NURSING
PROCESS
WHAT IS A NURSING PROCESS
ļ§A systematic, rational method of planning and
providing individualized nursing care.
ļ§An organized sequence of problem-solving
steps used to identify and to manage the
health problems of clients.
PURPOSE OF NURSING PROCESS
ļ§To identify a clientās health status and actual
or potential health problems or needs.
ļ§To establish plans to meet the identified
needs.
ļ§To deliver specific nursing interventions to
meet those needs.
PHASE OF THE NURSING PROCESS
PHASE DESCRIPTION
ASSESSMENT Collecting subjective
and objective data
DIAGNOSIS Analyzing subjective
and objective data to
make a professional
nursing judgment
PLANNING Determining outcome
criteria and developing
plan
IMPLEMENTATION Carrying out the plan
EVALUATION Assessing whether
outcome criteria have
been met and revising
the plan as
necessary
CHARACTERISTIC OF THE NURSING PROCESS
ļ¼Cyclic and dynamic
ļ¼Client centeredness
ļ¼Focus on problem solving and decision
making.
ļ¼Interpersonal and collaborative style
ļ¼Universal applicability
ļ¼Use of critical thinking
BENEFITS OF NURSING PROCESS
ļ¼Provides an orderly &systematic method for
planning &providing care.
ļ¼Enhances nursing efficiency by standardizing
nursing practice.
ļ¼Facilitates documentation of care.
ļ¼Provides a unity of language for the nursing
profession.
ļ¼Stresses the independent function of nurses.
ļ¼Increases care quality through the use of
deliberate actions.
ASSESSMENT
oCollect data
oOrganize data
oValidate data
oDocument data
ļ§The first and most critical phase of the nursing
process.
ļ§Defined as a systematic and continuous
collection, organization, validation, and
documentation of data.
ļ§Ongoing and continuous throughout all
phases of the nursing process.
FOUR TYPES OF ASSESSMENT
1. Initial Comprehensive Assessment
ļ¼Performed within a specified time after
admission.
ļ¼Establish a complete database for
problem identification, reference &future
comparison.
ļ¼Involves collection of subjective data
about clientās perception of his health of
all body parts or systems, past health
history, family history and lifestyle and
health practices as well as objective data
gathered during physical examination.
2. Problem-focused Assessment
ļ¼To determine the status of a specific
problem identified in an earlier
assessment. Ex: Hourly assessment of
clientās fluid. intake and urinary output in
an ICU.
3. Emergency Assessment
ļ¼Very rapid assessment performed in life
threatening situations.
ļ¼Immediate assessment is needed to
provide prompt treatment.
ļ¼The major concern is to determine the
status of the clientās life sustaining
physical functions. Ex: Evaluating clientās
airway, breathing and circulation when
cardiac arrest is suspected.
4. Time-lapsed Reassessment
ļ¼To compare the clientās current status to
baseline data previously obtained.
ļ¼Several months after initial assessment.
Ex: Reassessment of a clientās functional
health patterns in home care.
COLLECTION OF DATA
TYPES OF DATA
1. Subjective Data
