Nursing Process

The nursing process is a series of organised steps designed for nurses to provide excellent care. Learn the five phases, including assessing, diagnosing, planning, implementing, and evaluating.

Purpose of Nursing Process

What is the nursing process?

In nursing, this process is one of the foundations of practice. It offers a framework for thinking through problems and provides some organization to a nurse’s critical thinking skills. It’s important to point out that this process is flexible and not rigid. It is a tool to use in nursing care, but one that should allow for creativity and thinking outside of the box.

Let’s look a little more closely at the five steps. Here is an acronym to help you: ADPIE, which stands for assessing, planning, diagnosing, implementing and evaluating. For this lesson, we will be thinking of each part of the process as a slice of pie. All of the pieces added together give you the whole pie, or ADPIE.

 

Assessing

The first step in the nursing process is assessing. In this phase, data is gathered about the patient, family or community that the nurse is working with. Objective data, or data that can be collected through examination, is measurable. This includes things like vital signs or observable patient behaviors.

Subjective data is gathered from patients as they talk about their needs, feelings and perspectives about the problems they’re having. In this step, information about the patient’s response to their current situation is established.

Let me introduce you to Mrs. Apple and we will start with assessing. The nurse takes her blood pressure, pulse and oxygenation level, which are abnormal. She also notes that Mrs. Apple is sweating and pale. These are examples of objective data. Mrs. Apple states, ‘I feel like an elephant is sitting on my chest’ and ‘I am scared’. These are examples of subjective data.

 

Diagnosing

The second phase of the nursing process is diagnosing. The nurse takes the information from the assessment, analyzes the information and identifies problems where patient outcomes can be improved through the use of nursing interventions.

Nursing diagnoses are different from medical diagnoses because they address patient problems that result from the disease process while medical diagnoses focus on the disease process alone. The nurse takes the information he gathered during the assessment of Mrs. Apple and makes a list of her current problems. These include pain and fear, among others.

 

Planning

This moves us to the third phase of the nursing process, planning. The nurse prioritizes which diagnoses need to be focused on. The patient can, and should, be involved in this process. Planning starts with identifying patient goals. Goals are statements of what needs to be accomplished and stem from the diagnoses – both short and long term goals should be established. Next, the nurse plans the steps needed to reach those goals, and an individualized plan with related nursing interventions is created.

Let’s go back to Mrs. Apple. The nurse, along with Apple, sets goals for her pain management and plans steps to take. Although the nurse recognizes that Mrs. Apple is afraid, she prioritizes the pain first, knowing that addressing her pain may make her anxiety lesson.

 

Implementing

Professional nurses use the first three steps of the nursing process in order to provide excellent, thoughtful and purposeful nursing care. If we skipped straight to step four, the things that are best for the patient may not occur. The fourth phase of the nursing process, implementing occurs when the nursing interventions, or plan, are actually carried out.

Common nursing interventions include pain management, symptom management, preventing complications following surgery, teaching and educating patients, and procedures that are part of nursing care. In our scenario with Mrs. Apple, the nurse offers pain medication, teaches deep breathing and relaxation techniques, darkens the room and plays soft music for her.

 

Evaluation Phase

Once all nursing intervention actions have taken place, the nurse completes an evaluation to determine of the goals for patient wellness have been met. The possible patient outcomes are generally described under three terms: patient’s condition improved, patient’s condition stabilized, and patient’s condition deteriorated, died, or discharged. In the event the condition of the patient has shown no improvement, or if the wellness goals were not met, the nursing process begins again from the first step.

All nurses must be familiar with the steps of the nursing process. If you’re planning on studying to become a nurse, be prepared to use these phases every day in your new career.

  •         Assess
  •         Plan
  •         Implement
  •         Evaluate

The Nursing process is what we do every day in practice. Apply it to your own professional development. If it works for those in our care then we can apply it to ourselves and practice what we preach. Try completing a Development Assessment and Development Plan on yourself to help you focus on achieving your goals.