essay about nursing process

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Nursing process.

Tammy J. Toney-Butler ; Jennifer M. Thayer .

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Last Update: April 10, 2023 .

• Introduction

In 1958, Ida Jean Orlando started the nursing process that still guides nursing care today. Defined as a systematic approach to care using the fundamental principles of critical thinking, client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EDP) recommendations, and nursing intuition. Holistic and scientific postulates are integrated to provide the basis for compassionate, quality-based care. [1] [2] [3]

The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation.

Assessment is the first step and involves critical thinking skills and data collection; subjective and objective. Subjective data involves verbal statements from the patient or caregiver. Objective data is measurable, tangible data such as vital signs, intake and output, and height and weight.

Data may come from the patient directly or from primary caregivers who may or may not be direct relation family members. Friends can play a role in data collection. Electronic health records may populate data and assist in assessment.

Critical thinking skills are essential to assessment, thus the need for concept-based curriculum changes.

The formulation of a nursing diagnosis by employing clinical judgment assists in the planning and implementation of patient care.

The North American Nursing Diagnosis Association (NANDA) provides nurses with an up-to-date list of nursing diagnoses. A nursing diagnosis, according to NANDA, is defined as a clinical judgment about responses to actual or potential health problems on the part of the patient, family, or community.  

A nursing diagnosis encompasses Maslow's Hierarchy of Needs and helps to prioritize and plan care based on patient-centered outcomes. In 1943, Abraham Maslow developed a hierarchy based on basic fundamental needs innate to all individuals. Basic physiological needs/goals must be met before higher needs/goals can be achieved such as self-esteem and self-actualization. Physiological and safety needs provide the basis for the implementation of nursing care and nursing interventions. Thus, they are at the base of Maslow's pyramid, laying the foundation for physical and emotional health. [4] [5]

Maslow's Hierarchy of Needs

• Basic Physiological Needs: Nutrition (water and food), elimination (Toileting), airway (suction)-breathing (oxygen)-circulation (pulse, cardiac monitor, blood pressure) (ABCs), sleep, sex, shelter, and exercise.
• Safety and Security: Injury prevention (side rails, call lights, hand hygiene, isolation, suicide precautions, fall precautions, car seats, helmets, seat belts), fostering a climate of trust and safety (therapeutic relationship), patient education (modifiable risk factors for stroke, heart disease).
• Love and Belonging: Foster supportive relationships, methods to avoid social isolation (bullying), employ active listening techniques, therapeutic communication, and sexual intimacy.
• Self-Esteem: Acceptance in the community, workforce, personal achievement, sense of control or empowerment, accepting one's physical appearance or body habitus.
• Self-Actualization: Empowering environment, spiritual growth, ability to recognize the point of view of others, reaching one's maximum potential.

The planning stage is where goals and outcomes are formulated that directly impact patient care based on EDP guidelines. These patient-specific goals and the attainment of such assist in ensuring a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide a course of direction for personalized care tailored to an individual's unique needs. Overall condition and comorbid conditions play a role in the construction of a care plan. Care plans enhance communication, documentation, reimbursement, and continuity of care across the healthcare continuum.

Goals should be:

• Measurable or Meaningful
• Attainable or Action-Oriented
• Realistic or Results-Oriented
• Timely or Time-Oriented

Implementation

Implementation is the step that involves action or doing and the actual carrying out of nursing interventions outlined in the plan of care. This phase requires nursing interventions such as applying a cardiac monitor or oxygen, direct or indirect care, medication administration, standard treatment protocols, and EDP standards.

This final step of the nursing process is vital to a positive patient outcome. Whenever a healthcare provider intervenes or implements care, they must reassess or evaluate to ensure the desired outcome has been met. Reassessment may frequently be needed depending upon overall patient condition. The plan of care may be adapted based on new assessment data.

• Issues of Concern

According to a 2011 study conducted in Mekelle Zone hospitals, nurses lack the knowledge to implement the nursing process into practice and factors such as nurse-patient ratios inhibit them from doing so. Ninety percent of study participants lacked sufficient experience to apply the nursing process to standard practice. The study also concluded that a shortage of available resources, coupled with increased workloads due to high patient-nurse ratios, contributed to the lack of the nursing process implementation in the delivery of patient care. [6] [7] [8]

• Clinical Significance

The utilization of the nursing process to guide care is clinically significant going forward in this dynamic, complex world of patient care. Aging populations carry with them a multitude of health problems and inherent risks of missed opportunities to spot a life-altering condition.

As explored by Salmond and Echevarria, healthcare is changing, and the traditional roles of nurses are transforming to meet the demands of this new healthcare environment. Nurses are in a position to promote change and impact patient delivery care models in the future. [9] [10]

• Other Issues

Critical thinking skills will play a vital role as we develop plans of care for these patient populations with multiple comorbidities and embrace this challenging healthcare arena. Thus, the trend towards concept-based curriculum changes will assist us in the navigation of these uncharted waters. 

Concept-Based Curriculum

Baron further explores this need for a concept-based curriculum as opposed to the traditional educational model and the challenges faced with its implementation. A direct impact on quality patient care and positive outcomes. Nursing practice and educational environments form a bond with clinical knowledge and expertise, and that bond facilitates the transition into the current workforce as an indispensable team player and leader in this new wave of healthcare. 

Learning should be the focus and the integration into current practice. Learning is a dynamic process, propelled by a force that must coexist within the same learning milieu between educator and student, preceptor and novice, mentor, and trainee. 

IN the future, nurses must be able to problem-solve in a multitude of situations and conditions to meet these new adversities: challenging nurse-patient ratios, multifaceted approaches to prioritization of care, fewer resources, navigation of the electronic health record as well as functionality within the team dynamic and leadership style.

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Maslow's Hierarchy of Needs for Nursing Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN

Disclosure: Tammy Toney-Butler declares no relevant financial relationships with ineligible companies.

Disclosure: Jennifer Thayer declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Toney-Butler TJ, Thayer JM. Nursing Process. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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What is the Nursing Process?

Characteristics of the nursing process, history of the nursing process.

Understanding the nursing process is key to providing quality care to your patients. The nursing process is a cyclical process used to assess, diagnose, and care for patients as a nurse. It includes 5 progressive steps often referred to with the acronym:

• Planning/outcomes
• Implementation

In this article, we’ll discuss each step of the nursing process in detail and include some examples of how this process might look in your practice. 

The nursing process is a patient-centered, systematic, evidence-based approach to delivering high-quality nursing care. It consists of five steps: assessment , diagnosis , outcomes/planning, implementation, and evaluation.

The Nursing Process (ADPIE)

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1. assessment.

To begin the nursing process, assessment involves collecting information about the patient and their health. This information is used to identify any problems, or potential problems, that may need to be addressed while you’re caring for a patient. 

