An active, organized, cognitive process used 

to carefully examine one’s thinking and the 

thinking of others

Responsible for making accurate & appropriate decisions

• Separates professional nurses from technical personnel.

• Test & refine nursing approaches, learn from successes and 

failures, & apply new knowledge 

• Is guided by professional standards and ethics codes.

• Improve problems in patient care.

Basic Critical Thinking

• Concrete based on a set of rules

• Not enough experience to individualize

• Early step in developing reasoning

• Accepts diverse opinions and values 

• Weak competencies, inflexible attitudes, restrict ability 

to move to next leve

Complex Critical Thinkin

• Thinkers separate self from experts

• Analyze and examine choices independently

• Look beyond expert opinion 

• Each solution has benefits and risks

• More creative and innovativ

Commitment Critical Thinking

• Anticipates need to make choices 

• Accept accountability for decisions

• Choose an action or belief based on alternatives 

• Delay an action until a later tim

Scientific Method

• Uses reasoning

• Used by nurses when testing research questions in 

nursing practice situation

– Problem identification

– Collection of data

– Formulation of a research question or hypothesis

– Testing the question or hypothesis

– Evaluating results of the test or stud

Problem Solving Competencies

Decision making Competencies

Diagnostic Reasoning

Assigning meaning to the behaviors, physical 

signs and symptoms

Inference

 Drawing conclusions from related pieces of 

evidence

Clinical Decision Making

• Focuses on defining patient problems and 

selecting appropriate treatment

1.  Knowledge base

2.  Experience

3.  Critical thinking competencies 

4.  Attitudes

5.  Standard

1.  Ethical criteria for nursing judgment

2.  Criteria for evaluation

3.   Professional responsibility

 A tool used to clarify concepts through reflection by 

thinking back or recalling situation

– A visual representation of client problems and 

interventions that illustrates an interrelationship

 The traditional critical thinking competency that allows 

nurses to make clinical judgments and take actions 

based on reason

Assessment

Diagnosis

Planning

Implementation

Evaluation

– Observational overview

– Structured database format example: 

– Focused AssessmentA

– Patient

– Family and significant others

– Health care team

– Medical records

– Other records and literature

– Nurse’s experience

—information the patient tells you (or 

what the patient’s family tells you)

– “I have a headache”

– My husband says he has a headache

 the findings resulting from direct 

observation (what you see, hear, & touch)

– Blood Pressure 122/68

– Pt restless

– WBC 12,000

– Lungs: crackles bilaterally

• Interview 

– An organized conversation with the patient

• Nursing health history

– Data about the patient’s current level of wellness

- The name of nursing diagnosis as approved by NANDA international.

- descriptors used to give additional meaning to diagnosis. 

- ex:- impaired, compromised, decreased, deficient.

ex - deficient knowledge regarding post operative routines. (this whole thing is the label)

- a condition or etiology, identified from client's assesment data. 

(related to lack of exposure to instruction)

– Impaired skin integrity

- 

Describes human responses to health 

conditions or life processes that exist in 

an individual, family, or community

– At risk for altered skin integrity

– Potential for impaired skin integrity

Describes human responses to health 

conditions/life processes that may 

develop in a vulnerable individual, 

family, or community

Describes human responses to levels of 

wellness in an individual, family, or 

community.

 Disease condition based on specific 

evaluation of signs and symptoms

 Judgment about the patient in 

response to an actual or potential 

health problem

 An actual or potential physiological 

complication that nurses monitor to 

detect the onset of changes in a 

patient’s status

– Less than body requirements

• intakes of nutrients insufficient to meet metabolic 

needs

– change in normal bowel habits characterized by a 

decrease in frequency and/or passage of hard, dry 

stools

– increased isotonic fluid retention

Altered tissue perfusion

– decrease in nutrition and oxygenation at cellular level due 

to deficits in capillary blood supply.

Goal

Expected Outcomes

 Measurable

• (must be able to see it, feel it, patient state 

it, measure it etc

Assist to the selection of nursing interventions & 

criteria for evaluation

What does the patient want to achieve?

1. General goal statement

-Subject, behavior, time frame

2. Goal Criteria   AEB

-Measureable, observable, specific data

-Used to evaluate succes

Combining goals and 

outcomes statements

Patient centered

Singular goal or outcome Observable

Measurable Time limited

Mutual factors Realisti

Nurses implement care to meet patient goals.

• At times, multiple interventions may be needed.

• Priorities help nurses to anticipate and sequence 

nursing interventions.

• Action that resolve the problem

– Usually performed by the nurse

– Based on scientific rationale

• Includes - who, what, when, how 

– who will intervene

– what is the intervention

– when/how often is the intervention

– how the action will be performe

- independent

- actions that a nurse initiates

• Interventions/Nursing Prescription

– Can be performed by nurse

– Can be a doctor order that you carry out

– May be performed by another health care provider

• Scientific Rationale

– Why am I doing this intervention?

-Reassessing the patient

-Reviewing and revising 

the existing nursing 

care plan

-Organizing resources 

and care delivery

-Anticipating and 

preventing 

complication

• 1. Sit upright

• 2. Mouth care

• 3. Suction and airway equipment

• 4. Thicken liquids & no straws

• 5. Establish visual communication method

• 6. Monitor respiratory system

• Explains how each action will contribute to 

resolving the problem

– Must reflect scientific principles

– Reference rationale (textbook etc

Thickened liquids have a slower 

transient time & allows time to 

trigger swallow reflex(Scientific Rationale)

Provide rest periods as 

necessary during meal(Nursing Interventions)

Avoiding fatigue decreases the 

risk of aspiration. (Scientific Rationale)

1.  Were goals met?

– State exactly what happened

– Number each outcome criteria

2.   Barriers – What prevented patient      

from meeting outcome criteria?

Facilitators – What helped patient meet  

outcome criteria?

3.   Summary

Did the plan of care work? Is it appropriate   

for this patient? Do we need to change   

anything? Do we continue as written

• Identify evaluative criteria and standards

• Collect data and Reassess - Interpret and summarize 

findings to determine if criteria were met/if not why

• Document findings and clinical judgments

• Modify - should the plan be modified, aborted or was it 

successful