CRITICAL THINKING AND NURSING PROCESS

NURSING AS A SCIENCE • Nurses after have to make quick decisions in moments of

A. Problem Solving Process crisis
B. Nursing Process • We also assist points in making decisions
1. Assessment
2. Nursing Diagnosis CLINICAL REASONING
3. Planning • Logical thinking that links thoughts together in meaningful
4. Intervention ways. Clinical reasoning is reflective, concurrent and creative
5. Evaluation thinking about patients and patient care.
6. Documentation • Critical thinking inside the clinical setting is called clinical
reasoning
NURSING PROCESS • It is the keystone of good clinical judgment
• A systematic, creative approach to thinking and doing that
versus used to obtain, categorize and analyze patient data REFLECTION/REFLECTIVE JUDGMENT
and to plan actions to meet patient needs • A kind of critical thinking that considers a broad array of
• A type of problem-solving process requiring the use of possibilities and reflects on the merits of each in a given
decision making, clinical judgment and variety of clinical situation
thinking skills
• A way of thinking and acting based on the scientific method CLINICAL JUDGMENT
• A tool for identifying patient’s problems or potential • Clinical judgment are conclusions and opinions about
problems and an organized method to meet patient’s needs patient’s have, drawn from basement data. they may or may
• Developed in 1950s to describe the nurse’s independent role not be made using critical thinking.
in providing patient care
• Nurses are taught to use this framework consistently and ANALYSIS
methodically • The process of breaking down materials into component
parts and identifying the relationship among them
PROBLEM SOLVING
• The mental activity of identifying a problem (unsatisfactory CRITICAL ANALYSIS
state) and finding a reasonable solution to it. requires • Is the questioning applied to a situation or idea to determine
decision making: may or may not require the use of critical essential information and ideas and discard superfluous
thinking information and ideas.
• Problem solving steps:
- Define the problem CRITICAL THINKING
- Consider all possible alternative solution to the problem • The art of thinking about your thinking while you are
- Consider the possible outcome for each alternative thinking so as to make your thinking more clear, precise,
- Predict the likelihood of each outcome occurring and accurate, relevant, consistent and fair. (Paul, 1988)
fewest undesirable outcomes
CHARACTERISTICS OF CRITICAL THINKING
CRITICAL THINKING 1. Rational and reasonable
• Goal oriented, purposeful thinking that involves many 2. Involves conceptualization
mental attitudes and skills, such as determining which data Concept – mental image of reality
are relevant and making inferences. Essential when a 3. Requires reflection
problem is ill defined and thus have a single best solution. Reflective thinking – integrates past experiences to
• Using critical thinking and nursing process can help develop present to explore potential alternatives
good clinical reasoning skills that result in solid clinical 4. Involves both cognitive and altitude
judgment 5. Involves creative thinking (innovation ideas and
• CRITICAL - requiring careful judgment products)
• THINKING - to reason 6. Involves knowledge
Nursing knowledge
DECISION MAKING - Facts, information, principles, theories, research
• The process of choosing the best action to take action most findings and conceptual models
likely to produce desired outcome. Involves deliberation, Ethical knowledge
judgment, and choice. - Standard of conduct)
• Decision must be made whenever there are mutually Personal knowledge
exclusive choices, but not necessarily problems - Knowing and actualizing oneself
• Choosing the best action to meet a desired goal and is part Practice wisdom
of the critical thinking process
 - Acquired from institution, tradition, authority, • The process by which the assessment data are sorted and
trial and error, clinical experience) analyzed so that specific actual and potential hx problems
are identified.
CRITICAL THINKING ATTITUDES
1. Independent thinking OUTCOME IDENTIFICATION
2. Intellectual humility • Refers to formulating and documenting measurable, realistic,
3. Intellectual courage client-focused goals
4. Intellectual empathy
5. Intellectual integrity PLANNING
6. Intellectual perseverance • The nurse and the patient collaborate and choose specific
7. Intellectual curiosity interventions for each nursing diagnosis
8. Faith in reason
9. Faith mindedness IMPLEMENTATION
10. Interest in exploring thoughts and feelings • Carrying out the nsg intervention in a systematic way

