Kasumi Mikami¹, Ryoko Tsuchiya², Keiko Aizu¹, Yoshiko Nishizawa¹

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¹ Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan.
² Hirosaki University School of Medicine & Hospital, Hirosaki, Japan.
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Abstract: Aims: The purpose of this study was to clarify the thought processes of nurses in performing nursing assessment. Methods: The participants comprised 20 nurses working in a surgery ward. Patient information on a case, including presenting illness, vital signs, and other findings from admission until 09:00 on the day after surgery, was shown to the participants. After reading the case report, the nurses presented their assessments. Based on these assessments, nursing problems, patient strengths, and patient information were identified. Nursing problems and patient strengths were described by various words and sentences, and were classified according to similar content. Results: The number of nursing problems ranged from 1 to 8 and patient strengths from 0 to 6 for each nurse. The mean number of nursing problems was 4.7 ± 1.8, and the mean number of patient strengths was 2.2 ± 1.4. The main nursing problems were respiratory complications, postoperative wound pain, and anxiety, and the main patient strength was family cooperation. Patient information as evidence of respiratory complications included history of smoking, chest radiography results, postoperative vital signs, sputum color and properties. Patient information as evidence of postoperative wound pain included complaints of pain, epidural anesthesia, use of patient-controlled anesthesia and its effect. Patient information indicating family cooperation included family structure, preoperative visits by family, and presence of family while providing informed consent. Significant differences were seen in the number of nursing problems and patient strengths according to cognitive style. Conclusions: Postoperative complications were the nursing problems most commonly extracted by nurses. To clarify nursing problems and patient strengths, the nurses made assessments on the basis of information such as patient complaints, vital signs, and test results. However, extracted nursing problems and patient strengths were diverse, suggesting that nursing problems and patient strengths as determined by nurses differed between individual nurses.

Keywords: Nursing Assessment, Thought Process, Patients, Nursing Problems, Patient Strength

Cite this paper: Mikami, K. , Tsuchiya, R. , Aizu, K. and Nishizawa, Y. (2014) Thought Processes of Nurses in Nursing Assessment: Analysis of Nursing Problems and Patient Strengths, Patient Information. Open Journal of Nursing, 4, 991-1003. doi: 10.4236/ojn.2014.413106.

References

[1]   Yura, H. and Walsh, M. (1984) The Nursing Process: Assessing, Planning, Implementing, Evaluating. In: With Its Translation Supervised by Ikuko Iwai, Mitsuko Ina, 3rd Edition, Igaku-Shoin Ltd., Tokyo.

[2]   Alfalo-LeFevre, R. (2014) Applying Nursing Process: The Foundation for Clinical Reasoning. 8th Edition, Wolters Kluwer Health, Philadelphia.

[3]   Kim, H.S., Schwariz-Barcott, D., Tracy, S.M., Fortin, J.D. and Sjöström, B. (2005) Strategies of Pain Assessment Used by Nurses on Surgical Units. Pain Management Nursing, 6, 3-9.
http://www.sciencedirect.com/science/article/pii/S1524904204001596#
http://dx.doi.org/10.1016/j.pmn.2004.12.001

[4]   Matsunami, M., Hirose, C., Kojima, M., Hori, M., Kinoshita, E. and Nakagawa, C. (2003) Evaluation of Methods Used to Collect and Apply Initial Information. Journal of Japan Society of Nursing Diagnosis, 8, 42-50.

