What is the Order of the Nursing Plan?
The nursing plan is not a static document but a dynamic, systematic framework known as the nursing process, or ADPIE. It is the foundation of compassionate, quality care, utilizing critical thinking and evidence-based practices to ensure optimal patient outcomes. Each of the five steps builds upon the last, ensuring a continuous loop of care that can be adapted as a patient's condition changes.
The Five Steps of the Nursing Process (ADPIE)
Step 1: Assessment
This initial phase involves the systematic collection of subjective and objective data about a patient's health status, requiring critical thinking.
- Subjective Data: Information from the patient or family about symptoms and feelings.
- Objective Data: Measurable data like vital signs and lab results.
- Data Sources: Includes interviews, physical exams, and medical history.
Step 2: Diagnosis
Based on assessment data, the nurse makes a clinical judgment about a patient's response to health problems. This differs from a medical diagnosis. NANDA-I provides standardized language for nursing diagnoses.
- Actual Problem Diagnosis: Identifies a current health problem.
- Risk Diagnosis: Focuses on potential problems.
- Health Promotion Diagnosis: Addresses a patient's desire to improve well-being.
Step 3: Planning
Nurses collaborate to set patient-centered, evidence-based goals for care. Goals should be SMART:
- Specific
- Measurable
- Achievable
- Relevant
- Time-bound
Step 4: Implementation
This is the action phase where nurses perform interventions to achieve goals. Interventions can be independent, dependent (requiring an order), or collaborative.
Examples include administering medication, providing education, and performing wound care.
Step 5: Evaluation
The nurse assesses the care plan's effectiveness by comparing outcomes to goals. This step involves reassessing the patient and documenting progress, leading to potential revisions or termination of the plan.
The Cyclical and Collaborative Nature of the Nursing Process
The nursing process is a continuous cycle where evaluation informs future assessments and adjustments. It also involves collaboration with the entire healthcare team for a holistic approach.
Nursing Diagnosis vs. Medical Diagnosis
| Feature | Nursing Diagnosis | Medical Diagnosis |
|---|---|---|
| Focus | Patient's response | Disease or condition |
| Scope | Holistic | Physiological systems |
| Made By | Registered Nurse (RN) | Physician |
| Example | Impaired Gas Exchange | Chronic Obstructive Pulmonary Disease (COPD) |
| Change | Can change | Remains in health history |
| Accountability | Nurse for interventions | Physician for treatment |
Conclusion
The answer to what is the order of the nursing plan is the systematic and cyclical ADPIE framework: Assessment, Diagnosis, Planning, Implementation, and Evaluation. This process provides a clear, evidence-based roadmap for delivering high-quality, patient-centered care. For nurses, mastering ADPIE is not just about following steps, but about cultivating the critical thinking and clinical judgment necessary to adapt care to each patient's unique and evolving needs. It solidifies the nurse's role as a key collaborator and advocate in the healthcare journey, ensuring that every intervention is purposeful and effective. For more information on the standards of professional nursing practice, nurses and students can refer to reputable sources like the National Center for Biotechnology Information (NCBI) on the nursing process found at https://www.ncbi.nlm.nih.gov/books/NBK499937/.
