ADPIE – Nursing Process Steps

ADPIE – Nursing Process Steps ADPIE is an acronym that stands for assessment, diagnosis, planning, implementation and evaluation. The ADPIE process helps medical professionals remember the process and order of the steps they need to take to provide proper care for the individuals they are treating. This process is important as it provides a useful and throughout framework in patient care for developing critical thinking and problem solving skills. By following the ADPIE process medical professionals can improve the efficiency of their work and develop to more accurate decisions in a timely manner. PROCESS OVERVIEW The purpose of ADPIE is to help improve an individuals mental, emotional and/or physical health through analysis, diagnosis and treatment. The ADPIE process allows medical professionals to identify potential problems, develop solutions and monitor the results on an individual basis. If the process does not improve the individuals condition then the process should be reevaluated and the proper adjustments should be made in order to correct the issue. Here is an explanation detailing each step of the process: ASSESSMENT Assessment is the first step of the ADPIE process. During the assessment phase medical professionals will attempt to identify the problem and establish a data base by interviewing the individual and/or family members, observing their behavior and performing examinations. This step focuses heavily on collecting/recording data, validating information and listing any abnormalities in the data. Assessment data can be collecting in one of two ways, subjective or objective. Subjective data is data that can not be measured directly. This can include verbal information such as asking questions, obtaining verbal feedback, interviewing other individuals and collecting/gathering information on a patients health history. Subjective data is often referred to as symptomatic as it can not be measured or observed directly. Objective data is data that is measurable and can be seen, heard, felt or smelt. This can include performing an examination to measure a patients weight, blood pressure, heart rate and body temperature. Because objective data is measurable they are often referred to as signs. During the assessment phase it is important to gather as much data as possible and identify if the data is accurate, concise, consistent and clear. Once you’ve gathered enough accurate data you can form a conclusion about the patients condition and move into the next phase, which is diagnosis. DIAGNOSIS The diagnosis phase of the process is the phase where the medical professional develops a theory or hypothesis about the individuals situation based on the information that has been collected while performing an assessment. While nurses are unable to form a professional diagnosis they are able to develop their critical thinking and communicate their clinical judgments to their team members. In fact nurses have a standardized language for communicating their clinical judgments, which comes from NANDA international. Some examples of terms nurses may use include: Activity intolerance Anxiety Constipation Decreased cardiac output Fluid volume deficit Hypothermia Sleep deficit The diagnostic process allows the medical professional to make a determination about the individual and form an opinion on whether it is an physiological, mental or emotional condition, or another situation that the individual is dealing with. While a professional diagnosis may not be given by a nurse these medical professionals are able to identity actual or potential medical /health risks. Once a diagnosis has been performed any potential risks that may cause complications or harm to the individual should be placed in order with the highest risk listed as the top priority (life-threatening) and lower risks being addressed later in the list (non life-threatening / minor / future well-being). As problems are identified and corrected new problems/priorities may need to be addressed so continuous assessment of the individuals condition should be performed on a regular basis. After the problems have been identified and prioritized the phase of the process is planning. PLANNING Planning is the process of developing a plan and establishing SMART goals in order to achieve a desired outcome such as reducing pain or improving cardiovascular function. SMART goals stand for specific, measurable, attainable, realistic/relevant and time restricted. SMART goals are developed to provide the individual with a focused set of activities that are designed to improve their condition. They also provide medical professionals with a plan in which they can measure and evaluate the individuals improvements. Goals may be short-term or long-term, should be singular in nature and must focus on the individual outcome. Upon developing smart goals the medical professional should determine whether or not the goals are a good fit for the individual and able to be easily attained. In addition to creating SMART goals a care plan and intervention strategies should also be developed and communicated to the team in order to maximize the success of the plan. A care plan should involve the steps and strategies that need to be taken in order to achieve the desired goal. Intervention strategies are developed to help keep the individual on track and may be communicated to the individual and/or medical team or performed directly by a member of the medical team as part of the treatment. After the care plan, interventions and SMART goals have been established it needs to be implemented. IMPLEMENTATION The implementation phase of the process is the actionable part of the process where the individual and medical team implement the care plan, SMART goals and interventions so that the individual can achieve their goals and the process can be evaluated and measured. The implementation phase may be performed using a combination of direct care and indirect care. Direct care is care that is given directly to the patient in either a physical or verbal manner. Direct care may include assisting the patient with mobility, performing physical care and range of motion exercises with the patient and assisting with daily living activities. It may also include coaching, counseling and providing feedback to the individual. Indirect care is care that is given while away from the patient. Indirect care may include monitoring / supervising the medical staff, delegating responsibilities and advocating on behalf of the individuals you care for. While implementing the care plan it is important for the medical professional to use critical judgement and question procedures in the care plan in order to ensure that they appropriately meet the demands and concerns of the individuals receiving the care. Steps or procedures that appear to be inappropriate, non-actionable or questionable should be questioned and reevaluated with the medical staff and the individual receiving the care plan in order to ensure it is safe and aligns with the medical teams/individuals goals. EVALUATION The last phase of the process is the evaluation phase. This is the part where the medical professionals assess and evaluate the success of the planning and implementation processes to ensure that the individual is making progress towards his/her goals and is achieving the desired outcome. Evaluate if the process is working and identify what is bringing the individual closer to his/her goals. If the process is not working reassess it and determine whether it needs to be modifying or eliminated. Evaluations should be performed throughout the ADPIE process on a regular basis in order to assess the plan and make adjustments when they need to be made. By performing regular evaluations medical professionals can determine the appropriate course of action, identify potential errors and ensure that the process is working as smoothly as possible. ADPIE RECAP The ADPIE process is designed to assist medical professionals in identifying and addressing potential medical concerns. By implementing the process medical professionals are able to assess the patients condition through the collection of subjective and objective data, develop a diagnosis based on the information that has been collected, create a plan with interventions and SMART goals for the patient to follow, implement the process to achieve the plans goals and evaluate the individuals performance and ability to achieve their goals through the implementation of a care plan. ADPIE is an excellent way to improve the critical thinking process and allows for the creation, evaluation and reevaluation of procedures so that they can be implemented and modified until a desired outcome is achieved.