The nursing process is a modified scientific method. Nursing practise was first described as a four stage nursing process by Ida Jean Orlando in 1958. It should not be confused with nursing theories or Health informatics. The diagnosis phase was added later.
The nursing process uses clinical judgement to strike a balance of epistemology between personal interpretation and research evidence in which critical thinking may play a part to categorize the clients issue and course of action. Nursing offers diverse patterns of knowing. Nursing knowledge has embraced pluralism since the 1970s.
The nursing process is goal-oriented method of caring that provides a framework to nursing care. It involves six major steps:
- Assess (what data is collected?)
- Diagnose (what is the problem?)
- Outcome Identification - (Was originally a part of the Planning phase, but has recently been added as a new step in the complete process).
- Plan (how to manage the problem)
- Implement (putting plan into action)
- Rationale (Scientific reason of the implementations)
- Evaluate (did the plan work?)
According to some theorists, this six-steps description of the nursing process is outdated and misrepresents nursing as linear and atomic.
The nurse completes an holistic nursing assessment of the needs of the individual/family/community, regardless of the reason for the encounter. The nurse collects subjective data and objective data using a nursing framework, such as Marjory Gordon's functional health patterns.
Models for data collection
Nursing assessments provide the starting point for determining nursing diagnoses. It is vital that a recognized nursing assessment framework is used in practice to identify the patient's* problems, risks and outcomes for enhancing health. The use of an evidence-based nursing framework such as Gordon's Functional Health Pattern Assessment should guide assessments that support nurses in determination of NANDA-I nursing diagnoses. For accurate determination of nursing diagnoses, a useful, evidence-based assessment framework is best practice.
- Client Interview
- Physical Examination
- Obtaining a health history (including dietary data)
- Family history/report
- Diagnostic Data
Nursing diagnoses represent the nurse's clinical judgment about actual or potential health problems/life process occurring with the individual, family, group or community. The accuracy of the nursing diagnosis is validated when a nurse is able to clearly identify and link to the defining characteristics, related factors and/or risk factors found within the patients assessment. Multiple nursing diagnoses may be made for one client.
In agreement with the client, the nurse addresses each of the problems identified in the diagnosing phase. When there are multiple nursing diagnoses to be addressed, the nurse prioritizes which diagnoses will receive the most attention first according to their severity and potential for causing more serious harm. For each problem a measurable goal/outcome is set. For each goal/outcome, the nurse selects nursing interventions that will help achieve the goal/outcome. A common method of formulating the expected outcomes is to use the evidence-based Nursing Outcomes Classification to allow for the use of standardized language which improves consistency of terminology, definition and outcome measures. The interventions used in the Nursing Interventions Classification again allow for the use of standardized language which improves consistency of terminology, definition and ability to identify nursing activities, which can also be linked to nursing workload and staffing indices. The result of this phase is a nursing care plan.
The nurse implements the nursing care plan, performing the determined interventions that were selected to help meet the goals/outcomes that were established. Delegated tasks and the monitoring of them is included here as well.
The nurse evaluates the progress toward the goals/outcomes identified in the previous phases. If progress towards the goal is slow, or if regression has occurred, the nurse must change the plan of care accordingly. Conversely, if the goal has been achieved then the care can cease. New problems may be identified at this stage, and thus the process will start all over again.
The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the individual/family/community has. The nursing process not only focuses on ways to improve physical needs, but also on social and emotional needs as well.
- Cyclic and dynamic
- Goal directed and client centered
- Interpersonal and collaborative
- Universally applicable
The entire process is recorded or documented in order to inform all members of the health care team.
Variations and documentation
- Funnell, R., Koutoukidis, G.& Lawrence, K. (2009) Tabbner's Nursing Care (5th Edition), page 72, Elsevier Pub, Australia.
- page 432, Marriner-Tomey & Allgood (2006) Nursing Theorists and their work
- Reed, P. (2009) Inspired knowing in nursing. Pg 63 in Loscin & Purnell (Eds) (2009) Contemporary Nursing Process.Springer Pub
- Kim, H (2010) The Nature of Theoretical Thinking in Nursing. page 6.
- Bradshaw, J & Lowenstein (2010) Innovative Teaching Strategies in Nursing and Related Health Professions.
- Funnell, R., Koutoukidis, G.& Lawrence, K. (2009) Tabbner's Nursing Care (5th Edition), page 222, Elsevier Pub, Australia.
- Kozier, Barbara, et al. (2004) Assessing, Fundamentals of Nursing: concepts, process and practice, 2nd ed., p. 261
- Barbara Kuhn Timby (2008-01-01), Fundamental Nursing Skills and Concepts, p. 114, ISBN 978-0-7817-7909-8