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State the five components of the nursing process -1

The five steps of the nursing process

The nursing process is an evidence-based, five-step process used to help

guide nurses to think holistically about their patient’s overall picture and
plan of care. Nurses learn the nursing process during nursing school and
informally use this process when taking care of patients in the
professional setting.

When planning how a shift will play out with patients, the nurse must use
clinical judgment to create a general plan for the day. The nursing
process allows the nurse to gather information, prioritize problems, and
set goals for each patient. As nurses gain more experience, the nursing
process comes naturally when making decisions for patient care.

The steps are as follows:

1. Assessment phase
2. Diagnosis phase
3. Planning phase
4. Implementing phase
5. Evaluation phase

1. Assessment phase

During the assessment phase, the nurse will look at any subjective and
objective data collected in the patient’s history. An example of objective
data could be oxygen saturation trends from the chart, or documentation
demonstrating that the patient’s oxygen liter flow was increased several
times overnight. Subjective data could be information you got during
nursing handoff- perhaps the overnight nurse mentioned that the patient
was looking “air-hungry” and using accessory muscles to breathe.

What you will want to do during the assessment phase is gather all of this
information and make your assessment about what is going on. Your
nursing assessment starts before you see the patient, but continues
throughout the shift. If the physician were to ask you if the patient looked
worse than before, you could provide the details you gathered during
your nursing assessment.
2. Diagnosis phase
During the diagnosis phase, you’ll take those assessment findings and
formulate a few nursing diagnoses that will guide your care for the shift.
A nursing diagnosis is separate from the medical diagnosis and will be
subjective based on your nursing judgment. A medical diagnosis must be
determined by the physician, for example, “acute respiratory failure.” A
nursing diagnosis should be more focused on addressing the problems
your patient will face during your shift, for example, “impaired gas
exchange” or “risk for impaired mobility.” By creating a nursing diagnosis,
you’re already prioritizing the patient’s needs.

3. Planning phase
The planning phase is also referred to as the outcomes phase and it is
the stage that helps the nurse start formulating a plan of action. During
this phase, the nurse will create some goals for the shift. What do you
want to make sure happens on your shift? Again, safety is the top
priority, so you’ll want to plan goals that prioritize airway, breathing and
circulation first. Your first goal might be something like, “The patient will
maintain an oxygen saturation of at least 92% this shift.”

For each of the medical issues, the nurse must assign a simple,
achievable and measurable goal for a positive outcome for the patient.
Generally, these are short-term goals and are evaluated on a shift-by-
shift basis.

4. Implementing phase
As the nurse, what are the action items you will take to see that these
goals are met? During the implementation phase, you’ll create a few
nursing interventions to help achieve the patient’s goals. For
example, “Will titrate oxygen liter flow to maintain saturations above 92%
this shift.”
Once you’ve addressed airway and breathing, you can create additional
action items that will help meet the goals from the planning phase. What
will help your patient’s oxygen levels stay up? The next goals could be
something like, “Will encourage patient to use incentive spirometry 10 times
an hour,” or “Will ambulate patient three times a shift and encourage cough
and deep breathing.”
5. Evaluation phase
The final phase of the nursing process is the evaluation phase. It takes
place following the interventions to see if the goals have been met.
During the evaluation phase, the nurse will determine how to measure
the success of the goals and interventions. For a patient with respiratory
issues, one evaluation tool would be to trend the patient’s oxygen
saturation levels throughout the shift. Ask yourself, “Were you able to
wean the oxygen or did you have to increase the liter flow?”

Here are a few possible outcomes that the nurse can use to classify the
intervention:

 Patient's condition improved: Patient maintained O2

saturations above 92% this shift, no use of accessory
muscles, the patient is now off oxygen
 Patient's condition stabilized: The nurse was able to wean
oxygen this shift
 Patient's condition deteriorated: Oxygen liter flow was
increased twice today, continue to monitor

2-list characteristics of the nursing process?

1. Critical Thinking:
This basically deals with the problem-solving process and the decision making process. For
egg. When a 4-year-old boy refuses to take a medication in pill form because it is “too big and
it hurts to swallow”, the nurse demonstrates critical thinking by checking out available options
such as asking the mother for the best method her child generally follows (by breaking the pill
in half and swallowing smaller bits) or perhaps by enquiring with the pharmacy for an
alternative pediatric formula in liquid form. It is basically the nurse taking a call on the best
possible decision to make.

2. Assessing:
This is the process by which a nurse studies the socio-physio-psychological state of the
patient, based on subjective and objective data.

