Introduction
In 1958, Ida Jean Orlando developed the nursing process that continues to guide nursing care today. The nursing process is defined as a systematic approach to care that uses the fundamental principles of critical thinking, patient-centered treatment, goal-oriented tasks, evidence-based practice (EBP) recommendations, and nursing intuition. Holistic and scientific postulates are integrated to provide the basis for compassionate, quality care.[1][2][3]
Function
The nursing process serves as a systematic guide to patient-centered care, comprising 5 sequential steps. The 5 steps are assessment, diagnosis, planning, implementation, and evaluation.
Assessment
Assessment is the first step and involves critical thinking skills and the collection of subjective and objective data. Subjective data include verbal statements from the patient or caregiver. Objective data include measurable, tangible findings, such as vital signs, intake and output, and height and weight. Data may come directly from the patient or from primary caregivers, who may or may not be direct relatives. Friends can also play a role in data collection. Electronic health records may populate data and assist in assessment. Critical thinking skills are essential to assessment; therefore, concept-based curricular changes are needed.
Diagnosis
Formulating a nursing diagnosis using clinical judgment assists in planning and implementing 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 experienced by the patient, family, or community.A nursing diagnosis encompasses the Maslow hierarchy of needs and helps prioritize and plan care based on patient-centered outcomes. In 1943, Abraham Maslow developed a hierarchy of basic needs innate to all individuals. Basic physiological needs must be met before higher needs, such as self-esteem and self-actualization, can be achieved. Physiological and safety needs provide the basis for implementing nursing care and interventions. Therefore, these needs are at the base of the Maslow pyramid, laying the foundation for physical and emotional health.[4][5]
The Maslow Hierarchy of Needs
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Basic physiological needs: Nutrition (water and food), elimination (toileting), airway (suction), breathing (oxygen), circulation (pulse, cardiac monitor, and blood pressure) (ABCs), sleep, sex, shelter, and exercise.
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Safety and security: Injury prevention (side rails, call lights, hand hygiene, isolation, suicide precautions, fall precautions, car seats, helmets, and seat belts), fostering a climate of trust and safety (therapeutic relationship), and patient education (modifiable risk factors for stroke and heart disease).
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Love and belonging: Fostering supportive relationships, using methods to avoid social isolation (bullying), employing active listening techniques, using therapeutic communication, and supporting sexual intimacy.
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Self-esteem: Acceptance in the community and workforce, personal achievement, a sense of control or empowerment, and acceptance of one's physical appearance or body habitus.
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Self-actualization: An empowering environment, spiritual growth, the ability to recognize the point of view of others, and reaching one's maximum potential.
Planning
The planning stage is where goals and outcomes are formulated, based on evidence-based practice (EBP) guidelines that directly impact patient care. These patient-specific goals and their attainment help ensure a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide direction for personalized care tailored to an individual's unique needs. Overall condition and comorbidities play a role in developing a care plan. Care plans enhance communication, documentation, reimbursement, and continuity of care across the health care continuum.
Goals should be:
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Specific
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Measurable or meaningful
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Attainable or action-oriented
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Realistic or results-oriented
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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, administering oxygen, providing direct or indirect care, administering medications, and adhering to standard treatment protocols and EDP standards.
Evaluation
Evaluation, the final step of the nursing process, is vital to a positive patient outcome. Whenever a healthcare professional intervenes or provides care, they must reassess to ensure the desired outcome has been achieved. Reassessment may be needed frequently, depending on the patient's overall condition. The plan of care may be adapted based on new assessment data.
Issues of Concern
According to a 2011 study conducted in hospitals in the Mekelle Zone, nurses lack the knowledge to implement the nursing process in practice, and nurse-to-patient ratios hinder their ability to do so. Ninety percent of study participants lacked sufficient experience to apply the nursing process in standard practice. The study also concluded that a shortage of resources, coupled with increased workloads due to high patient-to-nurse ratios, contributed to the underuse of the nursing process in patient care.[6][7][8]
Clinical Significance
The use of the nursing process to guide care is clinically significant going forward in this dynamic, complex world of patient care. Aging populations carry with them a multitude of health problems and inherent risks of missed opportunities to spot a life-altering condition. As explored by Salmond and Echevarria, healthcare is changing, and the traditional roles of nurses are transforming to meet the demands of this new healthcare environment. Nurses are well-positioned to promote change and influence future models of patient care delivery.[9][10]
Other Issues
Critical thinking skills play a vital role in developing care plans for these patient populations with multiple comorbidities and in navigating this challenging healthcare arena. Thus, the trend towards concept-based curricular changes helps us navigate these uncharted waters.
Concept-Based Curriculum
Baron further explores the need for a concept-based curriculum as opposed to the traditional educational model, as well as the challenges of implementing it. A direct impact on quality patient care and positive outcomes. Nursing practice and educational environments foster clinical knowledge and expertise, facilitating the transition into the current workforce as an indispensable team player and leader in this new wave of healthcare. Learning should be the focus, with integration into current practice. Learning is a dynamic process, propelled by a force that must coexist within the same learning milieu among educator and student, preceptor and novice, and mentor and trainee. In the future, nurses must be able to problem-solve in a multitude of situations and conditions to meet these new challenges: nurse-patient ratios, multifaceted approaches to prioritizing care, fewer resources, navigation of the electronic health record, and functioning within team dynamics and leadership styles.
