Contexts for the Study of the Economic Influence of Nursing Diagnoses on Patient Outcomes. Contextos para o estudo da influencia economica dos diagnosticos de enfermagem sobre os resultados do paciente. Contextos para el estudio de la influencia economica de los diagnosticos de enfermeria en los resultados de pacientes

Standardized Nursing Diagnoses in a Surgical Hospital Setting: A Retrospective Study Based on Electronic Health Data

Introduction

In electronic health records (EHRs), standardized nursing terminologies (SNTs), such as nursing diagnoses (NDs), are needed to demonstrate the impact of nursing care on patient outcomes. Unfortunately, the use of NDs is not common in clinical practice, especially in surgical settings, and is rarely included in EHRs.

Objectives

The aim of the study was to describe the prevalence and trend of NDs in a hospital surgical setting by also analyzing the relationship between NDs and hospital outcomes.

Methods

A retrospective study was conducted. All adult inpatients consecutively admitted to one of the 15 surgical inpatient units of an Italian university hospital across 1 year were included. Data, including the Professional Assessment Instrument and the Hospital Discharge Register, were collected retrospectively from the hospital's EHRs.

Results

The sample included 5,027 surgical inpatients. There was a mean of 6.3 ± 4.3 NDs per patient. The average distribution of NDs showed a stable trend throughout the year. The most representative NANDA-I ND domain was safety/protection. The total number of NDs on admission was significantly higher for patient whose length of stay was longer. A statistically significant correlation was observed between the number of NDs on admission and the number of intra-hospital patient transfers. Additionally, the mean number of NDs on admission was higher for patients who were later transferred to an intensive care unit compared to those who were not transferred.

Conclusion

NDs represent the key to understanding the contribution of nurses in the surgical setting. NDs collected upon admission can represent a prognostic factor related to the hospital's key outcomes.

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.

A nationwide survey of patient problem occurrence across different nursing healthcare sectors

AIM

The aim of this study was to determine the patient problems that nurses encounter in different clinical settings and the extent to which they report being able to influence those patient problems.

DESIGN

Exploratory online survey research.

METHOD

Data were collected through an online questionnaire. We prepared a 2 × 2 matrix to compare the rate of occurrence against the average level of reported influence. Descriptive statistics were used for the data analysis.

RESULTS

A total of 440 nurses working in different settings completed the questionnaire. Nurses report having the most influence on patient problems related to self-care, mobility and functions of the skin. Nurses experience less influence on problems with voice/speech and the tasks required for participation in work/employment.

The connection between nursing diagnosis and the use of healthcare resources

AIM

The health service invests up to 75% of its resources on chronic care where the focus should be on caring rather than curing. Nursing staff focuses their work on such care. Care requires being redorded in health histories through the standardized languages. These records enable useful analyses to organisational and healthcare decision-making. Our proposal is to know the association of between nursing diagnosis and a higher total expenditure on health.

METHOD

An observational cross-sectional analytical study was performed based on data from electronic health records in Primary Care (Drago-AP), hospital discharges (CMBD-AH) and prescriptions (REC-SCS) of patients over 50 from 2012-2013 in the Canary Islands. A descriptive, bivariate and multivariate analysis was undertaken to create a predictive model on the use of resources.

INDEPENDENT VARIABLES

Sociodemographic (age, sex, type of health-care affiliation, type of prescription charge) and nursing diagnosis (ND) recorded in late 2012. Dependent variables: Resources consumed in 2013.

RESULTS

582,171 patients met the criteria for inclusion. 53.0% of them were women with an average age of 64.3 years (SD 10.8years). 53.2% were pensioners. 49% of the included population had an ND, with an average of 2.1ND per patient. The average costs per patient were 1824.62€ (with a median of 827.5€) 25 and 27 percentiles of 264.1€ and 1824.7€, respectively. The bivariate analysis showed a significant correlation between these expenses and all the demographic variables; the expenses increased when a nursing diagnosis has been made (Spearman's rank=0.37: the more diagnoses, the more expenses). In the multivariate analysis, a first linear regression with the sociodemographic variables as independent variables explains 13.7% of the variability of the logarithm of the full costs (R²=0.137). If we add to this model the presence of nursing diagnoses, the explanatory capacity reaches 19.77% (R²=0.1977).

CONCLUSION

Compared with a model that only consists of sociodemographic variables, nursing diagnoses can enhance the explanatory capacity of the use of healthcare resources.

Impact of nursing diagnoses on patient and organisational outcomes: a systematic literature review

AIMS AND OBJECTIVES

To investigate the impact of nursing diagnoses on patient and organisational outcomes in any field of health care where nurses are involved.

BACKGROUND

In healthcare systems, descriptions of patient complexity and outcomes and payment criteria are primarily based on medical diagnoses and procedures. Other aspects of patient care are rarely considered. Nursing diagnoses are believed to be related to healthcare outcomes, but comprehensive evidence for this association is missing.

DESIGN

Systematic literature review.

METHODS

The search was conducted in PubMed, CINAHL and Scopus databases without year or language limitations. The studies were categorised according to their methodological quality (low, good or high) and classified based on their levels of evidence on a scale of 1 (strongest evidence) to 5 (weakest evidence).

RESULTS

Seventeen of 3426 potentially relevant studies met the eligibility criteria. Eleven studies were classified as low, five as good and one as high quality. The levels of evidence were rated as 2 for one study, three for two studies, four for nine studies and five for five studies. Nursing diagnoses were found to predict patient (quality of life, mortality) and organisational (length of hospital stay, hospital charges, amount of nursing care, discharge dispositions) outcomes. Patient care plans based on nursing diagnoses improved sleep quality, quality of life and glycaemic control. When added to information from disease-based classification systems (e.g. diagnosis-related groups), nursing diagnoses improved the predictions of the above outcomes.

