analysis step of the nursing process

The Nursing Process: A Comprehensive Guide

In 1958, Ida Jean Orlando began developing the nursing process still evident in nursing care today. According to Orlando’s theory, the patient’s behavior sets the nursing process in motion. Through the nurse ‘s knowledge to analyze and diagnose the behavior to determine the patient’s needs.

Application of the fundamental principles of critical thinking , client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EBP) recommendations, and nursing intuition, the nursing process functions as a systematic guide to client-centered care with five subsequent steps. These are assessment , diagnosis, planning, implementation, and evaluation ( ADPIE ).

Table of Contents

What is the nursing process.

• What is the purpose of the nursing process? 

Characteristics of the nursing process

Nursing process steps, collecting data, objective data or signs, subjective data or symptoms, verbal data, nonverbal data, primary source, secondary source, tertiary source, health interview, physical examination, observation, validating data, documenting data.

• 2. Diagnosis: “What is the problem?” 

Initial Planning

Ongoing planning, discharge planning, developing a nursing care plan, behavioral nursing interventions, community nursing interventions, family nursing interventions, health system nursing interventions, physiological nursing interventions, safety nursing interventions, skills used in implementing nursing care, 1. reassessing the client, 2. determining the nurse’s need for assistance, nursing intervention categories, independent nursing interventions, dependent nursing interventions, interdependent nursing interventions, 4. supervising the delegated care, 5. documenting nursing activities, 1. collecting data, 2. comparing data with desired outcomes, 3. analyzing client’s response relating to nursing activities, 4. identifying factors contributing to success or failure, 5. continuing, modifying, or terminating the nursing care plan, 6. discharge planning.

The nursing process is defined as a systematic, rational method of planning that guides all nursing actions in delivering holistic and patient-focused care. The nursing process is a form of scientific reasoning and requires the nurse’s critical thinking to provide the best care possible to the client.

What is the purpose of the nursing process?

The following are the purposes of the nursing process:

• To identify the client’s health status and actual or potential health care problems or needs (through assessment).
• To establish plans to meet the identified needs.
• To deliver specific nursing interventions to meet those needs.
• To apply the best available caregiving evidence and promote human functions and responses to health and illness (ANA, 2010).
• To protect nurses against legal problems related to nursing care when the standards of the nursing process are followed correctly.
• To help the nurse perform in a systematically organized way their practice.
• To establish a database about the client’s health status, health concerns, response to illness, and the ability to manage health care needs.

The following are the unique characteristics of the nursing process: 

• Patient-centered . The unique approach of the nursing process requires care respectful of and responsive to the individual patient’s needs, preferences, and values. The nurse functions as a patient advocate by keeping the patient’s right to practice informed decision-making and maintaining patient-centered engagement in the health care setting.
• Interpersonal . The nursing process provides the basis for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing due to the interaction. It involves the interaction between the nurse and the patient with a common goal.
• Collaborative . The nursing process functions effectively in nursing and inter-professional teams, promoting open communication, mutual respect, and shared decision-making to achieve quality patient care .
• Dynamic and cyclical .The nursing process is a dynamic, cyclical process in which each phase interacts with and is influenced by the other phases.
• Requires critical thinking . The use of the nursing process requires critical thinking which is a vital skill required for nurses in identifying client problems and implementing interventions to promote effective care outcomes.

The nursing process consists of five steps: assessment, diagnosis, planning, implementation, and evaluation . The acronym ADPIE is an easy way to remember the components of the nursing process. Nurses need to learn how to apply the process step-by-step. However, as critical thinking develops through experience, they learn how to move back and forth among the steps of the nursing process.

The steps of the nursing process are not separate entities but overlapping, continuing subprocesses. Apart from understanding nursing diagnoses and their definitions, the nurse promotes awareness of defining characteristics and behaviors of the diagnoses, related factors to the selected nursing diagnoses, and the interventions suited for treating the diagnoses.

The steps of the nursing process are detailed below:

1. Assessment: “What data is collected?”

The first phase of the nursing process is assessment . It involves collecting, organizing, validating, and documenting the clients’ health status. This data can be obtained in a variety of ways. Usually, when the nurse first encounters a patient, the nurse is expected to assess to identify the patient’s health problems as well as the physiological, psychological, and emotional state and to establish a database about the client’s response to health concerns or illness and the ability to manage health care needs. Critical thinking skills are essential to the assessment, thus requiring concept-based curriculum changes.

Data collection is the process of gathering information regarding a client’s health status. The process must be systematic and continuous in collecting data to prevent the omission of important information concerning the client.

The best way to collect data is through head-to-toe assessment. Learn more about it at our guide: Head to Toe Assessment: Complete Physical Assessment Guide

Types of Data

Data collected about a client generally falls into objective or subjective categories, but data can also be verbal and nonverbal. 

Objective data are overt, measurable, tangible data collected via the senses, such as sight, touch , smell , or hearing , and compared to an accepted standard, such as vital signs, intake and output , height and weight, body temperature, pulse, and respiratory rates, blood pressure , vomiting , distended abdomen, presence of edema , lung sounds, crying, skin color, and presence of diaphoresis.

Subjective data involve covert information, such as feelings, perceptions, thoughts, sensations, or concerns that are shared by the patient and can be verified only by the patient, such as nausea , pain , numbness, pruritus, attitudes, beliefs, values, and perceptions of the health concern and life events.

Verbal data are spoken or written data such as statements made by the client or by a secondary source. Verbal data requires the listening skills of the nurse to assess difficulties such as slurring, tone of voice, assertiveness, anxiety , difficulty in finding the desired word, and flight of ideas.

Nonverbal data are observable behavior transmitting a message without words, such as the patient’s body language, general appearance , facial expressions, gestures, eye contact, proxemics (distance), body language, touch, posture, clothing. Nonverbal data obtained can sometimes be more powerful than verbal data, as the client’s body language may not be congruent with what they really think or feel. Obtaining and analyzing nonverbal data can help reinforce other forms of data and understand what the patient really feels.

Sources of Data

Sources of data can be primary, secondary, and tertiary . The client is the primary source of data, while family members , support persons, records and reports, other health professionals, laboratory and diagnostics fall under secondary sources.

The client is the only primary source of data and the only one who can provide subjective data. Anything the client says or reports to the members of the healthcare team is considered primary.

A source is considered secondary data if it is provided from someone else other than the client but within the client’s frame of reference. Information provided by the client’s family or significant others are considered secondary sources of data if the client cannot speak for themselves, is lacking facts and understanding, or is a child. Additionally, the client’s records and assessment data from other nurses or other members of the healthcare team are considered secondary sources of data.

Sources from outside the client’s frame of reference are considered tertiary sources of data . Examples of tertiary data include information from textbooks, medical and nursing journals, drug handbooks, surveys, and policy and procedural manuals.

Methods of Data Collection

The main methods used to collect data are health interviews, physical examination, and observation.

The most common approach to gathering important information is through an interview. An interview is an intended communication or a conversation with a purpose, for example, to obtain or provide information, identify problems of mutual concern, evaluate change, teach, provide support, or provide counseling or therapy. One example of the interview is the nursing health history , which is a part of the nursing admission assessment. Patient interaction is generally the heaviest during the assessment phase of the nursing process so rapport must be established during this step.

Aside from conducting interviews, nurses will perform physical examinations, referencing a patient’s health history, obtaining a patient’s family history, and general observation can also be used to gather assessment data. Establishing a good physical assessment would, later on, provide a more accurate diagnosis, planning, and better interventions and evaluation .

Observation is an assessment tool that depends on the use of the five senses (sight, touch, hearing, smell, and taste ) to learn information about the client. This information relates to characteristics of the client’s appearance, functioning, primary relationships, and environment. Although nurses observe mainly through sight, most of the senses are engaged during careful observations such as smelling foul odors, hearing or auscultating lung and heart sounds and feeling the pulse rate and other palpable skin deformations.

Validation is the process of verifying the data to ensure that it is accurate and factual. One way to validate observations is through “double-checking,” and it allows the nurse to complete the following tasks:

• Ensures that assessment information is double-checked, verified, and complete. For example, during routine assessment, the nurse obtains a reading of 210/96 mm Hg of a client with no history of hypertension . To validate the data, the nurse should retake the blood pressure and if necessary, use another equipment to confirm the measurement or ask someone else to perform the assessment.
• Ensure that objective and related subjective data are valid and accurate. For example, the client’s perceptions of “feeling hot” need to be compared with the measurement of the body temperature.
• Ensure that the nurse does not come to a conclusion without adequate data to support the conclusion. A nurse assumes tiny purple or bluish-black swollen areas under the tongue of an older adult client to be abnormal until reading about physical changes of aging.
• Ensure that any ambiguous or vague statements are clarified. For example, a 86-year-old female client who is not a native English speaker says that “I am in pain on and off for 4 weeks,” would require verification for clarity from the nurse by asking “Can you describe what your pain is like? What do you mean by on and off?”
• Acquire additional details that may have been overlooked. For example, the nurse is asking a 32-year-old client if he is allergic to any prescription or non-prescription medications. And what would happen if he takes these medications.
• Distinguish between cues and inferences. Cues are subjective or objective data that can be directly observed by the nurse; that is, what the client says or what the nurse can see, hear, feel, smell, or measure. On the other hand, inferences are the nurse’s interpretation or conclusions made based on the cues. For example, the nurse observes the cues that the incision is red, hot, and swollen and makes an inference that the incision is infected.

Once all the information has been collected, data can be recorded and sorted. Excellent record-keeping is fundamental so that all the data gathered is documented and explained in a way that is accessible to the whole health care team and can be referenced during evaluation. 

2. Diagnosis: “What is the problem?”

The second step of the nursing process is the nursing diagnosis . The nurse will analyze all the gathered information and diagnose the client’s condition and needs. Diagnosing involves analyzing data, identifying health problems, risks, and strengths, and formulating diagnostic statements about a patient’s potential or actual health problem. More than one diagnosis is sometimes made for a single patient. Formulating a nursing diagnosis by employing clinical judgment assists in the planning and implementation of patient care .

The types, components, processes, examples, and writing nursing diagnosis are discussed more in detail here “ Nursing Diagnosis Guide: All You Need To Know To Master Diagnosing ”

3. Planning: “How to manage the problem?”

Planning is the third step of the nursing process. It provides direction for nursing interventions . When the nurse, any supervising medical staff, and the patient agree on the diagnosis, the nurse will plan a course of treatment that takes into account short and long-term goals. Each problem is committed to a clear, measurable goal for the expected beneficial outcome. 

The planning phase is where goals and outcomes are formulated that directly impact patient care based on evidence-based practice (EBP) guidelines. These patient-specific goals and the attainment of such assist in ensuring a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide a course of direction for personalized care tailored to an individual’s unique needs. Overall condition and comorbid conditions play a role in the construction of a care plan. Care plans enhance communication, documentation, reimbursement , and continuity of care across the healthcare continuum.

Types of Planning

Planning starts with the first client contact and resumes until the nurse-client relationship ends, preferably when the client is discharged from the health care facility.

Initial planning is done by the nurse who conducts the admission assessment. Usually, the same nurse would be the one to create the initial comprehensive plan of care.

Ongoing planning is done by all the nurses who work with the client. As a nurse obtain new information and evaluate the client’s responses to care, they can individualize the initial care plan further. An ongoing care plan also occurs at the beginning of a shift. Ongoing planning allows the nurse to:

• determine if the client’s health status has changed
• set priorities for the client during the shift
• decide which problem to focus on during the shift
• coordinate with nurses to ensure that more than one problem can be addressed at each client contact

Discharge planning is the process of anticipating and planning for needs after discharge. To provide continuity of care, nurses need to accomplish the following:

• Start discharge planning for all clients when they are admitted to any health care setting.
• Involve the client and the client’s family or support persons in the planning process.
• Collaborate with other health care professionals as needed to ensure that biopsychosocial, cultural, and spiritual needs are met.

A nursing care plan (NCP) is a formal process that correctly identifies existing needs and recognizes potential needs or risks. Care plans provide communication among nurses, their patients, and other healthcare providers to achieve health care outcomes. Without the nursing care planning process, the quality and consistency of patient care would be lost.

The planning step of the nursing process is discussed in detail in Nursing Care Plans (NCP): Ultimate Guide and Database .

4. Implementation: “Putting the plan into action!”

The implementation phase of the nursing process is when the nurse puts the treatment plan into effect. It involves action or doing and the actual carrying out of nursing interventions outlined in the plan of care. This typically begins with the medical staff conducting any needed medical interventions. 

Interventions should be specific to each patient and focus on achievable outcomes. Actions associated with a nursing care plan include monitoring the patient for signs of change or improvement, directly caring for the patient or conducting important medical tasks such as medication administration, educating and guiding the patient about further health management, and referring or contacting the patient for a follow-up.

A taxonomy of nursing interventions referred to as the Nursing Interventions Classification (NIC) taxonomy, was developed by the Iowa Intervention Project. The nurse can look up a client’s nursing diagnosis to see which nursing interventions are recommended. 

Nursing Interventions Classification (NIC) System

There are more than 550 nursing intervention labels that nurses can use to provide the proper care to their patients. These interventions are categorized into seven fields or classes of interventions according to the Nursing Interventions Classification system.

These are interventions designed to help a patient change their behavior. With behavioral interventions, in contrast, patient behavior is the key and the goal is to modify it. The following measures are examples of behavioral nursing interventions:

• Encouraging stress and relaxation techniques
• Providing support to quit smoking
• Engaging the patient in some form of physical activity , like walking , to reduce the patient’s anxiety , anger, and hostility

These are interventions that refer to the community-wide approach to health behavior change. Instead of focusing mainly on the individual as a change agent, community interventionists recognize a host of other factors that contribute to an individual’s capacity to achieve optimal health, such as:

• Implementing an education program for first-time mothers
• Promoting diet and physical activities
• Initiating HIV awareness and violence-prevention programs
• Organizing a fun run to raise money for breast cancer research 

These are interventions that influence a patient’s entire family.

• Implementing a family-centered approach in reducing the threat of illness spreading when one family member is diagnosed with a communicable disease
• Providing a nursing woman support in breastfeeding her new baby
• Educating family members about caring for the patient

These are interventions that designed to maintain a safe medical facility for all patients and staff, such as:

• Following procedures to reduce the risk of infection for patients during hospital stays.
• Ensuring that the patient’s environment is safe and comfortable, such as repositioning them to avoid pressure ulcers in bed

These are interventions related to a patient’s physical health to make sure that any physical needs are being met and that the patient is in a healthy condition. These nursing interventions are classified into two types: basic and complex.

• Basic. Basic interventions regarding the patient’s physical health include hands-on procedures ranging from feeding to hygiene assistance.
• Complex. Some physiological nursing interventions are more complex, such as the insertion of an IV line to administer fluids to a dehydrated patient.

These are interventions that maintain a patient’s safety and prevent injuries, such as:

• Educating a patient about how to call for assistance if they are not able to safely move around on their own
• Providing instructions for using assistive devices such as walkers or canes, or how to take a shower safely.

When implementing care, nurses need cognitive, interpersonal, and technical skills to perform the care plan successfully.

• Cognitive Skills are also known as Intellectual Skills are skills involve learning and understanding fundamental knowledge including basic sciences, nursing procedures, and their underlying rationale before caring for clients. Cognitive skills also include problem-solving, decision-making, critical thinking, clinical reasoning, and creativity.
• Interpersonal Skills are skills that involve believing, behaving, and relating to others. The effectiveness of a nursing action usually leans mainly on the nurse’s ability to communicate with the patient and the members of the health care team.
• Technical Skills are purposeful “hands-on” skills such as changing a sterile dressing , administering an injection, manipulating equipment, bandaging, moving , lifting, and repositioning clients. All of these activities require safe and competent performance.

Process of Implementing

The process of implementing typically includes the following:

Prior to implementing an intervention, the nurse must reassess the client to make sure the intervention is still needed. Even if an order is written on the care plan, the client’s condition may have changed.

