The nursing process is the systematic, cyclical, patient-centred problem-solving framework that registered nurses use to deliver, document, and evaluate patient care. In the United States its current authoritative form is set out in the American Nurses Association's Nursing: Scope and Standards of Practice (fourth edition 2021), which lists six standards of practice that map onto the five phases known by the acronym ADPIE: assessment, diagnosis, planning, implementation, and evaluation. The discipline's nursing process began as a four-phase model in the 1967 ANA standards, expanded to five in 1973, and added an explicit outcomes-identification step (sometimes abbreviated ADOPIE) in the most recent edition. EssayFount writing experts use this guide with pre-licensure students writing first care plans, RN-to-BSN students writing concept-map assignments, MSN students writing comprehensive case studies, and DNP students whose quality-improvement projects must align with the ANA standards.
The American Nurses Association's six standards of practice and where ADPIE lives inside them
The 2021 ANA Scope and Standards of Practice lists six numbered standards of practice (assessment, diagnosis, outcomes identification, planning, implementation, and evaluation), eighteen standards of professional performance (covering ethics, advocacy, education, scholarly inquiry, and similar competencies), and a definition of nursing as the protection, promotion, and optimisation of health and abilities. The first six standards correspond to the procedural phases of the nursing process; the rest define the wider professional context the process operates inside.
The five-phase ADPIE form taught in most pre-licensure curricula compresses outcomes identification into the planning phase. The six-phase ADOPIE form keeps it as a separate step. Both formulations describe the same procedural sequence; the question of whether outcomes identification is its own phase is less a clinical disagreement than a curricular choice. This guide uses ADPIE because that is the form the National Council Licensure Examination questions are written against and the form most current US textbooks adopt.
Standardised nursing language gives each phase a vocabulary. NANDA International's Nursing Diagnoses: Definitions and Classification 2024-2026 (twelfth edition 2023, edited by T. Heather Herdman, Shigemi Kamitsuru, and Camila Takao Lopes) supplies the diagnosis labels. The Nursing Interventions Classification (Howard Butcher and colleagues, seventh edition 2018) supplies the intervention labels. The nursing outcomes classification coursework support (Sue Moorhead and colleagues, sixth edition 2018) supplies the outcome labels. NANDA-I, NIC, and NOC together form the so-called NNN linkages that connect the diagnostic, planning, and evaluation phases.
A single case: a 68-year-old patient on post-operative day one after total hip arthroplasty
Reading the nursing process well means following one patient through every phase. The case below sits with the same patient through assessment, diagnosis, planning, implementation, and evaluation, and the case sections under the next five headings each return to her. The patient is a 68-year-old woman on post-operative day one after a right total hip arthroplasty for primary osteoarthritis. She has a documented history of hypertension controlled with lisinopril, type two diabetes managed with metformin, and a thirty-year-ago twenty-pack-year tobacco history with no current use. The post-operative orders include scheduled multimodal analgesia, deep-vein-thrombosis prophylaxis with enoxaparin, hip-precaution positioning, and a physical-therapy consult for first ambulation.
Phase 1, Assessment: collecting and validating the data, not interpreting it
Assessment is the systematic collection, validation, organisation, and documentation of patient data. Data sources include the patient interview, physical examination, vital-signs measurement, focused functional and psychosocial screening, the medical record, and the multidisciplinary team's contributions. The assessment data are subjective (what the patient reports) and objective (what the nurse observes or measures), and they are organised against a structured framework such as Marjory Gordon's eleven functional health patterns or the head-to-toe systems review.
The discipline draws a hard line between data and interpretation. A note that says the patient "is anxious" has crossed into interpretation; the assessment-phase note says heart rate 104, restless in bed, patient verbalises worry about falling, all of which are observable cues. Mixing assessment data with interpretation is the single most common error in undergraduate care plans and is the failure mode that graders catch first.
For the post-operative case: pain six on the zero-to-ten numerical rating scale at rest, eight with movement; surgical-site dressing intact, clean and dry, no drainage on initial inspection; blood pressure 132 over 84; heart rate 92, regular; temperature 37.6 degrees Celsius; respiratory rate 18 with oxygen saturation 96 percent on room air; hip-precaution positioning maintained with abduction wedge in place; urinary catheter draining clear yellow urine 60 millilitres per hour; lower-extremity neurovascular check intact bilaterally with two-plus pedal pulses; patient declines first ambulation, reporting fear of pain. The assessment also documents the home situation (lives with husband in a single-storey home, two non-skid bathmats, one bath rail, no shower chair) and the patient's stated goal (return home in three days for grandchild's birthday).
Phase 2, Diagnosis: turning clusters of cues into NANDA-I statements
Diagnosis is the analytic phase. The nurse clusters related cues from the assessment database, identifies patterns, compares those patterns against the NANDA-I taxonomy, and writes a nursing-diagnosis statement for each pattern that meets the diagnostic criteria. A medical diagnosis names the disease (osteoarthritis, congestive heart failure, pneumonia); a nursing diagnosis names the patient's response in NANDA-I language (acute pain, activity intolerance, ineffective airway clearance). The two coexist in the chart but drive different care: the medical diagnosis drives the medical plan; the nursing diagnosis drives the nursing care plan.
