Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC

Reduction of patients' bed rest time after percutaneous renal biopsy evaluated by the Nursing Outcomes Classification: Randomized clinical trial

PURPOSE

To evaluate the reduction of patients' bed rest time after percutaneous renal biopsy (PRB) from 24 to 8 h using the Nursing Outcomes Classification (NOC).

METHODS

This was a randomized clinical trial registered with Clinical Trials number NCT04629235. The sample comprised 16 patients in the intervention group and 18 in the control group. In the intervention group, the rest time was modified to 8 h, and afterward, the patients were released to ambulate, whereas the control patients remained at absolute rest for 24 h after PRB according to institutional protocol. All patients were observed for 24 h and evaluated at five time points with the outcomes and indicators of the NOC: before the biopsy, immediately after, at the 8th hour, at the 12th hour, and at the 24th hour after the procedure.

RESULTS

In the 170 evaluations performed, statistically significant differences were identified in the outcome Comfort status: physical and the indicators "physical well-being and comfortable position." None of the complications were related to reduced bed rest time.

CONCLUSIONS

Reducing patients' bed rest time from 24 to 8 h did not increase complications from PRB, and using the NOC provided a standardized and reliable assessment.

IMPLICATIONS FOR NURSING PRACTICE

Important evidence was identified for patient care after PRB, demonstrating the positive impact on patient comfort and the possibility of reducing costs to the institution and the workload of the multidisciplinary team. In addition, these findings may contribute to strengthening the use of NOC in clinical practice, teaching, and research.

Application of NANDA-I nursing diagnoses, nursing interventions classification, and nursing outcomes classification in research and practice of cardiac rehabilitation nursing: A scoping review

PURPOSE

To describe the current application status of NANDA-I nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) in cardiac rehabilitation nursing and identify useful NANDA-I, NIC, and NOC (NNN) linkages for clinical nursing practitioners.

METHODS

This scoping review was performed in accordance with the Joanna Briggs Institut guidelines. We systematically searched eight databases, and the literature search took place between June and July 2023. The characteristics and results of the studies were synthesized and analyzed in a narrative way.

FINDINGS

The application of NANDA-I nursing diagnosis, NIC and NOC in cardiac rehabilitation nursing can be divided into three topics: the content, value and effect of NANDA-I nursing diagnosis, NIC and NOC.

CONCLUSION

The application of NANDA-I, NIC, and NOC in the field of cardiac rehabilitation nursing shows positive effects on the whole, which can provide more standardized theoretical guidance, improve nursing outcomes in clinical settings, and enhance nursing quality.

IMPLICATIONS FOR NURSING PRACTICE

This experience report will guide nurses to use NANDA-I, NIC, and NOC for better cardiac rehabilitation care.

Impact of a mobile application-based home care nursing program on patients' quality of life and family burden

OBJECTIVE

This study aims to identify the effectiveness of a mobile application-based home care nursing service in improving patient quality of life and healthy lifestyle and reducing the family burden.

METHODS

This study was a clinical trial with a pre- and post-test control group design. The accessible population in this study was post-discharge patients from general hospitals in West Kalimantan and East Kalimantan, Indonesia, who required home care nursing. We allocated a selected sample of 40 people to the intervention group and 40 people to the control group using a randomized block design. We gave mobile application-based home care nursing to the intervention group and community health nursing care to the control group. This study was conducted in 10 months (January-October 2022). We measure the patient quality of life, healthy lifestyle, and family burden before and 3 months after the intervention.

RESULTS

There was no significant difference in the post-test quality of life between the two groups (p =  0.187), but there was a significant difference in the psychological (p =  0.014) and environmental health (p =  0.021) domain of quality of life. There was no significant difference in the post-test of a healthy lifestyle between the two groups (p =  0.083). There was a significant difference in the post-test family burden between the two groups (p =  0.015).

CONCLUSION

Mobile Application-Based Home Care Nursing is effective in improving patient quality of life in the psychological and environmental health domains and reducing the family burden for post-discharge patients.

Identification of Predictors for Clinical Deterioration in Patients With COVID-19 via Electronic Nursing Records: Retrospective Observational Study

BACKGROUND

Few studies have used standardized nursing records with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) to identify predictors of clinical deterioration.