CRITICAL THINKING EVALUATION

1. Using language • Assessing the patient’s response to the nsg interventions.
• Precise, specific • The responses are compared with the expected outcomes to
• Avoid clichés, jargon, euphemisms determine whether they have been achieved.
2. Perceiving
• Avoiding selective perception GOALS
• Recognizing differences in perception • To explore patient’s hx status
3. Believing and knowing • Identify actual or potential hx care problems
• Distinguishing facts from interpretation • Determine desired outcomes
• Supporting facts, opinions, beliefs, and preference • Deliver specific nsg interventions that will solve problems
4. Clarifying and promote hx and evaluate caregiving and determine
• Questioning to clarify meaning of words and phrases whether outcomes have been achieved.
• What's your name to clarify issues, beliefs
5. Comparing NURSING PROCESS (ANA, 2014)
• Noting similarities and differences - Cyclical
6. Judging/evaluating - Dynamic
- Interpersonal
• Providing evidence to support judgments
- Collaborative
• Develop evaluation criteria
- Universally applicable
7. Reasoning
• Framework for providing specific nursing care to individuals,
• Recognizing assumptions
families, and communities
• Distinguishing between relevant and irrelevant data
• Orderly and systematic
• Evaluating sources of information • Interdependent
• Generating and evaluating solutions • Patient centered using patient’s strengths
• Exploring application, consequence, • Appropriate for use throughout life span
advantages/disadvantages • Can be used in all settings

NURSING PROCESS COLLECTING DATA

• Is it method of problem identification or problem solving SUBJECTIVE DATA
(Gordon, 1994 ) • Covert data
• Is a key systematic method for taking independent nursing • Symptoms
option (Ralph & Taylor, 2O14) • Not measurable
• Can be obtained only from what the client tells the nurse
COMPONENTS OF THE NURSING PROCESS • Include client’s thoughts, beliefs, feelings, sensation,
• Assessment perception of self, health
• Diagnosis • NOTE: “Data from significant others and other health
• Outcome identification professionals may also be subjective if they consist of
• Planning opinion and perception rather than fact”
• Implementation - You may not always be able to obtain subjective data
• Evaluation
OBJECTIVE DATA
ASSESSMENT (Data Collection) • Can be detected by someone other than the client
• Collecting, organizing, documenting, and validating data • Observation and examination of the client
about a patient’s health status
SOURCES OF DATA
NURSING DIAGNOSIS Primary Data: The client
Secondary Data: Obtained from sources other than the client • Client’s expectation of caregivers
a. Significant others
b. Other health care providers VALIDATING THE DATA
c. Client’s written record, past and present hospitalization • The act of “double-checking” or verifying data in order to:
1. To ensure complete, accurate and factual information
ONGOING ASSESSMENT 2. To eliminate nurse’s own biases, errors and
• During every NPI misperceptions of the data
• Focus assessment 3. To avoid jumping to faulty conclusion, premature closure
• Specific problem, activities, behavior
• To identify new problems A NURSE MUST VALIDATE DATA WHEN:
• To evaluate outcomes achievement and problem resolution 7. Subjective and objective data, interview, physical
examination do not agree.
INITIAL ASSESSMENT 8. The client’s statements differs times in the assessment
• Admission assessment 9. The data seem extremely abnormal
• Database assessment 10. Factors are present that interfere with accurate
• Comprehensive assessment measurement
• Can include focus assessment
• To make initial problem list ORGANIZING DATA
