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The nursing process is a process by which nurses deliver care to patients, supported by nursing models or philosophies. The nursing process was originally an adapted form of problem-solving and is classified as a deductive theory.

Nursing process is a patient centered, goal oriented method of caring that provides a framework to nursing care. It involves five major steps of assessment, nursing diagnosis, planning, implementation/intervention and evaluating.

A - Assess (what is the situation?) D - Diagnose (what is the problem?) P - Plan (how to fix the problem) I - Implement (putting plan into action) E - Evaluate (did the plan work?) All together equaling ADPIE

Characteristics of the nursing process[edit | edit source]

The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the patient has, and for every element of patient care, rather than once for each patient. The nurse's evaluation of care will lead to changes in the implementation of the care and the patient's needs are likely to change during their stay in hospital as their health either improves or deteriorates. The nursing process not only focuses on ways to improve the patient's physical needs, but also on social and emotional needs as well.

  • Cyclic and dynamic
  • Goal directed and client centered
  • Interpersonal and collaborative
  • Universally applicable
  • Systematic[1]

Analogy with purchase of gasoline[edit | edit source]

The nursing process is not something foreign or unusually complex. On the contrary, we use the nursing process method on a daily basis without even realizing it. For example, a trip to the gas station to get fuel requires Assessing the various prices and the number of people waiting to get gas among other things. A subsequent decision, or Diagnosis, is made based on the former criteria. This may include pulling into the gas station to fuel up or going down the road for better prices and/or less of a crowd. The price is right and there's not much of a crowd, we're pulling in. Now the Planning can take place. This may include which pump to use, how much gas to put in the tank, whether or not to clean the windows along with other things. We're at the pump and ready to fuel up. We must now Implement what we planned prior to pulling up to the pump. We've pulled up on the passenger side because the gas tank resides on this side, part of our plan. We've also given ourselves enough room to exit without getting blocked in by another vehicle, part of our plan also. We now unscrew the gas cap and begin fueling or Implementing what we planned. Things went well. We are fueled up and have exited the gas station without complication. Our Evaluation of the trip to the gas station would be a good one. We may take notice of slight details needing revision, such as paying for the gas, and make note of that for further occasions. The Nursing process is that simple in theory. However, as a nurse, the nursing process tool will be used for more complex and difficult situations but is applied the same way as the gas station analogy.

Phases of the Nursing process[edit | edit source]

The following are the steps or phases of the nursing process.

  • Assessment (of patient's needs)
  • Diagnosis (of human response needs that nurses can deal with)
  • Planning (of patient's care)
  • Implementation (of care)
  • Evaluation (of the success of the implemented care)

Assessing phase[edit | edit source]

The nurse should carry out a complete and holistic nursing assessment of every patient's needs, regardless of the reason for the encounter. Usually, an assessment framework, based on a nursing model or Waterlow scoring, is used. These problems are expressed as either actual or potential. For example, a patient who has been rendered immobile by a road traffic accident may be assessed as having the "potential for impaired skin integrity related to immobility".

Models for data collection[edit | edit source]

The following nursing models are used to gather the necessary and relevant information from the patient in order to effectively deliver quality nursing care. This will help the nurse determine the ranking of the problems encountered.

How to collect data

  • Client Interview
  • Physical Examination
  • Observation

Diagnosing phase[edit | edit source]

Nursing diagnoses are part of a movement in nursing to standardize terminology which includes standard descriptions of diagnoses, interventions, and outcomes. Those in support of standardized terminology believe that it will help nursing become more scientific and evidence based.The purpose of this stage is to identify the patient's nursing problems. See Nursing diagnosis

File:Maslow's hierarchy of needs.svg

Maslow's hierarchy of needs is used when the nurse prioritizes identified nursing health problems from the patient.

Types of diagnosis

  • Actual Diagnosis-a judgment on client's response to a present health problem
  • High Risk-based on most likely to develop
  • A Possible Nursing Diagnosis-a health problem is unclear and causative factor is unknown
  • Wellness Diagnosis-indicating a well response of the patient

Components of a nursing diagnosis

  • Problem Statement (diagnostic label): describes the patient's health problem
  • Etiology (related factor): the probable cause of the health problem
  • Defining Characteristic: a cluster of signs and symptoms;

e.g. Ineffective airway clearance related to the presence of tracheo-bronchial secretion as manifested by thick tenacious sputum upon expectoration.

Problem (Ineffective airway clearance) + Etiology (related to) + Defining Characteristics (as manifested by)

Planning phase[edit | edit source]

In agreement with the patient, the nurse addresses each of the problems identified in the planning phase. For each problem a measurable goal is set. For example, for the patient discussed above, the goal would be for the patient's skin to remain intact. The result is a nursing care plan which is actualization of the health care to provide basic data to the patient.

Implementing phase[edit | edit source]

The methods by which the goal will be achieved are also recorded at this stage. The methods of implementation must be recorded in an explicit and tangible format in a way that the patient can understand should he or she wish to read it. Clarity is essential as it will aid communication between those tasked with carrying out patient care. Actual doing stage 444666

Evaluating phase[edit | edit source]

The purpose of this stage is to evaluate progress toward the goals identified in the previous stages. If progress towards the goal is slow, or if regression has occurred, the nurse must change the plan of care accordingly. Conversely, if the goal has been achieved then the care can cease. New problems may be identified at this stage, and thus the process will start all over again. It is at this stage that measurable goals must be set—failure to set measurable goals will result in poor evaluations.

The entire process is recorded or documented in an agreed format in the patient's care plan in order to allow all members of the nursing team to perform the agreed care and make additions or changes where appropriate.

Development of the Nursing process[edit | edit source]

Since its inception, the nursing process has been developed and honed by different authors. Additional detail has been added for each stage of the process, and new or adapted stages have also been suggested. The most recent 'repackaging' of the nursing process comes in the form of the ASPIRE approach to planning and delivering care.[3]. This approach—developed at Hull University (UK) as a teaching and learning tool—takes the 5-stage approach outlined above and enhances it. 'Diagnosis' is retitled 'Systematic Nursing Diagnosis' to reflect the process of diagnosis in addition to the final product. An additional stage--'Recheck'--is placed between Implementation and Evaluation, and reflects the information-gathering activities carried out by nurses, necessary to make an informed judgement about the effectiveness of patient care.

See also[edit | edit source]

References[edit | edit source]

  1. Kozier, Barbara, et al. (2004) Assessing, Fundamentals of Nursing: concepts, process and practice, 2nd ed., p. 261
  2. Notes on Healthcare Process, 2004
  3. Barrett D, Wilson B, Woollands A (2009) Care Planning: a guide for nurses. Harlow: Pearson Education


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