Nursing Diagnoses for Coronavirus Disease, COVID-19: Identification by Taxonomic Triangulation

Deductive Care Methodology: Describing and testing modes of care research

OBJECTIVE

Define the modes of procedure of the Deductive Care Methodology (DCM) in the generation of knowledge about person's health care.

METHODOLOGY

Design and test of the DCM modes based on three phases: mapping of the DCM, generation of models from this methodology and testing of the models through studies in a clinical context.

RESULTS

The DCM presents five levels of abstraction with three modes broken down to 16 types. The modes are: Philosophical Mode to conceptualize and obtain generalities about reality, Mathematical Mode to operate with generalities, and Physical Mode to operationally verify, validating the results and the predictive capacity of the model. This MDC allows the creation of three models: Knowledge Model about Person Care, an ontology of care, Vulnerability Model about the person and Taxonomic Triangulation Model for knowledge management. All models generate products for computational knowledge management. In addition, the models are applied in teaching and generate research with more than a hundred participations in conferences and journals, of which five impact publications (from 2008 to 2022) classified in the categories of Nursing and Informatics are analysed.

CONCLUSIONS

The DCM collects prior knowledge to work with certainties, evidence and applying inferences that do not depend on the number of cases or inductive designs. This research presents a formal structure of the DCM with an interdisciplinary orientation between Health Sciences and Computer Sciences.

Nursing diagnoses in patients with COVID-19 admitted to the intensive care unit: CROSS-MAPPING

To identify and analyze the nursing diagnoses listed in the medical records of COVID-19 patients admitted to an intensive care unit using Taxonomy II of NANDA-I. Background: COVID-19 is a complex disease with heterogeneous behaviors, and the role of intensive care nurses in accurately identifying related signs and symptoms has become even more critical during the pandemic. Nurses rely on classification systems or taxonomies to standardize concepts and language in practice. Method: This quantitative study employed a descriptive and individual approach, utilizing the cross-mapping method. Data were collected from 57 medical records of critical care patients in a hospital in northeastern Brazil between July 2020 and March 2021. Three researchers analyzed the mapped diagnoses, and agreement was assessed using the Content Validation Index and Fleiss' Kappa. Results: Among the listed nursing diagnoses, 54.28% were found to be standardized, 45.71% had corresponding nursing diagnoses, and 5.71% did not have an equivalent diagnosis in the reference taxonomy used in the study. Due to the possibility of multiple nursing diagnoses in the same patient, the most frequent diagnoses were Risk of pressure injury in adults (66.66%), Risk of falls in adults (64.91%), and Risk of infection (45.61%). Among the 37 diagnoses mapped, the risk diagnoses were the most prevalent and could be prevented if identified early. Conclusions: The study highlights the importance of standardized nursing diagnoses in the ICU for COVID-19 patients and the need for accurate identification and prevention of risk diagnoses to enhance patient care and improve outcomes.

Active and Healthy Confinement: Care Recommendations on Activity, Sleep and Relationships

Persons that lived through periods of confinement suffered an impact on their physical and mental health. The adaptation of the lifestyle in relation to activity, sleep and social relationships is key to facing these periods of confinement. The aim is to validate a series of care recommendations aimed at being able to maintain an active and healthy confinement, which serves to prepare the population for future health crises. This study is part of a general strategy based on a care recommendation guide for COVID-19. The validation was carried out by a group of experts using the Delphi technique through a questionnaire that uses the Content Validity Index (CVI) and considers high validation those with a score >0.80. A total of 75 care recommendations are proposed: 30 on activity-exercise (CVI = 0.82), 14 on sleep-rest (CVI = 0.83) and 31 on roles-relationships (CVI = 0.83). Additionally, 49 recommendations achieve high validation. The care recommendations integrate a person-centred model, which addresses individual characteristics (age, health status, professional role). An active and healthy confinement requires respecting social distance measures, maintaining a balance between physical activity and sleep, and using technologies to promote social contact, which promote well-being and avoid depression and anxiety.

Intensive and Critical Care Nursing of a COVID-19 Patient in Turkey: A Case Study

BACKGROUND

A multidisciplinary approach is required to provide holistic care and treatment in the fight against the COVID-19 pandemic. Being in the center of the multidisciplinary approach, nurses provide therapeutic, primary, and psychosocial care for the patients.

OBJECTIVES

This study was conducted to diagnose according to the North American Nursing Diagnosis Associations by determining the care needs of a case who was diagnosed with COVID-19, planning interventions, and observing the results.

METHODS

This descriptive case study included a patient who applied to a university hospital located in Istanbul/Turkey between March and April 2020 because of COVID-19. As the inclusion criteria, only a positive result from a polymerase chain reaction test was accepted. The details of the patient presented in the study were obtained through face-to-face interviews and electronic medical records.

