Chapter 5 Critical Thinking and the Nursing Process Fundamentals of Nursing: Standards & Practices, 2E

Chapter 5Critical Thinking and the Nursing Process

Fundamentals of Nursing: Standards & Practices, 2E

Copyright 2002 by Delmar, a division of Thomson Learning 5-2

Critical ThinkingCritical thinking is “…reasonable

reflective thinking that is focused on deciding what to believe or do” (Ennis, 1987).


Components of Critical ThinkingMental operationsKnowledgeAttitudes


Phases of Critical ThinkingTrigger eventAppraisal of the eventExplorationIntegration


Promoting Development & Application of Critical Thinking Identify goals Determine what knowledge is required Assess the margin for error Determine the amount of time available

for decision making Identify available resources Recognize factors that may influence

decision making


Critical Thinking SkillsInterpretationAnalysisInfluenceExplanationEvaluationSelf-regulation


Critical Thinking and Creativity Critical thinkers are also creative

thinkers. Creative thinking is the foundation for

individualizing client care. A major block to creativity is groupthink. It takes intellectual courage to think

something different from one’s peers and then act on those thoughts.


Critical Thinking and Problem Solving Critical thinkers avoid pitfalls of problem

solving by defining a problem, analyzing the data, understanding the causes, and creating new ideas that will lead to problem resolution.


Critical Thinking and Decision Making Nurses exercise clinical judgment by making

sound decisions. Clinical judgment is viewed as critical thinking

applied in clinical situations. Nursing judgments are formed after collecting

and examining assessment data. Nursing judgments occur in every phase of the

nursing process.


Nursing ProcessThe nursing process “…provides the

basis for critical thinking in nursing” (Alfaro-LeFavre, 1998).


Historical Perspective Lydia Hall (1955) first referred to nursing

as a “process”. Yura and Walsh (1967) identified four

steps in the nursing process: assessing, planning, implementing, and evaluating.

In 1974, Gebbin and Lavin added nursing diagnosis to the above steps.


Overview of the Nursing Process

A process is a series of steps or acts that leads to accomplishment of some goal or purpose.

The purpose of the nursing process is to provide individualized, holistic, effective, and efficient care to clients.


Steps in the Nursing ProcessAssessment

• Collecting data from a variety of sources

• Validating the data• Organizing data• Categorizing or identifying patterns in

data


• Making initial inferences or impressions

• Recording or reporting data• Types of data

Primary data source Secondary data source Subjective data Objective data


Diagnosis• Diagnosis involves analysis and synthesis of

the data that have been collected.• Formulation of the list of nursing diagnoses

is the outcome of this process.• Nursing diagnoses provide the basis for

client care delivered through the remaining steps of the nursing process.


• Types of nursing diagnoses Actual nursing diagnosis Risk nursing diagnosis Possible nursing diagnosis Wellness nursing diagnosis


Outcome Identification and Planning

• Formulate guidelines that establish the proposed course of nursing action in the resolution of nursing diagnoses

• Develop the client’s plan of care• Planning can begin once the nursing

diagnoses have been developed and client strengths have been identified.


• The planning phase involves several tasks The list of nursing diagnoses is prioritized. Client-centered long- and short-term goals

are written. Specific interventions are developed. The entire plan of care is recorded in the

client’s record.


• Goals are broad statements that describe the intended change in the client’s behavior.

• Expected outcomes are specific objectives related to the goals and are used to evaluate the nursing interventions.

• Nursing interventions are activities that the nurse will execute to enable accomplishment of the goals.


Implementation includes• the execution of the nursing plan of care• nursing activities that have been planned to

meet the goals set with the client• assessment skills, psychomotor skills, and

interpersonal skills• reporting and documentation


Evaluation• determines if the client goals have

been met, partially met, or not met• is an ongoing process• Nurses continually evaluate data in

order to make informed decisions during other phases of the nursing process.

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Chapter 5 Critical Thinking and the Nursing Process Fundamentals of Nursing: Standards & Practices, 2E