NURSING PROCESS What is it? — A PRACTICAL INTRODUCTION
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NURSING PROCESS
What is it?
— A PRACTICAL
INTRODUCTION - extracted text
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NURSING PROCESS
What is it?
— A PRACTICAL
INTRODUCTION
Revised version 1984
First published in 1982
Reprinted five times in 1983
Translated into Swedish by Kerstin Karlsson for the School of
Nursing, Uppsala, Sweden
Translated into German by Use Zajic for nurses in Berlin
NHS Learning Resources Unit
55 Broomgrove Road
Sheffield S10 2NA
Telephone 0742 661862
R7O9O
The Authors
Jean Heath BA SRN SCM CERT Ed
Jean Heath has been with the NHS Learning
Resources Unit in Sheffield since 1976.
She leads workshops on Curriculum Planning
and sees the philosophy of the Nursing
Process as a main focus for decision making
for those who plan, teach or learn.
Gladys M. Law BA SRN SCM BTA Cert RCNT
DN Dip in Adv Nurs Studies
Gladys Law was appointed from 1979-1984, by
the Department of Health and Social
Security, to act as advisor/co-ordinator
for activities relating to implementation
of the Nursing Process in England and
Wales.
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*7 do not pretend to teach
her how, I ask her to teach
herself, andfor this purpose
I venture to give her some
hints”.
“Notes on Nursing”
F. Nightingale (1859)
(in 1970 edition published by Duckworth)
3
Contents
Acknowledgements
3
Foreword
4
Introduction
7
The Nursing Process
a sequence of steps
13
Assessment
17
Planning
29
Implementation
39
Evaluation
41
Doubts and Dilemmas
45
Conclusion
51
Further Reading
54
4
We acknowledge the help of our
many friends and colleagues who
have supported the development
of this booklet. We would
especially mention those who
have committed themselves to
using the Nursing Process, without
whom this booklet would never have
materialised.
5
Foreword
This publication has been produced in
response to numerous requests for
information, at an introductory level,
which is concise and understandable.
Many of those who are attempting to
use the Nursing Process, or teach
others about it, have identified
a need for such a publication. This
booklet perhaps, could form a bridge to the
more advanced literature which is already
available.
Our aim is, therefore, to provide a simple,
practical guide to the Nursing Process for
anyone new to the topic. It is directed
primarily to nurses in clinical areas
who are introducing Nursing Process but who
may be unclear or unconvinced of the
advantages of adopting this approach.
We hope to reduce some of the anxiety which
can occur when approaching change, but we
are also aware of the danger of trivializing
some of the concepts presented when attempting
to simplify. Readers are therefore, encouraged
to go on to further reading, thinking and action.
6
This second edition takes into account
more recent thinking and writing about the
nursing process. Some of the terminology
has also been changed.
7
As you read through this
booklet, you willfind
that we have suggested
some activities for you.
Ifyou are a nurse learner,
do make sure you have the
approval of the person in
charge first—you may need
supervision in practice.
The Cartoons have
been drawn by
STEVE GLEADALL
8
Introduction
The Nursing Process is a logical, systematic
approach to the total care of a patient.
It involves the following steps:
1. Assessing
2. Planning
3. Implementing
4. Evaluating
Each of these steps will be considered
separately in this booklet, but this approach
to nursing care must be seen as a whole—
each step is dependent on the others.
9
PROCESS ISN’T 4 m
I USE E.VERWW. WHAT
HEY/ FANCIED
AMERICAN
NONSENSE/
The word “Process” just means a course
of action—a way of working which has some
order to it.
The Nursing Process means a series of related
actions involved when nursing—it is an
orderly way of going about your business of
caring for each patient, as an individual.
* It is a way of ensuring that the
nursing you give is tailor-made
for each individual patient.
* It is a way of ensuring that you plan your
nursing around the identified needs
of the person for whom you are caring.
* It is a way of ensuring that all the
details you need to give individualised
care, are available and documented for:—
10
— other nurses to use when you
are off duty
— an up-to-date record of
progress
— future reference if necessary.
* It offers a framework for
evaluating each patient’s
progress and for further
assessment and planning.