Other nursing tasks or activities may also be performed by non- RN members of the healthcare team. Members of this team may include unlicensed assistive personnel (UAP) and caregivers , as well as other licensed healthcare workers, such as licensed practical nurses/licensed vocational nurses (LPNs/LVNs). The nurse may need assistance when implementing some nursing intervention, such as ambulating an unsteady obese client, repositioning a client, or when a nurse is not familiar with a particular model of traction equipment needs assistance the first time it is applied.

3. Implementing the nursing interventions

Nurses must not only have a substantial knowledge base of the sciences, nursing theory, nursing practice , and legal parameters of nursing interventions but also must have the psychomotor skills to implement procedures safely. It is necessary for nurses to describe, explain, and clarify to the client what interventions will be done, what sensations to anticipate, what the client is expected to do, and what the expected outcome is. When implementing care, nurses perform activities that may be independent, dependent, or interdependent.

Nursing interventions are grouped into three categories according to the role of the healthcare professional involved in the patient’s care:

A registered nurse can perform independent interventions on their own without the help or assistance from other medical personnel, such as: 

• routine nursing tasks such as checking vital signs
• educating a patient on the importance of their medication so they can administer it as prescribed

A nurse cannot initiate dependent interventions alone. Some actions require guidance or supervision from a physician or other medical professional, such as:

• prescribing new medication
• inserting and removing a urinary catheter
• providing diet
• Implementing wound or bladder irrigations

A nurse performs as part of collaborative or interdependent interventions that involve team members across disciplines.

• In some cases, such as post- surgery , the patient’s recovery plan may require prescription medication from a physician, feeding assistance from a nurse, and treatment by a physical therapist or occupational therapist.
• The physician may prescribe a specific diet to a patient. The nurse includes diet counseling in the patient care plan. To aid the patient, even more, the nurse enlists the help of the dietician that is available in the facility.

Delegate specific nursing interventions to other members of the nursing team as appropriate. Consider the capabilities and limitations of the members of the nursing team and supervise the performance of the nursing interventions. Deciding whether delegation is indicated is another activity that arises during the nursing process.

The American Nurses Association and the National Council of State Boards of Nursing (2006) define delegation as “the process for a nurse to direct another person to perform nursing tasks and activities.” It generally concerns the appointment of the performance of activities or tasks associated with patient care to unlicensed assistive personnel while retaining accountability for the outcome.

Nevertheless, registered nurses cannot delegate responsibilities related to making nursing judgments. Examples of nursing activities that cannot be delegated to unlicensed assistive personnel include assessment and evaluation of the impact of interventions on care provided to the patient.

Record what has been done as well as the patient’s responses to nursing interventions precisely and concisely.

5. Evaluation: “Did the plan work?”

Evaluating is the fifth step of the nursing process. This final phase of the nursing process is vital to a positive patient outcome. Once all nursing intervention actions have taken place, the team now learns what works and what doesn’t by evaluating what was done beforehand. Whenever a healthcare provider intervenes or implements care, they must reassess or evaluate to ensure the desired outcome has been met. The possible patient outcomes are generally explained under three terms: the patient’s condition improved, the patient’s condition stabilized, and the patient’s condition worsened.

Steps in Evaluation

Nursing evaluation includes (1) collecting data, (2) comparing collected data with desired outcomes, (3) analyzing client’s response relating to nursing activities, (4) identifying factors that contributed to the success or failure of the care plan, (5) continuing, modifying, or terminating the nursing care plan , and (6) planning for future nursing care.

The nurse recollects data so that conclusions can be drawn about whether goals have been fulfilled. It is usually vital to collect both objective and subjective data. Data must be documented concisely and accurately to facilitate the next part of the evaluating process.

The documented goals and objectives of the nursing care plan become the standards or criteria by which to measure the client’s progress whether the desired outcome has been met, partially met, or not met.

• The goal was met , when the client response is the same as the desired outcome.
• The goal was partially met , when either a short-term outcome was achieved but the long-term goal was not, or the desired goal was incompletely attained.
• The goal was not met.

It is also very important to determine whether the nursing activities had any relation to the outcomes whether it was successfully accomplished or not.

It is required to collect more data to confirm if the plan was successful or a failure. Different factors may contribute to the achievement of goals. For example, the client’s family may or may not be supportive, or the client may be uncooperative to perform such activities. 

The nursing process is dynamic and cyclical. If goals were not sufficed, the nursing process begins again from the first step. Reassessment and modification may continually be needed to keep them current and relevant depending upon general patient condition. The plan of care may be adjusted based on new assessment data. Problems may arise or change accordingly. As clients complete their goals, new goals are set. If goals remain unmet, nurses must evaluate the reasons these goals are not being achieved and recommend revisions to the nursing care plan .

Discharge planning is the process of transitioning a patient from one level of care to the next. Discharge plans are individualized instructions provided as the client is prepared for continued care outside the healthcare facility or for independent living at home. The main purpose of a discharge plan is to improve the client’s quality of life by ensuring continuity of care together with the client’s family or other healthcare workers providing continuing care.

The following are the key elements of IDEAL discharge planning according to the Agency for Healthcare Research and Quality:

• I nclude the patient and family as full partners in the discharge planning process.
• Describe what life at home will be like
• Review medications
• Highlight warning signs and problems
• Explain test results
• Schedule follow-up appointments
• E ducate the patient and family in plain language about the patient’s condition, the discharge process, and next steps throughout the hospital stay.
• A ssess how well doctors and nurses explain the diagnosis, condition, and next steps in the patient’s care to the patient and family and use teach back.
• L isten to and honor the patient’s and family’s goals, preferences, observations, and concerns. 

A discharge plan includes specific components of client teaching with documentation such as:

• Equipment needed at home. Coordinate home-based care and special equipment needed.
• Dietary needs or special diet . Discuss what the patient can or cannot eat at home.
• Medications to be taken at home. List the patient’s medications and discuss the purpose of each medicine, how much to take, how to take it, and potential side effects.
• Resources such as contact numbers and addresses of important people. Write down the name and contact information of someone to call if there is a problem.
• Emergency response: Danger signs. Identify and educate patients and families about warning signs or potential problems.
• Home care activities. Educate patient on what activities to do or avoid at home.
• Summary. Discuss with the patient and family about the patient’s condition, the discharge process, and follow-up checkups.

39 thoughts on “The Nursing Process: A Comprehensive Guide”

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You can download the articles by printing them as PDF :) You can use a service called printfriendly (google it) to make PDFs of our webpages.

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God bless you too, and if you have any more questions, feel free to ask!

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Thank you so much, Alisa. If you need more information or help regarding this, let us know.

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Hi Millicent, Thank you so much for the kind words! 😊 I’m really glad you’re finding the site useful.

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This way, you can turn any page into a PDF for your personal use. If you have any more questions or need further assistance, feel free to ask. Always here to help!

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The Nursing Process

The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care. Assessment An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain mediation.

Diagnosis The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.

Outcomes / Planning Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it.

Implementation Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.

Evaluation Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

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The 5 Nursing Process Steps – (Learn Each Step in Detail)

One of the most important tools a nurse can use in practice is the nursing process. Although nursing schools teach first-year students about the nursing process, some nurses fail to grasp the impact its proper use can have on patient care. In this article, I will share information about the nursing process, its history, its purpose, its main characteristics, and the 5 steps involved in carrying out the nursing process. After reading this article, you will be able to answer the question, “what is the nursing process” and understand what is involved in each of the 5 steps of the nursing process. Additionally, throughout this article, after discussing a step of the nursing process, I will share an example of how the nurse would proceed with that step. For this article’s purposes, we will use information about the following patient: Mr. Collie, a fifty-four-year-old white male being admitted to the Medical-Surgical floor for acute congestive heart failure.

What Is The Nursing Process In Simple Words?

When was the nursing process developed, who developed the nursing process, what is the purpose of the nursing process, what are the 7 main characteristics of the nursing process, 1. within the legal scope of practice, 2. based on sound knowledge, 4. client-centered, 5. goal-directed, 6. prioritized, 7. dynamic and cyclical, how many steps are there in the nursing process, what are the 5 steps of the nursing process, step #1: assessment phase.

STEP #2: DIAGNOSIS PHASE

STEP #3: PLANNING PHASE

STEP #4: IMPLEMENTATION PHASE

STEP #5: EVALUATION PHASE

Useful Resources To Gain More Information About The Nursing Process

Blogs/websites, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. how is nursing process different from the scientific method, 2. do all nurses use the nursing process, 3. do doctors also use the nursing process, 4. what does adpie stand for, 5. is it always necessary for a nurse to follow all steps of the nursing process, 6. how does critical thinking impact the nursing process, 7. how does a health information system affect the nursing process, 8. how to use maslow hierarchy in the nursing process, 9. which nursing process step includes tasks that can be delegated, 10. which nursing process step includes tasks that cannot be delegated, 11. how does the nursing process apply to pharmacology.

What is the Nursing Process?

Characteristics of the nursing process, history of the nursing process.

Understanding the nursing process is key to providing quality care to your patients. The nursing process is a cyclical process used to assess, diagnose, and care for patients as a nurse. It includes 5 progressive steps often referred to with the acronym:

• Planning/outcomes
• Implementation

In this article, we’ll discuss each step of the nursing process in detail and include some examples of how this process might look in your practice. 

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The nursing process is a patient-centered, systematic, evidence-based approach to delivering high-quality nursing care. It consists of five steps: assessment , diagnosis , outcomes/planning, implementation, and evaluation.

The Nursing Process (ADPIE)

1. Assessment

To begin the nursing process, assessment involves collecting information about the patient and their health. This information is used to identify any problems, or potential problems, that may need to be addressed while you’re caring for a patient. 

Example: If you’re admitting an older patient who is falling and getting injured at home, you’ll want to do a thorough physical and mental health assessment, including a medical history to try and determine why this is happening. 

Some important things you’ll want to find out are:

• What medications and over-the-counter products is the patient taking
• History of alcohol and recreational drug use
• Where the person lives and the layout of their home, including scatter rugs they may be tripping over: clutter, pets, stairs, slippery tubs they’re climbing into or out of, fluid or food spills on floors, lighting, mobility aids they use, etc.

2. Diagnosis

The Nursing Diagnosis is the second step in the nursing process and involves identifying real or potential health problems for a patient based on the information you gathered during the assessment. 

Example: Using the falls patient example above, you may identify from your assessment that the patient is falling because they’re tripping on things in their environment that they don’t see, like their pet cat lying on the floor and loose scatter rugs. 

Based on this, you might form a diagnosis such as “Falls related to poor vision, cluttered environment, unsteady gait, Lt. hip pain due to previous fall.”

3. Outcomes/Planning

Planning or Outcomes is the third step in the nursing process. This step involves developing a nursing care plan that includes goals and strategies to address the problems identified during the assessment and diagnosis steps. 

Example: Continuing with the example above, you will likely recommend that the patient keep their environment,

• Free of scatter rugs
• Check to ensure the cat is not underfoot before they mobilize
• Suggest the patient use a walker for support when mobilizing
• Recommending that the patient schedule an eye exam to get their vision checked if they have not had one in the last year or two would also be a good idea or if they’ve noticed any changes in their vision lately.

4. Implementation

As the fourth step of the nursing process, implementation involves putting the plan of care into action. 

Example In the above example, this would include: 

• Making sure the patient’s environment is free of clutter and tripping hazards while in the hospital or a skilled nursing facility.
• Teaching the patient to wear proper footwear before mobilizing.
• Assisting the patient with mobility as needed, including putting proper footwear on the patient if needed.
• Speaking to the patient and family about removing scatter rugs from the patient’s home, scheduling an eye exam, and ensuring proper footwear is worn for mobilizing at home.
• Discussing with the patient and family about getting the patient a walker to assist with mobility on discharge and providing one while the patient is admitted.

5. Evaluation

The last step of the nursing process is evaluation , which involves determining whether or not the goals of care have been met. 

Example Here you would look back at the patient’s medical record to see if the patient has had any further falls since implementing the preventative actions above. 

If so, you would repeat the nursing process over and reassess why this is still happening and plan new actions to prevent future falls.

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The nursing process is also characterized by the following elements. 

1. Dynamic and Cyclic

The nursing process is an evolving process that continues throughout a patient’s admission or illness and ends when the problems identified by the nurse are no longer an issue.

2. Patient-Centered and Goal-Directed

The entire nursing process is sensitive to and responsive to the patient's needs, preferences, and values. As nurses, we need to act as patient advocates and protect the patient’s right to make informed decisions while involving the patient in goal setting and attainment.

3. Collaborative and Interpersonal

This describes the level of interaction that may be required between nurses, patients, families and supports, and the interprofessional healthcare team. These aspects of the nursing process require mutual respect, cooperation, clear communication, and decision-making that is shared between all parties involved.

4. Universally Applicable

As a widely and globally accepted standard in nursing practice, the nursing process follows the same steps, regardless of where a nurse works. 

5. Systematic and Scientific

The nursing process is also an objective and predictable process for planning, conducting, and evaluating patient care that is based on a large body of scientific evidence found in peer-reviewed nursing research.

6. Requires Critical Thinking

Most importantly, it’s essential that nurses use critical thinking when planning patient care using the nursing process. This means as nurses, we must use a combination of our knowledge and past experiences with the information we have about a current patient to make the best decisions we can about nursing care.

The nursing process was introduced in 1958 by Ida Jean Orlando. Today, it continues to be the most widely-accepted method of prioritizing, organizing, and providing patient care in the nursing profession.

It’s characterized by the key elements of:

• Critical thinking
• Client-centered methods for treatment
• Goal-oriented activities
• Evidence-based nursing research and findings

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• The nursing process helps nurses to provide quality patient care by taking a holistic view of each patient they plan care for.
• The nursing process is an evidence-based approach to caring for patients that helps nurses provide quality care and improve patient outcomes.
• Ida Jean Orlando introduced the nursing process in 1958.
• The primary focus of the nursing process is the patient or client. The process is designed to meet the real and potential healthcare needs of the patient/client and to prevent possible illness or injury.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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Career Advice > Professional Development > Upskilling and Promotions > Nursing Process Steps: What They Are and Why They Matter

Nursing Process Steps: What They Are and Why They Matter

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You probably became über-familiar with the nursing process and care plans in nursing school . But what’s the nursing process definition? How do nurses follow these steps? Why are they so important?

In this article, we’ll answer those questions and more. You’ll learn about the five nursing process steps and explore examples of how they play out in real-word scenarios.

What Is the Nursing Process?

The nursing process is a uniform sequence of five steps nurses follow when assessing and caring for patients. It requires critical thinking , a patient-centered approach, knowledge of current evidence-based practices, and a nurse’s intuition. You’ll apply this process whether you’re working in onsite or remote nursing jobs .

What Are the Steps of the Nursing Process?

The nursing process steps are summarized in the acronym ADPIE. It stands for:

• A ssessment
• I mplementation
• E valuation

Let’s take a close look at how to complete the steps of the nursing process:

Step 1: Assessment

The nursing process steps begin with assessment. Before any clinical judgments or interventions are made, it’s crucial that an assessment is performed. This includes gathering objective and subjective data , past medical history, family history, and medication reconciliation.

Assessments also involve obtaining information about a patient’s physical, social, spiritual, mental, and emotional health. Nurses should also assess a patient’s lifestyle, economics, and cultural background .

Nurses follow systematic methods of performing assessments and collecting data on patients. For example, a physical assessment may be conducted via a head-to-toe assessment. There may also be focused assessments, where a nurse focuses on one specific problem or area of the patient’s life.

Example: A new patient is admitted to the unit. The nurse obtains the patient’s blood pressure, heart rate, respiration rate, temperature, and oxygen saturation. The nurse performs a head-to-toe assessment and gauges the patient’s pain level. The nurse documents this information .

Why Is Assessment Important?

Nursing care is not the time or place to be making assumptions. Assess, don’t guess! As a nurse, you are basing your entire care plan and interventions on your assessment. Without this step, the interventions may not be effective, as they may not be addressing the true problem.

A nursing process assessment is also essential for identifying major problems, prioritizing interventions, and considering expected outcomes. In fact, the initial assessment often identifies life-threatening conditions that need immediate interventions. As you can imagine, assessments can lead to better patient outcomes.

Step 2: Diagnosis

During the nursing process, the diagnosis step involves analyzing the information gathered from the assessment and drawing conclusions from it. But I thought nurses couldn’t diagnose? You are correct. Nurses cannot make medical diagnoses, but they can and do make nursing diagnoses.

