The Nursing

Process

Eimear Cardwell NURS

1592
Ai
m
• To understand the nursing process in preparation for
practice.

LEARNING OUTCOMES
• Be able to state what the term “Nursing Process” means.
• Able to identify the components of the nursing process.
• Understands how to conduct a nursing assessment.
• Can discuss care planning.
• Can discuss how to keep satisfactory records of care.
 • Problem solving focus to nursing
care.

What is • Introduced in 1967 by Yura and

the Walsh

"Nursing • Person-centred.
Process"
• Cyclical process
Why the
Nursing
Process ?
 A person is an individual: each has needs,
experiences and connections to others that
make them who they are.
Person- WE ARE NOT ALL THE SAME
centredn
ess
Who do you
think has the
most care needs?
 Will these
Women's care
needs be the
same ?
WE ARE NOT ALL
THE SAME

• Basic needs
• Beliefs: how we see things – possibly
despite what the evidence is telling
us.
• Values: part of self-identity, beliefs
attached to desirable outcomes, help
us to choose between different ways
of behaving. Can change over time.
 NMC Code (2020): Prioritise
People
https://
www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-c
ode.pdf

01 02 03 04
Treat people as Listen to people and Make sure that Act in the best
individuals and respond to their people’s physical, interests of people at
uphold their dignity preferences and social and all times
concerns psychological
needs are assessed
and responded to
Stages of the
Nursing Process

• Assessment
• Diagnosis (Nursing)
• Planning
• Implementation
• Evaluation

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Standards
3.4 understand and apply a person-centred
of approach to nursing care,
Proficienc demonstrating shared assessment,
planning, decision making and goal
y for setting when working with people, their
families, communities and populations
Registere of all ages
d Nurses
(NMC,
2018)
1.Aassessm
ent
 When referring
or discharging On admission
the patient

When to When the

When the
patient
patient’s
assess a needs change
identifies a
need

Patient? When
meeting a
patient for
the first time
Where does patient
information come
from?
• The patient
• Family
• Friends
• Medical notes
• Observation
• Other health and social care professionals
 Subjective
• What the patient tells you about how they are
feeling

Objective
What • Can be measured, e.g. blood pressure, weight,

informatio blood tests.

Primary
n? • Comes from the patient themselves
(Kozier et al, 2008)
Secondary
• Other sources, e.g. family
 SUBJECTIVE V's OBJECTIVE
I was travelling fast I was travelling at 75 miles per hour
 1.Check the information that has already
been provided, e.g. medical history, ED
record.
2. Observe the patient as you approach –
what can you tell about them?
Assessing 3. ABC assessment.
the 4.Observation of physiological
patient measurements relevant to the patient’s
(Stonehouse, 2017) presentation.

5.Health history.
1.Check information already
provided
2. Observe the
patient as you
approach them
 3.ABC
Assessment
4. Observation
of
physiological
measurements
5. Health History
& Assessment
•Why
•What
•How
TOOLS USED TO
TAKE A HISTORY -
THE MEDICAL
MODEL
• Presenting complaint (PC)
• History of presenting complaint
(HPC)
• Past medical history (PMH)
• Drug history
• Social history
• Family history

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Asking questions (Egan, 2014;

Noland & Ellis,

2008)
• Make sure that you take account of any communication
needs that the patient may have.
• Introduce yourself.
• Try to establish a good rapport with the patient.
• One question at a time.
• Ask open questions.
• Avoid leading questions.
• Listen attentively and paraphrase back as necessary.
• Ask follow up questions, where appropriate.
NURSING ASSESSMENT TOOLS
Assessment tools

Medical Model - to take a history

ABCDE - To assess how acutely

unwell a patient is

NEWS 2- To assess vital signs

Gordons Functional Health Patterns -

framework for assessing an
individual's health and identifying
areas of improvement

Roper, Logan and Tierney activity of

daily living -12 areas to assess the
ability to function This Photo by Unknown Author is licensed under CC BY-SA-NC
2.Nursing
diagnosis
What is a nursing diagnosis?

A nursing diagnosis is a clinical judgment concerning a

human response to health conditions/life processes, or a
vulnerability to that response, by an individual.

Nursing diagnoses are the foundation of nursing care plans.

Nursing diagnoses drive actions and allow for continued
assessment, prioritization, organization, and effective health
outcomes.
 Information obtained during the assessment is
used to identify actual or potential problems.

To establish a base line for monitoring

improvement and/or deterioration in their
Nursin condition.

g Provides the basis for nursing interventions and

diagno care.

sis Nursing care and interventions will be set out in

the patient’s care plan.
NMC (2018)
Standard
3.4 understand and apply a
s of person-centred approach to
proficienc nursing care,
demonstrating shared
y for assessment, planning,
decision-making and goal
Registere setting when working with
d Nurses people, their families,
communities and
populations of all ages
 ABCDE ASSESSMENT
Airway – Patient speaking no swelling
28 year old Arjun
Breathing – RR high and Spo2 in
normal range doctor informed.
Wheezing heard

Circulation – HR increased BP in
normal range doctor informed.