THE NURSING PROCESS IS A LOGICAL, SYSTEMATIC
APPROACH TO THE TOTAL CARE OF A PATIENT
\
After reading this you may want
to say ^Whafs wrong with what I
am doing now?” or “How can I
give individualised care when we
are short of staff and very busy?”
etc., etc. We have attempted to
answer some of the questions
people have asked towards the end
of this booklet, but please
read the bit in between first.
11
Although each phase or step of the Nursing
Process is presented separately, each
depends on the other and all steps can
occur simultaneously for different aspects
of a patient’s nursing care. You might also feel
that in a busy ward or day hospital it is
not always possible to follow through each
step fully before proceeding to the next.
Obviously you will not insist on asking
your patient about his hobbies if he is
vomiting or haemorrhaging!
The framework is intended to help you
nurse more efficiently and effectively.
When doing anything new or different,
however, it can sometimes take a little
longer initially.
For example—
you may remember
yourfeelings and
difficulties when
learning to drive?
12
The Nursing Process is a series of
related actions which take place
when providing individualised
nursing. It provides a framework
for making decisions, setting
goals, taking action and measuring
patient progress and the
effectiveness of nursing.
The Nursing Process is not carried out in
isolation. The work of other professionals
for example—doctors, physiotherapists,
social workers, district nurses—
is taken into account as necessary. These
people may be using a similar framework
for their care. Nurses continue to work
in collaboration to take into account
the patient’s medical diagnosis if known,
and carry out medically prescribed treatment
as appropriate.
Frequently nurses are required to co-ordinate
the activities of other health care workers
and organise appropriate and continuous care for
13
each patient. The nurse could well be the
only member of this team who is in continuous
day-to-day contact with the patient.
In order to understand the
practical implication of
these four important steps
it is necessary to look at
each of them in more detail.
REMEMBER:
The Nursing Process provides a
framework for the total nursing
care of a patient.
14
THE NURSING PROCESS
This sequence of steps gives us a framework
for nursing which is based on the
individual needs of the person for whom we
are caring, and involving him/her whenever
possible.
Step 1.
ASSESSMENT
* Collecting the information we need.
* Identifying the patient’s actual and
potential problems.
Step 2.
PLANNING
*
Determining priorities.
♦
Setting goals.
♦
Choosing appropriate measures.
♦
Writing care plans.
16
Step 3.
IMPLEMENTATION
* Carrying out the care plan as
agreed at the planning stage.
17
Step 4.
EVALUATION
♦ Has the patient reached his goal?
♦ Measuring our success.
* Further assessment and planning if
goal has not been reached.
♦ Analysing the steps of the process
and making necessary adjustments.
Let us now look at each step in more detail.
18
Step 1.
Assessment
An initial assessment is carried out and
recorded as soon as possible. We can add to
this as further relevant information is
obtained.
IF I'M GOING TO LOOK
AFIER DIE PATIENT,
WHAT 00 I HEED TO
KNOW?
MfP/C/lL DIAGNOSIS,
TREATMENT.
19
Relevant information can be gathered in
various ways and from many sources, for example:—
1. your own observations
-O
2. the patient
J____ L
[<J WAY IN <
3. friends and
Relatives
4. other information and prescriptions
relating to Patient Care
from other members of the care team
e.g. doctors, social workers and
physiotherapists.
20
Why do we need all this information?
The reasons are:—
* to try to establish what is normal for
that person, his/her likes and dislikes,
and perhaps strengths and weaknesses.
* To identify his/her specific problems
and nursing needs.
♦
To establish a good working
relationship between you and your
patient.
* To give opportunity for the
patient to ask questions.
* to give information to the patient.
* To provide an assessment which can be
shared with other staff caring for the
patient. This should prevent omissions
or duplications.
Gathering information about a patient is
very important. It sets the scene for any
further action, wrong information leads to
wrong actions. Lack of information leads
to inadequate action. Make sure, however,
that there is good reason for collecting
this information.
21
For example, we may know that Mr. Brown is
65, is in hospital for a prostatectomy and he is on
Dr. Smith’s list for Tuesday, but we may not
necessarily know that his dentures are broken,
he hates all forms of fruit juice and he has
never been able to sleep on his back since
“that accident at work in 1950”. All these
are vital details for successful post
operative nursing care.