Example: If you’re admitting an older patient who is falling and getting injured at home, you’ll want to do a thorough physical and mental health assessment, including a medical history to try and determine why this is happening. 

Some important things you’ll want to find out are:

• What medications and over-the-counter products is the patient taking
• History of alcohol and recreational drug use
• Where the person lives and the layout of their home, including scatter rugs they may be tripping over: clutter, pets, stairs, slippery tubs they’re climbing into or out of, fluid or food spills on floors, lighting, mobility aids they use, etc.

2. Diagnosis

The Nursing Diagnosis is the second step in the nursing process and involves identifying real or potential health problems for a patient based on the information you gathered during the assessment. 

Example: Using the falls patient example above, you may identify from your assessment that the patient is falling because they’re tripping on things in their environment that they don’t see, like their pet cat lying on the floor and loose scatter rugs. 

Based on this, you might form a diagnosis such as “Falls related to poor vision, cluttered environment, unsteady gait, Lt. hip pain due to previous fall.”

3. Outcomes/Planning

Planning or Outcomes is the third step in the nursing process. This step involves developing a nursing care plan that includes goals and strategies to address the problems identified during the assessment and diagnosis steps. 

Example: Continuing with the example above, you will likely recommend that the patient keep their environment,

• Free of scatter rugs
• Check to ensure the cat is not underfoot before they mobilize
• Suggest the patient use a walker for support when mobilizing
• Recommending that the patient schedule an eye exam to get their vision checked if they have not had one in the last year or two would also be a good idea or if they’ve noticed any changes in their vision lately.

4. Implementation

As the fourth step of the nursing process, implementation involves putting the plan of care into action. 

Example In the above example, this would include: 

• Making sure the patient’s environment is free of clutter and tripping hazards while in the hospital or a skilled nursing facility.
• Teaching the patient to wear proper footwear before mobilizing.
• Assisting the patient with mobility as needed, including putting proper footwear on the patient if needed.
• Speaking to the patient and family about removing scatter rugs from the patient’s home, scheduling an eye exam, and ensuring proper footwear is worn for mobilizing at home.
• Discussing with the patient and family about getting the patient a walker to assist with mobility on discharge and providing one while the patient is admitted.

5. Evaluation

The last step of the nursing process is evaluation , which involves determining whether or not the goals of care have been met. 

Example Here you would look back at the patient’s medical record to see if the patient has had any further falls since implementing the preventative actions above. 

If so, you would repeat the nursing process over and reassess why this is still happening and plan new actions to prevent future falls.

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The nursing process is also characterized by the following elements. 

1. Dynamic and Cyclic

The nursing process is an evolving process that continues throughout a patient’s admission or illness and ends when the problems identified by the nurse are no longer an issue.

2. Patient-Centered and Goal-Directed

The entire nursing process is sensitive to and responsive to the patient's needs, preferences, and values. As nurses, we need to act as patient advocates and protect the patient’s right to make informed decisions while involving the patient in goal setting and attainment.

3. Collaborative and Interpersonal

This describes the level of interaction that may be required between nurses, patients, families and supports, and the interprofessional healthcare team. These aspects of the nursing process require mutual respect, cooperation, clear communication, and decision-making that is shared between all parties involved.

4. Universally Applicable

As a widely and globally accepted standard in nursing practice, the nursing process follows the same steps, regardless of where a nurse works. 

5. Systematic and Scientific

The nursing process is also an objective and predictable process for planning, conducting, and evaluating patient care that is based on a large body of scientific evidence found in peer-reviewed nursing research.

6. Requires Critical Thinking

Most importantly, it’s essential that nurses use critical thinking when planning patient care using the nursing process. This means as nurses, we must use a combination of our knowledge and past experiences with the information we have about a current patient to make the best decisions we can about nursing care.

The nursing process was introduced in 1958 by Ida Jean Orlando. Today, it continues to be the most widely-accepted method of prioritizing, organizing, and providing patient care in the nursing profession.

It’s characterized by the key elements of:

• Critical thinking
• Client-centered methods for treatment
• Goal-oriented activities
• Evidence-based nursing research and findings
• The nursing process helps nurses to provide quality patient care by taking a holistic view of each patient they plan care for.
• The nursing process is an evidence-based approach to caring for patients that helps nurses provide quality care and improve patient outcomes.
• Ida Jean Orlando introduced the nursing process in 1958.
• The primary focus of the nursing process is the patient or client. The process is designed to meet the real and potential healthcare needs of the patient/client and to prevent possible illness or injury.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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How to write a successful nursing process essay.

In this blog, you will learn about what is a nursing process and why it is important to have a nursing process. Additionally, you will learn how to  write a top-notch nursing process essay. Read the full blog to find out how.

What is the nursing process?

The Nursing Process is a scientific method used by nurses to ensure quality patient care. This process consists of five steps: assessment, diagnosis, planning, implementation, and evaluation. By following these steps, nurses can provide the best possible care to their patients.

Assessment is the first step of the nursing process. During this phase, nurses collect data about their patients through observation, interviews, and physical examinations. This information is used to identify the patient’s problems and needs.

Diagnosis is the second step of the nursing process. During this phase, nurses use the data from the assessment phase to develop a plan of care. This plan is aimed at solving the patient’s problems and meeting their needs.

Planning is the third step of the nursing process. During this phase, nurses develop a detailed plan of care that includes the goals and objectives for the patient. This plan is then used to guide the implementation of care.

Implementation is the fourth step of the nursing process. During this phase, nurses carry out the plan of care. This includes providing treatments and therapies, as well as teaching patients and their families about their condition.

Evaluation is the fifth and final step of the nursing process. During this phase, nurses assess the patient’s progress and determine whether the goals of care have been met. This information is then used to revise the plan of care, as needed. Nursing process essay.

The Importance of the Nursing Process

The nursing process is an essential tool for nurses to provide high-quality, individualized care. It is a flexible framework that can be adapted to meet the needs of any patient. By using the nursing process, nurses can ensure that they are providing the best possible care to their patients.

The nursing process is a systematic approach to providing high-quality nursing care. It is a framework that nurses can use to ensure that they are providing the best possible care to their patients. The nursing process includes four main steps: assessment, diagnosis, planning, and implementation.

Assessment is the first step of the nursing process. During the assessment phase, nurses gather information about their patients’ health status. This information is used to identify patients’ needs and to develop a plan of care. Nursing process essay.

Diagnosis is the second step of the nursing process. During the diagnosis phase, nurses use the information gathered during the assessment phase to develop a plan of care. The plan of care is individualized to each patient and is based on the patient’s diagnosis.

Planning is the third step of the nursing process. During the planning phase, nurses develop a plan of care that is individualized to each patient. The plan of care is based on the patient’s diagnosis and is designed to meet the patient’s specific needs.