OBJECTIVE

This study aims to standardize the nursing documentation records of patients with COVID-19 using SNOMED CT and identify predictive factors of clinical deterioration in patients with COVID-19 via standardized nursing records.

METHODS

In this study, 57,558 nursing statements from 226 patients with COVID-19 were analyzed. Among these, 45,852 statements were from 207 patients in the stable (control) group and 11,706 from 19 patients in the exacerbated (case) group who were transferred to the intensive care unit within 7 days. The data were collected between December 2019 and June 2022. These nursing statements were standardized using the SNOMED CT International Edition released on November 30, 2022. The 260 unique nursing statements that accounted for the top 90% of 57,558 statements were selected as the mapping source and mapped into SNOMED CT concepts based on their meaning by 2 experts with more than 5 years of SNOMED CT mapping experience. To identify the main features of nursing statements associated with the exacerbation of patient condition, random forest algorithms were used, and optimal hyperparameters were selected for nursing problems or outcomes and nursing procedure-related statements. Additionally, logistic regression analysis was conducted to identify features that determine clinical deterioration in patients with COVID-19.

RESULTS

All nursing statements were semantically mapped to SNOMED CT concepts for "clinical finding," "situation with explicit context," and "procedure" hierarchies. The interrater reliability of the mapping results was 87.7%. The most important features calculated by random forest were "oxygen saturation below reference range," "dyspnea," "tachypnea," and "cough" in "clinical finding," and "oxygen therapy," "pulse oximetry monitoring," "temperature taking," "notification of physician," and "education about isolation for infection control" in "procedure." Among these, "dyspnea" and "inadequate food diet" in "clinical finding" increased clinical deterioration risk (dyspnea: odds ratio [OR] 5.99, 95% CI 2.25-20.29; inadequate food diet: OR 10.0, 95% CI 2.71-40.84), and "oxygen therapy" and "notification of physician" in "procedure" also increased the risk of clinical deterioration in patients with COVID-19 (oxygen therapy: OR 1.89, 95% CI 1.25-3.05; notification of physician: OR 1.72, 95% CI 1.02-2.97).

CONCLUSIONS

The study used SNOMED CT to express and standardize nursing statements. Further, it revealed the importance of standardized nursing records as predictive variables for clinical deterioration in patients.

Exploring Nursing Care for Patients With COVID-19 Using International Classification for Nursing Practice-Based Nursing Records

This study explored nursing care topics for patients with the coronavirus disease 2019 admitted to the wards and intensive care units using International Classification for Nursing Practice-based nursing narratives. A total of 256630 nursing statements from 555 adult patients admitted from December 2019 to June 2022 were extracted from the clinical data warehouse. The International Classification for Nursing Practice concepts mapped to 301 unique nursing statements that accounted for the top 90% of all cumulative nursing narratives were used for analysis. The standardized number of nursing statements for each concept was calculated according to the types of nursing care and compared between the two groups. The most documented topics were related to infection; physical symptoms such as sputum, cough, dyspnea, and shivering; and vital signs including blood oxygen saturation and body temperature. Nurses in the intensive care units frequently documented concepts related to the directly monitored and assessed physical signs such as consciousness, pupil reflex, and skin integrity, whereas nurses in wards documented more concepts related to symptoms patients complained. This study showed that the International Classification for Nursing Practice-based nursing records can be used as source of information to identify nursing care for patients with coronavirus disease 19.

Identification of North American Nursing Diagnosis Association-Nursing Interventions Classification-Nursing Outcomes Classification of nursing home residents using on-time data by android smartphone application by registered nurses

PURPOSE

We aimed to investigate the nursing process linkages formed by Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) according to the primary NANDA-I diagnoses by registered nurses (RNs), customized to nursing home (NH) residents in Korea, using a developed smartphone application for NH RNs.

METHODS

This is a retrospective descriptive study. Applying quota sampling, a total of 51 NHs from all operating 686 NHs hiring RNs participated in this study. Data were collected from June 21 to July 30, 2022. Data on NANDA-I, NIC, NOC (NNN) of nurses applied to the NH residents were collected through a developed smartphone application. The application consists of general organization and residents' characteristics, NANDA-I, NIC, and NOC. RNs selected randomly up to 10 residents and NANDA-I with risk factors and related factors over the past 7 days, followed by all applied interventions out of 82 NIC. RNs then evaluated residents through 79 selected NOC.

