OVERVIEW OF THE

NURSING PROCESS
• The Nursing Process is the cornerstone of
the Nursing profession.

• It is synonymous with the problem – solving

approach for discovering the healthcare
and nursing care needs of the patients.
The Nursing Process

Lydia Hall originated the term “Nursing Process” in 1955.

The Nursing Process is an organized, systematic manner

of providing goal- oriented and humanistic care that is
both efficient and effective.
The Nursing Process

The Nursing Process is organized and systematic

because it is composed of six sequential and interrelated
steps, namely: Assessment, Diagnosis, Outcome
Identification, Planning, Implementation and
Evaluation (ADOPIE)
The Nursing Process is goal-oriented and because
(1) the plan of care is developed and implemented with
great consideration to the unique needs and concerns of
the individual patient;
(2) it is individualized; and
(3) it involves aspect of human dignity.
The Nursing Process is efficient because it
is relevant to the needs of the patient. It
promotes patient satisfaction and progress.

The Nursing Process is effective because

it utilizes resources wisely in terms of
human, time and cost resources.
Phases of the Nursing Process (ADOPIE)

I. Assessment. Is collecting, validating, organizing and

recording data about the patient’s health status.
 Purpose: To establish a data base.
 Activities During Assessment:
1. Collecting data
Types of Data:
a. Subjective data (symptoms)
b. Objective data (signs)
Methods of Collection of Data:
a. Interview. It is planned, purposeful conversation.
Example: Collection of data for health history.
b. Observation
Examples: Use of senses, units of measure,
physical examination and interpretation
of laboratory results.
Sources of Data:
a. Primary Source: Patient

b. Secondary Sources: Family members, friends and

significant others, Patient’s Record or Chart, Health
Team Members, Related Literature (books, journals,
researches, brochures)
2. Verifying/ Validating Data. Making sure your
information is accurate.
Examples: (1)The patient’s urine is dark in color. This
may indicate dehydration or the patient may had taken
certain medication or food.
To validate dehydration, assess if the patient is vomiting,
having diarrhea, having inadequate fluid intake or other
conditions that involve fluid loss. Then check other
assessment parameters like changes in weight, urine
output, vital signs, skin turgor, mucous membrane, that
support presence of dehydration
II. Diagnosing. Is a process which results to a diagnostic
statement or Nursing Diagnosis. It is the clinical act of
identifying problems.
 Purpose: To identify the patient’s health care needs and to
prepare diagnostic statements.
 Nursing Diagnosis. Is a statement of patient’s potential or
actual alteration of health status. It uses the critical-
thinking skills of analysis and synthesis.
 Nursing Diagnosis uses PRS/PES format.
P- problem
R- related to factors
S- signs and symptoms

P- problem
E- etiology
S- signs and symptoms
 Activities During Diagnosing:
1. Organizing Data. Clustering facts into groups of information.
Examples:
(1) Data about patient’s nutritional status
Subjective Data
“I have no appetite to eat”
“Foods and fluids taste bitter”
Objective Data
Weight loss (10lbs. In 2 weeks)
Pallor
Poor skin turgor
(2) Data about patient’s fluid balance status
Subjective Data
“I had 15 watery stools since last night until morning.”
“I feel very thirsty.”
“I feel warm.”
“I feel weak and nauseous.”
Objecive Data
Temperature= 37.9 C
Urine is dark and concentrated.
Skin is flushed, warm and dry
Poor skin turgor
Dry and sore mucous membrane of the mouth, cracked
lips
Soft, sunken eyeballs
Tachycardia (pulse rate= 110 bpm)
BP= 90/50 (low BP)
Tachypnea (RR= 24/min)
Hematocrit 54% (elevated Hct)
Increased BUN
Urine output is 20-25 ml/hour (oliguria- low urine output)
2. Comparing data gathered during assessment against
standards.
Standards are accepted norms, measures, or patterns for
purposes of comparison.
Examples:
The standard color of the skin is pinkish.
The standard rbc level is 4.5 million to 5.5 million/cu.mm
The standard consistency of stool is well-formed
The standard pulse rate of an adult is 60 to 100bpm
The standard urine output is 30-60 mls/hour
3. Analyzing data after comparing with standards.
Examples:
Passage of frequent watery stool may lead to
dehydration and loss of electrolytes like potassium, sodium
Pallor, dyspnea, weakness, fatigue, RBC= 4
million/cu.mm., Hgb (hemoglobin)= 10g/dl indicate
inadequate oxygenation
Noisy breathing respiratory muscle weakness, unable to
cough up thick mucous secretions indicate inability to clear
airways effectively.
 Poor appetite to eat, weight loss of 10 lbs., weakness indicate
inadequate nutritional intake.