Deformity – Alert

Exposure – No rash or injuries

Nursing assessment tools in

practice
NEWS ASSESSMENT
RR 26 (3)
SP02 95% (1)
BP 132 /81 (0)
Pulse 121 (2)
ACVPU Alert (0)
Temp 38.1 (1)

Total NEWS 7
What are
our
problems?

What is our
nursing
diagnosis?
What are Arjun's Problems?

What is our nursing diagnosis?

3.Care
Planning
Nursing
models
• Nursing models provide a framework for the assessment
and care planning process.
• Care is assessed and planned differently in different
specialties because patients in different specialties have
different needs.
• Patients are individuals.
• Integrated care pathways are used in some clinical areas.
These are multi-disciplinary and apply to a particular group
of patients with similar problems.
 Benefits of
care
planning
•(Dept.
Personalised care
•Health,
Holistic care

2009)
• Promoting health
• Reducing health inequalities
• Stimulating choice
• Reducing inefficiency
Stages of care planning (Ellis,
Standing and Roberts, 2020).
• Identify the problem(s) and nursing diagnosis
• Establish the goals
• Determine nursing interventions
• Evaluate care processes
• Review dates

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3.5 demonstrate the ability to accurately
process all information gathered during
the assessment process to identify needs
for individualised nursing care and
develop person-centred evidence-based
plans for nursing interventions with
agreed goals
What should be taken into
account when care
planning?
•The patient should know the reason for the assessment
•The assessment should be flexible and adaptable to the needs of the individual
•The patient must be fully involved and their dignity, independence, and interests should
be paramount
•The patient can have someone with them, if preferred
•Appropriate language and terminologies should be used throughout the consultation
•The diversity of the individual client, their beliefs, values, culture and their circumstances
must be considered
•It is essential to consider the patient's gender, sexuality, ethnicity, disability and religion as
part of the assessment
•Be open to listening to the patient's personal history and life story
•The entire family's needs should be considered, inclusive of the patient and their carers:
remember the importance of providing holistic care
•Cost-effectiveness should also be taken into account
• Department of Health, 2011; National Institute for Health and Care Excellence, 2021

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What does a care plan
look like?
Problem Goal Intervention Evaluation Review date
Mr Ellis is For pain score to be RN to provide analgesia Mr Ellis was 25 May 2021
complaining of reduced to 0/10. to Tim as prescribed provided with
abdominal pain. Pain on the drug chart. analgesia as
score is 8/10 prescribed which
Pain score to be reduced his pain
checked 30 minutes score to 0/10
after giving medication within 30 minutes.
and at least 4-hourly He has been
once pain is controlled. resting on his left
side and stated
Nursing staff to that he is
position Mr Ellis comfortable.
comfortably.
 Problem
What is Arjuns Problem?
GOALS
 WHAT IS ARJUN'S
GOAL?
PROBLEM GOAL INTERVENTION EVALUATION REVIEW DATE
Arjun is complaining For Arjun to have a
of shortness of normal respiratory
breath & wheezing. rate and Pattern and
no wheeze
 Equipment Medications
Referrals

MDT
Patients Normal
Investigations & interventions
Activities
Tests
Treatments
Monitoring
Protocols

Intervention Specialist
Advice
Personal Care
s Risk Assessments
Vital Signs Monitoring
Activities

Monitoring Charts
Patients Positioning
Preferences
Family Involvement
 Evidence based approaches
What
Interventi
ons National Guidelines Guidelines

should be
based on Trust Policy
Interventi Evidence based approaches – Royal
College of Physicians
on: to
complete
National Guidelines –NICE, NHS
a NEWS2 England

score
every four Trust Policy – For example High
dependency areas will increase
hours frequency of NEWS2
 Interventions are nursing
actions/procedures or treatments
built on clinical judgement and
knowledge, performed to meet the
needs of patients

Brooks (2019) outlined three types of

intervention:
• Those independently initiated by
INTERVENTIONS nurses
• Those that are dependent on a
physician or other health
professionals
• Those that are interdependent, that
is, those rely on the experience,
skills and knowledge of multiple
professionals.
 WHAT ARE
ARJUN'S
PROBLEM GOAL INTERVENTIONS?
INTERVENTION EVALUATION REVIEW DATE