Information about a patient has often been
collected in a rather haphazard way, usually
by the person who stays to listen just that
little bit longer. It may not be reported
or recorded anywhere but in one person’s
head. And yet it is this type of information
which makes all the difference to Mr. Brown.
It might be important to sort out his denture
problem before he has his prostatectomy.
So—what then are the advantages of this
detailed assessment?
For the Patient
♦
The patient’s normal pattern of life
can be taken into account when nursing
care is planned.
22
* He is more likely to be seen as a whole
person with social and psychological aspects
being taken into account as well as
the physical.
* The patient can be encouraged to be
actively involved in his own care.
* This approach enables the person for
whom we are caring to retain some
degree of independence and control
of his/her life.
* A better relationship can be built
between patient and nurse.
* The patient’s family can be included
if and when necessary.
For the Nurse
* It focuses on the unique role of the
nurse. It focuses on nursing and
enhances the nursing contribution to
the multi-disciplinary team.
♦ An increased understanding of the
patient as a person helps us focus on
the individual as a whole rather
responding only to the medical
diagnosis.
23
♦ A written assessment provides security.
We can look more objectively at the
information we have gained and consider
what is to be achieved. It aids
decision making.
* The assessment is the foundation on
which nursing care is planned, carried
out and evaluated.
For Teaching and Learning
It provides a structure for both teaching
and assessing learners.
* It provides an opportunity for ongoing
learning by presenting a total view of
a patient’s care.
* It is ideal for the nurse learner who
is helped to appreciate the reasons
for nursing actions.
And, last but not least
* A systematic approach should increase
professional competence and
credibility.
Of course, the information we need to collect
varies according to the patient for whom we
are caring, but will include:—
24
— the patient’s own perceptions of his
situation, his needs and his problems.
Parents, relatives or friends may
also provide information.
— our observations and recording of the
patient’s current physical, psychological
and social state.
— how the present illness or disability,
and the fact of becoming a patient,
has affected the individual’s normal
pattern of life.
— medical history, investigations and
instructions.
You may need practice to become skilled
in collecting information from your patient.
You should learn to look at, and listen to,
him or her. Gathering information is not
an end in itself.
Inappropriately lengthy questioning must not
become more important than your patient.
An understanding of the reasoning behind
the questions you ask is necessary.
25
Virginia Henderson (1969), in her small
booklet ‘Basic Principles of Nursing Care’
lists 12 components of nursing care (page 19).
These are:—
• Respiration
• Ability to communicate
• Nutrition
• Hygiene
• Elimination
• Safety
• Sleep
• Spiritual needs
• Maintenance
of temperature
• Educational needs
• Mobility
• Social needs
This list offers a good guide when taking
a nursing assessment. An example of how this
may be used is found on the next page with
the first suggested activity for you to try.
One of the aims of these activities is to
encourage you to be constructively critical
of what you are doing and more important...
of why you are doing it.
26
ACTIVITY 1.
You may like to use this structured assessment
sheet to collect information about one ofyour
patients. Is there anything you would like
to add or change?
NURSING ASSESSMENT
Patient’s Name
and other admission details:
Physical
Hygiene
Rest/Sleep
Elimination
Nutrition
Mobility/Safety
Present complaint
Allergies
Respiratory state
Skin
Pain/Comfort
Medications
Social
Family/Friends
Occupation/Recreation
Visitors
Language
Housing
Interests
Psychological
Mental State
Reaction to
illness/hospital
Means of coping
with stress/pain
Spiritual needs
27
After you have completed this assessment
you may wish to reflect on how you used it
e.g. at what point did you feel you needed
more than a heading to prompt your question?
Were there some questions or headings you felt
were irrelevant? Did you formulate open-ended
questions in order to get more than YES/NO
replies from your patient? For example,
“Do you have false teeth?” may just give you a
yes/no answer whereas, “Have you any difficulties
with your teeth?” may encourages the
patient to enlarge on any difficulties he/she
may have e.g.
a. with dentures needing repair/lost/
ill fitting
b. decayed, broken teeth.
