(years)
† Scheffé test; ‡ PBL, problem based learning.
There was a strong, significantly positive correlation between metacognition and problem-solving ability (r = 0.672, p < 0.001), and communication competence and problem-solving ability (r = 0.542, p < 0.001). There was also a strong, significantly positive correlation between metacognition and communication competence (r = 0.557, p < 0.001; Table 4 ).
Relationships between metacognition, communication competence, and problem-solving ability (N = 192).
Variables | Metacognition | Communication Competence | Problem-Solving Ability |
---|---|---|---|
r ( ) | r ( ) | r ( ) | |
Metacognition | 1 | ||
Communication competence | 0.557 (<0.001) | 1 | |
Problem-solving ability | 0.672 (<0.001) | 0.542 (<0.001) | 1 |
Among general characteristics, variables were converted into dummy variables as needed to confirm their effect on the problem-solving ability of nursing students (e.g., age, 23 years or older = 1; academic level, third year = 1; interpersonal relationships, very good = 1; satisfaction with major, more than satisfied = 1; the number of PBL experiences, 3–6 times = 1; and the number of training weeks, 7 weeks or more = 1). A hierarchical stepwise multiple regression analysis was then performed, inputting communication ability followed by metacognition, which were significantly correlated.
The Durbin–Watson value was 1.96 (close to 2), which confirmed that there was no autocorrelation between the independent variables. The variance inflation factor was 1.013 to 4.999; as all value were less than 10, there were no problems with multicollinearity between independent variables.
General characteristics that showed a significant difference with problem-solving ability in univariate analyses were first input to Model 1, namely age, academic level, interpersonal relationships, and satisfaction with major. This model explained 8.1% of the variance in problem-solving ability. When PBL experience and frequency, clinical practice, and number of weeks were added to Model 1 (Model 2), the variance explained was 12.5%, namely an increased of 4.4% compared to Model 1. When communication competence and metacognition were additionally added to Model 2 (Model 3), the variance explained was 51.2%, which is an increase of 38.7% compared to Model 2. Finally, age (β = 0.11, p = 0.048), communication competence (β = 0.24, p = 0.001), and metacognition (β = 0.52, p = 0.023) were significantly related to problem-solving ability. These variables exhibited an explanatory power of 51.2% (F = 21.01, p < 0.001) regarding job satisfaction; the most influential variable was metacognition ( Table 5 ).
Factors influencing problem-solving ability (N = 192).
Variables | Model 1 | Model 2 | Model 3 | ||||||
---|---|---|---|---|---|---|---|---|---|
B | β | t | B | β | t | B | β | t | |
Age (R = ≥23) | 0.13 | 0.16 | 2.29 * | 0.10 | 0.13 | 1.77 | 0.09 | 0.11 | 1.99 * |
Academic level (R = Junior) | −0.06 | −0.09 | −1.22 | −0.23 | −0.31 | −2.71 * | −0.12 | −0.17 | 1.91 |
Interpersonal relationships (R = Very good) | 0.16 | 0.17 | 2.41 * | 0.14 | 0.15 | 2.11 * | −0.19 | −0.02 | −0.33 |
Satisfaction with major (R = Satisfied) | 0.13 | 0.17 | 2.40 * | 0.11 | 0.15 | 2.10 * | −0.01 | −0.02 | −0.35 |
PBL experience | −0.25 | −0.34 | −2.25 * | −0.09 | −0.11 | −1.01 | |||
Number of PBL experiences (R = 3–6) | 0.14 | 0.19 | 1.66 | 0.14 | 0.18 | 2.13 * | |||
Clinical practice experience | 0.11 | 0.16 | 1.16 | 0.11 | 0.16 | 1.16 | |||
Weeks of clinical practice experience (R = ≥7) | −0.00 | −0.004 | −0.03 | 0.09 | 0.12 | −0.03 | |||
Communication competence | 0.19 | 0.24 | 3.42 * | ||||||
Metacognition | 0.38 | 0.52 | 8.22 * | ||||||
Adj R = 0.081, F = 5.20, = 0.001 | Adj R = 0.125, F = 4.42, < 0.001 | Adj R = 0.512, F = 21.01, < 0.001 |
† Dummy variables; ‡ Reference; ¶ PBL, problem-based learning; * p < 0.05.
In this study, the mean problem-solving ability score of nursing students was 3.63 out of 5, which is similar to the 3.56 points reported in a study targeting third- and fourth- year students in the department of nursing [ 24 ]. However, the current value is higher than the 3.44 points reported in a study targeting first- and second-year students [ 13 ]. Participants in these studies were nursing students in the second, third, and fourth years of study in this paper, in the third and fourth years in the study done by Kim et al. [ 24 ]; and in the first and second grades in the study by Ji et al. [ 13 ]. Problem-solving ability can be developed under the influence of various factors; those identified in previous studies include communication ability [ 13 ], critical thinking ability [ 12 , 25 ], metacognition [ 11 ], and self-directed learning [ 2 ]. These factors are continuously improved through various interpersonal relationships formed while learning and studying liberal arts and other major subjects, rather than existing as innate abilities [ 26 ]. Therefore, the degree of problem-solving ability was rather high in the study targeting the upper grades. Problem-solving ability in various unexpected situations is essential for working as a nurse [ 27 ]. In the current study, the problem-solving ability score of nursing students approximated the 72.6 percentile of the full 100-point scale. Although this score is relatively high, it is nevertheless necessary to improve problem-solving ability; given the nature of the nurse’s job, this ability represents a very important competency. Therefore, it is necessary to improve the problem-solving ability level of nursing students in Korea. The results of this study showed that factors affecting nursing students’ problem-solving ability were metacognition, communication competence, and age. It is necessary to establish a strategy that considers these factors to improve the problem-solving ability of nursing students.
The participants’ average metacognitive score was 3.86 out of 5, which was slightly higher than the 3.61 observed in a study conducted using the same tools for second-year nursing students [ 12 ]. While direct comparison using other tools is difficult, the metacognitive level of 72.3 obtained by Kim [ 28 ] for all grades in the nursing department was lower than the 77.2 points (out of 100 points) obtained in this study. According to Sternberg and Sternberg [ 29 ], the problem-solving phase includes problem identification, problem expression, strategy formulation, information construction, resource allocation, supervision, and evaluation. For health science students, metacognitive instruction has been shown to have a positive effect on students’ problem-solving ability and in improving academic achievement [ 30 ]. That is, metacognition is a key factor in predicting learning outcomes in the problem-solving domain [ 31 ]. These results were replicated in this study, which showed that a higher metacognitive level of nursing students indicated a significantly higher problem-solving ability. The subjects of this study were second-, third-, and fourth-year nursing students, and it is thought that their metacognitive level was improved compared to students in earlier phases of education, as a result of the curriculum of the nursing department. Educational programs and strategies to improve metacognition will be needed to improve the problem-solving ability of nursing students. The components of metacognition are thinking deeply in the planning stage, establishing possible strategies, undertaking regulating and monitoring activities to carry out the strategy, and revising and regulating to ensure that the solution is progressing in an appropriate direction to achieve the goal [ 32 ]. Therefore, a professor who instructs and checks nursing students is necessary to enable them to set their own goals in the curricular and non-curricular programs as they advance through the course, plan and implement strategies to achieve their goals through deep thinking, and conduct their own monitoring and control processes.
The average communication competence score of the subjects was 3.92 out of 5. Previous studies targeting students in various years of the course at the department of nursing found that the communication competence of nursing students also improved as they progressed through the course, with values reported of 3.58 points [ 33 ] and 3.56 points [ 34 ].
In previous studies, communication competence was a factor affecting nursing students’ problem-solving ability [ 13 ]. However, the current study is valuable because it additionally revealed that the level of problem-solving ability significantly increased according to the level of communication competence. Case-based education is suggested as a strategy to simultaneously improve communication competence and problem-solving skills in nursing student education [ 17 ]. This is because it is difficult to solve problems through integrative thinking and effective communication in a clinical environment, such as a hospital, with only theoretical knowledge of nursing subjects. Thus, the PBL method is applied to theoretical education in nursing colleges [ 35 , 36 ]. The results of this study showed that the presence or absence of PBL education had a significant effect on the problem-solving ability of nursing students; this ability improved when the PBL factor was added to Model 2. Therefore, it is necessary for nursing professors to practice and improve the communication competence of their students through case-based education in various subjects beginning in the first year to improve the problem-solving abilities of the students.
Additionally, the age of the subjects was also a factor influencing the problem-solving ability. Stewart, Cooper, and Moulding [ 37 ] reported that metacognitive levels increase with age. The study revealed that the communication competence of nursing students improved through various experiences [ 38 ]. Age may have had a similar influence.
Previous studies identified critical thinking disposition, empathy, nursing professional intuition, self-leadership [ 24 ], learning motivation [ 17 ], and communication competence [ 13 ] as examples of factors that affect nursing students’ problem-solving ability. However, this study demonstrated that metacognition also significantly affects the problem-solving ability of nursing students. In particular, metacognition and communication competence are considered key concepts, as they explained 51.2% of nursing students’ problem-solving ability. Therefore, it is necessary to consider and continuously apply educational strategies to improve metacognition and communication competence in the education of nursing students in the future.
This study is limited by the small number of nursing colleges that were included in the sampling, as this hinders the generalizability of the results.
This was a descriptive research study that identified the degree of and correlations between metacognition, communication competence, and problem-solving ability of nursing students, and identified factors that affect problem-solving ability. The results demonstrated that age, communication competence, and metacognition were the factors that most significantly affected the problem-solving ability of nursing students. Among these factors, metacognition had the greatest influence. Therefore, to improve the problem-solving ability of nursing students, an educational strategy is needed to improve communication competence through case-based learning in the curriculum, and development and application of activities such as PBL. In addition, the guidance of professors is needed to enable nursing students to improve their metacognition.
Since this study revealed that metacognition is a factor that influences the problem-solving ability of nursing students, we recommend conducting a study to check whether it affects actual problem-solving by developing and applying a metacognitive improvement curriculum in the future.
We would like to thank the nursing students who participated in the study.
This study was supported by the research fund of Korean Bible University in 2021.
Conceptualization, E.C. and J.J.; methodology, E.C. and J.J.; validation, E.C.; formal analysis, E.C.; investigation, E.C. and J.J.; resources, E.C. and J.J.; data curation, E.C.; writing—original draft preparation, E.C.; writing—review and editing, J.J.; supervision, E.C.; project administration, E.C. and J.J.; funding acquisition, E.C. All authors have read and agreed to the published version of the manuscript.
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Gangneung–Wonju National University (No. GWNUIRB-2022-1).
Informed consent was obtained from all subjects involved in the study.
Conflicts of interest.
The authors declare no conflict of interest.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Strategies for using a problem solving approach to solution.
A. Identify Problem
B. Explore Past Attempts to Address Issue
C. Explore Alternatives/Challenges to Determine Solutions
D. Choose Solutions
E. Implement Process
F. Evaluate Outcomes
One of the most important tools a nurse can use in practice is the nursing process. Although nursing schools teach first-year students about the nursing process, some nurses fail to grasp the impact its proper use can have on patient care. In this article, I will share information about the nursing process, its history, its purpose, its main characteristics, and the 5 steps involved in carrying out the nursing process. After reading this article, you will be able to answer the question, “what is the nursing process” and understand what is involved in each of the 5 steps of the nursing process. Additionally, throughout this article, after discussing a step of the nursing process, I will share an example of how the nurse would proceed with that step. For this article’s purposes, we will use information about the following patient: Mr. Collie, a fifty-four-year-old white male being admitted to the Medical-Surgical floor for acute congestive heart failure.
When was the nursing process developed, who developed the nursing process, what is the purpose of the nursing process, what are the 7 main characteristics of the nursing process, 1. within the legal scope of practice, 2. based on sound knowledge, 4. client-centered, 5. goal-directed, 6. prioritized, 7. dynamic and cyclical, how many steps are there in the nursing process, what are the 5 steps of the nursing process, step #1: assessment phase.
