Hi and welcome to Nursing School Explained. Today's topic is the nursing process which
is the foundation of nursing practice. Sometimes it can be a little bit difficult to grasp it in
the beginning, but really you have considered or applied this process in your entire life. It's
basically just a methodical way of going about doing something. And real life experiences that you
might have had with a process such as the nursing process might be planning a trip, going somewhere,
or preparing a meal. So you're going to have to go through all these different steps of accomplishing
that goal that you're having which is either to get somewhere or to eat a delicious meal at
the end. So let's see how this applies to nursing and go through the different steps of the nursing
process together. We always start with assessment. Assessment is the foundation of nursing practice.
And that includes everything from your basic vital signs, your physical assessment, assessing the
patient from head to toe as well as looking into the patient's medical history, their co-morbidities,
their past surgeries, their medications, their allergies and so forth. Of course it also includes
labs and diagnostic data such as x-rays, CT scans, MRIs, any kind of surgical procedures
and so forth. So without the assessment we don't really know what's going on with the patient. So
we have to figure out first to assess and then move on. So the second step would be
to diagnose or analyze or identify the problem and set the priority. So depending on what program
you're in and what your school focuses on you might have heard of nursing diagnoses.
Now some programs have done away with nursing diagnosis because people get confused with
those. There's a certain terminology that you need to use, what's the difference between the
nursing and the medical diagnosis, is it the same or not? But really what this comes down to,
rather than using a certain terminology and a way of setting this up, we basically just need to focus
based on our assessment data what are the patients problems, what do I currently have
to focus on to get the patient better and if they're hospitalized to get them to discharge.
Right, what are my priorities? So I identify the problem and then I set my priorities depending
on the list of problems that I have come up with. And the steps to follow, always follow your ABC's.
So if the patient has a breathing problem, let's say they're admitted with pneumonia,
then you're going to focus on their oxygenation. You're going to focus on assessing their lungs,
their o2 sat, their respiratory rate, their heart rate, their temperature, those very basic things.
Now oxygenation here would be a breathing problem so that would be before any kind of other pain
management or skin issues those kind of things. So that's why you should always focus on your ABC's
for priority setting. And then you should follow Maslow's hierarchy of needs because we're going
to have some physical needs and they are going to come over, they're going to take greater priority
over psychosocial needs. So, for example, in the oxygenation, again oxygenation, being
able to breathe, is a higher priority than dealing with pain. Pain is very important and
I know we have to address it, but in terms of priority, breathing always comes first.
Pain, which is a psychosocial need, would come second. And then we always have to address actual
problems before potential or risk for problems. You have probably seen "risk for" problems, some
of those would be like "risk for infection", "risk for falls" or something that students like to use a lot.
But really at the hospital everybody's risk or falls because you're hooked up to IVs, you might
have impaired mobility, you might be on certain medications. But actual problems always come before.
So you wouldn't plan to go into a care plan on a potential problem with whatever the patient is
at risk for before you address the actual problems. If you're baking a cake and you are missing baking
powder, you're not going to say "Oh, potentially I might need eggs", no the actual problem is "I am
short of baking powder" and I have to address that otherwise I can't bake my cake. So so
actual or actually identified problems always come before. And this might change. So the patient
initially might be having an infection, whatever that might be and somebody else who might be
admitted for another problem, let's say they've had a knee replacement. They would be at risk for
infection, right? But they don't have an actual infection so their priorities with that knee
surgery or knee replacement would be different than this risk for infection and would take
higher priority. So skin integrity, for example, or wound care would be taken priority because now we
have an actual, there is a break in the skin, which could be a risk for infection. So always make sure
that you have the actual before the potential or risk for problems that you address. Then we move on
to the third step, which is the planning, which is also called plan of care or care plan.
Most of you have probably heard or have written care plans. A lot of students dread those because
they are these big papers that you have to write and you really have to analyze your patient.
But really what it is, it's following the steps of the nursing process and it shows your professor
that you are able to follow these steps and safely care for your patient. So after assessment and from
identification now we know what we have to focus on with our patient. We move into the planning
phase and formative goals, which are also called expected outcomes. And they will always start with
"The patient will ...". The patient will do something or achieve something. And in order to formulate the
goal, they have to be following this SMART criteria, which means they have to be specific, measurable,
attainable, relevant, and time-based. So a goal, for example, would be "the patient will ambulate
30 feet by the end of my shift". This is specific: the patient will measurable walk or ambulate the
30 feet; it's attainable because it's a short distance; it's relevant to the patient who just
had knee surgery; and it's time based by the end of my shift. Now depending if you work in the acute
care or maybe the long-term care facility or in home health, for example, time based and acute care
most likely will be shorter, so by the end of my shift, within the next hour whatever that
might be, but if you're working in the home health setting and somebody is admitted for IV antibiotics
that they're going to be on for six weeks, now it might be the time frame might be
longer, it might be those six weeks, it might be three weeks, whatever it might be.
