Steps of Nursing Process


The nursing process is the application of critical thinking to client care activities.


Nursing process involves 5 steps which include Assessment, Nursing Diagnosis, Planning , Implementation and Evaluation.


Assessment is the first phase in nursing process. It has 2 sub-phases  , Data Collection and Data Analysis. Assessment consist of systematic and orderly collections and analysis of data about the health status of the client for the purpose of making the Nursing Diagnosis.

Such data are obtained via History taking, Observation, physical examination, laboratory data, X-rays and other diagnostic studies.

Any assessment guidelines includes the following:

  • Biographical data.
  • A health history including family members.
  • Subjective and objective data about current health status including physical examination, medical diagnosis and results of diagnostic studies.
  • social, cultural and environmental data.
  • Behaviors that may place a person at risk for potential disease problems.


Nursing Diagnosis is the second phase of nursing process. A Nursing Diagnosis is a clinical judgement about individual, family or community responses to actual or potential health problems.

Models for these diagnostic statements have been provided by many authors based on the taxonomy developed by NANDA. For most clients, there will be more than one nursing diagnosis.

Nursing diagnostic statements are derived from the nurse’s inferences which are based on the assessed and validated data coupled with nursing, scientific and humanistic concepts and theories.


Planning is the third phase of the nursing process. Planning involves the mutual setting of goals and objectives judging priorities and designing methods to resolve actual or potential problems. Two things are accomplished in the planning phase of nursing process, which includes

  • Establishing goals and objectives
  • Selection of nursing intervention.

Goals and Objectives

Goals and Objectives which are derived from the nursing diagnosis evolve from and are predicted by the problem portion of the nursing diagnoses. Goals are stated in broad terms to identify effective criteria for evaluating nursing action. Objectives are short statement of desired or expected outcomes of the client.


This is the phase of identification of nursing actions. Nursing interventions evolve from the etiology position of nursing diagnosis. Each nursing action is based on carefully thought out scientific rationale and specifies what kind of nursing care is to be done to meet the clients problems effectively. The nursing care plan deals with actual and potential problems.


Implementation is the fourth phase of the nursing process.Implementation refers to the actions initiated to accomplish the defined goals and objectives. This is the actual giving of nursing care.  It is putting plan into action.

The implementation phase begins when the nurse begins to consider various alternative actions and selects those most suitable to achieve the planned goals and objectives. Nursing actions may be carried out by the nurse who developed the nursing care plan or by other nurses or nursing assistants.


Evaluation is the fifth and final phase of the nursing process. It is the appraisal of the client’s appraisal of the client’s behavioral changes that are result of the  action of the nurse.

Evaluation consists of the following 5 steps.

  1. Review the goals or predicted outcomes.
  2. Collect data about the client’s responses to nursing action.
  3. Compare actual outcomes to predicted outcomes and decide if goals have been met.
  4. Record the conclusion.
  5. Relate nursing plans to client outcomes.
I'm so glad to be a murse.

Last night as I was watching my brother play some indoor soccer my 19 months nephew had a febrile seizure. The place was packed and I just ran toward my sister in law and grabbed him. He was cyanotic and non responsive. As soon as I got him in my arms all the nursing knowledge that I’ve learned just kicked in. His lips where purple so I immediately thought he was choking. I checked his mouth and gave him 4 breaths. The seizure finally stopped. I lay him on a bench and made sure that his airway was clear. My sister in law was in the verge of a mental breakdown and my brother was trying to calm her down. Then the EMT’s arrived and I gave them a complete SBAR report of what had happened. They just stared and me and asked me if I had any medical experience. I just told them “I’m a nursing student”. This could be the proudest moment of nursing school. The image of seeing my nephew pale, cyanotic and breathless will stick with me all my life. As I waited in the ER I came to the realization that my calling in nursing is to be an ER nurse. I came to this conclusion because as all these mayhem was happening around me I focused on my task and I was confident of my knowledge. Also I really enjoyed the adrenaline rush I got from it.

