History of The Nursing Process

• The nursing process is a systematic method for nurses to identify healthcare needs.
• It can be used on both healthy and sick individuals.
• It aims to provide individual care.

History of the Nursing Process

• The concept was first used in 1955 by Lydia Hall, named the "Nursing Process System".
• Dorothy Johnson (1959), Idea Jean Orlanda (1961), and Ernestine Wiedenbach (1963) handled the nursing process in three stages.
• Yura and Walsh (1967), Kartz (1979), McFarlene and Castledine (1982) defined the nursing process stages as four steps.
• In 1973, Kritina Gebbie and Mary Am Lavin focused on nursing diagnosis.
• In 1974, after the first meeting of the North American Nursing Diagnosis Association (NANDA), Gebbie and Lavin added nursing diagnosis to the process.
• In 1982, NANDA created the "Nursing Diagnosis Terminology".
• In 1992, NANDA began to represent international participation, taking the name "international".
• The nursing process is used in every branch of nursing.

Features of the Nursing Process

• It is universal and used in every health institution for all age groups.
• The process is cyclical, continuous, and dynamic.
• Is patient-centered.
• Ensures scientifically planned and systematic care.
• Provides individual and systematic care evaluation.
• Increases critical thinking, decision-making, and problem-solving abilities in nurses.
• Improves nurses' interpersonal, technical, and intellectual skills.

Purpose of the Nursing Process

• To identify the individual's health needs.
• To determine the individual's priorities.
• To determine the goals of care.
• To identify and implement nursing interventions.
• To evaluate the effectiveness of nursing care.

The Nursing Process

• There are 5 steps in the nursing process:
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

Assessment

• It involves collecting, organizing, validating, and documenting data.
• There are two types of data:
  • Subjective: Data expressed verbally by the patient and their family (e.g., "I'm getting short of breath").
  • Objective: Data collected through physical assessment, diagnostic procedures, and laboratory results (e.g., blood pressure 90/50 mmHg).

Data Collection Method

• Observation.
• Interview.
• Physics Assessment:
  • Inspection (observation).
  • Auscultation (hearing).
  • Palpation (manual examination).
  • Percussion (hitting with fingers).
  • Olfaxation (by smelling).
• Data source:
  • Healthy/sick individual
  • Family Member
  • Support People
  • Patient records
  • Other health professionals
  • Diagnosis and laboratory results
  • Previous records

Organizing Data

• Written or computerized recording formats are used to organize data.
• Data is collected and recorded with the data collection form.

Validating and Documenting Data

• The data collected must be complete, real, and correct.
• Data records must be accurate, timely, and include all information regarding the patient's health status.
• Data should be recorded realistically and without interpretation by the nurse.

Diagnosis

• Nursing diagnosis describes the patient’s actual and potential response to a health problem.
• The nurse analyzes diagnostic data to determine the nursing diagnosis (ANA 1991).

Types of Nursing Diagnosis

• Actual (problem-focused): A diagnosis related to a patient's problem with signs and symptoms (e.g., ineffective breathing pattern).
• Risk (potential): There is no problem now, but one could develop if no action is taken (e.g., risk of impaired skin integrity due to pelvic fracture).
• Wellness/health promotion: Used to identify how to improve a patient's health (e.g., possibility/potential for parental role development).

Nursing Diagnosis Component

• Identification of the problem.
• Determination of etiology (cause of the problem/related factors).
• Identification of symptoms (signs-symptom/descriptive feature).
• There are no signs or symptoms in risk diagnoses.

Documentation of Nursing Diagnosis

• The nursing diagnosis is listed, and the order of priority is determined in the patient care plan.
• The actual diagnoses are handled first. Then the risk diagnoses should be handled.
• It is important to prioritize nursing diagnoses, like ineffective breathing patterns.

Planning

• Conscious and systematic phase of the nursing process. It includes decision-making and problem-solving.
• Necessary interventions are determined to prevent, reduce, or eliminate the patient's health problems.

Planning Process

• Determination of priorities. Actions that need to be taken urgently.
• Determining the goals/desired outcomes of patient care.
• Selection of initiatives.
• Writing the care plan.

Implementation

• This phase carries out the care plan to achieve the specified goal.
• Known as the delivery of care.
• Providing care safely and effectively depends on professional knowledge, experience, and the ability to establish positive interpersonal relationships.
• All applications made are recorded.

Evaluating

• This the most important stage of the nursing process.
• It checks if the goals were reached.
• If not, the problem is handled again, and new interventions are planned.
• In cases where goals cannot be achieved, possible reasons include:
  • Lack of data.
  • Inappropriate diagnosis.
  • Unrealistic goals.
  • Wrong method choice.
  • Unsuitable interventions.
  • Incomplete implementation.
  • Unexpected changes in the patient's condition.
• The nursing process begins again from the first step.