The purpose of this video is to provide a brief overview of the nursing process.
It will include the importance of using the nursing process as well as the purpose and actions
in each phase of it. The nursing process is important because it
provides a framework for clinical decision-making, which helps to guide care and promote critical
thinking. It is a systematic and goal oriented framework for problem solving. Critical thinking
is used thought the nursing process to improve client care.
The nursing process is cost efficient and a part of the standard of care - it is required by professional standards.
The nursing process also .. • Promotes professionalism
• Enhances the quality of clinical decisions made
• Promotes collaboration with the client and interdisciplinary team
• Improves efficiency and timeliness of care
• Improves communication among nurses and with the public since it helps others understand what nurses do
• Increases client participation in care • promotes client autonomy and individualized care
While you will learn the steps in a sequence, in reality the nursing process is dynamic
and cyclical in nature. It is important to know the steps and be able to identify the
purpose of and actions in each step. ADPIE is an acronym that is used to help you remember
the steps in order: Assessment, Diagnosis, Planning, Implementation and Evaluation.
The Purpose of the Assessment phase is to establish a database about the client’s
response to health concerns or illness and their ability to manage healthcare needs.
Basically you need to gather information about the client. Remember to use your critical
thinking to help you with identifying what information needs to be collected.
In the assessment phase nurses collect subjective and objective data about the patient in a
systematic way through observations, interview questions and physical examinations. Data
is collected, organized, validated, and recorded. Subjective Data is Reported but not objectively
measureable. You cannot see it. It includes verbal descriptions of health.
Subjective data are often referred to as symptoms and represent things a client tells you
that you cannot observe or measure. Most subjective data will be collected during a health history.
Objective Data on the other hand is measurable. Think about things like temperature, blood pressure
and weight. Objective data are often referred to as signs.
These signs can be measured, seen, heard, felt, or smelled and are often collected during a physical exam.
For more information about data collection please see the links to more videos below.
Use critical thinking In the assessment phase to correctly interpret data. Are the data
clear, precise and consistent? Begin clustering cues and formulating inferences while you
assess the client to guide further data collection. Recognize patterns and trends in the data
and compare them with standards. Then come to a conclusion about the client’s problem
and move into the Diagnostic phase of the nursing process.
Formulating a clear diagnoses aids communication among team members.
Nurses cannot make a medical diagnoses like Asthma or Myocardial infacrtion. However,
nurses have an internationally standardized language for communicating clinical judgments.
This language comes from NANDA International. Examples of NANDA labels include activity
intolerance, decreased cardiac output, constipation, fluid volume deficit and hypothermia among
many others. Nurses may identify an actual, risk, possible
or wellness diagnosis. For more information about how to cluster cues, recognize and formulate
a Nursing diagnosis please see the links provided below.
Critical thinking about the client’s condition is essential in the formulation of a nursing
diagnosis. Concept mapping is one tool to promote critical thinking that aids in visualising
the interconnections between data gathered so an accurate diagnosis can be formulated.
Once the nursing diagnoses are identified, Priorities are established.
In general, problems that have the potential to cause harm to the client or others if they
are not addressed receive the highest priority. Then non-lifethreatening issues are addressed
followed by those that may affect future well-being. It is important to note that priorities are
always changing therefore continuous assessment of identified priorities is important.
Mallow's hierarchy of needs is one framework that is commonly used to help identify priorities in nursing care.
Physiologic needs receive first priority.
This level includes life threatening problems (or risk factors) that pose a threat to physiologic needs.
For example, problems with breathing, circulation, nutrition, hydration, elimination,
temperature regulation, and physical comfort.
Safety and Security needs come next.
These problems (or risk factors) that pose a threat to safety and security include things like environmental hazards or fear.
The third priority 3 is Love and belonging.
The problems (or risk factors) posing a threat to feeling loved and a part of something come next.
They include things like isolation or loss of a loved one.
Problems or risk factors posing a threat to self-esteem
such as the inability to perform normal activities comes next.
Finally, problems or risk factors posing a threat to the ability to achieve personal goals are addressed.
Once priority diagnoses are identified, Goals or Outcomes are established.
These goals provide direction for the selection of nursing interventions
Provide a focus for evaluation Are developed in consultation with the client
and can be short or long term
Goals or Outcomes Must be… Client centered, Singular, Mutual
And SMART. SMART goals are Specific, Measurable, Attainable, Relevant/Realistic and Time-limited.
For more information about making and recognizing SMART goals please watch the SMART goals video. The link is provided below.
Once goals are identified, interventions are developed and a care plan is communicated to the team.
There are a variety of ways that care plans are communicated in the clinical setting.
Interventions may be Nurse initiated, Physician initiated or Collaborative.
For example, A Nurse initiated intervention may be to encourage client to deep breath q1h.
A Physician initiated intervention may be to Change the abdominal dressing BID.
There would be an order to go with this intervention that would specify how to do the dressing change.
A Collaborative intervention may be to Encourage the client to ambulate with walker q4h.
In selection of interventions consider:
The Nursing Diagnosis Goals/Outcomes
Evidence-base Feasibility
Acceptability to client and Resources available
In the planning phase critical thinking is essential to ensure that the plan is SMART.
It is important that the plan is realistic and appropriate for the client.
In the next phase you implement the plan.
Direct Care is performed through interactions with client.
Examples include assisting with activities of daily living or physical care techniques.
It may also involve counseling, teaching or observing for adverse reactions among other things performed
with the client. Indirect Care included in the care plan is
performed away from client on their behalf. Examples include advocacy, delegating, supervising
and evaluating the work of others. Ensure that critical thinking is used when
carrying out the actions in the care plan. For example, you wouldn’t want to give a
heparin injection to someone with excessive bruising just because it says to in the care
plan and orders. Re-assessment of the client’s condition should happen on an ongoing basis.
In the evaluation phase assess if nursing interventions have been effective or helpful
in meeting desired outcomes. Has the situation changed? If goals were not met, what need
to be adjusted to help the client meet their goals? A decision will need to be made to
terminate, continue or revise the care plan. Evaluation should be completed throughout
the nursing process. It is one of the most important steps requiring critical thinking
to assess if what you are doing is helping the patient. If progress is not being made
find out why and revise the care plan. Thank you for watching this video. Please
see the related videos below for more detailed information. Send me a message or leave a
comment if there is anything you want to see more of.