Nursing Process Essay

691 Words3 Pages
Writing Assignment 6.1 The Nursing Process: Assessment and Diagnosis By: Rodney Gene Sheaffer Jr. NU100 Pam Pauli 02/06/15 ABSTRACT What is the nursing process? The nursing process is the organizational framework for the process of nursing (Ackley 2014). It covers all of the steps necessary to provide the highest quality of care. A nurse uses this process to effectively assess, diagnose, plan, implement and evaluate their patient. In this paper we will look at the individual steps in the nursing process as well as using these steps to assess and diagnose a patient. A.D.P.I.E. The Nursing process is made up of five important steps. We commonly refer to these steps as ADPIE. A: stands for assessment, the assessment encompasses subjective (What the patient tells the RN and what is visually observed) and objective (Vital signs, medical history) information. The RN also looks at physiological, psychological, sociocultural, spiritual, economic, and life-style factors as well. D: is the diagnoses, the nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs (American Nurses Association 2014). An example of a diagnosis is insomnia. Insomnia is the disruption in the amount and quality of sleep that impairs functioning (Ackley, 2014) linked stress and depression. P: represents the plan. Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals (American Nurses Association, 2014) For example, A short term goal for a patient with insomnia would be to achieve X amount of hours of sleep per night over the course of a week. Next is I: which stands for Implementation. After the nurse has assessed, diagnosed, and made a plan for the patient it must be implemented. Implementation is the steps taken to achieve the goals set by the nurse and the
Open Document