Once information is obtained it has
to be interpreted in order to identify the
individual patient’s nursing problems. These
should be recorded on the care plan as clear,
concise statements. Here are two simple
examples:
28
Assessment Information
Patient’s Problems
(recorded on
assessment form)
(recorded on care
plan)
— Patient confined to
bed on leg traction,
has difficulty
moving in bed
This information
would lead us to
identify a potential
problem of the
patient in the
future developing
pressure sores
and could be
written as:—
Potential problem
—the development
of pressure sores.
This information
could lead us to
identifying an actual
problem of fear
of falling.
— History of having
fallen repeatedly
at home
— Reluctant to walk
unaided to toilet
— Says he is frightened
of falling again.
You may like to think of other examples.
Some problems may be ongoing and realistically
cannot be resolved by the nurse e.g. poor
housing. This problem may have to be referred
29
to another professional, in this case the
social worker. However, the nurse’s
awareness of the problem will enable her to
have more understanding of the patient’s
situation especially when planning discharge.
The whole of the Nursing Process relies on
skillful and sensitive assessment of the
patient’s nursing requirements. The next three
steps depend on this.
You can now move on to the planning step—
30
Step 2.
Planning
When you are planning nursing care you
should be guided by the information you
have collected and the patient's problems
which have been indentified. You may feel
that the last statement is unnecessary,
but if you stop for a few moments and
think of how we often operate in this
situation ...
I'VE CQLLCCrEQ A LOT OF
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NURSING PROCESS
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For example:
We sometimes carry out nursing with minimum
information about a patient. We have
preconceived ideas C "backed by experience
and routine") about what we should do. We
have general plans which fit all ""Gastrectomy
patients"". We have general guidelines of
care in our heads and it is often considered
easier to operate with these guidelines than
to listen to the individual patient and
adapt and modify in response to his or her needs.
C
StXERM.
If
♦ J
32
When planning nursing care:—
* Decide on priorities. Using the information
gathered and the problems identified,
what do you need to pay attention to first?
What needs doing now and what can be left
until later? (When appropriate, discuss
this with your patient).
* Write down the patient’s goals. This
means that you write down what you, as a
nurse working with the patient, hope to
achieve.
In doing this you may find you have both long
and short term goals.
Goals
We feel a word of clarification is needed
here as to what we mean by goals
in this context.
A GOAL is a statement about what you and
the patient or perhaps his family aim to
achieve. This should form a basis for
evaluation later.
33
You may already use words and phrases like:
— expected outcome of care
— aims of care
— expected patient outcomes.
— patient goals.
Do use whichever terms you are familiar with
but be clear about the meanings.
For example—on the next page are two
problems.
34
PATIENT’S
PROBLEMS
PATIENT
GOALS
long term
short term
1.14 kgs
overweight
lose
14 kgs
In 7 days
Mr. B. will
lose 1.5 kgs
2. Unable to
give own
insulin
Will be
able to
administer
own insulin
injection
After demonstration
and discussion,
Mr. B. will
be able to:—
— discuss with
understanding,
alternative
strengths
and dilutions
of insulin
(by Jan. 1)
— accurately
draw up his
prescribed
dose of
insulin (by
Jan. 2)
— administer
this safely
(by Jan. 3)
35
ACTIVITY 2.
Look again at the example given above—will
it be easier to measure success ifyou
write the more general long term goal or if
you try to be more specific and write short
term goals?
We hope you answer short term goals. You
will most likely think, initially, in terms of
long term goals but those are usually stated in
general terms and are difficult to evaluate.
By being specific and putting a time limit
for yourself and your patient it is easier to say “Yes,
that was achieved” or “That goal was unrealistic,
perhaps my initial assessment was inaccurate”
or “The approach was not particularly helpful”.
Patient goals or ‘expected outcome
of care’ are the forecast of what is
thought possible for an individual patient
within a given length of time. It will not
always be a solution to the whole problem.
For example, the patient may be 32 kgs overweight;
the long term goal may be to lose that weight,
but 1.5 kgs per week is a realistic, achievable
goal for that particular patient in
that particular time.
It is important to be able to measure or
evaluate achievement in real terms.
36
Patient goals should indicate:—
WHA T change is to take place, WHA T the
patient will be able to do or what his
condition should be,
WHEN the patient is expected to achieve
this and.
HOW the change will be observed.
If you would like more practice on this,
perhaps you would like to do the next activity.
ACTIVITY 3.