RESULTS

We found the frequently used NANDA-I diagnoses, Nursing Interventions Classifications and Nursing Outcomes and Classifications applied for NH residents by RNs and developed the top five NOC linkages used to build care plan.

CONCLUSION

It is time to pursue high-level evidence and reply to the questions raised in NH practice using NNN with high technology. The outcomes for patients and nursing staff are improved by the continuity of care made possible by uniform language.

IMPLICATIONS FOR NURSING PRACTICE

NNN linkages should be used to construct and utilize the coding system of electronic health records or electronic medical records in Korean long-term care facilities.

Impact of standardized nursing terminologies on patient and organizational outcomes: A systematic review and meta-analysis

AIMS

To explore the impact of 12 American Nurses Association recognized standardized nursing terminologies (SNTs) on patient and organizational outcomes.

BACKGROUND

Previous studies reported an effect of SNTs on outcomes, but no previous frameworks nor meta-analyses were found.

DESIGN

Systematic review and meta-analyses.

REVIEW METHODS

PubMed, Scopus, CINAHL, and OpenGrey databases were last consulted in July 2021. All abstracts and full texts were screened independently by two researchers. The review included primary quantitative studies that reported an association between recognized SNTs and outcomes. Two reviewers independently assessed the risk of bias and certainty of evidence for each meta-analyzed outcome using the "Grading of Recommendations, Assessment, Development and Evaluation" (GRADE) approach.

RESULTS

Fifty-three reports were included. NANDA-NIC-NOC and Omaha System were the most frequently reported SNTs used in the studies. Risk of bias in randomized controlled trials and not-randomized controlled trials ranged from high to unclear, this risk was low in cross-sectional studies. The number of nursing diagnoses NANDA-I moderately correlated with the intensive care unit length of stay (r = 0.38; 95% CI = 0.31-0.44). Using the Omaha System nurse-led transitional care program showed a large increase in both knowledge (d = 1.21; 95% CI = 0.97-1.44) and self-efficacy (d = 1.23; 95% CI = 0.97-1.48), while a reduction on the readmission rate (OR = 0.46; 95% CI = 0.09-0.83). Nursing diagnoses were found to be useful predictors for organizational (length of stay) and patients' outcomes (mortality, quality of life). The GRADE indicated that the certainty of evidence was rated from very low to low.

CONCLUSIONS

Studies using SNTs demonstrated significant improvement and prediction power in several patients' and organizational outcomes. Further high-quality research is required to increase the certainty of evidence of these relationships.

CLINICAL RELEVANCE

SNTs should be considered by healthcare policymakers to improve nursing care and as essential reporting data about patient's nursing complexity to guide reimbursement criteria.

Nurses' lived experiences in the utilization of standardized nursing languages in documentation of nursing care, in Cross River State, Nigeria

PURPOSE

The concept of standardized nursing languages (SNLs) was introduced to solve the problem created by the use of different terminologies to document care by nurses working in diversified contexts. This study explored professional nurses' experiences in the utilization of SNL in documenting patients' care.

METHODS

A qualitative descriptive design was adopted for this study, and a purposive sampling technique was used to select eight nurses for the study from a tertiary health facility. Data were collected using an in-depth interview guide. Rigour and trustworthiness were ensured using the techniques of credibility, dependability, transferability, and confirmability. Data were analyzed according to Braun and Clarke's six-step thematic analyses.

FINDINGS

The key finding indicates that nurses appreciate the advantages of utilizing SNLs; however, they encounter some problems in formulating correct nursing diagnoses and several challenges in using SNLs, such as manpower shortage, lack of time, inappropriate materials, inadequate knowledge of NOC and NIC. These challenges have caused the utilization of SNLs among nurses to be poor.

CONCLUSIONS

SNLs have been recognized as the gold standard for nursing practice; however, their usage is poor. To ensure the adequate use of SNLs, it is the responsibility of the nurse and the institution to resolve the barriers to the use of SNLs. The study recommends that the utilization of SNLS could be improved with the provision of more seminars, the creation of a policy on SNLs use, and the use of electronic documentation IMPLICATION TO NURSING: This study contributes by providing a picture of nurses' experiences in utilizing SNLs in Nigeria, identifying challenges experienced and recommending ways to tackle these challenges.

