Maintenance process

from Wikipedia, the free encyclopedia

As a nursing process in the professional is health and nursing a systematic working method for collecting, planning, implementation and evaluation of nursing interventions referred. This method , also known as the care control loop , is based on the assumption that care is a dynamic problem-solving and relationship process that can be controlled, among other things, via feedback processes. Depending on the model, the process comprises four to six phases that logically build on one another and influence one another. The phases of the care process are mapped in the legally required care documentation .

The nursing process was first described somewhat imprecisely by Lydia Hall around 1950, and then described more concretely by the nursing theorist Ida Jean Orlando in 1961 (nursing process theory). In 1967, Helen Yura and Mary B. Walsh from the United States also introduced the nursing process. Her theoretical work was based on approaches based on nursing theory as well as knowledge from systems theory , cybernetics and decision theory . In 1974 the nursing process was established as part of nursing work (nursing) by the World Health Organization (WHO) and is considered to be one of the few globally established work techniques in professional nursing. In Germany, the nursing process was in the 1985 nursing education was added. In Austria, who was nursing process in 1997 as part of professional actions in the health and medical care law incorporated in 2003 was followed by Germany with the codification of the nursing process as a teaching content in the elderly care training .

Definition and purpose

The definition of the nursing process is based on the assumption that nursing is based on the development of a relationship between the person being cared for and the carer. Those involved in this relationship process pursue a common goal, namely the problem solving for the care recipient or the compensation of problems that cannot be solved by the care provider. The development of common goals and solution strategies is called the problem-solving process. The nursing process should structure these two nursing processes and enable organized and holistically oriented, individual care. It is defined as a series of logical, interdependent and goal-oriented considerations, decision-making and action steps which, in the sense of a cyclical control loop, contain a feedback effect in the form of readjustment and assessment.

The care process, which is based on the problems, resources and skills of an individual in need of care, is intended to ensure the safety of the person being cared for and to involve them and their relatives in the care. By applying the nursing process, the technical continuity of the nursing process should be ensured and it should be ensured that the necessary information is available to all those involved. The care process should make care objectively assessable and thus ensure its quality. In addition, two things should be ensured through the documentation of the process: On the one hand, the services provided should be made transparent and comprehensible, and on the other hand, the quality of care should also be verifiable in the legal sense of preserving evidence.

Historical development of the nursing process

In the 1950s, as part of the development of nursing theory in the United States, questions arose as to a definition of nursing, its true nature and structure. These questions arose from a number of different approaches, including emphasizing the scientific aspect of nursing. The role model of care should be changed and professionalized. The caregiver's physical and psychosocial problems should be better identified in order to help manage them. This led to the idea of ​​looking at care as a process. The requirement to plan care and to carry it out in a verifiable manner manifested itself. As a result, a series of papers and reflections on the planning and structure of some aspects of systematic care appeared; Helen Yura and Mary B. Walsh mention the work of Hildegard Peplau , Lydia Hall , Dorothee Johnson and Ida Jean Orlando in particular . As one of the co-founders of the process concept, the latter published the book The Dynamic Nurse-Patient Relationship: Function, Process and Principles of Professional Nursing Practice in 1961 , in which she described the elements of the nursing process and emphasized the importance of the nurse's participation in the nursing process. In 1967, Yura and Walsh published the first comprehensive work on the nursing process: The Nursing Process: Assessing, Planning, Implementing, Evaluating . In addition to knowledge of nursing theory, the authors cited systems theory , cybernetics and decision theory as the basis . The method spread throughout the United States in the 1970s, and the four-phase model described by Yura and Walsh was adopted in a slightly modified form by the World Health Organization (WHO) in 1974 and established as part of professional activity in nursing.

In German-speaking countries, Liliane Juchli presented the nursing process based on Virginia Henderson's theory in her standard didactic work for the first time in German-speaking nursing. In 1981, the Swiss Verena Fiechter and Martha Meier took up the concept and developed a six-phase model from it, which they published as the first German-language monograph on the nursing process (nursing planning: a guide for practice) . In 1985, the individual components of the nursing process were included in the German Nursing Act as training goals for nurses . With the introduction of the common principles and standards for quality and quality assurance according to § 80 of the Eleventh Book of the Social Security Code , the application of the care process and the corresponding care documentation in all German care facilities became mandatory in 1996. In Austria, the nursing process was legally anchored in the Health and Nursing Act in 1997 and, analogous to the medical process, is defined there as the independent activity of qualified nurses with responsibility for order and implementation. The professional and competent application of the nursing process by nursing staff became compulsory in Germany in 2003 under the term Planned Care in the Geriatric Care Act and in 2004 in the Nursing Act.