The first phase of the nursing process is the assessment phase. In this phase, the nurse collects and organizes data related to the patient. Data includes information about the patient, family, caregivers, or the patient's community or environment as it is relevant to his health and well-being. |
All phases of the nursing process are essential. The following are a few reasons why the assessment phase is important for nurses to provide care. In the assessment phase of the nursing process steps, the nurse gathers all pertinent information that will be used to establish a care plan. Every other step of the nursing process builds upon the previous. Without a thorough assessment, the other steps of nursing care may be negatively impacted, resulting in unfavorable outcomes. When assessments are performed correctly, they help reduce risks to patient safety which could occur when symptoms or other factors are not considered. |
The assessment phase of the nursing process involves gathering information about the patient which is used to guide planning care, setting goals for recovery, and evaluating patient progress. Nurses can obtain information about the patient by implementing the following objectives. The patient is the nurse’s main source of information. Therefore, it is essential to establish rapport with them as soon as possible. with the patient's family or caregivers when appropriate. Family members, friends, or other caregivers often offer insight into what is going on with the patient. It is important for nurses to listen to the patient’s support people and gather any information available. When the patient feels comfortable, it makes it easier to get the necessary information that will be used to establish a plan of care. The patient interview is one of the main sources of information used to plan patient care. Any information that is measurable or observable such as vital signs and test results is considered objective data. Subjective data is information gathered from the patient. |
Assessments are vital to the nursing process. The information gathered in the assessment phase impacts every component of patient care. Nurses must demonstrate excellent verbal and written communication skills, strong attention to detail, and possess an in-depth understanding of body systems. The most frequently used clinical skills for patient assessment are inspection, percussion, palpation, and auscultation. |
The assessment phase is a critical component of the nursing process. Information gathered in this phase is used to establish a foundation upon which all patient care moving forward is established. Remember, it is normal for patients to feel nervous or fearful when they are sick and in an unfamiliar place, like a hospital. Therefore, the nurse needs to establish an environment conducive to patient comfort. The assessment may include but is not limited to, the following aspects: environmental, physical, cultural, psychological, safety, and psychosocial assessments. The following is a guideline of what should happen during the assessment phase. During the assessment phase, the nurse collects objective and subjective data using proven methods to assess the patient. The most common methods for collecting data are the patient interview, physical examination, and observation. The patient interview is a deliberate or intended communication or conversation with the patient. It is used to obtain information, identify problems that concern the patient and/or the nurse, evaluate changes, provide support, and educate the patient and family/caregivers. The nurse will also conduct a head-to-toe nursing assessment addressing each body system and noting any abnormalities, complaints, or concerns. Observation requires the nurse to use all their senses (sight, touch, smell, hearing) to learn about the patient. After collecting data, the nurse must organize and validate data and document about the patient's health status. Validation is the process of verifying data to be sure it is factual and accurate. Nurses must be careful to not come to conclusions without adequate data to support their conclusion. It is also necessary to understand the difference between inferences and cues. Cues are signals the patient uses to alert the nurse about a concern or question or objective data the nurse can observe or measure. Inferences are the nurse's conclusion or interpretation based on cues. For example, the patient may complain about a painful incision two days post-operatively, and the nurse may observe the incision site is red and feels hot. These are cues. The nurse then makes an inference that the operative incision is infected. After data from the assessment is collected, organized, and validated, it must be recorded. One thing I always tell nursing students and cannot stress enough to any nurse is, "If you didn't document it, you didn't do it." While that may seem harsh, from a legal standpoint, if a nurse is asked to verify care or treatment and there is no supporting documentation, there is no way to prove the care occurred. Thorough documentation is one of the best ways for everyone involved in patient care to be aware of changes in the patient's status, and it helps promote effective collaboration within the interdisciplinary team. |
While all the nursing process steps are essential, without a thorough assessment, the other steps of the nursing process are not as easy to follow through. Nurses must recognize barriers that could impede the assessment phase and find ways to overcome them. The following are five common challenges you may face during the assessment phase and some suggestions on how to overcome them. Limited Time There are days when nurses feel as though there aren’t enough hours to accomplish all the work that needs to be done. When you are short-staffed or have several patients waiting for a nursing assessment before you can initiate care, it can feel a bit overwhelming. Even on the busiest of days, it is important for nurses to perform thorough nursing assessments for all patients assigned to them. That means it is necessary to learn to manage time efficiently. The first step in overcoming limited time is to be familiar with the format or forms your employer uses to record assessments. For example, the Health Information Technology for Economic and Clinical Health Act of 2009 advanced the adoption and use of electronic health records. Nearly one hundred percent of hospitals use some type of EHR. Electronic health records have helped improve workflow by eliminating time spent pulling physical charts or documenting in paper charts. Interruptions It is not uncommon for interruptions to occur when nurses are performing assessments. While some interruptions may be necessary, all are not. Interruptions during patient assessments can delay care and could result in errors or omissions. The best way to overcome the challenge of interruptions during the assessment step of the nursing process is to provide for privacy before you begin the assessment. Whether you are working in triage, assessing a patient newly admitted to your floor, or in a busy emergency room, it is possible to reduce interruption. Pull the privacy curtain closed if you are in an area with more than one patient or several staff close by. Some facilities use "Do Not Disturb" or "Room in Use" signs to provide privacy for nurses and patients. Inexperience Every nurse knows the importance of a good nursing assessment. Newly graduated nurses are less experienced than other nurses and may feel uneasy about performing a nursing assessment alone. Additionally, if your facility changes its documentation format or implements a new program for charting, and you've not yet used the program, your inexperience could pose a challenge when doing an assessment. The only way to overcome inexperience is to become experienced. Nursing assessments are typically classified as either a Complete Health Assessment or a Problem-Focused Assessment. Know which type of assessment you need to perform. Gather basic equipment: gloves, thermometer, blood pressure cuff, stethoscope, penlight, and watch. Establish a sense of trust and respect between the patient and yourself. No matter which type of assessment you perform, it should be systematic, making sure you cover each body system. If you assess each body system and make notes about what is normal/abnormal, you decrease the chances of omissions in documentation. Remember, take your time, trust your instincts, and if you need help, ask for it. Patient Anxiety Patient anxiety can create a significant challenge for nurses during a patient assessment. Anxiety can hinder communication making it difficult to gather all the necessary data. If anxiety is bad enough, it can cause changes in vital signs, which could be misinterpreted as something more than an anxious reaction. Before beginning an assessment, take the time to make your patient comfortable. While you may not have time for a long conversation or "get to know you" session, you can ease your patient's anxiety by being calm and friendly. Some questions may make patients feel uncomfortable, especially teenagers. Allow them time to answer your questions without feeling rushed. Verify their understanding by asking if they can explain what you've discussed in their own words. Remember, everyone gets nervous or anxious at times, and when we are sick, it can be worse. It's nothing personal against you or your skills. Make everything about the patient. Patients Not Being Forthcoming About Symptoms Whether it is fear of the unknown, embarrassment, or another reason, there are times when patients may be apprehensive about sharing personal information. Lack of information or omission of details that the patient may think is irrelevant may negatively impact the process of care planning. Therefore, while it is easy to understand a patient's apprehension, it is crucial for nurses to gather as much information as possible when performing a nursing assessment. It can be easy to feel frustrated if a patient is not forthcoming about symptoms during an assessment. Keep in mind, being sick and needing medical care can be frightening. The best way to get patients to talk to you is to be accepting of them, no matter what. Be sure to tell your patient you are there for them and will work with them to help them get better. When you say things like you will "work with them," it lets your patient know you are going to do your part, but you expect them to do theirs as well. If you feel like your patient is withholding information, instead of making an accusation, try to rephrase the question. Make your questions clear so the patient knows what information you need. |
The format for recording nursing assessment data may vary from one facility to another. However, the information gathered for the assessment is relatively similar. The following are examples of content the nurse should include in the initial nursing assessment phase of the nursing process. 04/19/22 13.30 J. Mock, LPN 54 yrs. 2 mos. M 6’2” 268lbs 4oz Dr. Michael Coulvan 03/04/1968 CHF, acute Temp 98.8, Resp. 20, Pulse 76, BP 136/80 NKDA, no food allergies Jerold R. Collie 123 Blakely Lane, Clayton, MO. 1234 (318) 555-1234 Alert & Oriented x3; PERRLA, Unaided hearing; Bilateral hand grips equal; Bilateral foot push equal; no evidence of tremors; denies tingling, burning, loss of consciousness, hallucinations, disorientation, visual disturbances, or hx/o brain injury or stroke. Pulses present, regular, and strong: x2 upper extremities (Radial); present X2 lower extremities (Pedal); heart rate regular, strong; capillary refill <3 second upper and lower extremities Respirations even, labored; Dyspnea on exertion; Lungs: Bilateral rales in lung bases; Cough: Nonproductive; Oxygen: 2L per NC Reports 10 lb weight gain in last two weeks. Continent of bowel; Last BM 4/19/22; Laxatives: No, Enemas: No; Hx of Constipation: No Continent of bladder; Uses urinal prn; urinal emptied of approximately 200 cc clear, amber urine Skin is pink, warm, and dry; Mucous membranes pink and moist Reports pain and stiffness in joints of hands mostly in the a.m.; denies history of gout, arthritis, bursitis, or fractures; Negative paralysis; Negative contractures, No congenital anomalies; No prosthetic devices; Able to carry out most ADLs with minimal assist but may require periods of rest r/t dyspnea with exertion; Uses walker for ambulation. Headache Constant, throbbing 5 Full weight-bearing; Ambulatory with 1 person assist; Client uses walker occasionally; No supportive devices Client is alert, friendly, and answers questions readily; Comprehension: rapid. Divorced; Client lives alone in his own home; Has two adult children who live nearby and visit frequently; Client reports he has several close friends who call or visit often. History of hypertension; Denies any other medical issues prior to this admission. Client reports previous substance abuse, methamphetamine was his drug of choice. Client states he has been substance and alcohol-free for three years. Paternal hx/o CHF, HTN, and Lung Ca. Maternal hx/o DM, and HTN. *In addition to the information the nurse will gather during her assessment, the assessment phase of the nursing process includes gathering objective data such as copies of laboratory or diagnostic testing. If the facility uses electronic health records, as most do, this information will probably already be uploaded to the patient’s electronic chart. It is, however, the nurse’s responsibility to gather and verify all data is available. |
The assessment phase of the nursing process lays the foundation upon which all other nursing process steps build. The information gathered during the nursing assessment tells the nurse about the patient’s history, current complaints, medications, and any other pertinent information that may impact care planning. Without a thorough, proper patient assessment, it is impossible to develop a patient-specific care plan. Nurses collect data during the assessment phase by communicating with the patient, spouse, and caregivers, reading patient records, nursing observation, and collecting measurable data such as vital signs. Subjective data is any information the nurse collects through communication. A few examples of subjective data include the reason for the patient’s visit to the doctor, patient or family medical history, medications the patient is taking, and any symptoms such as chills, aches, or pain. Objective data is any measurable information obtained from sources other than the patient. For example, the patient’s height, weight, vital signs, and laboratory or diagnostic test results are objective data collected during a patient assessment. Nurses collect verbal data by talking to patients, their family members (when appropriate), and other members of the healthcare team. Subjective matter is usually often the result of verbal communication during the patient interview. Nonverbal data is collected during the assessment phase of the nursing process by observing the patient's body language, reading patient charts, or medical test results. For example, the patient may not offer a verbal report of pain, but the nurse may observe him clutching or guarding his side, which could indicate pain. The nurse can use the nonverbal data to form assessment questions as a way of following up with what she has observed or read. The primary source of data collection during the nursing assessment is the patient. Other sources include family, friends, caregivers, and other members of the healthcare team. Data are also collected from laboratory or diagnostic reports, the patient’s medical records, and the nurse’s observations. Tertiary data are data gathered from sources such as the patient's chart, lab, or x-ray reports. Nurses may also use tertiary sources such as diagnostic manuals or textbooks to verify or compare information. Nurses can use a few methods to verify the accuracy of data collected during the assessment phase of the nursing process. A few ways to verify data is to clarify information with the patient by asking additional questions, compare objective and subjective data to see if there are any discrepancies, recheck data by repeating the assessment, and verifying data with another nurse or healthcare team member. One example of verifying data is to perform repeat vital sign check. For instance, if Mr. Jones has a blood pressure reading of 220/100 but has no history of hypertension, the nurse should retake his blood pressure to validate its accuracy. If the nurse feels it is necessary, they may use different equipment or ask someone else to perform the vital sign check to check for accuracy. The primary methods nurses use to collect data are observation, patient interviews, and head-to-toe assessments. Nurses use various tools and equipment to help gather data about patients. A few examples of tools and equipment nurses use include a stethoscope, blood pressure cuff, thermometer, pulse oximeter, and scales. You may need a glucometer and lancets to check blood sugar, as well. |
Diagnosis is the second phase of the nursing process. It is also designated by the American Nurses Association as the second Standard of Practice. The standard is defined by the ANA stating, "The registered nurse’s analysis of assessment data to determine actual or potential diagnoses, problems, and issues.” The nursing diagnosis reflects the nurse’s clinical judgment about a patient’s response to potential or actual health issues or needs. |