NANDA-I statements take three forms. An actual diagnosis uses the three-part PES format: problem (the NANDA-I label), etiology (the related-to factors), and signs and symptoms (the as-evidenced-by defining characteristics). A risk diagnosis uses a two-part format with the problem and the risk factors but no defining characteristics, because the problem has not yet occurred. A health-promotion diagnosis uses a one-part format that names a desire to enhance a behaviour or status.
For the post-operative case, two actual nursing diagnoses cluster from the data. First, acute pain related to surgical tissue trauma as evidenced by patient-reported pain six out of ten at rest and eight with movement. Second, impaired physical mobility related to surgical procedure and post-operative pain as evidenced by patient declining first ambulation. A risk diagnosis is added: risk for falls related to recent hip arthroplasty, post-operative weakness, and patient-reported fear of pain. The diagnoses are then prioritised: acute pain first because it drives the impaired mobility; impaired physical mobility second because resolving it depends on resolving the pain; risk for falls third because the risk window extends through the recovery period.
Phase 3, Planning: outcomes that can be evaluated and interventions that target the etiology
Planning takes the prioritised diagnoses and writes for each one a measurable, time-bound expected outcome and a list of nursing interventions that target the etiology. Outcomes use NOC labels and the SMART convention: specific, measurable, achievable, relevant, time-bound. Interventions use NIC labels with a documented rationale for each. The output is the written care plan or concept map, the artefact the next phase carries out.
The most documented planning failures are three: outcomes that are not measurable (a goal that the patient will "feel better" cannot be evaluated against any data point); interventions written without a rationale linking them to the diagnosis etiology; and a list of diagnoses without a stated prioritisation rule. Maslow's hierarchy of needs, with physiological needs first, then safety, love and belonging, esteem, and self-actualisation, is the prioritisation framework most curricula use; the airway-breathing-circulation-disability-exposure (ABCDE) framework is the equivalent in critical-care contexts. Stating which framework is in use is part of what the planning phase produces.
For the post-operative case, the care plan reads in part: for acute pain, expected outcome is patient reports pain at three or below on the zero-to-ten scale within two hours of analgesic administration; interventions are scheduled multimodal analgesia per orders, ice application to the surgical site, repositioning every two hours, and patient teaching on the relationship between pain control and ambulation tolerance. For impaired physical mobility, expected outcome is patient ambulates ten metres with a front-wheeled walker and physical-therapy supervision by end of shift; interventions are coordination with physical therapy on timing relative to analgesia, hip-precaution reinforcement during turning and transfers, and a planned bedside-to-doorway pre-walk before the corridor attempt. For risk for falls, expected outcome is patient remains free from falls during admission; interventions are bed in lowest position with two side rails up, call light within reach, non-skid socks, and reorientation each shift to call before getting up.
Phase 4, Implementation: doing the work and recording the patient's response
Implementation is the doing phase. The nurse carries out the planned interventions, supervises any delegated to unlicensed assistive personnel or licensed practical nurses, and documents each action in the medical record. Documentation under ANA standards is incomplete unless it includes the patient's response to each intervention; an entry that records administration of an analgesic without recording the patient's reported pain change after the analgesic took effect does not meet the standard.
Charting formats vary by institution. SOAP (subjective, objective, assessment, plan) and SOAPIE (the same with intervention and evaluation added) are common in narrative settings. DAR (data, action, response) is common in focus-charting institutions. Charting by exception, where only deviations from the planned trajectory are documented, is common in long-term care. The intervention label is drawn from NIC; the documentation format follows institutional convention. The pairing keeps the chart readable across shifts and across electronic health record vendors.
For the post-operative case, the implementation record on day one shift two reads in part: oxycodone five milligrams administered at 0900 with patient-reported pain at six pre-administration; ice pack applied for twenty minutes at 0905; patient repositioned to left lateral with abduction wedge at 0930; patient-reported pain at three on reassessment at 1015; physical therapy at bedside at 1030; patient ambulated eight metres with front-wheeled walker and supervision; patient tolerated activity with stable vital signs and pain reported at four post-walk; patient returned to bed with hip precautions reinforced. Each line records both the action and the response.
Phase 5, Evaluation: comparing actual response with expected outcomes and revising the plan
Evaluation is the comparison phase. Each expected outcome from the planning phase is judged against the documented response: met, partially met, or not met. The judgement carries a brief rationale, and any outcome that was partially met or not met triggers a revision of the diagnosis, plan, or interventions before the next cycle. Evaluation occurs at every shift handoff, at every change in patient condition, and at discharge. Skipping evaluation is the most documented gap in real-world care plans and is the failure mode that turns a procedurally complete plan into a clinically blind one.
