Nursing Process
Defining the Terms:
o Critical thinking
o Problem solving
o The nursing process
o Decision making
Critical Thinking and Practicality
• If this process were performed in a random manner, patient outcomes would suffer.
• Critical thinking is a crucial skill in the administration of safe and competent nursing
care.
Evidence Based Practice, critical thinking and the Nursing Process
• Analyze: this includes trying to understand the relationship between different aspects of
the problem. For example, if you are working with a patient complaining of significant
pain, you should differentiate the level of pain and the normal level for this patient.
• Apply standards: this refers to using established recommended practices or professional
guidelines such as the AORN Standards of Practice & Joint Commission.
• Discriminate: this refers to prioritizing essential functions over nonessential functions.
• Gather information: this takes into account data and information that is acquired during
patient assessment including any deviations from normal. Related information is
grouped together in order to identify warning signals, symptoms and trends
• Evidence based practice is another hot buzz word in nursing that has really
been talked about a lot over the last 10 or so years.
• Definition:
• Evidence based practice (EBP) is the conscientious use of current best evidence
in making decisions about patient care (Sackett, Straus, Richardson,
Rosenberg, & Haynes, 2000).
• It is a problem solving approach to clinical practice and administrative issues
that integrates:
• A systematic search for and critical appraisal of the most relevant evidence to
answer a burning clinical question
• One's own clinical expertise can and should be used
• Emphasis should be placed on Patient preferences and values
• Draw conclusions or inferences: this refers to interpretation of the data and
information. For example, say a patient demonstrates moderate changes in vital signs,
with a decrease in urinary output and pale skin. Using available data and nursing
instinct, it could be inferred that the patient has active blood loss which would be an
appropriate inference for the given data (Lipe & Beasley, 2005).
, • Predict: based on the observations, experience and conclusions, you indicate in advance
what will take place. This might be the expected outcome.
• Transform knowledge into successful solutions: the data and information gathered
should be compared with past experience and nursing theories to help ensure accuracy
in clinical practice
The Nursing Process
• Assessment: this involves the collection and interpretation of data to be used in
developing a nursing diagnosis. This would include an assessment of the nurse’s patients
with a focus on the problems that caused their hospital admissions. For example if they
were admitted for myocardial infarction, they should be checked for chest pain or
dyspnea.
• Diagnosis: this step is the process of identifying and classifying data collection during
assessment in order to develop the plan of care. Accepted nursing diagnosis came from
the North American Nursing Diagnosis Association International (NANDA-I). A nursing
diagnosis sets the stage for determining patient outcomes.
• Outcome identification: once the nursing diagnosis is determined the perioperative
nurse identifies the desired outcome. The outcome is measureable and provides
direction for outlining a plan of care.
• Plan: after collecting and interpreting the data, identifying the nursing diagnosis and
desired outcome a plan of care is developed and communicated to the team.
• Implementation: put the plan into action, in other words, perform the nursing activities
and interventions and respond with critical thinking. This step is where the standards,
guidelines and best practices are implemented.
• Evaluation: this entails checking, observing and appraising the results of interventions
taken during the implementation phase.
• Modification: both the problem solving process and the nursing process are cyclical. If
the process is not effective, then all of the steps must be reexamined and modified and
a new course of action is implemented.
Nursing Care Plans
• Written guidelines for client care
• Lend credibility to the science of nursing
• Organized so nurse can quickly identify nursing actions to be delivered
• Coordinates resources for care
• Enhances the continuity of care
• Organizes information for change of shift report
Defining the Terms:
o Critical thinking
o Problem solving
o The nursing process
o Decision making
Critical Thinking and Practicality
• If this process were performed in a random manner, patient outcomes would suffer.
• Critical thinking is a crucial skill in the administration of safe and competent nursing
care.
Evidence Based Practice, critical thinking and the Nursing Process
• Analyze: this includes trying to understand the relationship between different aspects of
the problem. For example, if you are working with a patient complaining of significant
pain, you should differentiate the level of pain and the normal level for this patient.
• Apply standards: this refers to using established recommended practices or professional
guidelines such as the AORN Standards of Practice & Joint Commission.
• Discriminate: this refers to prioritizing essential functions over nonessential functions.
• Gather information: this takes into account data and information that is acquired during
patient assessment including any deviations from normal. Related information is
grouped together in order to identify warning signals, symptoms and trends
• Evidence based practice is another hot buzz word in nursing that has really
been talked about a lot over the last 10 or so years.
• Definition:
• Evidence based practice (EBP) is the conscientious use of current best evidence
in making decisions about patient care (Sackett, Straus, Richardson,
Rosenberg, & Haynes, 2000).
• It is a problem solving approach to clinical practice and administrative issues
that integrates:
• A systematic search for and critical appraisal of the most relevant evidence to
answer a burning clinical question
• One's own clinical expertise can and should be used
• Emphasis should be placed on Patient preferences and values
• Draw conclusions or inferences: this refers to interpretation of the data and
information. For example, say a patient demonstrates moderate changes in vital signs,
with a decrease in urinary output and pale skin. Using available data and nursing
instinct, it could be inferred that the patient has active blood loss which would be an
appropriate inference for the given data (Lipe & Beasley, 2005).
, • Predict: based on the observations, experience and conclusions, you indicate in advance
what will take place. This might be the expected outcome.
• Transform knowledge into successful solutions: the data and information gathered
should be compared with past experience and nursing theories to help ensure accuracy
in clinical practice
The Nursing Process
• Assessment: this involves the collection and interpretation of data to be used in
developing a nursing diagnosis. This would include an assessment of the nurse’s patients
with a focus on the problems that caused their hospital admissions. For example if they
were admitted for myocardial infarction, they should be checked for chest pain or
dyspnea.
• Diagnosis: this step is the process of identifying and classifying data collection during
assessment in order to develop the plan of care. Accepted nursing diagnosis came from
the North American Nursing Diagnosis Association International (NANDA-I). A nursing
diagnosis sets the stage for determining patient outcomes.
• Outcome identification: once the nursing diagnosis is determined the perioperative
nurse identifies the desired outcome. The outcome is measureable and provides
direction for outlining a plan of care.
• Plan: after collecting and interpreting the data, identifying the nursing diagnosis and
desired outcome a plan of care is developed and communicated to the team.
• Implementation: put the plan into action, in other words, perform the nursing activities
and interventions and respond with critical thinking. This step is where the standards,
guidelines and best practices are implemented.
• Evaluation: this entails checking, observing and appraising the results of interventions
taken during the implementation phase.
• Modification: both the problem solving process and the nursing process are cyclical. If
the process is not effective, then all of the steps must be reexamined and modified and
a new course of action is implemented.
Nursing Care Plans
• Written guidelines for client care
• Lend credibility to the science of nursing
• Organized so nurse can quickly identify nursing actions to be delivered
• Coordinates resources for care
• Enhances the continuity of care
• Organizes information for change of shift report
