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The Nursing Process The Nursing Process • An organizational framework for the practice of nursing • Orderly, systematic • Central to all nursing care • Encompasses all steps taken by the nurse in caring for a patient The Nursing Process • Assessment • Nursing Diagnosis • Planning • Implementation • Evaluation The Nursing Process Assessment • Data collection (subjective, objective, environmental) • Medication history • Nursing assessment • Data analysis The Nursing Process Nursing Diagnosis • Judgment or conclusion about the risk for—or actual—need/problem of the patient • NANDA format The Nursing Process Planning • Identification of goals and outcome criteria • Prioritization • Time frame The Nursing Process Implementation • Initiation and completion of the nursing care plan as defined by the nursing diagnoses and outcome criteria • Follow the “five rights” of medication administration The “Five Rights” of Medication Administration • Right drug • Right dose • Right time • Right route • Right patient The “Sixth Right”—System Analysis • The entire “system” of medication administration: • Ordering, dispensing, preparing, administering, documenting The Nursing Process Evaluation • Ongoing part of the nursing process • Determining the status of the goals and outcomes of care • Monitoring the patient’s response to drug therapy