The document discusses the nursing process, which is a systematic, cyclic framework for providing quality nursing care. It consists of 5 steps: assessment, diagnosis, planning, implementation, and evaluation. Assessment involves collecting client data from various sources. Diagnosis identifies actual or potential nursing problems. Planning establishes goals and interventions. Implementation carries out planned interventions. Evaluation determines if goals were met and identifies need for re-planning. The nursing process framework guides nursing practice across all settings and specialties.

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2. Nursing
Process
• The nursing process is nursing practice in action. The
nursing process is the framework for providing
professional, quality nursing care. It directs nursing
activities for health promotion, health protection, and
disease prevention and is used by nurses in every
practice setting and specialty.

3. History of
Nursing Process
• Lydia Hall first described nursing process in a 1955.
In 1967, Yura and Walsh published the first
comprehensive book on nursing process, in which
they described four steps in the nursing process:
assessment, planning, intervention, and evaluation.
Gebbie and Lavin (1974) described nursing process as
five step process by adding diagnosis to it.

4. Definition of
Nursing Process
• Nursing process is defined as an orderly , systematic
way of identifying the client’s problems, making plans
to solve them, initiating the actions or assigning others
to implement it and evaluating the extent to which the
plan was effective in resolving the problems identified.

5. Characteristics of
Nursing Process
• Providing framework- Nursing process is a framework
that enables a nurse to give nursing care to individuals,
families and communities.
• Systematic and orderly- Each nursing activity is part of an
ordered sequence of activities. The nursing process directs
each step of nursing care in a sequentially ordered manner.

6. Characteristics of
Nursing Process...
• Cyclic and Dynamic- Each step in nursing process flows on to
the next step. In some nursing situations, all the stages occur
almost simultaneously and some times in cyclic form.
• Goal directed and client oriented- The nursing process offers
a means for nurses and patients to work together to identify
specific outcomes related to health promotion, disease and illness
prevention, health restoration, and coping with altered
functioning;

7. Characteristics of
Nursing Process
• Interpersonal- In Nursing process we have the amount of
interaction that might be necessary between nurses, patients of
similar illnesses and the medical team. It might involve group
therapy and / or family counselling.
• Universally applicable- This process is universally standard and
no matter what the institution it may be, the process remains the
same. It is like a common nursing language with common nursing
terminology followed universally.

8. Characteristics of
Nursing Process
• Scientific problem solving- Nursing process is a systematic
process which as based on scientific and critical thinking. It
involves scientific methods or problem solving such as
problem identification, data collection, hypothesis
formulation, plan of action, hypothesis testing,
interpretation of results, and evaluation, resulting in
conclusion or revision of the study.

9. Phases or steps of
Nursing Process
• There are 5 steps in Nursing Process-
• Assessment
• Diagnosis
• Outcome identification and planning
• Implementation
• Evaluation

10. Assessment
• Assessment is the first step in the nursing process and
includes collection, verification, organization,
interpretation, and documentation of data. The
completeness and correctness of the information
obtained during assessment are directly related to the
accuracy of the Nursing Process.

11. Types of Nursing
Assessment
• Nursing assessments include
• The comprehensive initial assessment,
• The focused assessment,
• The emergency assessment, and
• The time-lapsed assessment.

12. The comprehensive
initial assessment
• The initial assessment is performed shortly after the
patient is admitted to a healthcare agency or service. The
purpose of this assessment is to establish a complete
database for problem identification and care planning. The
nurse collects data concerning all aspects of the patient’s
health, establishing priorities for ongoing focused
assessments and creating a reference for future comparison

13. The focused
assessment
• In a focused assessment, the nurse gathers data
about a specific problem that has already been
identified. A focused assessment may be done during
the initial assessment if patient health problems
surface, but it is routinely part of ongoing data
collection. Another purpose of the focused
assessment is to identify new or overlooked problems.

14. The emergency
assessment
• An emergency assessment to identify life-
threatening problems at the time of crisis. For
example choking in the dining room, a bleeding
patient brought to the emergency room with a stab
wound, an unresponsive patient in the rehabilitation
unit or sudden collapse of a patient in the ward.

15. The time-lapsed
assessment
• The time-lapsed assessment is scheduled to
compare a patient’s current status to baseline
data obtained earlier. Time lapsed assessment is
done to reassess health status and to make
necessary revisions in the plan of care.

16. Data collection
• first step in assessment includes data collection. Data
are collected from a variety of sources; however, the
client should be considered the primary source of
data. As much information as possible should be
gathered from the client. Secondary sources and
include family members, other health care providers,
and medical records

17. Data collection
• Two types of information are collected through the
assessment component: subjective and objective.
• Subjective data are gathered by interacting with the client and
include the client’s feelings, perceptions, and concerns.
• Objective data are observable and measurable and are
obtained through physical examination and diagnostic tests.

18. Data validation
• Validation is the act of confirming or verifying. The
purpose of validating is to keep data as free from
error, bias, and misinterpretation as possible.
Validation is an important part of assessment because
invalid information can lead to inappropriate nursing
care. After validation data are recorded and analyzed.

