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The Nursing Process


The nursing process can be defined as the framework which provides quality and professional nursing care. This framework is used by nurses to promote and protect health as well as prevention of diseases by nurses in different healthcare settings and fields. The nursing process is the basis for the critical thinking in the nursing profession. The North American Nursing Diagnosis Association (NANDA-I) played a significant role in the establishment of the present-day nursing diagnosis. In 1973, the association published the first-ever nursing diagnosis guidelines, which later became the nursing diagnostic standards. The nursing process, according to this standard, included the assessment, diagnosis, Identification, planning of outcome, implementation, and evaluation phases. These phases can be compared to the critical thinking stages in the decision-making process.

Critical Thinking

Black (2013) understands critical thinking to be a self-regulatory and purposeful judgment that allows for the analysis, interpretation, evaluation, conclusion, and explanation of the methodological, evidential, conceptual, and contextual aspects of the judgment. Critical thinking is significant in all aspects of human life, and like other skills, it can be learned. However, critical thinking is very important in the nursing process. Thus, critical thinkers are keen on developing their questioning attitude, which helps in the exploration of the situation with the aim of explaining the situation. In the nursing practice, universal intellectual principles are required to address and solve issues. Thus, the nursing process is also a critical thinking technique devised for solving the problems of patients in a clinical setting. Generally, the nursing process can be the selected progression of actions with the intention of realizing the nursing objectives (tdmu, n.d).

Historical Perspective

The nursing profession lacked an intellectual basis before the year 1960, but in the same year, the nursing leaders and educators initiated the naming and identification of the elements of the intellectual process in nursing. This was the origin of the nursing process, which later, in the 1970s and 1980s, led to the diagnosis debate in nursing. The nurses began realizing that they were capable of making independent interventions in nursing through the application of particular significant characteristics (Black, 2013).

The National Group for the Classification of Nursing Diagnosis currently known as North American Nursing Diagnosis Association(NANDA-I) took up the role of publishing the first nursing diagnosis in the year 1973. The major duty of NANDA International was to facilitate the advancement, enhancement, distribution and utilization of the standard terminology in nursing diagnosis with the aim of improving the citizens’ health care (Barros, 2009). The nursing process has been identified as having a sequence of steps. The nursing standards of practice by NANDA had a significant impact on the nursing process as it introduced other steps in the nursing diagnosis. Now, the standard nursing process involves the assessment, diagnosis, identification of outcomes and planning, implementation and evaluation (tdmu, n.d).

Nursing Process

The initial stage in the nursing process is the assessment stage, and it involves the gathering of data about the particular patient, their family, or the society in which they live. The data collected might include physiological, sociocultural, psychological, environmental, financial and spiritual information. Thus, the assessment stage involves several stages, including the actual collection, verification, data organization, interpretation and finally, the recording of the data (Black, 2013). Data can be collected from different sources, including the primary source (patients) and secondary sources, such as the family of the patient, medical records, and other healthcare practitioners. The interviewing, as well as the physical examination techniques, can be effective in the collection of primary data.


The assessment phase of the nursing diagnosis is the basis of the patient’s database, and the subjective and objective data are collected at this stage. The subjective data includes data from the patient’s perspective, such as perceptions, feelings, and concerns collected through interviews. On the other hand, the objective data can be assessed through physical examination and diagnostic tests. The significance and meaning of the collected data can be determined through critical thinking. Clustering the collected data would enable the nurse to identify the data which is most relevant and those that are less relevant for recording and reporting, determine deviations in the data and identify the cause and effect patterns (time, n.d).


The diagnosis stage involves advanced data analysis. Nursing and medical diagnosis are used as a basis for selecting the nursing intervention that would provide the best outcome. The development of the nursing diagnosis can be achieved through critical thinking. Some possible nursing diagnoses include actual problems, wellness conditions, potential problems and collaborative problems. The data analysis would act as the foundation of the care planning, development, and recording of a list of nursing diagnoses (Black, 2013).

Identification And Planning Of Outcome

This process involves the establishment of the guidelines for the nursing action plan in regard to the nursing diagnosis and development of the care plan for the patient. This is carried out through the identification of the nursing diagnosis, identification and recording of the long and short-term goals and outcomes, development of possible nursing interventions and the recording of the plan of care. Following the recording of the nursing diagnosis, the nurse has to make the appropriate decision. This is only possible through the help of critical thinking techniques, which makes it possible for the nurse to decide which of the diagnoses is more important and requires urgent attention than the rest. The nursing intervention is then assigned to each diagnosis, and the plan of care can then be implemented to accomplish treatment goals.


Implementation is the execution of the patient’s plan of care by the care providers. The planned activities are executed to achieve the treatment goals. Implementation is a continuous process as it requires assessment of the patient’s condition prior to, during and subsequent to the nursing intervention.

During and subsequent assessment, both the positive and the negative responses to the intervention by the patient may be indicated. Critical thinking skills are essential at this stage as the nurse needs to think through the circumstances, ask the patient and the family questions that are appropriate, and make appropriate decisions. The nurse also needs to report and document the patient’s conditions before, during as well as after the intervention. Moreover, the particular intervention, the patient’s response, and the outcomes need to be recorded.


Evaluation entailed the determination of whether the goals set have been completely, partially or not met at all. The possibility that the goals have been met would result in the nurse making a decision on whether the nursing activities should be stopped or continued to maintain the status of the patient. The possible reasons for partial or not meeting the goals of the plan could be incomplete data for assessment, unrealistic goals, extremely optimistic time frames and inappropriate nursing intervention for the particular client. If the goal is partially or not met, the nurse is obligated to reassess the condition closely through the collection of data and making modifications to the care plan.

Critical Thinking And The Nursing Process

Critical thinking Nursing process
Encounter problems Assessment
Collection of data Assessment
Identification of the nature of the problem Generation of nursing diagnosis
Determination of the action plan Planning
Executing the plan Implementation
Plan evaluation Evaluation


The nursing process includes the assessment, diagnosis, Identification, and planning of outcome, implementation, and evaluation phases. The nursing process is dynamic as the nurses are in a continual transition from one stage to the other. The establishment of the nursing standards by the NANDA-I paved the way for the current nursing diagnostic standards used globally. The process begins all over again after the completion of the phases of the nursing process. Most of the time, the nurses can execute two or more of these stages at the same time by using critical thinking skills. The phases of the nursing process can be compared to the critical thinking stages in the decision-making processes of an organization.


Barros, A.L. (2009). Classification of Nursing Diagnoses and Interventions: NANDA and NIC. Acta Paul Enferm,22 (70),864-7.

Black, B.P. (2013). Professional Nursing: Concept and Challenges. Elsevier: Health Sciences

Pesut, D.J. & Herman, J. (1999). Clinical Reasoning: The Art and Science of Critical and Creative Thinking, Albany, NY: Delmar. (n.d). Nursing process: definition, objectives, functions, steps. General characteristics. Phases the first stage of the nursing process. Examination and determination of health status as the phase of the first stage of nursing process.



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