Nursing process models

A nursing process model represents an abstract procedure for problem solving and provides an analytical model of action which only becomes process-related and job-specific through a concrete nursing situation. Models with four, five or six phases are widespread; the terms used for the individual phases are not uniform.

Four-phase model

Graphic representation of the four-phase nursing process model

The model, which is divided into four phases or steps, is used and propagated by the WHO. In this model, nursing diagnoses can be used in the second phase, with which a standardized naming of the nursing needs and the assignment of nursing activities is made possible. However, the model allows the, in many cases disadvantageous, individual formulation of nursing problems in cases in which a diagnosis is not possible or not customary in the country. In German-speaking nursing science, this four-step model has been gaining in importance since the mid-1990s , among other things through the work of Monika Krohwinkel , and is increasingly gaining ground in nursing practice against the six-step model introduced in 1981.

It is divided into the phases:

  • Assess care needs : Assessment - collection of all care-related information
  • Creating a care plan: Planning - making a care diagnosis or determining the care problems and resources; Establishing the care goals and planning the care measures
  • Execute Care Plan: Intervention or Implementation - Practical implementation of care
  • Assess the effect and quality of care: Evaluation - review of the achievement of goals and the quality of care

To facilitate the integration of nursing diagnoses in Germany, Heuwinkel-Otter, Nümann-Dulke, Matscheko developed a modification of the 4-phase model of the WHO in the standard work “People care” . Phase 1: Nursing diagnostics (nursing diagnostic process) - collecting information, including resources (by means of discussions, examinations, measurements, etc.) - analyzing, interpreting information - synthesizing (bundling) information - naming clusters of labels, formulating nursing diagnoses (suspected diagnosis and / or final) 2 Phase: Nursing therapy Define nursing goals and direction (activating, constant, palliative, coordinating and preventive) Plan nursing measures Implement nursing measures (including prevention, health advice ) 3rd phase: Nursing evaluation Evaluate the success of nursing therapy based on the situation of the person in need of care, e.g. B. State of health, change in behavior. Phase 4: Maintenance Adjustment Adjust the care therapy, due to a changed situation of the patient (it is the person better or worse), unsuccessful maintenance therapy, a new nursing knowledge, new scientific evidence.

Five-phase model

The five-phase or five-step model, which is predominantly used in North America, contains the diagnosis phase as an additional step after the assessment. The model represents a variant of the WHO model expanded by the North American Nursing Diagnosis Association (NANDA). The newly created level is used to make a nursing diagnosis from the information obtained in the first phase. The purpose of this extension was to emphasize the importance of well-founded nursing diagnoses and their application in the nursing process, which enable a more precise assignment of the necessary nursing measures. Similar to the diagnosis-related case groups , the use of standardized nursing diagnoses facilitates the billing and evaluation of nursing interventions.

Six-phase model

Graphical representation of the maintenance process according to Fiechter / Meier

The six-phase model was developed by Fiechter and Meier and is the most widespread nursing process model in German-speaking countries due to its early introduction. The aim of this model is to create an individual care plan for a specific patient or person in need of care based on an inductive process , in which conclusions can be drawn about the underlying care problems based on the information received.

It consists of the following steps:

  • Information collection: Nursing anamnesis and assessment - collection of all care-related information
  • Identifying Problems and Resources : Nursing Diagnosis - Making a nursing diagnosis or identifying the nursing problems and resources
  • Establishing the care goals
  • Care planning: planning of care measures
  • Implementation of the measures: Implementation - Practical implementation of the maintenance
  • Assessment of the care carried out: Evaluation - review of the achievement of goals and the quality of care

Nursing evaluation

The individual phases of the maintenance process can vary in duration, sequence, overlap and term, but they can still be identified, examined and analyzed. According to Yura and Walsh, neither the choice of model nor the terminology play a role in the nursing result.