A nursing diagnosis is essentially the nurse’s clinical judgment of a patient’s real or potential response to health issues or needs. Like medical diagnoses, they are regulated and follow a universal, standard framework. The North American Nursing Diagnosis Association (NANDA) develops nursing diagnosis definitions and terms, providing a uniform guide for all nurses to abide by when creating their nursing diagnosis for patients.

The nursing diagnosis framework follows a PES format: P roblem + E tiology + S ymptoms.

Example: After reviewing assessment information, the nurse determines an appropriate nursing diagnosis. The nurse’s diagnosis reads: Ineffective peripheral tissue perfusion related to decreased cardiac output as evidenced by pain in extremities, discoloration of skin, and lack of sensation in peripheral tissue.

Why Is Diagnosis Important?

The diagnosis determines the care plan and interventions to be implemented. Basically, the proper diagnosis corresponds with appropriate, specific interventions tailored to the exact problem the patient is experiencing. It also keeps the nurse’s focus on the patient as a whole, enabling the nurse to provide holistic, patient-centered care.

Step 3: Planning

The planning phase is where the nurse creates a care plan based on the assessment and nursing diagnosis. It involves selecting nursing interventions to implement, setting goals , and outlining implications and expected outcomes.

Example: After selecting a nursing diagnosis (ineffective peripheral tissue perfusion), the nurse creates a care plan.

Nursing interventions: monitor vital signs, assess for sudden changes, assess capillary refill, and monitor hemoglobin levels.

Expected outcomes: Patient will maintain adequate tissue perfusion as evidenced by strong pulses, warm skin to touch, normal skin coloration, and full sensation in extremities.

Why Is Planning Important?

Planning in the nursing process ensures that care and interventions are purposely selected and performed. It promotes intentionality, high-quality care, and continuity of care across providers.

Step 4: Implementation

In the nursing process steps, implementation is the actual, tangible practice of nursing care. The care plan guides the care provided, which allows several members of the healthcare team to participate in the implementation.

This step involves performing the planned nursing interventions, such as taking vital signs, monitoring lab values, providing wound care, raising the head of the bed, or palpating pulses.

Example: The nurse reviews the patient’s labs in the electronic medical record (EMR) and checks hemoglobin levels. The nurse also performs a focused assessment, checking capillary refill on the patient. This nurse is implementing the planned nursing interventions in their care plan.

Why Is Implementation Important?

You can make the best nursing care plan there is, but if you don’t act it out, it won’t benefit the patient. Implementation in the nursing process is the way to achieve goals and expected outcomes.

Step 5: Evaluation

The last of the nursing process steps is evaluation. The nurse must evaluate the effectiveness of the interventions, which requires assessment, monitoring, critical thinking, and revising the care plan when appropriate. You can use nursing outcomes classification to measure the patient’s response to your intervention.

Additional issues may arise or you may see that existing issues found upon initial assessment are now resolved. Although this is the last step, it is not the end of the process. Evaluation is an ongoing practice that follows each and every nursing intervention.

Example: The nurse obtains a patient’s blood pressure after administering an anti-hypertensive medication. The nurse evaluates the effectiveness of the medication. If the blood pressure remains elevated, the nurse knows another intervention is needed, such as calling the doctor or administering a PRN medication.

Why Is Evaluation Important?

Evaluation is how you know whether or not your intervention was effective. It alerts you if more or different interventions are needed. It also helps you assess your patient’s progress towards their goals and expected outcomes.

Nursing Process Steps In Order: Example

In general, the nursing process is carried out in order. This means that the nurse will first assess, then create a nursing diagnosis, and so on. However, some of these steps can occur at the same time.

Example: A nurse receives a new patient on the unit. Upon assessment, they find that the patient’s oxygen saturation is declining and they are using effort to breathe. The nurse thinks, “This patient has an ineffective breathing pattern related to COPD as evidenced by orthopnea, shortness of breath, and use of accessory muscles to breathe.”

They quickly think of a plan, which includes repositioning the patient, monitoring vital signs, and applying oxygen per orders. The nurse applies a continuous pulse oximeter to the patient’s finger, and initiates 2L of O2 via nasal cannula. In 15 minutes, the nurse evaluates the patient and obtains vital signs.

As you can see in the above nursing process examples, the process itself can be very dynamic when carried out. While nursing care plans can be written or created in the EMR, they also serve as an internal framework for the nurse throughout the shift as they care for patients.

Put the Nursing Process into Action

Now that you’ve learned (or reviewed) the nursing process steps, are you ready to implement them? Assess your current job and determine if it’s really serving you. Need help finding a better fit? IntelyCare can help you find the job that is the best match for you.

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5 Key Steps of the Nursing Process: A Comprehensive Guide

06 Apr, 2023 | By: AIAM Author

As a nurse, the well-being of your patients is your top priority. But how do you ensure that you’re providing the best possible care? By following the five essential steps of the nursing process, of course! From assessment to evaluation, each step plays a critical role in delivering comprehensive care that addresses not just the physical needs of your patients but their emotional and psychological needs as well.

In this guide, we’ll take a deep dive into each step of the nursing process, equipping you with the knowledge and skills you need to provide exceptional care and make a meaningful impact in the lives of your patients. So let’s get started!

What Is the Nursing Process?

The nursing process is a systematic, patient-centered approach that emphasizes the importance of thorough assessment, careful planning, and thoughtful evaluation.

The nursing process empowers nurses to provide individualized care tailored to each patient’s needs. By taking a collaborative approach involving the patient, their family, and other healthcare team members, nurses can achieve positive health outcomes and improve their patients’ overall quality of life.

So if you’re a nurse, embrace the nursing process with enthusiasm and confidence, knowing that it is an invaluable tool that can help you make a real difference in the lives of those under your care.

What is the purpose of the nursing process?

The nursing process aims to provide a systematic and patient-centered approach to delivering quality care that meets each patient’s needs. The nursing process helps nurses identify and address the complex needs of their patients by following a step-by-step framework that includes assessment, diagnosis, planning, implementation, and evaluation.

By using the nursing process, nurses can gather important information about their patients, identify potential problems, set priorities, develop care plans, implement interventions, and evaluate the effectiveness of the care provided.

The nursing process also promotes collaboration among healthcare professionals, patients, and their families and helps ensure that the care provided is consistent, safe, and of the highest quality. Ultimately, the nursing process aims to help nurses deliver comprehensive care that promotes positive health outcomes and improves their patients’ overall quality of life.

What are the characteristics of the nursing process?

The nursing process has several key characteristics, making it a practical framework for delivering quality care. These characteristics include:

• Patient-centered care: The nursing process prioritizes patients’ preferences, values, and beliefs and aims to provide individualized care tailored to their needs.
• Systematic and organized care: The nursing process follows a step-by-step framework that includes assessment, diagnosis, planning, implementation, and evaluation, ensuring that all aspects of care are considered.
• Evidence-based practice: The nursing process is grounded in evidence-based practices. Nurses use the latest research and best practices to ensure that the care provided is safe, effective, and of the highest quality.
• Collaborative work: The nursing process encourages open communication, shared decision-making, and teamwork to achieve positive health outcomes.
• Dynamic and ongoing care plan: The nursing process is dynamic and ongoing, meaning that it is continually updated and revised as the patient’s needs and health status change. It allows nurses to adapt their care plans and interventions to ensure the patient receives the best care possible.

What Are the 5 Nursing Process Steps?

Now you are informed that nurses can provide the best patient care thanks to the nursing process. But how does each step work? In the upcoming paragraphs, we’ll look at the five key steps of the nursing process and explore how each one plays a vital role in delivering quality care.

So, whether you’re a nursing student or simply curious about the care process, get ready to learn more!

1. Assessment

As the first step in the nursing process, assessment involves gathering information about the patient’s health status and needs. It includes physical, psychological, social, and spiritual assessments and considers the patient’s medical history, current medications, and any allergies they may have. By conducting a thorough assessment, nurses can identify potential health problems and determine the appropriate interventions to address them.

It’s important to note that during the assessment phase, the patient plays an active role in the process. Nurses should involve patients in the assessment by asking open-ended questions, actively listening to their concerns, and noting any symptoms or discomfort they are experiencing. This approach helps establish a trusting relationship between the nurse and the patient.

Patients may also provide valuable insights into their health status, lifestyle, and preferences, which can help nurses develop a more comprehensive understanding of their needs. Ultimately, involving the patient in the assessment process ensures that their care is individualized and aligned with their goals and expectations.

2. Diagnosis

The next step in the nursing process is diagnosis. Diagnosis involves analyzing the data collected during the assessment to identify any actual or potential health problems.

Nurses use their clinical judgment and critical thinking skills to interpret the data and develop a clear understanding of the patient’s health status. This step is vital as it sets the foundation for the next step.

3. Planning

Planning is the third step in the nursing process and involves developing a care plan. During this stage, nurses are responsible for setting goals and objectives, identifying interventions that will help achieve those goals, and determining the resources required to implement the plan.

It is essential to involve the patient and their family in the planning process to ensure the plan is patient-centered and reflects the patient’s needs and values. Such an approach can promote patient empowerment and encourage ownership in their care.

The care plan should be realistic and achievable based on the patient’s health status and available resources. A well-developed care plan ensures the patient receives the best possible care and achieves positive health outcomes.

4. Implementation

Implementation is the fourth step in the nursing process and involves carrying out the plan of care. Implementation includes:

• Administering medications
• Providing treatments and interventions
• Educating patients and their families about their health status and care plan

Nurses should ensure that the care provided is consistent with the plan of care and that the patient is actively involved in the process.

5. Evaluation

The final step in the nursing process is evaluation. During the last stage of the nursing process, nurses are responsible for assessing the effectiveness of the care plan and determining whether the patient’s goals and objectives have been effective.

Nurses should also evaluate any complications or side effects of the care provided and adjust the care plan as needed. Evaluation is an ongoing process that helps ensure that the patient receives the best possible care and achieves positive health outcomes.

The Bottom Line

In conclusion, the nursing process is a systematic and patient-centered approach to delivering quality care. By following the five essential steps of assessment, diagnosis, planning, implementation, and evaluation, nurses can ensure that they address all aspects of the patient’s health and deliver individualized care that meets their needs. So whether you’re a nursing student or a healthcare professional, understanding the nursing process is essential for exceptional patient care.

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The Nursing Process: A Comprehensive Guide for Student Nurses and Licensed Nurses

The nursing process is the cornerstone of the nursing practice. Whether you’re a student nurse or an experienced nurse, you should always remember and practice the nursing process by heart. It’s a fundamental approach to providing excellent patient care, making sure you give your patients the finest results possible. The five steps of the nursing process will be covered in full in this article, along with helpful implementation advice.

The Purposes of the Nursing Process

The nursing process serves the following key purposes:

• Identifying Health Status and Needs

The nursing process is used to assess the client’s current health status and identify any actual or potential healthcare problems or needs.

• Establishing Care Plans

In doing the nursing process, you develop plans to address the identified healthcare needs and concerns.

• Delivering Targeted Interventions

The nursing process provides specific nursing interventions to meet the client’s identified needs.

• Promoting Health and Evidence-Based Care

The nursing process also supports evidence-based care. Applying the best available evidence to support nursing care and promote positive human functions and responses to health and illness.

• Legal Protection

The nurses are being protected from legal issues related to nursing care when the nursing process is followed correctly.

• Systematic Organization

The nursing process serves as a guide for nurses to perform their practice in a systematically organized way.

• Establishing a Health Database

Through the nursing process, the nurse can create a comprehensive database about the client’s health status, concerns, response to illness, and ability to manage their health care needs.

Overall, the nursing process is a crucial framework that guides nurses in providing high-quality, evidence-based, and personalized care to their clients.

What is the Nursing Process?

The nursing process is a problem-solving approach that involves assessing, diagnosing, planning, implementing, and evaluating patient care. It’s a cyclical process, meaning that each stage builds upon the previous one, and it’s essential to revisit earlier stages as needed. This process is used in various healthcare settings, from hospitals to community health organizations, and applies to patients of all ages and conditions.

The 5 Steps of Nursing Process

• Assessment – This is the first step in the nursing process and is called data collection. Assessment is both the most basic and the most complex nursing skill, which is at the same time both the initial step in the nursing process and an ongoing component in every other step in the process. To assess well, the five senses and physical inspection techniques such as inspection, palpation, percussion, and auscultation are being utilized to identify abnormalities or changes in status and for the nurse to intervene appropriately.

Data collection is composed of observation of the patient, patient interview, family and support systems, examination of the patient, and the review of medical records. Culture consideration is given an important venue while assessing a patient and one essential skill of assessment is the ability of the nurse to collect only relevant data. In assessment, family relationships, support systems, food preferences, lifestyle habits and activities of daily living, communication styles, and health care beliefs are all included as aspects.

Frameworks used as guidelines in the assessment are  Maslow’s theory  of basic needs, Henderson’s components of nursing care, Gordon’s functional health needs, NANDA’s human response patterns, Nursing theories, and human growth and development.

Nursing observations result in objective data. Objective data are factual data that are observed by the nurse. The nurse describes the signs or behaviors observed without drawing conclusions or making interpretations. Data that consists of information given verbally by the patient is called subjective data. Examples of objective and subjective data are:

Objective data:  Tremors of both hands, hair combed, makeup applied, Urinated to approximately 300 cc dark amber urine

Subjective data:  “I want to be alone.”, “I feel very nervous about the surgery.”, “This catheter is killing me.”

An interview is a structured form of communication utilized by a nurse to collect data. The use of therapeutic communication like open-ended questions is very beneficial to elicit a comprehensive image of the health pattern.

A complete examination of the patient is another integral aspect of the assessment. The body system approach and the cephalocaudal (head-to-toe) approach are mainly used for the examination to be methodical and also to avoid omissions. An examination is composed of visualization, auscultation, percussion, also the five vital signs (temperature, pulse, respiration, blood pressure, and pain.

• Diagnosis – It is the second step in the nursing process, and it is the phase by which the nurse analyzes the data gathered and identifies the problem for the patient. It is the process of data analysis, problem identification, and the formulation of nursing diagnosis.

A nursing diagnosis is a clinical judgment about the patient’s response to actual or potential health conditions or needs. Similar to medical diagnoses, they are governed and adhere to an international, uniform framework. In order to provide a standard reference for all nurses to follow when developing their nursing diagnoses for patients, the North American Nursing Diagnosis Association (NANDA) creates definitions and terminology related to nursing diagnosis.

Formulating a nursing diagnosis follows this format: P-E-S ( P roblem +  E tiology +  S ymptoms.), although not all types of nursing diagnoses because the risk nursing diagnosis does not include symptoms since there is just a possibility of an occurrence. The three types of nursing diagnoses are actual, risk, and possible nursing diagnoses. When writing the nursing diagnosis, the nurse usually uses the words “related to,” abbreviated as “r/t”? Examples of diagnosis are:

Actual nursing diagnosis : Impaired skin integrity r/t physical immobilization as manifested by disruption of the skin surface over the elbows and coccyx

Risk nursing diagnosis :  Risk for impaired skin integrity r/t physical immobilization in a total body cast.

Possible nursing diagnosis :  Possible nutritional deficit (It is an incomplete problem statement since the validity of the problem is uncertain but considered a possibility based on the patient’s response).

• Planning – This phase is also known as outcome identification. With your diagnoses in hand, the next step would be to develop a plan of care. This involves setting specific, measurable, achievable, relevant, and time-bound (SMART) goals for the patient. As a nurse, you’ll work with the patient and other healthcare professionals to create a plan that addresses the patient’s needs and promotes optimal health outcomes.

Tips for Planning:

Involve the patient and their family in the planning process as much as possible.

Ensure the plan is realistic and achievable.

Prioritize the patient’s needs and focus on the most critical issues first.

The  SMART technique,  abbreviated as specific, measurable, attainable, realistic, and time-bound, is usually used in making an outcome statement. Meanwhile, an outcome statement is composed of patient behavior, criteria of performance, conditions (if needed), and time frame.

There are two types of goals used in the planning stage: Short-term and Long-term goals. Short-term goals focus on immediate needs and ensure the patient’s skin remains healthy to prevent complications.