At the end it doesn’t really matter “the rush” that I got from this experience. What matters is that my patient (aka nephew) had a positive outcome. Nursing is not about you its about making sure that the patient will get the most positive outcome.

Assistive Devices for Ambulation

Assistive Devices for Ambulation

Definition: used to provide an extension of the upper extremities to help transmit body weight and provide support for the clients (canes, crutches, walkers)

A. Collaborative Care

  1. Nursing Interventions
  • Determine client’s mobility status and ability to bear weight per provider’s order
  • Monitor the client for the need of a safety belt
  • Instruct the client to wear shoes with non-slip soles
  • Monitor the client for risk orthostatic hypotension
  • Provide safe environment free of clutter

B. Client Education and Refferal

  1. Avoid rapid position changes to prevent orthostatic hypotension
  2. Inspect rubber tips on the device for wear and replace as needed
  3. Physical Therapy consult

C. Crutches

  1. Monitor client for correct fit of crutches: 2 - 3 finger widths between the axilla and top of the crutch
  2. Position hands on crutch pads with elbows flexed ( do not bear weight on axilla)

D. Non-weight bearing

  1. Begin in the tripod position, maintain weight on the “unaffected” (weight-bearing) extremity
  2. Advance both crutches and the affected extremity
  3. Move the “unaffected” weight-bearing foot/leg forward (beyond the crutches)
  4. Advance both crutches, and then the affected extremity
  5. Continue sequence making steps of equal length

E. Weight bearing

  1. Move crutches forward about one step’s length
  2. Move “affected” leg forward; level with the crutch tips
  3. Move the “unaffected” leg forward
  4. Continue sequence making steps of equal length

F. Walking up stairs

  1. Hold to rail with one hand and crutches with the other hand.
  2. Push down on the stair rail and the crutches and step up with the “unaffected” leg.
  3. If not allowed to place weight in the affected leg, hold up with the unaffected leg.
  4. Bring the affected leg and the crutches up beside the unaffected leg.
  5. Remember the unaffected leg goes up first and the crutches move with the affected leg.

G. Walking down stairs

  1. Place the affected leg and the crutches down on the step below; support weight by leaning on the crutches and the stair rail.
  2. Bring the unaffected leg down.
  3. Remember the affected leg goes down first and the crutches move with the affected leg.

H. Cane

  1. For correct size have the client wear shoes. The correct length is measured from the wrist to the floor.
  2. Cane is used on the unaffected side to provide support to the opposite affected lower limb.
  3. Advance the cane simultaneously with the opposite affected lower limb.
  4. The unaffected limb should assume the first full weight-bearing step on level surfaces.

I. Walker

  1. For correct size have the client wear shoes. The client’s wrists are even with the handgrips on the walker when arms are dangling downward
  2. Advance the walker approximately 12 inches
  3. Advance with the affected lower limb
  4. Move unaffected limb forward
Tobacco use and the developing world

It is estimated that over 1 billion people will die of tobacco related illnesses within the 21st century. It is estimated that over 80% of tobacco related deaths will occur in low and middle income countries. Although tobacco usage in many developed nations has steadily decreased over the past decades, tobacco usage in the developing world has continued to exponentially increase.

One of the most startling examples of this has occurred in the western pacific region of the world. This area extends from China to The Philippines to Australia. Smoking in this region has increased to point to where over 45% of all cigarettes consumed in the world are consumed by this region.

Within the area, China is the largest consumer of tobacco products. They consumed over 35% of the world’s cigarettes in 2009. Further, over 60% of all Chinese men are estimated to be current smokers. Accordingly, lung cancer rates have more than doubled within the past ten years within China.

 Of particular concern for the World Health Organization and the World Bank are the related human and economic costs that are associated with increases in smoking rates. Current international objectives are to reduce smoking rates by over 40% by 2025. The intended methods include: encouraging nations to enact stronger tobacco tax laws, stronger tobacco labeling laws, and other control related laws. Regulations of this type have been directly linked to significant reductions in national smoking rates.

