IntroductionChapter 1

The present day nurse provides care for the people in health and illness. Nursing is one of the health services, which contributes to well-being of an individual, family and community. Therefore, nursing is defined as a humanistic science dedicated to maintain and promote health, preventing illness, care for and rehabilitation of the sick and disabled persons. Nursing process includes doing, thinking and interaction component. It is mainly and basically a problem-solving approach of nursing cares.

The nursing process is a process by which nurses deliver care to patients. It is often supported by nursing models or philosophies. The nursing process was originally an adapted form of problem-solving and is classified as a deductive theory.

The science of nursing process is based on a broad theoretical framework. The nursing process is the method by which this framework is applied to practice nursing. It is a deliberative problem solving approach that requires cognitive, technical and inter personal skills and is directed to meet the needs of the patient.

The Nursing Process is a method for organizing and delivering nursing care to understand its functions, components and interactions, the nurse should have a working knowledge of the nature of the process. Therefore, nursing process can be applicable to any setting or system with any patient regardless of his/her place on the health illness continuum. In every discipline the process is used to their professional practice differently using various names. Nurses currently call this process the nursing process. Physicians call it patient evaluation and management; health planners call it health planning; researchers call it the research method and other disciplines call it problem solving.

The scientific method is used by other disciplines to provide a way of problem solving for their members and as a basis from which to formulate research that will expand the theoretical base of the discipline. Since nursing also has the concern of expanding its theoretical knowledge to provide a sound basis for its practice, it is very important that the nursing process be scientifically grounded.

Nursing is both an art and a science. It requires the understanding and application of specific knowledge and skills and it draws on knowledge and techniques derived from the humanities and the physical, social, medical and biological sciences (WHO 1996 p.4)

“Nursing is the act of diagnosing and managing human responses to potential or actual changes in health status, care is provided to maintain the clients’ health, restore the client's health status, well-being and prevent illness or injury to the client”

International Council for Nurses, Geneva, 1969 defined Nursing as “the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge and to do this in such a way, as to help him gain independence as rapidly as possible”.

“The Nursing Process has traditionally been defined as a systematic method for assessing health status, diagnosing health care needs, formulating a plan of care, initiating plan and evaluating the effectiveness of plan”.

“Nursing process is defined as a systematic, purposeful set of interpersonal actions”. (White,1982).

Generally, the nursing process is a series of planned steps and actions directed toward meeting the needs and solving the problems of client and their families in systematic way.5

A process is series of steps or components leading to achievement of goal. Process denotes the act of continuously moving forward proceeding from one point to another on the way to a goal. Process is a method used to produce, accomplish or attain a specific result.

Purpose is the goal or specific aim of the process. Organization is the series of steps or components needed to achieve the goal. Creativity is the process in a continuous progression from one point to another to achieve a specific goal.

The Nursing Process can be defined in terms of THREE major dimensions

Nursing diagnoses are part of a movement in nursing to standardize terminology which includes standard descriptions of diagnoses, interventions, and outcomes. Those in support 6of standardized terminology believe that it will help nursing become more scientific and evidence based. In the United Kingdom, the diagnosis stage of the process is dropped. Although nurses in the UK determine a patient's needs or problems, they are not widely regarded as “diagnoses”.

The planning phase refers to prioritizing the nursing diagnosis, setting goals for meeting patient's needs and designing strategies for achieving goals. To achieve these goals, the nursing care plan is prepared, which is a written document initiated by a nurse, so that the other nursing stage on the unit what nursing care the client needs and when, nursing care plan can be modified according to patient's need.

It is the second step of nursing process. It is based on individual problems and need of patients. Nursing care is prescribed and these are itemized as a list of written nursing instructions.

During this step in the nursing process, the nurse actually initializes and completes the actions necessary to accomplish the short term and long term goals. It involves carrying out the prescribed nursing care. Charts, notes and record of nursing care given with the results and response of patient to the nursing care have to be maintained during implementation phase.

This step ascertains the success of the nursing care and need to alter the plan. It is concerned with the observation and assessment of patient's progress. It determines the effectiveness of nursing care given to patient. Progress notes have to be maintained to assist the evaluation. In short, nursing process is a logical, rational way of thinking about nursing and nursing practice. It facilitates personalized care; promote scientific nursing practice and documentation of nursing components in modern changing trends in nursing. Traditionally, the scope of nursing was restricted to bedside nursing care only. In modern trends health care services are changing from disease to health. A nurse's role has expanded in this scientific era. It is categorized as: 71. Nurse practitioner—qualified to work and practice as a professional, 2. Nurse clinician—qualified to provide care and treatment to sick, 3. Nurse specialist—an expert in the specific field.