Subjective data : personal data personal opinions, values, aesthetics, religion, upbringing,
beliefs, life style, diet, family, personal details such as name, address, age, etc.

Objective data : scientific data based on the format of systematic questionnaires for history of
illnesses, symptoms shown by the patient, temperature, blood pressure, height, weight, etc.

Data collection is the form of verbal and non verbal communication, written medical
references from medical practitioners, and also by body language. Accurate data collection is
dependent upon the skill and communication of the nurse to gain the patient’s trust.

3. Diagnosis:
The nature of the illness or the problem as the nurse sees it. This comprises of the a) problem
statement as the patient has stated it, b) Etiology or the probable cause, and c) defining
characteristics (signs and symptoms)

4. Planning:
Here, the problems identified are conveyed to the patient and measurable goals are set.

5. Implementing and Evaluating:

This is the step by step method of carrying out the plans to achieve the set goal. If, on
evaluation there seems to be no progress towards good health, the nurse will have to make
necessary changes in the form of treatment resulting in reviewing and modifying the patient’s
nursing care plan.

6. Documenting and Reporting:

The patient’s entire medical history and forms of treatment are recorded and documented.
Every step of the nursing care plan is shown with a recommended follow-up plan. This
document or patient file is confidential and is the property of the medical institution. Upon
request a duplicate copy may be presented or relevant details may be supplied. This patient
file cannot be circulated to any outside concerns and call be pulled up in a court of law if there
is a breach in trust.

After going through the above mentioned phases and steps of the nursing process we will
understand better what the characteristics of this entire process is.

1. Cyclic and Dynamic: – it is an ongoing continuous process throughout the stages of

illness and treatment and ends with the cease of the illness.
2. Goal directed and Client oriented: The nursing process is intended to treat the patient
and is in the best interest of the patient.
3. Interpersonal and Collaborative: This goes to explain the amount of interaction that might
be necessary between nurses, patients of similar illnesses and the medical team. It might
involve group therapy and / or family counselling.
4. Universally applicable: This process is universally standard and no matter what the
institution it may be, the process remains the same. It is like a common nursing language with
common nursing terminology followed universally.
5. Scientific and Systematic: The process is based on the objective format, viz., scientific
format. Every symptom or sign is a result of a scientific fact which leads to scientific methods
of treatment and follow-ups. It is systematic and goes from step to step as in the phases
mentioned above. It is not based on mere instincts, but outlined within a framework of set
parameters.

3-describe the components and purpose of the nursing assessment?

A nursing assessment is a process where a nurse gathers, sorts and

analyzes a patient’s health information using evidence informed tools to
learn more about a patient’s overall health, symptoms and concerns. This
includes considering the patient’s biological, social, psychological, cultural
and spiritual values and beliefs.[1] A nurse then documents and interprets
this information to inform the patient’s care plan and ongoing decision-
making about the patient’s health status, which may include identifying
urgent, emergent and or life-threatening conditions.

Assessments are critical to patient safety because lack of nursing

assessments can pose a patient safety risk.  Timely and appropriate
holistic nursing assessment is a fundamental skill that all nurses should
demonstrate in any area of nursing practice.

What is included in a nursing assessment?

During a nursing assessment the nurse collect both subjective and

objective information using evidence informed tools to assess the patient
as a whole. A nursing assessment may include, but is not limited to the
following:

 environmental assessment

 cultural assessment

 physical assessment

 psychological assessment

 safety assessment

 psychosocial assessment

4 types of nursing assessments:

The four medical assessments regularly performed on patients

are:

1. Initial assessment

Also called a triage, the initial assessment's purpose is to

determine the origin and nature of the problem and to use that
information to prepare for the next assessment stages. Due to
the fact that the rest of the medical process relies on the
accuracy of this initial assessment, it is the most thorough phase
of the entire process.

It usually consists of getting the patient's medical history and

performing a physical exam on them or, in the case of patients
with mental issues, performing a psychological assessment.
Depending on the patient's condition, the initial assessment may
also include recording the patient's vital signs and looking for
subtle symptoms that may be signs of an underlying condition.

2. Focused assessment

After the initial assessment, the medical issue is fully exposed

and treated in the focused assessment phase. Given the fact that
a patient's condition may rapidly change, especially in an
emergency situation, their vital signs are constantly monitored
throughout all four assessments. The focused assessment also
involves relieving the patient from pain and stabilizing their
condition, when needed. Also, depending on the exact nature of
the issue, a long-term treatment plan that aims to resolve the
root cause is implemented during this phase.