For the post-operative case, the day-one shift-two evaluation reads: acute pain outcome met (patient reports pain at three within ninety minutes of analgesic administration). Impaired physical mobility outcome partially met (patient ambulated eight metres with supervision, two metres short of the ten-metre target). Risk for falls outcome met (no falls during shift). The plan is revised forward: continue current pain regimen; advance ambulation goal to fifteen metres with physical therapy on the next shift; maintain fall-prevention interventions through discharge.
The cycle: how evaluation feeds back into reassessment
The nursing process is not a one-time linear sequence. Each evaluation phase generates new data, and that new data enters the next assessment phase. A patient whose pain outcome is met but whose ambulation outcome is partially met carries forward a revised plan with a more aggressive ambulation target, and the next shift's assessment looks for the new patient cues that target produces. The cycle is continuous, the assessment data is continuous, and the care plan is a living artefact. Treating the care plan as a one-time document that gets stapled into the chart and never opened again is the second most documented gap in practice, after the missed-evaluation gap.
The nursing process and the frameworks that sit alongside it
The nursing process operates at the level of the individual patient. Three other frameworks operate at adjacent levels and appear in nursing curricula alongside it. The Iowa Model and the Johns Hopkins Evidence-Based Practice Model operate at the system level and produce the practice changes that update what counts as an evidence-based intervention inside the planning phase. The Plan-Do-Study-Act cycle operates at the quality-improvement level and is the framework most DNP capstone projects use. The Situation-Background-Assessment-Recommendation communication tool sits inside the implementation phase as the standard structure for handoff and escalation. None of these frameworks displaces the nursing process; they supply complementary procedural shapes for problems at different scales, and a strong DNP project names the patient-level framework (the nursing process) and the system-level framework (Iowa or PDSA) explicitly and shows how they interact.
Where the nursing process most often breaks down in real charts
Three failure points appear in nearly every audit of nursing-process documentation. The first is missed evaluation: outcomes written in planning but never evaluated against the patient's documented response. The second is medical-diagnosis substitution: a chart entry that names "pneumonia" or "congestive heart failure" in the nursing-diagnosis field and then proceeds without the response-focused vocabulary the nursing care plan needs. The third is interpretation in the assessment phase: subjective conclusions about the patient's emotional or behavioural state appearing as data rather than as inferences drawn from cues. Strong programmes audit for these three patterns specifically and target their fundamentals teaching at preventing them.
Reader questions about the nursing process
What are the 5 stages of the nursing process?
The five stages of the nursing process are Assessment, Diagnosis, Planning, Implementation, and Evaluation, abbreviated ADPIE. Assessment collects subjective and objective data; Diagnosis selects a NANDA-I label and writes a PES statement; Planning sets prioritised, measurable patient outcomes from the Nursing Outcomes Classification; Implementation delivers the interventions selected from the Nursing Interventions Classification; Evaluation re-measures the outcomes and decides whether to continue, modify, or resolve the plan. The American Nurses Association's Standards of Practice (third edition, 2021) codifies the same five stages for licensed practice in the United States.
What are the six steps of the nursing process?
The six-step variant, written ADOPIE, separates Outcomes Identification from Planning to align with the American Nurses Association's standard 3. The steps are Assessment, Diagnosis, Outcomes identification, Planning, Implementation, and Evaluation. Splitting outcomes from planning forces the nurse to declare measurable patient goals before designing the interventions to reach them and is the formulation most often used in graduate documentation and Magnet-recognised hospitals. The ANA decision to standardise on six steps in 1998 is the reason both the five-stage and six-stage versions are still in circulation.
What are the 5 C's of nursing?
The 5 C's of nursing are commitment, conscience, competence, compassion, and confidence, named by Sister Simone Roach in her 1987 framework on the human act of caring. They are caring values rather than steps of the nursing process and frame the moral character expected of a competent professional nurse. The 5 C's are often confused with ADPIE because both are five-letter mnemonics, but Roach's framework describes who the nurse is, while ADPIE describes what the nurse does. Both are commonly tested but answer different curriculum questions.
What are the 7 principles of nursing?
The seven principles of nursing most often listed in licensure-preparation texts are accountability, advocacy, caring, collaboration, integrity, justice, and respect. They are derived from the American Nurses Association's Code of Ethics for Nurses (2015 revision) and are not a stage list of the nursing process. The principles operate at the level of professional values and shape how each ADPIE stage is performed: an assessment is honest because of integrity, a plan respects autonomy because of justice, an intervention is delivered without discrimination because of advocacy.
What are the 5 basic nursing procedures?
The five most commonly tested basic nursing procedures are vital-signs measurement, hand hygiene and infection control, medication administration, intravenous-catheter management, and head-to-toe physical assessment. They sit inside the Implementation phase of the nursing process and are taught in fundamentals courses before students rotate onto the floor. Each has its own safety pre-checks: the rights of medication administration before drug delivery, the World Health Organization five moments of hand hygiene before contact, and the cross-checking of identity bands before any intervention.