Despite this observation, a trend towards the four-phase WHO model developed and developed worldwide. In contrast to the five- and six-phase model, in the second phase of the four-phase model, nursing diagnoses can be used both with and without a classification system, but it still allows the free formulation of nursing problems, which is common in some countries. It is superior to the six-phase model according to Fiechter and Meier, which is still frequently used in the German-speaking area, in terms of logic and because of a more clearly defined terminology. In contrast to the five-level system, which explicitly provides for the incorporation of a nursing diagnosis, in the model according to Fiechter and Meier there are no nursing diagnoses or nursing science-based taxonomic classifications according to NANDA Taxonomy II , NIC or NOC . The nursing staff must therefore describe the nursing problems identified in the information collection independently and assign them the appropriate nursing measures. In the opinion of the medical service of the umbrella associations of the health insurance funds , this model therefore places high demands on the professional competence of the nursing staff and requires analytical and communication skills as well as social competence. In order to establish these skills, some of which are lacking, in German nursing, since 2007, as part of the nursing education offensive of the German Education Council for nursing professions, among other things, an adjustment of the quality level of training to European and international conditions has been formulated. It turns out to be disadvantageous that the free formulation not only makes it more difficult to settle uniformly, but also hinders the exchange of data between the sectors. For example, cross-institutional communication in the event of relocations or the use of care documentation for statistical or nursing studies is made more difficult.

The most well-known care classification systems for mapping the components of the care process in German-speaking countries are as follows:

  • Practice-oriented nursing diagnostics (POP) classifies nursing diagnoses according to a resource model

There are numerous other nursing classification systems around the world which describe nursing diagnoses, goals and measures and could be used for nursing process documentation.

Tabular comparison

The position of nursing planning in the various nursing process models can be compared in a table:

Four-phase model Five-phase model Six-phase model
Assessment (information gathering and nursing diagnosis) Assessment (information gathering) Information gathering
- Diagnosis (nursing diagnosis) Recognition of resources and care problems (analogous to care diagnosis)
Planning (care planning) Planning (care planning) Definition of goals (first part of care planning)
- - Planning of measures (second part of care planning)
Implementation / intervention Implementation / intervention execution
Evaluation Evaluation Evaluation

Phases of the nursing process

Information gathering

In all nursing process models, the cyclical control loop is based on the assessment of nursing needs. In this step, the care-relevant information is collected using various methods. As a rule, the first contact between the carer and the person in need of care takes place during the admission interview. The interview has a targeted care history, in which the master data, the physical and psychological state and the lifestyle of the person in need of care are recorded. The anamnesis can be structured using checklists and various nursing assessment instruments . Additional sources of information include information from relatives, previous care plans, medical history, and observations from other professional groups. Based on a different understanding of the importance of nursing diagnostics for the quality of nursing care, a physical examination is usually carried out by the nurse outside of the German-speaking area, during which any nursing-related restrictions are diagnosed. The care problems, risks, resources and care goals are formulated from the results of this collection of information. The PESR format derived from nursing diagnostics can be used to precisely describe individual nursing problems. A native of the English abbreviation stands for PESR P roblem, E tiology, S ymptom, R Escource, the German variant, the E is assigned to the factors / causes. It is necessary to thoroughly grasp and assess the initial situation in order to enable the following steps in the nursing process. The collection of information is never completed, however, since information that subsequently becomes known can lead to the determination of new care priorities.

In the five-phase model, this phase is split up. In the first step, the pure information collection takes place; in the second step, recognized care problems are assessed and described. The six-phase model according to Fiechter and Meier also separates the collection of information and the identification of problems and resources into individual phases.

Care planning

Together with the person in need of care, as part of the care planning process, it is determined what need and scope the care should have, based on the resources and habits of the person concerned as well as the institutional possibilities. Nursing goals are defined, which are based on the focal points of the nursing problems identified in the anamnesis, and corresponding nursing priorities are set. According to Fiechter and Meier, a subdivision into long-term long-term goals and smaller, more easily achievable sub-goals makes sense, but all goals should be formulated in such a way that they are achievable and verifiable. Heath and Law define care goals in this context as “A goal is what you, the patient, or even their family hope to achieve. This should be the basis for the later evaluation “In the six-phase model according to Fiechter and Meier, this part of the planning phase forms an independent third phase, while in the other models it is related to the planning of the measures.

