Which step in the nursing process would involve promoting a safe environment for the client

While nurses have different specializations and work in various environments, one approach remains the same: the nursing process. First defined in 1958, the nursing process is the core element that works to provide the most holistic patient-focused care. Nurses use this model alongside evidence-based practice (EBP) recommendations, critical thinking, and, most importantly, their nurses’ intuition.

Each of the five phases within the process form an accurate picture of assessing and treating a patient. Here’s how the nursing process works.

Nursing Process Phase 1: Assessing

The first step of the nursing process, the assessment stage, requires critical thinking skills and data collection. Assessing the situation involves collecting the patient’s current vital signs and symptoms, known as objective data.

Additionally, subjective data is collected including the patient’s background such as personal and family medical history. This is also the time to document and record the patient’s economic, cultural, spiritual, and lifestyle factors.

If the patient is unable to speak for themselves, the nurse collects the subjective data from a caregiver or guardian. Past health records also assist in the assessment phase’s objective data. All this information together will set the stage for the next step in the process — diagnosis.

Nursing Process Phase 2: Diagnosing

A diagnosis is a nurse’s clinical judgement on a patient’s current or potential health and what the patient’s future needs may be. A nursing diagnosis utilizes Maslow’s Hierarchy of Needs  to effectively hypothesize and prioritize patient care decisions.

Developed in the mid-1940’s by Abraham Maslow, this tool helps develop the patient’s proper treatment by starting from the most basic of patient necessities and moving to higher levels for patient fulfillment.

Maslow’s Hierarchy of Needs is understood in five tiers, which are:

• Physiological needs: This refers to the necessary needs for an individual to survive.
  • Vitals including blood pressure, breathing, elimination habits, and temperature
  • Basic necessities such as nutrition, environment, sex/reproduction, and sleep.

• Safety and security needs: These needs refer to the patient’s right to feel secure and safe in their environment, bodies, health, and resources.
  • Injury prevention (handrails, suicide precautions, wheelchairs, seat belts, hand washing, etc.)
  • Climate involving trust and safety (therapeutic relationships, trusting relationships with caretakers, etc.)
  • Patient education (explaining risks for health issues and how to mitigate them)

• Social belonging needs: A patient’s quality of life highly depends on how they are accepted and cared for in relationships.
  • Supportive and loving relationships with loved ones, friends, etc.
  • Methods to avoid social isolation, including bullying or social anxiety
  • Employing active listening and therapeutic techniques

• Self-esteem needs: This tier is centered on a patient’s feelings about themselves and their accomplishments.
  • Acceptance in community and workforce
  • Personal achievements and sense of self control
  • Acceptance of body and physical appearance

• Self-actualization needs: The final tier involves the patient’s overall state of who they are, what they stand for, and their spiritual beliefs, if any.
  • Creating an empowering environment and room for spiritual growth
  • Reaching maximum potential in themselves with the ability to keep an open mind and see others’ viewpoints

Nursing Process Phase 3: Outcome/planning

After the assessment and diagnosis, a plan is created to best treat the patient. The nurse and patient will establish priorities, as well as develop goals and desired outcomes for the patient based on EDP guidelines. Planning comes in three stages: initial planning, ongoing planning, and discharge planning. The goals and desired outcomes will differ slightly depending on which planning stage the nurse treats the patient.

Nursing goals should follow the SMART goal formula:

• Specific: The goal is detailed and defined enough to allow a clear vision.
• Measurable: There is a quantifiable measure to track the patient’s progress.
• Action-oriented or attainable: The goal is within reach of the patient or nurse’s current circumstances. If a goal calls for multiple steps, the goal is broken down to achieve it over time. The goal also takes required skills, knowledge, or actions into account.
• Realistic: The goal must be achievable with the current resources available, skillset, and diagnosis.
• Timely or time-based: There must be a clear deadline or countdown, creating opportunity for midpoint check-ins, and possible reevaluations.

An example of a simple goal is: “I want to be more compassionate with my patients,” whereas an example of a SMART goal is: “I will spend an extra five minutes getting to know each new patient by asking at least three personal questions so I can talk with them over the duration of their stay.”

Creating goals provides nurses direction in prevention and intervention for their role in the patient’s care. The planning/outcome phase allows for enhanced communication and documentation across the patient’s care plan. Documenting these goals, in tandem with the nurse’s assessment and diagnosis, allows other medical professionals to see the holistic view of the patient’s individual and unique needs. Once the outcome planning stage is complete, the nursing process moves towards action of implementation.

Nursing Process Phase 4: Implementing

This step in the nursing process is when goals and treatment are put into action. It involves ongoing data collection and carrying out planned actions for created goals. During this time, nurses are continuously monitoring the patient’s progress, implementing nursing orders and assessing patient needs depending on their condition. This can also involve direct nursing intervention, including applying a cardiac monitor or oxygen for additional data.

Additionally, the implementation process involves promoting the patient’s self-care, if possible, as well as involving caretakers, guardians, or loved ones in the healing process. Delegation of tasks and determining what is relevant for the patient in the moment using critical thinking skills and nurses’ intuition are also contributing factors for successful implementation.

Nursing Process Phase 5: Evaluating

The last step in the nursing process involves evaluating the patient’s progress and reassessing the desired outcome or SMART goals outlined in the previous phases.

Action steps in the evaluating phase include:

• Identifying the criteria and standards based on the SMART goals and desired outcomes
• Evaluating the collected data
• Interpreting and summarizing findings
• Documenting findings in patient’s care plan
• Revising care plan based on findings 

The nursing process is an essential part of holistic patient care. It’s important to take into account each patient’s unique problems and individual care needed to thrive, making the nursing process essential to a patient’s wellbeing.

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
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.

Outcomes / Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it.

Implementation
Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.

Evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.