Implementation is the fourth and final step of the nursing process. During the implementation phase, nurses carry out the plan of care. This phase includes providing nursing care to patients and monitoring their progress. Nursing process essay

The Five Steps of the Nursing Process

The nursing process: assessment, the nursing process: diagnosis, the nursing process: planning, the nursing process: implementation, the nursing process: evaluation.

The nursing process is a systematic approach to delivering high-quality nursing care. It begins with assessment, which is the gathering of information about the patient’s health status. This information is used to develop a plan of care, which is then implemented and evaluated. The nursing process is an important tool for nurses to use to ensure that they are providing the best possible care to their patients.

The Nursing Process is a scientific method used by nurses to ensure quality patient care. The first step of the Nursing Process is diagnosis. In order to make an accurate diagnosis, nurses must first assess the patient’s symptoms and medical history. Nursing process essay

Once the assessment is complete, the nurse will develop a plan of care based on the diagnosis. The plan of care will include the treatments and interventions necessary to help the patient recover.

The planning phase of the nursing process is the most important and time-consuming phase. During this phase, the nurse develops a plan of care based on the assessment data and the patient’s goals. The plan of care is a detailed, individualized plan that outlines the nursing interventions that will be used to achieve the patient’s goals.

The implementation phase is when the nurse carries out the plan of care. This includes carrying out nursing interventions and monitoring the patient’s response to them. The nursing process is an important tool for ensuring that patients receive the best possible care. Nursing process essay

After completing the assessment and diagnosis phases of the nursing process, nurses move on to the evaluation stage. This is when nurses determine whether or not the patient’s condition has improved after implementing the nursing care plan. To do this, nurses must collect data from the patient and compare it to the data collected during the assessment phase. This data can be collected through patient interviews, physical exams, and laboratory tests.

Once the data is collected, nurses can determine if the patient’s condition has improved, worsened, or stayed the same. If the patient’s condition has improved, nurses can continue with the care plan. If the patient’s condition has worsened, nurses may need to modify the care plan. If the patient’s condition has stayed the same, nurses may need to re-evaluate the care plan.

Final Remarks.

To write a successful nursing process essay, students must first understand the nursing process. Once they have a good understanding of the nursing process, they can then begin to brainstorm ideas for their essay. Nursing process essay

When brainstorming ideas, students should keep in mind the purpose of the essay. The purpose of the nursing process essay is to describe how the nursing process can be used to provide quality patient care. Nursing process essay

Once students have brainstormed ideas, they can then begin to write their essay. When writing their essay, students should keep the following tips in mind:

• Be sure to include an introduction and a conclusion.
• Be sure to describe each step of the nursing process in detail.
• Be sure to provide examples of how the nursing process can be used to provide quality patient care.
• Be sure to proofread and edit their essay before submitting it.

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What Is the Nursing Process? A Guide for Effective Patient Care

Written by: university of tulsa   •  mar 25, 2024.

What Is the Nursing Process? A Guide for Effective Patient Care                                                    ¶

The primary goal of any health care facility is to provide the best quality patient care possible, to attain the best patient results. Nurses are crucial to meeting this goal, as their work often puts them on the front lines during various stages of patient care. Because nursing responsibilities vary so much, certain guardrails are necessary to enable nurses to focus their knowledge and skills to deliver optimal care and contribute to a facility’s goals.

The nursing process provides these guardrails. This multi-layered strategy helps nurses provide holistic, evidence-based patient care that’s flexible enough to respond to precise patient needs as they evolve. For those interested in obtaining an accelerated bachelor of nursing degree , it is important to understand what the nursing process is, and why it is key to providing quality nursing care.

What Is the Nursing Process? ¶

The nursing process is a systematic series of methodologies designed to break down nursing care into specific steps. These steps provide standards for nurses to build their strategies for different phases of patient care delivery. These standards can keep a nurse’s practice focused in a way that enables them to concentrate on and complete tasks that potentially improve patient outcomes.

It is a complex concept whose different steps overlap to form a singular cohesive strategy. At the same time, defining the various parts of the nursing process provides a better understanding of how they fit within the overall context of nursing care.

History of the Nursing Process ¶

In 1958, nurse theorist Ida Jean Orlando recognized that the nursing profession needed more guardrails to streamline nursing care. To build these guidelines, Orlando integrated principles she developed through her research of the mental health field into the nursing field, highlighting the importance of nurse communication with patients and other health care associates. According to a bio of Orlando published on the website NurseLabs, this integration is essential because “patients have their own meanings and interpretations of situations, and therefore nurses must validate their inferences and analyses with patients before concluding."

Orlando’s nursing theory, which was published in 1961, was designed to explore the relationship within the nurse/patient dynamic. By dividing the dynamic into five distinctive yet interconnected steps, the theory made it possible to recognize the ways in which this dynamic can fluctuate within the course of treatment. This theory emphasized patient behavior, equating how behavioral changes could be interpreted as new patient needs. It also highlighted the nurse’s role in reacting to these needs as they evolved, pointing out how well developed competencies like critical-thinking skills can lead nurses to make the best decisions possible.

Today, Orlando’s theory is used to ensure patients aren’t merely receiving nursing care. Rather, that they are receiving the specific type of nursing care that’s required for their unique situation. By implementing the theory, nurses can better recognize and react to a patient’s needs with greater effectiveness and efficiency. This can potentially improve a health care facility’s ability to reach the goal of providing care that can improve patient outcomes.

The Nursing Process Steps ¶

The key to understanding the nursing process is to individually examine the nursing process steps and what they bring to the table. Each step can help nurses better gauge how they can apply their knowledge and skills situationally based on patient behaviors, which are tied to patient needs. This can potentially be beneficial to patients in the short- and long-term.

Step 1: Assessment ¶

In the nursing assessment stage, nurses gather as much information regarding the patient as possible. This allows nurses to establish a baseline that supports the initial care delivery strategy. This baseline contains enough flexibility to allow nurses to use their critical-thinking skills to make adjustments based on patient needs.

There are several sources and methods nurses can use to gather their assessment data . These sources are typically separated into three tiers.

• Primary sources
• Secondary sources
• Tertiary sources

The primary source in the assessment phase is the actual patient. They can provide the nurse with subjective, detailed information on what they feel is wrong with them and how it is impacting their daily functionality. The typical data-gathering methods here include patient interviews, conducting physical examinations, and patient observation.

The secondary sources stem from people and information somehow connected to the patient’s sphere of influence. This can be a patient’s family, friends, or guardians. This type of data can also come from professional resources. These can include a patient’s primary care physician or their electronic health record (EHR).

Tertiary sources extend beyond a patient’s sphere of influence. These sources can range from medical journals and textbooks to in-house procedural manuals. These can help nurses establish further context regarding specific patient conditions.

These sources collectively provide the pieces a nurse needs to carry out the rest of the nursing process. Nurses must be aware that these pieces are subject to change due to elements such as the development of a new symptom. As such, nurses must be prepared to reassess a patient’s situation should a change occur.

