homework: assessment and interventions

Angel_rnstudent · Nov 17, 2011

hi..im very new to this site and very new at being a nursing student. im having trouble getting anywhere with the "evidence based practice"

can anyone help with this?

Esme12, ASN, BSN, RN · Nov 17, 2011

evidence-based practice (ebp) "entails making decisions about how to promote health or provide care by integrating the best available evidence with practitioner expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected. this is done in a manner that is compatible with the environmental and organizational context. evidence is comprised of research findings derived from the systematic collection of data through observation and experiment and the formulation of questions and testing of hypotheses" (www.ebbp.org).

evidence-based practice (ebp) involves complex and conscientious decision-making which is based not only on the available evidence but also on patient characteristics, situations, and preferences. it recognizes that care is individualized and ever changing and involves uncertainties and probabilities.

ebp develops individualized guidelines of best practices to inform the improvement of whatever professional task is at hand. evidence-based practice is a philosophical approach that is in opposition to rules of thumb, folklore, and tradition. examples of a reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information.

evidence-based treatment (ebt) is an approach that tries to specify the way in which professionals or other decision-makers should make decisions by identifying such evidence that there may be for a practice, and rating it according to how scientifically sound it may be. its goal is to eliminate unsound or excessively risky practices in favor of those that have better outcomes.

ebt uses various methods (e.g. carefully summarizing research, putting out accessible research summaries, educating professionals in how to understand and apply research findings) to encourage, and in some instances to force, professionals and other decision-makers to pay more attention to evidence that can inform their decision-making. where ebt is applied, it encourages professionals to use the best evidence possible, i.e. the most appropriate information available.

now, the ahrq (http://www.ahrq.gov/clinic/epcix.htm) agency for healthcare research and quality's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all americans. as 1 of 12 agencies within the department of health and human services, ahrq supports research that helps people make more ( including joint commision, cms, cdc and hhs)informed decisions and improves the quality of health care services. ahrq was formerly known as the agency for health care policy and research. ahrq is committed to improving care safety and quality by developing successful partnerships and generating the knowledge and tools required for long-term improvement. the goal of our research is measurable improvements in health care in america, gauged in terms of improved quality of life and patient outcomes, lives saved, and value gained for what is spent.

http://www.ahrq.gov/clinic/epcindex.htm#pediatric

http://www.ahrq.gov/clinic/epcsums/broncsum.htm

care plan examples.

http://www.pterrywave.com/nursing/care%20plans/nursing%20care%20plans%20toc.aspx

http://wps.prenhall.com/chet_perrin_criticalcare_1/98/25166/6442700.cw/index.html

an introduction to the use of the pediatric nursing care plans

http://nurse-thought.blogspot.com/2009/01/pediatric-nursing-care-plans.htm

http://wardclass.blogspot.com/2008/09/sample-ncp-for-pneumonia.html

http://one.xthost.info/wcbackup/sample%20ncp%20for%20pneumonia.pdf

now care plan basics: if you think it out step by step by the age of the child and what you should pick first by maslows hierachry of needs and direct your need to the needs of the child that is age appropriate. the care plan will need to be directed to the child's age and growht and development stage. this site is full of information but the best information is from daytonite (rip) and the begining is here..

care plan basics: https://allnurses.com/general-nursing-student/help-care-plans-286986.html

every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the nanda taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what nanda calls defining characteristics.

how does a doctor diagnose? he/she does (hopefully) a thorough medical history and physical examination first. surprise! we do that too! it's part of step #1 of the nursing process. only then, does he use "medical decision making" to ferret out the symptoms the patient is having and determine which medical diagnosis applies in that particular case. each medical diagnosis has a defined list of symptoms that the patient's illness must match. another surprise! we do that too! we call it "critical thinking and it's part of step #2 of the nursing process. the nanda taxonomy lists the symptoms that go with each nursing diagnosis.

here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

now, listen up, because what i am telling you next is very important information and is probably going to change your whole attitude about care plans and the nursing process. . .a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its rns to learn by graduation is how to use the nursing process to solve patient problems

care plan reality: the foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. what is happening to them could be a medical disease, a physical condition, a failure to be able to perform adls (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. therefore, one of your primary aims as a problem solver is to collect as much data as you can get your hands on. the more the better. you have to be a detective and always be on the alert and lookout for clues. at all times. and that is within the spirit of step #1 of this whole nursing process.

