FUNDAMENTALS OF NURSING

Module 1: Overview of the Nursing Process

Ins�tute of Health and Sciences and Nursing

 Module 1: Overview of the Nursing Process

Objectives:
1. Describe the phases of the nursing process.
2. Identify major characteristics of the nursing process.
3. Describe the purposes of the nursing process.

Key Concepts
1. The five phases of the nursing process are assessment, diagnosis, planning,
implementation, and evaluation.

Ins�tute of Health and Sciences and Nursing

 Module 1: Overview of the Nursing Process

2. The nursing process has distinctive characteristics that enable the nurse to respond to
the changing health status of the client. These characteristics include its cyclic and
dynamic nature, client centeredness, a focus on problem solving and decision making,
interpersonal and collaborative style, universal applicability, use of critical thinking, and
use of clinical reasoning.

3. DEFINITION
The Nursing Process is a deliberate intellectual activity where the practice of Nursing is
performed in a systematic manner. Throughout the process, the nurse uses a
comprehensive knowledge base

4. PURPOSES
The main purpose based on the definition is to provide a systematic methodology for
nursing Practice. It unifies, standardizes and directs nursing care. The nurse’s roles and
functions are defined in the steps of the nursing process.
Communication, collaboration and synchronization of health team members are
enhanced by the nursing process providing a continuity of care which means you don’t
need to stay with your patient 24/7. Through the Nursing Process, you can endorse what
needs to be done for the next hours that you will not be around to the next nursing
personnel on duty. And all she has to do is also check on what you have accomplished
so far using the Nursing Process.
Accountability and responsibility to clients can be demonstrated by the Nursing process
as we document all the deliberate activity we have performed during the course of our
care. Such documentation is assumed to provide an accurate and truthful picture of what
has transpired with the patients while you we stay with him. Through that documentation
we are making it known the worth of our services as nurses. Such display of accountability
is extended not only to the clients but also to the service providers and the agency or
institution we are working with.

5. COMPONENTS OF THE NURSING PROCESS

a. Assess the client’s health status,
b. To make judgments and diagnoses of the clients’s needs
c. To plan
d. To implement
e. To evaluate appropriate patient health outcomes and nursing actions employed
during the course of patient care

Ins�tute of Health and Sciences and Nursing

 Module 1: Overview of the Nursing Process

The steps of the nursing process build upon each other, but they are not linear. There is
overlap of each step with the previous and subsequent steps.
The nursing process is dynamic and requires creativity for its application. The steps
remain the same, but the application and results will be different in each client situation.
The nursing process is designed to be used with clients throughout the life span and in
any setting in which a nurse provides care for clients. It is also a basic organizing system
for the Licensure Examination for Registered Nurses.
Comprehensive Knowledge is based on careful study and innovations from the
biophysical, behavioral and humanistic science. The reason why you took up subjects on
Anatomy and Physiology, Biology, Chemistry, Psychology, Philosophy, Anthropology and
Theoretical Foundations of Nursing and later on knowledge on Fundamentals of Nursing,
Maternal and child Nursing, Medical Surgical Nursing, Psychiatric, Community Health
Nursing, and other related body of knowledge like Bioethics in health care, leadership
and management, jurisprudence etc.

6. Without the comprehensive knowledge base, a nurse wouldn’t be able to understand

very well the patient’s health status and thus will be unable to appropriately diagnose
nursing problems or client’s health needs and consequently unable to effectively,
efficiently, adequately, and appropriately plan, implement and evaluate intervention and
in the end unable to achieve favorable health outcomes for the patient.

