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Letter to the Editor
Methodological bases, taxonomy and critical thinking: Authors’ response
Bases metodológicas, taxonomía y pensamiento crítico: respuesta de los autores
H. Nafría-Soriaa,
Corresponding author
hectornaf@hotmail.com

Corresponding author.
, J. Moreno-Españab, H. Sánchez-Herreroc, E. García-Menéndezd, C. Moreno-Del Castilloa, I. Fernández-Vallea
a Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
b Residente Medicina Interna Hospital Universitario Virgen de la Victoria, Málaga, Spain
c Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
d Nefrología-Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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We are aware of the relevance of using our own language&#44; although we must recognise that there may be different ways of approaching the same case&#44; given that the patient himself&#44; based on his personal and clinical profile&#44; and even his knowledge and attitude towards his health problem&#44; will be a determining factor in the approach of the nursing approach to the diagnosis&#44; the objectives to be achieved &#40;NOC&#41; and the interventions necessary for this &#40;NIC&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the case in question&#44; the approach differs from other cases of patients with McArdle&#39;s disease &#40;inability to degrade glycogen at a muscular level&#41;&#44; precisely because on this occasion we are dealing with an expert patient&#44; with extensive knowledge and a high level of autonomy in the management of a disease of low prevalence&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which is largely unknown to many health professionals&#44; including nurses&#46; For this reason&#44; after assessing the patient&#44; it was decided not to include ineffective health management as a nursing diagnosis&#46; We believe it is appropriate to point out that the diagnosis proposed by the authors corresponds to a diagnosis from the NANDA-I version 2012-2014&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Currently&#44; the NANDA-I version 2021-2023 identifies this diagnosis as <span class="elsevierStyleItalic">Ineffective self-management of health &#40;00276&#41;</span>&#46; However&#44; with the mastery and management capacity that the patient has in the expert category&#44; the authors of the paper consider that a more accurate diagnosis that could be considered is that of <span class="elsevierStyleItalic">Willingness to improve self-management of health &#40;00293&#41;</span>&#44; and more specifically&#44; that of <span class="elsevierStyleItalic">Willingness to improve exercise &#40;00307&#41;&#46;&#41;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This is based on the fact that the patient demanded information throughout the clinical process to improve their present and future state of health&#44; as well as the intention to improve and adapt physical activity to the disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the most salient points of the clinical case is the role of the patient&#44; who is fully aware of his or her disease&#44; so the patient&#39;s perspective was taken into account at all times&#46; Physical activity is one of the therapeutic pillars&#44; together with an adequate diet&#44; for people living with McArdle&#39;s disease&#46; In this particular case&#44; the patient was aware of and monitored the therapeutic approach to the disease&#44; as well as the early warning signs and symptoms&#46; He therefore followed the relevant dietary management to promote better adaptation to physical activity and went to the emergency department when the symptoms were present&#46; This is an example of the importance of relying on the patient&#39;s experience to address chronic diseases and&#44; in general&#44; any aspect of health&#44; as it makes the healthcare system more efficient and sustainable&#44; as well as promoting a better therapeutic relationship between the patient and the professional&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors would like to stress the importance of including patients in the management and care of their health&#44; as patient empowerment must be one of the objectives to be pursued by all health actions&#46; In this way&#44; the aim is to achieve a consensus between the scientific-technical experience of healthcare professionals and the subjective experience of individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In this case&#44; with McArdle&#39;s disease being a rare condition&#44; it is much more important to have the patient as an expert and to include his or her own experience within his or her own context as part of the comprehensive assessment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; we would like to highlight the importance of encouraging debate on the evidence generated and thank the journal <span class="elsevierStyleSmallCaps">Enfermer&#237;a</span> I<span class="elsevierStyleSmallCaps">ntensiva</span> for the opportunity to do so&#46; It is undoubtedly a process of continuous improvement that allows the exchange of information and different points of view on the published work&#44; bringing dynamism to the publications&#46;</p></span>"
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