SMART Goals for Nursing With Clear Examples

SMART goals for nursing

Goals provide a keen sense of motivation, direction, clarity, and a clear focus on every aspect of your career or (nurse) life .

You are letting yourself have a specific aim or target by setting clear goals for yourself.

There is a method called the SMART goal that is used by a lot of people to guide them in setting their goals. In this article, you are going to learn how to set up SMART goals for nursing with plenty of examples of SMART goals for nursing .

But first, let me tell you what the SMART goal is generally speaking.

The acronym SMART stands for the terms Specific, Measurable, Attainable, Relevant, and Time-Bound.

All these five elements are the main parts of the SMART goal. This simple yet powerful method brings structure and ensures that your goals are within reason and are attainable.

The SMART goal helps you in defining what the “future state” of your goal would look like, and how it is to be measured.

SMART goals are:

  • Specific – clear, unambiguous, and well defined
  • Measurable – has a criterion that helps you measure your progress
  • Att ainable – beyond reach and not impossible to achieve
  • Relevant – realistic and has relevance to your life or career
  • Time-Bound – well defined time, has a starting date and an ending date

Often, people or businesses set unrealistic goals for themselves that only lead to failure.

For instance, you may be a nurse practitioner and you set goals such as “I will be the best at _____.” This specific type of goal is vague and has no sense of direction in it.

Here is a thorough video from DecisionSkills that I encourage you to watch before continuing reading.

After the video, you’ll have a much better understanding of setting SMART goals for nursing.

Now it’s time to give you a couple of examples of SMART goals for nursing.

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Examples of SMART goals for nursing

Table of Contents

Examples of SMART Goals for Nursing

In this fast-paced and busy day-to-day life, the job of a nurse can get stressful and overwhelming–with all the workloads and patients emerging from left to right.

SMART goals are especially helpful in nursing as it helps in defining a developmental framework and helps you see your progress towards your goal.

  • Patient Care
  • Professional Development

Next, a more specific answer to each category.

Today, I will construct a checklist for an updated patient and staff safety and hazard. I will use our ward policy guidelines in constructing this checklist.

I will let every staff nurse check this list based on a once-a-month rotation. I shall complete the checklist by the end of September and have it measured monthly.

#2 Patient Care

SMART goals for nursing: Patient care

I shall hand over the assessment notes, care instructions, and patient details to the next shift nurse as I complete my shift.

I have to finish this before the break time so that the details of the patients would be noted and important instructions would be followed.

#3 Efficiency

I will document the additional tasks following the timetabling meeting weekly so that I can efficiently balance my time and be able to manage all my duties.

This will benefit me as it improves my overall time management .

#4 Accuracy

I will record all my notes about the patient as soon as I leave his or her room, while the information is still fresh and complete in my mind.

This will help in ensuring the accuracy of the information before I proceed to my next endeavor.

#5 Professional Development

By the end of this year, I shall attend two workshops that will help me with my specialty or another field that will help me for the betterment of my profession as a nurse .

Next, I’m going to give you examples of SMART goals for nursing students.

Examples of SMART Goals for Nursing Students

SMART goals for nursing students

Scenario:  You’re a 1st-year college student who’s taking up nursing.

Your professor in one of your major subjects has announced that you’ll be having your final examination at the end of the month.

You know that this subject is critical, and you want to pass this subject no matter what.

SIMPLE GOAL

I want to pass our final examination.

I will finish reading three chapters of our book within this day. I’ll write down every important terminology and its definition in my notebook.

I will also take a 15-minute break in every hour of studying.

For tomorrow, I will make flashcards that will help me easily retain this information and terminologies better.

On the day before our examination, I will make sure to have sufficient rest and enough amount of sleep.

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Let’s move on to examples of SMART goals for nurse practitioners.

Examples of SMART Goals for Nurse Practitioners

Scenario:  You’re a nurse practitioner, but your monthly salary is not enough since you’ll be having to pay for your loans and other payable.

So, your perceived solution to this problem is to strive and get promoted in the acute care facility which gives a higher pay than your current position.

I want to be promoted to a higher position and make more money.

I will work harder so that my chances of getting promoted in the acute care facility would be higher.

This new job pays me an amount of $30 per hour, including a night differential.

I will aspire to be a better nurse practitioner day by day, so that by August 30th, my manager would see my potential, and get me promoted.

Examples of SMART Goals for Nurse Practitioner Students

Scenario:  You’re a nurse practitioner student who’s failing in his/her exams and got the lowest grade in your class.

You know to yourself that something is wrong with your study methods because even if you study hard, you don’t see the fruit of your labor.

I want to learn the other nurse practitioner students’ study methods.

I will improve my study methods by asking my fellow nurse practitioner students how they prepare for tasks and exams.

Today, I will talk to one of my fellow nurse practitioner students, and ask them if we could have a group study together as we prepare for the upcoming examination.

Examples of SMART Goals for Nurse Managers

Examples of SMART goals for nurse managers

Scenario:  You’re the department manager and you’re assigned to handle the nurses in the hospital.

You notice that the work environment is getting unhealthy, and the nurses in your department are uncomfortable with each other and with you.

I want to improve my relationship with the nurses that I handle.

I will make sure to promote a healthy working environment by having a meeting once or twice a month to discuss prevailing and relevant issues in our department and hear some constructive feedback from the nurses that I handle.

I will make sure to treat them all equally and with the utmost respect regardless of their age or gender.

But I will also set professional boundaries among the nurses that I handle, and I will make sure that I lay these limits very clearly so that no one will violate them.

Examples of SMART Goals for Nursing Care Plans

Scenario: You’ve learned from a workshop that by showing compassion and empathy to your patient, they will adhere better to the medications which would lead to quicker recovery.

See also: Compassion in Nursing

I want to show more empathy to the patients that I’m handling.

I will make sure to spend an extra 5-10 minutes with each of my new patients.

I will ask them questions about their interests and hobbies so that I can distract them from their health condition.

Also, I will make sure to put myself into their position by thinking about what they must be feeling about the situation.

My way of communicating with them should be as if I’m just having a conversation with a friend, but of course with respect and boundaries.

See also: Nursing Care Plan – Full Guide & Free Templates

More Tips for Creating SMART Goals

Pursuing an “I will” statement is more effective than an “I want” statement .

As you create your own SMART goals, remember to ask yourself the following questions:

  • How is my goal specific? Where is the focus?
  • How is my goal measurable? How will I be able to track my progress?
  • How is my goal achievable? Are my resources enough to achieve this goal?
  • How is my goal relevant? How will this help in my career as a nurse?
  • Is my goal time-bound? Is my goal set in a realistic time frame?

Aside from the five elements comprising SMART goals, it is important to have a model and visualization of your goals as if you have already achieved your goal.

Not only will this motivate you, but this will also give you the feeling of success that comes from achieving that specific goal of yours.

Release any doubts that you have. Those doubts whispering that you’re not enough, or those negative thoughts that kept you awake all night.

Let those negative self-talk go.

The more you say something to yourself, the more likely these things will happen in reality. So, it is always best to talk nicely to yourself.

While releasing your doubts and visualization of your goals are both effective, all these things will only matter once you take consistent action towards your desired goal to progress each day.

Things may get overwhelming and you may not know where to start, so it is advisable to do one task at a time.

It may seem hard at first, that’s just how things are.

But as you keep going, you will get closer and closer to your goal.

The Art of Setting SMART Goals

If these tips were not enough for you, I highly recommend you to check out more about SMART nursing goals from No products found. book.

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We’re an affiliate As an Amazon Associate, I earn from qualifying purchases. Thank you if you use our links, we really appreciate it! 🙂

Conclusion: SMART Goals for Nursing

By setting SMART goals for nursing students, nurse practitioners, nurse practitioner students, nurse managers, and nursing care plans, you are setting a clear focus for your ideas and efforts that will allow you to reach your goals in a much shorter period.

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But you should also take note of the possible drawbacks to SMART goals that may hinder you from achieving your goals.

At this point, you should have a clear understanding of how to set SMART goals for nursing.

If you would like to learn some more check out these articles of ours:

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Develop Good Habits

15 SMART Goals Examples for Your Nursing Career

There might be affiliate links on this page, which means we get a small commission of anything you buy. As an Amazon Associate we earn from qualifying purchases. Please do your own research before making any online purchase.

Pursuing a nursing career requires plenty of discipline and effort. You have to learn how to care for a sick or injured person and comfort them when they feel at their weakest.

When pursuing a nursing career, your physical and mental health are put at risk. So it’s vital to develop skills that will help you stay organized and efficient to stay motivated and succeed at work – like creating SMART goals. Nursing becomes much more fulfilling when you know how you can achieve your aims.

Table of Contents

What Are SMART Goals?

Most people create goals to help them achieve the desired outcome. But very few stick to them until the end. This is because they approach goal setting the wrong way.

Have a look at these two statements:

  • I want to pass my exam.
  • To pass my exam, I will study every day for at least 20 minutes and reread the chapters as I complete them.

The first statement is a goal nursing students may typically set. The second one is a SMART goal. Other than stating what the goal is, a SMART goal also includes instructions on how to achieve it. This is the only way an action plan can work.

“SMART” stands for “Specific, Measurable, Attainable, Relevant, and Time-bound.”

Here’s what each segment means in practice.

S: Specific

Being specific is crucial for achieving both short- and long-term goals. The questions your goal should answer are “What?” “Who?” “When?” “Where?” “Which?” and “Why?” Then, once you reach a specific milestone or the final deadline, you’ll be sure you achieved the goal.

M: Measurable

Measurable goals have a precise time, amount, or another unit of measurement built into them. It’s easy to track your progress if the goal has metrics. For example, if the objective is to read 20 pages of a book each day or to spend 15 minutes doing yoga, it’s easy to measure how much of the activity you actually did.

A: Attainable

Goals that aren’t attainable often lead to frustration. When creating a goal, examine your current life situation and aim for objectives that aren’t beyond your reach. Otherwise, failure can be discouraging.

Imagine setting a goal to get a nursing job in the most elite private hospital right after graduation. Although not impossible, it’s doubtful that a person can master everything it takes to become a highly skilled nurse practitioner so early in their career.

R: Relevant

Relevant goals are about what you really need and want. Your goals should align with what you hold dear and value in life.

You probably have more than one goal in life. Focusing on all of them at once is highly unlikely to bring success. Instead, shift your attention to the goals that are most relevant to your current life situation.

T: Time-Bound

Time-bound goals are about setting deadlines. When creating a goal, you want to set a target date to achieve it. When you look at your goal, the outcome should be clear. And as the deadline approaches, it will be visible whether or not you are on track to succeed.

An essential part of setting goals is the wording. You can achieve fantastic results when you focus on the right things. However, when you don’t, it’s only a matter of time before your motivation dies. This is why it’s best to shift your attention from the outcome goals to the process goals. You can learn more about the difference in this blog post .

And to learn more about SMART goals, check out this post .

Why SMART Goals Are Important for Nurses

According to the American Association of Colleges and Nursing (AACN) , over 250,000 students are enrolled in a program preparing new registered nurses at the baccalaureate level. There was a surprising 5.6% increase in 2020.

what are the 5 smart goals in nursing | nursing goals examples | smart goals for nursing students during preceptorship examples

To compete with your peers in nursing school or as a practitioner, you need to give your maximum to succeed. The best way of doing so is by setting goals that will keep you focused and motivated. Setting SMART goals will ensure you actually complete your objectives.

8 SMART Goal Examples for Nurses

1. improve communication skills.

To improve my communication skills, I will listen closely to what others are saying to me. If I can’t keep up, I will ask them to clarify. Finally, I will ask people whether they understood me after I’ve spoken. I should become a better communicator by the end of the year.

S: This goal explains precisely how to improve your communication skills. M: By asking for clarity anytime you don’t understand something, you can measure your progress based on how often you have to ask in a given day or month. A: This is a reasonable, attainable goal you can start doing anytime, anywhere. R: The goal is relevant to becoming a better nurse since communication is vital in this field. T: At the end of the year, you can compare your communication skills before starting this process-oriented goal.

2. Improve Time Management

I will document all tasks following a weekly timetable during my workday to balance my time and accomplish my duties more efficiently. I will do this for two weeks to improve my overall time management.

S: This goal explains precisely what you can do to improve your time management as a nurse. M: You can measure the number of tasks you documented, as well as measure how much more efficient you’ve become by the extra time you have for other jobs. A: This goal is attainable and straightforward. R: Having strong time management skills is crucial when you’re a nurse. This goal is relevant to your nursing career. T: You should document the tasks each week following the timetable. You can create an additional sense of urgency by deciding that you have to complete the documentation before returning to work. Two weeks is enough time to see if the strategy is working for you.

3. Be More Accurate

To become more accurate as a nurse, I will write all notes about my patient the moment I leave the room, while my memory is still fresh. Then, after one week, I should have more accurate notes.

S: Compared to “I want to be more accurate,” this is a rather specific goal describing how you can achieve it. M: You can measure this goal in terms of how many notes you got down. It’s not good to skip a bunch of notes – the point is to get ALL of them down right away. A: You can squeeze in a minute after leaving a patient room to take notes, so this goal is highly attainable. R: This goal is relevant to you wanting to become more accurate at nursing. T: The sense of urgency is created by “the moment I leave the room,” so you know you should act fast to complete your goal. In a week, you can see the difference this strategy makes in your accuracy.

4. Develop Professionally

I will attend two nursing workshops or webinars per year to help my professional development.

S: Instead of saying, “I want to develop my career,” you state the exact activity that will help you do so. M: The goal is to attend two events per year, so it’s easy to measure your progress. A: Given that you may have to work more than usual this year, anything more than two webinars per year might be hard to achieve. R: The goal is directly relevant to you advancing your nursing career. T: The goal resets at the end of the year, so you want to plan your time wisely.

5. Explain Things to Patients

I will learn to use plain language so I can communicate better with my patients. Whenever I learn a new medical term in the next three months, I’ll find a simpler way to explain it.

S: This is a specific goal about changing how you explain things to your patients.

M: The goal progress can be measured by the number of new medical and laymen’s terms you learned.

A: This goal is attainable, and it’s a win-win both for you as a nurse and for your patients.

R: This is a highly relevant goal in anyone’s nursing career.

T: After three months, you’ll see a difference in how you communicate with your patients.

6. Stress Less

To combat stress at work, I will practice stress management. I will exercise, meditate, listen to music, or take some time off for myself every day for one hour. I’ll get more sleep in and talk to friends and family about what’s troubling me. Then, after two weeks, I’ll re-assess.

S: Instead of saying, “I want to stress less,” you can give specific details about how you can achieve that.

M: You can measure your progress by the number of hours you spent on self-care . Also, you can measure how doing these activities impact your response to stressful situations at work compared to before.

A: You may feel pushed for time, but an hour per day for yourself is not that much. If you can’t make it an hour straight, you can split the activities into two sessions of thirty minutes.

R: Doing what you love releases tension and stress you may feel at work, so it’s like performing a small reset after a tiresome workday. You’ll start fresh tomorrow, which is relevant to managing stress at work.

T: After two weeks, you can decide if your quality of life has improved.

7. Stay Healthy

To stay healthy, I will practice healthier habits. For the next month, I will work out every other day and meal prep in advance to ensure my diet is healthy and balanced. In addition, I will eat more raw foods and avoid sugars and soda.

S: This goal describes in detail what you can do to stay healthy.

M: You can measure the goal by how many workouts you got in or how many healthy meals you prepared over the week.

A: Working out can take as little as 15 minutes of your time, and meal prep can be done once for the rest of the week, so both goal segments won’t be too time-consuming.

R: Being a nurse in these hectic times is challenging. To keep your immune system up, you have to take extra care of your health.

T: Working out every other day means you need to find time off and squeeze in a workout long before it’s time for bed. Also, you can assess how you feel at the end of the month.

8. Be More Compassionate

To be more compassionate, I will spend two to five minutes asking each new patient about their lives and learning more about their interests. Then, I will discuss their interests with them to distract them from stressing out about their condition. By next week, I will be a more compassionate caregiver.

S: Instead of saying, “Be more compassionate,” you specify how exactly you can achieve that.

M: If you have never spent time discussing your patients’ interests before, doing so for two to five minutes is a way to measure your progress.

A: This goal takes just minutes to complete, and you can do so whenever you find it convenient.

R: This goal is relevant to you becoming a more compassionate nurse practitioner.

T: In just one week, you can decide if this strategy helped achieve your goal.

9. Avoid Burnout

To help avoid burnout, I will use my PTO to take time off for a mini vacation at least twice a year. I’ll practice stress reduction techniques, like meditation and yoga, at least three times a week. I’ll try to get enough sleep on my days off. I’ll practice deep breathing if I feel stressed during my shift. I’ll also practice a self-care activity, like getting a pedicure or massage, at least once every two weeks. After three months, I’ll reflect on what helped me feel less stressed and assess whether I have early signs of burnout.

S: This goal is specific because it describes exactly what you’ll do to decompress and reduce stress. The goal also specifies what self-care and stress reduction techniques you’ll try.

M: The goal is measurable because it states how often you’ll practice techniques to avoid burnout. 

A: The goal is attainable because practicing yoga or meditation three times a week is easier than every day. You’ll likely be able to take at least a couple of PTO days twice a year, if not more.

R: The goal is relevant because burnout can easily happen to nurses, given the high stress and demands of the job.

T: The goal sets a timeframe of three months to evaluate how you’re doing and what’s worked to reduce stress and burnout risk.

10. Uplevel My Skillset

I will try to start at least ten IVs in the next two weeks. I’ll offer to insert IVs, catheters, or NG tubes for other nurses’ patients whenever there’s an opportunity for the next two months. I’ll practice recognizing a cardiac rhythm on telemetry once a shift and discuss my questions with the charge nurse. In three months, I’ll make a list of skills I’ve improved on and ones I want to practice more.

S: This goal gets very specific about what skills you want to practice — IVs, catheters, NG tubes, and reading telemetry. 

M: The goal is measurable because you’ll reflect on what went well and where you want to improve after three months.

A: The goal is attainable because most other nurses are always grateful for a helping hand with many of these skills. If you work where there are telemetry patients, you’ll have plenty of rhythm strips to look at and senior nurses to learn from.

R: This goal is relevant because technical skills are always in demand in the field of nursing, although it depends somewhat on where you work. If you do work at the bedside, improving your skills will also help you better care for patients. 

T: The goal sets a timeframe to get in as much practice as you can, as well as when to re-assess. 

