Transcript Selling an Idea or a Product

Theoretical Explanations for
the Need to Use NANDA-I,
NOC and NIC
Margaret Lunney, RN, PhD
Who Needs Theoretical
Explanations?
Nurses & others who:
• value the research-theory-practice
relationship
• Need an explanation for use of
standardized terms
• Are concerned about the complexity of
N/N/N
Explanations Currently Used
1. Need for documentation of nursing
diagnoses, interventions, and outcomes
2. Visibility of nursing’s contribution
Note: 1 & 2 are viewed by critics as self
serving for nursing
3. Improved quality & manageable costs
Note: Need additional research support for
this position
Theoretical Explanations for
use of N/N/N
•
Theoretical perspectives indicate the need for
N/N/N
–
Linguistic Theory
•
–
Critical thinking theory/concepts
•
–
Hayakawa, S.I., & Hayakawa, A. (1990). Language in
thought and action (5th ed). New York: Harcourt Brace.
Scheffer & Rubenfeld (2000). Consensus statement on CT
Concept of Accuracy
•
Lunney (2001). Critical thinking and nursing diagnosis
Linguistic theory proposes
that:
Languages are:
• fundamental mechanism of survival
• the most highly developed of symbolic
processes
• tools for communication with self and
others
• sources of cooperative actions with
others
• tools to improve human experiences
Linguistic theory proposes
that:
• Scientific names are needed because word
usage varies by region
• Naming is a “great” step forward; it makes
discussion possible
• There are no “right” names for anything
• Definitions tell us nothing about things;
they are statements about linguistic habits
• Definitions are instrumental and historical,
not law
Linguistic theory proposes
that:
• Naming is classifying
• Classifications are developed for specific
purposes
• Classifications contribute to pooled
knowledge
• Pooled knowledge helps us to deal with
the physical world
• Science seeks generally useful
classifications, ones that produce results
• Results in nursing = quality of nursing
care
Words and phrases are Maps to
the Territory
• Many maps are needed to “know” a
territory
• No maps “fully” represent the territory
• All maps together do not “equal” the
territory
• The goal is to make “good maps” of the
territory
Meaning, Context, Experience
• The meanings of words are known
through context
• Context is gained through experience
• Experience with use of N/N/N:
–
–
depicts interrelationships
reduces complexity
Words ALWAYS have
Extensional AND Intensional
Meanings
• Extensional
–
relates to the physical world
• Intensional
–
relates to individual connotations
• Prejudice occurs from focusing on
intensional
How We Know What We Know
• We experience only a small fraction of
phenomena
• We abstract the objects of our experiences
• It makes no sense to distrust abstractions
• We need to be AWARE of abstracting
• Words always need to be connected with
what they stand for.
Avoid this:
words
defining words
Abstraction Ladder (read
from bottom)
8. Wealth
7. Asset
6. Farm asset
5. Livestock
4. Cow
3. Bessie
2. Perception
1. Process_______________________
Words are abstractions of
similarities, not differences.
Abstraction Ladder: Example
in Nursing
8. Human-Environment
Interaction
7. Nurse-Client Partnership
6. Functional Health Patterns
5. Cognitive-Perceptual Pattern
4. Decision Making
3. Decisional Conflict re: infant
feeding choice
2. Cheryl’s Breastfeeding
1. Experience of breastfeeding
____________________________
Gigliotti & Lunney, 1998
Application to N/N/N:
Describe, Explain, Predict
• Explain relation of naming to knowing;
names as maps to the territory; no ‘right’
names
• Acknowledge reality of naming--names do
not fully reflect a phenomenon; names
capture similarities not differences
• Describe essential nature of abstraction &
levels of abstraction
• Demonstrate connections to the extensional
world through case studies: real, computerbased, video-taped, written
Critical Thinking (CT),
Accuracy, Discernment
• Complexity of /N/N/N:
–
–
~1000 concepts with related information/knowledge
Ambiguous relationships among concepts
• Complexity of N/N/N affects:
–
–
efficiency & effectiveness of thinking
discernment of diagnoses, interventions, and
outcomes
• Reduce complexity of N/N/N by:
–
–
–
Selecting common terms for specific populations
Use literature sources
Conduct consensus validation studies
What is CT?
Consensus of 57 Nurse Experts:
• Cognitive Skills (7)
–
–
–
–
–
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Analyzing
Applying Standards
Discriminating
Information Seeking
Logical Reasoning
Predicting
• Habits of mind (10)
Scheffer & Rubenfeld, 2000
Rubenfeld & Scheffer, 2006
Lunney, 2001, 2009, Ch 1
Why Accuracy of NDx?
• Accuracy is an outcome of CT
• Dx choices guide interventions &
outcomes
• Client data lead to many possible dx
choices
• Research findings show that low
accuracy is a reality
What is Accuracy of NDx?
• Definition
“A rater’s judgment of the degree to
which a diagnostic statement matches
the cues in a client situation.”
(Lunney, 1990)
• Characteristics
–
–
–
–
–
Ranges from high to low
Relative to interactive elements
Simple to complex according to # of cues, types
of cues, characteristics of cues
Includes supporting and conflicting cues
Relative to the whole situation
Why discernment of
outcomes/interventions?
• Clinical situations differ based on
contextual factors (e.g., culture, history)
• Many possible outcomes & interventions
• Appropriate outcomes & interventions
need to be selected through CT & in
partnership with consumer
Using N/N/N improves CT for
accuracy/discernment
• More efficient and effective:
–
–
–
–
–
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Analyzing the interrelationships of diagnoses to
interventions, interventions to outcomes, etc.
Discriminating the meaning of data
Information seeking pertaining to diagnoses,
outcomes, interventions & interrelationships
Applying standards for quality-based holistic care
Logical reasoning to determine the rationale for
inferences/conclusions
Predicting a plan of care & quality-based outcomes
of care.
Effects on Quality of Using
N/N/N, Lunney, 1999, 2006
Using N/N/N
• Be aware that the labels of N/N/N/ are
NOT nursing; nursing is more than this
• Show connections of N/N/N to thinking &
actions through case studies
• Demonstrate through theories that using
N/N/N improves quality