Perceptions of Turkish Nursing Students on Nursing Diagnose

Objective: This study aimed to determine how Turkish nursing students’ perceived nursing diagnosis. Methods: This descriptive and cross-sectional study was carried out with 655 nursing students in the Departments of Nursing in the Health Sciences Faculties of two universities, in the Aegean and western Black Sea Region, between 15 February and 5 April 2020. The Students Information Form and Perceptions of Nursing Diagnosis Scale were used for data collection. The independent samples t-test, one-way ANOVA test, and the Mann-Whitney U-test with Bonferroni-correction were used to determine the differences between the groups. Pearson correlation analysis was used to determine the effects of independent variables Results: The mean age of the nursing students was 21.12±1.39; 76.6% of them were female and 36.8% were in the second-year. 53.7% of the nursing students reported that they had difficulty in making nursing diagnoses. The overall Perceptions of Nursing Diagnosis Survey score of the nursing students was found to be 2.46±051. Statistically significant difference was found between Perceptions of Nursing Diagnosis Survey scores in terms of gender (p=0.012), the necessity of nursing diagnosis (p<0.001), and having sufficient knowledge about nursing diagnosis (p=0.019). Conclusions: The findings of this study have revealed that Turkish nursing students’ perceptions of nursing diagnoses are positive. It is important that use effective teaching methods in teaching nursing diagnoses in fundamental nursing education, to give more importance to nursing diagnoses. It is recommended to plan qualitative studies to in-depth examine students’ perceptions with randomized controlled studies involving innovative educational interventions in the future

Challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria

PURPOSE

The purpose of this study was to assess the challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria.

METHODS

Using convergent mixed method design, the qualitative and quantitative data were collected from 427 nurses and nine stakeholders. This was done in one phase with the use of validated questionnaires and in-depth interview guide/key informant interview guide. Data were collected for 5 months and analyzed with SPSS version 25. Qualitative data were analyzed using themes.

RESULTS

The explored significant challenges by stakeholders and nurses to sustainability of standardized nursing care plan (SNCP) in all the selected hospitals were inadequate knowledge of standardized nursing languages (SNLs), inadequate staffing, lack of motivation, lack of mandate to use SNLs by the educational system, lack of computers on the wards, weakness of previous training on SNL/SNCP, lack of interest, and high patient load.

CONCLUSION

The study concludes that inadequate knowledge of SNLs and inadequate staff could contribute to non sustainability of SNCP.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should be continuously trained on standardized nursing languages. Staff motivation and increasing the number of staff on the wards would increase the interest of the nursing staff. This will in turn improve the quality of documentation and patient care.

Nursing outcomes and interventions associated with the nursing diagnoses: Risk for or actual frail elderly syndrome

PURPOSE

To clinically validate nursing outcomes and interventions associated with the nursing diagnoses of Risk for Frail elderly syndrome or Frail elderly syndrome.

METHODS

This cross-sectional study utilized an instrument containing assessment cues, nursing diagnoses, outcomes, and interventions in a sample of 28 older adults. The Generalized Estimation Equation model, complemented by the Bonferroni test, was used for statistical analysis.

RESULTS

Twenty-three (82%) older adults were diagnosed with Risk for Syndrome and five (18%) with Frail elderly syndrome. Ten outcomes and three interventions were validated with significant differences statistically.

CONCLUSIONS

The clinical validation made it possible to demonstrate the clinical evolution of these patients under follow-up.

IMPLICATIONS FOR NURSING PRACTICE

Those outcomes and interventions are a linkages proposal between them and the nursing diagnoses.

OBJETIVO

Validar clinicamente os resultados e intervenções de enfermagem associados ao diagnóstico de enfermagem Risco para Síndrome do Idoso Frágil ou Síndrome do Idoso Frágil. MÉTODOS: Estudo transversal que utilizou um instrumento contendo possibilidades de avaliação, diagnóstico de enfermagem, resultados e intervenções em uma amostra de 28 idosos. A análise estatística utilizou o modelo de Equações de Estimativas Generalizadas, complementado pelo teste de Bonferroni.

RESULTADOS

Vinte e três (82%) idosos foram diagnosticados com Risco de Síndrome e cinco (18%) idosos com Síndrome. Dez resultados e três intervenções foram validados com diferença estatisticamente significativa. CONCLUSÕES: A validação clínica permitiu demonstrar a evolução clínica desses pacientes em acompanhamento. Implicações para a prática de enfermagem. Esses resultados e intervenções são uma proposta de vínculo entre eles e os diagnósticos de enfermagem.

