses unique terminology?

Problem Solving Processes

Nursing Process Problem Solving Research Process
Assessment Assessment Assessment
Diagnosis Analysis Statement of Problem
Planning Choose Solution Design Research
Implementation Solution Conduct Research
Evaluate Evaluate Analyze/Conclude

Standardized Classification Systems

A number of standardized classifications are used with nursing process. The oldest of these is NANDA. This acronym stands for North American Nursing Diagnosis Association. This group has developed the standardized listing of Nursing Diagnoses including the description of defining characteristics for each diagnosis that appears in your text.

NIC - Nursing Intervention Classification has been under development for the past 8 years. Most of the work has been done by a research group at the University of Iowa with input from nurses all over the United States. This taxonomy lists and classifies nursing interventions (nursing activities). The NIC was developed for many reasons including to:

  1. Standardize the nomenclature of nursing treatments
  2. Teach Nursing decision-making to Nursing Students
  3. Maximize use of nursing and health care information systems (computer technology)
  4. Determine the costs of services provided by nurses
  5. Communicate the unique functions of nursing.
  6. Expand nursing knowledge about the links between diagnoses, treatments and outcomes.

The NIC system may be especially helpful to you in planning care. In session 2 of Nursing Process you will have an opportunity to explore the NIC. The NIC book: Nursing interventions classification is on reserve in the library if you wish to look at it in more detail. You can also read more about NIC on the web.

NOC

Nursing Outcomes Classification is the newest taxonomy. It is still in the developmental stage. NOC lists standardized outcomes for the evaluation of nursing care. It is increasingly important for all health care professionals to demonstrate measurable outcomes of the care they provide. Consumers want to know that they are getting value for their money. Measuring outcomes provides data that demonstrates whether or not the care we provide makes important differences in the health of people. The NOC may help you to write appropriate measurable goals for your patient. The NOC book: Nursing outcomes classification is also on reserve in the library. You may also learn more about NOC on the web

Pros and Cons of Nursing Process and Nursing Diagnosis

Your text clearly describes some of the advantages of using Nursing process and nursing diagnoses. Not everyone agrees that nursing diagnoses are the way to organize nursing thinking. Two recent articles discussed concerns from an ethical and from an international perspective.

The article by Mitchell (1991) critiqued nursing diagnoses from an ethical perspective. Many of the concerns she raised were related to process of labeling. When we assign a nursing diagnosis we also label the person. Mitchell believes that the experience of being judged and labeled produces suffering because the person is treated as an object rather than a unique being. Labeling is an exercise of power. Exercise of power always increases the vulnerability of the one over whom it is exercised no matter what benevolent purpose the power serves (p. 99).

Thinking questions:

What do you think about these criticisms? Do you think these concerns outweigh the advantages? Do you want to know more about her position?

To learn more READ: Mitchell, G., (1991) Nursing diagnosis: An ethical analysis. Image. 23 (2), 99-103.

The article by Lutzen & Tishelman (1996) considers nursing diagnosis from an international perspective. Among the concerns raised by these Swedish authors is the assumption that client needs and experiences can be classified according to predetermined categories. They point out that these categories are not value-free and even though we say the nursing process is mutual it often is not. In addition, these nurses believe that nursing diagnoses do not reflect the complexity of real world situations, they reduce human experience to an often ill-fitting label. Nursing diagnoses are statements of problems. Consequently, nurses may not pay attention to strengths that may help the person manage their health concerns.

These authors also wonder if nursing diagnosis is just more jargon contributing to poor communication rather than improving communication.

What do you think of theses criticisms? Do you think the advantages of nursing diagnosis outweigh these concerns? In a global health care system should American systems and ideas dominate? Why or why not? What are some other alternatives?

Want to know more? READ: Lutzen, C. & Tishelman, C. (1996). Nursing diagnosis: A critical analysis of underlying assumptions. International Journal of Nursing Studies. 33(2), 190-200.

 

Nursing Process Session 1

John J

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