ADPIE: The 5 Stages of the Nursing Process
One of the most common acronyms used by nurses and other healthcare professionals is ADPIE, which stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation.
There is more to ADPIE than just a fancy acronym – it is actually a summary of a nursing process that is vital in delivering holistic patient care. ADPIE supports nurses and other medical professionals to be critical thinkers and effective problem solvers.
If the ADPIE process is adequately followed, efficiency at work and delivery of more precise decisions are most likely to be achieved.
Assessment is the first step of ADPIE, wherein data collection happens. It includes taking vital signs, accomplishing head-to-toe assessment, gathering patient’s medical history, taking note of all the subjective complaints while observing the objective physical observations from a patient.
- Data Collection
Data gathering involves interviewing the patient and/or family members, having a keen observation of their behavior, and conducting physical examinations. This step concentrates on relevant data collection, evidence validation, and recording the noted abnormalities in the report.
In the assessment stage, nurses should constantly think about what could possibly be going on with their patients to effectively gather and record enough information. If adequate data are collected during the first step, the database will be established and problem identification will be much easier.
- Objective versus Subjective Data
There are two types of data: objective data and subjective data. Objective data are the pieces of information that you can see, hear, feel, smell, and measure. This includes body temperature, blood pressure, heart rates, tremors, pallor, diaphoresis, weight, and height. We often referred to the objective data as “signs”.
Subjective data on the other hand are pieces of information that are immeasurable. This includes spoken information that you collected during the patient’s interview such as emotions, level of pain, itchiness, tinnitus, and other subjective complaints which are often referred to as “symptoms”.
Keep in mind that assessment plays a vital role in nursing care plans; an accurate and complete collection of data must always be ascertained. Using appropriate interpersonal skills that will encourage patients to verbalize their complete medical history will also be a great help in the assessment stage. Once accurate and ample data are gathered, we may now move on to the next step of ADPIE process.
Diagnosis is the stage wherein nurses come up with a concept about their patient’s condition based on the collected data from the assessment phase. While physicians create medical diagnoses, nurses establish nursing diagnoses to aid the patient in their current or potential health problems. But nurses can identify patients’ responses to disease and modify nursing care plans to meet the patient’s needs. Nursing diagnosis also helps in facilitating better communication between medical team members. The comprehensive judgments of nurses, which are evidence-based, could determine the actual and potential health risks to their patients.
There are standardized nursing diagnoses that professional nurses use to guide them in charting. Often, the nursing diagnoses are based on the taxonomy created by the North American Nursing Diagnosis Association or NANDA. As an example, if the patient says that she is in pain, you may use impaired comfort or acute pain as the nursing diagnosis.
Other NANDA nursing diagnoses include Anxiety, Sleep Deprivation, Ineffective Airway Clearance, etc. One may find more information about each nursing diagnosis from nursing textbooks approved by NANDA International. The said organization has a fast-growing list of nursing diagnoses where nursing professionals can choose from.
After the diagnosis is established, identified risks that may cause harm or complications to the patient must be placed in order. Life-threatening risks shall be listed as the top priority followed by other risks in descending order being the most minor as the lowest priority.
- Maslow’s Hierarchy of Needs
Based on NANDA, a nursing diagnosis can be created with the use of Maslow’s Hierarchy of Needs which was developed by American Psychologist, Abraham Maslow. The said hierarchy is based on the fundamental needs of all human beings wherein the basic needs of the first level must be achieved before the needs of the next higher level can be met.
Maslow’s Hierarchy of Needs involves a pyramid structure. As mentioned, the bottom level needs to be met before an individual can move on to the next level of the pyramid.
- First Level: Basic Physiological Needs. This level at the bottom part of the pyramid includes air, water, food, shelter, rest, shelter, clothing, reproduction, and elimination. These are the highest priority and the most basic human survival needs according to Maslow. The concept of ABC (Airway, Breathing, and Circulation) in nursing belongs to the highest priority of Maslow’s hierarchy. It usually has the most vital role when it comes to the prioritization of care and nursing diagnosis.
- Second Level: Safety and Security Needs. This level pertains to protection from violence and theft, emotional stability and well-being, health, and financial security. A few important instances in nursing include basic safety while in the hospital. Providing instructions on using guard rails and call lights to prevent falls, the importance of hygiene, and frequent hand washing to prevent infection, are just a few examples. Making a patient feel safe and secure before a surgical operation or when facing serious medical situations is also part of this level.
- Third Level: Love and Belonging Needs. The social needs on the third level involve human interaction. Friendships and family relationships are among these needs. Every individual needs to accept themselves and also feel accepted by their family, friends, and colleagues. Nursing professionals support these needs by actively listening to their patients and encouraging them in activities that keep the patient from avoiding social isolation.
- Fourth Level: Self-esteem Needs. The primary concept of this need is self-respect and self-confidence. To believe that you are valuable and confident that you are capable of personal growth and accomplishments. Hospitalized patients who are dependent on others and sometimes feel not useful are difficult to attain this level. Nurses should listen and encourage their patients to feel significant to the lives of their family, friends, and their workplace. For patients who may not able to return to work, the nurse can gather information about personal achievements and focus on them. These patients can feel delighted and encouraged to feel good about themselves.
