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by
Damion Jenkins, MSN, RN (Columnist)
Since the Next-Gen NCLEX-RN is a test that challenges nursing concepts rather than focusing solely on nursing content, you must understand how to use The Nursing Process.
The Nursing Process is a systematic approach nurses use to provide effective, safe patient care. It comprises five phases: Assessment & Analysis, Diagnosis, Planning, Implementation, and Evaluation. Each phase plays a crucial role in delivering quality nursing care, and understanding these phases is essential for success on the NCLEX exam.
This article is part of a more extensive study guide for the Next-Gen NCLEX-RN:
- Best Free Online Next-Gen NCLEX-RN Study Guide
- Next-Gen NCLEX-RN Question Leveling: Recognition, Comprehension, Application, and Analysis
- Next-Gen NCLEX-RN Identifying Prioritization, Delegation, and Scope of Practice Questions
- Next-Gen NCLEX-RN Expert Test-Taking Strategies
Phase 1: Assessment & Analysis
The first step of The Nursing Process, assessment, is a nurse's most important skill to grow and nurture. Assessment allows nurses to identify actual or potential alterations in health, safety, and overall well-being for their patients, families, and communities. Assessment can include:
- Interviewing the patient
- Physically assessing the well-being of the patient
- Reviewing medical records
- Observing behaviors and interactions
- Collaboration with other healthcare members
- Identify actual or potential health alterations.
On the NCLEX, many questions challenge candidates to understand the importance of assessment. Sometimes, the question is written to challenge the candidates' understanding of the importance of further assessment when there isn't enough information to make a sound judgment. Other times, the questions may challenge the candidates' ability to recognize the limitations of their scope of practice. Despite the structure of the questions, knowing the key points surrounding the concept of assessment will help in selecting correct answers.
Key points for assessment include:
- Always assess first, then implement
- When in doubt, assess further
- RNs must complete all initial assessments, such as new patients and changes in status.
- The PN must report all changes of status to the RN so they can validate the findings.
- The PN is perfectly capable of assessing clients when the assessment is ongoing.
- The words observe, inspect, monitor, examine, and determine are all indicators that assessment is required.
Once the assessment phase of The Nursing Process is completed, the nurse must take the time to review all of the information collected, which leads to analysis.
Analysis
During the analysis phase of The Nursing Process, the nurse takes the time to put all the pieces together. Over time, this practice becomes second nature, but for new graduate nurses, this requires some conscious effort. When you take the time to make sense of all of the information collected from a patient or an NCLEX test question, the focus or problem becomes much clearer. This step allows for easier identification of actual or potential issues and enables the nurse to move more confidently into the next phase of The Nursing Process.
On the NCLEX, the concept of analysis is often challenged. In fact, analysis-level questions are the most complex questions on the exam and therefore require sharp analysis skills. Since this is a skill that nursing students do not get very much practice with during their programs, this is often the most difficult skill for new grads to master before sitting for their exams. To help you improve your analysis skills, we've put together a few key points to remember.
Some key points for analysis include:
- To effectively analyze data, candidates must know the nursing content.
- During the analysis phase, nurses are looking for data significance & meaning.
- Analysis requires questions to be asked and answered systematically.
- Analysis helps nurses to conclude the status of their patients.
- Sound nursing judgment comes from strong analysis skills.
- The analysis phase should always end with the question: Does this make sense?
Once all of the data has been analyzed, the nurse can easily identify actual and potential alterations to health, thus leading to the next phase of The Nursing Process.
Phase 2: Diagnosis
During the diagnosis phase of The Nursing Process, nurses create a list of all the actual and potential alterations to health that their patients present with. Nursing diagnoses stem from the direct observations of the nurse and are health issues that the nurse is licensed to manage. On the NCLEX, questions written about the diagnosis phase of The Nursing Process challenges candidates to understand the why.
We all learned that nursing diagnoses cannot include medical diagnoses. The typical reason given for this is nurses are not doctors. Although this is true, it does not explain the difference between a nursing diagnosis and a medical diagnosis. Therefore, here are the key differences so test-takers can better understand their role in creating and managing nursing diagnoses.
Nursing Diagnosis:
- Stem from direct observations through assessment skills
- Nurses can identify and validate findings that support the diagnosis
- Nurses do not need the assistance of diagnostics or labs to identify and validate nursing diagnoses
Examples of nursing diagnoses include acute pain, altered nutrition, decreased cardiac output, ineffective coping mechanisms, knowledge deficit, risk for injury, etc.
Medical Diagnosis:
- Stem from the interpretation of diagnostic studies and labs
- Only a PA, NP, or physician can order, interpret, and validate the findings of diagnostic studies and lab reports
- Medical practitioners require the assistance of diagnostics or labs to identify and validate medical diagnoses
Examples of medical diagnoses include asthma, bowel obstruction, congestive heart failure, diabetes, fibromyalgia, hyperlipidemia, etc.
Once a nurse has identified all the actual and potential nursing diagnoses for the patient, they can move into planning.
Phase 3: Planning
During the planning phase of The Nursing Process, the nurse focuses on assigning priorities to all of the actual and potential health alterations, as well as begins to consider all of the ways that the nurse can meet the patient's needs. The nurse will establish goals that are patient-specific, measurable, and have an established time frame. To meet the goals that have been established, the nurse must also identify all nursing interventions that will assist the nurse in meeting the needs of the patient.