Step 2: Diagnosis       ¶

Once all of the assessment data has been collected, the nurse can then examine that information in the nursing diagnosis phase. This essentially allows nurses to detect the health issue, including the elements that may be driving the issue. Analyzing the data gathered from the nursing assessment stage is a critical component of diagnosis, but there are other factors in play as well. These factors include the identification of health issues, the detection of potential patient strengths and vulnerabilities, and the development of diagnostic statements based on medical findings.

A proper nursing diagnosis is designed to treat the patient in a way that mirrors Maslow’s Hierarchy of Needs. Developed by psychologist Abraham Maslow, this hierarchy allows nurses to prioritize the structure of their diagnosis so the most critical patient needs are met. 

The priority of diagnosis based on Maslow’s Hierarchy of Needs includes:

• Basic physiological needs . This includes a patient’s fundamental functions like breathing, circulation, sleep, and nutrition. They can also include other elements that can alleviate psychological stress, such as shelter.
• Safety and security . This includes incorporating measures that minimize the risk of injury, such as putting fall precautions in place. This can also point to the development of a therapeutic relationship within the patient/nurse dynamic to generate trust.
• Love and belonging . This includes taking the steps to preserve supportive relationships and create environments that minimize the possibilities of social isolation.
• Self-Esteem . This includes a patient’s acceptance of who they are, which can include self-acceptance.
• Self-Actualization . This includes a patient’s ability to connect to an empowering environment that allows them to obtain personal growth.

From a care delivery perspective, nursing diagnosis primarily concentrates on addressing and ensuring a patient’s core physiological and safety needs. However, nurses should be mindful of the other three tiers as the nursing process progresses into other stages.

Step 3: Planning ¶

The planning stage is where nurses develop a treatment strategy. The nursing care plan stemming from this is commonly a collaborative process that involves input from the nurse, their supervising medical personnel, and the patient. This input must reflect agreement on the information determined in the diagnostic stage. The strategy here typically strives to meet both short-term and long-term health goals, shaped through the principles of evidence-based practice, (i.e., holistic care based on current medical knowledge and research). 

Because the planning stage concurrently focuses on achieving short-term and long-term goals, there are different types of planning nurses should practice within this stage. These three planning types are initial, ongoing, and discharge. 

In the initial planning stage, the nurse who conducted the initial patient assessment would build the framework for the plan care strategy.

In the ongoing planning stage, all nurses involved in the patient’s care collaborate to develop the initial framework into a complex strategy. Ongoing planning must contain enough flexibility to shift strategic elements in the event of changing health status, patient care priorities, or the development of new issues that may emerge during care delivery.

The final stage, discharge planning, concentrates on a patient’s exit strategy. As the name implies, this plans for a patient’s discharge, but it also involves developing strategies for continuity of care, making sure a patient’s needs are met in a way that addresses long-term health goals.

Step 4: Implementation ¶

Implementation in the nursing process springs strategies into action. This phase typically starts by conducting patient-specific interventions that aim to achieve desired, predetermined outcomes. These interventions are usually collaborative efforts involving nurses and appropriate medical staff. 

During the implementation phase, nurses monitor patients to detect signs of health improvement or decline. They may also take on an active role in patient care through duties such as administering medication or providing the patient with health management education. Additionally, they may need to conduct assessments and diagnoses based on patient progress. 

These implementation strategies can be developed around various nursing interventions. There are hundreds of interventions nurses can consider, and they fall under the guise of the Nursing Interventions Classification (NIC) System, a taxonomy devised to allow nurses to refine their care strategies to meet patient needs as much as possible. The taxonomy breaks up these interventions into six distinctive categories:

• Behavioral Nursing Interventions . These focus on encouraging patients to modify their behaviors to improve their health. Examples include supporting patients to quit smoking or engaging patients in physical activity such as walking.
• Community Nursing Interventions . These concentrate on creating peripheral factors that can encourage patients to make smart, health-oriented decisions. This can include promoting healthy eating habits or implementing proactive health education programs.
• Family Nursing Interventions . These focus on extending health strategies beyond the individual patient and toward the health of family members and loved ones. Examples of this intervention in action include educating a patient’s family about slowing the spread of a communicable disease or how to care for a patient after they’ve been released from the hospital.
• Health Systems Nursing Interventions . These hone in on ways to keep a facility safe for patients and staff alike. These include following procedures designed to lower the risk of patient infection and making sure patients remain comfortable in their hospital room.
• Physiological Nursing Interventions . These ensure a patient’s physical needs are met in a way that optimizes their health. These can include basic procedures such as assisting them with hygiene or feeding or conducting complex procedures like handling patient IV lines.
• Safety Nursing Interventions . These concentrate on maintaining a healthy patient environment that promotes safety and proactively prevents injuries. This can include educating patients on the best ways to use assistive devices or making sure a patient’s call button functions properly.

Nursing interventions can either be executed independently, with assistance or supervision from health care professionals, or as part of a collaborative effort across multiple health care disciplines. The scope of some of these interventions can depend on where they are practiced. For instance, some states may allow nurse practitioners to have full prescriptive authority, which would allow them to prescribe medications independently. Other states require nurse practitioners to have a supervised medical professional such as a physician sign off on a prescription.

Proper implementation in the nursing process requires nurses to reach into their bag of cognitive skills. These skills, such as critical thinking, problem-solving, and decision-making competencies, allow them to apply their nursing and medical knowledge to actionable skills. Interpersonal skills are also important during the implementation stage, as they can help nurses build trust and rapport with patients. Additionally, health care-specific technical skills such as injection administration, medical equipment utilization, and bandaging are also key components of the implementation process.

Step 5: Evaluation ¶

The nursing evaluation phase allows a nurse to review the effectiveness of the rest of the nursing process. By determining what worked well and what fell short, nurses can gain a clearer picture of whether or not a care delivery strategy resulted in achieving the desired outcome. It can also give nurses the information they need to potentially adjust future care delivery strategies.

There are six components within the evaluation step:

• Collecting data from the patient care strategy
• Comparing data with goal-oriented outcomes
• Analyzing the patient’s response to a nurse’s activities
• Pinpointing the factors that led to attaining a goal or falling short
• Making adjustments to the nursing care plan
• Transitioning the patient from one phase of care to another

The final component is particularly important in this stage, as it can help patients prepare for their lives after they’ve been discharged. This component can be associated with numerous education-driven components, such as educating patients on dietary restrictions, at-home medication usage, and emergency contact numbers. It can also include paying close attention to the patient’s post-treatment goals and honoring their post-care preferences.

The Principles of the Nursing Process ¶

The primary goal of the nursing process is to streamline quality care so that optimal results may be achieved. The road toward achieving this goal contains several key characteristics that make sure the guardrails of the nursing process are sturdy and keep nurses focused on the task at hand.

