1. NURSING
PROCESS
PREPARED AND PRESENTED BY
MRS.S.ANUKRISHNAN,
VICE PRINCIPAL CUM HOD OBG NURSING,
P.D.BHARATESH COLLEGE OF NURSING,
HALAGA, BELGAUM.

3. NURSING PROCESS - INTRODUCTION
 The term NURSING PROCESS originated in
1955 by Haul.
 Johnson (1959), Orlando (1961), and
Wiedenbach (1963) were the first users of the
term nursing process.
 The Nursing Process enables the nurse to
organize and deliver nursing care.

4. NURSING PROCESS -
INTRODUCTION
 For the successful application of Nursing
Process,
◦ the nurse integrates elements of critical thinking to
make judgments
◦ and take actions based on reason.
 The nursing process is used to
◦ identify, diagnose and treat human responses to
health and illness.

5. ASSESSMENT
EVALUATING DIAGNOSING
Critical
thinking
IMPLEMENTING PLANNING

6. NURSING PROCESS -
INTRODUCTION
 It is a dynamic continuous process as the
clients need change.
 The use of Nursing Process promotes
individualized nursing care
 And assists the nurse in responding to client
needs in a timely and reasonable manner to
improve or maintain the client’s level of
health.

7. 1. Definition
 It is a systematic, rational method of
planning and providing nursing care. Its
goal is to identify a client’s health care
status and actual or potential health
problems, to establish plans to meet the
identified needs, and to deliver specific
nursing interventions to address those
needs.

8. The Nursing Process is:
A systematic, rational method of planning
and
providing individualized nursing care.

9. Definition
 The nursing process is cyclical, that is,
its components follow a logical
sequence, but more than one
component may be involved at one time.
At the end of the first cycle, care may be
terminated if goals are achieved, or
cycle may continue with reassessment
or plan of care may be modified.

10.  It is synonymous with the PROBLEM
SOLVING APPROACH that directs the nurse
and the client to determine the need for
nursing care, to plan and implement the care
and evaluate the result.
 It is a G O S H approach (goal-oriented,
organized, systematic and humanistic care)
for efficient and effective provision of nursing
care.

11. 2. PURPOSE OF THE
NURSING PROCESS
1. Identify a client’s health status and actual or
Potential health problems or needs.
2. To establish plans to meet the identified
needs.
3. Deliver specific nursing interventions to meet
those needs.

12. PURPOSE OF THE NURSING PROCESS
4. To Achieve Scientifically-
Based, Holistic, Individualized
Care For The Client.
5. To Achieve The Opportunity To
Work Collaboratively With
Clients, Others.
6. To Achieve Continuity Of Care.

13. 3. Benefits of Nursing Process
1. Provides an orderly & systematic method for planning
& providing care
2. Enhances nursing efficiency by standardizing nursing
practice
3. Facilitates documentation of care
4. Provides a unity of language for the nursing
profession
5. Is economical
6. Stresses the independent function of nurses
7. Increases care quality through the use of deliberate

14. 3. Benefits of Nursing Process
1. Continuity of care
2. Prevention of duplication
3. Individualized care
4. Standards of care
5. Increased client participation
6. Collaboration of care

15. 4. Characteristics of the Nursing
Process
1] Cyclic & dynamic in nature
2] Client centered
3] Focus on problem solving & Decision making
4] Interpersonal & Collaborative style
5] Universal applicability
6] Use of critical thinking.
7] Data from each phase provide input into the next
phase.
8]Decision making involved in every phase of nursing
process.

16. CHARACTERISTICS:
a. Systematic:
 The nursing process has an ordered sequence of
activities and each activity depends on the accuracy
of the activity that precedes it and influences the
activity following it.

17. b.Dynamic:
 The nursing process has great interaction and
overlapping among the activities and each activity
is fluid and flows into the next activity

18. c. Interpersonal: The nursing process ensures that
nurses are client-centered rather than task-centered
and encourages them to work to enhance client’s
strengths and meet human needs.

19.  d. Goal-directed: The nursing process is a means
for nurses and clients to work together to identify
specific goals (wellness promotion, disease and
illness prevention, health restoration, coping and
altered functioning) that are most important to the
client, and to match them with the appropriate
nursing actions

20. e. Universally applicable:
 The nursing process allows nurses to practice
nursing with well or ill people, young or old, in any
type of practice setting

21. 5. Phases/Steps nursing
process
a. Assessing
b. Diagnosing
c. Planning
d. Implementing
e. Evaluating