• To determine the need for care • Using Gordon’s 11 Functional Health patterns
• Using Maslow’s Basic Human Needs to prioritize problem
EMERGENCY ASSESSMENT • The NANDA – I taxonomy serves its intended purpose of
• To identify life-threatening problems sorting / categorizing nursing diagnosis to help nurses locate
• During the physiological psychological crisis of the nursing diagnosis within the taxonomy
patient/client
• Fast phase assessment RECORDING DATA
• Record ink on the form provided by the agency
TIME LAPSE REASSESSMENT • Write legibly and neatly
• Compare client current status to that previous data that was • Use acceptable and appropriate abbreviations
obtain several months ago • Record subjective data in client’s own words
• Current status might be related to the old problem • Record cues not inferences
• Avoid vague generalities (e.g. good, normal)
DATA COLLECTION METHOD
1. Observation NURSING DIAGNOSIS
2. Physical examination • “Clinical judgment concerning a human response to health
3. Nursing interview condition / life processes or vulnerability for that response,
by an individual, family, or community
NURSING INTERVIEW • “Human responses are the central concern of the nursing
• Purposeful, focused interaction care”
• To obtain subjective data about the effects of the illness on
patient’s daily functioning and ability to cope TYPES OF NURSING DIAGNOSIS
Problem – focused diagnosis
DIRECT INTERVIEW • A clinical judgment concerning an undesirable human
• Highly structured, controlled by nurse response to health condition/life process that exists in an
• To obtain specific factual information individual, family, or community
• Defining characteristics; signs and symptoms present during
NONDIRECTIVE INTERVIEW assessment
• Allow patient to control and to express • May be resolved during shift depending on the nursing care
• Time consuming • “sakit akong ulo”
• Promote communication and rapport
Risk diagnosis
COMPONENT OF NURSING HEALTH HISTORY • A clinical judgment concerning the susceptibility of an
• Biographical data individual, family, or community for developing an
• Chief complaint (reason for visit) undesirable human response to health condition/life
• History of present illness processes
• Past health status • No defining characteristic
• Review of system and effects on functioning • Presence of risk factors
• Social and family history
• Lifestyle, habits, daily living patterns Health promotion diagnosis
• Spiritual well-being • A clinical judgment concerning motivation and desire to
• Psychological data increase well-being and to actualize health potential.
• Perception of health status and illness
 • These responses are expressed by a readiness to enhance HOW TO WRITE NURSING DIAGNOSIS
specific health behavior and can be used in any health state. • Problem focused
• Preparedness/readiness to improve health of the patient ➔ Diagnostic label + related factor + defining
characteristics
PARTS OF A DIAGNOSTIC LABEL: ➔ problem-Focused Diagnosis related to ____________
1. Descriptor or modifier (Related Factors) as evidenced by ____________ (Defining
2. Focus of the diagnosis or the key concept of the diagnosis Characteristics).
• Risk Diagnosis:
Examples: ➔ Diagnostic label t risk factor
• Ineffective breathing pattern
➔ Risk for ____________ as evidenced by ____________
• Risk for constipation
(Risk Factors).
• Deficient fluid volume
• Health Promotion
• Impaired skin integrity
➔ Diagnostic label
• Readiness for enhanced resilience
➔ Diagnostic label+ defining characteristic
Modifier Focus of the diagnosis
• Ineffective • Breathing Pattern
MASLOW’S HIERARCHY OF NEED
• Risk for • Constipation
• Deficient • Fluid Volume
• Impaired • Skin Integrity
• Readiness for enhance • Resilience

