The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation. Assessment is the first step and involves critical thinking skills and data collection; subjective and objective

2.  Nursing process is a modified scientific method. Nursing process was first described as a four-
stage nursing process by Ida Jean Orlando in 1958. The diagnosis phase was added later.
 The nursing process functions as a systematic guide to client-centered care with five sequential
steps. These are Assessment, diagnosis, planning, implementation, and evaluation It is a
systematic method of planning and providing individualized nursing care.

3.  NURSING: The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health, its recovery, or to a peaceful death the
client would perform unaided if he had the necessary strength, will or knowledge and to do
this in such a way as to help the client gain independence as rapidly as possible.
ACCORDING TO VIRGINA HENDERSON(1966)
 PROCESS: It is a series of planned actions or operations directed towards a particular result
or goal.

4.  NURSING PROCESS : It is a five-step clinical decision making approach that includes
assessment, diagnosis, planning, implementation, and evaluation. The purpose of the nursing
process is to diagnose and treat human responses to actual or potential health problems.
AMERICAN NURSING ASSOCIATION(2003)
 NURSING CARE PLAN: Nursing care plan provides direction on the type of nursing care
the individual/family/community may need. It contains all of the relevant information about a
patient’s diagnoses, the goal of treatment, the specific nursing orders and a plan for
evaluation.

5. STEPS OF NURSING PROCESS

6.  Nursing assessment is the first step of nursing process and may be defined as collecting,
validating, organizing and documenting client data.
ACCORDING TO CAROL TAYLOR
 Nursing assessment is a deliberate and systematic collection of data to determine a client’s
current and past health status and to determine the client’s present and past coping patterns.
ACCORDING TO CAPRENITO MOYER(1991)

7. 1. INITIALASSESSMENT: Also known as admission assessment, is performed within a
specified time after admission to establish a complete, database for problem identification,
reference, and future comparison.
2. FOCUSED ASSESSMENT : Ongoing process integrated with nursing care to determine the
status of a specific problem identified in an earlier assessment.
3. EMERGENCY ASSESSMENT: Occurs during any physiologic or psychological crisis of the
client to identify the life-threatening problems and to identify new or overlooked problems.
4. TIME-LAPSED ASSESSMENT: It occurs several months after the initial assessment to
compare the client’s current status to baseline data previously obtained.

8. ASSESSMENT ACTIVITIES:
ACTIVITIES
1.
COLLECT
DATA
2.
VALIDATE
DATA
3.
ORGANISE
DATA
5.
DOCUMENT
DATA
Two types of
data collected:
a. Subjective
Data
b. Objective
Data
Double checking
of data to
confirm
accuracy
Grouping the
data using Head
to Toe model,
systemic review
Documents
subjective data in
client’s own
words using
medical terms,
keys etc.
4.
ANALYSIS
OF DATA
Organizing the
information into
meaningful &
usable clusters.

9.  Data collection is a term used to describe a process of preparing and collecting data. It
includes accumulation of information about the client on initial assessment which provides
baseline information. The data includes information about client’s health problems.

10.  DATA: Information that is collected during a study.
 DATA COLLECTION: It is a term used to describe a process of preparing and collecting
data.
OR
It is the process of gathering information about the client that begin with the first client
contact, using methods/skills of assessment.

11. The gathering of information about the client’s status includes:
 Strengths and weakness of the patient
 Response of the patient
 Knowledge related to health status
 Beliefs and values
 Life-style
 Health related goals
 Support system

12. TYPES OF DATA:
 Subjective Data: It is collected via personal communication.
◦ These are the symptoms of health problem.
◦ Information perceived only by the affected person. It is provided by client himself through interview or
in written form.
◦ It include the client’s feeling and statement related to his health problems.
◦ FOR EXAMPLE: Pain experience, feeling dizzy, feeling anxious.
 Objective Data: It is collected via observations.
◦ These are the signs regarding health problem.
◦ Observable and measureable data that can be seen, heard, or felt
by someone other than the person experiencing them.
◦ FOR EXAMPLE: Elevated temperature, skin moisture, vomiting.

