Discuss how the five phases of the nursing process may be used to provide effective nursing care (1500-2000)
The nurse as a health care provider meets the total needs of the patient and this need to be done in an attentive and cautious way as there is life involved. Nursing is concerned with the psychological, spiritual, social and physical aspect of the person rather than only on the patient’s medical condition. Critical thinking alone is not enough for solving problems. Critical thinking needs to be combined with scientific methods to identify patient’s problems and provide care in an effective way. This structure of thinking and acting is called the nursing process.
The nursing process plan is an important aid in the hospitalization of patients. It is a systematic, client oriented not task centred which enables the nurse to identify the client care problems. The effective use of the nursing process helps the nurse to determine not only existing problems but also problems that might arise in the future. Being able to assume problems may prevent pain and complications to the client. The nursing process consists of five interrelated phases – assessment, diagnosis, planning, implementation and evaluation. Each of the five steps depends on the efficiency of the previous steps. In each step of the nursing process both the nurse and the patient need to work together as partners. The nursing process is also a continuous process because health conditions can change from time to time. The nurse must frequently reassess, implement, insert new interventions and revaluate the overall process. The nursing process has no specific periods, it can last for days, months or years, and all this depends on the patient’s current status. All steps of the nursing process rely upon complete and authentic information gained and given about the client.
The nursing process begins as soon as a relationship forms between the patient and the nurse. This nurse-client relationship will help and also determine part of the end results.
Assessment begins by gaining data regarding the patient. Data can be collected from a variety of sources. The client is the primary source which can share personal perceptions and feelings about health and illness. During the assessing process the nurse and the patient will eventually start building a sense of trust between them. It is the nurse duty to make the patient comfortable enough to talk and give information; this will help the nurse to identify more quickly the patient strengths and weaknesses. Secondary sources are utilizing when additional information is required to clarify data and when the patient is unable to provide information. However, they include the patient’s family or individuals present in the patient’s environment. When data is given by secondary sources it is also important for the nurse to avoid being defensive as this may cause both the client and relatives to avoid being honest and open. The nurse communication must make the patient and family feel free to share their comments and also ask some questions, after all this aids for a better plan of care. The nurse while gaining information from secondary sources should carefully consider the patient’s right to confidentiality.
Interviewing, observation and physical examination are three major methods that are used to gather information during nursing assessment. By interviewing the patient the nurse can acquire specific information and naturally it facilitates nurse-patient relationship. The nonverbal components of a nurse-patient interaction frequently transmit a message more effectively than the actual spoken words. The patient’s facial expression however also reveals important information. On the other hand observation involves the use of senses to acquire information and this mostly requires practice from the nurse. The focus of physical examination is the diagnosis of the disease. Both objective and subjective data are used while assessing the patient. Objective data consist of observational attitudes towards the patient’s behaviour. Subjective data is gathered when the nurse while interviewing the patient obtain data about his/her feelings.
After the assessing part, documentation of data needs to be done. The purpose of documentation is to establish communication amongst the members of the health team. Documentation also tracks the patient progression and regression. Assessment is a continues activity that begins at the time of admission and continue during patient contact.
After the nurse has collected and prioritized the patient data, diagnosis begins. The North American Nursing Diagnosis Association (NANDA) which operates the official list of nursing diagnostics states that nursing diagnosis are “ a professional judgment based on the application of clinical knowledge which determined potential or actual experiences and responses to health problems and life processes”. Through nursing diagnosis the nurse can determine actual and potential health problems. Existing needs will always take the priority upon potential problems not because they are not important but the existing ones would need to be tackled first to try to avoid potential ones. In the diagnosing step, the nurse analyzes data gathered from the nursing assessment. These data help the nurse to identify patient strengths and health problems. In this phase data are processed, classified, interpreted, and validated. Classification allows the nurse to manage the large volume of data. Placing data into categories also helps the nurse to identify missing data that require for more discussion. Interpretation leads the nurse to recognize the patients’ patterns and trends. While through validation the nurse is able to verify the accuracy of data. Errors in the diagnostic process such as inaccurate interpretation of data, incomplete data and lack of knowledge or experience can result in nursing diagnostic statements that are not suitable for the patient. Diagnosis will help the nurse to report the findings to other health care professions and work collaboratively with them to resolve the patient problem. We should be aware about the difference occurring between nursing diagnosis and medical diagnosis. While the nursing diagnosis identifies responses to health and illness medical diagnosis focuses more on curing.