In order to achieve the defined care goals, the necessary care interventions are planned by the caregivers and those in need of care. These actions, also known as nursing measures, are defined as the application of nursing and interpersonal skills, the instruction and advice of the care recipient, and the organization and delegation of the work. In addition to the needs and resources of the person in need of care and their relatives, the institutional framework such as the number of staff and care products are taken into account during planning. The measures must be precisely, unambiguously and comprehensibly formulated, the parameters type, quality and time intervals of the measures must be described; as a motto is also used here: "Who, what, with what, when, how often". If care standards or expert standards are defined, it is sufficient to specify them. In Germany, the short descriptions of full takeover (VÜ), partial takeover (TÜ), support (U) and advice, guidance and supervision (BA) for the specification of the scope of care are common and correspond to the description of the care measures and the following documentation underlying legal requirements. The planning has the character of a care ordinance and is binding for everyone involved in care.

execution

The care is carried out on the basis of the care planning. Heath and Law emphasize the consideration of institutional conditions at this stage; The practical implementation is influenced by external circumstances such as time, staffing levels and necessary aids as well as by the individual feelings and changes in condition of the care recipient or by the care result. During the implementation of the care plan, the individual process phases overlap: Observed reactions of the person in need of care lead to corresponding modifications of the planning, care problems can arise again, be solved or lead to a reassessment of priorities due to a change in urgency. These necessary adjustments to changed circumstances or new information are incorporated into the care process and this is adapted to the current needs of the person being cared for.

The need to start and enforce the implementation according to the planning is referred to as enforcement in production technology or service theory. This is not common in nursing. Such consistent implementation of planning will only succeed if the planning depicts the process with sufficient accuracy and takes the actual requirements into account. For a successful implementation of the planning, the initial assessment to determine the specifications and the repeated evaluation for feedback from the nursing process are decisive. The few text analyzes of the plans and reports on the implementation of the maintenance that have existed so far are of interest .

evaluation

In the last phase of the nursing process, which is also referred to as evaluation, assessment or evaluation, the control loop closes with feedback. By means of a target / actual analysis of the care result, this phase enables further care to be adapted to the actual care needs and evaluates its quality. For this purpose, the care reports are evaluated, the person in need of care is observed, and assessment instruments and objective measurement criteria are used. If the care result does not match the specified care goal, it is determined why the goal was missed. Possible reasons can be incomplete information collection, a misjudgment of the initial situation or the need for care, an overly optimistic setting of the care goal or the planning of inappropriate care measures. The care plan is then adapted to the actual situation, care goals achieved lose priority, new goals or goals that have not been achieved are formulated, planned and prioritized.

Without sufficient information collection and without regular updating of the planning, the implementation may start incorrectly at the beginning and later the planning becomes outdated as the process progresses so that only a new planning provides a valid working basis for the implementation. As long as the evaluation follows the implementation without delay, this divergence of process and plan can be avoided by progressive correction of the planning on the basis of the last evaluation.

Practical nursing implementation

The nursing process as a working method is considered to be the highest available level of development in countries with an academic nursing education as being introduced across the board. It is particularly deeply rooted in the Anglo-American countries. The nursing process is used there already in training to nursing core skills such as communication, analytical self-reflection , creative problem solving and critical thinking (Engl. Critical Thinking ) to develop. In addition, the nursing process in nursing research serves as the basis for researching, testing and developing further concepts. Examples include the progress in the perception of nursing influences in the Clinical Pathway , the connection of the nursing process with the case management and care diagnostics and the trade policy and the nursing research process (Engl. Nursing research process ), which refers to the results of nursing interventions in a macrocosm concerns . For countries that are less developed in nursing science, the implementation has only partially arrived in everyday nursing care. In Germany, where the nursing process is required by law, its implementation is considered problematic and has not yet been introduced, understood and implemented across the board in nursing practice. Deficiencies in the professional framework are responsible for this, for example a lack of nursing staff, deficits in training and further education as well as problems in the institutional implementation of nursing models or documentation systems.

