Advanced Nursing Process
The Advanced Nursing Process is a new version of the general Nursing Process, which provides a structure for nursing practice [1-4]. The Nursing Process leads the nurse to assess patients’ care needs and to plan and evaluate nursing care. It contains five phases: Nursing Assessment, Nursing Diagnoses, Outcomes / Planning, Implementation, and Evaluation [2, 5]. As a structure with five phases alone, scientists criticised it for missing literature-based content and standardised concepts [6, 7]. The question was: What does the Nursing Process consist of? What content knowledge should it contain to be taught and researched?
To fill this research gap, the Advanced Nursing Process was developed. The term Advanced Nursing Process was first mentioned by Ackley & Ladwig [1]. The term “advanced” means “further developed, deepened, based on scientifically defined concepts”. Later, Müller-Staub et al., (2015) published a definition: “The Advanced Nursing Process consists of defined, validated concepts. It includes assessment, nursing diagnoses, nursing interventions and nursing outcomes that are rooted in scientifically based nursing classifications” [8], page 13 and [9, 10].
The Advanced Nursing Process is implemented by using standardized nursing classifications [6-28]. To teach it to nurses, the method ‘Guided Clinical Reasoning’ (GCR) was suggested. According to studies, GCR is a teaching method that supports the application of the Advanced Nursing Process [12, 29-35].
Research indicates [21, 36, 37] three nursing classifications represent the body of nurses' knowledge: the Nursing Diagnosis Classification NANDA-I [38], the Nursing Interventions Classification NIC [39, 40], and the Nursing Outcomes Classification NOC [18]. Together, they are called NNN-Classification [41]. The NNN is research-based and was reported being the most used nursing classification [17, 26, 36, 37, 42]. It provides the content for the Advanced Nursing Process and contains 244 nursing diagnoses [38], 540 NOC nursing outcomes [18], and 565 NIC nursing interventions [40], see the following graph.
The aim of the Advanced Nursing Process is the application of scientific knowledge to clinical patient situations by valid concepts of nursing diagnoses, interventions and nursing-sensitive patient outcomes [8, 12, 16, 19, 21, 24, 33, 34, 36, 37, 42, 52, 55-60].
Nursing Process - Clinical Decision Support Systems (NP-CDSS) in EHRs can help nurses to apply the Advanced Nursing Process in practice, and an international standard gives direction on how to develop such a system in EHRs. With the aid of Clinical Decision Support Systems according to the NP-CDSS standard, clinical nurses can apply evidence-based knowledge in care planning and evaluations [61]. Studies revealed that the Advanced Nursing Process can significantly enhance patient outcomes [12, 30, 31, 33, 42, 57, 62-64]. Applying the NNN classifications in the Advanced Nursing Process points out what nurses do, why they do it, which objectives nurses’ pursue and which nursing-sensitive patient outcomes patients achieve [3, 4, 8, 17].
January 2023
References[edit]
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