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Sabtu, 15 Maret 2008

INFO : WEBSITE ASKEP

Situs berisi kumpulan askep medikal dan bedah, silahkan kunjungi http://www.asuhankeperawatan.com

INFO : WEBSITE ASKEP

Situs berisi kumpulan askep medikal dan bedah, silahkan kunjungi http://www.asuhankeperawatan.com

Jumat, 29 Februari 2008

Nursing Career

Discover Nursing
I wanted a versatile career where I could help people so I decided to become a nurse. It ended up being much more than I expected it .
www.discovernursing.com

For information on baccalaureate and graduate nursing education, nursing career options, and financial aid, contact:. American Association of Colleges of ...
www.bls.gov

Nursing Careers
Nursing is a career filled with endless personal and professional rewards. If you choose nursing, you are choosing to spend your life helping others, ...
www.marylandhealthcareers.org

Nurse.com
Students - Nursing News, Careers, Education, Forums ...
So obviously, you're interested in a career as a nurse! ... Nursing Specialties: a detailed look at the more popular career specialties, with additional ...
www.nurse.com

Nurse.com
Nursing Excellence - Nursing News, Careers, Education ...
Click here to submit a nomination for the 2008 Nursing Excellence Awards ... Events, Career Fairs / Seminars / Tours / Nursing Excellence Awards / Virtual ...
www.nurse.com

Nursing as a Second Career
Considering nursing as a second career? Read this Q&A to find out which types of nursing programs are right for you.
www.allnursingschools.com

AACN - Education Center
The Bachelor of Science degree in nursing is the critical first step for a career in professional nursing. The American Association of Colleges of Nursing ...
www.aacn.nche.edu

Nurses for a Healthier Tomorrow
The Nurse Career. Nursing is poised to change the face of health care as never before. The Bureau of Labor Statistics reports employment among RNs will grow ...
www.nursesource.org

Choose Nursing: Exploring Career Options
Flight Nurses and Certified Registered Nurse Anesthetists are two examples. Check out what they do. Then take a look at other opportunities in nursing, ...
www.choosenursing.com

NCC
Whether you are a student at second-level school or a mature person considering your career options, or if you are already qualified as a nurse/midwife, ...
www.nursingcareers.ie




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Rabu, 27 Februari 2008

Nursing Process

The nursing process is a process by which nurses deliver care to patients, supported by nursing models or philosophies. The nursing process was originally an adapted form of problem-solving and is classified as a deductive theory.

Characteristics of the nursing process

The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the patient has, and for every element of patient care, rather than once for each patient. The nurse's evaluation of care will lead to changes in the implementation of the care and the patient's needs are likely to change during their stay in hospital as their health either improves or deteriorates. The nursing process not only focuses on ways to improve the patient's physical needs, but also on social and emotional needs as well.

  • Cyclic and dynamic
  • Goal directed and client centered
  • Interpersonal and collaborative
  • Universally applicable
  • Systematic

The nursing process is not something foreign or unusually complex. On the contrary, we use the nursing process method on a daily basis without even realizing it. For example, a trip to the gas station to get fuel requires Assessing the various prices and the number of people waiting to get gas among other things. A subsequent decision, or Diagnosis, is made based on the former criteria. This may include pulling into the gas station to fuel up or going down the road for better prices and/or less of a crowd. The price is right and there's not much of a crowd, we're pulling in. Now the Planning can take place. This may include which pump to use, how much gas to put in the tank, whether or not to clean the windows along with other things. We're at the pump and ready to fuel up. We must now Implement what we planned prior to pulling up to the pump. We've pulled up on the passenger side because the gas tank resides on this side, part of our plan. We've also given ourselves enough room to exit without getting blocked in by another vehicle, part of our plan also. We now uscrew the gas cap and begin fueling or Implementing what we planned. Things went well. We are fueled up and have exited the gas station without complication. Our Evaluation of the trip to the gas station would be a good one. We may choose to use this method in the future. The Nursing process is that simple in theory. However, as a nurse, the nursing process tool will be used for more complex and difficult situations but is applied the same way as the gas station analogy.

Skills

The nursing process involves skills a nurse should possess when he or she has to initiate the initial phase of the process. Having these skills contributes to the greater improvement of the nurse's delivery of health care to the patient, including the patient's level of health, or health status.