Value orientation of care on outcome

The central criterion for updating the planning of the nursing processes must be the outcome for the patient, not primarily cost optimization or consideration of existing capacity bottlenecks. At first sight, this seems problematic; in fact, such a value orientation on the outcome will work more economically and efficiently according to the concept of Beyond Budgeting and thus better serve the patient, the care team and the facility.

Newer methods show that experiences from customer service can be transferred well to clinical care. Instead of a mechanistic control of the processes, the value-oriented approach is pursued. This is all the more true as the qualification of the nursing staff is increasingly structured for reasons of cost and therefore the management of the differently qualified nursing staff is gaining in importance.

Care content orientation

Various authors agree that the care content orientation is meaningless for the application of the care process. It is not itself a nursing model or content- related nursing theory , but merely a working method that can be transferred to existing nursing principles and applied nursing models. However, alongside other authors, Nancy Roper , Winifred Logan and Alison Tierney called for the successful adaptation of a care model to everyday care in order to be able to apply the care process successfully. Studies have shown that the contentless transfer of the nursing process to practice actually has an impact on the efficiency of the method.

The focus of the survey on different care models and the care problem they identified can make this clear. The problem, which is presented in a very simplified table, relates to the inpatient admission of an overweight person in need of care without taking into account the cause that could cause weight gain.

Care model used Survey focus method Observation / statement Detected maintenance problem
R / L / T model (adaptation according to Liliane Juchli ) ATL criterion : Eating and drinking Checklist Weight control Measured weight does not correspond to the BMI
Orem self-care Self-care deficit Anamnesis interview, observation Objectively and subjectively, patient ingests too much food Measured weight does not correspond to the BMI after weight control
Transcultural care according to Leininger Socio-cultural backgrounds Anamnesis interview, observation The patient does not feel accepted with his weight within his social environment Measured weight does not correspond to the BMI after weight control

Application of a care system

One of the prerequisites and at the same time objectives of the nursing process is the holistic perception of the care recipient in the relationship process. In practice, this means that the choice of the care system must be a reference care system. In such systems, the caregiver and the person in need of care are assigned to one another and a continuous relationship development as well as a comparative observation of the condition are made possible. It is irrelevant whether reference care is used according to the German understanding of group care or Anglo-American primary nursing . In contrast to this, within the pure functional maintenance, the tasks are distributed on the basis of professional competence in a task or activity-oriented manner . As a result, a defragmentation of the maintenance process can be observed, which makes a meaningful application in practice impossible.

Detection systems

A prerequisite for the management of the nursing staff and the documentation of the service provided is good support for recording the incremental service information. It should be noted that both requirements serve to prevent uncertainty among staff and to replace control by bystanders with an automatic reporting procedure. Both promote the motivation of the performers and reduce their stress levels. Modern solutions convey a good perception of such support and independence. This increases motivation across all qualification groups.

Documentation systems

In order to map the nursing process in a comprehensible manner for the nursing staff, the documentation systems resulting from the legal requirement of planned nursing must both cover the documentation requirements and be adaptable to existing nursing models, models and theories. In practice, this has failed in many cases because external companies without knowledge of nursing science were commissioned to develop corresponding written or virtual systems. From this initial situation, focal areas that did not correspond to the nursing process in some cases resulted in direct documentation requirements. The overestimation of physical problems and the assessment can be observed, for example through the integration of assessment instruments. Progress reports, evaluation, psychosocial aspects and the perspective of the person in need of care are underrepresented.

Nursing education

As one of the main reasons for the inadequate or often empty implementation of the nursing process and only related to the documentation, deficiencies in nursing education in particular are named. The equation of the nursing process and nursing planning, which is widespread in German nursing practice, can primarily be traced back to the lack of teaching of nursing science and academic principles during and after nursing training. This includes, among other things, the inadequate communication of the connection between the nursing process and the respective nursing documentation in nursing practice. It is often assumed that the maintenance process as such takes place when the documentation system has to be filled out as required by law.

