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Chapter 1
Critical Thinking and
the Nursing Process
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Competencies
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Describe how nursing is both an art and a
science.
Discuss the components of critical
thinking.
Apply the universal intellectual standards
to the critical thinking process.
Define the nursing process.
Describe the six steps of the nursing
process.
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Art of Nursing
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Incorporate aspects of caring and
sharing into practice.
Role of intuition, “intuitive links”
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Science of Nursing
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Analytical thinking
Based on scientific principles and
research data
Reflective thinking: art and science
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Critical Thinking
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Purposeful, goal-directed thinking
process that strives to problem solve
patient care issues through the use
of clinical reasoning
Combines logic, intuition, and
creativity
Essential to nursing practice
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Clinical Reasoning
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Disciplined, creative, and reflective
approach
Used concurrently with critical
thinking
Purpose—establish potential
strategies for patients to reach their
desired health goal
Essential to nursing practice
(continues)
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Clinical Reasoning
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Key elements (Paul & Elder, 2000)
Purposeful
Problem-solving strategy
Based on assumptions
(continues)
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Clinical Reasoning
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Conducted from some point of view
Based on data, information, and
evidence
Expressed through, and shaped by,
concepts and ideas
Implications and consequences
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Components of
Critical Thinking
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Interpretation
Analysis
Inference
Explanation
Evaluation
Self-regulation
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Interpretation
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Decode hidden messages
Clarify the meaning of information
Categorize information
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Analysis
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Examines ideas and data
Identifies discrepancies
Reflects on reasons for
discrepancies
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Inference
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Speculates
Derives
Reasons
Skill developed with experience
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Explanation
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Requires that conclusions drawn
from inferences are correct and can
be justified
Scientific and nursing literature
serve as basis for clinical
justification
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Evaluation
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Examines the validity of the
information
Leads to final conclusion that can be
implemented
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Self-Regulation
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Reflects on critical thinking skills
and determines what techniques
were effective and which were
problematic
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Universal Intellectual
Standards for Critical
Thinking
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Clarity
Accuracy
Precision
Depth
Breadth
Logic, applied to clinical reasoning
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Nursing Process
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Assessment
Diagnosis
Planning
Outcome identification
Implementation
Evaluation
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Assessment
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First step in nursing process
Purpose
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Sources of information
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Identifies the patient’s current health
status
Actual and potential health problems
Areas for health promotion
Health history
Physical assessment
Diagnostic and laboratory data
Dynamic phase
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Health History
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Gathers subjective data from the
patient
Information may or may not be
validated by physical assessment
findings
(continues)
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Health History
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Possible sources of information
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Patient
Family
Neighbors
Friends
Bystanders
Old charts
Medical records
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Physical Assessment
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Objective data
Observable, measurable data
Possible approaches—body
systems, head to toe, or functional
health patterns
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Diagnostic and
Laboratory Data
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Objective data
May include items such as: blood
and urine studies, cultures, X rays,
and diagnostic procedures
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Diagnosis
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Second step in nursing process
Describes conditions treated by
nurses
North American Nursing Diagnosis
Association (NANDA)
Provides the basis for selection of
nursing interventions to achieve
outcomes for which the nurse is
accountable
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Collaborative Problem
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Requires the nurse to work
jointly with the physician and
other members of the health
care team in monitoring,
planning, and implementing
patient care
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Planning
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Third step in nursing process
Prioritization of nursing diagnoses
Framework to assist prioritization
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Maslow’s hierarchy of needs
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Outcome Identification
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Fourth step in the nursing process
Establish patient goals
Develop patient outcomes
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Short-term
Long-term
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Intervention Selection
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Independent nursing interventions
Collaborative interventions
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Implementation
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Fifth step in nursing process
Nurse executes the interventions
that were devised during the
planning stage
Dynamic process
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Evaluation
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Sixth step in nursing process
Determine patient’s progress in
achieving outcomes
Continual and dynamic process
Evaluate each outcome separately
Document if outcome achieved or
not achieved
May result in revising the plan of
care
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Critical Pathways
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Show the outcome of predetermined
patient goals over a period of time
State what activity the patient
should be capable of completing on
a daily basis
Critical incidents
Variance
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Documenting
the Nursing Process
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Methods
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SOAPIER
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Subjective
Objective
Assessment
Plan
Implementation
Evaluation
Revision
(continues)
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Documenting
the Nursing Process
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PIO
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Problem
Intervention
Outcome
(continues)
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Documenting
the Nursing Process
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DAR
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Data
Action
Response
PIE
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Problem
Intervention
Evaluation
(continues)
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Documenting
the Nursing Process
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CBE
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Charting by exception
Focus
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Specific to client’s primary diagnosis
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