Arjun is complaining For Arjun to have a • Monitor Arjuns peak

flow before and after
of shortness of normal respiratory nebulisers.
breath & wheezing. rate and pattern and • Administer nebulisers
no wheeze every four hours as
prescribed.
• Monitor Arjuns Vital
Signs every four
hours.
• Encourage Arjun to
remain in an upright
position.
• Assess for signs of
respiratory distress.
 How are
you
going to
Evaluation
evaluate
the
patients
care?​
 HOW ARE YOU
GOING TO
EVALUATE
ARJUNS CARE ?
PROBLEM GOAL INTERVENTION EVALUATION REVIEW DATE

Arjun is complaining For Arjun to have a • Monitor Arjuns peak Arjuns peak flow
flow before and after
of shortness of normal respiratory nebulisers.
was 320 before his
breath & wheezing. rate and pattern and • Administer nebulisers nebulisers this
no wheeze every four hours as improved to 450
prescribed. after his nebuliser
• Monitor Arjuns Vital
Signs every four however his normal
hours. peak flow is 550.
• Encourage Arjun to
remain in an upright
position.
• Assess for signs of
respiratory distress.
 WHEN
SHOULD
WE SEE
REVIEW
DATE
AN
IMPROVE
MENT?
 HOW ARE YOU
GOING TO
EVALUATE
ARJUNS CARE ?
PROBLEM GOAL INTERVENTION EVALUATION REVIEW DATE

Arjun is complaining For Arjun to have a • Monitor Arjuns peak Arjuns peak flow Review in 24 hours
flow before and after
of shortness of normal respiratory nebulisers.
was 320 before his 06.02.25
breath & wheezing. rate and pattern and • Administer nebulisers nebulisers this
no wheeze every four hours as improved to 450
prescribed. after his nebuliser
• Monitor Arjuns Vital
Signs every four however his normal
hours. peak flow is 550.
• Encourage Arjun to
remain in an upright
position.
• Assess for signs of
respiratory distress.
4.Implementation
of care

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PROCESS OF
IMPLEMENTATION

Reassessing the patient

Reviewing and Revising the existing nursing care plan
Decision Making
Prioritising
Organising Resources and care delivery
Anticipating and preventing complication
Identifying areas of Assistance
Implementing Skills
5.Evaluation
Of Care
 Evaluation is how you know whether or not your
intervention was effective.

What is It determines whether after the nursing process

the patient's condition or wellbeing improves

the It alerts you if more or different interventions are

needed

evaluation Help you assess your patients progress towards

their goals and expected outcomes

stage? Establish if the nursing care was effective

You are determining if expected outcomes were

met and not necessary the nursing interventions
How do we
evaluate? Review the patient Reassess the patient to
centered goals that gather data indicating
were established in the the patients response
care planning stage to the nursing goals

Compare the actual

Revise initial care plan
outcome with the goals
based on new
and decide whether the
assmessnt data
goal was achieved
 ABCDE ASSESSMENT
Airway – Patient speaking no swelling
28 year old Arjun
Breathing – RR 16 and Spo2 in normal
range doctor informed. No wheezing
heard.

Circulation – HR 75 & BP in normal

range doctor informed.

Deformity – Alert

Exposure – No rash or injuries

Re-assessment to evaluate
care
NEWS ASSESSMENT
RR 16 (0)
SP02 98% (0)
BP 122 /81 (0)
Pulse 74 (2)
ACVPU Alert (0)
Temp 36.1 (0)

Total NEWS 0
Things to consider when evaluating the care
plan
Did anything unanticipated occur?

Has the client’s condition changed?

Were the expected outcomes and their time frames realistic?

Are the nursing diagnoses accurate for this client at this time?

Are the planned interventions appropriately focused on supporting outcome attainment?

What barriers were experienced as interventions were implemented?

Does ongoing assessment data indicate the need to revise diagnoses, outcome criteria, planned interventions, or implementation
strategies?

Are different interventions required?

 SUMMARY OF NURSING
PROCESS FOR ARJUN

• Assessment Breathing problem

• Diagnosis (Nursing) Shortness of Breath & Wheeze

• Planning Care Plan which was SMART

• Implementation Provided Care
• Evaluation Evaluated care and Arjun was
discharged
Question
s?
•
Further Reading
The Marsden Manual – Inpatient Care and the assessment process

• Resources
Clinicalskills.net A-E assessment

• Clinicalskills.net recording and Interpreting NEWS2

• NMC Code
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

• Peate, I (2020) Fundamentals of assessment and care planning for nurses New jersey
Wiley Blackwell

• Ellis P (2023) Patient assessment and care planning in nursing 4th ed Los Angeles
Learning Matters
Books
• Holland,K (2019) Applying the Roper-Logan-Tierney model in practice Edinburgh
Elsevire

• Gulanick M & Myers J (2022) Nursing care plans: diagnosis, interventions & outcomes
Missouri Elsevire

• Flynn Makic MB & Martinez-Kratz M (2022) Ackley and Ladwigs nursing diagnosis
handbook: an evidence based guide to planning care 13th ed St Louis Mosby