uderstanding the nursing process

llg, PhD, RN · Nov 28, 2007

Perhaps you should elaborate a little on what you mean. The nursing process only has 4 steps -- so, I'm sure you can understand the basics. (Assess, plan, intervene, evaluate). Some people include "diagnose" as a second step. (Asses, diagnose, plan, intervene, evaluate).

As you probably understand the basic steps of the process, tell us a little about what it is that you don't understand? That would help the experienced people give you some guidance.

Daytonite, BSN, RN · Nov 29, 2007

The nursing process very simply the problem solving process. It is nothing more or less. You have solved problems in your life using the same basic solving process before, you just didn't know it! What nursing has done is to give the process a name (The Nursing Process) and broken it down into steps for you that allow you organize and prioritize patient care. The nursing process guides all the actions and decisions that you make about the patient. The five steps of the nursing process are:

Assessment (collect data from medical record and by doing a thorough physical assessment of the patient)
Nursing Diagnosis (list the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis to use)
Planning (determine measurable goals/outcomes and nursing interventions)
Implementation (initiate the nursing interventions)
Evaluation (determine if goals/outcomes have been met)

What you must also understand is that in nursing these steps should be followed in this sequence, that there is some overlapping of the steps at times and that in the clinical area these steps are constantly occurring in a cycle that never stops for each patient and their problems.

Now, I said that you have used this process in your own life prior to nursing school, but didn't know it. Let me give you an example and equate it with the nursing process for you. You are driving down the road and hear a bang! and you start to have trouble controlling the direction of your car as the steering wheel starts to jerk around, so you slow down and pull over because you know something is obviously wrong (patient enters the healthcare system for help). When the car stops you might look under the hood of the care. You also walk around the car to take a look (Step #1 - assessment). You discover that one of the rear tires is flatter than a pancake. You have a flat tire (Step #2 - diagnosis). What to do. Lucky you took a class in how to change a tire. You can use the spare tire in the trunk to replace the flat tire along with the tools that are there (Step #3 - planning). So, you roll up your sleeves, open the trunk and start pulling out the jack and the spare tire and get to work (Step #4 - implementation). When you're finished you put the jack and the flat tire in the trunk, get back in the car and carefully start your journey again, slowly at first, making sure your new tire is secure and working properly (Step #5 - Evaluation).

Make sense? I think if you think back to the many times in your life that things have gone wrong, you have followed much the same kind of logic to get the situation solved. As I said, all nursing has done is applied some fancy names and labels to the process. Strip it down to its bare bones and you're doing nothing more than diagnosing and changing a flat tire. A little simple, perhaps, but it's a good analogy. An added bonus is that this nursing process is the same one you use to write a care plan. A care plan is the nursing process documented on paper.

Now, each of the steps has been expanded with information that is necessary for you to know. For instance, in the assessment part you learn how to do a complete head to toe physical exam. For diagnosing you learn about NANDA and the nursing diagnoses. For planning you have your nursing textbooks to teach you about nursing interventions and what the expected outcomes are. You also are learning about medical diseases and how the doctors treat and test for them.

And that, kiddo, is about as easy as I can make it for you. Hope that has helped. A book that might help you with this as well is Nursing Care Planning Made Incredibly Easy! published by Lippincott Williams & Wilkins. You are being taught the nursing process now in order to think critically and eventually to write care plans. As working RNs we are required to have a written care plan in the medical record of each of our patients to document the nursing process we are using in ministering to them. This is a federal law (Title 42).