19. Diagnosis
(Nursing Diagnosis)
• The second step in the nursing process is the formulation of
the list of nursing diagnosis. A nursing diagnosis focuses on
an individual, family, or community response to actual or
potential health problems. An actual nursing diagnosis
indicates that a problem exists and is composed of the
diagnostic label, related factors, and signs and symptoms. An
example of an actual diagnosis is impaired skin integrity
related to prolonged pressure on bony prominence

20. Diagnosis
(Nursing Diagnosis)
• A risk nursing diagnosis (potential problem) indicates that a
problem does not yet exist, but special risk factors are
present. A risk diagnosis is composed of the diagnostic label
preceded by the phrase ‘‘risk for,’’ with the specific risk
factors listed. An example of a risk diagnosis is risk for
impaired skin integrity related to inability to turn self from
side to side in bed.

21. Outcome identification
and planning
planning is a framework on which scientific nursing practice is based.
The four critical elements of planning include:
• Establishing priorities
• Setting goals and developing expected outcomes
• Planning nursing interventions
• Documenting (Writing Nursing care Plan)

22. Outcome identification
and planning
• Establishing priorities- When an individual client has more
than one diagnosis, the nurse and client need to establish
priorities to identify which nursing diagnosis will be addressed
initially in the plan of care. One of the most common
methods of setting priorities is the consideration of Maslow’s
hierarchy of needs, which requires that a life-threatening
diagnosis be given more urgency than a non–life-threatening
diagnosis.

23. Outcome identification
and planning
• Setting goals and developing expected outcomes-
After formulating nursing diagnoses, and establishing
priorities, the nurse sets goals and identifies and
establishes expected outcomes for each nursing
diagnosis. Goals should be established to meet the
immediate, as well as long-term prevention and
rehabilitation, needs of the client.

24. Outcome identification
and planning
• Planning nursing interventions - A nursing intervention is
an action performed by a nurse that helps the client to
achieve the results specified in the goals and expected
outcomes. These actions are based on scientific principles
and knowledge from nursing, behavioral, and physical
sciences. It is important to identify as many nursing
interventions as possible so that if one proves to be
unsuitable, others are readily available.

25. Outcome identification
and planning
• Documenting (Writing Nursing care Plan) – After
careful planning all the detail in written in a format known as
nursing care plan. There are a lot of formats used for writing
nursing care plan. They vary from institution to institution .
Number of columns may be different but basic information
is more or less same. Here we are going to discuss a 5
column nursing care plan which can be used in every setting.

27. Implementation
• During the implementation step of the nursing
process, nursing actions planned in the previous step
are carried out. The purpose of implementation is to
assist the patient in achieving valued health outcomes:
promote health, prevent disease and illness, restore
health, and facilitate coping with altered functioning.

28. Implementation
• The plan of care is best implemented when patients
who are able and willing to participate have maximum
opportunities to provide self-care. Family members
and other support people, as well as other healthcare
professionals, may also be involved in successfully
implementing the plan of care

29. Implementation
• The implementation phase of the nursing process
requires cognitive (intellectual), psychomotor
(technical), and interpersonal communication skills.
• Nurses perform a variety of activities that are
designed to assist clients in meeting needs.

30. Implementation
• Nursing implementation activities include:
• Ongoing assessment- Because a client’s condition can change
rapidly, or new data may become available, ongoing assessment is
necessary to validate the relevance of proposed interventions.
• Establishment of priorities- Priorities are based on severity of the
problems that are deemed most important by the nurse, client, family,
or significant others.

31. Implementation
• Allocation of resources- Whereas some interventions are complex
and require the knowledge and skills of a registered nurse, other
interventions are relatively simple and can be delegated to assistive
personnel.
• Initiation of nursing interventions- Interventions can be
implemented on the basis of standing orders or protocols. A standing
order is a standardized intervention written, approved, and signed by a
prescribing practitioner

32. Implementation
• Nursing interventions include:
• Assisting with activities of daily living (ADL)
• Delivering skilled therapeutic interventions
• Monitoring and surveillance of response to care
• Teaching
• Discharge planning

33. Implementation
• Documentation of interventions- Communication
concerning implementation of interventions must be
provided through written documentation and should also be
verbally conveyed when responsibility of the client’s care is
transferred to another nurse. The nurse is legally required to
record all interventions and observations related to the
client’s response to treatment.

34. Evaluation
• Evaluation is the fifth step in the nursing process and
involves determining whether the client goals have
been met, have been partially met, or have not been
met. Even though it is the final phase of the nursing
process, evaluation is an ongoing part of daily nursing
activities. Steps in evaluation includes-

35. Evaluation
• Establishing standards.
• Collecting data.
• Determining achievement of goal.
• Relating nursing actions to client’s health status.
• Judging the value of nursing interventions.
• Reassessing the client’s status.
• Modifying the plan of care (Re-planning)

36. By – SURESH KUMAR ( Nursing Tutor )