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Critical Thinking
Critical thinking is a core academic skill that teaches
undergraduate and postgraduate students to question
or reflect on their own knowledge and information
presented to them. This skill is essential for students
working on assignments and performing research. It's
also an invaluable skill in many workplace scenarios
Use clinical reasoning and clinical decision
making
– to practice safe and effective nursing care
– to improve clinical systems
– to decrease errors in clinical judgment
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 Critical Thinking Skills
• Analyzing
• Applying standards
• Discriminating
• Information seeking
• Logical reasoning
• Predicting
• Transforming knowledge

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 Critical Thinking and Nursing

• Critical thinking underlies each step of the

nursing process

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 Nursing Process
The nursing process is a systematic, rational method of
planning and providing nursing care.

Its purpose is to identify a client’s health care status, and

actual or potential health problems, to establish plans to
meet the identified needs, and to deliver interventions
to address those needs.

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Guidelines for Writing Nursing Care
Plans
-Date and sign the plan
-Use category headings
-Use standardized/ approved medical or English
symbols and key words
-Be specific
-Refer to procedure book or other sources rather
than including steps
-Tailor the plan to the client
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Guidelines for Writing Nursing
Care Plans
-Incorporate prevention and health maintenance
-Include ongoing assessment
-Include collaborative and coordination activities
-Include discharge planning and home care needs

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Steps of Nursing Process
• Assessment
• Diagnosis
• Planning
• Intervention
• Evaluation
• Documentation

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 1-Assessing
• Collecting data
• Organizing data
• Validating data
• Documenting data

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 Subjective Data
• Symptoms or covert data
• Apparent only to the person affected
• Can be described only by person affected
• Includes sensations, feelings, values, beliefs,
attitudes, and perception of personal health
status and life situations

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 Objective Data
• Signs or overt data
• Detectable by an observer
• Can be measured or tested against an accepted
standard
• Can be seen, heard, felt, or smelled
• Obtained through observation or physical
examination

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 Sources of Data
1-Primary Source :The client
2-Secondary Sources

All other sources of data

Should be validated, if possible

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 2-Diagnosing
Diagnosis is a statement or conclusion regarding
the nature of a phenomenon
Diagnostic labels are the standardized NANDA
names
Nursing diagnosis is a statement of the high risk
or actual problems in the clients’ status that the
nurse is licensed &competent to treat.
(physiological, sociocultural, developmental,
spiritual etc.
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Components of a Nursing Diagnosis
To help client to achieve a maximal level of wellness & highest
level of independence

1-Problem statement (diagnostic label)

Describes the client’s health problem or
response
Qualifiers added to give additional meaning
e.g.. for qualifiers

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Patient health problem\needs  related to r\t
(etiology)  as evidenced by (aeb) \ manifested
by (mb) \ characterized by (S&S)
- Pain r\t crushed tissue aeb verbal patient
complain 7\10, facial expression of grimacing
when moving hand
- Constipation r\t low fiber diet intake &
decreased mobility aeb abdominal distention &
no bowel movement for 3 days
- Risk for injury r\t generalized weakness
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 Writing Nursing Diagnoses
• Basic Two-Part Statement
– Problem (P)
– Etiology (E)
• Basic Three-Part Statement
– Problem (P)
– Etiology (E)
– Signs and symptoms (S)

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Components of a Nursing Diagnosis
1-Problem statement (diagnostic label)
-Impaired (made worse, weakened, damaged, reduced,
deteriorated)
-Decreased (lesser in size, amount, or degree)
-Ineffective (not producing the desired effect)
-Compromised (to make vulnerable to threat(
- Altered
- - Risk for

2-Etiology (related factors and risk factors)

Identifies one or more probable causes of the health
problem
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Components of a Nursing Diagnosis
• Defining characteristics (S&S)
– Cluster of signs and symptoms indicate the presence
of a particular diagnostic label (actual diagnoses)
– Actual nursing diagnoses client’s have signs and
symptoms
– For risk for nursing diagnoses no subjective or
objective data
– Factors that cause the client to be more vulnerable to
the problem form the etiology or a risk for nursing
diagnoses

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 Steps in Diagnostic Process
1-Analyzing Data
A-Compare data against standards( vital signs,wt, ht)

B-Cluster cues (sputum, Inspiratory crackles auscultated

throughout right upper, lower lungs, Diminished breath
sounds on right side)..nsg dx (Ineffective Airway
Clearance related to viscous secretions & shallow
chest expansion secondary to pain,

