Review the required readings about the nursing process. In your own words, define each
step of the process and provide an example for each step.
In the implementation step, what is meant by direct and indirect care as described by the
Nursing Intervention Classification (NIC) project?
Discuss the three (3) types of nursing interventions (nurse-initiated, dependent, and
interdependent) that applies to the patient care situation. Provide an example of each (refer
to your textbook).
Explain how the nursing process provides the basis for the registered nurse to make a
nursing judgment that results in safe patient care with good outcomes.
Discuss how the registered nurse evaluates the overall use of the nursing process. Identify
three (3) variables that may influence the ability to achieve the desired outcomes for the
How is the plan of care modified when the outcomes are not met?
How does the RN use the nursing process to make decisions about the priority of care?
Part 1: Nursing Process
Nursing process is the key factor that facilitates the nurses in delivering quality patient centered
care. Nursing is defined as the science and art concerned with protecting and promoting peoples
psychological, physical, psychological and cultural aspects. The science is based on a big
theoretical framework whereas its art is depicted on the caring capacities and skills of each nurse.
The concept of nursing process was established to defined to guide the nurses when making
decisions on care provision and it involves five major steps namely; a) Assessment, b)
diagnosis, c) planning/identification of outcome, d) implementation, and e) evaluation
(Bruylands Et al., 2013).
Assessment is the first step of nursing process and involves gathering of information and data
concerning a particular event. The nurses are encouraged to perform holistic care assessment of
both patient healthcare history and physical examination so as to determine the specific
healthcare demands of a patient. The data gathered is sorted, organized and documented for
future references. Nursing diagnosis is the second step in nursing process; which involves
analysis of the assessment and data gathered. Diagnosis process is conducted with the aim of
establishing the patient’s specific healthcare needs. It involves identifying the actual problem
including disease clinical manifestation. It also includes identification of risks factors and ways
to improve patient’s outcome (Liu, 2013).
Planning step entails all activities geared towards development of priorities, objectives and the
identification of the desired outcomes. It involves identification of specific nursing interventions
as documented by action plan. Nursing action plan is effective if it is guided by Maslow’s
hierarchy of needs and the Betty Neuman’s system theory. The implementation process involves
putting the action plan into action to achieve the desired outcome set for each patient. The patient
continued to receive treatment and quality care until their healthcare condition is achieved. The
last step is evaluation and it involves assessing of the outcomes to see if it is congruent with the
action plan. If the outcomes are negative, the interventions are modified appropriately (Fleming,
According to Nursing Interventions Classifications (NIC), direct nursing interventions refer to
nursing interventions which involve direct interaction with the client/patient. For example,
medication therapy being provided to person with congestive heart failure. Indirect nursing
interventions include strategies that are implemented to improve patient’s health but the client is
indirectly involved. This includes issues such as introduction of hourly rounding’s in hospital to
reduce the number of hospital falls. Nursing interventions are classified into three broad
categories including; a) dependent, b) interdependent, and c) independent intervention.
Interdependent intervention involves nursing actions that are implemented through partnership
and teamwork. It involves intensive consultations across the healthcare provider before any
intervention is implemented. These includes actions such recommend surgery to patients with
hyperthyroidism. This will only be done if all other therapy implemented has failed, and it
involves a lot of consultation between the healthcare providers before the decision is made. The
dependent interventions involve strategies that are recommended by higher health care
authorities to the nurses. These include actions such as terminating patient’s medication due to
reactions. The independent intervention includes all actions that can be implemented by the
nurse without any consent from the authority. These involve all practices permitted by nurse
practitioner scope of practice (Kehrel, 2015).
