The five steps in the ADPIE nursing process (with benefits)
ADPIE stands for assessment, diagnosis, planning, implementation and evaluation. It summarises the five-step process nurses use to provide proper, standardised care to patients. Nursing schools teach ADPIE as a foundational principle and expect students to apply it throughout their careers whether they work in hospitals, nursing homes or clinical settings. In this article, we define ADPIE and explain each of the five steps.
**Related: 7 types of nursing careers**
What is ADPIE?
The acronym ADPIE often appears in nursing school courses and various standardised tests. Nurses usually follow this guide to provide a care plan that they can tailor and adjust to individual cases. The five-step process typically addresses physical, mental and emotional health problems beginning with initial analysis and diagnosis and ending with a treatment plan. Ida Jean Orlando, an Irish-American nurse and Yale professor, introduced ADPIE to the medical community in the 1960s as a method focused on patient behaviour and improved patient-nurse communication.
The five steps in the ADPIE process
According to Ida Jean Orlando's original intention, the ADPIE steps encourage nurses to record patient complaints and to include patients in treatment planning. It may represent a simple process for some patients and a prolonged process for others. For example, a patient care plan might begin and conclude in a few months or last several years depending on how nurses assess, reevaluate and adjust their ADPIE treatment to meet patient needs. The five steps in the process, which advise nurses on their interactions with patients, include:
When patients check themselves into a hospital or emergency centre and report a specific health problem for the first time, nurses conduct an assessment. Assessment represents the first stage of ADPIE. Nurses usually record the patient's concerns and self-diagnosis at this point, cross-referencing the symptoms against medical databases. They try to identify the patient's problem, taking into consideration health history, psychological state, family interactions, environmental influences and physiological conditions.
Assessments may be brief or relatively prolonged. Nurses interview the patient, observe behaviour and perform examinations. If necessary, nurses may also speak with family members. Nurses might use an assessment to begin treatment for simple problems like dehydration or insomnia, but if the recorded symptoms suggest a more serious concern, they may pass the information on to other medical providers.
Related: 7 types of nursing careers
Nurses often use the data gained from assessments to consider, eliminate or identify potential diagnoses. They rarely begin diagnosis independently, working instead as part of a broader medical team that may include other nurses, physicians, psychologists, chiropractors and surgeons. Once the medical team reaches the appropriate mental, physiological or emotional diagnosis, it might assess the patient's potential risks. These identified risks assist the team as it considers various treatment options and starts to prioritise treatment stages.
Example: A patient arrives at a hospital emergency room. A nurse is usually a patient's first point of contact, initiating the assessment process by asking questions, writing observation notes and doing simple examinations (e.g. temperature reads, coordination tests or medical scans). The nurse typically reports these symptoms to a medical team and may suggest a probable cause for the patient's symptoms, such as dehydration, food poisoning or anxiety. The nurse's notes often assist the doctors who are ultimately responsible for diagnosing serious symptoms or risks.
After the medical team makes a diagnosis, they proceed to the planning stage of ADPIE. Planning represents an important step in the patient's overall treatment as it directs how the medical team carries out the latter stages of implementation and evaluation. If possible, the patient may actively participate in planning treatment, but conditions like mental illness might exclude the patient from serious consultations. Planning often consists of two components, collaboration and goal setting.
Planning patient care involves the collaboration of medical providers at many levels and across a number of disciplines. Each member of a medical team plays a specific role in assisting the patient, though with varying degrees of importance. Nurses, for example, may provide information on a patient's allergies, personal concerns and medical history as doctors consider drug treatment options. A patient care team may include general practitioners, physicians, anesthesiologists, psychologists, nurses and medical assistants.
The planning stage typically concludes with health care providers setting up a combination of short-term and long-term goals for the patient. Short-term goals are typically achieved within hours or days and thus receive immediate priority. Long-term goals refer to those that may take weeks or months as part of a broader procedure. Health care providers often use SMART goals during the planning stage to stay motivated and monitor their progress. SMART goals refer to specific, measurable, achievable, relevant and time-bound actions.
The medical team often communicates care plans and intervention strategies to the patient on a continual basis to ensure the patient participates in the treatment process. Patients may share their hesitations, preferences and personal care goals. Nurses might speak with the patient's family to help them follow the plan and resolve their questions throughout the process. After the medical team designs a care plan, they move forward with its implementation.
Health care providers proceed with implementation by following SMART goals. This step involves a combination of direct care and indirect care. Direct care involves specific interaction with the patient, such as coaching for mobility problems, performing physical care treatment, conducting medical scans, suggesting exercises and assisting with normal living activities. Indirect care involves treatment that affects the patient in less obvious ways, such as when a nurse monitors other medical staff, delegates responsibilities or speaks on behalf of the patient.
The implementation stage includes revision and reevaluation. If the members of the medical team have any concerns, they might suggest changes to the overall plan. Nurses directly involved with patient treatment often present new information to the medical team during this step. Some common procedures in the implementation stage include:
checking and documenting vital signs
verbally communicating with the patient to evaluate the efficiency of the medical team's care plan
administering medications to the patients as prescribed by the treating physician
performing diagnostic tests
engaging medical equipment when necessary to provide treatments and assistance
In the evaluation stage, the care team assess the progress of their treatment plans. Usually, evaluation overlaps with the other stages of ADPIE. Nurses and other health care providers perform evaluations repeatedly to monitor the patient's condition. They might decide to keep certain aspects of the plan and revise other ineffective aspects.
In some cases, evaluation represents the final stage in which a patient's cured and returns home. In other situations, the evaluation stage finds an error in diagnosis, planning or implementation. In this case, the medical team usually returns with the new information and tries again. If the medical team performs its evaluation correctly, it may find the appropriate course of action to assist the patient.
How to improve your nursing skills
Nurses hoping to improve their skills may find a number of options for training, experience and practice. To advance in their careers, they may explore the options below:
1. Find mentors
Maintain relationships with nursing teams, physicians and clinical staff. Experienced medical professionals usually provide practical guidance, answer questions and introduce you to other training routes. Some mentors may also remember you when promotions and other opportunities arise. Establishing mentoring relationships may support your long term career development and job security.
2. Continue your education
You can acquire additional degrees or certifications from nursing schools to continue your education. Formal education provides official training, which supervisors in charge of hiring and promotions usually appreciate. Many health care employers seek nurses with college-level nursing degrees such as a Bachelor of Science in nursing or a Master of Science in nursing. Advancing your career with additional qualifications like a formal degree might also demonstrate your passion for your career and your ability to improve in your role.
3. Stay informed on industry topics
Keep informed on nursing trends and technology. You might participate in workshops, subscribe to an industry publication or attend health care seminars. Some of these options might offer formal certifications as well. By taking part in activities related to the nursing industry, you may also demonstrate your eagerness for career advancement.
4. Practice communication skills
Try to communicate clearly with staff and patients and practice active listening on a regular basis. You might learn active listening techniques or learn how to incorporate critical feedback into your work. Be willing to speak with supervisors and ask their opinions. Good communication also conveys your leadership and teamwork skills to others.