What Are the Components of Care in Nursing?

Nurses always strive to deliver high-quality care and assistance to patients in healthcare settings. In order to achieve this crucial objective, care needs to be comprehensive and standardized, yet transparent.

For this reason, registered nurses create care plans for patients based on five core components. These components, which form a step-by-step list, ensure that every action is taken to the best of their abilities and backed up by evidence. Experts claim these principles are essential for safe, holistic care.

The five core components are assessment, diagnosis, planning, implementation or action, and evaluation. Nurses will move through each of these stages to deliver the best possible care during a shift and to help them to achieve specific goals that improve patient outcomes.

This process appears quite laborious at first, but with experience, nurses will be able to undertake these tasks and make important decisions more naturally.

These components also make up a broader care plan for patients. Care plans are vital in healthcare as they promote evidence-based nursing, record and measure actions, and provide a clear and documented version of events for nurses and other healthcare professionals to refer to and work from.

Equally important is their usefulness for identifying and working through problems and challenges. They also allow nurses to evaluate the actions taken so they can revise care and support to help the patient in future shifts.

Nurses can learn the skills required to create and implement care plans effectively by enrolling in one of the reputable accelerated BSN nursing programs that are available online.

If you already have a bachelor’s degree in any subject but are now interested in entering the healthcare industry, you can apply for a nursing degree such as an Accelerated Bachelor of Science in Nursing (ABSN).

Many of these degrees are ‘fast-tracked’ which means you will be able to earn a BSN in less than two years and complete most of your coursework and assessments online so you will not have to relocate to a physical campus. After graduating you will then be able to take an RN licensure exam (NCLEX-RN) to get a license to work in states across the country.

When attending nursing school, you will become very familiar with the core components of care in nursing and how to follow and uphold them when working in hospitals and other professional settings.

These components have become standardized for a reason as they have been proven to deliver excellent care and overall support to patients.

While each of these phases will be different depending on the patient, illness, and treatment, the broader framework remains unchanged and is seen as an essential means to providing high-quality, round-the-clock care.

Assessment phase

Creating a care plan for a patient is of the utmost importance as this will provide structure and efficiency to the support they get thereafter, and perhaps most importantly, ensure they get the right care needed to get back to full health.

The first phase, therefore, is centered around client assessment. Doctors and nurses will conduct tests, analyze medical results, and sift through all the data collected in a patient’s medical history to find the best way to proceed.

This objective data is then supplemented by subjective thoughts and opinions, which may not carry equal weight but will provide additional context and information.

An example of how this process might work is when a nurse analyzing a patient with heart problems may look at oxygen saturation trends on a graph, which is objective data, and then use subjective input from another nurse such as comments about a patient using accessory muscles to breath correctly during the night.

Doctors and nurses generally categorize these assessments into 12 different areas. These are:

• Physical
• Emotional
• Cultural
• Environmental
• Sexual
• Psychosocial
• Cultural
• Spiritual
• Cognitive
• Functional
• Age
• Economic

All this information can be used to make a proper assessment. It is important to note, these assessments are different from a formal medical diagnosis. A nurse aims to provide the best possible care during a shift or over several days.

They generally spend more time with patients and are more directly involved in smaller tasks and maintaining care. The mantra that “nurses treat the illness while doctors treat the disease” is an important distinction to note.

Diagnosis phase

This point leads into the second phase. After assessing the findings, a physician will have provided a medical diagnosis. It is then the responsibility of a nurse, using the information gathered during the assessment phase, to address the issues and problems at hand.

A nurse needs to provide the best possible care during a shift and will do everything they can to prioritize a patient’s needs. They might diagnose that there is a risk of impaired mobility, disturbed sleep patterns, or urinary retention.

A diagnosis in this context describes a patient’s health status and what has contributed to it. It will also begin to ‘rank’ or sort through the problems based on how critical they are. Nurses will obviously focus on anything that is a mortality risk, and work down from there.

For example, making sure a patient can breathe properly is more important than their mobility. Nurses often refer to Maslow’s hierarchy of needs to ensure they are prioritizing the right areas and abilities. Doing this at the start of a shift enables nurses to anticipate challenges and make fast, effective decisions for the highest quality of care.

The diagnosis phase will also see both short-term and long-term expected patient outcomes covered. While nurses will concentrate their efforts on the immediate shift at hand, they will also have one eye on how things could potentially develop in the future. When everything has been outlined, they can start putting a plan into action.

Planning phase

The planning phase is also called the outcomes phase as it flows from the assessment and diagnosis phases, using the information and decisions made during those phases to come up with an effective plan of action.

This phase is defined by the American Nurses Association as the stage where “the registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes”.

Nurses will create goals based on the diagnosis and factor in principles like safety, dignity, privacy, and communication. Patient safety is obviously critical so any plan will prioritize this, depending on the situation.

Using the example of a patient with acute respiratory failure, a nurse in this situation will plan everything around ensuring airways are clear and that the patient can breathe properly.

A plan will require goals linked to specific metrics or results. For example, a nurse might want to ensure a patient struggling with a lung issue can maintain an oxygen saturation level of above 90%.

They can then move from this to addressing other issues if they are present. For each issue, nurses should provide a simple, achievable goal that will improve care quality and help the patient to get better. Nurses focus on the short-term here as they work through each shift.

Implementation phase

In order to achieve the listed goals during a shift, nurses need to set out a series of ‘action items’. The action or implementation phase is characterized by nursing interventions that should be documented in the care plan.

These interventions will help to achieve goals and provide the support, care, and assistance that patients need. Using the acute respiratory failure example again, interventions here might require a nurse to change of flow of titrate oxygen to optimize saturation levels during a shift.

