NURSING PROCESS

Is a systematic, rational
method of planning and
providing individualized
nursing care.

5 Steps in the Nursing

Process

Assessment
Primary Source - Client / Family
Secondary Source - physical exam, nursing
history, team members, lab reports, diagnostic
tests..
Subjective -from the client (symptom)
Objective - observable data (sign)
Assessment-Collecting data
Make sure information is complete & accurate
Validate prn
Interpret and analyze data Compare to standard
norms
Organize and cluster data

Diagnosis
Interpret & analyze clustered data
Identify clients problems and strengths
Formulating a Nursing Diagnosis
Problem( Diagnostic Label)-based on your
assessment of client(gathered information), pick a
problem from the NANDA list...
Etiology- determine what the problem is caused by or
related to (R/T)...
Defining characteristics- then state as evidenced by
(AEB) the specific facts the problem is based on...

Types of Nursing
Diagnoses
Actual
Imbalanced nutrition; less than body
requirements RT chronic diarrhea, nausea, and
pain AEB height 55 weight 105 lbs.
Risk
Risk for falls RT altered gait and generalized
weakness
Wellness
Family coping: potential for growth RT
unexpected birth of twins

Planning
This is when the nurse organizes a nursing care plan
based on the nursing diagnoses.
Nurse and client formulate goals to help the client with
their problems
Prioritize client problems
Types of goals
Short term goals
Long term goals
Cognitive goals
Psychomotor goals
Affective goals

Goals are patient-centered and

SMART

Implementation
This is the Doing step
Carrying out nursing interventions
(orders) selected during the planning
step
This includes monitoring, teaching,
further assessing, reviewing NCP,
incorporating physicians orders and
monitoring cost effectiveness of
interventions

Evaluation
Final step of the Nursing Process but
also done concurrently throughout client care
Examines if nursing interventions are working
Outcome criteria met? Problem resolved!
Outcome criteria not fully met? Continue plan
of care- ongoing.
Outcome criteria unobtainable- review each
previous step of NCP and determine if
modification of the NCP is needed.
Were the nsg interventions
appropriate/effective?

Resources:
Kee, Hayes, and McCuistion 8th
edition Pharmacology: A Nursing
Approach

MINDANAO STATE UNIVERSITY

ILIGAN INSTITUTE OF TECHNOLOGY
COLLEGE OF NURSING
Resource Unit
General Objective: The student nurses will be able to review the knowledge of their classmates about
the Nursing
Process.
Specific
Content
Time Frame
Teaching
Resources
Evaluation
Objective
Throughout the
20 minutes of
discussion, the
student nurse
will be able to:

Explain the
introduction of
the Nursing
Process

Explain the first

part of the
Nursing process

Explain the
second part of
the Nursing
process

Strategy

Parts of Nursing
Process

Assessment

Diagnosis

Planning

5 minutes

Discussion

3 minutes

3 minutes

3 minutes

Discussion

Discussion

Discussion

Kee, Hayes, and

McCuistion 8th
edition
Pharmacology: A
nursing approach

Kee, Hayes, and

McCuistion 8th
edition
Pharmacology: A
nursing approach

Kee, Hayes, and

McCuistion 8th
edition
Pharmacology: A
nursing approach

Kee, Hayes, and

McCuistion 8th

Explained the
parts of the
Nursing Process
briefly.

Explained the
difference
between the
subjective and
objective data
briefly.

Explained how to
diagnose correctly
through
assessment data
briefly.