Effectiveness of Standardized Nursing Terminologies for Nursing Practice and Healthcare Outcomes: A Systematic Review

PURPOSE

This review evaluates the effectiveness of using standardized terminologies in nursing.

METHODS

A systematic literature review was performed via PubMed, Web of Science, CINAHL, and OVID databases for articles published between January 1973 and September 2020. The Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies was used to assess the quality of all included studies.

RESULTS

Fourteen studies were selected for data extraction and analysis, which included a total of 24,243 patients and 99 nurses. Of the studies that met the inclusion criteria, the quality of five were of high quality, one was of moderate quality, and eight was of weak quality. All articles were summarized according to two themes: the identification of common outcomes or interventions, and the validation or evaluation of the effectiveness of standard nursing terminology sets.

CONCLUSION

Standardized terminologies in nursing help nurses to implement care plans according to nursing procedures, supervise changes in patients' sensitive indicators, improve patients' health outcomes, and contribute to evidence-based nursing practices and global data resource sharing.

IMPLICATIONS FOR NURSING PRACTICE

Standardized nursing terminologies have positive effects on clinical practice, are essential for enriching nurses' knowledge, and alter nurses' attitudes regarding education and guidance, which promotes the clinical application of these terminologies.

Educational interventions by nurses in caregivers with their elderly patients at home

INTRODUCTION

The home is the natural setting for the development of informal care. The work that nurses are required to develop in this context (the carer/the elderly dependent/the home) focuses on training and educational activities to assist these two groups, such as demonstrating care activities to help dependent seniors, instruction in self-care techniques and teaching strategies for the use of human and material resources.

AIMS

This article analyzes care education interventions performed by nurses, and the factors that facilitate, or limit, health care training.

METHODOLOGICAL APPROACH

This is a qualitative, descriptive study designed to be flexible and openly analytical in its approach to the research problem and the dynamic nature of the home environment. Triangulation of the methodological techniques and study subjects was applied.

RESULTS

Nursing interventions related to professional attitudes, such as encouraging communication and facilitating teaching; communication interventions in health education and counseling; and technical interventions aimed at improving access to health information and support for the informal carer. Lack of will, the advanced age of the carer, emotional state and work overload are factors that undermine care instruction, which if reversed, would become learning facilitators. The lack of time and resources in the home are the major limiting factors on care teaching, according to nurses. Evidence from our study suggests that care in the home is considered a key primary health care strategy, one in which nurses play a significant role.

Use of standardized terminologies in clinical practice: A scoping review

AIM

To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice.

INTRODUCTION

The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice.

METHODS

A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG.

RESULTS

One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs.

CONCLUSION

Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.

International Collaboration and New Research Evidence on Nanda International Terminology

OBJECTIVES

To discuss priorities and possibilities for promoting international collaboration and new research evidence on NANDA International, Inc. (NANDA-I).

METHODS

Theoretical reflection article based on the literature and the authors' opinions on the subject matter, carried out by six research nurses.

CONCLUSIONS

International research collaboration for NANDA-I allows the improvement of research production in an actual clinical setting, especially with multicenter and validation studies, conducted by researchers from different countries. This provides for improved understanding of patients' experiences and may help to produce robust scientific evidence.

IMPLICATIONS FOR NURSING KNOWLEDGE

The generation of new evidence may lead to an increase in NANDA-I visibility and in nurses' understanding of its meaning for clinical practice and for the formulation of diagnostic hypotheses.

Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC

OBJECTIVE

To evaluate the nursing outcomes of hospitalized patients at high risk for falls through NOC and correlate NOC outcomes called Knowledge: Fall Prevention and Fall Prevention Behavior with patients' sociodemographic and clinical variables.

BACKGROUND

Falls represent one of the major safety incidents in the hospital setting. The role of nursing is fundamental in preventing these events, from risk assessment to outcome evaluation. One of the strategies for evaluating nursing outcomes is the use of Nursing Outcomes Classification (NOC).

METHODS

A cross-sectional study conducted with a sample of 68 adult patients at high risk for falls admitted to clinical and surgical units. The patients received three evaluations. Data collect was prospective with an instrument containing five results and 28 NOC indicators. Descriptive and analytical analysis considered the NOC 5-point Likert scale.

