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THE NURSING PROCESS A systematic problem-solving approach used to identify, prevent and treat actual or potential health problems and promote wellness.

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Presentation on theme: "THE NURSING PROCESS A systematic problem-solving approach used to identify, prevent and treat actual or potential health problems and promote wellness."— Presentation transcript:

Nursing Diagnosis: Definition

THE NURSING PROCESS  COMPREHENSIVE  GOAL ORIENTED  INTERPERSONAL  SYSTEMATIC  DYNAMIC.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 36 Implementing and Evaluating Care.

The Nursing Process.

Nursing Process NUR101 Fall 2010 Lecture #6 and #7 K. Burger, MSEd, MSN, RN, CNE PPP By: Sharon Niggemeier MSN, RN Revised KBurger 8/06, 9/08,8/10.

Concept Map. What is a concept map care plan ?  An innovative approach to planning and organizing nursing care  A diagram of patient problems and interventions.

Recreational Therapy: An Introduction

Nursing Diagnosis Chapter Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  The term nursing diagnosis.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1 Overview of Nursing Process, Clinical Reasoning, and Nursing Practice.

CRITICAL THINKING in Nursing Practice: chapter 14 “…active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others.”

Nursing Process & Critical Thinking By: Omaimah Ali Qadhi MSN, RN, BSN King Saud University/School of Nursing.

Copyright 2002, Delmar, A division of Thomson Learning.

RENI PRIMA GUSTY, SK.p,M.Kes

NURSING PROCESS. PRE TEST n 1. Identify all steps of the nsg process n 2. Identify the step of the Nsg process where goals are identified. n 3. Identify.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 — Nursing Diagnosis, Outcome Identification, Planning, Implementation,

Nursing Process- Evaluation. Evaluation Evaluation measures the client’s response to nursing actions and progress toward achieving health care goals.

Chapter 17 Nursing Diagnosis

Chapter 6 Nursing Process and Critical Thinking

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2 Nursing Process.

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Problem Solving: The Nursing Process

Apr 05, 2019

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Problem Solving: The Nursing Process. Developed by Tim Corbett RN, MA, LMHC. VALIDATION. consciously inquiring about the opinions & feelings of your patients seeking mutual consensus. Mutual Problem Solving. A collaborative nurse-patient relationship is called therapeutic reciprocity

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Problem Solving:The Nursing Process • Developed by Tim Corbett RN, MA, LMHC

VALIDATION • consciously inquiring about the opinions & feelings of your patients • seeking mutual consensus

Mutual Problem Solving • A collaborative nurse-patient relationship is called therapeutic reciprocity • Mathis-Kraft et al (1990) claim that patients who take a more active role in their treatment recover faster

Patient-Nurse Contracts • A contract is a formal agreement between the nurse & patient outlining activities & responsibilities of each party • problem solving & goal accomplishment is achieved by negotiation & compromise • A contract discusses purpose, roles, & expectations of nurse & patient

Benefits for Nurse & Patient • patients take a more active role & experience greater satisfaction • nurses have more opportunities to be nurturing & caring & being advocates for their patients

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Making Decisions and Solving Problems