Long-term goals aim for the patient to regain independence with daily activities post-discharge and prevent future complications.

Nursing Diagnosis: Risk for impaired skin integrity related to decreased mobility post-surgery.

Short-Term Goals: At the end of 2 days of nursing intervention, the:

• Patient will have intact skin with no redness or irritation by the end of the day.
• Patient will be able to independently turn from side to side in bed by the second-day post-surgery.
• Patient’s pain will be managed to a level of 4 or less on a 0-10 scale using pain medication.

Long-Term Goals: At the end of 4 weeks of nursing interventions, the:

• Patient will be able to ambulate with a walker independently.
• Patient will demonstrate proper wound care techniques to prevent infection.
• Patient will maintain adequate nutritional intake to promote healing.
• Implementation – The implementation stage involves putting the plan of care into action. As a nurse, you’ll carry out the interventions and treatments outlined in the plan, working closely with other healthcare professionals as needed. This stage requires strong communication and organizational skills, as well as the ability to adapt to changing circumstances.

Nursing interventions are considered activities that are planned and implemented to help patients achieve identified outcomes. Nursing interventions are often given nursing rationale to prove that those interventions are based on principles and knowledge integrated from nursing education and experience as well as from behavioral and physical sciences.

Nursing interventions should be safe for the patient, be congruent with other therapies, realistic, and consider meeting the lower level of survival needs before higher-level needs. It is imperative too that nursing interventions meet the patient’s personal goals and values.

Nursing diagnosis :  Knowledge and skill deficit in taking newborn rectal temperature related to first-time parenting as evidenced by verbalization of lack of knowledge (“ Hindi ko po alam kung paano kumuha ng temperature ng baby ko” as verbalized by the mother).

Goal and Outcome :  After 24 hours of nursing interventions, the patient will learn how to take an accurate rectal temperature of her newborn.

Nursing interventions:

• Discuss when to take baby’s temperature; signs and symptoms indicating illness.
• Demonstrate how to take a rectal temperature on newborn,
• Explain safety precautions and when to notify physician for fever
• Provide reinforced practice in taking her newborn’s temperature

There are several types of nursing interventions. These are the environmental management, independent nursing intervention or one that is nurse-initiated and ordered intervention, the dependent nursing intervention or nurse-initiated and physician-ordered intervention, and the collaborative intervention or intervention applied with the assistance of other health team members, like a dietician, pharmacist, midwife, and others.

• Evaluation – this phase should be done continuously while care is being given and as the nurse evaluates progress from intermediate outcomes up to discharge outcomes. Evaluating is composed of documenting responses to interventions, evaluating the effectiveness of interventions, evaluating outcome achievement, and reviewing the nursing care plan.

When deciding how well an outcome was met, there are three alternatives: met, partially met, and not met. When written, an outcome evaluation statement includes if met, partially met, or not met and actual patient behavior as evidence.

Nursing diagnosis: Ineffective airway clearance related to bronchial inflammation, edema formation, and sputum production as evidenced by dyspnea and coughing.

Goals and Outcome:

After 8 hours of nursing interventions, the patient will be able to maintain a patent airway by displaying clear breath sounds upon auscultation, no dyspnea, and a normal respiratory rate and oxygenation values.

Nursing Interventions:

Independent:

• Assess the rate and rhythm of respiration and use of accessory muscles.
• Elevate the head of the bed.
• Administered salbutamol via nebulization as ordered.

Evaluation:

After 8 hours of nursing intervention, the patient was able to maintain a patent airway as evidenced by clear breath sounds, a respiratoty rate of 18 cpm, 02 sat of 99%, and absence of dyspnea.

Or you can also write:

Goals and outcomes were met as evidenced by clear breath sounds, a respiratory rate of 18 cpm, 02 sat of 99%, and absence of dyspnea.

If outcomes are not met, the nurse should revise the care plan when appropriate.A review of the nursing care plan is composed of reassessment, review of nursing diagnoses, review of outcomes and replanning, and review of implementation.

Overall, the nursing process is a vital part of nursing practice, providing a framework for delivering high-quality patient care. By following the five stages of the nursing process – assessment, diagnosis, planning, implementation, and evaluation – you’ll be able to provide patient-centered care that addresses the individual’s unique needs. Always remember that a wrong assessment will lead to an ineffective nursing care plan so in the first step, you should be good in conducting the assessment to target the main problems of the patient to address them effectively and to avoid repeating the cycle and delaying the needed care to the patient.

• Hughes, Suzanne. (2012). Kozier and Erb’s Fundamentals of Nursing: Concepts, Process and Practice. Nurse Education in Practice. 12. e12. 10.1016/j.nepr.2011.09.002.
• NANDA International & Herdman, T. H. (2012). NANDA International Nursing diagnoses: Definitions and classification 2012-14. Wiley-Blackwell.

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Getting Ready for the Next-Generation NCLEX® (NGN): How to Shift from the Nursing Process to Clinical Judgment in Nursing

Authored by.

Donna D. Ignatavicius , MS, RN, CNE, CNEcl, ANEF, FAADN

Linda Silvestri , PhD, RN, FAAN

What is the Nursing Process?

The nursing process has been used for over 50 years as the systematic, stepwise method for problem solving to make safe, client-centered clinical decisions. Originally, there were four nursing process steps, published in the late 1960s. These were:

• Implementation

In the early 1970s, the North American Nursing Diagnosis Association (NANDA, currently called NANDA-I) was formed to develop a common language to identify standardized nursing diagnoses based on a nurse’s interpretation of assessment data. As a nurse educator, you likely include this additional step of Diagnosis as part of the nursing process, referred to as ADPIE:

Using a problem-solving approach as a basis for nursing practice requires the use of critical thinking and decision-making. Some experts have referred to that thinking more recently as clinical reasoning. The 2020 NCLEX-RN® Test Plan identifies the nursing process as one of five integrated processes which is defined as “a scientific, clinical reasoning approach to client care that includes assessment, analysis, planning, implementation, and evaluation” (NCSBN, 2019, p.5). Note that this definition does not include Diagnosis; rather the second step of the nursing process is labeled as Analysis.

The NCLEX-RN® and NCLEX-PN® do not measure the nursing graduate’s knowledge of nursing diagnoses (NDs) because NDs are not universally used as originally intended as a standardized language, even in the United States where the NANDA nursing diagnosis list began. Yet many faculty continue to teach the nursing process as a five-step ADPIE approach.

Comparing the Nursing Process and Clinical Judgment

While the nursing process has been taught in prelicensure programs for many years, nurses continue to make serious errors in practice, including failure-to-rescue clinical situations that sometimes result in sentinel events. Based on these errors and employer dissatisfaction with the clinical-decision ability of new graduates, the National Council of State Boards of Nursing (NCSBN) developed a model of clinical judgment that is built on and expands the nursing process. Officially entitled the NCSBN Clinical Judgment Measurement Model (NCJMM), this evidence-based model identifies six cognitive skills needed to make appropriate clinical judgments. These skills include:

• Recognize Cues
• Analyze Cues
• Prioritize Hypotheses
• Generate Solutions
• Take Action
• Evaluate Outcomes

The NCJMM will be the basis for the Next-Generation NCLEX-RN and NCLEX-PN (NGN) new test items that will be presented most often in an unfolding case format . These cases will present clinical situations in which the test candidate will need to use clinical judgment skills to answer questions about how to manage the presented client’s care.

If you are teaching in a state, province, or territory in which the nursing process is required as a regulation for prelicensure nursing education, follow these guidelines to help transition from the nursing process to clinical judgment:

• Use the term clinical judgment as part of your program’s definition of professional nursing and end-of-program student learning outcomes (also called program learning outcomes).
• Introduce the nursing process in your first basic nursing course as the foundation for clinical decision-making.
• Minimize emphasis on the NANDA nursing diagnosis list and ensure that students understand that the diagnostic labels and taxonomy are not universally used in health care today. Instead, assist students in learning the signs, symptoms, and behaviors that nurses and other interprofessional health care team members utilize and understand. For example, fever is a more commonly used term in nursing and health care than hyperthermia. A nurse can take a client’s body temperature and determine that he or she has a fever if the thermometer reads 103 o F (39.4 o C).     
• Introduce the NCSBN definition of clinical judgment and the six cognitive skills of the NCJMM early in your nursing program.
• Have students practice using the six cognitive skills in a variety of learning activities, including unfolding case studies in place of excessive lecture throughout your program.

Building on the Nursing Process to Transition to Clinical Judgment

As you and your students transition from the nursing process to clinical judgment, remember that clinical judgment is more closely aligned with how nurses in practice actually think to make the best possible decisions about client care. Also recall that clinical judgment in nursing is not a new concept. For example, Tanner, the National League for Nursing, and others have posited for almost 15 years that clinical judgment is a better problem-solving approach than the nursing process.

The NCJMM cognitive skills can be aligned with the nursing process steps and phases of Tanner’s clinical judgment model as illustrated below:

Comparison of the Nursing Process with Tanner’s Clinical Judgment Model and the NCSBN Clinical Judgment Measurement Model (NCJMM)

While these models may look very similar, the thinking processes differ. For example, in the Assessment step of the nursing process, the nurse collects subjective and objective client data using a systematic approach. By contrast, the Recognize Cues cognitive skill of clinical judgement requires the nurse to collect client data and then decide “What matters most?”—which client data (findings) are relevant in a specific contextual clinical situation and which data are not relevant? Two other examples comparing the nursing process steps and the cognitive skills of the NCJMM are described below:

As you begin or continue making the transition of building on the nursing process to emphasize clinical judgment in your program, remember that clinical judgment will be the focus of the new test item types for the NGN by no sooner than 2023. You still have time to begin the transition journey, but we suggest that you start it soon! More NGN resources are available on www.ncsbn.org and the Elsevier Evolve Faculty Resources webpage.

Reference :

National Council of State Boards of Nursing (NCSBN). (2018). NCLEX-RN® Examination: Test plan for the National Council Licensure Examination for Registered Nurses. Chicago, IL: Author.

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2.4 The Nursing Process

The nursing process is a critical thinking model based on a systematic approach to patient-centered care that nurses use to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA). These standards are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently. [1] The mnemonic ADOPIE is an easy way to remember the ANA Standards and the nursing process, with each letter referring to the six components of the nursing process: Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation. See an illustration of the cyclical nursing process in Figure 2.3. [2]

The Assessment component of the nursing process is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.” [3] A nursing assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. Nursing assistants should observe and report things to the nurse that they notice when providing care, such as reddened or open skin, confusion, increased swelling, or reports of pain. [4]

The Diagnosis phase of the nursing process is defined as, “The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.” [5] A nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. Nursing diagnoses are the basis for the nursing care plans and are different than medical diagnoses. [6]

Outcomes Identification

The Outcomes Identification phase of the nursing process is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” [7] The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the patient based on their assessment data and nursing diagnoses. [8] Nurses may communicate expected outcomes to nursing assistants, such as, “The client will walk at least 100 feet today.”

The Planning phase of the nursing process is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” Assessment data, nursing diagnoses, and goals are used to select evidence-based nursing interventions customized to each patient’s needs and concerns. Goals and nursing interventions are documented in the patient’s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care. [9]

Nursing Care Plans

Nursing care plans are part of the Planning step of the nursing process. A nursing care plan is a type of documentation created by registered nurses (RNs) that describes the individualized planning and delivery of nursing care for each specific patient using the nursing process. Nursing care plans guide the care provided to each patient across shifts so care is consistent among health care personnel. Some nursing interventions can be assigned or delegated to licensed practical nurses (LPNs) or nursing assistants with the RN’s supervision. [10] Although nursing assistants do not create or edit care plans, they review this document to know what care should be provided to each client within their scope of practice.

Implementation

The Implementation phase of the nursing process is defined as, “The nurse implements the identified plan.” [11] Nursing interventions are implemented or delegated with supervision according to the care plan to assure continuity of care across multiple nurses and health professionals caring for the patient. Interventions are also documented in the patient’s medical record as they are completed. [12] The nursing assistant’s largest responsibility during the nursing process is safely implementing their delegated interventions in the nursing care plan.

The Evaluation phase of the nursing process is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [13] During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed. To assist the nurse in evaluation, nursing assistants must report any changes in patient condition or new observations related to new interventions. Because nursing assistants spend the most time with the residents, it is important to communicate with the nurse if asked to implement an intervention that is known to be ineffective with a resident so a different, more effective alternative can be identified.

Benefits of Using the Nursing Process

Using the nursing process has many benefits for all members of the health care team. The benefits of using the nursing process include the following [14] :

• Promotes quality patient care
• Decreases omissions and duplications
• Provides a guide for all staff involved to provide consistent and responsive care
• Encourages collaborative management of a patient’s health care problems
• Improves patient safety
• Improves patient satisfaction
• Identifies a patient’s goals and strategies to attain them
• Increases the likelihood of achieving positive patient outcomes
• Saves time, energy, and frustration by creating a care plan or path to follow
• American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
• “ The Nursing Process ” by Kim Ernstmeyer at Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
• This work is a derivative of Nursing Fundamentals by Chippewa Valley Technical College and is licensed under CC BY 4.0 ↵

A critical thinking model based on a systematic approach to patient-centered care that nurses use to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA).

A type of documentation created by registered nurses (RNs) that demonstrates the individualized planning and delivery of nursing care for each specific patient using the nursing process.

Nursing Assistant Copyright © by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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What Is the Nursing Process? A Guide for Effective Patient Care

Written by: university of tulsa   •  mar 26, 2024.

What Is the Nursing Process? A Guide for Effective Patient Care                                                    ¶

The primary goal of any health care facility is to provide the best quality patient care possible, to attain the best patient results. Nurses are crucial to meeting this goal, as their work often puts them on the front lines during various stages of patient care. Because nursing responsibilities vary so much, certain guardrails are necessary to enable nurses to focus their knowledge and skills to deliver optimal care and contribute to a facility’s goals.

The nursing process provides these guardrails. This multi-layered strategy helps nurses provide holistic, evidence-based patient care that’s flexible enough to respond to precise patient needs as they evolve. For those interested in obtaining an accelerated bachelor of nursing degree , it is important to understand what the nursing process is, and why it is key to providing quality nursing care.

What Is the Nursing Process? ¶

The nursing process is a systematic series of methodologies designed to break down nursing care into specific steps. These steps provide standards for nurses to build their strategies for different phases of patient care delivery. These standards can keep a nurse’s practice focused in a way that enables them to concentrate on and complete tasks that potentially improve patient outcomes.

It is a complex concept whose different steps overlap to form a singular cohesive strategy. At the same time, defining the various parts of the nursing process provides a better understanding of how they fit within the overall context of nursing care.

History of the Nursing Process ¶

In 1958, nurse theorist Ida Jean Orlando recognized that the nursing profession needed more guardrails to streamline nursing care. To build these guidelines, Orlando integrated principles she developed through her research of the mental health field into the nursing field, highlighting the importance of nurse communication with patients and other health care associates. According to a bio of Orlando published on the website NurseLabs, this integration is essential because “patients have their own meanings and interpretations of situations, and therefore nurses must validate their inferences and analyses with patients before concluding."

Orlando’s nursing theory, which was published in 1961, was designed to explore the relationship within the nurse/patient dynamic. By dividing the dynamic into five distinctive yet interconnected steps, the theory made it possible to recognize the ways in which this dynamic can fluctuate within the course of treatment. This theory emphasized patient behavior, equating how behavioral changes could be interpreted as new patient needs. It also highlighted the nurse’s role in reacting to these needs as they evolved, pointing out how well developed competencies like critical-thinking skills can lead nurses to make the best decisions possible.

Today, Orlando’s theory is used to ensure patients aren’t merely receiving nursing care. Rather, that they are receiving the specific type of nursing care that’s required for their unique situation. By implementing the theory, nurses can better recognize and react to a patient’s needs with greater effectiveness and efficiency. This can potentially improve a health care facility’s ability to reach the goal of providing care that can improve patient outcomes.

The Nursing Process Steps ¶

The key to understanding the nursing process is to individually examine the nursing process steps and what they bring to the table. Each step can help nurses better gauge how they can apply their knowledge and skills situationally based on patient behaviors, which are tied to patient needs. This can potentially be beneficial to patients in the short- and long-term.

