Definition of the Nursing Process
The nursing process is a scientific, clinical method used by nurses to ensure the quality of patient care. It is a systematic, rational method of planning and providing individualized nursing care. The core concept is that it acts as a modified version of the scientific method used in the sciences. It is not merely a checklist but a dynamic, cyclical process that requires critical thinking and decision-making.
Unlike the medical model, which focuses primarily on curing disease, the nursing process focuses on the human response to health conditions. It emphasizes the holistic needs of the patientphysical, emotional, psychological, and social. The ultimate goal of the nursing process is to promote, maintain, and restore health, or to provide a peaceful death when that is the only viable option.
The process serves several critical functions in professional nursing. It organizes the nurse's thinking and actions, preventing nursing care from becoming a series of isolated tasks. It ensures continuity of care, as different nurses can follow the plan established by the team. Furthermore, it creates a legal record of the care provided, serving as documentation for the patient's chart.
The Five Phases of the Nursing Process
The nursing process consists of five distinct, interrelated phases. These steps often overlap and occur simultaneously rather than in strict sequential order. A nurse may be assessing a new problem while simultaneously implementing care for a previously identified issue. However, for the sake of study and understanding, the phases are categorized as follows:
1. Assessment
Phase 1 Assessment is the first step and the foundation of the entire nursing process. It is the deliberate, systematic collection of data about a patients health status. Without accurate and comprehensive assessment, the subsequent phases cannot be effective.
Data collection involves two main types of information:
- Subjective Data: This is information that the patient tells you. It includes symptoms such as pain ("I have a headache"), feelings of nausea, anxiety, or fatigue. It is often referred to as "what the patient says."
- Objective Data: This is information that the nurse observes or measures through physical examination and diagnostic tests. It includes vital signs (blood pressure, heart rate), laboratory results, wound appearance, and lung sounds. It is referred to as "what the nurse sees."
Assessment can be comprehensive (a total health history and physical exam done upon admission) or focused (targeting a specific problem). Nurses use various methods to gather this data, including interviewing, observation, physical examination, and reviewing medical records. Data validation is also a crucial sub-step, where the nurse ensures the information is accurate and complete.
2. Diagnosis
Phase 2 Nursing Diagnosis is the clinical judgment about the individual, family, or community responses to actual or potential health problems or life processes. It is important to distinguish a Nursing Diagnosis from a Medical Diagnosis.
A medical diagnosis identifies a disease (e.g., Diabetes Mellitus, Pneumonia) and is made by a physician. A nursing diagnosis, in contrast, identifies the patient's response to that disease (e.g., Imbalanced Nutrition: Less than Body Requirements related to inability to utilize glucose). Nurses treat the human response, not the disease itself.
Nurses use standardized taxonomy, such as NANDA International (NANDA-I), to formulate diagnoses. A standard nursing diagnosis statement typically has three parts:
- Problem (P): The health status or human response.
- Etiology (E): The related cause or contributing factors.
- Signs and Symptoms (S): The defining characteristics or evidence of the problem.
Accurate diagnosis allows the nurse to identify the patient's priorities for care.
3. Planning/Outcomes Identification
Phase 3 Once the nursing diagnoses are established, the nurse moves into the planning phase. This phase involves establishing priorities, setting goals, and selecting nursing interventions.
Setting Priorities: Nurses often deal with multiple patient problems simultaneously. Prioritization is essential to ensure life-threatening issues are addressed first. The common hierarchy used is:
- High Priority: Problems that are life-threatening or involve immediate safety (e.g., airway obstruction, severe bleeding).
- Intermediate Priority: Problems that are non-emergent but require attention to prevent complications (e.g., activity intolerance, lack of knowledge).
- Low Priority: Problems that can be addressed later or are long-term (e.g., social isolation regarding hobbies).
Setting Goals (Outcomes): The nurse must establish patient-centered goals. These should be SMART: Specific, Measurable, Attainable, Relevant, and Time-bound. Goals can be short-term (achieved in a few hours or days) or long-term (achieved over weeks or months).
Selecting Interventions: Finally, the nurse selects the actions that will help achieve the goals. These interventions are based on scientific rationale and evidence-based practice.
4. Implementation
Phase 4 Implementation is the phase where the nursing plan is put into action. It involves carrying out the interventions identified during the planning phase. This is often viewed as the "doing" phase of the nursing process.
During implementation, the nurse performs hands-on care, educates the patient and family, and monitors the patient's progress. Interventions are generally categorized into three types:
- Independent Interventions: Actions that the nurse can initiate without a physician's order (e.g., teaching a patient how to cough and deep breathe, repositioning for comfort, emotional support).
- Dependent Interventions: Actions that require a physician's order (e.g., administering medication, performing wound care with specific instructions, inserting a catheter).
- Collaborative (Interdependent) Interventions: Actions carried out in conjunction with other members of the healthcare team (e.g., consulting a physical therapist for gait training, coordinating with a dietitian for meal planning).
Documentation is a vital component of implementation. The nurse must record exactly what was done, how the patient responded, and when it occurred. This creates a permanent record of the care provided.
5. Evaluation
Phase 5 Evaluation is the final phase of the nursing process, but it essentially loops back to the beginning. In this phase, the nurse compares the patients current health status with the outcomes established during the planning phase.
The purpose of evaluation is to judge whether the nursing interventions were effective. Did the patient meet the goal? Was the problem resolved?
The evaluation can result in one of three conclusions:
- The goal was met: The patients response is consistent with the expected outcome.
- The goal was partially met: The patient showed progress but did not fully achieve the desired outcome.
- The goal was not met: There was no progress or the patients condition deteriorated.
Based on these findings, the nurse revisits the assessment. If goals were met, care for that specific problem is discontinued. If goals were not met, the nurse must determine why: was the planning unrealistic? Was the assessment inaccurate? Or has the patient's condition changed? The nursing process then begins againreassessing, re-diagnosing, and planning new interventions.
Conclusion
The nursing process is not a linear path but a continuous cycle. It acts as the framework for all nursing actions, ensuring that care is not random but purposeful and evidence-based. By adhering to this five-step processAssessment, Diagnosis, Planning, Implementation, and Evaluationnurses can deliver high-quality, holistic care that adapts to the changing needs of the patient, promoting the best possible health outcomes.
