patterns of knowing

8/12/2019 Patterns of Knowing

1/16

CUES NURSINGDI GNOSIS PL NNING INTERVENTION R TION LE EV LU TION

Objective Cues (basedon interview):

Very pooreyesight due tomaculardegeneration

86 years oldwidow

Living alonein a new

environment

Risk for Injuryrelatedto poor eyesight dueto macular

degeneration and newenvironment

After an eight-hour(8)shift ofcollaborative nursing

intervention:

There wouldbe noincidence ofinjury or anyfall

The patientwould be ableto verbalizefeelings ofsecurity aboutpersonal safety

1. Alter patientsenvironment

2. Assist withambulationand activitiesof daily living(ADL)

3. Teach patientabout possiblesources ofinjury in the

homeenvironment

4. Continue toasses anypotential harmin the patientsenvironment

1. To reducepossibility ofinjuries

resulting fromunfamiliaritywith theenvironment

2. To reduceopportunitiesfor injuriesand provideverbal cueing

3. To allowpatient toidentify andcorrectpotentiallyharmfulsituations

4. To prevent anypotential

injury and tomodifypatientsenvironmentfor safety

GOAL MET: After theeight-hour (8)shift ofcollaborative nursing

intervention:

There were noincidence ofinjury or anyfall

The patientwas able toverbalizefeelings ofsecurity aboutpersonal safety


2/16




86 years oldwidow

Living alone ina new

environment

Risk for self caredeficit related to pooreyesight and activity

restrictions

After a continuouscollaborative nursingintervention:

Patient careneeds wouldbe met, with orwithoutassistance

1. Assist patientwith activitiesof daily living

as needed orrequested

2. Help patientidentify self-care deficitsand alternativemethods ofaccomplishingthose activities

3. Refer tocommunityagencies ifnecessary

1. To maintainhealth andself-esteem

2. To assureavailability ofinformationand help afterdischarge

3. To ensurecontinuity ofcare outside

the hospital

GOAL MET: After acontinuouscollaborative nursing

intervention:

Patient care needs aremet, with and withoutassistance


3/16




86 years oldwidow


environment

Subjective Cues:

Patient has hipfracture uponadmission andis scheduledfor surgery

Pain related tomovement of bonefragments due to hip

fracture

After a two to fourhours of collaborativenursing intervention:

There wouldbe a decreasein or absenceof pain

Patient wouldhave asatisfactionwith painrelief (ratespain as 3 outof 10 from an8 out of 10score on a 10point painrating scale)

1. Align andpositionextremity and

patientcorrectly

2. Gently positionor turn patient

3. Administeranalgesics,NSAIDs, andmuscle

relaxants asordered

4. Use painrating scale toasses pain

1. To reducepressure onnerves and

tissues

2. To preventmuscle spasmandmalalignmentof bonefragments

3. To reducepain, edema

and musclespasm

4. To assesseffectiveness ofnursing carein relation topatients pain

GOAL MET: After atwo to four hours ofcollaborative nursing

intervention:

There was adecrease inpain

Patient hassatisfactionwith painrelief (ratespain as 3 outof 10 from an8 out of 10score on a 10point painrating scale)


4/16




86 years oldwidow


environment

Subjective Cues:


Impaired physicalmobility related todecreased muscle

strength and pain dueto hip fracture


Patient wouldhave asufficientmusclestrength toparticipate ingait-trainingprogram

Patient wouldachieveoptimal levelof functionwithambulatoryassistive device

1. Cooperatewith physicaltherapist in

muscle-strengtheningprogram

2. Teach andassist patientin exerciseprogram,includeresistivestrengthening

exercise ofuninvolvedlower and bothupper limbs,elbowextension,shoulderdepressors,and knee andhip extension