After the nurse collects patient data and identifies patient strengths and health problems, it is time to plan for nursing action. The nurse here can debate with a specialist to choose an adequate type of plan of care to a particular patient. During planning the nurse needs to work hand in hand with the patient and family to prioritize the nursing diagnosis. Educating the patient and answering questions about the patients’ doubts is really useful in this phase as this gives a clear image on what the patient needs are to build his/her outcomes. Prioritizing takes place by identifying patient goals and expected outcomes, identify nursing interventions that may help the patient to achieve his/her goals, and communicate the plan of care. If an outcome is nursed-focused rather than patient-centred it is incorrectly done. If a patient is not willing enough to achieve certain goals and outcomes than the plan of care would be waste of time. The inclusion of the patient as and active participant in the plan of care will help to facilitate the achievement of the outcomes. Patient’s refusal to participate in the plan of care may result to a failure in validation. The nurse, patient and family need to work together to make the goals valuable and lead to a worthwhile plan of care. The initial planning is the initial assessment as soon as the patient admission and this may change several times according to the patient new diagnosis and goals. Ongoing planning is the assessment done by all the nurses who work with the client throughout the time a patient is admitted to hospital. Discharge planning is the plan of care after the patient is discharged from hospital.
The implementation phase begins after the nursing care plan has been developed. Here plan of care is put into action to see how effective it is. The purpose of implementation is to assist the patient in achieving desired health goals: prevent disease and illness, restore health and facilitate coping with altered functioning. It is important for the nurse to assess the patient periodically so it will be easy for the nurse to establish whether interventions are being effective. Again when implementing nursing care it is important to work in partnership with the patient and family. Before implementing nursing action, the nurse should reassess the patient again to make sure whether the action is still needed. It is very typical that changes occur within the nursing actions due to health changes which may be enhanced or deteriorated. After all it is of great importance to face the patient about his/her health situation caringly, he/she has right to know what he/she is experiencing. Documentation is really important in this phase both for the nurse and for the patient. The nurse through documentation can evaluate and examine the patient’s status while the patient can by him/herself analyze his/her own health advancement and where he/she can improve more to reach goals. After documentation is done the nurse should consult colleagues to see if other approaches might be more successful.
The process of evaluation which is ongoing happens as soon as all the nursing intervention actions occur. Through evaluation the nurse in relation with the patient determine whether the goals/outcomes stated in the plan of care have been met, partially met or not met. Effectiveness of care is determined through this process in which new modification can be introduced. Based on the patient’s responses to the plan of care and achievement the nurse can decide whether to terminate, if there are difficulties in achieving outcomes or continue the plan of care if more time is needed to achieve goals. The purpose of evaluation is to determine the overall patient’s progress, lack of progress and the effectiveness of nursing care in helping patient’s achieve their expected outcomes/goals. Evaluation can be conducted at the end of the nursing process and this is done by comparing the patient’s health status with the outcomes defined in the plan of care. If evaluation reveals that the patient has made little or no progress towards goals/outcomes stated in the plan of care the nurse needs to revaluate each previous step. If the outcome was achieved by the patient then the care plan can be revised again without the need to add more outcomes in the nursing plan. An effective evaluation can result from the nurse’s accurate communication with the patient and good observation skills throughout the ongoing process. Evaluation can give a feedback; this feedback is judging the nurse whether being a good care giver or what could be arranged next time to be a better one.
When the nursing process is used effectively it promotes many advantages both towards the nurse and patient. From the nurse’s point of view, the nursing process enables you to determine if your nursing care helped the client. The nursing process also helps the nurse to avoid errors and inadequacy in the plan of care. The nurse by making use of the nursing process can improve communication with the rest of the health care professions and patients. On the other hand, the client is an active participant, knowing well his/her roles in his/her health status. Therefore, the patient is given a sense of responsibility. When the nursing process is delivered in a proper way, it works efficiently leading to satisfying results. This is the reason why nurses are encouraged to make use of this process as much as possible. Sometimes it is difficult to manage to implement the nursing process well to each patient. Often wards are too chaotic having opposing patients or being short of staff and it is difficult for a nurse to give a lot of attention on each patient. Nurses are human and as humans they are not perfect, although they try to give their best in patient’s care and needs. After all their dedicated work, nurses get back a huge sense of satisfaction when seeing that they were part of great difference to others.