The document discusses the nursing process and its introduction, definition, steps, and importance. It provides a brief history of the development of the nursing process from the 1950s to the present. The key steps discussed in detail include assessment, nursing diagnosis, planning, implementation, and evaluation. The nursing process is presented as a systematic, problem-solving approach that directs nursing activities and provides quality nursing care.

1. BY
PROF . R. BABU
HOD MEDICAL SURGICAL NURSING

2. NURSING PROCESS- INTRODUCTION:
Framework for professional quality Nsg care
Directs activities for
Used in every practice setting

3. 1955-lydia hall termed Nsg process
1953-FRY uesd the term NP , (unpopular)
1959-Johnson devpd
1961-Orlando used NP
1963-widenback further dvpd
1963 THREE STEP NP

4. 1967-Yura & Walsh wrote a book on NP BY 4 STEPS

5. 1973- Eight standards of practice published by ANA
1974-started (NANDA) NORTH AMERICAN NURSING
DIANGNOSIS ASSOCIATION , nursing diagnosis was added in
to nsg process.
1991-ANA made revision of standards & included outcome
identification as a specific parts of the planning phase.
Nursing process –definition
Is a assertive problem solving approach to the identification &
treatment of patient problems

6.  provide care for clients(individualized ,holistic, effective &
efficient manner
Helps to provide professional ,quality of nsg care
Directs nsg activities for health promotion, health protection
And disease prevention
Provides an organizing framework for nurses
By using NP the nurse can focus on unique responses of
patients

7. Nursing Models
All models have 4 core components,
The person,
Their environment,
Health and
Nursing
(but all have different emphasis)

8. The Person
*Body (physical/ biological)
*Activities of daily living
*Genetic makeup
*Gender
*Nature/ Nurture

9. SOCIETY
FAMILY & FRIENDS
WORK
PLAY
EFFECTS OF ILLNESS

10. SPRIT
Belief systems about the meaning of
life, death, hope, suffering,
 it may involve organized religion,
other customs or “New age”
spirituality.

11. ENVIRONMENT
Home , neighbors
Work, social activities,
Town , country,
Political affairs

12. MIND (PSYCOLOGICAL)
Healthy, impaired or damaged
 Intellect
 Attitudes
Effect of illness stress,
fears,
memories
 Emotional support

13. A process is a series of steps/acts that leads to accomplishment
of some goals / purpose
NP is A dynamic & requires creativity for its application
In NP the steps remains same but applications & results will be
different In each settings
NP is designed to be used with clients throughout the life span
& in any clinical setting

15. Steps in assessment

16. Data collection:
1.Primary source- clients
2.Secondary source- others
Types of data:
Subjective data- pt’s feelings, perceptions, concern's
Objective data-observable, measureable data's obtained through
Physical examinations& diagnostic studies

17. Characteristics of data:
1.Descriptive
2.Concise
3.Complete
4.Asst should include, Inferences, statements
5.Always use open ended questions
Types of data collection:
 Structured interview
Semi structured interview

18. 1. Non verbal observation
 Sight-Physical,psychological (and social)
 Touch -Skin temp, hydration, pulse/BP
Sound-Breath wheeze ,strider
 Smell-breath body fluids infections, gangrene
2. Verbal Communication
 Patients/ clients
 Family and friends (Meaningful others)
Nursing colleagues
Medical colleagues
 Other members of multidisciplinary team

19. Written records
 G.P Letter
Transfer letter
 Old notes

20. Why are good communication skills required?
 To establish and maintain a relationship with
patients and their families
To encourage patients to describe all relevant
aspects of their problems
To get and give accurate information
 To use time and opportunity effectively
 To improve patient satisfaction with the care
given
 To improve thrust and cooperation with the care
 To reduce negative emotions and fear

21. Prepare adequately
 Introduce yourself- prepare patient
Use nonverbal communication
 Be courteous
 Use sensitivity, compassion and empathy
 Use focused questions (opened and closed)
 Listen
 Clarify
Summarize what they describe
Make notes
reflect

22. Definition:
It is a clinical judgment about individual, family, (or) community
Responses to actual & potential health problems/life process.
Nursing diagnosis provide the basis for selection of nursing
interventions to achieve outcomes for which the nurse is
accountable
*NANDA

23. Medical diagnosis Nursing diagnosis
Terminology used for clinical Terminology used for a clinical
judgment by the (DR) that identifies judgment by the professional nurse
(or)determines a specific disease, That identifies the clients actual risk,
condition (or)pathological state wellness (or) syndrome responses to
a health state, problem/ condition
CASE (ETIOLOGY ) FOCUSED CARE FOCUSED
FOCUSED ON DISEASE PROCESS FOCUS ON THE HUMAN RESPONSE TO
STIMULAI

24. COMPARISON OF MEDICAL/NURSING DIAGNOSIS
Medical diagnosis Nursing diagnosis
COPD Ineffective breathing pattern
Altered cerebral perfusion
CVA
APPENDECTOMY Pain acute (abdomen)
AMPUTATION DISTURBED BODY IMAGE
DIARRHOEA FLUID VOLUME DEFICIT

