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Critical Thinking in Respiratory Care: A Problem-Based Learning Approach FREE TO VIEW

Eric Magaña, MD
Chest. 2002;122(5):1871. doi:10.1378/chest.122.5.1871
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By Shelley C. Mishoe, PhD, RRT, and Melvin A. Welch, Jr., MPH, RRT, RCP, eds. New York, NY: McGraw-Hill, 2002; 720 pp; $59.95

Critical Thinking in Respiratory Care: A Problem-Based Learning Approach is a multiauthor text that is aimed at respiratory care students and instructors. The book is divided into the following two sections: “Professional Skills in Respiratory Care” and “Patient Problems in Respiratory Care.” Chapters in each section start out with “Learning Objectives” and “Key Words,” while “Critical Content” bulletins periodically summarize important points and the concepts just reviewed.

The book starts somewhat tediously with chapters on “Problem-Based Learning,” “Critical Thinking,” and “Clinical Problem Solving.” Cases provided in the text illustrate these concepts quite well, and the accompanying text could be reduced substantially. These chapters are too wordy and border on pontification. The sections on ethics and patient education are thoughtfully written and lack the verbosity of previous chapters. Respiratory care practitioners have assumed a multitude of roles in modern health care, and this is well-illustrated in a chapter dedicated to describing the profession, validating its importance, and inspiring the reader to explore beyond the traditionally defined roles. The process of critical thinking is laid out beginning with the history and physical examinations and the significance of various findings. The development of treatment plans and the prioritization of treatments are appropriately illustrated. The dynamics of participation in the total care team are explored as well. The final chapter in this section, on “Time and Resource Management,” is particularly well-done. It gives valuable insight into how to manage staffing issues and to optimize time usage, and all medical directors of respiratory care departments would be well-served to read this chapter of the book.

The second section comprises about half of the book and is also generally well-done. Real-world, patient-centered cases are the dominant feature of each chapter. The accompanying text provides essential background information needed to solve these clinical vignettes, each of which artfully represents real situations and thus serves to develop critical thinking. Bread-and-butter topics such as asthma, COPD, cystic fibrosis, pneumonia, obstructive sleep apnea, and cardiogenic pulmonary edema are extensively covered in dedicated chapters. These are well- developed expositions that include information on pathophysiology, diagnosis, and treatment. While the content is significantly detailed in these chapters, it is presented in an easily readable manner. Trauma, AIDS, ARDS, and neuromuscular diseases are addressed nicely in addition to pediatric and neonatal issues. While each of these subjects is too broad for a single source to address all of their intricacies, the essentials of caring for these patients are provided.

The greatest assets of this book are the critical thinking exercises and the patient-centered problems that are distributed throughout each chapter. Many of the concepts addressed in the first section in an awkward and overly wordy manner are clearly and concisely demonstrated in the second section with the aid of the patient cases. This is done so well that the second section could stand alone as an extremely valuable resource in the training of respiratory therapists who wish to achieve excellence in their profession.




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