Step 1: Assessment ¶

In the nursing assessment stage, nurses gather as much information regarding the patient as possible. This allows nurses to establish a baseline that supports the initial care delivery strategy. This baseline contains enough flexibility to allow nurses to use their critical-thinking skills to make adjustments based on patient needs.

There are several sources and methods nurses can use to gather their assessment data . These sources are typically separated into three tiers.

• Primary sources
• Secondary sources
• Tertiary sources

The primary source in the assessment phase is the actual patient. They can provide the nurse with subjective, detailed information on what they feel is wrong with them and how it is impacting their daily functionality. The typical data-gathering methods here include patient interviews, conducting physical examinations, and patient observation.

The secondary sources stem from people and information somehow connected to the patient’s sphere of influence. This can be a patient’s family, friends, or guardians. This type of data can also come from professional resources. These can include a patient’s primary care physician or their electronic health record (EHR).

Tertiary sources extend beyond a patient’s sphere of influence. These sources can range from medical journals and textbooks to in-house procedural manuals. These can help nurses establish further context regarding specific patient conditions.

These sources collectively provide the pieces a nurse needs to carry out the rest of the nursing process. Nurses must be aware that these pieces are subject to change due to elements such as the development of a new symptom. As such, nurses must be prepared to reassess a patient’s situation should a change occur.

Step 2: Diagnosis       ¶

Once all of the assessment data has been collected, the nurse can then examine that information in the nursing diagnosis phase. This essentially allows nurses to detect the health issue, including the elements that may be driving the issue. Analyzing the data gathered from the nursing assessment stage is a critical component of diagnosis, but there are other factors in play as well. These factors include the identification of health issues, the detection of potential patient strengths and vulnerabilities, and the development of diagnostic statements based on medical findings.

A proper nursing diagnosis is designed to treat the patient in a way that mirrors Maslow’s Hierarchy of Needs. Developed by psychologist Abraham Maslow, this hierarchy allows nurses to prioritize the structure of their diagnosis so the most critical patient needs are met. 

The priority of diagnosis based on Maslow’s Hierarchy of Needs includes:

• Basic physiological needs . This includes a patient’s fundamental functions like breathing, circulation, sleep, and nutrition. They can also include other elements that can alleviate psychological stress, such as shelter.
• Safety and security . This includes incorporating measures that minimize the risk of injury, such as putting fall precautions in place. This can also point to the development of a therapeutic relationship within the patient/nurse dynamic to generate trust.
• Love and belonging . This includes taking the steps to preserve supportive relationships and create environments that minimize the possibilities of social isolation.
• Self-Esteem . This includes a patient’s acceptance of who they are, which can include self-acceptance.
• Self-Actualization . This includes a patient’s ability to connect to an empowering environment that allows them to obtain personal growth.

From a care delivery perspective, nursing diagnosis primarily concentrates on addressing and ensuring a patient’s core physiological and safety needs. However, nurses should be mindful of the other three tiers as the nursing process progresses into other stages.

Step 3: Planning ¶

The planning stage is where nurses develop a treatment strategy. The nursing care plan stemming from this is commonly a collaborative process that involves input from the nurse, their supervising medical personnel, and the patient. This input must reflect agreement on the information determined in the diagnostic stage. The strategy here typically strives to meet both short-term and long-term health goals, shaped through the principles of evidence-based practice, (i.e., holistic care based on current medical knowledge and research). 

Because the planning stage concurrently focuses on achieving short-term and long-term goals, there are different types of planning nurses should practice within this stage. These three planning types are initial, ongoing, and discharge. 

In the initial planning stage, the nurse who conducted the initial patient assessment would build the framework for the plan care strategy.

In the ongoing planning stage, all nurses involved in the patient’s care collaborate to develop the initial framework into a complex strategy. Ongoing planning must contain enough flexibility to shift strategic elements in the event of changing health status, patient care priorities, or the development of new issues that may emerge during care delivery.

The final stage, discharge planning, concentrates on a patient’s exit strategy. As the name implies, this plans for a patient’s discharge, but it also involves developing strategies for continuity of care, making sure a patient’s needs are met in a way that addresses long-term health goals.

Step 4: Implementation ¶

Implementation in the nursing process springs strategies into action. This phase typically starts by conducting patient-specific interventions that aim to achieve desired, predetermined outcomes. These interventions are usually collaborative efforts involving nurses and appropriate medical staff. 

During the implementation phase, nurses monitor patients to detect signs of health improvement or decline. They may also take on an active role in patient care through duties such as administering medication or providing the patient with health management education. Additionally, they may need to conduct assessments and diagnoses based on patient progress. 

These implementation strategies can be developed around various nursing interventions. There are hundreds of interventions nurses can consider, and they fall under the guise of the Nursing Interventions Classification (NIC) System, a taxonomy devised to allow nurses to refine their care strategies to meet patient needs as much as possible. The taxonomy breaks up these interventions into six distinctive categories:

• Behavioral Nursing Interventions . These focus on encouraging patients to modify their behaviors to improve their health. Examples include supporting patients to quit smoking or engaging patients in physical activity such as walking.
• Community Nursing Interventions . These concentrate on creating peripheral factors that can encourage patients to make smart, health-oriented decisions. This can include promoting healthy eating habits or implementing proactive health education programs.
• Family Nursing Interventions . These focus on extending health strategies beyond the individual patient and toward the health of family members and loved ones. Examples of this intervention in action include educating a patient’s family about slowing the spread of a communicable disease or how to care for a patient after they’ve been released from the hospital.
• Health Systems Nursing Interventions . These hone in on ways to keep a facility safe for patients and staff alike. These include following procedures designed to lower the risk of patient infection and making sure patients remain comfortable in their hospital room.
• Physiological Nursing Interventions . These ensure a patient’s physical needs are met in a way that optimizes their health. These can include basic procedures such as assisting them with hygiene or feeding or conducting complex procedures like handling patient IV lines.
• Safety Nursing Interventions . These concentrate on maintaining a healthy patient environment that promotes safety and proactively prevents injuries. This can include educating patients on the best ways to use assistive devices or making sure a patient’s call button functions properly.

Nursing interventions can either be executed independently, with assistance or supervision from health care professionals, or as part of a collaborative effort across multiple health care disciplines. The scope of some of these interventions can depend on where they are practiced. For instance, some states may allow nurse practitioners to have full prescriptive authority, which would allow them to prescribe medications independently. Other states require nurse practitioners to have a supervised medical professional such as a physician sign off on a prescription.

Proper implementation in the nursing process requires nurses to reach into their bag of cognitive skills. These skills, such as critical thinking, problem-solving, and decision-making competencies, allow them to apply their nursing and medical knowledge to actionable skills. Interpersonal skills are also important during the implementation stage, as they can help nurses build trust and rapport with patients. Additionally, health care-specific technical skills such as injection administration, medical equipment utilization, and bandaging are also key components of the implementation process.

Step 5: Evaluation ¶

The nursing evaluation phase allows a nurse to review the effectiveness of the rest of the nursing process. By determining what worked well and what fell short, nurses can gain a clearer picture of whether or not a care delivery strategy resulted in achieving the desired outcome. It can also give nurses the information they need to potentially adjust future care delivery strategies.

There are six components within the evaluation step:

• Collecting data from the patient care strategy
• Comparing data with goal-oriented outcomes
• Analyzing the patient’s response to a nurse’s activities
• Pinpointing the factors that led to attaining a goal or falling short
• Making adjustments to the nursing care plan
• Transitioning the patient from one phase of care to another

The final component is particularly important in this stage, as it can help patients prepare for their lives after they’ve been discharged. This component can be associated with numerous education-driven components, such as educating patients on dietary restrictions, at-home medication usage, and emergency contact numbers. It can also include paying close attention to the patient’s post-treatment goals and honoring their post-care preferences.

The Principles of the Nursing Process ¶

The primary goal of the nursing process is to streamline quality care so that optimal results may be achieved. The road toward achieving this goal contains several key characteristics that make sure the guardrails of the nursing process are sturdy and keep nurses focused on the task at hand.

For instance, the process must also focus on the patient. This means honoring the patient’s needs, but also adhering to their values and preferences. This can also require the nurse to advocate for the patient to other nursing staff and health care professionals to ensure patient desires are maintained throughout the care delivery process.

The nursing process must also be collaborative. Nursing care depends on interactions between a nurse and other health care professionals including physicians. As such, nurses need to foster an environment of collaboration driven by mutual respect, clear communication, and mutual decision-making that aims toward care optimization.

In addition, the process must be adaptable and ready to pivot based on the needs of the patient. Nurses must be able to adjust strategies the moment a current strategy shows signs of deviating from patient and facility goals. This requires nurses to use critical thinking to efficiently shift care strategies to meet a patient’s needs as they evolve.

Finally, the process must be interpersonal. Nurses and patients should develop a rapport during care delivery. This connection can allow a patient to trust a nurse and their strategy. This could ultimately make it easier for nurses to give patients optimized care.

Why the Nursing Process Matters ¶

The framework of the nursing process is crucial to modern health care. It provides nurses with points of reference that remain unchanged even as care concepts evolve. As technical innovations such as EHRs and artificial intelligence (AI) infuse the health care space, these nursing process guidelines make it possible for nurses to see how and where these innovations can be implemented within the context of care delivery. This can lead to greater efficiency in integrating new concepts into a nursing strategy, which can potentially lead to optimized patient care. 

The nursing process also allows nurses to pay better attention to a patient’s needs based on Malsow’s Hierarchy of Needs. The process can foster a sense of belonging and self-worth among patients, as nurses may integrate strategies that meet these specific needs in addition to a patient’s physiological and safety needs. This can also allow nurses to integrate cultural competency into their plans. 

By focusing on patient needs, nurses can better understand and respect the different cultural beliefs and philosophies regarding care delivery. This understanding can lead to a better sense of trust within the patient/nurse dynamic, as the patient may be more willing to work with a nurse who recognizes their cultural heritage and viewpoints.

Additionally, this framework can help nurses mitigate the complexities of unique health care challenges, such as providing care to patients with comorbidities. This nursing process can make it easier to break down bigger care challenges into smaller, isolated episodes. This could then make the challenges more manageable from a strategic vantage point.

Guide Others Through the Process ¶

The nursing process provides the guidelines that can streamline nursing strategies and make them operate with greater efficiency. However, these processes still rely on the talent of nurses to truly make a difference in patient care. Nurses who know how to apply the steps within the context of care delivery can truly make a positive impact on a health care facility — one that can enable a facility to attain its goal of providing the best patient care possible.

The University of Tulsa’s Accelerated Bachelor of Science in Nursing (ABSN) program can help prepare you to make such an impact. Our program is designed to help you build the foundational knowledge and skills to develop strong process strategies that can lead to the kind of targeted care that can make a difference in the lives of patients. 

Learn how we can jumpstart your success.

Recommended Readings

Achieving Health Care Justice: Breaking Down Racial Disparities in Health Care

Change Theory in Nursing: How It’s Evolving the Profession

ABSN vs. BSN: Which One Should You Choose?

American Association of Nurse Practitioners, Nurse Practitioner Prescriptive Authority

American Nurses Foundation, Technology-Enabled Nursing Practice

American Nursing Association, The Nursing Process

American Nursing Association, What Is Evidence-Based Practice in Nursing?

American Nursing Association, What is Nursing?

Indeed, “Why Cultural Competence Is an Important Quality in Nursing”

National Library of Medicine, “Nursing Process”

Nurselabs, “Nursing Theories Guide: Ida Jean Orlando Nursing Process”

Nurselabs, “The Nursing Process: A Comprehensive Guide”

U.S. Centers for Medicare and Medicaid Services, Electronic Health Records

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The Nursing Process: Everything Next-Gen NCLEX-RN Test-Takers Need to Know

This section of allnurses' Next-Gen NCLEX-RN Study Guide focuses on The Nursing Process. Resources

• Next Gen Nclex
• Table of Contents:
• Phase 1: Assessment & Analysis

Phase 2: Diagnosis

Phase 3: planning.

• Phase 4: Implementaion

Phase 5: Evaluation

• Thinking Critically

Since the Next-Gen NCLEX-RN is a test that challenges nursing concepts rather than focusing solely on nursing content, you must understand how to use The Nursing Process.

The Nursing Process is a systematic approach nurses use to provide effective, safe patient care. It comprises five phases: Assessment & Analysis, Diagnosis, Planning, Implementation, and Evaluation. Each phase plays a crucial role in delivering quality nursing care, and understanding these phases is essential for success on the NCLEX exam.

This article is part of a more extensive study guide for the Next-Gen NCLEX-RN:

• Best Free Online Next-Gen NCLEX-RN Study Guide
• Next-Gen NCLEX-RN Question Leveling: Recognition, Comprehension, Application, and Analysis
• Next-Gen NCLEX-RN Identifying Prioritization, Delegation, and Scope of Practice Questions
• Next-Gen NCLEX-RN Expert Test-Taking Strategies

Phase 1: Assessment & Analysis

The first step of The Nursing Process, assessment, is a nurse's most important skill to grow and nurture. Assessment allows nurses to identify actual or potential alterations in health, safety, and overall well-being for their patients, families, and communities. Assessment can include:

• Interviewing the patient
• Physically assessing the well-being of the patient
• Reviewing medical records
• Observing behaviors and interactions
• Collaboration with other healthcare members
• Identify actual or potential health alterations.

On the NCLEX, many questions challenge candidates to understand the importance of assessment. Sometimes, the question is written to challenge the candidates' understanding of the importance of further assessment when there isn't enough information to make a sound judgment. Other times, the questions may challenge the candidates' ability to recognize the limitations of their scope of practice. Despite the structure of the questions, knowing the key points surrounding the concept of assessment will help in selecting correct answers.

Key points for assessment include:

• Always assess first, then implement
• When in doubt, assess further
• RNs must complete all initial assessments, such as new patients and changes in status.
• The PN must report all changes of status to the RN so they can validate the findings.
• The PN is perfectly capable of assessing clients when the assessment is ongoing.
• The words observe, inspect, monitor, examine, and determine are all indicators that assessment is required.

Once the assessment phase of The Nursing Process is completed, the nurse must take the time to review all of the information collected, which leads to analysis.

During the analysis phase of The Nursing Process, the nurse takes the time to put all the pieces together. Over time, this practice becomes second nature, but for new graduate nurses, this requires some conscious effort. When you take the time to make sense of all of the information collected from a patient or an NCLEX test question, the focus or problem becomes much clearer. This step allows for easier identification of actual or potential issues and enables the nurse to move more confidently into the next phase of The Nursing Process.

On the NCLEX, the concept of analysis is often challenged. In fact, analysis-level questions are the most complex questions on the exam and therefore require sharp analysis skills. Since this is a skill that nursing students do not get very much practice with during their programs, this is often the most difficult skill for new grads to master before sitting for their exams. To help you improve your analysis skills, we've put together a few key points to remember.

Some key points for analysis include:

• To effectively analyze data, candidates must know the nursing content.
• During the analysis phase, nurses are looking for data significance & meaning.
• Analysis requires questions to be asked and answered systematically.
• Analysis helps nurses to conclude the status of their patients.
• Sound nursing judgment comes from strong analysis skills.
• The analysis phase should always end with the question: Does this make sense?

Once all of the data has been analyzed, the nurse can easily identify actual and potential alterations to health, thus leading to the next phase of The Nursing Process.

During the diagnosis phase of The Nursing Process, nurses create a list of all the actual and potential alterations to health that their patients present with. Nursing diagnoses stem from the direct observations of the nurse and are health issues that the nurse is licensed to manage. On the NCLEX, questions written about the diagnosis phase of The Nursing Process challenges candidates to understand the why .

We all learned that nursing diagnoses cannot include medical diagnoses . The typical reason given for this is nurses are not doctors. Although this is true, it does not explain the difference between a nursing diagnosis and a medical diagnosis. Therefore, here are the key differences so test-takers can better understand their role in creating and managing nursing diagnoses.

