Nursing Process (PLEASE HELP ME)

  1. I'am having a really hard time with the nursing process. At my school we are doing it according to the "Roy's adaptation model"

    I understand the behavior and stilmuli.

    but how do you formulate the nursing diagnosis?
    what are the goals based on?
    what are the intervention based on?

    are the intervention based on the goal? and the goal based on the nursing diagnosis?

    I am so confused!!

    thank you in advance
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    About hope4thebest

    Joined: Sep '06; Posts: 41; Likes: 4

    6 Comments

  3. by   Melina
    Quote from hope4thebest
    but how do you formulate the nursing diagnosis?
    what are the goals based on?
    what are the intervention based on?

    are the intervention based on the goal? and the goal based on the nursing diagnosis?

    I am so confused!!

    thank you in advance
    The nursing diagnosis is derived from your assessment of the patient. It is a standardized statement about your patient's health for the purpose of providing nursing care. These statements can concern the patient's actual health state as well as any risks. Your goal is what you want to achieve or maintain regarding your patient's health, and it is the basis for the nursing care plan. The interventions are the steps the nursing team takes to implement the patient's goal.
    Hope this helps!

    ~Mel'
  4. by   MIA-RN1
    If possible, take a look at a book of nursing diagnoses (I like Ackley and used it all thru school). The diagnoses are all standardized, meaning that we don't make them up, but we use one that applies to our patient. you can look up certain conditions and then see what diagnoses apply. The nursing process and nursing diagnoses go hand in hand. The diagnosis gives us a direction to start from with our nursing process.
    So lets say that you go in to check on your patient who is paralyzed from a stroke and you find a yucky sacral wound that wasn't there before. The applicable nursing diagnosis would be "impaired skin integrity". The R/T would be immobility (the skin integrity is impaired related to immobility) The reason the patient is immobile is the head injury, so you could then add 'secondary to CVA"
    So your whole nursing diagnosis would be "Impaired skin integrity r/t immobility secondary to CVA."
    Now, what do you want to do about it? What would you like to see happen? Perhaps its to keep the wound from becoming infected, perhaps its to heal the wound, etc. Those are your goals.
    So far you have Asssessed and Diagnosed. Next you need to Plan. What can you do, as a nurse and within your professional scope, to help this patient and to meet your goals? These are your interventions.
    Some ideas for this patient might be: reposition q2h, clean wound and bandage as ordered, assure patient receives nutritionally balanced menu. Monitor patients VS for signs of infection, and always always Continue to monitor patient.
    THose are the interventions that will help you meet your goal.
    So you go and do them and they become your Implementation.
    Then you go back, look at what you did. Did it help? Did it make things better or the same? What would you change? What would you do differently? That is your evaluation stage. Now rethink your diagnosis...is it still applicable? Maybe now the wound is healed but since the patient is still immobile, your next diagnosis could be "risk for impaired skin integrity" Then you start it all over again.
    That is how you would use a nursing diagnosis and apply the nursing process. For me they are all intertwined.
    Many people will not use diagnoses after school, at least not in the formal sense that you use them in school. The exercises you are doing now are going to teach you how to think like a nurse, so that even if you are not using the diagnoses, you will think in terms of them when planning your patient's care. Where I work, we do actually use them in our charting. (PAR notes)
    You will also find as you begin to work as a nurse that you will start to look at your patients whole picture, and pick out the couple most important issues and start to treat them within your scope of practice. I find myself doing that more and more. Most of my patients priority issues are pain, risk for fluid volume deficit, risk for hemorrhage, infection and risk for infection. So if you get to know the most basic diagnoses, you will use them without realizing it later on down the line.
  5. by   Daytonite
    hi, hope4thebest!

    sister callista roy's nursing theory of adaptation comes complete with a six step nursing process. i think that, perhaps, this is what you might be a bit confused about? please excuse your american neighbors who may not be familiar with this particular theorist and what you are being taught pertaining to the nursing process. in actuality is isn't all that different from what u.s. nurses are taught, it's just a tad different in it's approach and language used to describe it.

    http://www.geocities.com/ninquiry2002/callistaroy.html - reading this shortened version of her model may help you. her nursing process involves six steps:
    1. assessment of behaviour
    2. assessment of stimuli
    3. nursing diagnosis
    4. goal setting
    5. intervention
    6. evaluation
    now, i will admit that i'm not that up to date on roy's theory, but the first two steps are asessments. you say you understand those two steps ok. that information from the assessments is then used to develop a nursing diagnosis, set goals, design nursing interventions by manipulating the patient's environment and then evaluating the effectiveness of those interventions and revising them as necessary. this actually is not much different from what coopergrrlrn was trying to tell you, just that roy's language and use of terms is much different than used here in the u.s.

    i'm really not sure how you are to formulate the nursing diagnosis. here in the states we have guidelines from nanda (north american nursing diagnosis association) to help us out. i suggest you go back to your instructors and have them clarify just how you are to develop these nursing diagnoses. is it possible that you are also using nanda nursing diagnoses?

    the interventions are going to be plain old nursing care that i image you are being taught in basic nursing or nursing fundamentals class. those behavior and stimuli assessment items that are not normal are the things you are going to develop your nursing interventions around. a simple one, for example, might be vomiting. your interventions are going to be things you, the nurse, will do to help the patient adapt (this is within roy's model) such as apply a cold compress to the forehead, have the patient avoid sudden movement, keep an emesis basin near the patient, give oral care after an episode of vomiting. get the picture?

    goals are actually based on the nursing diagnosis. for example, if you diagnose someone with bad, smelly feet as a result of not bathing (this is just an example and this is not a real nursing diagnosis) your goal is going to be the person's feet are going to be free of foul smells after a thorough bathing. you see, the goal is kind of like the diagnosis being turned around on itself. when writing goals for nursing diagnoses, however, they may be a bit more complex than something like poor hygiene. you also have to take into consideration what the patient is capable of doing. therefore, you want your goals to be "individualized" for each patient, or tailored to their ability.

    does that help you out?

    i saw your post earlier, but i was involved in something myself and just didn't have time to write a post. welcome to allnurses!
  6. by   hope4thebest
    All of the explanation very helpful, it helped clearify most if not all of the problems I had... THANK you ALL so MUCH
  7. by   abbythetabby
    Quote from hope4thebest
    I'am having a really hard time with the nursing process. At my school we are doing it according to the "Roy's adaptation model"

    I understand the behavior and stilmuli.

    but how do you formulate the nursing diagnosis?
    what are the goals based on?
    what are the intervention based on?

    are the intervention based on the goal? and the goal based on the nursing diagnosis?
    We use the Roy model at our school. The thing that helped my classmates the most was clustering a pt's behavior and stimuli. Draw a line thru the middle of a sheet of paper. On one half write all the adaptive (or good) stimuli and behavior. On the other half, write the non-adaptive (or bad). Group all the related bad assessment info together and your most approprate nursing diagnosis will become much easier to see.

    I agree that the Ackley book is good. Once you have your Dx, you can find related interventions and goals and choose the ones that best suit your patient.

    Hope that helps.
  8. by   Daytonite
    check out this site. all about the nursing process!

    http://home.cogeco.ca/~nursingprocess/index.htm - this is a beautiful site that defines and explains a bit of what the nursing process is. you can also click on the links at the left side of the webpage to go to various subjects included within the nursing process to find out more about them.

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