Have you ever considered how nurses seamlessly take over patient care with just a handover report, instantly understanding what needs to be done? It’s a common scenario every shift, and the answer lies in the nursing process, a critical thinking framework guiding nurses in delivering optimal patient care. This article delves into the nursing process, emphasizing the crucial role of Coordination Of Care Nursing Diagnosis in ensuring patient well-being and safety within today’s healthcare landscape.
Understanding the Foundations: Critical Thinking and Clinical Reasoning in Nursing
Before exploring the nursing process in detail, it’s essential to grasp the underlying principles of critical thinking and clinical reasoning that empower effective nursing practice. Critical thinking in nursing goes beyond simply following instructions; it’s about actively analyzing clinical situations, fostering teamwork, promoting collaboration, and optimizing workflow for patient safety and the best possible outcomes.[^1] It involves verifying patient information, ensuring accuracy, and tailoring care plans based on individual needs, current best practices, and relevant research.
Key attributes of a critical thinker in nursing include:
- Independent Thinking: Formulating your own informed opinions and judgments.
- Fair-mindedness: Approaching all viewpoints with impartiality and without bias.
- Insight into Egocentricity and Sociocentricity: Recognizing personal biases and prioritizing the greater good in patient care.
- Intellectual Humility: Acknowledging the limits of one’s knowledge and expertise.
- Nonjudgmental Approach: Applying professional ethics and standards rather than personal biases in decision-making.
- Integrity: Maintaining honesty and strong moral principles in all aspects of practice.
- Perseverance: Persistently working through challenges to ensure optimal patient care.
- Confidence: Trusting in one’s abilities to effectively carry out nursing tasks and responsibilities.
- Openness to Thoughts and Feelings: Being receptive to diverse perspectives and approaches to care.
- Curiosity: Continuously questioning and seeking deeper understanding to improve patient outcomes.
Clinical reasoning is the “complex cognitive process that nurses use to gather and analyze patient information, evaluate its significance, and consider alternative actions to make sound judgments for patient care.”[^2] It’s a skill honed through knowledge and experience, enabling nurses to generate options, weigh evidence, and choose the most effective course of action for each patient.[^3]
Inductive and Deductive Reasoning in Clinical Judgment
Inductive reasoning, or “bottom-up thinking,” is crucial in nursing. It involves observing cues—data deviating from expected findings—to identify patterns and formulate hypotheses. Cues act as hints, signaling potential patient issues. Nurses organize these cues, forming generalizations to understand the bigger picture and develop hypotheses about patient problems. A generalization is a judgment derived from gathered facts and observations. A hypothesis is a proposed explanation for a situation, aiming to clarify the “why” behind a problem so solutions can be explored.
Paying close attention to patients and their environment is vital for inductive reasoning. Nurses, much like detectives (Figure 4.1), must be observant and utilize their senses to detect subtle cues.[^4] Strong inductive reasoning skills are essential, especially in emergencies where quick pattern recognition and action are critical.
Figure 4.1 Inductive Reasoning: Looking for Cues
Example: Observing redness, warmth, and tenderness at a surgical incision site, a nurse uses inductive reasoning to recognize a pattern of infection signs, hypothesizing a surgical site infection. This leads to notifying the provider and obtaining an antibiotic prescription, demonstrating inductive reasoning in practice.
Deductive reasoning, or “top-down thinking,” applies general rules or standards to specific situations. Nurses use established protocols, such as the Nurse Practice Act, hospital policies, and professional guidelines, to guide patient care decisions.
Example: Based on research showing the benefits of rest for patient recovery, a hospital implements a “quiet zone” policy (Figure 4.2).[^5] Nurses then use deductive reasoning to apply this policy to all patients, ensuring uninterrupted nighttime rest, regardless of individual sleep issues.
Figure 4.2 Deductive Reasoning Example: Implementing Interventions for a Quiet Zone Policy
Clinical judgment, the outcome of critical and clinical reasoning, is defined by the National Council of State Boards of Nursing (NCSBN) as “the observed result of critical thinking and decision-making. It’s the process of using nursing knowledge to assess situations, identify prioritized patient concerns, and implement evidence-based solutions for safe care.”^6 The NCLEX exam assesses clinical judgment, ensuring nurses’ competence in providing safe patient care.
Evidence-based practice (EBP), as defined by the American Nurses Association (ANA), is a “problem-solving approach that integrates best evidence from research, clinical expertise, patient assessment, and patient preferences to deliver optimal care.”[^7]
The Nursing Process: A Systematic Approach to Patient Care
The nursing process is a structured, patient-centered care model that utilizes critical thinking and clinical judgment. It is grounded in the American Nurses Association (ANA) Standards of Professional Nursing Practice, which outline the expected actions and behaviors of all registered nurses.[^8] Remember the nursing process using the mnemonic ADOPIE: Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation.
