Case Study: The Challenges of Self‐Management of Exacerbation of Pulmonary Symptoms

PURPOSE. This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self‐management for a female veteran. DATA SOURCES. Data were obtained through the author's clinical practice in primary care nursing and research literature sources. DATA SYNTHESIS. The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA‐International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSIONS. This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations. IMPLICATIONS FOR NURSING PRACTICE. Employing the NANDA‐International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

Using Standardized Nursing Languages in End‐of‐Life Care Plans

PURPOSE: This case study demonstrates the challenges to achieve dignified life closure and a comfortable death for a middle‐aged woman with terminal cancer and her family. DATA SOURCES: Data were obtained from a patient known through the author's clinical experiences, personal family experiences, and published sources. DATA SYNTHESIS: The appropriate nursing diagnosis, patient outcomes, and nursing interventions were identified through the use of NANDA‐International, the Nursing Outcomes Classification, and the Nursing Interventions Classification. CONCLUSIONS: This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with emotional distress at the end of life. IMPLICATIONS FOR NURSING PRACTICE: Employing the NANDA‐International standardized nursing diagnosis, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for considering and improving a dying patient's care in a primary and home setting.     

Case Study: Home Nursing Care for a 62‐Year‐Old Woman with Multiple Health Problems

PURPOSE. This case study illustrates the characteristics of, and challenges for, a woman in the United States with multiple health problems. DATA SOURCES. Data were obtained through the authors' experience and knowledge of community health nursing and from published literature. DATA SYNTHESIS. NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification were utilized to identify appropriate nursing diagnoses, interventions, and outcomes for the client. CONCLUSION. This case study illustrates and provides appropriate nursing diagnoses, interventions, and outcomes relevant to a woman with many health concerns. It provides guidance for nurses in community health settings when caring for patients with multiple health problems. IMPLICATIONS FOR NURSING PRACTICE. Utilizing the standardized nursing languages of NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification can provide the necessary framework for enhancing and improving the management of care for patients with many health concerns in the community setting.     

Case Study: Home Nursing Care for a 62-Year-Old Woman with Multiple Health Problems

PURPOSE.  This case study illustrates the characteristics of, and challenges for, a woman in the United States with multiple health problems.
DATA SOURCES.  Data were obtained through the authors' experience and knowledge of community health nursing and from published literature.
DATA SYNTHESIS.  NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification were utilized to identify appropriate nursing diagnoses, interventions, and outcomes for the client.
CONCLUSION.  This case study illustrates and provides appropriate nursing diagnoses, interventions, and outcomes relevant to a woman with many health concerns. It provides guidance for nurses in community health settings when caring for patients with multiple health problems.
IMPLICATIONS FOR NURSING PRACTICE.  Utilizing the standardized nursing languages of NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification can provide the necessary framework for enhancing and improving the management of care for patients with many health concerns in the community setting.     

Supporting Breast‐feeding When a Woman Is Homeless

PURPOSE. This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings. DATA SOURCES. The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. DATA SYNTHESIS. The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. CONCLUSIONS. This case shows that NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. IMPLICATIONS FOR NURSING. When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA‐I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.     

Case Study: A Woman Who Hemorrhages 24 Hours Post Tonsillectomy

PURPOSE. This case study focused on the emergency nursing care of a 32‐year‐old female, less than 24 hours post operatively from a tonsillectomy. The purpose is to identify the priority nursing diagnoses, patient outcomes, and nursing interventions that guided nursing care during this emergency. DATA SOURCES. Data were obtained through the author's clinical practice in emergency nursing and literature sources. DATA SYNTHESIS. NANDA International Classification, the Nursing Outcomes Classification, and the Nursing Interventions Classification were used to identify the appropriate nursing diagnosis, patient outcomes, and nursing interventions of an adult with a postoperative hemorrhage. CONCLUSIONS. This case study provides emergency nurses and students with the pertinent nursing diagnoses, patient outcomes, and nursing interventions for persons with post‐op hemorrhage after tonsillectomy.     

Case Study: Child With Global Developmental Delay

PURPOSE. This case study focused on the care of a child with global developmental delay. DATA SOURCES. Data were obtained through the author's clinical practice in long‐term care pediatric rehabilitation and literature sources. DATA SYNTHESIS. NANDA‐International Classifications, the Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) were used to identify the appropriate nursing diagnosis, nursing interventions, and patient outcomes. CONCLUSIONS. This case study provides the pertinent nursing diagnoses, interventions, and outcomes for a child with global developmental delay. The interdisciplinary team approach and family involvement is addressed. IMPLICATIONS FOR NURSING. Use of NANDA, NIC, and NOC outcomes constructs for enhancing the care of a child with global developmental delay.     

