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TEACHING STRATEGY FOR NURSING FUNDAMENTALS: HELPING NURSING STUDENTS TO TO LEARN ABOUT NANDA-I NURSING DIAGNOSIS

NANDA-I Expert: Dr. Rosa Rifà Ros (Spain)

PURPOSE AND TEACHING OBJECTIVES FOR NURSING FUNDAMENTALS SUBJECT

Content on Nursing Fundamentals, in the Nursing Foundations course, is generally placed in the first academic year of the undergraduate nursing program, and aims to introduce students to the nursing profession. A first step includes sharing the evolution of the nursing profession throughout history. Once the historical context has been covered, the concept of person as a bio-psycho-social-spiritual being within a specific environment is introduced. This step is crucial, as it establishes a foundation from which to understand the person as a whole being, and to start developing clinical reasoning with a specific methodology: NANDA, NIC and NOC taxonomies and the OPT model.

The teaching objectives for the Nursing Basics subject are:

  • To understand the importance of the Nursing Care Process as a strategy for providing individualized and high quality care.
  • To develop communication skills for the nursing assessment interview, deepening understanding of the functional health patterns of Marjory Gordon to perform comprehensive and systematic assessments.
  • To apply the nursing methodology to solve practical real case scenarios, using Marjory Gordon’s functional health patterns, clinical reasoning networks, NANDA-I’s taxonomy for problem identification, and the NIC and NOC taxonomies, to plan interventions and evaluate results.

DESCRIPTION OF THE TEACHING STRATEGY FOR NURSING FUNDAMENTALS

The Nursing Fundamentals course follows a longitudinal case scenario, which is developed within the setting of a skilled nursing facility for elderly clients. This methodology enables the student to move through different stages of the nursing care plan, guided by the theoretical content that is also being taught during different lessons.

The theoretical lessons are complemented by a diversity of practical exercises and games that inform the student about his/her level of achievement on the theoretical content sections. In addition, to consolidate and put into practice the different theoretical content, two practical individual and group activities are used. These two activities, along with a final practical exercise, enable continuous assessment of the Diagnosis Fundamentals subject. The activities and exercise are described below.

ACTIVITY 1: CLINICAL REASONING PROCESS: NURSING PLAN OF CARE

The activity has two main parts: 1) A nursing assessment of a person, and 2) A nursing care plan tailored to the person’s needs, derived from the nursing assessment and using the NANDA-I, NIC, and NOC taxonomies, the OPT model, and the clinical reasoning networks. The sequence of this activity includes:

  1. Within the clinical placement, and guided by an academic mentor, each student conducts a nursing assessment of a client skilled nursing facility for elderly clients, who does not require acute assistance, following the functional health patterns of Marjory Gordon. To move to the next step of the activity, the professor must approve the student’s assessment.
  2. The student proposes a nursing care plan based on the assessment conducted. The care plan will be presented in a standardized template of the OPT model, and includes:
    1. Diagnostic stage of the nursing diagnostic process, following the NANDA-I taxonomy and the OPT model with clinical reasoning networks.
    2. Once the NANDA-I nursing diagnosis(es) has been identified, the student will choose the most suitable NOC for the chosen diagnosis(es) (along with the selection of adequate diagnostic indicators). The student will then identify the suitable NIC(s) for the chosen NOC(s) and NANDA-I diagnosis(es) related factors (along with the selection of the adequate activities). Then, the student will propose a follow-up evalation of the chosen NOC(s) at the final conclusion of the activity.

ACTIVITY 2: NURSING DIAGNOSIS: NANDA-I TERMINOLOGY

This activity aims to integrate, in a practical way, 25 NANDA-I diagnoses labels. It incorporates the steps of assessment and diagnosis from the Nursing Care Plan. The activity is implemented within small groups (4 to 5 students). Each group studies one single diagnosis label. Through collaborative learning, the different groups working together will better understand the 25 diagnostic labels. The activity is developed as follows:

  1. Once the NANDA-I nursing diagnosis label has been assigned by the professor, each group assesses the nursing diagnosis by identifying its defining characteristics and related factors, or risk factors.
  2. Each group designs a case scenario in which the diagnosis can be contextualized. The group also chooses an image that enables them to conceptualize and explain the diagnosis. The professor must validate the content of this phase before the group can move forward to the next step.
  3. Each group develops a short video where its members explain the diagnosis, using the following information:
    1. Diagnosis label with its definition
    2. Brief synthesis of the case scenario developed and the patterns identified
    3. Key data of the case scenario and their relationship to the defining characteristics and related factors/risk factors of the diagnosis
    4. Confirmation of the nursing diagnosis selected, based on the data
    5. Description and reasons behind the images chosen to reinforce the concept underlying the diagnosis
    6. The video must be submitted and validated by the professor
    7. Once validated, the group can present the video to the class, and share their discussions in the process.

