What Is the Nursing Process? A Guide for Effective Patient Care                                                   

The primary goal of any health care facility is to provide the best quality patient care possible, to attain the best patient results. Nurses are crucial to meeting this goal, as their work often puts them on the front lines during various stages of patient care. Because nursing responsibilities vary so much, certain guardrails are necessary to enable nurses to focus their knowledge and skills to deliver optimal care and contribute to a facility’s goals.

The nursing process provides these guardrails. This multi-layered strategy helps nurses provide holistic, evidence-based patient care that’s flexible enough to respond to precise patient needs as they evolve. For those interested in obtaining an accelerated bachelor of nursing degree , it is important to understand what the nursing process is, and why it is key to providing quality nursing care.

What Is the Nursing Process?

The nursing process is a systematic series of methodologies designed to break down nursing care into specific steps. These steps provide standards for nurses to build their strategies for different phases of patient care delivery. These standards can keep a nurse’s practice focused in a way that enables them to concentrate on and complete tasks that potentially improve patient outcomes.

It is a complex concept whose different steps overlap to form a singular cohesive strategy. At the same time, defining the various parts of the nursing process provides a better understanding of how they fit within the overall context of nursing care.

History of the Nursing Process

In 1958, nurse theorist Ida Jean Orlando recognized that the nursing profession needed more guardrails to streamline nursing care. To build these guidelines, Orlando integrated principles she developed through her research of the mental health field into the nursing field, highlighting the importance of nurse communication with patients and other health care associates. According to a bio of Orlando published on the website NurseLabs, this integration is essential because “patients have their own meanings and interpretations of situations, and therefore nurses must validate their inferences and analyses with patients before concluding."

Orlando’s nursing theory, which was published in 1961, was designed to explore the relationship within the nurse/patient dynamic. By dividing the dynamic into five distinctive yet interconnected steps, the theory made it possible to recognize the ways in which this dynamic can fluctuate within the course of treatment. This theory emphasized patient behavior, equating how behavioral changes could be interpreted as new patient needs. It also highlighted the nurse’s role in reacting to these needs as they evolved, pointing out how well developed competencies like critical-thinking skills can lead nurses to make the best decisions possible.

Today, Orlando’s theory is used to ensure patients aren’t merely receiving nursing care. Rather, that they are receiving the specific type of nursing care that’s required for their unique situation. By implementing the theory, nurses can better recognize and react to a patient’s needs with greater effectiveness and efficiency. This can potentially improve a health care facility’s ability to reach the goal of providing care that can improve patient outcomes.

The Nursing Process Steps

The key to understanding the nursing process is to individually examine the nursing process steps and what they bring to the table. Each step can help nurses better gauge how they can apply their knowledge and skills situationally based on patient behaviors, which are tied to patient needs. This can potentially be beneficial to patients in the short- and long-term.

Step 1: Assessment

In the nursing assessment stage, nurses gather as much information regarding the patient as possible. This allows nurses to establish a baseline that supports the initial care delivery strategy. This baseline contains enough flexibility to allow nurses to use their critical-thinking skills to make adjustments based on patient needs.

There are several sources and methods nurses can use to gather their assessment data . These sources are typically separated into three tiers.

• Primary sources
• Secondary sources
• Tertiary sources

The primary source in the assessment phase is the actual patient. They can provide the nurse with subjective, detailed information on what they feel is wrong with them and how it is impacting their daily functionality. The typical data-gathering methods here include patient interviews, conducting physical examinations, and patient observation.

The secondary sources stem from people and information somehow connected to the patient’s sphere of influence. This can be a patient’s family, friends, or guardians. This type of data can also come from professional resources. These can include a patient’s primary care physician or their electronic health record (EHR).

Tertiary sources extend beyond a patient’s sphere of influence. These sources can range from medical journals and textbooks to in-house procedural manuals. These can help nurses establish further context regarding specific patient conditions.

These sources collectively provide the pieces a nurse needs to carry out the rest of the nursing process. Nurses must be aware that these pieces are subject to change due to elements such as the development of a new symptom. As such, nurses must be prepared to reassess a patient’s situation should a change occur.

Step 2: Diagnosis      

Once all of the assessment data has been collected, the nurse can then examine that information in the nursing diagnosis phase. This essentially allows nurses to detect the health issue, including the elements that may be driving the issue. Analyzing the data gathered from the nursing assessment stage is a critical component of diagnosis, but there are other factors in play as well. These factors include the identification of health issues, the detection of potential patient strengths and vulnerabilities, and the development of diagnostic statements based on medical findings.

A proper nursing diagnosis is designed to treat the patient in a way that mirrors Maslow’s Hierarchy of Needs. Developed by psychologist Abraham Maslow, this hierarchy allows nurses to prioritize the structure of their diagnosis so the most critical patient needs are met. 