Before a plan of care can be established, nurses must determine which nursing diagnosis/diagnoses apply to their patients. The following are a few reasons why the diagnosis phase of the nursing process is important. The diagnosis phase of the nursing process helps nurses view the patient from a holistic perspective. Using a nursing diagnosis can lead to higher quality nursing care and improved patient safety, as care is based upon the needs outlined in the diagnosis. The diagnosis phase helps increase the nurse’s awareness and can strengthen their professional role. |
In the diagnosis phase, the nurse follows a set of objectives that end with developing the nursing diagnosis/diagnoses used to establish patient care. These are the main objectives of the diagnosis phase: The nurse must identify what problem the patient is experiencing related to the medical diagnosis. Any situation or problem that could result because of the patient’s medical diagnosis is a risk factor for a nursing diagnosis and must be addressed. All data gathered during the assessment phase of the nursing process must be compiled, validated, and analyzed to support an appropriate nursing diagnosis. Nursing theories involve an organized framework of concepts and purposes that guide nursing practices. A nurse’s theory is their unique perspective about the patient’s status and measures needed to improve the patient’s outcome. After identifying problems and risk factors, analyzing data, and developing a nursing theory, the nurse can then establish a nursing diagnosis or diagnoses which is used to establish a nursing care plan. |
Nurses will utilize several skills in the diagnosis phase of the nursing process steps. Critical thinking, problem-solving, and communication skills are necessary to work in this phase. Nurses must also demonstrate the ability to prioritize patient needs. |
The diagnosis phase of the nursing process involves three main steps: data analysis, identification of the patient’s health problems, risks, and strengths, and formation of diagnostic statements. Data Analysis involves the nurse clustering cues, comparing patient data against standards, and identifying inconsistencies or gaps in the data. After data analysis, the nurse will work with the client to identify actual, risk, and possible diagnoses. In this step, the nurse will determine if an identified problem classifies as a nursing diagnosis, medical diagnosis, or collaborative diagnosis/problem. It is important to involve the patient in this step whenever possible, to identify the client's resources, coping abilities, and strengths. The last step of the diagnosis phase involves creating a nursing diagnosis. The nursing diagnosis may have up to three components: a NANDA-I approved , a which defines the cause of the diagnosis, and an as that uses patient-specific data to justify the diagnosis and diagnostic statement. |
The nursing diagnosis is different from a medical diagnosis. It requires careful consideration of the patient’s individual problems, situation, and needs to develop appropriate nursing diagnoses. Here are a few examples of challenges that may occur during the diagnosis phase of the nursing process and some suggestions on how to overcome them. Creating a Nursing Diagnosis Is Often a Complex Process Although there are resources and guidelines to help nurses develop nursing diagnoses, the process can be complex. Before nurses can create a nursing diagnosis, they must interview and assess the patient and review data, which can be time-consuming. While you may not overcome the complexities of creating nursing diagnoses, it is possible to make the process easier. For example, be sure to review all objective data, including baseline vitals, laboratory or diagnostic test results, and subjective data. Make sure the patient's medical history is accurate and find answers to any questions not yet answered. The more information you have to work with, the easier it becomes to develop diagnoses based on that data. Nurses May Interpret Data Differently Some data are taken at face value, such as laboratory or diagnostic test results or vital signs, which are measurable. Subjective data is data reported by the patient. It is information given to the nurse by the patient based on the patient’s perception of what he is feeling. Despite efforts to appreciate the patient’s perception, nurses sometimes interpret data differently. When this happens, it can create a challenge when developing nursing diagnoses for the nursing care plan. It is essential for nurses to have a clear understanding of which data is objective or subjective. Once the differences in data are realized, nurses must be careful to not rely upon only one piece of data or their own perception of data to create a nursing diagnosis. Instead, establishing nursing diagnoses should be a collaborative effort among the nursing care team. Nurses assigned to a patient’s care should discuss their perception of data and make informed decisions based on all data. Insufficient Data to Support a Nursing Diagnosis Nurses must review all available data, including but not limited to subjective and objective findings, lab and diagnostic test results, and narrative notes from the patient interview before a nursing diagnosis can be made. If the nurse does not obtain enough data during the assessment, it will be difficult to establish appropriate nursing diagnoses. The best way to overcome the challenge of insufficient data is to perform a thorough assessment, patient and/or family interview, and make sure all results from any tests are readily available for review. If you have reached the diagnosis phase of the nursing process and find you do not have enough data, go back to the sources of information and gather data. You may find that you need to reassess the patient or ask additional questions. Lack of Communication Between Nursing Staff Although patients are assigned a primary nurse, nursing is a team effort that requires collaboration. When there is a lack of communication between nursing team members, information may be inadvertently omitted from notes or reports. This failure in communication makes getting a complete view of the patient's status difficult, resulting in challenges in developing appropriate nursing diagnoses. Nurses must be alert and responsive to patients and one another. End of shift report is an excellent way for nurses to communicate changes in a patient's status. Nurses should make notes of anything pertinent before handing off care to the next shift nurse and clearly communicate concerns about the patient's progress or lack thereof. When the lack of communication is resolved, nurses can compare information to use when establishing nursing diagnoses, ensuring the patient gets the best care possible. Deciding the Type of Nursing Diagnose to Use There are four main types of nursing diagnoses: Problem-focused, Risk, Health Promotion, and Syndrome. When nurses get to the diagnosis phase of the nursing process, they must determine which type or types of diagnoses are relevant to their patients. While experienced nurses may find it easier to decide which type of diagnosis to use, new or less experienced nurses may find it challenging. Additionally, some healthcare facilities prefer nurses to use a specific type of diagnosis, which can be frustrating, especially if the nurse feels a different type of nursing diagnosis is more appropriate. Overcoming the challenge of choosing the right type of nursing diagnosis requires understanding when each type is most appropriate. If the nurse has sufficient data from the assessment phase, they can then identify potential diagnoses and determine which type of diagnosis to use. The following are the four types of nursing diagnoses and examples of each. focus on a specific problem the patient is experiencing. This type of diagnosis has three components: a nursing diagnosis, related factors or diagnosis statement, and defining characteristics or the as evidenced by statement. For example, the patient with chronic obstructive pulmonary disease (COPD) could have a problem-focused nursing diagnosis of "Ineffective Breathing Pattern related to decreased lung expansion as evidenced by dyspnea and ineffective cough." identify potential problems or risks the patient may experience because of his medical diagnosis. A risk nursing diagnosis typically has two components, the diagnosis, and risk factors. The patient with COPD may have a risk diagnosis of "Risk for Ineffective Airway Clearance related to decreased lung capacity." (a.k.a. Wellness Nursing Diagnosis) is based on the nurse's clinical judgment about the patient's desire and motivation to increase his well-being. These diagnoses focus on the client's transition from one level of wellness to a higher level of wellness. Health promotion nursing diagnoses are usually one-part statements or include only a diagnostic statement. The COPD patient's Health Promotion Nursing Diagnosis may state "Readiness for Enhanced Wellness." are clinical judgments related to a cluster of risk nursing diagnoses predicted to occur because of a particular event or situation. The syndrome nursing diagnosis is also written as a one-part statement. For example, the COPD patient may have a syndrome diagnosis of “Ineffective Airway Clearance, Impaired Gas Exchange, Ineffective Breathing Pattern.” |
After reviewing the data collected in the assessment phase of the nursing process, the nurse determines which type of diagnosis is appropriate and moves to the planning phase. In the case of Mr. Collie, the nurse chooses a problem-focused nursing diagnosis and a risk nursing diagnosis. • Decreased Cardiac Output r/t impaired contractility and increased preload and afterload AEB irregular heartrate of 118, fatigue, and dyspnea on exertion (Problem-focused) • Risk for Impaired Skin Integrity r/t edema, decreased tissue perfusion, and decreased activity. (Risk) |
Although they share similarities, nursing and medical diagnoses are different. The nursing diagnosis is used by a nurse to identify a patient’s actual or potential risk(s), wellness, or responses to a health problem, condition, or state. A medical diagnosis is used by physicians to determine or identify a specific condition, disease, or pathologic state. NANDA-I stands for North American Nursing Diagnosis Association International. NANDA-I is a professional organization that researches, develops, disseminates, and refines nursing diagnosis terminology. The organization was formed as NANDA in 1982, it was renamed NANDA-I in 2002 because of its increased worldwide membership. Each nursing diagnosis is made up of four main components: problem and its definition, etiology, risk factors, and defining characteristics. The primary purpose of establishing a nursing diagnosis is to communicate the healthcare needs of the patient among members of the healthcare team and within the delivery system. The nursing diagnosis allows nurses to facilitate individualized care for the patient and family and strengthens the profession. The nursing diagnosis serves as the basis for selecting nursing interventions, which have a significant impact on patient outcomes. If an accurate nursing diagnosis is not chosen, the plan of care and subsequent nursing interventions may not address the patient’s issues appropriately resulting in negative patient outcomes. Nursing diagnoses are ranked in order of importance. Immediate life-threatening problems or issues related to survival are given the highest priority. Nursing diagnoses focus on the patient’s response to health conditions, and patients often respond differently. Therefore, it is not uncommon for patients with the same medical diagnosis to have different nursing diagnoses. |
The planning phase of the nursing process is the stage where nursing care plans that outline goals and outcomes are created. The goals and outcomes formulated during this phase directly impact patient care and are based on evidence-based nursing practices. |
The planning phase of the nursing process is essential in promoting high-quality patient care. It is considered the framework upon which scientific nursing practice is based. The following are three of the top reasons why the planning phase is so important. Care planning provides direction for personalized patient care based on the client's unique needs. The planning phase enhances communication between patients, nurses, and other members of the healthcare team. Planning encourages continuity of care across the healthcare continuum and promotes positive patient outcomes. |
The American Nurses Association's Standards of Clinical Nursing Practice identifies planning as one of the essential principles for promoting the delivery of competent nursing care. The planning phase of the nursing process has five main objectives, all of which focus on nursing interventions to promote positive patient outcomes. The following are the main objectives of the planning phase. The nurse reviews the nursing diagnoses and prioritizes them according to physiological and psychological importance. This step helps the nurse organize the patient’s nursing diagnoses into a format that promotes effective planning. This objective of the planning phase of the nursing process involves setting goals related to each diagnosis. Goal setting helps to provide guidelines for nursing interventions and establishes criteria by which the care plan's effectiveness is evaluated. Remember the acronym SMART when developing goals. SMART goals are Specific, Measurable, Relevant, and Time-bound. After goals are established, the nurse can identify expected outcomes based on each goal. Outcomes should be realistic, mutually desired by the patient and nurse, and attainable within a designated amount of time. After goals are agreed upon and established, the nurse then implements decision-making skills to select nursing interventions that are relevant to the nursing diagnoses. Interventions are prioritized in order of planned implementation. After priorities, goals, outcomes, and interventions are established, the nurse must document the care plan. Documentation of the care plan includes nursing orders which communicate the interventions the nursing staff will implement for the client. Nursing orders must be well-written and should include the order date, which action will be performed, a detailed description, the time frame in which the intervention will be performed, and the nurse's signature. |
Nurses utilize many of the same skills for each of the nursing process steps. In the planning phase, nurses must have strong communication skills, time management and organizational skills, and a willingness to work collaboratively with the patient and interdisciplinary team. Nurses must have strong critical thinking skills, as they must weigh the risks and consequences of each intervention. |
The planning phase of the nursing process is when nurses formulate goals and outcomes that impact patient care. This step involves prioritizing patient needs, identifying expected outcomes, establishing nursing interventions, and identifying patient-centered goals. In the planning phase, nurses identify goals and outcomes for patient care based on evidence-based practice guidelines. Once objectives of planning are met, the nurse creates a written plan of care, or care plan. The care plan is a written guide organizing data about the patient's care into a formal statement of strategies or interventions the nurse will enact to help the patient achieve optimal outcomes. |
