Methodological bases, taxonomy and critical thinking

Dear Editor,

We found the clinical case published in the journal ENFERMERÍA INTENSIVA by Nafría-Soria et al.¹ on rhabdomyolysis in a patient with McArdle's disease (MD) very interesting. We would like to thank the authors for their personal interest in an aspect that we consider so important for the nursing profession, such as the use of scientific methodology in healthcare practice. With regard to this case, we would like to make a series of considerations and contribute ideas on this clinical issue.

To follow the scientific method, nurses have developed a specific and common language to designate everything we do in our daily practice.² Taking as the benchmark another profession parallel to ours, I do not believe that doctors will identify diagnoses without considering the exact and specific cause of these problems, since they will have to act on it to solve the problem. Causes are not a matter of indifference; it is important to pinpoint exactly the right one.

Returning to the case at hand, methodologically we could opt for a focused assessment (FA) in the areas that have to be monitored more closely due to the disease’s impact, avoiding irrelevant assessment. Important data on his hypothyroidism and how it affects his clinical condition are omitted, as well as information on the patient's conception and management of the disease. We find it strange that, as a professional colleague diagnosed 20 years ago with MD, he does not understand his disease process and does not know how to live with it, since he does incompatible physical exercises, which is something he should be aware of to avoid complications.

According to Carpenito-Moyet³ none of the nursing diagnoses (ND) presented in the case¹ are such. The ND cannot be related to medical problems since the nurse has no autonomy to solve them without the corresponding authorisation of a physician to apply the prescribed treatments and techniques (what level of autonomy does a nurse have to palliate pain of this nature or how can they solve acute renal failure if not with the help of fluid therapy and drugs prescribed by another professional?) Therefore, based on scientific evidence, these are all collaborative or interdependent problems.

There are several explanations for this: one, the NANDA taxonomy² contains certain labels for diagnostic concepts that can lead to imprecise use, without an FA that can differentiate it from a symptom, medical problem or medical treatment. Two, nurses in advanced clinical practice in other countries where the taxonomy is implemented have different competencies to diagnose and treat health problems to those of other nurses in our country,⁴ and therefore not all diagnoses are feasible for any nurse in any context.

A possible ND in the patient with this chronic disease is in Readiness for advanced health management (ineffective management of own health (00162)²; despite being a nurse, it is not at all clear what level of control he has over his disease, since nothing has been recorded in this respect. In addition, certain needs will have to be met due to his acute situation, in which we sense that the doctor will have prescribed rest and he will have no autonomy in this.

On reflection, the methodological bases come first and then all the existing classifications or taxonomies, but all of this must be linked to critical thinking and guided by knowledge and, of course, by common sense. An ND is a clinical judgement, i.e., a complex mental process that goes beyond simply stating a disorder that we observe in the patient/client.