  • Cognitive or Intellectual skills, such as analyzing the problem, problem solving, critical thinking and making judgements regarding the patient's needs. Included in these skills are the ability to indentify, differentiate actual and potential health problems through observation and decision making by synthesizing nursing knowledge previously acquired.
  • Interpersonal skills, which includes therapeutic communication, active listening, conveying knowledge and information, developing trust or rapport-building with the patient, and ethically obtaining needed and relevant information from the patient which is then to be utilized in health problem formulation and analysis.
  • Technical skills, which includes knowledge and skills needed to properly and safely manipulate and handle appropriate equipment needed by the patient in performing medical or diagnostic procedures, such as vital signs, and medication administrations.

Phases of the nursing process

The following are the steps or phases of the nursing process.

  • Assessment (of patient's needs)
  • Diagnosis (of human response needs that nursing can assist with)
  • Planning (of patient's care)
  • Implementation (of care)
  • Evaluation (of the success of the implemented care)

Assessing Phase

The nurse should carry out a complete and holistic nursing assessment of every patient's needs, regardless of the reason for the encounter. Usually, an assessment framework, based on a nursing model or Waterlow scoring, is used. These problems are expressed as either actual or potential. For example, a patient who has been rendered immobile by a road traffic accident may be assessed as having the "potential for impaired skin integrity related to immobility".

Models for data collection

The following nursing models are used to gather the necessary and relevant information from the patient in order to effectively deliver quality nursing care.

  • Gordon's functional health patterns
  • Roy's adaptation model
  • Body systems model
  • Maslow's hierarchy of needs

Diagnosing Phase

Nursing diagnoses are part of a movement in nursing to standardize terminology which includes standard descriptions of diagnoses, interventions, and outcomes. Those in support of standardized terminology believe that it will help nursing become more scientific and evidence based.The purpose of this stage is to identify the patient's nursing problems.
















Maslow's hierarchy of needs is used when the nurse prioritizes identified nursing health problems from the patient.

Planning Phase

In agreement with the patient, the nurse addresses each of the problems identified in the planning phase. For each problem a measurable goal is set. For example, for the patient discussed above, the goal would be for the patient's skin to remain intact. The result is a nursing care plan.

Implementating Phase

The methods by which the goal will be achieved is also recorded at this stage. The methods of implementation must be recorded in an explicit and tangible format in a way that the patient can understand should he wish to read it. Clarity is essential as it will aid communication between those tasked with carrying out patient care.

Evaluating Phase

The purpose of this stage is to evaluate progress toward the goals identified in the previous stages. If progress towards the goal is slow, or if regression has occurred, the nurse must change the plan of care accordingly. Conversely, if the goal has been achieved then the care can cease. New problems may be identified at this stage, and thus the process will start all over again. It is due to this stage that measurable goals must be set - failure to set measurable goals will result in poor evaluations.

The entire process is recorded or documented in an agreed format in the patient's care plan in order to allow all members of the nursing team to perform the agreed care and make additions or changes where appropriate.

Nursing Assessment

Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status.

Stage one of the nursing process

Assessment is the first stage of the nursing process in which the nurse should carry out a complete and holistic nursing assessment of every patient's needs, regardless of the reason for the encounter. Usually, an assessment framework, based on a nursing model is used.

The purpose of this stage is to identify the patient's nursing problems. These problems are expressed as either actual or potential. For example, a patient who has been rendered immobile by a road traffic accident may be assessed as having the "potential for impaired skin integrity related to immobility".

Components of a nursing assessment

Nursing history

Taking a nursing history prior to the physical examination allows a nurse to establish a rapport with the patient and family. Elements of the history include:

  • health status
  • course of present illness including symptoms
  • current management of illness
  • past medical history including family's medical history
  • social history
  • perception of illness

Psychological and social examination

The psychological examination may include;

  • Client’s perception (why they think they have been referred/are being assessed; what they hope to gain from the meeting)
  • Emotional health (mental health state, coping styles etc)
  • Social health (accommodation, finances, relationships, genogram, employment status, ethnic back ground, support networks etc)
  • Physical health (general health, illnesses, previous history, appetite, weight, sleep pattern, diurinal variations, alcohol, tobacco, street drugs; list any prescribed medication with comments on effectiveness)
  • Spiritual health (is religion important? If so, in what way? What/who provides a sense of purpose?)
  • Intellectual health (cognitive functioning, hallucinations, delusions, concentration, interests, hobbies etc)

Physical examination

A nursing assessment includes a physical examination: the observation or measurement of signs, which can be observed or measured, or symptoms such as nausea or vertigo, which can be felt by the patient.

The techniques used may include Palpation, Auscultation and Percussion in addition to the "vital signs" of temperature, blood pressure, pulse and respiratory rate, and further examination of the body systems such as the cardiovascular or musculoskeletal systems.