Influence on the quality of care

Studies have shown that the improvement in the quality of care through the introduction of the care process, initially only perceived intuitively by caregivers, can also be objectively demonstrated. In addition to a large number of verifiable studies from the United States, there are also some nursing studies in Europe that come to the same result. A number of other quality-influencing criteria that go hand in hand with the implementation of the nursing process, such as the full implementation of a nursing mission statement and adapted documentation systems, lead to a significant improvement in the nursing results. This applies in particular to long-term care: those affected stated that they felt more individualized and that they talked to the caregivers more often. In her study, Krohwinkel was able to demonstrate that isolation, dependency and uncertainty increased without the use of the nursing process. In other studies, the rates of the identified nursing problems have objectively improved in relation to the actually present ones; the target achievement rate rose significantly in the area of ​​easy-to-achieve nursing goals. At the same time, Andrey Miller was able to demonstrate in a study in geriatric nursing homes that those affected who are cared for systematically according to the nursing process are less incontinent, show less dependent behavior and work more actively with care. The result depends on the willingness of the care recipient to cooperate . In the area of ​​short-term hospital stays, however, no significant improvement in the quality of care could be demonstrated.

Metatheoretical analysis

Within the international and national nursing science and nursing research, the meaning and use of the nursing process is questioned and the limits of its effectiveness are discussed. Various approaches can be identified, which are guided by acceptance and implementation in practice and the basic understanding of nursing. Among other things, it is criticized that the nursing process is not a working method originally derived from nursing practice and therefore elements of nursing activity that are perceived as important, such as intuition and experience, are reduced. The instrumentalized and rationalized approach within the application is called into question, which makes it difficult to find meaning in a job. In the Anglo-American, strongly theory-based nursing, additional questions arise that deal with the further development of nursing on the basis of the nursing process or question the nursing process as a conceptual obstacle to further nursing research activity. In Grove's view, the isolation of individual care problems in favor of a comprehensive care understanding of what is being cared for leads to a narrower view of care, which loses sight of macrocosmic and macroeconomic aspects and thus hinders the further development of care. Basically, despite critical consideration, the nursing process is not in doubt as the core of professional nursing activity; the demands are to clarify the systematic foundations that form the starting point of the nursing-scientific criticism.

literature

  • Anette Heuwinkel-Otter, among other things: nursing diagnoses, observation techniques, nursing measures. (People care, Volume 2)., Springer, Berlin 2006, ISBN 3-540-29433-3 .
  • Anette Heuwinkel-Otter among others: Caring for people. Care diagnoses for the smock pocket. Springer MedizinVerlag, Heidelberg 2011, ISBN 978-3-642-01318-8 .
  • Ruth Brobst et al: The nursing process in practice. Hans Huber, Bern 1997, ISBN 3-456-83553-1 .
  • Verena Fiechter, Martha Meier: Care planning. Recom, 1998, ISBN 3-89752-063-X .
  • Liliane Juchli: Thiemes care. 9th edition. Thieme Verlag, Stuttgart 2000, ISBN 3-13-500009-5 .
  • Manfred Hülsken-Giesler: The access to the other: For the theoretical reconstruction of professionalization strategies of nursing action in the field of tension between mimesis and machine logic. (Nursing Science and Nursing Education, Volume 3). V&R unipress, 2008, ISBN 978-3-89971-373-2 .

Journal articles:

