Chapter 2: The Nursing Process — ADPIE Framework

The nursing process is the systematic, evidence-based framework nurses use to deliver individualized, patient-centered care. Its five steps — Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE) — form a continuous cycle that guides clinical decision-making.

The Five Steps of ADPIE

Assessment is the foundation. Nurses collect subjective data (what the patient reports — symptoms, pain, history) and objective data (measurable findings — vital signs, lab values, physical examination). Tools include head-to-toe assessment, functional assessments, and validated screening instruments.

Diagnosis involves analyzing assessment data to identify actual or potential health problems. Nursing diagnoses differ from medical diagnoses: they focus on the human response to illness rather than the disease itself. NANDA International maintains the standardized taxonomy of nursing diagnoses.

Planning requires setting measurable, patient-centered goals and selecting nursing interventions. Goals must be SMART: Specific, Measurable, Achievable, Realistic, and Time-bound.

Implementation is the execution of the care plan — administering medications, performing procedures, educating patients, and coordinating care.

Evaluation measures whether goals were met. If outcomes are not achieved, the nurse reassesses and revises the plan.

NANDA Nursing Diagnoses

NANDA diagnoses follow a three-part PES format:

• Problem (the nursing diagnosis label)
• Etiology (related to / contributing factors)
• Signs and Symptoms (as evidenced by / defining characteristics)

Type	Example
Actual	Impaired Gas Exchange related to alveolar-capillary membrane changes AEB SpO₂ 89%
Risk	Risk for Falls related to altered gait and orthostatic hypotension
Health Promotion	Readiness for Enhanced Nutrition
Syndrome	Frail Elderly Syndrome

Priority Setting

Nurses prioritize diagnoses using Maslow’s Hierarchy of Needs and the ABC framework (Airway, Breathing, Circulation). Life-threatening problems always take priority over psychosocial needs.

Priority	Framework	Examples
First	Physiological (ABC)	Airway obstruction, hemorrhage
Second	Safety/Security	Fall risk, infection risk
Third	Love/Belonging	Isolation, grief
Fourth	Self-Esteem	Body image disturbance
Fifth	Self-Actualization	Spiritual distress

Key Checklist

• Write a correctly formatted three-part NANDA nursing diagnosis for a patient with pneumonia and SpO₂ of 88%
• Distinguish between actual, risk, and health-promotion nursing diagnoses with one example each
• Apply the ABC priority framework to rank four nursing problems in order of urgency