These five steps are: 1. The nurse must have a critical self-evaluation of his or her knowledge, attitudes and skills. The nurse should also obtain a cultural assessment of the patient's background. The nurse can use the subjective and objective findings of both a physical examination and health history. 2. The nurse should establish goals on which he or she has collaborated with the patient, nurse, family, and other members of the health care team. 3. The nurse should then develop a plan of care. 4. After the care plan has been developed, it should now be implemented. 5. Finally, evaluation of the treatment plan should be carried out. A key element of the five-step process is to include the patient, healthcare team members, and family when establishing a plan of care to implement (Andrews,