How to use the nursing process

Home Health Columnist / Guide · May 18, 2014

Moved to our Nursing Student Assistance forum for help with nursing program assignents

You might want to check out the FAQ section link for great resources on care planning, nursing diagnosis etc.

Esme12, ASN, BSN, RN · May 18, 2014

You are putting the cart before the horse a bit.....Here are the steps of the nursing process and what you should be doing in each step: ADPIE from our Daytonite

Assessment
(collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)

Determination of the patient's problem(s)/nursing diagnosis
(make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)

Planning
(write measurable goals/outcomes and nursing interventions)

Implementation
(initiate the care plan)

Evaluation
(determine if goals/outcomes have been met)

The Nursing Process is really the Scientific Method in disguise:

The steps of the scientific method are to:

Ask a Question
Do Background Research
Construct a Hypothesis
Test Your Hypothesis by Doing an Experiment
Analyze Your Data and Draw a Conclusion
Communicate Your Results

from: Steps of the Scientific Method

The first 2 steps comprise the assessment, the hypothesis is analogous to the diagnosi; you plan the intervention, and analyze the outcomes as an experiment, and then reevaluate and document your results.

What I would suggest you do is to work the nursing process from step #1

#1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms.

#2. Don't forget to include an assessment of their ability to perform adls (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you.

#3. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. Did you miss any of the signs and symptoms in the patient? If so, now is the time to add them to your list.

This is all part of preparing to move onto the next step of the process which is

#4. Determining your patients problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

#5. How are all your interventions changing/helping this patient.

You, I and just about everyone we know have been using a form of the scientific process, or nursing process, to solve problems that come up in our daily lives since we were little kids.

For example: As a contributor to AN....Daytonite said best.

You are driving along and suddenly you hear a bang, you start having trouble controlling your car's direction and it's hard to keep your hands on the steering wheel. You pull over to the side of the road. "What's wrong?" You're thinking. You look over the dashboard and none of the warning lights are blinking. You decide to get out of the car and take a look at the outside of the vehicle. You start walking around it. Then, you see it..............a huge nail is sticking out of one of the rear tires and the tire is noticeably deflated.
What you have just done is.......
Step #1 of the nursing process--performed an assessment. You determine that you have a flat tire. You have just done.....
Step #2 of the nursing process--made a diagnosis. The little squirrel starts running like crazy in the wheel up in your brain. "What do i do?" You are thinking. You could call AAA. No, you can save the money and do it yourself. You can replace the tire by changing out the flat one with the spare in the trunk. .......Good thing you took that class in how to do simple maintenance and repairs on a car!
You have just done.....
Step #3 of the nursing process--planning (developed a goal and intervention). You get the jack and spare tire out of the trunk, roll up your sleeves and get to work. You have just done.....
Step #4 of the nursing process--implementation of the plan. After the new tire is installed you put the flat one in the trunk along with the jack, dust yourself off, take a long drink of that bottle of water you had with you and prepare to drive off. You begin slowly to test the feel as you drive....... Good....... Everything seems fine. The spare tire seems to be ok and off you go and on your way. You have just done
Step #5 of the nursing process--evaluation (determined if your goal was met).
Does this make more sense? Can you relate to that? That's about as simple as the nursing process can be simplified to... BUT........ you have the follow those 5 steps in that sequence or you will get lost in the woods and lose your focus of what you are trying to accomplish.
critical thinking involves knowing:
the proper sequence of steps in the nursing process
the normal anatomy and physiology of the human body
how the normal anatomy and physiology are changed by the medical and disease process that are going on
the normal medical treatment that the doctor(s) are likely to order to treat the medical and disease process going on
the nursing interventions that you have learned for the things that support the medical and disease process that is going on
making the connection (this is the critical thinking part) between the disease, the treatment and the nursing interventions and where on the sequence of the nursing process you are

step #1 - assessment - look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology

step #2 - determine the patient's problem(s)/nursing diagnosis/part 1 - make a list of the abnormal assessment data

step #3 - determine the patient's problem(s)/nursing diagnosis/part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use

Episteme · May 18, 2014

I am not sure what you are asking.

Are you asking about how a student's knowledge of the nursing process is probed with test question?

Are you asking how the nursing process is taught?

Are you asking how a student's knowledge of and ability to use the nursing process is tested in nursing school?

Nursing pursuit · May 18, 2014

I'm asking how do you apply it on a nursing test?

