Nursing diagnosis application using NANDA, NIC, and NOC

Standardized Nursing Terminology

STANDARDIZED TERMINOLOGY TO COMMUNICATE NURSING INTERVENTIONS

STANDARDIZED TERMINOLOGY TO COMMUNICATE NURSING

Nursing practice is the fabric of patient care with threads running through nearly every patient experience. While a medical diagnosis is typically the catalyst for a nursing care plan, it does not completely define patient care. In this paper, I hope to demonstrate the crucial role that a nursing diagnosis plays in establishing and maintaining quality patient care. I write first about nursing diagnoses, then frame the discussion with a scenario of presenting symptoms and a medical diagnosis. The next sections of the paper address the elements of data collection, integration of information and knowledge, accessing wisdom, and the conclusions drawn from the discussion.

The Nursing Diagnosis

It is helpful to begin with a definition of nursing diagnosis, so as to distinguish it from a medical diagnosis and as a way to lay a path to nursing interventions and outcomes. A nursing diagnosis is a clinical judgment with an ecological basis. That is to say that a nursing diagnosis takes into consideration the individual patient, as well as aspects of the family and community that are related to the health circumstances or medical problem of the patient. A nurse is accountable for articulating a nursing diagnosis that uses a standardized frame derived from the relation of the various elements (NANDA, NOC, and NIC) and from a consistent use of terminology to describe both the elements and the relationships between the elements. From this, it should be apparent that a nursing diagnosis does not serve as a way of recasting or renaming the medical diagnosis, but rather enables the nurse to look at the entire constellation of factors that can impact the patient's health in relation to the medical diagnosis. In essence, the nursing diagnosis enables the nurse to understand the ecological context in which the patient seeks wellness. The mechanism that enables the nursing diagnosis is a holistic nursing assessment that provided information that is, at a minimum, useful, and that has the potential to drive the identification of interventions that will achieve outcomes that are characteristic of high quality nursing care.

Ongoing Assessment

The benefit of performing early and regular assessment of PU development risk stratification, which is facilitated through the use of stratification scales such as the Braden scale, is that it fosters identification of appropriate early interventions. In the instance of increasing risk for the development of pressure ulcers, it is necessary to adopt preventative measures that serve to reduce the variables that predispose the skin tissue to hypoperfusion (Bavarescol & de Fatima Lucenall, 2012). Variables that are also considered include the provision of localized skin care, and ways to optimize the general health and nutritional status of the patient (Bavarescol & de Fatima Lucenall, 2012). From this discussion, the iterative relation between the nursing diagnosis and the nursing interventions made be made salient.

Therapeutic Interventions

A total of nine interventions were validated as priority for the prevention of pressure ulcers. As points out, this high number of priority interventions indicates that the specificity of care for this common clinical situation is substantive, and that a timely and appropriate addition to the NANDA would be the nursing diagnosis of Risk of Pressure Ulcer (Bavarescol & de Fatima Lucenall, 2012).

Validated priority interventions for the clinical situation described above demonstrate the NANDA-NIC linkages, and include the following: Skin care (topical treatments), positioning, bathing, vital signs monitoring, nutrition management, urinary elimination management (Bavarescol & de Fatima Lucenall, 2012). All of these interventions, and several others, have been validated as priority interventions for the clinical conditions that present a risk to maintaining skin integrity (Bavarescol & de Fatima Lucenall, 2012). It is important to recognize that the linkage between the NANDA nursing diagnoses and the NIC interventions are not prescriptive, but rather indicate a way forward that relies on the judgment of nurses regarding the skin condition of the patient and other mitigating circumstances (Bavarescol & de Fatima Lucenall, 2012; Park, 2010).

NIC

The Nursing Interventions Classification (NIC) system is a standardized, comprehensive, evidence-based, classification of nursing interventions (Bulechek, 2013). Bulechek (2013) explains that the fundamental categorization of NIC interventions covers a wide spectrum of approaches to nursing care as follows: Both independent and collaborative interventions, care that is directly or indirectly provided, interventions designed for health promotion and for treating disease or illness; interventions with a physiological and psychosocial focus geared for patients, their families, or the communities in which they live. Interventions are applicable to all four nursing practice settings, including family nurse practitioner, nursing education, nursing informatics or health policy, and nursing leadership. For example, interventions may include the communication of the care plan across care contexts, measures of productivity and competency in training programs, curricular design, research on the effectiveness of interventions, reimbursement for care, and the new field of informatics that focuses on the efficacious integration of data across settings and information management systems (Bulechek, 2013). These examples of applications of the NIC nursing interventions serve to clarify the inherent integration of the elements of NIC, NOC, and NANDA.