For the individual nurse, smoking cessation interventions should be initiated whenever possible. Nursing interventions related to smoking cessation have been linked to increases in smoking cessation and positive lifestyle changes among patients.

Nursing Interventions for Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that causes inflammation, or swelling, in many joints throughout the body, which rheumatoid arthritis nursing interventions can help. This condition can lead to pain, redness, stiffness, deformity of the joints and other severe effects like disability and premature death.

While rheumatoid arthritis does not currently have a cure, a number of treatment options can relieve symptoms of it and prevent it from worsening. A nurse can help those with rheumatoid arthritis through the following rheumatoid arthritis nursing interventions:


Medication is one of the main treatment methods for rheumatoid arthritis. While a doctor needs to prescribe the medication, a nurse can educate the patient on the medication and help them continue with it………….Rheumatoid arthritis

Lifting and Transfer of Clients

Lifting and Transfer of Clients

Implement safe care using proper body mechanics when lifting, positioning, transporting, or assisting a client to reduce the risk of injury.


  1. Assess client’s mobility and strength.
  2. Instruct client to assist when possible.
  3. Use mechanical lift and assistive devices.
  4. Avoid twisting the thoracic spine or bending at the waist.
  5. Use major muscle groups and tighten abdominal muscles.
Teens (who follow me)

If you guys EVER need to talk about anything at all I’m here. I’m mid-20’s and I’ve been through it all. Plus I have taken counseling classes and am currently doing counseling course work. So no matter what it is I won’t judge I won’t blame. I’ll just listen and offer both empathy and life experience. Sometimes it’s nice to talk to a stranger who you know can never know who you are. Just wanted to throw that out there.

I still angst quite a bit but, that is just my way of venting. If I acted on everything I thought and felt I would never have been able to get through high school college now nursing school and hold down steady management jobs since 15. I’m not as nuts as a seem just a bit sad. But, aren’t we all?

Point being you need to talk. Talk to me. I’ll listen.

Disclaimer: I might recommend certain treatments so you are warned. Thinking from a nursing perspective means trying to get you better as fast as possible.

Caring for and Connecting With Homeless Adolescents

BY: Lynn Rew

Homeless adolescents face multiple obstacles during a phase of life when they should be developing skills and patterns of behavior that will contribute to being productive members of American society. But because they have become disconnected from the usual socializing institutions of home and school, they may attempt to connect with other youth from similar backgrounds. Homelessness not only poses a threat to the public health but also, more importantly, the nation suffers the loss of human potential as the numbers of homeless youth grow.

Adolescents living in homes and communities with few external assets lack connections to caring adults including parents, teachers, and neighbors. These are the youth who are more likely than others to run away or be thrown out of their homes. Researchers have noted that runaway behavior, particularly in early adolescence, is a critical time to intervene in a positive way because it is often the gateway to serious criminal behavior, substance abuse, and chronic homelessness.

Far less is known about the strengths of homeless youth than about their deficits and needs. In addition to self-care practices, homeless youth described numerous examples of connecting with others. They developed a community of peers, a street family, from whom they realized unconditional acceptance and acquired information to ensure their survival. This phenomenon of caring and connectedness was described in contrast to the estrangement they felt from their families of origin and other adults in institutions such as hospital emergency departments. Community responses to the needs of homeless adolescents should focus on their strengths and not merely their deficits.

theres almost too many tv shows on tonight that its overwhelming..
like my dvr can’t keep up with it recording all of them at the same times so I have to try and choose which one gets recorded first / is most important.. and then try to record the other one at a different time and make sure theres room on my dvr cause i still refuse to delete episodes of weeds and breaking bad from it……..

 like rly theres 8 shows on tonight. 6 that i REALLY watch.. 

life is so hard~~~~

Background Info

St. Croix is the largest of the US Virgin Islands with a population of roughly 50,000 with one major hospital on the island and several smaller clinics. While there are health care services on the island, the populace faces many healthcare disparities and difficulty accessing these services. The high level of poverty and lack of infrastructure makes it difficult for the local population to access proper care. Many of the same diseases that disproportionately affect people of color in the US mainland also disproportionately affect people of color on the island of St. Croix: diseases such as such as cancer, stroke, hypertension, diabetes, and obesity.