For instance, the process must also focus on the patient. This means honoring the patient’s needs, but also adhering to their values and preferences. This can also require the nurse to advocate for the patient to other nursing staff and health care professionals to ensure patient desires are maintained throughout the care delivery process.

The nursing process must also be collaborative. Nursing care depends on interactions between a nurse and other health care professionals including physicians. As such, nurses need to foster an environment of collaboration driven by mutual respect, clear communication, and mutual decision-making that aims toward care optimization.

In addition, the process must be adaptable and ready to pivot based on the needs of the patient. Nurses must be able to adjust strategies the moment a current strategy shows signs of deviating from patient and facility goals. This requires nurses to use critical thinking to efficiently shift care strategies to meet a patient’s needs as they evolve.

Finally, the process must be interpersonal. Nurses and patients should develop a rapport during care delivery. This connection can allow a patient to trust a nurse and their strategy. This could ultimately make it easier for nurses to give patients optimized care.

Why the Nursing Process Matters ¶

The framework of the nursing process is crucial to modern health care. It provides nurses with points of reference that remain unchanged even as care concepts evolve. As technical innovations such as EHRs and artificial intelligence (AI) infuse the health care space, these nursing process guidelines make it possible for nurses to see how and where these innovations can be implemented within the context of care delivery. This can lead to greater efficiency in integrating new concepts into a nursing strategy, which can potentially lead to optimized patient care. 

The nursing process also allows nurses to pay better attention to a patient’s needs based on Malsow’s Hierarchy of Needs. The process can foster a sense of belonging and self-worth among patients, as nurses may integrate strategies that meet these specific needs in addition to a patient’s physiological and safety needs. This can also allow nurses to integrate cultural competency into their plans. 

By focusing on patient needs, nurses can better understand and respect the different cultural beliefs and philosophies regarding care delivery. This understanding can lead to a better sense of trust within the patient/nurse dynamic, as the patient may be more willing to work with a nurse who recognizes their cultural heritage and viewpoints.

Additionally, this framework can help nurses mitigate the complexities of unique health care challenges, such as providing care to patients with comorbidities. This nursing process can make it easier to break down bigger care challenges into smaller, isolated episodes. This could then make the challenges more manageable from a strategic vantage point.

Guide Others Through the Process ¶

The nursing process provides the guidelines that can streamline nursing strategies and make them operate with greater efficiency. However, these processes still rely on the talent of nurses to truly make a difference in patient care. Nurses who know how to apply the steps within the context of care delivery can truly make a positive impact on a health care facility — one that can enable a facility to attain its goal of providing the best patient care possible.

The University of Tulsa’s Accelerated Bachelor of Science in Nursing (ABSN) program can help prepare you to make such an impact. Our program is designed to help you build the foundational knowledge and skills to develop strong process strategies that can lead to the kind of targeted care that can make a difference in the lives of patients. 

Learn how we can jumpstart your success.

Recommended Readings

Achieving Health Care Justice: Breaking Down Racial Disparities in Health Care

Change Theory in Nursing: How It’s Evolving the Profession

ABSN vs. BSN: Which One Should You Choose?

American Association of Nurse Practitioners, Nurse Practitioner Prescriptive Authority

American Nurses Foundation, Technology-Enabled Nursing Practice

American Nursing Association, The Nursing Process

American Nursing Association, What Is Evidence-Based Practice in Nursing?

American Nursing Association, What is Nursing?

Indeed, “Why Cultural Competence Is an Important Quality in Nursing”

National Library of Medicine, “Nursing Process”

Nurselabs, “Nursing Theories Guide: Ida Jean Orlando Nursing Process”

Nurselabs, “The Nursing Process: A Comprehensive Guide”

U.S. Centers for Medicare and Medicaid Services, Electronic Health Records

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How to Write a Nursing Essay with a Quick Guide

Ever felt the blank-page panic when assigned a nursing essay? Wondering where to start or if your words will measure up to the weight of your experiences? Fear not, because today, we're here to guide you through this process.

Imagine you're at your favorite coffee spot, armed with a cup of motivation (and maybe a sneaky treat). Got it? Great! Now, let's spill the secrets on how to spin your nursing tales into words that not only get you that A+ but also tug at the heartstrings of anyone reading. We've got your back with nursing essay examples that'll be your inspiration, an outline to keep you on the right path, and more!

What Is a Nursing Essay

Let's start by dissecting the concept. A nursing essay serves as a focused exploration of a specific aspect of nursing, providing an opportunity for students to demonstrate their theoretical knowledge and its practical application in patient care settings.

Picture it as a journey through the challenges and victories of a budding nurse. These essays go beyond the classroom, tackling everything from tricky ethical dilemmas to the impact of healthcare policies on the front lines. It's not just about grades; it's about proving, 'I'm ready for the real deal.'

So, when you read or write a nursing essay, it's not just words on paper. It's like looking into the world of someone who's about to start their nursing career – someone who's really thought about the ins and outs of being a nurse. And before you kick off your nursing career, don't shy away from asking - write my essay for me - we're ready to land a professional helping hand.

How to Start a Nursing Essay

When you start writing a nursing essay, it is like gearing up for a crucial mission. Here's your quick guide from our nursing essay writing service :

Choosing Your Topic: Select a topic that sparks your interest and relates to real-world nursing challenges. Consider areas like patient care, ethical dilemmas, or the impact of technology on healthcare.

Outline Your Route : Plan your essay's journey. Create a roadmap with key points you want to cover. This keeps you on track and your essay on point.

Craft a Strong Thesis: Assuming you already know how to write a hook , kick off your writing with a surprising fact, a thought-provoking quote, or a brief anecdote. Then, state your main argument or perspective in one sentence. This thesis will serve as the compass for your essay, guiding both you and your reader through the rest of your writing.

How to Structure a Nursing Essay

Every great essay is like a well-orchestrated performance – it needs a script, a narrative that flows seamlessly, capturing the audience's attention from start to finish. In our case, this script takes the form of a well-organized structure. Let's delve into the elements that teach you how to write a nursing essay, from a mere collection of words to a compelling journey of insights.

Nursing Essay Introduction

Begin your nursing essay with a spark. Knowing how to write essay introduction effectively means sharing a real-life scenario or a striking fact related to your topic. For instance, if exploring patient care, narrate a personal experience that made a lasting impression. Then, crisply state your thesis – a clear roadmap indicating the direction your essay will take. Think of it as a teaser that leaves the reader eager to explore the insights you're about to unfold.

In the main body, dive into the heart of your essay. Each paragraph should explore a specific aspect of your topic. Back your thoughts with examples – maybe a scenario from your clinical experience, a relevant case study, or findings from credible sources. Imagine it as a puzzle coming together; each paragraph adds a piece, forming a complete picture. Keep it focused and let each idea flow naturally into the next.

