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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: 978-1-118-70121-8

May 2013, Wiley-Blackwell

392 pages



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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How to Use this Book.

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

1 Use of Critical Thinking to Achieve Positive Health Outcomes.

2 Diagnostic Reasoning and Accuracy of Diagnosing Human Responses.

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

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

Part II: Case Study Application of Strategies.

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

5.1 Woman Admitted for Diagnostic Testing of a Lung Nodule.

5.2 Adaptation to the Pain of a Fractured Hip.

5.3 Acute Presentation of an Elderly Woman with Cancer.

5.4 Substance Abuse Crisis Associated with Stress Overload.

5.5 Communication of Perceptions and Mechanical Ventilation.

5.6 Preparing for Orthopedic Surgery with Other Health Problems.

5.7 Helping a School Child with Asthma.

5.8 Birth of a 25-week Neonate.

5.9 Emergency Care for a Seriously Burned Man.

5.10 Dilemma of Addressing Overlapping Diagnoses in Acute Care.

5.11 The Hypermetabolic State

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

5.13 Cardiac Disease and Self Management.

5.14 Woman with a Neurological Problem.

5.15 Orthopedic Care of a Woman with Total Hip Replacement.

5.16 Using Orem'sTheory for Care of a Woman with Terminal Cancer.

5.17 Cardiac Disease and Anticoagulation Therapy.

5.18 Diabetes Self Management when Other Family Members Need Care.

5.19 Impetus of Diabetic Crisis to Improve Self Management.

5.20 Self Management of Diabetes and Stress.

5.21 Telephone Nurse Advice and an AIDS-Related Crisis.

5.22 Woman who Experienced a Significant Childhood Loss.

5.23 Young Woman Whose Mother is Dying.

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

5.25 Elderly Woman Who Thinks She Should Not be Discharged.

5.26 Elderly Man Who is Angry.

5.27 Homeless Woman’s Reaction to Loss.

5.28 Family Stress and Alzheimer’s Disease.

5.29 Family Struggling with Ostomy Care at Home.

5.30 Nonparticipation in Rehabilitation with a Colostomy.

5.31 Man with Urinary Incontinence After Prostate Surgery.

5.32 Palliative Care and the Outcome of Comfort.

5.33 Hospice and Palliative Care.

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

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

5.36 Woman with a History of Being Battered.

5.37 Woman in Labor with Complications.

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

5.39 Business Woman with Stress in her Personal Life.

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

6.1 Role of Nurses in the Protection of Children.

6.2 Responses to Mechanical Ventilation.

6.3 Family Caregiving at End of Life.

6.4 Man with Renal Calculi and Stent Placement.

6.5 Helping a Man with Low Literacy.

6.6 Self-Management of Chronic Illness and Financial Status.

6.7 Case Management for Homeless Man with Severe Pancreatitis.

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

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

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

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

7.2 Parenting of a Child with Spina Bifida.

7.3 Woman Who Experienced Early Childhood Trauma.

7.4 Living with Multiple Health Problems.

7.5 Response to Limitations Associated with Cardiac Disease.

7.6 Living with Chronic Obstructive Pulmonary Disease.

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

8.1 Mother Breastfeeding Her Newborn.

8.2 Nursing Communication for Continuity of Care.


A Webliography.

B Assessment Tool: Functional Health Patterns.

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

D Nursing Diagnosis Accuracy Scale (NDAS).


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