What step in the nursing process wherein you determine the clients progress towards the attainment of expected outcomes and effectiveness of nursing care?
ADPIE: The 5 Stages of the Nursing Process Show
One of the most common acronyms used by nurses and other healthcare professionals is ADPIE, which stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation. There is more to ADPIE than just a fancy acronym – it is actually a summary of a nursing process that is vital in delivering holistic patient care. ADPIE supports nurses and other medical professionals to be critical thinkers and effective problem solvers. If the ADPIE process is adequately followed, efficiency at work and delivery of more precise decisions are most likely to be achieved. I. AssessmentAssessment is the first step of ADPIE, wherein data collection happens. It includes taking vital signs, accomplishing head-to-toe assessment, gathering patient’s medical history, taking note of all the subjective complaints while observing the objective physical observations from a patient.
Data gathering involves interviewing the patient and/or family members, having a keen observation of their behavior, and conducting physical examinations. This step concentrates on relevant data collection, evidence validation, and recording the noted abnormalities in the report. In the assessment stage, nurses should constantly think about what could possibly be going on with their patients to effectively gather and record enough information. If adequate data are collected during the first step, the database will be established and problem identification will be much easier.
There are two types of data: objective data and subjective data. Objective data are the pieces of information that you can see, hear, feel, smell, and measure. This includes body temperature, blood pressure, heart rates, tremors, pallor, diaphoresis, weight, and height. We often referred to the objective data as “signs”. Subjective data on the other hand are pieces of information that are immeasurable. This includes spoken information that you collected during the patient’s interview such as emotions, level of pain, itchiness, tinnitus, and other subjective complaints which are often referred to as “symptoms”. Keep in mind that assessment plays a vital role in nursing care plans; an accurate and complete collection of data must always be ascertained. Using appropriate interpersonal skills that will encourage patients to verbalize their complete medical history will also be a great help in the assessment stage. Once accurate and ample data are gathered, we may now move on to the next step of ADPIE process. II. DiagnosisDiagnosis is the stage wherein nurses come up with a concept about their patient’s condition based on the collected data from the assessment phase. While physicians create medical diagnoses, nurses establish nursing diagnoses to aid the patient in their current or potential health problems. But nurses can identify patients’ responses to disease and modify nursing care plans to meet the patient’s needs. Nursing diagnosis also helps in facilitating better communication between medical team members. The comprehensive judgments of nurses, which are evidence-based, could determine the actual and potential health risks to their patients.
There are standardized nursing diagnoses that professional nurses use to guide them in charting. Often, the nursing diagnoses are based on the taxonomy created by the North American Nursing Diagnosis Association or NANDA. As an example, if the patient says that she is in pain, you may use impaired comfort or acute pain as the nursing diagnosis. Other NANDA nursing diagnoses include Anxiety, Sleep Deprivation, Ineffective Airway Clearance, etc. One may find more information about each nursing diagnosis from nursing textbooks approved by NANDA International. The said organization has a fast-growing list of nursing diagnoses where nursing professionals can choose from. After the diagnosis is established, identified risks that may cause harm or complications to the patient must be placed in order. Life-threatening risks shall be listed as the top priority followed by other risks in descending order being the most minor as the lowest priority.
Based on NANDA, a nursing diagnosis can be created with the use of Maslow’s Hierarchy of Needs which was developed by American Psychologist, Abraham Maslow. The said hierarchy is based on the fundamental needs of all human beings wherein the basic needs of the first level must be achieved before the needs of the next higher level can be met. Maslow’s Hierarchy of Needs involves a pyramid structure. As mentioned, the bottom level needs to be met before an individual can move on to the next level of the pyramid.
Nurses make the nursing diagnosis and identify the potential and actual health risks of the patients prioritized based on Maslow’s hierarchy of needs. The nursing diagnosis is vital to the next step of the process. III. PlanningAfter determining the nursing diagnosis, it brings us now to “P” in the ADPIE acronym, which stands for Planning. This step is to develop a plan on how to achieve the desired goal/s for the patients. These goals should always be SMART – an acronym which stands for Specific, Measurable, Attainable, Realistic/Relevant, and Time-bound. SMART goals aim to provide patients with a customized set of activities to improve their health conditions. They also contribute plans to measure and evaluate the patients’ improvements to nursing professionals. The goals that should be developed may be short or long-term focused on the patients’ outcome, and must be a good fit for them. For example, a patient who has mobility problems should have a nursing care plan that can allow them to move from the bed to a chair at least three times a day and sit there for a certain amount of time. This plan is specific, measurable, attainable, realistic, and time-bound (SMART). A patient diagnosed by a nursing professional with a lack of adequate nutrition may have a plan that entails eating several small meals a day instead of three large meals. Again, this goal is specific, measurable, attainable, realistic, and time-bound (SMART). Aside from creating SMART goals, a nursing care plan and intervention strategies must be developed and communicated to the patient and the rest of the medical team, as part of the treatment. This will surely help in achieving the success of the goals. IV. ImplementationThe “I” in the ADPIE process stands for Implementation. This fourth step is the action part of the process, where you carried out the nursing care plan that you have developed earlier. Take note that in the planning stage, nurses are simply forming a plan and no action has begun yet. The implementation stage, on the other hand, is where you act on that individual plan. In short, implementation is the key to continuing patient care. The implementation stage is commonly executed using a combination of direct care and indirect care.