For extra practice in writing patient
goals try the following exercise
using the information you have already
gathered in Activity 1.
REMEMBER— You will want to know if each of
the patient's problems have
been met.
We realize that this exercise is difficult to
do without knowing more about the patient.
However, do try and suggest what the expected
outcome of care might be for these problems
for a patient you have known.
37
PATIENT
INFORMATION
PATIENT
GOALS
A
12.5 kgs. overweight
1
2
B
Has marked stiffness
and weakness in both
legs
1
2
C
Skin red over sacral
area
1
2
D
Very frightened of
walking to bathroom
1
2
E
A diabetic child does
not know how to give
his/her insulin
1
F
Your patient is very
worried about having
anaesthetic
— Discuss the goals with a colleague
— Ask yourself—“Can I really know if
these goals have been achieved for each
patient?”
38
2
1
2
Now decide what you need to do,
— can you do this yourself?
— do you need to check with colleague/
qualified staff/sister/doctor?
and if necessary,
— have you got the people to help
or refer to?
— have you got the equipment you need?
THEN WRITE THE CARE PLAN
The way you structure your care plan may
look something like this:—
NURSING CARE PLAN
Name of Patient:
Patient’s
Problem
Expected
Outcome
Nursing
Action
1
2
3
etc.
39
Date
Nurse’s
Signature
or this:—
Patient’s
Identified
problems
Patient
Goal
Action
to be
taken
1
2
3
etc.
ACTIVITY 4.
Activity 1 suggested you take a nursing
assessment. Look again at your information
andfill in either of the above care
plan sheets. They are, of course, similar—
ifs just a matter of which words you
prefer to use.
40
Date
Nurse’s
Signature
Step 3.
Implementation
CARRYING OUT YOUR PLAN
The action planned may take many different
forms but:—
— It will be based on a careful assessment
of the patient’s problems and needs.
— The possible outcomes of the action
will have been considered
— Your available resources, in terms of
time, other staff, necessary equipment,
etc., will have been assessed.
— The patient, when at all possible, will
be working with you to achieve the set
goals agreed upon.
41
In some circumstances, as changes occur,
you may need to adapt or modify nursing care
plans.
The care plans must be easily accessible
to the nursing staff caring for a particular
patient.
ACTIVITY
Think about wards you have worked on and
consider where nursing care plans were kept—
were they easily accessible—can you think of an
alternative or better storage place?
Remember, these are confidential documents.
42
Step 4.
Evaluation
It is important for patients, and for
nurses to be able to measure the
effectiveness of nursing. This step
will be made easier if achievable
patient goals and review dates
have previously been written.
Evaluating care should show the patient’s
response to nursing care and indicate
progress. Evaluating what we do in this
way should improve performance and
increase a patient’s well-being and
the quality of care we give.
This approach should
make it easier to find
out what is successful,
where things went wrong
or what part of a
patient’s care needs
improving. You may wish
to look back over the
steps you have taken
and ask yourself...
43
When Assessing
— did you have sufficient information
about the patient on which to base
your decisions?
— did you miss some vital clues in your
observations?
— were your communication skills
effective in relation to the:—
— patient/relatives
— other nurses and
— other professionals?
— was your nursing knowledge adequate
to deal with the situation?
When Planning
— should you have referred this to ... ?
— was the patient as informed as he or
she would wish?
— were patient/relatives/friends working
with or against the goals set?
— did you have the resources you needed?
— did you set goals which you could really
evaluate?
44
In Implementing and Evaluating
— had you the skill/knowledge to act in this
or that situation?
— can you evaluate the patient’s progress?
— is further assessment required?
— were the care plans followed—or were
a number of nursing approaches used
which were not recorded? If that was
the case it may be impossible to
decide which of your actions were
beneficial.
— is the patient and his/her family satisfied
with their nursing care?
(How did you ascertain this?)
It is necessary to record the evaluation
of the original care plan. Where you make
this recording will depend on forms
designed locally.
45
Doubts and Dilemmas
Many nurses question the value of attempting
to use the Nursing Process. This is
a common response to anything new or different.
A healthy critical attitude should be
encouraged but your criticism should be based
on adequate knowledge.
