CLINICAL DECISION MAKING &
THE NURSING PROCESS
NRS 110
Critical Thinking Revisited
• Knowledge
• Experience
• Reflection
• Intuition
Components of Critical Thinking in
Nursing
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Specific Knowledge Base
Experience
Critical Thinking Competencies
Diagnostic Reasoning
Clinical Decision Making
Nursing Process
Critical Thinking Attitudes
Critical Thinking Standards
Intellectual Standards
Professional Standards
Clinical Decision Making
• Critical thinking process for choosing
the best actions to meet a desired goal
• To act or not to act, that is the question!
• Criteria used to make decisions
• Collaboration
• Problem Identification
• Who is responsible for making the
decision?
Level of Critical Thinking
• Basic
• Complex
• Commitment
NURSING PROCESS
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
The nursing process in action
Step One: Assessment
• Collect data (Types of data, Sources of
data, Methods of data collection)
• Organize data
• Validate the data
• Record & report
Step 2: Diagnosis
• Analysis of
assessment data
leads to problem
identification
• NANDA list
• Types of nursing dx.
Anatomy of a Nursing Diagnosis
• Problem (Diagnostic label)
• Etiology (Related factors and Risk
factors)
• Defining Characteristics
• Differentiating Nursing Diagnoses from
Medical Diagnoses
• Differentiating Nursing Diagnoses from
Collaborative Problems
The Diagnostic Process
• Analyzing data: Compare data against
standards, cluster data, identify gaps
and inconsistencies in data
• Identify health problems, determine
problems and risks, determine
strengths
Formulating Diagnostic Statements
Step 3: Planning
• Set priorities
• Apply standards
• Identify goals &
outcomes
• Select interventions
• Record the plan
(nursing care plan)
What are the priorities?
Maslow’s Hierarchy of Basic
Human Needs
Guidelines for Writing Goal
Statements
• Write goals in terms of client responses
• Be sure the desired outcomes are
realistic and compatible with ordered
therapies
• Make sure that each goal is derived
from only one nursing diagnosis
• Use observable, measurable terms for
outcomes
• Involve the client in the process
CONCEPT MAP Ineffective
Airway Clearance (Gas Exchange)
Step 4: Implementation
• Put your plan into
action
• Perform the
interventions
• Note patient
response to
interventions
• Record & report
Types of Interventions
• Independent (nurse initiated)
• Dependent (physician initiated)
• Collaborative
Step 5: Evaluation
• Did the plan work?
• Was goal achieved?
• What was the
outcome of the care
provided.
• Stated in
measurable terms.
• It’s all about
outcomes!
Case Scenario
• A.A. is an 28 y.o. female who was admitted
with pneumonia. She presents with
complaint of cold x 2 weeks, dyspnea on
exertion, , orthopnea, decreased oral intake.
Assessment of patient reveals:
• T 103F, P 92, R 22 shallow, BP 122/80
• Dry mucous membranes, hot pale skin
• Decreased breath sounds, inspiratory
crackles
• Ineffective cough-coughing up thick pink
sputum
• Lethargic, c/o being weak
Now lets write the plan down!
Concept Map Steps
• Place your main issue/problem in the middle
• Determine key problems/concepts that have
a direct relationship to the main problem
• Add clinical data to appropriate problem
boxes
• Draw lines between related problems. Label
with a nursing diagnosis
• Identify goals/outcomes
• Add interventions
• Evaluate patient response to interventions
CONCEPT MAP Ineffective
Airway Clearance (Gas Exchange)