The nursing process is a modified scientific method. Nursing practise was first described as a four-stage nursing process by Ida Jean Orlando in 1958. It should not be confused with nursing theories or health informatics. The diagnosis phase was added later.
The nursing process uses clinical judgement to strike a balance of epistemology between personal interpretation and research evidence in which critical thinking may play a part to categorize the clients issue and course of action. Nursing offers diverse patterns of knowing. Nursing knowledge has embraced pluralism since the 1970s.
Some authors refer to a mind map or abductive reasoning as a potential alternative strategy for organizing care.Intuition plays a part for experienced nurses.
The nursing process is goal-oriented method of caring that provides a framework to nursing care. It involves seven major steps:
- Assess (what data is collected?)
- Diagnose (what is the problem?)
- Outcome Identification - (Was originally a part of the Planning phase, but has recently been added as a new step in the complete process).
- Plan (how to manage the problem)
- Implement (putting plan into action)
- Rationale (Scientific reason of the implementations)
- Evaluate (did the plan work?)
According to some theorists, this seven-steps description of the nursing process is outdated and misrepresents nursing as linear and atomic.
Main article: Nursing assessment
The nurse completes an holisticnursing assessment of the needs of the individual/family/community, regardless of the reason for the encounter. The nurse collects subjectivedata and objectivedata using a nursing framework, such as Marjory Gordon's functional health patterns.
Models for data collection
Nursing assessments provide the starting point for determining nursing diagnoses. It is vital that a recognized nursing assessment framework is used in practice to identify the patient's* problems, risks and outcomes for enhancing health. The use of an evidence-based nursing framework such as Gordon's Functional Health Pattern Assessment should guide assessments that support nurses in determination of NANDA-I nursing diagnoses. For accurate determination of nursing diagnoses, a useful, evidence-based assessment framework is best practice.
- Client Interview
- Physical Examination
- Obtaining a health history (including dietary data)
- Family history/report
Main article: Nursing diagnosis
Nursing diagnoses represent the nurse's clinical judgment about actual or potential health problems/life process occurring with the individual, family, group or community. The accuracy of the nursing diagnosis is validated when a nurse is able to clearly identify and link to the defining characteristics, related factors and/or risk factors found within the patients assessment. Multiple nursing diagnoses may be made for one client.
Main article: Nursing care plan
In agreement with the client, the nurse addresses each of the problems identified in the diagnosing phase. When there are multiple nursing diagnoses to be addressed, the nurse prioritizes which diagnoses will receive the most attention first according to their severity and potential for causing more serious harm. For each problem a measurable goal/outcome is set. For each goal/outcome, the nurse selects nursing interventions that will help achieve the goal/outcome. A common method of formulating the expected outcomes is to use the evidence-basedNursing Outcomes Classification to allow for the use of standardized language which improves consistency of terminology, definition and outcome measures. The interventions used in the Nursing Interventions Classification again allow for the use of standardized language which improves consistency of terminology, definition and ability to identify nursing activities, which can also be linked to nursing workload and staffing indices. The result of this phase is a nursing care plan.
The nurse implements the nursing care plan, performing the determined interventions that were selected to help meet the goals/outcomes that were established. Delegated tasks and the monitoring of them is included here as well.
- pre-assessment of the client-done before just carrying out implementation to determine if it is relevant
- determine need for assistance
- implementation of nursing orders
- delegating and supervising-determines who to carry out what action
The nurse evaluates the progress toward the goals/outcomes identified in the previous phases. 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.
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 individual/family/community has. The nursing process not only focuses on ways to improve physical needs, but also on social and emotional needs as well.
- Cyclic and dynamic
- Goal directed and client centered
- Interpersonal and collaborative
- Universally applicable
The entire process is recorded or documented in order to inform all members of the health care team.
Variations and documentation
See also: Nursing documentation
The PIE method is a system for documenting actions, especially in the field of nursing. The name comes from the acronym PIE, meaning Problem, Intervention, Evaluation.
- ^Funnell, R., Koutoukidis, G.& Lawrence, K. (2009) Tabbner's Nursing Care (5th Edition), p. 72, Elsevier Pub, Australia.
- ^Marriner-Tomey & Allgood (2006) Nursing Theorists and their work. p. 432
- ^Reed, P. (2009) Inspired knowing in nursing. p. 63 in Loscin & Purnell (Eds) (2009) Contemporary Nursing Process.Springer Pub
- ^Kim, H (2010) The Nature of Theoretical Thinking in Nursing. p. 6.
- ^Bradshaw, J & Lowenstein (2010) Innovative Teaching Strategies in Nursing and Related Health Professions.
- ^Funnell, R., Koutoukidis, G.& Lawrence, K. (2009) Tabbner's Nursing Care (5th Edition), p. 222, Elsevier Pub, Australia.
- ^Kozier, Barbara, et al. (2004) Assessing, Fundamentals of Nursing: concepts, process and practice, 2nd ed., p. 261
- ^Barbara Kuhn Timby (2008-01-01), Fundamental Nursing Skills and Concepts, p. 114, ISBN 978-0-7817-7909-8
The 5 Steps of the Nursing Process
The nursing process is a scientific method used by nurses to ensure the quality of patient care. This approach can be broken down into five separate steps.
The first step of the nursing process is assessment. During this phase, the nurse gathers information about a patient's psychological, physiological, sociological, and spiritual status. This data can be collected in a variety of ways. Generally, nurses will conduct a patient interview. Physical examinations, referencing a patient's health history, obtaining a patient's family history, and general observation can also be used to gather assessment data. Patient interaction is generally the heaviest during this evaluative phase.
The diagnosing phase involves a nurse making an educated judgment about a potential or actual health problem with a patient. Multiple diagnoses are sometimes made for a single patient. These assessments not only include an actual description of the problem (e.g. sleep deprivation) but also whether or not a patient is at risk of developing further problems. These diagnoses are also used to determine a patient's readiness for health improvement and whether or not they may have developed a syndrome. The diagnoses phase is a critical step as it is used to determine the course of treatment.
Once a patient and nurse agree on the diagnoses, a plan of action can be developed. If multiple diagnoses need to be addressed, the head nurse will prioritize each assessment and devote attention to severe symptoms and high risk factors. Each problem is assigned a clear, measurable goal for the expected beneficial outcome. For this phase, nurses generally refer to the evidence-based Nursing Outcome Classification, which is a set of standardized terms and measurements for tracking patient wellness. The Nursing Interventions Classification may also be used as a resource for planning.
The implementing phase is where the nurse follows through on the decided plan of action. This plan is specific to each patient and focuses on achievable outcomes. Actions involved in a nursing care plan include monitoring the patient for signs of change or improvement, directly caring for the patient or performing necessary medical tasks, educating and instructing the patient about further health management, and referring or contacting the patient for follow-up. Implementation can take place over the course of hours, days, weeks, or even months.
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 everyday in your new career.