13. Sources of data may be primary or secondary
Sources of data
Primary data
The client is the primary source of data. Client is
the best source of information unless he is too ill,
confused, he provides subjective data. He provides
most accurate information about health care needs,
life style patterns,, present past illness.
Secondary data
•Family members or other supporting
persons
•Health professionals
•Health records and reports
•Laboratory and diagnostic analyses

14. There are different methods used by the nurses to collect data from the patient .The
data gathered helps to make nursing diagnosis and plan care .The three major
methods used by nurses to gather information are:
METHODS OF DATA COLLECTION
OBSERVATION INTERVIEW
PHYSICAL
EXAMINATION

15. 1. OBSERVATION: Observation is the method of data collection through use of senses, i.e.
sight, smell, hearing and touch. Observation is a skill that requires practice.
A nurse should observe the following:
 Clinical signs of client’s distress(e.g. pallor or flushing, labored breathing, behavior
indicating pain).
 Threats to client’s safety(e.g. lowered side rails)
 Presence of functioning of equipment(e.g. oxygen, cardiac monitor)
 Immediate environment(e.g. people in the room ventilation)

16. 2. INTERVIEW: Interviewing is a planned communication or conversation with a purpose. The
client is interviewed to collect information about him/her. This serves the following purpose:
 To collect specific information required for diagnosis and planning
 To establish client-nurse relationship
 To allow client to participate in goal settings.
APPROACHES
1. DIRECTIVE: The client
respond to the questions
but may have limited
opportunity to ask the
question(e.g. in an
emergency situation
2. NON DIRECTIVE: In
this the nurse allows the
client to control the
purpose and have more
opportunities to ask the
questions.

17. 3. PHYSICAL EXAMINATION: Nurses perform physical assessment to obtain the objective data
needed to complete the assessment phase of the nursing process. Data can also be obtained by
physical examination of the client.
It includes various techniques:
 Inspection
 Palpation
 Percussion
 Auscultation
 Olfaction
It also includes:
 History taking
 Physical assessment i.e. head to toe assessment, Review of the system

18. COMPONENTS OF A NURSING HEALTH HISTORY:
 Biographic data
 Chief complaints
 History of present illness
 Past health history
 Family history
 Review of system
 Lifestyle
 Social data
 Psychological data
 Pattern of health care

19.  In simple words validation means cross-checking the collected information. Validation
prevents from misinterpretation, misunderstanding and incorrect conclusions. The act of
double-checking or verifying data confirms that it is accurate and complete.
 Validation of data is the process of confirming or verifying that the subjective and objective
data collected are reliable and accurate.

20. Purpose of data validation:
• Ensure that data collection is complete
• Obtain additional data that may have been overlooked
• Avoid jumping to conclusion
• Differentiate cues and inferences

21.  After collecting and validating, the data obtained must be organized by a nurse so as to be
useful to the health care professionals and to others involved in the client’s care. The nurse
use a written or computerized format that organize the data systematically.
 Many agencies uses an admission assessment format which assists the nurse in collecting and
organizing the data, e.g. :
 HIERARCHY OF NEEDS: Maslow’s hierarchy of needs proposed the basis needs are to be
met first.

23.  Data analysis is a process of inspecting, cleansing, transforming, and modeling data with the
goal of discovering useful information, informing conclusions, and supporting decision-
making.
 To arrive at nursing diagnosis we must go through the steps of data analysis. This process
requires diagnostic reasoning skills, often called critical thinking.

24. STEPS OF DATAANALYSIS:
1. Identify abnormal data and strengths
2. Cluster the data
3. Draw inferences and identify the problem
4. Propose possible nursing diagnosis
5. Check for defining characteristics
6. Confirm or rule out
7. Document the conclusion

25. 1. IDENTIFY ABNORMAL DATAAND STRENGTH:
• The nurse should have basic knowledge of risk factors for the client.
• Collected data should be reliable
• Identified potential weaknesses are used in formulating the risk diagnosis and abnormal
findings are used in formulating actual nursing diagnosis
2. CLUSTER THE DATA: While clustering the data we may find that certain cues are pointing
towards a problem but more data are required to support the problem. Nursing diagnosis
should always be derived from clusters of significant data rather than from a single cue.

