The nursing process

The Nursing Process is about the nurse getting to know the patient as a whole person and not just a patient with an illness.

The Nursing Process provides individual nursing care that focuses on actual or potential alterations to health (Richards & Edwards 2008).

It is about planning and establishing the needs of the patient and helping to deliver these needs through planning and implementation.   It does not only help the patient but also any family members.

The Nursing Process was introduced into the UK in 1977.  It originated in the 70s in the USA and was established to help teach students a holistic approach to care (Physical, Intellectual, Emotional and Spiritual PIES) (Hilton Penelope A 2004).

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There are four steps to the process although separate entities they are not separate and each one overlaps with the other and can be reassessed on an ongoing basis.  The four steps are Assess, Plan, Implementation and Evaluate.

The Nursing Process has four steps to it as stated above.  Lets look at each  one in turn:-

Assessment stage is about collecting as much information about the patient from as many different sources as possible.  Information can come from the patient themselves, family/carer, GP, other Health team members and any previous medical records.  There are two different types of data which can be collected; Subjective data or symptoms is collected by the nurse from the patient and can include feelings, worries or pain.  Objective data or signs is by means of a head to toe physical examination and general observation  Castledine George 2004).  Once all the relevant personal patient information has been en-gathered the nurse can move onto physical health information and can therefore establish the patient’s health problems past and present.  As the nurse is speaking to the patient, they would be establishing what is wrong with them, how much pain they are in and could it lead to a further complication or could it be easily sorted out.  The nurse would also be taking the patient’s vital signs.

Planning stage is between the nurse and patient it is about setting goals that can be achieved, they can be short term or long term.  It is about setting the patient a task and also to see if this can be achieved within the time scale given.

Implementation can be between the nurse, patient and any other health care professionals.  It is about putting the planning and goals into action and hopefully getting the patient back on track and being able to deal with what is wrong with them and making small changes to help them move forward.

Evaluation is to determine how effective the care has been and to ascertain if the goals have been achieved.  If some of the goals have not been achieved its about going back through the nursing care plan and reviewing the dates and possibly changing some of the goals to try and problem solve anything that has not worked out the way it should have (Lloyd Helen et al, 2007).

The Nursing Model by Roper Logan & Tierney was introduced around the 1970s and later published in 1980 in the “Elements of Nursing”.  It has subsequently been redefined and redeveloped and was introduced into nursing to help nurses look at the patient as a real person and not just a medical label (Nazarko Linda 2008).

Throughout its life the Nursing Model was changed to incorporate 12 Activities of Living; these would be the foundation of the nursing model and would help nurses redefine what nursing was all about and understand that the patient’s health and ill-health are linked to their lifestyle and their way of life (Alexander et al, 2006).

Taking two Activities of Living; lets look at each one in turn.

Communication:- In order for the nurse to gather information and establish what is wrong with the patient there must be good communication skills (Lloyd & Stephen 2007), along with speaking and the asking of open and closed questions; there must be good listening and observing skills.  It is about the nurse and patient building up a good rapport and the nurse building up the trust of the patient.  The environment in which they are speaking has to be private and as comfortable as possible.  There must be respect and the nurse must assure the patient of confidentiality.  The nurse must use the appropriate language to ascertain the information that she requires, do not use to much medical jargon and if the patient is not able to understand does the questions have to be written down or be in a different language altogether.

The use of open and closed questions; open questions starting with who, what, where and why are allowing the nurse and patient to chat and allowing the patient to chat about life and what is worrying them at the moment; and the nurse time to make any relevant observations about the patient.

The nurse must listen to the patient’s answers but also make her own observations.  Ask one question at a time and allow the patient time to answer.  Be aware of your own body language and the patients, don’t raise your voice unnecessarily and if there is a moment of silence this will allow the patient time to think about their own thoughts.  Use eye contact, don’t hurry the patient and be sympathetic and patient at all times.   When looking to conclude the discussion bring everything together and summarise any relevant points and ask the patient if they are happy with what has been discussed and if they have any final questions.  Thank them for their time and say that you will be back to discuss anything further when required.

Maintaining a safe environment:- Looking at the patient as a whole and educating the family and carers with the knowledge and understanding of what is required.  Taking into account that there may be other people involved ie other Health team members and taking onboard what they have to say and suggest.

Behaviour change does the patient have to have a better and healthier eating plan put in place; do they require to get more exercise.  If this is the case can the patient get out and about or do they require assistant to get to and from the doctors or does the health visitor have to come to their house.  Does the patient have all of the relevant information to hand in order to achieve these goals.

If the patient is allowed home the family/health care people have to make sure that the patient’s home has a safe environment; the family have to make sure that there is not too many objects around the house that the patient may trip over or bang into (Potter & Perry). Although the patient may have liked being in the hospital and having people doing things for them; once it is time for them to go home there was a fear that they would not be able to cope and end up back in hospital. Therefore getting them back home to familiar surroundings allows them to have privacy and safety.  Allows them the independence and freedom to please themselves.

To summarise the Roper Logan & Tierney Model is one of the most widely used models in the West of Scotland.  It provides nurses with a framework for   en-gathering information and therefore helps them provide the nursing care and standards that are required to meet the needs of the patient in this ever changing environment.