In May of this year a small group of students from the Johns Hopkins University School of Nursing will be traveling to St. Croix to provide health care education to the area in order to address some of these concerns and disparities. Students for the School of Nursing have been traveling to St. Croix to provide public health nursing interventions and community health care education for the past 12 years and we will be the 21st group of students to travel to St. Croix.

Some of our planned interventions include:

· Hypertension and diabetes screening at La Reine Farmer’s Market’s health fair

· Scoliosis screening, dental education, anti-bullying education, and nutrition education at several local schools

· Hypertension and diabetes screening at Flamboyant Gardens senior citizens housing complex

· Home visits to provide education for chronically ill

· Collaborate with Lutheran Social Services who runs homes for disabled adults and children

High Dependency Nursing Care: Observation, Intervention and Support for Level 2 Patients free ebook ,

High Dependency Nursing Care: Observation, Intervention and Support for Level 2 Patients

<p>English | Sep 3, 2004 | ISBN: 0415267552, 0415267544 | 481 Pages | PDF | 4 MB<br /> <br /> Written by a team of nurses experienced in providing, supporting and developing high dependency care, this book discusses practical issues and explores the current evidence base for clinical practice. It covers all important skills needed and best practice for caring for high dependency patients or undertaking post registration courses to prepare them for high dependency nursing.</p>

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I took my sister to emergency hospital cause her sclera was inflamed and then I happened to heard what’s happening to this another ward and turned out that it’s a cancer patient and just recently died. I can share my sympathy with the nurses who were on duty because of the exhaustion they experienced. No sleep, not eating on time, monitoring the patient, checking for bleeding, and other nursing interventions. But what bothered me was when the patient’s family were crying and mourning for their loss the nurses showed a sign of relief and happiness on their faces which I think is inappropriate. How insensitive and unprofessional. Yes, it is tiring but this is the career that you chose. Try to be responsible. There are people crying becuse of their loss and you’re smiling? Instead of comforting them, you’re actually feeling happy because someone died. That’s very irresponsible. I’m disgusted.

Public Health Nursing: Practicing Population-Based Care free ebook ,

Public Health Nursing: Practicing Population-Based Care

<p>Public Health Nursing: Practicing Population-Based Care explores the scientific discipline of public health and in particular public health nursing. This public health nursing perspective is applied throughout the chapters and demonstrates how public health nurses use various interventions based on best evidence in their practice, both to protect and enhance the health of the public. This innovative text includes key topics such as a discussion of historical evidence in coming to know the meaning of the terms used to describe public health nursing &nbsp;the exploration of the use of technology in public health &nbsp;social epidemiology as well as the traditional content on epidemiology &nbsp;and an innovatively designed assessment tool that uses Healthy People 2010, A Systematic Approach to Health Improvement, as its framework. The highlight of this text is the focus on the 17 intervention strategies identified in the Population-Based Public Health Nursing Practice Intervention Wheel including a discussion of how these interventions may be applied to the three levels of practice: individual/family, community, and systems.</p>

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Reflection Writing: Identify and discuss the assessments and nursing interventions when caring for a patient who has just returned from the Post Anaesthetic Care Unit (PACU) with a PCA and an abdominal wound

Reflection Writing: Identify and discuss the assessments and nursing interventions when caring for a patient who has just returned from the Post Anaesthetic Care Unit (PACU) with a PCA and an abdominal wound

Reflection Writing: Identify and discuss the assessments and nursing interventions when caring for a patient who has just returned from the Post Anaesthetic Care Unit (PACU) with a PCA and an abdominal wound

Guided Reflection of the Video, “Receiving a patient to the ward from PACU”.


