What is the Nursing Process?
Understanding the nursing process is key to providing quality care to your patients. The nursing process is a cyclical process used to assess, diagnose, and care for patients as a nurse. It includes 5 progressive steps often referred to with the acronym:
ADPIE
- Assessment
- Diagnosis
- Planning/outcomes
- Implementation
- Evaluation
In this article, we’ll discuss each step of the nursing process in detail and include some examples of how this process might look in your practice.
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What is the Nursing Process?
The nursing process is a patient-centered, systematic, evidence-based approach to delivering high-quality nursing care. It consists of five steps: assessment, diagnosis, outcomes/planning, implementation, and evaluation.
The Nursing Process (ADPIE)
| Assessment | Identify patients' health needs and collect subjective and objective nursing data about their condition. |
| Diagnosis | Identify any real or potential health problems that the patient is experiencing or may possibly experience. |
| Plan | Develop a nursing plan of care, which outlines the actions that will be taken to meet the needs identified to achieve the desired patient outcomes. |
| Implementation | Carry out the plan of care and monitor patients' progress. |
| Evaluation | Evaluate whether the plan of care was successful. If necessary, the process is then repeated until the patient is discharged or until they reach all their health care goals. |
1. Assessment
To begin the nursing process, assessment involves collecting information about the patient and their health. This information is used to identify any problems, or potential problems, that may need to be addressed while you’re caring for a patient.
Example:
If you’re admitting an older patient who is falling and getting injured at home, you’ll want to do a thorough physical and mental health assessment, including a medical history to try and determine why this is happening.
Some important things you’ll want to find out are:
- What medications and over-the-counter products is the patient taking
- History of alcohol and recreational drug use
- Where the person lives and the layout of their home, including scatter rugs they may be tripping over: clutter, pets, stairs, slippery tubs they’re climbing into or out of, fluid or food spills on floors, lighting, mobility aids they use, etc.
2. Diagnosis
The Nursing Diagnosis is the second step in the nursing process and involves identifying real or potential health problems for a patient based on the information you gathered during the assessment.
Example:
Using the falls patient example above, you may identify from your assessment that the patient is falling because they’re tripping on things in their environment that they don’t see, like their pet cat lying on the floor and loose scatter rugs.
Based on this, you might form a diagnosis such as “Falls related to poor vision, cluttered environment, unsteady gait, Lt. hip pain due to previous fall.”
3. Outcomes/Planning
Planning or Outcomes is the third step in the nursing process. This step involves developing a nursing care plan that includes goals and strategies to address the problems identified during the assessment and diagnosis steps.
Example:
Continuing with the example above, you will likely recommend that the patient keep their environment,
- Free of scatter rugs
- Check to ensure the cat is not underfoot before they mobilize
- Suggest the patient use a walker for support when mobilizing
- Recommending that the patient schedule an eye exam to get their vision checked if they have not had one in the last year or two would also be a good idea or if they’ve noticed any changes in their vision lately.
4. Implementation
As the fourth step of the nursing process, implementation involves putting the plan of care into action.
Example
In the above example, this would include:
- Making sure the patient’s environment is free of clutter and tripping hazards while in the hospital or a skilled nursing facility.
- Teaching the patient to wear proper footwear before mobilizing.
- Assisting the patient with mobility as needed, including putting proper footwear on the patient if needed.
- Speaking to the patient and family about removing scatter rugs from the patient’s home, scheduling an eye exam, and ensuring proper footwear is worn for mobilizing at home.
- Discussing with the patient and family about getting the patient a walker to assist with mobility on discharge and providing one while the patient is admitted.
5. Evaluation
The last step of the nursing process is evaluation, which involves determining whether or not the goals of care have been met.
Example
Here you would look back at the patient’s medical record to see if the patient has had any further falls since implementing the preventative actions above.
If so, you would repeat the nursing process over and reassess why this is still happening and plan new actions to prevent future falls.
Characteristics of the Nursing Process
The nursing process is also characterized by the following elements.
1. Dynamic and Cyclic
The nursing process is an evolving process that continues throughout a patient’s admission or illness and ends when the problems identified by the nurse are no longer an issue.
2. Patient-Centered and Goal-Directed
The entire nursing process is sensitive to and responsive to the patient's needs, preferences, and values. As nurses, we need to act as patient advocates and protect the patient’s right to make informed decisions while involving the patient in goal setting and attainment.
3. Collaborative and Interpersonal
This describes the level of interaction that may be required between nurses, patients, families and supports, and the interprofessional healthcare team. These aspects of the nursing process require mutual respect, cooperation, clear communication, and decision-making that is shared between all parties involved.
4. Universally Applicable
As a widely and globally accepted standard in nursing practice, the nursing process follows the same steps, regardless of where a nurse works.
5. Systematic and Scientific
The nursing process is also an objective and predictable process for planning, conducting, and evaluating patient care that is based on a large body of scientific evidence found in peer-reviewed nursing research.
6. Requires Critical Thinking
Most importantly, it’s essential that nurses use critical thinking when planning patient care using the nursing process. This means as nurses, we must use a combination of our knowledge and past experiences with the information we have about a current patient to make the best decisions we can about nursing care.
History of the Nursing Process
The nursing process was introduced in 1958 by Ida Jean Orlando. Today, it continues to be the most widely-accepted method of prioritizing, organizing, and providing patient care in the nursing profession.
It’s characterized by the key elements of:
- Critical thinking
- Client-centered methods for treatment
- Goal-oriented activities
- Evidence-based nursing research and findings
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