NURSING PROCESS

APPLICATION
The nursing process is often
defined as the application of
critical thinking to client care
activities .

The purpose of the nursing process is to

provide care for clients that is individualized,
holistic, effective, and efficient.

It directs nursing activities for health

promotion, health protection, and disease
prevention and is used by nurses in every
practice setting and specialty. The nursing
process provides the basis for critical
thinking in nursing

Thinking Ways
Ritual.
Random.

Appreciative.
Critical.

RITUAL THINKING
Underlies the development of habits
actions we perform so often, that we do
them automatically, without conscious
decisions.

RANDOM THINKING
Is the free association of ideas at the
unconscious level that can lead to
impulsive implementation of the first
problem solving solution.

APPROCIATIVE
THINKING
Reflects awareness of human values and
respect for clients individual needs.

CRITICAL THINKING
Is based on the scientific method i.e.
deliberate and systemic use of rational
informed thought process in problem
finding and problem solving.

STEPS OF NURSING
PROCESS
Nursing process involves five steps which
include assessment, nursing diagnosis,
planning, implementation and evaluation.

ASSESSMENT
Is the first phase in the nursing process and
has two sub phases which include data
collection and data analysis or synthesis.

 Assessment consist of the systematic and

orderly collections and analysis of data about
the health status of the patient to making the
nursing diagnosis.

Incorrect or insufficiency assessment leading

to false diagnosis.

ASSESSMENT
GUIDLINES
Biographical data.
Health history
including family
members.
Subjective and
objective data (
physical exam,
medical diagnosis,
medical problem,
diagnostic studies
result.)

Social, cultural and

environmental
data.
Behaviours risks
lead to potential
problem.
Traditionally
nursing used
medical
assessment
framework for the
collection &
organization of
data.

Subjective Data
Subjective data are data from the clients point of
view and include feelings, perceptions, and
concerns. The method of collecting subjective
information is primarily the interview. Using
therapeutic interviewing techniques, the nurse
collects data that will begin to build the client
database. Examples of subjective information
include such statements as:
I drink only coffee for breakfast.
I have had pains in my legs for three days now.
I go to sleep easily each night, but I wake up about
two hours later and cannot go back to sleep until it
is time to get up in the morning.

Objective Data
Objective data are observable and
measurable data that are obtained through
both standard assessment techniques
performed during the physical examination
and diagnostic tests. The primary method
of collecting objective information is the
physical examination, which provides
information about the function of body
systems.

Examples of objective
information include:
T 98.6F, P 100, R 12, B/P 130/76
Bowel sounds auscultated in all four
quadrants
Gait slow, shuffling, and unsteady
This objective information may add to or
validate subjective information. Validation
is a critical step in data collection to avoid
omissions, prevent misunderstandings, and
avoid incorrect inferences and
conclusions.

Diagnosis
The second step in the nursing process
involves further analysis (breaking the
whole down into parts that can be
examined) and synthesis (putting data
together in a new way) of the data that
have been collected. Formulation of the
list of nursing diagnoses is the outcome of
this process. According to the North
American Nursing Diagnosis Association
(NANDA) a nursing diagnosis is a clinical
judgment about individual, family, or
community responses to actual or
potential health problems/life processes.
Nursing diagnoses provide the basis for
selection of nursing interventions to
achieve outcomes for which the nurse is
accountable.

The nurse uses critical-thinking and decision-making

skills in developing nursing diagnoses. This process is
facilitated by asking questions such as:
Are there problems here?
If so, what are the specific problems?
What are some possible causes for the problems?
Is there a situation involving risk factors?
What are the risk factors?
Is there a situation in which a problem can develop if
preventive measures are not taken?
Has the client indicated a desire for a higher level of
wellness in a particular area of function?
What are the clients strengths?
What data are available to answer these questions?
Are more data needed to answer the question?
If so, what are some possible sources of the data that
are needed?

Comparison of Medical Diagnoses

and Nursing Diagnoses

Types of Nursing
Diagnoses

Outcome Identification
and Planning
Planning is the third step of the nursing
process and includes the formulation of
guidelines that establish the proposed
course of nursing action in the resolution
of nursing diagnoses and the development
of the client's plan of care.

The planning phase involves several

tasks:
The list of nursing diagnoses is
prioritized.
Client-centered long- and short-term
goals and outcomes are identified and
written.
Specific interventions are developed.
The entire plan of care is recorded in
the clients record.

Expected outcomes are specific objectives related to the

goals and are used to evaluate the nursing
interventions.
They must be measurable, have a time limit, and be
realistic. Once goals and expected outcomes have
been established, nursing interventions are planned
that enable the client to reach the goals.
Consider, for example, two outcomes:
The patients shortness of breath will improve.
The patient will be less short of breath within 15
minutes
as evidenced by patient rating the shortness of breath at
less than 3 on a scale of 1 to 10, respiratory rate
between
16 and 20, and relaxed appearance.

Establishing Goals
After the priorities of the nursing
diagnoses and expected outcomes
have been established, the
immediate, intermediate, and longterm goals and the nursing actions
appropriate for attaining the goals
are identified. The patient and his or
her family are included in
establishing goals for the nursing
actions.

For example, goals for a patient with diabetes

and a nursing diagnosis of deficient
knowledge related to the prescribed diet may
be stated as follows:
Immediate goal: Demonstrates oral intake
and tolerance of 1500-calorie diabetic diet
spaced in three meals and one snack per day.
Intermediate goal: Plans meals for 1 week
based on diabetic exchange list.
Long-term goal: Adheres to prescribed
diabetic diet.

IMPLEMENTATION
The fourth step in the nursing process is
implementation.
Implementation involves the execution of the
nursing
plan of care derived during the planning
phase.
When implementing the plan of care, the
actions listed as interventions are
performed. The patients response to
each intervention is noted and documented.
This documentation provides the basis for
evaluation and revision of the plan of care.

The plan of nursing care serves as the basis for

implementation:
The immediate, intermediate, and long-term
goals are used as a focus for the
implementation of the designated nursing
interventions.
While implementing nursing care, the nurse
continually assesses the patient and his or
her response to the nursing care.
Revisions are made in the plan of care as the
patients condition, problems, and responses
change and when reassignment of priorities
is required.
Implementation includes direct or indirect
execution of the
planned interventions. It is focused on resolving
the patients nursing diagnoses and
collaborative problems and achieving
expected outcomes, thus meeting the
patients health needs.

BASIC CONCEPTS IN NURSING PRACTICE

Evaluation
Evaluation, the final step of the nursing
process, allows the nurse to determine the
patients response to the nursing
interventions and the extent to which the
objectives have been achieved.

Through evaluation, the nurse can answer the following

questions:
Were the nursing diagnoses and collaborative problems
accurate?
Did the patient achieve the expected outcomes within
the
critical time periods?
Have the patients nursing diagnoses been resolved?
Have the collaborative problems been resolved?
Have the patients nursing needs been met?
Should the nursing interventions be continued, revised,
or discontinued?
Have new problems evolved for which nursing
interventions
have not been planned or implemented?
What factors influenced the achievement or lack of
achievement
of the objectives?
Do priorities need to be reassigned?
Should changes be made in the expected outcomes and
outcome criteria?