11. Be a Team Player

Whenever I’m caught up with my own work, I’ll offer to help coworkers with transferring patients or giving medications. I’ll be kind in all my interactions with doctors, therapists, social workers, and other nurses. Every month, I’ll reflect on any feedback I’ve gotten from supervisors or coworkers.

S: The goal here is to be mindful of your interactions with coworkers. It also talks about which tasks you’ll help others with.

M: By thinking about constructive feedback, you’ll be able to measure how well you’re working with your team.

A: The goal is attainable since it states that you’ll offer to lend a hand whenever you’re caught up on your own work.

R: Being a great team player is an integral part of being a nurse.

T: The goal sets a monthly timeframe for reflecting on how you’re doing as a team member.

12. Improve Workflow

I’ll come to my shift ten to fifteen minutes early so I can review my patient assignments before starting my shift. I’ll make a list of the main tasks I need to complete and which patients I need to see first. I’ll try to get the most difficult tasks done early in my shift. Each week, I’ll write down what went well and what could be better. After three weeks, I’ll re-assess and think about ways to be even more efficient. 

S: Here, you’re setting a goal to be at work ten or fifteen minutes early to have time to prepare. Prioritizing tasks and making a schedule for your shift are specific ways to improve workflow. 

M: A weekly list of things that did or didn’t work can help you measure your workflow and see how you can improve. 

A: The goal is attainable since you’ll already need to do some preparation for work and complete tasks. 

R: The goal is relevant because a better workflow will improve efficiency and time management, which will help your day or night run smoothly!

T: Reassessing your progress after three weeks makes for a good time-bound goal.

13. Ace Nursing Job Interviews

I will apply for at least three jobs I’m interested in each week and follow up if I haven’t heard back in one week. Two days before my interview, I’ll research the company and review ten common interview questions online to feel more prepared. I’ll also choose what I’ll wear and think of three questions to ask the interviewer a day ahead of time. 

S: The goal details exactly what you’ll do to secure a job interview and get prepared. It also mentions how many questions you’ll have ready to ask the company.

M: The goal specifies three questions to have ready and how many potential interview questions you’ll prepare for. You can also measure your success by whether you get the job!

A: Looking up interview questions online and preparing a day ahead of time are all attainable goals.

R: If you’re on the hunt for your perfect nursing job, acing the interview is an important part of the process. 

T: This goal puts a timeframe on when you’ll follow up with a potential employer and start preparing for your interview. 

14. Be More Thorough

I’ll perform a head-to-toe assessment on each of my patients within two hours of starting my shift, sooner if they’re more critical. I’ll come to work ten minutes early so I can review my patient’s chart before seeing them. I’ll make a list of each body system to make sure I cover everything in report. I’ll re-assess where I could improve in a month. 

S: This goal mentions what you’ll do to ensure you’re being thorough, like doing full assessments. 

M: The goal is measurable by re-assessing areas for improvement in a month and making sure you’ve covered each body system in report. 

A: Doing a full assessment is likely a part of your workflow anyway. Coming in a little before your shift gives you some time to review details in their chart. 

R: Being thorough is good practice as a nurse since it helps stop problems before they start.

T: The goal is time-bound because it sets the bar at two hours for when to have patient assessments done, as well as a monthly reflection period. 

15. Improve Patient Outcomes

I will provide printed instructions to patients on discharge and ask them to repeat back what I tell them to ensure they understand. I’ll do thorough assessments each shift. I’ll make sure my patients get all their questions answered before they leave. 

S: This goal talks about just a couple of ways to help patients have better outcomes — making sure they have detailed instructions they understand how to follow. 

M: Having patients repeat back what they heard is a way to measure their understanding. 

A: If you discharge patients, you’ll have to spend time going over discharge instructions anyway. Thinking about the best ways to do it might help improve their outcomes. 

R: Many of us enter nursing because we want to help people. This goal is relevant because nurses are a huge part of patient success!

T: The goal is time-bound because you’re making sure all questions are answered before the patient discharges. Depending on where you work, you may even set reminders to follow up with outpatients and see how they’re doing long term.

Final Thoughts on SMART goals for Your Nursing Career

Regardless of where you are in your life right now, you can always rely on SMART goals. Nursing doesn’t have to be so challenging when breaking each challenge into smaller objectives and facing them one at a time.

Plus, you can use this free printable SMART goals worksheet to make your goal-planning even more straightforward.

And if you want more SMART goal ideas and examples, be sure to check out these blog posts:

  • 9 Examples of SMART Goals for Occupational Therapy
  • 5 SMART Goals Examples to Improve Workplace Teamwork
  • 7 SMART Goals Examples for Improving Your Listening Skills

Finally, if you want to take your goal-setting efforts to the next level, check out this FREE printable worksheet and a step-by-step process that will help you set effective SMART goals .

smart goals nursing | smart goals for nurses examples | nursing smart goals and objectives examples

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  • November 29, 2023

How to Set SMART Goals in Nursing + Examples

Why are we still talking about SMART goals in 2024? Well, to put it simply – because they work! Setting SMART goals can help you to define a goal that is possible within a given time frame because you have set out a plan to reach milestones within a timeline that is realistic and attainable .

Table of Contents

What are smart goals.

SMART stands for Specific, Measurable, Achievable, Relevant, and Time-Bound . SMART goals can be used for both professional as well as personal goals, as the clear objectives and milestones help to eliminate the chance of falling off track.

Setting SMART goals are also an integral part of the care planning process necessary for meeting clinical requirements while in nursing school and for professional nurses in the care of patients.

It’s no surprise that setting SMART goals is an extremely important skill for nurses and nursing students – so we put together more details on how to set SMART goals as well as provide detailed examples that can help you in the nursing field.

How to Set SMART Goals

smart goals in nursing

We’re going to learn how to set SMART goals in nursing that will actually help you achieve success in the field. Using the SMART method, we’ll work through real-life examples that can be applied in nursing school, passing the NCLEX, providing professional patient care, and more!

1. Specific

specific smart goals

Many people find their goals difficult to achieve because they’re too vague.  You should make your goal as narrow as possible.

Answer these questions:

What do you want to achieve? When do you want to achieve it? Why do you want to achieve this? What are the steps to achieve this goal?

Being specific can also help the nursing student set specific goals for the patient. This can be accomplished by setting specific criteria for the patient to meet based on a nursing diagnosis.

2. Measurable

measurable smart goals

A goal needs to be measurable if you want to track your progress.  You might say, “I want to be kinder to patients,” but how do you measure that?  What evidence will you have for how well you’re doing?

If you’re a nursing student, you can easily track your progress by looking at your grades, your projects, and the number of assignments you’ve completed. If you’re trying to budget, you could look at how well you’re able to fall under your budget for the month. Learn how to make more money with these 17 best jobs for nursing students .

If you are developing a plan of care for a patient, you will need to have measurable criteria to track the patient’s goal progress.

3. Attainable

attainable

SMART goals in nursing should be attainable – if you don’t feel like you can achieve your goal, you’ll become discouraged.

When caring for patients, you will want to have long term and short term goals. An unattainable  short term goal for a patient may be for them to be infection free within 2 hours if they just began their day 1 of 10 antibiotics. On the contrary, an attainable long term goal for that same patient may be to have the patient infection free after the 10-day course of antibiotic therapy.

4. Realistic

realistic

Your SMART goals should be realistic, and they should relate to your environment. 

In a patient care setting, the goal must be realistic to what the patient can achieve. A patient who has had a limb amputation will not be able to walk without a prosthetic device. A goal related to the patient safely ambulating out of bed will not be realistic in this scenario.

5. Time-Bound

timebound

The most measurable SMART nursing goals examples are time-bound.  Rather than being open-ended, they have a concrete finish line.

Short-term goals may be achieved by the end of the month. Long-term goals might have a time frame of up to a year.

Short-term goal: by the end of the month Long-term goal: by March of next year

Related: A Guide to Subjective vs Objective Data in Nursing

15 Smart Goals Examples for Nurses & Nursing Students

smart nursing goals

Let’s take a look at some simple goals, along with better examples of SMART goals in nursing professionals as well as for nursing students.

Patient Care SMART Goals

nurse goals

1. Short term goal: Patient will breath better

Smart goal: The patient will increase the oxygenation saturation from 85% to 95% by using effective breathing techniques within the next 8 hours. 

2. Long term goal: Patient will have improved skin.

Smart goal: The patient’s pressure ulcer will decrease from a stage 3 to a stage 1 by increasing diet in protein and by adhering to a strict turning schedule over the next 2 months. 

3. Short term goal: Patient will have less pain.

Smart goal: The patient’s pain level will decrease from a level 10 to a level 3 by the next shift through the adherence of a strict medication schedule.

4. Long term goal: Patient will be compliant with hypertensive medications.

Smart goal: The patient will demonstrate compliance with hypertensive medication by using a medication organizer and verbalizing the consumption of daily medications.

5. Simple goal: I want to get better at listening.

Smart goal: I will pay close attention to what my patients and coworkers tell me.  If I do not understand, I will ask them to clarify.  I will focus on them instead of thinking about what I want to say next.

6. Simple goal: I want to get better at explaining things to patients.

Smart goal: I will learn the layman’s terms for complicated medical jargon so that I can communicate more easily with patients.  Instead of using technical language, I will explain things in terms people can understand.

7. Simple goal: I want to be more culturally sensitive.

Smart goal: I will ask each patient whether I need to be aware of any cultural beliefs or norms while in charge of their care.  I will also seek feedback from coworkers regarding cultural sensitivity.

8. Simple goal: I want to make my patients happy.

Smart goal: I will work to put my patients at ease by finding out what helps them to relax.  I will make sure that I meet certain parameters in offering them care each time I speak with them.

Professional Development SMART Goals

Examples of SMART goals in healthcare can also be utilized to help you develop as a medical professional. Below are a few examples of what we’d call a “simple goal” as well as examples of how to make this into a SMART nursing goal.

nurses

9. Simple goal: I want to get promoted.

Smart goal: I will go above and beyond in my job duties.  If a better position opens up, I will apply for it.  I will make my interest in further responsibilities known to my supervisors.

10. Simple goal: I want a raise.

Smart goal: I will perform my tasks to the best of my abilities.  I will make my workplace more efficient and increase the quality of patient care.  If I have not been considered for a raise after six months, I will put together a case and present it to my supervisor.

11. Simple goal: I want to be better at my job.

Smart goal: I will keep checklists to make sure I do my duties during every shift.  I will check in with coworkers and ask for feedback when needed.

Related: Get more experience (and extra income) with these 15 best nurse side hustles.

12. Simple goal: I want to learn from my coworkers at my new job.

Smart goal: I will ask a more experienced coworker if they would be willing to mentor me.  I will ask about what I should know while working here.  I will talk to my supervisor about how I can observe more closely.

Related: 20 Positive Nurse Affirmations for a Growth Mindset

Nursing School SMART Goals

Utilizing proper SMART goals in nursing school can really elevate your academic success by making your goals actionable. These types of SMART goals examples can work in nursing school or any other academic area you may be focusing on.

nursing student goals

13. Simple goal: I want to finish my assignments on time.

Smart goal: I will do my assignments when they’re first given.  For long-term projects, I will create a timeline and work steadily on them until they are complete.  I will keep track of my assignments using to-do lists and schedules.

Keep track more easily with our favorite planners for nurses . 

14. Simple goal: I want to pass all my exams.

Smart goal: I will create a study schedule to review all the relevant material prior to my exams.  I will create study materials.  I will reread my assignments and make use of faculty office hours if needed. 

Speaking of exams, pass the NCLEX the first time with this 5-week NCLEX Study Schedule

15. Simple goal: I want to remember important information without wasting time.

Smart goal: I will create flashcards that have key terms and concepts from the reading.  I will frequently use these to quiz myself so that I know I remember the most important points.

16. Simple goal: I want to be more social.

Smart goal: I will look up campus events, join a study group, and make an effort to interact with more people.  I will answer questions in class and participate in discussions with my classmates.

Related: What’s a Passing NCLEX Score?

Workplace Efficiency SMART Goals

Nursing performance goals could be set using the SMART goal method – have a look at a few examples of SMART nursing goals that involve being more efficient, and, therefore, more effective, at your job:

17. Simple goal: I want to decrease patient wait time.

Smart goal: I will complete patient intake procedures in a timely manner.  I will be efficient when weighing patients and asking them preliminary questions.  I will try to see them quickly without making them feel rushed.

18. Simple goal: I want to do more hands-on procedures.

Smart goal: I will complete a certain number of specific procedures in the next two months.  I will volunteer to do these procedures whenever possible, and I will ask my coworkers to help me get more experience.

19. Simple goal: I want to get more done during a shift.

Smart goal: I will put my down time to better use by sorting patient files.  I will make lists of tasks to complete and work on them when I’m not seeing patients.  I will create a system to streamline the intake and recording process for patients.

Related: How-To Guide for Why I Want to Be a Nurse Essay

Other SMART Goal Tips

1. write them down..

Whether you write them in a journal or an online document, writing your SMART nursing goals out makes it easier to track them. We’ve put together a list of the best nursing school planners that help you to keep track of personal and professional goals, academic deadlines, as well as other calendar events.

If you’re already out of nursing school, then you can check out our 6 picks for nurse planners .

2. Keep track.

Get in the habit of updating your progress.  You can even use tracking apps to make sure you’re on schedule. Here are some apps to help you do that.

3. Celebrate micro-wins.

Even small amounts of progress are progress!  Let yourself celebrate each new step, even if it’s just a single procedure or patient. Read more on how to create micro wins in your life here .

4. Focus on your own goals, not other people’s.

You’re not competing with other people.  You’re competing with yourself.  Keep the focus on you and don’t get distracted by those surrounding you.

A big component of clinical requirements while in nursing school, is to develop careplans for patients. In this instance, the student is focusing on the goal of the patient, not theirs. 

The same goes for the nurse when care planning for the patient. The are focusing on the goals of the patient, not theirs.

5. Remember what motivates you.

Why did you set these goals in the first place?  Because you want to become a better practitioner, right?  Keep that in mind as you work to stay motivated. Remember to celebrate success and achievement, as you don’t want to burnout with constant ambition.

Related: 7 Examples of Nursing Strengths and Weaknesses for Interviews

The best way to create SMART goals in nursing is to ask yourself what you want to accomplish.  Then you’ll look for attainable ways to do that.  It’s important that the goal be measurable, and that it’s not so difficult you get frustrated.

You’ll notice that in the SMART nursing goals examples, the biggest drawback is vagueness.  The more specific you are, the easier it will be to measure your progress!

Do you have a better idea now of your future goals?  What are your plans?  Let us know in the comments below!

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17 Awesome Examples of SMART Goals for Nursing Students

In a career like nursing, you will be faced with many different obstacles and challenges that you must work to overcome. Because being a nurse is not easy and requires a lot of focus and dedication, you must have a good set of smart goals to manage your time effectively. This post will find some examples of SMART goals for nursing students that you can use for inspiration when creating your own personal plan-setting strategy.

17 Awesome Examples of SMART Goals for Nursing Students - Examples of SMART Goals for Nursing Students

But before we dive into examples, let’s explore smart goals and their benefits so you can understand their importance.

Table of Contents

What are smart nursing goals.

The nursing goal is similar to the more common goals that you might find elsewhere, but there are some key differences. SMART is an acronym that stands for five critical characteristics of practical goals:

Your goal should include all of the essential details about what your goal is, and what needs to be done to complete it. For example, instead of simply writing down “I am going to get better grades”, you would write down something like “I will study every day after school with my study guide until I get 100% on our midterm exam.” This could also include relevant dates of when the work must be finished by. 

Your goals need to have some metrics associated with them so you can keep track of your progress. For example, if you write down “I am going to get better grades”, there is no way of knowing exactly how well you are doing compared to before. Making your goal measurable can help avoid this.

If you were to instead write down: “I will study every day after school with my study guide until I get 100% on our midterm exam”, then it would be possible for you to know how well you are doing because you could record the date when you completed the exam and markdown your grade when you receive it.

Your goals need to resonate with your current academic and future nursing endeavors. If your academic standing is precarious (e.g., if your grades are not meeting the required standards), your goals should be pertinent and strategically designed to turn around your academic trajectory. Setting goals that directly relate to and support your progress in your nursing program will ensure that your efforts are concentrated and meaningful.

This means that your goals should be something that you can actually achieve, given all of the resources and support available to you. For example, if there is no way for you to get into a nursing program right now because it requires an advanced degree, then working towards becoming a nurse right now would not be very realistic. You don’t want to set yourself up for failure by picking a goal you can’t hope to accomplish because of something out of your control.

This just means that your goal has some definitive deadline by which it must be completed. Otherwise, when will the plan be attained? A good example would be “I will study every day after school with my study guide until I get 100% on our midterm exam .”

Getting into the habit of making things time-bound is also a good idea in general, since time management skills are going to be very important if you want to become a medical professional.

Bringing It All Together

When you have brilliant and short-term goals in mind, it will be much easier for you to plan out the steps you need to take to achieve your ultimate objective. It’s all about being well-informed and making the most out of your time.

Small goals might have a time frame of a month. Larger ones might extend that time frame to a year. Again, choose something that is attainable but still a challenge. Often, people or businesses set unrealistic goals for themselves that only lead to failure.

That’s why you need to follow the framework of the 5 steps above to help you create a plan that you’ll have a better chance of achieving. With that being said, let’s go into some sample goals that are practical for nursing students everywhere.

17 Examples of SMART Goals for Nursing Students

SMART goals examples are an excellent tool for both nursing students and nursing assistants. They can be used for a variety of purposes. It is not just a goal-setting system used by nurses. You can start by choosing one of these goals and making it more specific to you, or let these serve as inspiration and create your own! Check out these 17+ examples of SMART goals for nurses to get your creativity flowing.

Patient Care

The first category is excellent patient care. These are goals that have to do with caring for patients in the hospital or at home. They include goals for nursing evaluations . You can create a treatment plan or do something different like:

  • I will provide excellent, compassionate care to my clients by making them feel safe and comfortable at all times throughout their stay.
  • I will develop a care plan for each patient that I see in my practice today. Each project will include specific nursing diagnoses, prioritized outcomes, possible interventions, and rationales for each intervention, including expected results. 

Community Outreach/Education

These types of goals pertain to outreach and education about health topics related to nursing or the health conditions of patients you may encounter.