The nursing process guides the registered nurse in taking patients medical history while still
remaining culturally competent. Nursing process requires the nurses to identify the healthcare
problem, identify the etiology analyze the risk factors. Using the data generated form these
process, the nurse can design patient focused action plan. The process also guides the identified
intervention implementation in an orderly and structured manner. The outcomes expected are
goal oriented and focused in providing care to the patient (Lu Et al., 2015). The process requires
documentation in each step and well communicated whenever it is necessary. The nurse
interventions are then evaluated to check if they match the expected patient outcome. The
evaluation process requires joint effort between the healthcare providers; and where the
outcomes are not achieved, it may require a little bit of brainstorming to identify the gap and to
establish the variables that need to be re-evaluated. Some of the variables that can be re-
evaluated include the data gathering/ assessment to check if the information was collected
thoroughly or there was some information that were overlooked. The second variables include
diagnosis to check if risk factors were adequately explored (Vaillant-Roussel Et al., 2014).
In some cases, the etiology can be wrong or inadequately explored. In some cases, the expected
outcomes and interventions developed could be unrealistic or unreasonably unmanageable. If
the outcomes are not met, the nursing process begins all over again from the assessment,
diagnosis and action plan to implementation. This time, the nurse can involve other peers so that
they can contribute to the healthcare dilemma and hopefully identify the relevant ideologies in
establishing the best intervention. The best intervention is the evidence based one. The nurses
need to make thorough research to identify the best practice which must be agreed by all the
health care providers and the stake holders involved. This way, the nursing processes helps the
registered nurse by helping then identify and define the problem, gather the healthcare
information relevant to the matter and to generate the best possible conclusions (Svavarsdottir Et
Part 2: Nursing care plan
George King lives in a residential care facility. His movement is restricted and mainly depends
on wheel chair. He can manage the daily living activities such as bathing and dining. He likes
living in isolation. He has history of Cardiac Heart Failure disease, hyperlipidemia, and
hypertension and lower extremity weakness. He is under the following medication. His previous
medication including Lopressor 50 mg, Atorvastatin 20 mg, Furosemide 20 mg and Quinapril
He is currently on Metoprolol 50 mg; Quinapril 40 mg, Furosemide 40 mg which are
administered orally and cefazolin 1.5 g diluted in 50 mL 0.9% normal saline which is
administered thrice a day. Recent routine medical checkup reported a pressure ulcer on his right
side of the buttock. The ulcer is estimated to be around 10 mm by 8 mm. It is red in color with
yellow sports all over it. The ulcer produces foul odor.
Height: 5’8”; Weight: 56 kg; Temperature: 36.6 0 C; Pulse: 90 BPM; Respiration: 22/Minute; Bp:
160/7 80 mm Hg: Skin is most but pale; the pupils dilated; the neurovascular system, muscular
system and gastrointestinal system are intact. The patient complains of memory loss.
1) Manage the pressure ulcer
2) Pain relieve
3) Patient education
The pressure ulcer is on the patient’s right side of the buttock. The ulcer is estimated to be
around 10 mm by 8 mm. It is red in color with yellow sports all over it. The ulcer produces foul
The main objective is to relieve the discomfort associated with the pressure ulcer. The patient has
to verbalize reduction of pain by 80%. The patient must be taught on ways to ensure that the
pressure ulcer does not progress and to prevent occurrences of the pressure ulcer in the future.
a) Establish the main reason why the patient prefers to use the movement aid rather than
walking. This will facilitate identifying strategies to ensure that the patient does not
remain sitting most part of his life
b) Record the patients agility to record and monitor the patient pattern of movement so as to
determine alternative walking aids that can be used other than the wheel chair
c) Nurse will conduct evidence based practice that can be applied to reduce progression of
the disease and to relieve as well as cure the pressure ulcer nursing interdisciplinary
d) Educate the patient on behavioral modification such as mild exercises that can be done
routinely to ensure that the patient does not remain seated most part of his life
Rationale and evaluation
a) The patient verbalizes pain relief. There is little discomfort. The main reason the
pressure ulcer occurred was the prolonged sitting in one position. The patient verbalizes
the understanding of the disease pathophysiology
b) The routine monitoring and increased exercise relieved the patient pressure ulcer. The
patient was also advised to use roho cushion seats to reduce the pressure on the wound
c) The teaching program was objective and realistic. The RN is considering to teach other
patients on strategies to reduce the pressure ulcer
Part 3: Patient teaching plan
Working in partnership between the patient and the healthcare provider is important because it
makes it possible to establish an all-inclusive relationship between these two parties. The man
aim of partnership is to improve the quality of care. Communication is a key factor in teaching
the patient on the best self-care management. Patient education program is important because it
enables patient understand their health conditions thereby improving their self-esteem. The
registered nurse is responsible for the development of a teaching plan; and during the process,
the nurse should put several factors into consideration. To decide the format of teaching, the
nurse must be close with the patient so as to identify their specific care needs that needs to be
addressed through education (Fleming, 2014).