3. Providewritteninstruction orvideos forexercises

4. Encouragequadricepsexercise, arm-strengtheningexercises, and

abdominal and

1. To maximizepatientsprogress in

rehabilitation

2. To developstrength in allextremitiespreparatory toinitiation ofambulation

3. For patient torefer or

inquire to asneeded

4. To developmusclestrength whichwill help withrehabilitation

5. Because softtissue

surroundinghip requiresabout 3 to 5months ofhealing tosufficientlystabilize thepatient

6. To reducecomplications

related to


intervention:

Patient nowhave asufficientmusclestrength toparticipate ingait-trainingprogram

Patientachieved anoptimal levelof functionwithambulatoryassistive device


5/16

glutealcontractionexercises

5. Be aware thatorderedweight-bearing statusof involvedextremity mustbe maintainedunlesschanged by thephysician

6. Get patient outof bed and intochair, usuallywithin 24 to48 hours aftersurgery

7. Instruct andassist patientwith transferfrom bed tochair

immobilitymost especiallypressure soresand muscleatrophy

7. To preventaccidentfalling andimpropermovements,which couldcause hipmalalignmentand furtherdamage


6/16




86 years oldwidow


environment

Subjective Cues:


Ineffective copingrelated to stress ofliving alone and poor

eyesight


Patient wouldidentifyeffective andineffectivecopingpatterns,verbalize senseof control,reportdecrease in

negativefeelings andmodifylifestyle asneeded

1. Provide anatmosphere ofacceptance

2. Provide factualinformationconcerning thediagnosis,treatment andprognosis

3. Arrangesituations thatencourage her

autonomy.Give her asmanyopportunitiesas possible tomake decisionsfor herself

4. Encourageverbalizationof feelings,

perceptionsand fears

5. Encouragepatient toidentify herown strengthsand abilities

6. Determinebarriers to

using support

1. Establishingrapport isessential to a

therapeuticrelationshipand supportsthe client inself-reflection.Recognizingproblems andsharingfeelings is bestbrought aboutin an

atmosphere ofwarmth andtrust

2. Factualinformationserves as afoundation forthe patient toexplorefeelings and

alternativecopingstrategies.Stressed clientsoftenmisunderstandfacts andrequirefrequentclarification sothat

appropriate


intervention:

Patient wasable to identifyeffective andineffectivecopingpatterns,verbalize senseof control,report

decrease innegativefeelings andmodifiedlifestyle


7/16

systems

7. Refer patientto acommunity-based supportgroup

conclusionscan be drawn

3. Enhances asense ofcontrol,personalachievementand self-esteem

4. Open,nonthreateningdiscussionsfacilitate theidentificationof causativeandcontributingfactors

5. Assists thepatient indevelopingappropriatestrategies forcoping basedon personalstrengths andpreviousexperiences.Improves self-concept andsense of abilityto managestress

6. To help thepatient achievemaximumusage ofavailablesupport system


8/16

7. Community

support isbeneficial inhelping to meetunresolvedneeds,decreasingfeelings ofsocial isolation,and facilitatingpositive self-image


9/16



Very pooreyesight dueto maculardegeneration

86 years oldwidow

Living alonein a new

environment

Subjective Cues:


Anxiety related tointernalized feelingsof inadequacy,

resentment,frustration,situational crises,unmet needs,separation fromsupport system(daughter) andchange in healthstatus (hip fracture)as evidenced byexpressed concern

regarding changes inlife events


Patient willac-knowledgeand discussfears/con-cerns

Patientwould beable toverbalizeawarenessof feelingsof anxietyand healthyways to dealwith them

The patientwill be abletodemonstrateproblemsolving and

useresourceseffectively

1. Notepalpitations,elevated

pulse/respi-ratory rate

2. Acknowledgefears/anxieties,validateobservationswith patient

3. Identify patientsperceptions ofthe situationsand events

4. Evaluate copingmechanismsbeing used bythe patient

5. Maintainfrequent contact

with the patient.Be available forlistening andtalking asneeded

6. Acknowledgefeelings asexpressed

7. Identify ways inwhich the

1. Changes invital signs maysuggest the

degree ofanxiety thepatient isexperiencingor reflect theimpact ofphysiologicalfactors