NOTE:
1. Each nursing diagnosis has a label and a clear definition.
2. It is critical to know the definition of the diagnoses
3. Nurses must need to know the diagnostic indicators.

SOME EXCEPTION OF NSG DIAGNOSIS WITH ONE WORD

• Anxiety
• Constipation
• Fatigue and Nausea

Note: in these diagnoses, the modifier and focus are inherent in

the one term

DIAGNOTIC INDICATORS
The information that is used to diagnose and differentiate one
diagnosis from another

Include:
1. Defining characteristics
• Observable cues/inferences that cluster as manifestations
of a diagnosis
• An assessment that identifies the presence of a number of
defining characteristics lends support to the accuracy of
the nursing diagnosis

2. Related factors
• An integral component of all problem. Focused diagnoses
- Etiologies, circumstances, facts or influences that have
some type of relationship with the nursing diagnosis
- Example: cause, contributed facts

3. Risk factors
• Influences that increase the vulnerability of an individual,
family, group or community to an unhealthy event
- Example: environmental, psychological, genetic
 GORDON’S 11 FUNCTIONAL HEALTH PATTERNS

GORDON’S 11 FUNCTIONAL HEALTH PATTERNS - Fluid Balance, Readiness for Enhanced

- Fluid Volume, Deficient, Risk for and Actual Fluid
GORDON's 11 FUNCTIONAL HEALH PATTERNS
Volume, Excess Fluid Volume, Imbalanced, Risk for
HEALTH PERCEPTION / COGNITIVE SEXUAL - Hyperthermia
HEALTH MANAGEMENT PERCEPTUAL REPRODUCTIVE - Hypothermia Infant
COPING / - Feeding Pattern, Ineffective
NUTRITIONAL / METABOLIC SLEEP / REST STRESS - Nausea Nutrition, Imbalanced, Less Than Body
TOLERANCE Requirements
ELIMINATION SELF- - Nutrition, Imbalanced, More Than Body
SELF-CONCEPT VALUE-BELIEF
PECEPTION Requirements, Risk for and Actual
ROLE / - Nutrition, Readiness for Enhanced
ACTIVITY / EXERCISE
RELATIONSHIP - Swallowing, Impaired
- Thermoregulation, Ineffective
1. Health Perception and Health Management Pattern. - Tissue Integrity, Impaired
• This is clients' views on health and well-being and how - Skin Integrity, Impaired, Risk for and Actual Oral
health is maintained. Mucous Membrane, Impaired
• Examples:
- Adherence to a drug regimen 3. Elimination Pattern
- Participation in health-promoting activities such as • Elimination pattern focuses on excretory patterns (bowel,
regular exercise bladder, skin), including the client's
- Annual check-ups are all recommended • perception of abdominal function.
- Energy Field, Disturbed • Examples:
- Health Maintenance, Ineffective - Voiding pattern
- Health-Seeking Behaviors (Specify) - Pain on urination
- Infection, Risk for - Appearance of urine and stool
- Injury, Risk for - Sweating
o Risk for injury, Suffocation - Bowel
o Risk for injury, Poisoning - Bladder
o Risk for injury, Trauma - Odor
- Latex Allergy Response, Risk for and Actual - Elimination Patter
- Management of Therapeutic Regimen, Effective - Bowel Incontinence
- Management of Therapeutic Regimen (Individual, - Constipation, Risk for, Actual, and Perceived
Family, Community), Ineffective - Diarrhea
- Management of Therapeutic Regimen, Readiness for - Urinary Elimination, Readiness for Enhanced Urinary
Enhanced Incontinence
- Noncompliance (Specify) o Functional Urinary Incontinence
- Perioperative-Positioning Injury, Risk for o Reflex Urinary Incontinence
- Protection, Ineffective o Stress Urinary Incontinence
- Surgical Recovery, Delayed o Total Urinary Incontinence
o Urge Urinary Incontinence, Risk for and Actual
2. Nutrition and Metabolism Pattern - Urinary Retention
• Food and fluid consumption patterns in relation to
metabolic demand indicators of local 4. Activity and Exercise Pattern
• nutrient supply. • The activity and exercise pattern focuses on the everyday
• Examples: activities that require energy
- Impaired skin integrity • expenditure, such as exercise, activity, leisure, and
- Impaired oral mucous membrane recreational activities.
- Imbalanced Nutrition • Examples:
- Height and Weight - Activities of daily living
- Body Mass Index (BMI) - Exercise
- Adult Failure to Thrive - Cardiovascular and respiratory status
- Aspiration, Risk for - Activity Intolerance, Risk for and Actual
- Body Temperature, Imbalanced, Risk for - Airway Clearance, Ineffective
- Breastfeeding, Effective - Autonomic Dysreflexia, Risk for and Actual
- Breastfeeding, Ineffective - Bed Mobility, Impaired
- Breastfeeding, Interrupted - Breathing Pattern, Ineffective
- Dentition, Impaired - Cardiac Output, Decreased
 - Disuse Syndrome - Stress-relieving activities
- Risk for Diversional Activity, Deficient - Exercises that enhance sleep
- Dysfunctional Ventilatory Weaning Response - Sleep, Readiness for Enhanced
- Falls, Risk for - Sleep Deprivation
- Fatigue - Sleep Pattern, Disturbed
- Gas Exchange, Impaired - Using any medications to sleep
- Growth and Development, Delayed Development, - Feeling after waking up
Risk for Delayed Growth
- Risk for Disproportionate 7. Self-Perception and Self-Concept Pattern
- Home Maintenance, Impaired • This assessment is to know how the person sees and
- Infant Behavior, Disorganized, Risk for and Actual, and views themself, which allows a deeper
Readiness for Enhanced Organized • understanding of the individual’s self-esteem and self-
- Peripheral Neurovascular Dysfunction, Risk for concept. It directly identifies how a
- Physical Mobility, Impaired • person treats their own self, body image, and worth.
- Sedentary Lifestyle • Examples:
- Self-Care Deficit - Objective Data
o Feeding - Attitudes about self
o Bathing – Hygiene - Client’s body image
o Dressing – Grooming - Anxiety, like Death Anxiety
o Toileting - Body Image, Disturbed
- Spontaneous Ventilation, Impaired - Fear
- Tissue Perfusion, Ineffective (Specify Type: Renal, - Helplessness Loneliness, Risk for
Cerebral, Cardiopulmonary, Gastrointestinal, - Personal Identity, Disturbed
Peripheral) - Powerlessness, Risk for and Actual
- Transfer Ability, Impaired - Self-Concept, Readiness for Enhanced
- Walking, Impaired - Self-Esteem, Chronic Low, Situational Low, and Risk
- Wandering for Situational Low
- Wheelchair Mobility, Impaired - Self-Mutilation, Risk for and Actual