  • I will educate ten community members on the importance of flu vaccinations today by providing flyers from the CDC during flu season.
  • I will speak with two patients today about stress management to help them deal with anxiety, mental health issues, and depression.

Leadership/Management

These goals are typically appropriate for nurses who are in charge nurse, nurse manager, or other leadership roles within a workplace setting.

  • I will complete my first competency as a charge nurse by leading three medications today according to our hospital’s policy and procedure manual using proper labeling methods.
  • I will work alongside my team member who is struggling to take 30-minute lunch breaks each day to develop a plan to help him accomplish this task. Next week, I will also follow up on this plan to make sure he has been successful.

Professional Development/Knowledge

These professional goals may be used for nurses who are seeking to develop more knowledge about their profession or read about new information so they can stay abreast of what is required in their jobs.

  • This month, I will set aside time to learn about the latest evidence-based practices that have proven successful for wound care interventions. 
  • I will read nursing journals to improve my nursing skills and implications on the nursing profession.
  • I will initiate at least 2 casual and short conversations with my coworkers or patients to practice my interpersonal skills.

Nursing Career Related

These types of goals are helpful if you are trying to plan your career path as a nurse. You may also want to make these types of goals if you’re going to become an influential figure in some aspect of healthcare (i.e. nursing leadership, public health, education).

  • I will take the ASN exam by January 1st. I will review my experience with the Praxis exam and what I learned to help me in this process along the way.
  • I want to become an influential figure in healthcare, so I will read two articles about people who have made significant contributions in their fields each week.
  • At the end of the year, I will review each article’s points that relate to influence and record how these apply to my career goals moving forward.
  • I will research 1 RN program every weekday after dinner, so I can begin working towards becoming a registered nurse.

These are goals that don’t necessarily pertain to your career as a nurse but are geared towards becoming more knowledgeable about things or people surrounding the nursing profession like patient care , managing money, etc.

  • This year, I will attend four movies with my friends where nursing is an integral part of the storyline.
  • I will review all of my bills by January 1st and set up automatic monthly payments for all of them, so I never have to worry about late fees again.
  • I will delete my Facebook account without changing any security settings so outside influences cannot impact how I spend time online anymore.  

Workplace Efficiency

When it comes to the workplace, efficiency goals are essential to consider if you are trying to become more efficient at your job. Due to the Affordable Care Act, many hospitals have made some changes, including shorter patient stays, minor nurse-to-patient ratio requirements, etc.

  • I will read about these changes on Friday night of this week, and prepare myself for all of the new processes that come with them to be an effective employee.
  • I will schedule all non-emergency meetings early in the morning so they do not interfere with my ability to complete all patient care activities throughout the day.
  • After five years of employment at this hospital, I will start a master’s degree program that CCNE accredits because I would like to learn more about critical care nursing.

Nursing students face a lot of challenges to accomplish their goals because they do not have a lot of control over many aspects of their learning experience. For that reason, it is even more critical for students to set SMART goals because these can help them focus on what is most relevant and meaningful when trying to achieve success in school.

One thing to remember is always to create short-term nursing goals, first achieve them, and then move to the next. You have to move step by step.

Write Your SMART Goals Down!

The best way to make sure your goals are smart is to write them down so you can review them often. When writing down your goals, be as specific as possible about what you want to accomplish and how you will go about doing so. Be detailed in your plans of action and consider the steps it will take for you to achieve each goal. Also, try to keep them concise by removing unnecessary words or phrases.

10 Bonus Examples of SMART Goals for Nursing Students

  • Clinical Skills Enhancement : Improve intravenous (IV) insertion skills by practicing on simulation arms and successfully performing 5 error-free insertions on patients under supervision by the end of the clinical rotation.
  • Academic Excellence : Achieve a grade of 90% or higher on all pharmacology exams this semester by dedicating 3 hours per week to study, including group study sessions and utilizing online resources for quiz practice.
  • Professional Development : Attend at least two professional nursing seminars or workshops on pediatric care within the next 6 months to enhance my understanding of current practices, and to network with experienced professionals.
  • Patient Communication : Develop effective patient communication skills by conducting patient interviews under supervision, and receiving instructor feedback on at least 10 different occasions before the end of the term.
  • Time Management : Master time management by prioritizing tasks and utilizing a digital planner, aiming to complete all assignments at least two days before the deadline for the upcoming semester.
  • Research Competency : Contribute to nursing research by assisting in the data collection for a faculty-led study and completing a 20-page literature review on the chosen topic within the next 4 months.
  • Health Assessment Proficiency : Conduct 30 comprehensive patient health assessments in a clinical setting with 100% accuracy on documentation, to be achieved within the next 8 weeks.
  • Professional Certifications : Obtain Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certifications by enrolling in the courses now and completing them within the next 3 months.
  • Community Service : Participate in community health outreach programs for at least 20 hours over the next semester to better understand public health issues and practice health education.
  • Leadership Skills : Take on a leadership role in a student nursing organization, aiming to lead a team in organizing at least one educational event or initiative by the end of the academic year.

Each goal is designed to be attainable within a set time frame and can help you, as a nursing student, with your nursing education and future career, while providing you with a clear measure of success. By focusing on these areas, you can aim for a well-rounded skill set that prepares you for both the demands of your studies and the challenges of clinical practice.

Final Thoughts on SMART Goals for Nursing Students:

Now that you have SMART nursing goals examples, hopefully, you will use these to help set your personal goals for this new year. Following the guidance in this blog post will ensure that your goals provide value and consistency in all aspects of your life, both during and after school. With that, don’t forget to share this with your fellow nursing school study group!

Also Check Out:

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  • 15 Things Every Nursing Student Needs to Know
  • Nursing Math Questions
  • 16 Effective Tips for Nursing School

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SMART goals – great topics for nursing students, and clear and distinguishable enough to incorporate. This is a great description!

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critical thinking nursing smart goal

  • Nurse Spotlight
  • Student Resources

The Value of Critical Thinking in Nursing

portrait of Gayle Morris, BSN, MSN

Gayle Morris

Contributing Writer

Learn about our editorial process .

Updated October 3, 2023

Male nurse checking on a patient

Are you ready to earn your online nursing degree?

Some experts describe a person's ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as "necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation."

"This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice," he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

"Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe."

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

"Nurses are at the patient's bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider," she explains.

Featured Online MSN Programs

Top 5 ways nurses can improve critical thinking skills.

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. "What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?"

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. "Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help." Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It's important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that "critical thinking is a self-driven process. It isn't something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive."

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient's care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient's mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

  • Ask questions.
  • Gather information.
  • Implement a strategy.
  • Evaluate the results.
  • Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what's happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

"We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care," he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

"Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient's blood pressure because medication administration is a task that must be completed," Slaughter says. "A nurse employing critical thinking skills would address the low blood pressure, review the patient's blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld."

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

  • Learn from their mistakes and the mistakes of other nurses
  • Look forward to integrating changes that improve patient care
  • Treat each patient interaction as a part of a whole
  • Evaluate new events based on past knowledge and adjust decision-making as needed
  • Solve problems with their colleagues
  • Are self-confident
  • Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient's cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient's overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Portrait of Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University's RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter's clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Portrait of Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Portrait of Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

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The Importance of Critical Thinking in Nursing

Nurse using critical thinking at work

An American Association of Nurse Practitioners (AANP) survey found that a majority of nurse practitioners saw three or more patients per hour. Nurse practitioners see patients of all ages with a broad spectrum of potential ailments. Critical thinking skills in nursing improve patient outcomes by enabling evidence-based decision-making. 

Nurse practitioners gather considerable amounts of patient data through evaluations, tests and conversations. Each patient’s information can be interpreted and analyzed to determine the best courses of action for their health. A growing emphasis on critical thinking in nursing stems from the increasing importance of nurse practitioners in primary care.

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Growing need for critical thinking in nursing.

There is a significant shortage of primary care services throughout the United States. GoodRx identified 80% of counties as “health care deserts” or locations without easy access to necessary services. This data includes the following categories relevant to family nurse practitioners:

  • 9% of counties lack enough primary care providers to serve the local population
  • Residents in 20% of counties are at least 30 minutes away from hospitals
  • Residents in 45% of counties are at least 20 minutes away from community health centers

“Health care deserts” are worsening because of a shortage of primary care physicians. The Association of American Medical Colleges ( AAMC ) estimates up to 48,000 more primary care providers are needed to meet patient care needs by 2034. This shortfall translates to a lack of preventive care and increased reliance on emergency care facilities.

The U.S. Bureau of Labor Statistics ( BLS ) projects a 52% growth in nurse practitioner roles by 2030. This growth is fueled not only by “health care deserts” but an aging population and public health threats like COVID-19. Critical thinking by nurse practitioners can overcome these challenges even with limited resources and stressful situations.

The Critical Thinking Process

The first step in incorporating critical thinking into patient care is understanding the critical thinking process. The National League for Nursing Accreditation Commission ( NLNAC ) defines critical thinking as:

“the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief based.”

Critical thinking in nursing does not move in a straight line because each patient is unique. There isn’t a one-size-fits-all diagnosis for patients because there isn’t a single type of patient. Nurse practitioners can apply the following steps in the Clinical Reasoning Cycle as they evaluate patient care decisions.

Consider the Situation

First impressions of new patients can distract from effective evaluations. Personal experiences and assumptions may lead to hasty conclusions about patient needs. The first step to critical thinking in nursing involves a dispassionate consideration of the facts.

Nurse practitioners often have the basic facts about their patients’ conditions before stepping into exam rooms. A simple repetition of the patient’s age and reported illness counters assumptions that can negatively impact patient care.

Collect Information

Critical thinking requires the synthesis of existing and new information for effective analysis. Nurse practitioners can pull useful details from patient charts and histories when they are available. An evaluation of visual appearance, speech, blood pressure and other metrics builds on this previous work.

Skilled practitioners automatically apply their knowledge of physiology, pharmacology and other areas during the collection process. They also keep best practices, cultural competence and ethics in mind while working with patients. This recall makes it easier to process information during diagnosis.

Process Information

There is a multi-step process for turning raw information into useful insights for patient care. Nurse practitioners effectively process patient data by:

  • Analyzing information within the context of normal and abnormal ranges
  • Separating relevant and irrelevant data while finding information gaps
  • Focus on relationships between symptoms and cues
  • Deduce potential causes of health problems
  • Compare similar situations between current and past patients
  • Predict potential outcomes and complications from treatment

Nurse practitioners are ready to diagnose patient conditions following this process. Depending on symptoms, they’ll have considered and eliminated multiple diagnoses based on careful consideration of the facts. This step also takes into consideration risks for other health issues without treatment.

Set Goals and Act

A patient’s course of treatment should follow the SMART model for goal-setting. The best treatment plans are Specific, Measurable, Achievable, Realistic and Timely to support the measurement of their efficacy. This model creates a repeatable process that is effective across patient demographics and conditions.

Critical thinking in nursing produces clear goals that are essential to patient adherence to treatment. Treatment plans may include prescribed medications, therapies and visits with specialists. Nurse practitioners collaborate with their patients and colleagues on supportive frameworks for effective treatment.

Evaluate and Reflect

Follow-up appointments provide opportunities for evaluation of treatment plans. Nurse practitioners compare past and present metrics when determining improvements in patient conditions. A useful method for evaluating success is whether the following rights of clinical reasoning were applied:

  • Right cues 
  • Right patient
  • Right action
  • Right reason

Frequent reflection on this process is essential for improvement as a nurse practitioner. Self-directed explorations of what should have been done and what could have happened in each case sharpen critical thinking skills. An understanding of what was learned in each case creates points of comparison for future patients.

Improving Your Critical Thinking

Critical thinking in nursing improves through thoughtful deliberation and frequent use. Nurse practitioners should speak with their colleagues and mentors about their applications of critical thinking. Frequent collaboration on patient care also places the focus on evidence-based care rather than personal assumptions.

Updated knowledge of nursing resources and tools makes it easier to implement critical thinking in nursing. Medical journals and continuing education courses reinforce what nurse practitioners have learned throughout their careers. Carson-Newman University provides a strong foundation for improved critical thinking through its Online MSN-FNP.

Preparing for Clinical Decisions at Carson-Newman

Carson-Newman’s innovative program prepares BSN & MSN-educated nurses for future roles as family nurse practitioners (FNPs). The in-person requirements for this 100% online degree are clinical placements and a three-day campus residency. Students can complete the Online MSN-FNP in as little as 32 months.

Every course in the program is taught by an experienced nurse educator who also practices in their community. Carson-Newman reinforces the importance of critical thinking in nursing with courses on topics including:

  • Advanced Health Assessment
  • Advanced Pathophysiology
  • Advanced Primary Care Nursing for Adults

FNP students receive full support from Carson-Newman to identify clinical placements in their communities. They also receive one-on-one guidance from Student Success Advisors throughout their time at the University. This commitment to nursing education helped Carson-Newman reach the top third of graduate nursing programs in U.S. News & World Report's rankings.

Contact an enrollment advisor today to learn how Carson-Newman can prepare you for a role as an FNP.

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About carson-newman’s online fnp programs.

Founded in 1851, Carson-Newman is a nationally ranked Christian liberal arts university. An online, yet personal, learning environment connects you with fellow students, faculty, and staff. Faith and learning are combined to create evidence-based online graduate nursing programs designed to transform you into a more autonomous caregiver.

Through its online program and student-centric curriculum, Carson-Newman provides a life-changing education where students come first. Designed for working nurses, Carson-Newman’s affordable FNP programs feature 100% online coursework with no mandatory log-in times, clinical placement service, and exceptional individualized support that prepare graduates to pass the FNP licensure exam.

If you’re ready for the next step in your nursing career, consider the online Master of Science in Nursing – Family Nurse Practitioner offered by Carson-Newman University and accredited by the CCNE.

For those who already hold an MSN degree, consider pursuing a Post-Master’s FNP Certificate to enjoy all the leadership opportunities, job satisfaction and autonomy of a family primary care provider. For more information, visit onlinenursing.cn.edu.

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What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

critical thinking nursing smart goal

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What Is Critical Thinking In Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

critical thinking nursing smart goal

smart goals for critical thinking

9 SMART Goals Examples for Developing Critical Thinking

Critical thinking is all about using your head to make judgments rather than simply following your gut instinct or going along with what others think or do.

It’s about being open-minded and considering all the available information before coming to a conclusion. But that’s easier said than done.

Luckily, developing goals is an amazing approach to sharpening your critical thinking skills. Whether you are an industry professional or a college student, setting SMART goals will elevate your ability to think critically.

You’ll be living more successfully in your career and personal life. After all, SMART goals are crucial to making a step-by-step plan for realizing your visions. This is a powerful tool that determines if you attain your dreams.

Table of Contents

What is a SMART Goal?

It would be best if you used the SMART goal framework to set goals for improving critical thinking. SMART is an acronym that stands for specific, measurable, attainable, relevant, and time-based.

Let’s discuss each SMART component for critical thinking:

The more specific your goals, the higher your chance of reaching them. If you only create vague goals, you lose out on opportunities for success.

For instance, suppose your goal is to boost critical thinking. Although this is a worthy goal, it isn’t precise enough. How will you go about improving your critical thinking skills? Why is critical thinking necessary to you in the first place?

Specificity will ensure you are on the right path to goal attainment. You will have a better structure and plan to arrive at your destination.

The importance of creating measurable goals can’t be understated. You must have a metric to track progress regularly. That way, you’ll clearly understand how close you are to goal completion.

If your critical thinking goals involve reading more books on the topic, you could make them quantifiable. For example, you could “read four books on critical thinking until three months later.” Since you know the exact amount of books you must read, you can pace yourself more effectively.

When developing goals for critical thinking skills, you must be realistic. For example, if you want to enhance your ability to learn new information, you can’t expect to do so in a few days. You must stay dedicated and have a long enough timeline to tackle this goal.

Consider the “why” when creating goals for yourself. Using the previous example, boosting your learning ability could be a means to get better grades in school or excel in the workplace.

Making sure all your goals are relevant will encourage you to stay motivated throughout the process. Ask yourself, “ Does this goal align with my values and interests?” If the answer is yes, then you’ll have a much easier time sparking inspiration.

It would help if you had a timeline to aid you in turning goals into reality . Adding an end date for your critical thinking goals will hold you accountable for making progress.

Otherwise, you may procrastinate and abandon the race to success altogether. That would be an unfortunate turn of events, so ensure you have an exact target end date.

Why Are SMART Goals Important for Critical Thinking?

Thinking critically is an essential skill in any part of life. Whether you’re trying to solve a complex problem at work, deciding your finances, or even just hoping to understand the news, critical thinking will help you make rational judgments.

That’s why setting SMART goals is instrumental in upgrading your critical thinking. SMART goals can force you to think critically about your options and make decisions that align with your objectives.

problem solving

Regardless if you’re trying to enhance your critical thinking skills for work or your personal life, SMART goals can be a true lifesaver.

9 SMART Goals Examples for Critical Thinking

Let’s take a look at several SMART goals examples to improve your critical thinking skills:

1. Be an Active and Engaged Learner

“In the next 6 months, I want to improve my ability to actively and deeply engage with new information. I will read for 20 minutes daily and reflect on what I’ve read.”

Specific: The individual wants to become an active and engaged learner.

Measurable: You will read for 20 minutes every day and reflect on what you’ve read.

Attainable: This is an achievable goal because it is specific and measurable.

Relevant: The goal is appropriate because learning is integral to thinking critically.

Time-based: This goal is time-bound because it has an end date of 6 months.

2. Develop a Growth Mindset

“By the end of two weeks, I want to develop a growth mindset. I will read one book on the power of mindset and complete all the exercises. And for the cherry on top, I’ll seek a mentor to help me develop my growth mindset.”

Specific: The goal is to develop a growth mindset by reading books and completing exercises on the topic.

Measurable: The person will ensure they read at least one book on the topic and find a mentor.

Attainable: This can be developed with time and directed effort.

Relevant: A growth mindset benefits anyone looking to expand their thinking capabilities.

Time-based: You will develop a growth mindset within two weeks.

3. Be Aware of Your Biases

“I’ll strive to be more aware of my personal biases and preconceptions. For one month, I will read one article or book each week on bias and write down my thoughts in a journal. I will also speak to three people from different perspectives about an issue I feel strongly about.”

Specific: There are actionable steps to becoming more aware of your biases, such as reading about biases and talking to people with unique perspectives.

Measurable: You can check your progress by tracking how often you read about bias and talk to others with different perspectives.