Each action item should be linked to the diagnosis and planning aspects of the care plan as this will make everything clear and transparent, both for nurses during a shift and for doctors when they refer to it.

Documenting the plan will also ensure continuity of care for the patient across shifts and departments. Nurses should also provide a rationale for their interventions as this ensures medical care is administered based on the best possible evidence and information. This is part of evidence-based practice (EBP) which is cited as an indicator of high-quality care.

Again, achieving short-term goals is usually a priority here but nurses will take future events into consideration to ensure they are taking the right steps for the patient’s needs.

One example of where interventions might have to be tweaked or changed is when a patient is undergoing surgery within the next 24 hours. A nurse might have to follow a nothing-by-mouth (NPO) instruction to withhold food and water so the procedure is not delayed.

Evaluation phase

After a plan has been outlined and implemented, it is then time to evaluate the whole process and determine whether it was successful based on the outcomes. Nurses can classify each intervention into three categories based on whether the patient’s condition improved, stabilized, or deteriorated.

They will use the critical thinking skills they have acquired during their degree and nurtured on the job to analyze objective data and make a final evaluation.

Obviously, it is a natural part of the care that outcomes are not always desirable through no fault of the care team. However, when expected outcomes have not been realized, nurses will need to consider how the care plan can be revised in the future.

Evaluation and reassessment is always ongoing task until a patient is discharged, as things can change every time a nurse interacts with a patient, has a meeting with a physician or gets new test results. This can lead to the emergence of higher-priority goals which will then need to be planned and implemented.

To support the evaluation, nurses can also look beyond outcomes and list anything that occurred unexpectedly and any unforeseen challenges that arose. They can also review the goals and time frames that were listed in the plan.

Were these realistic and did they lead to the expected outcomes? Time frames are very important in the context of care plans as outcomes will generally need to be achieved within 12, 24, 36, and 46-hour time span depending on the goal.

In addition to the five components of care that ensure a plan is recorded, measured, and implemented effectively and transparently, there are also five ‘principles’ of care. These principles will inform and feed into many of the decisions that are made when creating a plan and putting it into action.

One principle that has already been referenced is patient safety, but nurses should also consider four other principles — dignity, independence, privacy, and communication.

The five principles of care

Patient safety is, of course, always a major consideration, not least during the planning and implementation phases.

Nurses will again use the critical thinking and clinical judgment skills they have learned at university and during rotations to assess whether certain action items should go ahead or be altered to mitigate the risk of further injury and ensure the patient is safe.

More general safety precautions need to be adhered to as well, such as cleaning and the regular washing of hands. Nurses will need to take some of these measures to prevent infections on the ward.

The next principle is the dignity of the patient. Communicating with patients with respect and compassion is very important, as it is easy for their self-esteem and morale to drop when they are laid up in the hospital.

Nurses should treat patients with respect, listen to their opinions and views, and take things they are saying on board. While these views should not factor heavily into the actions taken, nurses should always be upfront and open about what is happening. Ensuring patients’ bodies are covered appropriately is also important.

Dignity is also linked to the third principle — independence. Nurses can encourage patients to remain independent of body and spirit by urging them to do certain tasks themselves and allowing them to be physically active where possible.

Patients can begin to feel restless and helpless when they are cared for incessantly so nurses should always try to prevent any immediate mental and physical declines.

The fourth principle is privacy. Patients expect that their medical histories and procedures will not be discussed with other people outside of the immediate care team.

Finally, nurses will need to communicate regularly with patients about everything that is going on and to involve them, where necessary, in the decisions that will be made during the care plan. Talking and listening and being approachable and kind will create an environment where the patient is more at ease and content with the support and care they are receiving.

Key skills

In addition to the core components and principles already outlined, nurses will also have to demonstrate several key skills during the plan to ensure the right decisions are made.

Two very important skills nurses will use regularly are critical thinking and clinical reasoning. Critical thinking is defined as “objective analysis and evaluation” with a view to making an informed judgment. Nurses will most likely be deploying critical thinking during each phase of the care plan.

There are certain mindsets and attitudes that are central to critical thinking, such as independence of thought, fair-mindedness, and intellectual curiosity. Nurses are not expected to simply follow orders when implementing a care plan.

They will need to use critical thinking to make decisions and take additional steps to ensure high-quality care is administered. These attitudes will be cultivated when earning a degree and during placements, but they also should continue into work settings.

Clinical reasoning is like critical thinking but is defined as the use of both formal and informal thinking to evaluate evidence and formulate strategies. This cognitive process will again need to be developed over time and it is something that nurses will find easier and more natural as they gain knowledge and experience.

Nurses will use both critical thinking and clinical reasoning to make a clinical judgment that aims to generate the best solutions for patient care.

Two other skills that will play a part in this process are inductive reasoning and deductive reasoning. Inductive reasoning uses a set of specific observations and logical thinking to make a generalized conclusion.

Deductive reasoning goes in the oppositive direction, using general observations for specific conclusions. Both can contribute to evidence-based practice in nursing.

To conclude, the five components of nursing that are used for creating safe, high-quality care plans are assessment, diagnosis, planning, implementation, and evaluation. Each of these phases requires nurses to use a range of skills, principles, and abilities to make informed decisions with the aim of improving the patient’s health and achieving goals.

Nurses can learn how to move through each of these stages and deploy critical thinking and other key skills by earning a degree and completing clinical rotations. After graduation, nurses will become more familiar with how to create plans and implement interventions to achieve positive outcomes.

These components are the cornerstone of high-quality care, and they will eventually become second nature for nurses to reference throughout their careers.