The following represents the more common
questions asked and comments made about
Nursing Process. We have attempted to respond
to these although we are aware that there are
no ‘right’ answers. These responses are
offered from our experiences over the last
few years of talking and working with those
who are exploring, in practice, the challenge
of using the Nursing Process.
**************************************
*
★
*
★
*
*
★
it
*
★
*
*
★
★
Why do we need to
make changes in
Nursing?
it
it
ir
it
it
it
*
★
*
*
★
it
■kitic-kit-k-kicit-kit-kif-kicic-kic-kitititit + icititiciciticicic'kitititit
We should always be striving to make
improvements in the quality of care we give.
46
Providing continuity and consistency in patient
care is an increasing problem. Verbal
and written communication can become more
concise and relevant using the Nursing
Process
Some of the routines in nursing are not
always as ‘good’ as we may think—nursing
research supports this, e.g.
Hamilton Smith, S.
(1972)
Nil by mouth?
R.C.N. Research Project
Series 1 No. 1
Lelean, S. R.(1973)
Ready for Report Nurse?
R.C.N. Research Project
Series 2 No. 2
There is other research which suggests that
improving communication with our patients can
have very real benefits.
BooreJ.R. P. (1978)
Prescription for Recovery
R.C.N. Research Series
Hayward, J. (1975)
Information—a
Prescription against pain
R.C.N. Research Project
Series 2 No. 5
47
★ ****★*★★**★★*★★★**★*★******** it * it * it ★ it it it
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*
ir
We don’t have
enough nurses to
use the Nursing
Process
*
it
it
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*
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The Nursing Process will not provide more nurses
where there is a genuine shortage. It can,
however, aid you in selecting the priorities
of care needed for individual patients and
enable nurses to use their time more effectively.
By identifying each patient’s problems
and nursing requirements it is easier
to demonstrate your ‘real’ nursing workload.
Ritual, non beneficial and ineffective
actions can be reduced. It may be possible
to use the Nursing Process on one or two
patients at first, to enable the nurses to
get used to this approach and become
skilled in its use.
48
ACTIVITY
Ifyou claim you are presently short of staff
in the area in which you work, make a list of
the care you have been unable to give to your
patients in the pastfew days. Could you
accurately identify this?
Was this recorded in yourpatienfs records?
♦
♦
♦
♦
♦
♦
*
♦
*
*
*
*
♦
*
*
*
*
Will the Nursing
Process take
more time?
*
*
♦
*
*
♦
*
♦
♦
*
*
*
J♦
♦
*
♦
*
*t******t***«*«***********************
Initially, it may do. Formulating individual
care plans may take more mental effort.
Nurses usually find, however, that it takes
less time as their skills develop.
Some nurses presently spend a great deal of
time in writing. They often duplicate records
by keeping bathing and bowel books, and
work lists etc., as well as ongoing patient
records. Putting all the information about
49
a patient in one place can save time and
produce a comprehensive permanent record.
Sometimes the contents of nursing records are
not of great value, cliches such as “All
nursing care given” and “Slept well” recur
over and over again. These statements may
mean something different to each nurse
involved with a patient and be far removed
from how the patient sees his/her own situation.
Using the Nursing Process can make sure we
make the best use of the documentary time we
have.
**********************************
*
*
*
*
*
*
*
*
J
*
How
Howwill
willDoctors
Doctorsand
andother
other
Groups of Staff react?
$
*
*
*
*
*
**********************************
Nurses usually find that they are supportive,
or at least let nursing staff get on with
nursing in their own way. Some professionals
in the field of social work, psychology,
physiotherapy and medicine are already
using a systematic problem solving approach
to their own work.
50
Where problems have arisen it has sometimes
been either because the nurses themselves did
not know enough about nursing process to
describe it to others or nursing staff have
felt pressured into using it by nurse managers,
teachers, etc.
*****************************
*
*
*
*
*
*
*
Who
should
do
the
Nursing
*
*
*
*
*
Assessment and write the
*
*
*
*
*
*
care
plans?
*
*♦
*
******************************
It will depend to some extent on the grades of
staff employed. Ideally it should be trained
staff (SRNs and SENs) or nurse learners who
are supervised by a trained nurse. Other
staff such as nursing auxiliaries can contribute
information, follow written care plans and
take part in discussions held about a patient’s
progress. Situations are not always ideal,
however. Where there are only auxiliary staff
in attendance it will have to be decided
locally to what extent they will contribute.