3. Time-lapsed assessment

After the medical condition is properly diagnosed and a

treatment plan is implemented, the time-lapsed assessment is
conducted to evaluate how the patient reacts to the agreed
treatment plan and how their condition is evolving. Depending
on the issue, a time-lapsed assessment can last from a few hours
to a few months. Throughout this time, the patient is constantly
evaluated and their condition is compared to previously recorded
parameters to see if the treatment is effective.

4. Emergency assessment

The emergency assessment is performed during emergency

procedures, when it is crucial to evaluate the patient's airway,
breathing and circulation, as well as the exact cause of the
problem. Emergency assessments can take place outside typical
healthcare settings and in these situations the registered nurse
must also make sure that no other people are negatively affected
by the emergency rescue process. If the emergency assessment
is a success and the patient's vital signs are stabilized, the next
step is usually a focused assessment.

4-differentiate between objective and subjective data?

What Is Subjective Information?

Subjective is a term that refers to someone’s personal opinions or feelings
regarding a particular subject matter. Subjective views or opinions are not
based on truth or fact. They are one person’s unique interpretation of an idea
and their own thoughts, feelings, and background. A subjective observation is
influenced by a number of factors, including many different types of biases. In
grammar, subjective means any qualities that refer to the subject of a
sentence.

What Is Objective Information?

The word “objective” refers to factual, data-based information that is not
informed by bias. Although feelings and personal opinions are not objective,
objective data like facts or historical information can form the basis for an
opinion or feeling. When someone gives you an objective assessment of a
topic, it is formulated from data, verifiable facts, or other irrefutable evidence
without considering the speaker’s personal feelings. Journalists strive to
objectively report facts, as not to influence their readership with their
subjective personal biases. Objectivity in grammar can also refer to the
“object” or a sentence, meaning a noun that the subject of the sentence acts
on.

Subjective vs. Objective: Understanding the Difference

Subjective and objective are two forms of perception, and the main difference
between them is that a subjective point of view focuses on a personal
interpretation of the subject, while an objective viewpoint is based on factual
data. Here are the three main differences between subjective and objective.

1. 1. Facts versus feelings. An objective reading of a text focuses on the

facts and data-based information, regardless of the person’s feelings. A
subjective reading of a text focuses on a person’s unique feelings and
experience.
2. 2. Embracing versus denying bias. Subjectivity refers to the personal
opinion that a subject has, embracing personal biases. Being objective
means erasing any personal bias that a reader may have.
3. 3. Grammatical meanings. In grammar, subjective refers to the subject
of a sentence, or the noun performing an action. Objective refers to
qualities dealing with the object of a sentence, or a noun that an action
is done to.

5-state the sources of data for a nursing assessment?

The primary source of data collection during the nursing assessment is the patient. Other
sources include family, friends, caregivers, and other members of the healthcare team.
Data are also collected from laboratory or diagnostic reports, the patient’s medical
records, and the nurse’s observations.

6-Demonstrate the four skills of physical examination?

Inspection

In medical terms, “inspection” means to look at the person or body part. It is

the first step in a physical exam.

Palpation

Palpation is a method of feeling with the fingers or hands during a physical

examination. The health care provider touches and feels your body to
examine the size, consistency, texture, location, and tenderness of an organ
or body part.

Auscultation

Auscultation is listening to the sounds of the body during a physical

examination. Auscultation is usually done using a tool called a stethoscope.
Health care providers routinely listen to a person’s lungs, heart, and
intestines to evaluate these things about the sounds:

 Frequency
 Intensity
 Duration
 Number
 Quality

Percussion

Percussion is a method of tapping body parts with fingers, hands, or small

instruments as part of a physical examination. It is done to determine:

 The size, consistency, and borders of body organs

 The presence or absence of fluid or gas in body areas
Percussion of a body part produces a sound, like playing a drum. The sound
is a sign of the type of tissue within the body part or organ.

 Lungs sound hollow on percussion because they are filled with air.
 Bones, joints, and solid organs such as the liver sound solid.
 The abdomen sounds like a hollow organ filled with air, fluid, or
solids.

7-list and discuss the steps of the nursing diagnostic process?