2. Feelings arereal, and it is

helpful tobring them outin the open sothey can bediscussed anddealt with

3. Regardless ofthe reality ofthe situation,perception

affects howeachindividualdeals with theillness/stress

4. May bedealing wellwith thesituation at the

moment; e.g.,


intervention:

Patient ac-knowledgedanddiscussedfears/con-cerns

Patient wasable toverbalize

awarenessof feelingsof anxietyand healthyways to dealwith them

The patientde-monstratedproblemsolving anduse

resourceseffectively


10/16

patient can gethelp whenneeded,includingtelephonenumbers ofcontact persons

8. Stay with orarrange to havesomeone staywith the patientas indicated

denial andregression maybe helpfulcopingmechanismsfor a time.However, useof suchmechanismsdiverts energythe patientneeds forhealing, andproblems needto be dealtwith at somepoint in time

5. Establishesrapport,promotesexpression offeelings

6. Oftenacknowledging feelingsenables patientto deal more

appropriatelywith situation

7. Providesassurance thatstaff/resourcesare availableforassistance/su-pport

8.

Continuoussupport may


11/16

help patientregain internallocus ofcontrol andreduceanxiety/fear toa manageablelevel


12/16


Objective Cues(based oninterview):

Very pooreyesight dueto maculardegeneration

86 years oldwidow

Living alonein a newenvironment

Subjective Cues:

Patient haship fractureuponadmissionand isscheduled

for surgery

Situational lowSelf esteem relatedto changes in

health status androle performanceand loss of controlof some aspect oflife


Patient would beable to verbalizerealistic viewand acceptanceof self insituation

Identify existingstrengths andview self as

capable person

Recognize andincorporatechange into self-concept inaccuratemanner withoutnegating self-worth

Demonstrateadaptation tochanges/eventsthat haveoccurred asevidenced bysetting ofrealistic goalsand activeparticipation in

work/play/personal

1. Ask what thepatient wouldlike to be called

2. Identify basicsense of self-esteem, imagepatient has ofexistential,physical,psychologicalself. Identifylocus of control

3. Active-Listenpatient concernsand fears

4. Encourageverbalization offeelings,accepting whatis said

5. Providenonthreateningenvironment

6. Observenonverbalcommunication,e.g., bodyposture andmovements, eye

contact,gestures, use of

1. Showscourtesy/respect and

acknowledgesperson

2. May provideinsight intowhether this isa singleepisode orrecurrent/chronic situationand can helpdetermineneeds andtreatmentplan. It ishelpful toknow whethertheindividualslocus ofcontrol isinternal orexternal toprovide mosthelpfulinterventions

3. Conveys senseof caring andcan be helpfulin identifyingthe patients

needs,problems, and

GOAL MET: After a twoto four hours ofcollaborative nursing

intervention:

Patient was ableto verbalizerealistic viewand acceptanceof self insituation

Patientidentified

existingstrengths andview self ascapable person

Mrs. Sarmientorecognized andincorporatedchange into self-concept inaccuratemanner withoutnegating self-worth

The patient wasable todemonstrateadaptation tochanges/eventsthat have

occurred asevidenced by


13/16

relationships touch

7. Encouragediscussion ofphysical changesin a simple,direct, and

factual manner.Give realisticfeedback anddiscuss futureoptions, e.g.,rehabilitationservices

8. Acknowledgeefforts atproblem solving,

resolution ofcurrentsituation, andfuture planning

9. Introduce tasksat patients levelof functioning,progressing tomore complexactivities as

tolerated

copingstrategies andhow effectivethey are.Providesopportunity toduplicate andbegin a

problem-solvingprocess

4. Helps patientbegin to adaptto change andreducesanxiety aboutaltered

function/life-style

5. Promotesfeelings ofsafety,encouragingverbalization

6. Nonverballanguage is a

large portionofcommunication andtherefore isextremelyimportant.How theperson usestouch providesinformation

about how it is

setting ofrealistic goalsand activeparticipation inwork/play/personalrelationships


14/16

accepted andhowcomfortablethe individualis with beingtouched

7.