Attainable: This goal is reachable with intentional effort.

Relevant: Recognizing your personal biases is crucial to drawing rational conclusions.

Time-based: You should complete this goal in the next month .

4. Examine Evidence and Arguments

“For 5 months, I will increase my ability to examine evidence and arguments. I’ll do this by attending two workshops and reading 5 articles and books on the subject. Furthermore, I will discuss with my mentor how to examine evidence and arguments.”

Specific: This SMART statement clearly defines what the individual wants to achieve.

Measurable: The individual will know they are making progress when they attend the workshops, read the articles and books, and talk to their mentor.

Attainable: This goal is achievable as long as the individual is willing to commit the time and effort.

Relevant: This is relevant to the individual’s life as it will help them develop a critical thinking skill that is useful in many day-to-day situations.

Time-based: The goal should be reached within 5 months.

5. Question Assumptions

“I’ll start questioning my assumptions more, especially when making decisions for three months. I will do this by setting aside 10 minutes at the start of every day to reflect on my assumptions, and I’ll question assumptions that others make during conversations.”

Specific: The goal states the objective, what will be done to achieve it, and the timeline.

Measurable: You could keep track of the number of times you question assumptions in a day or week.

Attainable: This goal is possible because it is realistic to question assumptions more.

Relevant: This is pertinent to critical thinking because it helps you reflect on your assumptions and biases.

Time-based: The specific timeline for this goal is three months. It could also be something that you work on every day.

6. Consider Different Viewpoints

“I will consider different points of view when making decisions for the next two months. I will try to see things from the perspective of others, even if I disagree with them.”

unique viewpoints

Specific: The goal is clear and concise, stating precisely the objective.

Measurable: This can be measured by observing the decision-making process and determining whether or not different viewpoints were considered.

Attainable: This goal can be met by changing how you approach decision-making.

Relevant: This is relevant to critical thinking because it requires you to think from different perspectives.

Time-based: There is a two-month timeline for meeting this particular goal.

7. Reflect on Your Beliefs and Values

“I will spend 30 minutes each week reflecting on my beliefs and values for a month. I want to be able to articulate why I hold the beliefs that I do and how my values guide my thinking process.”

Specific: There is a set time for reflection and a focus on both beliefs and values.

Measurable: You’ll reflect on your beliefs and values for 30 minutes each week.

Attainable: The statement is achievable with regular reflection.

Relevant: Understanding your own beliefs and values will help you think more objectively.

Time-based: You should complete this goal within the next month.

8. Be Persistent in the Search for Truth

“I will never accept something as true just because it is convenient or popular. I’ll never rush when dealing with complex problems. I will take at least 10 minutes to consider all sides of the issue and gather as much information as possible before making a judgment.”

Specific: There are particular actions to being persistent in your search for truth, such as taking 10 minutes to consider all sides of the issue and gathering information.

Measurable: Ensure you are taking the time to consider all sides of an issue before making a judgment.

Attainable: This goal is doable with intentional effort.

Relevant: Persisting in your search for truth will support rational thinking.

Time-based: This is a recurring SMART goal to pursue every single day.

9. Set Learning Objectives

“In the next month, I want to learn more about data analysis to make informed decisions in my work. I will do this by taking an online course on data analysis and reading two books on the subject. Lastly, I’ll chat with my boss and colleagues about data analysis and how it can be used in our work.”

Specific: You want to learn more about data analysis to improve your work decisions.

Measurable: The goal is measurable because it includes taking an online course and reading two books on the subject.

Attainable: This is feasible because you are taking active steps to learn about data analysis.

Relevant: This is pertinent to the individual because data analysis can foster critical thinking in their work.

Time-based: The goal is time-bound since it has a one-month timeline.

Final Thoughts

Creating SMART goals is necessary in order to boost your critical thinking. Although other goal techniques like visualization could lend a helping hand, you should still take advantage of the SMART framework.

SMART goals are a powerful tool in your arsenal, and it would certainly be a waste not to apply them in your daily life.

In any case, don’t be shy to apply the 9 SMART goals examples for efficient critical thinking. You will surely be steps closer to succeeding in all areas.

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How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples

how-to-improve-critical-thinking-skills-in-nursing-strategies-methods-ways-improving-nurses-examples

Last updated on August 19th, 2023

Nurses play a critical role in making critical decisions that directly impact patient outcomes in the dynamic field of healthcare. Developing strong critical thinking skills is essential for success in this role.

In this article, we present a comprehensive list of 23 nursing-specific strategies aimed at improving critical thinking and improve the quality of patient care.

24 Strategies to improve critical thinking skills in nursing

You may also want to check out: 15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

1. Reflective Journaling: Delving into Deeper Understanding

Reflective journaling is a potent tool for nurses to explore their experiences, actions, and decisions.

By regularly pondering over situations and analyzing their thought processes, nurses can identify strengths and areas for improvement.

This practice encourages the conscious development of critical thinking by comparing past experiences with current knowledge and exploring alternative solutions.

After a particularly challenging case, a nurse reflects on their decision-making process, exploring what worked well and what could have been done differently.

2. Meeting with Colleagues: Collaborative Learning for Critical Thinking

Regular interactions with colleagues foster a collaborative learning environment. Sharing experiences, discussing diverse viewpoints, and providing constructive feedback enhance critical thinking skills .

Colleagues’ insights can challenge assumptions and broaden perspectives, ultimately leading to more well-rounded clinical judgments.

A nursing team gathers to discuss a recent complex case, sharing their perspectives, insights, and lessons learned to collectively improve patient care strategies.

3. Concept Mapping: Visualizing Complexity

Concept mapping is an excellent technique to synthesize intricate patient information. By creating visual representations of patient problems and interventions, nurses can identify relationships and patterns that might not be apparent otherwise.

This strategy aids in comprehensive care planning and encourages nurses to think holistically about patient care.

Creating a concept map to connect patient symptoms, diagnostics, and interventions reveals patterns that help the nurse formulate a comprehensive care plan.

4. Socratic Questioning: Digging Deeper into Situations

The art of Socratic questioning involves asking probing questions that lead to deeper understanding.

Applying this technique allows nurses to uncover assumptions, examine inconsistencies, and explore multiple viewpoints.

This approach is especially valuable when reviewing patient history, discussing conditions, and planning care strategies.

When assessing a patient’s deteriorating condition, a nurse asks probing questions to uncover potential underlying causes and prioritize appropriate interventions.

5. Inductive and Deductive Reasoning: From Specifics to Generalizations

Developing skills in both inductive and deductive reasoning equips nurses to analyze situations from different angles.

Inductive reasoning involves drawing conclusions from specific observations, while deductive reasoning starts with general premises to arrive at specific conclusions.

Proficient use of these methods enhances nurses’ ability to make accurate clinical judgments.

When encountering a series of patients with similar symptoms, a nurse uses inductive reasoning to identify a common pattern and deduce potential causes.

6. Distinguishing Statements: Fact, Inference, Judgment, and Opinion

Clear thinking demands the ability to differentiate between statements of fact, inference, judgment, and opinion.

Nurses must critically evaluate information sources, ensuring they rely on evidence-based practice.

This skill safeguards against misinformation and supports informed decision-making.

While reviewing a patient’s history, a nurse differentiates factual medical information from inferences and subjective judgments made by different healthcare professionals.

7. Clarifying Assumptions: Promoting Effective Communication

Recognizing assumptions and clarifying their underlying principles is vital for effective communication. Nurses often hold differing assumptions, which can impact patient care.

By acknowledging these assumptions and encouraging open discussions, nursing teams can collaboratively create care plans that align with patients’ best interests.

Before suggesting a treatment plan, a nurse engages in a conversation with a patient to understand their cultural beliefs and preferences, ensuring assumptions are not made.

8. Clinical Simulations: Learning through Virtual Scenarios

Clinical simulations provide nurses with a risk-free environment to practice decision-making and problem-solving skills.

These virtual scenarios mimic real-life patient situations and allow nurses to test different approaches, assess outcomes, and reflect on their choices.

By engaging in simulations, nurses can refine their critical thinking abilities, learn from mistakes, and gain confidence in their clinical judgment.

Engaging in a simulated scenario where a patient’s condition rapidly changes challenges a nurse’s decision-making skills in a controlled environment.

9. Case Studies and Grand Rounds: Analyzing Complex Cases

Engaging in case studies and participating in grand rounds exposes nurses to complex patient cases that require in-depth analysis.

Working through these scenarios encourages nurses to consider various factors, potential interventions, and their rationale.

Discussing these cases with colleagues and experts fosters collaborative critical thinking and widens the spectrum of possible solutions.

Nurses participate in grand rounds, discussing a challenging case involving multiple medical specialties, encouraging a holistic approach to patient care.

10. Continuing Education and Lifelong Learning: Expanding Knowledge

Staying up-to-date with the latest advancements in nursing and healthcare is crucial for effective critical thinking.

Pursuing continuing education opportunities, attending conferences, and engaging in self-directed learning keeps nurses informed about new research, technologies, and best practices.

This continuous learning enriches their knowledge base, enabling them to approach patient care with a well-rounded perspective.

Attending a nursing conference on the latest advancements in wound care equips a nurse with evidence-based techniques to improve patient outcomes.

11. Debates and Discussions: Encouraging Thoughtful Dialogue

Organizing debates or participating in structured discussions on healthcare topics stimulates critical thinking.

Engaging in debates requires researching and presenting evidence-based arguments, promoting the evaluation of different perspectives.

Nurses can exchange insights, challenge assumptions, and refine their ability to defend their viewpoints logically.

Engaging in a debate on the pros and cons of a new treatment method encourages nurses to critically analyze different viewpoints and strengthen their own understanding.

12. Multidisciplinary Collaboration: Gaining Insights from Various Disciplines

Collaborating with professionals from diverse healthcare disciplines enriches nurses’ critical thinking.

Interacting with doctors, pharmacists, therapists, and other experts allows nurses to benefit from different viewpoints and approaches.

This cross-disciplinary collaboration broadens their understanding and encourages innovative problem-solving.

Collaborating with physical therapists, nutritionists, and pharmacists helps a nurse develop a holistic care plan that addresses all aspects of a patient’s recovery.

13. Ethical Dilemma Analysis: Balancing Patient Autonomy and Best Practice

Ethical dilemmas are common in nursing practice. Analyzing these situations requires nurses to weigh the principles of beneficence, non-maleficence, autonomy, and justice.

By critically examining ethical scenarios, nurses develop the capacity to navigate morally complex situations, prioritize patient welfare, and make ethically sound decisions.

When faced with a patient’s refusal of treatment due to religious beliefs, a nurse evaluates the ethical considerations, respects autonomy, and seeks alternatives.

14. Root Cause Analysis: Investigating Adverse Events

When adverse events occur, performing a root cause analysis helps identify the underlying causes and contributing factors.

Nurses engage in a systematic process of analyzing events, exploring the “5 Whys” technique , and developing strategies to prevent similar occurrences in the future.

This approach cultivates a thorough and analytical approach to problem-solving.

After a medication error, a nurse leads a root cause analysis to identify system failures and implement preventive measures to enhance patient safety.

15. Creative Thinking Exercises: Expanding Solution Repertoire

Encouraging creative thinking through brainstorming sessions or scenario-based exercises widens the range of possible solutions nurses consider.

By thinking outside the box and exploring innovative approaches, nurses develop adaptable problem-solving skills that can be applied to complex patient care challenges.

Brainstorming creative approaches to comfort a distressed pediatric patient empowers a nurse to find innovative methods beyond routine interventions.

16. Journal Clubs: Fostering Evidence-Based Discussion

Participating in journal clubs involves healthcare professionals coming together to dissect recent research articles.

This practice ignites critical thinking by allowing nurses to evaluate study methodologies, scrutinize findings, and consider the implications for their practice.

Engaging in evidence-based discussions not only cultivates a culture of critical inquiry but also reinforces continuous learning.

At the monthly journal club meeting, Nurse Mark engages in a discussion on a recent research article focusing on pain management strategies for post-operative patients.

The group analyzes the study design, scrutinizes the findings, and considers the potential implications for their practice.

During the discussion, Mark raises thought-provoking questions about the study’s methodology and suggests potential applications in their hospital’s patient care protocols.

This active participation in journal clubs not only refines Mark’s critical thinking but also instills evidence-based practices into his nursing approach.

17. Critical Reflection Groups: Collaborative Learning and Analysis

Similarly, establishing critical reflection groups, where nurses meet regularly to discuss experiences, cases, and challenges, fosters collective learning.

These sessions encourage the exchange of diverse perspectives, enriching the analysis process and ultimately enhancing patient care strategies.

Through shared insights and discussions, nurses can refine their clinical reasoning and broaden their problem-solving capabilities.

Nurse Emma actively participates in critical reflection groups in order to broaden her clinical knowledge. During a recent meeting, the group tackled a difficult patient case with complicated symptomatology.

Emma suggests alternative diagnostic pathways based on her own experiences. Emma’s critical thinking skills are honed as a result of the group’s dynamic interaction, which also emphasizes the importance of collaborative decision-making in complex scenarios.

18. Mindfulness and Reflection Practices: Enhancing Self-Awareness

Mindfulness techniques, such as meditation and deep breathing, encourage self-awareness and a clear mind.

Engaging in these practices helps nurses become more attuned to their thoughts and emotions, leading to better self-regulation and improved decision-making during high-pressure situations.

Engaging in mindfulness exercises before a demanding shift helps a nurse maintain focus, manage stress, and make clear-headed decisions.

19. Problem-Based Learning: Applying Knowledge in Real Scenarios

Problem-based learning involves presenting nurses with real-world patient cases and encouraging them to collaboratively solve the problems.

This approach bridges the gap between theoretical knowledge and practical application, fostering critical thinking through active problem-solving.

Working through a simulated patient case challenges nurses to apply theoretical knowledge to practical situations, refining their clinical reasoning.

20. Self-Assessment and Feedback: Evaluating Decision-Making Skills

Regularly assessing one’s own decision-making process and seeking feedback from peers and mentors is essential for improvement.

Reflecting on past decisions, considering alternative approaches, and understanding the rationale behind them contribute to the refinement of critical thinking skills.

A nurse evaluates their performance after a patient’s unexpected complication, seeking feedback from peers and mentors to identify areas for improvement.

21. Cultural Competence Training: Navigating Diverse Perspectives

Cultural competence training enhances critical thinking by enabling nurses to understand the diverse cultural beliefs and practices of patients.

This knowledge is vital for providing patient-centered care, as it encourages nurses to think critically about the unique needs of each individual.

A nurse attends cultural competence training to understand the dietary preferences of a diverse patient population, ensuring respectful and patient-centered care.

22. Active Listening and Empathetic Communication: Gathering Insights

Active listening and empathetic communication with patients and their families enable nurses to gather comprehensive information about their conditions, concerns, and preferences.

This data forms the basis for critical analysis and informed decision-making in patient care.

Through attentive listening, a nurse uncovers a patient’s underlying concerns, leading to an informed care plan that addresses both medical needs and emotional well-being.

23. Mentorship and Preceptorship: Learning from Experienced Professionals

Having a mentor or preceptor provides novice nurses with the opportunity to learn from experienced professionals.

Mentors guide critical thinking by sharing their insights, challenging assumptions, and offering guidance in complex situations. This relationship fosters growth and expertise development.

A novice nurse gains valuable insight from a mentor, who guides them through complex cases, offering real-world wisdom and refining critical thinking skills.

24. Self-Assessment and Feedback: Evaluating Decision-Making Skills

Reflecting on past decisions, considering alternative approaches, and understanding the rationale behind them contribute to the refinement of critical thinking skills .

Nurse Sarah regularly takes time to assess her decision-making skills by reviewing past patient cases. After a challenging case involving conflicting symptoms, she reflects on her initial approach, the outcomes, and what she could have done differently.

She seeks feedback from her senior colleague, who provides insights on alternative diagnostic paths. Sarah’s self-assessment and feedback-seeking process enable her to identify areas for improvement and refine her critical thinking in similar situations.

  • Clinical Reasoning In Nursing (Explained W/ Example)
  • 8 Stages Of The Clinical Reasoning Cycle
  • What is Critical Thinking in Nursing? (Explained W/ Examples)

Enhancing critical thinking skills is an ongoing journey that transforms nursing practice.

Reflective journaling, collaborative learning, concept mapping, Socratic questioning , reasoning techniques, distinguishing statements, and clarifying assumptions all play integral roles in nurturing these skills.

By incorporating these strategies into their daily routines, nurses can improve their critical thinking skills.

Additionally, this will help nurses in navigating the complexities of the healthcare field with confidence, expertise, and the ability to make well-informed decisions that improve patient outcomes.

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Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021.

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  • About Open RN

Chapter 4 Nursing Process

4.1. nursing process introduction, learning objectives.

  • Use the nursing process to provide patient care
  • Identify nursing diagnoses from evidence-based sources
  • Describe the development of a care plan
  • Prioritize patient care
  • Describe documentation for each step of the nursing process
  • Differentiate between the role of the PN and RN

Have you ever wondered how a nurse can receive a quick handoff report from another nurse and immediately begin providing care for a patient they previously knew nothing about? How do they know what to do? How do they prioritize and make a plan?

Nurses do this activity every shift. They know how to find pertinent information and use the nursing process as a critical thinking model to guide patient care. The nursing process becomes a road map for the actions and interventions that nurses implement to optimize their patients’ well-being and health. This chapter will explain how to use the  nursing process  as standards of professional nursing practice to provide safe, patient-centered care.

4.2. BASIC CONCEPTS

Before learning how to use the nursing process, it is important to understand some basic concepts related to critical thinking and nursing practice. Let’s take a deeper look at how nurses think.

Critical Thinking and Clinical Reasoning

Nurses make decisions while providing patient care by using critical thinking and clinical reasoning.  Critical thinking  is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” [ 1 ] Using critical thinking means that nurses take extra steps to maintain patient safety and don’t just “follow orders.” It also means the accuracy of patient information is validated and plans for caring for patients are based on their needs, current clinical practice, and research.