5. Cognition and Perception Pattern 8. Roles and Relationships Pattern

• Cognition and perception pattern focuses on a person’s • This assessment focuses on a person's roles – with who
ability to understand and utilize the they are as an individual, as a part
• information with sensory functions. Sensory experiences • of society, and the established relationship created with
such as pain, pleasure, etc., are other people.
• identified and further evaluated. Any data relating to • Examples:
neurological functions affected by - Perception of current major roles
• emotions are collected to aid this process. - Client satisfaction with work, family, social
• Examples: relationships
- Memory retainment - Client responsibilities
- Sense of time and place - stucture of the family
- Recognizing sensations and emotions - who will take care if there are no family member to
- Language spoken help you
- Attention span - problem with children
- Adaptive Capacity, Intracranial, Decreased - Caregiver Role Strain, Risk for and Actual
- Confusion, Acute and Chronic - Communication, Readiness for Enhanced Family
- Decisional Conflict (Specify) Process, Interrupted, and Family Process,
- Environmental Interpretation Syndrome, Impaired Dysfunctional: Alcoholism
- Knowledge, Deficient (Specify) - Family Process, Readiness for Enhanced
- Knowledge, Readiness for Enhanced (Specify) - Grieving, Anticipatory
- Memory, Impaired - Grieving, Dysfunctional, Risk for and Actual
- Pain, Acute and Chronic - Parent, Infant, and Child Attachment, Impaired, Risk
- Sensory Perception, Disturbed (Specify: Visual, for
Auditory, Kinesthetic, Gustatory, Tactile, Olfactory) - Parenting, Impaired, Risk for and Actual, and Parental
- Thought Processes, Disturbed Role Conflict
- Unilateral Neglect - Parenting, Readiness for Enhanced
- Relocation Stress Syndrome, Risk for and Actual
6. Sleep and Rest Pattern - Role Performance, Ineffective
• The assessment focuses on the person's sleep, rest, and - Social Interaction, Impaired
relaxation habits. - Social Isolation
• Examples: - Sorrow, Chronic
- Sleeping patterns - Verbal Communication, Impaired
 - Violence, Self-Directed and Other-Directed, Risk for

9. Sexuality and Reproduction Pattern

• This pattern focuses on assessing the person’s
satisfaction or dissatisfaction towards sexual
• and reproduction functions. Also, concerns about
sexualities are discovered.
• Examples:
- Client’s capability to reproduce
- Problems with sexual performance
- Desire Disorders
- Pregnancy
- Anything related to reproductive and sexuality
- Rape-Trauma Syndrome: Compound Reaction and
Silent Reaction
- Sexual Dysfunction
- Sexuality Patterns, Ineffective

10. Coping and Stress Tolerance Pattern

• This assessment focuses on the person's perception of
stress and coping mechanisms.
• Support systems are evaluated, and stress symptoms are
noted. The effectiveness of a
• person's coping techniques in terms of stress tolerance is
also assessed.
• Examples:
- Client’s coping mechanism with stress
- Client’s emotions
- Support Systems
- Adjustment, Impaired
- Community Coping, Ineffective and Readiness for
Enhanced
- Coping, Readiness for Enhanced
- Family Coping, Compromised and Disabled Family
Coping, Readiness for Enhanced
- Individual Coping, Ineffective
- Coping, Defensive
- Denial, Ineffective
- Post-Trauma Syndrome, Risk for and Actual
- Suicide, Risk for

11. Values and Belief Pattern

• This assessment focuses on the person’s values and
spiritual beliefs that urge them to make
• decisions.
• Examples:
- Religion
- Value-belief conflicts related to health,
- Unique religious practices
- Impaired Religiosity, Risk for and Actual
- Spiritual Distress, Risk for and Actual
- Spiritual Well-Being, Readiness for Enhanced
 NURSING DIAGNOSIS

STEPS IN WRITING NURSING DIAGNOSES NURSING OUTCOME

5. Review the assessment data • Nursing Outcome- refers to a measurable behavior and
6. Identify the problem focus area. perception demonstrated by an individual, family group or a
7. Functional health pattern (need) community that is responsive to nursing intervention.
8. Formulate your health problem • Nursing Outcome Classification (NOC) – a system that can be
9. Diagnostic label used to select outcome measure related to nursing diagnosis
10. State the cause if known “Outcomes need to be identified before nursing interventions
11. State the signs, symptoms, risk factors if appropriate are determined”

