Steps and Characteristics of the Nursing Process

The Nursing Process has been an important blueprint in quality nursing care. It was first developed in 1958 by Ida Jean Orlando (although an earlier version is attributed to Lydia Hall). A series of 5 steps, the Nursing Process aims to establish a standard of nursing care that is client-centered, evidence-based, compassionate, holistic, and scientific.

In this guide, we talk about the Nursing Process itself – the steps and characteristics – as well as provide examples of its applications and challenges in its use. Through the years, the Nursing Process has been critiqued by students and nurses, and we include some arguments and discussions here, too.

Steps

Assessment

The Assessment step of the Nursing Process is all about data collection. A registered nurse understands that this must be done both systematically and dynamically. That means assessing a patient not only physiologically (objective data), but also psychologically, socioculturally, politically, spiritually, even economically (subjective data). At the core of this step is a nurse’s consciousness of the holistic nature of care.

Challenges

time constraints, interruptions, inexperience, patient anxiety, incomplete disclosure about symptoms

Diagnosis

With the Nursing Process, it’s important to remember that the success of one step is highly dependent on the step that precedes it. Thus, a robust Assessment is necessary for a robust Diagnosis.

At this stage, a nurse makes a clinical judgment about the patient’s response to a potential or actual health issue. The Diagnosis is critical – is the basis for the patient’s care plan.

Challenges

highly complex process, different nurses have different interpretations, insufficient data, poor communication among nursing staff

Planning

The Planning phase, sometimes called Outcomes, is the goal-setting stage of the Nursing Process, in accordance with evidence-based practices. These goals may be short or long term but at the end of the day must establish a course of direction. A good patient care plan can be picked up by any medical or healthcare professional and executed.

Challenges

formatting the care plan, failure to establish measurable goals & outcomes, unrealistic goals, limited patient input, timing

Implementation

This is the action phase of the Nursing Process, when the plan established and goals formulated are actually carried out. Nursing interventions are initiated, which must also be carefully documented in the patient’s record. Continuity of care is essential to the success of this step.

Challenges

lack of clinical experience, patient noncompliance, psychosocial factors, nursing care plan is not aligned with the diagnoses, nursing shortage

Evaluation

This final step of the Nursing Process, Evaluation is the appraisal of the care plan. As its name implies, the Nursing Process is a process and thus continues beyond these five steps. Modifications should be made to the care plan where appropriate, and the patient must be assessed and reassessed regularly to evaluate the effectiveness of the care plan in achieving the goals set.

Challenges

incomplete documentation, patient frustration, patient withholding information, family denial of the patient’s need for continued care, patient requesting termination of care plan before discharge goals are met

Characteristics 

The credibility of the Nursing Process comes from key properties that necessarily characterize it. Different sources have different numbers of characteristics, but their essences remain the same.

Within the legal scope of practice 

It goes without saying that the Nursing Process should first and foremost be used within the nurse’s legal scope of practice.

Knowledge-based

For the Nursing Process to truly be effective, its user, the nurse, must draw from learned, sound knowledge and acquired skills. Otherwise, nurses will be unable to properly identify problems and of course, resolve them. It is thus important for nurses to always be learning new and better ways to perform interventions and to assimilate new ideas and techniques.

Well-planned

An approach that is purposeful and intentional makes way for effective nursing care to be delivered. It is as simple as this.

Patient-centered, goal-directed

What does patient-centered care truly entail? It involves recognition of the patient’s autonomy and puts the patient’s health needs and goals as the fuel that drives the vehicle of care that is being delivered. The Nursing Process supports a care plan that is totally individualized, with no two goals for two patients being exactly the same. All members of a nursing team must fully understand their equal roles in any patient’s well-being.

Prioritized 

We know now that the Nursing Process is continuous and not always linear. With patient health & well-being at stake, one characteristic that the Nursing Process must embody is being prioritized. This means that more serious health issues should be addressed first, with risk factors always considered and weighed. The level of priorities may change throughout the process as well.

Dynamic & cyclical 

Countless factors are being considered throughout the Nursing Process. Conditions, circumstances, and the environment are always changing, and a nurse should be aware and flexible at all times. The steps of the Process affect each other (not just the preceding or subsequent ones).

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