Case study: a young male with auditory hallucinations in paranoid schizophrenia

PURPOSE. The purpose of this case study is to demonstrate use of the nursing process and the standardized nursing languages of NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a young male with paranoid schizophrenia to deal with auditory hallucinations. DATA SOURCES. Data were obtained from the experience and expertise of the author and published literature. DATA SYNTHESIS. This case study demonstrates nurses' clinical decision making in providing care for an adolescent with mental illness. CONCLUSION. This case study provides the pertinent nursing diagnosis, patient outcomes, and nursing interventions for a young male with auditory hallucinations in paranoid schizophrenia. IMPLICATIONS FOR NURSING. The use of NANDA‐I, NOC, and NIC can provide the necessary framework for enhancing and improving the management of care with patients who experience auditory hallucinations in paranoid schizophrenia.     

Case Study: The Challenges of Self-Management of Exacerbation of Pulmonary Symptoms

PURPOSE.  This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self-management for a female veteran.
DATA SOURCES.  Data were obtained through the author's clinical practice in primary care nursing and research literature sources.
DATA SYNTHESIS.  The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification.
CONCLUSIONS.  This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations.
IMPLICATIONS FOR NURSING PRACTICE.  Employing the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

Older Adult Who Falls: A Case Study

PURPOSE. The purpose of this case study is to illustrate the nursing process by incorporating the standardized nursing languages of NANDA International, the Nursing Interventions Classification, and the Nursing Outcomes Classification to assist an older adult with a history of falls. DATA SOURCES. The data sources were the author's clinical nursing practice and research‐based evidence related to falls of older adults. DATA SYNTHESIS. The data were synthesized by using clinical reasoning to select the best possible nursing diagnoses, interventions, and patient outcomes. CONCLUSIONS. To provide a framework for nurses to achieve positive patient outcomes, standardized nursing languages should be incorporated into patients' clinical nursing databases. IMPLICATIONS FOR NURSING. In determining factors that relate to falls, nurses need to obtain baseline data, set goals with patients, and identify milestones, while encouraging patients to be active participants in plans of care.     

Consensus‐Validation Study Identifies Relevant Nursing Diagnoses,Nursing Interventions,and Health Outcomes for People with Traumatic Brain Injuries

A consensus‐validation study used action research methods to identify relevant nursing diagnoses, nursing interventions, and patient outcomes for a population of adults with traumatic brain injury (TBI) in long‐term care. In meetings totaling 159 hours to reach 100% consensus through group discussions, the three classifications of NANDA International's (NANDA‐I's) approved nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) were used as the basis for three nurses experienced in working with adults with TBI to select the elements of nursing care. Among almost 200 NANDA‐I nursing diagnoses, 29 were identified as relevant for comprehensive nursing care of this population. Each nursing diagnosis was associated with 3–11 of the more than 500 NIC interventions and 1–13 of more than 300 NOC outcomes. The nurses became aware of the complexity and the need for critical thinking. The findings were used to refine the facility's nursing standards of care, which were to be combined with the interdisciplinary plan of care and included in future electronic health records.     

My First Patient as a Nurse Practitioner: A Man With Low Literacy

PURPOSE: The purpose of this case study is to demonstrate the use of the nursing process and the standardized nursing languages of NANDA‐I, the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a man with low literacy to self‐manage his medication regimen. DATA SOURCES: The data sources for this article are clinical nursing practice, research evidence related to helping people with low literacy, and the books that explain NANDA‐I, NOC, and NIC. DATA SYNTHESIS: This case study demonstrates nurses’ clinical decision making in providing care for a person with low health literacy. CONCLUSIONS: Low health literacy should be considered when nurses identify the nursing diagnosis of Ineffective Self‐Health Management. After trust is established, a screening tool should be used to evaluate the person's literacy level. Active partnership of the nurse and the person supports interventions to assist the person implement the medication regimen. IMPLICATIONS FOR NURSING: Inadequate evaluation of health literacy may result in mislabeling a person as “nonadherent” or “noncompliant” to a medication or treatment regimen. Low literacy is often an unrecognized barrier to effective self‐health management.     

A Case Study of Teen Parenting

PURPOSE: The purpose of this case study is to demonstrate how the use of the standard nursing languages of NANDA International (NANDA‐I), the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) help a teen mother provide safe care for her newborn. In addition, this study aims to demonstrate how important standardized nursing languages are in documenting the care provided. DATA SOURCES: The data sources for this article are clinical nursing practice, research evidence in the form of care directives from the American Academy of Pediatrics regarding newborn safety and feeding, and the books that provide directions for the use of NANDA‐I, NIC, and NOC. DATA SYNTHESIS: This case demonstrates the use of the nursing process in providing care for a teen mother and a newborn. CONCLUSIONS: Many new mothers, especially teens, are poorly informed regarding normal newborn care and safety upon hospital discharge. For this reason, teen mothers should be referred for nursing assessments in the home environment after discharge. IMPLICATIONS FOR NURSING: This case demonstrates the need for education of all parents prior to hospital discharge and supports the need for home‐based evaluations to ensure the safety of the infant. This case also supports the use of standardized nursing language to document the care provided.     