RESULTS

Evaluation of the Knowledge: Fall Prevention and Fall Prevention Behavior outcomes showed that patients have a limited level of knowledge and rarely demonstrated preventive behavior. Vital Signs (0802), Medication Response (2301) and Safe Health Care Environment (1934) pointed to the existence of adequate patient monitoring and safe environment.

CONCLUSION

The evaluation of patient outcomes supported by a standardized classification system such as the NOC highlights the patient's clinical evolution and produces data that support the planning of care and management interventions, providing more effective and safer practices.

Health education: the effectiveness of interventions in patients with heart failure

OBJECTIVES

To evaluate the effectiveness of NIC interventions "Teaching: Disease Process", "Health Education" and "Cardiac Care" in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) "Ineffective Health Control".

METHODS

Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman's Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%.

RESULTS

The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001).

CONCLUSIONS

The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.

Nurses' characteristics and practice environments: Comparison between clusters with different attitude and utilisation profiles regarding nursing diagnosis

AIM

To identify clusters of nurses in relation to the utilisation and attitude towards nursing diagnosis and to compare their profiles considering demographics, professional characteristics and nursing practice environments.

BACKGROUND

Nursing diagnosis has benefits for both patients and nurses, and the attitude of nurses towards nursing diagnosis has been proposed as a determinant of its use. Therefore, an adequate understanding of nurses' attitude and utilisation profiles regarding nursing diagnosis is essential for the nursing managers who want to adopt nursing diagnosis as a practice framework.

METHODS

A cross-sectional survey design was used. A sample of 239 nurses working in the Catalan primary health care system were categorised into clusters with similar attitude and utilisation profiles, which were compared with each other a posteriori.

RESULTS

Nursing managers were grouped into more positive attitude clusters than clinical nurses. Nurses working in supportive nursing practice environments were classified into more positive attitude and higher utilisation clusters.

CONCLUSION

The field of work and nursing practice environments were found as differential factors in profiles of nurses with different attitudes towards and/or utilisation of nursing diagnosis.

IMPLICATIONS FOR NURSING MANAGEMENT

The promotion of supportive nursing practice environments could enhance the implementation and maintenance of nursing diagnosis as a practice framework in primary health care.

Effectiveness of Postpartum Homecare Program as a New Method on Mothers' Knowledge about the Health of the Mother and the Infant

Background:

Reduced maternal mortality due to pregnancy and delivery is one of the priorities of reproductive health programs of World Health Organization. Benefiting from appropriate social support, such as receiving homecare, has an important role in mothers’ adaptation and health. Lack of access to comprehensive and desirable health services is the most important barrier to improvement of maternal health. In this study, the effect of postpartum homecare on mother's knowledge about maternal and child health is evaluated.

Materials and Methods:

This study was two-group field trial which was conducted in 2015 on 62 postpartum mothers who were selected randomly in Shahid Beheshti Hospital of Isfahan. Mothers and infants of the intervention (experimental) groups were first visited at the hospital and then received two visits at home. The control group received routine postpartum care. A researcher-designed questionnaire was used for data collection. Data analysis was conducted using SPSS18 and independent, paired t-test, and Chi-square tests.

Results:

Comparing the demographic characteristics between both groups revealed no significant difference. After the intervention mothers’ knowledge about maternal (t = 4.26; p < 0.001) and child (t = 3.19; p = 0.003) health showed a significant difference between the intervention (experimental) and control groups.

Conclusions:

Performance of postpartum homecare as a new and useful method in the health system of Iran can increase mothers’ knowledge about their own health and their children, enhance their ability to adapt with the postpartum period, and improve the health level of vulnerable populations.

Evaluation of Patients in a Smoking Cessation Support Group Using the Nursing Outcomes Classification

PURPOSE

To evaluate patients in a smoking cessation support group using the Nursing Outcomes Classification (NOC).

METHODS

Prospective observational cohort study conducted with 21 patients participating in a smoking cessation support group. Data were collected using an instrument consisting of 2 NOC outcomes and 20 indicators, applied during each of the six support group meetings.

FINDINGS

The two NOC outcomes, Smoking Cessation Behavior (1625) and Substance Withdrawal Severity (2108), showed statistically significant differences over time in many of their indicators.

