The aim of this research paper is to identify related NANDA, NIC, and NOC elements for a patient scenario in the cardiology (telemetry-medsurg) floor and then describe in detail the data, information, knowledge, and wisdom (DIKW FRAMEWORK) that guided the work.
JB is a 60-year-old male patient complaining of acute pain after soft tissue damages during cardiac surgery.
NANDA, NIC, and NOC Elements
JB’s experience of pain was subjective and therefore was difficult to evaluate. JB reported the pain as severe and thorough. This was however the most reliable method to assess his pain. JB had cognitive abilities and was unlikely to exaggerate his condition on the pain rating scale when he indicated the pain intensity at 8 out of possible 10.
It is recognized that patients may depict pain in highly variable manners. Objective reporting aims to avoid the challenge associated with the self-reporting. While the patient’s self-reporting, vital signs and behaviors are important, observable reactions to pain are necessary particularly when the patient is unable to use the reporting scale due to impaired cognitive capabilities (Linde, et al., 2013).
JB’s observable reactions include inability to sleep for long, perform physical activities or move his upper limbs. JB is also unable to do certain activities of daily living such as taking care of himself. JB’s upper limbs tend to be restrained. Occasionally, when the pain becomes severe, there are notable autonomic reactions in him. For instance, JB’s blood pressure rises, he sweats (diaphoresis), his pulse rate rises and he becomes thirsty and breathes deeply.
JB’s acute pain requires effective intervention.
- Analgesic Administration – strong evidence has shown the effectiveness of analgesic administration to control acute soft tissue injuries and subsequent pain (Argoff, 2013).
- Conscious Sedation – the treatment for severe pain will require conscious sedation to ensure that JB maintains consciousness, airways, not afraid, reacts to physical commands, experiences acceptable levels of pain and lacks critical changes in vital signs during acute pain management
- Pain Management – JB requires pain management through medication to facilitate recovery, enhance quality of life, comfort and a sense of well-being
- Patient-Controlled Analgesia Assistance – JB will control his dosage for pain relief and achieve faster relief. Only JB can administer the medications and control intakes.
For the case of JB, the identified NOC elements include pain level, pain control and comfort rate. Disruptive effects of pain may also be noted. The expected pain management outcomes from JB generally include increased comfort levels, effective response to medication and high rates of pain control.
- JB will use pain rating scale to indicate the current rate of pain severity and show the required comfort objectives based on his cognitive abilities
- The patient will understand how excessive pain may be controlled
- JB would show that pain management strategies have relieved the pain to acceptable levels and with controllable, minimal side effects
- Interventions should ensure that JB recovers with noticeable acceptable level of pain, that is, the acute pain should be at the comfort level and any decrease should be reported to care providers
- JB should display capabilities to rest sufficiently without unbearable discomfort
- Nurses should inform JB of other nonpharmacological techniques that may be applied to control pain severity
Data, Information, Knowledge, and Wisdom
DIKW framework provides a vital tool for examining nursing concepts and guide nurses during practical application in patient interventions (Looman, et al., 2012).
Discrete facts were obtained from JB during examination. They are both subjective and objective data obtained during JB’s diagnosis. Subjective data included JB’s account of his pain experience while objective data included data obtained from pain rating scale and diagnosis. Data on pain severity and management were gathered over time to determine any changes, both declines and improvements.
Information consists of data and relevant meanings. Nurses can obtain information through constructing and combining different data obtained from patients’ examination. This results into a meaningful picture within the patient’s context. JB’s information for acute pain treatment and management was constructed from various data gathered progressively from diagnosis.
Knowledge consists of analyzed information, which provides relations and interactions between different defined and formalized elements. Knowledge about JB must be constructed from relevant information obtained from data gathered during diagnosis and data collected on a continuous basis. Knowledge about JB’s acute pain is useful for effective treatment and management of pain.
Wisdom is effective application of knowledge to control and overcome human challenges. Nurses must apply their knowledge on pain management, explain to the patient why certain interventions are necessary and others are not. In acute pain management, nurses use their wisdom to recognize JB’s situation, interventions required and possible outcomes and follow-ups.
The research paper has applied elements of NANDA, NIC, and NOC and DIKW framework to identify and describe a patient scenario in the Medsurg floor. NANDA, NIC, and NOC show how nurses can rely on a comprehensive language system to provide quality care while DIKW framework provides effective means of collecting and analyzing data to enhance interventions and patient outcomes.
Argoff, C. E. (2013). Topical analgesics in the management of acute and chronic pain. Mayo Clinic Proceeding, 88(2), 195-205.
Linde, S. M., Badger, J. M., Machan, J. T., Beaudry, J., Brucker, A., Martin, K.,… Navedo, R. (2013). Reevaluation of the Critical-Care Pain Observation Tool in Intubated Adults After Cardiac Surgery. American Journal of Critical Care, 22(6), 491.
Looman, W. S., Erickson, M. M., Garwick, A. W., Cady, R., Kelly, A., Pettey, C., & Stanley, M. F. (2012). Meaningful Use of Data in Care Coordination by the Advanced Practice Registered Nurse: The TeleFamilies Project. Computers Informatics Nursing, 30(12), 649–654.