The Nursing Process & Critical Thinking – LPN/LVN Study Notes

Nursing Process – Core Framework

  • Five cyclical, inter-related steps remembered by the acronym ADPIE ("A Delicious PIE"):
    • A – Assessment
    • D – Diagnosis
    • P – Planning
    • I – Implementation
    • E – Evaluation
  • Purpose: systematic, evidence-based method that supports critical thinking and holistic, client-centered care.
  • Galen College of Nursing mantra: “Pure Calling, Pure Dedication, Pure Excellence, Pure Compassion.”

Critical Thinking & the Practical/Vocational Nurse (LPN/LVN)

  • Effective care demands analysis of “actual client situations.”
  • Critical thinking in nursing involves:
    • Continuous questioning of data, assumptions, and outcomes.
    • Validation/verification before conclusions are drawn – “Never assume, always validate!”
  • LPN/LVN scope:
    • Functions interdependently with RNs and health-care providers.
    • Has greater independence in data collection & implementation, greater dependence in planning & evaluation.

Step 1 – Assessment / Data Collection

  • Begins on admission and continues every encounter.
  • For LPN/LVN often termed a “focused assessment.”
  • Data types:
    • Objective (measurable/observable): vital signs, lab values, diagnostic tests, behaviors noted.
    • Subjective (verbatim reports): client’s feelings, perceptions, symptoms.
  • Requirements:
    • Completeness, factual accuracy, timeliness.
    • Validation = double-checking data to ensure correctness.
  • Outcome: foundation for nursing diagnosis & all subsequent steps.

Step 2 – Nursing Diagnosis vs. Nursing Problem

  • RN formulates formal NANDA-I nursing diagnoses.
  • LPN/LVN identifies or contributes to nursing problems and communicates findings to the RN.
  • Both diagnoses/problems describe responses to health conditions rather than medical diseases.
  • Example pair:
    • RN Diagnosis: Altered nutrition; less than body requirements related to impaired dentition.
    • VN Problem: Eats only 5%5\% of each meal related to inability to chew.

Step 3 – Planning

  • Converts problems/diagnoses into a client-centered plan of care.
  • LPN/LVN assists RN by providing data, priorities, and suggestions.
  • Guiding concepts:
    • SMART goals – Specific, Measurable, Attainable, Resource-oriented, Time-bound.
    • Maslow’s Hierarchy of Needs ensures physiologic & safety needs addressed before higher-level concerns.
    • Safety & life-threatening issues trump other needs (e.g., airway "I can’t breathe" > fall risk toileting request).
  • Planning activities where VN assists:
    • Nursing goals & outcomes
    • Nursing diagnoses refinement
    • Health teaching & discharge planning
    • Care-continuity, documentation, safety management

Example Goal

  • Desired Outcome (within 24 h24\text{ h}): Client will consume 15001500 calories of pureed food and 2000 mL2000\text{ mL} of fluid.

Step 4 – Implementation

  • Action phase – executing interventions to meet goals while maintaining safety and staying within LPN/LVN scope.
  • Interventions must be:
    • Evidence-based, clear, and feasible.
    • Documented precisely for continuity and evaluation.
  • Example Implementation Orders for the nutrition problem:
    • Provide six small pureed meals.
    • Offer 240 mL240\text{ mL} of liquids at 0600, 1000, noon, 1400, 1600, 1800, 2000.
    • Vary flavors: Jell-O, ice cream, lemon-lime soda, chocolate milk, pineapple juice; honor preference for herbal tea.

Step 5 – Evaluation

  • Compares actual outcomes with expected outcomes.
  • Continuous loop: baseline → initial plan → ongoing reassessment → modification.
  • VN responsibilities:
    • Collect post-intervention data (e.g., calorie counts, fluid intake).
    • Communicate findings to RN for plan adjustment.
  • Example Evaluation Result:
    • On Day 22 client met calorie goal but only 1600 mL1600\text{ mL} (not 2000 mL2000\text{ mL}) fluids – partial goal attainment → revise plan (increase fluid offerings, explore barriers).

RN vs. LPN/LVN Roles – Comparative Snapshot

  • Assessment/Data Collection: VN independent (focused) – must validate & report.
  • Diagnosis: RN independent; VN contributes data/problems.
  • Planning: RN leads; VN assists, ensures SMART & Maslow alignment.
  • Implementation: VN can act independently within scope; collaborates for complex interventions.
  • Evaluation: RN judges goal attainment; VN gathers data & communicates.
  • Both collaborate with interdisciplinary team for holistic, client-centered care.

Holistic & Ethical Considerations

  • Nursing process embodies holistic philosophy – client treated as a whole being: physiological, psychological, sociocultural, developmental, and spiritual dimensions.
  • Maintaining dignity, safety, and informed participation are ethical imperatives woven through every step.
  • Comprehensive documentation assures legal accountability and supports quality improvement.