CONCLUSIONS

The NOC outcomes demonstrated the clinical evolution and behavioral improvement of patients during the smoking cessation process.

IMPLICATIONS FOR NURSING PRACTICE

The findings highlight important elements of the evaluation of behavioral change and severity of withdrawal symptoms.

Nursing Outcomes for Patients with Risk of Perioperative Positioning Injury

PURPOSE

To select and refine the outcomes and indicators of Nursing Outcomes Classification for the diagnosis of risk for perioperative positioning injury.

METHOD

Validation study on expert consensus and refinement through pilot study.

FINDINGS

Eight outcomes and 35 indicators were selected in consensus. After clinical testing was performed, in which 10 patients were assessed at five different times. Eight outcomes and 33 indicators remained in the protocol.

CONCLUSION

This study made it possible to select the most relevant outcomes and indicators to be measured for this diagnosis in clinical practice.

IMPLICATIONS FOR NURSING PRACTICE

Validation studies by consensus and clinical testing are important to promote the accuracy, creating opportunities to legitimize, and improve the concepts of taxonomies.

Identifying nursing interventions associated with the accuracy used nursing diagnoses for patients with liver cirrhosis

ABSTRACT Objective: to identify the nursing interventions associated with the most accurate and frequently used NANDA International, Inc. (NANDA-I) nursing diagnoses for patients with liver cirrhosis. Method: this is a descriptive, quantitative, cross-sectional study. Results: a total of 12 nursing diagnoses were evaluated, seven of which showed high accuracy (IVC ≥ 0.8); 70 interventions were identified and 23 (32.86%) were common to more than one diagnosis. Conclusion: in general, nurses often perform nursing interventions suggested in the NIC for the seven highly accurate nursing diagnoses identified in this study to care patients with liver cirrhosis. Accurate and valid nursing diagnoses guide the selection of appropriate interventions that nurses can perform to enhance patient safety and thus improve patient health outcomes.

Case Management for Patients with Complex Multimorbidity: Development and Validation of a Coordinated Intervention between Primary and Hospital Care

In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic disease. Nevertheless, there is little scientific evidence on the impact of using a case management program for patients with complex multimorbidity regarding hospital resource utilisation.

We evaluated an integrated case management intervention set up by community-based care at outpatient clinics with nurse case managers from a telemedicine unit. The hypothesis to be tested was whether improved continuity of care resulting from the integration of community-based and hospital services reduced the use of hospital resources amongst patients with complex multimorbidity.

A retrospective cohort study was performed using a sample of 714 adult patients admitted to the program between January 2012 and January 2015. We found a significant decrease in the number of emergency room visits, unplanned hospitalizations, and length of stay, and an expected increase in the home care hospital-based episodes. These results support the hypothesis that case management interventions can reduce the use of unplanned hospital admissions when applied to patients with complex multimorbidity.

Home-based nursing interventions improve knowledge of disease and management in patients with heart failure

OBJECTIVE

to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire.

METHODS

in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered.

RESULTS

overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4.

CONCLUSION

the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument.

Identification of Nursing Diagnosis-Outcome-Intervention Linkages for Inpatients in Gynecology Department Nursing Units

PURPOSE

The aim of this study was to identify the nursing diagnosis-outcome-intervention (NANDA-NOC-NIC) linkages for gynecology inpatients shown in their electronic nursing records.

METHODS

This retrospective and descriptive research was conducted in two steps and based on the 287 electronic nursing records for 253 patients. First, nursing diagnoses, outcomes and interventions were collected. To identify major nursing diagnoses, a comparison was done with the top 10 nursing diagnoses from this research and with previous research selected using a content validity index developed by a team of professionals. Second, nursing outcomes and interventions that were associated with major nursing diagnoses were identified.

RESULTS

Nineteen nursing diagnoses, 12 nursing outcomes, and 40 nursing interventions were collected. The top 5 major nursing diagnoses were identified and 7 nursing outcomes and 18 nursing interventions associated with these diagnoses were checked.

CONCLUSION

The identified NANDA-NOC-NIC linkages can contribute to improving nursing practice and will help in the establishment of standardized nursing care.

Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems

OBJECTIVE

Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC) related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults.

METHODS

Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms.

RESULTS

Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop.

