Chapter 11
Blended Skills and Critical
Thinking Throughout the Nursing
Process
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Historical Development of the Nursing
Process
• 1955—nursing process term used by Hall
• 1960s—specific steps delineated
• 1967—Yura and Walsh published first comprehensive
book on nursing process
• 1973—ANA Congress for Nursing Practice developed
Standard of Practice
• 1982—state board examinations for professional nursing
uses nursing process as organizing concept
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Five Steps of the Nursing Process
• Assessing—collecting, validating, and communicating of
patient data
• Diagnosing—analyzing patient data to identify patient
strengths and problems
• Planning—specifying patient outcomes and related
nursing interventions
• Implementing—carrying out the plan of care
• Evaluating—measuring extent to which patient achieved
outcomes
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Question
Which step of the nursing process is a nurse using when
she analyzes patient data to determine her patient’s
strengths following a CVA?
A. Assessing
B. Diagnosing
C. Planning
D. Implementing
E. Evaluating
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Answer
Answer: B. Diagnosing
Rationale:
The diagnosing step involves analyzing patient data to
determine strengths and weaknesses.
The assessing step refers to the collection, validation,
and communication of patient data.
In the planning step, the nurse determines patient
outcomes and related nursing interventions and in the
Implementing step the nurse carries out the plan.
When evaluating, the nurse measures the extent to
which the patient achieved outcomes.
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The Steps of the Nursing Process
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Question
Which of the following characteristics of the nursing
process describes the interaction and overlapping of
steps within the process itself?
A. Systematic
B. Dynamic
C. Interpersonal
D. Universally Applicable
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Answer
Answer: B: Dynamic
Rationale:
The nursing process is dynamic in that there is much
interaction and overlapping of the steps.
It is systematic since it is an ordered sequence of
activities.
Interpersonal refers to the human being at the heart of
nursing.
The nursing process is universally applicable in that it is a
framework for all nursing activities.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Characteristics of the Nursing Process
• Systematic—part of an ordered sequence of activities
• Dynamic—great interaction and overlapping among the
five steps
• Interpersonal—human being is always at the heart of
nursing
• Outcome oriented—nurses and patients work together to
identify outcomes
• Universally applicable—a framework for all nursing
activities
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Problem Solving and the Nursing Process
• Trial-and-error problem solving
• Scientific problem solving
• Intuitive thinking
• Critical thinking
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Question
Tell whether the following statement is true or false.
Critical thinking occurs when a nurse directly apprehends
a situation based on its similarity or dissimilarity to other
situations.
A. True
B. False
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Answer
Answer: B. False
Intuitive thinking occurs when a nurse directly
apprehends a situation based on its similarity or
dissimilarity to other situations.
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Benefits of the Nursing Process
• Patient
– Scientifically based, holistic individualized patient
care
– Continuity of care
– Clear, efficient, cost-effective plan of action
• Nurse
– Opportunity to work collaboratively with other
healthcare workers
– Satisfaction of making a difference in lives of patients
– Opportunity to grow professionally
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Four Blended Skills
• Cognitive skills—make sense of the situation and grasp
what is necessary to achieve goals
• Technical skills—manipulate equipment skillfully to
produce desired outcome
• Interpersonal skills—establish and maintain caring
relationships that facilitate achievement of goals
• Ethical/legal skills—personal moral code and professional
role responsibilities
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Question
A nurse’s personal moral code is to assist all patients to
the best of her ability. What blended skill would she use
when seeking out special services for a homeless patient
with a diabetic foot ulcer?
A. Cognitive
B. Technical
C. Interpersonal
D. Ethical/Legal
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Answer
Answer: D. Ethical/Legal
Rationale:
Using ethical/legal skills is the best answer as it involves
following a moral code and acting professionally.
Cognitive skills involve thinking through a situation to
achieve outcomes.
Technical skills relate to the proper use of equipment.
Interpersonal skills are used to develop caring
relationships.
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Cognitively Skilled Nurses
• Offer scientific rationale for patient plan of care
• Select nursing interventions most likely to yield desired
outcomes
• Use critical thinking to solve problems creatively
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Technically Skilled Nurses
• Use technical equipment with competence and ease to
achieve goals with minimal distress to patients
• Creatively adapt equipment and technical procedures to
needs of patients in diverse circumstances
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Interpersonally Skilled Nurses
• Use interactions with patients and significant others and
colleagues to affirm their worth
• Elicit personal strengths and abilities of patients to
achieve health goals
• Provide the healthcare team with knowledge about
patient goals and expectations
• Work collaboratively with healthcare team as respected
and credible colleagues
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Ethically and Legally Skilled Nurses
• Are trusted to act in ways that advance interests of
patients
• Are accountable for the practice
• Act as effective patient advocates
• Mediate ethical conflict among patient, significant others,
and healthcare team
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Considerations When Posed With a
Thinking Challenge
• Purpose of thinking
• Adequacy of knowledge
• Potential problems
• Helpful resources
• Critique of judgment/decision
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Characteristics of Interpersonal Caring
• Promotion of dignity and respect of patients
• Centrality of the caring relationship
• Mutual enrichment of both participants in the nursepatient relationship
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Developing Ethical/Legal Skills
• Developing accountability
• Reporting incompetent, unethical, or illegal practice
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Steps in Concept Map Care Planning
• Develop a basic skeleton diagram
• Analyze and categorize data
• Analyze nursing diagnoses relationships
• Identify goals, outcomes, and interventions
• Evaluate patient’s responses
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Question
Tell whether the following statement is true or false.
Concept mapping is an instructional strategy that
requires learners to identify, graphically display, and link
key concepts.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: A. True
Concept mapping is an instructional strategy that
requires learners to identify, graphically display, and link
key concepts.
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Critical Thinking and Clinical Reasoning
• Is purposeful, informed, outcome-focused thinking
• Is driven by patient, family, and community needs
• Is based on principles of nursing process and scientific
method
• Uses both intuition and logic, based on knowledge, skills,
experience
• Requires strategies that make the most of human
potential
• Is constantly reevaluating, self-correcting, and striving to
improve
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