Step 3：Analyze nursing diagnoses
relationships
Draw lines between nursing diagnoses to indicate
relationships.
Prepared to verbally explain to your clinical faculty
why you have made these links if it is not obvious.
Concept mapping is a holistic approach to patient
care.
This step focuses on the relationships between
diagnoses and the labeling of nursing diagnoses .
Step 4：Identifying goals, outcomes,
and interventions
Write patient goals and outcomes and then list
nursing interventions to attain the outcomes for
each of the numbered diagnoses on your map.
The nursing interventions should include
appropriate treatments and medications and
patient teaching.
Prepared to verbally explain the goals and
rationales for nursing interventions with your
clinical faculty.
Step 5：Evaluate patient’s responses
This step is the written evaluation of the
patient’s physical and psychosocial
responses.
It also involves writing your clinical
impressions and inferences regarding the
patient’s progress toward expected
outcomes and the effectiveness of your
interventions to bring these outcomes about.
Documentation
Documentation involves correctly identifying
patient assessment data to record about a
problem, determining what to record about
the interventions to correct the problem, and
describing the patient’s responses to the
interventions.
Concept map care plans as the basis of
documentation --- detail in chapter 7
Medication Administration
Organizing the drugs to be administered
Relationship of the drug to the problem
Interacting effects of the drug related to the
total clinical picture.
Example: Digitalis -- Decreased cardiac output
。what is the relationship between low levels
of Potassium and digitalis?
。assessing the patient carefully for adverse
reactions to the drug.
Nursing Standards of Care
Standards of the American Nurses Association
general standards of care
Standards of the Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO)
specific policies and procedures
Standardized nursing care plans
based on typical nursing diagnoses
Nursing Standards of Care--con’s
Patient education standards
appropriate for the patient’s individual needs
and ability
Insurance agency & government care standards
clinical pathway / critical pathway
Utilization review standards
review charts. Judge the necessity and
appropriateness of care and efficiency with
which care is delivered.
Managed Care in Hospital Settings
There is a direct relationship between the
care standards described above and the
management of care.
Hospital-based nurse case managers
assigned to monitor and coordinate their
progress through the health-care system.
To make links for patients to home health
services, transitional care units, long-term
care facilities, and other agencies to
provide quality care.