Each skill is presented in the nursing process format: assessment, planning, implementation, evaluation, and documentation. The nursing process is continual and cyclic.
Evaluation of outcome incorporates a feedback loop leading to further assessment, decision making, and implementation that ensures effective care. Documentation ensures the generation of a database for subsequent research that facilitates evidence bases nursing care.
Overview of the nursing process
The nursing process is the foundation and or organizational framework that guides professional nursing practice (craven & hirnle, 2000). It ensures the provision of individualized nursing care to clients/patients, families, and communities.
Professionally, the nursing process is recognized as a model on which professional nursing standards are based and remains the universally accepted method of science nursing practice.
The nursing process involves scientific reasoning that allows the nurse to identify, organize and manage the health problem of a client in a systematic and conceptual practice.np promotes critical thinking which is central to all nursing care.
Critical thinking is an essential component of professional accountability and quality nursing care. Critical thinking is deliberate and goal-directed. It utilizes:
⦁ Mental operation- decision making and reasoning
⦁ Knowledge- having the facts and understanding the reason behind the action
⦁ Attitude- curious/open-minded/non-judgemental
Critical thinking is summarised in the words of Martha Rodgers: when an apple is cut, others see the seed in the apple. We, nurses, see apples and seeds.
The term process means steps. The nursing process encompasses all steps taken by the nurse in caring for a patient.
Summary of steps in nursing process
The steps of the nursing process are:-
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
Assessment
A systematic process of collecting, analyzing, and verifying patient data so as to make a judgment
Nursing diagnosis
Holistic analysis and interpretation of data collected that best respond to a patient’s problem or response to disease. It can also be described as standardising statement about the health of a client (individual, family, or community) for the purpose of providing nursing care
Planning
In this step, the nurse lists client-centered goals and expected outcomes. Critical thinking in planning involves critical evaluation of pre-established diagnosis, the urgency of the problem, resources of client, and health care delivery system.
Components of planing
⦁ Establish priorities by ranking nursing diagnoses
⦁ Patient goals and criteria (outcome criteria)- provide direction for patient’s nursing intervention and set standards for determining the effectiveness of interventions.
⦁ Nursing intervention. Actions designed to assist the client in moving from the present level of health status to a status that is described in an expected outcome
⦁ Scientific rationale – a reason to support nursing interventions.
⦁ Nursing care plan-outcome of the planning phase.
Implementation
It involves the actual carrying out of the plan. It focuses on signs and symptoms that supported the nursing diagnosis and therefore are proof of appropriate nursing interventions. Skills required for implementation are cognitive, interpersonal, and psychomotor.
Evaluation
This involves the measurement of the client’s response to nursing interventions and progress towards achieving goals. It requires the nurse’s ability to interpret and summarize the findings. For each criterion set, the nurse should indicate if met, unmet, or partially met and write briefly the facts that support one of the three choices.
Documentation
The entire process is recorded in an agreed format in the patient’s care plan and nursing notes. This communicates interventions and outcomes and avoids duplication
Brief summary of the evolution of the nursing process
Hall l.1955: originated the term nursing process
Catholic University of America 1967: proposed four components of the nursing process as assessment, planning, intervention, and evaluation.
Ana. Standards of nursing practice. 1973: referred to a five-step process: assessment, diagnosis, planning, intervention, and evaluation.
Gebbie k & Lavin ma. 1975: initiated the use of five steps of a nursing process model in the first national conference on classification of nursing diagnosis in1973.
Sr calister Roy 1976: used six steps of the nursing process; assessment of patient behavior, problem identification, goal setting, intervention, selection of approaches & evaluation.
Benefits of the nursing process
Stresses the independent and collaborative care function of the nurse.
Promotes accountability.
Provides an orderly and systematic method for planning and providing evidenced-based individual care.
Enhances nursing efficiency and effectiveness thus increasing quality care
Facilitates standardization of nursing practice.
