The Nursing Process
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Direct answer
The nursing process is a systematic, patient-centred, goal-directed framework for delivering nursing care, classically described in five steps: assessment, nursing diagnosis, planning, implementation and evaluation (ADPIE). It is cyclical rather than linear — evaluation feeds back into assessment — and each phase is documented, making it both a clinical tool and a legal record. It grew from the problem-solving approach formalised for nursing by Yura and Walsh in the late 1960s.
What you must remember
- Assessment collects subjective data (what the patient reports) and objective data (what you observe or measure); a cue gathered on assessment leads to an inference.
- Nursing diagnosis is stated in PES format — Problem, Etiology (related to), Signs and symptoms (as evidenced by) — using NANDA-I approved labels; it describes the human response, not the medical disease.
- Planning sets priorities and writes goals: prioritise using ABC (airway, breathing, circulation) and Maslow's hierarchy (physiological needs before safety before psychosocial), and write goals that are specific, measurable, achievable and time-bound.
- Implementation is the action phase; interventions are independent (nurse-initiated), dependent (carrying out medical orders such as giving a prescribed drug) or interdependent/collaborative (joint decisions with the team).
- Evaluation judges whether goals were met, partially met or not met by comparing patient outcomes with the expected outcomes, and triggers reassessment and revision of the plan.
- Documentation runs through every phase; if care is not recorded, legally it was not done.
- The process is continuous — a changing patient means reassessment, so plans are reviewed daily or with any change in condition.
Common confusion
The nursing diagnosis and the medical diagnosis are constantly confused. "Acute pain related to surgical incision as evidenced by guarding and a pain score of 7" is a nursing diagnosis; "acute appendicitis" is a medical diagnosis — the nurse treats the response, the physician treats the disease. Students also muddle goals with interventions: a goal describes the desired patient outcome ("patient's pain score will be 3 or less within one hour"), while the intervention is the action taken (administer prescribed analgesia, reposition). Finally, evaluation assesses the patient's progress toward the goal, not whether the nurse performed the intervention correctly.
Exam-focused takeaway
Five-step order questions, PES-format stems and priority-setting scenarios dominate this topic. Learn the characteristics — systematic, dynamic, interpersonal, outcome-oriented and universally applicable — and the phase in which each action belongs. A favourite stem asks which phase involves "reviewing whether the expected outcome was achieved" (evaluation) or which type of intervention giving a bath is (independent). Expect NANDA-style matching and questions on revising a plan when goals are unmet, which loops straight back to assessment.
Frequently asked questions
What are the five steps of the nursing process?
Assessment, nursing diagnosis, planning, implementation and evaluation — remembered as ADPIE, with evaluation feeding back into reassessment.
What is the PES format?
Problem, Etiology and Signs/symptoms — for example, "Ineffective airway clearance related to thick secretions as evidenced by crackles and a weak cough."
How are nursing diagnoses prioritised?
Life-threatening problems first using ABC (airway, breathing, circulation), then Maslow's hierarchy, with patient preferences and quick-to-resolve problems considered in sequencing.
What is the difference between dependent and independent interventions?
Dependent interventions require a physician's order (administering a prescribed drug), while independent interventions are nurse-initiated (positioning, health education, mouth care).
When is the care plan revised?
When evaluation shows goals are unmet or partially met, when the patient's condition changes, or at defined review intervals — each revision begins with reassessment.