The nursing process functions as a systematic guide to client-centered

care with 5 sequential steps. These are assessment, diagnosis, planning,
implementation, and evaluation.
Assessment
Assessment is the first step and involves critical thinking skills and data
collection; subjective and objective. Subjective data involves verbal
statements from the patient or caregiver. Objective data is measurable,
tangible data such as vital signs, intake and output, and height and
weight.
Data may come from the patient directly or from primary caregivers who
may or may not be direct relation family members. Friends can play a
role in data collection. Electronic health records may populate data and
assist in assessment

Diagnosis
The formulation of a nursing diagnosis by employing clinical judgment
assists in the planning and implementation of patient care.
The North American Nursing Diagnosis Association (NANDA) provides
nurses with an up-to-date list of nursing diagnoses. A nursing diagnosis,
according to NANDA, is defined as a clinical judgment about responses
to actual or potential health problems on the part of the patient, family, or
community.  
A nursing diagnosis encompasses Maslow's Hierarchy of Needs and helps
to prioritize and plan care based on patient-centered outcomes. In 1943,
Abraham Maslow developed a hierarchy based on basic fundamental
needs innate to all individuals. Basic physiological needs/goals must be
met before higher needs/goals can be achieved such as self-esteem and
self-actualization. Physiological and safety needs provide the basis for the
implementation of nursing care and nursing interventions. Thus, they are
at the base of Maslow's pyramid, laying the foundation for physical and
emotional health.

Planning
The planning stage is where goals and outcomes are formulated that
directly impact patient care based on EDP guidelines. These patient-
specific goals and the attainment of such assist in ensuring a positive
outcome. Nursing care plans are essential in this phase of goal setting.
Care plans provide a course of direction for personalized care tailored to
an individual's unique needs. Overall condition and comorbid conditions
play a role in the construction of a care plan. Care plans enhance
communication, documentation, reimbursement, and continuity of care
across the healthcare continuum.
Goals should be:

1. Specific

2. Measurable or Meaningful

3. Attainable or Action-Oriented

4. Realistic or Results-Oriented

5. Timely or Time-Oriented

Implementation
Implementation is the step that involves action or doing and the actual
carrying out of nursing interventions outlined in the plan of care. This
phase requires nursing interventions such as applying a cardiac monitor
or oxygen, direct or indirect care, medication administration, standard
treatment protocols, and EDP standards.

Evaluation
This final step of the nursing process is vital to a positive patient
outcome. Whenever a healthcare provider intervenes or implements care,
they must reassess or evaluate to ensure the desired outcome has been
met. Reassessment may frequently be needed depending upon overall
patient condition. The plan of care may be adapted based on new
assessment data.

8- Discuss the advantages of nursing diagnosis for the profession of

nursing?

Advantages of nursing process:

 
The nursing process helps the nurse and the nursing in many ways
Helps to create a health data base of a patient
 
Helps to identify actual or potential health problems of a patient
 
Helps to establish priorities of nursing actions for providing proper
services to the patients.
 
Helps to define specific nursing actions for providing proper
services to the patients
 
Helps to develop planned organized and individualised nursing
care.
 
Helps to encourage for innovative nursing care.
 
Helps to provide for alternative nursing actions.
 
 Helps to develop nursing autonomy and to foster nursing
accountability
 
Helps to increase the effectiveness of nursing care.

9-formulate nursing diagnoses from a nursing assessment?

As we have already established, a nursing diagnosis is an important step in the

nursing process. It is a concrete and evidence-based way for nurses to
communicate their professional judgments to patients, fellow nursing
professionals, members of other medical areas, and the public. The nursing
diagnosis is developed based on information gathered in the assessment phase.
Further, once a nursing diagnosis is elaborated, the nurse can move ahead and
create a care plan, which can be used to measure outcomes of a patient’s care at
a later phase.

“A nursing diagnosis is a clinical judgment concerning a human response to

health conditions/life processes, or a vulnerability for that response, by an
individual, family, group or community. A nursing diagnosis provides the basis
for selection of nursing interventions to achieve outcomes for which the nurse
has accountability.”

10-Develop a nursing care plan from a nursing assessment?

How to Write a Nursing Care Plan

When writing a nursing care plan, you first have to determine what type
of care plan you are interested in. If it is for your own use throughout
the shift, then an informal one may be beneficial; however, if it is for the
patient’s chart and required during your shift then an individualized care
plan is the way to go. 

Step 1: Assessment

The first step in writing an organized care plan includes gathering

subjective and objective data. This information can come from, 

 Verbal statements from patient and family

 Vital signs
 Physical complaints
 Body conditions
  Medical history
 Height and weight
 Intake and output

Step 2: Diagnosis

Using the information and data collected in Step 1, a nursing diagnosis is

chosen that best fits the patient, the goals, and objectives for the
patient’s hospitalization. 

