In 1958, Ida Jean Orlando started the nursing process that still guides nursing care today. Defined as a systematic approach to care using the fundamental principles of critical thinking, client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EDP) recommendations, and nursing intuition. Holistic and scientific postulates are integrated to provide the basis for compassionate, quality-based care.
The nursing process is a systematic guide to client-centered care with five sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation.
Assessment is the first step and involves critical thinking skills and data collection, subjective and objective. Subjective data involves verbal statements from the patient or caregiver. Objective data is measurable, tangible data such as vital signs, intake and output, and height and weight.
Data may come from the patient directly or from primary caregivers who may or may not be directly related to family members. Friends can play a role in data collection. Electronic health records may populate data and assist in assessment.
Critical thinking skills are essential to the assessment, thus the need for concept-based curriculum changes.
Formulating a nursing diagnosis by employing clinical judgment assists in planning and implementing patient care.
The North American Nursing Diagnosis Association (NANDA) provides nurses with an up-to-date list of nursing diagnoses. According to NANDA, a nursing diagnosis is a clinical judgment about responses to actual or potential health problems on the part of the patient, family, or community.
A nursing diagnosis encompasses Maslow’s Hierarchy of Needs and helps to prioritize and plan care based on patient-centered outcomes. In 1943, Abraham Maslow developed a hierarchy based on basic fundamental needs innate to all individuals. Basic physiological needs/goals must be met before higher needs/goals, such as self-esteem and self-actualization, can be achieved. Physiological and safety needs are the basis for implementing nursing care and interventions. Thus, they are at the base of Maslow’s pyramid, laying the foundation for physical and emotional health.  
Maslow’s Hierarchy of Needs
Basic Physiological Needs: Nutrition (water and food), elimination (Toileting), airway (suction)-breathing (oxygen)-circulation (pulse, cardiac monitor, blood pressure) (ABCs), sleep, sex, shelter, and exercise.
Safety and Security: Injury prevention (side rails, call lights, hand hygiene, isolation, suicide precautions, fall precautions, car seats, helmets, seat belts), fostering a climate of trust and safety (therapeutic relationship), patient education (modifiable risk factors for stroke, heart disease) (modifiable risk factors for stroke, heart disease).
Love and Belonging: Foster supportive relationships, methods to avoid social isolation (bullying), employ active listening techniques, therapeutic communication, and sexual intimacy.
Self-Esteem: Acceptance in the community, workforce, personal achievement, sense of control or empowerment, accepting one’s physical appearance or body habitus.
Self-Actualization: Empowering environment, spiritual growth, ability to recognize the point of view of others, reaching one’s maximum potential.
Based on EDP guidelines, the planning stage is where goals and outcomes are formulated that directly impact patient care. These patient-specific goals and the attainment of such assist in ensuring a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide a direction for personalized care tailored to an individual’s unique needs. Overall condition and comorbid conditions play a role in constructing a care plan. Care plans enhance communication, documentation, reimbursement, and continuity of care across the healthcare continuum.
The goals should be:
Specific \sMeasurable or Meaningful \sAttainable or Action
-Oriented \sRealistic or Results
-Oriented \sTimely or Time-Oriented \sImplementation
Implementation is the step that involves Action or doing and the actual carrying out of nursing interventions outlined in the plan of care. This phase requires nursing interventions such as applying a cardiac monitor or oxygen, direct or indirect care, medication administration, standard treatment protocols, and EDP standards.
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This final step of the nursing process is vital to a positive patient outcome. Whenever healthcare providers intervene or implement care, they must reassess or evaluate to ensure the desired outcome has been met. Reassessment may frequently be needed depending on the overall patient condition. The plan of care may be adapted based on new assessment data.
Go to: \sIssues of Concern.
According to a 2011 study conducted in Mekelle Zone hospitals, nurses lack the knowledge to implement the nursing process into practice, and factors such as nurse-patient ratios inhibit them from doing so. Ninety percent of study participants lacked sufficient experience to apply the nursing process to standard practice. The study also concluded that a shortage of available resources, coupled with increased workloads due to high patient-nurse ratios, contributed to the lack of the nursing process implementation in the delivery of patient care.   
Go to: \clinical Significance.
The utilization of the nursing process to guide care is clinically significant in the future in this dynamic, complex world of patient care. Aging populations carry many health problems and inherent risks of missed opportunities to spot a life-altering condition.
As explored by Salmond and Echevarria, healthcare is changing, and the traditional roles of nurses are transforming to meet the demands of this new healthcare environment. Nurses are in a position to promote change and impact patient delivery care models in the future. 
Go to: \sOther Issues.
Critical thinking skills will play a vital role as we develop care plans for these patient populations with multiple comorbidities and embrace this challenging healthcare arena. Thus, the trend towards concept-based curriculum changes will assist us in navigating these uncharted waters.
Baron further explores this need for a concept-based curriculum instead of the traditional educational model and the challenges faced with its implementation. A direct impact on quality patient care and positive outcomes. Nursing practice and educational environments form a bond with clinical knowledge and expertise. That bond facilitates the transition into the current workforce as an indispensable team player and leader in this new wave of healthcare.
Learning should be the focus and the integration into current practice. Learning is a dynamic process, propelled by a force that must coexist within the same learning milieu between educator and student, preceptor and novice, mentor and trainee.
In the future, nurses must be able to problem-solve in a multitude of situations and conditions to meet these new adversities: challenging nurse-patient ratios, multifaceted approaches to prioritization of care, fewer resources, navigation of the electronic health record as well as functionality within the team dynamic and leadership style.
My patient is a four-year-old female whose diagnosis is a brain tumor in her pineal region, Everything else can be made up but has to correlate with her diagnosis. Please look at the template. It has to hit all the requirements of the rubric.
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