The nursing process is a systematic, patient-centered, goal-oriented
method of caring that provides a framework for nursing practice. Unit III
discusses each of the five steps of the nursing process—assessing, diagnosing, outcome
identification and planning, implementing, and evaluating. It al...
THE NURSING
PROCESS
The nursing process is a systematic, patient-centered, goal-oriented
method of caring that provides a framework for nursing practice. Unit III
discusses each of the five steps of the nursing process—assessing, diagnosing, outcome
identification and planning, implementing, and evaluating. It also describes the blended skills
nurses need to use the process for promoting patient well-being, and concludes with a chap-
ter on documentation, reporting, and conferring.
The steps of the nursing process are not actually separate items but, rather, are parts of a
whole, used to identify needs, to establish priorities of care, to maximize strengths, and to
resolve actual or potential alterations in human responses to health and illness, thereby pro-
moting health to the highest level possible for each patient.
Assessment, the systematic and continuous collection and communication of data,
allows analysis of data to identify problems and strengths of patients. During outcome iden-
tification and planning, the nurse and patient mutually identify expected outcomes and agree
on nursing interventions necessary to meet these outcomes. The nurse implements the plan
of care, adapting it to each individual, and documents nursing actions and patient responses.
After implementation, the nurse and patient evaluate the effectiveness of the plan, based
on achievement of outcomes, and determine if the plan should be continued, modified, or
terminated.
The nursing process is nursing practice in action. Unit III provides the information neces-
sary to begin to apply the nursing process. As blended skills are learned and practiced (both
by students and by nurses), the process becomes an integral component of each nurse–patient
interaction. The outcome is compassionate, comprehensive, and individualized nursing care.
,“ .Basic
. . the
to nursing process is
any philosophy ofeducative and therapeutic
nursing seems to be these when
three nurse and (1)
concepts: patient can come
reverence for
to know
the gift ofand
life;to(2)
respect each
respect for other, as persons
the dignity, who
worth, are alike,and
autonomy, andindividuality
yet different,ofaseach
persons
who
human share in the
being; (3)solution of problems.
resolution ”
to act dynamically in relation to one’s beliefs. ”
HILDEGARD PEPLAU (1909–1999)
ERNESTINE WIEDENBACH • had been
(1900–1996) an active
• a faculty participant
member at YaleinUniversity
ANA and School
NLN, and a leader where
of Nursing, in recognizing the
she developed
significance of interpersonal relationships in psychiatric nursing. Her landmark
her model of nursing from years of experience in various nursing positions book integrated theory into her model at a time
when nursing theory was in its infancy.
, 11 Blended Skills and Critical
Thinking throughout the
Nursing Process
CHARLOTTE HORVATH
Charlotte is a single mothe
r whose
5-year-old daughter will
be
discharged soon. Ms. Hor
vath
learn how to perform wou is to
nd
for her daughter at home. care
H
teaching session thus far. owever, she has missed every planned
ADDIE WARNER
Addie is an elderly African
American woman who had
suffered a cerebrovascular accident
(CVA). She is currently being cared
for in a neurologic step-down unit. The patient frequently uses her call
light and is called “demanding” by the staff.
JERMAINE BYRD
Jermaine is a 58-year-old man
who has just returned to the
medical–surgical unit after under-
going vascular surgery on the
femoral artery. Orders include assessing the distal pulses to ensure
adequate blood flow. However, when assessing the patient, the
posterior tibial pulse is not palpable.
188
, CHAPTER 11 Blended Skills and Critical Thinking throughout the Nursing Process 189
terized their “work” as being independent, evidence-based, or
LEARNING OBJECTIVES creative.
But as society and the healthcare delivery system change,
After completing the chapter, you will be able to
so does nursing. Nurses now work with healthy and ill
accomplish the following:
patients in both private and institutional settings. In addition
1. Describe the historic evolution of the nursing to their role as caregivers, nurses fill specialized roles as care
process. managers/coordinators, teachers, counselors, advocates, and
researchers. Nurses are responsible for a unique dimension
2. Describe the nursing process and each of its five
of healthcare—“the diagnosis and treatment of human
steps.
responses to actual or potential health problems” (American
3. List five characteristics of the nursing process. Nurses Association [ANA], 2003) and, as such, are knowl-
edgeable, competent, and independent professionals who
4. Contrast three approaches to problem solving.
work collaboratively with other healthcare professionals to
5. List three patient benefits and three nursing design and to deliver holistic care. As the role has changed,
benefits of using the nursing process correctly. definitions of nursing have evolved to acknowledge essential
features of professional nursing:
6. Describe how to develop the four blended skills
essential to nursing practice. • Provision of a caring relationship that facilitates health
and healing
7. Use a model of critical thinking when making
• Attention to the range of human experiences and
clinical judgments and decisions.
responses to health and illness within the physical and
8. Identify four habits that assist in the development social environments
of technical skills. • Integration of objective data with knowledge gained from
an appreciation of the patient or group’s subjective expe-
9. Develop a personal plan to develop the
rience
interpersonal skills essential to quality care.
• Application of scientific knowledge to the processes of
10. Explain the relationship between a nurse’s sense of diagnosis and treatment through the use of judgment and
accountability and the patient’s well-being. critical thinking
• Advancement of professional nursing knowledge through
11. Describe the steps in concept mapping care
scholarly inquiry
planning.
• Influence on social and public policy to promote social
12. Identify personal strengths and weaknesses in light justice
of nursing’s essential knowledge and skills.
As the practice of nursing became more complex, nurses
began to study the process of nursing to both understand and
improve the means nurses use to accomplish their aims. (See
KEY TERMS the accompanying Reflective Practice display for an exam-
ple of this process.) This chapter provides an overview of the
assess nursing diagnoses
nursing process and then describes the blended skills needed
concept mapping nursing process to successfully use the nursing process.
critical thinking plan
critical thinking scientific problem
indicators solving THE NURSING PROCESS
decision making standards for critical Historical Perspective
evaluate thinking Since Hall first used the term “nursing process” in 1955,
trial-and-error problem many nurses have struggled to define exactly what constitutes
expected outcomes
solving the “work of nursing” and what makes nurses successful. In
implement the 1960s, nursing theorists began to describe nursing as a
intuitive problem distinct entity among the healthcare professions and also
solving delineated specific steps in a process approach to nursing
practice. In 1967, Yura and Walsh published the first compre-
hensive book on nursing process, in which they described
four steps in the nursing process: assessment, planning, inter-
Traditionally, nurses prided themselves on comforting those vention, and evaluation. They viewed the element of nursing
who were ill and on executing with precision such tasks as diagnosis as the logical conclusion of the assessment phase,
dressing wounds, administering medications, and bathing, whereas Gebbie and Lavin (1974) made nursing diagnosis a
feeding, and ambulating patients. Physicians ordered many separate step in the process. These and other studies led to the
of these tasks, and few nurses in the past would have charac- development of the five-step nursing process commonly used
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