Process
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- Conduct a nursing assessment
- collection of subjective and objective data relevant to the care recipient's (person, family, group, community) human responses to actual or potential health problems / life processes.
- Cluster and interpret cues/patterns
- Assessment data must be clustered and interpreted before the nurse can plan, implement or evaluate a plan to support patient care
- Generate Hypotheses
- possible alternatives that could represent the observed cues/patterns.
- Validation & Prioritization of Nursing Diagnoses
- taking necessary steps to rule out other hypotheses, to confirm with the patient(s) the validity of the hypotheses, and to prioritize the list of diagnoses. A focused assessment may be needed to obtain data for one or more diagnoses
- Planning
- Determining appropriate (realistic) patient outcomes and interventions most likely to support attainment of those outcomes through evidence-based practice
- Implementation
- Putting the plan of care (nursing diagnoses - outcomes - interventions) into place, preferably in collaboration with the care recipient(s)
- Evaluation
- Movement toward identified outcomes is continually evaluated, with changes made to interventions as necessary. When no positive movement is occurring, reassessment to reevaluate appropriateness of diagnoses and/or achievability of outcomes must occur.
Read more about this topic: Nursing Diagnosis
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