Editor’s Note
As part of our September focus on Evidence-Based Nursing, Dr. Paulo Carlos Garcia revisits the work of Marjory Gordon to explore how nursing knowledge, clinical judgment, and evidence come together in person-centered decision-making. He argues that evidence becomes meaningful only when nurses first understand the person, the situation, and the nursing phenomenon requiring attention.
Evidence-Based Nursing has become an essential part of the contemporary language of nursing practice, education, and research. Nurses are encouraged to seek the best available evidence, critically appraise it, and incorporate it into decisions about care. Yet there may be a question that needs to come before these steps: “Evidence for which decision?”
The comments and questions raised when revisiting Marjory Gordon’s work suggest that we may need to go one step further. Before a decision can be supported by evidence, nurses must first understand the person, the person’s experience, the situation in which care occurs, and the nursing phenomenon that calls for attention. Evidence does not begin with a database search. It begins with disciplined attention to human experience.
Scientific evidence, no matter how robust, does not by itself determine what is meaningful in a particular care situation. It does not independently recognize a human response, uncover a pattern, establish a priority, formulate a nursing judgment, or determine which outcome matters most to a particular person. These interpretations depend on nursing knowledge, clinical judgment, the relationship established with the person, and an understanding of the context in which care takes place.
This blog supports a simple position: evidence-based nursing begins not with evidence alone, but with understanding. From that understanding, nurses recognize patterns and meanings, formulate judgments, define desired outcomes, make decisions, seek and integrate evidence, act, evaluate, and learn. Revisiting Gordon helps us see why this sequence remains profoundly relevant.
Looking Back to Move Forward
In 1994, in Nursing Diagnosis: Process and Application, Marjory Gordon discussed practice guidelines as systematically developed recommendations intended to assist professionals and patients in choosing appropriate care for specific clinical situations. She emphasized that available research should be reviewed and that recommendations should be evaluated according to the strength of the evidence supporting them. Read more than three decades later, this description feels remarkably contemporary: research appraisal, clinical recommendations, professional judgment, and patient participation are already connected within the decision-making process.
Gordon’s concern with research was not limited to the selection of interventions. From the early development of nursing diagnosis, she recognized a reciprocal relationship between conceptual development and research. Diagnostic concepts could generate questions for investigation, while research could test, refine, and expand nursing knowledge. Knowledge used in professional practice, therefore, was not static; it was to be generated, examined, and revised as the discipline developed.
At the same time, Gordon described the Nursing Process using the language of problem identification and problem solving. But her account was not merely technical. She wrote of a helping relationship characterized by knowledge, reasoning, and caring, and of nursing practice as requiring clinical judgment, nursing science, intuition, empathy, and technical skill. She also emphasized that thinking does not proceed in a straight line: assessment, emerging hypotheses, possible actions, and anticipated outcomes interact as understanding develops.
Most importantly, a general problem-solving structure becomes a Nursing Process only when it is filled with nursing values, concepts, knowledge, and standards. In her writing on clinical diagnosis, Gordon also described nursing as traditionally concerned with a holistic view of the person and the situation, including human responses, functioning, strengths, and the interaction between person and environment. Before there is a problem to solve, then, there is a human experience to understand.
Evidence Does Not Make Decisions
The contemporary understanding of evidence-based practice makes it even clearer that using evidence does not simply mean applying research findings. The JBI Model of Evidence-Based Healthcare makes clear that evidence is not considered in isolation. The best available evidence is integrated with the context in which care occurs, the person’s needs, preferences, and values, and professional judgment and expertise.
Importantly, the JBI Model does not reduce evidence to effectiveness alone. By considering feasibility, appropriateness, meaningfulness, and effectiveness, it asks not only whether an intervention can work, but whether it can be implemented in a particular setting, fits the circumstances of care, is meaningful to those receiving it, and is likely to achieve the intended outcomes. The model also situates evidence-based healthcare within a broader movement of evidence generation, synthesis, transfer, and implementation, underscoring that translation into practice is an active process rather than an automatic consequence of research.
For nursing, this perspective has a direct implication. Evidence becomes clinically useful only after the nurse has understood the person and the situation, recognized the phenomenon requiring attention, formulated a clinical judgment, and clarified the outcome that matters. The question is therefore not simply whether evidence exists, but whether it is relevant, meaningful, feasible, and applicable to the decision being made for this person, in this context.