Providesopportunity tobeginincorporatingactual changesin anaccepting andhopefulatmosphere

8. Providesencouragement andreinforcescontinuationof desiredbehaviors

9. Providesopportunityfor patient toexperience

successes,reaffirmingcapabilitiesand enhancingself-esteem


15/16

CUES NURSINGDI GNOSIS PL NNING INTERVENTION R TION LE EV LU TIONObjective Cues(based oninterview):

Verypooreyesightdue tomaculardegeneration

86 yearsoldwidow

Livingalone ina newenvironment

SubjectiveCues:

Patienthas hipfractureuponadmission andisscheduled forsurgery

Hassurgery

Decisional conflictrelated tosituationalcrises/personalvulnerability;

multiple lifechanges/maturational crises asevidenced bydelayed decisionmaking oruncertainty aboutchoices seenthrough herunsigned consentform


Patientwould beable toidentifyineffectivecopingbehaviorsandconsequences

Mrs.Sarmientowould

verbalizeawarenessof owncoping/problem-solvingabilities.

Patient willmeetpsychologica

l needs asevidenced byappropriateexpression offeelings,identificationof options,and use ofresources

1. Reviewpathophysiologyaffecting the patientand extent of feelingsof

hopelessness/helplessness/loss of control overlife, level of anxiety;perception of situation

2. Establish therapeuticnurse-patientrelationship

3. Note expressions ofindecision, dependence

on others, and inabilityto manage own ADLs

4. Assess presence ofpositive copingskills/inner strengths,e.g., use of relaxationtechniques, willingnessto express feelings, useof support systems

5. Encourage patient totalk about what ishappening at this timeand what has occurredto precipitate feelingsof helplessness andanxiety

6. Evaluate ability tounderstand events.Correct misperceptions,

provide factual

1. Impairment ofnormal functioningfor more than 2weeks, especially inpresence of chronic

condition, mayreflect depression,requiring furtherevaluation

2. Patient may feelfreer in the contextof this relationshipto verbalize feelingsofhelplessness/powerl

essness and todiscuss changes thatmay be necessary inthe patients life

3. May indicate need tolean on others for atime. Earlyrecognition andintervention canhelp patient regain

equilibrium

4. When the individualhas coping skills thathave been successfulin the past, they maybe used in thecurrent situation torelieve tension andpreserve theindividuals sense of

control

GOAL MET: After atwo to four hours ofcollaborativenursingintervention:

Patient wasable toidentifyineffectivecopingbehaviorsandconsequences

Mrs. Sar-mientover-balizedaware-ness ofowncoping/problem-solvingabilities.

Patient metpsychological needs asevidenced byappropriateexpression offeelings,identificationof options,and use ofresources


16/16

the nextday butstill notsignedherconsentyet

information

7. Discuss feelings of self-blame/projection ofblame on others

8. Note expressions ofinability to find

meaning in life/reason for living,feelings of futility oralienation from God

9. Promote safe andhopeful environment,as needed. Identifypositive aspects of thisexperience and assistpatient to view it as a

learning opportunity

10.Inform MedicalOfficer-on-dutyregardingreinforcement onexplaining consent forsurgery and theprocedure itself

5. Provides clues toassist patient todevelop coping andregain equilibrium

6. Assists inidentification and

correction ofperception of realityand enables problemsolving to begin

7. Although thesemechanisms may beprotective at themoment of crisis,they eventually arecounterproductive

and intensifyfeelings ofhelplessness andhopelessness

8. Crisis situation mayevoke questioning ofspiritual beliefs,affecting ability tocope with currentsituation and plan

for the future

9. May be helpfulwhile patientregains innercontrol

10.Serves as a guide forpatient in decisionmaking (clientadvocate role)

patterns of knowing

Documents