The nursing process is a crucial tool in nursing to provide appropriate and effective care to patients. It consists of five components that constantly adjust and change according to the patients’ needs. Registered Nurses (RNs), in any area of nursing, utilize the nursing process to deliver patient-focused care effectively (American Nurses Association, 2006) (Kuckyt, 2008).
During the assessment phase, it is essential to collect factual information by obtaining various types of data. This includes psychological, physiological, and sociocultural data. Economic and lifestyle factors also contribute to patients’ recovery. In this phase, the RN gathers information through direct observation, physical assessment, as well as other sources like the patient themselves, their family members, and laboratory or test results.
Before moving forward with the remaining four phases of the Nursing Process and developing a successful care plan, it is essential to have this information. For instance, when obtaining a medical history from a patient diagnosed with Ketoacidosis, the nurse finds that the patient has not received any formal education on the condition and lacks financial means. In the diagnosis phase, the registered nurse goes beyond the physician’s clinical diagnosis.
The Registered Nurse (RN) utilizes the data acquired during the assessment phase and applies critical thinking skills to identify additional problems that may impact the patient’s response to treatment (Ackley, 2008). These nursing diagnoses are part of a system called “The North American Nursing Diagnosis Association” or NANDA. The RN selects an approved diagnosis from the NANDA list that is relevant to their patient. For instance, in the case of the aforementioned patient, the nurse determines a NANDA approved diagnosis of “Deficient Knowledge” and includes a defining characteristic of their verbalization of the issue, along with a related factor of being unfamiliar with information resources.
The NANDA is a collection of approved diagnoses used by nurses. It also includes suggested classifications for nursing outcomes (NOC) and nursing interventions (NIC). During the planning phase of the nursing process, nurses formulate measurable outcome statements and determine suitable nursing interventions using NOC and NIC (Ackley, 2008) (Blias, 2006).
Patients with Ketoacidosis should achieve several Nursing Outcomes Classification (NOC) within specific timeframes. These NOC include acquiring knowledge of diet in four days, understanding the disease process in seven days, becoming familiar with medications within five days, and discovering available health resources within seven days. It is crucial to establish time limits for each NOC achievement. In the planning phase of the nursing process, goals should prioritize patients’ needs over those of the nursing staff. These goals must concentrate on addressing patients’ requirements rather than catering to the nurses’ demands (Quan, 2007).
The fourth phase of the nursing process involves personalized interventions (NIC’s) that aim to provide optimal care for the patient and achieve the established goals (Ackley, 2008) (Quan, 2007). Suitable NIC’s for patients with Ketoacidosis may encompass verbal and written teaching about the disease process and medications, as well as involvement from a dietician. Additional NIC’s for this patient may involve personalized conversation and introduction to community health resources that offer further education and financial assistance (Ackley, 2008).
It is crucial to document each intervention listed. The nursing care plan begins during the intervention phase of the nursing process. The nurse continuously evaluates the effectiveness of the interventions utilized (Quan, 2007) (Ackley, 2008) (Blias, 2006). Although technically the evaluation phase is listed as the last phase in the nursing process, it is evident throughout the entire process and included in each phase. During this phase, the registered nurse determines whether the interventions have succeeded or failed based on achieving the NOC’s.
Failure to meet the NOC’s will lead to another assessment to determine the reason for the failure. This assessment may identify an error in the initial diagnosis or a need to modify the interventions utilized. For instance, in the case of a patient with Ketoacidosis, it was found through the second assessment that the patient had a reading disability, which prevented them from effectively utilizing the provided literature. As a result, the intervention list would need to be adjusted to cater to the patient’s learning needs, including more verbal and illustrated information rather than relying solely on written words.
The effectiveness or response of the patient to each phase (Kuckyt, 2008) (Quan, 2007) (Ackley, 2008) is constantly evaluated by the RN as they travel from one phase to another. With experience, the RN can swiftly move or even skip phases based on prior knowledge and experience. Orem’s Self-Care Theory (Dennis, 1997) incorporates and demonstrates the use of the nursing process. The theory focuses on achieving self-care for the patient and comprises of three fundamental steps or phases (Dennis, 1997).
According to Orem’s self-care theory, the initial step is comparable to the assessment and diagnosis stages of the nursing process. This entails gathering information to identify factors and establish self-care requirements for a particular patient. The subsequent step, akin to the planning phase of the nursing process, involves creating and organizing a strategy to enhance the patient’s self-care condition. The data obtained in the first step is utilized in devising an individualized care plan that addresses the patient’s specific needs.
The third and final step in Orem’s theory is referred to as regulate and control. This step is similar to the implementation and evaluation phase in the nursing process. During this step, the nurse carries out nursing care and continuously assesses the effectiveness of the care provided in relation to achieving the ultimate goal (Blias, 2006) (Dennis, 1997). Orem’s theory aligns with the nursing intervention phase as both aim to restore the patient’s ability to perform self-care. Orem’s theory includes three types of nursing systems.
There are three different systems of patient care: wholly compensatory, partly compensatory, and supportive-educative. In the wholly compensatory system, the nurse takes care of all the actions required for patient care. In the partly compensatory system, both the nurse and the patient work together to accomplish patient care. The supportive-educative system is optimal, with the patient taking responsibility for their own self-care while the nurse supports and encourages them in this process (Dennis, 1997). Both the nursing process and Orem’s theory can be applied together to effectively promote patient care.
While the Orem’s theory expands on the basic nursing process, it emphasizes self-care and active patient involvement in care decisions. This is in contrast to passive involvement where the patient is the recipient of care.
References
- Ackley, B. a. (2008). Nursing Diagnosis Handbook-An Evidence-based Guide to Planning Care (Vol. 8). St. Lous: Mosby.
- American Nurses Association. (2006, nd nd). The Nursing Process: A Common Thread Amongst All Nurses. Retrieved September 26, 2009, from American Nurses Association: http://www. nursingworld. org/EspeciallyForYou/StudentNurses/Thenursingprocess. spx
- Blias, K. E. (2006). Professional Nursing Practice:Concepts and Perspectives(5th ed. ). Upper Saddle River: Pearson Education Inc.
- Dennis, C. (1997). Self-Care Deficit Theory. St. Louis: Mosby. Kuckyt, C. (2008, November 20). Nursing Process & Critical Thinking. Retrieved September 27, 2009, from Nursing Process & Critical Thinking: http://home. cogeco. ca/~nursingprocess/index. htm
- Quan, K. (2007, nd nd). The Nursing Process. Retrieved September 26, 2009, from The Nursing Site: http://www. thenursingsite. com/Articles/the%20nursing%20process. htm
