1. The Nursing Process
Kalyani Mohanraj
Associate Professor
CCN

2. Planning
• Deliberate systematic phase of the nursing
process that involves problem solving and
decision making.
– Prioritizing problems (nursing diagnosis)
– Formulate goals/desired outcomes
– Select nursing interventions
– Write nursing orders

3. Types of Planning
• Initial planning
– Initiated soon after the initial assessment
– Comprehensive plan based on the data
• Ongoing planning/daily planning
– Individualize the initial plan
– Modified every shift
– Evaluate effectiveness of care
• Discharge planning
– Deals with care needs at home/hospice

4. Setting Priorities
• Establishing preferential sequence of
addressing nursing diagnoses and
interventions.
– High priority – life threatening conditions
– Medium priority – health threatening problems
– Low priority – minimum nursing interventions

5. Guide Lines to Set Priorities
• Abraham Maslow’s hierarchy of needs
• Clients preference
• Resources available
• Health beliefs and values of client
• Medical treatment plan

6. Setting Outcome Criteria
• They describe in observable client
responses what the nurse hopes to
achieve by implementing the nursing
interventions.
– Goals/desired outcome/objective/outcome
criteria/expected outcome all these terms are
used interchangeably.

7. Components of Goals
• Derived from the problem in the nursing
diagnoses
• It is stated as the opposite healthy client
response
• Must have the following clauses
– Subject – client/part or attribute of client
– Verb – action the client is expected to perform
– Conditions/modifiers – what/when/where/how
– Criterion of performance – standard/quality of
perfomance

8. Guide Lines for Writing Goals
• In terms of client responses
• Realistic/Achievable
• Address one nursing diagnosis
• Observable and measurable terms
• In collaboration with client

9. Samples
Nursing Diagnoses Goals/desired outcome
Impaired physical
mobility
Improved mobility -
Ambulates with crutches
by the end of this week
Ineffective airway
clearance
Effective airway
clearance – coughs and
deep breathes every two
hours

10. Subje
ct
Verb Conditions/
Modifiers
Criterion
Client Drinks 2500ml of fluid Daily (time)
Client Admini
sters
Correct insulin
dose
Using aseptic
technique (quality
standard)
Client Lists 3 hazards of
smoking
Accuracy

11. Nursing Interventions
• Actions taken by the nurse to achieve the
goals/expected outcome
• Focus on eliminating/reducing/modifying
the etiology of the nursing diagnosis
• If not possible, to treat the signs and
symptoms (defining characteristics)
– E.g.
• Anxiety related to hospitalization
• Pain related to surgical incision

12. Types of Nursing Interventions
• Independent interventions
– Activities the nurses are licensed to initiate on the
basis of their knowledge and skills
• Dependent interventions
– Activities carried out under the physicians’ orders or
supervision or according to specified routines
• Collaborative interventions
– With other health team members e.g.
physiotherapists, social workers dieticians etc.,

13. Criteria for selecting the
Interventions
• Safe and appropriate
• Achievable with the resources available
• Congruent with the client’s values and
beliefs
• Compatible with other therapies
• Based on nursing knowledge or
experience
• Within established standards of care

14. Formats of Care Plans
• Student care plans
• Computer generated care plans
– Standardized care plans
– Individualized care plans
• Concept maps
• Collaborative care plans/Critical path ways

15. Student care plan
Asse
ssme
nt
data
Nursi
ng
diagn
osis
Goals Plann
ing
Ratio
nale
Imple
ment
ation
Evalu
ation

16. Implementing
• The phase in which the nurse carries out
or delegates the planned interventions.
– Reassess the client
– Determine the need for assistance
– Implement the intervention
– Supervise delegated care
– Document nursing activities