Contemporary nursing literature takes a similar direction by describing evidence-based practice as a problem-solving approach that integrates scientific evidence, clinical expertise, information generated through care, and the person’s preferences and values. Gordon’s writing anticipated important elements of this integration. When considering interventions, she emphasized the person’s choices and capabilities, available resources, situational factors, and professional judgment grounded in an understanding of the person as a whole.
Evidence, therefore, informs a decision; it does not replace the process through which that decision is constructed. And perhaps the point is even more fundamental: evidence does not begin with a decision alone. It begins with understanding the person, the situation, and the nursing phenomenon that requires attention.
Nursing Knowledge Gives Evidence Meaning
Nursing clinical judgment does not begin in a bibliographic database. It begins in the encounter with a person, a family, a group, or a community. The nurse observes, listens, establishes a relationship, gathers information, and seeks to understand how data relate to one another, to the person’s experience, and to the environment. Through this process, patterns are recognized, meanings are uncovered, and human responses that warrant nursing attention become visible.
Disciplinary knowledge shapes this entire process: what nurses notice, the questions they ask, the relationships they establish among data, the meanings they attribute to them, and the possibilities they consider. Recent discussions in the Gordon Scholar series have revisited this issue, highlighting how nursing theories, disciplinary frameworks, patterns of knowing, and standardized nursing languages shape what nurses notice, how they interpret and give meaning to a care situation, and what they recognize as relevant to nursing. These disciplinary lenses contribute to the formation of clinical judgments, which, in turn, inform subsequent decisions about care.
Here, clinical judgment and clinical decision-making are closely related but not identical. Clinical judgment is the professional interpretation and evaluation through which meaning is attributed to a situation and a defensible conclusion is reached. Decision-making uses that judgment to choose among possible courses of action. The distinction matters because evidence may support a decision, but the decision itself rests on a prior understanding of what the situation means.
Evidence from different disciplines can and should inform care. Nursing knowledge does not exclude other forms of knowledge; rather, it helps determine which phenomena require investigation and which nursing questions and decisions need support. The movement can therefore be expressed as: knowing the person and the person’s experience → recognizing patterns and meanings → formulating judgments → defining desired outcomes → making decisions → seeking and integrating evidence.
It is not enough to ask, “What is the best available evidence?” We also need to ask: What are we trying to understand? What nursing phenomenon is present? What meaning does this situation hold for the person? What judgment are we formulating? What outcome are we trying to achieve? And what decision needs support? Methodological quality remains essential, but high-quality evidence for the wrong question is still the wrong evidence for the decision that needs to be made.
From Diagnosis to Evidence-Informed Intervention
For Gordon, a nursing diagnosis was not the endpoint of an intellectual process. It helped delineate the phenomenon requiring care, guided the identification of expected outcomes, and provided a basis for decisions about interventions. She also recognized an important limitation: many links between diagnoses and interventions were supported primarily by clinical judgment and needed research to strengthen their scientific foundation.
That observation remains highly relevant. Clinical judgment and evidence are not competitors. Research can test, expand, and strengthen the knowledge nurses use to make judgments and decisions, while clinical judgment helps identify the questions for which evidence is needed.
An accurate diagnosis or other clinically defensible nursing judgment makes the phenomenon more explicit. Defining an expected outcome clarifies the change, maintenance, adaptation, or experience of health we are trying to achieve. From there, the nurse can formulate a more precise question and seek evidence about which interventions are most likely to contribute to that outcome for this person in this context.
Gordon also emphasized that selecting an intervention requires considering alternatives, possible consequences, available resources, and the likelihood that a particular action will be effective for a particular person. This moves us away from evidence-based practice as a ready-made recipe. It is not about finding an intervention in a systematic review and applying it indiscriminately. It is about integrating scientific knowledge into an individualized clinical decision.
Outcomes Close – and Reopen – the Loop
Clinical decision-making does not end when an intervention is selected or carried out. Gordon emphasized ongoing evaluation. The person’s response to care generates new data that may confirm or challenge the initial judgment, indicate whether expected outcomes are being achieved, and show whether interventions should be maintained, modified, or replaced.
This logic is reflected in contemporary efforts to make clinical reasoning more explicit. Recent INKA content on the NANDA® 360 Clinical Reasoning Framework and Classification explores the connection between assessment data and the progressive development of diagnostic hypotheses and judgments, integrating and continuing this through goal assignment and nursing action recommendations based on that same assessment data. Structuring the reasoning pathway can make relationships among data, hypotheses, judgments, and decisions more visible while keeping professional judgment at the center of the process.