“Critical thinkers” possess certain attitudes that foster rational thinking. These attitudes are as follows:

  • Independence of thought: Thinking on your own
  • Fair-mindedness:  Treating every viewpoint in an unbiased, unprejudiced way
  • Insight into egocentricity and sociocentricity:  Thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good (sociocentricity)
  • Intellectual humility:  Recognizing your intellectual limitations and abilities
  • Nonjudgmental:  Using professional ethical standards and not basing your judgments on your own personal or moral standards
  • Integrity:  Being honest and demonstrating strong moral principles
  • Perseverance:  Persisting in doing something despite it being difficult
  • Confidence:  Believing in yourself to complete a task or activity
  • Interest in exploring thoughts and feelings:  Wanting to explore different ways of knowing
  • Curiosity:  Asking “why” and wanting to know more

Clinical reasoning  is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” [ 2 ]  To make sound judgments about patient care, nurses must generate alternatives, weigh them against the evidence, and choose the best course of action. The ability to clinically reason develops over time and is based on knowledge and experience. [ 3 ]

Inductive and Deductive Reasoning and Clinical Judgment

Inductive and deductive reasoning are important critical thinking skills. They help the nurse use clinical judgment when implementing the nursing process.

Inductive reasoning  involves noticing cues, making generalizations, and creating hypotheses.  Cues  are data that fall outside of expected findings that give the nurse a hint or indication of a patient’s potential problem or condition. The nurse organizes these cues into patterns and creates a generalization. A  generalization  is a judgment formed from a set of facts, cues, and observations and is similar to gathering pieces of a jigsaw puzzle into patterns until the whole picture becomes more clear. Based on generalizations created from patterns of data, the nurse creates a hypothesis regarding a patient problem. A  hypothesis  is a proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring. If a “why” is identified, then a solution can begin to be explored.

No one can draw conclusions without first noticing cues. Paying close attention to a patient, the environment, and interactions with family members is critical for inductive reasoning. As you work to improve your inductive reasoning, begin by first noticing details about the things around you. A nurse is similar to the detective looking for cues in Figure 4.1 . [ 4 ]  Be mindful of your five primary senses: the things that you hear, feel, smell, taste, and see. Nurses need strong inductive reasoning patterns and be able to take action quickly, especially in emergency situations. They can see how certain objects or events form a pattern (i.e., generalization) that indicates a common problem (i.e., hypothesis).

Inductive Reasoning Includes Looking for Cues

Example:  A nurse assesses a patient and finds the surgical incision site is red, warm, and tender to the touch. The nurse recognizes these cues form a pattern of signs of infection and creates a hypothesis that the incision has become infected. The provider is notified of the patient’s change in condition, and a new prescription is received for an antibiotic. This is an example of the use of inductive reasoning in nursing practice.

Deductive reasoning  is another type of critical thinking that is referred to as “top-down thinking.” Deductive reasoning relies on using a general standard or rule to create a strategy. Nurses use standards set by their state’s Nurse Practice Act, federal regulations, the American Nursing Association, professional organizations, and their employer to make decisions about patient care and solve problems.

Example:  Based on research findings, hospital leaders determine patients recover more quickly if they receive adequate rest. The hospital creates a policy for quiet zones at night by initiating no overhead paging, promoting low-speaking voices by staff, and reducing lighting in the hallways. (See Figure 4.2 ). [ 5 ]  The nurse further implements this policy by organizing care for patients that promotes periods of uninterrupted rest at night. This is an example of deductive thinking because the intervention is applied to all patients regardless if they have difficulty sleeping or not.

Deductive Reasoning Example: Implementing Interventions for a Quiet Zone Policy

Clinical judgment  is the result of critical thinking and clinical reasoning using inductive and deductive reasoning. Clinical judgment is defined by the National Council of State Boards of Nursing (NCSBN) as, “The observed outcome of critical thinking and decision-making. It uses nursing knowledge to observe and assess presenting situations, identify a prioritized patient concern, and generate the best possible evidence-based solutions in order to deliver safe patient care.”  [ 6 ]  The NCSBN administers the national licensure exam (NCLEX) that measures nursing clinical judgment and decision-making ability of prospective entry-level nurses to assure safe and competent nursing care by licensed nurses.

Evidence-based practice (EBP)  is defined by the American Nurses Association (ANA) as, “A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories; clinical expertise and evidence from assessment of the health care consumer’s history and condition, as well as health care resources; and patient, family, group, community, and population preferences and values.” [ 7 ]

Nursing Process

The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA). These standards are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently. [ 8 ]  The mnemonic  ADOPIE  is an easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process:  A ssessment,  D iagnosis,  O utcomes Identification,  P lanning,  I mplementation, and  E valuation.

The nursing process is a continuous, cyclic process that is constantly adapting to the patient’s current health status. See Figure 4.3 [ 9 ]  for an illustration of the nursing process.

The Nursing Process

Review Scenario A in the following box for an example of a nurse using the nursing process while providing patient care.

Patient Scenario A: Using the Nursing Process [ 10 ]

Image ch4nursingprocess-Image001.jpg

A hospitalized patient has a prescription to receive Lasix 80mg IV every morning for a medical diagnosis of heart failure. During the morning assessment, the nurse notes that the patient has a blood pressure of 98/60, heart rate of 100, respirations of 18, and a temperature of 98.7F. The nurse reviews the medical record for the patient’s vital signs baseline and observes the blood pressure trend is around 110/70 and the heart rate in the 80s. The nurse recognizes these cues form a pattern related to fluid imbalance and hypothesizes that the patient may be dehydrated. The nurse gathers additional information and notes the patient’s weight has decreased 4 pounds since yesterday. The nurse talks with the patient and validates the hypothesis when the patient reports that their mouth feels like cotton and they feel light-headed. By using critical thinking and clinical judgment, the nurse diagnoses the patient with the nursing diagnosis Fluid Volume Deficit and establishes outcomes for reestablishing fluid balance. The nurse withholds the administration of IV Lasix and contacts the health care provider to discuss the patient’s current fluid status. After contacting the provider, the nurse initiates additional nursing interventions to promote oral intake and closely monitor hydration status. By the end of the shift, the nurse evaluates the patient status and determines that fluid balance has been restored.

In Scenario A, the nurse is using clinical judgment and not just “following orders” to administer the Lasix as scheduled. The nurse assesses the patient, recognizes cues, creates a generalization and hypothesis regarding the fluid status, plans and implements nursing interventions, and evaluates the outcome. Additionally, the nurse promotes patient safety by contacting the provider before administering a medication that could cause harm to the patient at this time.

The ANA’s Standards of Professional Nursing Practice associated with each component of the nursing process are described below.

The “Assessment” Standard of Practice is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.” [ 11 ]  A registered nurse uses a systematic method to collect and analyze patient data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, a nurse’s assessment of a hospitalized patient in pain includes the patient’s response to pain, such as the inability to get out of bed, refusal to eat, withdrawal from family members, or anger directed at hospital staff. [ 12 ]

The “Assessment” component of the nursing process is further described in the “ Assessment ” section of this chapter.

The “Diagnosis” Standard of Practice is defined as, “The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.” [ 13 ]  A nursing diagnosis is the nurse’s clinical judgment about the  client's  response to actual or potential health conditions or needs. Nursing diagnoses are the bases for the nurse’s care plan and are different than medical diagnoses. [ 14 ]

The “Diagnosis” component of the nursing process is further described in the “ Diagnosis ” section of this chapter.

Outcomes Identification

The “Outcomes Identification” Standard of Practice is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” [ 15 ]  The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the patient based on their assessment data and nursing diagnoses.

The “Outcomes Identification” component of the nursing process is further described in the “ Outcomes Identification ” section of this chapter.

The “Planning” Standard of Practice is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” [ 16 ]  Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each patient’s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the patient’s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care. [ 17 ]

The “Planning” component of the nursing process is further described in the “ Planning ” section of this chapter.

NURSING CARE PLANS

Creating nursing care plans is a part of the “Planning” step of the nursing process. A  nursing care plan  is a type of documentation that demonstrates the individualized planning and delivery of nursing care for each specific patient using the nursing process. Registered nurses (RNs) create nursing care plans so that the care provided to the patient across shifts is consistent among health care personnel. Some interventions can be delegated to Licensed Practical Nurses (LPNs) or trained Unlicensed Assistive Personnel (UAPs) with the RN’s supervision. Developing nursing care plans and implementing appropriate delegation are further discussed under the “ Planning ” and “ Implementing ” sections of this chapter.

Implementation

The “Implementation” Standard of Practice is defined as, “The nurse implements the identified plan.” [ 18 ]  Nursing interventions are implemented or delegated with supervision according to the care plan to assure continuity of care across multiple nurses and health professionals caring for the patient. Interventions are also documented in the patient’s electronic medical record as they are completed. [ 19 ]

The “Implementation” Standard of Professional Practice also includes the subcategories “Coordination of Care” and “Health Teaching and Health Promotion” to promote health and a safe environment. [ 20 ]

The “Implementation” component of the nursing process is further described in the “ Implementation ” section of this chapter.

The “Evaluation” Standard of Practice is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [ 21 ]  During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed. [ 22 ]

The “Evaluation” component of the nursing process is further described in the “ Evaluation ” section of this chapter.

Benefits of Using the Nursing Process

Using the nursing process has many benefits for nurses, patients, and other members of the health care team. The benefits of using the nursing process include the following:

  • Promotes quality patient care
  • Decreases omissions and duplications
  • Provides a guide for all staff involved to provide consistent and responsive care
  • Encourages collaborative management of a patient’s health care problems
  • Improves patient safety
  • Improves patient satisfaction
  • Identifies a patient’s goals and strategies to attain them
  • Increases the likelihood of achieving positive patient outcomes
  • Saves time, energy, and frustration by creating a care plan or path to follow

By using these components of the nursing process as a critical thinking model, nurses plan interventions customized to the patient’s needs, plan outcomes and interventions, and determine whether those actions are effective in meeting the patient’s needs. In the remaining sections of this chapter, we will take an in-depth look at each of these components of the nursing process. Using the nursing process and implementing evidence-based practices are referred to as the “science of nursing.” Let’s review concepts related to the “art of nursing” while providing holistic care in a caring manner using the nursing process.

Holistic Nursing Care

The American Nurses Association (ANA) recently updated the definition of  nursing  as, “Nursing integrates the art and science of caring and focuses on the 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 ANA further describes nursing is a learned profession built on a core body of knowledge that integrates both the art and science of nursing. The  art of nursing  is defined as, “Unconditionally accepting the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care.” [ 24 ]

Nurses care for individuals holistically, including their emotional, spiritual, psychosocial, cultural, and physical needs. They consider problems, issues, and needs that the person experiences as a part of a family and a community as they use the nursing process. Review a scenario illustrating holistic nursing care provided to a patient and their family in the following box.

Holistic Nursing Care Scenario

A single mother brings her child to the emergency room for ear pain and a fever. The physician diagnoses the child with an ear infection and prescribes an antibiotic. The mother is advised to make a follow-up appointment with their primary provider in two weeks. While providing discharge teaching, the nurse discovers that the family is unable to afford the expensive antibiotic prescribed and cannot find a primary care provider in their community they can reach by a bus route. The nurse asks a social worker to speak with the mother about affordable health insurance options and available providers in her community and follows up with the prescribing physician to obtain a prescription for a less expensive generic antibiotic. In this manner, the nurse provides holistic care and advocates for improved health for the child and their family.

Review how to provide culturally responsive care and reduce health disparities in the “ Diverse Patients ” chapter.

Caring and the nursing process.

The American Nurses Association (ANA) states, “The act of caring is foundational to the practice of nursing.” [ 25 ]  Successful use of the nursing process requires the development of a care relationship with the patient. A  care relationship  is a mutual relationship that requires the development of trust between both parties. This trust is often referred to as the development of  rapport  and underlies the art of nursing. While establishing a caring relationship, the whole person is assessed, including the individual’s beliefs, values, and attitudes, while also acknowledging the vulnerability and dignity of the patient and family. Assessing and caring for the whole person takes into account the physical, mental, emotional, and spiritual aspects of being a human being. [ 26 ] Caring interventions can be demonstrated in simple gestures such as active listening, making eye contact, touching, and verbal reassurances while also respecting and being sensitive to the care recipient’s cultural beliefs and meanings associated with caring behaviors. [ 27 ]  See Figure 4.4 [ 28 ]  for an image of a nurse using touch as a therapeutic communication technique to communicate caring.

Touch as a Therapeutic Communication Technique

Review how to communicate with patients using therapeutic communication techniques like active listening in the “ Communication ” chapter.

Dr. Jean Watson is a nurse theorist who has published many works on the art and science of caring in the nursing profession. Her theory of human caring sought to balance the cure orientation of medicine, giving nursing its unique disciplinary, scientific, and professional standing with itself and the public. Dr. Watson’s caring philosophy encourages nurses to be authentically present with their patients while creating a healing environment. [ 29 ]

Read more about Dr. Watson’s theory of caring at the  Watson Caring Science Institute .

Now that we have discussed basic concepts related to the nursing process, let’s look more deeply at each component of the nursing process in the following sections.

4.3. ASSESSMENT

Assessment  is the first step of the nursing process (and the first  Standard of Practice  set by the American Nurses Association). This standard is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.” This includes collecting “pertinent data related to the health and quality of life in a systematic, ongoing manner, with compassion and respect for the wholeness, inherent dignity, worth, and unique attributes of every person, including but not limited to, demographics, environmental and occupational exposures, social determinants of health, health disparities, physical, functional, psychosocial, emotional, cognitive, spiritual/transpersonal, sexual, sociocultural, age-related, environmental, and lifestyle/economic assessments.” [ 1 ]

Nurses assess patients to gather clues, make generalizations, and diagnose human responses to health conditions and life processes. Patient data is considered either subjective or objective, and it can be collected from multiple sources.

Subjective Assessment Data

Subjective data  is information obtained from the patient and/or family members and offers important cues from their perspectives. When documenting subjective data stated by a patient, it should be in quotation marks and start with verbiage such as,  The patient reports.  It is vital for the nurse to establish rapport with a patient to obtain accurate, valuable subjective data regarding the mental, emotional, and spiritual aspects of their condition.

There are two types of subjective information, primary and secondary.  Primary data  is information provided directly by the patient. Patients are the best source of information about their bodies and feelings, and the nurse who actively listens to a patient will often learn valuable information while also promoting a sense of well-being. Information collected from a family member, chart, or other sources is known as  secondary data . Family members can provide important information, especially for individuals with memory impairments, infants, children, or when patients are unable to speak for themselves.

See Figure 4.5 [ 2 ]  for an illustration of a nurse obtaining subjective data and establishing rapport after obtaining permission from the patient to sit on the bed.

Example.  An example of documented subjective data obtained from a patient assessment is,  “The patient reports, ‘My pain is a level 2 on a 1-10 scale.’”

Objective Assessment Data

Objective data  is anything that you can observe through your sense of hearing, sight, smell, and touch while assessing the patient. Objective data is reproducible, meaning another person can easily obtain the same data. Examples of objective data are vital signs, physical examination findings, and laboratory results. See Figure 4.6 [ 3 ]  for an image of a nurse performing a physical examination.

Physical Examination

Example.  An example of documented objective data is,  “The patient’s radial pulse is 58 and regular, and their skin feels warm and dry.”

Sources of Assessment Data

There are three sources of assessment data: interview, physical examination, and review of laboratory or diagnostic test results.

Interviewing

Interviewing includes asking the patient questions, listening, and observing verbal and nonverbal communication. Reviewing the chart prior to interviewing the patient may eliminate redundancy in the interview process and allows the nurse to hone in on the most significant areas of concern or need for clarification. However, if information in the chart does not make sense or is incomplete, the nurse should use the interview process to verify data with the patient.

After performing patient identification, the best way to initiate a caring relationship is to introduce yourself to the patient and explain your role. Share the purpose of your interview and the approximate time it will take. When beginning an interview, it may be helpful to start with questions related to the patient’s  medical diagnoses  to gather information about how they have affected the patient’s functioning, relationships, and lifestyle. Listen carefully and ask for clarification when something isn’t clear to you. Patients may not volunteer important information because they don’t realize it is important for their care. By using critical thinking and active listening, you may discover valuable cues that are important to provide safe, quality nursing care. Sometimes nursing students can feel uncomfortable having difficult conversations or asking personal questions due to generational or other cultural differences. Don’t shy away from asking about information that is important to know for safe patient care. Most patients will be grateful that you cared enough to ask and listen.

Be alert and attentive to how the patient answers questions, as well as when they do not answer a question. Nonverbal communication and body language can be cues to important information that requires further investigation. A keen sense of observation is important. To avoid making inappropriate  inferences , the nurse should validate any cues. For example, a nurse may make an inference that a patient is depressed when the patient avoids making eye contact during an interview. However, upon further questioning, the nurse may discover that the patient’s cultural background believes direct eye contact to be disrespectful and this is why they are avoiding eye contact. To read more information about communicating with patients, review the “ Communication ” chapter of this book.

A  physical examination  is a systematic data collection method of the body that uses the techniques of inspection, auscultation, palpation, and percussion. Inspection is the observation of a patient’s anatomical structures. Auscultation is listening to sounds, such as heart, lung, and bowel sounds, created by organs using a stethoscope. Palpation is the use of touch to evaluate organs for size, location, or tenderness. Percussion is an advanced physical examination technique typically performed by providers where body parts are tapped with fingers to determine their size and if fluid is present. Detailed physical examination procedures of various body systems can be found in the Open RN  Nursing Skills  textbook with a head-to-toe checklist in  Appendix C . Physical examination also includes the collection and analysis of vital signs.

Registered Nurses (RNs)  complete the initial physical examination and analyze the findings as part of the nursing process. Collection of follow-up physical examination data can be delegated to  Licensed Practical Nurses/Licensed Vocational Nurses (LPNs/LVNs) , or measurements such as vital signs and weight may be delegated to trained  Unlicensed Assistive Personnel (UAP)  when appropriate to do so. However, the RN remains responsible for supervising these tasks, analyzing the findings, and ensuring they are documented .

A physical examination can be performed as a comprehensive, head-to-toe assessment or as a focused assessment related to a particular condition or problem. Assessment data is documented in the patient’s  Electronic Medical Record (EMR) , an electronic version of the patient’s medical chart.

Reviewing Laboratory and Diagnostic Test Results

Reviewing laboratory and diagnostic test results provides relevant and useful information related to the needs of the patient. Understanding how normal and abnormal results affect patient care is important when implementing the nursing care plan and administering provider prescriptions. If results cause concern, it is the nurse’s responsibility to notify the provider and verify the appropriateness of prescriptions based on the patient’s current status before implementing them.