Web links

Individual evidence

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  2. ↑ Appendix 1 to Section 1, Paragraph 1, Item A. 1.2. Elderly Care Training and Examination Ordinance of November 26, 2002, Federal Law Gazette I, pp. 4418, 4423.
  3. ↑ Verena Fiechter, Martha Meier: Care planning. Recom, 1998, ISBN 3-89752-063-X , p. 31.
  4. ↑ a b Monika Krohwinkel : The nursing process using the example of apoplexy sufferers: A study on the recording and development of holistic rehabilitation process nursing. Nomos Verlagsgesellschaft, 1993, p. 28.
  5. ↑ a b c d e Medical Service of the Central Associations of the Health Insurance Funds (Ed.): Policy statement on the care process and documentation - recommendations for action for professionalization and quality assurance in care. April 2005. Available online at: Nursing Process ( Memento from February 28, 2013 in the Internet Archive ) ( PDF ; 1.7 MB)
  6. ↑ Karin Wittneben, 1991, quoted in Maria Mischo-Kelling, Henning Zeidler : Internal Medicine and Nursing. 2. revised Edition. Urban and Schwarzenberg, Munich 1992, ISBN 3-541-13892-0 , pp. 2-6.
  7. ^ A b c Maria Mischo-Kelling, Henning Zeidler: Internal medicine and nursing. 2. revised Edition. Urban and Schwarzenberg, Munich 1992, ISBN 3-541-13892-0 , pp. 2-6.
  8. ^ Afaf Ibrahim Meleis , 1985, quoted in Maria Mischo-Kelling, Henning Zeidler: Internal medicine and nursing. 2. revised Edition. Urban and Schwarzenberg, Munich 1992, ISBN 3-541-13892-0 , p. 2.
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  10. ↑ Ann Marriner-Tomey : Nursing theorists and their work. Recom, 1992, ISBN 3-315-00082-4 , p. 346.
  11. ^ Helen Yura, Mary B. Walsh: The Nursing Process: Assessing, Planning, Implementing, Evaluating. Appleton-Century-Crofts, 1967.
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  13. ↑ Liliane Juchli: Nursing - Practice and theory of health promotion and care of the sick. known under the term “Die Juchli”, Thiemes Pflege since 1997 : the textbook for nurses in training. 11th edition. Thieme Verlag, 2009, ISBN 978-3-13-500011-4 .
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  16. ↑ § 3 sentence 2 No. 1 APflG
  17. ↑ § 3 Paragraph 2 KrPflG
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  21. ^ Nancy Roper: Nursing Principles in the Nursing Process. Hans Huber, 1997, ISBN 3-456-82776-8 , p. 14 f.
  22. ↑ Explained in Verena Fiechter, Martha Meier: Care planning. 10th edition. Recom Verlag, 1998, ISBN 3-89752-063-X .
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  24. ^ Lothar Ullrich: Thiemes intensive care and anesthesia. Georg Thieme Verlag, 2006, ISBN 3-13-130910-5 , p. 22.
  25. ^ German Education Council for Nursing Professions: Nursing Education offensively: The educational concept of the German Education Council for Nursing Professions. Elsevier, Urban & Fischer Verlag, 2007, ISBN 978-3-437-28250-8 , pp. 5-7, 24-29.
  26. ^ Deutscher Pflegeverband: Specialist information from the German care association eV - Pflegediagnosen. available online under nursing diagnoses ( PDF )
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  28. ↑ NANDA-International: NANDA I Nursing Diagnoses Definitions and Classification 2012–2014. RECOM Verlag, Kassel 2013.
  29. ^ S. Moorhead, M. Johnson, M. Maas, E. Swanson (Eds.): Nursing Outcomes Classification (NOC): Measurement of Health Outcomes. 5th edition. Elsevier, St. Louis, MO 2013.
  30. ↑ GM Bulechek, HK Butcher include: Nursing Interventions Classification (NIC). 6th edition. St. Louis, Missouri 2013.
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  32. ↑ Gabriele Vitt: Care quality is measurable. Schlütersche, 2002, ISBN 3-87706-684-4 , pp. 26-27.
  33. ↑ Petra Keitel, Christian Loffing (ed.): Action- oriented care documentation. Kohlhammer, 2007, ISBN 978-3-17-019302-4 , pp. 33-37.
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  36. ^ A b Nicole Menche: Repetition Care Today. Elsevier, Urban & Fischer Verlag, 2006, ISBN 3-437-27840-1 , pp. 40-41.