It is normal to face challenges, no matter which phase of patient care you are involved with. The planning phase can feel a bit tricky because nurses need to be careful to develop plans considering the individuality of the patient. The following are a few examples of challenges you could phase when you begin planning patient care. Not Knowing How to Format the Care Plan There are different formats for creating a care plan. If nurses do not know the format their facility uses, it can be easy to overlook components of the plan, which may impact the delivery of care and patient outcomes. Not knowing how to format a care plan is probably one of the easiest challenges to overcome in the planning phase. With the implementation of electronic health records and programs that help nurses choose nursing diagnoses and interventions, creating care plans has become easier. As a nurse creating a care plan, your job is to make sure all relevant information is included in the plan. The nursing diagnosis, interventions and expected outcomes, time frames in which outcomes should be accomplished, and a place to document evaluations should all be included. Not Establishing Goals and Expected Outcomes Have you ever heard the saying, "Failure to plan is planning to fail"? That principle applies to everything in life, including patient care. No care plan is complete without clear goals and outcome identification. If there are no goals or an insufficient number of goals relevant to the nursing diagnoses, deciding on interventions is impossible. The nursing care plan should always be patient-centered and individualized. Goals and outcomes should be tailored to meet each patient's needs and should be considerate of the patient's cultural beliefs and values. Nurses use the nursing care plan as a road map that all members of the nursing team use to help the patient reach goals. It is vital that nurses establish goals that are attainable and relevant to the patient's specific needs. In the planning phase of the nursing process, the nurse should establish short-term and long-term goals and determine the outcome associated with achieving those goals. Establishing goals and outcomes is vital to this step in the nursing process. Therefore, nurses should take the time to consider each goal and outcome carefully and discuss the plan with the patient and healthcare team. Unrealistic Goals While it is okay to be optimistic about a patient’s ability to achieve goals, it is essential for nurses to be realistic about what their patients can or cannot do. If goals are unrealistic, patients can quickly become frustrated. Frustration often leads to noncompliance, which can negatively affect patient outcomes. After carefully determining nursing diagnoses, the nurse must determine which goals the patient can achieve realistically. Realistic goals are specific and well-defined, measurable, achievable, relevant to the patient's status and needs, and achievable within a specific timeframe. To overcome the challenge of unrealistic goals, identify what is essential in helping the patient achieve optimal outcomes. Discuss goals with the patient, family, care providers, and nurse manager. Once realistic goals are identified, offer support and encouragement to the patient. The nurse should continually monitor and assess the patient's progress toward meeting goals. Limited Patient Input Although nurses can create nursing care plans independent of patient input, excluding patients from plans about their care may lead to distrust or confusion. If a patient feels he cannot communicate with nurses or his opinion is not valued, it can result in noncompliance with the care plan and negatively impact the patient’s outcome. When patients are involved in their care, the processes of planning and implementation seem to flow easier. Nurses can overcome the challenge of limited patient output by promoting a comfortable, trusting nurse-patient relationship which encourages patient participation. Ask the patient about their health goals and what limits they feel may affect their ability to reach goals. Offer suggestions about desired goals and expected outcomes and explain why they are relevant to the patient's health and long-term well-being. Being Unsure of Appropriate Time Frames to Meet Expected Outcomes/Goals It is possible for nurses to create realistic goals and expected outcomes in the care plan but to set unrealistic time frames in which the patient is expected to meet those goals. One reason this challenge occurs is nurses sometimes fail to plan care based on an individual patient’s abilities. Instead, they establish goals based on their perception of what any patient with the same diagnosis may be capable of achieving. When working through the planning phase of the nursing process, nurses must consider patients as individuals with specific needs and abilities. The nurse should specify a time frame for achieving goals that is reasonable and that does not create undue stress or worry for the patient. When discussing the care plan with the patient, it is important to explain each goal to the patient. Include education about why there is an anticipated time for accomplishing goals and what each person's responsibilities are to help make achieving the goals possible. |
Once the nursing diagnosis or diagnoses are established, the nurse completes the planning phase of the nursing process by determining patient goals and expected outcomes and establishing which nursing interventions to initiate. The following are goals and expected outcomes for Mr. Collie based on the nursing diagnoses of Decreased Cardiac Output and Risk for Impaired Skin Integrity. The client will verbalize understanding of activities and lifestyle changes focused on reducing cardiac workload. The client will demonstrate adequate cardiac output AEB vital signs within normal limits. The client will report decreased episodes of dyspnea. Monitor vital signs. Palpate peripheral pulses. Assess for signs of edema. Monitor for signs of pallor or cyanosis. Maintain skin integrity. The client will verbalize understanding of techniques/behaviors to prevent skin breakdown by end of shift. Inspect skin, noting areas of altered circulation, bony prominences, and/or signs of emaciation. Encourage frequent position changes Provide alternating pressure mattress, heel protectors, and elbow protectors |
There are four main components of a nursing care plan: Client Assessment, including medical and diagnostic reports, Nursing Diagnosis, Desired Outcomes/Goals, Nursing Interventions with evidence-based rationale, and Evaluation. The best way to write a nursing care plan is to include information associated with the nursing process steps. Review all relevant data, medical history, vital signs and assessment data, physical, emotional, spiritual, ad psychosocial needs, identify areas where improvement is needed, and establish risk factors. A nursing diagnosis is an actual or potential health problem that nurses can address without physician intervention. A few examples include risk for falls, risk for compromised skin integrity, and risk for dehydration. Setting goals requires establishing desired outcomes and identifying measures by which the patient will achieve them. Although there may be situations where it is not possible, it is ideal to set goals with the patient when they are able. Nursing interventions are actions taken by the nurse to help patients achieve goals and meet desired outcomes. Nursing interventions include initiating fall precautions, administering medications, and assessing the patient’s pain level. of the plan and change or update, as needed or indicated. The next two FAQs about the planning phase are related to setting goals. Goals are statements of purpose describing an objective to be accomplished. All goals in the nursing care plan should be client-centered and measurable. Each goal should focus on the problem, measures to resolve the problem, and rehabilitation. The time frame given to accomplish goals in the care plan varies, depending on the setting where patient care is provided. A tip I always share with students is, if you are not sure how to write a goal, try converting the nursing diagnosis into a positive statement of action. A short-term goal in nursing care plans is a goal focused on demonstrating a change in behavior. Short-term goals can be completed in as little as a few minutes or up to a few days. The nurse should consider what behavior the patient can most easily exhibit or identify to show understanding of goals and attempts to achieve goals. For example, let’s consider the following nursing diagnosis and determine a short-term goal. Long-term goals are the desired outcome related to accomplishing one or more short-term goals for an extended period. In some cases, long-term goals can take weeks, months, or even years, to achieve. Planning occurs in three stages: initial, ongoing, and discharge. Initial planning occurs when the nurse performing the admission assessment develops a preliminary plan of care. Ongoing planning is the process of updating the patient’s plan of care as new information is collected and evaluated. Discharge planning begins at admission and involves the anticipation of the client’s needs and plans to meet those needs after discharge from care. When possible, the patient should be included in all phases of the nursing process. The patient is the best source of data, the person being treated, and usually the most reliable source of information used to determine the patient’s strengths, weaknesses, and likelihood of compliance with a plan of care. |
The fourth phase of the nursing process is the implementation phase. This phase is when nurses initiate the interventions established during the planning phase. |
After the nursing assessment is performed, nursing diagnoses are established, and a care plan is developed, the plan must be initiated. All phases of the nursing process are essential. The following are three of the top reasons why the implementation phase is so important. Implementation of the nursing process is significant because it involves action on the nurse's part to promote positive patient outcomes. Conversely, if the care plan is not implemented, there is a lack of nursing care, negatively impacting patient outcomes. When the nursing care plan is implemented (implementation phase), nurses can begin to gauge patient responses to interventions. Implementation supports continuity of care. Care begins from the first patient encounter and continues until discharge. |
The implementation phase of the nursing process is an ongoing process in patient care. From the time a plan is established, the implementation process continues in a cycle which includes the five objectives below. The nursing care plan is developed based on data from the initial nursing assessment. However, because a patient's condition can change quickly or nurses may obtain new data, ongoing assessments are necessary to validate the need for proposed interventions. Ongoing observations and assessments provide information supporting adaptations of the nursing care plan to promote improved, individualized care. Utilizing data from initial and going assessments, the nurse then establishes priorities for implementing care. Prioritization is based upon which problems are considered most important by the nurse, patient, family/significant others, previously scheduled tests/treatments (diagnostic tests, surgery, therapy), and available resources. Before implementing nursing interventions, the nurse must review proposed interventions and determine the skills and knowledge level required to safely and effectively implement them. For example, the nurse will consider if the patient can independently perform an activity, if a family member may assist, or if the activity requires assistance from a healthcare professional. Although some interventions require the skills and knowledge of a registered nurse, others are less complex and may be delegated to licensed practical/vocational nurses or assistive personnel. The nurse allocates personnel resources by determining the needs of the client, the type of personnel who are available, and facility protocol for care. After verifying priorities and determining resources, the nurse can initiate nursing interventions. Interventions are determined by the cause of the problem and often vary among patients with similar nursing diagnoses depending on expected outcomes for each patient. When initiating nursing interventions, the patient's preference and developmental level should be considered. Additionally, nurses must review the physician's orders which may impact nursing interventions by imposing restrictions on specific factors such as the patient's allowed activity level or diet. Nurses are legally obligated to document all interventions and any observations concerning the patient's response to those interventions. Documentation may be done on checklists, flow sheets, or in narrative form. Any verbal communication between the patient and nurse or among the healthcare team related to interventions and patient responses should be recorded, as well. |
Like the other nursing process steps, the implementation phase requires broad clinical knowledge, critical thinking and analysis skills, and strong judgment. Whether a nurse is caring for one patient, or several patients, careful planning and time management skills are essential in this phase. Nurses must have psychomotor, interpersonal, and cognitive skills as these serve as competencies through which high-quality nursing care is delivered. Psychomotor skills are necessary to safely perform nursing activities such as handling medical equipment competently. Interpersonal skills help nurses establish therapeutic nurse-patient relationships and promote interdisciplinary collaboration. Cognitive skills are necessary to help the nurse understand the rationale for proposed interventions and make appropriate observations. |
Implementation involves a focus on accomplishing predetermined goals and continuous progress toward achieving desired outcomes. This phase of the nursing process involves prioritizing nursing interventions, assessing patient safety during nursing interventions, delegating interventions when appropriate, and documenting all interventions performed. |
Nursing interventions vary depending on the patient and the setting where care is provided. The following are examples of common challenges nurses face during the implementation phase of the nursing process and suggestions for how to overcome them. Lack of Clinical Experience Even when goals and desired outcomes are clearly defined, inexperienced nurses may find implementing nursing interventions challenging. Inexperience may occur because the nurse is newly graduated or if a nurse is transferred to a department where they have never worked. While the most effective way to overcome a lack of clinical experience is to work as much as you can and gain experience, patient care cannot wait for us to feel comfortable performing unfamiliar tasks. When nurses face challenges implementing patient care because of inexperience, the best way to overcome it is to speak up and ask for help. As a nursing instructor, I always encouraged my students to ask questions about everything. The only bad question is the one you do not ask. Nurse leaders, supervisors, and administrators appreciate nurses who readily admit when they need help or guidance. Patient Noncompliance Noncompliance is recognized by NANDA-I as a nursing diagnosis. It is defined as “the behavior of a patient or caregiver that does not correspond with the therapeutic plan agreed upon by the individual, family or guardian, and healthcare provider.” Noncompliance can negatively impact patient outcomes, reduce the patient’s quality of life, and result in increased healthcare costs. One of the best ways to prevent or stop patient noncompliance is to involve the patient in all aspects of care planning. Nurses should ensure the patient is educated about their illness, plans to manage the illness, and expected outcomes of therapies. Education should also include information about how noncompliance may negatively affect the patient's outcome. The patient's understanding of all education should be verified, and if the nurse is unsure the patient clearly understands, teaching should be repeated. Psychosocial Factors Psychosocial factors can impact all aspects of patient care. For example, if there is a presence of domestic abuse or violence, the patient may be afraid to discuss important issues related to care, which could result in misunderstanding established goals. Psychosocial factors may seem a little tricky to navigate. However, if they become a factor affecting the implementation of the nursing process steps, nurses must find a way to try and address the issues. For instance, if the nurse suspects a patient is afraid to discuss certain issues in the presence of others, the nurse should ask for privacy while talking to the patient. By doing so, the nurse offers the patient the opportunity to speak openly without fear of retaliation by an abuser. Then the nurse can discuss options for care with the patient and how to proceed moving forward. Nursing Care Plan Does Not Reflect Appropriate Care for the Nursing Diagnoses Every step of the nursing process builds upon the previous step. Nurses must perform a thorough assessment and collect sufficient data before making nursing diagnoses. After a nursing diagnosis is established, interventions are planned to help resolve the issue(s) the patient is experiencing. If the planned interventions do not align appropriately with the care expected for a nursing diagnosis, implementing the care plan properly cannot occur. It is vital for nurses to handle each phase of the nursing process with deliberate care and appropriate actions. Nursing care plans should be evaluated by the nursing team to ensure that the patient’s needs are addressed, and planned interventions are relevant to the nursing diagnosis/diagnoses. Nursing Shortage The World Health Organization estimates a shortage of more than four million nurses in the United States. No matter how well-written a nursing care plan is, if there is not enough staff to carry out the nursing interventions, the plan cannot be successfully implemented. While it is understandable that one nurse cannot remedy the nursing shortage, there are things all nurses can do to help relieve the impact the shortage causes. |
Implementation of the nursing care plan involves educating the patient and helping him achieve goals and expected outcomes. It also involves putting the planned nursing interventions into action. To implement the care plan, the nurse will establish priorities, delegate tasks to appropriate staff, initiate interventions, and document interventions and the patient’s response. Nursing documentation should be accurate and relevant to the patient. Use appropriate nursing language and facility-approved abbreviations. In the case of Mr. Collie, the nurse's documentation may look like the following narrative. 04/19/22 @ 1430: Discussed plan of care with client and son who was present in the room, including educating about goals and expected outcomes. The client verbalizes understanding of the importance of lifestyle and activity changes to reduce cardiac workload, the need for vital signs to be within normal limits, and measures to decrease episodes of dyspnea, and safety precautions. The client also verbalizes understanding of the risk for impaired skin integrity and verbally recalls skin integrity is at risk due to "bad circulation and swelling." The client voices understanding that frequent position changes and keeping the skin clean and dry will decrease the likelihood of skin breakdown. Assessed peripheral pulses, which are present and strong bilaterally in upper and lower extremities X2, 2+ pitting edema noted in bilateral lower extremities. Skin remains intact, pink, warm, and dry, no signs of redness or pallor. Heel and elbow protectors applied. Alternating pressure mattress in place and operational. ------------D. Leonard, RN |
