NURSING PROCESS - INTRODUCTION

Practice of nursing is caring which is directed by the way the nurses view the client, the client’s environment, health and the purpose of nursing.
To nurses the nursing process provides a useful description of how nursing should be performed.
As nurses remain in constant interaction with their clients, professional colleagues, medical and health care team members, they have the best opportunity to assess the patient’s needs and provide evidence-based care.

HISTORY OF NURSING PROCESS

The term ‘Nursing Process’ was first used/mentioned by ‘Lydia Hall’, a nursing theorist, in 1955 wherein she introduced 3 STEPs: Observation, Administration of care and Validation.
In 1967, Yura and Walsh added assessment to the three steps and described a four phase process (APIE).
In the mid-1970s an addition of diagnostic phase resulted into a five step process (ADPIE).
The use of nursing process in clinical practice was started in 1973 by the American Nurses Association (ANA) in Standards of Nursing Practice.
After 1980 the nursing process was added to the General Nursing Curriculum in India.
In 1991, revisions were made to the standards to incorporate outcome identification in the planning phase. now a 6-step process (ADOPIE) Assessment, Diagnosis, Outcome Identification, Planning, Implementation and Evaluation.

DEFINITION

Nursing - caring the clients during times of illness and assisting the client to achieve maximum health potential throughout the life cycle.
Process - a series of rational thoughts, decisions and acts to achieve a goal. It implies a movement which has beginning, middle and an ending.

“The nursing process is systematic, goal directed, Client-centered method for structuring the delivery of nursing care.”
Nursing Process (NP) is defined as a systematic, continuous and dynamic method of providing care to clients. It comprises series of sequential phases built upon the preceding step. Each phase logically leads to the next. As one step leads to the next step it results into ultimate achievement of mutually determined nursing outcomes/goals.

CHARACTERISTIC OF NURSING PROCESS

It is a G O S H approach (goal-oriented, organized, systematic and humanistic care) for efficient and effective provision of nursing care.

Goal-oriented – Nurse make her objective based on client’s health needs.
Note: Goals and plan of care should be base according to client’s problems / needs NOT according to your own problem as the nurse.
Organized / Systematic – The nursing process is composed of 6 sequential and interrelated steps and these 6 phases follow a logical sequence.
Individualized & Humanistic care - plan to care is developed and implemented taking into consideration the unique needs of the individual client in providing care, it involves respect of human dignity. Therefore, it is individualized (no 2 person has the same health needs even with same health condition/illness).

Cyclic and Dynamic in nature – data from each phase provides the input into the next phase so that is becomes a sequence of events (cycle) that are constantly changing (dynamic) base on client’s health status.
Involves skill in Decision-making – nurse makes important decisions related to client care, she choose the best action/steps to meet a desired goal or to solve a problem. She must make decisions whenever several choices or options are available.
Uses Critical Thinking skills – the nurse may encounter new ideas or less-than-routine or non-ordinary situations where decisions must be made using critical thinking.

PURPOSE OF NURSING PROCESS

To identify a client’s health status; his Actual/Present and potential/possible health problems or needs.
To establish a plan of care to meet identified needs.
To provide nursing interventions to meet those needs.
To provide an individualized, holistic, effective and efficient nursing care.

PHASES OF NURSING PROCESS

Assessment - involves collection of information or details about the client obtained from different sources, e.g., through interview, physical examination using different methods and clinical examination.
Nursing Diagnosis- identify the client’s problem(s).
Outcome identification & Planning - development of strategies to alleviate client’s problem identified in nursing diagnosis through a series of steps.
Implementation - starting and completing the strategies planned with help of client, family members and health care team members.
Evaluation - assessment of strategies planned to alleviate the clients’ suffering or otherwise re-plan and revise the care.

BIBLIOGRAPHY

BNS-101 Nursing Foundation, Published By -IGNOU; 2017 [cited 2018 Feb 25].
“Birpuri” S Sharma. Principles and practice of nursing, Published By -Jaypee Publication, 2012
Burton M, Ludwig LJM. Fundamentals of nursing care: concepts, connections & skills. Second edition. Philadelphia, PA: F.A. Davis Company; 2014.
Kozier B, Berman A, editors. Kozier & Erb’s fundamentals of nursing: concepts, process, and practice. 9th ed. Boston: Pearson; 2012.
Nugent PM, Vitale BA. Fundamentals of nursing: content review plus practice questions. 2014.
Perry AG, Potter PA, Ostendorf W. Clinical nursing skills & techniques. 8th edition. St. Louis, Missouri: Elsevier; 2014.
Potter PA, Perry AG, Hall A, Stockert PA. Fundamentals of nursing. Eighth edition. St. Louis, Mo: Mosby Elsevier; 2013.
Treas LS, Wilkinson JM. Basic nursing: concepts, skills, & reasoning. Philadelphia, PA: F.A. Davis Company; 2014.

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