These phases integrate the intellectual functions of problem-solving in an effort to define nursing actions.

The nursing process is a cyclical and ongoing process that can end at any stage if the problem is solved. The nursing process exists for every problem that the patient has, and for every element of patient care, rather than once for each patient. The nurse's evaluation of care will lead to changes in the implementation of the care and the patient's needs are likely to change during their stay in hospital as their health either improves or deteriorates.

Nurse makes decisions about individual clients and about groups of clients. The nurse uses criteria such as the clinical condition of the client, Maslow's hierarchy of needs, risks involved in treatment delays and client's expectations of care determine which clients have the greatest priorities for care.

Nursing theory is the term given to the body of knowledge that is used to support nursing practice. In their professional education nurses will study a range of interconnected subjects which can be applied to the practice setting. This knowledge may be derived from experiential learning, from formal sources such as nursing research or from non-nursing sources. To speak of nursing theory is often difficult. Nursing is many things to many people. Most universally agreed upon is that Nursing is a science involving people, environment and process fueled by a vision of transcendence in the context of healthcare. It is interesting to note that 90% of all Nursing theories have been generated in the last 20 years. Many schools encourage students to formulate theories of Nursing as part of their curriculum. Some might argue that this multiplicity of theory is detrimental to the practice and undermines common vision. Others would say that the nature of the young science is sufficiently far reaching to require such tactics in order to elicit true consensus. It cannot be denied, however, that there is much vanity involved in the formulation of nursing theory. The pages of “Nursing Science Quarterly”, a major mouthpiece for Nursing Theory, are rife with examples of semantical hair-splitting.

Nursing models are conceptual models, constructed of theories and concepts. They are used to help nurses assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformity and seamless care.

Theories of Nursing fall into roughly 5 categories. There are meta theories, grand theories, mid-range theories, min-theories and micro-theories.10

The first theorist to clearly articulate a role of nurses distinct from the medical profession was Florence Nightingale. Her theories were developed during the Crimean War and published in Notes on Nursing: What It Is, and What It Is Not in 1859. Nightingale's model is based on the idea that the nurse manipulates the environment to promote the patient's well being.

Nurses quickly realized that treating patients based upon their disease rather than making a holistic assessment was not a satisfactory way of attending patient care.

Purposely left off this list is that most famous of all nurses, Florence Nightingale. Ms. Nightingale never actually formulated a theory of nursing science but was posthumously accredited with same by others who categorized her personal journaling and communications into a theoretical framework.

Also left off are many who simply improvised on others work and acclaimed their thoughts as new theoretical vision.

Nursing Process has implications for the profession of nursing, the patient/client and the individual nurse. Professionally the nursing process defines the scope of nursing practice and identifies standards of nursing care. The patient/client benefits by the use of nursing process, since it ensures quality care while encouraging the patient/client to participate in care. It also benefits the individual nurse, increased job satisfaction and enhancement of professional growth.

The Nursing Process provides a basis for disciplined thinking to a clinical situation; it requires clinical judgment (clinical reasoning). Exercises in clinical judgment are important to challenge the nurse to think, to recall facts and to apply the information to a new situation.

Other authors have conceptualized the process as including observation, inference, validation, assessment, action and evaluation. Over the years, new terminology has evolved and as nursing science develops, other terminology no doubt will be employed. Thus we have in the literature such terms as nursing diagnosis, clinical judgment, assessment, nursing prescriptions and so on. All of these terms refer in some way to the components of the nursing process and constitute the anatomy of nursing practice.

There is no limit to the number of times the cycle can be reinitiated. This continuous and continual evaluation provides feedback on the effectiveness of the plan or the need for revision. 14Revision may be needed in the data collection method, the diagnosis, the goals, the plan, or the intervention method.

The nurse's role in most cases is one of “interdependence and co participation” with the client and other health team members. In general, the nurse is expected to have the following intellectual, interpersonal and technical skills:

Some of these are used during various phases of the nursing process.

Application of the nursing process requires sound knowledge of the physical and behavioural sciences and a repertoire of intellectual, interpersonal and technical skills.

Nursing process is referred to as the basic framework for the practice of nursing, which allows the nurse to provide care in a systematic, organized fashion. Because nursing is an evolving profession, this framework is constantly being modified and adapted to current practice. Periodic analysis and review of the current trends in nursing process allow the practicing nurse to improve patient care.