The nursing process is a modified

scientific method The scientific method is an empirical method for acquiring knowledge that has characterized the development of science since at least the 17th century (with notable practitioners in previous centuries; see the article history of scientific me ...

. 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 Health informatics is the field of science and engineering that aims at developing methods and technologies for the acquisition, processing, and study of patient data, which can come from different sources and modalities, such as electronic hea ...

. The diagnosis phase was added later. The nursing process uses clinical judgement to strike a balance of

epistemology Epistemology (; ), or the theory of knowledge, is the branch of philosophy concerned with knowledge. Epistemology is considered a major subfield of philosophy, along with other major subfields such as ethics, logic, and metaphysics. Episte ...

between personal interpretation and research evidence in which

critical thinking Critical thinking is the analysis of available facts, evidence, observations, and arguments to form a judgement. The subject is complex; several different definitions exist, which generally include the rational, skeptical, and unbiased analys ...

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. Some authors refer to a

mind map A mind map is a diagram used to visually organize information into a hierarchy, showing relationships among pieces of the whole. It is often created around a single concept, drawn as an image in the center of a blank page, to which associated r ...

abductive reasoning Abductive reasoning (also called abduction,For example: abductive inference, or retroduction) is a form of logical inference formulated and advanced by American philosopher Charles Sanders Peirce beginning in the last third of the 19th centu ...

as a potential alternative strategy for organizing care.

Intuition Intuition is the ability to acquire knowledge without recourse to conscious reasoning. Different fields use the word "intuition" in very different ways, including but not limited to: direct access to unconscious knowledge; unconscious cognition; ...

plays a part for experienced nurses.

Phases

The nursing process is goal-oriented method of caring that provides a framework to nursing care. It involves seven major steps: *A : Assess (what data is collected?) *D :

Diagnose Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engineer ...

(what is the problem?) *O : Outcome Identification - (Was originally a part of the Planning phase, but has recently been added as a new step in the complete process). *P :

Plan A plan is typically any diagram or list of steps with details of timing and resources, used to achieve an objective to do something. It is commonly understood as a temporal set of intended actions through which one expects to achieve a goal. ...

(how to manage the problem) *I : Implement (putting plan into action) *R :Rationale (Scientific reason of the implementations) *E : Evaluate (did the plan work?) According to some theorists, this seven-steps description of the nursing process is outdated and misrepresents nursing as linear and atomic.

Assessing phase

The nurse completes a

holistic Holism () is the idea that various systems (e.g. physical, biological, social) should be viewed as wholes, not merely as a collection of parts. The term "holism" was coined by Jan Smuts in his 1926 book ''Holism and Evolution''."holism, n." OED Onl ...

nursing assessment Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. Nursing assessment is the first step in the nursing process. A section of the nu ...

of the needs of the individual/family/community, regardless of the reason for the encounter. The nurse collects subjective

data In the pursuit of knowledge, data (; ) is a collection of discrete values that convey information, describing quantity, quality, fact, statistics, other basic units of meaning, or simply sequences of symbols that may be further interprete ...

and objective

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.

=Methods

= *Client Interview *Physical Examination *Obtaining a health history (including dietary data) *Family history/report

Diagnosing phase

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.

Planning phase

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. The most common terminology for standardized nursing diagnosis is that of the evidence-based terminology developed and refined by

NANDA International NANDA International (formerly the North American Nursing Diagnosis Association) is a professional organization of nurses interested in standardized nursing terminology, that was officially founded in 1982 and develops, researches, disseminates an ...

, the oldest and one of the most researched of all standardized nursing languages. 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, which are aimed at the related factors (etiologies) not merely at symptoms (defining characteristics). A common method of formulating the expected outcomes is to use the

evidence-based Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indivi ...

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 A nursing care plan provides direction on the type of nursing care the individual/family/community may need. The main focus of a nursing care plan is to facilitate standardised, evidence-based and holistic care. Nursing care plans have been used fo ...

Implementing phase

The nurse implements the

, 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. Activities * pre-assessment of the client-done before just carrying out implementation to determine if it is relevant * determine need for assistance * implementation of nursing orders * delegating and supervising-determines who to carry out what action

Evaluating phase

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.

Characteristics

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. The entire process is recorded or documented in order to inform all members of the health care team.

Variations and documentation

The PIE method is a system for documenting actions, especially in the field of

nursing Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...

. The name comes from the acronym ''PIE'', meaning Problem, Intervention, Evaluation.

References

{{DEFAULTSORT:Nursing Process Nursing Critical thinking Scientific method