CHAPTER 6 Making Decisions and Solving Problems Rose Aguilar Welch This chapter describes the key concepts related to problem solving and decision making. The primary steps of the problem-solving and decision-making processes, as well as analytical tools used for these processes, are explored. Moreover, strategies for individual or group problem solving and decision making are presented. Objectives •  Apply a decision-making format to list options to solve a problem, identify the pros and cons of each option, rank the options, and select the best option. •  Evaluate the effect of faulty information gathering on a decision-making experience. •  Analyze the decision-making style of a nurse leader/manager. •  Critique resources on the Internet that focus on critical thinking, problem solving, and decision making. Terms to Know autocratic creativity critical thinking decision making democratic optimizing decision participative problem solving satisficing decision The Challenge Vickie Lemmon RN, MSN Director of Clinical Strategies and Operations, WellPoint, Inc., Ventura, California Healthcare managers today are faced with numerous and complex issues that pertain to providing quality services for patients within a resource-scarce environment. Stress levels among staff can escalate when problems are not resolved, leading to a decrease in morale, productivity, and quality service. This was the situation I encountered in my previous job as administrator for California Children Services (CCS). When I began my tenure as the new CCS administrator, staff expressed frustration and dissatisfaction with staffing, workload, and team communications. This was evidenced by high staff turnover, lack of teamwork, customer complaints, unmet deadlines for referral and enrollment cycle times, and poor documentation. The team was in crisis, characterized by in-fighting, blaming, lack of respectful communication, and lack of commitment to program goals and objectives. I had not worked as a case manager in this program. It was hard for me to determine how to address the problems the staff presented to me. I wanted to be fair but thought that I did not have enough information to make immediate changes. My challenge was to lead this team to greater compliance with state-mandated performance measures. What do you think you would do if you were this nurse? Introduction Problem solving and decision making are essential skills for effective nursing practice. Carol Huston (2008) identified “expert decision-making skills” as one of the eight vital leadership competencies for 2020. These processes not only are involved in managing and delivering care but also are essential for engaging in planned change. Myriad technologic, social, political, and economic changes have dramatically affected health care and nursing. Increased patient acuity, shorter hospital stays, shortage of healthcare providers, increased technology, greater emphasis on quality and patient safety, and the continuing shift from inpatient to ambulatory and home health care are some of the changes that require nurses to make rational and valid decisions. Moreover, increased diversity in patient populations, employment settings, and types of healthcare providers demands efficient and effective decision making and problem solving. More emphasis is now placed on involving patients in decision making and problem solving and using multidisciplinary teams to achieve results. Nurses must possess the basic knowledge and skills required for effective problem solving and decision making. These competencies are especially important for nurses with leadership and management responsibilities. Definitions Problem solving and decision making are not synonymous terms. However, the processes for engaging in both processes are similar. Both skills require critical thinking, which is a high-level cognitive process, and both can be improved with practice. Decision making is a purposeful and goal-directed effort that uses a systematic process to choose among options. Not all decision making begins with a problem situation. Instead, the hallmark of decision making is the identification and selection of options or alternatives. Problem solving, which includes a decision-making step, is focused on trying to solve an immediate problem, which can be viewed as a gap between “what is” and “what should be.” Effective problem solving and decision making are predicated on an individual’s ability to think critically. Although critical thinking has been defined in numerous ways, Scriven and Paul (2007) refer to it as “ the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.” Effective critical thinkers are self-aware individuals who strive to improve their reasoning abilities by asking “why,” “what,” or “how.” A nurse who questions why a patient is restless is thinking critically. Compare the analytical abilities of a nurse who assumes a patient is restless because of anxiety related to an upcoming procedure with those of a nurse who asks if there could be another explanation and proceeds to investigate possible causes. It is important for nurse leaders and managers to assess staff members’ ability to think critically and enhance their knowledge and skills through staff-development programs, coaching, and role modeling. Establishing a positive and motivating work environment can enhance attitudes and dispositions to think critically. Creativity is essential for the generation of options or solutions. Creative individuals can conceptualize new and innovative approaches to a problem or issue by being more flexible and independent in their thinking. It takes just one person to plant a seed for new ideas to generate . The model depicted in Figure 6-1 demonstrates the relationship among related concepts such as professional judgment, decision making, problem solving, creativity, and critical thinking. Sound clinical judgment requires critical or reflective thinking. Critical thinking is the concept that interweaves and links the others. An individual, through the application of critical-thinking skills, engages in problem solving and decision making in an environment that can promote or inhibit these skills. It is the nurse leader’s and manager’s task to model these skills and promote them in others. FiGURE 6-1 Problem-solving and decision-making model. Decision Making This section presents an overview of concepts related to decision models, decision-making styles, factors affecting decision making, group decision making (advantages and challenges), and strategies and tools. The phases of the decision-making process include defining objectives, generating options, identifying advantages and disadvantages of each option, ranking the options, selecting the option most likely to achieve the predefined objectives, implementing the option, and evaluating the result. Box 6-1 contains a form that can be used to complete these steps. BOX 6-1    Decision-Making Format Objective: _____________________________________ Options Advantages Disadvantages Ranking                                 Add more rows as necessary. Rank priority of options, with “1” being most preferred. Select the best option. Implementation plan: ______________________________________________________________________________ Evaluation plan: __________________________________________________________________________________ A poor-quality decision is likely if the objectives are not clearly identified or if they are inconsistent with the values of the individual or organization. Lewis Carroll illustrates the essential step of defining the goal, purpose, or objectives in the following excerpt from Alice’s Adventures in Wonderland: One day Alice came to a fork in the road and saw a Cheshire Cat in a tree. “Which road do I take?” she asked. His response was a question: “Where do you want to go?” “I don’t know,” Alice answered. “Then,” said the cat, “it doesn’t matter.” Decision Models The decision model that a nurse uses depends on the circumstances. Is the situation routine and predictable or complex and uncertain? Is the goal of the decision to make a decision conservatively that is just good enough or one that is optimal? If the situation is fairly routine, nurse leaders and managers can use a normative or prescriptive approach. Agency policy, standard procedures, and analytical tools can be applied to situations that are structured and in which options are known. If the situation is subjective, non-routine, and unstructured or if outcomes are unknown or unpredictable, the nurse leader and manager may need to take a different approach. In this case, a descriptive or behavioral approach is required. More information will need to be gathered to address the situation effectively. Creativity, experience, and group process are useful in dealing with the unknown. In the business world, Camillus described complex problems that are difficult to describe or resolve as “wicked” (as cited in Huston, 2008 ). This term is apt in describing the issues that nurse leaders face. In these situations, it is especially important for nurse leaders to seek expert opinion and involve key stakeholders. Another strategy is satisficing. In this approach, the decision maker selects the solution that minimally meets the objective or standard for a decision. It allows for quick decisions and may be the most appropriate when time is an issue. Optimizing is a decision style in which the decision maker selects the option that is best, based on an analysis of the pros and cons associated with each option. A better decision is more likely using this approach, although it does take longer to arrive at a decision. For example, a nursing student approaching graduation is contemplating seeking employment in one of three acute care hospitals located within a 40-mile radius of home. The choices are a medium-size, not-for-profit community hospital; a large, corporate-owned hospital; and a county facility. A satisficing decision might result if the student nurse picked the hospital that offered a decent salary and benefit packet or the one closest to home. However, an optimizing decision is more likely to occur if the student nurse lists the pros and cons of each acute care hospital being considered such as salary, benefits, opportunities for advancement, staff development, and mentorship programs. Decision-Making Styles The decision-making style of a nurse manager is similar to the leadership style that the manager is likely to use. A manager who leans toward an autocratic style may choose to make decisions independent of the input or participation of others. This has been referred to as the “decide and announce” approach, an authoritative style. On the other hand, a manager who uses a democratic or participative approach to management involves the appropriate personnel in the decision-making process. It is imperative for managers to involve nursing personnel in making decisions that affect patient care. One mechanism for doing so is by seeking nursing representation on various committees or task forces. Participative management has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction. Any decision style can be used appropriately or inappropriately. Like the tenets of situational leadership theory, the situation and circumstances should dictate which decision-making style is most appropriate. A Code Blue is not the time for managers to democratically solicit volunteers for chest compressions! The autocratic method results in more rapid decision making and is appropriate in crisis situations or when groups are likely to accept this type of decision style. However, followers are generally more supportive of consultative and group approaches. Although these approaches take more time, they are more appropriate when conflict is likely to occur, when the problem is unstructured, or when the manager does not have the knowledge or skills to solve the problem. Exercise 6-1 Interview colleagues about their most preferred decision-making model and style. What barriers or obstacles to effective decision making have your colleagues encountered? What strategies are used to increase the effectiveness of the decisions made? Based on your interview, is the style effective? Why or why not? Factors Affecting Decision Making Numerous factors affect individuals and groups in the decision-making process. Tanner (2006) conducted an extensive review of the literature to develop a Clinical Judgment Model. Out of the research, she concluded that five principle factors influence decision making. (See the Literature Perspective below.) Literature Perspective Resource: Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45 (6), 204-211. Tanner engaged in an extensive review of 200 studies focusing on clinical judgment and clinical decision making to derive a model of clinical judgment that can be used as a framework for instruction. The first review summarized 120 articles and was published in 1998. The 2006 article reviewed an additional 71 studies published since 1998. Based on an analysis of the entire set of articles, Tanner proposed five conclusions which are listed below. The reader is referred to the article for detailed explanation of each of the five conclusions. The author considers clinical judgment as a “problem-solving activity.” She notes that the terms “clinical judgment,” “problem solving,” “decision making,” and “critical thinking” are often used interchangeably. For the purpose of aiding in the development of the model, Tanner defined clinical judgment as actions taken based on the assessment of the patient’s needs. Clinical reasoning is the process by which nurses make their judgments (e.g., the decision-making process of selecting the most appropriate option) ( Tanner, 2006 , p. 204): 1.  Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand. 2.  Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns. 3.  Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit. 4.  Nurses use a variety of reasoning patterns alone or in combination. 5.  Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. The Clinical Judgment Model developed through the review of the literature involves four steps that are similar to problem-solving and decision-making steps described in this chapter. The model starts with a phase called “Noticing.” In this phase, the nurse comes to expect certain responses resulting from knowledge gleaned from similar patient situations, experiences, and knowledge. External factors influence nurses in this phase such as the complexity of the environment and values and typical practices within the unit culture. The second phase of the model is “Interpreting,” during which the nurse understands the situation that requires a response. The nurse employs various reasoning patterns to make sense of the issue and to derive an appropriate action plan. The third phase is “Responding,” during which the nurse decides on the best option for handling the situation. This is followed by the fourth phase, “Reflecting,” during which the nurse assesses the patient’s responses to the actions taken. Tanner emphasized that “reflection-in-action” and “reflection-on-action” are major processes required in the model. Reflection-in-action is real-time reflection on the patient’s responses to nursing action with modifications to the plan based on the ongoing assessment. On the other hand, reflection-on-action is a review of the experience, which promotes learning for future similar experiences. Nurse educators and managers can employ this model with new and experienced nurses to aid in understanding thought processes involved in decision making. As Tanner (2006) so eloquently concludes, “If we, as nurse educators, help our students understand and develop as moral agents, advance their clinical knowledge through expert guidance and coaching, and become habitual in reflection-on-practice, they will have learned to think like a nurse” ( p. 210 ). Implications for Practice Nurse educators and managers can employ this model with new and experienced nurses to aid in understanding thought processes involved in decision making. For example, students and practicing nurses can be encouraged to maintain reflective journals to record observations and impressions from clinical experiences. In clinical post-conferences or staff development meetings, the nurse educator and manager can engage them in applying to their lived experiences the five conclusions Tanner proposed. The ultimate goal of analyzing their decisions and decision-making processes is to improve clinical judgment, problem-solving, decision-making, and critical-thinking skills. Internal and external factors can influence how the situation is perceived. Internal factors include variables such as the decision maker’s physical and emotional state, personal philosophy, biases, values, interests, experience, knowledge, attitudes, and risk-seeking or risk-avoiding behaviors. External factors include environmental conditions, time, and resources. Decision-making options are externally limited when time is short or when the environment is characterized by a “we’ve always done it this way” attitude. Values affect all aspects of decision making, from the statement of the problem/issue through the evaluation. Values, determined by one’s cultural, social, and philosophical background, provide the foundation for one’s ethical stance. The steps for engaging in ethical decision making are similar to the steps described earlier; however, alternatives or options identified in the decision-making process are evaluated with the use of ethical resources. Resources that can facilitate ethical decision making include institutional policy; principles such as autonomy, nonmaleficence, beneficence, veracity, paternalism, respect, justice, and fidelity; personal judgment; trusted co-workers; institutional ethics committees; and legal precedent. Certain personality factors, such as self-esteem and self-confidence, affect whether one is willing to take risks in solving problems or making decisions. Keynes (2008) asserts that individuals may be influenced based on social pressures. For example, are you inclined to make decisions to satisfy people to whom you are accountable or from whom you feel social pressure? Characteristics of an effective decision maker include courage, a willingness to take risks, self-awareness, energy, creativity, sensitivity, and flexibility. Ask yourself, “Do I prefer to let others make the decisions? Am I more comfortable in the role of ‘follower’ than leader? If so, why?” Exercise 6-2 Identify a current or past situation that involved resource allocation, end-of-life issues, conflict among healthcare providers or patient/family/significant others, or some other ethical dilemma. Describe how the internal and external factors previously described influenced the decision options, the option selected, and the outcome. Group Decision Making There are two primary criteria for effective decision making. First, the decision must be of a high quality; that is, it achieves the predefined goals, objectives, and outcomes. Second, those who are responsible for its implementation must accept the decision. Higher-quality decisions are more likely to result if groups are involved in the problem-solving and decision-making process. In reality, with the increased focus on quality and safety, decisions cannot be made alone. When individuals are allowed input into the process, they tend to function more productively and the quality of the decision is generally superior. Taking ownership of the process and outcome provides a smoother transition. Multidisciplinary teams should be used in the decision-making process, especially if the issue, options, or outcome involves other disciplines. Research findings suggest that groups are more likely to be effective if members are actively involved, the group is cohesive, communication is encouraged, and members demonstrate some understanding of the group process. In deciding to use the group process for decision making, it is important to consider group size and composition. If the group is too small, a limited number of options will be generated and fewer points of view expressed. Conversely, if the group is too large, it may lack structure, and consensus becomes more difficult. Homogeneous groups may be more compatible; however, heterogeneous groups may be more successful in problem solving. Research has demonstrated that the most productive groups are those that are moderately cohesive. In other words, divergent thinking is useful to create the best decision. For groups to be able to work effectively, the group facilitator or leader should carefully select members on the basis of their knowledge and skills in decision making and problem solving. Individuals who are aggressive, are authoritarian, or manifest self-oriented behaviors tend to decrease the effectiveness of groups. The nurse leader or manager should provide a nonthreatening and positive environment in which group members are encouraged to participate actively. Using tact and diplomacy, the facilitator can control aggressive individuals who tend to monopolize the discussion and can encourage more passive individuals to contribute by asking direct, open-ended questions. Providing positive feedback such as “You raised a good point,” protecting members and their suggestions from attack, and keeping the group focused on the task are strategies that create an environment conducive to problem solving. Advantages of Group Decision Making The advantages of group decision making are numerous. The adage “two heads are better than one” illustrates that when individuals with different knowledge, skills, and resources collaborate to solve a problem or make a decision, the likelihood of a quality outcome is increased. More ideas can be generated by groups than by individuals functioning alone. In addition, when followers are directly involved in this process, they are more apt to accept the decision, because they have an increased sense of ownership or commitment to the decision. Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. Involvement can be enhanced by making information readily available to the appropriate personnel, requesting input, establishing committees and task forces with broad representation, and using group decision-making techniques. The group leader must establish with the participants what decision rule will be followed. Will the group strive to achieve consensus, or will the majority rule? In determining which decision rule to use, the group leader should consider the necessity for quality and acceptance of the decision. Achieving both a high-quality and an acceptable decision is possible, but it requires more involvement and approval from individuals affected by the decision. Groups will be more committed to an idea if it is derived by consensus rather than as an outcome of individual decision making or majority rule. Consensus requires that all participants agree to go along with the decision. Although achieving consensus requires considerable time, it results in both high-quality and high-acceptance decisions and reduces the risk of sabotage. Majority rule can be used to compromise when 100% agreement cannot be achieved. This method saves time, but the solution may only partially achieve the goals of quality and acceptance. In addition, majority rule carries certain risks. First, if the informal group leaders happen to fall in the minority opinion, they may not support the decision of the majority. Certain members may go so far as to build coalitions to gain support for their position and block the majority choice. After all, the majority may represent only 51% of the group. In addition, group members may support the position of the formal leader, although they do not agree with the decision, because they fear reprisal or they wish to obtain the leader’s approval. In general, as the importance of the decision increases, so does the percentage of group members required to approve it. To secure the support of the group, the leader should maintain open communication with those affected by the decision and be honest about the advantages and disadvantages of the decision. The leader should also demonstrate how the advantages outweigh the disadvantages, suggest ways the unwanted outcomes can be minimized, and be available to assist when necessary.