25. COMPONENTS OF NURSING DIAGNOSIS
i

26. Cont….
1.THE DIAGNOSTIC LABEL:
 Consists of one (or) more nouns also include adjectives,
that the name of the diagnosis & can be a word or phrase
that describes the pattern of related cues
2.DEFINITION:
It provides a clear description & differentiates one
diagnosis from other similar diagnosis
3.DEFININIG CHARACTERISTICS:
These are the observable cues/inferences that cluster as
manifestations , of an actual (or) potential/ wellness
diagnosis

27. Cont…
4. RISK FACTORS
These are elements that increase the chances of an
Individual, family (or) community being susceptible to a
Disease state, (or) life events that will have an impact on
health
5.RELATED FACTORS
It can precede , be associated with, contribute to, (or)be
Related to nursing diagnoses , in some type of patterned
relationship

28. FORMAT OF NURSING DIAGNOSIS
Two part statement:
 Consists of two components
 1st components is a problem statement (or) diagnostic label
That describes the patients response to an actual/potential
health problems/ wellness condition
 problem + etiology:
1. Feeding self care deficit
( problem )
2. related to decrease strength and endurance
( Etiology )

29. The dignostic lable + etiology are linked with the term
‘'Related to’’
 Ex: disturbed body image (RT)loss of left lower limb
extremity
 Activity intolerance (RT)decreased oxygen carrying
capacity of the cells

30. THREE PART STATEMENT
It consists of problem + Etiology + Defining characteristics
Defining characteristics:
 These are collection of data, that are also known as signs/
symptoms, subjective data, objective data, (or)
Clinical manifestations.
In three part nsg diagnosis format, the 3rd part is joined to the
first two components with the connecting phrase
‘’ AS EVIDENCED BY “

31. 1. Feeding self care deficit
( problem )
2. Related to decrease strength and endurance
( Etiology )
3. As evidenced by inability to maintain fork in hand
from plate to mouth.

32. CATEGORIES OF NSG DIAGNOISES

33. 1.Actual diagnosis:
Are those problems identified by the nurse that are already in
existence
2.Risk diagnosis:
Are identified by the nurse when there is a recognized
vulnerability for the individual human response to a
problem (or) life process, but when, that response has not
yet manifested itself
3.wellness diagnosis:
Identifies the individual (or) aggregate condition (or) state
of being healthy that may be enhanced by deliberate health
promoting activities
One part statement( readiness for enhanced community
coping) ‘’ there is no (R/T) phrase.

34. 4.Syndrome diagnosis - "A clinical judgment describing a
specific cluster of nursing diagnoses that occur together,
and are best addressed together and through similar
interventions." An example of a syndrome diagnosis is:
Approved NANDA Syndrome Diagnoses
•Rape Trauma Syndrome
•Disuse Syndrome
•Post-trauma Syndrome
•Relocation Stress Syndrome
•Impaired Environmental Interpretation Syndrome

35. GUIDELINE TO WRITE NSG DIAGNOSIS
1.The medical diagnosis should not be included in the
Nsg diagnosis
2.The nsg diagnosis statement must be written with the
scope of independent nsg function
3.The nsg diagnosis should not be influenced by personal
bias
4.Phrase the nsg diagnosis in terms of problem not a need
5.Check the client problem precedes the etiology & 1, 2 are
linked by (R/T), not as due to , or , caused by
6.Defining characteristics should follow the etiology & it
should be linked with by the phrase AS MANIFESTED BY

36. 7.Use only the approved NANDA nsg diagnosis for the
problem
8.Always write problem 1st & etiology 2nd
9.Be sure the problem statement indicates what is
unhealthy about the client (or) what the client wants to
10.Use legally defining terms to write nsg diagnosis
11.Avoid using the defining characteristics by medical
diagnosis
12.The diagnostic statement should give direction for nsg
interventions

37. PLANNING

38. PLANNING
Definition –planning:
Planning is the 3rd step of nursing process; it
includes the formulation of guidelines that
establish & proposed course of action in the
resolution of nursing diagnoses, and the
development of the clients plan of care.

39. PLANNING
Purposes of planning;
1.helps to deliver the competent nsg care.
2.helps to maintain /improve health at an
optimal level.
3.acts as framework for basic scientific nsg
practice.