Nursing Essay Conclusion

As writing a nursing essay nears the end, resist the urge to introduce new elements. Summarize your main points concisely. Remind the reader of the real-world significance of your thesis – why it matters in the broader context of nursing. Conclude with a thought-provoking statement or a call to reflection, leaving your reader with a lasting impression. It's like the final scene of a movie that leaves you thinking long after the credits roll.

Nursing Essay Outline

Before diving into the essay, craft a roadmap – your outline. This isn't a rigid skeleton but a flexible guide that ensures your ideas flow logically. Consider the following template from our research paper writing service :

Introduction

• Opening Hook: Share a brief, impactful patient care scenario.
• Relevance Statement: Explain why the chosen topic is crucial in nursing.
• Thesis: Clearly state the main argument or perspective.

Patient-Centered Care:

• Definition: Clarify what patient-centered care means in nursing.
• Personal Experience: Share a relevant encounter from clinical practice.
• Evidence: Integrate findings from reputable nursing literature.

Ethical Dilemmas in Nursing Practice

• Scenario Presentation: Describe a specific ethical challenge faced by nurses.
• Decision-Making Process: Outline steps taken to address the dilemma.
• Ethical Frameworks: Discuss any ethical theories guiding the decision.

Impact of Technology on Nursing

• Current Trends: Highlight technological advancements in nursing.
• Case Study: Share an example of technology enhancing patient care.
• Challenges and Benefits: Discuss the pros and cons of technology in nursing.
• Summary of Key Points: Recap the main ideas from each section.
• Real-world Implications: Emphasize the practical significance in nursing practice.
• Closing Thought: End with a reflective statement or call to action.

A+ in Nursing Essays Await You!

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Nursing Essay Examples

Here are the nursing Essay Examples for you to read.

Writing a Nursing Essay: Essential Tips

When it comes to crafting a stellar nursing essay, a few key strategies can elevate your work from ordinary to exceptional. Here are some valuable tips from our medical school personal statement writer :

Connect with Personal Experiences:

• Approach: Weave personal encounters seamlessly into your narrative.
• Reasoning: This not only adds authenticity to your essay but also serves as a powerful testament to your firsthand understanding of the challenges and triumphs in the nursing field.

Emphasize Critical Thinking:

• Approach: Go beyond describing situations; delve into their analysis.
• Reasoning: Nursing essays are the perfect platform to showcase your critical thinking skills – an essential attribute in making informed decisions in real-world healthcare scenarios.

Incorporate Patient Perspectives:

• Approach: Integrate patient stories or feedback into your discussion.
• Reasoning: By bringing in the human element, you demonstrate empathy and an understanding of the patient's experience, a core aspect of nursing care.

Integrate Evidence-Based Practice:

• Approach: Support your arguments with the latest evidence-based literature.
• Reasoning: Highlighting your commitment to staying informed and applying current research underscores your dedication to evidence-based practice – a cornerstone in modern nursing.

Address Ethical Considerations:

• Approach: Explicitly discuss the ethical dimensions of your topic.
• Reasoning: Nursing essays provide a platform to delve into the ethical complexities inherent in healthcare, showcasing your ability to navigate and analyze these challenges.

Balance Theory and Practice:

• Approach: Connect theoretical concepts to real-world applications.
• Reasoning: By bridging the gap between theory and practice, you illustrate your capacity to apply academic knowledge effectively in the dynamic realm of nursing.

Highlight Interdisciplinary Collaboration:

• Approach: Discuss collaborative efforts with other healthcare professionals.
• Reasoning: Acknowledging the interdisciplinary nature of healthcare underscores your understanding of the importance of teamwork – a vital aspect of successful nursing practice.

Reflect on Lessons Learned:

• Approach: Conclude with a thoughtful reflection on personal growth or lessons from your exploration.
• Reasoning: This not only provides a satisfying conclusion but also demonstrates your self-awareness and commitment to continuous improvement as a nursing professional.

As we wrap up, think of your essay as a story about your journey into nursing. It's not just about getting a grade; it's a way to share what you've been through and why you want to be a nurse.

Imagine the person reading it – maybe a teacher, a future coworker, or someone starting their nursing journey. They're trying to understand your passion and why you care about nursing.

So, when you write, remember it's more than just an assignment. It's your chance to show why nursing matters to you. And if you ever need help – there's always support from our essay writer online .

Ready to Excel in Your Nursing School Essay?

Order now and experience the expertise of our professional writers!

How to Write a Nursing Essay?

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Assessing the patient's needs and planning effective care

Benjamin Ajibade

Senior Lecturer, Mental Health Nursing, Northumbria University

View articles · Email Benjamin

Nurses have an essential role to play in the assessment and planning of patient care. This is emphasised in the Nursing and Midwifery Council's 2018Future Nurse proficiency standards. In this article, the author discusses the importance of person-centred care in assessing needs and highlights the need for all nursing interventions to be evidence based. The topics covered include assessing people's needs, care planning, stages of care planning, benefits of care planning, models of care, care pathways, and care clustering in mental health care. The article also highlights the significance of record-keeping.

The central role of nurses in assessing patient needs and planning care is one of the core areas emphasised in Future Nurse, the Nursing and Midwifery Council's (NMC) (2018a) nursing proficiency standards. The document categorises ‘assessing needs and planning care’ as the third of seven areas of proficiency, which are grouped into ‘platforms’. Future Nurse emphasises that the delivery of person-centred care and evidence-based nursing interventions are vital components for effective patient assessment and care planning. The standards further highlight that the nurse should understand the need to assess each patient's capacity to make their own decisions and to allow them the opportunity to give and withdraw consent.

An assessment is a form of a dialogue between client and practitioner, in which they discuss the needs of the former to promote their wellbeing and what they expect to happen in their daily life ( National Institute for Health and Care Excellence (NICE), 2021 ). Nursing assessment involves collecting data from the patient and analysing the information to identify the patient's needs, which are sometimes described as problems.

The process of planning care employs different strategies to resolve the needs identified as part of an assessment. Ideally, this will include the selection of appropriate evidence-based nursing interventions. When planning care, the patient's needs and wishes should be prioritised, and the individual must be involved in the decision-making process to ensure a person-centred approach. The planned care must take into account the patient's conditions, personal attributes and choices. It is worth noting that the principles of care planning are transferable between hospital, home and care home settings.

Section 2 of the NMC Code highlights the importance of partnership working with patients to ensure the delivery of effective high-quality care and of involving them in their care, which includes empowering patients by enabling them to make their own decisions ( NMC, 2018b ). The patient should be viewed holistically, with importance placed on the physical, psychological, social and spiritual aspects of the person's life, which are inextricable.

The intrinsic factors of a patient's condition will often affect their concordance with the advice and treatment offered. Consequently, it is important to understand the reasons for non-concordance and to tailor treatments/recommendations to each individual, which will improve the quality of care delivered.