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School of Nursing

Academic success program, strategies for problem solving.

Nursing students will be expected to have or develop strong problem-solving skills. Problem solving is centered on your ability to identify critical issues and create or identify solutions. Well-developed problem solving skills is a characteristic of a successful student. Remember, problems are a part of everyday life and your ability to resolve problems will have a positive influence on your future.

6 Steps of Problem Solving

Step 1: Identify and Define the Problem

It is not difficult to overlook the true problem in a situation and focus your attention on issues that are not relevant. This is why it is important that you look at the problem from different perspectives. This provides a broad view of the situation that allows you to weed out factors that are not important and identify the root cause of the problem.

Step 2: Analyze the Problem

Break down the problem to get an understanding of the problem. Determine how the problem developed. Determine the impact of the problem.

Step 3: Develop Solutions

Brainstorm and list all possible solutions that focus on resolving the identified problem. Do not eliminate any possible solutions at this stage.

Step 4: Analyze and Select the Best Solution

List the advantages and disadvantages of each solution before deciding on a course of action. Review the advantages and disadvantages of each possible solution. Determine how the solution will resolve the problem. What are the short-term and long-term disadvantages of each solution? What are the possible short-term and long-term benefits of each solution? Which solution will help you meet your goals?

Step 5: Implement the Solution

Create a plan of action. Decide how you will move forward with your decision by determining the steps you must take to ensure that you move forward with your solution. Now, execute your plan of action.

Step 6: Evaluate the Solution

Monitor your decision. Assess the results of your solution. Are you satisfied with the results? Did your solution resolve the problem? Did it produce a new problem? Do you have to modify your solution to achieve better results? Are you closer to achieving your goal? What have you learned?

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Problem-based learning in nursing education: a process for scenario development

Affiliation.

• 1 College of Health Professions, Northern Kentucky University, Highland Heights, KY 41099, USA. [email protected]
• PMID: 20173591
• DOI: 10.1097/NNE.0b013e3181ced891

Problem-based learning (PBL) is a strategy that enhances students' ability to critically apply cumulative knowledge to actual clinical problems. It necessitates collaborative student effort to analyze and solve unfolding clinical problems that are fluid and reflect real-life situations. The authors describe an approach developed to generate PBL scenarios and guidelines that may be of use to others wishing to use PBL in their curriculum.