So depending on the setting that you're at, the time frame on the goals will be will be different .
But remember for the plan of care you always have to come up with the goals in the SMART format. And
I'm sure that you've got plenty of instruction from your professors regarding how to accomplish
this. But if you stick with the SMART acronym, you will always be okay. And don't make it complicated!
Right? "Patient will ambulate for 30 feet by the end of my shift" - perfect - it's very simple. It
doesn't have to be rocket science. Or if you're addressing the pain: "The patient's pain
level will be less than three out of ten thirty minutes after the administration of any pain
medications" or: "The patient will have no signs and symptoms of infection to the surgical sites by the
end of my shift." Now I've addressed the infection. So keep it very simple but follow this format and,
of course, the goals have to be specific to the problem that you have identified as your priority.
Once you've identified the goals and the expected outcome and you have planned your priorities, then
you can go into the implementation phase. So in the implementation phase, we, the goal is to achieve
the expected outcome that we've just formulated. And it has to be individualized for your patient.
So two patients who've been admitted for a knee replacement might not have the same goals because
one might already be three days post-op and the other one might have been just coming
out of surgery so the priorities will be very different. So there is no cookie-cutter kind of a
recipe book that you can apply here, but it has to be individualized for your patient
and to those priorities that you have identified in the prioritization and planning or maybe
diagnosing phase. And then for interventions we have independent, dependent, and collaborative
interventions. So independent interventions are those that you can do independently, that you don't
need an order for. That would be elevating the head of the bed, elevating the leg, applying an ice pack,
keeping the patient comfortable, repositioning them, all those things that you don't need an order for.
Dependent interventions would be something that you need an order for: administering pain
medications, wound care orders, any of those things that you need to have a higher level of a license
give you the orders to do that. So you depend on somebody else to perform your interventions. And
then collaborative interventions could be something that you would collaborate
with somebody, let's say, physical therapy, occupational therapy, the social worker, remember
we can also have psychosocial needs here that we need to address, such as anxiety or fear or disturbed
body image if there was an amputation, for example, so there's all these psychosocial needs and we would
also collaborate with different disciplines on doing that. Now keep in mind the nurse still plays
a role into achieving these collaborative goals or implementations and interventions, but we are
not going to be necessarily the first person that will address these collaborative problems.
And then once we have implemented our interventions and we have followed two, three, four,
five different interventions to achieve our goal, we are going to evaluate. So we are going to see
the problem that we have identified and the plan that we developed with the interventions to
achieve the goal. Have we now achieved the goal? So we're going to look at the goal and see have
we achieved it? If yes, great - goal achieved, perfect, move on. Re-evaluate, re-assess your patient and see
what else you have to focus on now then so that you can get them better, right? So revise the plan
of care either if you have achieved the goal or if you maybe now have identified "Oh maybe I need
to change my plan of care". So maybe now there's been a change in the patient status or with the
interventions that I have implemented I didn't really achieve my goal, so now I have to go back,
reassess and revise as needed. So now I would go back assess my patient: physical assessment, vital
signs, labs and diagnostics, any orders. And then again re-prioritize, identify maybe the new problems
or see what else i can do for the patient, plan, come up with a goal following the SMART criteria.
Based on that I'll come up with my interventions, and they might be different from my first go
around because now on my first go around I didn't achieve my goal and then I evaluate and I see "Did
I now achieve my goal?" Again if I've accomplished it - perfect, check that off. And then move on to the
next problem that you've identified. So maybe now your oxygenation goal has been met but the
patient is still at risk for falls, so now you need to address that and have the interventions
and potential patient education to achieve these goals. So the prioritization here is very important
and this is a continuous process. So this is not something that changes. There will always be these, these phases of the nursing process that you follow when you're planning care for your patient.
And keep in mind this will also help you on your exams because you always have to assess
before you intervene, before you implement right? Because if you don't know what's going on with
the patient, how are you going to know what your goal is going to be and your priorities?
So you have to assess before you implement. And that's very helpful on exams as well.
Thank you for watching Nursing School Explained and this video on the nursing process that serves as
a foundation of nursing practice. Please also watch my other videos that go into more of the specifics
in the to the different phases of the nursing process here. Thanks for watching, please subscribe,
comment, and leave me any feedback, I always appreciate that. And I'll see you next time!