- Fifth Level: Self-actualization Needs. This is the highest spot in the pyramid according to Maslow. All the other levels must be met before they can be fulfilled. Self-actualization involves the fulfillment of the full potential as a person. There are cases wherein this level cannot be reached at all. Nurses should assist these patients to reach their other goals to reach their maximum potential in time.
Nurses make the nursing diagnosis and identify the potential and actual health risks of the patients prioritized based on Maslow’s hierarchy of needs. The nursing diagnosis is vital to the next step of the process.
After determining the nursing diagnosis, it brings us now to “P” in the ADPIE acronym, which stands for Planning. This step is to develop a plan on how to achieve the desired goal/s for the patients. These goals should always be SMART – an acronym which stands for Specific, Measurable, Attainable, Realistic/Relevant, and Time-bound.
SMART goals aim to provide patients with a customized set of activities to improve their health conditions. They also contribute plans to measure and evaluate the patients’ improvements to nursing professionals. The goals that should be developed may be short or long-term focused on the patients’ outcome, and must be a good fit for them.
For example, a patient who has mobility problems should have a nursing care plan that can allow them to move from the bed to a chair at least three times a day and sit there for a certain amount of time. This plan is specific, measurable, attainable, realistic, and time-bound (SMART).
A patient diagnosed by a nursing professional with a lack of adequate nutrition may have a plan that entails eating several small meals a day instead of three large meals. Again, this goal is specific, measurable, attainable, realistic, and time-bound (SMART).
Aside from creating SMART goals, a nursing care plan and intervention strategies must be developed and communicated to the patient and the rest of the medical team, as part of the treatment. This will surely help in achieving the success of the goals.
The “I” in the ADPIE process stands for Implementation. This fourth step is the action part of the process, where you carried out the nursing care plan that you have developed earlier.
Take note that in the planning stage, nurses are simply forming a plan and no action has begun yet. The implementation stage, on the other hand, is where you act on that individual plan. In short, implementation is the key to continuing patient care.
The implementation stage is commonly executed using a combination of direct care and indirect care.
- Direct Care
Direct care involves the provision of hands-on care to help the patient meet their goals. It involves carrying out nursing interventions such as proper wound care, administering medication or oxygen, applying a cardiac monitor, repositioning, or assisting in a patient’s ambulation. It also includes observing the patients working individually. The nurse provides feedback about the patient’s development and discusses modifications in the care plan for them to meet their desired goals.
- Indirect Care
Indirect care, on the other hand, involves monitoring the other healthcare staff to make sure that they are working harmoniously to carry out the goals of the nursing care plan. Anything that transpires in the patient’s care that is completed while the nurse is away from the patient is called indirect care. Anyone who carries out the nursing care plan, either direct or indirect, must document it in the patient’s hospital medical record.
During the implementation of the nursing care plan, nursing professionals need to use their critical judgment to ensure that the procedures in the nursing care plan can meet the needs and demands of the patients receiving care. Inappropriate or questionable procedures should be questioned and re-evaluated from time to time.
Just like in the earlier stages of the ADPIE nursing process, these nursing actions should also be communicated to the patients receiving the care plan to confirm compliance and ensure continuity of patient care. After this step, nursing professionals must evaluate the outcome of carried-out interventions.
The final step which is “E” in the ADPIE nursing process stands for Evaluation. This is the stage where in the healthcare professional weighs the outcome of the nursing actions done in the implementation stage. The evaluation phase is the time that nurses should be asking themselves, “Did the plans work successfully, are still in the process of being effective, or have failed and therefore need to be changed?”
An effective use of the nursing process includes continuous monitoring throughout the patient’s admission to determine if the care plan is appropriate to him or her. If there are parts of the plan that seem to be making the patient’s condition worse, these parts should immediately be stopped.
The evaluation stage ensures that the patients are building progress towards their goals and accomplishing the desired outcome. Healthcare professionals must constantly assess and evaluate the nursing process. It is important to always re-evaluate if the process is not working and determine whether some parts need to be changed, reduced, or completely removed.
The patient should be involved in the evaluation process at all times. If the patient feels that the plan is not working the way it should be, the nurse should pay attention and work to modify the nursing care plan or enlighten the patient of the details and explore further on how to make it work.
In the end, the evaluation part of ADPIE should work to make the whole nursing process run smoothly and keep the patient and the healthcare professionals functioning together for the benefit of the patients.
Although evaluation is the final stage of the nursing process, healthcare professionals must take note that evaluations should be performed throughout the ADPIE process to regularly assess the plan and make modifications when necessary.
Here are examples of comprehensive ADPIE nursing process to help aspiring nurses and professionals understand this vital nursing tool.
Scenario 1: A patient with a shoulder injury from a vehicular accident from a month ago
- Apparent facial grimace when the patient is moving his shoulder
- The shoulder area shows limited range of motion upon physical assessment
Subjective data: “The level of my pain is 10/10. Is it possible to increase the dose of my pain relievers?”