Identify and discuss the assessments and nursing interventions when caring for a patient who has…

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Nurses Make the Best Chronic Disease Managers

Nurses Make the Best Chronic Disease Managers

Kicking off the news for nurses this week is a look at how nurses in the UK are impacting ongoing health and wellness for chronic disease patients. researchers at St. George’s University of London worked with nearly 300 patients over the age of 60 to determine if nurse led interventions impact patients with chronic health conditions like diabetes or CHF.

Nurses Help Patients Set Activity Goals


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Razor’s Edge

Razor’s Edge

View film on Razor’s Edge website.


Write a paper: Reflect on the following:

.Give an overview of the film’s content.

.Reflect on your feelings as you viewed this film.

.Identify 2 problems.

.Describe two nursing interventions appropriate to remedy each problem.

.Use Evidence Based…

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Protocol of a multi-centre randomised controlled trial of a web-based information intervention with nurse-delivered telephone support for haematological cancer patients and their support persons.

Protocol of a multi-centre randomised controlled trial of a web-based information intervention with nurse-delivered telephone support for haematological cancer patients and their support persons.

BMC Cancer. 2015 Apr 17;15(1):295

Authors: Bryant J, Sanson-Fisher R, Stevenson W, Smits R, Henskens F, Wei A, Tzelepis F, D'Este C, Paul C, Carey M

BACKGROUND: High rates of anxiety, depression and unmet needs are evident amongst haematological cancer patients undergoing treatment and their Support Persons. Psychosocial distress may be minimised by ensuring that patients are sufficiently involved in decision making, provided with tailored information and adequate preparation for potentially threatening procedures. To date, there are no published studies evaluating interventions designed to reduce psychosocial distress and unmet needs specifically in patients with haematological cancers and their Support Persons. This study will examine whether access to a web-based information tool and nurse-delivered telephone support reduces depression, anxiety and unmet information needs for haematological cancer patients and their Support Persons.
METHODS/DESIGN: A non-blinded, parallel-group, multi-centre randomised controlled trial will be conducted to compare the effectiveness of a web-based information tool and nurse-delivered telephone support with usual care. Participants will be recruited from the haematology inpatient wards of five hospitals in New South Wales, Australia. Patients diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, Burkitt’s lymphoma, Lymphoblastic lymphoma (B or T cell), or Diffuse Large B-Cell lymphoma and their Support Persons will be eligible to participate. Patients and their Support Persons will be randomised as dyads. Participants allocated to the intervention will receive access to a tailored web-based tool that provides accurate, up-to-date and personalised information about: cancer and its causes; treatment options including treatment procedures information; complementary and alternative medicine; and available support. Patients and Support Persons will complete self-report measures of anxiety, depression and unmet needs at 2, 4, 8 and 12 weeks post-recruitment. Patient and Support Person outcomes will be assessed independently.
DISCUSSION: This study will assess whether providing information and support using web-based and telephone support address the major psychosocial challenges faced by haematological patients and their Support Persons. The approach, if found to be effective, has potential to improve psychosocial outcomes for haematological and other cancer patients, reduce the complexity and burden of meeting patients’ psychosocial needs for health care providers with high potential for translation into clinical practice.

PMID: 25886517 [PubMed - as supplied by publisher]

via pubmed: lymphoma daily
Recovery Focused Nursing Care Plan

Recovery Focused Nursing Care Plan

Recovery Focused Nursing Care Plan

Title: Recovery Focused Nursing Care Plan


7. You must support your work with references. In particular this means that his means that you will need to locate references that support nursing and consumer interventions as wells as in identifying potential strengths [especially through the literature on the Recovery Model] as well as when…

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Essay the Drugs and IV Fluids

Essay the Drugs and IV Fluids

Essay the Drugs and IV Fluids DRUG NAME


EXPECTED ACTIONS Possible ADVERSE, side effects and related patient/family education Nursing considerations and







Side effects:

Patient/family education:






Side effects:

Patient/family education:






Side effects:


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