4. Identifying gaps and inconsistencies in data.

Example: Patient claims she is gaining too much weight but
actually, she is underweight.

5. Determining the patient’s health problems, health risk, and

strengths.
Example: Inadequate nutrition
Altered body image
6. Formulating Nursing Diagnoses statements.
Examples:
Fluid volume deficit related to frequent passage of
watery stool.
Alteration in nutrition: less than body requirements
related to poor appetite to eat.
Inadequate oxygenation related to poor oxygen- carrying
capacity of the blood.
Summary of Steps of Nursing Diagnosis
A. Cluster Data (recognize pattern or trend)
Diarrhea for 10 days
Distended abdomen
Cramping before and during each bowel movement
Family history of colon cancer
B. Compare with standards
Soft, formed stool, daily
Abdomen soft, non-distended
Defecation non painful
C. Make sure Reasoned Conclusion
Bowel elimination problem

D. Nursing Diagnosis
Alteration in Bowel Elimination (Diarrhea) related to:
(a) food intolerance, (b) irritation
Comparison of Correct and Incorrect Nursing
Diagnosis:
(1) Correct: Acute pain related to physical exertion.
Incorrect: Acute pain related to myocardial infarction.
(2) Correct: Ineffective breathing pattern related to
increased airway secretions,
Incorrect: Ineffective breathing pattern related to
pneumonia.
(3) Correct: Anxiety related to lack of knowledge about
cardiac catheterization.
Incorrect: Cardiac catheterization related to angina
(4) Correct: Diarrhea related to food intolerance.
Incorrect: Diarrhea related to colon cancer.
(5) Correct: Impaired physical mobility related to pain in
right knee. Anxiety related to difficulty in ambulating.
Incorrect: Pain and anxiety related to difficulty in
ambulating.
(6) Correct: High risk for injury related to disorientation.
Incorrect: High risk for injury related to absence of side
rails.
(7) Correct: Altered body image related to the effects of
mastectomy
Incorrect: Mastectomy related to breast cancer.
III. Outcome Identification. Refers to formulating and
documenting measurable, realistic, patient-focused goals. It
provides the basis for evaluating nursing diagnosis.

 Purposes:
To provide individualized care.
To promote patient participation.
To plan care that is realistic and measurable.
To allow involvement of support people.
Activities During Outcome Identification:
1. Establishing priorities.
A priority is something that takes precedence in position,
deemed the most important among several items.
Priority setting is a decision- making process that ranks
the order of nursing diagnoses in terms of importance to
the patient.
Priority setting involves the following:

a. Life – threatening situations should be given highest

priority, e.g., difficulty in breathing, chest pain, hemorrhage,
suicidal tendencies.
b. Use the principle of ABC’s (airway, breathing,
circulation); airway should always be given the highest
priority.
c. Use Maslow’s hierarchy of needs; Physiologic needs are
given priority over psychosocial needs. E.g., attend to the
patient with nausea and vomiting before the patient who is
anxious.
Priority setting involves the following:

d. Consider something that is very important to the patient,

e.g. pain, anxiety (before giving health teachings).

