NURSING PROCESS IN THE DELIVERY OF NURSING CARE SERVICES

 Decision making is one of the most frequent activities performed by a professional

nurse. At the bedside or in the boardroom, nurses must make decisions and solve
problems to produce outcomes that enhance patient care.
 All decisions are not made in response to problems, but all problems were resolved
because of decisions made along the way. Nurses need to make decisions that are
appropriate to the context of the situation and considerate of the culture where the
services are being provided. These decisions need to be based on knowledge of the
individuals, relationships, ethics, politics, and financial considerations of the situation.

Nursing Process is defined as systematic, rational method of planning that guide all nursing
actions in delivering holistic and patient-focused care.

Who developed the Nursing Process

- The earliest version of the nursing process was introduced in 1955 by Lydia E. Hall.
- Ms. Hall identified three steps of the nursing process: observation, administration of
care, and validation. Other versions of the nursing process appeared throughout the
next decade.
- Dorothy Johnson, in 1959, described nursing as "fostering the behavioral
functioning of the client.” Ms. Johnson’s version of the nursing process included the
three steps: assessment, decision, and nursing action.

- Finally, in 1961, Ida Jean Orlando-Pelletier introduced the version of the nursing
process known to nurses today.
It is based upon the “Deliberative Nursing Process Theory”
- Ms. Orlando-Pelletier's version of the nursing process includes five steps:
Assessment, Diagnosis, Planning, Implementation, and Evaluation.
 Most nurses do not recognize the use of nursing process as decision-making tool
 The nursing process is ongoing and begins with phase I, assessment, according to
Figure 1. This phase includes defining the assumptions and context, collecting data,
identifying and naming the problem(s), and deciding on actions or interventions.
 Phase II is implementation or intervention as planned in phase I.
 Phase III is evaluating the outcomes.
 For example, during a home visit to a patient, the nurse is concerned about the
safety of an elderly man who is post–cerebral vascular accident (stroke) with some
mobility problems
o Assessment: Nurse identifies all safety hazards and labels the problem
o Diagnosis: “Alteration in safety related to environmental hazards.”
o Planning: Review the environment with the patient and make necessary
changes
o Implementation: Eliminating throw rugs or anchoring them to the floor,
removing extension cords or taping them down, and discussing how the cats
can be controlled when the patient is walking through the house
o Evaluation: Short-term evaluation of the changes will occur on the next
home visit; Long-term evaluation will be measured by the lack of falls by the
patient

 Using the nursing process as a guide, start the decision-making process by collecting
data and assessing the situation. It is important to make decisions with as much
information as possible
 Leaders make their most successful decisions when they assess the strengths and
weaknesses of the people and the environment
 Good decision making relies on building relationships, knowing the politics of the
players, understanding the time and other environmental constraints, integrating
cultural values, and staying true to personal and organization ethics.
 Cultural diversity found in any organization needs to be considered in any decision
that affects more than one person. Differences in frames of reference, perspectives,
 norms, values, and communication style are often aggravated by prejudices,
stereotypes, and misunderstandings (Broome, et al., 2002)
 Sources of data for decision making come from more formal sources such as quality
assurance, benchmarking, and risk management data
 Scientific research data make excellent assessment data and should be the basis for
much of decision making in nursing whenever possible
 Nursing process can easily be adapted as a theoretical model for solving leadership
and management problems.

Table 1. Comparing the decision-making process with the nursing process

Decision-Making Process Simplifies Nursing Process

Identify the decision Assess
Collect data
Identify criteria for decision Plan
Identify alternatives
Choose alternative Implement
Implement alternative
Evaluate steps in decision Evaluate

 Table 1 shows how closely the nursing process parallels the decision-making
process.
 The weakness of the nursing process, like the traditional problem-solving model, is in
not requiring clearly stated objectives. Goals should be clearly stated in the planning
phase of the process, but this step is frequently omitted or obscured. However,
because nurses are familiar with this process and its proven effectiveness, it
continues to be recommended as an adapted theoretical process for leadership and
managerial decision making.