The priority of diagnosis based on Maslow’s Hierarchy of Needs includes:

• Basic physiological needs. This includes a patient’s fundamental functions like breathing, circulation, sleep, and nutrition. They can also include other elements that can alleviate psychological stress, such as shelter.
• Safety and security. This includes incorporating measures that minimize the risk of injury, such as putting fall precautions in place. This can also point to the development of a therapeutic relationship within the patient/nurse dynamic to generate trust.
• Love and belonging. This includes taking the steps to preserve supportive relationships and create environments that minimize the possibilities of social isolation.
• Self-Esteem. This includes a patient’s acceptance of who they are, which can include self-acceptance.
• Self-Actualization. This includes a patient’s ability to connect to an empowering environment that allows them to obtain personal growth.

From a care delivery perspective, nursing diagnosis primarily concentrates on addressing and ensuring a patient’s core physiological and safety needs. However, nurses should be mindful of the other three tiers as the nursing process progresses into other stages.

Step 3: Planning

The planning stage is where nurses develop a treatment strategy. The nursing care plan stemming from this is commonly a collaborative process that involves input from the nurse, their supervising medical personnel, and the patient. This input must reflect agreement on the information determined in the diagnostic stage. The strategy here typically strives to meet both short-term and long-term health goals, shaped through the principles of evidence-based practice, (i.e., holistic care based on current medical knowledge and research). 

Because the planning stage concurrently focuses on achieving short-term and long-term goals, there are different types of planning nurses should practice within this stage. These three planning types are initial, ongoing, and discharge. 

In the initial planning stage, the nurse who conducted the initial patient assessment would build the framework for the plan care strategy.

In the ongoing planning stage, all nurses involved in the patient’s care collaborate to develop the initial framework into a complex strategy. Ongoing planning must contain enough flexibility to shift strategic elements in the event of changing health status, patient care priorities, or the development of new issues that may emerge during care delivery.

The final stage, discharge planning, concentrates on a patient’s exit strategy. As the name implies, this plans for a patient’s discharge, but it also involves developing strategies for continuity of care, making sure a patient’s needs are met in a way that addresses long-term health goals.

Step 4: Implementation

Implementation in the nursing process springs strategies into action. This phase typically starts by conducting patient-specific interventions that aim to achieve desired, predetermined outcomes. These interventions are usually collaborative efforts involving nurses and appropriate medical staff. 

During the implementation phase, nurses monitor patients to detect signs of health improvement or decline. They may also take on an active role in patient care through duties such as administering medication or providing the patient with health management education. Additionally, they may need to conduct assessments and diagnoses based on patient progress. 

These implementation strategies can be developed around various nursing interventions. There are hundreds of interventions nurses can consider, and they fall under the guise of the Nursing Interventions Classification (NIC) System, a taxonomy devised to allow nurses to refine their care strategies to meet patient needs as much as possible. The taxonomy breaks up these interventions into six distinctive categories:

1. Behavioral Nursing Interventions. These focus on encouraging patients to modify their behaviors to improve their health. Examples include supporting patients to quit smoking or engaging patients in physical activity such as walking.
2. Community Nursing Interventions. These concentrate on creating peripheral factors that can encourage patients to make smart, health-oriented decisions. This can include promoting healthy eating habits or implementing proactive health education programs.
3. Family Nursing Interventions. These focus on extending health strategies beyond the individual patient and toward the health of family members and loved ones. Examples of this intervention in action include educating a patient’s family about slowing the spread of a communicable disease or how to care for a patient after they’ve been released from the hospital.
4. Health Systems Nursing Interventions. These hone in on ways to keep a facility safe for patients and staff alike. These include following procedures designed to lower the risk of patient infection and making sure patients remain comfortable in their hospital room.
5. Physiological Nursing Interventions. These ensure a patient’s physical needs are met in a way that optimizes their health. These can include basic procedures such as assisting them with hygiene or feeding or conducting complex procedures like handling patient IV lines.
6. Safety Nursing Interventions. These concentrate on maintaining a healthy patient environment that promotes safety and proactively prevents injuries. This can include educating patients on the best ways to use assistive devices or making sure a patient’s call button functions properly.

Nursing interventions can either be executed independently, with assistance or supervision from health care professionals, or as part of a collaborative effort across multiple health care disciplines. The scope of some of these interventions can depend on where they are practiced. For instance, some states may allow nurse practitioners to have full prescriptive authority, which would allow them to prescribe medications independently. Other states require nurse practitioners to have a supervised medical professional such as a physician sign off on a prescription.

Proper implementation in the nursing process requires nurses to reach into their bag of cognitive skills. These skills, such as critical thinking, problem-solving, and decision-making competencies, allow them to apply their nursing and medical knowledge to actionable skills. Interpersonal skills are also important during the implementation stage, as they can help nurses build trust and rapport with patients. Additionally, health care-specific technical skills such as injection administration, medical equipment utilization, and bandaging are also key components of the implementation process.

