Have you heard of the NURSING PROCESS?
It is something that you will definitely come across in NURSING School, it is one of the foundational, and common aspects shared in nursing, and in being a nurse.
If you haven’t heard of it…and if you want to become a nurse, you will hear of it! If you are in nursing school, then you definitely have already heard of it.
What am I talking about, the NURSING PROCESS.
This is part of what makes nursing, nursing, and a nurse, a nurse… in the sense of how nurses practice nursing.
It is a…”PROCESS”, an actual guide to systematically care for patients. In this BLOG, I am going to go over each process…step by step and share some information about each one.
The NURSING PROCESS is a five or six step method, depending on the school that you go to.
As the dynamics in health care change, and populations and diseases change, the commonality of the NURSING PROCESS will keep nurses on track no matter what the situation, or where you work, or what patient population you care for. Nursing care is generally holistic in nature, and the Nursing Process allows for a patient-focused, patient-centered approach… as you will see.
The nursing process is actually, and usually inherently built into many documentation systems, whether, you are using a paper system, or an electronic medical health record.
So I am going to share the Nursing Process steps, and then describe and define each step.
The nursing process consists of 5 or 6 sequential steps.
These are done on a continuum, not just by one nurse then, DONE, but continued by each nurse, and then are adapted and changed, or updated as the patient’s course progresses.
In nursing school you may have had to perform an assessment as part of your skills, well this is where that translates from the patient to the Nursing Process. As part of being a nurse, the first step you will need to do is…THE ASSESSMENT…You will assess your patient: by taking their VITAL SIGNS, performing a head to toe body assessment; and also interviewing and conversing with the patient, and obtaining their history. You may learn things about the patient that nobody knew. As nursing is holistic in nature, the nurse will assess the patient physically, physiologically, psychologically, emotionally, spiritually, socio-culturally, and economically. What you are doing, technically, is gathering data, obtaining your baseline information, which is also going to be the foundation for the next steps in the NURSING PROCESS. After you have obtained the data, you will need to then document it, so that the next nurse can continue and add to the assessment.
To help nurses make systematic, concise, realistic, and universally accepted and STANDARDIZED nursing diagnoses, The North American Nursing Diagnosis Association, or better known as NANDA, and was established in 1982. NANDA is a professional organization of nurses, who standardized nursing diagnoses.
NANDA has grown to be not just in North America, when in 2002, NANDA evolved, and became known as NANDA International or NANDA – “I”, which now encompasses more than 30 countries.
So after the nursing assessment is done, then a NURSING DIAGNOSIS is made. This is not a medical diagnosis, such as headache or abdominal pain (maybe the patient had abdominal surgery), but a nursing diagnosis is a symptom or response associated with the surgery for example, “anxiety”, “pain” or a “Risk of…” …something…you fill in the blank, but due to the abdominal surgery.
This doesn’t mean you identify a specific disease or ailment. Rather, your diagnosis will identify a general cause of symptoms (e.g., constipation, hypothermia, anxiety) and/or any risks the patient faces (e.g., shock, stroke, fall, tissue death).
Nursing diagnoses are based on a familiar concept, that of
Abraham Maslow, who in 1943 developed his Hierarchy of Needs. In this concept, a patient must meet their basic Physiological needs before they can advance through the stages of Safety and Security, Love and Belonging, Self-Esteem, and Self-Actualization.
These hierarchy of needs are something you will also come across. If you have not, you will, so take some time to study and review these. Learn how they correlate to patients and the overall nursing process, as they are foundational for the physical and emotional health of your patient. Why do you think you assess the patient physiologically, psychologically, emotionally, and spiritually, to name a few?
3. Outcomes Identification:
This is newest to the list for some schools…, although this is not a new concept,
this is where expected outcomes are Identified. According to the ANA (or American Nursing Association) this is also the third Standard of Practice in Nursing. This is where goals are set. Goals should individualized for the patient, appropriate for the patient, realistic for the patient; and should include time lines, whether they are or include short-term goals and long-term goals. Now just to mention, you should have outcomes or goals Identified for each of the nursing diagnoses that you come up with… I know… more work!!!
One last thing to mention… these individualized goals that you make should be SMART goals, and I don’t mean smart vs dumb goals,
But SMART goals in the sense of the acronym S-M-A-R-T: with SMART being
Specific, Measurable, Attainable/Action oriented, Relevant/Realistic, Timeframe.
Be sure to research these also, as they are tied into the Nursing Process.
In some schools, this can take the place and or be combined or included in the Outcome Identification.
After the Outcomes are identified, this is where NURSING INTERVENTIONS come in. Nurses begin planning nursing interventions to implement in the next step. Remember, these nursing interventions are evidence-based, not pulled out of thin air, and they are what the nurse plans to do, how they plan to assist the patient in the doing, so that the patient can achieve the desired outcome. Nursing interventions can be independent, dependent, and or collaborative.
In the planning stage,
This is where we plan, or focus, on How the patient is going to meet their goals, and how as the nurse will assist the patient doing and meeting their goals. The plan should consider the short and long term goals from the Outcomes Identification step.
The PLAN is again individualized, and prioritized to the patient, evidence-based in theory and application, and is modified according to the patient response, and documented accordingly. The Plan should include and be in agreement with the patient, family, and health care team. It’s kind of the “what needs to be done”.
***FYI…If your school does not use the “O” or outcome identification step, then in the PLANNING stage is where the goals are developed. And again. they would be SMART goals, not dumb goals.
In the Implementation step, this is “where we do what we said we would do”. This is where the plan is put into motion. The Nursing Process and care plan are then implemented through the steps created for the patient. Documentation in the health record provides for continuity of care, and prepares all those involved for the patient’s discharge, and can uncover and address hidden needs.
The Nurse will monitor the implementation of the goals, to ensure the patient is following through. If the patient in unable to follow through, or follow through is not effective, then the plan may need to be reevaluated. Which leads to the next step.
In the evaluation stage, this is where we review the overall care plan, to verify if the patient met the goals set, then modify the goals accordingly. It should take into account the clinical status of the patient, and evaluate the overall nursing care effectiveness, then again modify as needed.
The evaluation stage is one that is continuously evaluated, modified, and reevaluated as needed, such as, Did the patient meet their goals? Are new goals needed?
In this stage you may learn that you need a new overall reassessment of the patient, goals may need to be changed or modified, especially and hopefully as the patient progresses to recovery. The evaluation is the last stage in the nursing process, however it is not the least stage. You should be constantly evaluating the patient as you move through the other stages…Assessment, Diagnosis, Outcome Identification, Planning, and Implementation… That is Evaluation.
So these steps or processes…
1. the Nursing Assessment
2. the Nursing Diagnosis
3. Outcome identification…
5. Implementation and
Are what make up the NURSING PROCESS.
TO make this all easy to remember, You can use the acronym A-D-O-P-I-E or Assessment, Diagnosis, OUTCOME Identification, Plan, Implementation and Evaluation.
Or if your school uses A-D-P-I-E or Assessment, Diagnosis, Plan, Implementation and Evaluation without the “O” or Outcome Identification.
You just have to learn, and apply, and make what happens in each step second nature. The good news is, you will do this so much in nursing school, that it will become… second nature.
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