• Clinical Competence*
• Curriculum*
• Decision Support Techniques
• Education, Nursing*
• Faculty, Nursing
• Models, Nursing
• Problem-Based Learning*
• Students, Nursing*

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• Florence Nightingale J Nurs
• v.29(3); 2021 Oct

Creativity in Nursing Care: A Concept Analysis

Mohammad ali cheraghi.

1 Department of Critical Care and Nursing Management; School of Nursing and Midwifery, Tehran University of Medical Sciences; Health Sciences Phenomenology Association; Ministry of Health and Medical Education, Tehran, Iran

Shahzad Pashaeypoor

2 Department of Community Health Nursing & Geriatric Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran

Leila Mardanian Dehkordi

3 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Sahar Khoshkesht

4 Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran

The aim of this study was to present the concept analysis of creativity in nursing care using the Walker and Avant (2019) approach. In this regard, the keywords “creativity” and “nursing care” were searched through PubMed, Ovid, Scopus, EMBASE, Google Scholar, SID, and Web of Science between the years 2000 and 2018 along with hand searching of reference lists extracted from more than 342 articles. Finally, 37 articles that had inclusion criteria were examined based on the eight stages mentioned in Walker and Avant’s concept analysis approach. Results revealed that creativity in nursing care includes fluidity of mind and the creation and acceptance of new ideas for patient care in such a way that the new methods are simple, useful, efficient, affordable, and safe. This requires a creative vision, creative sensitivity, and creative thinking. If there is a supportive environment, motivation, sensitivity, and divergent thinking skills, individuals can demonstrate their creativity. This may result in successful decision-making in the clinical setting and therefore contribute to increasing the organization’s effectiveness and the quality of care. All nurses can act as agents encouraging change by the use of creativity to improve the quality of care. It is an educational guide for future nurses to implement creativity in practice. Also, this finding can be used for future research and the development of specific tools. Finally, it is suggested to consider creativity in the other aspects of clinical practice as well.

Introduction

With the development of science and technology, society needs people who can take steps in the direction of change and development ( Mosakhani et al. , 2010 ). One of the important capabilities of organizations for their survival, success, and excellence in the globalization age is creativity (Rangaraju & Kennedy, 2012). Health care organizations must provide creative responses in order to deal with all the emerging needs and different circumstances ( Denhardt et al. , 2018 ). The creativity of any social system is based on the creativity of the people of that system. In such a situation, the presence of knowledgeable and creative employees in the organization is very helpful (Tayebi Shirmard & Mirzaei, 2017). Also, nurses often face unpredictable situations, for which they have not been trained before. Their education no longer meets the needs of the 21 st century. To deal with these new and complex situations, nurses need a higher level of competence and attitude and must be able to respond in a timely, effective, creative, and flexible manner (Institute of Medicine, 2010).

First time in 1973, Myra Levine used the metaphor “Linking the art and nursing science” to describe creativity and introduced it as a daily event that was essential for nursing interactions ( Ma et al. , 2018 ). Creativity is an important skill to solve the problem and create a new idea. Nurses should use their creativity to conceive of their potential problems and its subsequent outcomes and prepare themselves for the future. They should also use it for decision-making and problem-solving (Bunkers, 2011).

Nursing creativity can be executed in a variety of areas, including education, research, management, and clinical practice. Obviously, these areas interact with each other. However, creativity in nursing care is a new concept which perceived less than others, and for this reason, the art of nursing care is not publicly visible and remains hidden in the profession.

As new technology and genetic knowledge have changed medical and nursing care (Toole, 2012), there is a need for simple, cost-effective, and low-risk alternatives that embrace nursing creativity. The health system requires new ideas and creative problem-solving methods in the face of future changes ( Cresswell et al. , 2016 ). The authors of Individualized care emphasize the attitude toward patients as unique individuals and the obligation to care for them according to their conditions. Efforts to provide patient-centered care, such as evidence-based medicine, emphasize changes in infrastructures. Therefore, nurses should try to work with other healthcare disciplines to create a creative care model that meets the new needs of patients. Obviously, to improve the quality of patient care in a modern healthcare system, it is crucial to use creativity for harmonizing arts and nursing science ( Hewitt-Taylor, 2015 ).

Although previous studies have shown the importance of creative thinking and creativity in nursing, due to the complexity of the psychological and social forces involved in the formation of creativity, individuals face challenges in understanding and managing the creativity (Sadeghi Mal Amiri, 2015; Ma et al., 2018; Zuber & Moody, 2018).

In the 21st century, there is a growing tendency in health systems toward the concept of creativity and innovation to overcome the challenges of the health system, improve quality of care, increase fair access to care services, and reduce subsequent costs. This is not possible without understanding the concept of creativity. Many studies have been conducted in this field, especially in the humanities ( Fox, 2013 ; Khessina et al. , 2018 ; Nembhard & Lee, 2017; Vermeir et al. , 2018 ; Zuber & Moody, 2018). However, there has been no study emphasizing the dimensions of creativity in nursing care. Therefore, it seems necessary to recognize its features through the process of conceptual analysis and to explain its role in the clinical nursing setting.

Concept analysis is a strategy for examining the semantic structure of a concept. For a concept to be solid in theory and practice, it must be clearly defined and analyzed. Concept analysis helps us to distinguish that concept from others that may be similar but not the same as that concept. Concept analysis can be useful in refining ambiguous concepts and clarifying overused concepts for arriving at precise definitions. Additionally, it can be useful in tool development and language development in nursing. There are several methods for conducting concept analysis; in all of the methods, the analysis of a concept includes the analysis of the descriptive word and its usage. Therefore, a concept analysis of creativity in nursing care can help us to distinguish the concept from other similar borderline concepts, describe it in the nursing care domain, and provide a foundation for further research (Walker & Avant, 2019). Therefore, this study aimed to clarify the concept of creativity in nursing care based on Walker and Avant’s concept analysis approach.