Nursing pursuit · May 18, 2014

I wish you would of used a test question from an nclex book as an example. Also how do you know if it's a nursing process question or not?

Esme12, ASN, BSN, RN · May 18, 2014

Again, I think you are putting the cart before the cart.

Well...it is essentially the same. You look at the question. You look at what information is provided...you look at the disease process and what information they provided. The you think according to Maslows hierarchy of needs...and the ABC's. You look at what is the MOST important and what you should do FIRST.

These critical thinking, or application type, questions require you to draw from a number of disciplines and knowledge. the basic strategy for answering critical thinking (application type) questions is as follows, you must:

know and consider the normal anatomy and physiology
know and consider abnormal anatomy for the disease in question
know and consider the resulting signs and symptoms when the disease occurs and how they proceed from mild to fatal - each sign and symptom can be related back to the pathophysiology of the disease
know and consider how the doctor diagnoses and treats the disease in question
know nursing interventions for the signs and symptoms you are being asked about
know the steps of the nursing process and what goes on in each of the steps and consider how they are affecting the question you are being asked
know and consider the principles behind the actions being done - there are many kinds of principles: principles of nursing, principles of biology, principles of chemistry, principles of physics, etc.
read the stem of the question carefully and answer that because the test makers try to trip you up by distracting you with conflicting information they give you in the answer choices that sounds good but has no relationship to what the question is asking for
ask yourself "why" a patient is experiencing some sign or symptoms to get at the underlying problem. nursing like other disciplines treats the problem/signs and symptoms.

http://www.amazon.com/fundamentals-success-applying-critical-thinking/dp/0803610564/ref=pd_sim_b_3/002-1123730-3462415

Esme12, ASN, BSN, RN · May 18, 2014

I wish you would of used a test question from an nclex book as an example. Also how do you know if it's a nursing process question or not?

Breathe! You are anxious and that is ok. The link above I gave it to a book...Fundamentals Success: A Course Review Applying Critical Thinking to Test-Taking. You don't have the basics yet so it will be overwhelming to try to figure out NCLEX questions.

It is admirable that you want a jump start....but you are going to get so overwhelmed. Try looking at the book that might help.

Episteme · May 18, 2014

OK. Here is how the NCLEX gets a notion of how well you know your nursing process.

First they will give you a clinical vignette:

It's 1815 and Emergency Medical Services arrives at the ER with Mrs. S. They were called to the patient's home because she had a syncopal episode as she rose from the dinner table. According to her husband she struck her head on the edge of the kitchen counter splitting open her scalp at the back of her head. She had a few "seizure like" movements, and then gradually woke up. By that time Mr. S. had called 911 and the kitchen floor was quite bloody. As the nurse admits Mrs. S. he notes that the patient has a dressing on her head with no apparent fresh blood. Mrs. S's vital signs are T= 97.4, P= 135, R=28, BP=102/54 %sat 100 on 2L of oxygen.

Then they will ask you a series of questions that relate to the vignette.

1) What is the next priority assessment the nurse should make?

A. Determine Mrs. S's level of consciousness and orientation to person, time, place and circumstances

B. Orient the patient and her husband to the ER and give them a brief description of what they can expect

C. Make certain the side rails of the gurney are in the up position

D. Give Mrs. S. the call light and show her how to use it.

The answer is (A). Options B, C, and D are all nursing actions. The only assessment listed is A. Now, a lot of the experienced nurses reading this question would be very alarmed about Mrs. S's pulse rate of 135, her tachypnea and her relatively low BP. They might want to look at the monitor to see if she's in normal sinus rhythm, confer with the MD about getting a stat EKG, listen to her heart and look at her CBC. Those would be really important things to check out. But they aren't listed. So whereas I (a neuro nurse) would instantly want to do neuro checks, my colleagues with ER/CCU/ICU experience would want to assess her cardiovascular system next... but we would all choose A because it's the only assessment listed.

I could give you a lot of examples. Does this answer your question?

Nursing pursuit · May 18, 2014

Wow that book is less than $10. I might get it. I was once in the nursing program and got kicked out. This is why I'm trying to go ahead. I can't help my anxiety, it's been there ever since I knew how tough nursing classes are.

Nursing pursuit · May 18, 2014

That helps a little. So, can you use a different example other than assessment? How about planning?

Nursing pursuit · May 19, 2014

That does help Episteme. So you linked the abnormal vitals to cardiovascular assessment but since there were none, you go with the only assessment which is A. How did you figure out that the high pulse rate, tachypnea and low BP is linked strictly to cardiovascular?