CONCLUSION

This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.Objetivo.Construir definições conceituais para alguns indicadores do resultado de enfermagem Gravidade de Infecção da Nursing Outcomes Classification (NOC) relacionados aos problemas respiratórios, a partir de evidências científicas sobre sinais e sintomas de infecção em pessoas adultas. Métodos. Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL, LILACS e SCOPUS. Foram incluídos estudos com textos na integra, publicados em espanhol, português ou inglês, usando os descritores gravidade da infecção, classificação dos resultados de enfermagem da NOC, infecções respiratórias, e sinais e sintomas respiratórios. Resultados. Analisaram-se nove publicações que embasaram a elaboração das definições conceituais de oitos indicadores do Resultado de Enfermagem Gravidade de Infecção: expectoração purulenta, febre, hipotermia, instabilidade da temperatura, dor, colonização em cultura de expectoração, elevação na contagem das células brancas e depressão na contagem das células brancas. Conclusão. O estudo contribuiu para a compreensão dos termos utilizados no resultado enfermagem Gravidade de Infecção, de modo a aperfeiçoar e facilitar o uso da NOC, à medida que apresenta refinamento do ponto de vista conceitual dos indicadores selecionados, de modo a produzir melhores evidências científicas.

Aplicabilidade dos resultados de enfermagem em pacientes com insuficiência cardíaca e volume de líquidos excessivo

RESUMO Objetivo Testar a aplicabilidade clínica da Nursing Outcomes Classification em pacientes com insuficiência cardíaca descompensada e Diagnóstico de Enfermagem Volume de Líquidos Excessivo. Métodos Estudo longitudinal conduzido em duas etapas em um hospital universitário no ano de 2013. Na primeira etapa, utilizou-se a validação por consenso de especialistas para selecionar os resultados de enfermagem e os indicadores relacionados ao diagnóstico de enfermagem; na segunda, foi realizado um estudo longitudinal para avaliação clínica dos pacientes, utilizando-se o instrumento contendo os resultados e indicadores produzidos no consenso. Resultados Foram realizadas avaliações em 17 pacientes. Na avaliação clínica, mensuraram-se os resultados de enfermagem através da avaliação de seus indicadores. Seis resultados apresentaram aumento nos escores, quando comparados às médias da primeira e da última avaliação. A utilização da Nursing Outcomes Classification na prática clínica demonstrou melhora dos pacientes internados por insuficiência cardíaca descompensada. Conclusão A Nursing Outcomes Classification foi sensível às alterações no quadro clínico dos pacientes.

Laser therapy in pressure ulcers: evaluation by the Pressure Ulcer Scale for Healing and Nursing Outcomes Classification

AbstractOBJECTIVETo describe the pressure ulcer healing process in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy evaluated by the Pressure Ulcer Scale for Healing (PUSH) and the result of Wound Healing: Secondary Intention, according to the Nursing Outcomes Classification (NOC).METHODCase report study according to nursing process conducted with an Intensive Care Unit patient. Data were collected with an instrument containing the PUSH and the result of the NOC. In the analysis we used descriptive statistics, considering the scores obtained on the instrument.RESULTSA reduction in the size of lesions of 7cm to 1.5cm of length and 6cm to 1.1cm width, in addition to the increase of epithelial tissue and granulation, decreased secretion and odor.CONCLUSIONThere was improvement in the healing process of the lesion treated with adjuvant therapy and the use of NOC allowed a more detailed and accurate assessment than the PUSH.

Psychometric evaluation of the Positions on Nursing Diagnosis scale

AIM

To study the psychometric properties of the Positions on Nursing Diagnosis (PND) scale.

BACKGROUND

The PND is a scale to measure nurses' attitudes toward nursing diagnosis. In previous studies, reliability of the scale was supported but its construct validity is still unclear with studies reporting both one-factor and three-factor models.

METHODS

A cross-sectional study was conducted with a convenience sample of 262 nurses enrolled from one general public hospital and three long-term care facilities in Italy. Construct validity was assessed with confirmatory factor analysis. Criterion and contrasting-group validities were tested, as well as internal consistency reliability.

RESULTS

Confirmatory factor analysis showed the adequacy of a one-factor model of the PND scale. Criterion and contrasting-group validities were supportive, as was internal consistency reliability.

CONCLUSIONS

The PND is a valid and reliable scale to measure nurses' attitudes toward nursing diagnosis. Its use in practice and research is recommended.