The first step in the process of implementing a nursing care plan is to determine what, how, and when an intervention should be performed. Once you know the what, how, and when, you can determine if the task can be delegated and to whom. The three types of interventions implemented in the nursing process are independent, dependent, and interdependent. are actions nurses can perform on their own and do not require assistance from other team members. For example, routine tasks such as monitoring vital signs or assessing the patient's pain level are independent nursing interventions. require instructions or input from the physician. For instance, if the patient needs a new medication, the physician must prescribe the medication and order the amount and frequency. Dependent nursing interventions are interventions the nurse may not initiate on her own. are also known as collaborative interventions. These interventions involve all members of the interdisciplinary team. For example, if a patient had a total knee replacement, his recovery plan may include a prescription medication from the doctor, assistance with dressing from the nurse or unlicensed assistive personnel, and physical or occupational therapy by the physical therapist or occupational therapist. While many sources use the words interchangeably, intervention and implementation are defined somewhat differently. Interventions are planned nursing activities performed on a patient's behalf. They include assessment, adherence to medication therapy, and problem-solving. Implementation is . Strategies to prioritize patient care typically include the use of nursing diagnoses combined with Maslow’s Hierarchy of Needs Theory. Any nursing diagnosis that suggests a risk or threat to the patient’s survival should be the nurse’s first priority. Remember your ABCs: Airway, Breathing, Circulation. Other physiological needs necessary for survival are considered. Psychosocial needs are then addressed. Psychological needs including a sense of love or belonging, self-esteem, and self-actualization are prioritized last. Medication administration is part of the implementation phase of the nursing process steps. The nursing interventions outlined in the planning phase should include information about medication administration. When the nurse initiates the action of administering the medication, she is implementing the plan of care. All members of the nursing team have roles related to implementing the care plan. In the planning phase of the nursing process, the Registered Nurse determines which tasks may be delegated to Licensed Practical/Vocational Nurses, Nursing Assistants, or other members of the healthcare team. It is essential to remember that, even if a task is delegated, the RN in charge of the patient’s care is accountable for making sure all tasks are completed. |
Evaluation is the final phase of the nursing process. Although evaluation is considered the last of the nursing process steps, it does not indicate an end to the nursing process. Instead, evaluation should be an ongoing process carried out in daily nursing activities that ensures quality nursing interventions and the effectiveness of those interventions. |
The evaluation phase of the nursing process is important because it fulfills several purposes. The following are the top three reasons why this phase is essential in the nursing process. The primary purpose of an evaluation is to determine the patient’s progress toward achieving established goals and outcomes. Through evaluation, it is possible to determine a healthcare agency’s ability to provide safe and effective healthcare services. Evaluation provides a mechanism to help nurses define, explain, and measure the results of nursing interventions. |
The Standards of Clinical Nursing Practice established by the American Nurses Association designates evaluation as a fundamental component of the nursing process. This phase of the nursing process has the following objectives. The effectiveness of nursing interventions is determined by evaluating goals and expected outcomes to determine if they provide direction for patient care. It is essential to evaluate nursing interventions because they serve as standards by which patient progress is measured. The evaluation phase is not meant to make nurses feel as if their work is being critiqued or judged. Evaluation allows nurses to verify if the care they are providing meets the standard of care for the patient’s needs. Evaluation involves reviewing all aspects of the patient’s care and determining its effectiveness in helping the patient recover. Because nurses work collaboratively with one another and other members of the healthcare team, the evaluation phase promotes the nurses’ sense of accountability to their patients and to one another. In the evaluation phase of the nursing process, nurses compare and analyze data from the time the patient was admitted to care and determine if positive or negative trends are occurring. This data is helpful in deciding the next course of action to take in patient care. Although the evaluation phase is the fifth and last step in the nursing process, nurses constantly evaluate patient progress. Evaluation allows nurses to establish a pattern of continuous care and attention, which helps promote positive patient outcomes. |
The evaluation phase of the nursing process is primarily based on the nurse's accurate and efficient use of observation, critical thinking, and communication skills. Some changes in a patient's status may be subtle, requiring sharp observational skills. The ability to analyze reassessment data and use critical thinking are necessary to determine if outcomes have been met or decide if changes in the care plan are needed. As in other phases of patient care, the nurse must demonstrate strong communication skills, as evaluation includes the patient and all members of the healthcare team. |
During the evaluation phase of the nursing process, nurses determine the patient’s response to interventions and whether goals have been met. The evaluation process consists of seven steps, as follows. Standards and goals are established during the planning phase of the nursing process steps and carried out in the implementation phase. Nurses use evaluation to determine the presence of changes in the patient's status relevant to the established standards. The nurse uses assessment skills early in the nursing process to gather data used to establish goals and expected outcomes. Those same skills are vital for comprehensive, effective evaluation to occur. Nurses gather data to help determine the success of nursing interventions. The data collected during the evaluation phase must answer the question, “Did the patient achieve the treatment goals and expected outcomes outlined in the care plan?” Nurses validate goal achievement by analyzing the patient’s response to nursing interventions outlined in the nursing care plan. Effective nursing interventions address relevant patient needs. If the nursing intervention is efficient, it can be a primary factor related to helping clients resolve actual or potential problems or risk factors. During the evaluation phase, the nurse must use critical thinking skills to determine which nursing actions contributed to improved patient outcomes and to what degree they were effective. This step in the evaluation process allows the nurse to analyze the patient's response to interventions, determine the benefits of those interventions, and identify opportunities or needs for change. In the evaluation phase of the nursing process, the nurse uses observation and assessment skills to reevaluate the patient's status. In this step, the nurse compares baseline data collected in the initial nursing assessment with the patient's current health status. If the evaluation determines a lack of progress toward established goals, the nursing care plan is revised or modified. At this point, revisions are developed by beginning the nursing process anew. The client is reassessed (Assessment), more appropriate nursing diagnoses are established (Diagnosis), new or revised goals and outcomes are developed (Planning), new nursing interventions are implemented, or previous interventions are repeated to maximize effectiveness (Implementation). Then the patient's response is reevaluated (Evaluation). |
The evaluation phase of the nursing process is the point where nurses and patients hope to see measurable improvement. The following are a few challenges nurses may face when in the evaluation phase. Incomplete Documentation Every nurse is responsible for documenting patient progress and other pertinent information. If one nurse fails to document and report patient changes or progress, or to record laboratory or diagnostic test results, it can lead to challenges when it is time for the evaluation phase. The most effective way to overcome this challenge is to avoid it happening altogether. Be sure to document information about your patients during each shift. Any change in status, progress or lack of progress, subjective and objective findings, or other relevant information should be readily available for any nurse caring for that patient. Patient Frustration In a perfect world, patients would be admitted to care, nursing interventions would be implemented, and we would see positive results. Unfortunately, it doesn’t always work that way. One of the challenges nurses face in the evaluation phase is frustration related to slow progress or failing to meet goals. Overcoming the challenges that occur when patients become frustrated takes patience and understanding. If you find yourself in the evaluation phase of the nursing process steps and faced with this situation, take the time to talk to your patient. Assure them that progress does not always happen as quickly as we would like and encourage them to keep pressing forward. Let your patient know that you are there to support and help them and that your priority is to see them improve. Sometimes all it takes to calm a patient and help them regain focus is an assuring word and calming presence. Patients Withholding Information It is not uncommon for patients to try and mask symptoms or deny concerns when nurses evaluate their progress. This is especially common when a patient has been hospitalized or in a care facility for an extended period and wants to return home. In situations like this, a strong nurse-patient relationship and good communication skills are necessary. If you feel your patient is not being forthcoming about their progress, or perhaps new symptoms have emerged that they do not want to discuss, ask direct questions. Explain the importance of transparency when reporting progress, problems, or concerns. Family Denial of the Patient’s Need for Continued Care As nurses, we naturally hope that interventions positively impact our patients and that we can see improvement when evaluating them. Family members hope to see their loved ones recover and return to normal, as well. A significant challenge nurses can face when evaluating patient progress occurs when the patient's status declines or there is little improvement and family members deny the reality of the patient's situation. Many times, the fear of the unknown or lack of understanding is what causes family denial. If family members struggle with accepting the idea of continued care or changes in the plan of care, the nurse should acknowledge their concerns and offer support. When appropriate, talk with the patient and family together and discuss the previous plan of care and any suggestions for alterations or changes and the rationale for them. Patient Wishing to Terminate Care Before Discharge Goals Are Met Nurses understand that patients respond differently to care with some progressing faster than others, and the evaluation process helps to identify those patients who need extra time or updated care plans. Unfortunately, because patients do not always understand the complexities of interventions and expected outcomes, it can lead to feelings of despair. If patients slowly progress or fail to meet goals and expected outcomes, their frustration sometimes leads them to give up or desire to seek care elsewhere. When faced with this challenge, it is crucial for nurses to approach the patient with an attitude of empathy and attempt to discuss the patient's concerns. Depending on the patient's status and ability to understand, it may take some time and reinforced teaching to help them understand that slow progress is not failure. Explain your view of your patient's current status compared to his status on admission. Encourage the patient by assuring him that even slow progress is progress. Offer ideas of ways you think the care plan can be amended to suit his needs and ask for input. Remember, despite your best efforts, there may be times when patients decide to terminate care. Unless the patient has been deemed incapable of making informed decisions, you may not interfere with his choice to leave your care. It is necessary to document everything you discuss with the patient and his response to your instructions and education. If the patient decides to leave your facility's care, there is appropriate paperwork to be signed, called an A.M.A. (Against Medical Advice) discharge. The charge nurse or physician is usually responsible for having the patient sign this form and submitting it to administration. |
In the evaluation phase, the nurse reassesses the patient and determines if goals and outcomes are being met or if the care plan needs to be modified. Observations are recorded in the patient’s chart. 04/20/22 @ 1500: After twenty-four hours of nursing intervention, the client demonstrates adequate cardiac output as evidenced by decreased blood pressure of 130/78 and pulse rate of 72. The client states his breathing is less labored and that if he begins to feel short of breath, he lies still to rest. O2 per NC @ 2L continuous. Observed 500 cc clear, amber urine in the urinal. The patient continues to have 2+ pitting edema in bilateral lower extremities. MD notified, awaiting response/order. The client has turned/repositioned q2h to decrease the risk of impaired skin integrity. No signs of compromised skin integrity noted at this time. -------D. Leonard, RN |
The primary purpose of evaluation in the nursing process steps is to determine if patient goals and expected outcomes have been met or if the nursing care plan needs to be modified. The steps of evaluation in the nursing process include collecting data, comparing data with desired goals and expected outcomes, analyzing the patient’s response to nursing interventions, identifying factors impacting the success or failure of the nursing care plan, continuing, modifying, or terminating the care plan, and planning future nursing care. Although the nursing process is focused on nursing diagnoses and interventions, each member of the patient’s healthcare team has a role and the actions they take in patient care can impact the effectiveness of the nursing care plan. Therefore, the most effective way of improving evaluation in the nursing process, is to include the patient, family (when appropriate), and all members of the interdisciplinary team in the process. Although healthcare facilities and organizations have minimum guidelines for the frequency of nurse evaluations, it should be an ongoing process involved in patient care. The patient’s status and the effectiveness of nursing interventions should be continuously evaluated, and the care plan should be modified, when necessary. In the evaluation phase, nurses gather much of the same type of information as what is gathered during the assessment. During this phase, nurses review current vital signs and laboratory or diagnostic test results. They use information entered into the patient’s chart, such as nurses’ notes, flow sheets, and other pertinent information. Additionally, during the evaluation, nurses reinterview the patient and look for both subjective and objective data to determine if the plan of care was effective. The registered nurse assigned to the patient’s care is the primary person responsible for the evaluation phase of the nursing process. The RN evaluates all information necessary to determine if the goals and expected outcomes were met or if alterations in the plan are needed. Keep in mind, however, every member of the nursing care team plays a vital role in the RN's ability to conduct a thorough evaluation because each person is responsible for documenting their work and the patient’s response. |
Blogs/websites, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. how is nursing process different from the scientific method, 2. do all nurses use the nursing process, 3. do doctors also use the nursing process, 4. what does adpie stand for, 5. is it always necessary for a nurse to follow all steps of the nursing process, 6. how does critical thinking impact the nursing process, 7. how does a health information system affect the nursing process, 8. how to use maslow hierarchy in the nursing process, 9. which nursing process step includes tasks that can be delegated, 10. which nursing process step includes tasks that cannot be delegated, 11. how does the nursing process apply to pharmacology.
