Critical thinking is a process based on reason and reflection, knowledge, and instinct derived from experience. The nursing process is a problem-solving method used to guide nursing practice in providing holistic care for individuals, groups, and communities.

The five cognitive skills necessary to apply critical thinking to clinical problems are (1) a systematic approach to problem solving, (2) caring sensitivity to the client’s perspective of a problem or need, (3) unbiased inquiry and creative analysis of cause and effect, (4) intuition, and (5) reflection-in-action (evaluation), in which valid conclusions are based on logical consistency. Critical thinking is a necessary skill for professionals. Critical thinking requires the application of creativity; the ability to develop innovative solutions.

Critical thinking includes both problem-solving and decision-making processes. In problem solving, problems are identified, information is gathered, a specific problem is named, a plan for solving the problem is developed, the plan is put into action, and results of the plan are evaluated. Decision making is the consideration and selection of interventions from a repertoire of actions that facilitate the achievement of a desired outcome.

The nursing process is the specific problem-solving method used by nurses to arrive at the point at which decisions about client care can be made. The nursing process was first described in the 1950s and 1960s by early nursing theorists, Peplau, Hall, Johnson, and Wiedenbach. The steps in the nursing process were defined in 1991 by the American Nurses Association (ANA) in its standards of care for various nursing specialties. They are comparable to the steps of the problem-solving process and include assessment, diagnosis, outcome identification and planning, implementation, and evaluation.

Assessment includes the collection, verification, organization, interpretation, and documentation of client data. Data can be gathered from the primary source (the client) and from secondary sources (family members, other professionals, health records, etc.). Subjective data are feelings, perceptions, and concerns from the client’s point of view, including a health history. Objective data are observable and measurable data that are obtained through both standard assessment techniques performed during the physical examination and diagnostic tests. Both subjective and objective data are clustered into an organizing framework for collection of data, such as Gordon’s Functional Health Problems. This process requires critical thinking ability.

The North American Nursing Diagnosis Association (NANDA) defines nursing diagnosis as a clinical judgment about individual, family, or community responses to actual or potential health problems or life processes. Nursing diagnoses differ from medical diagnoses because (1) they focus on actual or potential health problems or life processes, rather than on disease; (2) they change as the client’s health problems change; and (3) they identify a problem for which a nurse is licensed and qualified to intervene independent from the physician.

There are several types of nursing diagnoses. An actual nursing diagnosis indicates a problem actually exists. A risk nursing diagnosis (potential problem) indicates that a problem does not yet exist, but risk factors are present. A possible nursing diagnosis indicates a situation in which a problem could arise unless preventive action is taken or a statement of a hunch by the nurse that cannot be confirmed or eliminated until more data have been collected. A wellness nursing diagnosis indicates the client’s expression of a desire to attain a higher level of wellness in some area of function. A collaborative problem, in contrast to the nursing diagnosis, is one managed through the use of interventions prescribed by other health care practitioners and/or nurses.

The outcome identification and planning step of the nursing process is the third step. This step includes prioritizing the list of nursing diagnoses, writing client-centered long- and short-term goals and outcomes, developing specific interventions, and recording the plan of care in the client’s record. Priority should be given to life-threatening situations. Goals are broad statements that describe an intended or desired change in the client’s behavior. They are derived with the input of the client and should be consistent with nursing diagnoses. Expected outcomes are specific objectives related to the goals. They are used to evaluate nursing interventions, so they should be measurable, achievable within a certain time limit, and realistic. A nursing intervention is an activity that the nurse will execute for and with the client to enable accomplishment of the goals.

Implementation, the fourth step in the nursing process, is the execution of the nursing plan of care derived during the planning phase. The skills needed for implementation include the ability to assess the client throughout the nursing process, psychomotor skills, interpersonal skills, and critical thinking skills. The nurse must also accurately report and document the client’s assessment data, treatment, and responses to treatment.

Evaluation, the fifth step in the nursing process, involves determining whether the client goals have been met, partially met, or not met. Evaluation is a continuous process. When goals are not met or are only partially met, the reasons may be that (1) the initial assessment data may have been incomplete, (2) the goals and expected outcomes may not have been realistic, (3) the time frame may have been too optimistic, or (4) the goals and/or nursing interventions may not have been appropriate for the client.

The problem-solving process and the nursing process are similar. In problem solving, encountering a problem and collecting data are comparable to assessment; identifying the exact nature of a problem is comparable to formulating a nursing diagnosis; determining a plan or action is comparable to the planning step; carrying out the plan is comparable to implementation; and evaluating the plan in a new situation is comparable to evaluating the effects of an intervention.