Types of Assessments

Several types of nursing assessment are used in clinical practice:

  • Primary Survey:  Used during every patient encounter to briefly evaluate level of consciousness, airway, breathing, and circulation and implement emergency care if needed.
  • Admission Assessment:  A comprehensive assessment completed when a patient is admitted to a facility that involves assessing a large amount of information using an organized approach.
  • Ongoing Assessment:  In acute care agencies such as hospitals, a head-to-toe assessment is completed and documented at least once every shift. Any changes in patient condition are reported to the health care provider.
  • Focused Assessment:  Focused assessments are used to reevaluate the status of a previously diagnosed problem.
  • Time-lapsed Reassessment:  Time-lapsed reassessments are used in long-term care facilities when three or more months have elapsed since the previous assessment to evaluate progress on previously identified outcomes. [ 4 ]

Putting It Together

Review Scenario C in the following box to apply concepts of assessment to a patient scenario.

Scenario C [5]

Image ch4nursingprocess-Image002.jpg

Ms. J. is a 74-year-old woman who is admitted directly to the medical unit after visiting her physician because of shortness of breath, increased swelling in her ankles and calves, and fatigue. Her medical history includes hypertension (30 years), coronary artery disease (18 years), heart failure (2 years), and type 2 diabetes (14 years). She takes 81 mg of aspirin every day, metoprolol 50 mg twice a day, furosemide 40 mg every day, and metformin 2,000 mg every day.

Ms. J.’s vital sign values on admission were as follows:

  • Blood Pressure: 162/96 mm Hg
  • Heart Rate: 88 beats/min
  • Oxygen Saturation: 91% on room air
  • Respiratory Rate: 28 breaths/minute
  • Temperature: 97.8 degrees F orally

Her weight is up 10 pounds since the last office visit three weeks prior. The patient states, “I am so short of breath” and “My ankles are so swollen I have to wear my house slippers.” Ms. J. also shares, “I am so tired and weak that I can’t get out of the house to shop for groceries,” and “Sometimes I’m afraid to get out of bed because I get so dizzy.” She confides, “I would like to learn more about my health so I can take better care of myself.”

The physical assessment findings of Ms. J. are bilateral basilar crackles in the lungs and bilateral 2+ pitting edema of the ankles and feet. Laboratory results indicate a decreased serum potassium level of 3.4 mEq/L.

As the nurse completes the physical assessment, the patient’s daughter enters the room. She confides, “We are so worried about mom living at home by herself when she is so tired all the time!”

Critical Thinking Questions

Identify subjective data.

Identify objective data.

Provide an example of secondary data.

Answers are located in the Answer Key at the end of the book.

4.4. DIAGNOSIS

Diagnosis  is the second step of the nursing process (and the second Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse analyzes assessment data to determine actual or potential diagnoses, problems, and issues.” The RN “prioritizes diagnoses, problems, and issues based on mutually established goals to meet the needs of the health care consumer across the health–illness continuum and the care continuum.” Diagnoses, problems, strengths, and issues are documented in a manner that facilitates the development of expected outcomes and a collaborative plan. [ 1 ]

Analyzing Assessment Data

After collection of assessment data, the registered nurse analyzes the data to form generalizations and create hypotheses for nursing diagnoses. Steps for analyzing assessment data include performing data analysis, clustering of information, identifying hypotheses for potential nursing diagnosis, performing additional in-depth assessment as needed, and establishing nursing diagnosis statements. The nursing diagnoses are then prioritized and drive the nursing care plan. [ 2 ]

Performing Data Analysis

After nurses collect assessment data from a patient, they use their nursing knowledge to analyze that data to determine if it is “expected” or “unexpected” or “normal” or “abnormal” for that patient according to their age, development, and baseline status. From there, nurses determine what data are “clinically relevant” as they prioritize their nursing care. [ 3 ]

Example.  In Scenario C in the “Assessment” section of this chapter, the nurse analyzes the vital signs data and determines the blood pressure, heart rate, and respiratory rate are elevated, and the oxygen saturation is decreased for this patient. These findings are considered “relevant cues.”

Clustering Information/Seeing Patterns/Making Hypotheses

After analyzing the data and determining relevant cues, the nurse  clusters  data into patterns. Assessment frameworks such as Gordon’s  Functional Health Patterns  assist nurses in clustering information according to evidence-based patterns of human responses. See the box below for an outline of Gordon’s Functional Health Patterns. [ 4 ]  Concepts related to many of these patterns will be discussed in chapters later in this book.

Example.  Refer to Scenario C of the “Assessment” section of this chapter. The nurse clusters the following relevant cues: elevated blood pressure, elevated respiratory rate, crackles in the lungs, weight gain, worsening edema, shortness of breath, a medical history of heart failure, and currently prescribed a diuretic medication. These cues are clustered into a generalization/pattern of fluid balance, which can be classified under Gordon’s Nutritional-Metabolic Functional Health Pattern. The nurse makes a hypothesis that the patient has excess fluid volume present.

Gordon’s Functional Health Patterns [ 5 ]

Health Perception-Health Management:  A patient’s perception of their health and well-being and how it is managed

Nutritional-Metabolic:  Food and fluid consumption relative to metabolic need

Elimination:  Excretory function, including bowel, bladder, and skin

Activity-Exercise:  Exercise and daily activities

Sleep-Rest:  Sleep, rest, and daily activities

Cognitive-Perceptual:  Perception and cognition

Self-perception and Self-concept:  Self-concept and perception of self-worth, self-competency, body image, and mood state

Role-Relationship:  Role engagements and relationships

Sexuality-Reproductive:  Reproduction and satisfaction or dissatisfaction with sexuality

Coping-Stress Tolerance:  Coping and effectiveness in terms of stress tolerance

Value-Belief:  Values, beliefs (including spiritual beliefs), and goals that guide choices and decisions

Identifying Nursing Diagnoses

After the nurse has analyzed and clustered the data from the patient assessment, the next step is to begin to answer the question, “What are my patient’s human responses (i.e., nursing diagnoses)?” A  nursing diagnosis  is defined as, “A clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community.” [ 6 ]  Nursing diagnoses are customized to each patient and drive the development of the nursing care plan. The nurse should refer to a care planning resource and review the definitions and defining characteristics of the hypothesized nursing diagnoses to determine if additional in-depth assessment is needed before selecting the most accurate nursing diagnosis.

Nursing diagnoses are developed by nurses, for use by nurses. For example, NANDA International (NANDA-I) is a global professional nursing organization that develops nursing terminology that names actual or potential human responses to health problems and life processes based on research findings. [ 7 ]  Currently, there are over 220 NANDA-I nursing diagnoses developed by nurses around the world. This list is continuously updated, with new nursing diagnoses added and old nursing diagnoses retired that no longer have supporting evidence. A list of commonly used NANDA-I diagnoses are listed in  Appendix A . For a full list of NANDA-I nursing diagnoses, refer to a current nursing care plan reference.

NANDA-I nursing diagnoses are grouped into 13 domains that assist the nurse in selecting diagnoses based on the patterns of clustered data. These domains are similar to Gordon’s Functional Health Patterns and include health promotion, nutrition, elimination and exchange, activity/rest, perception/cognition, self-perception, role relationship, sexuality, coping/stress tolerance, life principles, safety/protection, comfort, and growth/development.

Knowledge regarding specific NANDA-I nursing diagnoses is not assessed on the NCLEX. However, analyzing cues and creating hypotheses are part of the measurement model used to assess a candidate’s clinical judgment. Read more about the NCLEX and Next Generation NCLEX in the “ Scope of Practice ” chapter.

Nursing diagnoses vs. medical diagnoses.

You may be asking yourself, “How are nursing diagnoses different from medical diagnoses?” Medical diagnoses focus on diseases or other medical problems that have been identified by the physician, physician’s assistant, or advanced nurse practitioner. Nursing diagnoses focus on the  human response  to health conditions and life processes and are made independently by RNs. Patients with the same medical diagnosis will often  respond  differently to that diagnosis and thus have different nursing diagnoses. For example, two patients have the same medical diagnosis of heart failure. However, one patient may be interested in learning more information about the condition and the medications used to treat it, whereas another patient may be experiencing anxiety when thinking about the effects this medical diagnosis will have on their family. The nurse must consider these different responses when creating the nursing care plan. Nursing diagnoses consider the patient’s and family’s needs, attitudes, strengths, challenges, and resources as a customized nursing care plan is created to provide holistic and individualized care for each patient.

Example.  A medical diagnosis identified for Ms. J. in Scenario C in the “Assessment” section is heart failure. This cannot be used as a nursing diagnosis, but it can be considered as an “associated condition” when creating hypotheses for nursing diagnoses. Associated conditions are medical diagnoses, injuries, procedures, medical devices, or pharmacological agents that are not independently modifiable by the nurse, but support accuracy in nursing diagnosis. The nursing diagnosis in Scenario C will be related to the patient’s response to heart failure.

Additional Definitions Used in NANDA-I Nursing Diagnoses

The following definitions of patient, age, and time are used in association with NANDA-I nursing diagnoses:

The NANDA-I definition of a “patient” includes:

  • Individual:  a single human being distinct from others (i.e., a person).
  • Caregiver:  a family member or helper who regularly looks after a child or a sick, elderly, or disabled person.
  • Family:  two or more people having continuous or sustained relationships, perceiving reciprocal obligations, sensing common meaning, and sharing certain obligations toward others; related by blood and/or choice.
  • Group:  a number of people with shared characteristics generally referred to as an ethnic group.
  • Community:  a group of people living in the same locale under the same governance. Examples include neighborhoods and cities. [ 8 ]

The age of the person who is the subject of the diagnosis is defined by the following terms: [ 9 ]

  • Fetus:  an unborn human more than eight weeks after conception, until birth.
  • Neonate:  a person less than 28 days of age.
  • Infant:  a person greater than 28 days and less than 1 year of age.
  • Child:  a person aged 1 to 9 years
  • Adolescent:  a person aged 10 to 19 years
  • Adult:  a person older than 19 years of age unless national law defines a person as being an adult at an earlier age.
  • Older adult:  a person greater than 65 years of age.

The duration of the diagnosis is defined by the following terms: [ 10 ]

  • Acute:  lasting less than 3 months.
  • Chronic:  lasting greater than 3 months.
  • Intermittent:  stopping or starting again at intervals
  • Continuous:  uninterrupted, going on without stop.

New Terms Used in 2018-2020 NANDA-I Diagnoses

The 2018-2020 edition of  Nursing Diagnoses  includes two new terms to assist in creating nursing diagnoses: at-risk populations and associated conditions. [ 11 ]

At-Risk Populations  are groups of people who share a characteristic that causes each member to be susceptible to a particular human response, such as demographics, health/family history, stages of growth/development, or exposure to certain events/experiences.

Associated Conditions  are medical diagnoses, injuries, procedures, medical devices, or pharmacological agents. These conditions are not independently modifiable by the nurse, but support accuracy in nursing diagnosis [ 12 ]

Types of Nursing Diagnoses

There are four types of NANDA-I nursing diagnoses: [ 13 ]

  • Problem-Focused
  • Health Promotion – Wellness

A  problem-focused nursing diagnosis  is a “clinical judgment concerning an undesirable human response to health condition/life processes that exist in an individual, family, group, or community.” [ 14 ]  To make an accurate problem-focused diagnosis, related factors and defining characteristics must be present.  Related factors  (also called etiology) are causes that contribute to the diagnosis.  Defining characteristics  are cues, signs, and symptoms that cluster into patterns. [ 15 ]

A  health promotion-wellness nursing diagnosis  is “a clinical judgment concerning motivation and desire to increase well-being and to actualize human health potential.” These responses are expressed by the patient’s readiness to enhance specific health behaviors. [ 16 ] A health promotion-wellness diagnosis is used when the patient is willing to improve a lack of knowledge, coping, or other identified need.

A  risk nursing diagnosis  is “a clinical judgment concerning the vulnerability of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes.” [ 17 ]  A risk nursing diagnosis must be supported by risk factors that contribute to the increased vulnerability. A risk nursing diagnosis is different from the problem-focused diagnosis in that the problem has not yet actually occurred. Problem diagnoses should not be automatically viewed as more important than risk diagnoses because sometimes a risk diagnosis can have the highest priority for a patient. [ 18 ]

A  syndrome diagnosis  is a “clinical judgment concerning a specific cluster of nursing diagnoses that occur together, and are best addressed together and through similar interventions.” [ 19 ]

Establishing Nursing Diagnosis Statements

When using NANDA-I nursing diagnoses, NANDA-I recommends the structure of a nursing diagnosis should be a statement that includes the  nursing diagnosis  and  related factors  as exhibited by  defining characteristics . The accuracy of the nursing diagnosis is validated when a nurse is able to clearly link the defining characteristics, related factors, and/or risk factors found during the patient’s assessment. [ 20 ]

To create a nursing diagnosis statement, the registered nurse completes the following steps. After analyzing the patient’s subjective and objective data and clustering the data into patterns, the nurse generates hypotheses for nursing diagnoses based on how the patterns meet defining characteristics of a nursing diagnosis.  Defining characteristics  is the terminology used for observable signs and symptoms related to a nursing diagnosis. [ 21 ]  Defining characteristics are included in care planning resources for each nursing diagnosis, along with a definition of that diagnosis, so the nurse can select the most accurate diagnosis. For example, objective and subjective data such as weight, height, and dietary intake can be clustered together as defining characteristics for the nursing diagnosis of nutritional status.

When creating a nursing diagnosis statement, the nurse also identifies the cause of the problem for that specific patient.  Related factors  is the terminology used for the underlying causes (etiology) of a patient’s problem or situation. Related factors should not be a medical diagnosis, but instead should be attributed to the underlying pathophysiology that the nurse can treat. When possible, the nursing interventions planned for each nursing diagnosis should attempt to modify or remove these related factors that are the underlying cause of the nursing diagnosis. [ 22 ]

Creating nursing diagnosis statements has traditionally been referred to as “using PES format.” The  PES  mnemonic no longer applies to the current terminology used by NANDA-I, but the components of a nursing diagnosis statement remain the same. A nursing diagnosis statement should contain the problem, related factors, and defining characteristics. These terms fit under the former PES format in this manner:

Problem (P)  – the patient  p roblem (i.e., the nursing diagnosis)

Etiology (E)  – related factors (i.e., the  e tiology/cause) of the nursing diagnosis; phrased as “related to” or “R/T”

Signs and Symptoms (S)  – defining characteristics manifested by the patient (i.e., the  s igns and  s ymptoms/subjective and objective data) that led to the identification of that nursing diagnosis for the patient; phrased with “as manifested by” or “as evidenced by.”

Examples of different types of nursing diagnoses are further explained below.

Problem-Focused Nursing Diagnosis

A problem-focused nursing diagnosis contains all three components of the  PES format :

Problem (P)  – statement of the patient response (nursing diagnosis)

Etiology (E)  – related factors contributing to the nursing diagnosis

Signs and Symptoms (S)  – defining characteristics manifested by that patient

SAMPLE PROBLEM-FOCUSED NURSING DIAGNOSIS STATEMENT

Refer to Scenario C of the “Assessment” section of this chapter. The cluster of data for Ms. J. (elevated blood pressure, elevated respiratory rate, crackles in the lungs, weight gain, worsening edema, and shortness of breath) are defining characteristics for the NANDA-I Nursing Diagnosis  Excess Fluid Volume . The NANDA-I definition of  Excess Fluid Volume  is “surplus intake and/or retention of fluid.” The related factor (etiology) of the problem is that the patient has excessive fluid intake. [ 23 ]

The components of a  problem-focused nursing diagnosis  statement for Ms. J. would be:

Fluid Volume Excess

Related to excessive fluid intake

As manifested by bilateral basilar crackles in the lungs, bilateral 2+ pitting edema of the ankles and feet, increased weight of 10 pounds, and the patient reports, “ My ankles are so swollen .”

A correctly written problem-focused nursing diagnosis statement for Ms. J. would look like this:

Fluid Volume Excess related to excessive fluid intake as manifested by bilateral basilar crackles in the lungs, bilateral 2+ pitting edema of the ankles and feet, an increase weight of 10 pounds, and the patient reports, “My ankles are so swollen.”

Health-Promotion Nursing Diagnosis

A health-promotion nursing diagnosis statement contains the problem (P) and the defining characteristics (S). The defining characteristics component of a health-promotion nursing diagnosis statement should begin with the phrase “expresses desire to enhance”: [ 24 ]

Signs and Symptoms (S)  – the patient’s expressed desire to enhance

SAMPLE HEALTH-PROMOTION NURSING DIAGNOSIS STATEMENT

Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. demonstrates a readiness to improve her health status when she told the nurse that she would like to “learn more about my health so I can take better care of myself.” This statement is a defining characteristic of the NANDA-I nursing diagnosis  Readiness for Enhanced Health Management , which is defined as “a pattern of regulating and integrating into daily living a therapeutic regimen for the treatment of illness and its sequelae, which can be strengthened.” [ 25 ]

The components of a  health-promotion nursing diagnosis  for Ms. J. would be:

Problem (P):  Readiness for Enhanced Health Management

Symptoms (S):  Expressed desire to “learn more about my health so I can take better care of myself.”

A correctly written health-promotion nursing diagnosis statement for Ms. J. would look like this:

Enhanced Readiness for Health Promotion as manifested by expressed desire to “learn more about my health so I can take better care of myself.”

Risk Nursing Diagnosis

A risk nursing diagnosis should be supported by evidence of the patient’s risk factors for developing that problem. Different experts recommend different phrasing. NANDA-I 2018-2020 recommends using the phrase “as evidenced by” to refer to the risk factors for developing that problem. [ 26 ]

A risk diagnosis consists of the following:

As Evidenced By  – Risk factors for developing the problem

SAMPLE RISK DIAGNOSIS STATEMENT

Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. has an increased risk of falling due to vulnerability from the dizziness and weakness she is experiencing. The NANDA-I definition of  Risk for Falls  is “increased susceptibility to falling, which may cause physical harm and compromise health.” [ 27 ]

The components of a  risk diagnosis  statement for Ms. J. would be:

Problem (P)  – Risk for Falls

As Evidenced By  – Dizziness and decreased lower extremity strength

A correctly written risk nursing diagnosis statement for Ms. J. would look like this:

Risk for Falls as evidenced by dizziness and decreased lower extremity strength.