Documentation of the assessment

The assessment is documented in the patient's medical or nursing records, which may be on paper or as part of the electronic medical record which can be accessed by all members of the healthcare team.

Assessment tools

A range of instruments has been developed to assist nurses in their assessment role. These include:

  • the index of independence in activities of daily living
  • the Barthel index
  • the Crighton Royal behaviour rating scale
  • the Clifton assessment procedures for the elderly
  • the general health questionnaire
  • the geriatric mental health state schedule

Other assessment tools may focus on a specific aspect of the patient's care. For example, the Waterlow score deals with a patient's risk of developing a Bedsore (decubitus ulcer), the Glasgow Coma Scale measures the conscious state of a person, and various pain scales exist to assess the "fifth vital sign".

Nursing Diagnosis

From Wikipedia, the free encyclopedia

A nursing diagnosis is a standardized statement about the health of a client (who can be an individual, a family, or a community) for the purpose of providing nursing care. Nursing diagnoses are developed based on data obtained during the nursing assessment.

The main organization for defining standard diagnoses in North America is the North American Nursing Diagnosis Association, now known as NANDA-International. Other international associations are AENTDE (Spanish), AFEDI (French language) and ACENDIO (Europe).

Nursing diagnoses are part of a movement in nursing to standardize the terminology involved. This includes standard descriptions of diagnoses, interventions and outcomes. Nurses who support of standardized terminology believe that it will help nursing become more scientific and evidence-based. Other nurses feel that nursing diagnoses are an ivory tower mentality and neither help in care planning nor in differentiating nursing from medicine.

Structure of diagnoses

The NANDA-International system of nursing diagnosis provides for five categories.

  1. Actual diagnosis - a statement about a health problem that the client has and the benefit from nursing care. An example of an actual nursing diagnosis is: Ineffective airway clearance related to decreased energy as manifested by an ineffective cough.
  2. Risk diagnosis - a statement about health problems that a client doesn't have yet, but is at a higher than normal risk of developing in the near future. An example of a risk diagnosis is: Risk for injury related to altered mobility and disorientation.
  3. Possible diagnosis - a statement about a health problem that the client might have now, but the nurse doesn't yet have enough information to make an actual diagnosis. An example of a possible diagnosis is: Possible fluid volume deficit related to frequent vomiting for three days as manifested by increased pulse rate.
  4. Syndrome diagnosis - used when a cluster of nursing diagnoses are seen together. An example of a syndrome diagnosis is: Rape-trauma syndrome related to anxiety about potential health problems as manifested by anger, genitourinary discomfort, and sleep pattern disturbance.
  5. Wellness diagnosis - describes an aspect of the client that is at a low level of wellness. An example of a wellness diagnosis is: Potential for enhanced organized infant behaviour, related to prematurity and as manifested by response to visual and auditory stimuli.

Process of diagnoses

  1. Collect data - statistical data relevant to achieving a diagnosis.
  2. Cues/patterns - changes in physical status. (for example: lower urinary output)
  3. Hypothesis - possible alternatives that could have caused previous cues/patterns.
  4. Validation - taking necessary steps to rule out other hypothesis, to single out one problem.
  5. Diagnosis - making a decision on the problem based on validation.
  6. Strategies - taking necessary action to solve the problem and/or to provide adequate nursing care.

Nursing Care Plan

From Wikipedia, the free encyclopedia

A nursing care plan outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment. The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.

Characteristics of the nursing care plan

  1. It focuses on actions which are designed to solve or minimize the existing problem.
  2. It is a product of a deliberate systematic process.
  3. It relates to the future.
  4. It is based upon identifiable health and nursing problems.
  5. It focus is holistic.

Elements of the plan

In the USA, the nursing care plan may consist of a NANDA nursing diagnosis with related factors and subjective and objective data that support the diagnosis, nursing outcome classifications with specified outcomes (or goals) to be achieved including deadlines, and nursing intervention classifications with specified interventions.lll

The nursing process

Care plans are formed using the nursing process. First the nurse collects subjective data and objective data, then organizes the data into a systematic pattern, such as Marjory Gordon's functional health patterns. This step helps identify the areas in which the client needs nursing care. Based on this, the nurse makes a nursing diagnosis. As mentioned above, the full nursing diagnosis also includes the relating factors and the evidence that supports the diagnosis. For example, a nurse may give the following diagnosis to a patient with pneumonia that has difficulty breathing: Ineffective Airway Clearance related to tracheobronchial infection (pneumonia) and excess thick secretions as evidenced by abnormal breath sounds; crackles, wheezes; change in rate and depth of respiration; and effective cough with sputum.