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Data: Diagnosis of COPD
S&S= wheezing
O2 saturation 90%
Tachypnea Resp rate = 28breaths\min

Ineffective breathing pattern r\t inflammation

of lung lobes aeb wheezing, low saturation
level (90%) , tachypnea (rate 28
breaths\min)

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Data= Laboroscopic cholecystectomy
S&S = complaining of pain 8\10 of the upper
Rt quadrant of abdomen

- Abdominal pain r\t to surgical removal of

gall bladder aeb patient complaining of pain
intensity 8\10

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Data: patient has a history of hypertension,
he has multiple blood pressure medication
Bp= 160\90 mm\Hg
Pulse = 88 beats\min

Risk for falling down r\t side effects of

multiple medication

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 3- Planning
Definition : systematic phase of the nursing
process that involves decision making and
problem solving

-Planning should be initiated after the initial

assessment

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 The Planning Process
Consists of following activities:
-Setting priorities
-Establishing client goals/desired outcomes
-Selecting nursing interventions
-Writing individualized nursing interventions on care
plans
-Establishinga preferential sequence for addressing nursing
diagnoses and interventions
High priority (life-threatening)
Medium priority (health-threatening)
Low priority (developmental needs)
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 Purpose of Desired Goals/
Outcomes

-Provide direction for planning interventions

-Serve as criteria for evaluating progress
-Enable the client and the nurse to determine
when the problem has been resolved
-Help motivate the client and nurse by providing a
sense of achievement

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 Components of Goal/Desired
Outcome Statements
-Subject
-Verb
-Condition or modifier
-Criterion of desired performance

( subject) will lose weight 3 kg in 3 weeks

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 Guidelines for Writing
Goals/Desired Outcomes
-Write in terms of the client responses
-Must be realistic
-Ensure compatibility with the therapies of other
-professionals
-Derive from only one nursing diagnosis
-Use observable, measurable terms
-Make sure client considers them to be important
and values them
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 Goals/Desired Outcomes
-Goals are broad statements about the client’s
status
-Desired outcomes are more specific, observable
criteria used to evaluate whether the goals have
been met

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 Table 13-2 Deriving Desired
Outcomes from Nursing
Diagnoses

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 4- Implementing
-Based on first three phases
Assessing
Diagnosing
Planning
-Provides the basis for the nursing actions
performed during the implementing step

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Implementing Nursing Interventions
-Base on scientific knowledge
-Clearly understand interventions
-Adapt activities to the individual client
-Implement safe care
-Provide teaching, support, and comfort.
-Be holistic
-Respect the dignity of the client and enhance self esteem
-Encourage active client participation

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 Evaluation Process
-Collecting data related to the desired outcomes
-Comparing the data with outcomes
-Relating nursing activities to outcomes
-Drawing conclusions about problem status
-Continuing, modifying, or terminating the nursing care
plan

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 Documentation
• Purposes of Client Records:

• Planning client care

• Research
• Education
• Legal documentation
• Health care analysis

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 Documenting Nursing Activities
-Record nursing interventions and client responses
-Must not be recorded in advance.
-The Nursing Process – Evaluating
-Planned, ongoing, purposeful activity
-Determine client’s progress
-Effectiveness of care plan
-Continuous
-Nurses demonstrate responsibility and accountability
for their actions

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 PIE Documentation
-Group information into three categories:
Problem, Interventions, Evaluation
-Consists of a client assessment flow sheet and
progress notes

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Computerized Documentation
-Developed to manage volume of information
-Use of computers to store the client’s database,
new data, create and revise care plans and
document client’s progress
-Information easily retrieved.
-Possible to transmit information from one care
setting to another

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 Security for Computerized
Records
-Passwords required and should not be shared
-Never leave the computer terminal unattended after
logging on
Do not leave client information displayed
-Know the facility’s policy and procedure for
correcting an entry error
-Follow agency procedures for documenting sensitive
material
-Installed firewalls

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 Documenting the Nursing
Process
-Record should describe the client’s ongoing status
-Reflect the full range of the nursing process

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 Kardexes
-Concise method of organizing and recording data
-Information quickly accessible
-Pertinent information about the client
-Allergies
-List of medications including IV fluids
-List of daily treatments and procedures
-List of diagnostic procedures
-Physical needs that are to be met
-Stated goals
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 Legal & Ethical Standards for
Documentation
-Client’s record is a legal document
-May be used to provide evidence in court

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 Factors To Consider In
Documentation
-Date and time
-Timing
-Legibility(‫)سهولة القراءة‬
-Accepted terminology
-Correct spelling
-Signature

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