7. HISTORICAL PERSPECTIVES
Nursing as a Science was sought in the early 1960’s when the nursing discipline as has
sought to define itself as a true profession with a scientific base for its practice and
emerging theories. Empirical pattern became the dominant pattern which focused on
observable, objective, logical hard data and an analytical, verbal and linear line of
reasoning. Other ways of knowing especially personal knowledge, which includes
subjectivity, sensing, feeling, intuition, emotion and experience were devalued or
discredited.
Science considered to be true knowledge was based on the superiority of empirical
validation while all other forms of knowledge were considered mere speculation.
(Christensen, 1990)
So In 1960, the scientific era stimulated the development of the Nursing Profession with
the aim of creating a science in Nursing.
Before the scientific era, you have learned from your theoretical foundation in Nursing
subject how the work and documentation of Florence Nightingale has helped shape
Modern Nursing. However, history would tell us that before the scientific era, nursing was
generally based on apprenticeship learning and the application of isolated principles.
Nurses depended on the physician’s diagnosis and orders which usually consisted of vital
signs and simple treatments. Hygienic and comfort measures were initiated by nurses but

Ins�tute of Health and Sciences and Nursing

 Module 1: Overview of the Nursing Process

nothing more. Also nurses like physicians believed they knew better what was best for
the patient hence making the patient as passive recipients of care.
But the scientific era where nurses began to question the purpose of Nursing and the
current trends has continued to change that pre scientific era concept of Nursing through
the work of our Nursing theorists and Nursing Scientists.
However, in the 1980’s there has been a growing awareness that too much reliance on
empirical knowledge has led to a distorted view of the world especially in Nursing. It was
asserted that Nursing integrates all four patterns on knowing not only empirical, but also
ethical, esthetic and personal knowledge which are valid also and useful for certain
purposes.
In terms of the Nursing Process, Lydia Hall first referred to nursing as a “process” in a
1955 journal article, yet the term was not widely used until the late 1960s (Edelman &
Mandle, 1997). Referring to the “nursing process” as a series of steps, Johnson (1959),
Orlando (1961), and Wiedenbach (1963) further developed this description of nursing. At
this time, the nursing process involved only three steps: assessment, planning, and
evaluation.
In their 1967 book The Nursing Process, Yura and Walsh identified four steps in the
nursing process: assessment, planning, implementation and evaluation.
The Standards of Practice, first published in 1973 by the American Nurses Association
(ANA), included eight standards. These standards identified each of the steps, including
nursing diagnosis, that are now included in the nursing process.
Fry (1953) first used the term nursing diagnosis, but it was not until 1974, after the first
meeting of the group now called the North American Nursing Diagnosis Association
(NANDA), that Gebbie and Lavin added nursing diagnosis as a separate and distinct step
in the nursing process. Prior to this, nursing diagnosis had been included as a natural
conclusion to the first step, assessment.
Following publication of the ANA standards, the nurse practice acts of many states were
revised to include the steps of the nursing process specifically. The ANA made revisions
to the standards in 1991 to include outcome identification as a specific part of the planning
phase. Currently, the steps in the nursing process are: Assessing, Diagnosis, Outcome
Identification and Planning, Implementation and Evaluation.
The American Nurses Association address each step of the nursing process in their
publication of practice standards.

Ins�tute of Health and Sciences and Nursing

 Module 1: Overview of the Nursing Process

Study Questions
1. What are the purposes of the nursing process?
2. The nursing process is both interpersonal and collaborative between the nurse and
the client.
a. True b. False

3. Assessing is a continuous process carried out through all the phases of nursing.
a. True b. False

References:
• Kozier and Erbs. Fundamentals of Nursing: Concepts Process and Practice. 9th
Edition. Pearson Prentice Hall, 2010
• Taylor, et.al. Fundamentals of Nursing: The Art and Science of Nursing Care. 5th
Edition. Lippincott Williams and Wilkins, 2005
• Taylor, et al. Fundamentals of Nursing: The Art and Science of Nursing Care Skill
Checklist. 5th edition. Lippincott Williams and Wilkins, 2005
• ADPCN Manual
• Fish and Shelly
• Venzon. Professional Nursing in the Philippines. 10th edition. C & E Publishing
Inc, 2005
• Mary Ellen Murray, Leslie Atkinson. Understanding the Nursing Process. 6th Ed.
• Paula Christensen, Janet Kenney. Nursing Process: Application of Conceptual
Models. 3rd Ed

Ins�tute of Health and Sciences and Nursing