26. 3. DRAW INFERENCES AND IDENTIFY THE PROBLEM: The nurse will write what she
think the data is saying and determine where she can treat independently.
4. PROPOSE POSSIBLE NURSING DIAGNOSIS: If the situation requires primarily nursing
intervention then the nursing diagnosis may be wellness diagnosis, risk diagnosis, or actual
diagnosis.
5. CHECK FOR DEFINING CHARACTERISTICS: To choose the most accurate diagnosis and
to delete the diagnosis which is not valid for the client.

27. 6. CONFIRM OR RULE OUT: The nurse can rule out the particular diagnosis with the other
health care professionals who are caring for the client.
7. DOCUMENT THE CONCLUSION: This is the last and important step of data analysis, as
conclusion is an important element in writing any document. In this there is discussion of
views and opinions.

28.  The documentation is the recording of data accumulated during the assessment. It is the
integral part of all the phases of the nursing process
 To complete the assessment phase, the nurse records client data. Accurate documentation is
essential and should include all data collected about the client’s health status.

29.  Diagnosis is the science and art of identifying problems. It is the second step of nursing
process.
 It is a clinical judgment about individual, family, or community responses to actual or
potential health problems/life processes.
ACCORDING TO NANDA(2007)

30. Each nursing diagnosis has three components:
• Label on actual or potential health problems that nursing care can affect.
• Related factors :Factors that may contribute to or be associated with the human response.
• Evidence: sign and symptoms that point to the nursing diagnosis
COMPONENTS OF NURSING DIAGNOSIS:
A typical nursing diagnosis statement has two or three parts/statements:
 In two parts nursing diagnosis, the first component is a problem statement or diagnostic label,
while second component is the etiology.
 The three part nursing diagnosis statement consists problem, etiology and sign and
symptoms(PES Format).

31. TYPES OF NURSING DIAGNOSIS:
TYPES OF
NURSING
DIAGNOSIS
Actual nursing
diagnosis
Risk nursing
diagnosis
Wellness nursing
diagnosis
Syndrome nursing
diagnosis
Possible nursing
diagnosis

32.  ACTUAL NURSING DIGNOSIS:. It is a statement about a health problem that the client
has, & could benefit from nursing care. In this we use three part nursing diagnosis i.e. PES
(Problem, etiology, sign & symptoms) format.
e.g.- Constipation related to decreased fluid intake as evidenced/manifested by no bowel
movement.
 RISK NURSING DIAGNOSIS: It is a statement about a health problem that the client
doesn’t have yet, but is at a higher than normal risk of developing in the near future. In this
we use two part nursing diagnosis i.e. PE (Problem and etiology) format
e.g.-Risk for injury related to altered mobility
 POSSIBLE NURSING DIAGNOSIS: In this, additional data can be gathered. This is one in
which evidence about the health problem is not clear. It is usually written in two part
statement.
e.g.- Possible constipation related to effects of anesthesia on GI muscles

33.  SYNDROME NURSING DIAGNOSIS: It is used when cluster of nursing diagnosis are
present. These are to be written as one part statement.
e.g.- Post trauma syndrome, rape trauma syndrome
Common errors in writing nursing diagnosis:
• Writing the client’s response instead of a problem
• Placing the etiology before the response
• Not using nursing terminology
• Starting the diagnosis with a nursing intervention

34. NURSING GOALS:
A specific expected outcome of nursing intervention as related to established nursing diagnosis.
A goal is stated in terms of a desired, measurable change in patient status or behavior.
Nursing goals provide direction for selection of appropriate nursing interventions and
evaluation of patient progress . A goal is what nurses want the patient to achieve. There are
two types of goal:
TYPES OF
GOALS
SHORT TERM
GOALS
LONG TERM
GOALS

35.  It involves determining beforehand the strategies or
course of actions to be taken before implementation
of nursing care.
 To be effective, involve the client and his family in
planning.
 Planning is to formulate the way to manage the
problem.

