The Nursing Process: What's In It For Me?

The nursing process, which is the foundation that drives all current nursing practice, is one of the misunderstood theories in nursing. Many nursing students have difficulty understanding this process and what it means for our patients and our nursing practice.

This nursing theory was developed by Ida Jean Orlando, a nursing theorist, in the late 1950s from observations she recorded between nurses and patients. Her observations revealed what constitutes “good” and “bad” nursing. Through these observations, Orlando concluded that the patient needs to be central in nursing care; the nursing process is a significant component of the nursing care plan; and that nursing care needs to be directed at improving outcomes for the patient, and not nursing goals.

The systematic way of identifying and solving a patient’s health problem is facilitated by the nursing process. The nursing process involves five components:

• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

ASSESSMENT
Assessment is completed on the first day a patient is admitted for healthcare services, which also establishes rapport between the nurse and the patient. Both subjective and objective data are collected. Subjective data is what the patient/family says. Objective data is what the nurse observes. Assessment data is collected by means of history taking and physical examination. Assessment employs solid knowledge of interviewing skills and examination techniques combined with the use of all five senses.

DIAGNOSIS
Based on the assessment, a nursing diagnosis can be made. The diagnosis may represent an actual or a potential problem of the patient. This diagnosis utilizes proper analysis and synthesis of the data collected from the health history and health assessment. The main purpose of making a nursing diagnosis is to set goals for the patient and utilize effective nursing interventions for treatment and prevention of further complications. Through this step, the care the nurse provides is made more definitive.

Diagnosis helps the nurse to provide nursing care more effectively and accept legal responsibility and accountability for actions taken. The patient’s perceived or actual problem is defined as the nursing diagnosis. This is different from a medical diagnosis, which only takes into account the actual medical problem. The North American Nursing Diagnosis Association (NANDA) has approved the formal collection of nursing diagnoses.

PLANNING
Once a nursing diagnosis is made, a nursing care plan is developed. This helps to resolve the diagnosed problem in an orderly way. Much like we plan our day to reach certain goals, the nurse develops and implements a nursing care plan for the patient to reach set healthcare goals. Planning serves as a basis for implementation of appropriate nursing interventions. Planning usually begins with simple nursing measures and moves to complex interventions or from invasive to non-invasive techniques. Poor planning will result in poor outcomes for the patient.

IMPLENTATION
The care plan is actualized through nursing interventions and is implemented by the nurse with patient and family involvement. The plan may be altered during the implementation phase of the nursing process based on the patient’s changing needs. Nursing interventions are independent of most healthcare team members. Certain interventions that are implemented by the nurse, such as medication management, are interdependent with the prescribing healthcare team member. Sound nursing judgment, critical thinking and decision making skills are essential for selection of appropriate nursing interventions based on scientific principles.

EVALUATION
During the evaluation phase of the nursing process, the patient’s responses to the nursing interventions and the extent to which the goals have been achieved are determined. The outcome of the interventions is also recorded. These findings are made in a precise manner and they are accurately documented in the patient’s record for future reference. There may be positive and negative outcomes during evaluation. If the goal is not achieved during evaluation, the nursing care plan is updated based on the patient’s current condition.

The role of the nurse is to determine and meet the patients' immediate need for help in their diseased state. The patient’s presenting behavior may be a plea for help. However, the help needed may not be what it appears to be. Therefore, nurses need to use their perception, thoughts about perception, or the feeling engendered from their thoughts to explore with patients the meaning of the behavior. This process helps the nurse find out the nature of the distress and what help the patient actually needs.

Orlando’s theory remains one of the most effective practice theories available. The use of her theory keeps the nurse’s focus on the patient. The strength of this theory is that it is clear, concise, and easy to use with practice. The nursing process is just that – a process of dynamic collaboration that is effective for both nurse and patient on their journey toward health and wellness.

Lisette Shanhai
RN, BSN, CRP
Facilitator

Source: M. Murray (2000) Understanding the Nursing Process in a Changing Care Environment