See King’s Fund Project Paper No. 21
4 A Handbook for Nurse to Nurse Reporting’
2nd Edition, March, 1983
51
110 VUW
Conclusion
There is a great danger of using the nursing
process in a mechanical way without appreciating
its real essence which is, to try to improve
standards of nursing carefor patients—to improve
the way we communicate and work together
with patients and with all those who are
working to that end.
We have presented the nursing process as a
series of steps and have attempted to show
how they interrelate to form a framework
which can be used for the patient’s benefit.
It will only be of value if nurses use
nursing process with understanding and flexibility.
We have presented the basic principles,
which by necessity you will need to expand
and develop in nursing practice. To do this
you need commitment—change is not always easy.
52
Your commitment can then be channelled by
understanding and your routines supported
by reason.
We hope you enjoy using the Nursing Process
and that this booklet will stimulate you to
continue to explore ways of improving patient care.
53
Suggestions for Further Reading
from British Literature
Books and Booklets
BOWER, Fay Louise
(1977)
THE PROCESS OF PLANNING
NURSING CARE
The C. V. Mosby Company
HEATH, J. &
LAW,G. M.
(1983)
NUSING PROCESS
WHAT IS IT?
(Adapted for Psychiatric Nursing)
NHS Learning Resources Unit,
55 Broomgrove Road,
SheffieldS 10 2NA
HENDERSON, V.
(1969)
BASIC PRINCIPLES OF
NURSING CARE
The International Council of
Nurses
HUNT, J. M. and
(1980)
MARKS-MARAN, D. J.
NURSING CARE PLANS
(The Nursing
Process at Work)
HM & M Publishers
KING’S FUND
PROJECT PAPER
(1983)
A HANDBOOK FOR
NURSE-TO-NURSE
REPORTING
KRATZ, C.R.
(Editor)
(1979)
THE NURSING PROCESS
LONG, R.
(1981)
Balliere Tindall
SYSTEMATIC NURSING
CARE
Faber and Faber
54
McFarlane,
(1982)
Baroness of LLandafT &
CASTLEDINE, G.
A GUIDE TO THE
PRACTICE OF NURSING
USING THE
NURSING PROCESS
The C. V. Mosby Company
NURSING TIMES
BOOKLET
(1978)
REDISCOVERING THE
PATIENT
Supplement to
Nursing Times,
30th November
‘DISCHARGE
PROCEDURES ’
NURSING TIMES
PUBLICATION
NURSING TIMES
PUBLICATION
(1980)
‘TEACHING THE
NURSING PROCESS’
NURSING TIMES SERIES—NURSING PROCESS IN ACTION
NORTON. D.
1. THE QUIET
REVOLUTION
17th June, 1981
KERSHAW. J.
2. TEACHING AND
EVALUATING CARE
24th June, 1981
LESLIE. F. A.
3. THE NURSING PROCESS
RELATED TO MENTAL
HANDICAP CARE
IstJuly, 1981
KEANE. P.
4. THE NURSING PROCESS
RELATED IN A
PSYCHIATRIC CONTEXT
BAINES, L.
5. FULLY INVOLVED
15th July, 1981
55
ROBERTSON. R.
6. THE NURSING PROCESS
IN COMMUNITY
NURSING
22nd July, 1981
ROPER, N.
LOGAN. W. W.
TIERNEY. A. J.
(1980)
ROPER. N.
LOGAN, W. W.
TIERNEY. A. J.
(1981)
ROPER, N.
LOGAN. W. W.
TIERNEY, A. J.
(1981)
ROYAL COLLEGE
OF NURSING
(1979)
IMPLEMENTING THE
NURSING PROCESS
ROYAL COLLEGE
OF NURSING
(1980)
STANDARDS OF NURSING
CARE
ROYAL COLLEGE
OF NURSING
(1981)
TOWARDS STANDARDS
(1980)
A WAY TO BETTER CARE
THE ELEMENTS OF NURSING
Churchill Livingstone
LEARNING TO USE THE
PROCESS OF NURSING
Churchill Livingstone
MODELS OF NURSING
Churchill Livingstone
Articles
ASHWORTH. P.