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Dive deep into the multifaceted world of nursing management with a special focus on problem-solving. This comprehensive guide presents a detailed look at the process, importance, and challenges of problem-solving in nursing management. By highlighting essential skills, neurologically based frameworks, and the relationship with decision-making, it offers both theoretical understanding and practical solutions. Explore real-life case studies, leadership's role, and the link with critical thinking. This is an enriching journey towards developing strategic competencies and achieving effective problem-solving in a vital healthcare sector.
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What do the algorithm-based and intuition-driven approaches to problem-solving in nursing management entail?
What is the first stage of problem solving in nursing practice?
What is problem solving in nursing management and how is it different from decision making?
What is the relationship between critical thinking and problem solving in nursing?
What is the final stage of problem solving in nursing practice?
What is the significance of problem-solving in nursing management?
What are the key skills required for effective problem-solving in nursing management?
How can critical thinking skills be enhanced for effective problem solving in nursing management?
What are the key steps involved in the problem-solving process in nursing management?
What does the neurological framework in nursing management involve?
What is decision making in nursing management?
Problem solving in nursing management is a crucial process that you need to grasp as a prospective or current nurse. This involves using a logical, systematic approach to resolving issues encountered in a nursing environment, focusing on maintaining quality patient care .
Problem Solving: This is identifying and overcoming obstacles to achieving a goal. In nursing, this generally revolves around improving patient health outcomes and ensuring efficient healthcare facility operations.
Nursing professionals are constantly faced with intricate issues that require decisive and effective solutions. The ability to implement problem-solving is crucial in maintaining optimal patient care , operational efficiency , and fostering team collaboration.
For instance, suppose a sudden shortage of resources like catheters or syringes is experienced in a healthcare facility. In such a case, the nursing manager will need to swiftly solve the problem either by reallocating resources, timely ordering supplies, or finding a temporary alternative, ensuring the patients' needs are continually met.
Effective problem-solving in nursing management is anchored on a set of key skills. These abilities equip you to navigate complex situations and formulate impactful solutions. They include:
These skills are interconnected. For example, your ability to think critically informs your decisiveness. Your decisions are then made clear to your team through effective communication, and together, through collaboration, the problem is solved.
In your nursing management journey, you will come across multiple challenges when attempting to solve problems. These obstacles might occur due to several factors, such as resource limitations, personnel issues, and complex patient needs .
Resource Constraints | Shortage of essential medical supplies or understaffing. |
Personnel Issues | Conflicts among team members or unforeseen absence of staff. |
Complex | Patients with rare medical conditions that require specialized care. |
While these challenges can be daunting, equipping yourself with robust problem-solving skills will help you navigate these complications and maintain high standards of patient care.
Delving deeper into the problem-solving process in nursing management, you get to navigate its intricacies and mechanisms. This exploration can bolster your abilities to resolve complex situations in your nursing career.
Problem-solving in nursing management is a multifaceted task that often involves several steps. To understand how to tackle issues expertly, you will need a clear understanding of each stage.
Problem-Solving Process: A systematic approach used to address complications and make decisions. In nursing, it’s composed of several steps, each essential to the resolution of issues.
Here are the key steps:
Many problem-solving methods exist, but one valuable perspective is through understanding the neurological framework in nursing management. This biological approach delves into how your brain processes information and develops solutions.
Neurological Framework: A biological perspective that explains how a nurse's brain processes, analyses, and responds to problems encountered in the nursing environment.
This framework refers to cognitive processes which involve:
Nursing management often involves complex and unique problems. To effectively tackle these challenges, it's crucial to breed creativity in the problem-solving process.
Imagine there's a sudden surge in patient intake due to a local health crisis, resulting in a bed shortage. A creative solution might be to convert other non-critical spaces such as conference rooms temporarily into patient monitoring units, thereby managing the surge effectively.
In a nursing environment, you are not working in isolation. Collaboration is a critical aspect of problem-solving in nursing management, as diverse insights can lead to innovative and effective solutions.
Consider a scenario where there's a need to implement a new system for managing patient records. To effectively solve potential issues in system implementation, you might need input from various team members including nursing staff, IT specialists, and data management experts. Each member's contribution, based on their expertise and perspective, is crucial in charting a comprehensive problem-solving strategy, ensuring the successful implementation and integration of the new system.
Decision making and problem-solving are two interconnected aspects in the realm of nursing management. Understanding their correlation and distinctiveness is key to effectively managing issues and improving patient outcomes in a healthcare setting.
The connection between decision making and problem solving in nursing management is truly significant. In almost every situation where a problem arises, decision making is an inseparable component of the problem-solving process.
Decision Making in Nursing: This involves selecting a course of action from different alternatives. It is the bridge connecting problem analysis with implementing solutions, and it requires evaluation of information, predicaments, and possible outcomes.
Once you have identified and defined a problem, analysed it, and developed potential solutions, the next step involves decision making. This is where you select the most suitable solution among the alternatives.
For instance, if you are dealing with a bed shortage problem in your healthcare facility, some possible solutions could be outsourcing to other healthcare facilities, using other spaces such as conference rooms as makeshift wards, or deploying portable hospital beds.
Each of these solutions has its pros and cons, and it's here that decision-making skills come into play. You'll need to compare and contrast each option, considering factors like cost, time, resources available, and the overall impact on patient care. The chosen solution is then implemented, and the effects are evaluated for future reference.
Though inherently connected, problem solving and decision making are distinct processes within nursing management. Where problem-solving is a comprehensive process that entails identifying, analysing, and solving issues, decision making is a component nested within this process, acting as the transition point from analysis to action.
Problem Solving in Nursing: This is a broader process involving the identification of an issue or obstacle, systematic analysis to understand it, devising potential solutions, choosing the most suitable through decision making, implementing it, and finally reviewing the effectiveness of the implemented solution.
Consider a real-life scenario such as medication errors. If these errors are occurring frequently in your healthcare setup, the problem-solving process will involve identifying the issue (increased medication errors), defining and analysing it (finding the root causes, such as miscommunication or system glitches). This would then lead to brainstorming potential solutions, like improved communication systems or enhanced employee training. The decision-making process would then come into play when choosing the best solution to implement.
Effective decision making underpins successful problem solving in nursing management. Implementing the right techniques can enhance your decision-making process, thus leading to more effective problem resolution.
Some proven techniques include:
Working collaboratively to brainstorm and analyse solutions promotes critical thinking and creativity, ensuring that the chosen solution maximises the use of resources and improves patient outcomes .
In unavoidable circumstances where decisions have to be made rapidly and with limited information, using intuition, a nurse's experience, and insights combined with analytical thinking can be beneficial. This is where the balanced blend of clinical expertise and effective risk-taking come into play.
Decision making is never static in nursing management. The cyclic nature of the decision-making process, where outcomes of decisions are continually assessed and feedback is used to improve future decision making, showcases its dynamic and iterative nature. This reinforces the vital role decision making plays in the problem-solving process.
By exploring various examples and case studies, you gain a practical view of problem-solving in nursing management. These insights can better equip you to tackle real-life challenges in a healthcare setting.
Case studies provide a thorough view of how problem-solving strategies are applied in various nursing management scenarios. Analysing such cases exposes you to diverse methods and solutions and encourages you to think critically and innovatively.
Case Study Analysis: A detailed examination of a particular instance or event to draw conclusions, develop solutions, or learn from the situation.
Let's investigate a case concerning patient waiting times. In a healthcare facility, it is observed that patients often have to wait for prolonged periods to receive care, leading to dissatisfaction and affecting the overall quality of service. The problem-solving steps might look like this:
Case study analysis provides a rich source of knowledge and transferable insights that can be helpful in similar or entirely different scenarios. Drawing parallels from varying contexts and understanding how solutions are adapted to unique situations helps bolster your problem-solving skills and adaptability in nursing management.
Different nursing scenarios call for diverse problem-solving strategies. Understanding the varying approaches, from algorithm-based to intuition-driven, equips you to manage multidimensional and intricate issues effectively.
Algorithm-based Approach: This involves following a clearly defined set of rules or procedures to solve a problem. It can be applicable in situations with defined parameters and scope, such as diagnosing a health condition based on a specific set of symptoms.
Intuition-driven Approach: This combines a nurse's experience, knowledge, and instinct to solve a problem. It applies to ambiguous scenarios where conventional rules may not be applicable, such as managing a patient's fear or anxiety.
Problem-solving in nursing management is all about adapting to the environment and the situation. The right approach may vary, calling for flexibility, creativity, critical thinking, and a deep understanding of the issue for successful resolution.
The real world of nursing is complex and dynamic, and various problem-solving strategies can apply on any given day. To navigate smoothly, you need to understand how the various approaches can be adapted to specific situations.
Consider solving a recurrent communication issue within your nursing team. The algorithmic approach might involve establishing clear communication protocols or using digital tools to streamline interaction. However, the intuition-driven approach might involve informal team-building meetings to foster better personal connections. In this situation, the best solution might be a blend of the two approaches to ensure both procedural clarity and improved team relationships.
The key takeaway here is that there is no "one-size-fits-all" solution in nursing management. Problem-solving requires flexibility, openness, and the ability to judge which strategy will perform best in a particular scenario.
Problem-solving strategies in nursing management form the backbone of effective healthcare services. By ensuring that nursing personnel can tackle issues with aplomb and proficiency, these strategies contribute significantly to patient satisfaction and positive outcomes.
The first step towards demystifying problem-solving processes in nursing management is the development of strategic problem-solving competencies. The journey from novice to expert involves honing these skills and integrating them into your practical work.
Strategic Problem-Solving Competencies: These are a set of core skills that facilitate effective problem-solving in nursing management, including critical thinking, innovative thinking, collaboration, adaptability, leadership, and decision-making.
Acquiring these skills involves both academic learning and practical experiences. Gaining theoretical knowledge lays the foundation, while integrating this knowledge within a clinical context enriches and refines these competencies.
The role of leadership in implementing problem-solving strategies must not be understated. Effective leadership not only guides teams through problem-solving processes but also fosters a supportive environment where team members feel safe to contribute ideas and question assumptions.
Leadership in Nursing: This involves guiding, motivating, and supporting nursing staff to deliver quality healthcare services. Also, it encompasses enhancing team cooperation, improving communication, and fostering a culture of continuous learning.