After determining the nursing diagnosis, the nurse must state the expected outcomes, or goals. A common method of formulating the expected outcomes is to reverse the nursing diagnosis, stating what evidence should be present in the absence of the problem. The expected outcomes must also contain a goal date. Following the example above, the expected out come would be: Effective airway clearance as evidenced by normal breath sounds; no crackles or wheezes; respiration rate 14-18/min; and no cough by 01/01/01.

After the goal is set, the nursing interventions must be established. This is the plan of nursing care to be followed to assist the client in recovery. The interventions must be specific, noting how often it is to be performed, so that any nurse or appropriate faculty can read and understand the care plan easily and follow the directions exactly. An example for the patient above would be: Instruct and assist client to TCDB (turn, cough, deep breathe) to assist in loosening and expectoration of mucous every 2 hours.

The evaluation is made on the goal date set. It is stated whether or not the client has met the goal, the evidence of whether or not the goal was met, and if the care plan is to be continued, discontinued or modified. If the care plan is problem-based and the client has recovered, the plan would be discontinued. If the client has not recovered, or if the care plan was written for a chronic illness or ongoing problem, it may be continued. If certain interventions are not helping or other interventions are to be added, the care plan is modified and continued.

There are also care plans written for "at risk" problems, as well as "wellness" care plans. These follow a similar format, only designed to prevent problems from happening and continue or promote healthy behavior.

Nurse Education

From Wikipedia, the free encyclopedia

Nurse education consists in the theorical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. This education is provided to nursing students by experienced nurses and other medical professionals who have qualified or experienced for educational tasks. Most countries offer nurse education courses that can be relevant to general nursing or to specialized areas including mental health nursing, pediatric nursing and post-operatory nursing. Courses leading to autonomous registration as a nurse typically last four years. Nurse education also provides post-qualification courses in specialist subjects within nursing.

Historical background

During recent past decades, the moving on education has replaced the more practically focussed, but often ritualistic, training structure of conventional preparation. Nurse education integrates today a broader awareness of other disciplines allied to medicine, often involving inter-professional education, and the utilization of research when making clinical and managerial decisions. Orthodox training can be argued to have offered a more intense practical skills base, but emphasized the hand maiden relationship with the physician. This is now outmoded, and the impact of nurse education is to develop a confident, inquiring graduate who contributes to the care team as an equal. In some countries, not all qualification courses have graduate status. Traditionally, from the times prior to Florence Nightingale, nursing was seen as an apprenticeship, often undertaken in religious orders such as convents by young women, although there has always been a proportion of male nurses, especially in mental health services. In 1860 Nightingale set up the first nurse training school at St Thomas' Hospital, London. Nightingale's curriculum was largely base around nursing practice, with instruction focussed upon the need for hygiene and task competence. Her methods are reflected in her "Notes on Nursing", (1898).

Some other nurses at that time, notably Ethel Bedford-Fenwick, were in favor of formalized nursing registration and curriculum that were formally based in higher education and not within the confines of hospitals.

Nurse education in the United States has been conducted within university schools, although it is unclear who offered the first degree level program. So far as known Yale School of Nursing became the first autonomous school of nursing in the United States in 1923. In Europe the University of Edinburgh was the first European institution to offer a nursing degree in 1972.

Nursing School

An Associate of Science in Nursing (ASN) is an entry-level tertiary education nursing degree. In the United States, this type of degree is usually awarded by community colleges or similar nursing schools. Some four year colleges also offer this degree. Students awarded an Associate of Science in Nursing are qualified to sit for the NCLEX-RN and apply for licensure as a Registered Nurse.

Some hospital-based nursing schools that granted diplomas altered their curriculum to offer associate degrees.

Many nursing schools offering a bachelor's degree have "fast-track" programs to enable practicing nurses with an associate's degree to earn a bachelor's degree in approximately two years.

Similar degrees

  • Associate of Nursing (AN)
  • Associate of Applied Science in Nursing (AASN)
  • Associate Degree in Nursing (ADN)

A Diploma in Nursing or Nursing Diploma is an entry-level tertiary education nursing degree.

In the United States, this type of degree is usually awarded by hospital-based nursing schools. Students awarded a Diploma in Nursing are qualified to sit for the NCLEX-RN and apply for licensure as a Registered Nurse.

At one time, all nurses in the United States were diploma-prepared. The Cherry Ames series of children's books was created to encourage girls to go into the nursing profession during World War II. She was a "hospital diploma" nurse.

Although the number of hospital-based nursing schools continues to decrease, many still exist. Some require that non-nursing prerequisite courses be completed at another school prior to admission or coordinate their program with classes at a nearby school, though many are still self-contained.