According to North American Nursing Diagnosis Association (NANDA),

defines a nursing diagnosis as “a clinical judgment about the human
response to health conditions/life processes, or a vulnerability for that
response, by an individual, family, group or community.”

A nursing diagnosis is based on Maslow’s Hierarchy of Needs pyramid

and helps prioritize treatments. Based on the nursing diagnosis chosen,
the goals to resolve the patient’s problems through nursing
implementations are determined in the next step. 

Step 3: Outcomes and Planning

After determining the nursing diagnosis, it is time to create a SMART

goal based on evidence-based practices. SMART goals stands
for Specific, Measurable, Achievable, Relevant, and Time-Bound. It is
important to consider the patient’s medical diagnosis, overall condition,
and all of the data collected. 

It is also during this time you will consider goals for the patient and
outcomes for the short and long term. These goals must be realistic and
desired by the patient. For example, if a goal is for the patient to seek
counseling for alcohol dependency during the hospitalization but the
patient is currently detoxing and having mental distress - this might not
be a realistic goal. 

Step 4: Implementation

Now that the goals have been set, you must put the actions into effect
to help the patient achieve the goals. While some of the actions will
show immediate results (ex. giving a patient with constipation a
suppository to elicit a bowel movement) others might not be seen until
later on in the hospitalization. 

The implementation phase means performing the nursing interventions

outlined in the care plan. Interventions are classified into seven
categories: 

 Family
 Behavioral
 Physiological
 Complex physiological
 Community
 Safety
 Health system interventions

Some interventions will be patient or diagnosis-specific, but there are

several that are completed each shift for every patient:

 Pain assessment
 Position changes
 Fall prevention
 Providing cluster care
 Infection control

Step 5: Evaluation 

The fifth and final step of the nursing care plan is the evaluation phase.
This is when you evaluate if the desired outcome has been met during
the shift. There are three possible outcomes, 

 Met
 Ongoing
 Not Met

Based on the evaluation, it can determine if the goals and interventions

need to be altered. 

11-list and discuss the five steps of the implementation methods?

[Link]
Initial discovery. Uncover your basic needs.
2. Analysis
Determine exact project requirements.
3. Solution Modeling
Iterative design, configuration, and development.
Initial training and user acceptance testing.
4. Deployment
Prepare and finally go live.
5. Operation
Transition to client ownership and ongoing support.

12-Discuss the steps of evaluation process?

1. Planning or defining the scope of the evaluation

2. For the evaluation, meet with the key client.
3. Locate and meet with other important stakeholders.
4. Research the program’s context and acquire background information.
5. Look at prior evaluations to see what problems, designs, and data collection
methods were used.
6. Review and refine or create a program theory of change.

2. Designing the evaluation

3. Determine the type of assessment.
4. Create a list of specialized evaluation questions and sub-questions.
5. For each question or sub-question, choose measurements.
6. Determine the data sources for each question or sub-question.
7. Select a design that is appropriate for each question or sub-question.
8. Create a data collection strategy that includes instruments and sampling
techniques.
9. Create a plan for analyzing the data.
10. Establish resource and timing constraints.

3. Conducting the evaluation

4. Explain the evaluation design to the customer and relevant stakeholders.
5. Create a work plan that includes examining and testing the approach, as well as
training data collectors and drafting protocol.
6. Collect information.
7. Clean the data and prepare it for analysis by creating table shells (if not done as
part of the evaluation design).
8. Examine the data.
9. Create visuals.
10. Write up your findings.

4. Reporting the Evaluation’s Findings

 Determine the most important facts and themes: what works, what doesn’t, and
what needs to be improved.
 Complete the report.
 Inform the client of the findings and facts.
 Inform program officials and key stakeholders about findings and assertions of
fact, and make any necessary adjustments.
 Allow program officials to see the draft report and provide feedback.
 Make clear and detailed suggestions that specify who should do what and when.
 Verify that recommendations are supported by evidence.

5. Reporting and Following Up on Evaluation Results

 Determine who will receive what type of research distribution output (for
example, a briefing, a two- to four-page summary, the entire report, or an in-
depth workshop) and put the strategy into action.
 Determine what lessons to teach and how to teach them.
 Determine how official suggestions will be implemented.
 Store electronic files in evaluative knowledge repositories in read-only format.
 Consider expanding your reach through professional associations and journals.