 Hi, and welcome to Nursing School Explained. Today's topic is the nursing process, which is the foundation of nursing practice. Sometimes it can be a little bit difficult to grasp it in the beginning, but really you have considered or applied this process in your entire life. It's basically just a methodical way of going about doing something and real life experiences that you might have had with a process such as a nursing process might be planning a trip going somewhere or preparing a meal. So you're going to have to go through all these different steps of accomplishing that goal that you have, which is either to get somewhere or to eat a delicious meal at the end. So let's see how this applies to nursing and go through the different steps of the nursing process together. We always start with assessment. Assessment is the foundation of nursing practice, and that includes everything from your basic vital signs, your physical assessment, assessing the patient from hand to toe, as well as looking into the patient's medical history, their comorbidities, their past surgeries, their medications, their allergies, and so forth. Of course, it also includes labs and diagnostic data such as x-rays, CT scans, MRIs, any kind of surgical procedures, and so forth. So without the assessment, we don't really know what's going on with the patient. So we have to figure out first to assess and then move on. So the second step would be that to diagnose or analyze or identify the problem and set the priority. So depending on what program you're in and what your school focuses on, you might have heard of nursing diagnosis. Now some programs have done away with nursing diagnosis because people get confused with those. There's a certain terminology that you need to use. What's the difference between the nursing and the medical diagnosis? Is it the same or not? But really what this comes down to, rather than using a certain terminology and a way of setting this up, we basically just need to focus based on our assessment data. What are the patient's problems? What do I currently have to focus on to get the patient better and if they're hospitalized to get them to discharge? What are my priorities? So I identify the problem and then I set my priorities depending on the list of problems that I have come up with. And the steps to follow always follow your ABCs. So if the patient has a breathing problem, let's say they were admitted with pneumonia, then you're going to focus on their oxygenation. You're going to focus on assessing their lungs, their otusat, their respiratory rates, their heart rate, their temperature, those very basic things. Now oxygenation here would be a breathing problem, so that would be before any kind of other pain management or skin issues, those kind of things. So that's why you should always focus on your ABCs for priority setting. And then you should follow Maslow's hierarchy of needs because we're going to have some physical needs and they're going to come over, they're going to take greater priority over psychosocial needs. So for example, in the oxygenation, again oxygenation being able to breathe is a higher priority than dealing with pain. Pain is very important and I know we have to address it, but in terms of priority, breathing always comes first. Pain, which is a psychosocial need, would come second. And then we always have to address actual problems before potential or risk for problems. You have probably seen risk for problems, some of those would be like risk for infection, risk for falls or something that students like to use a lot. But really at the hospital everybody is risk for falls because you're hooked up to IVs, you might have impaired mobility, you might be on certain medications. But actual problems always come before. So you wouldn't plan to go into a care plan on a potential problem with whatever the patient is at risk for before you address the actual problems. If you're baking a cake and you are missing baking powder, you're not going to say, oh, potentially I might need eggs. No, the actual problem is I'm short of baking powder and I have to address that, otherwise I can't bake my cake. So actual or actually identified problems always come before. And this might change. So the patient initially might be having an infection, whatever that might be, and somebody else who might be admitted for another problem, let's say they've had a knee replacement, they would be at risk for infection, right? But they don't have an actual infection. So their priorities with that knee surgery or knee replacement would be different than this risk for infection and would take higher priority. So skin integrity, for example, or wound care would be taken priority because now we have an actual, there is a break in the skin, which could be a risk for infection. So always make sure that you have the actual before the potential or risk for problems that you address. Then we move on to the third step, which is the planning, which is also called plan of care or care plan. Most of you have probably heard or have written care plans, a lot of students dread those because they are these big papers that you have to write and you really have to analyze your patient. But really what it is, it's following the steps of the nursing process and it shows your professor that you are able to follow these steps and safely care for your patient. So after assessment and problem identification, now we know what we have to focus on with our patient, we move into the planning phase and formulate goals, which are also called expected outcomes. And they will always start with the patient will, the patient will do something or achieve something. And in order to formulate the goal, they have to be following this smart criteria, which means they have to be specific, measurable, attainable, relevant, and time-based. So a goal, for example, would be the patient will angrily 30 feet by the end of my shift. This is specific, the patient will measurable walk or angrily 30 feet. It's attainable because it's a short distance. It's relevant to the patient who just had knee surgery and it's time-based by the end of my shift. Now depending if you work in your acute care or maybe the