Nursing Diagnosis:

• Stem from direct observations through assessment skills
• Nurses can identify and validate findings that support the diagnosis
• Nurses do not need the assistance of diagnostics or labs to identify and validate nursing diagnoses

Examples of nursing diagnoses include acute pain, altered nutrition, decreased cardiac output, ineffective coping mechanisms, knowledge deficit, risk for injury, etc.

Medical Diagnosis:

• Stem from the interpretation of diagnostic studies and labs
• Only a PA, NP, or physician can order, interpret, and validate the findings of diagnostic studies and lab reports
• Medical practitioners require the assistance of diagnostics or labs to identify and validate medical diagnoses

Examples of medical diagnoses include asthma, bowel obstruction, congestive heart failure, diabetes, fibromyalgia, hyperlipidemia, etc.

Once a nurse has identified all the actual and potential nursing diagnoses for the patient, they can move into planning.

During the planning phase of The Nursing Process, the nurse focuses on assigning priorities to all of the actual and potential health alterations, as well as begins to consider all of the ways that the nurse can meet the patient's needs. The nurse will establish goals that are patient-specific, measurable, and have an established time frame. To meet the goals that have been established, the nurse must also identify all nursing interventions that will assist the nurse in meeting the needs of the patient.

On the NCLEX, questions written about the planning phase of The Nursing Process make up the majority of the exam. Planning questions typically involve many nursing concepts that fall within the NCLEX test plan categories of Management of Care (NCLEX- RN) and Coordination of Care (NCLEX-PN). These questions often require the test-taker to make careful decisions regarding what action is best or which intervention will meet the client's needs based on their clinical presentation.

Since the planning phase of The Nursing Process involves many nursing concepts and considerations, we've created a list of key terms that can help you to find the nursing concept the question is challenging, so you can focus on selecting the correct answer.

Concept: Establishing Priorities

• Key Terms: Best, first, initial, most, next

Concept: Therapeutic Communication

• Key Terms: Appropriate response, addressing behaviors, concerns and emotions, communication and responding to others (patient, family, staff)

Concept: Delegation

• Key Terms: Creating an assignment, Asking others to complete tasks, Giving instructions to other members of the nursing team (RN, LPN, UAP)

Concept: Teach & Learning Principle

• Key Terms: Patient understands, Nurse evaluates the effectiveness of discharge instructions, Nurse expects the client to return demonstrate, patient needs further explanation

Understanding that the nursing concept of safety can be incorporated and challenged on every question type is important. There aren't any specific terms or statements that can alert the test-taker that the question is focusing on safety. Since the NCLEX aims to determine if candidates are demonstrating safe decision-making skills, it is vital to consider safety at all times.

Once the planning phase is completed, the nurse can implement the plan.

Phase 4: Implementation

The implementation phase of The Nursing Process includes all activities and interventions that help the nurse meet the patient's needs. These activities include but are not limited to assisting patients with activities of daily living (ADLs), teaching others, performing patient care skills, giving medications, putting safety measures in place, documenting, and supervising the care that other healthcare team members provide.

On the NCLEX, questions about The Nursing Process's implementation phase are also very common. Candidates often have to decide which action or intervention will best meet the patient's needs or resolve the problem presented in the question. Implementation questions can come from all of the other NCLEX test plan categories. 

Since implementation focuses on the action or interventions of nursing practice, these questions can embody all of the test plan categories. To make it easier to understand, we've created a list of actions and interventions you may see from each category on the NCLEX test plan.

Category: Safe and Effective Care Environment

• Actions and Interventions: Effectively communicate, verify orders, advocate for patient rights, supervise care provided by others, report client findings and observations, provide care within scope of practice, document care, perform ongoing safety checks

Category: Health Promotion and Maintenance

• Actions and Interventions: Provide education, teaching and instructions to others, complete comprehensive health assessments, plan the care of outpatient and members of the community

Category: Psychosocial Integrity

• Actions and Interventions: Respond to behavioral changes, assist patients with coping strategies, provide end-of-life care, use therapeutic communication techniques, promote a safe and therapeutic environment

Category: Physiological Integrity

• Actions and Interventions: Assist patients with activities of daily living, provide comfort measures, monitor physical health status, perform post-mortem care

The final phase of The Nursing Process is evaluation. After completing the actions, interventions, nursing skills, teaching, etc., it's time to determine if we've met the patient's needs. This step is just as essential as the assessment.

On the NCLEX, questions that focus on the evaluation phase of The Nursing Process challenge candidates to understand the intricacies of expected and unexpected outcomes. Did the nitroglycerin tablet have the intended effect on the patient? Is the patient having an adverse reaction to the medication? Is the absence of chest pain the goal for administering nitroglycerin?

These are all examples of evaluating the effectiveness of treatment. Whether the interventions performed are independent, dependent, or interdependent, the nurse is responsible for evaluating whether or not it is meeting the client's needs and whether the task was done correctly and safely. To help you identify if the question is about evaluation, we've created a list of key terms to signal that you're working within the evaluation phase of The Nursing Process.

Here is a list of key terms that will let you know you should be focusing on the concept of evaluation:

• Accountability
• Correctness
• Effectiveness
• Patient Response to Treatment
• Standards of Care

The current care plan will be continued if the nurse identifies that the actions and interventions meet the patient's needs. Suppose the nurse identifies that the actions or interventions are not meeting the patient's needs or are not resulting in expected outcomes. In that case, the nurse will return to the assessment phase of The Nursing Process and collect more information to create and initiate a new care plan.

Critical Thinking

Many nursing students have a hard time speaking to the concept of critical thinking.

• What does critical thinking mean?
• What are the steps in critical thinking?
• How does one learn to think critically?

Critical thinking is one of the hardest concepts to teach nursing students. The nursing professors more or less facilitate it. However, the student must take the initiative and effectively demonstrate critical thinking through disciplined and systematic practice. Fortunately, we've identified a simplified yet effective process for mastering critical thinking, which helps significantly in improving a test-taker's accuracy when answering practice questions.

To be able to think critically, one must be able to:

• Have good observational skills
• Scrutinize information to determine its significance
• Identify issues that need to be resolved
• Prepare to address the issues
• Engage in activities that work towards solving the issues
• Measure the success of resolving the issues

What do the above steps sound like? Let's take a closer look:

• Observation = Assessment
• Scrutinize = Analysis
• Identify Issues = Diagnosis
• Prepare to Address Issues = Planning
• Activities to Solve the Issues = Implementation
• Measuring Success = Evaluation

Critical thinking is the same thing as using The Nursing Process. Many nursing students leave their programs not fully understanding that The Nursing Process was designed as a systematic approach to critical thinking so that nurses remain objective, safe, and always work within their scope of practice.

About Damion Jenkins, MSN, RN

Damion Jenkins has 14 years experience as a MSN, RN and specializes in NCLEX Prep Expert - 100% Pass Rate!.

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• v.8(5); 2021 Sep

Nursing process from theory to practice: Evidence from the implementation of "Coming back to existence caring model" in burn wards

Mojgan lotfi.

1 Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz Iran

Vahid Zamanzadeh

Rahim khodayari‐zarnaq.

2 Department of Health policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz Iran

3 Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz Iran

Khorshid Mobasseri

4 Student Research Committee, Tabriz University of Medical Sciences, Tabriz Iran

5 Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz Iran

Associated Data

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

To develop the caring model and utilize and evaluate the effect of the model in the nursing student's learning process in burn wards.

A longitudinal multiphase study.

In the first phase, "Coming back to existence caring model" was developed, in the second phase, to evaluate the program, 35 students in the first semester and 31 students in the second semester of the 2017–2018 academic year were selected randomly, and their logbooks were analysed.

Components of the nursing process, based on the model, were wound management, care and documentation, early mobilization, discharge planning and patient education. The lowest nursing process utilization in both semesters was in the sexuality domain. The most nursing diagnosis was a risk for infection. In the discharge plan, education about how the patient communicates with others in the second semester was less than other educational content (61/3%). However, empowering students was remarkable.

1. INTRODUCTION

Clinical education forms the core of nursing education and plays a key role in forming the identity of the nursing profession (Mudaly & Mtshali,  2018 ). Clinical learning activities provide a real‐life learning experience and the opportunity to transfer knowledge to practical situations (Flood & Robinia,  2014 ). The application of nursing scientific knowledge in practice is possible in the use of nursing theories and models in care (Bond et al.,  2011 ). Despite this, studies have shown that there are multiple problems such as inconsistency between theoretical lessons and clinical work, the lack of clarity of the goals of clinical education, the lack of realistic evaluations and educational facilities, are obstacles to achieving the goals of this period (Arkan et al.,  2018 ; Fiset et al.,  2017 ). In fact, clinical abilities obtained by students are not in a favourable position, and they have not acquired the skills and abilities required at the end of their education (Bennett & Jan Rodd,  2017 ).

To perform a clinical decision‐making process, it is necessary to examine and identify the problem, evaluate the existing solutions, and ultimately select the best option; this process is carried out at the clinic through the nursing process, and in fact, a nursing process is a tool for helping the nurse to make appropriate clinical decision‐making and critical thinking (Guerrero,  2019 ). The nursing process model involves assessing, planning, implementing and evaluating patient situations, with the ultimate goal of preventing or resolving problematic situations (Benedet et al.,  2018 ).

The burn is one of the main and common health problems that face the victims with significant challenges in their lives (Elsherbiny et al.,  2011 ). A nurse, who cares for a patient with a burn, injuries requires a high level of knowledge about post‐burn physiological changes as well as accurate examination skills to determine minor changes in the patient's condition (Knighton,  2020 ). Current worldwide reports indicate insufficient knowledge of first aid and initial management for burns amongst nurses (AL‐Sudani & Ali,  2017 ; Kut et al.,  2005 ). Reviews of the literature conducted in Iran indicate that the nursing process in Iran is not practically implemented or is performed incompletely (Rajabpoor et al.,  2018 ; Moghadas & Sedaghati Kesbakhi, 2020 ; Ghafouri Fard et al.,  2012 ; Zamanzadeh et al.,  2015 ). Successful internship programs (AL‐Mahmood et al., ; Neto et al.,  2018 ) and using a grounded comprehensive holistic care model (Lotfi,  2014 ) have an effective role in the implementation of the nursing process.

There are many models in nursing, such as the Roy adaptation model, which, while being holistic and paying attention to the four basic dimensions in human beings, has paid less attention to spiritual health (Meleis,  2011 ). Or in the biological, psychological and social care model of maladaptation, all nursing steps are described; however, the focus is generally on the process of adapting to malnutrition, and its use to returning patients to the community is not clear (Zamanzadeh et al.,  2014 ). Fisher's model of spiritual health and well‐being, despite paying attention to spiritual health, does not have instructions for clinical use (Fisher,  2013 ). Furthermore, a review of the literature showed that although the issue of burns has been considered by researchers in various dimensions, attention is often paid to their physical and beauty problems than to the process of bringing them back to the community (Fauerbach et al.,  2007 ; Willebrand et al.,  2002 ; Zamanzadeh et al.,  2014 ). "Coming back to existence caring model" can cover the deficiencies of previous models (Lotfi,  2014 ), and a nursing plan based on it can be useful in improving the skills of nursing students in the implementation of the nursing process and improve understanding of patients' conditions and their easier return to the community.

Therefore, due to the lake of a study on the process of returning these patients to the community, the lack of evidence on a model‐based approach to care, standardization in burn nursing care and incomplete implementation of the nursing process in Iran, a nursing plan was developed based on the model and implemented, and 35 Students' logbooks in the first semester and 31 students' logbooks in the second semester of the 2017–2018 academic year were selected randomly and analysed.

2.1. Study design and participants

The study comprised two phases that started in September 2014, and it is still ongoing.

In the first phase, the nursing plan was developed according to the “Coming back to existence caring model.” This model is comprehensive nursing care consistent with the available substitution and needs of Iranian society. To investigate how patients with burns return to the community, the qualitative study was designed using grounded theory. After analysis of 23 interviews with 16 participants, four themes were extracted as follows: A) matrix of self (context), including factors affecting the returning process, B) self‐disruption (main concerns), C) locating (strategies), including the solutions adopted by individuals in the returning process, and D) Balance (outcome). Returning to life outcomes were physical integration, connecting to the lifestream, and return to existence (Zamanzadeh et al.,  2014 ). Since burn disturbances affect all aspects of patients' existence, and balance is achieved through complex mental processes of locating and matrix context, the proposed model for helping patients need to be holistic, considering all their physical, mental, spiritual and value dimensions in the form of their matrix. The present model is called the “Coming back to existence caring model.” Its ultimate goal is to improve the level of inner satisfaction of the individual in all dimensions, and ultimately, to accept oneself as a transcendent human being. The model is presented in two general sections, structure and main stages. The structure of the model includes the ideas and beliefs, goals, knowledge, and skills required. We have used the model steps in this study, which include four basic steps based on the nursing process to achieve the model goal (Figure  1 ).

Nursing process according to “Coming back to existence caring model”

In the nursing process, the first action of the nurse, after obtaining general information in different areas of patients’ matrix (background), is to assess their condition and examine the main consequences of burns using various methods such as observation and interview in different dimensions, and afterwards, to identify the type of rupture (physical, mental, interactive and equilibrium) using the collected information, and locating that, including the positive (such as commitment) and negative (such as passive) strategies used by the individual to protect themselves to determine nursing diagnoses and planning. The goal of planning is to achieve balance. After performing the appropriate interventions, the evaluation of the level of balance is performed with regard to achieving physical integrity, connecting to the lifestream, and returning to oneself.

In the following, according to the curriculum of BS in nursing and medical–surgical course content (adults / elderly 3) training, logbook related to the nursing process in burn patients was designed by the research team. Afterwards, the logbook ran for two years in nursing students' training in burn wards in pilot form, and the logbook, the educational content, the registration section of the care program and its educational processes were modified and finalized in each semester on the basis of feedback received from students and Nursing Instructors. Nursing Care and completion of the logbook of each patient was done by senior students under the supervision of a Nursing Instructor during the internship program of elderly/adults 3 in the burn wards at the Sina Hospital of Tabriz.

In the second phase, to test the program and to evaluate the effect of the model in the learning process, 35 Students' logbooks in the first semester and 31 Students' logbooks in the second semester of the 2017–2018 academic year were selected randomly and analysed. All educational logbooks were selected, and their details were analysed.

2.2. Statistical analysis

In the second phase, data were analysed using the Statistical Package for Social Sciences (SPSS) 16.0. Categorical variables were described as relative frequency (%) and compared with the chi‐square or Fisher exacts tests. The results were considered statistically significant if p  < .05.

2.3. Ethics

Ethical approval for the study was received by the Ethics Committee in Research Affairs, Tabriz University of Medical Sciences; NO: TBZMED.REC.1394. 462.

In the first phase, the nursing care plan was designed according to the “Coming back to existence caring model” and applied in the burn wards to empower nursing students to apply the Nursing Process. The components include wound management in terms of colour and texture, signs of infection, healing, care, and documentation, early mobilization, discharge planning, and patient education about how burns affect limb function, the healing process and returning to pre‐burn conditions, potential problems and complications after discharge, taking medication at home, nutrition, wound caring, communication with others, movement, and physical limitations, and setting time of referral for follow‐up after discharge. After designing the model in the form of a logbook, it was delivered to each student by the instructor, who is one of the researchers, and completed by them.

In the second phase, total records including Steps of the nursing process registered in the logbooks by the students were analysed.

Table  1 illustrates the patients’ socio‐demographic characteristics and burn‐related health status assessment registered in the logbooks. In the second semester, students' performance in assessing the nutritional status of patients improved, and in the first semester, the rate of registered specialized treatment received by patients was higher ( p  ≤ .05).

Socio‐demographic characteristics and burn‐related health status assessment Registered in the logbooks

Categorical variables expressed as n (%).

According to the above table, the type of specialized treatment received during hospitalization and nutrition status assessment showed a significant difference in the two semesters ( p  ≤ .05). The lowest domains assessed were the patient's sexual status, beliefs and values in both semesters. After the patient's assessment, a nursing diagnosis was made about the patient's health status. After a comprehensive patient assessment, the students obtained relevant nursing diagnoses, which are shown in detail in the table below (Table  2 ).