Leadership employs a variety of approaches in implementing problem-solving strategies. Different leadership styles can be applied based on the nature of the problem and the team dynamics. Transformational leadership, for instance, inspires others to exceed their personal goals and work for a collective purpose. On the other hand, participative leadership encourages open discussions and collective decision-making, promoting a more inclusive and democratic problem-solving process.
Leadership is also instrumental in creating an environment that encourages the sharing of problems openly, without fear of judgment, hence facilitating early identification and efficient resolution of issues. By also ensuring that learning opportunities are provided to enhance team problem-solving capabilities, leadership positively influences problem-solving outcomes.
Effective resource utilization is a critical component of successful problem-solving strategies in nursing management. The term 'resources' in this context includes human resources such as nursing staff and doctors, as well as material resources like medical supplies, equipment, and facilities.
Resource Utilisation: This refers to the efficient and effective use of available resources to achieve desired outcomes. In nursing, it involves ensuring that staff, equipment, and supplies are optimally used to deliver quality healthcare services and solve arising problems.
Problem-solving often necessitates the optimal use of available resources. For example, if there is an issue of high patient-to-nurse ratio, one of the possible solutions could be redistributing nursing staff according to workload and patient needs, or hiring additional staff if finances permit.
Every solution should be weighed based on its resource implications. The best solution is often the one that optimally utilises available resources to provide the maximum benefit. For example, while hiring additional staff might solve the problem, it might not be the best solution if the budget is very limited. In such a case, reallocation of existing staff may be a more practical solution.
Similarly, if there is a shortage of a particular supply, then alternatives may need to be sought, or rationing implemented. A critical analysis of such situations is necessary to ensure that the solutions proposed and implemented do not create other problems related to resource allocation and use.
It's also important to remember to continuously evaluate the impact of your solutions on resource utilisation. This will not only help you ensure sustainable use of resources but also contribute to continuous improvement in problem-solving strategies.
Understanding the stages of problem-solving in nursing practice is fundamental to addressing various challenges that arise in the healthcare sector. These problem-solving stages enable you to identify issues, create and implement solutions, and review the outcomes for improvement purposes.
The initial phase of problem-solving in nursing management involves the assessment and identification of the issue at hand. This stage is critical as the correct identification of the problem lays the foundation for effective solution design and implementation.
Initial Assessment: This is the preliminary evaluation of the situation, leading to the recognition of existing problems. This stage involves observation, questioning, and data gathering to understand the issue better.
This initial step requires keen observation skills and critical thinking. While observation helps in gathering relevant details, critical thinking enables you to scrutinize this information and identify potential problems. You could also use feedback from your team and other relevant stakeholders to gain a comprehensive understanding of the issue.
For instance, suppose you discover unusually high levels of patient discomfort during specific hours. The initial assessment might involve examining patient records during these hours, observing nursing practices in these time frames, and seeking feedback from both patients and nursing staff. This comprehensive approach could potentially reveal the issue, like a shortage of staff during peak hours, leading to delayed or inefficient care.
Once the problem is identified, the next phase is generating actionable solutions. The validity and effectiveness of these solutions significantly influence the problem-solving process's success, thus necessitating careful deliberation and thorough evaluation.
Actionable Solution: A practical, feasible strategy that can be implemented to resolve the problem. It's typically developed through brainstorming, analysis, and evaluation of various alternatives.
The process of formulating actionable solutions involves brainstorming potential remedies, evaluating these against a set criteria, and choosing the most viable option. Ideally, this should be a collaborative effort involving all relevant stakeholders. Collaborative problem-solving encourages diversity in ideas and promotes inclusivity.
Careful Analysis | Evaluation Against Set Criteria | Choosing Viable Option |
Gather as many potential solutions as possible through brainstorming sessions | Evaluate potential solutions based on criteria such as feasibility, efficiency, and impact | The most suitable solution is chosen after careful evaluation |
Innovation is a key driver in formulating actionable solutions. Traditional problem-solving methods might fail in the face of complex or unique problems, necessitating innovative ideas. Remember, the most effective solutions often result from 'thinking outside the box'.
The final stage of problem-solving is evaluation and reflection. After implementing the chosen solution, it is essential to assess its effectiveness in solving the identified problem. This stage offers an opportunity to learn from the implemented action and make necessary adjustments for future improvement.
Evaluation and Reflection: This stage involves reviewing the implemented solution to assess its effectiveness. Reflection involves learning from the process and experiences to ensure continuous improvement.
To achieve meaningful evaluation and reflection, a systematic approach must be adopted. Begin with the assessment of the effect of the solution on the original problem. Have the waiting times reduced following the staff adjustments? Is there an improved level of patient comfort? These are the kind of questions you need to address.
Following the evaluation, it's crucial to reflect on the entire process. Consider what worked well and what didn't. Reflecting on these experiences offers valuable insights that can be used to improve future problem-solving processes.
Take the earlier example of high levels of patient discomfort due to staff shortage during peak hours. Suppose, after implementing the solution of adjusting staff schedules, you find that there's a significant improvement in patient comfort levels. This shows that your solution worked. However, during reflection, you realise that the process took more time than necessary due to delayed decision-making. For future improvement, you could consider setting specific timelines for each stage of the problem-solving process.
In conclusion, problem-solving is a cyclical process. It doesn't end with implementing a solution; instead, it opens doors for continuous learning and improvement. Adapting to this cycle is key to honing your problem-solving proficiency in nursing management.
Problem solving in nursing management is underpinned by the practice of critical thinking. An understanding of the delicate interplay between these two capabilities is central to the enhancement of nursing management and the ultimate delivery of efficient patient care.
There is a strong relationship between critical thinking and problem solving in nursing, evidenced by the significant role each plays in the healthcare sector. Critical thinking provides the foundation upon which problem-solving strategies are built.
Critical Thinking: This is the disciplined process of analysing, interpreting, evaluating, and drawing conclusions from varying levels of data, information or experiences. It involves a deeper level of thinking to understand, evaluate and resolve complex issues or situations.
The process of problem-solving often begins with an evaluation of the situation, gathering data, appraising the data, and coming with strategic solutions. By applying critical thinking, you can get a clear understanding of the problem, which helps devise more effective solutions.
For example, in implementing new protocols in a nursing unit, critical thinking may involve evaluating the necessity of the change, the potential effect on the nursing staff’s workflow, and patient care. The ability to think critically facilitates well-informed decisions, thereby enhancing the problem-solving process.
Beyond problem identification and solution generation, critical thinking is also instrumental in the review phase of the problem-solving process. It allows you to reflect on the effectiveness of implemented solutions, the overall process, and areas that could be improved. Therefore, the integration of critical thinking not only enriches problem-solving but also contributes to continuous learning and improvement in nursing management.
Enhancing critical thinking skills in the nursing workforce enriches problem-solving efforts and ultimately results in improved patient outcomes and service delivery. This strengthening could be achieved through several strategies.
Enhancing Critical Thinking: The process of improving critical thinking skills to enhance one's ability to evaluate complex situations effectively and make informed decisions.
Firstly, continuous learning and professional development activities such as workshops, seminars, and online courses can provide essential tools for sharpening critical thinking skills.
Secondly, fostering a culture of open communication and collaborative problem-solving offers great benefits. These platforms facilitate the sharing of diverse perspectives, promoting deep analyses, and enriching the problem-solving process.
Lastly, reflective practice can also positively impact critical thinking abilities. Regular reflection on your practice, experiences, and learnings enables you to identify gaps in your thinking and areas of improvement. It encourages a deeper level of thinking that enriches the problem-solving process.
The application of critical thinking skills often results in improved problem-solving outcomes in nursing management. Several instances illustrate this relationship.
For instance, consider a situation where a nursing unit has seen a significant increase in medication errors. The nursing manager applies critical thinking to evaluate the situation, identify potential causes, and devise solutions. Through an in-depth review of pharmaceutical administration procedures, team collaboration, discussion, and data evaluation, the nursing manager identifies the root cause - an overly complicated method of logging medication.
Armed with this information, they innovate a simpler, more effective system. By cutting down on needless complexity, the nursing unit sees a drastic decrease in medication errors. This example shows how the application of critical thinking streamlined a complex process, providing an effective solution to the problem at hand.
Another instance could be changing patient demographics, with more elderly patients requiring care. A nursing manager applies critical thinking to understand the unique needs of these patients and the potential challenges that might arise in catering to these needs. As a result, they develop tailored care plans and training programmes for the nursing staff to better care for elderly patients, resulting in improved patient satisfaction.
These examples highlight how critical thinking can lead to effective problem solving in nursing management, ultimately resulting in better service delivery and patient care. Therefore, enhancing critical thinking should be seen as a vital strategy for improving problem-solving proficiency in nursing management.
The algorithm-based approach involves following a clear set of rules or procedures to solve a problem, often with defined parameters. The intuition-driven approach combines a nurse's experience, knowledge, and instinct to solve a problem, especially in ambiguous scenarios.
The first stage of problem solving in nursing practice is initial assessment and identification, which involves the evaluation of the situation to recognise existing problems. This stage requires observation, questioning, and data gathering.
Problem solving is a broader process involving the identification of an issue, systematic analysis to understand it, devising potential solutions, choosing the most suitable through decision making, implementing it, and finally reviewing the effectiveness of the implemented solution. Decision making, on the other hand, is a component nested within this process.
Critical thinking provides the foundation for problem-solving strategies in nursing. It involves the disciplined process of analysing, evaluating, and interpreting data, which allows for a clear understanding of the problem and thus the generation of effective solutions. Critical thinking also enriches the problem-solving process by facilitating review and continuous improvement.
The final stage of problem solving in nursing practice is evaluation and reflection, where the effectiveness of the implemented solution is assessed, and learnings are drawn from the process for future improvement.
Problem-solving in nursing management is crucial in maintaining optimal patient care, operational efficiency, and fostering team collaboration by resolving intricate issues with decisive and effective solutions.
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Home » Degrees » RN to MSN » Registered Nurse to Master of Science in Nursing in Administrative Leadership in Nursing » How Leaders Approach Problem-Solving
No environment is free from problems. But, some require more creative solutions than others.
Healthcare, in particular, presents almost unlimited opportunities for things to go wrong — both in terms of patient care and inter-staff/intra-staff relationships. The problems present within healthcare settings are often a matter of life and death.
It takes effective leadership to keep all issues to a minimum and patient safety remains a priority.
If we think about the great leaders throughout time, they share a few common characteristics. Specific to nurse leaders, Indeed.com lists the following as core qualities for leaders:
Another valuable quality in leadership is being proactive in problem-solving. Good leaders handle issues as they arrive. They are capable of “putting out fires,” and that’s important. Yet, great leaders anticipate problems before they come to a head.
While some of the above resonates as more intuitive, emotional intelligence — as opposed to procedural — can be learned. Of course, there are practical skills nurse leaders need to develop as well.
Examples of these skills are healthcare finance and economics. Mastering budgets and efficiently allocating resources is important for nurse leaders. Nurses also need to know how to communicate financial demands to upper administration.
The online Registered Nurse (RN) to Master of Science in Nursing (MSN) in Administrative Leadership program from Northeastern State University (NSU) dedicates a course to heightening nurses’ skills and knowledge surrounding this responsibility.
NSU’s program also includes a course titled Organizational and Systems Management in Nursing. The course description states that nurses will learn about “contemporary influences, theories, principles, and functional strategies related to management/administration and organizational systems at the micro, meso, and macrosystem levels.”
While nurse leaders don’t necessarily need to be experts in human resources, it’s a substantial knowledge base. Human resources knowledge is especially relevant given the persistence of lateral and horizontal violence (LHV) within the nursing profession. The World Health Organization (WHO), International Council of Nurses and Public Services International have recognized this issue as a significant global public health priority.
Just how dangerous is LHV to nursing? A study published by Nurse Management describes LHV as: “all acts of meanness, hostility, disruption, discourtesy, backbiting, divisiveness, criticism, lack of unison, verbal or mental abuse, and scapegoating. [These] behaviors taint healthcare organizations; cause irreparable harm to workplace culture; breakdown team communication; and severely impact the quality of the care provided, thereby jeopardizing patient safety.”
With a solid leadership foundation, nurses can handle toxic behaviors that damage the work environment. In doing so, they change the workplace culture and guiding others to follow in their footsteps.