Direct care involves the provision of hands-on care to help the patient meet their goals. It involves carrying out nursing interventions such as proper wound care, administering medication or oxygen, applying a cardiac monitor, repositioning, or assisting in a patient’s ambulation. It also includes observing the patients working individually. The nurse provides feedback about the patient’s development and discusses modifications in the care plan for them to meet their desired goals.
Indirect care, on the other hand, involves monitoring the other healthcare staff to make sure that they are working harmoniously to carry out the goals of the nursing care plan. Anything that transpires in the patient’s care that is completed while the nurse is away from the patient is called indirect care. Anyone who carries out the nursing care plan, either direct or indirect, must document it in the patient’s hospital medical record. During the implementation of the nursing care plan, nursing professionals need to use their critical judgment to ensure that the procedures in the nursing care plan can meet the needs and demands of the patients receiving care. Inappropriate or questionable procedures should be questioned and re-evaluated from time to time. Just like in the earlier stages of the ADPIE nursing process, these nursing actions should also be communicated to the patients receiving the care plan to confirm compliance and ensure continuity of patient care. After this step, nursing professionals must evaluate the outcome of carried-out interventions. V. EvaluationThe final step which is “E” in the ADPIE nursing process stands for Evaluation. This is the stage where in the healthcare professional weighs the outcome of the nursing actions done in the implementation stage. The evaluation phase is the time that nurses should be asking themselves, “Did the plans work successfully, are still in the process of being effective, or have failed and therefore need to be changed?” An effective use of the nursing process includes continuous monitoring throughout the patient’s admission to determine if the care plan is appropriate to him or her. If there are parts of the plan that seem to be making the patient’s condition worse, these parts should immediately be stopped. The evaluation stage ensures that the patients are building progress towards their goals and accomplishing the desired outcome. Healthcare professionals must constantly assess and evaluate the nursing process. It is important to always re-evaluate if the process is not working and determine whether some parts need to be changed, reduced, or completely removed. The patient should be involved in the evaluation process at all times. If the patient feels that the plan is not working the way it should be, the nurse should pay attention and work to modify the nursing care plan or enlighten the patient of the details and explore further on how to make it work. In the end, the evaluation part of ADPIE should work to make the whole nursing process run smoothly and keep the patient and the healthcare professionals functioning together for the benefit of the patients. Although evaluation is the final stage of the nursing process, healthcare professionals must take note that evaluations should be performed throughout the ADPIE process to regularly assess the plan and make modifications when necessary. Patient ScenariosHere are examples of comprehensive ADPIE nursing process to help aspiring nurses and professionals understand this vital nursing tool. Scenario 1: A patient with a shoulder injury from a vehicular accident from a month ago ASSESSMENT Objective data:
Subjective data: “The
level of my pain is 10/10. Is it possible to increase the dose of my pain relievers?” PLANNING (Expected outcomes)
IMPLEMENTATION
EVALUATION
Scenario 2: A Patient with Osteomyelitis ASSESSMENT Objective data:
Subjective data: 10/10 level of pain as verbalized by the patient DIAGNOSIS:
PLANNING (Expected outcomes)
IMPLEMENTATION For Acute pain related to infectious process and swelling:
For Hyperthermia related to inflammatory response to infection:
EVALUATION
Scenario 3: A Patient Diagnosed with Stage IV Metastatic Cancer ASSESSMENT Objective data:
Subjective data: “I have no idea what the doctor is saying to me. It is too much information and I am very confused.” DIAGNOSIS: Knowledge deficit related to new health diagnosis or treatment PLANNING (Expected outcomes)
IMPLEMENTATION
EVALUATION
ConclusionThe nursing process is possibly the most significant tool in a nurse’s knowledge kit. This process is a well-established, systematic problem-solving technique based on five easy-to-remember steps with the ADPIE acronym: Assessment, Diagnosis, Planning, Implementation, and Evaluation. Through practical application of the ADPIE nursing process, nursing professionals can easily determine the needs of their patients, develop an individualized care plan, and promptly provide adequate, effective patient-focused care. The ADPIE process begins with assessment wherein all the subjective and objective data are gathered. These data allow the nursing professionals to develop nursing diagnoses, which is the second step. Once the nursing diagnosis is identified, nurses will create a nursing care plan with actions and SMART goals for their patients. These plans should then be acted upon through the process called implementation to achieve the goals of the nursing care plan. Finally, the evaluation process is being done during and after implementation to ensure that the patients have effectively achieved their goals. These 5 steps are followed in a specific order to ensure appropriate patient care from the start of treatment until the end. Overall, the ADPIE nursing process helps nurses accomplish their finest and be responsible for possible faults and errors throughout patient care. Nursing ReferencesAckley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon Disclaimer:Please follow your facilities guidelines, policies, and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Which step of the nursing process involves checking the effectiveness of a nursing plan?The final phase of the nursing process is the evaluation phase. It takes place following the interventions to see if the goals have been met. During the evaluation phase, the nurse will determine how to measure the success of the goals and interventions.
What are the steps of evaluation in nursing process?The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation. Assessment is the first step and involves critical thinking skills and data collection; subjective and objective.
What are the 5 stages of the nursing process?The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care. Assessment. ... . Diagnosis. ... . Outcomes / Planning. ... . Implementation. ... . Evaluation.. During which step of the nursing process would the nurse review the patient's plan of care and determine whether a goal was met?Evaluation is the fourth step in the nursing process. During evaluation, the nurse determines whether the patient's goals were achieved.
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