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Nursing Process Steps (CRITICAL THINKING)

In this video I am going to walk you through the nursing process step by step.

And be sure to watch the entire video because there is a little change to the nursing process

that you might not know about, and I'll let you know what that is, coming up.

I've also got a free cheat sheet for you to help you rock the nursing process in nursing

school both at clinical, as well on your nursing school exams.

And be sure to subscribe and hit the bell so you never miss out on any other tips and

resources to help you succeed in nursing school.

So, let's do this.

Hey friend, I'm Christina Rafano from nursingschoolofsuccess.com and you are watching the nursing school show,

where we give you the tips and the resources that you need to totally own nursing school

and become the best nurse you can be.

So I have a question for you: have you ever gotten confused over the nursing process,

like what to do when, or even, like, what the heck am I supposed to do just in general?!

Well, you are not alone.

This is exactly how I felt when I started nursing school.

I felt so lost, and it's one of the most common questions that students ask me all the time.

So in this video we are going to cover the nursing process and the exact actual steps

that you are going to follow with every single one of your patients.

So, let's dive in.

So the nursing process is really just a step by step system for what exactly you will do

as a nurse.

And you know how much I love step by step systems, right?

So all you need to do is follow the steps and you will be golden, my friend.

So let's talk about each of the steps of the nursing process, what they are, and then what

you'll do in each step.

So there is a handy dandy mnemonic for the nursing process, and mnemonics are awesome,

right?

You may or may not have heard it before: it's called ADPIE.

This stands for assessment, diagnosis, planning, implementation, and evaluation.

And there's one small change that some nursing programs use, and I'll let you know exactly

what that is when we get there, so be sure to watch out for that.

So let's walk through each of these steps of the nursing process.

So now, the first step is the A in ADPIE, which is assessment.

And assessment is by far the number one most important thing you will ever do as a nurse.

This is really where nurses shine.

And knowing how to assess a patient really well is what's going to set you apart.

Anyone can give an injection, or start an IV, or give meds.

But it's your skills with the nursing assessment that will really help you stand out from the

crowd and put you in the forefront of your nursing school class.

So what exactly is the nursing assessment?

Well, the nursing assessment really has 2 main components.

The first, is collecting data (meaning taking vital signs, getting the patient's history,

asking them questions about their lifestyle, and performing a head to toe assessment or

a focused nursing assessment).

And the second one is critical thinking.

So as you're performing the nursing assessment, so you're taking vital signs, asking the patient

questions, and performing your head to toe assessment, you are constantly thinking about

what could be going on with your patient and what you need to assess for further.

So this is the critical thinking piece in nursing.

You're always on your game, noticing slight changes in the patient's condition, how they

respond to questions, and being aware of just if something just isn't right, or feels off.

Let's talk about the first component of collecting data: You'll need to assess their vital signs,

complete your head to toe assessment, and ask about their patient history, of course.

But, you'll also want to ask questions about their day to day activities, their spirituality,

their psychological health, their relationships with other people, their major life stressors,

things like that.

So the nursing assessment actually goes way deeper, way beyond just performing a standard

head to toe assessment on your patient.

You are actually asking a lot of personal questions too so that you can take care of

them better and provide better care.

Now, let's talk about the critical thinking piece of the nursing assessment.

You will always, always be thinking about what the underlying problems is, what's going

on with them, and noticing if you need to assess a certain area further.

So for example, let's say if you're taking a cardiac patient, and you notice on their

heart monitor that their heart rhythm is going a little crazy.

So, you run into their room, but when you get there, they're talking to you, they're

moving around, and you're going to shock them right away to get their heart back into a

normal rhythm.

No!

You're not going to do that.

You're going to say, "Hmmm...well, they're moving around a lot, and I think I'll have

him sit still for a while and see what his heart is really doing."

So that is that critical thinking piece.

Now that's an extreme example but you get the point.

And here's a BONUS TIP for you when it comes to the nursing assessment: always, always,

always assess your patient and not the monitors.

If your patient is alert, and oriented and talking to you and moving around, don't just

call a code because the cardiac monitor was telling you that a code was necessary.

No.

Use your awesome critical thinking skills, my friend, and assess your patient.

Look at your patient, not the monitors.

So in the assessment step of the nursing process, or the A in ADPIE, you are going to be asking

your patient questions, doing your head to toe assessment, and using your awesome critical

thinking skills to get an idea of what actually might be going on with them, and what you

need to assess for further.

So now let's talk about the diagnosis step of the nursing process, the D in ADPIE.

So when you hear diagnosis for the first time, you probably would be thinking about a medical

diagnoses.

But this is not the case in nursing.

So the nursing diagnosis is not a medical diagnosis.

The nursing diagnosis revolves around the patient's response to what is happening with

them.

Hear that right, the patient's response.

So, for example, a nursing diagnosis is not a medical diagnosis such as Asthma.