assessment is an important skill. it will take you a long time to become proficient in assessing patients. assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. history can reveal import clues. it takes time and experience to know what questions to ask to elicit good answers. part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. but, there will be times that this won't be known. just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

a nursing diagnosis standing by itself means nothing. the meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient. in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are.

what i would suggest you do is to work the nursing process from step #1. take a look at the information you collected on the patient during your physical assessment and review of their medical record. start making a list of abnormal data which will now become a list of their symptoms. don't forget to include an assessment of their ability to perform adls (because that's what we nurses shine at). the adls are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. what is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. this is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

care plan reality: what you are calling a nursing diagnosis (ex: activity intolerance) is actually a shorthand label for the patient problem. the patient problem is more accurately described in the definition of this nursing diagnosis (every nanda nursing diagnosis has a definition).

activity intolerance

(page 3,

nanda-i nursing diagnoses: definitions & classification 2007-2008

)

definition

:

insufficient physiological or psychological energy to endure or complete required or desired daily activities

(does this sound like your patient's problem?)

defining characteristics (symptoms):

abnormal blood pressure response to activity, abnormal heart rate to activity, electrocardiographic changes reflecting arrhythmias, electrocardiographic changes reflecting ischemia, exertional discomfort, exertional dyspnea, verbal report of fatigue, verbal report of weakness

related factors (etiology):

bed rest, generalized weakness, imbalance between oxygen supply and demand, immobility, sedentary lifestyle

i've just listed above all the nanda information on the diagnosis of activity intolerance from the taxonomy. only you know this patient and can assess whether this diagnosis fits with your patient's problem since you posted no other information.

one more thing . . . care plan reality: nursing diagnoses, nursing interventions and goals are all based upon the patient's symptoms, or defining characteristics. they are all linked together with each other to form a nice related circle of cause and effect.

you really shouldn't focus too much time on the nursing diagnoses. most of your focus should really be on gathering together the symptoms the patient has because the entire care plan is based upon them. the nursing diagnosis is only one small part of the care plan and to focus so much time and energy on it takes away from the remainder of the work that needs to be done on the care plan.

https://allnurses.com/nursing-student-assistance/pediatric-nursing-careplan-274803.html

Esme12, ASN, BSN, RN · Nov 17, 2011

great care plan book..nursing diagnosis handbook, 9th edition

by betty j. ackley , msn , eds , rn and gail b. ladwig , msn , rn , chtp

lulain · Nov 17, 2011

Looks like my post got kind of lost... Just an FYI, to start a new thread, hit the "new thread" button under the Nursing Student Assistance page. :)

Clovery · Nov 17, 2011

hi..im very new to this site and very new at being a nursing student. im having trouble getting anywhere with the "evidence based practice"
can anyone help with this?

I think you probably wanted to start a new thread for this question... Evidence based practice refers to interventions that nurses perform which are based on documented research and proven results. For example, say you read in article in The American Journal of Nursing (this is hypothetical, not a real article) and the authors conducted a study in which they examined the spread of C. dif (a bacteria that causes diarrhea) to patients on units where 1. nurses primarily used alcohol based hand sanitizer as their hand hygiene method and 2. nurses primarily washed with soap and water as their hand hygiene method. The results of the study revealed that when a patient on a unit has C. dif, the spread of the illness from this bacterium was significantly reduced when nurses washed their hands with soap and water vs using hand sanitizer. So when you are in the hospital, and dealing with a patient with C. dif, and you wash with soap and water after exiting their room, you are using evidence-based practice.

If you're looking for resources for evidence based practice, like for a research paper or care plan, you should check scholarly journals, especially nursing journals. Your school provides access to databases which you can use to search for these. If you don't know how to do that, a librarian will be able to assist you. There are care plan books which list rationales and citations for evidence based practice, like Ackley & Ladwig "Nursing Diagnosis Handbook".

Hope that helped - it's really quite a broad topic.

Esme12, ASN, BSN, RN · Nov 17, 2011

Looks like my post got kind of lost... Just an FYI, to start a new thread, hit the "new thread" button under the Nursing Student Assistance page. :)

Since I've been amember since 2005 I think I know how to start a new thread. :anbd:

It didn't get lost I gave you the way for you to find your own answers and evidence based practice guidelines. I also gave you care plan templates and examples as well as nursing diagnosis. If you click on the links you might be pleasantly surprised.

Just because I didn't do the work for you doens't mean the thread went of topic......just saying:smokin:

an2on, BSN, RN · Nov 17, 2011

esme12, call you help with my post about the bladder?

Thanks.