NURSING PROCESS

• CRITICAL THINKING

  Intentional higher level thinking to define a client’s problem, examine evidence-based practice, and make choices in the delivery of care
• Clinical reasoning


  Application of critical thinking to the clinical situation
• Clinical reasoning


  Cognitive process using thinking strategies to gather and analyze clinical information, evaluate relevance, and decide on possible nursing actions to improve client’s physiologic and psychosocial outcomes
• Use of Critical Thinking Skills by Nurses

  • Use knowledge from other subjects and fields
  • Deal with change in stressful environments
  • Make important decisions
  • Guide in problem-solving and decision-making process with creativity
• Approaches to problem solving

  1. Intuition

  2. Use of scientific basis

  3. Use of nursing process
• Intuition


  Problem-solving approach relying on a nurse’s inner sense
• Clinical judgment in nursing

  Decision-making process to ascertain the right nursing action to be implemented at the appropriate time in the client’s care
• Nursing Process Description


  1. Systematic and continuous collection, validation, and communication of client data compared to standard/norm

  2. Includes client’s perceived needs, health problems, experiences, practices, values, and lifestyles

  3. Critical thinking process used by professional nurses to apply best available evidence to caregiving and promoting human functions and responses to health and illness
• Nursing Process according to Kozier

  • Cyclic and dynamic
  • Client-centered
  • Universally applicable
  • Focus on problem-solving
  • Presence of interpersonal collaboration
  • Use of critical-thinking
• Nursing Process according to Udan


  • Goal-oriented
  • Organized
  • Systematic
  • Humanistic plan of care
  • Efficient and Effective nursing care
• Methods of Data Collection in Nursing

  Examination should be conducted systematically using Cephalocaudal approach, Body System approach, and Review of System approach
• Methods of Data Collection

  • Nursing Health History taking
  • Physical Assessment
  • Laboratory Results & other diagnostic tests results
  • Physicians history and physical assessment
• Components of a Nursing Health History
• Biographic data includes: name, address, age, sex, martial status, occupation, religion
• Reason for visit/Chief complaint is the primary reason why a client seeks consultation or hospitalization
• History of present Illness includes: usual health status, chronological story, family history, disability assessment
• Past Health History includes all previous immunizations and experiences with illness
• Family History reveals risk factors for certain diseases like Diabetes, hypertension, cancer, mental illness
• Review of systems includes a review of all health problems by body systems
• Lifestyle includes personal habits, diets, sleep or rest patterns, activities of daily living, recreation or hobbies
• Social data includes family relationships, ethnic and educational background, economic status, home and neighborhood conditions
• Psychological data includes information about the client’s emotional state
• Pattern of health care includes all health care resources like hospitals, clinics, health centers, family doctors
• Validation of Data includes Cues (subjective or objective data observed by the nurse) and Inferences (the nurse's interpretation or conclusion based on the cues)
• Not all data require validation. Clarify any ambiguous or vague statements. Double check data that are extremely abnormal. Determine the presence of factors that may interfere with accurate measurement
• Communicate/Record/Document Data: nurse records all data collected about the client’s health status in a factual manner, not as interpreted by the nurse. Record subjective data in the client’s word to maintain original meaning
• Example of Inference: Red swollen wound with drains = infected wound; Dry skin = dehydrated
• Critical Thinking


  The process of intentional higher level thinking to define a client’s problem, examine evidence-based practice in caring for the client, and make choices in the delivery of care
• Clinical Reasoning


  The application of critical thinking to the clinical situation. It is the cognitive process that uses thinking strategies to gather and analyze clinical information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client’s physiologic and psychosocial outcomes
• Nursing Process


  Systematic and continuous collection, validation, and communication of client data compared to what is standard/norm. Includes the client’s perceived needs, health problems, related experiences, health practices, values, and lifestyles. Critical thinking process used by professional nurses to apply the best available evidence to caregiving and promoting human functions and responses to health and illness
• Methods of data collection

  Examination should be conducted systematically: Cephalocaudal approach – head-to-toe assessment, Body System approach – examine all the body system, Review of System approach – examine only particular area affected
• Components of Nursing Health History

  • Biographic data: name, address, age, sex, martial status, occupation, religion, Reason for visit/Chief complaint: primary reason why client seek consultation or hospitalization, History of present Illness: usual health status, chronological story, family history, disability assessment, Past Health History: all previous immunizations, experiences with illness, Family History: risk factors for certain diseases (Diabetes, hypertension, cancer, mental illness), Review of systems: review of all health problems by body systems, Lifestyle: personal habits, diets, sleep or rest patterns, activities of daily living, recreation or hobbies, Social data: family relationships, ethnic and educational background, economic status, home and neighborhood conditions, Psychological data: information about the client’s emotional state, Pattern of health care: all health care resources including hospitals, clinics, health centers, family doctors
• Validation of data


  Cues: subjective or objective data observed by the nurse; it is what the client says, or what the nurse can see, hear, feel, smell or measure, Inferences: The nurse interpretation or conclusion based on the cues
• Validating assessment data


  Not all data require validation, Clarify any ambiguous or vague statements, Double check data that are extremely abnormal, Determine the presence of factors that may interfere with accurate measurement
• Communicate/Record/Document Data


  nurse records all data collected about the client’s health status, data are recorded in a factual manner not as interpreted by the nurse, Record subjective data in client’s word; restating in other words what client says might change its original meaning
• Diagnosis


  P – Problem/Diagnostic Problem, E - Etiology, S – Signs/Symptoms
• Nursing Diagnosis


  vs Medical Diagnosis
• Implementation


  When selecting an intervention 6 factors should be considered: The desired patient outcome, Characteristics of the Nursing Diagnosis, Research Base for the Intervention, Feasibility for Performing the Intervention, Acceptability to the Patient, Compatibility of the nurse
• Techniques in Critical Thinking

  Critical Analysis: Application of all questions, Socratic Questioning: Recognize and examine assumptions, Inductive Reasoning: Specific to general, Deductive Reasoning: General to specific
• Types of Statements


  • Facts: Can be verified through investigations, Inferences: Conclusions drawn from facts, Opinions: beliefs formed over time