But, if your patient with asthma is really restless, nervous or anxious, the nursing

diagnosis could be something like "anxiety" because that is the patient's response to

their asthma.

Does that make sense?

So let's take another example.

If you are taking care of a patient who had a stroke and maybe can't use the left side

of their body, you may write a nursing diagnosis of "impaired physical mobility" or "impaired

swallowing" depending on their situation.

Because those are the patient's responses to their stroke, but it's not the medical

diagnosis of the stroke itself.

I hope that makes sense.

So, the D in ADPIE, or the diagnosis step of the nursing process is not a medical diagnosis,

it is a nursing diagnosis, which is the patient's response to what is going on with them.

Now, it's important to note that nursing diagnoses are actually standardized.

There is an organization called the North American Nursing Diagnosis Association (or

NANDA-International, or NANDA-I for short).

And they, actually, have made a whole list of the standardized nursing diagnoses for

you can use.

This actually makes it so, so easier for you, because all you need to do is choose from

that list, because it's standardized.

So, most of your nursing textbooks will have the list of the NANDA-I nursing diagnoses.

So you can check all of them out there.

Now let's move on to the next step of the nursing process.

So you're expecting it to be P right?

Well, we'll have that little change I talked about earlier right here.

So, some nursing schools actually put an O in first, making it ADOPIE (A-D-O-P-I-E).

And the O in ADOPIE stands for outcome identification.

Now, outcome Identification in the nursing process means that you decide what it looks

like when the patient actually meets their goal.

It's basically goal setting.

So, so far, you've assessed your patient, you've come up with a nursing diagnosis, and

now it's time to create some goals for them.

And these are the outcomes that you hope to see, the goals that your patient hopes that

they will meet.

And you'll also describe exactly what it looks like when they meet that goal, or that outcome.

So let's use our stroke example from before.

If we have a nursing diagnosis of, "impaired swallowing," you might work with your patient

to create a goal, or an outcome, of "The patient will show no signs or symptoms of aspiration

after eating," or, uh, "The patient will demonstrate techniques to prevent aspiration during meals."

Those are both really good outcomes or goals to that patient.

So, that is a little change of the nursing process that some schools use, and yours might.

So it's that O in ADOPIE, which stands for outcome identification.

So you are just identifying the outcome or the goal for your patient, the goals that

your patient wants to achieve.

And now we'll talk about the next step in the nursing process, which is the P in ADPIE,

which stands for planning.

And Planning just means that you are figuring out the game plan of how your patient is going

to achieve their goals.

So these are really the interventions that you will do to make those goals happen.

So let's keep with our stoke example from before for our patient with impaired swallowing.

So, if we set a patient goal of, "the patient will demonstrate techniques to prevent aspiration

during meals," that's a pretty good goal, the interventions that you can plan for and

do are, maybe, working with speech language pathology to figure out the best swallowing

technique for them, the nurse can encourage them to stick with those techniques, and the

nurse could also continue to educate them on those swallowing techniques.

So all of those interventions would be good for the nurse to do.

And all of this is part of the P in ADPIE, of the planning step of the nursing process,

planning out exactly what you will do as the nurse to help the patient reach their goals.

Now, the next step of the nursing process is implementation, which is the I in ADPIE.

This is actually where you do the planned interventions that you planned in the previous

step.

So you have assessed your patient, you have come up with an awesome nursing diagnosis

for them, you've worked with them on setting outcomes or goals, and you have planned what

you are going to do about it to help make those goals happen.

And now, it's all about the action, my friend.

So in the implementation phase, you are simply doing the interventions that you came up with

in the planning phase.

So, in our example, you would set up an evaluation with speech language pathology, be consistently

encouraging your patient to use those swallowing techniques, and you'll be educating them on

how to do them properly.

So, that is the implementation phase of the nursing process, it's all about making those

interventions happen.

And finally, the last step of the nursing process is evaluation, so E in ADPIE, which

stands for evaluation, where you evaluate if the patient met their goals or not, and

what needs to be changed in order to help them meet their goals, or what new goals maybe

should be created.

This is basically an assessment all over again.

You're always evaluating your patient's progress, where they are in their recovery journey,

and what needs to be changed in the previous steps to help them meet their goals.

So the last step of the nursing process is evaluation, where you are really just reassessing

your patient to make sure that they're meeting their goals, they're making progress toward

their goals, and see if anything needs to be changed or not.

And those are the steps of the nursing process, ADPIE: assessment, diagnosis, planning, implementation

and evaluation.

Now, be sure to grab the free cheat sheet that we've got for you to help you rock the

nursing process and your nursing assessments.

You can find that link in the description below this video.

And, of course, if you liked this video, let me know in the comments below, hit the like

button, share it with your friends, and of course, be sure to subscribe and hit the bell

so you never miss a video.

Thanks for being a nursing school rock star, now go become the nurse that God created only

YOU to be.

And I will catch you next time on the nursing school show.

Take care.