long-term care facility or in home health, for example, time-based in acute care most likely will be shorter. So by the end of my shift, within the next hour, whatever that might be. But if you're working in the home health setting and somebody's admitted for IV antibiotics, that they're going to be on for six weeks, now it might be the time frame might be longer, it might be those six weeks, it might be three weeks, whatever it might be. So depending on the setting that you're at, the time frame on the goals will be, will be different. But remember for the plan of care, you always have to come up with the goals in the smart format. And I'm sure that you've got plenty of instruction from your professors regarding how to accomplish this. But if you stick with the smart acronym, you will always be okay. And don't make it complicated, right? Patient will angrily 30 feet by the end of my shift. Perfect. It's very simple. Your own house doesn't have to be rocket science. Or if you're addressing the pain, the patient's pain level will be less than three out of 10, 30 minutes after the administration of any pain medications, or the patient will have no signs and symptoms of infection to the surgical site by the end of my shift. Now I've addressed the infection. So keep it very simple, but follow this format. And of course, the goals have to be specific to the problem that you have identified as your priority. Once you've identified the goals and the expected outcome and you have planned your priorities, then you can go into the implementation phase. So in the implementation phase, we, the goal is to achieve the expected outcome that we've just formulated. And it has to be individualized for your patient. So two patients who've been admitted for a knee replacement might not have the same goals because one might already be three days post-op and the other one might have been just coming out of surgery. So the priorities will be very different. So there is no cookie cutter kind of a recipe book that you can apply here, but it has to be individualized for your patient. And to those priorities that you have identified in the prioritization and planning or maybe diagnosing phase. And then for interventions, we have independent, dependent and collaborative interventions. So independent interventions are those that you can do independently that you don't need an order for. That will be elevating the head of the bed, elevating the leg, applying an ice pack, keeping the patient comfortable, repositioning them, all those things that you don't need an order for. Dependent interventions would be something that you need an order for, administering pain medications, wound care orders, any of those things that you need to have a higher level of a license, give you the orders to do that. So you depend on somebody else to perform your interventions. And then collaborative interventions could be something that you would collaborate with somebody, let's say physical therapy, occupational therapy, the social worker. Remember, we can also have psychosocial needs here that we need to address such as anxiety or fear or disturbed body image. There wasn't an invitation, for example. So there's all these psychosocial needs. And we would also collaborate with different disciplines on doing that. Now, keep in mind, the nurse still plays a role into achieving these collaborative goals or implementations and interventions. But we are not going to be necessarily the first person that will address these collaborative problems. And then once we have implemented our interventions, and we have followed two, three, four or five different interventions to achieve our goal, we are going to evaluate. So we are going to see the problem that we have identified and the plan that we've developed with the interventions to achieve the goal, have we now achieved the goal? So we're going to look at the goal and see have we achieved it? If yes, great goal achieved, perfect, move on, reevaluate, reassess your patient and see what else you have to focus on now, so that you can get them better, right? So revise the plan of care, either if you have achieved the goal or if you maybe now have identified, oh, maybe I need to change my plan of care. So maybe now there's been a change in the patient status or with the interventions that I have implemented, I didn't really achieve my goal. So now I have to go back, reassess and revise as needed. So now I would go back, assess my patient, physical assessment, vital signs, labs and diagnostics, any orders. And then again, reprioritize, identify maybe the new problems or see what else I can do for the patient. Plan, come up with a goal following the smart criteria. Based on that, I'll come up with my interventions and they might be different from my first go around because now I first go around, I didn't achieve my goal. And then I evaluate and I see did I now achieve my goal. Again, if I've accomplished it, perfect, check that off and then move on to the next problem that you've identified. So maybe now your oxygenation goal has been met, but the patient is still at risk for falls. So now you need to address that and have the interventions and potential patient education to achieve these goals. So the prioritization here is very important. And this is a continuous process. So this is not something that changes. There will always be these these phases of the nursing process that you follow when you're planning care for your patient. And keep in mind, this will also help you on your exams because you always have to assess before you intervene before you implement, right? Because if you don't know what's going on with the patient, how are you going to know what your goal is going to be and your priorities. So you have to assess before you implement. And that's very helpful on exams as well. Thank you for watching Nursing School Explained in this video on the nursing process that serves as a foundation of nursing practice. Please also watch my other videos that go into more of the specifics in the two different phases of the nursing process here. Thanks for watching. Please subscribe, comment and leave me any feedback. I always appreciate that and I'll see you next time.