The Bachelor of Science in Nursing (BSN) is a four year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school. Though one is eligible to sit for the NCLEX-RN licensing examination to become a registered nurse after graduating from either a two year program with an Associate's Degree (ADN) or from a four-year nursing program with a BSN, the BSN prepares nurses for a professional role away from the bedside with coursework in nursing science, research, leadership, and nursing informatics.

A Master of Science in Nursing (MSN) is an advanced-level quaternary education degree for Registered Nurses. It is required to become an advanced practice nurse, such as a Nurse Practitioner, Clinical Nurse Specialist, Nurse Anesthetist, Nurse Midwife, or a Clinical nurse leader, and is considered an entry-level degree for nurse educators and managers. It is also a prerequisite for doctorate-level nursing education.

This graduate-level degree may focus in one or more of many different advanced nursing specialties such as acute care, adult, family, geriatrics, neonatal, palliative care, pediatric, psychiatric, women's health, etc.

The Doctor of Nursing Practice (DNP or DrNP) degree is similar to a Doctor of Nursing Science but with an emphasis on clinical practice rather than research, teaching, or theory. See the American Association of Colleges of Nursing Stance on the Doctor of Nursing Practice Doctor of Nursing Practice. The Position Statement from October 2006 provides background information, program listings, frequently asked questions and talking points about the Doctor of Nursing Practice degree . The DNP is more than a leadership role in the discipline of nursing, and for the certified and licensed nurse practitioner, may become the required level of training for practice at that level.

A Doctor of Nursing Science (D.N.Sc.) is an advanced-level academic degree in Nursing. When first introduced in the 1970s, the Doctor of Nursing Science was intended to be the "clinical," or practice, based doctorate. However, upon further comparison, the DNSc curriculum was notably similar to that of the Doctor of Philosophy (Ph.D.), which is traditionally a research or education based doctorate. Like the Ph.D., the D.N.Sc. requires writing and defending a dissertation for successful completion and graduation of the program. The Doctor of Nursing Science degree, due in part to its great similarity with the Ph.D. and with the introduction of the DNP, has started being phased out as a doctoral-degree option. For example, the prestigious Yale University School of Nursing, which formerly offered the DNSc, has now begun offering only the Doctor of Philosophy degree.

A master's-level degree is a prerequisite for doctorate-level nursing education. This type of degree is required for advanced practice nursing roles Nurse Practitioner, Nurse Anesthetist, Nurse Midwife; and is preferred for nurse educators and nurses in leadership positions.

Persons holding a nursing doctorate, whether D.N.P., Ph.D., D.N.Sc., Dr.NP, Ed.D., or the many other doctorates nurses can attain, are not licensed as Physicians. Only those licensed and certified as an Advanced Practice Nurse (i.e., Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, Certified Nurse Midwife or Clinical Nurse Specialist) may provide care in the medical arena; i.e. Nurse Practitioners have assumed many roles previously held by physicians. The state of licensure dictates the rules and regulations and these vary greatly. Other roles held by doctorate prepared nurses include nursing education, nursing research, executive and non-executive management, and clinical instruction.

source : wikipedia.com

History of nursing

Nursing has existed in various forms in every culture, although the definition of the term and the practice of nursing has changed greatly over time. The oldest sense of the word in the English language a woman employed to suckle and generally care for a younger child. The former being known as a wet nurse and the latter being known as a dry nurse. In the 15th century, this developed into the idea of looking after or advising another, not necessarily meaning a woman looking after a child. Nursing has continued to develop in this latter sense, although the idea of nourishing in the broadest sense refers in modern nursing to promoting quality of life.

It was during time of war that a significant development in nursing history arose when Florence Nightingale, working to improve conditions of soldiers in the Crimean War, laid the foundation stone of professional nursing with the principles summarised in the book Notes on Nursing. Florence Nightingale was fundamental in establishing the realization of the need for nurses and she could be considered the "Mother of Modern Nursing." Other important nurses in the development of the profession include: Mary Seacole, who also worked as a nurse in the Crimea; Agnes Elizabeth Jones and Linda Richards, who established quality nursing schools in the USA and Japan, and Linda Richards who was officially America's first trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston.

Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that nurses primary purpose is to follow the direction of medics. This tendency is certainly not observed in Nightingale's Notes on Nursing, where the doctors are mentioned relatively infrequently and often in critical tones, particularly relating to bedside manner.

The modern era has seen the development of nursing degrees and nursing has numerous journals to broaden the knowledge base of the profession. Nurses are often in key management roles within health services and hold research posts at universities.




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