eBook: Nursing Care Plans Guidelines for individualizing Client Care Across the Life Span 8th edition


  • eBook: Nursing Care Plans Guidelines for individualizing Client Care Across the Life Span 8th edition eBook
  • Price: $5
  • Published: 2010
  • ISBN-10: 0803622104
  • ISBN-13: 978-0803622104
SKU: 978-0803622104 Categories: ,


eBook: Nursing Care Plans Guidelines for individualizing Client Care Across the Life Span 8th edition

Critical Thinking: Adaptation of Theory to Practice


Critical thinking is defined as the “intellectually

disciplined process of actively and skillfully conceptualizing,

applying, analyzing, synthesizing, and evaluating

information gathered from or generated by observation,

experience, reflection, reasoning, or communication, as a

guide to belief and action” (Scriven, 1987). Critical thinking

requires cognitive, psychomotor, and affective skills in

order to use the tools of a comprehensive knowledge base,

the nursing process, and established standards of care, as

well as nursing research, to analyze data and plan a course

of action based on new insights and conclusions. To this

end, the nurse defines the problem, selects pertinent information

for the solution, recognizes stated and unstated

assumptions, formulates and selects relevant and promising

hypotheses, draws conclusions, and judges the validity

of the inferences (Hickman, 1993). Although critical

thinking skills are used in all aspects of nursing practice,

they are most evident when assessment data are analyzed

to identify relevant information, make decisions about

client needs, and develop an individualized plan of care.

Therefore, client assessment is the foundation on which

identification of individual needs, responses, and problems

is based. Nurses of the future will still manage and

interpret data and evaluate nursing activities and interventions.

They will also need competencies in case and

financial management, healthcare policy and economics,

legislative outcomes, and research methods. Additionally,

they will need skills of delegation and the ability to think

and reason across diverse settings in which they will practice

(Pesut & Herman, 1999).

To facilitate the steps of assessing and diagnosing in

the nursing process and to aid in the critical thinking process,

assessment databases have been developed (Fig. 3.1) that use

a nursing focus instead of the traditional medical approach of

a review of systems. To achieve this nursing focus, we have

grouped NANDA-I (NANDA International, formerly the

North American Nursing Diagnosis Association) nursing

diagnoses into related categories titled Diagnostic Divisions

(Box 3.1). These categories reflect a blending of theories, primarily

Maslow’s Hierarchy of Needs and a self-care philosophy.

These divisions serve as the framework or outline for

data collection and direct the nurse to the corresponding

nursing diagnosis labels.

Because these divisions are based on human responses

and needs and are not specific systems, data may be recorded

in more than one area. For this reason, the nurse is encouraged

to keep an open mind and to collect as much information

as possible before choosing the nursing diagnosis label.

The results (synthesis) of the collected data are written concisely

(client diagnostic statements) to best reflect the client’s


From the specific data recorded in the database, the

related or risk factors (etiology) and signs and symptoms

can be identified, and an individualized client diagnostic

statement can be formulated according to the problem, etiology,

and signs and symptoms (PES) format to accurately

represent the client’s situation. For example, the diagnostic

statement may read as follows: “ineffective peripheral tissue

Perfusion related to decreased arterial flow, evidenced by

decreased pulses, pale and cool feet, thick brittle nails,

numbness and tingling of feet when walks 1/4 mile.”

Outcomes are identified to facilitate choosing

appropriate interventions and to serve as evaluators of

both nursing care and client response. In addition to being

measurable, outcomes must be achievable and desired by

the client. These outcomes also form the framework for


Interventions are designed to specify the action of the

nurse, the client, and significant other(s). They are not allinclusive

because such basic nursing actions as “bathe the

client” or “notify the physician of changes” have been omitted.

It is expected that these actions are included in routine

client care. On occasion, controversial issues or treatments

are presented for the sake of information and because different

therapies may be used in different care settings or geographic


Interventions need to promote the client’s movement

toward health and independence. This requires involvement

of the client in his or her own care, including participation

in decisions about the care activities and projected outcomes.

This promotes client responsibility, negating the idea

that healthcare providers control clients’ lives.


eBook: Nursing Care Plans Guidelines for individualizing Client Care Across the Life Span 8th edition