Standardized nursing languages and structured data can contribute to the same goal. They can make more explicit the relationship among what was observed, how information was interpreted, what was judged, what was decided, which interventions were implemented, and which outcomes were achieved. When these data are appropriately structured and analyzed, practice becomes more than a setting in which evidence is applied; it can also become a source for generating and refining nursing knowledge.
The process is therefore not merely a problem-solving cycle. It is a continuous movement of understanding, judgment, action, evaluation, and learning: understand the person and situation → recognize patterns and meanings → judge → define outcomes → decide → seek and integrate evidence → act → evaluate → understand again.
Evidence-Based Nursing as a Way of Thinking
More than three decades separate Gordon’s work from current discussions of interoperability, clinical decision support systems, large datasets, and artificial intelligence. Technologies have changed. The need for professional judgment, ethical responsibility, and understanding of the person has not.
Recent Gordon Scholar discussions of artificial intelligence illustrate this contemporary challenge. Technology can help organize and analyze information, expand learning opportunities, and support reasoning. Yet it cannot remove the nurse’s responsibility to interpret meaning, recognize what matters in a particular human situation, exercise critical judgment, and preserve person-centered care.
Perhaps, then, Evidence-Based Nursing is best understood not only as a set of methodological steps, but as a way of thinking and caring. It requires nurses to understand the person and the situation, recognize patterns and meanings relevant to nursing, formulate clinically defensible judgments, define desired outcomes, identify the decisions that need to be made, seek the best available evidence to support those decisions, examine its applicability, act in partnership with the person, and evaluate the outcomes.
Before we ask, “What is the best evidence?” we may first need to ask, “What are we trying to understand?” Then, “What is our clinical judgment and what outcome matters?” And only then, “Evidence for which decision?” After we act, an equally important question remains: “Did it work for this person, in this context, and for the outcome we intended to achieve?”
This continuous movement among human experience, disciplinary knowledge, judgment, outcomes, evidence, decision, action, and evaluation connects Dr. Marjory Gordon’s legacy to the challenges of nursing today. It also reminds us that evidence becomes meaningful in nursing only when it is brought into a thoughtful, disciplined, and person-centered process of understanding and care.
References
Choperena, A. (2026, August 12). Artificial intelligence as an adjunct to clinical reasoning in nursing education. International Nursing Knowledge Association. https://nanda.org/blog/artificial-intelligence-as-an-adjunct-to-clinical-reasoning-in-nursing-education/
Gengo, R. (2026, July 14). How nursing’s disciplinary knowledge shapes clinical judgment. International Nursing Knowledge Association. https://nanda.org/blog/how-nursings-disciplinary-knowledge-shapes-clinical-judgment/
Gordon, M. (1994). Nursing diagnosis: Process and application (3rd ed.). Mosby-Year Book.
International Nursing Knowledge Association. (2026a, March 10). The assessment pathway and NANDA® 360 clinical reasoning framework. https://nanda.org/blog/the-assessment-pathway-and-nanda-360-clinical-reasoning-framework/
International Nursing Knowledge Association. (2026b). Looking back to move forward: Dr. Gordon’s 1973 call for research-informed nursing practice. https://nanda.org/blog/looking-back-to-move-forward-dr-gordons-1973-call-for-research-informed-nursing-practice/
Jordan, Z., Lockwood, C., Munn, Z., & Aromataris, E. (2019). The updated Joanna Briggs Institute Model of Evidence-Based Healthcare. International Journal of Evidence-Based Healthcare, 17(1), 58–71. https://doi.org/10.1097/XEB.0000000000000155
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5–15. https://doi.org/10.1111/wvn.12021
About the Author
Paulo Carlos Garcia, PhD, MSc, RN, is a Professor at the University of São Paulo School of Nursing (EEUSP) in Brazil and a member of the current cohort of Gordon Scholars in The Marjory Gordon Program for Knowledge Development, Clinical Reasoning & Decision Making. Through this international program, a collaboration between the International Nursing Knowledge Association and the Boston College Connell School of Nursing, Gordon Scholars work with mentors and colleagues from around the world to advance assessment-driven, diagnosis-centered nursing knowledge and clinical reasoning, and NANDA 360. The Gordon Scholars’ work has informed practice, scholarship, policy, and instruction worldwide. Dr. Garcia’s current work focuses on critical care nursing, clinical reasoning, nursing concepts and classifications, the Nursing Process, and evidence-based health care.
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