Assessment and n
During the assessment phase, the nurse perceives
the patient according to the presenting subjective
and objective data. She then makes judgments
and forms mental actions based upon her
perceptions. Reaction to the above process results
in the formulation of nursing diagnoses.
Before incorporating these diagnoses into the
plan of care, the nurse must interact with the
patient to ensure that he perceives the same
strengths and problems. Tliis is a critical point in
the nursing process because planning evolves
from the nursing diagnoses. If there is concensus
at this phase, then mutual goal setting can
proceed.
In the diabetic outpatient department the
nurse's assessment reveals that David's blood
sugars are presently within normal range, and he
can successfully adminster his own insulin. However
David does not have any knowledge of diabetes
and its resulting lifestyle adjustment. The
nurse perceives that enrollment in the patient
education programme is needed, however before
proceeding she checks her perceptions with the
patient. David confides that he has heard that
diabetes causes impotence and he is most
anxious and concerned about this. Based upon
this nurse-patient interaction involving shared
perceptions, mutually agreed upon nursing diagnoses
are established. These are as follows:
anxiety related to perceived threat of impotence;
knowledge deficit related to the management of
diabetes mellitus; and active role in health maintenance
evidenced by proper administration of
insulin.
It is important to diagnose strengths, not just
problems (Martens 1986, Houldin et al. 1987). If
strengths and resources are identified, then the
patient and nurse can build on strengths to
overcome future problems.
The nurse and David prioritized the nursing
diagnoses. Anxiety was listed as the most important
diagnosis, because until David's anxiety
is decreased, learning will be imp>eded.
Planning and implementation
Based upon the above nursing diagnoses, the
nurse and David set the following goals.
1 David will report an increase in psychological
and physiological comfort.
2 David will be able to describe the disease
process of diabetes, the causes and factors
contributing to symptoms, and procedures
for management and control.
3 David will continue to administer his insulin
safely and will keep his blood sugars within
normal limits.
This setting of goals is the first step of the
planning process (Stanton et al. 1980). Transaction
occurs between the patient and nurse.
They bargain, negotiate and exchange information,
leading to the establishment of mutuaUy