Nursing Process

The nursing process is described as being an individualised problem solving approach in which patients receive nursing care. The nursing process consists of four distinct phases, each having a discreet role in the process, theses phases of the process are: assessment, planning, intervention and evaluation. (Oxford Dictionary of Nursing 2003) It is important that the four stages of the process from assessment to evaluation are carried out sequentially because each phase follows logically from one to the other.

As a result the maximum well-being of the patient is always the key issue and the nurse is aware and confident of action to be taken during intervention.

This essay will describe the nursing process and the importance each of the phases in turn. It will highlight the significance of each element not only in ensuring the physical and general well-being of the patient but also treating the patient as an individual. Finally the importance of evaluating the complete process will be discussed in order that nursing staff may reflect on the success of their actions.

Assessment is the initial and a very important stage of the nursing process. It involves the gathering of information on the patient’s overall state of health from which a care plan may be created (Oxford Dictionary of Nursing 2003). It is suggested that the ability to assess a patient is to find out their health needs, and to highlight fears and expectations that the patient may have. Questions will focus on the medical, social, psychological, spiritual and cultural needs of the patient, rather than just focusing upon medical and physical needs as each patient is different (Nursing Midwifery Council (NMC 2010)).

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That may be resolved through additional questioning of family or friends if required, examining medical records and taking into account the doctor’s diagnosis. This is vital to the nursing process to allow a high standard of care to be reached for each patient. Assessment is important as it helps the nurse gain knowledge and understanding and the ability to identify the patient’s needs (Linda Nazarko 2008). However it has been proposed that in certain care setting in depth assessments are not carried out resulting in the patient not receiving holistic care.

Sometimes elderly patients in a care home may need continual assessment which may not always be possible due to lack of staff. (Dingwall L 2008). The NMC (2010) recommend that nurses refer and adhere to the code of conduct at all times when carrying out assessments in order to offer support to the patient and to recognise that treating each patient as an individual is essential and respecting their dignity is vital in maintaining a high standard of care. A high standard of assessment will ensure the efficiency of the next element, planning.

Planning consists of the nurse working with the patient and other members of the multi-disciplinary team, in developing a care plan to assist the patient and staff in reaching short-term and long-term goals that were identified in the earlier assessment process. Its focus is holistic and is based on the clinical judgement of the nurse and other medical staff, using assessment information such as the patient’s individual needs and wishes in relation to their health (Royal College of Nursing (RCN)).

According to the International Journal of Palliative Nursing (March 2007) as nurses are in a unique position to assist in the planning process, they require knowledge, skills and resources to provide the highest level of care. This could become a major issue if the nurse does not have the appropriate information about the patient. According to John McKinnon (2004) the involvement of patients in decision-making to improve patient compliance with medical advice between a practitioner and patient, can be regarded as having a positive sequential link with patient-centred care planning.

It is suggested to be a process of co-operative care that underpins the principles of patient centeredness and partnership working. This shows the importance of working along with a patient when creating a care plan in the planning stage of the nursing process. However this may lead to conflict as the nurse and the patient may have different priorities from each other, for example, if the patient requires a blood transfusion but they are a Jehovah witness.

It has been accepted that planning is a process which offers patient’s active involvement in deciding, agreeing and knowing how their health will be managed, thus allowing the patient’s ethical belief to stay intact. (Department of Health 2006 (DH)). Once the planning stage of the nursing process is completed the next stage is intervention. The intervention phase of the nursing process is the beginning of the practical nursing care to the patient. Details of treatment are clearly given to and are acknowledged by the patient.

Thus goals laid out in planning will be achieved by the patient and nursing staff. Throughout this phase the nurse will continually review the patient to ensure that the interventions are successful (Jyoti Beck 2011). It has been suggested that the early phase of intervention is time consuming. However as soon as the procedures are integrated into daily standard care they become more manageable even when they are in addition to the current workloads as long as the goals are in suitable practice (Maria Dunckley et al 2005).

This suggests that the nurse must ensure that they never undermine the care of a patient’s everyday needs as these are as important as the action plan is in part of the nursing process. Furthermore, another important part of the intervention phase is documentation. As the intervention stage is an accurate, up-to-date account of the patient’s progress, it must be signed by each nurse engaged in delivering the care as detailed in the care plan. (NMC Code 2010). Nursing interventions are designed to promote and maintain holistic wellbeing of the patient.

In order to prevent further ill health, the nurse carries out these interventions by using a range of knowledge and skills acquired using evidence based practice (British Journal of Nursing 2010). Evaluation is the final stage of the nursing process, it is the final phase in the previous stages of care. It reviews how assessment, planning and intervention have identified the specific needs of the patient, how successful the delivery of nursing care has been. (www. rcn. org. uk). It will also examine patient satisfaction.

Evaluation is on-going and is an active process which may involve the change in the patient’s health, resulting in further planning of care or indeed discontinuation of the treatment at the intervention stage. When nurses carry out evaluation they should analyse the previous phases of the nursing process in order to determine whether expected outcomes for the patient have been met. This will define the level of recovery the patient has reached and their ability to cope with their own health care needs independently.

Evaluation is a feed -back mechanism for judging the quality of care given on the patient’s progress. It specifies if the patient’s problems have been resolved and if there is a need to re-assess, re- implement and re-evaluate the care plan. In conclusion this essay has demonstrated the four different stages of the nursing process and its value to practice. It is of utmost importance that a professional working relationship exists between the patient and other members of the multi-disciplinary team in order for the patient to receive the best outcomes for their health and well-being.

The nursing process enables nurses to continually question the care they give to patient and acquire better knowledge and understanding of working for benefit and safety of the patient. It can be seen that each phase of the process of nursing is essential, as each part contributes to the patient having maximum holistic health outcomes and patient satisfaction from the treatment that they receive from nurses. The nursing process encourages nursing practice to improve the effectiveness and quality of healthcare to be beneficial to the patient.

This assignment also discussed the issues where the nursing and patient may have their differences of opinion when receive treatment in clinical practice, and the nurse must adhere to respecting the patient’s dignity in every case. Without the nursing process the efficiency and quality of care that the patient would receive may not be patient centered as nursing care would rarely involve the patient but focus on the illness. The process of nursing helps to keep nursing practice current as nurses apply Evidence Based Practice in the care they provide.

It is the nurse’s duty to stay currently informed and educated on any treatments as nurses must provide a high standard of practice and care at all times by using the best available evidence. Each section of the process helps the nurse to contributes to improved patient outcomes because nurses must make decisions on a regular basis on what is the appropriate care to provide for the patient. The four elements comprising assessment, planning, intervention and evaluation will help reduce the negative outcomes since the care is based on a plan incorporating the use of evidence-based practice and ensures patient satisfaction.