e. Patients with unstable condition should be given priority

over those with stable conditions. E.g., attend to the patient
with fever before attending to the patient who is scheduled
for physical therapy in the afternoon.
f. Consider the amount of time, materials, equipment
required to care for patients. E.g., attend to the patient who
requires dressing change for postop wound before
attending to the patient who requires health teachings and
is ready to be discharged late in the afternoon.

g. Actual problems take precedence over potential

concerns. E.g., Fluid volume deficit (actual problem) should
be given priority before high risk for infection (potential
problem).
h. Attend to the patient before equipment, e.g., assess the
patient before checking contractions like IV fluids, urinary
catheter, drainage tubes.

i. Do assessments before implementation, e.g., when a

patient complains of pain, check location, severity, etc.; and
check vital signs before administering analgesics.
Nursing diagnoses are classified as high-priority, medium-
priority, and low-priority.
High-priority nursing diagnoses are those that are
potentially life-threatening and require immediate action.
Examples: Impaired Gas Exchange, Ineffective Breathing
Pattern, Self-Directed Risk for Violence.
Medium-priority nursing diagnoses are those that could
result in unhealthy consequences, such as physical or
emotional impairment, but are not life-threatening.
Examples: Fatigue, Activity Intolerance, Ineffective
Coping and Dysfunctional Grieving.
Low-priority nursing diagnoses involve problems that
usually can be resolved easily with minimal interventions
and are unlikely to cause significant dysfunction.
Examples: sensation of hunger in a patient who is on
NPO, in preparation for a diagnostic procedure; minimal
pain on the third postoperative day, related to ambulation.
2. Establishing patient’s goals and outcome criteria.
A patient goal is an educated guess, made as a broad
statement, about what the patient’s state will be after the
nursing intervention is carried out.
Behavioral goals are written to indicate a desired state. They
contain an action verb and a qualifier that indicate the level of
performance that needs to be achieved.

Examples of behavioral verbs used in patient goals are as

follows:
Calculate distinguish participate
Classify draw practice
Communicate explain recall
Compare express recite
Define identify record
Demonstrate list state
describe name use
Goals may be short-term or long-term.
Short-term goal can be met in a relatively short period
(within days or less than a week).
Long-term goal requires more time (several weeks or
months).
Outcome criteria are specific, measurable, realistic
statements of goal attainment. Outcome criteria are
written in a manner that they answer the questions: who,
what actions, under what circumstances, how well,
and when.
Therefore, the characteristics of well-stated outcome
criteria are as follows:

S- Specific
M- Measurable
A- Attainable
R- Realistic
T- Time-framed
Examples of goals and outcome criteria are as follows:

(1) Goal
The patient will report a decreased anxiety level regarding
surgery.

Possible Outcome Criteria

During health teaching, the patient discusses fears and
concerns regarding surgical procedure.
After health teaching, the patient verbalizes decreased anxiety.
(2) Goal
 The patient will demonstrate safety habits when
performing ADL’s (activities of daily living) and injury
prevention.
Possible Outcome Criteria
 The patients uses call light system for assistance at each
need to use bathroom immediately after instruction by the
nurse.
 The patient demonstrates safety practices in dressing and
hygiene.
 The patient uses over-the-bed lights, non-skid slippers
when transferring to chair or out of bed.
(3) Goal
 The patient will immobilize pulmonary secretions.
Possible Outcome Criteria
 After the teaching session, the patient demonstrates
proper coughing techniques.
 The patient drinks at least six glasses of water per day
while in the hospital.
 The caregiver or significant other demonstrates proper
techniques of chest physiotherapy including percussion,
vibration and postural drainage, before discharge.
IV. Planning. Involves determining beforehand the
strategies or course of actions to be taken before
implementation of nursing care. To be effective, involve the
patient and his family in planning.
 Purposes:
 To identify the patient’s goals and appropriate nursing
interventions.
To direct patient care activities.
To promote continuity of care.
To focus charting requirements.
To allow for delegation of specific activities.
Activities During Planning
1. Planning nursing interventions.
 To direct activities to be carried out in the implementation
phase.
Nursing interventions are “any treatment, based upon
clinical judgment and knowledge, that a nurse performs to
enhance patient outcomes.”
Nursing interventions are also called nursing orders.
Nursing interventions are independent, dependent and
interdependent/collaborative activities that nurses carry
out to provide patient care.
2. Writing a nursing plan of care.
The nursing plan of care is a written summary of the care
that a patient is to receive. It is the “blueprint” of the
nursing process.
The plan of care is nursing centered.
Sample Nursing Plan of Care
• Nursing Diagnosis
(Use the NANDA- accepted list of nursing diagnosis)
Risk for injury related to sensory and integrative
dysfunction manifested by altered mobility and faulty
judgment.
• Patient Goal
(One or more patient goals established from nursing
diagnosis).
Patient will demonstrate safety habits when performing
ADL’s and injury prevention.
Patient Outcome Criteria
(Specific, measurable, realistic statements that can be
evaluated to judge goal attainment).