MEDICAL OR NURSING DIAGNOSIS (ANALYZE) ACTIVITIES OF OUTCOME IDENTIFICATION

• Myocardial infarction 1. Establish priorities
• High risk for body image disturbance Priority
• Chronic ulcerative colitis • is a choice that comes first over other possible options.
• Diarrhea r/t CUC as evidenced by 10-12 loose watery, foul- • often based on urgency or importance
smelling stools per day
• Fear r/t possible recurrence & uncertain outcome of disease Priority Setting
• Priority setting-is a decision-making process that ranks the
IDENTIFY THE DIAGNOSTIC LABEL, RISK FACTOR, order of nursing diagnoses in terms of importance to the
ETIOLOGY, DEFINING CHARACTERISTICS patient.
• Ineffective airway clearance r/t decreased energy as • “Priorities constantly change as the patient situation and
evidenced by an ineffective cough. condition change".
• Risk for injury r/t altered mobility and disorientation.
• Ineffective airway clearance related to the presence of HIGH PRIORITY PATIENTS INVOLVES...
tracheo-bronchial secretion as evidenced by thick tenacious • Life threatening situation
sputum upon expectoration c.) (example: difficulty breathing, hemorrhage)
• Something that needs immediate attention
CHARACTERISTICS OF A DIAGNOSTIC STATEMENT d.) (example: preparation for a test, discharge from the
• A diagnostic statement is clear & concise facility that will occur shortly)
• It is specific & client centered • Something that is very important to the patient
• It relates to one client problem e.) (example: pain, anxiety)
• It is accurate
• It is based on reliable and relevant assessment data PRIORITY SYSTEM
• High Priority → potentially life threatening and require
COMMON SOURCES OF DIAGNOSTIC ERRORS immediate actions.
• Errors in data collection • Medium Priority → involve problems that could result in
• Errors in clustering data unhealthy consequences such as physical and emotional
• Errors in diagnostic statement impairment but not likely to threaten life.
• Low priority → problems that can be easily resolved with
NURSING CARE PLAN minimal interventions and have little potential to cause
b.) Care plan for each individual patient is based on significant dysfunction
assessment data and patient preference. 2. e.g. Pain (moderate, after minor surgery)

OUTCOME IDENTIFICATION 2. Establish Patient Outcomes And Outcome Criteria

• The formulation of goals and measurable outcomes that Patient Outcome
provides the basis for evaluating nursing diagnoses. • An educated guess, made as a broad statement about what
(ANA, 2014) that patient's state will be after the nursing intervention is
• The most recent addition of the nursing process. completed.
• It directly addresses the problem stated in the nursing
PURPOSES OF OUTCOME IDENTIFICATION diagnosis.
• Providing individualized care f.) Must be behavioral
• Promoting patient participation g.) Written to indicate a desired state
• Planning realistic and measurable care h.) Contain an action verb and a qualifier that indicate level
• Allowing for involvement of support people of performance that needs to be achieved
o Qualifier – a description of the parameter for the
outcome
 NURSING OUTCOME VERSUS NURSING INTERVENTION ALFARO-LEFEVRE (2014) AN OUTCOME CRITERION REQUIRES
• Nursing outcomes → provides a point of reference for THE FOLLOWING:
determining whether the intervention is appropriate and • Subject: Who is the person expected to achieve the goal?
effective. • Verb: What actions must the person do to achieve the goal?
• The intervention states what the nurse will do. • Condition: Under what circumstances is the person to
perform the action?
Short term outcome • Criteria: How well is the person to perform the action?
• Can be met in a relatively short period (within days or less • Specific Time: When is the person expected to perform the
than 1 week) action?