36. STEPS OF NURSING PLANNING:
STEPS OF NURSING PLANNING
INITIAL PLANNING:
It is done by the nurse who
perform admission
assessment in order to
prioritize problem, identify
goals and correlate nursing
care to resolve problems
ONGOING PLANNING:
It involves continuous
updating of client’s plan of
care. Every nurse who cares
for the client is involved in
ongoing planning.
DISCHARGE
PLANNING:
It involves anticipation and
planning for the client’s
needs after discharge

37. TYPES OF CARE PLAN:
TYPES
Student care plan
Institutional care
plan
Computerized care
plan
Standardized care
plan
Care plan for
community based
settings

38.  STUDENT CARE PLAN: Students learn to write and use care plan as a part of their
education. It is essential for learning the problem solving techniques, nursing process, skills
of written communication, organizational skill needed for nursing care plan.
• By using care plan students can apply knowledge gained in the classroom and from literature
to practice situation.
• In student care plan detailed rationale is included.
 INSTITUTIONAL CARE PLAN: They are concise documents that become part of the
client’s medical record.
• Each institution has its own format, but the basic information contained in it is universal.
 COMPUTERIZED CARE PLAN: Pre written care is created for specific nursing diagnosis
and after making assessment the nurse can use the standardized care plan with different
patients with similar problems.

39.  STANDARDIZED CARE PLAN: It is a pre planned pre-printed guide for the nursing care
of client groups with common needs. This type of care plan generally follows the nursing
format.
 CARE PLAN FOR COMMUNITY BASED SETTINGS: In this setting the client/family
unit is in equal partnership with health care professional.
• Here, the nurse designs a care plan to educate the patient/family how to integrate care within
family activities.

40. 1. SETTING PRIORITIES: It is a process of establishing a preference order for nursing
strategies. The nurse begin planning by deciding which nursing diagnosis requires attention first,
which second and so on. Nurse can group them as having high, medium, and low priority.
2. ESTABLISHING CLIENT GOALS/DESIRED OUTCOMES: After establishing priorities,
the nurse sets goals for each nursing diagnosis. This provides a clear focus for the type of
intervention necessary to care for the client. When goals are met the problems are solved.
3. SELECTING NURSING STRATEGIES: Nursing strategies or interventions are nursing
actions chosen to treat a specific nursing diagnosis in order to achieve client goals.
4. WRITING NURSING ORDERS: Nursing orders are the specific actions the nurse takes to
help the client meet established health care goals.

41.  Nursing plan is putting nursing care plan into action.
 To help client attain goals and achieve optimal level of health.
 Requires knowledge, technical skills, communication skills, Therapeutic use of self.
 This phase provides the actual nursing activities and client responses. It consist of doing and
documenting the activities that are the specific nursing actions needed to carry out the
interventions or nursing orders.

42. NURSING SKILLS DURING IMPLEMENTATION:
NURSING SKILLS
1. COGNITIVE
SKILLS
2.INTERPERSONAL
SKILLS
3. TECHNICAL
SKILLS
It involves application
of nursing knowledge
to identify client’s
needs. It include
problem solving and
decision making
It include verbal and
non-verbal response,
communication.
It is the skill needed to
use equipment,
machine supplies in a
particular specialty.
E.g. equipment such as
ventilator, infusion
pump etc.
4. PSYCHOMOTOR
SKILLS
It include hand on
skills need to
perform procedures
such as
administering
injection, drugs,
lifting, moving

43. 1. Reassessing the client
2. Reviewing and revising the existing nursing care plan
3. Organizing resources and care delivery
4. Anticipating and preventing complications
5. Implementing nursing interventions

44. RESPONSIBILITIES IN IMPLEMENTING OF NURSING CARE PLAN:
 Reviewing the planned information
 Scheduling and organizing interventions
 Supervising with other team members
 Achievement of organizational and client care goal
 Providing direct nursing care
 Providing counseling
 Involving client in health care
 Teaching client in health care
 Teaching the client and family
 Document nursing care provide

45.  This is the last phase of the nursing process which include the judgment of the effectiveness of
nursing care to meet goals based on the client’s behavioral responses.
 Comparing the response to predetermined standards or outcome criteria

46.  While documenting evaluation phase, the nurse can draw one of the four possible judgments:
o The goal was completely met
o The goal was partially met
o The goal was completely unmet
o New problems or nursing diagnosis have developed

47. TYPES OF EVALUATION:
TYPES OF EVALUATION
1. ACCORDING TO CRITERIA:
a. Structure evaluation
b. Process evaluation
c. Outcome evaluation
2. ACCORDING TO TIME AND
FREQUENCY:
a. Ongoing evaluation
b. Intermediate evaluation
c. Terminal evaluation