Nursing Interventions and Scientific Rationale

V. Implementation. Is putting the nursing care plan into

action.
• Purpose: To carry out planned nursing interventions to
help the patient attain goals and achieve optimal level of
heath.
• Activities
Reassessing
Set priorities
Perform nursing interventions
Records actions

Critical to Remember: Something that is not written is

considered as not done.
VI. Evaluation. Is assessing the patient’s response to
nursing interventions and then comparing the response to
predetermined standards or outcome criteria.
Purpose: To appraise the extent to which goals and
outcome criteria of nursing care have been achieved.
Activities:
Collect data about the patient’s response.
Compare the patient’s response to goals and outcome
and criteria.
Analyze the reasons for the outcomes.
Modify care plan as needed.
Characteristics of Nursing Process
• Problem-oriented
• Goal-oriented
• Orderly, planned, step by step (systematic).
• Open to accepting new information during its application.
• Interpersonal
• Permits creativity among nurses and patients in devising
ways to solve the health problems.
• Cyclical
• Universal
Benefits of the Nursing Process for the Patients
1. Quality patient care. It meets standards of care.
2. Continuity of care.
3. Participation by the patients in their health care. This
reflects respect for human dignity.
Benefits of the Nursing Process for the Nurse
1. Consistent and systematic nursing education.
2. Job satisfaction.
3. Professional growth.
4. Avoidance of legal action.
5. Meeting professional nursing standards.
6. Meeting standards of accredited hospitals.
The Heart of the Nursing Process
(K-Knowledge; S- Skills; C- Caring)
A. Manual
Technical Skills
B. Intellectual
( Critical thinking)
• Careful, deliberate, goal directed- to solve problems/
• Make decisions
• Good habits of inquiry
• Check for evidence
• Keeping an open mind
• Avoid jumping into conclusions
C. Interpersonal
• To establish positive interpersonal relationships, with
patients, co-workers (requires communication skills)
Caring- Willingness and Ability to care
• being able to care
• Understanding ourselves
• To be more able to understand others
• To be more objective/non-judgmental
• Requires ability to listen empathetically.
• Listen with intent.
• Enter into another’s way of thinking and viewing the world.
• Connecting with another’s feelings and perceptions.
• Identifying with another’s struggles, frustrations and
desires.
• Then, being able to detach from feelings and returning to
our own frame of reference.
Willingness to care
• Keep the focus on what is best for the patient.
• Respect the beliefs/values of others.
• Stay involved.
• Maintain a healthy lifestyle.
Caring Behaviors
• Inspiring someone/instilling hope and faith.
• Demonstrating patience, compassion and willingness to
persevere.
• Offering companionship.
• Helping someone stay in touch with positive aspect of his
life.
• Demonstrating thoughtfulness.
• Bending the rules when it really counts.
• Doing the “little things”
• Keeping someone informed.
• Showing your human side by sharing “stories”.
THANK YOU!