Application of the Nursing Process

Application of the Nursing Process Paper
Using APA format, the information from this course, and your assigned readings write
a six (6) to ten (10) page paper (excludes cover and reference page) addressing the
application of the nursing process to a patient care scenario.

Application of the Nursing Process


Nursing process is the scientific methodology used by Registered Nurses to perfect
provision of quality health care to their patients. The overall nursing process is broken into
five distinct steps that include: assessment, diagnosing, care-planning, implementation, and
evaluation phases. The process does not always produce expected results, but it can call for
its repetition in order to address cons from the process. Therefore, the following article will
indulge to discuss the meaning and use of the nursing process in making good nursing
judgments that effect patient care. The discussion will also go ahead to describe a plan of care
using the nursing process for patient with a history of CHF, hypertension and lower extremity

The meaning and use of the nursing process in making good nursing

judgments that effect patient care

The first phase in the nursing process is the assessment phase. The meaning behind
this step is that the RN gathers information about a particular patient’s physiological,
psychological, spiritual and sociological status (Timby, 2009). The main method used by
RNs to garner this data is through interviews, physical assessment, digging out of patient’s
health history and general observation of the patient’s health behavior. This phase completes


by documenting the relevant information in retrievable forms. Diagnosing phase follows as
the second phase in nursing process. During this phase, The RN involves himself or herself in
making an intellectual judgment about the likelihood or actual health disorder with a client
(Timby, 2009). This phase can incorporate multiple diagnosis techniques directed to a single
client. The diagnosis can be done to a single patient rather to a group of patient if a specific
condition from an already disorder in the course of treatment. This assessment not only
comprises of actual description of the problem, but also whether or not the patient is
susceptible to developing another complication (Timby, 2009). The other reasons behind
diagnosis are to gauge patient’s readiness for health improvement and to determine whether
or not the patient has developed a syndrome. The meaning of diagnosis phase is crucial is in
suggesting the appropriate course of treatment to undertake to that particular diagnosed
Planning phase is the third step used in nursing process. In this face, plan of action is
developed. The plan is developed as a result of patient and the nurse agreeing on the
diagnosis Timby (2009). This phase still suggest that if there is multiple diagnosis that need
to be addressed, the RN will focus or prioritize each assessment and concentrate to severe
symptoms and high risks conditions. For each single problem, it is assigned a clear,
measurable objective for the expected beneficial result. In this phase, therefore, Registered
Nurse overly refer to the evidence based Nursing Outcome Classification, which is a program
of standardized terms and measurements for tracking client wellness.
According to Timby (2009), in the book Fundamental nursing skills and concepts,
Nursing Intervention Classification (NIC) can also be employed as a resource for planning. In
planning phase, independent nursing interventions are nurse actions started by RN that do not
need any direction or any order from another nurse in planning medication for a patient


(Timby, 2009).inter-dependent nursing interventions are activities of a RN and other
practitioners with sole role of addressing a single factor. Nurse-imitated nursing intervention
is a treatment imitated by a nurse in response to a nursing diagnosis.
The fourth phase in nursing process, which is the crucial one, is the implementation
phase. During this phase, the RN follows through the already Plan of Action (POA). Timby
(2009) argued that the plan is particular to each and every patient and aims at achievable
outcomes. Actions and activities involved in a nursing care plan comprises monitoring of the
patient for signs of change or improvement, directly caring for the patient or engaging crucial
medical roles, educating and giving directions to a patient about further health management,
and contacting the patient follow-up (Timby, 2009). The duration in implementation phase
can vary and can take hours, days, weeks or even months (Timby, 2009). During
implementation phase, indirect care comprises, for example, Emergency Cart Checking and
interventions for communities such as social, economic and political aspects. Direct care
implies that the patient will have to attend herself or himself with medication without
assistance of medical practitioners near him or her.
The last step is provided by Timby (2009), in the book Fundamental nursing skills
and concepts, is the evaluation phase which comprises all nursing intervention action that has
taken place to the above steps. Once all the intervention activities have taken place, the RN
completes an evaluation for client wellness to have been met (Timby, 2009). Possible client
outcomes are generally provided under by three terms: patient’s disorder improved, patient’s
disorder stabilized, and patient’s disorder deteriorated, died or discharged. If the condition of
the client does not show any improvement, or if the set objectives are not met, the nursing
process starts afresh and cycle repeats itself (Timby, 2009). The Registered Nurse can
evaluate the entire use of nursing process by its outcomes. One of the outcomes to consider is


