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This presentation outlines the implementation of the nursing process through concept mapping, focusing on complex care plans in musculoskeletal, neurological, medical-surgical, critical care, and behavioral health areas. It provides step-by-step guidance for assessing patient data, developing visual diagrams, and correlating nursing diagnoses with treatment interventions. Emphasis is placed on critical thinking and the integration of clinical information, enabling nursing students to create effective, multi-system care plans that enhance patient outcomes and facilitate personalized care.
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NP3 (223) STUDENT CONCEPT MAP ASSESSMENT PRESENTATION Nursing Process 3 Spring 2012 Alice Ramming RN, MSN
STUDENT LEARNING OUTCOME • SLO # 1 • Utilize the Nursing Process • To: Implement a multi-system plan of care with complex problems in the musculoskeletal/neurological/medical surgical, critical care, and behavioral health areas
Assignment • NP3_SPRING_studyguide_2012-Rev.1/31/2012 34 • NP 3 • Care Plan Concept Mapping Steps • 1. Preparation • A. Assessment • B. Gather and cluster clinical patient data • C. Health history • D. Physical assessment data • E. Review treatments and medications
Assignment Continued • 2. Step I • A. Develop basic skeleton diagram • B. Write the patient's initials, age, sex, major medical diagnosis (DSMIV), and priority nursing diagnosis in the middle of a blank sheet of paper • C. Add associated nursing diagnosis in a separate area flowing outward from the patient's data that is in the middle of the sheet, like the spokes of a wheel. Focus on one primary nursing diagnosis and continue following step 2.
Assignment Continued • Step 2 • A. Analyze and categorize the data gathered from the medical record and graphically place them around the center of the page. Include • 1. Data that shows how the patient‘s disease is manifested • 2. Stage of development with supporting behaviors (Erickson). • 3. Expected outcomes/goals (time specific and measurable). • 4. Interventions • 5. Medications and treatments • 6. Teaching • 7. Documented rationales • 8. Evaluation of the interventions • B. The graphic representation should be your own creation and can be in color with any shapes that you choose
Assignment Continued • 3. Step 3 • A. Use a arrows and lines to draw links between the nursing diagnoses • B. Ask yourself if the diagram represents the whole picture? • C. Most problems are interrelated • 4. Step 4 • A. Write notes on the map and update it if you see a client more than once • B. Use the map and the notes that you write as a working tool that you can add to as your day progresses. • C. Document the patient's actual response for your evaluation of response to nursing care • Adapted from: Schuster, P. Concept Mapping: A Critical Thinking Approach to Care Planning, (new edition)
ASSESSMENT RUBRICK • OUTCOME/OBJECTIVE YES NO COMMENTS GOAL MET • YES/NO • Data demonstrates how the patient’s disease/disability is manifested • X Excellent representation of disease process yes • Primary and related nursing diagnoses were documented • x Priority diagnosis yes • Demonstrated expected outcomes/goals (time specific and measurable) • x yes • Demonstrated appropriate interventions • x yes • Medications, treatments and procedures were documented • yes yes • Reflected patient teaching and related it to nursing/medical diagnosis • yes yes • Documented and referenced appropriate rationales • yes yes • Overall map demonstrated graphic representation of related concepts • yes Excellent graphics • Comments • Good job