  37. ↑ Ruth Brobst et al: The nursing process in practice. Hans Huber, Bern, 1997, ISBN 3-456-83553-1 , p. 128.
  38. ↑ H. Jung-Heintz: Basics and steps of the nursing process. In: Liliane Juchli: Thiemes care. 9th edition. Thieme Verlag, Stuttgart 2000, ISBN 3-13-500009-5 , p. 133.
  39. ↑ See for example Susan K. Grove: The practice of nursing research: conduct, critique, and utilization. Elsevier Health Sciences, 2005, ISBN 0-7216-0626-1 , pp. 21-23 and Lois White: Foundations of nursing. Cengage Learning, 2005, ISBN 1-4018-2692-X , pp. 128-139.
  40. ↑ Kathrin Engel: Quality assurance in inpatient care facilities: The use of the Resident Assessment Instrument RAI 2.0 as a quality instrument. W. Kohlhammer Verlag, 2008, ISBN 978-3-17-020065-4 , pp. 32-33.
  41. ↑ a b Gabriele Vitt: Care quality is measurable. Schlütersche, 2002, ISBN 3-87706-684-4 , p. 25.
  42. ↑ [1]  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Dead Link / www.ehealth-impact.org  
  43. ↑ See: Meike Schwermann, Markus Münch: Professional pain assessment in people with dementia: A guide for nursing practice. W. Kohlhammer Verlag, 2007, ISBN 978-3-17-019850-0 ; Angela Paula Löser: Evaluation - Evaluation of the nursing process: Evaluation procedure for the process-based design of nursing. Schlütersche, 2006, ISBN 3-89993-163-7 , p. 107 and Barbara Kozier: Fundamentals of nursing: concepts, process and practice. Pearson Education, 2007, Volume 2008, Part 2, ISBN 978-0-13-197653-5 , pp. 25-26.
  44. ^ Nancy Roper, Winifred Logan, Alison Tierney: The Elements of Nursing. Recom, 1993, ISBN 3-315-00086-7 , pp. 63 f.
  45. ↑ Markus Lotz: On the language of fear: A study on the interaction in the nursing admission interview. Mabuse-Verlag, 2000, ISBN 3-933050-61-8 .
  46. ↑ Sabine Walther: Query ?! Initial nursing discussions in the hospital. Huber, Bern 2001, ISBN 3-456-83657-0 .
  47. ↑ See Nicole Menche: Repetitorium Pflege Today. Elsevier, Urban & Fischer Verlag, 2006, ISBN 3-437-27840-1 , p. 38.
  48. ^ Achim Uhl: Quality development of social and health services for people with care and support needs. LIT Verlag, Münster 2008, ISBN 978-3-8258-1770-1 , pp. 108-109.
  49. ↑ Thorsten Bücker: Team organization with primary nursing: A systemic organizational development approach in the hospital. Schlütersche, 2006, ISBN 3-89993-155-6 , pp. 42–45.
  50. ↑ Barbara Schmidt-Rettig, Siegfried Eichhorn: Hospital management theory: theory and practice of an integrated concept. W. Kohlhammer Verlag, 2007, ISBN 978-3-17-019914-9 , pp. 326-327.
  51. ↑ Registration and release facility
  52. ↑ Sabine Bartholomeyczik , Maria Morgenstern: Quality dimensions in care documentation - a standardized analysis of documents in nursing homes. In: Care. 17 2004, pp. 187-195.
  53. ↑ Birgitt Budnik, Reinhard Lay: Care planning made easy: for health care and nursing. Elsevier, Urban & Fischer Verlag, 2005, ISBN 3-437-26952-6 , pp. 20-22.
  54. ↑ a b Results published in E. Rath, U. Biesenthal: Care planning and care documentation. In: Care magazine. Kohlhammer, Ed. 12/1994, Vol. 47, ISSN  0945-1129 , pp. 2-13.
  55. ↑ Monika Krohwinkel: The nursing process using the example of apoplexy patients: A study on the recording and development of holistic rehabilitation process nursing. Nomos Verlagsgesellschaft (study based on the AEBDL structural model)
  56. ↑ Gabriele Vitt: Care quality is measurable. Schlütersche, 2002, ISBN 3-87706-684-4 , pp. 65-76. (Study as part of the self-care model)
  57. ↑ Cf. Olivia Dibelius, Charlotte Uzarewicz: Nursing Science versus Nursing Management? In: Andreas Kerres, Bernd Seeberger (Hrsg.): Textbook Pflegemanagement. Springer, 2001, ISBN 3-540-41311-1 .
  58. ↑ See Susan K. Grove: The practice of nursing research: conduct, critique, and utilization. Elsevier Health Sciences, 2005, ISBN 0-7216-0626-1 , pp. 21-23.
This version was added to the list of articles worth reading on June 9, 2010 .