Long-term Outcome Example of Outcome criterion

• Requires more time (perhaps several weeks or months). • The patient (who) verbalizes (what action) three dietary
- Usually describe expected benefits or results that are modifications of a low salt diet to his wife (under what
seen after the plan of care has been implemented. May circumstances) accurately (how well) after the teaching
indicate ongoing activity session (when)
- Usually describe expected benefits or results that are
seen after the plan of care has been implemented. PLANNING
• Development of nursing strategies designed to ameliorate
“The nurse needs to revise outcomes if the patient’s situation or patient problems
medical condition changes” • A written plan of care is developed to direct nursing care
activities
EXAMPLE OF BEHAVIORAL VERBS USED IN PATIENT GOALS
• Calculate PURPOSES OF PLANNING
• Classify • Direct patient care activities
• Communicate • Promote continuity of care
• Compare • Focus charting requirements
• Construct • Allow for delegation of specific activities
• Contrast
• Define ACTIVITIES OF THE PLANNING PHASE
• Demonstrate 1. Planning nursing interventions
• Describe • Determining appropriate nursing Interventions for
• Discuss specific patient
• Distinguish 2. Writing a patient plan of care
• Draw • It documents the problem solving process
• Explain • It is a critical element in focusing nursing activities
• Express • It serves as evaluation criteria
• Identity • It mast reflect the standard of care
• List
• Maintain NURSING INTERVENTIONS CLASSIFICATION (NIC)
• Name • Nursing interventions are organized in a three-level
• Participate taxonomy consisting of domains, classes and interventions
• Perform • Interventions can be nurse-initiated, or treatments initiated
• Practice by the physician or other provider
• Recall
• Recite PLANNING NURSING INTERVENTION
• Record • Determining appropriate nursing interventions for a specific
• Stand patient
• State • Nursing interventions – are any treatment, based upon
clinical judgment and knowledge, that a nurse performs to
• Use
enhance patient/client outcomes. (Bulecheck et al., 2013 as
• Verbalize
cited in Craven, 2017)
• Walk
IMPORTANT CONCEPTS IN WRITING A PLAN OF CARE
OUTCOME CRITERIA
1. Patient centered
• Specific, measurable, realistic statements of goal attainment.
2. Step by step process as evidenced by the following:
• Present information that will guide the evaluation phase of
• Sufficient data are collected to substantiate nursing
the nursing process.
diagnosis
• Answers the questions who, what actions, under what
• At least one goal must be stated for each nursing
circumstances, how well and when
diagnosis
 • Nursing interventions must be specifically designed to DOMAINS & CLASSES
meet the identified goal 1. Physiologic: Basic
• Each nursing intervention must be supported by scientific • Activity and Exercise Management
rationale • Elimination Management
• Evaluation must address whether each goal was • Immobility Management
completely met, partially met or completely unmet • Nutrition Support
• Physical Comfort Promotion
TYPES OF PLANS OF CARE • Self-care Facilitation
1. Instructional plan of care or student care plan 2. Physiologic: Complex
2. Clinical plans of care • Electrolyte and Acid-Base Management
• Multidisciplinary • Drug Management
• Nurses often take the primary responsibility in • Neurologic Management
developing and updating the plan • Perioperative Care
• All members of the team are encouraged to read and add • Respiratory Management
to the plan • Skin/Wound Management
• Thermoregulation
TYPES OF CLINICAL PLAN OF CARE • Tissue Perfusion Management
• Individual Plan of Care – for each patient 3. Behavioral
• Standardized plan of care – written by group of nurse • Behavior Therapy
experts in given areas for a patient population with specific • Cognitive Therapy
medical diagnosis • Communication Enhancement
• Generic Plan of care – written for a specific nursing diagnosis • Coping Assistance
• Computerized Plan of Care – generated from assessment • Patient Education
data entered into a computer about a specific patient
• Psychological Comfort Promotion
4. Safety
IMPLEMENTATION PHASE
• Crisis Management
Implementation
• Risk Management
• Action phase
5. Family
• Actual initiation of the plan
• Childbearing Care
• Activities:
• Childrearing Care
- Reassessment
• Lifespan Care
- Setting priorities
6. Health System
- Perform nursing interventions
• Health System Mediation
- Recording of nursing actions
• Health System Management
IMPLEMENTATION SKILLS NEEDED: • Information Management
• Intellectual skills 7. Community
• Interpersonal skills • Community Health Promotion
• Technical skills • Community Risk Management
Nursing Interventions
MAJOR CATEGORIES OF NURSING INTERVENTION (NIC)
• Are any treatment based upon clinical judgment and
I. COGNITIVE INTERVENTIONS
knowledge that a nurse performs to enhance patient/client
outcomes (Bulecheck et al., 2013) • Applying general principles of teaching and learning
process
• To monitor health status
A. Educational Interventions
• Prevent, resolve, or control a problem
• Develop teaching plan
• Assist with activities of daily living (ADL)
• Health education
• Promote optimum health and independence (Alfaro-LeFevre,
• Assess readiness to learn
2014)
B. Delegation and Supervisory Interventions
INTERVENTIONS CAN BE: • Delegation – transfer of responsibility for the
performance of the task to another individual
• Direct or indirect
while retaining accountability for the outcome
• Independent, dependent, interdependent
- Principles of delegation: Observe RIGHTs:
• Multidisciplinary
person, task, circumstances, communication,
evaluation
NURSING INTERVENTIONS CLASSIFICATION (NIC)
• Supervisory intervention is applied in the
• Nursing Interventions are organized into 7 domains, classes,
context of overseeing overall care of patient it
and interventions (by Research team from Iowa College of
includes ensuring that other members of the
Nursing)
team and those involved with patient and family
• The NIC provides 554 interventions
show return demonstration of care
• It provides label and definition for each intervention
 II. INTERPERSONAL INTERVENTIONS
A. Coordinating Interventions – with other members of
the health team
• Example:
- Referral to other health care
- Self-help group
- Home health agencies
B. Supportive Interventions – emphasize the use of
communication spiritual distress, and caring
behavior and comfort.
C. Psychosocial Interventions
- exploring feelings
- focus on resolving emotional, psychological,
or social problems
III. TECHNICAL INTERVENTIONS
A. Maintenance Interventions – retains certain state of
health, preventing complication or deterioration of
physical and psychological functioning and
preserving independence
Include:
• Basic hygiene
• Skin care
• Other routine nursing activities
B. Surveillance or Monitoring Interventions – include
detecting changes from baseline data and
recognizing abnormal responses
Example:
• Frequent checking of VS
• Detecting odors
• Skin temperature
C. Psychomotor Interventions
Example:
• Insertion of catheter
• Suctioning
• Care of equipment
• Changing
• Removing
• Cleansing