DISCUSSION

Specified care plans enable defining problems in practice for all needs of the individual and developing solution recommendations. It was observed that there were improvements and a decrease in symptom severity after the interventions were applied for the symptoms developing in the case. The execution of the treatment and care practices under quality and effective nursing care such as giving proper ventilatory support at the right time, giving prone position for a long time, and providing sufficient fluid resuscitation and an early and balanced diet contributed to the patient's discharge from the intensive care unit successfully without having any organ dysfunction. This presentation is expected to be a source for collaborative nursing care for other cases diagnosed with COVID-19 and intensive care indications.

CONCLUSIONS

Nursing care interventions were applied for gas exchange, risk of decreased tissue perfusion, excess fluid volume, and constipation nursing diagnosis. It was observed that there were improvements and a decrease in symptom severity after the interventions were applied for the symptoms developing in the case. This presentation is expected to be a source for collaborative nursing care for other cases diagnosed with COVID-19 and intensive care indications.

Care Recommendations for the Chronic Risk of COVID-19: Nursing Intervention for Behaviour Changes

The COVID-19 pandemic is a challenge for health systems. The absence of prior evidence makes it difficult to disseminate consensual care recommendations. However, lifestyle adaptation is key to controlling the pandemic. In light of this, nursing has its own model and language that allow these recommendations to be combined from global and person-centred perspectives. The purpose of the study is to design a population-oriented care recommendation guide for COVID-19. The methodology uses a group of experts who provide classified recommendations according to Gordon’s functional patterns, after which a technical team unifies them and returns them for validation through the content validity index (CVI). The experts send 1178 records representing 624 recommendations, which are unified into 258. In total, 246 recommendations (95.35%) are validated, 170 (65.89%) obtain high validation with CVI > 0.80, and 12 (4.65%) are not validated by CVI < 0.50. The mean CVI per pattern is 0.84 (0.70−0.93). These recommendations provide a general framework from a nursing care perspective. Each professional can use this guide to adapt the recommendations to each individual or community and thus measure the health impact. In the future, this guideline could be updated as more evidence becomes available.

Responses Presented by Adult Patients with COVID-19, Based on the Formulated Nursing Diagnoses: A Scoping Review

(1) Background: this review aims to identify the human responses exhibited by adult patients with COVID-19, by listing the corresponding nursing diagnoses. Nursing diagnosis it's a clinical analysis of human responses to a person, family, or community. Therefore, it is possible to state that nursing diagnoses represent human responses. (2) Methods: a scoping review was conducted following recommendations provided by the Joanna Briggs Institute (JBI) and the research was carried out between December 2020 and 15 January, 2021, via CINAHL Complete, Complementary Index, MEDLINE, Science Direct, Academic Search Complete, Science Citation Index, Directory of Open Access Journals, Scopus, Social Sciences Citation Index, Business Source Complete, eBook Index (by B-on), and the Cochrane Database of Systematic Reviews (by Cochrane Library). (3) Results: with respect to studies using the NANDA-I taxonomy, the findings have shown that "impaired gas exchange" was the most highlighted nursing diagnosis. ICNP taxonomy, the relevant nursing diagnosis is "cough present". (4) Conclusions: concurrently, as suggested by the human responses documented in this review, throughout the pandemic, the requirements for adequate care provision have been constantly updated, to improve the quality of life of those patients, as much as possible.

Nursing diagnoses in hospitalized patients with COVID-19 in Indonesia

Background

The COVID-19 pandemic has become a global public health issue, and the roles of nurses are very much needed in providing nursing services in the current situation. The enforcement of appropriate nursing diagnoses for patients with COVID-19 is also fundamental in determining proper nursing care to help the patients achieve maximum health.

Objective

This study aimed to describe and analyze nursing diagnoses in patients with COVID-19 treated in the isolation rooms and ICUs.

Methods

This study used a secondary data analysis from hospital medical record data of patients with COVID-19 from early December 2020 to the end of February 2021. Data were selected using a cluster random sampling technique and analyzed using descriptive statistics.

Results

The results showed that the signs and symptoms of the patients with COVID-19 that often appeared were fever, cough, shortness of breath, and decreased consciousness. The common nursing diagnoses in the hospitalized patients with COVID-19 were hyperthermia, ineffective airway clearance, gas exchange disorder, self-care deficit, spontaneous ventilation disorder, spontaneous circulation disorder, knowledge deficit, and shock risk.

Conclusion

This study offers an insight into nursing practices in the hospital setting, which can be used as a basis for nurses to perform complete nursing assessments and nursing diagnoses during the pandemic.

