Critical Thinking, Nursing Diagnosis, Interventionand Outcomes
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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.


Margaret Lunney, RN, PhD, Professor and Graduate Programs Coordinator, College of Staten Island, Staten Island, NY, Doctoral Faculty, Graduate Center, City University of New York, New York, NY, USA.


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 Interventions77

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 Interventions329

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