Brooker (2007) developed the acronym VIPS to address some of the confusion surrounding what should or should not be perceived as person-centred care. VIPS stresses the following:

• V is a value base that affirms the value of each human being, irrespective of age and cognitive ability. This is the foundation for individualised care
• I is individualised care that considers the individual's distinctiveness and holistic needs
• P is about seeing the world from the patient's perspective, to ensure that the health professional takes the patient's point of view into account when providing care
• S is about maintaining a social environment that supports the patient's psychological needs, including their mental, emotional and spiritual needs.

Health professionals should endeavour to involve the patient in decision-making and enable them to make choices as much as possible, using a range of approaches to achieve this ( Lloyd, 2010 ). Unless proven otherwise, a nurse must assume that a patient has the capacity to make their own decisions, in line with the Mental Capacity Act 2005.

The following draws on the author's experience in mental health nursing but can be applied to other areas of nursing care.

Care planning

Planning care is essential in the delivery of appropriate nursing care. Following assessment of a patient's needs, the next stage is to ‘plan care’ to address the actual and potential problems that have been identified. This helps to prioritise the client's needs and assists in setting person-centred goals. Planned care will change as a patient's needs change and as the nurse and/or other health professionals identify new needs. Care planning assists professionals to communicate information about the patient's care to others ( Department of Health (DH), 2013a ; NICE, 2021 ), to facilitate continuity of care. Communication may be predominantly verbal, but it will also always involve documentation in a variety of formats, including computer-based, handwritten or preprinted care plans.

It is essential for nurses to consider their consultation style when developing a care plan in order to reduce the risk of paternalism when communicating with the patient and discussing their needs. Collaborative consultation encourages patients to participate in their care and improves rapport, while a paternalistic approach will generally minimise an individual's part in, and responsibility for, their own care needs and may compromise care outcomes and concordance ( Leach, 2010 ). A collaborative/partnership consultation style facilitates a person-centred approach by the practitioners and involves the patient in their care. Such an approach can include asking questions such as: ‘We have different types of treatment approaches that could be considered, what are your preferences?’ This is in contrast to a paternalistic consultation style with the health professional announcing any decisions with a statement such as: ‘I am going to prescribe a certain treatment for you.’

When drawing up a care plan with a patient the nurse should take into account a number of considerations ( Box 1 ).

Box 1.Nursing considerations

• The patient should know the reason for the assessment
• The assessment should be flexible and adaptable to the needs of the individual
• The patient must be fully involved and their dignity, independence, and interests should be paramount
• The patient can have someone with them, if preferred
• Appropriate language and terminologies should be used throughout the consultation
• The diversity of the individual client, their beliefs, values, culture and their circumstances must be considered
• It is essential to consider the patient's gender, sexuality, ethnicity, disability and religion as part of the assessment
• Be open to listening to the patient's personal history and life story
• The entire family's needs should be considered, inclusive of the patient and their carers: remember the importance of providing holistic care
• Cost-effectiveness should also be taken into account

Sources: Department of Health, 2011; National Institute for Health and Care Excellence, 2021

Stages of care planning

Care planning has been described as the third stage of the nursing process ( NMC, 2018a ; Toney-Butler and Thayer, 2021 ). It includes assessing the patient's needs, identifying the problem(s), setting goals, developing evidence-based interventions and evaluating outcomes ( Matthews, 2010 ). This will require the health professional to apply high-level critical thinking, decision-making and problem-solving skills. It is important to note that a care plan can be prescriptive: it is devised after a patient has been assessed through the prescription of nursing actions ( Hogston and Simpson, 2002 ) or through collaborative working involving the multidisciplinary team.

In some situations there will be differences between what the nurse sees as a priority in terms of the patient's needs and what the patient wants. An example of this would be a patient with mental health problems who may be at high risk of self-harm, who may need to be put on intermittent 15-minute observation. In such cases, a patient would be deemed as not having capacity to make decisions and the nurse will need to use their clinical judgement to prescribe the best treatment option. The care plan can still be agreed in conjunction with the patient once the nurse has explained the reasons for the interventions and acknowledged in the care plan that this is not the patient's preferred choice.

In situations where the patient has capacity to make decisions, the care plan should be agreed in collaboration with the service user ( NHS England, 2016a ).

Identifying needs

As part of the care planning process, the nurse will identify a patient's needs/problems and propose a set of interventions to address them in order of priority, ensuring that everything is in agreement with the patient. To ensure that appropriate goals are set, a patient's needs will be classified as high, intermediate and low.

Each goal provides an indication as to the expected outcome, along with the proposed interventions required to meet the patient's problems/needs, all of which must be patient centred. It is important, in collaboration with the patient, to set both short-term, achievable goals and longer-term goals that may take days, weeks or months to accomplish. One way nurses can ensure this is to apply the SMART goal-setting approach to ensure that the goals are ( Revello and Fields, 2015 ; NurseChoice, 2018 ):

• M easurable
• A chievable
• T imely (within a defined time frame).

Interventions

Interventions are nursing actions/procedures or treatments built on clinical judgement and knowledge, performed to meet the needs of patients. The actions should be evidence based and indicate who will carry them out, when and how often ( Hogston and Simpson, 2002 ). The scheduled interventions will have been agreed with the patient with the aim of improving their health condition, and each subsequent action should strive to meet the goals set at the previous stage. Brooks (2019) outlined three types of intervention:

• Those independently initiated by nurses
• Those that are dependent on a physician or other health professionals
• Those that are interdependent, that is, those rely on the experience, skills and knowledge of multiple professionals.

Independent nursing interventions are planned and actioned by nurses autonomously ( NMC, 2018a ), and these actions do not require the nurse to have direction from another health professional. When actioning interventions dependent on other health professionals, the nurses must determine the appropriateness of any directions from other health professionals before carrying them out because the nurse remains accountable for the actions, for example, the administration of prescribed medication ( NMC, 2018a ). Due to developments in the nursing profession, some advanced nurse practitioners can now prescribe interventions, eg prescription of medication can be done by nurse independent prescribers or nurse supplementary prescribers ( Royal College of Nursing, 2014 ). Interdependent interventions are usually recorded in collaborative care plans reviewed in multidisciplinary (MDT) meetings and must be agreed by all parties involved. Both the goals and interventions must be communicated in a timely manner to all those involved in the patient's care.

This is the stage when a planned intervention is evaluated to assess whether or not it has been achieved. This can be an ongoing process, and the care plan should document the frequency and time frame for evaluating the intervention. If the initial goal becomes unachievable, the nurse will be required to reassess the patient's needs, and review and revise the interventions.

Benefits of care planning

The DH (2011) highlighted that the aim of care planning is to improve the quality of care and outcomes by respecting individual wishes and enabling patients to acknowledge the ownership of their condition and ensuring they have the ability to influence the outcomes. Health professionals should engage individuals in decision-making and facilitate them to take control of their health by agreeing common goals to improve outcomes. This will have additional benefits for both the patient and health services as it should reduce the number of GP appointments and emergency admissions the patient may require. Promoting self-management of long-term conditions can also help slow progression of illness.