ACTIVITY 3: FINAL PRACTICAL ASSESSMENT

This final activity consists of the assessment and improvement of the nursing plan of care developed by a classmate (anonymous). The student assesses and improves the plan of care developed by a classmate, using the assessment criteria and considering the following items/questions:

  1. Analysis of the suitability of the data gathered during the assessment. Do you think that all the functional health patterns have enough data to clearly identify the problem or nursing diagnoses? Which functional health patterns do you think are more relevant in this particular situation? Reflect on your answer.
  2. Assess if the focus of attention in the case is correct.
  3. Analyze the diagnostic hypothesis(es).
  4. Assess the clinical reasoning network. Do you think that the main diagnosis is correct? Should it be a different diagnosis in the care plan? Why or why not?
  5. Assess the NOC(s) identified, along with the indicators selected.
  6. Assess the NIC(s), along with the selected activities for individualized care.

DESCRIPTION OF THE SEQUENCE OF THE TEACHING STRATEGY

First, the longitudinal case scenario is introduced. The students use brainstorming to identify the data needed to develop a plan of care. This enables the introduction of the clinical reasoning process and the theoretical content related to the nursing assessment. Once this content has been integrated, the first practical activity is introduced: CLINICAL REASONING PROCESS: NURSING PLAN OF CARE (described above). This activity will be submitted and assessed by the professor before finalization of the content on the diagnostic process. In parallel to the development of the first practical activity, the theoretical content on the diagnostic process, NANDA-I taxonomy, and clinical reasoning networks are also introduced using the longitudinal case scenario that was shared at the very beginning.

Then, the second practical activity is initiated: NURSING DIAGNOSIS: NANDA-I TERMINOLOGY (described above). The rest of the work will be mentored by the professor outside classroom activities. The following sessions will keep advancing theoretical content: NIC and NOC taxonomies in the nursing plan of care.

Once this content has been integrated, the practical activity, CLINICAL REASONING PROCESS: NURSING PLAN OF CARE, (described above) can be continued and will be submitted one week before the end of the subject.

Subsequently, the presentation of the videos occurs within the activity, NURSING DIAGNOSIS: NANDA-I TERMINOLOGY. Before the subject is finished, a final review of the main content is shared following in-class practical exercises and games. 

In the final session of the Nursing Fundamentals subject, the assessment exercise is presented: FINAL PRACTICAL ASSESSMENT (described above). Each student will have 48 hours to conduct the revision of a classmate’s plan of care, and submit this to the professor.

STUDENTS’ EVALUATION OF THE COURSE

At the end of the subject, a quantitative evaluation should be conducted to consider the opinions of the students. Qualitative comments can also enable greater understanding of the quantitative metrics.

PROFESSIONAL PROFILE of ROSA RIFÀ ROS

Nursing professor; Postgraduate placement coordinator; Registered Nurse, Anthropologist, MSc and PhD in Nursing Science.

Nursing Basics Teacher in the Blanquerna School of Health Sciences-Ramon Llull University of Barcelona, Spain (1997 to present).

During her academic career as a nursing professor, Dr. Ros has had one primary focus: to teach nursing language and diagnoses to present and future generations of nurses, so it can be properly understood and applied in clinical practice. This idea, which she passionately defends, led her to constantly search for new teaching methodologies to introduce nursing students to NANDA International Nursing Diagnoses (NANDA-I), and the Nursing Intervention Classification (NIC) and Nursing Outcomes Classification (NOC) as professional languages, and the Outcome-Present State-Testing (OPT) Model (1-7) as a model for clinical reasoning. In 2021, Dr. Ros received the NANDA-I Mentor’s Award as recognition for her mentorship of students and nurses within Spain, and her dedication to the use, research and teaching of the NANDA-I terminology. We are pleased to share this innovative method Dr. Ros uses in her own classroom.

REFERENCES

  1. Pesut J, Herman J. Clinical Reasoning: The art & science of critical & creative thinking. Columbia: Delmar Publishers; 1999
  2. Pesut DJ. Clinical Judgment: Foreground/Background. Journal of Professional Nursing. 2001; 17 (5): 215. 
  3. Pesut DJ. Reflective clinical reasoning. A: Haynes L, Butcher HK, Boese T, ed. Nursing in contemporany society: Issues, trends anf transition into practice. Boston: Prentice Hall; 2004.p.146-62.
  4. Pesut DJ. 21st Century nursing knowledge work: Reasoning into the future. A Weaver CA, Deleney CW, Weber P, Carr RL, ed. Nursing informatics for the 21st century: An international look at practice trends and the futur. Chicago : Healthcare Information and Management Systems Society; 2006.
  5. Kautz DD, Kuiper RA, Pesut DJ, Williams RL. Using NANDA,NIC and NOC (NNN) Language for Clinical reasoning with the Outcome-Present State-Test (OPT) Model. International Journal of Nursing Terminologies and Classifications. 2006; 17(3): 129-38.
  6. Kautz DD, Kuiper R, Pesut DJ, Knight-Brown P, Daneker D. Promoting Clinical Reasoning in Undergraduate Nursing Students: Application and Evaluation of the Outcome Present State Test (OPT) Model of Clinical Reasoning. International Journal of Nursing Education Scholarship [revista on line] 2005. [Consultat el 9/10/2011]; 2 (1):1. Disponible a: http://www.bepress.com/ijnes/vol2/iss1/art1/
  7. Kuiper R, Pesut, DJ. Promoting cognitive and metacognitive reflective learning skills in nursing practice: Self-regulated learning theory. Journal of Advanced Nursing. 2004; 45 (4), 381-91.