Ask an NP: What is the Nursing Process?
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The nursing process is a systematic planning method that directs nursing actions in delivering holistic, patient-centered care. This is how nurses create care plans and reach patient care goals. The nursing process is a type of scientific reasoning that requires critical thinking in nurses to provide the most optimal treatment.
The nursing process aims to identify a patient’s health status through assessment, establish plans to meet the detected needs and deliver nursing interventions to fulfill those needs. This is done by applying evidence-based care to promote human functions and responses to health and sickness. The process helps nurses practice in an analytically organized way. It also establishes a database about the patient’s health status and their response to illness.
The nursing process is patient-centered, in which the nurse is responsive to an individual’s needs and values. It is collaborative, in which nurses partner with an interdisciplinary team to achieve quality patient care. It is interpersonal, where the nurse and patient respect each other as people and grow through the interactions. The process requires critical thinking so that nurses can identify patient issues and implement interventions to solve them. Lastly, it is a dynamic and cyclical process in which each stage interacts with and is influenced by other stages.
The Five Steps
The nursing process consists of five steps used in assessing, diagnosing, and caring for patients as a nurse. The steps are often referred to by the acronym: ADPIE. ADPIE stands for assessment, diagnosis, planning, implementation, and evaluation.
The assessment step in the nursing process refers to identifying a patient’s health needs and collecting data about their illness. In the nurse’s first encounter with the patient, they assess the patient’s health problems and their physiological and emotional state. This involves gathering, organizing, and documenting the patient’s health status. The nurse creates a database of the patient’s responses to health concerns and their ability to manage their healthcare needs.
In this role, nurses collect data in a systematic and continuous approach to prevent the omission of essential information. This is done through a health interview, physical exam, and observation. Nurses need to validate the data to ensure accuracy. One way nurses can do this is by double-checking. They can repeat blood pressure readings or ask patients questions for clarification.
An assessment can be done both objectively and subjectively. Examples of collecting data objectively include a head-to-toe physical exam and taking vital signs. To evaluate the patient’s health status, the nurse can objectively assess intake and output, lung sounds, crying, and skin color. Subjective assessments are done by listening to the patient, as they express their thoughts and feelings. Examples include asking the patient for a pain level and inquiring about their values and beliefs.
Nurses often use listening skills to assess a patient’s status such as identifying anxiety, flight of ideas, and slurred speech. Nonverbal data can also be helpful in an assessment. For instance, body language, facial expression, and grooming can differ from what the patient tries to portray. During the assessment phase, the nurse should determine what medications the patient is taking, their medical and social history, and functional capabilities.
The next step in the nursing process is diagnosis. In this step, nurses identify real or potential health problems for a patient based on the information gathered during their assessment. They will analyze the gathered information and diagnose the patient’s condition and needs.
To diagnose a patient, the nurse must identify health problems and risks. Then they formulate diagnostic statements about a patient’s actual or potential health problem. Some diagnoses are problem-focused, while others can be health promotion or at-risk diagnoses.
Some patients may have more than one diagnosis depending on their level of complexity. The nursing diagnosis helps nurses develop the care plan. It provides the basis for selecting nursing interventions to achieve optimal outcomes for the patient. Creating diagnoses helps identify nursing priorities and interventions. It also provides a common language between nursing professionals and the healthcare team.
Nursing diagnoses are different from medical diagnoses. A medical diagnosis is focused on the exact scientific illness. A nursing diagnosis is focused on patient care. Nursing diagnoses are specific to nurses because there are distinct and precise actions that nurses can perform for a specific condition.
A patient with a medical diagnosis of “pneumonia” can have a nursing diagnosis of “ineffective airway clearance.” The nurse is targeting the patient’s inability to clear up their airway. As a result, the nurse can teach the patient to do deep breathing exercises, administer nebulizer treatments and oxygen, and position the patient upright for lung expansion.
Another example of a nursing diagnosis is “risk for unstable blood glucose” in a patient with a medical diagnosis of “type 2 diabetes mellitus.” The nurse has identified a potential health problem for the patient based on their history of diabetes. Using this nursing diagnosis as a guideline, the nurse can ensure the patient eats a diabetic diet and performs routine glucose monitoring to prevent hyperglycemia.
After formulating a nursing diagnosis, the nurse can move to the third nursing process step: planning. In this phase, the nurse develops a care plan that includes strategies and goals to tackle the problems detected during the assessment and diagnosis steps. It helps provide direction in forming specific nursing interventions that will directly impact patient care. It also helps nurses establish priorities in patient care.
The planning step is also when outcomes are devised based on evidence-based practice guidelines. Nurses will have to set measurable, achievable, realistic, and specific goals. This will have to differentiate between short-term goals and long-term goals. For instance, a short-term goal can be maintaining adequate nutrition by eating smaller, more frequent meals. A long-term goal can be that the decubitus ulcer will completely heal in three months.
The planning phase is initially done by the nurse conducting the admission assessment. Additionally, all nurses who work with the patient are involved in ongoing planning. It allows the nurse to determine if the patient’s health status has changed and set priorities for their shift. The last preparation is discharge planning, which is anticipating and planning for needs after discharge. Discharge planning is started for patients admitted to a healthcare setting.
The next step of the nursing process is the implementation step. This is when the nurse puts their plan into action. The nurse carries out various interventions to support the nursing diagnosis and plan. The interventions need to be specific and focus on achievable outcomes. Interventions in a care plan can be administering medications, educating the patient about their health management, or monitoring the patient’s vital signs.
Nurses implement interventions in this phase but must also reassess the patient before and after the intervention is completed. Some interventions are independent, where the nurse can perform these tasks autonomously. Examples are checking vital signs and providing patient education on their medication. Other interventions are dependent—they require an order or supervision from a physician. Examples are administering medication, providing a specific diet, and implementing wound care.
Implementing interventions in the nursing process is essential in achieving optimal patient outcomes. Specific examples of nursing interventions that support nursing diagnoses are: turning the patient every two hours to prevent ulcers; monitoring the patient’s blood pressure every four hours; educating the patients about daily weights at home to monitor for fluid overload; providing meals consistent with a low-fat diet, etc. Note how these interventions are specific.
The final step of the nursing process is the evaluation. An evaluation aims to verify the patient’s progress toward achieving established goals. This is when the nurse determines if the goals of care have been met. The nurse evaluates which interventions worked once all nursing interventions have been completed. The nursing process is only complete once the nurse evaluates the effectiveness of their care.
The nurse compares the collected data after the interventions during the evaluation with the desired outcomes. The nurse recognizes aspects that contributed to the success or failure of the care plan. For example, if the nursing diagnosis was “risk for falls,” the nurse would review the patient’s medical record to see if there have been any further falls since implementing the preventative actions.
The nursing process starts over again if the outcomes are not at the goal. The nurse will have to reassess why the outcomes were negative and what they can do to change that. They can modify the care plan as needed using critical thinking skills. Evaluation happens on an ongoing basis and keeps nurses accountable.
Applying the Nursing Process
The nursing process is an evolving method that continues throughout a patient’s admission or resolution of an illness. It is patient-centered and encourages nurses to serve as patient advocates. To achieve outcomes, the process forces nurses to work in an interdisciplinary team and with the patient and their families. It is a systematic and scientific procedure that requires critical thinking and evidence-based practice.
The nursing process helps nurses create care plans for each patient. The care plan is unique to each patient and includes their needs and health challenges. The nurse would start with an assessment, form a nursing diagnosis, and then start their plan. Afterward, they would implement the planned nursing interventions and evaluate if they led to optimal patient outcomes.