Textbook of Medical-Surgical Nursing 3e

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Unit 1 Contemporary concepts in nursing

development of autonomy and accountability in nursing and have helped to delineate the scope of practice. Choosing a nursing diagnosis When choosing the nursing diagnoses for a particular patient, the nurse must first identify the commonalities among the assessment data collected. These common features lead to the categorisation of related data that reveal the existence of a problem and the need for nursing intervention. The patient’s identified problems are then defined in terms of nursing diag- noses. It is important to remember that nursing diagnoses are not medical diagnoses; they are not medical treatments prescribed by the doctor; and they are not diagnostic studies. Nursing diagnoses are not the equipment used to implement medical therapy, and they are not the problems that the nurse experiences while caring for the patient. They are the patient’s actual or potential health problems that independent nursing actions can address. Nursing diagnoses that are succinctly stated in terms of the specific problems of the patient will guide the nurse in the development of the nursing plan of care. To give additional meaning to the diagnosis, the charac- teristics and the aetiology of the problem must be identified and included as part of the diagnosis. For example, the nursing diagnoses and their defining characteristics and aetiology for a patient who has rheumatoid arthritis may include: • Impaired physical mobility related to pain and stiffness with joint movement • Self-care deficits (bathing/hygiene, dressing/grooming, feeding, toileting) related to fatigue and joint stiffness. • Low self-esteem (chronic, situational, risk for situational) related to loss of independence. • Imbalanced nutrition (less than body’s requirements), related to fatigue and inadequate food intake. Collaborative problems In addition to nursing diagnoses and their related nursing interventions, nursing practice involves certain situations and interventions that do not fall within the definition of nursing diagnoses. These activities pertain to potential problems or complications that are medical in origin and require collab- orative interventions with the doctor and other members of the healthcare team. The term collaborative problem is used to identify these situations. Collaborative problems are certain physiological compli- cations that nurses monitor to detect changes in status or onset of complications. Nurses manage collaborative problems using doctor-prescribed and nursing-prescribed interventions to minimise complications (Carpenito, 2012). A primary focus of the nurse when treating collaborative problems is monitoring the patient for the onset of complications or changes in the status of existing complications. The complications are usually related to the patient’s disease process, treatments, medications, or diagnos- tic studies. The nurse prescribes nursing interventions that are appropriate for managing the complications and implements the treatments prescribed by the doctor. Figure 2-5 depicts the dif- ferences between nursing diagnoses and collaborative problems. After the nursing diagnoses and collaborative problems have been identified, they are recorded on the plan of nursing care. Planning Once the nursing diagnoses have been identified, the planning component of the nursing process begins. This phase entails the following:

Situation identified (health status, problem)

Can the nurse legally order the primary interventions to achieve a goal?

Yes

No

Nursing diagnosis

Are medical and nursing interventions needed to achieve the patient goal?

Prescribe and execute the interventions that are definitive for prevention, treatment or health promotion

Yes

No

Discharged from nursing care

Collaborative problems

Monitor and evaluate condition

Prescribe and implement interventions that are in the domain of nursing

Implement the prescriptive orders

1. Assigning priorities to the nursing diagnoses and collaborative problems. 2. Specifying expected outcomes. 3. Specifying the immediate, medium-term, and long-term goals of nursing action. 4. Identifying specific nursing interventions appropriate for achieving the outcomes. 5. Identifying interdependent interventions. 6. Documenting the nursing diagnoses, collaborative problems, expected outcomes, nursing goals, and nursing interventions on the plan of nursing care. 7. Communicating to appropriate personnel any assessment data that point to health needs that can best be met by other members of the healthcare team. Figure 2-5  Differentiating nursing diagnoses and collaborative problems (Redrawn from Carpenito, L.J. (2012). Nursing diagnosis: Application to clinical practice (14th ed.). Philadelphia: Lippincott Williams & Wilkins.)