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Critical Thinking to Achieve Positive Health Outcomes: Nursing Case Studies and Analyses

Critical Thinking to Achieve Positive Health Outcomes: Nursing Case Studies and Analyses

Margaret Lunney (Editor)

ISBN: 978-0-813-81601-2 June 2009 Wiley-Blackwell 392 Pages


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This book uses the latest research findings to apply critical thinking processes for the development of diagnostic reasoning and the selection of patient outcomes and nursing interventions.Four chapters describe the meaning of intelligence, critical thinking, and application of critical thinking processes within nursing. The case studies and their ultimate resolution to intervention and outcome illustrate these processes by enabling repeated practice. Case studies are organized into four sections; problem diagnoses, risk diagnoses, health promotion diagnoses, and strength diagnoses. A companion website provides on-line resources.

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Contributors ix

Preface xix

Acknowledgments xxiii

How to Use this Book xxv

Part I: Strategies for Critical Thinking to Achieve Positive Health Outcomes 3

1 Use of Critical Thinking to Achieve Positive Health Outcomes 5

2 Diagnostic Reasoning and Accuracy of Diagnosing Human Responses 23

3 Guiding Principles for Use of Nursing Diagnoses and NANDA-I, NOC, and NIC 39

4 Application of the Guiding Principles and Directions for Use of NANDA-I, NOC, and NIC 55

Part II: Case Study Application of Strategies 73

5 Case Studies with a Primary Focus on Problem Diagnoses and Associated Outcomes and Interventions 77

5.1 Woman Admitted for Diagnostic Testing of a Lung Nodule 78

5.2 Adaptation to the Pain of a Fractured Hip 83

5.3 Acute Presentation of an Elderly Woman with Cancer 87

5.4 Substance Abuse Crisis Associated with Stress Overload 91

5.5 Communication of Perceptions and Mechanical Ventilation 96

5.6 Preparing for Orthopedic Surgery with Other Health Problems 100

5.7 Helping a School Child with Asthma 105

5.8 Birth of a 25-week Neonate 110

5.9 Emergency Care for a Seriously Burned Man 115

5.10 Dilemma of Addressing Overlapping Diagnoses in Acute Care 119

5.11 The Hypermetabolic State 124

5.12 Low Accuracy Nursing and Medical Diagnoses Can Lead to Harm 129

5.13 Cardiac Disease and Self Management 133

5.14 Woman with a Neurological Problem 137

5.15 Orthopedic Care of a Woman with Total Hip Replacement 143

5.16 Using Orem’s Theory for Care of a Woman with Terminal Cancer 147

5.17 Cardiac Disease and Anticoagulation Therapy 151

5.18 Diabetes Self Management when Other Family Members Need Care 157

5.19 Impetus of Diabetic Crisis to Improve Self Management 161

5.20 Self Management of Diabetes and Stress 165

5.21 Telephone Nurse Advice and an AIDS-Related Crisis 171

5.22 Woman who Experienced a Significant Childhood Loss 176

5.23 Young Woman Whose Mother is Dying 181

5.24 Rehabilitation of a Male with a Young Family after a Stroke 186

5.25 Elderly Woman Who Thinks She Should Not be Discharged 191

5.26 Elderly Man Who is Angry 194

5.27 Homeless Woman’s Reaction to Loss 197

5.28 Family Stress and Alzheimer’s Disease 200

5.29 Family Struggling with Ostomy Care at Home 206

5.30 Nonparticipation in Rehabilitation with a Colostomy 211

5.31 Man with Urinary Incontinence After Prostate Surgery 216

5.32 Palliative Care and the Outcome of Comfort 220

5.33 Hospice and Palliative Care 225

5.34 Two-Year-Old Bess’s Response to Parents’ Divorce 229

5.35 Challenges in Helping a Person to Accept Long-Term Care 234

5.36 Woman with a History of Being Battered 238

5.37 Woman in Labor with Complications 243

5.38 Integration of Neuman’s Systems Model in Postpartum Nursing 247

5.39 Business Woman with Stress in Her Personal Life 252

6 Case Studies with a Primary Focus on Risk Diagnoses and Associated Outcomes and Interventions 257

6.1 Role of Nurses in the Protection of Children 258

6.2 Responses to Mechanical Ventilation 263

6.3 Family Caregiving at End of Life 268

6.4 Man with Renal Calculi and Stent Placement 273

6.5 Helping a Man with Low Literacy 277

6.6 Self Management of Chronic Illness and Financial Status 283

6.7 Case Management for Homeless Man with Severe Pancreatitis 286

6.8 Psychiatric Care of an Adult Male with Poor Impulse Control 291

6.9 Response to a Diagnosis of Chronic Illness When Confounded by Other Life Events 296

7 Case Studies with a Primary Focus on Health Promotion Diagnoses and Associated Outcomes and Interventions 301

7.1 Support of a Mexican-American Woman in Postpartum Care 302

7.2 Parenting of a Child with Spina Bifida 307

7.3 Woman Who Experienced Early Childhood Trauma 311

7.4 Living with Multiple Health Problems 317

7.5 Response to Limitations Associated with Cardiac Disease 321

7.6 Living with Chronic Obstructive Pulmonary Disease 325

8 Case Studies with a Primary Focus on Strength Diagnoses and Associated Outcomes and Interventions 329

8.1 Mother Breastfeeding Her Newborn 330

8.2 Nursing Communication for Continuity of Care 334


A Webliography 337

B Assessment Tool: Functional Health Patterns 339

C The Lunney Scoring Method for Rating Accuracy of Nurses’ Diagnoses of Human Responses 347

