The nursing process is a fundamental staple concept to understand in nursing school, both for exams and during clinicals with patients, and will follow you throughout your entire nursing career. ADPIE is an acronym that stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation. These are the steps of the nursing process, which are chiefly the steps to providing proper care to your patient.
Most importantly, the nursing process (ADPIE) is one of the ultimate things you’ll be expected to learn and master in nursing school, and for that matter, as a future nurse!
The Nursing Process: ADPIE
ADPIE, or in other words, the nursing process steps, are a huge staple in the nursing care world. It is vital that you have a strong foundation of it in order to be a successful future nurse, so that’s why we’re here to break it down for you. The nursing process does involve a lot of critical thinking skills, and since many nursing test questions are based on this concept, it’ll make your whole life easier once you understand it for good!
Now remember; the acronym ADPIE stands for:
Interestingly, the funny thing is that we actually use ADPIE in everyday situations without even realizing it. Once you see how simple it is to think about, it will be easier to break it down during your exams, and with managing patient care. Let’s take a non-nursing example here to show you what we mean.
Imagine: you wake up on Monday morning after a late night of caring for patients during your clinical rotation. You have a lot of studying to do for your nursing exam, and you know that you’re going to need an extra big cup of coffee. Because it took a little longer to brew, and you’re running 10 minutes late to class. You pour that delicious, warm drink into your thermos, frantically throw it in your backpack, and book it to school. When you finally make it to class, you grab your computer out of your bag and open it up, but it won’t turn on. What do you do first?
Well, first, you’re going to assess the situation (the “A” in ADPIE).
Why isn’t the computer turning on? Why is it all wet? And why is your thermos empty and everything smells like coffee?
At this stage, you are playing detective and strictly gathering data. Similarly, in nursing, this would be the stage when you first go in to see your patient, the beginning of the assessment, where we collect all the data about the patient, both objective and subjective.
In this case, these would be things like your first impression and vitals. What does the patient look like? Does the patient have pale skin? Is the patient groaning in pain? What do their vitals stable? Is their breathing labored? Is the patient angry, scared, confused or delirious? When taking the health history, do you notice a history of heart problems? What kind of medication is the patient taking?
These are all observations and data collection to determine the health of the patient when doing an assessment on a patient. As the first step in the process, gathering all this information will allow you to proceed with the next step: your nursing diagnosis.
Now the “D” in ADPIE stands for diagnosis, and that brings us to our next step after gathering that data that we were just presented with. Going back to our example: “Well,” you say to yourself, “it seems to me from all my evidence here, that my coffee must’ve leaked out onto my computer, and therefore my computer is not working because it has gotten soaked with coffee!” Good deduction, detective!
So just like that, in our clinical assessment if we are dealing with a patient, we make a nursing diagnosis, where we identify actual or potential medical /health risks. The nursing diagnosis is developed by NANDA and should be prioritized based on Maslow’s hierarchy of needs. This diagnosis is key to the next step in the process: making a nursing care plan.
Now that brings us to “P” in the ADPIE acronym, which stands for planning.
Back to our computer example: When you look at your computer and have figured out the cause, you now have to make a quick plan. What are you going to do to fix the problem? You decide here that you need to run to get this computer fixed by a professional. “Let’s see,” you think, “I have to call to see if the store is open, make an appointment, find out if youe computer was backed up, leave school, take the bus to 33rd street, walk two blocks…”
When we apply that to nursing, and patient care, we make a plan based on the assessment and nursing diagnosis of our patient. You would then set SMART goals, which is an acronym that stands for specific, measurable, attainable, realistic and timely short-and long-term goals for the patient. From here, we can move on to the implementation part of the process.
Next comes the “I” in ADPIE; the implementation portion of the process. Let’s circle back to the computer example.
Because implementation is the action part of your plan; where you actually get up and bolt to the computer store to fix this, fast!
Notice here the difference between the planning stage and the implementation stage. In the planning stage, you are simply forming the plan. No action has begun yet, The implementation stage, however, is where you act on that specific plan. Or, intervening.
Similarly, when we take this back into nursing and patient care, this is where we implement our plan for our patient. As the action portion of the process, this is where our plans are carried out. Implementation is the step where we finally intervene to help them, like physically giving drugs, educate, monitor, etc. Now we are moving forward with care. After this step, we must evaluate the outcome of such interventions.
And finally, we evaluate; the “E” in the ADPIE nursing process. Where does this bring us with the computer example?
As the final step, you are done carrying out your plan, and here’s where you are waiting anxiously at the computer store, and the person helping you comes out to tell you, “Well my friend, it’s your lucky day. It was almost too late, but we saved your computer and it works like it’s brand new again. Now, remember, keep liquids far away!”
Now with patient care, this would be where you ask yourself as a nurse, were we successful in making in meeting the desired outcome? Did the plan work or is it in the process of being successful?
If goals were not met with the health of the patient, we need to reassess and begin the process over, noting why the goals weren’t met, and make changes to the new plan of care for the patient to make sure new goals will be completed, in order to accomplish the health goals of patient care.
The Nursing Process and Exam Questions
The nursing process is very relevant in nursing exams, as well as the NCLEX®. Have you ever been stuck on a question in a test, wondering which answer to choose because they all look correct? Well, a good tip to keep in mind is that many exam questions are actually just asking you to identify a part of the nursing process!
Remember, assessments are always the first step in the process. Interventions should not be implemented, (the fourth step), until after an assessment has been done. Burn this into your brain for those exams when you are asked about priorities! This is a common mistake. Rethink back to our computer example: You wouldn’t run to the computer store the first moment your computer didn’t turn on without doing some detective work, right? Just like you don’t give your patient medication before you find out what’s really going on.
How to Identify The Nursing Process Questions
When you come to a question that makes you feel stumped, look for some keywords to make you realize the exam is asking you an assessment question, which might be: assess, collect, determine, gather, identify, observe, do first, etc. If words like these are in the question, you most likely want to look at answers that involve an assessment of the patient.
Some keywords that will trigger you to think the exam is asking you an implementation or intervention question might be: action, next, implement, intervention, etc. If words like these are in the question, you most likely want to look at answers that involve an intervention.
Words such as evaluation and interpretation in the question should make you think – you guessed it – that you should be choosing an evaluation option as the answer.
Now don’t forget, when you come upon these types of questions in exams, take a breath, read and reread the entire question. After that, ask yourself, “Which part of the nursing process is this question asking me?”
See how understanding how the nursing process can help you with those tricky questions? You just gotta break it down!
Remember, you have to get the nursing process down as a fundamental concept in order to build your critical thinking skills to not only pass your exams, but to also become a great nurse, so make sure you understand it!
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