EVALUATION
• The sixth phase
• The judgment of the effectiveness of nursing care to meet
patient goals based on patient’s responses
• Ongoing all throughout the nursing process
• The plan of care is the foundation of evaluationon skills,
relief of
 ACTIVITY AND QUIZ
SOME ANSWERS ARE INCORRECT
Parts Type of Diagnosis Correct/Incorrect
1. Diagnostic label: Diarrhea
Related factor: increase level of anxiety Problem-Focused Correct
Defining characteristic: loose watery stools for 5 times in 24 hours
2. Diagnostic label: hyperthermia
Related factor: dehydration Problem-Focused Correct
Defining characteristic: warm to touch
3. Diagnostic label: risk for electrolyte imbalance
Risk Diagnosis Correct
Related factor: diarrhea
4. Diagnostic label: Readiness for enhanced knowledge Health Promotion Incorrect
5. Diagnostic label: Readiness for enhanced knowledge
Defining characteristics: Expressed desire to enhance knowledge Health Promotion Correct

Don’t state the nursing diagnosis in medical term

1. It is an observable cues that cluster as manifestations of a diagnosis. Defining

2. Nursing diagnosis can be obtained during an interview False

3. It is the reason for seeking health care Chief complaint

4. Nursing process holds the nurse accountable & responsible for the complete, accurate and True
relevant steps in the nursing process

5. Which refers to an integral component of all problem focused diagnoses? Related factors

6. The information that is used to diagnose and differentiate one diagnosis from another Diagnostic label
Includes the following EXCEPT:

7. A stressors experienced, usual coping pattern ,communication style, Sources of support. Psycho

8. Which clinical judgment concerns with motivation and desire to increase well-being and to Health promo
actualize health potential?

9. An interview was conducted by Nurse Meg , she allows patient to control and to express Non directive
What type of interview did the nurse utilized?

10. Which of the following is a method that is used by nurses in the nursing process to provide a Gordon
more comprehensive nursing assessment of the patient.?

11. Which refers to a clinical judgment concerning an undesirable human response to health Problem focused
condition/life process that exists in an individual, family or community?

12. Nurse Mimi formulates a nursing diagnosis stated as Impaired skin integrity related to Abrasion .
destruction of tissues as evidence by Abrasions. Which is the defining characteristic in the
nursing diagnosis?

13. Nurse Macy must validate when: Select that applies All except consistent data

14. Which refers to the clinical judgment concerning the susceptibility of an individual, family or Risk diagnosis
community for developing an undesirable human response to health condition/life
processes?

15. Nurse Mimi formulates a nursing diagnosis stated as Impaired skin integrity related to impaired
destruction of tissues as evidence by Abrasions. Which is the modifier in the nursing
diagnosis?