Summary of nursing process

Component	Purpose	Steps
Assessment	To gather, verify, and communicate data about client so data base is established	Ø Collecting nursing health history Ø Performing physical examination Ø Collecting laboratory data Ø Validating data Ø Clustering data Ø Documenting data
Nursing diagnoses	To identify client health care needs and responses to health problems so as to direct nursing care	Ø Identifying client problems Ø Formulating nursing diagnoses Ø Documenting nursing diagnoses
Planning	To identify client’s goals; to determine priorities of care to determine expected outcomes, to design nursing strategies to achieve goals of care	Ø Identifying client goals Ø Establishing expected outcomes Ø Selecting nursing actions Ø Consulting Ø Delegating actions Ø Writing nursing care plan
Implementation	To complete nursing actions necessary for accomplishing plan	Ø Performing nursing actions Ø Reassessing client Ø Reviewing and modifying existing care plan
Evaluation	To determine extent to which goals of care have been achieved	Ø Comparing client response to expected outcomes Ø Analysing reasons for results and conclusions Ø Modifying care plan

ROLES AND FUNCTIONS OF THE NURSE

A contemporary nurse possesses knowledge and skills in a variety of areas. In the past, nurses provided care and comfort while they carried out specific nursing functions, but changes in nursing have expanded the roles of nurses to include health promotion, illness prevention, health restoration, and concern for the whole client (see box above).

CARE GIVER

The nurse directly helps the client to regain health through the healing process. The nurse addresses the holistic health care of the client, including helping the client and family restore emotional and social well-being.

DECISION MAKER

The nurse, before taking any action, interprets available information and decides the best approach for the individual client. These decisions can be made alone, with the client and family, or with other health care pro­fessionals.

PROTECTOR AND CLIENT ADVOCATE

The nurse maintains a safe environment, helps pre­vent injury, and protects the client from possible adverse effects related to treatment. The nurse also protects the client's human and legal rights and assists him or her in asserting those rights if the need arises.

MANAGER

The nurse delegates responsibility, supervises other health care workers, manages the resources of the practice setting, and coordinates activities

REHABILITATOR

The nurse assists the client's return to maximal functioning through teaching and helping the client to cope with changes associated with illness or disability

COMFORTER

The nurse cares for the client as a person through emotional support. The client needs help in reaching therapeutic goals.

COMMUNICATOR

The nurse is continually involved in promoting com­munication among all people affected by the client's' needs. Communication is critical in meeting the needs of clients, families, and communities

TEACHER

The nurse explains concepts and facts about health care to the client, reinforces learning, and evaluates progress. Teaching is individualized and may be formal or informal

Career Roles. Career roles are specific employment positions. Most skills required for the expanded roles of the 1980s and 1990s are taught in baccalaureate nursing programs. These skills are now directed toward the generalist practitioner. The newer requirements for nursing specialization are redefining the term "expanded role" (Mechanic, 1988). Nursing specialties have input into the educational requirements for these roles and career opportunities (see box at left).

One method of redesigning nursing roles has been the focus of differentiated nursing practice. This practice had early design in the educational setting where graduate-expected competencies were based on different types of educational experiences. Differentiated practice is now expanding into clinical practice as new nursing roles incorporate primary nursing and case management principles (Harkness et al., 1992). Broadly defined, differentiated practice structures roles and functions of nurses according to education, experience, and competence, while recognizing the importance of all roles to create a community of professional nursing practice (Koerner, 1992). For example, in such a system there is a clear difference between the responsibilities of a baccalaureate-prepared nurse versus one with an associate's degree.

CAREER ROLES

NURSE EDUCATOR

Nurse educators work in schools of nursing, staff development departments, and client education departments. They provide educational programs for student nurses and nurses and teach clients about self-care and home care. They usually are required to have graduate nursing education

CLINICAL NURSE SPECIALIST

Clinical nurse specialists work in critical, acute, long-term, and community health care agencies (Figure 1-5). They often specialize in managing specific diseases, and they function as clinicians, educators, managers, consultants, and researchers. They have master's degrees in nursing

NURSE PRACTITIONER

Nurse practitioners are certified to provide health care to clients, usually in outpatient or community settings. Adult nurse practitioners provide primary care to adults; family nurse practitioners provide primary care for families; pediatric nurse practitioners provide care for infants and children; gerontology nurse practitioners provide care to older adults; and obstetrics-gynecology nurse practitioners provide primary care for women. Most have master's degrees in nursing.

CERTIFIED NURSE-MIDWIFE

Certified nurse-midwives are certified by the American College of Nurse-Midwives to provide independent care for women during normal pregnancy, labor, and delivery. They practice in conjunction with a health care agency, which provides assistance

NURSE ANESTHETIST

Nurse anesthetists are registered nurses who have advanced training in anesthesiology. They provide surgical anesthesia under the supervision of an anesthesiologist and administer anesthetics to clients during minor surgery.

NURSE ADMINISTRATOR

Nurse administrators manage client care within a health care agency. They may hold middle-level (e.g., head nurse) or upper-level (e.g., director) management positions. They usually have baccalaureate degrees in nursing and may have master's degrees.

NURSE RESEARCHER

Nurse researchers investigate nursing problems to improve care and to define and expand the scope of nursing practice. They may be in academic, independent, or community settings. They must have a graduate degree in nursing. In some settings, a doctoral degree is required

Health Care Team

In most practice settings, the nurse works with other health care professionals to provide total care for clients (see box below). The involvement of many persons in the client's health care can pose risks for fragmenting care. Because nurses have the greatest opportunity to interact with all professionals in the health care team, they often coordinate and integrate services within the care plan.

OTHER HEALTH CARE TEAM MEMBERS

PHYSICIAN

A physician is a professional who has earned a degree of doctor of medicine or doctor of osteopathy and has passed a licensing examination. Most physicians specialize their practice of medicine. Nurses work closely with physicians under supervision or as collaborators.

PHYSICIAN ASSISTANT

Physician assistants have medical training and work under the direction of physicians in hospitals, clinics, and private offices (they do not practice in Canada). Nurses work with them as they do with physicians.

THERAPIST

Therapists are licensed to assist in the examination and treatment of clients in special ways (i.e., as physical, occupational, or respiratory therapists). Their education varies but usually involves 4-year programs. Nurses collaborate with them and evaluate their work.

PHARMACIST

Pharmacists are licensed to formulate and dispense drugs. They may have bachelor of science degrees or doctorates in pharmacology. Pharmacists provide valuable information to nurses about drugs and their use and effects.

SOCIAL WORKER

Social workers are trained to counsel and refer clients to appropriate agencies. They have baccalaureate or master's degrees. Nurses work together with them to identify the best resources for the client, particularly when the client returns home.

CHAPLAIN

Chaplains offer spiritual support and guidance to clients and their families. They may be employed by an agency or provided by a church in the community. A client may request a chaplain, or a nurse may refer the client to one.