Nursing Process
The nursing process is a systematic, five-step problem-solving framework used by nurses to provide patient-centered care: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE). It is the foundation of all nursing practice and the organizing framework for the NCLEX.
Exam Tip
ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation. Always ASSESS before implementing (unless immediate safety threat). LPNs contribute to all steps but RN leads. "What would you do FIRST?" usually = ASSESS. The nursing process is cyclical, not linear.
What Is the Nursing Process?
The nursing process is a cyclical, evidence-based approach to patient care that guides clinical decision-making. It consists of five sequential steps that form the foundation of professional nursing practice. All NCLEX-PN questions are based on the nursing process.
The Five Steps (ADPIE)
| Step | What Happens | Key Actions |
|---|---|---|
| Assessment | Collect data about the patient | History, physical exam, vital signs, lab review, patient interview |
| Diagnosis | Identify health problems | Nursing diagnoses (NOT medical diagnoses) based on assessment data |
| Planning | Set goals and plan interventions | SMART goals, prioritize using ABCs/Maslow's, select interventions |
| Implementation | Carry out the plan | Perform nursing interventions, administer medications, provide care |
| Evaluation | Determine if goals were met | Reassess, compare outcomes to goals, revise plan if needed |
LPN/LVN Role in Each Step
| Step | LPN Role | RN Role |
|---|---|---|
| Assessment | Collect data (focused assessments), report findings | Comprehensive assessment, interpret data |
| Diagnosis | Contribute data to support diagnoses | Formulate nursing diagnoses |
| Planning | Contribute to planning, assist with goal setting | Develop the care plan, set priorities |
| Implementation | Implement interventions, reinforce teaching, administer medications | All interventions plus initial teaching and complex care |
| Evaluation | Collect evaluation data, report outcomes | Evaluate goal achievement, modify care plan |
Assessment Types
| Type | Description | Who Performs |
|---|---|---|
| Comprehensive | Head-to-toe, all systems, on admission | RN only |
| Focused | Specific body system or complaint | LPN or RN |
| Ongoing | Continuous monitoring during care | LPN or RN |
| Emergency | Rapid assessment (ABCs) in crisis | Any licensed nurse |
NCLEX-PN and the Nursing Process
The NCLEX-PN tests the nursing process through the Client Needs framework:
| Client Needs Category | Nursing Process Focus |
|---|---|
| Coordinated Care | Planning, Implementation (delegation) |
| Safety & Infection Control | Assessment, Implementation |
| Health Promotion | Assessment, Implementation (teaching) |
| Psychosocial Integrity | Assessment, Implementation |
| Basic Care & Comfort | Implementation, Evaluation |
| Pharmacological Therapies | Implementation (medication administration) |
| Reduction of Risk Potential | Assessment, Implementation |
| Physiological Adaptation | Assessment, Implementation, Evaluation |
Exam Alert
The nursing process is tested throughout the entire NCLEX-PN. Remember ADPIE: always Assess before Implementing. If a question asks what to do "first," assessment is usually the answer unless there is an immediate safety threat. LPNs participate in all 5 steps but the RN leads Diagnosis, Planning, and Evaluation.
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Related Terms
Care Plan (Nursing)
A nursing care plan is a written document that outlines a patient's identified health problems, measurable goals, and specific nursing interventions. It is developed by the RN based on nursing assessment data and guides the entire nursing team in providing consistent, individualized care.
Clinical Judgment
Clinical judgment is the process by which nurses observe, interpret, respond to, and reflect on patient data to make informed decisions about patient care. The NCSBN Clinical Judgment Measurement Model (NCJMM) is the framework used on the NCLEX to evaluate this competency.
Maslow's Hierarchy of Needs
Maslow's Hierarchy of Needs is a motivational theory organized as a five-level pyramid, used in nursing to prioritize patient care. From bottom to top: physiological needs, safety and security, love and belonging, self-esteem, and self-actualization. Lower-level needs must be met before addressing higher-level needs.
Delegation (Nursing)
Delegation in nursing is the process of transferring responsibility for performing a specific nursing task to another qualified individual (such as a CNA or UAP) while retaining accountability for the outcome. The five rights of delegation guide safe delegation decisions.
Scope of Practice (Nursing)
Scope of practice defines the legal boundaries of what a healthcare professional is authorized to do based on their education, licensure, and state Nurse Practice Act. For LPNs/LVNs, the scope includes basic nursing care, data collection, medication administration, and care plan implementation under RN or physician supervision.
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