Step 5: Evaluation

The nursing evaluation phase allows a nurse to review the effectiveness of the rest of the nursing process. By determining what worked well and what fell short, nurses can gain a clearer picture of whether or not a care delivery strategy resulted in achieving the desired outcome. It can also give nurses the information they need to potentially adjust future care delivery strategies.

There are six components within the evaluation step:

• Collecting data from the patient care strategy
• Comparing data with goal-oriented outcomes
• Analyzing the patient’s response to a nurse’s activities
• Pinpointing the factors that led to attaining a goal or falling short
• Making adjustments to the nursing care plan
• Transitioning the patient from one phase of care to another

The final component is particularly important in this stage, as it can help patients prepare for their lives after they’ve been discharged. This component can be associated with numerous education-driven components, such as educating patients on dietary restrictions, at-home medication usage, and emergency contact numbers. It can also include paying close attention to the patient’s post-treatment goals and honoring their post-care preferences.

The Principles of the Nursing Process

The primary goal of the nursing process is to streamline quality care so that optimal results may be achieved. The road toward achieving this goal contains several key characteristics that make sure the guardrails of the nursing process are sturdy and keep nurses focused on the task at hand.

For instance, the process must also focus on the patient. This means honoring the patient’s needs, but also adhering to their values and preferences. This can also require the nurse to advocate for the patient to other nursing staff and health care professionals to ensure patient desires are maintained throughout the care delivery process.

The nursing process must also be collaborative. Nursing care depends on interactions between a nurse and other health care professionals including physicians. As such, nurses need to foster an environment of collaboration driven by mutual respect, clear communication, and mutual decision-making that aims toward care optimization.

In addition, the process must be adaptable and ready to pivot based on the needs of the patient. Nurses must be able to adjust strategies the moment a current strategy shows signs of deviating from patient and facility goals. This requires nurses to use critical thinking to efficiently shift care strategies to meet a patient’s needs as they evolve.

Finally, the process must be interpersonal. Nurses and patients should develop a rapport during care delivery. This connection can allow a patient to trust a nurse and their strategy. This could ultimately make it easier for nurses to give patients optimized care.

Why the Nursing Process Matters

The framework of the nursing process is crucial to modern health care. It provides nurses with points of reference that remain unchanged even as care concepts evolve. As technical innovations such as EHRs and artificial intelligence (AI) infuse the health care space, these nursing process guidelines make it possible for nurses to see how and where these innovations can be implemented within the context of care delivery. This can lead to greater efficiency in integrating new concepts into a nursing strategy, which can potentially lead to optimized patient care. 

The nursing process also allows nurses to pay better attention to a patient’s needs based on Malsow’s Hierarchy of Needs. The process can foster a sense of belonging and self-worth among patients, as nurses may integrate strategies that meet these specific needs in addition to a patient’s physiological and safety needs. This can also allow nurses to integrate cultural competency into their plans. 

By focusing on patient needs, nurses can better understand and respect the different cultural beliefs and philosophies regarding care delivery. This understanding can lead to a better sense of trust within the patient/nurse dynamic, as the patient may be more willing to work with a nurse who recognizes their cultural heritage and viewpoints.

Additionally, this framework can help nurses mitigate the complexities of unique health care challenges, such as providing care to patients with comorbidities. This nursing process can make it easier to break down bigger care challenges into smaller, isolated episodes. This could then make the challenges more manageable from a strategic vantage point.

Guide Others Through the Process

The nursing process provides the guidelines that can streamline nursing strategies and make them operate with greater efficiency. However, these processes still rely on the talent of nurses to truly make a difference in patient care. Nurses who know how to apply the steps within the context of care delivery can truly make a positive impact on a health care facility — one that can enable a facility to attain its goal of providing the best patient care possible.

The University of Tulsa’s Accelerated Bachelor of Science in Nursing (ABSN) program can help prepare you to make such an impact. Our program is designed to help you build the foundational knowledge and skills to develop strong process strategies that can lead to the kind of targeted care that can make a difference in the lives of patients. 

Learn how we can jumpstart your success.

Recommended Readings

Achieving Health Care Justice: Breaking Down Racial Disparities in Health Care

Change Theory in Nursing: How It’s Evolving the Profession

ABSN vs. BSN: Which One Should You Choose?

Sources:

American Association of Nurse Practitioners, Nurse Practitioner Prescriptive Authority

American Nurses Foundation, Technology-Enabled Nursing Practice

American Nursing Association, The Nursing Process

American Nursing Association, What Is Evidence-Based Practice in Nursing?

American Nursing Association, What is Nursing?

Indeed, “Why Cultural Competence Is an Important Quality in Nursing”

National Library of Medicine, “Nursing Process”

Nurselabs, “Nursing Theories Guide: Ida Jean Orlando Nursing Process”

Nurselabs, “The Nursing Process: A Comprehensive Guide”

U.S. Centers for Medicare and Medicaid Services, Electronic Health Records