1. Pullen, Richard L. Jr EdD, RN

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Applying Nursing Process: A Tool for Critical Thinking1 by Rosalinda Alfaro-LeFevre is a straightforward approach to teaching the nursing process in the information age. The reader learns practical strategies to become an independent critical thinker by using new tools to help prioritize assessment, nursing diagnosis, and evidence-based critical thinking indicators. The text serves as a guide for novice nursing students to demonstrate confidence in their critical thinking skills and be better prepared for the National Council Licensure Examination (NCLEX).


The nursing process is often overwhelming and confusing to novice students when they enter nursing school. Even experienced nurses sometime need additional guidance in the organization of patient data to more effectively manage care. Applying Nursing Process provides a thorough, yet is not an exhaustive, overview as to why the nursing process is important and dynamic ways to encourage critical thinking. An introductory chapter emphasizes the importance of demonstrating a willingness to care, empathic listening and caring behaviors in the process of data collection. The "10 caring behaviors" help promote a sense of trust, respect, and collaboration among the patient, the patient's family, the nurse, and the interdisciplinary healthcare team.


A systematic 6-step process for assessment guides the reader in the initial phases of data collection. Guidelines for performing a head-to-toe assessment, health history interviewing techniques, and case study analyses provide the reader with a foundation to develop appropriate nursing diagnoses. A comprehensive list of nursing diagnoses from the North American Nursing Diagnosis Association (NANDA) with defining characteristics and related factors is included in a glossary. The text walks the reader through the steps of developing nursing diagnoses for adult patients. Novice students will find the Comprehensive Analysis Tool, which is a guide for diagnostic reasoning, helpful as they draw conclusions from patient data.


Middle chapters address the planning and implementation phases of the nursing process, which involves applying standards, setting priorities, clarifying outcomes, and ensuring the plan of care is adequately recorded. These chapters stress the importance of outcome-focused care that includes patients as partners, effective delegation, and introduces the reader to principles of effective charting. The "5 rights of delegation" will help the reader to be accountable in the safe and prudent delegation of nursing care.


An overall theme in these middle chapters focuses on discharge planning and case management with a goal of preparing the patient to perform activities of daily living following discharge from the hospital. The Nursing Interventions Classification (NIC) and Nursing Outcomes Classifications (NOC) are included in a glossary. These classifications systems encourage the reader to organize, synthesize, and prioritize patient-centered data.


Clinical nursing faculty will like the emphasis placed on patient teaching in discharge planning. The text clearly states that teaching patients about their health status and treatment plan, and motivating them to become involved in managing their care, is the key to empowering them to become their own best advocate and caregiver. The text also provides easy-to-read guidelines for patient teaching that address the unique needs of the Spanish-speaking individual. Readers will find the "Critical Thinking During Planning: Ten Key Questions" challenging and helpful during the rudimentary stages of the plan of care.


The text clearly relates how standards from regulatory bodies such as the American Nurses Association (ANA), Joint Commission on Accreditation of Health Care Organizations (JCAHO) and healthcare agency applies to all planning and implementation activities. Undergraduate nursing students would have no difficulty relating these standards to their clinical and professional learning experiences.


Effective written and verbal communication is essential in nursing practice. The text provides guidelines for accurately charting patient care in the medical record. Readers will find the "Memory-Jogs" for charting especially helpful, such as AIR (Assessment, Intervention, Response, Action) and DAR (Data, Action, Response). Because charting practices vary from one place to another, and because charting practices are changing at a rapid pace, Applying Nursing Process orients the reader to become familiar with the principles behind some of the common ways of charting, including focused charting, multidisciplinary charting, flowsheet charting, charting by exception, and source-oriented charting. These principles should be used whether charting is handwritten notes or computer generated. Readers are also provided with examples and rationales for effectively communicating the change-of-shift report.


Ongoing early evaluation is an integral part of chapters 1 through 5. The capstone chapter (chapter 6) focuses on how to do a formal comprehensive evaluation of an individual plan of care. It also examines the importance of quality improvement and the need to monitor how healthcare systems interact and impact patient outcomes and satisfaction. This chapter includes a critical thinking exercise that helps the reader to determine outcome achievement, identifying variables affecting achievement and deciding whether to discharge the patient.


A unique feature of the text is the description of specific behaviors that promote critical thinking using the cognitive, psychomotor, and affective domains of learning. The text includes several critical thinking exercises in each chapter, which promote problem-solving skills by immediately applying principles learned from didactic content. Novice students and nurses at all levels of preparation will find these critical thinking exercises helpful as they develop a plan of care within an ethical and legal framework.


Nursing faculty will find that the text will be a valuable tool in helping their students to organize data and solve problems. It progresses from simple to complex and could be included on the required or supplemental textbook list in any school of nursing. One recommendation is to include a small pocket companion to accompany the text for students in a clinical rotation. A small pocket companion would be easier for students to physically manage in a clinical rotation as they care for the patient. The text would also be a good resource for nurses on adult medical surgical units.




1. Alfaro-LeFevre, R. Applying Nursing Process: A Tool for Critical Thinking. Philadelphia, PA: Lippincott Williams and Wilkins. In press. [Context Link]