ESSAY :

Before we do the intervention to the patient, we need to know the nursing process. So
we can do it correctly and step by step. The purpose of this essay is to discuss the importance
of problem solving following the steps of the nursing process, (NP).The nursing process is
used to identify, prevent and treat actual or potential health problems, enabling the nurse to
plan care for a patient on an individual basis using. a systematic, step by step approach.
The NP is a method of problem solving therefore I will use the term the NP
throughout the essay. Focusing on the four major steps, assessment, planning,
implementation, and evaluating. Discussing the importance of continuity of care and why the
patients' needs may not be fully met if the NP is not followed. I will also be discussing why
critical thinking is important in decision making and problem solving. The NP helps the nurse
develop an understanding of the patients, differing from the medical process by treating the
patient holistically. Addressing not only the patients' physical emotional and mental health
but also their interests, values, beliefs ethnic religious and cultural background.
The first part of the NP is the assessment; it is an ongoing process helping to identify
patient needs, once these needs are established they can be incorporated in to the planning
implementation and evaluations stages. To give the patient the best possible care the nurse
must always have a specific aim in mind, considering how it applies to the individual patient
ensuring that the patient is being cared for as a whole based on their individual needs. The
assessment should be carried out soon after admission within 24 hours if possible. During the
initial interview here are two types of data to collect. Objective data, which is, observable and
measurable, and subjective data which only the patient can describe and explain. Both types
of data are of equal importance, although it is probably easier to obtain objective data as the
patient may feel awkward or embarrassed about discussing certain things and should be
encouraged, by asking further open questions. The nurse, explaining to the patient why so
much information is needed. Both types of data can be from either a primary or secondary
source. Primary data is information that only the patient can give, secondary data can be from
the patients' family, or discussions with members of the MDT. The medical notes, including,
previous reports and test results. are also a useful way of obtaining information, saving the
patient from unnecessary questioning. It should be mentioned that the NP although important
for patient care, is not an interrogation.

Planning is the second stage of the nursing process the phases are interdependent and
over lapping therefore the effectiveness of this stage depends on the quality and
comprehensiveness of the assessment. Establishing goals, interventions and outcomes is the
aim of the planning stage. Planning should begin soon after the initial assessment is carried
out, usually by the nurse taking the assessment. All nurses who care for the patient should
take part in the ongoing planning, amending if circumstances change. Although accurate
documentation is an essential part of the registered nurse and health care assistants role
(HCA) (RCN 2009) in many wards HCA provide much of the physical care and may not have
not been taught the significance of a care plan and may not report changes, or document
correctly. It is important to remember the care plan is important in the continuity of care of
the patient and may be referred to by members of the multi disciplinary team (MDT). The
planning stage determines the problems and establishes the risks and priorities. The patient
should be involved as much as possible in this stage. The nurse not making assumptions
about the patients problems, needs and abilities but should confer with the patient, giving the
patient the opportunity to contribute to their care planning.
Implementation is the next step involving putting the plan into action. The nurse
implements the plan of care by initiating planned nursing interventions to achieve patientcentred goals. In addition it is the nurse's responsibility to delegate specific tasks to
appropriate members of staff, ensuring that all the activities have been implemented
according to the care plan. It is not necessarily the nurse who initiated the care plan who
should be accountable; as all qualified nurses are accountable and must always be able to
justify action and omissions, for that reason the nurse caring for the patient, when the task is
carried out is responsible. It is therefore in the nurses' best interests to validate and respond to
adverse findings or patients responses. Not only to protect herself but for the implications to
the patients welfare and safety. Before Implementation the patient must be reassessed, to
make sure an intervention is still needed. Looking at the patient as a person not just their
medical needs is also a fundamental skill in nursing. Respecting their beliefs and values,
when considering interventions, adapting interventions to the patients needs if required. For
example a person with pressure ulcers who needs to be turned regularly may ask if they can
be left undisturbed when their relatives come to visit, this request must be adhered too if
possible. Obviously all requests aren't as simple and sometimes medical needs or time
restraints are a concern. Explaining to the patient that all efforts will be made to comply with
their wishes, however it may not be possible. Relating to the patient in this way will show

respect for their request, and hopefully they will understand why it isn't always feasible. It is
better to explain this initially, rather than agree with a request knowing that it can't always be
honoured. Going back on an agreement could damage the nurse patient relationship causing
friction between them.
Evaluation is the fourth step of the NP and is used to determine the effectiveness of
the Care plan establishing if outcomes have been met, whether they should be continued or
changed. Evaluation may be the most difficult stage of the NP. Describing evaluation as a
step may be incorrect, since evaluation should be a continues process, mentally taking notes
and evaluating throughout the implementation stage. Although the nurse may be busy and
have more than one patient to attend to, it is vital that all observations and actions are
documented, so that other nurses and members of the MDT can judge the efficiency of an
intervention.
As stated in the introduction of this essay the NP is a systematic guide to problem
solving, involving critical thinking and communication skills, as well as a sound theory and
medical based understanding. If the NP was just a case of ticking boxes it would still be a
valid way of gaining information relating to patient care, although it would not necessarily
solve any problems, only giving a general picture of the patients circumstances. Each patient
is an individual and come with their own set of unique problems. Every time the NP is carried
out it should be patient centred and related to giving the patient the best possible care. Each
step of the NP depends on the accuracy of the previous step, making sure sufficient accurate
data is gathered to support each stage. For the NP to be effective, reassessing goals and
interventions needs to be continuous and ongoing patients needs can change very quickly and
the nurse needs to update the priorities when problems arise.