48. 1. ACCORDING TO CRITERIA:
1. STRUCTURE EVALUATION: It involves the setting, in which care is provided. It
requires data about the settings, policies, structures, procedures, physical facilities, layout,
equipments and number of qualified personnel available for delivering the quality of the
client.
2. PROCESS EVALUATION: It focuses on the method and way in which the care has been
delegated; the activities performed by nurses and other personnel of the health team.
• It explores whether the care provided was relevant to the patient’s needs, appropriate,
complete and adequate.
3. OUTCOME EVALUATION: It focuses on the measurable changes in the patient’s health
status that result from the care given.

49. 2. ACCORDING TO TIME AND FREQUENCY:
1. ONGOING EVALUATION: It is performed while the implementation is going on or
immediately after an implementation or at each patient’s contact.
2. INTERMEDIATE EVALUATION: It is performed at specific intervals. e.g. – once a week
for the home care client. Evaluation continues till the client achieves the health goals.
3. TERMINAL EVALUATION: Evaluation at the time of discharge includes the status of the
goal achievement and client’s self-care abilities with regard to follow-up care.
• Most agencies have special discharge record for this evaluation.

50.  Nurse must know the hospital policies, procedures and protocols of interventions and
recording data.
 Nurse must have up to date knowledge and information of many subjects, such as physiology,
psychology , pharmacology. It helps nurses to understand client’s response.
 Nurse must have intellectual and technical skill to monitor the effectiveness of nursing
interventions.
 Nurse must have knowledge and skill of collecting subjective data and objective data.

51. WHY NURSES SHOULD DO EVALUATION IN NURSING PROCESS:
• It determines the effectiveness of nursing care plan.
• It evaluates whether the predetermined goals are achieved.
• It helps the nurse to discover/ identify the errors in the previous steps of nursing process.
• It helps the nurse to assess the client’s behavioral response to planned course of action.

52. ROLE OF NURSE:
ROLE OF
NURSE
MOTIVATOR RESEARCHER
COUNSELOR
COORDINATOR
MANAGER
COMMUNICATOR
EDUCATOR

53. Nursing
Assessment
Nursing
Diagnosis
Goal Planning Implementation Evaluation
SUBJECTIVE
DATA: Patient
verbalize that
he/she is not
able to pass
urine.
OBJECTIVE
DATA: I
observe that
client is having
impaired
urinary
elimination as
patient has not
voided from last
8 hours.
Impaired
urinary
elimination
related to
bladder
obstruction as
evidenced by
intake and
output
charting.
To
maintain
the
normal
urinary
pattern
of the
patient.
 To Assess
voiding pattern
(frequency and
amount) of the
patient.
To provide hot
compression to
the patient.
To insert urinary
catheter.
To maintain
intake and output
chart.
Voiding pattern of
the patient is
assessed i.e. patient
has not voided
from last 8 hours.
 Provided hot
water bottle to the
patient.
Urinary catheter is
inserted with sterile
techniques.
Intake and output
chart is maintained.
Patient is not
having bladder
discomfort and
passed 1800ml
of urine.

54. Today we discussed about:
 Introduction of nursing process
 Definition
 Steps of nursing process :
• Nursing assessment(methods of data collection and utilization of data)
• Nursing diagnosis
• Nursing planning
• Nursing implementation
• Evaluation
 Role of nurse

55.  Francis Celestina- Misra Kritika , “ A textbook of fundamental of nursing”; published by
lotus publisher; Edition-1st ; Pp-74-76
 Kaur Lakhwinder, Kaur Maninder, “A textbook of fundamental of nursing”; published by PV;
2012 Edition; Pp-117-121
 References:
 https://www.slideshare.net/mobile/jeena.aejy/nursing-process-presentation
 https://www.slideshare.net/mobile/farooqmarwat/nursing-process-26614365
 https://en.m.wikipedia.org/wiki/nursing-process
 https://www.slideshare.net/mobile/91varsha/analysis-and-utilization-of-relevant-data-in-
nursing-process
 https://careertrend.com/13373140/four-types-of-assessment-for-nursing
 https://en.m.wikipedia.org/wiki/Nursing_care_plan