[5]   Hoffman, K.A., Aitken, L.M. and Duffield, C. (2009) A Comparison of Novice and Expert Nurses’ Cue Collection during Clinical Decision-Making: Verbal Protocol Analysis. International Journal of Nursing Studies, 46, 1335-1344.
http://www.sciencedirect.com/science/article/pii/S0020748909001266
http://dx.doi.org/10.1016/j.ijnurstu.2009.04.001

[6]   Iitsuka, M., Kamota, R., Watanabe, Y. and Saitoh, K. (2011) Floor Nurses’ Clinical Judgments for Perioperative Patients. Bulletin of Fukushima School of Nursing, 13, 1-10.
http://ir.fmu.ac.jp/dspace/bitstream/123456789/244/1/BullFukushimaSchNurs_13_p1.pdf

[7]   Lachmanm, R., Lachman, J.L. and Butterfield, E.C. (1990) Cognitive Science & Information Processing. In: With Its Translation Supervised by Youji Hakoda, Koutarou Suzuki, Saiensu-Sha Co., Ltd., Tokyo.

[8]   Yamazaki, A. (1994) Study on Scanning Stratagem about Reflectivity and Impulsivity Cognitive Style. Kitaooji-Syobo, Kyoto.

[9]   Shigemi, S. (2004) Learning and Educating in Paper Patient. 28 Cases. Igaku-Shoin Ltd., Tokyo.

[10]   Takigiki, K. and Sakamoto, A. (2011) A Scale of Reflectivity-Impulsivity Cognitive Style. In: Hori, H., Ed., Collection of Psychological Measurements, Saiensu-Sha Co., Ltd., Tokyo, 195-198.

[11]   ganjoho.jp (2014) Cancer Statistics. http://ganjoho.jp/public/statistics/pub/statistics01.html

[12]   Onishi, C. and Akimoto, N. (2014) Adult Nursing Science, the Operation Period Nursing Theory. 3rd Edition, Nouvelle Hirokawa, Tokyo.

[13]   Herdman, T.H. (2012) NANDA International. In: Herdman, T.H., Ed., Nursing Diagnoses: Definitions & Classification, Wiley-Blackwell, Chichester.

[14]   Canobbio, M.M. (2000) Mosby’s Handbook of Patient Teaching. Mosby, St. Louis.

[15]   Gordon, M. (2008) Assess Notes Nursing Assessment & Diagnostic Reasoning. F.A. Davis Company Press, Philadelphia.

[16]   Cioffi, J., Conwayt, R., Everist, L., Scott, J. and Senior, J. (2009) “Patients of Concern” to Nurses in Acute Care Settings: A Descriptive Study. Australian Critical Care, 22, 178-186.
http://www.sciencedirect.com/science/article/pii/S1036731409001209#
http://dx.doi.org/10.1016/j.aucc.2009.07.001

[17]   Iizuka, M. (2011) Nurse’s Clinical Judgment of Patients Receiving Abdominal Surgery at the Time of Their Early Ambulation. Journal of Human Care Studies, 12, 9-21.

[18]   Kenney, J.W. (1995) Assessment Data Collection of the Family Client. In: Christensen, P.J. and Kenny, J.W., Eds., Nursing Process: Application of Conceptual Models, Mosby, St. Louis, 78-99.

[19]   Benner, P. (2001) From Novice to Expert Excellence and Power in Clinical Nursing Practice. Prentice Hall, Englewood Cliff.

[20]   Banning, M. (2008) Clinical Reasoning and Its Application to Nursing: Concept and Research Studies. Nursing Education in Practice, 8, 177-183.
http://www.sciencedirect.com/science/article/pii/S1471595307000595

[21]   Corcoran, S.A. (1990) Basic Concept of Clinical Judgment in the Nursing. Nursing Research, 23, 3-12.

[22]   Yamada, R., Izumi, K., Hiramatsu, T., Kato, M. and Shogenji, M. (2007) Investigation of Clinical Nurses’ Intuition Relationships between Hospital, Years of Experience and Nurses’ License. The Journal of the Japan Academy of Nursing Administration and Policies, 10, 40-47.
http://janap.umin.ac.jp/mokuji/J1002/10000004.pdf#search='Investigation+of+Clinical+Nurses%E2%80%99
+Intuition+Relationships+between+Hospital%2C+Years+of+Experience+and+Nurses%E2%80%99+License