Nursing diagnosis registered in the logbooks

According to the above table, the most frequent diagnosis in the domain of skin function in both semesters was a risk for infection (88.6% and 77.4%, respectively). And in the domain of Perception/ cognition in both semesters was deficient knowledge (51/4% and 83/9%, respectively). The lowest nursing diagnosis in both semesters was in the sexuality domain.

After all, nursing diagnoses were related to the consequences of burn injury that each student recorded from his or her patient (Table  3 ).

Registration of nursing diagnosis related to burn consequences

In the table above, in both semesters, the largest number of nursing diagnoses related to burn injury consequences was physical disability (82/9% and 80/6%, respectively), and the lowest nursing diagnosis was the lack of Excellence (5/7% and 0%, respectively). Furthermore, most students (85.7%) in the first semester and all students in the second semester were able to fulfil this section.

According to the nursing diagnosis, a care plan was performed and registered. Afterwards, interventions were evaluated to investigate the client's progress towards the achievement of goals or desired outcomes. In the analysis conducted in the first semester, 97.1% of the students had a care program, and 77.1% evaluated the interventions, and in the second semester, all of the students completed the care program and evaluated the interventions.

Early mobilization nursing process on the first day to the third day indicated that in the first semester, the patient ability assessment and related nursing diagnosis, implementation, and evaluation reduced from 97.1% on the first day to 85.7% on the second day and 62.9% on the third day. In the second semester, nursing process performance reduced from 100% on the first and second days to 74.2% on the third day.

After the doctor registered in the record that the patient could be discharged, the education sheet was completed, and after education, the related pamphlets were delivered to the patients.

Table  4 (discharge planning by students in two semesters) is provided here:

Discharge planning by students in two semesters

The table above indicates that although the number of content educated by students was higher in the first semester than the second semester, it is not statistically significant ( p  ≥ .05).

4. DISCUSSION

In the present study, the nursing care plan was designed according to the “Coming back to existence caring model” in Iran, in order to help patients to achieve an active and spiritual life. This model was tested in burn wards in nursing students' education in September 2014. Training based on this model empowered students in assessing the patient, nursing diagnoses related to burns, implementation, and evaluation of care, and training the patient during the discharge. It is expected that the description of this model will mediate the improvement of patient satisfaction, and the quality of nursing care. They help nurses to organize nursing care daily and allow them to offer higher quality care (Kaya et al.,  2010 ). A review indicated that very little information was found indicating a theory‐based approach to care; a study that investigated the Development and Implementation of an Innovative Burn Nursing Handbook for Quality Improvement and showed that utilizing innovative educational tools such as a handbook improved education and overall fundamental burn knowledge of practicing nursing staff significantly (Olszewski et al.,  2016 ). Works by (AL‐Sudani & Ali,  2017 ) showed that nurses could significantly improve their knowledge from 8.7%–100% right after attending a training course (AL‐Sudani et al.,  2017 ). Another study proved that participating in training courses is an independent factor affecting knowledge level and emphasized the importance of healthcare providers’ attendance to regular training courses (Lam et al.,  2018 ). Research studies concerning knowledge about the proper care of burn patients—conducted in Australia, the Netherlands, England and Brazil with health professionals, including nurses—have shown gaps in theoretical knowledge and its attendant technical‐assistance practices. Current worldwide reports indicate insufficient knowledge of first aid and initial management for burns among nurses (Alomar et al.,  2016 ; AL‐Sudani et al.,  2017 ; Kut et al.,  2005 ). In a Canadian retrospective study aimed at investigating factors associated with the implementation of nursing diagnoses, the results showed that nurses tend to document nursing diagnoses at institutions that have formal educational programs and computer‐generated care plans (Higuchi et al.,  1999 ). A study in Brazil showed that a smaller number of recordings were done in the steps relative to nursing diagnosis and evolution (Reppetto & Souza,  2005 ). A study in the same hospital showed that nurses' awareness of nursing diagnoses was very poor (Khajehgoodari et al.,  2020 ). Studies on nursing documentation in Iran have focused more on the quality of nursing documentation. These studies have reported that the quality of nursing documentation was unsuitable and did not contain necessary information (Rajabpoor et al.,  2018 ; Moghadas & Sedaghati Kesbakhi, 2020 ; Ghafouri Fard et al.,  2012 ; Tab rizi et al.,  2016 ; Zamanzadeh et al.,  2015 ). Results of this study showed that the top prevalent nursing diagnoses were the risk for infection, which is consistent with the results of Khajehgoodari's study and case study by Vinicius Lino Souza Neto and colleagues (Khajehgoodari et al.; Neto et al.,  2018 ). The results indicate the student's unfavourable status in the utilization of the nursing process in the sexuality domain. The reasons for this are the students' low experience in assessing the patient in the sexual domain during the education period, and the importance of examining this dimension in the clinic is insignificant. The findings of the present study can be included in the in‐service educational programs of clinical staff and training programs of nursing students to be useful in preventing or solving their problems by informing them about the problems of burn victims. According to the proposed model and the importance of the nursing process in providing comprehensive care, the findings of this study can be used in planning and implementing programs to continuously monitor the client's condition in the hospital, home and community to help him achieve the highest balance level which means gaining inner satisfaction and enjoying a meaningful life. Finally, the concepts extracted from the theory and model presented can be used as a conceptual framework for other research in this field. It is suggested that the implementation of the nursing process in the clinic be pursued more seriously in the educational curriculum of nursing students.

5. CONCLUSION

Due to the lack of standardization in burn nursing care, it is appropriate to integrate this model and practice or develop similar models in other burns wards. It seems that using a grounded comprehensive holistic care model has an effective role in the implementation of the nursing process, particularly in specialized care, such as burns. Therefore, designing a similar Holistic Nursing Care Model for burn patients in Iran is essential in order to help them to achieve an active and spiritual life. Improving Nursing Students' ability to implement Nursing Process in Burn Wards leads to quality of care and increases the patient survival and the quality of life.

CONFLICT OF INTEREST

There is no conflict of interest in the study.

ACKNOWLEDGEMENTS

We express our appreciation to all educators and students who participated in this study. We thank all the staff of the burn ward of sina teaching hospital in Tabriz for cooperating in this project. Special thank to departy of education of Tabriz nursing and medewifary faculty for supporting.

Lotfi M, Zamanzadeh V, Khodayari‐Zarnaq R, Mobasseri K. Nursing process from theory to practice: Evidence from the implementation of "Coming back to existence caring model" in burn wards . Nurs Open . 2021; 8 :2794–2800. 10.1002/nop2.856 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

DATA AVAILABILITY STATEMENT

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• Open access
• Published: 11 June 2024

Benefit finding among family caregivers of patients with advanced cancer in a palliative treatment: a qualitative study

• Yuanyi Song 1   na1 ,
• Min Wang 2   na1 ,
• Meina Zhu 1 ,
• Na Wang 1 ,
• Ting He 1 ,
• Zhihui Shi 1 ,
• Mengye Chen 1 ,
• Tian Ji 1 &
• Ying Shen 1  

BMC Nursing volume  23 , Article number:  397 ( 2024 ) Cite this article

186 Accesses

Metrics details

Benefit finding is the search for positive meaning from traumatic events, such as cancer. It can help caregivers have a positive experience in the caregiving process, relieve negative emotions, and reduce caregiving stress. The aim of this study was to explore benefit finding among caregivers of patients with advanced cancer in their palliative caregiving journey.

An exploratory qualitative design of phenomenology was used. Semistructured interviews were conducted with 19 caregivers of palliative care patients with advanced cancer. The Colaizzi 7-step analysis was used to analyse, summarize, and extract themes from the interview data.

The study identified five themes of caregiver benefit finding in the caregiving process: personal growth, strengthened relationships with patients, adjustment and adaptation, perceived social support, and perceived meaning in life. Most caregivers reported a closer, more dependent relationship with the patient, and only one caregiver did not report any positive changes.

Conclusions

Caregivers of palliative care patients with advanced cancer can have positive experiences in their care. Healthcare professionals should focus on supporting caregivers and helping them find positive experiences to cope with the challenges of caregiving and improve their quality of life.

Peer Review reports

According to 2020 data, there were 19.29 million new cancer cases and 9.96 million cancer-related deaths worldwide, and the incidence and mortality of cancer are increasing rapidly [ 1 ]. With advances in cancer treatment, palliative care provides comprehensive care for patients with advanced cancer, aiming to control symptoms such as pain, improve the quality of life for patients and family caregivers, preserve dignity and comfort, and positively affect the disease process as much as possible [ 2 ]. Benefit finding refers to seeking positive meaning from a traumatic event such as cancer [ 3 ]. It is the identification of benefits in the face of adversity and plays an important role in the cognitive process of adapting to adversity, a positive change that involves aspects of spiritual growth and a healthy lifestyle, an adaptive response to an adversarial situation [ 4 ].

Informal caregivers (spouses/partners, family members, close friends, etc.) play a crucial role in providing daily care and support to individuals with advanced cancer [ 5 , 6 ]. To meet the palliative care needs of people with advanced cancer, physical, psychological, spiritual, communication, decision-making, and financial issues may be addressed [ 7 ]. Caregiving is a complex and ever-evolving task. As the disease progresses, the caregiving burden gradually increases, often resulting in anxiety, depression, and fatigue among caregivers [ 8 ]. Nonetheless, positive psychology shows that caregivers can also experience positive changes, such as personal growth and closer relationships with others [ 9 , 10 , 11 ]. These positive meanings have the potential to enhance patient-caregiver interactions [ 9 ], redefine the meaning of life, and strengthen interpersonal relationships and self-perception [ 12 ].

The physical and mental health of patients and caregivers are interdependent and mutually influential [ 13 ]. Caregivers adapt to the stress caused by cancer by evaluating and adjusting coping mechanisms [ 14 , 15 ]. Benefit finding can assist caregivers in actively adapting to their role [ 16 ] and alleviating negative emotions and psychological distress [ 17 ]. Some studies have demonstrated that caregivers experience positive changes associated with the disease [ 9 , 10 , 11 ]. However, research on caregiver benefit finding in advanced cancer patients remains limited, and few studies have assessed caregivers during palliative care. Therefore, we interviewed caregivers of palliative care patients with advanced cancer to explore their positive experiences and benefit finding in the process of care, to improve the quality of care, and to inform intervention strategies.

Using an exploratory qualitative design of phenomenology [ 18 ], we aim to explore the positive experiences of family caregivers of advanced cancer patients in palliative care, delving into the benefit finding they experience from it. The data were collected from February 2023 to November 2023. We adhered to the Standards for Reporting Qualitative Research checklist for our reporting [ 19 ]. The Medical Ethics Committee of Zhongnan Hospital of Wuhan University approved this study (2022127). Given the vulnerability and sensitivity of the caregivers involved in palliative care, this study strictly adheres to ethical principles to ensure the legality of the research and full respect for the rights of the caregivers. Before the interviews, the purpose, methods, and potential risks of the study were explained to each caregiver, and their informed consent was obtained. At the same time, we have promised to respect the caregivers’ right to withdraw from the study at any time. To ensure the privacy and security of the caregivers, strict measures have been taken to anonymize the data, preventing the leakage of personal information. The interview data is securely stored on encrypted devices. Additionally, our research team possesses professional counseling skills and can provide necessary support and comfort during the interviews to ensure that the caregivers’ emotions are properly cared for.

Participants

The purposive sampling method was used to select the family caregivers of palliative care patients with advanced cancer in the oncology ward of a tertiary hospital in Wuhan as our study subjects. The inclusion criteria included being aged 18 years or older and being the primary caregiver of palliative care patients with advanced cancer during hospitalization. The caregivers were able to communicate and understand, and all participants signed the informed consent form. The exclusion criteria included the presence of psychiatric conditions, employment status, and other major stressful events that had occurred recently. The sample size was determined by the principle of data saturation, and 19 caregivers were ultimately included in this study. All participants provided informed consent and signed the informed consent form.

The interview guide was developed based on the research purpose and the review of existing literature and optimized through pilot interviews. The final interview outline was as follows: (a) Can you describe your experience of caregiving? (b) What difficulties did you encounter in caregiving and how did you overcome them? What support did you receive? (c) How has caregiving affected your own body, life, and family? What positive changes have occurred? (d) How has the way you relate to your patients changed? (e) What things in life are most important to you now? (f) Do you have anything else to say?

The interviews were conducted by specialty nurses who were learning and training in qualitative research methods before the interviews to ensure a standardized interview process. This study was conducted in the inpatient oncology ward, with one-on-one interviews taking place in quiet, private rooms designated for communication. Additionally, considering the convenience of the caregivers, telephone interviews were also conducted as part of the study. The purpose of the study was explained to the participants consent was obtained, and the interviews were audio-recorded throughout. The demographic information of the participants was collected, and interviews were subsequently conducted. The interviewers encouraged participants to express their thoughts and feelings deeply by listening carefully and following up with questions appropriately, and carefully observed and recorded the nonverbal messages, including tone of voice, intermittent pauses, facial, expressions, and body language. Leading or suggestive language was forbidden and any doubts in the interviews were clarified on time. Each interview lasted approximately 40 to 60 min and was adjusted accordingly based on the specific situation of the caregiver.

Data analysis

General demographic information was collected from caregivers, utilizing frequency and composition ratios for description. Within 24 h after each interview, the audio recordings of the interviews were transcribed verbatim into text, and the information was double-checked after transcription completion. The interview transcripts were imported into Nvivo 12.0 software for coding. The Colaizzi 7-step [ 20 ] analysis method was used for data analysis. ① The researchers repeatedly and carefully read all the interview materials of caregivers, to be fully familiar with and understand what caregivers provide. ② The data are analyzed word by word, to identify and extract the relevant, important, and meaningful statements relating to the result of the benefit finding. ③ Code recurring ideas within the text, and develop general statements or explain their meanings. ④ Group similar themes and descriptions together, comparing them repeatedly to identify and extract similar ideas, thereby forming a foundational framework for the benefit finding of caregivers. ⑤ Coordinate each theme closely with the research content, extracting original statements from caregivers and providing detailed descriptions. ⑥ Compare similar themes and descriptions repeatedly, distinguishing and extracting similar viewpoints to form the basic framework of caregiver benefit finding. ⑦ Present the generated thematic structure to the caregiver for validation and feedback to ensure the accuracy of the results. Text transcription analysis and coding were independently conducted by two researchers. Subsequently, the codes were compared and cross-analysed. Any disagreements were resolved through discussion within the research group until a consensus was reached. For example, if two researchers hold different views during the coding stage or understanding of the topic, we will reach a unified understanding through discussion.

A total of 19 caregivers participated in the interviews, one by telephone and the rest face-to-face. The average age of the patients was 54.37 (12.74) years (range: 30–82 years). The average time to cancer diagnosis was 3.58 (3.06) years (range: 1–12 years), of which 17 patients (89.5%) had metastases. The average age of the caregivers was 53.89 (14.55) years (range: 29–82 years). Most provided care for their spouses (36.8%), followed by their parents (26.3%) or children (26.3%), and a few were their sisters (10.5%). Additional details are provided in Table  1 .

Qualitative findings

The thematic analysis revealed five main themes and fifteen subthemes reflecting benefit finding of caregivers (Table  2 ).

Theme 1: personal growth

Serving as a caregiver.

In role change, the caregiver recognizes the importance of caregiving after the patient’s illness and takes the initiative to take on caregiving tasks and household chores.

“I treat her better than before. In the past, when we were running a pig farm and working together, I did not feel she was that vulnerable and did not pay enough attention to her. Now I do not let her do anything and just play mahjong every day. ” C12. “She used to always take care of me and care for the family. Now that she’s sick, I take care of her as much as I can. ” C9.

Enhanced familial responsibility

During the caregiving process, the caregiver becomes more deeply aware of his or her family responsibilities and subsequently becomes more actively involved in family life, collaborating to maintain harmony and happiness within the household.

“I’m more mature, have a stronger sense of family responsibility, and am family-centered except for work, where mom is most important.” C14. “I have come to understand the significance of fatherhood. While having children does not guarantee security in old age, we can still end up overwhelmed by their dependencies. Nevertheless, it is crucial to fulfill our duty towards our children, as they have been entrusted to us.” C15.

