Identify what the Nursing Process is
Framework
used for nursing care plan/ pathways for individual patient
Critical thinking
used to develop individualised care plan, detailing care and outcomes for each
patient
Familiar sequence/ process for sorting out ‘what to do’ •
ADPIE
mnemonic (Assessment, nursing Diagnosis, Planning, Implementation, Evaluation)
Identify the individual steps and their components
that are involved in the nursing process
Assessment Data collection both objective (perceived by the person) (and subjective (perceived by the person)DiagnosisNursing diagnosis based on assessment outcomes, Based on NANDA international NOT a medical diagnosisPlanning Identify outcomes, Prioritize nursing diagnosis ,They may change , they should be SMART goals Specific, Measurable, Attainable, RelevantImplementation Actions to achieve goals EVIDENCE BASED, documentedEvaluation Were the outcomes met, what is the evidence, what tools to use
The nursing process should aim to to be used with critical thinking and EBP. The patient should be consulted on their care and any decision made should take their values, beliefs and opinions into account.
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The nursing process
How should we prioritise/ what
theories can we use to prioritise our actions?DRSABCDPrimary Survey Airway - Is the airway patent?Breathing- Is breathing sufficientCirculation - is circulation sufficientDisability what is the level on consciousnessExposure - what might explain the patients condition
Evidence Based Practice (EBP) is the process of making clinical
decisions based upon evidence, combined with clinical experience and
patient expectations.
EBP is used in a variety of fields, including medicine, nursing, psychology and allied health.
The process involves an assessment of evidence using a hierarchy of
evidence types, with Cochrane systematic reviews commonly considered the
'gold standard' for evidence. For example, see the EBP evidence pyramid, or the Joanna Briggs Levels of Evidence.
To find evidence to base your decision upon, start by phrasing your
scenario as a specific, answerable question. You can use 'PICO' for
this.
[P] Who or what is your patient or population group?
[I] What is your intervention or indicator?
[C] What is your comparison or control?
[O] What outcome are you looking for?
For example:
A 47 year old woman comes to see you. She is overweight, concerned about
her overall health, and would like to lose weight quickly. She has
heard a report on the radio suggesting that resistant corn or potato
starch can reduce obesity. You begin to investigate any evidence to
support this.
Rephrased as a specific, answerable question, using PICO:
In [P] overweight, how does [I] resistant starch compared with [C] ordinary starch effect the [O] weight loss?
Next, translate PICO into a search strategy which you can apply to a database to find evidence.
treat each component as a separate concept.
brainstorm for synonyms and alternative spellings and terminology
for each concept, linking these with OR - this will broaden your search.
combine your concepts with AND - this will focus your search.
[P] overweight OR obese
AND
[I] resistant starch OR R.S.
AND
[C] ordinary starch
AND
[O] weight loss
Choose the most relevant components to combine - you don't need to
combine all four in a single search. For example, you could conduct a
search on ([P] AND [I] AND [C]), or on ([I] AND [C]), or ([P] and [I]).
Choose an appropriate EBP resource to search, select from the databases listed on the left, and conduct your search.
There are a number of EBP
processes which have been developed to help clinicians implement EBP in the
workplace and a number of EBP websites which explain the steps involved.
The most common procedure
follows 6 steps:
1.
Formulate a clinical question
2.
Search the literature
3.
Sort, read and critique the literature
4.
Come to a “clinical bottom line”, in other words
recommendations for day-to-day practice based only on the best available
literature.
5.
Implement the recommendations, documenting them, any changes you
choose to make and the outcomes of your intervention. In implementing the
recommendations you apply the research to your clinical setting and
client. You need to include your client and the service provider in this
implementation process. In other words, apply the evidence to the
situation in consultation with those who it will affect.
6.
Share the results of your EBP with others, ideally through
writing them up.
Although traditionally EBP
training emphasised accessing and appraising the research evidence, recently
there has been a drive to increase clinician awareness of the three components
of the EBP process (research evidence, clinical data and informed
client choice). This has led to the term E3BP being introduced to
reflect these three essential components (Dollaghan, 2007).
There are also a range of
online EBP resources available to make the process easier, including already
published systematic reviews, critically appraised papers (CAPs) and critically
appraised topics (CATs).
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Why should we only use accepted abbreviations? What can happen if we don’t?
To avoid confusion. May provide
care not nesessery / put patient in danger