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Tuesday, February 22, 2011

NANDA NIC NOC Linkages

NANDA-I (North American Nursing Diagnoses Association International)
The NANDA International Classification is used for the identification of nursing diagnoses. The classification is recognized as a well established diagnosis terminology which is included in UMLS and recognized by ANA. The NANDA Nursing Diagnoses: Definition & Classification 2009-2011 includes 21 new diagnoses, 9 revised diagnoses, 6 retired diagnoses, and has a total of 202 nursing diagnoses for use in practice. Each diagnosis has a definition and the actual diagnoses include defining characteristics and related factors. Risk diagnoses include risk factors (NANDA-I, 2009). In this study, NANDA-I diagnoses are based on 155 nursing diagnoses including related factors and signs/symptoms (NANDA-I, 1999) used in the study hospital.

The current 4th edition Nursing Outcomes Classification has 385 outcomes with definitions, indicators, and measurement scales (1 to 5) for use at the individual, family, and community levels. It includes 58 new outcome labels and 67 revised outcomes (Moorhead et al., 2008). NOC allows nurses to follow changes in or maintenance of outcome states over time and across settings. Before providing an intervention, nurses use NOC to understand the patient’s current problems and nursing diagnoses and rate the chosen outcome to obtain a baseline rating. After providing an intervention, NOC is used to measure the outcome and determine a change score. In this study, NOC outcomes are defined as the second edition of NOC with 260 outcomes labels (Johnson, Maas, & Moorhead, 2000) as the available terminology in the study hospital

The NIC taxonomy has 7 domains and 30 classes and 542 interventions in the fifth edition. It currently contains 34 new interventions and 77 revised interventions (Bulechek et al., 2008). Each intervention has a list of more specific activities for implementing the intervention that are selected based on the patients needs. In the study, NIC interventions from the third edition with 468 interventions were used in the study hospital as part of the nursing care planning (Dochterman & Bulechek, 2000)

NANDA NIC NOC NNN Linkages
NNN linkages provide associations between three standardized languages recognized by the American Nurses Organization: NANDA-I, NIC, and NOC. The first step in the process to link NNN is for nurses to determine a nursing diagnosis using NANDA-I diagnoses. The diagnoses that occur most frequently reflect their importance in representing an entire group of patients. After determining the nursing diagnosis, nurses consider which NOC outcomes are appropriate for the patient situation, and then choose NIC interventions that are most likely to achieve the desired outcome (Johnson, 2006).

Wednesday, February 2, 2011

Understanding, Accepting, and Managing Anger in Disasters

Understanding, Accepting, and Managing Anger in Disasters. Disasters may evoke a broad spectrum of reactions in survivors, as well as responders. The cause and phase of the disaster, whether natural or human caused, may influence the intensity of emotions. Across the spectrum of reactions, anger is often one of the most understandable but most difficult to manage. Anger can be productive if channeled in the right way, but it can also become a significant obstacle to recovery, eroding physical and mental health, as well as family and community cohesion. In some instances, it can even represent a danger to mental health responders who want to assist survivors. It is important that responders and caregivers understand anger in the post-disaster environment and use effective anger management strategies.

Understanding Anger
Disasters of human intent that cause loss of innocent lives, such as terrorist attacks, may generate the most anger, while natural disasters are often considered beyond human control. However, some survivors may become intensely angry once they recognize human factors involved in a natural disaster (e.g., they may feel that the government neglected to mitigate the disaster through upgrades to the physical infrastructure or provided insufficient post-disaster resources). As a result, some survivors may project anger toward counselors, if they perceive the counselors to be representatives of government agencies. Of course, the intensity of anger can be highly variable, the targets of anger can shift or remain fixed, and targets are not mutually exclusive.
Anger can be projected toward several targets at once, and assisting survivors with anger can be tricky because it is a dynamic and ever-changing reaction. As such, we cannot suggest a universal approach to coping with anger. Some survivors feel entitled to their anger and are not quick to let it go, and some degree of anger must be allowed. Counselors should introduce anger management techniques slowly while emphasizing that anger management is actually a way of shifting control back to survivors, not just a ploy to quiet them.

Accepting Anger
Anger can be motivating in some instances and actually a powerful force in overcoming certain obstacles. But anger can be unpleasant and there is a natural tendency to see anger as a negative emotion that should be squelched. Before suggesting that anger is counterproductive in disaster recovery, responders should consider the following:

  • Is the anger justified?
  • Is the anger purposeful?
  • Can the anger be channeled in a constructive manner?
  • Does something about the target or intensity of the anger represent a danger?

Allowing ventilation, affirming the anger, and demonstrating that it can be tolerated and understood are effective first steps to de-escalating anger. But these steps must be taken safely and constructively if possible. Survivor anger, which increases or escalates over time, is common in long-term recovery projects during the “disillusionment” phase, when frustration runs high. In such instances, verbal de-escalation and relaxation techniques are useful. Anticipate escalating anger in recovery projects that survivors may perceive as delayed, “too little, too late,” or complicated by setbacks.

Managing Anger
Anger can be contagious, and even counselors can become angry, especially if they have been impacted by the disaster. This is not uncommon and should be both acknowledged in training and reinforced in team supervision. Survivors benefit most from counselors who can remain neutral and avoid being pulled into the “blame game,” yet sustain their compassion and commitment in the face of anger. Counselors who become consumed with anger are not helpful to survivors.
During the impact phase or later with populations that are hard to reach, counselors are often meeting survivors for the first time—and during one of the worst times of the survivors’ lives. Without much of a baseline knowledge of an individual, it can be difficult to assess when a survivor may cross that fine line between losing emotional control and losing physical control to the point of becoming a danger. Anger may also be an issue as people assess their losses during the disillusionment phase of disaster, especially if resources are not fully realized as expected. The following are three simple safety tips:

  • Never sacrifice safety for rapport: As a disaster responder whose primary skill set is talking and listening, you know that building trust and creating an empathic connection is critical, but these should not be to one’s own detriment. You can rebuild rapport quicker than you will heal from a physical or psychological injury if a survivor becomes violent.
  • Getting out or away too soon is always better than too late: Trust your instinct and intuition. If the situation or behavior feels threatening or dangerous, it probably is
  • Don’t run from danger; run toward safety: Always have a plan B or exit strategy for any situation. In a home, know at least two ways out of the structure; in the community, identify safe places to go (e.g., lighted area, safe people) if the going gets rough.

In conclusion, counselors should be mindful to stay within the scope of their assigned program roles. After many years of work in the field of disaster response, one constant is true: the issues people have prior to the disaster are likely the same ones they have in the aftermath, especially those related to character and personality. Assisting a survivor in managing his or her anger is one way to help survivors cope with their response to the disaster, but if the survivor had long-standing issues with anger management prior to the disaster, these will likely continue and may even be exacerbated by the event. In some cases, these issues limit the effect of our assistance, so you may need to reconsider your definition of success. Full resolution is not always the goal



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