Perhaps the greatest responsibility of a nurse leader is to empower those in their charge. John Quincy Adams said, “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”
Northeastern State University recognizes empowerment as an essential skill. In the Leadership Development for the Advanced Nursing Professional course, students learn to “effectively manage change, empower others, and influence political processes.”
It takes much more than “putting in your time” to become an effective leader. Nurses might rise through the ranks based on experience, but are they actually effecting change in the nursing profession? Unless they possess a robust leadership skill set, the answer is likely no. So, what kind of leader do you want to be?
Learn more about Northeastern State University’s online RN to MSN in Administrative Leadership program .
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This paper analyses the role of problem solving in nursing practice including the process, acquisition and measurement of problem-solving skills. It is argued that while problem-solving ability is acknowledged as critical if today's nurse practitioner is to maintain effective clinical practice, to date it retains a marginal place in nurse education curricula. Further, it has attracted limited empirical study. Such an omission, it is argued, requires urgent redress if the nursing profession is to meet effectively the challenges of the next decade and beyond.
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Posted on May 29, 2019
Constant disruption has become a hallmark of the modern workforce and organisations want problem solving skills to combat this. Employers need people who can respond to change – be that evolving technology, new competitors, different models for doing business, or any of the other transformations that have taken place in recent years.
In addition, problem solving techniques encompass many of the other top skills employers seek . For example, LinkedIn’s list of the most in-demand soft skills of 2019 includes creativity, collaboration and adaptability, all of which fall under the problem-solving umbrella.
Despite its importance, many employees misunderstand what the problem solving method really involves.
Effective problem solving doesn’t mean going away and coming up with an answer immediately. In fact, this isn’t good problem solving at all, because you’ll be running with the first solution that comes into your mind, which often isn’t the best.
Instead, you should look at problem solving more as a process with several steps involved that will help you reach the best outcome. Those steps are:
Let’s look at each step in a little more detail.
The first step to solving a problem is defining what the problem actually is – sounds simple, right? Well no. An effective problem solver will take the thoughts of everyone involved into account, but different people might have different ideas on what the root cause of the issue really is. It’s up to you to actively listen to everyone without bringing any of your own preconceived notions to the conversation. Learning to differentiate facts from opinion is an essential part of this process.
An effective problem solver will take the opinions of everyone involved into account
The same can be said of data. Depending on what the problem is, there will be varying amounts of information available that will help you work out what’s gone wrong. There should be at least some data involved in any problem, and it’s up to you to gather as much as possible and analyse it objectively.
Once you’ve identified what the real issue is, it’s time to think of solutions. Brainstorming as many solutions as possible will help you arrive at the best answer because you’ll be considering all potential options and scenarios. You should take everyone’s thoughts into account when you’re brainstorming these ideas, as well as all the insights you’ve gleaned from your data analysis. It also helps to seek input from others at this stage, as they may come up with solutions you haven’t thought of.
Depending on the type of problem, it can be useful to think of both short-term and long-term solutions, as some of your options may take a while to implement.
Each option will have pros and cons, and it’s important you list all of these, as well as how each solution could impact key stakeholders. Once you’ve narrowed down your options to three or four, it’s often a good idea to go to other employees for feedback just in case you’ve missed something. You should also work out how each option ties in with the broader goals of the business.
There may be a way to merge two options together in order to satisfy more people.
Only now should you choose which solution you’re going to go with. What you decide should be whatever solves the problem most effectively while also taking the interests of everyone involved into account. There may be a way to merge two options together in order to satisfy more people.
At this point you might be thinking it’s time to sit back and relax – problem solved, right? There are actually two more steps involved if you want your problem solving method to be truly effective. The first is to create an implementation plan. After all, if you don’t carry out your solution effectively, you’re not really solving the problem at all.
Create an implementation plan on how you will put your solution into practice. One problem solving technique that many use here is to introduce a testing and feedback phase just to make sure the option you’ve selected really is the most viable. You’ll also want to include any changes to your solution that may occur in your implementation plan, as well as how you’ll monitor compliance and success.
There’s one last step to consider as part of the problem solving methodology, and that’s communicating your solution . Without this crucial part of the process, how is anyone going to know what you’ve decided? Make sure you communicate your decision to all the people who might be impacted by it. Not everyone is going to be 100 per cent happy with it, so when you communicate you must give them context. Explain exactly why you’ve made that decision and how the pros mean it’s better than any of the other options you came up with.
Employers are increasingly seeking soft skills, but unfortunately, while you can show that you’ve got a degree in a subject, it’s much harder to prove you’ve got proficiency in things like problem solving skills. But this is changing thanks to Deakin’s micro-credentials. These are university-level micro-credentials that provide an authoritative and third-party assessment of your capabilities in a range of areas, including problem solving. Reach out today for more information .
Home > ETD > Doctoral > 5866
Exploring student perceptions of problem-based learning and clinical field experiences: a phenomenological study.
Ashley Michelle Boles , Liberty University Follow
School of Education
Doctor of Philosophy in Education (PhD)
Mary Strickland
problem-based learning, medical education, higher-order thinking and processing, critical thinking, clinical reasoning, problem-solving, clinical field experiences
Education | Medicine and Health Sciences
Boles, Ashley Michelle, "Exploring Student Perceptions of Problem-Based Learning and Clinical Field Experiences: A Phenomenological Study" (2024). Doctoral Dissertations and Projects . 5866. https://digitalcommons.liberty.edu/doctoral/5866
The purpose of this phenomenological study is to understand the experiences of participating in a physical therapy course primarily taught using problem-based learning teaching methods for Doctor of Physical Therapy students at a university in the mid-western United States. This study aimed to understand student perception of PBL and its effects on clinical field experiences (CFEs), specifically related to higher-order processing skills. The theory guiding this study was the social constructivism theory as it explains how knowledge acquisition and learning occurs through social interactions during problem-based learning activities. The central research question this study attempted to answer was: What were the experiences of DPT students who participate in a PBL education? This study design was a qualitative, hermeneutic phenomenological study. Convenience sampling was done from a pool of DPT students at a university in the midwestern United States. Data collection methods included journal prompts, individual interviews, and focus groups. Data analysis was based on van Manen’s data analysis methods. Findings reveal DPT students preferred PBL over traditional teaching methods and felt the use of PBL improved their higher-order thinking and processing skills. Participants felt that PBL teaching methods were conducive to their learning as the method allowed for real-time feedback and a perception of better content retention. DPT students also felt that using PBL teaching methods improved their ability to prioritize and funnel information to organize information in a way conducive to developing a solution to the problem. Participants felt that the problem-solving, critical thinking, and clinical reasoning they developed during the therapeutic exercise course did carry over into their ability to apply these higher-order thinking and processing skills during CFEs.
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Problem-solving in nursing is the vital foundation that makes up a nurse's clinical judgment and critical thinking skills. Having a strong problem-solving skillset is pertinent to possessing the ability and means to provide safe, quality care to a variety of patients. Nurses must rely on their clinical judgment and critical thinking skills to ...
Nurses can implement the original nursing process to guide patient care for problem solving in nursing. These steps include: Assessment. Use critical thinking skills to brainstorm and gather information. Diagnosis. Identify the problem and any triggers or obstacles. Planning. Collaborate to formulate the desired outcome based on proven methods ...
A free flow of ideas is essential to problem-solving and decision-making because it helps prevent preconceived ideas from controlling the process. Many decisions in healthcare are arrived at by group or teams rather than by the individual, and this type of decision-making requires special skills. General steps to all decision making include:
Abdellah's work, based on the problem-solving method, serves as a vehicle for delineating nursing (patient) problems as the patient moves toward a healthy outcome. The theory identifies ten steps to identify the patient's problem and 11 nursing skills to develop a treatment typology.
Problem-solving skills. Practicing your problem-solving skills can improve your critical-thinking skills. Analyze the problem, consider alternate solutions, and implement the most appropriate one. ... Structure your thinking by incorporating nursing process steps or a SWOT analysis (strengths, weaknesses, opportunities, and threats) ...
The following are examples of attributes of excellent critical thinking skills in nursing. 1. The ability to interpret information: In nursing, the interpretation of patient data is an essential part of critical thinking. Nurses must determine the significance of vital signs, lab values, and data associated with physical assessment.
Step 2: Analyze the Problem. Break down the problem to get an understanding of the problem. Determine how the problem developed. Determine the impact of the problem. Step 3: Develop Solutions. Brainstorm and list all possible solutions that focus on resolving the identified problem. Do not eliminate any possible solutions at this stage.
2. Meeting with Colleagues: Collaborative Learning for Critical Thinking. Regular interactions with colleagues foster a collaborative learning environment. Sharing experiences, discussing diverse viewpoints, and providing constructive feedback enhance critical thinking skills. Colleagues' insights can challenge assumptions and broaden ...
This paper analyses the role of problem solving in nursing practice including the process, acquisition and measurement of problem-solving skills It is argued that while problem-solving ability is acknowledged as critical if today's nurse practitioner is to maintain effective clinical practice, to date it retains a marginal place in nurse education curricula Further, it has attracted limited ...
Some of the most important critical thinking skills nurses use daily include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Interpretation: Understanding the meaning of information or events. Analysis: Investigating a course of action based on objective and subjective data. Evaluation: Assessing the value of ...
To solve a problem you need to generate solutions. However, the obvious solution may not necessarily be the best. To generate solutions, a mixture of creative and analytical thinking is needed (Bransford, 1993). Creativity is about escaping from preconceived ideas that block the way to finding an innovative solution to a problem.
Problem solving occurs in a variety of nursing contexts, including direct client care, team-level leadership, and systems-level leadership. Nurses and nurse managers are challenged to move from step-by-step problem-solving techniques to incorporating creative thinking, which involves considering the context when meeting current and future ...
Nurse leaders perceive their role as a problem-solver, which is a necessary step in advocacy. 27 Problem-solving is a process that contains the elements of decision-making and critical thinking. 28. The theory that emerged from the core categories explicitly focused on the central phenomenon of LHV in the nursing work environment.
Background. Problem solving involves recognizing the difference between the problem solver's current state and the goal state to be reached, and resolving the obstacles that prevent them from achieving the goal [].Acquiring problem-solving ability based on judgment and critical thinking is an important element of nursing education [].Furthermore, the use of effective problem-solving ...
D. Choose Solutions. Focus on helping the client identify small steps, coping strategies, stress reduction, problem-solving and self-examination of results. E. Implement Process. Identify when patient will "stop and think" and use collaboratively agreed upon action. Journaling successes, emotions, and learning is helpful (Fontaine, 2003).
Critical thinking, problem-solving, and communication skills are necessary to work in this phase. Nurses must also demonstrate the ability to prioritize patient needs. ... Nurses utilize many of the same skills for each of the nursing process steps. In the planning phase, nurses must have strong communication skills, time management and ...
The problem-solving steps might look like this: Identification and Definition: The problem is identified as long patient waiting times. It is defined as patients waiting more than 45 minutes to receive care. ... Essential problem-solving skills in nursing management include critical thinking, decision-making, effective communication, leadership ...
Problem solving in clinical nursing practice is the essence of good care delivery. This paper gives an overview of a research study which identified the cognitive problem solving process nurses use while delivering care. The study was conducted in the clinical setting and used a qualitative research methodology of observation, followed by in ...
mentorship. delegation. open-mindedness. forward-thinking. accessibility. Another valuable quality in leadership is being proactive in problem-solving. Good leaders handle issues as they arrive. They are capable of "putting out fires," and that's important. Yet, great leaders anticipate problems before they come to a head.
Abstract. This paper analyses the role of problem solving in nursing practice including the process, acquisition and measurement of problem-solving skills. It is argued that while problem-solving ability is acknowledged as critical if today's nurse practitioner is to maintain effective clinical practice, to date it retains a marginal place in ...
1. Define the problem. Diagnose the situation so that your focus is on the problem, not just its symptoms. Helpful problem-solving techniques include using flowcharts to identify the expected steps of a process and cause-and-effect diagrams to define and analyze root causes.. The sections below help explain key problem-solving steps.
Evaluate the options. Select the best solution. Create an implementation plan. Communicate your solution. Let's look at each step in a little more detail. The first solution you come up with won't always be the best - taking the time to consider your options is an essential problem solving technique. 1.
The purpose of this phenomenological study is to understand the experiences of participating in a physical therapy course primarily taught using problem-based learning teaching methods for Doctor of Physical Therapy students at a university in the mid-western United States. This study aimed to understand student perception of PBL and its effects on clinical field experiences (CFEs ...