Research Questions

• What is the concept of creativity in patient care?
• What is the manifestation of creativity in patient care?
• What kind of attitude and behavior in the field of patient care reflects the creativity of nursing care?

Walker and Avant’s (2019) approach was used as the framework for this concept analysis. Walker and Avant’s approach is a simplified approach to Wilson’s 11-step systematic process that simplifies the concept by creating a clearer understanding of it. This approach provides a pragmatic framework that emphasizes the conceptual aspect of the concepts ( Chinn & Kramer, 2004 ). Walker and Avant’s (2019) concept analysis process includes eight stages that are described in Table 1 .

Walker and Avant’s Concept Analysis Stages

The concept was searched using keywords “Creativity” and “Nursing care” in credible databases such as PubMed, Ovid, Scopus, EMBASE, Google Scholar, SID, and Web of Science during 2000–2018, with hand searches of reference lists, and the search process was completed using the dictionary.

More than 342 articles were extracted. After removing duplicate items (36 items), examining the relevancy of titles (removing 231 items), reviewing the relevancy of the subject, and the validity of the source, the remaining 37 articles were examined. Exclusion criteria included irrelevant, duplicated articles and lack of access to the article in English. A total of 37 extracted articles were independently reviewed by two researchers S K and L M D who have a brilliant background in teaching nursing theories and concept analysis for nursing students and have written numerous articles in this field. Usually, in analyzing the concept, the quality of studies is not examined using common tools. However, an attempt was made to select the closest and the most authoritative studies in terms of methodological quality from reputable journals and peers review. Finally, the required data were extracted from the initial studies.

Select a Concept

The increase in emerging needs, the emergence of individualized care, and departure of the care from conventional academic stereotypes calls for evidence-based thinking and effective clinical reasoning. All this requires a fluid and creative mind while providing individualized care, which this concept has not been clarified yet. Price (2006) believes that if creativity is described in a complex and inapplicable manner or is not well-defined, it is unlikely to go beyond the conceptual stage.

In this study, after reviewing the literature and based on the researcher’s interest and the increasing role of creativity in clinical nursing, the concept of creativity in nursing care was selected. It should be noted that researchers have paid little attention to this concept in the field of patient care. Therefore, this analysis will help us to achieve a better understanding of this concept in this field.

Purposes of Analysis

The aim of this study was to present the concept analysis of creativity in nursing care and identify attributes, antecedents, and consequences.

Attributes of the Concept

Defining attributes of the concept include descriptive attributes that are used frequently while discussing the concept and play a major role in differentiating between concepts (Walker & Avant, 2019). Creativity can be defined in a variety of ways, including cognitive processes, personality traits, environmental variables, and interactions of these components. Nevertheless, there is a need to combine the concept in a clinical setting.

Creativity comes from the Latin word “creare” which means to create. Oxford dictionary defines creativity as “to use imagination or original ideas to create something” (Medical Dictionary, 2018). Creativity has an extensive definition. Lau (2011) points to three principles in the concept of creativity: (1) the new reconstruction of old ideas; (2) the selection of useful ideas; and (3) the examination of the relationship between ideas. New forms beyond the common rules can be created by creativity. Although , these three principles are not mostly related to nursing education, human simulations and other creative learning methods can join theory to practice so that nursing students can use different forms of creativity in care for patients and successful decision-making in the clinical setting (Marquis & Huston, 2009).

Based on the main purpose, in this study defined nursing care and then analyzed and developed the concept of creativity in nursing care. The medical dictionary considers nursing care as a general term, which refers to procedures and measures that are solely or primarily intended to reduce the pain, symptoms, and discomfort of the patient (Medical Dictionary, 2018). Therefore, any nursing practice that is carried out based on the above aim is called nursing care. Based on the literature review, definitions, and general conclusions, it can be concluded that the concept of creativity in clinical nursing can include three attributes:

• The reconstruction of old ideas or choice of a new way of providing patient care that has more advantages than the usual method.
• The selection of simple, useful, affordable, efficient, and safe ideas.
• The examination of the relationship between ideas and successful decision-making in a clinical setting.

In the other words, creative nursing care is fulfilling new ideas in the face of intricate clinical interactions and practices by nurses utilizing their fluid minds and old ideas and facilities. That is, such creative nursing care is not only new and simple but also affordable, efficient, useful, and safe. In other words, creativity in nursing care means using new thinking to produce a new idea and apply it to nursing care that must necessarily be more useful, efficient, and safer compared to older methods. This can be defined as a new way of providing patient care and may result in successful decision-making in the clinical setting.

Uses of the Concept

Although this concept is not well-clarified, creativity in nursing care has led to the creation of devices that facilitate the work, save time, increase the quality of care, and reduce the nursing workload. It also leads to self-belief, growth and prosperity, social status, and self-confidence in nursing staff. Other benefits of creativity include increased satisfaction, self-efficacy, and pleasure of discovery, lower workload and achieving reputation, social respect, and changing attitudes of authorities, universities, and society toward nursing society (Shahsavari et al., 2015 a).

A model case is a specific example of the intended concept that should have all the features of that concept (Walker & Avant, 2019). Such a model case is discussed below:

“Ms. X, due to her interest in nursing and assisting humankind, chose to be a nurse 20 years ago and graduated from one of the best universities. She has been enthusiastically working in the orthopedic ward for years. Besides other tasks defined for her, she has to change 10–12 wound dressings quickly and with the utmost precision every day. She sees that the risk of surgical site infection and the re-admission of patients after surgery are elevated, which imposes a lot of costs on the patients, system, and nurses. She also observes that her co-workers change the dressing less accurately due to lack of time and high workload. Due to the lack of items needed for changing dressing in the department, shortage of nursing staffs, and a large number of patients, as well as the impossibility of transferring all patients to the only available dressing room due to immobility of some of the orthopedic patients, nurses should use one dressing trolley for all patients, which itself increases the risk of transmission of infection. She always thinks about how to change the dressing of patients quickly and accurately without using hands according to sterile points in a way that the waste material is automatically removed after changing the dressing, and there is no risk of infection for the environment, patient, and nurse. She discusses the issue with the head nurse. The head nurse welcomes her idea and informs the authorities of the hospital. Finally, engineer Y is introduced to them to help change the old trolley’s use to design an automatic wound washing machine with the possibility of waste storage in a closed chamber and automatic waste disposal with the help of Ms. X’s idea.”

