A new way of thinking about nursing, thinking like a nurse, and care planning.

Tanner’s Model revolves around four primary actions: Noticing, interpreting, responding, and reflecting. Kind of like ADPIE where we assess, diagnose (nursing diagnosis), plan, implement, and evaluate. Keep in mind that when it comes to healthcare, things don’t tend to line up perfectly into little boxes. Instead, many themes, frameworks, and categories will often blend into another category, theme, or framework.

With Tanner’s Model, you see that “noticing” would incorporate “assessment” from the ADPIE approach. Assessments include patient history, reviewing their chart, understanding previous concerns and outcomes from similar situations; physical assessment, and other data collection.

“Interpreting” informs nurses to take the information gathered during the noticing step and interpret what it might mean for the patient. Potential concerns, potential outcomes, etc., which aligns with the diagnosis and planning portion of ADPIE.

Often, the planning part of ADPIE is misattributed to the implementation piece — planning is identifying the optimal outcome for our patient. For example, we have noticed an increase in falls from a patient; that increase seems to be around the patient needing to use the bathroom. Our plan will then be that our patient will have no falls and that our patient will use the toilet at appropriate intervals for the patient’s need. The planning portion now becomes part of interpreting and helps to inform our responding section within the new model.

Responding is, of course, our implementation piece. Here we come up with the actual nursing interventions. Just to name a few basic interventions:

• Nursing will ensure the patient is toileted after each meal as well as every 2 hours during the daytime, as needed.
• Nursing to ensure bed alarms are in use and working appropriately when patient is in bed.

Reflecting should go without saying; it is the old “Evaluation” piece of ADPIE where we see how the patient has responded to our interventions and see if we need to return to start of the model again to create a new plan with different interventions.

You may wish to look at the Lasater’s Clinical Judgment Rubric to help evaluate your own clinical judgement skills or to help in evaluating and supporting other nurses: See below for attachment of same.