22. 1. ASSESSING
a. Collect data
b. Organize data
c. Validate data
d. Analyze data
O
e. Document data
2. DIAGNOSING
a. Analyze data
V b. Identify health problems, risk, and
strengths
c. Formulate diagnostic statements
E 3. PLANNING
R a. Prioritize problems/diagnoses
b. Formulate goals/desired outcome
c. Select nursing interventions
V d. Write nursing orders
I
4. IMPLEMENTATION
a. Reassess the client
b. Determine the nurse’s need for
E assistance
c. Implement the nursing interventions
d. Supervise delegated case
W 5. EVALUATION
e. Document nursing activities
a. Collect data related to outcomes
b. Compare data with outcomes
c. Relate nursing actions to client goals/outcomes
d. Draw conclusions about problem status
e. Continue, modify, or terminate the client’s care plan

23. 5. a. Assessing - Definition
 It is the systematic and continuous collection,
organization, validation, and documentation of data
(information) as compared to what is standard /
norm .
 It is continuous process carried out during all
phases of the nursing process.
 For Eg. In evaluation phase assessment is done
to determine the outcomes of the nursing strategies
and to evaluate goal achievement.
 All phases of nursing process depend on the
accurate and complete collection of data.

24. 5. b. Purpose of
Assessment
1. To establish a data base (all the information
about the client):
2. Nursing health history
3. Physical assessment
4. The physician’s history & physical
examination
5. Results of laboratory & diagnostic tests
6. Material from other health personnel

25. 5. c. Types of assessment
There are 4 different types of
assessment:-
1] Initial assessment
2] Problem focused assessment
3] Emergency assessment
4] Time lapsed reassessment

26. Type Time performed Purpose Example
1.Initial Performed To establish a Nursing
assessment within complete admission
specified time database for assessment
after problem
admission to identification,
a health care reference, and
agency. future
comparison

27. Type Time performed Purpose Example
2.Problem- Ongoing To determine Hourly
focused process the status of a assessment of
assessment integrated with specific client’s fluid
nursing care problem intake and
identified in an urinary output
earlier in an ICU
assessment
Assessment of
client’s ability
to perform self
care while
assisting a
client to bathe.

28. Type Time performed Purpose Example
3.Emergenc During any To identify life- Rapid
y assessment physiologic or threatening assessment of a
psychologic problems person’s
crisis of the airway,
client breathing
status, and
circulation
during a
cardiac arrest
Assessment of
suicidal
tendencies or
potential for
violence.

29. Type Time Purpose Example
performed
4.Time- Several To compare the Reassessment
lapsed months after client’s current of a client’s
reassessment initial status to functional
assessment baseline data health patterns
previously in a home care
obtained. or outpatient
setting or, in a
hospital, at
shift change.

30.  Assessment varies according to
◦ purpose,
◦ timing,
◦ time available &
◦ client status.
 Nursing assessments focus on a client response to
a health problem.
 A Nursing assessment include the clients perceived
needs, health problems, related experience , health
practices, values and life styles.
 Data should be relevant to a particular health
problem.

31. Activities in Assessing phase
 Activities:
a. Collection of data
b. Validation of data
c. Organization of data
d. Analyzing of data
e. Recording/documentation of data
 Assessment = Observation of the patient +
Interview of patient, family & Significant Others +
examination of the patient + Review of medical
record

32. 5. d. Description of the assessment
phase
Phase Description Purpose Activities
i. Assessment Collecting, To establish Establish a database
Organizing, database about  Obtain a nursing
health history
Validating , the client’s  Conduct a physical
Analyzing & response to assessment
Documenting health concerns  Review client
client data. or illness and the records
ability to  Review Nursing
literature
manage health  Consult support
care needs. persons
 Consult health
professionals
update data as
needed organize
data validate data
communicate /
document data.

33. 5. d) a. Collecting Data – i.
Meaning
 Is the process of gathering information
about a client’s health status.
 It must be both systematic & continuous
 To prevent the omission of significant
data &
 reflect a client’s changing health status.
 To collect data clearly both the client & nurse
must actively participate.

34. • Client data includes past history as well
as current problems.
 Eg of Past history
 Eg of Current Problems
◦ History of allergic to
◦ pain, nausea, sleep
penicillin
patterns & religious
◦ Past surgical
practices.
procedures
◦ Folk healing
practices
◦ Chronic disease

35. 5. d) a. ii.Types of data
Subjective Data Objective data
 Also referred to as  Also referred to as signs or
symptoms or covert data overt data,
 Can be verified described by  Are detectable by an observer
only the person who or
affected.  Can be measured or tested
 Eg. Itching, pain, feelings of against an accepted standard.
worry.  They can be seen, heard felt
 It includes the client’s or smelled and
sensations, feelings values,  They are obtained by
beliefs, attitudes and observation or physical
perception of personal examination
health status and life
 For eg. Discoloration of skin,

36.  During Physical Examination, the nurse obtains
objective data to validate subjective data.
 Information supplied by family members, significant
others or health professionals are considered
subjective if it is not based on fact.
 A complete data base of both subjective & objective
data provides a base line for comparing the client’s
responses to nursing & medical intervention.