Achieving a profound understanding of the problem investigated by Ms. X and her interest to resolve such problem in addition to the supportive environment and the existence of intrinsic (interest in nursing, diligence, and purposefulness) and external motivations (work pressure and lack of time) are the motivating factors for proposing the idea of making this device by the aforementioned nurse. The aforementioned example is a model of creativity in nursing care in which woman X showed sensitivity to the problem, and with her fluid mind and putting aside old ideas proposed the idea of making an automatic wound washing machine. She then designed and built the machine with the help of an expert.

Borderline and Contrary Cases

Borderline cases include some of the attributes embracing the concept that are often mistakenly used instead of the concept (Walker & Avant, 2019). Innovation is one of the borderline cases of creativity. Innovation and creativity are two independent but interrelated concepts that sometimes lead to confusion for readers. Creativity is the process of thought, and innovation is a product obtained through the implementation of that creative thinking ( Sarooghi et al. , 2015 ). Innovation is, in fact, the use of creativity or problem-solving skills that results in a product, strategy, or service that meets needs in a new and different way ( Kaya et al. , 2016 ). In other words, applied creativity should always lead to innovation. Here’s an example of an innovation case:

“Ms. Z is a nurse in the department of surgery. She observes that many patients need self-care counseling after discharge. Although discharge training is practiced, many still need access to a physician and nurse. Therefore, surgical nurses are required to answer the patient’s questions besides their plenty of tasks. She thinks that it is better to establish a telenursing center equipped with a referral system at the hospital’s nursing office in order to save time and money and help the patient have better access to experts. The idea of implementing such a method is given to the hospital manager. Eventually, after examining different aspects, a center was established at the hospital.” This is a nursing innovation aimed at improving quality, saving time, and providing safe services. Though this idea has already existed, in this example, the nurse has used her creative thinking to establish a telenursing center presenting a new method that addresses the needs in a different way. Such thinking provides a coherent approach to define challenges. This helps to identify problems and to proceed according to previous ideas or according to existing guidelines.

If in the previous example, Ms. X only did the dressing process step-by-step according to the existing guidelines, her care lacked creativity. Therefore, routine care can introduce as a contrary case in creative nursing care, patient’s conditions, facilities, environment, and existing problems, as well as characteristics of creativity in nursing care must be considered.

Antecedents and Consequences

Antecedents: Antecedents are situations, events, or phenomena that precede the occurrence of a phenomenon and the main concept occurs due to their presence. It helps to refine the concept (Walker & Avant, 2019). There are six factors that affect people’s creativity: (1) having knowledge and experience; (2) being able to mentally present creative ideas and create new relationships in issues; (3) adopting a creative thinking style and confronting a routine life; (4) motivation; (5) resilient personality, and (6) supportive environment (Jokari & Jorfi, 2012). Participants in Chan’s study (2013) had different opinions about the experience factor. Some believed that laws and experience prevented the emergence of new thinking, while some emphasized the inspirational nature of the experience to create creative ideas. In the case of lack of time and work-related stress, the results are contradictory. Occasionally, work-related stress prevents the emergence of creative ideas, and sometimes the nurses move toward innovative ideas to overcome them. In other words, shortages of time lead to creativity and severe time shortage prevents it. However, there would be different perceptions depending on one’s perception of the problem and the nature of the task ( Denhardt et al. , 2018 ). Shahsavari et al. (2015b) classified the factors influencing creativity in clinical nurses into five groups. The intrinsic motivators include having an interest and love for nursing and doing the duties, positive emotions such as the sense of satisfaction, happiness, self-esteem, and self-belief. External motivators include workplace problems, workload and time pressure, success, and failure. Both of these motivators influence the behavior of nurses in different ways. The third group of motivators includes diligence, purposefulness, etc., and it shows why some people are more successful than others. The fourth group includes related motivators that lead individuals to help people and to be creative by inducing a profound understanding of the clinical issues along with a sense of altruism and empathy. Ultimately, spiritual motivators and religious beliefs also stimulate creativity in clinical nurses. In addition, a review study, which examined ways to develop and measure creativity in nursing, has referred to self-directed learning and teamwork as effective factors in increasing creativity in nursing learning and practice ( Ma et al. , 2018 ). Karpova et al. (2011) claim that the most important factors in increasing creativity include the creation of opportunities for creating ideas (problem-solving, designing and combining experience and knowledge), and being aware of the surroundings (exploring and asking the question), and programs that stimulate motivation and curiosity to raise questions, explore answers, and have diverse and creative thinking. Therefore, while personal characteristics and intrinsic motivations are the most important factors in stimulating creativity, the creation of a supportive environment by managers and authorities that also affects an individual’s motivation plays an indirect role in its emergence ( Tsai et al. , 2013 ).

Consequences: Consequences are caused following the occurrence of a phenomenon. Creativity means offering new thinking to improve quality. The researchers have interpreted the consequences of creativity in different ways. Shahsavari et al. (2015c) concluded in their data analysis phase that creativity is effective at both individual and organizational levels. At the individual level, it improves self-esteem and self-confidence. The pleasure of discovering is also considered as one of the creativity-related positive emotions. Creativity is also the result of positive emotions and physical and mental health. At the organizational level, creativity leads to simplification of the task, increased quality of care, reduced financial burden, safety, and comfort of patients, nurses, and other nursing personnel. Creativity improves organizational effectiveness, motivation, and teamwork. In other words, from an organizational perspective, increased productivity, lower costs, higher quality services are among the consequences of organizational creativity.

