Nursing Process and Clinical Decision-Making
Core concepts
The nursing process - assessment, diagnosis, planning, implementation, evaluation - is cyclical and dynamic, not linear. Assessment gathers subjective and objective data; diagnosis identifies the human response (not the medical disease); planning sets measurable, time-bound, patient-centred goals; implementation carries out interventions; evaluation judges goal attainment and restarts the cycle. Clinical decision-making draws on the ABCDE approach for deterioration, SBAR for handover, and structured tools such as early warning scores. Prioritization frameworks matter: Maslow (physiological first), ABC (airway, breathing, circulation), and acute-over-chronic. Critical thinking includes recognizing cues, generating hypotheses, and acting, then reflecting.
Traps
Candidates lose marks by choosing an intervention before completing assessment, by misclassifying a medical diagnosis as a nursing diagnosis, or by selecting "evaluate" options when the patient is unstable. Another trap is prioritization by emotional salience - the anxious patient is not necessarily the most urgent. Goals written as "patient will feel better" fail measurability. Also watch for questions asking what to do first versus next: first is usually assessment or safety; next follows the established plan.
Rule of thumb
If the patient is unstable, assess and stabilize before you educate or document. If two patients are stable, use ABC and acute-over-chronic to break the tie.
Worked example
Four patients: one with new-onset chest pain, one requesting discharge teaching, one with chronic pain rated 6/10, one awaiting a routine dressing change. The chest pain patient is prioritized because it is acute and potentially life-threatening (circulation). Only after stabilization do you address teaching and routine care.