DIAGNOSIS: Chronic pain related to shoulder injury
PLANNING (Expected outcomes)
- The patient will verbalize his pain as less than 7/10 during therapy by the end of this week
- The patient demonstrates the ability to cope with unrelieved pain within two weeks
- Assess the patient’s level of pain every shift and as necessary
- Teach the patient when to medicate for pain (i.e. before his physical therapy)
- Educate the patient about the action, duration, and side effects of the pain medications that he/she is currently taking
- Teach the proper breathing and relaxation techniques to reduce the pain
- Administer pain medications as needed
- Offer alternative therapies including acupuncture and massage, once cleared by his attending physician/s
- Educate on coping strategies and other positive diversional activities
- The patient continues to rate his pain as 8-9/10 during his physical therapy, continuing the goal is necessary.
- The patient is demonstrating some coping but must still be assisted with relaxation techniques. Convey interest in other alternative therapies, continue goal.
Scenario 2: A Patient with Osteomyelitis
- Fever (temperature of 101.5° F) and flushed skin
- Erythema, swelling, and warmth on the left arm
- Compromised mobility of the affected site or limb and loss of range of motion (ROM)
- Complete Blood Count (CBC) showing elevated white blood cells (WBC)
Subjective data: 10/10 level of pain as verbalized by the patient
- Acute pain related to infectious process and swelling
- Hyperthermia related to inflammatory response to infection
PLANNING (Expected outcomes)
- The patient will verbalize an acceptable pain level of 5 or less on a 0 to 10 pain scale, as confirmed by normal vital signs and relaxing effect, and body posture.
- The patient will sustain a normal body temperature as evidenced by consistent temperature measurements of less than 100° Fahrenheit, dry skin, and normal respiration rate.
For Acute pain related to infectious process and swelling:
- Assess the patient’s pain level being 10 as the highest and 0 as the lowest pain. Note the characteristics of pain.
- Monitor vital signs at least every four hours or as ordered by the physician
- Administer pain medication according to the physician’s orders.
- Encourage bed rest to lessen the movement of the affected area and alleviate the pain.
- Be considerate during wound care and use appropriate timing through administration of wound care during peaks of pain medications.
- Elevate the involved area to reduce the swelling and ease the pain.
- Provide hot and cold packs if not contraindicated by the attending physician.
- Provide activities to help with distractions such as listening to music, reading books, or watching television
For Hyperthermia related to inflammatory response to infection:
- Monitor the patient’s temperature at appropriate times and as clinically specified.
- Obtain temperature measurements from the same site and with the same tool for more accurate results
- Administer antipyretics as ordered to reduce fever for some time.
- Remove warm clothing and adjust the room temperature which affects the patient’s body temperature.
- Offer sponge baths and provide temperature lowering measurements such as a fan or cold cloth to the forehead.
- The patient verbalizes an acceptable pain level of 5 at the end of the shift
- The patient maintains a normal body temperature as evidenced by consistent temperature measurements of less than 100° Fahrenheit, a cool and dry skin
Scenario 3: A Patient Diagnosed with Stage IV Metastatic Cancer
- The patient appears nervous and intimidated by his or her surroundings
- The patient is not asking any questions
Subjective data: “I have no idea what the doctor is saying to me. It is too much information and I am very confused.”
DIAGNOSIS: Knowledge deficit related to new health diagnosis or treatment
PLANNING (Expected outcomes)
- The patient will verbalize the accurate information about condition and treatment by discharge
- The patient will perform newly learned tasks safely and correctly by discharge
- Assess current knowledge of the patient about the new diagnosis
- Assess for the readiness of learning about the illness of the patient, as sudden changes may affect the ability to absorb or process new information
- Have the patient participate in the development of the teaching plan to make the patient feel useful and participative
- Observe for possible barriers that might be a hindrance to learning such as literacy or educational attainment, so the nurse can adjust to his level accordingly
- Determine the appropriate learning style of the patient to facilitate learning
- Encourage the patient to ask questions and create a learning-friendly atmosphere
- Provide praises and encouragements during learning sessions
- The patient verbalizes accurate information about his condition and treatment
- The patient performs newly learned tasks safely and appropriately
The nursing process is possibly the most significant tool in a nurse’s knowledge kit. This process is a well-established, systematic problem-solving technique based on five easy-to-remember steps with the ADPIE acronym: Assessment, Diagnosis, Planning, Implementation, and Evaluation.
Through practical application of the ADPIE nursing process, nursing professionals can easily determine the needs of their patients, develop an individualized care plan, and promptly provide adequate, effective patient-focused care.
The ADPIE process begins with assessment wherein all the subjective and objective data are gathered. These data allow the nursing professionals to develop nursing diagnoses, which is the second step. Once the nursing diagnosis is identified, nurses will create a nursing care plan with actions and SMART goals for their patients.
These plans should then be acted upon through the process called implementation to achieve the goals of the nursing care plan. Finally, the evaluation process is being done during and after implementation to ensure that the patients have effectively achieved their goals.
These 5 steps are followed in a specific order to ensure appropriate patient care from the start of treatment until the end. Overall, the ADPIE nursing process helps nurses accomplish their finest and be responsible for possible faults and errors throughout patient care.
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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