Empirical Referents

Empirical referents are recognizable attributes of the concept whose emergence signifies the existence of the concept. Empirical referents are more important, especially when concepts are abstract and difficult to measure. It aims to identify the concept and facilitate its measurement (Walker & Avant, 2011). Here, several empirical examples put forward by the professional panel of the American Nursing Association (ANA) are presented. The predictive care model which enables the health system to anticipate and take special action to prevent disease, design an inspired infant wear, establish a direct caregiver connection for the elderly at the end of life, create safety campaigns for healthcare professionals, collaborative care clinics or professional international clinics, create hospital innovation units with new nursing roles, create units and motivational tools for patients, etc. through obtaining information from electronic medical records are among the creativities of American nurses (Hall & Wood, 2013).

Various tools and software have been developed to improve the quality and efficiency of the health system worldwide. For example, Robea is a nurse robot, the idea for the construction of which has been given by RIKEN-SRK in Japan to help older patients become more independent. New ideas for the construction of surgeon, scrub robots, and etc. are also becoming a reality ( Eriksson & Salzmann-Erikson, 2017 ). Shahsavari et al. (2015c) in Iran interviewed several creative nurses and examples of nursing creativities, including a wound washing machine for orthopedic patients, automatic washing of the dressing, a C-ARM desk (C-shaped arm is an imaging scanner intensifier), a robot that stretches out the patien’s leg during surgery, electronic tourniquet machine, optic laparoscope that is placed under a surgeon’s microscope to help students see eye surgeries better on a monitor.

As aforementioned, creativity in clinical nursing is not limited to the creation of useful devices. Many new creations may be new ways of taking care of or meeting the needs of patients ( Price, 2006 ). The development of useful and practical questionnaires, such as patient assessment forms, shortening forms, creation of online or cellphone-based online content by nurses, creation of international clinics are among different examples of creativity in clinical nursing. However, there is still a long way ahead in the field of creativity in nursing care. Various tools and questionnaires are also explained in the field of nursing creativity which measure different aspects of creativity such as Torrance tests of creative thinking (TTCT) (Torrance, 1990), Spanish creative intelligence test (CREA) (Almansa et al., 2013), and Rendcip’s standardized creativity questionnaire ( Nikbakht et al. , 2014 ). However, only one of them measures creativity in the nursing field. In fact, there is a need for an appropriate tool with satisfactory psychometrics to measure nursing creativity (Ma et al., 2017).

Conclusion and Recommendations

Creativity in nursing care is a complex concept, which has been discussed more frequently in theory than in practice. Therefore, there is a need for extensive studies on concept explanation. The aim of this study was to analyze the concept of creativity in nursing care. Creativity has various meanings, such as creating, making, producing designs, product relationships and attributes, a new and useful set of operations, reconstruction of old ideas, and a problem-solving method. However, the implementation of creativity in nursing clinical settings is of particular importance. Factors such as the existence of a supportive clinical environment, having some personality traits such as motivation, sensitivity to surrounding issues, divergent thinking skills, resistance, and having sufficient knowledge and experience can affect creativity in the clinical setting.

The results of this study revealed that creativity in nursing care includes the mind fluidity and creation of new ideas for patient care in the field of nursing practice in a way that the new method of patient care is simple, useful, effective, cost-effective, and safe. This requires a creative vision, creative sensitivity, and creative thinking in a way that the sensitivity to the problem, the ability to generate new ideas or reconstruction of old ideas, and connecting ideas to select new ways of care result in successful decision-making in the clinical setting.

As noted, creativity in nursing care simplifies tasks, saves time, and improves quality. Therefore, nurses’ perceptions about the concept of creativity in nursing care and the importance of its application in practice will be enhanced if such concept is clarified, and they thus will be able to successfully implement their creative thinking in providing patient care in today’s complex world. It is worth noting that our goal in this article is to refer to creativity in nursing care, which provides a platform for further discussion. There is a need to clarify the concept of creativity in nursing as a profession and other related areas. These include creativity in monitoring, management, budgeting, organizational charter, and human resources, accreditation, quality assurance, payment system, nursing shifts program, personnel charting based on the type of care, and indirect nursing care including nursing report, counseling, follow up, etc. The emergence of creativity in each of the above areas requires us to recognize it and create a way for the emergence of the context at the individual and organizational levels.

The concept of creativity is very complex and abstract. Therefore, clarification of this concept is very difficult. Also, this analysis was carried out relying on the available evidence that we could find, therefore, it is suggested that the results of our finding are combined with other new and unavailable evidence to clarify this concept.

All nurses can act as agents encouraging the change in processes and policies and the use of technology to improve better and cheaper care for patients and society. Nursing creativity leads to the development of better healthcare policies and practices, improvement of the quality of care, and advancement of health information technology. By considering creativity and its roles in patient care, this study was aimed attain these goals. It is an educational guide for future nurses to implement creativity in practice. Also, this finding is basic for further research in the field of creativity and can be used for the development of specific tools.

Author Contributions

Concept – S.K., S.P., L.M.D., M.A.C.; Design – S.K., S.P., L.M.D., M.A.C.; Supervision – S.K., S.P., L.M.D., M.A.C.; Resources – S.K., S.P., L.M.D., M.A.C.; Writing Manuscript – S.K.

Funding Statement

The authors declared that this study has received no financial support.

Peer-review: Externally peer-reviewed.

Conflict of Interest: The authors have no conflicts of interest to declare.

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