CONCLUSIONS

Nursing diagnoses have a great potential to predict patient and organisational outcomes. High-quality research is required to better investigate the existence and strength of these relationships.

RELEVANCE TO CLINICAL PRACTICE

The systematic use of nursing diagnoses in clinical practice, as well as the sharing of high-quality nursing data in large databases, may provide a considerable boost to the contribution of nursing to healthcare outcomes.

Effectiveness of standardized Nursing Care Plans in health outcomes in patients with type 2 Diabetes Mellitus: a two-year prospective follow-up study

Background

Implementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Diabetes Mellitus (T2DM) patients.

Methods

A two-year prospective follow-up study, in routine clinical practice conditions. 31 primary health care centers (Spain) participated with 24,124 T2DM outpatients. Data was collected from Computerized Clinical Records; SNCP were identified using NANDA and NIC taxonomies. Descriptive and ANCOVA analyses were conducted.

Results

18,320 patients were identified in the Usual Nursing Care (UNC) group and 5,168 in the SNCP group. At the two-year follow-up, the SNCP group improved all parameters except LDL cholesterol and diastolic blood pressure. We analyzed data adjustming by the baseline value for these variables and variables with statistically significant differences between groups at baseline visit. Results indicated a lowering of all parameters except HbA1c, but a statistically significant reduction was only observed with diastolic blood pressure results. However, the adjusted reduction of diastolic blood pressure is of little clinical relevance. Greater differences of control values for diastolic blood pressure, HbA1c, LDL-cholesterol and Body Mass Index were found in the SNCP group, but only reached statistical significance for HbA1c. A greater proportion of patients with baseline HbA1c ≥7 decreased to <7% at the two-year follow-up in the SNCP group than in the UNC group (16.9% vs. 15%; respectively; p = 0.01).

Conclusions

Utilization of SNCP was helpful in achieving glycemic control targets in poorly controlled patients with T2DM (HbA1c ≥7%). Diastolic blood pressure results were slightly improved in the SNCP group compared to the UNC group.

Trial Registration

ClinicalTrials.gov NCT01482481

Dilemmas, tetralemmas, reimagining the electronic health record

With the transition from paper-based to computer-based records, nursing practice shifts to computerized documentation of care in the electronic health record (EHR). Viewed not only as an electronic document, but as an instrument of modern economic and technological ideology that serves organizational goals of cost-efficiency, the EHR can be perceived as creating a dilemma for a patient-centered nursing practice. Viewing the EHR as relying solely on the use of standardized languages begets a number of questions and furthers the dilemma for nurses. Through a discussion that draws on the Indian tradition of the tetralemma, authors transcend the EHR/nursing dilemma.

A Dialogue on the Future of Nursing Practice

PURPOSE

The challenges of health care; its safety, effectiveness, and efficiency; the quality of care; and the outcomes patients experience are issues central to nursing practice. This centrality needs to be affirmed as the profession shapes its practice over the next 50 years. The purpose of this article is to initiate a dialogue on the future of nursing practice.

METHODS

The methods used are observation, reflection, dialogue, and proposed actions.

FINDINGS

The results of this process are preliminary. They suggest that the establishment of nursing hospitals is a distinct possibility.

CONCLUSIONS

This article concludes with a series of arguments for and against this position along with an invitation for your participation in this dialogue.

NURSING IMPLICATIONS

The major implications of this article are not "nursing" implications per se but client and patient implications and the future contribution of nursing to improved health and patient care.

Revisión de la etiqueta diagnóstica ansiedad ante la muerte

The inclusion of the diagnostic label of "death anxiety" by the North Americvan Nursing Diagnosis Association (NANDA) in the 2001-2002 taxonomy is justified by the interest in establishing the specific care required in terminal patients. Nevertheless, the definition of "death anxiety" does not delimit the concept precisely, since it does not clearly establish the difference between the terms "death anxiety" and "fear of death". Consequently, the need arose to design a project whose goal was to modify the nursing diagnostic label and defining characteristics proposed by the NANDA, as well as to formulate the related factors, which had not yet been developed. At the meeting of the Diagnostic Review Committee in February 2005, the NANDA considered the proposal, accepting both the modification of the definition of the diagnostic label and the inclusion of the related factors. The revision will be included in the 2007 NANDA taxonomy.

Improved Quality of Nursing Documentation: Results of a Nursing Diagnoses, Interventions, and Outcomes Implementation Study

PURPOSE

To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program.

METHOD

In a pretest-posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational intervention--an introductory class and consecutive classes, using a case discussion method--to implement nursing diagnoses, interventions, and outcomes. Two sets of 36 randomly selected nursing records were evaluated before and after implementation. The quality of documented nursing diagnoses, interventions, and nursing-sensitive patient outcomes was assessed by 29 Likert-type items with a 0-4 scale instrument, called Quality of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO) and tested using t-tests.

FINDINGS

Significant enhancements in the quality of documented nursing diagnoses, interventions, and outcomes were found following the implementation of a planned educational program.

CONCLUSIONS

The implementation of NANDA, NIC, and NOC (NNN) nursing diagnoses, interventions, and outcomes led to higher quality of nursing diagnosis documentation, etiology-specific nursing interventions, and nursing-sensitive patient outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Educational measures support nurses to improve documentation of diagnoses, interventions, and outcomes. The Q-DIO is a useful audit tool.