Initiating assistance

In the face of family difficulties, one of the caregivers expressed the selfless act of stepping up and offering help without hesitation. This selflessness is an important force in providing support.

“I will still step up to the plate when my relatives face any kind of trouble.” C7.

Theme 2: strengthening relationships with patients

Pleasant companionship.

The majority of caregivers reported harmonious family relationships during the caregiving process, highlighting the strong emotional connection and support they provide to their loved ones.

“I am in good health and can take good care of her. We have been getting along well over the past two years of treatment. There has always been a mutual understanding, and despite occasional friction, I can be the first to admit mistakes.” C2.

Increased intimacy

Caregivers spend more time with the patient, support and encourage each other, develop closer relationships, and increase the patient’s reliance on the caregiver.

“During the few years that I have taken care of her, I have done my best. She is also very understanding of me, worried that the physical demands of caring for her might wear me down. She will take care of me, remind me to pay attention to my health, and we are there for each other during hospital stays.” C6. “She underwent surgery in 2012, radiotherapy in 2015, and targeted therapy in 2023, and she is becoming increasingly dependent on me. She wanted me to accompany her throughout the treatment. In this life, we are sisters, but in the next life, we might not be. When she came to Wuhan for treatment, I accompanied her throughout.” C7.

Warmth and strength

Caregivers demonstrated selfless love, valuable companionship, and personality shifts in caregiving. They all express positive coping attitudes, perceive benefits in the face of adversity, and provide mutual support to face challenges together.

“Despite the great internal pressure, the back pain, and taking care of patients at night, I still insisted on giving all my love to my daughter and treating my sick daughter wholeheartedly without any complaint.” C1. “In the past, both my mom and dad worked outside and we usually spent little time together. However, now I have the opportunity to be with them more often, and I am especially happy to spend time with my mother.” C3. “I used to have a bad temper, but now I always defer to her.” C12.

Theme 3: Adjustment and adaptation

Energetic response.

When faced with the difficult situation of a family member with a serious illness, the caregiver adjusts to the pace of the treatment, adheres to the treatment with resolute determination, has trust in the healthcare team, and maintains a positive mindset.

“She has been sick for 13 years and has grown accustomed to it. My partner always says we do not have enough money for hospital treatment. I always encourage her to keep going because the doctors have not given up yet.” C6.

Despite the pain and anxiety associated with treatment, caregivers remain hopeful, valuing the current effects of treatment and the quality of life, and are not overly worried about the uncertainty of the future.

“We are interdependent, just want to get better soon. Our mentality is very positive there is nothing to worry about. We are not facing any major challenges, nor are we overwhelmed by any burdens. ” C12. “Before radiotherapy, I was very anxious about the patient’s condition and distressed that the patient was suffering from the disease. After radiotherapy, the treatment was effective and the pain was under control. While there is a possibility that the disease could recur, it’s something we can address when the disease can recur. There’s no need to worry about what may happen in the future.” C2.

However, some caregivers also reported that finding enjoyment in shifting their focus can help alleviate negative emotions and reduce caregiving stress.

“I often find joy in the face of adversity. Whether I’m playing cards or watching others play, I find time to go out, relax, have fun, forget my worries, and avoid crying at home.” C4.

Strengthen belief

Belief is a critical spiritual force that serves as the driving force and solid support for both patients and caregivers, instilling confidence in overcoming the disease.

“My daughter cannot live without my care, so this belief forces me to prioritize my health. Having cared for patients over the years, I seem to appear younger than my actual age.” C1. “I feel like we have a great task and an enormous responsibility on our shoulders. He can only rely on us. We cannot give in we must stand by his side and fight his cancer.” C10.

Patient factors

The patients themselves are resilient and optimistic, enduring the pain of illness and treatment yet remaining upbeat. The caregivers profoundly influenced and sustained hope and faith, alleviating the caregiving burden.

“I accompanied her through surgery, radiation, and chemotherapy. My mom is very optimistic and strong, and I felt comfortable being there for her without much stress.” C17. “She suffered a lot. Radiation and chemotherapy were difficult. I never heard her complain once. She was particularly resilient.” C18.

Theme 4: perceived social support

Family support.

Most of the caregivers reported feeling warmth during the patient’s illness with filial piety from their children and varying degrees of kindness and support expressed by relatives, friends, or neighbors.

“After she got sick, relatives, villagers, and friends showed great concern and helped us. I felt the warmth of their support. ” C9. “When we were in financial trouble, her mother would give us some money to use.” C5.

When the caregiver is providing hospital care, other family members take the initiative to undertake household chores, care for children, parents, and other obligations, and offer encouragement and support to the caregiver.

“I suffer from hepatitis B and severe fatty liver disease, and I spend all my time taking care of my mom. Fortunately, my family is very understanding and supportive, and my exceptionally kind in-laws assist in taking care of my son and daughter. They constantly encourage me to take good care of my mom. ” C3.

Social support

A case where a caregiver was supported by the company by approving a caregiving leave with no loss of pay.

“Leave from work does not affect pay the unit is still very humane.” C13.

Some caregivers mentioned that insurance, health insurance, and commercial insurance provided financial support and increased the patients’ chances of treatment and prolonged survival.

“I bought commercial insurance before she got sick, and it paid out 180,000 million RMB.” C1. “My mom has precision poverty alleviation health insurance and would not spend much on medical treatment.” C19.

Theme 5: perceived meaning in life

Cherishing companionship.

Faced with the uncertainty of life, caregivers cherish the present moment, do not worry too much about the future, and live with a positive attitude.

“I have to face the reality. I hope that I can live a good life and spend more time with my mother in a limited time.” C14.

Enhance health awareness

Caregivers can better understand the importance of good health, take the initiative to seek health-related knowledge, and pay attention to medical check-ups. The concept of seeking medical treatment should be changed, and medical treatment should be sought promptly if one feels uncomfortable. In addition, they are healthy and can take better care of patients.

“Both she and I value our health more. In the past, when I went to the hospital for examination, she would be very upset and say that I was making a mountain out of a molehill, being too worried and timid. Now she will take the initiative to ask me to have an examination.” C9. “Taking care of my mom has made me feel that my health is so important that I will be more conscious of my physical state and focus on weight management.” C14.

Maintenance of crisis consciousness

Caregivers purchase commercial insurance for themselves and their family members to respond to unknown risks, avoid potential financial losses, and receive timely protection in the event of an accident.

“Enhance the sense of crisis by purchasing commercial insurance for all family members.” C19. “At the same time, I have got commercial insurance for my dad. I hope that if there are any accidents at home, the financial piece will not be on us. ” C14.

Praying for well-being

Throughout the patient’s life, the caregiver is acutely aware of the patient’s significance and articulates their good wishes, hoping that the patient will recover or prolong his life, as well as wishing that the family and friends around him or her will be free from difficulties and frustrations.

“It is most important that mom is doing well on her treatment and is not resistant to medication, and I hope she can live a little longer.” C14. “May the loved ones around me be free from hardship and frustration.” C7. “Mom’s good health is the most important thing, but at the moment, it is no longer possible. In that case, it is crucial that she remains happy. In addition, truly, if she eats one more bite of food, I will be overjoyed.” C3.

Another caregiver hopes that a certain anticancer drug can be used in medicine as early as possible so that more people can afford it, and patients can be given more chances to treat their disease, control it, and prolong their lives.

“I hope that anticancer drugs will be included in the medical insurance plan as soon as possible.” C1.

In addition, only one caregiver reported that she did not experience any positive impact, that the patient’s personality had changed since she became ill, and that she was forceful, and assertive, and had difficulty getting along with the patient.

“She is looking at things with increasing difficulty, her mood is good one moment and bad the next, you never know when she might explode. My mom and I are very considerate of her, but she cannot seem to appreciate it. She is very dependent on me, and at the same time, she has a lot of dissatisfaction and resentment. ” C16.

This study explored the caregivers’ perceptions of benefit finding in palliative care patients with advanced cancer. Five themes were identified: personal growth, strengthening relationships with patients, adjustment and adaptation, perceived social support, and perceived meaning in life. The majority of caregivers reported benefit finding in the caregiving process, with only one caregiver not reporting any positive impact. This emphasizes the importance of providing psychological and social support to caregivers to help them better cope with their challenges and informs the refinement of palliative care support systems.

Cancer, as a major traumatic stressful event, has traditionally been studied mostly focusing on the negative emotions it triggers [ 21 ]. However, the Revision of Stress and Coping Theory [ 22 ] has brought positive emotions into the study of stress processes, and it reveals the coexistence of positive and negative emotions in coping with stress. Positive emotions help to restore physical, psychological, and social coping resources, and they produce positive coping processes, including seeking benefits.

The results of the study showed that caregivers experienced personal growth in caring for advanced cancer patients in palliative care, similar to the findings of Mei et al. [ 23 ]. Caregivers not only gained disease-related knowledge and skills [ 24 ] while assuming caregiving responsibilities and duties but also experienced the pleasure and satisfaction of companionship [ 25 , 26 ]. In addition, by reevaluating their values taking the initiative to assist others, and embracing a role as someone who is needed, caregivers elevate their sense of self-worth and infuse their lives with deeper meaning [ 27 ]. However, caregivers may experience negative psychological changes, such as anxiety, insecurity, and helplessness, while dealing with challenges. Therefore, while promoting the growth of caregivers, it is necessary to seriously consider ways to effectively ease their burden and stress, such as enhancing the social support system, offering tailored support, and attending to their mental well-being. During this process, caregivers can achieve self-growth and cognitive improvement during the caregiving process while maintaining their physical and mental health, thus better supporting and caring for patients.

During the caregiving process, spending time together significantly strengthened the emotional bond between the caregiver and the patient, resulting in a more intimate and dependent relationship, consistent with the study by Mosher et al. [ 11 ]. Family caregivers bear a variety of physical, emotional, social, and economic burdens [ 28 ]. Enhanced relationships and enjoyable moments together foster unity, understanding, and mutual support within the family, thereby improving cohesion and well-being. Therefore, prioritizing communication and interaction among family members is crucial for enhancing cooperation, and problem-solving skills, and continually strengthening the caregiver-patient relationships.

Research has shown that caregivers’ perceptions of benefits are closely related to their positive coping styles. Consistent with the findings of Li et al. [ 29 ], positive coping mechanisms can contribute to the level of benefit finding. Optimistic caregivers are more likely to view the caregiving experience in a positive light, which ultimately leads to a greater sense of benefit [ 30 ]. Furthermore, emotional catharsis, as a form of positive coping style, can effectively alleviate stress and negative emotions. In China, the low-income population and precise poverty alleviation healthcare policies provide financial support for patients. Caregivers perceive that social support can provide them with more resources and assistance, making it easier to identify benefits and opportunities—a perspective that contrasts with the Pascoe [ 31 ] and Kangas [ 32 ] studies. However, there are still inadequacies in the social support system in our developing country. To address this, the government is actively optimizing resource allocation and enhancing policy implementation. For instance, the implementation of medical care for major illnesses and preferential policies on personal income tax can alleviate the economic burden on families resulting from medical expenses. Additionally, the government is actively promoting the development of medical alliances and strengthening collaboration between communities and medical institutions to provide caregivers with more convenient and efficient medical services. Furthermore, the study highlights the need for improved communication between patients, caregivers, and healthcare providers to ensure that caregivers have access to crucial healthcare information [ 33 ]. It is essential to enhance communication, provide relevant resources, and encourage proactive decision-making in healthcare. The acknowledgement of social support aids individuals in adopting positive and beneficial coping styles [ 34 ]. The active search for benefit finding in the face of adversity is more likely to lead to social support, which can improve one’s ability to cope with challenges and enhance adaptive capacity and psychological well-being. With the combined efforts of government, society, and individuals, we can establish a more comprehensive social support system, providing caregivers with increased support and assistance.

In the course of caregiving, caregivers gain profound insights into the fragility and resilience of life, by reevaluating its meaning, which is key to reducing their stress levels [ 35 ]. They proactively adjust their lifestyles and devise coping strategies to navigate psychological and social challenges, ultimately finding meaning and deriving benefits from it [ 36 ]. Additionally, they remain vigilant to potential crises, purchase commercial insurance, and schedule regular medical check-ups. However, in the palliative care stage, most caregivers have a vision of prolonging the patient’s life, alleviating their pain, and improving their quality of life. These experiences and understandings are helpful for caregivers to better cope with difficult situations and maintain a positive attitude.

Benefit finding has been found to be an effective strategy for coping positively with stress [ 37 ], and it is vital to maintain a positive mood, which relieves stress, enhances well-being, and improves physical and mental health [ 31 , 38 ]. By strengthening the confidence of nurses and providing social support and resources, the burden of caregiving can be reduced [ 39 ]. Cognitive stress management [ 40 ], music therapy [ 41 ], group psychoeducation [ 42 ], expressive writing [ 43 ], and meaning-centered psychological interventions [ 44 ] have been proven to improve the level of benefit finding for caregivers, enabling them to gain positive influence from their caregiving experiences. These measures help reduce caregiving pressure and maintain positive attitudes among caregivers, thereby providing better support to patients.

Study limitations

This study collected data through individual interviews, but this method has limitations. Primarily, the subjective nature of interviews can lead to respondent selection bias, which may affect the universality of research findings. Additionally, all the interviewees were from the same region and ward, which means that they might face similar circumstances and challenges, leading to similarities in their caregiving experiences. Therefore, limitations in the types of cancer diseases among the patients also limit the transferability of findings. This study uses a qualitative approach with the primary aim of gaining insight into the human experiences of a specific sample, thus the conclusions may not apply to broader populations or environments. In the future, studies should be considered in different regions and cancer types to address these limitations. It is also important to assess the extent of the caregiver’s benefit from the care using a mixed-methods research approach. This could help us explore the mechanisms behind this phenomenon and guide the development of effective interventions.

Clinical implications

This study explored the phenomenon of benefit finding among caregivers of palliative care patients with advanced cancer, identifying five major themes that demonstrate the positive impacts that caregivers gain from their experiences with caregiving. These findings provide a valuable foundation for further research into carer benefit finding. The research findings can provide a basis for developing effective interventions targeted at caregivers to further support them in their work of caring for patients. By providing consistent support and assistance, people can enhance their coping abilities, improve their quality of life, and enable them to play a more active role in caregiving.

In summary, this study highlights the benefit finding of caregivers among caregivers of palliative care patients with advanced cancer in a variety of areas, including strengthening their emotional connection with the patient, redefining their meaning of life, personal growth, and improving their coping skills. Cancer care is a long-term task, and the positive impact of caregivers—an integral part of the treatment chain—is often overlooked. Therefore, future research should pay more attention to the long-term impact of caregivers’ benefit finding.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

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We would like to thank all participants in our research group. This research was supported by the Clinical Nursing Research Project Fund of Zhongnan Hospital of Wuhan University (LCHLYJ202203).

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Yuanyi Song and Min Wang are co-first authors.

Authors and Affiliations

Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China

Yuanyi Song, Meina Zhu, Na Wang, Ting He, Xu Wu, Zhihui Shi, Mengye Chen, Tian Ji & Ying Shen

Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China

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Contributions

Y. S., Y. S., M. W., M. Z., N. W., Z. S., and M. C. designed the research. Y. S. and M. W. designed the interview outline and participant materials, which were revised by M. Z., T. H., and T. J. Interviews were conducted by X. W. and Z. S. Under the supervision of T. H., T. J., and M. C. Y. S. and M. W. encoded, analyzed, and interpreted the data. Y. S., Y. S. and M. W. drafted the manuscript. Y. S., M. Z., N. W., M. C. and T. J. revised it critically and provided final approval for the submitted version.

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Correspondence to Ying Shen .

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This study was approved by the Medical Ethics Committee of Zhongnan Hospital of Wuhan University (2022127). All participants in the study have signed the informed consent form.

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Song, Y., Wang, M., Zhu, M. et al. Benefit finding among family caregivers of patients with advanced cancer in a palliative treatment: a qualitative study. BMC Nurs 23 , 397 (2024). https://doi.org/10.1186/s12912-024-02055-z

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Received : 23 February 2024

Accepted : 31 May 2024

Published : 11 June 2024

DOI : https://doi.org/10.1186/s12912-024-02055-z

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