37. Eg. Of subjective & objective
data.
Sl. Subjective Data Objective Data
No.
1 I have fever Body tem – 1000F
Tachycardia – 100 bt/mt
Dull & tired
Dried lips
2 I feel sick to my stomach Vomited 100ml of green tinged fluid
Abdomen firm
Slightly distended
Active bowel sounds in all 4 quadrants
3 I am short of breath RR – 28br/mt
Tachypnoea
Lung sound diminished in ® lower lobe.

38. 5. d) a. iii.Sources of Data
 Sources of data are primary or secondary.
 The client is the primary source of data.
 Secondary or indirect sources are family members or
other support persons, other health professionals,
records & reports laboratory and diagnostic analyses,
and relevant literature.
 All sources other than the client are considered
secondary sources.

39. Client
 The best source of data
 unless the client is to ill, young or
confused to communicate clearly.
 The client can provide subjective data
that no one else can offer.

40. Support people
 Family members, friends and care givers who know
the client well often can supplement or verify
information provided by the client.
◦ They might convey information about the client’s
response to illness
◦ the stresses client was experiencing before the
illness,
◦ family attitudes on illness and health,
◦ and the clients home environment.
 Support people data are very important in case of a
client who is very young unconscious or confused.

41. Client Records
 It includes information documented by various health
care professionals.
 Client records also contain data regarding the client’s
occupation, religion, and marital status.
 By reviewing the records the nurse can avoid asking
questions for which answers have already been
supplied.
 Medical records (Medical history, physical
examination, operative report, progress notes &
consultations by Physicians.)
 Records of therapies – Social workers, nutritionists,
dietitians or physical therapists

42. Laboratory records and
Health care professionals.

43. 5. d) a. iv. Data Collection
Methods
 The primary methods of data collection
are
◦ I. Observing – Occurs whenever the nurse is
in contact with the client or support persons.
◦ II. Interviewing – is used while taking the
nursing health History
◦ III. Examining – Major method used in the
physical health assessment.

44.  In reality, the nurse uses all three
methods simultaneously when
assessing clients.
 for Eg. During the client interview the
nurse observes, listens, asks
questions, and mentally retains
information to explore in the physical
examination.

45. 5. d) a. iv. I. Observing - Meaning
 is to gather data by using the senses.
 Observation is a conscious, deliberate
skill that is developed through effort &
with an organized approach.
Eg. Using the senses to observe client
data.

46. i. b. Methods of Observation
◦ Vision :- overall appearance (body size ,
general weight, signs of distress or posture
& grooming) discomfort, facial & body
gestures, skin colour & lesions
◦ Smell: - Body or Breath odors.
◦ Hearing: - lung, heart sounds, bowel
sounds, ability to communicate, language
spoken.
◦ Touch :- Skin temperature, moisture,

47. i. c.Aspects of Observation
 1] Noticing the data
 2] Selecting, organizing & interpreting the
data
 Eg : - A nurse who observes that a client’s
face is flushed, must relate that observation
to body temperature, activity, environmental
temperature, and blood pressure.
 Errors can occur in selecting, organizing &
interpreting data.

48.  Nursing observations must be organized so that nothing
significant is missed.
 Most nurses develop a particular sequence for observing
events, usually focusing on the client first.
 For Eg. A nurse walks into a client’s room and observes, in
the following order.
1]Clinical signs of client distress (Eg. pallor or flushing, labored
breathing, and behavior indicating pain or emotional distress)
2] Threats to clients safety, real or anticipated (Eg. a lowered side rail)
3]The presence and functioning of associated equipment (Eg.
Equipment & oxygen)
4] The immediate environment, including the people in it.

49. 5. d) a. iv. II. Interviewing
 An interview is a planned communication
or a conversation with a purpose
 for Eg. to get or give information, identify
problems of mutual concern, evaluate
change, teach
 Eg. for an Interview is nursing Health
history.
 There are 2 approaches in interview

50. Direct Indirect or nondirective
Highly structured & elicits Rapport- building interview
specific informations (understanding between two
or more people)
Nurse establishes purpose of Nurse allows the client to
interview and controls the control the purpose, subject
interview matter and pacing
Clients who responds may
have limited opportunity to
ask question or Discuss
concerns

51. Types of interview
questions
There are 4 types of interview questions
 Closed question
 Open ended question
 Neutral questions
 Leading question

52. Closed question Open ended Neutral questions Leading question
question
1. Used in direct 1. Associated with 1. Is a question the 1. Used in directive
interview, nondirective client can answer interview &
interview without direction or
2. Are restrictive 2. Invite clients to pressure from the 2. Thus directs client
discover & nurse. answer.
3. Generally requires explore, elaborate,
yes of No or short clarify or illustrate Eg.
factual answers their thoughts or 2. Used in non
feelings. directive that
question. a. You’re stressed
4. Often begin with about surgery
3. It specifies only
when, where, who, tomorrow, aren’t
the broad topic to Eg.
what, do, did or you?
be discussed & a. How do you feel
does, or is, are,
invites longer that about that?
was. b. You’ll take medicine
one or two words.
Eg. won’t you?
a. Are you having pain 4. An open ended b. Why do you think
now? question begins you had the
b. What medication did with what or how? operation?
you take? Eg.
a. What brought you to
hospital?
b. How did you feel in
that?

