Nursing Dx

FIGURE 1–1 • Diagram of the nursing process. The steps of the nursing process are interrelated, forming a continuous circle of thought and action that is both dynamic and cyclic.

Nursing leaders have identified a process that “combines the most desirable elements of the art of nursing with the most relevant elements of systems theory, using the scientific method.” This nursing process incorporates an interactive/interpersonal approach with a problem-solving and decision-making process that serves as a framework for the delivery of nursing care. 

The concept of nursing process was first introduced in the 1950s as a three-step process of assessment, planning, and evaluation based on the scientific method of observing, measuring, gathering data, and analyzing the findings. Years of study, use, and refinement have led nurses to expand the nursing process to five distinct steps that provide an efficient method of organizing thought processes for clinical decision making, problem-solving, and delivery of higherquality, individualized client care. The nursing process now consists of 

• assessment or the systematic collection of data relating to clients;
• diagnosis/need identification involving the analysis of collected data to identify the client’s needs or problems;
• planning, which is a two-part process of identifying goals and the client’s desired outcomes to address the assessed health and wellness needs along with the selection of appropriate nursing interventions to assist the client in attaining the outcomes;
• implementation or putting the plan of care into action; and 

• evaluation by determining the client’s progress toward attaining the identified outcomes, and the client’s response to and effectiveness of the selected nursing interventions for the purpose of altering the plan as indicated.
Because these five steps are central to nursing actions in any setting, the nursing process is now included in the conceptual framework of nursing curricula and is accepted as part of the legal definition of nursing in the Nurse Practice Acts of most states.
When a client enters the healthcare system, whether as an inpatient, a clinic outpatient, or a home-care client, the nursing process steps are set into motion. The nurse collects data, identifies client needs (nursing diagnoses), establishes goals, creates measurable outcomes, and selects nursing interventions to assist the client in achieving these outcomes and goals. Finally, after the interventions have been implemented, the nurse evaluates the client’s responses and the effectiveness of the plan of care in reaching the desired outcomes and goals to determine whether or not the needs or problems have been resolved and the client is ready to be discharged from the care setting. If the identified needs or problems remain unresolved, further assessment, additional nursing diagnoses, alteration of outcomes and goals, or changes of interventions are required.
Although we use the terms assessment, diagnosis, planning, implementation, and evaluation as separate, progressive steps, in reality they are interrelated. Together these steps form a continuous circle of thought and action, which recycles throughout the client’s contact with the healthcare system. Figure 1–1 depicts a model for visualizing this process. You can see that the nursing process uses the nursing diagnosis (the clinical judgment product of critical thinking). Based on this judgment, nursing interventions are selected and implemented. Figure 1–1 also shows how the progressive steps of the nursing process create an understandable model of both the products and the processes of critical thinking contained within the nursing process. The model graphically emphasizes both the dynamic and cyclic characteristics of the nursing process.