Syndrome Diagnosis

A syndrome is a cluster of nursing diagnoses that occur together and are best addressed together and through similar interventions. To create a syndrome diagnosis, two or more nursing diagnoses must be used as defining characteristics (S) that create a syndrome. Related factors may be used if they add clarity to the definition, but are not required. [ 28 ]

A syndrome statement consists of these items:

Problem (P)  – the syndrome

Signs and Symptoms (S)  – the defining characteristics are two or more similar nursing diagnoses

SAMPLE SYNDROME DIAGNOSIS STATEMENT

Refer to Scenario C in the “Assessment” section of this chapter. Clustering the data for Ms. J. identifies several similar NANDA-I nursing diagnoses that can be categorized as a  syndrome . For example,  Activity Intolerance  is defined as “insufficient physiological or psychological energy to endure or complete required or desired daily activities.”  Social Isolation  is defined as “aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state.” These diagnoses can be included under the the NANDA-I syndrome named  Risk for Frail Elderly Syndrome.  This syndrome is defined as a “dynamic state of unstable equilibrium that affects the older individual experiencing deterioration in one or more domains of health (physical, functional, psychological, or social) and leads to increased susceptibility to adverse health effects, in particular disability.” [ 29 ]

The components of a  syndrome nursing diagnosis  for Ms. J. would be:

– Risk for Frail Elderly Syndrome

– The nursing diagnoses of  Activity Intolerance  and  Social Isolation

Additional related factor: Fear of falling

A correctly written syndrome diagnosis statement for Ms. J. would look like this:

Risk for Frail Elderly Syndrome related to activity intolerance, social isolation, and fear of falling

Prioritization

After identifying nursing diagnoses, the next step is prioritization according to the specific needs of the patient. Nurses prioritize their actions while providing patient care multiple times every day.  Prioritization  is the process that identifies the most significant nursing problems, as well as the most important interventions, in the nursing care plan.

It is essential that life-threatening concerns and crises are identified immediately and addressed quickly. Depending on the severity of a problem, the steps of the nursing process may be performed in a matter of seconds for life-threatening concerns. In critical situations, the steps of the nursing process are performed through rapid clinical judgment. Nurses must recognize cues signaling a change in patient condition, apply evidence-based practices in a crisis, and communicate effectively with interprofessional team members. Most patient situations fall somewhere between a crisis and routine care.

There are several concepts used to prioritize, including Maslow’s Hierarchy of Needs, the “ABCs” (Airway, Breathing and Circulation), and acute, uncompensated conditions. See the infographic in Figure 4.7 [30]  on  The How To of Prioritization .

The How To of Prioritization

Maslow’s Hierarchy of Needs  is used to categorize the most urgent patient needs. The bottom levels of the pyramid represent the top priority needs of physiological needs intertwined with safety. See Figure 4.8 [31]  for an image of Maslow’s Hierarchy of Needs. You may be asking yourself, “What about the ABCs – isn’t airway the most important?” The answer to that question is “it depends on the situation and the associated safety considerations.” Consider this scenario – you are driving home after a lovely picnic in the country and come across a fiery car crash. As you approach the car, you see that the passenger is not breathing. Using Maslow’s Hierarchy of Needs to prioritize your actions, you remove the passenger from the car first due to safety even though he is not breathing. After ensuring safety and calling for help, you follow the steps to perform cardiopulmonary resuscitation (CPR) to establish circulation, airway, and breathing until help arrives.

Maslow’s Hierarchy of Needs

In addition to using Maslow’s Hierarchy of Needs and the ABCs of airway, breathing, and circulation, the nurse also considers if the patient’s condition is an acute or chronic problem. Acute, uncompensated conditions generally require priority interventions over chronic conditions. Additionally, actual problems generally receive priority over potential problems, but risk problems sometimes receive priority depending on the patient vulnerability and risk factors.

Example.  Refer to Scenario C in the “Assessment” section of this chapter. Four types of nursing diagnoses were identified for Ms. J.:  Fluid Volume Excess, Enhanced Readiness for Health Promotion, Risk for Falls , and  Risk for Frail Elderly Syndrome . The top priority diagnosis is  Fluid Volume Excess  because it affects the physiological needs of breathing, homeostasis, and excretion. However, the  Risk for Falls  diagnosis comes in a close second because of safety implications and potential injury that could occur if the patient fell.

American Nurses Association. (2021).  Nursing: Scope and standards of practice  (4th ed.). American Nurses Association.  ↵

Herdman, T. H., & Kamitsuru, S. (Eds.). (2018).  Nursing diagnoses: Definitions and classification, 2018-2020 . Thieme Publishers New York.  ↵

Herdman, T. H., & Kamitsuru, S. (Eds.). (2018).  Nursing diagnoses: Definitions and classification, 2018-2020.  Thieme Publishers New York.  ↵

Gordon, M. (2008).  Assess notes: Nursing assessment and diagnostic reasoning.  F.A. Davis Company.  ↵

NANDA International. (n.d.).  Glossary of terms .  https://nanda ​.org/nanda-i-resources ​/glossary-of-terms /  ↵

NANDA International. (n.d.).  Glossary of terms .  https://nanda ​.org/nanda-i-resources ​/glossary-of-terms/   ↵

NANDA International. (n.d.).  Glossary of terms.   https://nanda ​.org/nanda-i-resources ​/glossary-of-terms/   ↵

“The How To of Prioritization” by Valerie Palarski for  Chippewa Valley Technical College  is licensed under  CC BY 4.0   ↵

“ Maslow's hierarchy of needs.svg ” by  J. Finkelstein  is licensed under  CC BY-SA 3.0   ↵

4.5. OUTCOME IDENTIFICATION

Outcome Identification  is the third step of the nursing process (and the third Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” The RN collaborates with the health care consumer, interprofessional team, and others to identify expected outcomes integrating the health care consumer’s culture, values, and ethical considerations. Expected outcomes are documented as measurable goals with a time frame for attainment. [ 1 ]

An  outcome  is a “measurable behavior demonstrated by the patient responsive to nursing interventions.” [ 2 ]  Outcomes should be identified before nursing interventions are planned. After nursing interventions are implemented, the nurse will evaluate if the outcomes were met in the time frame indicated for that patient.

Outcome identification includes setting short- and long-term goals and then creating specific expected outcome statements for each nursing diagnosis.

Short-Term and Long-Term Goals

Nursing care should always be individualized and patient-centered. No two people are the same, and neither should nursing care plans be the same for two people. Goals and outcomes should be tailored specifically to each patient’s needs, values, and cultural beliefs. Patients and family members should be included in the goal-setting process when feasible. Involving patients and family members promotes awareness of identified needs, ensures realistic goals, and motivates their participation in the treatment plan to achieve the mutually agreed upon goals and live life to the fullest with their current condition.

The nursing care plan is a road map used to guide patient care so that all health care providers are moving toward the same patient goals.  Goals  are broad statements of purpose that describe the overall aim of care. Goals can be short- or long-term. The time frame for short- and long-term goals is dependent on the setting in which the care is provided. For example, in a critical care area, a short-term goal might be set to be achieved within an 8-hour nursing shift, and a long-term goal might be in 24 hours. In contrast, in an outpatient setting, a short-term goal might be set to be achieved within one month and a long-term goal might be within six months.

A nursing goal is the overall direction in which the patient must progress to improve the problem/nursing diagnosis and is often the opposite of the problem.

Example.  Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. had a priority nursing diagnosis of  Fluid Volume Excess.  A broad goal would be, “ Ms. J. will achieve a state of fluid balance. ”

Expected Outcomes

Goals are broad, general statements, but outcomes are specific and measurable.  Expected outcomes  are statements of measurable action for the patient within a specific time frame that are responsive to nursing interventions. Nurses may create expected outcomes independently or refer to classification systems for assistance. Just as NANDA-I creates and revises standardized nursing diagnoses, a similar classification and standardization process exists for expected nursing outcomes. The Nursing Outcomes Classification (NOC) is a list of over 330 nursing outcomes designed to coordinate with established NANDA-I diagnoses. [ 3 ]

Patient-Centered

Outcome statements are always patient-centered. They should be developed in collaboration with the patient and individualized to meet a patient’s unique needs, values, and cultural beliefs. They should start with the phrase “The patient will…” Outcome statements should be directed at resolving the defining characteristics for that nursing diagnosis. Additionally, the outcome must be something the patient is willing to cooperate in achieving.

Outcome statements should contain five components easily remembered using the “SMART” mnemonic: [ 4 ]

  • M easurable
  • A ttainable/Action oriented
  • R elevant/Realistic

See Figure 4.9 [ 5 ]  for an image of the SMART components of outcome statements. Each of these components is further described in the following subsections.

SMART Components of Outcome Statements

Outcome statements should state precisely what is to be accomplished. See the following examples:

  • Not specific:  “The patient will increase the amount of exercise.”
  • Specific:  “The patient will participate in a bicycling exercise session daily for 30 minutes.”

Additionally, only one action should be included in each expected outcome. See the following examples:

  • “The patient will walk 50 feet three times a day with standby assistance of one and will shower in the morning until discharge”  is actually two goals written as one. The outcome of ambulation should be separate from showering for precise evaluation. For instance, the patient could shower but not ambulate, which would make this outcome statement very difficult to effectively evaluate.
  • Suggested revision is to create two outcomes statements so each can be measured: The patient will walk 50 feet three times a day with standby assistance of one until discharge. The patient will shower every morning until discharge.

Measurable outcomes have numeric parameters or other concrete methods of judging whether the outcome was met. It is important to use objective data to measure outcomes. If terms like “acceptable” or “normal” are used in an outcome statement, it is difficult to determine whether the outcome is attained. Refer to Figure 4.10 [ 6 ]  for examples of verbs that are measurable and not measurable in outcome statements.

Figure 4.10

Measurable Outcomes

See the following examples:

  • Not measurable:  “The patient will drink adequate fluid amounts every shift.”
  • Measurable:  “The patient will drink 24 ounces of fluids during every day shift (0600-1400).”

Action-Oriented and Attainable

Outcome statements should be written so that there is a clear action to be taken by the patient or significant others. This means that the outcome statement should include a verb. Refer to Figure 4.11 [ 7 ]  for examples of action verbs.

Figure 4.11

Action Verbs

  • Not action-oriented:  “The patient will get increased physical activity.”
  • Action-oriented:  “The patient will list three types of aerobic activity that he would enjoy completing every week.”

Realistic and Relevant

Realistic outcomes consider the patient’s physical and mental condition; their cultural and spiritual values, beliefs, and preferences; and their socioeconomic status in terms of their ability to attain these outcomes. Consideration should be also given to disease processes and the effects of conditions such as pain and decreased mobility on the patient’s ability to reach expected outcomes. Other barriers to outcome attainment may be related to health literacy or lack of available resources. Outcomes should always be reevaluated and revised for attainability as needed. If an outcome is not attained, it is commonly because the original time frame was too ambitious or the outcome was not realistic for the patient.

  • Not realistic:  “The patient will jog one mile every day when starting the exercise program.”
  • Realistic:  “The patient will walk ½ mile three times a week for two weeks.”

Time Limited

Outcome statements should include a time frame for evaluation. The time frame depends on the intervention and the patient’s current condition. Some outcomes may need to be evaluated every shift, whereas other outcomes may be evaluated daily, weekly, or monthly. During the evaluation phase of the nursing process, the outcomes will be assessed according to the time frame specified for evaluation. If it has not been met, the nursing care plan should be revised.

  • Not time limited: “The patient will stop smoking cigarettes.”
  • Time limited:  “The patient will complete the smoking cessation plan by December 12, 2021.”

In Scenario C in Box 4.3, Ms. J.’s priority nursing diagnosis statement was  Fluid Volume Excess related to excess fluid intake as manifested by bilateral basilar crackles in the lungs, bilateral 2+ pitting edema of the ankles and feet, an increase weight of 10 pounds, and the patient reports, “My ankles are so swollen.”  An example of an expected outcome meeting SMART criteria for Ms. J. is,  “The patient will have clear bilateral lung sounds within the next 24 hours.”

4.6. PLANNING

Planning  is the fourth step of the nursing process (and the fourth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” The RN develops an individualized, holistic, evidence-based plan in partnership with the health care consumer, family, significant others, and interprofessional team. Elements of the plan are prioritized. The plan is modified according to the ongoing assessment of the health care consumer’s response and other indicators. The plan is documented using standardized language or terminology. [ 1 ]

After expected outcomes are identified, the nurse begins planning nursing interventions to implement.  Nursing interventions  are evidence-based actions that the nurse performs to achieve patient outcomes. Just as a provider makes medical diagnoses and writes prescriptions to improve the patient’s medical condition, a nurse formulates nursing diagnoses and plans nursing interventions to resolve patient problems. Nursing interventions should focus on eliminating or reducing the related factors (etiology) of the nursing diagnoses when possible. [ 2 ]  Nursing interventions, goals, and expected outcomes are written in the nursing care plan for continuity of care across shifts, nurses, and health professionals.

Planning Nursing Interventions

You might be asking yourself, “How do I know what evidence-based nursing interventions to include in the nursing care plan?” There are several sources that nurses and nursing students can use to select nursing interventions. Many agencies have care planning tools and references included in the electronic health record that are easily documented in the patient chart. Nurses can also refer to other care planning books our sources such as the Nursing Interventions Classification (NIC) system. Based on research and input from the nursing profession, NIC categorizes and describes nursing interventions that are constantly evaluated and updated. Interventions included in NIC are considered evidence-based nursing practices. The nurse is responsible for using clinical judgment to make decisions about which interventions are best suited to meet an individualized patient’s needs. [ 3 ]

Direct and Indirect Care

Nursing interventions are considered direct care or indirect care.  Direct care  refers to interventions that are carried out by having personal contact with patients. Examples of direct care interventions are wound care, repositioning, and ambulation.  Indirect care  interventions are performed when the nurse provides assistance in a setting other than with the patient. Examples of indirect care interventions are attending care conferences, documenting, and communicating about patient care with other providers.

Classification of Nursing Interventions

There are three types of nursing interventions: independent, dependent, and collaborative. (See Figure 4.12 [ 4 ]  for an image of a nurse collaborating with the health care team when planning interventions.)

Figure 4.12

Collaborative nursing interventions, independent nursing interventions.

Any intervention that the nurse can independently provide without obtaining a prescription is considered an  independent nursing intervention . An example of an independent nursing intervention is when the nurses monitor the patient’s 24-hour intake/output record for trends because of a risk for imbalanced fluid volume. Another example of independent nursing interventions is the therapeutic communication that a nurse uses to assist patients to cope with a new medical diagnosis.

Example.  Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. was diagnosed with  Fluid Volume Excess . An example of an evidence-based independent nursing intervention is,  “The nurse will reposition the patient with dependent edema frequently, as appropriate.” [ 5 ]  The nurse would individualize this evidence-based intervention to the patient and agency policy by stating,  “The nurse will reposition the patient every 2 hours.”

Dependent Nursing Interventions

Dependent nursing interventions  require a prescription before they can be performed. Prescriptions are orders, interventions, remedies, or treatments ordered or directed by an authorized primary health care provider. [ 6 ]  A  primary health care provider  is a member of the health care team (usually a physician, advanced practice nurse, or physician’s assistant) who is licensed and authorized to formulate prescriptions on behalf of the client. For example, administering medication is a dependent nursing intervention. The nurse incorporates dependent interventions into the patient’s overall care plan by associating each intervention with the appropriate nursing diagnosis.

Example.  Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. was diagnosed with  Fluid Volume Excess . An example of a dependent nursing intervention is,  “The nurse will administer scheduled diuretics as prescribed.”

Collaborative nursing interventions  are actions that the nurse carries out in collaboration with other health team members, such as physicians, social workers, respiratory therapists, physical therapists, and occupational therapists. These actions are developed in consultation with other health care professionals and incorporate their professional viewpoint. [ 7 ]

Example.  Refer to Scenario C in the “Assessment” section of this chapter. Ms. J. was diagnosed with  Fluid Volume Excess . An example of a collaborative nursing intervention is consulting with a respiratory therapist when the patient has deteriorating oxygen saturation levels. The respiratory therapist plans oxygen therapy and obtains a prescription from the provider. The nurse would document “ The nurse will manage oxygen therapy in collaboration with the respiratory therapist ” in the care plan.

Individualization of Interventions

It is vital for the planned interventions to be individualized to the patient to be successful. For example, adding prune juice to the breakfast meal of a patient with constipation will only work if the patient likes to drink the prune juice. If the patient does not like prune juice, then this intervention should not be included in the care plan. Collaboration with the patient, family members, significant others, and the interprofessional team is essential for selecting effective interventions. The number of interventions included in a nursing care plan is not a hard and fast rule, but enough quality, individualized interventions should be planned to meet the identified outcomes for that patient.

Creating Nursing Care Plans

Nursing care plans are created by registered nurses (RNs). Documentation of individualized nursing care plans are legally required in long-term care facilities by the Centers for Medicare and Medicaid Services (CMS) and in hospitals by The Joint Commission. CMS guidelines state, “Residents and their representative(s) must be afforded the opportunity to participate in their care planning process and to be included in decisions and changes in care, treatment, and/or interventions. This applies both to initial decisions about care and treatment, as well as the refusal of care or treatment. Facility staff must support and encourage participation in the care planning process. This may include ensuring that residents, families, or representatives understand the comprehensive care planning process, holding care planning meetings at the time of day when a resident is functioning best and patient representatives can be present, providing sufficient notice in advance of the meeting, scheduling these meetings to accommodate a resident’s representative (such as conducting the meeting in-person, via a conference call, or video conferencing), and planning enough time for information exchange and decision-making. A resident has the right to select or refuse specific treatment options before the care plan is instituted.” [ 8 ]  The Joint Commission conceptualizes the care planning process as the structuring framework for coordinating communication that will result in safe and effective care. [ 9 ]

Many facilities have established standardized nursing care plans with lists of possible interventions that can be customized for each specific patient. Other facilities require the nurse to develop each care plan independently. Whatever the format, nursing care plans should be individualized to meet the specific and unique needs of each patient. See Figure 4.13 [ 10 ]  for an image of a standardized care plan.

Figure 4.13

Standardized Care Plan

Nursing care plans created in nursing school can also be in various formats such as concept maps or tables. Some are fun and creative, while others are more formal.  Appendix B  contains a template that can be used for creating nursing care plans.

