03.06 Nursing Process

Alright, I’m assuming most of you have a really good grasp of what the nursing process is when we talk about it and why it’s important. But let’s talk through it a little bit and assuming, you know, hopefully from your N100 class, your Entero Nursing class, Fundamentals course, whatever, you’ve come in contact with what the nursing process is. Essentially, when we talk nursing process, we’re talking about A.D.P.I.E. What is A.D.P.I.E? A.D.P.I.E is the process or the framework that nurses can use for working through what they need to do at any given stage in a shift or in any career or in a patient care. Okay, so, what it is, really, it is Assess, Diagnose, Plan, Implement, and Evaluate. Okay, and that process repeats itself as we care for a patient. So, before you can plan interventions for a patient, before you can plan anything for a patient, you must first assess the situation. Always walk into a room, always assess, always assess what’s going on with the patient, make a diagnosis, basically making a judgment, call up what’s going on, make a plan for that. Intervene, basically implement, implement that plan, and then evaluate that plan. Did it work? Alright now, I really hope that in your nursing education and the experience you’ve had, you’ve seen why this is so important. A lot of times, what can happen on the floor and what can happen when you’re taking a test, is you walk into a situation, you walk into a question, and you go from assessing, skip all that stuff all the way to implementation. So, you walk in, you see a blood pressure low, you read a question, you see something that looks really terrifying and scary and you jump all the way to implementing. You’re like let’s do something, let’s start an IV, let’s do something, when you haven’t taken a minute to assess the situation, diagnose what’s really going on, make a plan, implement that plan, and then evaluate how well or if that plan even worked. So, if anything else, what I want to use A.D.P.I.E for assess, diagnose, plan, implement and evaluate, is to simply give you a method and a thought process to really make yourself stop, take a deep breath, think about what’s going on, and then, to work from there. Okay, does that make sense? So, when you walk into a question, we’ve talked about a lot of different steps, we’ve talked a lot about a lot of different tips for test taking. When you walk into a question, this nursing process, the nursing process never changes. Always follow this, okay? Assess your situation first, diagnose, plan, implement, and evaluate. The reason I have a pie right there is, you know, A.D.P.I.E. I thought that would work. So, always follow the process even if you have no idea what’s going on, okay. If you have no idea what’s going on, you can use A.D.P.I.E, you know, the steps you need to follow in A.D.P.I.E to follow out what you should do next. So, if in a question, you’ve done a plan, you know, you’re up to a plan. And then, you don’t understand what’s going on, but you know there’s a plan being done in the question. And then all the different items, all the different answer options are all talking about some sort of assessment or some sort of diagnosis and only one option is talking about implementation, that’s the one you need to follow, that’s the answer you need to pick. So, never break this process, ever. And that’s gonna help you tremendously in your career. And I just really wanna stress that a lot to you guys, is that you have to follow this process, okay. You have to go step by step here because it really keeps you slow, it keeps you thinking, it keeps you critically thinking and it keeps you moving in the way that you need to do. So, you walk into a scary situation, you walk into a scary room, you wall into a scary question, take a deep breath, and read it again, and say “Where am I in the nursing process and what’s the next step?”   Alright, let’s do an example here. This one’s a little bit hard. It says “A patient is receiving oxygen by nasal cannula. After morning care, the patient experiences dyspnea and complains of feeling tired. When planning for the patient’s bath the next day, the nurse should plan to?” Okay, so, what step are we in the nursing process right now? Right now, we’re talking about planning. Okay, so, we need to recognize where we are in the nursing process. We’ve assessed, we’ve diagnosed, we’ve plan, implement, evaluate, we’ve done our whole bath, now we’re back to the planning stage. We’ve evaluated, we said, okay, the patient is experiencing a lot of dyspnea, you know, after I implemented my bath, I’m evaluating, they all have dyspnea going on. I need to plan a new intervention here. So, that’s where we’re at in the nursing process, it’s the planning stage. So, first one is give a complete bed bath quickly. Bathe only the body parts that need bathing. Arrange for several rest periods during morning care. Continue with the same plan because dyspnea is unavoidable. So, let’s pretend that we don’t know what the right answer is. The first one is give a complete bed bath quickly. That’s implementation. Is that planning? No. That’s implementation. Bathe only the body parts that need bathing. Is that planning? No. That’s implementation again. Arrange for several rest periods during morning care. Arranging, that’s planning. That’s doing a planing piece of the nursing process. Number 4, continue with the same plan because dyspnea is unavoidable. So, is that evaluating? Is that doing anything? Like, we saw a problem in our patient, we implemented our first plan, we saw a problem. And now, it says, continue doing it, whatever. We evaluated, we diagnosed, we saw a problem with what’s going on, they’re not breathing, they’re experiencing dyspnea. And what is it this option says, it says continue with it ‘cause that’s cool, you know. Obviously, that one is not correct. So, by following the nursing process, by knowing that we’re in the planning phase, we can then select the right answer simply using the nursing process. So, what I want you to do when you get your next question, when you get another question on test, when you get a question on the NCLEX, or whatever, I want you to look at what phase am I in the nursing process? What needs to be done in that phase and is it time to go to the next phase? If you do that, if you write A.D.P.I.E. down just on your scratch paper, or whatever, write A.D.P.I.E. down on each question, circle where you’re at, and determine, is it time to move on to the next stage? Have I fully completed what needs to be done in this stage? And so, for this question here, for example, it says “What should the nurse plan to do?” The only option that’s allowing us to plan, that’s not implementing, or that’s not, you know, just ignoring the nursing process together. It’s number 3, which is, arrange for several rest periods during the morning care. Alright, so, always take the A.D.P.I.E. I want you to live by A.D.P.I.E. not just in nursing school, but as a nurse on the floor. Live by A.D.P.I.E. Alright, hope that helps guys and we’ll see you soon.