Heyy can you explain nursing process accordingly NANDA
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NANDA nursing process five steps assessment diagnosis planning implementation evaluation
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https://www.ncbi.nlm.nih.gov/books/NBK591814
The library doesn't have a dedicated nursing process textbook, but I have strong foundational knowledge plus the NANDA-I content. Let me now give you a thorough, well-structured answer.
The Nursing Process According to NANDA
The nursing process is a systematic, evidence-based framework that guides nurses in delivering individualized patient care. NANDA International (now called INKA - International Nursing Knowledge Association) has standardized the language of nursing diagnoses that sits at the heart of this process.
The nursing process has 5 steps, often remembered by the acronym ADPIE:
1. ASSESSMENT (A)
This is the first and most foundational step. No nursing diagnosis or care plan can be accurate without thorough data collection.
Types of Data Collected:
| Type | Examples |
|---|---|
| Subjective | Patient's complaints, feelings, history ("I feel short of breath") |
| Objective | Vital signs, lab results, physical exam findings |
| Current | Immediate presenting condition |
| Historical | Past medical/surgical history, medications, allergies |
Methods:
- Health history interview (biographical data, chief complaint, past history, family history, lifestyle)
- Physical examination (head-to-toe or body systems approach)
- Review of records (lab reports, old charts)
- Consultation with family, other healthcare providers
Frameworks Used to Guide Assessment:
- Gordon's 11 Functional Health Patterns (most commonly linked to NANDA-I)
- Maslow's Hierarchy of Needs
- Body Systems Model
2. DIAGNOSIS (D) - The NANDA Core
This is where NANDA-I plays its central role. A nursing diagnosis is the nurse's clinical judgment about a patient's response to actual or potential health conditions - it is NOT the same as a medical diagnosis.
NANDA-I Nursing Diagnosis: Structure (PES Format)
A properly written NANDA nursing diagnosis has 3 parts:
Problem (P) + Etiology (E) + Signs & Symptoms (S) Also called the PES format or Three-Part Statement
Example:
Ineffective airway clearance related to increased mucus secretion as evidenced by productive cough, wheezing, and SpO2 of 92%
Types of NANDA Nursing Diagnoses:
| Type | Description | Example |
|---|---|---|
| Actual (Problem-focused) | Problem currently present; has defining characteristics | Acute Pain |
| Risk | Patient is vulnerable to developing a problem; no signs/symptoms yet | Risk for Falls |
| Health Promotion | Readiness to improve wellbeing | Readiness for Enhanced Nutrition |
| Syndrome | A cluster of nursing diagnoses that occur together | Post-Trauma Syndrome |
NANDA-I Taxonomy II - 13 Domains:
NANDA organizes all diagnoses into 13 domains:
- Health Promotion
- Nutrition
- Elimination and Exchange
- Activity/Rest
- Perception/Cognition
- Self-Perception
- Role Relationships
- Sexuality
- Coping/Stress Tolerance
- Life Principles
- Safety/Protection (e.g., Risk for Infection, Risk for Falls, Impaired Skin Integrity)
- Comfort (e.g., Acute Pain, Chronic Pain, Nausea)
- Growth/Development
Priority Setting (Maslow + NANDA):
Diagnoses are prioritized using Maslow's Hierarchy - physiological needs (airway, breathing, circulation) always come before psychosocial needs.
3. PLANNING (P)
After identifying diagnoses, the nurse formulates a care plan with goals and expected outcomes.
Components of Planning:
- Setting priorities among nursing diagnoses
- Writing SMART outcomes/goals
- Selecting nursing interventions
- Documentation in the care plan
SMART Goals:
| Letter | Meaning | Example |
|---|---|---|
| S | Specific | "Patient will demonstrate..." |
| M | Measurable | "...pain scale 3/10..." |
| A | Achievable | Realistic for the patient |
| R | Relevant | Related to the nursing diagnosis |
| T | Time-bound | "...within 24 hours" |
Example Goal:
"Patient will maintain clear airways as evidenced by absence of adventitious breath sounds and SpO2 > 95% within 8 hours."
NIC (Nursing Interventions Classification):
NANDA-I pairs with NIC for interventions and NOC (Nursing Outcomes Classification) for outcomes - this trio is called NNN linkage and forms the backbone of standardized nursing care planning.
4. IMPLEMENTATION (I)
This step involves actually carrying out the nursing interventions identified in the care plan.
Types of Nursing Interventions:
| Type | Description | Example |
|---|---|---|
| Independent | Nurse acts without physician order | Repositioning, patient education, deep breathing exercises |
| Dependent | Require a physician's order | Administering medications, wound care per protocol |
| Collaborative | Done with other healthcare team members | Physiotherapy referral, dietary consultation |
During Implementation:
- Reassess the patient before acting
- Perform the intervention safely and correctly
- Document everything (time, what was done, patient response)
- Delegate appropriately when needed
5. EVALUATION (E)
The final step - but the process is cyclic, not linear. Evaluation leads back to reassessment.
Questions Asked During Evaluation:
- Were the goals/outcomes met? (fully, partially, or not met)
- Was the nursing diagnosis still accurate?
- Were the interventions effective?
- Do the priorities need to change?
Outcome Determination:
| Result | Action |
|---|---|
| Goal fully met | Discontinue or modify the care plan |
| Goal partially met | Continue interventions, revise if needed |
| Goal not met | Reassess - was the diagnosis wrong? Was the intervention appropriate? |
The Cyclic Nature of the Nursing Process
Assessment
↓
Diagnosis (NANDA)
↓
Planning (NOC goals + NIC interventions)
↓
Implementation
↓
Evaluation ──→ (back to Assessment if goals not met)
The process is continuous and dynamic - as the patient's condition changes, the nurse cycles back to reassessment and revises the plan accordingly.
Quick Summary Table
| Step | Key Question | NANDA Role |
|---|---|---|
| Assessment | What data do I have? | Gordon's Patterns guide data clustering |
| Diagnosis | What is the patient's problem? | NANDA-I standardized diagnoses used |
| Planning | What are my goals & interventions? | NOC + NIC linked to NANDA diagnoses |
| Implementation | How do I carry out the plan? | Interventions based on NANDA diagnosis |
| Evaluation | Were the goals met? | Revisit NANDA diagnosis if goals unmet |
NANDA-I (now INKA) published its latest edition - Nursing Diagnoses: Definitions and Classification 2024-2026, 13th Edition - which continues to refine this framework with updated diagnoses, definitions, and clinical reasoning tools. It currently contains over 260 approved nursing diagnoses across the 13 domains.
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