The main objective for patient education is to empower the patient, and once the teaching
process initiates, it should not cease until the registered nurse is sure that the patient can take
great care of themselves. The patients’ health care demand can be assessed through physical
examination and through consultation of medical history so that the nurse can identify the
specific patients’ healthcare requirements. Based on the patient’s assessment report, three
approaches can be used to teach the patient. Cognitive approach involves using the patient
cognitive function. The affective teaching involves applying of social cultural values and beliefs
to make the patient trust the registered nurse education. This is particularly important when
dealing with patient who belief in traditional and cultural values. Psychomotor involves physical
teaching to the patient. Additionally, the nurse should use the best format based on the patient
age, education back ground and cognitive function to strategize if he/she will use verbal, written
or audiovisual approach (Bruylands Et al., 2013).
Using the best approach, the nurse can identify the best intervention for each need. This includes
identification of long term and short term objectives. Other close persons that interact with the
patient can also join in the teaching process so that they can accord the patient the support he/she
needs. For the mentally challenged person, the psychomotor teaching approach is the best. For
the elderly, the registered nurse is advised to use audiovisual approach because it makes it better
for the patient to understand. The young and those whose cognitive function is in good condition
can be taught using cognitive approach and both verbal and written format. The registered nurse
should always check for feedback to evaluate if the patients completely understand the education
completely. During the assessment, the nurse should assess weakness and strengths. This will
enable the nurse to address the weakness better. Assessment can be conducted through
questionnaires and observations. The report made can be used to enhance the patient teaching
plan even more. In some cases, the objectives may not be realized because they are too
complicated or unmanageable. In this context, the registered nurse should begin the whole
process again, and where necessary integrate the peers so that they can contribute to strategies to
help the patient self-manage their care (Svavarsdottir Et al., 2014).
Bruylands, M., Paans, W., Hediger, H., & MÃ¼ller-Staub, M. (2013). Effects on the Quality of
the Nursing Care Process Through an Educational Program and the Use of Electronic
Nursing Documentation. International Journal Of Nursing Knowledge, n/a-n/a.
Fleming, J. (2014). A Future for Adult Educators in Patient Education. Adult Learning, 25(4),
Kehrel, U. (2015). The acceptance of process innovations in drug supply â€“ An empirical
analysis of patient-individualized blister packaging in stationary nursing facilities.
International Journal Of Healthcare Management, 8(1), 58-63.
Liu, J. (2013). Exploring nursing assistants’ roles in the process of pain management for
cognitively impaired nursing home residents: a qualitative study. J Adv Nurs, 70(5), 1065-
Lu, C., Tang, S., Lei, Y., Zhang, M., Lin, W., Ding, S., & Wang, P. (2015). Community-based
interventions in hypertensive patients: a comparison of three health education strategies.
BMC Public Health, 15(1). doi:10.1186/s12889-015-1401-6
Svavarsdottir, E., Sigurdardottir, A., Konradsdottir, E., Stefansdottir, A., Sveinbjarnardottir, E.,
& Ketilsdottir, A. et al. (2014). The Process of Translating Family Nursing Knowledge Into
Clinical Practice. Journal Of Nursing Scholarship, 47(1), 5-15. doi:10.1111/jnu.12108
Vaillant-Roussel, H., Laporte, C., Pereira, B., Tanguy, G., Cassagnes, J., & Ruivard, M. et al.
(2014). Patient education in chronic heart failure in primary care (ETIC) and its impact on
patient quality of life: design of a cluster randomised trial. BMC Family Practice, 15(1).