The Most Commonly Determined Nursing Diagnoses According to NANDA-I Taxonomy and Difficulties Using the Nursing Process in COVID-19 Outbreak

The study was planned to determine the most common nursing diagnoses according to NANDA International (NANDA-I) taxonomy and difficulties experienced in using of nursing process in COVID-19 outbreak. The sample of the descriptive cross-sectional study consisted of nurses cared for patients with COVID-19 (n = 114). Average age of nurses is 26.86 ± 6.68. Commonly determined nursing diagnoses according to NANDA-I taxonomy in patients with COVID-19 were imbalanced nutrition (66.7%), impaired gas exchange (40.4%), insomnia (21.1%), acute confusion (31.6%), hopelessness (96.5%), difficulty playing caregiver (84.2%), anxiety (38.6%) willingness to strengthen religious bond (71.9%), risk for infection (64.9%), nausea (49.1%). Twenty-four-years old and younger, high school graduates, caring for intubated patients, and those who stated that they did not use nursing diagnosis had more difficulty in using nursing process (<0.05). The use of nursing diagnoses and process for patients with COVID-19 is extremely important in ensuring individual and qualified nursing care.

Usability Evaluation by Nurses of a Knowledge-Based System of Care Plans for People Hospitalized by COVID-19

The aim of this study is to analyze the usability by nurses of the Knowledge-Based System "Diagnostics care for COVID-19." A convenience sample of 16 nurses was selected, among hospital workers and external experts. The group was divided into three subgroups intentionally to obtain different usability perspectives. Usability was evaluated by the System Usability Scale questionnaire. The participants completed the questionnaire on general usability, data inputs, and information output, after completing a minimum of 12 care plans. The first subgroup used real cases and the "think aloud" technique, the second simulated cases from the same hospital, and the third subgroup performed the external simulation. The highest scores were obtained in data inputs (94.38-97.50); and the lowest, in general usability (90.00-95.00). The subgroup of external experts scored the highest (93.13-95.63), and the first subgroup, which carried out real cases, gave the lowest score (90.00-94.38). The "think aloud" technique found an improvement in including more diagnoses and being able to carry out several plans for one person at the same time. The usability obtained was "excellent" in all subgroups and questionnaires, although the application showed limitations related to its characteristics imposed in the requirements specification.

Diagnostics of care about environment: A systematic review through nursing taxonomies

AIM

To analyse the representation of the environment in nursing diagnostic taxonomies.

DESIGN

Systematic scoping review through nursing taxonomies.

METHODS

The first phase identified nursing diagnostic taxonomies by systematic review. The diagnoses were associated with the environment by analysis of terms into the diagnosis label and definition. Data analysis was quantitative with frequency measurements. The second phase mapped the identified diagnoses to establish equivalences using analysis by terms in the diagnostic labels. Finally, the findings obtained in the first phase were compared with the OMAHA System.

RESULTS

The bibliographic search identified 112 studies and 16 standardized languages for diagnoses. NANDA-I and ICNP were the most frequent taxonomies; ATIC, the most recent; and OMAHA, the oldest. 2,062 diagnoses from four diagnostic taxonomies were analysed, and 361 associations corresponding to 352 environmental diagnoses were identified. All taxonomies included the environment but with different weight relative to the interpersonal and geopolitical category.

Validation of a manual of care plans for people hospitalized with COVID-19

Aim

Validate a manual of care plans for people hospitalized for coronavirus disease, COVID‐19.

Design

Validation study with a mixed‐method design.

Methods

Design and validation of a care plans manual for people hospitalized by COVID‐19. Care plans used standardized languages: NANDA‐I, Nursing Outcomes Classification (NOC) and Nursing Intervention Classification (NIC). The design included external and internal validation with quantitative and qualitative analysis. Data collection was between March and June 2020. The study methods were compliant with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist.

Results

The manual integrated 24 NANDA‐I diagnoses, 34 NOC and 47 NIC different criteria. It was validated by experts of Scientific‐Technical Commission, who recommended linking the diagnoses to an assessment. The internal validation validated 17 of 24 diagnoses, 56 of 65 NOC and 86 of the 104 NIC. During the discussion group, 6 new diagnoses proposed were validated and the non‐validated diagnoses were linked to the baseline condition of the person.

Nurses' perception of ethical challenges in caring for patients with COVID-19: a qualitative analysis

Nurses face several challenges in providing care for patients with coronavirus disease in 2019 (COVID-19). The study aimed to explain the nurses' perception of ethical challenges in this regard. The qualitative study was carried out using a content analysis method. Individual and semi-structured interviews were conducted with 24 nurses. Inductive content analysis was used to categorize the data. Nurses' narratives indicated that ethical challenges in caring for patients with COVID-19 included threats to professional values ​​and the absence of a holistic COVID-19 care approach. The first category was subcategorized into the risk of declining quality of patient care and a stigmatized public image about COVID-19 care. The second category was divided into poor spiritual care, poor compassionate care, and lack of family-centered care. Health care managers must develop protocols for nurses that address these issues to alleviate the ethical challenges of COVID-19 care.