40. Cont…

41. Elements in planning

42. ESTABLISHING PRIORITIES
 After formulating specific nsg diagnosis the nurse establishes
the priority
 Because most clients have more than one nsg diagnosis
 So it is necessary to ranking them in order of importance like
high, medium, or low priority
 High priority possess greatest threat to the clients , wellbeing
 Non life threatening diagnoses are ranked as medium priority
 Diagnosis that are not specifically related to the current illness
& prognosis are considered as low priority
 Use Maslow's hierarchy of needs

43. MASLOW’S HIERARCHY OF NEEDS
I)PHYSIOLOGICAL NEEDS;
A) PHYSICAL:
Personal hygiene
Activity
Sexuality
B) HOMEOSTATIC:
Eating
Drinking
Vital function(oxygenation)
Sleep & rest
elimination

44. II ) SAFTY & SECURITY NEEDS:
Religion & philosophy
Feelings of well being
III) Love & belonging:
Communication
Affection Modesty
Companionship
Dependence

45. IV) self esteem:
*recognition
V ) self actualization

46. Establishing
priority/goals/objectives/outcome
GOALS/OBJECTIVES:
o These are derived from problem statements of the nsg diagnosis
o A nsg goal objective is the desired change in the clients health
status after nsg intervention.
o Realistic goals /objectives give direction to the formation of nsg
intervention & also provide the basis for evaluation
o The goals/objectives must be written in terms of patient
behavior & that must be observable & measurable

47. PROBLEMS GOALS
1.PAIN By the end of evening client will
report pain is absent /
diminished
2. Impaired physical mobility Before discharge, client will
ambulate
Length of half way
independantly

48. PROBLEMS OBJECTIVES
1.Pain Clients pain reduces before
my shift
2. Impaired physical Client will ambulate before
mobility discharge

49. Goals may be short term/long term.
Depending on the client status.
Goals may be broad statement of
outcomes so it is better to use objectives.
While writing nsg care plan, objectives
Are written as the short statements of the expected outcomes.

50. Selecting nursing intervention
When selecting nsg interventions the
Nurse deliberates it out all possible
Intervention to achieve the expected
outcome By using standard care plan .
During planning the nurse reviews clients
needs, priorities& previous experience
to select the best nsg intervention.
As the nurse gains experience this planning process
becomes more efficient & experience based.

51. COMMUNICATING
NSG ORDERS
Nsg interventions are written as nsg orders.
Nsg orders should be clear & concise.
Nsg order communicates with the entire health care team.
Nsg order are signed by the nurse who is prescribing the
order .
Use only standard abbreviations accepted by health care
team.
Always refer the nursing procedure manual for all steps of
routine.

53. IMPLEMENTATION

54. PURPOSE OF IMPLEMENTATION

55. ACTIVITIES OF IMPLEMENTATION
1.ongoing assessment
2. establishing priorities
3. allocation of resources
4.initiation of nursing interventions
5.documentation of interventions & client
. response .

56. ONGOING ASSESSMENT
1.Nsg care plan is based on the
initial assessment data collected
by the nurse & nsg diagnosis
Derived from those data.
2.So ongoing asst is necessary to
validate the relevance of present intervention.
3.Ongoing asst demands attention to verbal/ non verbal cues .
4.It is important in home health care/ extended care settings
because of length of time that requires.

57. ESTABLISHING PRIORITIES
THE PRIORITIES ARE BASED ON :
1.which problem needs most important
by the nurse, client, &family or significant others
2.Activities previously scheduled by other
Departments.
3.Available recourses ,based on change of shift reports.
5.According to PT change of condition.
6.Time management
7. Based on flexibility

58. DELEGATING TASKS

59. Delegation is the process of transferring a selected nsg task
in a situation to an individual who is competent to
perform that specific tasks.
The registered nurses are accountable for appropriate
Delegation & supervision of care .
In general , registered nurses are authorized by law to
provide nsg care to clients directly & supervise & instruct
others to deliver this nsg care.
Decision about delegation are guided by the needs of the
client, the number & type of available personnel.

60. Types of nursing interventions

61. INDEPENDENT NSG INTERVENTION:
These are actions involve carrying out nurse prescribed
orders, written on nsg care plan.
 In this type nurse initiate care with out the direction or
supervision of another health care professional.
The nurses are legally accountable for the assessment they
make & for their nsg responses.
Ex: designing actions for increasing clients knowledge about
nutrition or activities of daily living

62. DEPENDANT NSG INTERVENTION
These are actions carrying out physician prescribed orders.
Ex: administering a medication, implementing a invasive
procedure, changing a dressing & preparing the client for
the diagnostic procedure.
Each dependent nsg intervention requires specified nsg
responsibilities & technical knowledge.
Ex: medication administration

63. INTER DEPENDANT NSG INTERVENTIONS
Interdependent/ collaborative interactions are those
Performed jointly by nurses & other members of the health
care team.
Ex: implementation of hypertension protocol, changing
the drug, iv line diet therapies.

64. PROTOCOLS & STANDING ORDERS
In addition the nsg intervention may be entirely based on
protocols & standing orders.
protocols & standing orders may expand the scope of nsg
practice , in certain clearly defined situations.
Protocols:
These are written plans , details the nsg activities to be
executed in specific situations
 protocols that describe nsg responsibilities when a client
is admitted / discharged from the institution.

65. STANDING ORDERS
A standing order is a written documented
rules, policies, procedures, regulations & orders
for the conduct of client care in various
stipulated clinical settings.
standing orders are approved & signed by the
physician in charge of care before these
implementation.

66. IMPLEMENTATION COMPONENT
1.Reasseing the client
2. Reviewing and modifying the existing nsg care plan
3.Identifying the Ares of assistance
4.Implementing nsg interventions

67. Thank u