Care planning empowers patients to care for themselves when they are self-managing their health and when they may have difficulty accessing a health professional. This became evident during the pandemic, with patients often having to go for extended periods between appointments with their health professionals. Care planning has really come into its own in community care in the past few years, which became evident during the pandemic—particularly in the field of mental health—because it leads to better patient concordance with treatment and other care needs without the need for constant input by health professionals. This benefits both health professionals and the NHS: it increases job satisfaction, brings efficiency savings and improves the quality of patient care ( DH, 2011 ).

Model of care

Models of care are used to deliver best practice in health care. An integrated services care model is multifaceted and enables the co-ordination of care by different health and social care professionals to meet individual patient needs. It encompasses patient-centred care and enables care staff across different providers to reduce duplication, confusion, delay and gaps in services ( Monitor, 2015 ). In the modern NHS, this is the preferred model of care.

The care plan is an integral part of this model because it enables the creation of shared care plans that map different care processes. It becomes a point of reference for various providers involved in the care of the patients, ensuring the co-ordination of care across services ( Curry and Ham, 2010 ; World Health Organization, 2016 ).

Care pathways

Care pathways, which are also known as critical pathways, clinical pathways, integrated care pathways, care paths and care maps, are used to describe a specific patient journey that dictates the care to be provided or process to be followed for a patient's particular condition or needs. An evidence-based care process is established for specific conditions by considering expert opinion that takes into account the evidence to recommend interventions that have been shown to achieve better health outcomes cost-effectively ( Centre for Policy on Ageing, 2014 ).

Care pathways are often developed at local level and have been shown to be efficacious at meeting local needs. They are also known to improve cross-setting collaborations. Clinical pathways are aimed at providing effective health care appropriate for the patient group of conditions, thereby reducing hospital stays, leading to cost-effective health care ( Kozier et al, 2008 ).

Care clusters

Care clustering is a needs assessment tool that is used to rate a patient's care need against specific scales:

‘A cluster is a global description of a group of people with similar characteristics as identified from a holistic assessment and then rated using the Mental Health Clustering Tool (MHCT).’

NHS England, 2016b

This framework is used to plan and organise mental health services, including the care and support provided to individuals based on their illness and individual needs. One of the care clustering tools used in the NHS is the Health of the Nations Outcome Scales (HoNOS) ( Wing et al, 1998 ; Yeomans, 2014 ; NHS England, 2016b ).

Mental health services were brought under the scope of Payment by Results (PbR) in the NHS in 2012-2013.

‘Payment by Results (PbR) is the transparent rules-based payment system in England under which commissioners pay healthcare providers for each patient seen or treated, taking into account the complexity of the patient's healthcare needs.’

Consequently, as part of the care planning process, nurses need to take into account the cost-effectiveness of any interventions in order to consider how much funding is likely to be available for an initial completion of assessments, during scheduled reassessment and at any subsequent reassessment after a significant change in the patient's needs.

Box 2.Importance of complying with guidelines when undertaking assessment and planning care

• You must be compliant with the Nursing and Midwifery Council (2018b ; 2021 ) guidelines for record and record-keeping
• Adhere to the employing local organisation's policy on record-keeping, eg local trust policy
• Follow the NHS trust Care Programme Approach (CPA) policy ( Department of Health, 2008 )
• Collaborate with all those involved in a patient's care planning process

Importance of record-keeping

Accurate record-keeping is essential in the assessment of needs and planning care. This complies with the NMC (2018b) which states that record-keeping is fundamental to nursing practice, emphasising that records must be accurate and precise.

Health professionals should be aware of the need for legal accountability when documenting care in a written record because such records could be used in any legal proceedings ( Dimond, 2005 ). A record refers to not only a patient's record, but encompasses all records related to an individual nurse's range of practice. It is important to include the person being cared for in the record-keeping process, who should be asked to sign the plan of care, if they have capacity to do so ( NMC, 2021 ).

It is good practice to make an entry in the care documentation if a service user is unable to sign or agree to their planned care and state the reason for this ( Butterworth, 2012 ). In addition to paper-based records, care plans can be entered into the electronic health/patient record system used in the practitioner's service ( NHS website, 2019 ).

Best practice in writing care plans

There are some critical factors to consider when writing a focused person-centred care plan. One of these is to clearly document in detail the needs of the patient and to use the patient's language whenever possible, for example: ‘Mr D likes to dress smart every morning, but has been finding it difficult to make the choice of clothing to wear.’ An example of a poor way to record the same issue might be: ‘Mr D is unable to dress by himself’ and the aim is ‘Mr D will appear to dress smartly’.

The documented goal/aim of the care plan should be determined by applying the SMART acronym. It is therefore vital to ensure that the aim is specific by focusing on issues that can be measured, with goals that are achievable and realistic. It is also important to suggest and record a time frame within which a patient's short-term and long-term goals could be achieved. In relations to Mr D's clothing, a daily time frame might be appropriate. To come to an agreement over this issue, Mr D might be asked: ‘Mr D, would you like to be able to make your own choice of clothes to wear every day with the support of staff?’ The projected daily goal would then be recorded as part of the care plan documentation.

An intervention must specify how a goal/aim will be achieved, including who will be responsible for implementing each task. This could be the staff nurse on duty, team nurse, team leader, the nurse in charge and/or the patient (please put the patient's name). Evaluation should be carried out regularly and documented, and should conform with the proposed time frame outlined as part of the suggested intervention. Evaluations should be undertaken whenever actions are performed in accordance with each proposed intervention, and details of the progress of the patient's problem/needs documented.

In conclusion, the article has discussed the importance of assessing patients' needs, emphasising person-centred care using the VIPS acronym devised by Brooker (2007) . It has stressed the notion for all nursing interventions to be evidence based. The stages of care planning were discussed, and the application of the SMART goal-setting approach was highlighted. Record-keeping is an integral part of care planning in the communication of patient's care and progress. The benefits of care planning in improving quality of care and outcomes, respecting individual wishes, thereby empowering the patient was recognised.

LEARNING OUTCOMES

• Nurses must ensure that assessment of patient needs and care planning are always focused on the person
• All nursing interventions must be evidence based
• The goals set out in a patient's care plan must be achievable and measurable, and should include time frames within which both short- and long-term goals can be achieved
• Record-keeping is a vital component of care planning and is part of communicating aspects of a patient's care, and their progress towards their goals, with other health professionals involved in their care

CPD reflective questions

• In the context of a patient's health, what should you aim to do when care planning?
• Who should you involve in the care planning and why? Should the patient have a copy of the care plan?
• Is it acceptable to destroy care plans or other records?
• When should care plans be reviewed?