The nursing process is dynamic and cyclical, constantly adapting to the patient’s evolving health status (Figure 4.3).[^9]
Figure 4.3 The Nursing Process
Consider Scenario A for an example of the nursing process in action.[^10]
Scenario A: Applying the Nursing Process
A patient is prescribed Lasix 80mg IV daily for heart failure. During the morning assessment, the nurse notes a blood pressure of 98/60, heart rate of 100, respirations of 18, and temperature of 98.7F. Reviewing the patient’s chart, the nurse sees a baseline blood pressure around 110/70 and heart rate in the 80s. Recognizing these cues as potential fluid imbalance, the nurse hypothesizes dehydration. Further data reveals a 4-pound weight loss since yesterday. The patient reports a dry mouth and lightheadedness. Using clinical judgment, the nurse diagnoses Fluid Volume Deficit, establishes fluid balance outcomes, withholds Lasix, and contacts the provider. Interventions to increase oral intake and monitor hydration are initiated. By shift end, fluid balance is restored.
In this scenario, the nurse uses clinical judgment, moving beyond routine medication administration. The nurse assesses, identifies cues, hypothesizes fluid imbalance, plans and implements interventions, and evaluates outcomes, prioritizing patient safety by contacting the provider before administering potentially harmful medication.
The ANA Standards of Professional Nursing Practice for each nursing process component are detailed below.
Assessment: Gathering Patient Data
The “Assessment” Standard states: “The registered nurse collects comprehensive data relevant to the healthcare consumer’s health and/or situation.”[^11] This involves a systematic approach to collect physiological, psychological, sociocultural, spiritual, economic, and lifestyle data. For instance, assessing a patient in pain includes evaluating their pain response and its impact on mobility, appetite, social interaction, and emotional state.[^12]
Learn more in the “Assessment” section.
Diagnosis: Identifying Patient Needs and Problems
The “Diagnosis” Standard: “The registered nurse analyzes assessment data to determine actual or potential diagnoses, problems, and issues.”[^13] A nursing diagnosis is a nurse’s clinical judgment about a patient’s response to health conditions. It forms the basis of the care plan and differs from medical diagnoses.[^14]
Explore this further in “Diagnosis.”
Outcomes Identification: Setting Patient Goals
The “Outcomes Identification” Standard: “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.”[^15] Nurses collaboratively set measurable, achievable goals with patients, based on assessment data and nursing diagnoses, for both short and long terms.
Further details are in “Outcomes Identification.”
Planning: Developing the Care Strategy
The “Planning” Standard: “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.”[^16] This involves selecting evidence-based nursing interventions tailored to patient needs, documented in a nursing care plan for consistent, collaborative care.[^17]
Learn more about care planning in “Planning.”
Nursing Care Plans: The Blueprint for Care
Nursing care plans are crucial documentation within the planning phase. A nursing care plan demonstrates individualized care planning and delivery using the nursing process, ensuring consistent care across shifts and healthcare team members. Registered Nurses (RNs) create these plans, and some interventions can be delegated to Licensed Practical Nurses (LPNs) or Unlicensed Assistive Personnel (UAPs) under RN supervision. Delegation and care plan development are further discussed in “Planning” and “Implementing.”
Implementation: Putting the Plan into Action
The “Implementation” Standard: “The registered nurse implements the identified plan.”[^18] This involves executing or delegating nursing interventions according to the care plan, ensuring consistent care delivery and documenting actions in the patient’s medical record.[^19]
Importantly, the “Implementation” Standard includes Coordination of Care and Health Teaching and Health Promotion as vital subcategories.[^20] Coordination of care nursing diagnosis becomes particularly relevant here, ensuring seamless and effective execution of the care plan through collaborative efforts.
Explore implementation further in “Implementation.”
Evaluation: Assessing Progress and Outcomes
The “Evaluation” Standard: “The registered nurse evaluates progress toward attainment of goals and outcomes.”[^21] Evaluation involves ongoing patient assessment to determine intervention effectiveness and overall care plan success, with continuous adjustments as needed.[^22]
Delve deeper into evaluation in “Evaluation.”