Nursing Mirror
28th August, pp 26-27
ASHWORTH, P.
(1980)
PROBLEMS AND SOLUTIONS
Nursing Mirror
4th September, pp 34-36
BALDWIN. S.M.
(1976)
MADE-TO-MEASURE CARE
Nursing Times
25th March, pp 468-469
56
BENDLE, M.
(1980)
CONFESSIONS OF A
NURSING PROCESS ADDICT
Nursing Times Community
Outlook,
11th December, pp 365-368
BREWER, Jill
(1983)
I SEE A PROCESSED LIGHT
AT THE END OF THE TUNNEL
Nursing Times,
30th March, pp 50-51
BOWMAN, G.S.
PARSONS, C.M.
POINTON, W.
(1983)
THE PITFALLS OF
IMPLEMENTING THE
NURSING PROCESS
12th J anuary, pp 29-3 5
CASTLEDINE.G.
(1981)
THE PROGRESS OF ‘THE
PROCESS’
Nursing Mirror
5 th February, p 14
CORMACK, D.F. S.
(1980)
THE NURSING PROCESS:—
an application of the
SOAPE model
Nursing Times
3rd April, Occasional
Papers, pp 37-40
CROWJ.
(1977)
THE NURSING PROCESS
1. Theoretical background
2. How and why to take
a nursing history
3. The nursing history
questionnaire (see
also pp 398-994 for
care plans)
Nursing Times
16th June, pp 892-896
23rd June, pp 950-957
30th June, pp 978-982
57
DUBERLEYJ.
(1977)
HOW WILL THE CHANGE
STRIKE ME AND YOU?
Nursing Times
10th December, pp 1736-1738
FRENCH, P.
(1981)
A MYTH, A MODEL, A
NECESSITY
Nursing Times
21st August, p 1468
GOOCH, J. K.
(1981)
AN EXPERIENCE OF THE
NURSING PROCESS
Nursing Times
5 th February, pp 237-238
GOOCH, J. K.
(1981)
CHANGE FOR THE BETTER
Nursing Times
12th February, p 264
HARGREAVES, I.
(1975)
NURSING PROCESS:
THE KEY TO
INDIVIDUALISED CARE
Nursing Times,
28th October, Occasional
Paper pp 89-92
HOLT, D. et al
(1980)
MAKING A NEW RECORD
Nursing Mirror,
21st August, pp 32-33
JONES, C.
(1977)
THE NURSING PROCESS
INDIVIDUALISED CARE
Nursing Mirror,
21 st October, pp 13-14
KRATZ, C.
(1977)
THE NURSING PROCESS
Nursing Times,
9th June, pp 854-855
58
McFarlane, j.
(1975)
WHAT DO WE MEAN BY
CARE?
Nursing Mirror,
2nd October, pp 47-48
McGILLOWAY,
F.A.
(1980)
THE NURSING PROCESS:
A PROBLEM SOLVING
APPROACH TO PATIENT
CARE
International Journal
of Nursing Studies
Vol. 17pp79-90
MEASURES, A.
(1979)
THE NURSING PROCESS
a useful step?
Nursing Mirror,
14th June, pp 20-21
NEILSON, A. F.
CLARK, M.O.
DAVIS, B.D.
(1978)
WHY DO WE NEED THE
NURSING PROCESS?
For Legal Reasons, For
Practical Reasons, For Professional
Reasons.
Nursing Times,
30th November,
pp 1984-1987
RAWLINS, Tessa
(1983)
DO WE REALLY NEED
THE PROCESS?
Nursing Times, 2nd March, p 64
ROWE, Margaret
(1983)
ME AND MY WARD
Nursing Times,
26th January, pp 30-31
SWAFFIELD, Laura
(1983)
CHANGE FOR THE BETTER
Nursing Times,
20th April, pp 59-61
59
SYSON-NIBBS, L.
(1980)
PROGRESS THROUGH A
PLANNED APPROACH
Nursing Mirror,
14th February, pp 42-44
TURNER, Janet
(1983)
‘IT’S’ NOT WHAT YOU
DO..?
Nursing Times,
4th May, p 64
WEST, A.
(1980)
PATIENT INTO PERSON
Nursing Mirror,
21 st February, pp 32-34
60
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