Application of Orem''s Self-Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes

PURPOSE: This paper aims to illustrate the process of theory-based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. DESIGN: Orem's self-care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. FINDINGS: Theory-based nursing care and standardized nursing language enhanced the client's ability to self-manage the chronic illness: diabetes. CONCLUSION: Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self-manage a chronic illness.     

Application of Orem's Self‐Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes

PURPOSE. This paper aims to illustrate the process of theory‐based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. DESIGN. Orem's self‐care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. FINDINGS. Theory‐based nursing care and standardized nursing language enhanced the client's ability to self‐manage the chronic illness: diabetes. CONCLUSION. Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self‐manage a chronic illness.     

Current Knowledge Related to Intelligence and Thinking With Implications for the Development and Use of Case Studies

PURPOSE. This paper reviews current knowledge regarding intelligence and thinking, and relates this knowledge to learning to diagnose human responses and to select health outcomes and nursing interventions. DATA SOURCES. Knowledge from relevant literature sources was summarized. DATA SYNTHESIS. The provision of high‐quality nursing care requires use of critical thinking with three elements of nursing care: nursing diagnosis, health outcomes, and nursing interventions. Metacognition (thinking about thinking) should be used with knowledge of the subject matter and repeated practice in using the knowledge. Because there are limited clinical opportunities to practice using metacognition and knowledge of these nursing care elements, case studies can be used to foster nurses’ expertise. CONCLUSIONS. Simulations of clinical cases are needed that illustrate application of the nursing knowledge represented in NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification. IMPLICATIONS. The International Journal of Nursing Terminologies and Classifications will promote the dispersion of case studies as a means of facilitating the implementation and use of nursing languages and classifications.     

Bullying and sexual harassment in the school setting.

This article defines bullying and sexual harassment, identifies associated characteristics of the aggressor and the victim, and describes implications for school nurses. The background of federal laws with a focus on the most current 1999 Supreme Court decision, holding a school district liable for damages under federal law (Title IX), is addressed with a case study. Health promotion issues and prevention concepts are outlined in a 10-Point Action Plan to facilitate the prevention and management of bullying and sexual harassment in schools. A survey tool to assess bullying and teaching plans for parents of victims and aggressors are provided. Suggested linkages among approved nursing languages, North American Nursing Diagnosis Association (NANDA) nursing diagnoses (NANDA, 1998), Nursing Interventions Classification interventions (Iowa Intervention Project, 2000), and Nursing Outcomes Classification outcomes (Iowa Outcomes Project, 2000) are included for use in developing nursing care plans for both aggressors and victims of harassment.     

Helping a Man with Leprosy: A Case Study

PURPOSE.  This case study illustrates nursing diagnoses and interventions for a man with leprosy.
DATA SOURCES.  Data sources were published literature on the disease of leprosy, and the experience and expertise of the authors in working with people with leprosy.
DATA SYNTHESIS.  Data were synthesized using the standardized nursing languages of North American Nursing Diagnosis Association International and the Nursing Interventions Classification. The accuracy of the diagnoses and the appropriateness of the nursing interventions were supported by the positive health outcomes of the patient.
CONCLUSIONS.  Although leprosy has been eradicated in some countries, the risk of new cases is present anywhere that Mycobacterium leprae still exists. The recommended treatment of multibacilar polychemotherapy has lowered the rate of new cases in Brazil.
IMPLICATIONS FOR NURSING PRACTICE.  Nurses need to incorporate evidence-based practice interventions for leprosy-based wound care, and nurses should encourage persons with leprosy to maintain regular medical care with multibacilar polychemotherapy.     

Coining and Defining Novel Nursing Terminology. Part 1: Critical Incident Nursing Diagnosis

PURPOSE.  In the first of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the North American Nursing Diagnosis Association (NANDA) International Classification—Critical incident nursing diagnosis (CIND)—defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication.
DATA SOURCES.  The literature, research studies, and meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article.
DATA SYNTHESIS.  The current nursing diagnoses in the NANDA International Classification are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations.
CONCLUSIONS.  Coining and defining a novel nursing terminology, CIND, for patient care during life-threatening situations are important and fill the gap in the current standardized nursing terminology.
IMPLICATIONS FOR NURSING PRACTICE.  Refining the NANDA International Classification will permit nursing researchers, among others, to conduct studies on nursing diagnoses in conjunction with the proposed novel nursing terminology: CIND. Parts 2 and 3 of this series will propose additional nursing terminology: critical incident nursing intervention and critical incident control, respectively.