4.7. IMPLEMENTATION OF INTERVENTIONS

Implementation  is the fifth step of the nursing process (and the fifth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse implements the identified plan.” The RN may delegate planned interventions after considering the circumstance, person, task, communication, supervision, and evaluation, as well as the state Nurse Practice Act, federal regulation, and agency policy. [ 1 ]

Implementation of interventions requires the RN to use critical thinking and clinical judgment. After the initial plan of care is developed, continual reassessment of the patient is necessary to detect any changes in the patient’s condition requiring modification of the plan. The need for continual patient reassessment underscores the dynamic nature of the nursing process and is crucial to providing safe care.

During the implementation phase of the nursing process, the nurse prioritizes planned interventions, assesses patient safety while implementing interventions, delegates interventions as appropriate, and documents interventions performed.

Prioritizing Implementation of Interventions

Prioritizing implementation of interventions follows a similar method as to prioritizing nursing diagnoses. Maslow’s Hierarchy of Needs and the ABCs of airway, breathing, and circulation are used to establish top priority interventions. When possible, least invasive actions are usually preferred due to the risk of injury from invasive options. Read more about methods for prioritization under the “ Diagnosis ” subsection of this chapter.

The potential impact on future events, especially if a task is not completed at a certain time, is also included when prioritizing nursing interventions. For example, if a patient is scheduled to undergo a surgical procedure later in the day, the nurse prioritizes initiating a NPO (nothing by mouth) prescription prior to completing pre-op patient education about the procedure. The rationale for this decision is that if the patient ate food or drank water, the surgery time would be delayed. Knowing and understanding the patient’s purpose for care, current situation, and expected outcomes are necessary to accurately prioritize interventions.

Patient Safety

It is essential to consider patient safety when implementing interventions. At times, patients may experience a change in condition that makes a planned nursing intervention or provider prescription no longer safe to implement. For example, an established nursing care plan for a patient states,  “The nurse will ambulate the patient 100 feet three times daily.”  However, during assessment this morning, the patient reports feeling dizzy today, and their blood pressure is 90/60. Using critical thinking and clinical judgment, the nurse decides to not implement the planned intervention of ambulating the patient. This decision and supporting assessment findings should be documented in the patient’s chart and also communicated during the shift handoff report, along with appropriate notification of the provider of the patient’s change in condition.

Implementing interventions goes far beyond implementing provider prescriptions and completing tasks identified on the nursing care plan and must focus on patient safety. As front-line providers, nurses are in the position to stop errors before they reach the patient. [ 2 ]

In 2000 the Institute of Medicine (IOM) issued a groundbreaking report titled  To Err Is Human: Building a Safer Health System . The report stated that as many as 98,000 people die in U.S. hospitals each year as a result of preventable medical errors.  To Err Is Human  broke the silence that previously surrounded the consequences of medical errors and set a national agenda for reducing medical errors and improving patient safety through the design of a safer health system. [ 3 ]  In 2007 the IOM published a follow-up report titled  Preventing Medication Errors  and reported that more than 1.5 million Americans are injured every year in American hospitals, and the average hospitalized patient experiences at least one medication error each day. This report emphasized actions that health care systems could take to improve medication safety. [ 4 ]

Read additional information about specific actions that nurses can take to prevent medication errors; go to the “Preventing Medication Errors” section of the “ Legal/Ethical”  chapter of the Open RN  Nursing Pharmacology  textbook.

In an article released by the Robert Wood Johnson Foundation, errors involving nurses that endanger patient safety cover broad territory. This territory spans “wrong site, wrong patient, wrong procedure” errors, medication mistakes, failures to follow procedures that prevent central line bloodstream and other infections, errors that allow unsupervised patients to fall, and more. Some errors can be traced to shifts that are too long that leave nurses fatigued, some result from flawed systems that do not allow for adequate safety checks, and others are caused by interruptions to nurses while they are trying to administer medications or provide other care. [ 5 ]

The Quality and Safety Education for Nurses (QSEN) project began in 2005 to assist in preparing future nurses to continuously improve the quality and safety of the health care systems in which they work. The vision of the QSEN project is to “inspire health care professionals to put quality and safety as core values to guide their work.” [ 6 ]  Nurses and nursing students are expected to participate in quality improvement (QI) initiatives by identifying gaps where change is needed and assisting in implementing initiatives to resolve these gaps.  Quality improvement  is defined as, “The combined and unceasing efforts of everyone – health care professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care), and better professional development (learning).” [ 7 ]

Delegation of Interventions

While implementing interventions, RNs may elect to delegate nursing tasks.  Delegation  is defined by the American Nurses Association as, “The assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel or licensed practical nurses (LPNs) while retaining accountability for the outcome.” [ 8 ]  RNs are accountable for determining the appropriateness of the delegated task according to condition of the patient and the circumstance; the communication provided to an appropriately trained LPN or UAP; the level of supervision provided; and the evaluation and documentation of the task completed. The RN must also be aware of the state Nurse Practice Act, federal regulations, and agency policy before delegating. The RN cannot delegate responsibilities requiring clinical judgment. [ 9 ]  See the following box for information regarding legal requirements associated with delegation according to the Wisconsin Nurse Practice Act.

Delegation According to the Wisconsin Nurse Practice Act

During the supervision and direction of delegated acts a Registered Nurse shall do all of the following:

Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.

Provide direction and assistance to those supervised.

Observe and monitor the activities of those supervised.

Evaluate the effectiveness of acts performed under supervision. [ 10 ]

The standard of practice for Licensed Practical Nurses in Wisconsin states, “In the performance of acts in basic patient situations, the LPN. shall, under the general supervision of an RN or the direction of a provider:

Accept only patient care assignments which the LPN is competent to perform.

Provide basic nursing care. Basic nursing care is defined as care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable.

Record nursing care given and report to the appropriate person changes in the condition of a patient.

Consult with a provider in cases where an LPN knows or should know a delegated act may harm a patient.

Perform the following other acts when applicable:

Assist with the collection of data.

Assist with the development and revision of a nursing care plan.

Reinforce the teaching provided by an RN provider and provide basic health care instruction.

Participate with other health team members in meeting basic patient needs.” [ 11 ]

Read additional details about the scope of practice of registered nurses (RNs) and licensed practical nurses (LPNs) in Wisconsin’s Nurse Practice Act in  Chapter N 6 Standards of Practice .

Read more about the American Nurses Association’s  Principles of Delegation.

Table 4.7 outlines general guidelines for delegating nursing tasks in the state of Wisconsin according to the role of the health care team member.

Table 4.7

General Guidelines for Delegating Nursing Tasks

Documentation of Interventions

As interventions are performed, they must be documented in the patient’s record in a timely manner. As previously discussed in the “Ethical and Legal Issues” subsection of the “ Basic Concepts ” section, lack of documentation is considered a failure to communicate and a basis for legal action. A basic rule of thumb is if an intervention is not documented, it is considered not done in a court of law. It is also important to document administration of medication and other interventions in a timely manner to prevent errors that can occur due to delayed documentation time.

Coordination of Care and Health Teaching/Health Promotion

ANA’s Standard of Professional Practice for Implementation also includes the standards  5A   Coordination of Care  and  5B   Health Teaching and Health Promotion . [ 12 ]   Coordination of Care  includes competencies such as organizing the components of the plan, engaging the patient in self-care to achieve goals, and advocating for the delivery of dignified and holistic care by the interprofessional team.  Health Teaching and Health Promotion  is defined as, “Employing strategies to teach and promote health and wellness.” [ 13 ]  Patient education is an important component of nursing care and should be included during every patient encounter. For example, patient education may include teaching about side effects while administering medications or teaching patients how to self-manage their conditions at home.

Refer to Scenario C in the “Assessment” section of this chapter. The nurse implemented the nursing care plan documented in Appendix C. Interventions related to breathing were prioritized. Administration of the diuretic medication was completed first, and lung sounds were monitored frequently for the remainder of the shift. Weighing the patient before breakfast was delegated to the CNA. The patient was educated about her medications and methods to use to reduce peripheral edema at home. All interventions were documented in the electronic medical record (EMR).

4.8. EVALUATION

Evaluation  is the sixth step of the nursing process (and the sixth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [ 1 ]  Both the patient status and the effectiveness of the nursing care must be continuously evaluated and the care plan modified as needed. [ 2 ]

Evaluation focuses on the effectiveness of the nursing interventions by reviewing the expected outcomes to determine if they were met by the time frames indicated. During the evaluation phase, nurses use critical thinking to analyze reassessment data and determine if a patient’s expected outcomes have been met, partially met, or not met by the time frames established. If outcomes are not met or only partially met by the time frame indicated, the care plan should be revised. Reassessment should occur every time the nurse interacts with a patient, discusses the care plan with others on the interprofessional team, or reviews updated laboratory or diagnostic test results. Nursing care plans should be updated as higher priority goals emerge. The results of the evaluation must be documented in the patient’s medical record.

Ideally, when the planned interventions are implemented, the patient will respond positively and the expected outcomes are achieved. However, when interventions do not assist in progressing the patient toward the expected outcomes, the nursing care plan must be revised to more effectively address the needs of the patient. These questions can be used as a guide when revising the nursing care plan:

  • Did anything unanticipated occur?
  • Has the patient’s condition changed?
  • Were the expected outcomes and their time frames realistic?
  • Are the nursing diagnoses accurate for this patient at this time?
  • Are the planned interventions appropriately focused on supporting outcome attainment?
  • What barriers were experienced as interventions were implemented?
  • Does ongoing assessment data indicate the need to revise diagnoses, outcome criteria, planned interventions, or implementation strategies?
  • Are different interventions required?

Refer to Scenario C in the “Assessment” section of this chapter and Appendix C . The nurse evaluates the patient’s progress toward achieving the expected outcomes.

For the nursing diagnosis  Fluid Volume Excess , the nurse evaluated the four expected outcomes to determine if they were met during the time frames indicated:

The patient will report decreased dyspnea within the next 8 hours.

The patient will have clear lung sounds within the next 24 hours.

The patient will have decreased edema within the next 24 hours.

The patient’s weight will return to baseline by discharge.

Evaluation of the patient condition on Day 1 included the following data: “ The patient reported decreased shortness of breath, and there were no longer crackles in the lower bases of the lungs. Weight decreased by 1 kg, but 2+ edema continued in ankles and calves .” Based on this data, the nurse evaluated the expected outcomes as “ Partially Met ” and revised the care plan with two new interventions:

Request prescription for TED hose from provider.

Elevate patient’s legs when sitting in chair.

For the second nursing diagnosis,  Risk for Falls , the nurse evaluated the outcome criteria as “ Met ” based on the evaluation, “ The patient verbalizes understanding and is appropriately calling for assistance when getting out of bed. No falls have occurred. ”

The nurse will continue to reassess the patient’s progress according to the care plan during hospitalization and make revisions to the care plan as needed. Evaluation of the care plan is documented in the patient’s medical record.

4.9. SUMMARY OF THE NURSING PROCESS

You have now learned how to perform each step of the nursing process according to the ANA Standards of Professional Nursing Practice. Critical thinking, clinical reasoning, and clinical judgment are used when assessing the patient, creating a nursing care plan, and implementing interventions. Frequent reassessment, with revisions to the care plan as needed, is important to help the patient achieve expected outcomes. Throughout the entire nursing process, the patient always remains the cornerstone of nursing care. Providing individualized, patient-centered care and evaluating whether that care has been successful in achieving patient outcomes are essential for providing safe, professional nursing practice.

Video Review of Creating a Sample Care Plan [ 1 ]

Image ch4nursingprocess-Image003.jpg

4.10. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activity elements will be provided within the element as immediate feedback.)

Instructions: Apply what you’ve learned in this chapter by creating a nursing care plan using the following scenario. Use the template in   Appendix B   as a guide.

The client, Mark S., is a 57-year-old male who was admitted to the hospital with “severe” abdominal pain that was unable to be managed in the Emergency Department. The physician has informed Mark that he will need to undergo some diagnostic tests. The tests are scheduled for the morning.

After receiving the news about his condition and the need for diagnostic tests, Mark begins to pace the floor. He continues to pace constantly. He keeps asking the nurse the same question (“How long will the tests take?”) about his tests over and over again. The patient also remarked, “I’m so uptight I will never be able to sleep tonight.” The nurse observes that the client avoids eye contact during their interactions and that he continually fidgets with the call light. His eyes keep darting around the room. He appears tense and has a strained expression on his face. He states, “My mouth is so dry.” The nurse observes his vital signs to be: T 98, P 104, R 30, BP 180/96. The nurse notes that his skin feels sweaty (diaphoretic) and cool to the touch.

Critical Thinking Activity:

Group (cluster) the subjective and objective data.

Create a problem-focused nursing diagnosis (hypothesis).

Develop a broad goal and then identify an expected outcome in “SMART” format.

Outline three interventions for the nursing diagnosis to meet the goal. Cite an evidence-based source.

Imagine that you implemented the interventions that you identified. Evaluate the degree to which the expected outcome was achieved: Met – Partially Met – Not Met.

Image ch4nursingprocess-Image004.jpg

  • IV GLOSSARY

The act or process of pleading for, supporting, or recommending a cause or course of action. [ 1 ]

Unconditionally acceptance of the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care. [ 2 ]

Groups of people who share a characteristic that causes each member to be susceptible to a particular human response, such as demographics, health/family history, stages of growth/development, or exposure to certain events/experiences. [ 3 ]

Medical diagnoses, injuries, procedures, medical devices, or pharmacological agents. These conditions are not independently modifiable by the nurse, but support accuracy in nursing diagnosis. [ 4 ]

Care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable. [ 5 ]

A relationship described as one in which the whole person is assessed while balancing the vulnerability and dignity of the patient and family. [ 6 ]

Individual, family, or group, which includes significant others and populations. [ 7 ]

The observed outcome of critical thinking and decision-making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care. [ 8 ]

A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.  [ 9 ]

Grouping data into similar domains or patterns.

Nursing interventions that require cooperation among health care professionals and unlicensed assistive personnel (UAP).

While implementing interventions during the nursing process, includes components such as organizing the components of the plan with input from the health care consumer, engaging the patient in self-care to achieve goals, and advocating for the delivery of dignified and person-centered care by the interprofessional team. [ 10 ]

Reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow. [ 11 ]

Subjective or objective data that gives the nurse a hint or indication of a potential problem, process, or disorder.

“Top-down thinking” or moving from the general to the specific. Deductive reasoning relies on a general statement or hypothesis—sometimes called a premise or standard—that is held to be true. The premise is used to reach a specific, logical conclusion.

Observable cues/inferences that cluster as manifestations of a problem-focused, health-promotion diagnosis, or syndrome. This does not only imply those things that the nurse can see, but also things that are seen, heard (e.g., the patient/family tells us), touched, or smelled. [ 12 ]

The assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel while retaining accountability for the outcome. [ 13 ]

Interventions that require a prescription from a physician, advanced practice nurse, or physician’s assistant.

Interventions that are carried out by having personal contact with a patient.

An electronic version of the patient’s medical record.

A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories; clinical expertise and evidence from assessment of the health care consumer’s history and condition, as well as health care resources; and patient, family, group, community, and population preferences and values. [ 14 ]

Statements of measurable action for the patient within a specific time frame and in response to nursing interventions. “SMART” outcome statements are specific, measurable, action-oriented, realistic, and include a time frame.

An evidence-based assessment framework for identifying patient problems and risks during the assessment phase of the nursing process.

A judgment formed from a set of facts, cues, and observations.

Broad statements of purpose that describe the aim of nursing care.

Employing strategies to teach and promote health and wellness. [ 15 ]

Any intervention that the nurse can provide without obtaining a prescription or consulting anyone else.

Interventions performed by the nurse in a setting other than directly with the patient. An example of indirect care is creating a nursing care plan.

A type of reasoning that involves forming generalizations based on specific incidents.

Interpretations or conclusions based on cues, personal experiences, preferences, or generalizations.

Nurses who have had specific training and passed a licensing exam. The training is generally less than that of a Registered Nurse. The scope of practice of an LPN/LVN is determined by the facility and the state’s Nurse Practice Act.

A disease or illness diagnosed by a physician or advanced health care provider such as a nurse practitioner or physician’s assistant. Medical diagnoses are a result of clustering signs and symptoms to determine what is medically affecting an individual.

Nursing integrates the art and science of caring and focuses on the 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. [ 16 ]

Specific documentation of the planning and delivery of nursing care that is required by The Joint Commission.

A systematic approach to patient-centered care with steps including assessment, diagnosis, outcome identification, planning, implementation, and evaluation; otherwise known by the mnemonic “ADOPIE.”

Data that the nurse can see, touch, smell, or hear or is reproducible such as vital signs. Laboratory and diagnostic results are also considered objective data.

A measurable behavior demonstrated by the patient that is responsive to nursing interventions. [ 17 ]

The format of a nursing diagnosis statement that includes:

Problem (P) – statement of the patient problem (i.e., the nursing diagnosis)

Etiology (E) – related factors (etiology) contributing to the cause of the nursing diagnosis

Signs and Symptoms (S) – defining characteristics manifested by the patient of that nursing diagnosis

Orders, interventions, remedies, or treatments ordered or directed by an authorized primary health care provider. [ 18 ]

Information collected from the patient.

Member of the health care team (usually a medical physician, nurse practitioner, etc.) licensed and authorized to formulate prescriptions on behalf of the client. [ 19 ]

The skillful process of deciding which actions to complete first, second, or third for optimal patient outcomes and to improve patient safety.

The “combined and unceasing efforts of everyone — health care professionals, patients and their families, researchers, payers, planners, and educators — to make the changes that will lead to better patient outcomes (health), better system performance (care), and better professional development (learning).” [ 20 ]

Developing a relationship of mutual trust and understanding.

A nurse who has had a designated amount of education and training in nursing and is licensed by a state Board of Nursing.

The underlying cause (etiology) of a nursing diagnosis when creating a PES statement.

Patients have the right to determine what will be done with and to their own person.

Principles and procedures in the discovery of knowledge involving the recognition and formulation of a problem, the collection of data, and the formulation and testing of a hypothesis.

Information collected from sources other than the patient.

Data that the patient or family reports or data that the nurse makes as an inference, conclusion, or assumption, such as  “The patient appears anxious.”

Any unlicensed personnel trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. [ 21 ]

Obtaining Subjective Data in a Care Relationship

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

  • Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021. Chapter 4 Nursing Process.
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In this Page

  • NURSING PROCESS INTRODUCTION
  • BASIC CONCEPTS
  • OUTCOME IDENTIFICATION
  • IMPLEMENTATION OF INTERVENTIONS
  • SUMMARY OF THE NURSING PROCESS
  • LEARNING ACTIVITIES

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