CLINICAL DECISION MAKING &

THE
NURSING PROCESS
NRS 110

Critical Thinking Revisited

Knowledge
Experience
Reflection
Intuition

Components of Critical Thinking in

Nursing

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?

Maslows 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.
Its 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)