The nursing process
The nursing process is a systematic, problem-solving approach that guides how nurses plan and deliver care. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
Overview: ADPIE
The nursing process has five steps, often remembered as ADPIE: Assessment, Diagnosis, Planning, Implementation, and Evaluation. It is cyclical: evaluation leads back to reassessment as the patient's condition changes. It underpins clinical reasoning and care plans.
Assessment
Assessment is collecting data about the patient. Subjective data are what the patient reports (symptoms, feelings, history, such as 'my chest hurts'); objective data are what the nurse observes or measures (vital signs, lab results, wound appearance). Assessment can be comprehensive, focused on a problem, or emergency.
Nursing diagnosis
A nursing diagnosis is a clinical judgement about a patient's response to health problems, which nurses can address independently. Unlike a medical diagnosis (such as pneumonia), a nursing diagnosis might be 'Ineffective airway clearance related to thick secretions, as evidenced by ineffective cough.' NANDA International maintains a standard list.
Planning and goals
Planning sets priorities and patient-centred goals. Goals should be SMART: specific, measurable, achievable, relevant, and time-bound. 'The patient will walk 50 metres with a walker, without shortness of breath, by day 3' is measurable; 'the patient will feel better' is not.
Prioritisation
Nurses prioritise using frameworks such as Maslow's hierarchy of needs (physiological needs first, then safety, belonging, esteem, and self-actualisation) and the ABCs (airway, breathing, circulation). An obstructed airway takes priority over pain management, which takes priority over teaching.
Implementation
Implementation means carrying out nursing interventions. Independent interventions are within nursing's own scope (repositioning, teaching); dependent interventions require a provider's order (giving medications); collaborative interventions involve the healthcare team (working with physiotherapy on mobility).
Evaluation
Evaluation determines whether goals were met, partly met, or not met, by comparing the patient's current state with the expected outcomes. If goals are not met, the nurse reassesses and revises the plan. Evaluation makes the process responsive rather than routine.
Worked example
A post-operative patient reports pain of 8 out of 10 (subjective) and has a heart rate of 110 (objective). Nursing diagnosis: acute pain related to surgical incision. Goal: pain at or below 3 out of 10 within one hour of intervention. Implementation: give prescribed analgesia, reposition, and use relaxation techniques. Evaluation: reassess pain an appropriate time after medication.
Key takeaways
The nursing process (ADPIE) is assessment, diagnosis, planning, implementation, and evaluation, in a cycle. Subjective data come from patients; objective data are observed or measured. Nursing diagnoses address responses to illness. Goals should be SMART. Prioritise with Maslow and the ABCs. Interventions are independent, dependent, or collaborative. Evaluation compares outcomes with goals.
Flashcard
Assessment, Diagnosis, Planning, Implementation, Evaluation
Check your understanding
Which patient need should a nurse address first, according to the ABCs?