D Nursing Diagnosis Accuracy Scale (NDAS) 355

Index 359

Section 1: Importance of Using Standardized Nursing Languages in the Electronic Health Record
1. The Electronic Health Record and Nursing: An International Agenda
2. The Need for and Use of Standardized Nursing Languages (SNLs) for the Electronic Health Record
3. What are we bringing to the table?
4. Theoretical Explanations for the Importance of Using NNN
Section 2: Understanding Accuracy of Nurses' Diagnoses
1. Lunney, M. (1990). Accuracy of nursing diagnoses: Concept development. Nursing Diagnosis, 1 (1), 12 -17.
2. Lunney, M., & Paradiso, C. (1995). Accuracy of interpreting human responses. Nursing Management, 26 (1), 48H-48K.
3. Lunney, M., Karlik, B., Kiss, M., and Murphy, P. (1997). Accuracy of nurses’ diagnoses of psychosocial responses. Nursing Diagnosis, 8 (4), 157-166.
4. Lunney, M. (1998). Where are we now? Accuracy of nurses’ diagnoses: Foundation of NANDA, NIC and NOC. Nursing Diagnosis: The Journal of Nursing Language and Classification, 9, 83-85.
5. Levin, R., Lunney, M. & Krainovich-Miller, B. (2005). .
6. Lunney, M. (2008). Critical need to address accuracy of nurses diagnoses. OJIN: Online Journal of Issues in Nursing.
7. Evidence-Based Nursing (EBN) and Diagnostic Accuracy in Electronic Health Records (EHR)
Section 3: Facilitating the Development of Intelligence and Critical Thinking Skills
1. Critical thinking Concepts and Definitions (from Scheffer & Rubenfeld, 2000)
2. Teaching Strategies to Enhance Aspects of Clinical Decision Making
3. Summary of Findings from Women’s Ways of Knowing, by Belenky, Clinchy, Goldberger & Tarule, 1986. Adapted by Margaret Lunney, June 2005
4. Lunney, M. (2003) Critical thinking and accuracy of nurses’ diagnoses. International Journal of Nursing Terminologies and Classifications, 14 (3), 96-107.
5. Lunney, M. (2008). Current knowledge related to intelligence and thinking with implications for the use and development of case studies. International Journal of Nursing Terminologies and Classifications, 19, 158-162.
6. Lunney, M. Frederickson, K., Sparks, A., & McDuffie, G. (2008). Facilitating critical thinking in online courses. JALN: Journal of Asynchronous Learning Networks, 12 (3/4), 85-97.
Section 4: Helping Students and Nurses to Develop as Diagnosticians
1. Lunney, M. (2006). Helping nurses to use NANDA, NOC and NIC: Novice to Expert. Nurse Educator, 31 (1), 40-46.
2. Teaching NANDA, NIC and NOC: Novice to Expert
3. Use of Health Promotion Diagnoses at Every Stage of Health and Illness, Lunney
4. Theoretical Explanations for the Need to Use NANDA-I, NOC and NIC, Lunney
Section 5: Developing Case Studies for Teaching, Testing, and as Research Tools
1. Lunney, M. (1992). Development of written case studies as simulations of diagnosis in nursing. Nursing Diagnosis, 3 (1), 23-29.
2. Development of Valid and Reliable Case Studies for Teaching, Diagnostic Reasoning, and Other Purposes
Section 6: Research Methods and Studies
1. Lunney, M. (1992). Divergent productive thinking factors and accuracy of nursing diagnoses. Research in Nursing & Health, 15, 303-311.
2. Redes, S., & Lunney, M. (1997). Validation by school nurses of the Nursing Intervention Classification for computer software. Computers in Nursing, 15 (6), 333-338.
3. Carlson-Catalano, J., Lunney, M., Paradiso, C., Bruno, J., Luise, B.K., Martin, T., Massoni, M., & Pachter, S. (1998). Clinical validation of ineffective breathing pattern, ineffective airway clearance and impaired gas exchange. IMAGE: Journal of Nursing Scholarship, 30, 243-248.
4. Parker, L & Lunney, M. (1998). Moving beyond content validation of nursing diagnoses. Nursing Diagnosis: The Journal of Nursing Language and Classification, 9 (4), 144-150.
5. Lunney, M. (2008). Need for international nursing diagnosis research and a theoretical framework. International Journal of Nursing Terminologies and Classifications., 19, 28-34.
6. Feasibility of Studying the Effects of using Nanda, NIC and NOC on Health outcomes
7. Nurses’ use of standard terms in an electronic health record, with and without NNN
8. Consensus Validation Results: NANDA, NIC and NOC Categories for Long Term Care of People with Traumatic Brain Injuries
9. Carlson, J. (2006). Consensus Validation Process: A Standardized Research Method to Identify and Link Relevant NNN Terms for Professional Practice.
10. Evidenced-based Nursing
11. Evidence Based Nursing (EBN) & Diagnostic Accuracy
12. Participant Action Research with Nurses to Identify NANDA, NIC, NOC Categories for Care of People with Diabetes and Women in Labor
13. Importance of Nursing Diagnosis Research
  • Provides a practical guide to how critical thinking skills can be applied to achieve positive health outcomes
  • Provides guiding principles for use of standardized nursing languages
  • Presents over 50 case studies to illustrate application of the guiding principles to clinical cases
  • Organizes case studies by problem diagnoses, risk diagnoses, health promotion diagnoses, and strength diagnoses
  • Includes access to a companion website with relevant journal articles and PowerPoint presentations as online learning resources
  • Written and edited by a leading expert in the use of standardized nursing languages