On the NCLEX, questions written about the planning phase of The Nursing Process make up the majority of the exam. Planning questions typically involve many nursing concepts that fall within the NCLEX test plan categories of Management of Care (NCLEX- RN) and Coordination of Care (NCLEX-PN). These questions often require the test-taker to make careful decisions regarding what action is best or which intervention will meet the client's needs based on their clinical presentation.
Since the planning phase of The Nursing Process involves many nursing concepts and considerations, we've created a list of key terms that can help you to find the nursing concept the question is challenging, so you can focus on selecting the correct answer.
Concept: Establishing Priorities
- Key Terms: Best, first, initial, most, next
Concept: Therapeutic Communication
- Key Terms: Appropriate response, addressing behaviors, concerns and emotions, communication and responding to others (patient, family, staff)
Concept: Delegation
- Key Terms: Creating an assignment, Asking others to complete tasks, Giving instructions to other members of the nursing team (RN, LPN, UAP)
Concept: Teach & Learning Principle
- Key Terms: Patient understands, Nurse evaluates the effectiveness of discharge instructions, Nurse expects the client to return demonstrate, patient needs further explanation
Understanding that the nursing concept of safety can be incorporated and challenged on every question type is important. There aren't any specific terms or statements that can alert the test-taker that the question is focusing on safety. Since the NCLEX aims to determine if candidates are demonstrating safe decision-making skills, it is vital to consider safety at all times.
Once the planning phase is completed, the nurse can implement the plan.
Phase 4: Implementation
The implementation phase of The Nursing Process includes all activities and interventions that help the nurse meet the patient's needs. These activities include but are not limited to assisting patients with activities of daily living (ADLs), teaching others, performing patient care skills, giving medications, putting safety measures in place, documenting, and supervising the care that other healthcare team members provide.
On the NCLEX, questions about The Nursing Process's implementation phase are also very common. Candidates often have to decide which action or intervention will best meet the patient's needs or resolve the problem presented in the question. Implementation questions can come from all of the other NCLEX test plan categories.
Since implementation focuses on the action or interventions of nursing practice, these questions can embody all of the test plan categories. To make it easier to understand, we've created a list of actions and interventions you may see from each category on the NCLEX test plan.
Category: Safe and Effective Care Environment
- Actions and Interventions: Effectively communicate, verify orders, advocate for patient rights, supervise care provided by others, report client findings and observations, provide care within scope of practice, document care, perform ongoing safety checks
Category: Health Promotion and Maintenance
- Actions and Interventions: Provide education, teaching and instructions to others, complete comprehensive health assessments, plan the care of outpatient and members of the community
Category: Psychosocial Integrity
- Actions and Interventions: Respond to behavioral changes, assist patients with coping strategies, provide end-of-life care, use therapeutic communication techniques, promote a safe and therapeutic environment
Category: Physiological Integrity
- Actions and Interventions: Assist patients with activities of daily living, provide comfort measures, monitor physical health status, perform post-mortem care
Phase 5: Evaluation
The final phase of The Nursing Process is evaluation. After completing the actions, interventions, nursing skills, teaching, etc., it's time to determine if we've met the patient's needs. This step is just as essential as the assessment.
On the NCLEX, questions that focus on the evaluation phase of The Nursing Process challenge candidates to understand the intricacies of expected and unexpected outcomes. Did the nitroglycerin tablet have the intended effect on the patient? Is the patient having an adverse reaction to the medication? Is the absence of chest pain the goal for administering nitroglycerin?
These are all examples of evaluating the effectiveness of treatment. Whether the interventions performed are independent, dependent, or interdependent, the nurse is responsible for evaluating whether or not it is meeting the client's needs and whether the task was done correctly and safely. To help you identify if the question is about evaluation, we've created a list of key terms to signal that you're working within the evaluation phase of The Nursing Process.
Here is a list of key terms that will let you know you should be focusing on the concept of evaluation:
- Accountability
- Correctness
- Effectiveness
- Goals
- Indicators
- Objectives
- Outcomes
- Patient Response to Treatment
- Standards of Care
The current care plan will be continued if the nurse identifies that the actions and interventions meet the patient's needs. Suppose the nurse identifies that the actions or interventions are not meeting the patient's needs or are not resulting in expected outcomes. In that case, the nurse will return to the assessment phase of The Nursing Process and collect more information to create and initiate a new care plan.
Critical Thinking
Many nursing students have a hard time speaking to the concept of critical thinking.
- What does critical thinking mean?
- What are the steps in critical thinking?
- How does one learn to think critically?
Critical thinking is one of the hardest concepts to teach nursing students. The nursing professors more or less facilitate it. However, the student must take the initiative and effectively demonstrate critical thinking through disciplined and systematic practice. Fortunately, we've identified a simplified yet effective process for mastering critical thinking, which helps significantly in improving a test-taker's accuracy when answering practice questions.
To be able to think critically, one must be able to:
- Have good observational skills
- Scrutinize information to determine its significance
- Identify issues that need to be resolved
- Prepare to address the issues
- Engage in activities that work towards solving the issues
- Measure the success of resolving the issues
What do the above steps sound like? Let's take a closer look:
- Observation = Assessment
- Scrutinize = Analysis
- Identify Issues = Diagnosis
- Prepare to Address Issues = Planning
- Activities to Solve the Issues = Implementation
- Measuring Success = Evaluation
Critical thinking is the same thing as using The Nursing Process. Many nursing students leave their programs not fully understanding that The Nursing Process was designed as a systematic approach to critical thinking so that nurses remain objective, safe, and always work within their scope of practice.