53. Planning the interview and
setting
 Before beginning an interview, the nurse
reviews available information.
Eg. Operative report, information about
the current illness.
 Each interview is influenced by time,
place, seating arrangement or distance,
and language.

54.  Time: -
Nurse need to plan for an interview with hospitalized clients
◦ physically comfortable,
◦ free of pain,
◦ when interruptions by friends, family, and other health
professionals are minimal.
The client should be made to feel comfortable & unhurried.
 Place: - Well lighted, well ventilated, moderate sized room,
free of nurse, movements, interruptions encourages the
communication.
 Seating arrangements: -
 Distance:-

55. Stages of an interview
 Opening or introduction 2 steps
1] establish rapport
2] orientation
 Body or development – closing

56. 5. d) a. iv. III. Examining
 Physical examination or physical
assessment is a systematic data
collection method that uses observation
to detect health problems.
 To conduct examination the nurse uses
techniques of 1) Inspection 2)
auscultation, 3) palpation, 4)
percussion.

57. Inspection

58. Palpation

59. Auscultation

60. Percussion

61.  Inspection: - Process of checking that
things are in the correct condition.
 Auscultation: - Examining the internal
organs by listening to the sounds that they
give out
 Palpation: - Examination of organ by
touches or pressure of the hand over the
part.
 Percussion: - Tapping with the fingers or

62.  The physical examination is carried our
systematically.
 It may be organized according to the
examiner’s preference,
 Head to toe approach (Cephalo caudal approach)
 System wise approach – examine all the body
system
 Review of system approach – examine only
particular area affected

63. b. Organization of data
 Uses a written or computerized format that
organizes assessment data systematically.
 Maslow’s basic needs
 Body system model
 Gordon’s functional health patterns

65. BODY SYSTEM MODEL
1)THE INTEGUMENTARY SYSTEM
2)THE SKELETAL SYSTEM
3)THE MUSCULAR SYSTEM
4)THE NERVOUS SYSTEM
5)THE ENDOCRINE SYSTEM
6)THE CIRCULATORY SYSTEM
7)THE LYMPHATIC SYSTEM
8)THE RESPIRATORY SYSTEM
9)THE DIGESTIVE SYSTEM
10)THE URINARY SYSTEM
11)THE REPRODUCTIVE SYSTEM

66.  Gordon’s Functional Health Patterns:
i. Health perception-health management pattern.
ii. Nutritional-metabolic pattern
iii. Elimination pattern
iv. Activity-exercise pattern
v. Sleep-rest pattern
vi. Cognitive-perceptual pattern
vii. Self-perception-concept pattern
viii. Role-relationship pattern
ix. Sexuality-reproductive pattern
x. Coping-stress tolerance pattern
xi. Value-belief pattern

67. c.Validating Data
 The information gathered during
assessment phase must be complete,
factual, and accurate because the
nursing diagnoses and interventions
are based on this information.
 Validation is double checking or
verifying the data is accurate and

68. Purposes of data validation
1. Ensure that data collection is complete
2. Ensure that objective and subjective data
agree
3. Obtain additional data that may have
been overlooked
4. Avoid jumping to conclusion
5. Differentiate cues and inferences

69.  Cues - subjective and objective data that can be
directly observed by the nurse.
(What client can say, what the nurse can see, hear,
feel, smell or measure)
 Inferences - Nurses interpretation or conclusions
made based on the cues
Example:
1. Red, swollen wound = infected wound
2. Dry skin = dehydrated

70. d. Analyze data
 Compare data against standard and identify
significant cues.
 Standard/norm are generally accepted
measurements, model, pattern:
Ex:
1. Normal vital signs,
2. Standard weight and height,
3. Normal laboratory/diagnostic values,
4. Normal growth and development pattern

71. e. Documenting data
 To complete the assessment phase, the nurse records
client data.
 record in a factual manner
 It includes all data collected about client status.
 Eg. Data in factual manner Wrong manner
 Slice of toast – I Appetite is good”
 Egg - I “normal appetite”
 Juice - 250ml.
 Coffee- 240ml.
- Record subjective data in client’s own words (more
accuracy)