Benefits of the Nursing Process: Enhancing Patient Care
The nursing process offers numerous benefits for nurses, patients, and the healthcare team:
- Enhanced quality of patient care
- Reduced omissions and redundancies in care
- Consistent and responsive care delivery across teams
- Improved collaboration in patient health management
- Enhanced patient safety
- Increased patient satisfaction
- Clear identification of patient goals and attainment strategies
- Increased likelihood of positive patient outcomes
- Efficient use of time and resources through structured care planning
By utilizing the nursing process, nurses deliver customized interventions, plan effective outcomes, and ensure actions are effective in meeting patient needs. This systematic approach, combined with evidence-based practices, embodies the “science of nursing.”
Holistic Nursing Care: Integrating Art and Science
The American Nurses Association (ANA) defines nursing as integrating “the art and science of caring,” focusing on “protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in the recognition of the connection of all humanity.”[^23]
The art of nursing is “unconditionally accepting the humanity of others, respecting their dignity and worth, and providing compassionate, comforting care.”[^24] Holistic nursing considers emotional, spiritual, psychosocial, cultural, and physical needs, recognizing patients within their family and community context.
Holistic Nursing Care Scenario:
A nurse in the emergency room encounters a single mother with a child suffering from ear pain and fever. After diagnosis and prescription, the nurse discovers the family’s financial constraints prevent them from affording the antibiotic and accessing local primary care. The nurse connects the mother with a social worker for insurance options and community providers and advocates for a more affordable generic antibiotic prescription, providing holistic care that addresses both medical and social determinants of health.
Learn more about culturally responsive care and reducing health disparities in the “Diverse Patients” chapter.
Caring and the Nursing Process: Building Therapeutic Relationships
The ANA emphasizes that “caring is foundational to nursing practice.”[^25] Effective nursing process application depends on developing a care relationship built on mutual trust, or rapport, representing the art of nursing. This relationship involves assessing the whole person—beliefs, values, attitudes—while respecting patient vulnerability and dignity.[^26] Caring interventions include active listening, eye contact, touch, and verbal reassurance, always respecting cultural beliefs related to caring behaviors.[^27] (Figure 4.4)
Figure 4.4 Touch as a Therapeutic Communication Technique
Explore therapeutic communication techniques in the “Communication” chapter.
Dr. Jean Watson’s theory of human caring emphasizes the importance of authentic presence and creating a healing environment, balancing the medical focus on cure with nursing’s unique caring perspective.[^29]
Learn more about Dr. Watson’s theory at the Watson Caring Science Institute.
In conclusion, the nursing process, with its emphasis on coordination of care nursing diagnosis within the implementation phase, provides a robust framework for patient-centered, holistic, and safe nursing practice. By mastering each step and integrating critical thinking and caring, nurses can significantly impact patient outcomes and satisfaction.
[^1]: Klenke-Borgmann L., Cantrell M. A., Mariani B. Nurse educator’s guide to clinical judgment: A review of conceptualization, measurement, and development. Nursing Education Perspectives. 2020;41(4):215–221. PubMed: 32569111
[^2]: Klenke-Borgmann L., Cantrell M. A., Mariani B. Nurse educator’s guide to clinical judgment: A review of conceptualization, measurement, and development. Nursing Education Perspectives. 2020;41(4):215–221. PubMed: 32569111
[^3]: Powers, L., Pagel, J., & Herron, E. (2020). Nurse preceptors and new graduate success. American Nurse Journal, 15(7), 37-39.
[^4]: “The Detective” by paurian is licensed under CC BY 2.0
[^5]: “In the Quiet Zone…” by C.O.D. Library is licensed under CC BY-NC-SA 2.0
[^7]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^8]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^9]: “The Nursing Process” by Kim Ernstmeyer at Chippewa Valley Technical College is licensed under CC BY 4.0
[^10]: “Patient Image in LTC.JPG” by ARISE project is licensed under CC BY 4.0
[^11]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^12]: American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
[^13]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^14]: American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
[^15]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^16]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^17]: American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
[^18]: American Nurses Association. (2021). Nursing: Scope and standards of practice (3rd ed.). American Nurses Association.
[^19]: American Nurses Association. (n.d.) The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
[^20]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^21]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^22]: American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
[^23]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^24]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^25]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^26]: Walivaara B., Savenstedt S., Axelsson K. Caring relationships in home-based nursing care – registered nurses’ experiences. The Open Journal of Nursing. 2013;7:89–95. PMC free article: PMC3722540 PubMed: 23894261
[^27]: American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
[^28]: “hospice-1793998_1280.jpg” by truthseeker08 is licensed under CC0
[^29]: Watson Caring Science Institute. (n.d.). Watson Caring Science Institute. Jean Watson, PHD, RN, AHN-BC, FAAN, (LL-AAN). https://www.watsoncaringscience.org/jean-bio/