whether the client has been vindicated from the disorder. Another important variable to put
into practice in evaluating the process is susceptibility of the patient to develop another
disorder from the previous one (Timby, 2009). Most importantly, the RN should be able to
evaluate the nursing process by observing outcome of a patient being able to be discharged
from the hospital. After the above evaluation of outcomes, the RN can grade the nursing
process as either not productive, productive or more productive based on the apparent
condition of the client.
The development of a plan of care using the nursing process for a for patient with a

history of CHF, hypertension and lower extremity weakness
Timby (2009) contends that the nursing process can assist a RN to develop a plan of
care by using its five stages. In the above scenario of a 78-year-old man, the RN will have to
gather important information to assist the client. One of the vital data to be recorded is that
the man has ability to walk short distances and transports himself to the communal dining
room. The man is able to administer himself medication and can bath himself. The RN should
also note that the man has a history of CHF, hypertension and lower extremity. Another data
to collect is that the client was continuing with direct care. The diagnosis will first begin by
rapid assessment of the patient’s personal information. The assessment data that support use
of this nursing diagnosis is a pressure ulcer over the ischium on the right buttocks. The other
important clinical manifestation is an oval wound about 10mm by 8mm with red and yellow
areas in the middle and black areas on some surrounding tissue producing a smelling foul.
The doctor uses independent nursing intervention to direct the client to receive intravenous
antibiotic therapy so as wound care can be initiated. The outcome that meets the criteria is
that similar medication that was dispensed to the man in the first place is still the same one
administered after diagnosis. This is because the RN nurse known that development of the


wound was as a result of methicillin-resistant staphylococcus aureus. The outcome of the
patient is psychomotor because the old man uses his physical abilities and procedures to aid
himself to get healed.
The RN uses dependent nursing interventions to prescribe the old man to undergo
surgical debridement of the black tissue. Time frame decision was one of interdependent
nursing interventions to ensure that there is a connection between earlier medication and the
current medication (Timby, 2009). To perfect the medication, the RN uses independent
nursing intervention to ensure that the client is administered with saline intravenously three
times a day. This period is to ensure complete neutralization of staphylococcus aureus.
Implementation will also involve dressing of the wound daily. Evaluation will aim to
determine whether SIlvaSorb will heal the entire wound and whether intravenously
administered Saline will suppress the activities of Staphylococcus aureus. The RN will also
incorporate other medical practitioners in scrutinizing the performance of the wound to see if
it would heal. If these symptoms persist, the RN will have to repeat the same nursing process
again and find other way to deal with the disorder.
Nursing teaching plan to avoid recurrence of the above condition
To assist the patience in preventing a recurrence of a similar incident once he returns
to the assisted living environment, RN will need to develop an individualized plan. In this
case, the RN will decide the format of the teaching plan to be in verbal form. The RN comes
to this conclusion by the fact that the client can talk, walk for short distances and count
transport himself to the communal living room by himself. The information that needs to be
included in the plan will include dressing the wound daily with SilvaSorb, saline
intravenously three times per day and correct adherence to the prescribed drugs including
Metoprolol and others. All this information will be used evaluation where all nursing


interventions used converge. Looking into results at the evaluation stage, can guide a
registered nurse (RN) to make effective decision on when and how to evaluate teaching-
learning process. The appropriate time for RN to determine how and when to evaluate the
teaching-learning process is when the patient start demonstrating psychomotor features, that
is, ability to use physical skills or procedures. The RN can also determine to evaluate
teaching-learning process by identifying priorities of learning needs within the overall plan of
care. In this case, the important learning needs is how to change the SIlvaSorb dressing
within the prescribed time.


In conclusion, nursing process has to be done tremendously to perfect nursing
activities towards provision of quality services to patients. Through the process assessment,
diagnosis, planning, implementation, and evaluation, RNs are able to address a particular
disorder systematically. If a disorder is not dealt with completely by the process, RNs are
advised to use the same nursing process to rectify areas of mistakes, and as a consequence,
develop other strategies within the process to holistically eradicate the disorder.



Timby, B. K. (2009). Fundamental nursing skills and concepts. Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.

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