Contributor – Maria Müller Staub, PhD, MSC, EdN, RN / FEANS, FNI

Author – Maria Müller Staub

First published – 2015

Major Concepts

Nursing process, nursing assessment, nursing diagnosis, nursing outcomes planning, implementation of nursing interventions, evaluation of nursing-sensitive patient outcomes, nursing documentation, electronic nursing record.

Typology

This is a nursing process model which provides an advanced, research-based definition of the nursing process and links it with scientific, standardized nursing language.

Description

The Advanced Nursing Process is a new version of the general Nursing Process, which provides a structure for nursing practice [1-4]. The Nursing Process leads the nurse to assess patients’ care needs and to plan and evaluate nursing care. It contains five phases: Nursing Assessment, Nursing Diagnoses, Outcomes / Planning, Implementation, and Evaluation [2, 5].

As a structure with five phases alone, scientists critizised it for missing literature-based content and standardised concepts [6, 7]. The question was: What does the Nursing Process consist of? What content knowledge should it contain to be taught and researched?
To fill this research gap, the Advanced Nursing Process was developed. The term Advanced Nursing Process was first mentioned by Ackley & Ladwig [1]. The term “advanced” means “further developed, deepened, based on scientifically defined concepts”. Later, Müller-Staub et al., (2015) published a definition: “The Advanced Nursing Process consists of defined, validated concepts. It includes assessment, nursing diagnoses, nursing interventions and nursing outcomes that are rooted in scientifically based nursing classifications” [8], page 13 and [9, 10].
The Advanced Nursing Process is implemented by using standardized nursing classifications [6-28]. To teach it to nurses, the method ‘Guided Clinical Reasoning’ (GCR) was suggested. According to studies, GCR is a teaching method that supports the application of the Advanced Nursing Process [12, 29-35].

Research indicates [21, 36, 37] three nursing classifications represent the body of nurses’ knowledge: the Nursing Diagnosis Classification NANDA-I [38], the Nursing Interventions Classification NIC [39, 40], and the Nursing Outcomes Classification NOC [18]. Together, they are called NNN-Classification [41]. The NNN is research-based and was reported being the most used nursing classification [17, 26, 36, 37, 42]. It provides the content for the Advanced Nursing Process and contains 244 nursing diagnoses [38], 540 NOC nursing outcomes [18], and 565 NIC nursing interventions [40], see the following graph.

The aim of the Advanced Nursing Process is the application of scientific knowledge to clinical patient situations by valid concepts of nursing diagnoses, interventions and nursing-sensitive patient outcomes [8, 12, 16, 19, 21, 24, 33, 34, 36, 37, 42, 52, 55-60].
Nursing Process – Clinical Decision Support Systems (NP-CDSS) in EHRs can help nurses to apply the Advanced Nursing Process in practice, and an international standard gives direction on how to develop such a system in EHRs. With the aid of Clinical Decision Support Systems according to the NP-CDSS standard, clinical nurses can apply evidence-based knowledge in care planning and evaluations [61]. Studies revealed that the Advanced Nursing Process can significantly enhance patient outcomes [12, 30, 31, 33, 42, 57, 62-64]. Applying the NNN classifications in the Advanced Nursing Process points out what nurses do, why they do it, which objectives nurses’ pursue and which nursing-sensitive patient outcomes patients achieve [3, 4, 8, 17].

Primary Source(s)

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28. Wilkinson, J.M., Nursing process and critical thinking. 2012, New Jersey: Prentice Hall.
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30. Leoni-Scheiber, C., H. Mayer, and M. Muller-Staub, Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses’ knowledge and attitude: Study protocol. Nurs Open, 2019. 6(3): p. 1269–1280.
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About Maria Müller Staub

Maria Müller-Staub is Professor Adj. emeritus at the Lectorat in Nursing Diagnostics at the Hanze University in Groningen and was head of Nursing Development and Research at the Stadtspital Waid in Zürich. Formerly, she was full professor in Acute Care at ZHAW University Winterhur, Switzerland. She has a long-term impact as nurse researcher and her funded research program on patient outcomes, community care and health care policy is widely recognized.

Her main focus in research is on nursing diagnostics, clinical decision-making and critical thinking. She lead projects to foster E-Health, nursing documentation, nursing care quality and Clinical Information Systems (CIS). To ensure cost effective, high quality, appropriate outcomes of nursing care delivered across settings, Standardized Nursing Languages (SNLs) are required. Without classifications, nursing has difficulties in communicating clinical problems – nursing diagnoses – in a clear, precise, or consistent manner. Maria Müller-Staub and her co-researchers perform high quality studies to fill this research gab. Based on the need to make nurses’ contribution to patients’ health visible and measurable, she became Founder and Director of Pflege PBS where her research focuses is on the accuracy of nursing diagnoses, on the effectiveness of interventions and on nursing-sensitive patient outcomes (NANDA-I, NIC & NOC).

Escalating costs and legal cases require health care disciplines to develop measures so that the quality of nursing services can be compared across settings and localities, therefore she developed and validated an instrument to measure the Quality of Diagnoses, Interventions and Outcomes (Q-DIO). The Q-DIO was translated into ten languages and yielded over 60 publications. The strengths of this instrument are the multiple methods that were used to assure its validity.
Maria Müller-Staub is a nurse leader with outstanding contributions to nursing research by focusing on patients’ care needs and on the effectiveness of nursing interventions. She is one of few specialists on the representation of Standardized Nursing Language (SNLs representing nursing knowledge) and has contributed significantly that nurses reach good nursing-sensitive patient outcomes. She was honored with several awards, e.g. for nursing curriculum development and excellent publications, and as a mentor supporting nurses’ critical thinking and clinical decision-making skills.

Prof. Müller-Staub is a recognized nursing scientist and was honored for being an inspiring teacher and mentor of more than 240 post-graduates and as promoter of doctoral students. She has led 80 research projects, 380 publications (157 peer-reviewed/indexed, 163 professional articles, 60 books/bookchapters) and held 218 oral presentations. Maria Müller-Staub was President of the Swiss Association for Nursing Research from 2011 to 2017 representing nine Academic Nursing Societies. She was also Principal Investigator to develop and evaluate the “Swiss Nursing Research Agenda”, which is seen as a leading model for European Nursing Research Strategies to guide national nursing research programs.