Introduction:
This paper is developed with the purpose of identifying NANDA, NIC and NOC elements and their linkage to the plan for nursing care the scenario chosen for the purpose is of a patient with cognitive heart failure. As suggested by Clark and Lang (1992) nursing terminologies are base for nursing care and planning, these terminologies help to define and describe nursing care. NANDA, NIC and NOC are the terms which are used for nursing profession on continuous basis, nurse select which nursing diagnosis is required to base on the patients actual health and condition and potential health needs with the use of NANDA. Then NOC outcomes terminology is used for the purpose of setting goals (short term and long term) which are desired and can be achieved based on the patient’s diagnosis.NIC interventions are used for th purpose of implementation and documentation of nursing care records. The nursing care outcomes are assessed based on the patients NIC intervention and final reports after treatments. As suggested by Kautz, Kuiper, Pesut, & Williams (2006) nurses should conduct continuous monitoring of patients condition and document all the care they provide.
This document tries to explain application of terminologies based on the scenario of patient with cognitive heart failure.
NANDA, NIC and NOC element:
There are many research which are being conducted on nursing science and the new knowledge is getting developed in past few decades, this New knowledge based related to NANDA, nursing interventions classification (NIC) and nursing outcomes classification (NOC) are the processes which shows need of redesigning of process models of nursing with the help of electronic support system. As suggested by Lunnay (2008 a) nursing profession requires professionals who can have critical thinking ability to develop processes of patient care. It is important for nurses to use critical thinking for the purpose of selection of right diagnosis, intervention and outcomes for patients.
Many researchers in nursing field have emphasized use of NANDA, NIC and NOC terminologies in nursing processes during development of theories like Pesut & Herman (1998) suggested that development of theories of nursing in middle range can be highly influence by uses of nursing terminologies like NANDA, NIC and NOC.
NANDA stands for North American Nursing Diagnoses Association which provides international classification which can be helpful for identifying diagnoses of nursing. These nursing diagnoses of NANDA have included 21 new diagnoses, 6 retired diagnoses and 9 revised diagnoses, which makes total of 202 nursing diagnoses which can be use for practice in nursing. Every diagnosis in the classification is defined and at the time of actual diagnosis it is required to define factors related and characteristics.
NOC stands for nursing outcomes classification, NOC helps nurses for maintaining outcome states during various period of time before intervention and after intervention, NOC assist nurses to understand current problem associated with patient and after intervention NOC assist for measuring the change score and outcomes.
NIC stands for nursing interventions classifications; the taxonomy of NIC includes thirty classes, seven domains and five hundred and forty two interventions. According to Bulechek et al. (2008) in present NIC includes seventy seven revised interventions and thirty four new interventions. Every intervention includes a list of particular activities for implementation of intervention which are based on the need of patients.
Applying NANDA, NIC and NOC for the case of Cognitive heart Failure:
According to Park, Hye Jin. (2010) with increase in the number of elderly people in united states of America there are chance of increase n number of cognitive heart failure in future, and the uses of nursing terminologies like NANDA, NIC and NOC with some models can provide more effectiveness to nursing processes, these terminologies and their usage will increase the accuracy on nursing care and that accuracy will results high quality of nursing care for patients.
As suggested by Albert (2006) nurses can help to increase effectiveness of nursing care delivery to cognitive heart failure patients when they work as part of multidisciplinary health care team. Nurses need to focus their nursing care base on the response of patients to the diagnosis with the help of nursing diagnoses (NANDA), Nursing Intervention (NIC) and desired outcome (NOC). Usage of NANDA, NIC and NOC linkage are very important parts of the nursing terminologies which provide high quality, cost effective patient care by improving patient outcomes.
According to American Heart Association (2009) cognitive heart failure treatment can be done with various options like change in lifestyle, medication and surgery. Research (Vinson, Rich, Sperry, Shah, & McNamara, 1990; Hoyt & Bowling, 2001) suggests that outcome of treatment options on cognitive heart failure patients are poor and around 40% of the patients are readmitted to the hospital in such cases.
In this scenario of cognitive heart failure the nurse first consider the main complaint of the patient which is dyspnea, and also consider history of patient, on the basis of history and main problem real and potential diagnoses are thought which are activity intolerance, impaired gas exchange and decrease cardiac output. The nursing diagnoses are analyzed for relationship of nursing diagnoses and finding other possible related nursing diagnoses.
On the basis of key problem of the patient nurse contrast and compare the present condition of patient and desired state of patient, present condition of patient having SaO2<85% hyper tension, pain , decrease breath sound are compared with desired state that is SaO2>90%, symmetrical breath sound, etc., The NOC for patient scenario based on comparison of present and desired states are respiratory status: Gas Exchange which taken from NOC classifications. Further identification of gap between present states and desired states helps in determination of intervention required, NIC intervention for this patient scenario are Acid base management, ventilation assistance, respiratory acidotes, oxygen therapy and pain management
Further using critical thinking the best possible interventions are selected which are Respiratory Acidotes, Acid-base management and Ventilation Assistance, selection of intervention are tested. At last nurses prepare plan for nursing care by using NANDA, nursing Diagnoses, NIC Nursing Interventions and NOC nursing outcome. The NANDA< NIC and NOC linkage with clinical information system for the problem cognitive heart failure provides information for decision making. This whole process of applying NANDA, NIC and NOC to the Cognitive heart failure patient help nurses to create knowledge and middle range theories.
Conclusion:
The purpose of the study was to understand application of NANDA, NIC and NOC terminologies for the patient with cognitive heart failure. The paper explains the meaning and definition of the terminologies mentioned and also discusses how to apply these terminologies on the patient scenario. In present scenario patients are coming to hospital with diverse problems and nurses need to identify and understand problem by selecting correct nursing diagnoses, nursing intervention and Nursing outcomes. The modern terminologies of nursing processes can create effective documentation and create visibility for nursing profession among other health care professions. Documentation of nursing processes with nursing terminologies can be time consuming but it is important for nurses to document their processes. The documented process can help nurses to measure their activity and outcome and can also help management to evaluate nurse performance.
References:
Clark, J. & Lang, N. (1992). Nursing’s next advance: An internal classification for nursing practice. International Nursing Review, 39(4), 109-111, 128.
Hoyt, R. E., & Bowling, L. S. (2001). Reducing readmissions for congestive heart failure.
American Family Physician, 63(8), 1593-1598.
Kautz, D. D., Kuiper, R., Pesut, D. J., & Williams, R. (2006). Using NANDA, NIC, and NOC (NNN) Language for clinical reasoning with the outcome-present state-test (OPT) model, International Journal of Nursing Terminologies & Classifications, 17(3), 129-138.
Lunney, M (2008a). Current knowledge related to intelligence and thinking with implications for the development and use of case studies. International Journal of Nursing Terminologies and Classifications, 19(4), 158-162.
Park, Hye Jin. (2010) "NANDA-I, NOC, and NIC linkages in nursing care plans for hospitalized patients with congestive heart failure." PhD (Doctor of Philosophy) thesis, University of Iowa.
Pesut & Herman (1998). OPT: Transformation of nursing process for contemporary practice. Nursing Outlook, 46, 29-36.
Vinson, J. M., Rich, M. W., Sperry, J. C., Shah, A. S., McNamara, T. (1990). Early readmission of elderly patients with congestive heart failure. Journal of American Geriatirics Society, 38(12), 1290-1295.
